Substance Abuse, Alcohol Addiction, Drug Addiction

Interdisciplinary Analysis of the Prescription Narcotic Epidemic

by Laura Tanksley

Steen, J.T. (2012). Encountering compassion in substance abuse studies: Views from a doctoral student. Journal of Social Work Practice in the Addictions, 12(2).

by Jeff T. Steen

Cognitive-Behavioural Treatment of Substance Abuse

by Derek Chechak

Mental health status of infrequent adolescent substance users

by Theresa Zolner

Trajectories of alcohol consumption among the elderly widowed population: A semi-parametric, group-based modeling approach

by Hui Liew

Using the 1992 to 2008 Health and Retirement Study (HRS), this extends previous research to examine the temporal... more Using the 1992 to 2008 Health and Retirement Study (HRS), this extends previous research to examine the temporal processes underlying the relationship between widowhood and subsequent drinking behaviors among the elderly widowed population and to examine the potential predictors of these trajectories. The semi-parametric mixture modeling (SPMM) approach found that that the type of drinking trajectory that characterize the post-bereavement drinking behavior of an individual is largely dependent upon the characteristics of the individuals (e.g. gender), the health conditions and health behavior of deceased spouse, prebereavement alcohol consumption, and depression. Men, respondents whose deceased spouses had cancer, and respondents who were married to a drinker seem to have greater difficulty overcoming the transitional burden associated with widowhood. They should be the main target of policy interventions designed to reduce alcohol use disorders.

Drugs, Courts, and the New Penology

by Eric Miller

Published in Stanford Law & Policy Review, Vol. 20, No. 2, 2009

The drug court innovation has had a major impact upon low-level judicial attitudes to drug crime. The drug court’s... more The drug court innovation has had a major impact upon low-level judicial attitudes to drug crime. The drug court’s success is primarily achieved through suppressing the larger political debates surrounding drug policy through the therapeutic emphasis on a politics of personal responsibility. Bipartisan agreement has, however, come at the cost of precluding a discussion of the relation of drug crime to race and class in the urban setting, and ignoring the manner in which the state has exacerbated the problems of drug addiction for those caught in the criminal justice system. Perhaps courts are the wrong place for such policy discussions. Nonetheless, they remain essential to addressing the social causes of drug use in the inner cities. As an alternative, I have suggested reformulating the grand jury to take over some of the duties of the drug court judge. My goal is to generate empowered deliberative democracy at the local level, and mitigate some of the effects of the drug court’s therapeutic use of discipline, while including more partners in the discussion of urban drug policy. Few people have recognized that the drug court’s therapeutic methodology is not a repudiation of politics but one that takes sides by embracing a coercive vision of justice based on a version of positive liberty. In particular, the court’s rejection of due process in favor of treatment expresses the now-classic opposition between positive and negative liberty; that is, the freedom to be left alone and the freedom to “determine someone to be...this rather than that.” Most critics who oppose the drug court’s methodology simply call for a return to a courtroom practice centered around due process protections as a form of negative liberty to protect vulnerable defendants against intrusive state power. I suggest a third concept of freedom, one that emphasizes a mutual respect for members of the community as peers sharing diverse values. That form of freedom can only emerge through non-coercive interaction in the public sphere through low-level political organizations. Accordingly, as an alternative to the current structure of drug courts, I propose both a more radical and a more natural structure for court-based drug rehabilitation: a grand jury model rather than a judicial one. Adopting the grand jury structure replaces the hierarchical relation between judge, on the one hand, and community and offender, on the other, with a horizontal relationship between community, offender, and law enforcement. The grand jury model envisages a reciprocal relationship between the community, addicts, and service providers, in which those serving on these drug-dedicated grand juries would be educated about the range of problems faced by and resources available to the drug-addicted and would, in turn, educate service providers and law enforcement officials about community needs. Properly constituted, the grand jury may both supervise addicts within a rehabilitation program and redirect others out of the system or onto a more traditional form of court disposition.

Induced theta activity as a biomarker for alcoholism in long-term abstinent alcoholics

by Casey Gilmore

Casey S. Gilmore & George Fein. Under review.

