Lesbian, gay, and bisexual (LGB) individuals have elevated rates of substance use disorders and present to treatment with more severe substance use problems. Despite this health disparity, recent reviews highlight the paucity of studies reporting sexual orientation in substance use research (e.g., Flentje, Bacca, & Cochran, 2015). Using data from 5 clinical trials of contingency management (CM), the current study investigated the impact of sexual orientation on 3 substance use outcomes: treatment retention, longest duration of abstinence, and percent negative samples submitted. Participants (N = 912; mean age = 36.6 years; 51.1% female; 45% African American, 42.2% Caucasian) were randomized to standard care in community-based intensive outpatient treatment (IOP) or the same plus CM. Patients identifying as LGB made up 10.6% of the sample. A significant proportion identified as bisexual (8.2% of the total sample). Regardless of sexual orientation, participants receiving CM achieved better treatment outcomes than those receiving IOP alone. There were no statistically significant differences between LGB and heterosexual participants in their response to IOP in general, and CM specifically, across all 3 treatment outcomes (ps < .05). However, equivalence testing revealed that outcomes were not statistically equivalent for LGB and heterosexual participants, with the exception of percentage of negative samples, which was equivalent within the CM group only. Differences in treatment response to CM and standard community-based IOP do not reach the level of statistical significance; however, in most cases, we cannot conclude that treatment response is equivalent for LGB and heterosexual individuals.

After reviewing currently available diagnostic assessment instruments for substance use disorders this paper describes the format and structure of the Munich-Composite International Diagnostic Interview (M-CIDI) substance disorder section. In addition, the test-retest reliability of diagnoses and criteria for nicotine, alcohol, illegal and prescription drugs, is reported. Findings obtained in community sample of adolescents and young adults indicate that the substance section is acceptable for almost all types of respondents, efficient in terms of time and ease of administration as well as reliable in terms of consistency of findings over time. The test-retest reliability over a period of an average of 1 month, as examined by two independent interviewers indicates good-to-excellent kappa values for all substance disorders assessed, with significant kappa values ranging between 0.55 for drug abuse and 0.83 for alcohol abuse. There was also fairly consistently high agreement for the assessment of single DSM-IV diagnostic criteria for abuse and dependence as well as the M-CIDI quantity-frequency and time-related questions. To conclude, although – unlike previous studies – this study was conducted in a community sample and not in patients and used considerably longer time intervals of more than a month between investigations, our M-CIDI reliability findings are at least as high as those from previous studies.