Event-related, target stimulus-phase-locked (evoked) brain activity in both the time and time-frequency (TF) domains... more Event-related, target stimulus-phase-locked (evoked) brain activity in both the time and time-frequency (TF) domains (the P3b ERP; evoked theta oscillations) has been shown to be reduced in alcoholics. Recently, studies have suggested that there is alcohol-related information in the non-stimulus-phase-locked (induced) theta TF activity. We applied TF analysis to target stimulus event-related EEG recorded during an oddball task from 41 long-term abstinent alcoholics (LTAA) and 71 non-alcoholic controls (NAC) to investigate the relationship between P3b, evoked theta, and induced theta activity. Results showed that induced theta 1) was larger in LTAA compared to NAC, and 2) was sensitive to differences between LTAA and NAC groups that was independent of the differences accounted for by P3b amplitude or evoked theta. These findings suggest that increased induced theta may likely be a biomarker for the effects of alcohol abuse on brain function.

Education, empowerment and community based structural reinforcement: An HIV prevention response to mass incarceration and removal

by Laura McTighe

Co-authored with Jeffery Draine (Temple Uniersity) and Philippe Bourgois (University of Pennsylvania)
Published in the International Journal of Law and Psychiatry, July 2011

In the context of US urban jails, incarceration is often seen as an opportune intervention point for prevention... more In the context of US urban jails, incarceration is often seen as an opportune intervention point for prevention interventions in public health. For the detained individual, it is an opportunity to reflect on individual choices and the potential for changes in one's life course. For population focused public health professionals, jail detention facilities represent a concentration of health risks, and an opportunity to have an impact on a significant portion of those at risk for HIV and other health concerns. This paper presents an innovative education and empowerment model that bridges across jail walls, beginning on the inside, and continuing on the outside of jail where individuals continue to be challenged and supported toward positive health and social choices. The intervention also seeks to foment community activism in the communities to which jail detainees return, thus aiming to have a structural impact. This paper examines both the intervention model and the challenges of examining the effectiveness claims for the intervention at multiple levels.

Substance use in college students with ADHD

by Mary Rooney

Rooney M, Chronis-Tuscano A, Yoon Y. Substance Use in College Students With ADHD. J Atten Disord. 2011 Feb 2

Objective: The college years represent a developmental transition during which the initiation and escalation of heavy... more Objective: The college years represent a developmental transition during which the initiation and escalation of heavy
drinking set the stage for lifelong difficulties with alcohol and other drugs. Evidence from studies of adolescents and young
adults with ADHD suggests that college students with the disorder may be uniquely vulnerable to alcohol- and drug related
problems. However, no studies have examined substance use in college students with ADHD. Method: Tobacco,
alcohol, illicit drug use, and associated impairment were examined in 91 college students with (n = 53) and without (n = 38) ADHD. Results: ADHD was associated with increased frequency of tobacco use, higher rates of dangerous or hazardous patterns of alcohol use, and higher levels of impairment related to marijuana and nonmarijuana illicit drug use, independent of conduct disorder history. Conclusion: These findings suggest that college students with ADHD may be at elevated risk for problematic patterns of substance use.

Disrupted Regulation of Social Exclusion in Alcohol-Dependence: An fMRI Study

by Alexandre Heeren

Maurage, P., Joassin, F., Philippot, P., Heeren, A., Vermeulen, N., Mahau, P., Delperdange, C., Corneille, O., Luminet, O., & de Timary, P. (in press). Disrupted regulation of social exclusion in alcohol-dependence: An fMRI study. Neuropsychopharmacology.

Adolescent impulsivity phenotypes characterized by distinct brain networks

by Robert Whelan

Nature Neuroscience. doi:10.1038/nn.3092

Robert Whelan, Patricia J Conrod, Jean-Baptiste Poline, Anbarasu Lourdusamy, Tobias Banaschewski, Gareth J Barker, Mark A Bellgrove, Christian Büchel, Mark Byrne, Tarrant D R Cummins, Mira Fauth-Bühler, Herta Flor, Jürgen Gallinat, Andreas Heinz, Bernd Ittermann, Karl Mann, Jean-Luc Martinot, Edmund C Lalor, Mark Lathrop, Eva Loth, Frauke Nees, Tomas Paus, Marcella Rietschel, Michael N Smolka, Rainer Spanagel, David N Stephens, Maren Struve, Benjamin Thyreau, Sabine Vollstaedt-Klein, Trevor W Robbins, Gunter Schumann, Hugh Garavan & the IMAGEN Consortium