Objective: We present the prevalence and incidence rates of alcohol, nicotine, and illicit substance use, abuse, and dependence in a sample of German adolescents and young adults. Patterns of onset, cohort trends, and use of various substance classes are also analyzed. Method: A prospective longitudinal epidemiological study with a representative sample of adolescents and young adults (n = 3,021; baseline age range = 14–24 years) was conducted in Munich, Germany. Participants were assessed between 1995 and 1999 with the Munich-Composite International Diagnostic Interview. Results: Cumulative lifetime incidence (up to age 28) of any substance abuse or dependence was 43.8%, and 12-month prevalence of any substance abuse or dependence was 24.4%. The lifetime incidence of nicotine dependence was most frequent (24.8%), followed by alcohol abuse (19.3%) and alcohol dependence (9.2%); 61.7% endorsed the regular use of a substance for at least one circumscribed period during their lifetime. Age-specific incidence rates and age at onset of substance use disorders differed by age cohorts. Furthermore, nicotine dependence was significantly associated with illicit substance use disorders (HR = 2.6, 95% CI 1.7–4.0). An interactive relationship between age, age at onset of nicotine dependence, and subsequent onset of illicit substance use disorders was found. Conclusions: Since the baseline investigation in 1995, high incidence rates of substance use disorders and substance use have been observed in this young German sample. Especially younger cohorts report significantly earlier ages at onset of abuse and dependence. There also seems to be a trend towards a secondary age at onset peak of nicotine dependence after the onset of illicit drug use disorders. Further investigations are needed to study these patterns in younger samples. However, results emphasize the need for a combined prevention of illicit drugs and nicotine dependence. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Bakgrund: Personer med substansbrukssyndrom (SUD) är en stigmatiserad och marginaliserad population i samhället som har ett stort vårdbehov. Tidigare forskning visar på att hälso- och sjukvårdspersonal har stigmatiserade fördomar och attityder gentemot denna patientgrupp. Denna studies syfte var att undersöka och belysa hur personer med SUD upplever hälso- och sjukvårdens bemötande vid vårdkontakter. Metod: Med hjälp av en deskriptiv litteraturöversikt, har material samlats in från tre databaser, PubMed, PsycInfo och CINAHL. Elva artiklar valdes ut och analyserades för att identifiera individer med SUD och deras upplevelse av bemötande inom hälso- och sjukvården. Resultat: Både positiva och negativa upplevelser rapporterades av deltagarna. Av resultatet framkom det att upplevd stigmatisering, en sämre kommunikation mellan patient och personal, en upplevd misstro och en negativ relation med personalen bidrog till ett sämre uppfattat bemötande. Det kunde bidra till att deltagarna var mindre angelägna att uppsöka vård. Ett gott bemötandet beskrevs som öppet och empatiskt, icke-dömande, en god kommunikation och en relation med vårdpersonalen som grundades på tillit. Det kunde resultera i att deltagarna var mer angelägna att uppsöka vård. Åtta teman och fyra subteman framkom när materialet studerades och resultatet presenteras utifrån dessa teman. Slutsats: Hälso- och sjukvården har en betydande roll i sitt inflytande på denna patientgrupp och har en stor möjlighet att lindra lidandet samt främja en god omvårdnad genom sitt bemötande. / Background: People with substance use disorders (SUD) are stigmatized and marginalized in society with a great need for care. Previous research shows that healthcare professionals have stigmatized prejudices and attitudes towards this patient group. This study aimed to investigate and shed light on how people with SUD experience the health service’s treatment at care contacts. Method: Using a descriptive literature review, the material has been collected from three databases, PubMed, PsycInfo and CINAHL. Eleven articles were selected and analyzed to identify individuals' with SUD experience of treatment in healthcare. Results: The results showed that perceived stigma, poorer communication between patient and staff, perceived mistrust and a negative relationship with the staff contributed to a more negative experience of the encounter. This could contribute to the participants being less likely to seek care. The better encounter was described as open and empathetic, non-judgmental, good communication and a relationship with the care staff that was based on trust. This could result in the participants being more likely to seek care. Eight themes and four sub-themes emerged when the material for this study was reviewed, and the results are presented based on these themes. Conclusion: Healthcare has a significant role in its influence on this patient group and has a great opportunity to alleviate suffering and to promote good care through its treatment.

This study examined differences in sexual risk behaviors by gender and over time among 1281 patients (777 males and 504 females) from 12 community-based substance use disorder treatment programs throughout the United States participating in CTN-0032, a randomized control trial conducted within the National Drug Abuse Treatment Clinical Trials Network. Zero-inflated negative binomial and negative binomial models were used in the statistical analysis. Results indicated significant reductions in most types of sexual risk behaviors among substance users regardless of the intervention arms. There were also significant gender differences in sexual risk behaviors. Men (compared with women) reported more condomless sex acts with their non-primary partners (IRR = 1.80, 95 % CI 1.21–2.69) and condomless anal sex acts (IRR = 1.74, 95 % CI 1.11–2.72), but fewer condomless sex partners (IRR = 0.87, 95 % CI 0.77–0.99), condomless vaginal sex acts (IRR = 0.83, 95 % CI 0.69–1.00), and condomless sex acts within 2 h of using drugs or alcohol (IRR = 0.70, 95 % CI 0.53–0.90). Gender-specific intervention approaches are called for in substance use disorder treatment.