The impulsive behavior that is often characteristic of adolescence may reflect underlying neurodevelopmental... more The impulsive behavior that is often characteristic of adolescence may reflect underlying neurodevelopmental processes. Moreover, impulsivity is a multi-dimensional construct, and it is plausible that distinct brain networks contribute to its different cognitive, clinical and behavioral aspects. As these networks have not yet been described, we identified distinct cortical and subcortical networks underlying successful inhibitions and inhibition failures in a large sample (n = 1,896) of 14-year-old adolescents. Different networks were associated with drug use (n = 1,593) and attention-deficit hyperactivity disorder symptoms (n = 342). Hypofunctioning of a specific orbitofrontal cortical network was associated with likelihood of initiating drug use in early adolescence. Right inferior frontal activity was related to the speed of the inhibition process (n = 826) and use of illegal substances and associated with genetic variation in a norepinephrine transporter gene (n = 819). Our results indicate that both neural endophenotypes and genetic variation give rise to the various manifestations of impulsive behavior.

Premorbid and current neuropsychological function in opiate abusers receiving treatment

by Graham Pluck

For Kids' Sake: A workforce development resource for family sensitive policy and practice in the Alcohol and Other Drugs sector

by Samantha Battams

Child wellbeing and protection concerns and the response of the alcohol and other drugs sector in Australia

by Samantha Battams

Alcohol home detoxification: a literature review

by Nigel Fleeman

There are various definitions, aims and objectives of, and settings for, detoxification. Careful assessment is... more There are various definitions, aims and objectives of, and settings for, detoxification. Careful assessment is essential before any client can be detoxified at home. Scales and biological markers exist to aid this process. Close supervision (i.e two or three home visits a day) is then required for at least 3 days. Supervision of clients can be done by the client's general practitioner (GP) or any member of a primary health care team as long as there is adequate specialist support. Clients can usually complete home detoxification within 9 days. It is safe and clinically effective for the vast majority of problem drinkers. Despite increasing the demand for detoxification, it is also cost-effective because it allows better utilization of in-patient facilities in the short term and should prevent more resources being required further along the treatment continuum. Home detoxification has wide support from both clients and their GPs. Indeed, there are many advantages for the client in detoxifying at home. However inpatient detoxification can never be replaced entirely. There will always be some problem drinkers for whom home detoxification is not a viable alternative (such as those with severe withdrawal symptoms and those lacking a suitable home environment).

Creating better stories: Alcohol and gender in transitions to adulthood

by Pete Seaman

A doubling of alcohol related deaths in the last 15 years (ISD Scotland, 2011) indicates that action is required to... more A doubling of alcohol related deaths in the last 15 years (ISD Scotland, 2011) indicates that action is required to reduce levels of alcohol consumption. A strong and pioneering set of polices have been laid out in the Scottish Government’s strategic document for tackling alcohol related harm; Changing Scotland’s Relationship with Alcohol. Although the evidence for the effectiveness of price and availability controls is strong at a population level, how these approaches will play-out across subgroups of the population is less well understood. Cutting beneath a national cultural relationship with alcohol are subgroup experiences where the role of alcohol is differentiated by class, gender, ethnicity and age cohort. In this report, we explore how a key population group, young adults, understand their relationship to alcohol and what influences their choices and behaviours.Further, we maintain a keen focus on a key factor which differentiates the experience of young adulthood – gender.

Explaining Cross-National Youth Substance Use Through Modernization Approach: A Study of Students in Eight Post-Yugoslac Societies

by Andrej Kirbis

Co-authored with Sergej Flere, Marina Tavcar Krajnc, Published in Policing in Central and Eastern Europe – Social Control of Unconventional Deviance: Conference proceedings. University of Maribor, Faculty of criminal justice and security. Editors: Gorazd Meško, Andrej Sotlar and John Winterdyk, p. 87-106.

Purpose: The purpose of this research was to compare mean levels of self-reported youth substance use measures in... more Purpose: The purpose of this research was to compare mean levels of self-reported youth substance use measures in eight post-Yugoslav entities in an effort to test the applicability of modernization approach in predicting substance use levels at the cross-national level. Design/methodology/approach:
2,178 first- and second-year social science students in ex-Yugoslav entities were surveyed with the aim of identifying similarities and differences in mean levels of tobacco, alcohol, and marihuana use. Findings: Three self-reported substance use measures showed high internal consistency and factor analysis yielded a one-dimensional structure. Cross-national comparisons showed that socioeconomically most developed entities (e.g., Slovenia and Croatia) had highest means on composite substance use measure, and Kosovo had the lowest, as expected based on the modernization approach. Research limitations/implications: The study results lend support to the modernization approach as being largely successful in explaining cross-national differences in youth substance use levels. Future studies should employ larger representative samples to allow generalisability. In addition, a larger array of deviance measures ought to be employed in the future.
Practical implications: The study has implications for both researchers and the policy makers in post-Yugoslav entities. Specifically, it shows that next to socioeconomic development, additional explanations and factors (e.g., predominant religious context, historical context) should be identified when explaining cross-national substance use differences among adolescents.
Originality/value: The study extends the understanding of cross-national substance use levels in post communist entities since quantitative data from the observed environments is largely missing and empirical studies largely exclude post-Yugoslav entities from their sampling frame.

Alcohol dependence symptoms among recent onset adolescent drinkers

by Arielle (Schmidt) Selya

Chien-Ti Lee, Jennifer Rose, Eden Engel-Rebitzer, Arielle Selya, and Lisa Dierker, Published in Addictive Behaviors (2011), 36(12), 1160-7.

This study examined prevalence of alcohol dependence symptoms and diagnosis among a nationally representative sample... more This study examined prevalence of alcohol dependence symptoms and diagnosis among a nationally representative sample of recent onset adolescent drinkers aged 12-21 years (mean 17 years) across different levels of drinking drawn from National Survey of Drug Use and Health (N=9490). We assessed whether the relationship between level of alcohol use and alcohol dependence was similar for individuals from different socio-demographic groups (i.e., gender, age group, ethnic group, family income, and substance use in the past year). The most prevalent DSM-IV alcohol dependence criteria at low levels of alcohol use were "unsuccessful efforts to cut down", "tolerance", and "time spent" in activities necessary to obtain alcohol or recover from its effect. Logistic regression with polynomial contrasts indicated increasing rates of each criterion and an overall dependence diagnosis with increasing alcohol exposure that differed most between the lowest levels of recent drinking frequency. After controlling for drinking quantity, younger adolescents, females, Native American/Alaskans and Asian/Pacific Islanders were most likely to experience alcohol dependence symptoms and a diagnosis of dependence, suggesting that these demographic subgroups may experience dependence symptoms or develop dependence more quickly after beginning to drink. Recognizing early symptoms of alcohol dependence may assist in early identification and intervention of those at risk for heavier drinker in the future.

DSM-IV alcohol abuse and dependence criteria characteristics for recent onset adolescent drinkers.

by Arielle (Schmidt) Selya

Jennifer Rose, Chien-Ti Lee, Arielle Selya, Lisa Dierker.  In press in Drug and Alcohol Dependence (2012), doi: 10.1016/j.drugalcdep.2011.12.013

BACKGROUND: Little is known about the psychometric properties of alcohol abuse and dependence criteria among... more BACKGROUND: Little is known about the psychometric properties of alcohol abuse and dependence criteria among recent-onset adolescent drinkers, particularly for those who consume alcohol infrequently. This study evaluated how well DSM-IV alcohol dependence criteria measure an alcohol use disorder (AUD) construct for recent onset adolescent drinkers at different levels of drinking frequency.

METHOD: Data were drawn from the National Survey on Drug Use and Health, a nationally representative sample of 9356 recent-onset adolescent drinkers, aged 12-21, who began drinking within the past year. Multiple group item response theory analysis was conducted to assess the 11 DSM-IV alcohol abuse and dependence criteria.