Bakgrund En kartläggning av stigma med stigmas underliggande betydelser såsom diskriminering, exklusion, makt underläge, etikettering, stereotypisering och fördomar, och hur dessa har en inverkan på personer med beroende när det uppsöker vården. Med en teoretisk utgångspunkt i personcentrerad vård, där mötet mellan patienter och hälso- och sjukvårdspersonal är i fokus. Syfte Att belysa upplevelser av stigma för patienter med substansberoende i mötet med hälso- och sjukvården utifrån ett patientperspektiv. Metod En icke-systematisk litteraturstudie, bestående av 17 peer-reviewed artiklar med ett urval av kvalitativa, kvantitativa och mixad metod, funna i CINAHL och PubMed. Kvalitetsgranskade efter Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering samt kvalitet avseende studier med kvantitativ och kvalitativ metodansats. Resultat Patienternas utsagor om tydliga fall då de upplevt stigma, diskriminering, bristande eller utebliven behandling på grund av sitt missbruk, i olika vård och omsorgs sammanhang. Med data och utsagor om bra och dåliga möten, samt förslag på förbättring för hur ett möte kan gå till för att minska stigma. Följder som blir av ett förväntat eller upplevt stigmatiserat bemötande, där utebliven vård, uppföljning och ovilja till rehabilitering är allvarliga biverkningar. Slutsats Det finns en stor misstro mellan personal och patienter, från bådas håll. Patienterna upplever att de inte får den vård och omsorg de har rätt till och enbart bli bemötta som problem. Det uppkommer brister i behandling då patienter inte får den abstinens eller smärtlindring de anser sig behöva. Denna bristande behandling leder till att många patienter ger sig av från sjukhusen utan att fullfölja sin behandling. / Background Mapping of stigma with stigma's underlying meanings such as discrimination, exclusion, power disadvantage, labelling, stereotyping and prejudice, and how these have an impact on people with addiction when they seek care. With a theoretical starting point in person-centred care, where the meeting between patients and health care personnel is in focus. Aim To describe experiences of stigma in patients with substance addiction in the encounter with healthcare from a patient perspective. Method A non-systematic literature review, consisting of 17 peer-reviewed articles with a selection of qualitative, quantitative, and mixed methods, found in CINAHL and PubMed. Quality reviewed according to Sophiahemmet University's assessment tool for scientific classification and quality regarding studies with a quantitative and qualitative method approach. Results The patients' statements about clear cases when they experienced stigma, discrimination, lack of or non-existent treatment due to their addiction, in various care and medical care contexts. With data and statements about good and bad meetings, as well as suggestions for improvement for how a meeting can be done to reduce stigma. Consequences of an expected or perceived stigmatized treatment, where failure to provide care, follow-up, and reluctance to rehabilitate are serious side effects. Conclusions There is a great deal of mistrust between staff and patients, from both sides. The patients feel that they do not receive the care and concern they are entitled to and are only treated as a problem. Deficiencies in treatment arise when patients do not get the abstinence or pain relief, they think they need. This lack of treatment leads to many patients leaving the hospital without completing their treatment.

This report presents an overview of the results of the US National Comorbidity Survey (NCS) (Kessler et al., 1994) and future directions based on these results. The NCS is a survey that was mandated by the US Congress to study the comorbidity of substance use disorders and nonsubstance psychiatric disorders in the general population of the US. (...)

No description available.

Abstract EXPLORING SUBSTANCE USE DISORDERS COMMUNITY OUTPATIENT COUNSELORS’ EXPERIENCES TREATING CLIENTS WITH CO-OCCURRING MEDICAL CONDITIONS. AN INTERPRETATIVE PHENOMENOLOGICAL ANALYSIS Lauretta Anne Cathers, Ph.D. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2013 Major Director: Amy Armstrong, PhD, Chair, Rehabilitation Counseling The Interpretative Phenomenological Analysis study presents the findings from a qualitative study examining substance use disorders (SUD) community outpatient treatment counselors’ experiences treating clients with co-occurring medical conditions. Interviews from five SUD community outpatient treatment counselors resulted in four emerging super-ordinate themes. The findings illustrate the relationships between SUDs, medical conditions and other predisposing, enabling and need factors. In order to assist clients in focusing on therapy, counselors work to identify resources to treat the basic needs of the clients, including medical care. Challenges included limited resources, complex system processes, and client fear and apathy. In addition, various unique challenges related to medical conditions treated by potentially habit forming medications and traumatic brain injury were identified. Counselors discussed how their roles and responsibilities have expanded to include case management and additional responsibility for the overall well-being of the clients they serve. They encouraged SUD educators to include more education on counselor self-care, trauma, pain conditions and the assessment process. Implications from the study highlight the need for integrated behavioral and physical health care.

Substance use disorders are serious health concerns in the United States. Furthermore, the National Survey on Drug Use and Health reports a continuous increase in substance use disorders in the United States during the last 10 years. However, there are not many effective pharmacotherapeutics available for substance use disorders. The current dissertation is focused on research aimed at discovering pharmacotherapeutics for substance use disorders. First part of dissertation focused on discovering methamphetamine (METH) use disorder therapeutics targeting specific mechanism of METH action on dopaminergic neurons. The second part of dissertation focused on opioids and cocaine use disorder therapeutics targeting rewarding pathway commonly activated by opioids and cocaine. With respect to METH, it induces release of dopamine (DA) in neuronal terminals by interacting with the vesicular monoamine transporter-2 (VMAT2) and DA transporter (DAT). VMAT2 inhibitors have been found by our research group to decrease METH-evoked DA release, METH-induced hyperlocomotion, and METH self-administration in rats. However, these VMAT2 inhibitors lacked selectivity and tolerance developed to these pharmacologic effects after repeated administration, thereby limiting their potential as pharmacotherapeutics for METH use disorders. In the current study, analogs from a novel scaffold were found to selectively inhibit VMAT2 and were evaluated using neurochemical and behavioral pharmacological approaches. R- and S-3-(4-methoxyphenyl)-N-(1-phenylpropan-2-yl)propan-1-amine (GZ-11610 and GZ-11608, respectively) exhibited 94- to 3450-fold selectivity for VMAT2 over human-ether-a-go-go (hERG) channel, DAT, serotonin transporter, and nicotinic acetylcholine receptors. GZ-11608 competitively and concentration-dependently inhibited METH-evoked DA release via VMAT2. Also, GZ-11610 (56-300 mg/kg, oral) and GZ-11608 (300 mg/kg, oral; 10-30 mg/kg, s.c.) reduced METH-induced hyperlocomotor activity in METH-sensitized rats. Furthermore, GZ-11608 (1-30 mg/kg, s.c.) inhibited METH self-administration, cue- and METH-induced reinstatement in a dose-dependent manner, and 30 mg/kg (s.c.), 10 mg/kg (s.c.), and 17 mg/kg (s.c.) produced significant effect, respectively. Importantly, the GZ-11608-induced decrease in METH self-administration was not surmounted by increasing the amount of METH available. GZ-11608 did not substitute for METH and did not serve as a reinforcer in rats self-administering METH and drug naïve rats, respectively. Thus, these VMAT2 inhibitors incorporating a new scaffold are novel leads for new pharmacotherapeutics to treat METH use disorders. Substances with high abuse potential including opioids and cocaine elevate extracellular DA concentration in the nucleus accumbens, and this mechanism has long been considered to underly substance-induced reward. DA in the nucleus accumbens originates from DA neuron cell bodies located in the ventral tegmental area in the midbrain. Interestingly, M5 muscarinic acetylcholine receptors (mAChRs) are proteins that are highly expressed on ventral tegmental area DA neurons. Also, studies investigating M5 mAChRs knockout mice showed reduced responding for cocaine in cocaine self-administration and decreased time spent in cocaine-paired and morphine-paired place preference studies. Pharmacological inhibition of M5 mAChRs function via microinfusing mAChR antagonists exhibiting no selectivity among M1-M5 mAChRs subtypes into the ventral tegmental area where expression of M5 mAChRs are dominant, reduced morphine-induced hyperlocomotion and cocaine seeking behaviors in rats. These studies support therapeutic potential of M5 mAChRs selectivity antagonists in opioids and cocaine use disorders. Thus, in the current study, affinity of a series of pethidine and quinuclidinyl N-phenylcarbamate analogs for M5 mAChRs was evaluated using in vitro and ex vivo neuropharmacological assays. Among the pethidine analogs, compound 6a showed the highest binding affinity at M5 (Ki = 0.38 µM), but also high affinity at M1 and M3 mAChRs (0.67 and 0.37 µM, respectively). Among the quinuclidinyl N-phenylcarbamate analogs, compound 13c exhibited the highest affinity at M5 (Ki = 1.8 nM), but also high affinity at M1, M2, M3 and M4 mAChRs (Ki = 1.6, 13, 2.6, 2.2 nM, respectively). Also, 13c acted as an agonist of mAChRs on oxotremorine-induced DA release from rat striatal slices. In addition, compound 13b was found exhibiting the highest selectivity (17-fold) at M3 over M2 mAChRs, suggesting potential of 13b as a chronic obstructive pulmonary disease therapeutics. Taken together, these novel analogs serve as leads for further discovery of subtype-selective M5 mAChR antagonists that may have potential as therapeutics for substance use disorders, as well as for chronic obstructive pulmonary disease.