RESULTS: Criteria most likely to be endorsed at lower AUD severity included "withdrawal," "problems at home, school or work" and "tolerance." The criteria "drinking larger amounts/longer period of time," "unsuccessful efforts to cut down" and "continuing to drink despite related health problems" were more likely to be endorsed at higher AUD severity. Two criteria, "tolerance" and "time spent getting, using or recovering from alcohol" showed differential item functioning between drinking frequency groups (<7 vs. ≥7days in past month), with lower discrimination and severity for more frequent drinkers. DSM-IV criteria were most precise for intermediate levels of AUD severity.

CONCLUSIONS: All but two DSM-IV criteria had consistent psychometric properties across drinking frequency groups. Symptoms were most precise for a narrow, intermediate range of AUD severity. Those assessing AUD in recent onset adolescent drinkers might consider additional symptoms to capture the full AUD continuum.

Caracterización neuropsicológica de la impulsividad funcional y disfuncional en adictos a sustancias: implicaciones clínicas

by José María Ruiz Sánchez de León

Pedrero-Pérez, E.J., Ruiz-Sánchez de León, J.M., Rojo Mota, G., Llanero Luque, M. y Puerta-García, C. (2012). Neuropsychological characterization of functional and dysfunctional impulsivity in drug addicts: clinical implications [In Spanish]. Adicciones, 24(1), 51-58.

La impulsividad es una de las variables más consistentemente vinculadas a las distintas fases del proceso adictivo.... more La impulsividad es una de las variables más consistentemente vinculadas a las distintas fases del proceso adictivo. Sin embargo, casi siempre se ha estudiado como una condición negativa, vinculada a psicopatología. Dickman (1990) propuso dos tipos de impulsividad, una disfuncional (ID) y otra funcional (IF). A ésta última la definió como la tendencia a tomar decisiones rápidas, orientadas a metas, mediante un proceso de toma de decisiones con riesgo calculado. Pocos estudios han abordado la caracterización neuropsicológica de ambas variantes, relacionándolas con el rendimiento en pruebas clásicas. Una muestra de 52 sujetos adictos en tratamiento cumplimentó el Dickman Impulsivity Inventory y una batería de pruebas neuropsicológicas clásicas. Se observaron correlaciones de débiles a moderadas entre la IF e indicadores de éxito en las tareas neuropsicológicas, mientras que la ID mostró una relación difusa y débiles correlaciones con indicadores de mal rendimiento en todas las tareas. La ID se mostró como una disposición que dificulta la realización de las tareas de forma global, sin interferencia específica, en tanto que la IF se relacionó consistentemente con mayor precisión, menor número de errores y mejor mantenimiento de los planes, y ello a partir de una mejor gestión atencional y una mayor resistencia al ruido. Se sugieren las implicaciones de cara a los tratamientos de las adicciones.

Palabras clave: Impulsividad funcional, impulsividad disfuncional, evaluación neuropsicológica, adicción, tratamiento, atención, funciones ejecutivas.

Impulsivity is a stable correlate throughout the course of drug addiction. However, it has always been studied as a negative condition, linked to psychopathology. Dickman (1990) proposed two subdimensions of impulsivity, dysfunctional (DI) and functional (FI). He defines the latter as the tendency for rapid, goal-oriented decision-making characterized by well calculated risks. Only a few studies have attempted to differentiate between these two subdimensions using classical neuropsychological tests. Fifty two drug addicts in treatment were tested using Dickman’s Impulsivity Inventory and a battery of classical neuropsychological tests. FI shows moderate to high correlations with many classical neuropsychological test scores in relation to enhanced executive functioning, whereas DI reveals surprisingly weak and scarce correlations with indicators of impaired executive functioning. DI appears to be a trait related to some difficulties in classical neuropsychological tests, while FI emerges as a consistent and much stronger predictor of higher attention capacity, lower distractibility, better precision, fewer errors, and better maintenance of goal-oriented strategies. Thus, functional impulsivity is related to positive conditions and more efficient cognitive functioning. Implications for the treatment of drug addictions are suggested.

Key words: Functional impulsivity, dysfunctional impulsivity, neuropsychological assessment, drug addiction, treatment, attention, executive functions.