More Hospitals Dropped Addiction Services Than Added Them

MedicalResearch.com Interview with:

Cory E. Cronin PhDDepartment of Social and Public HealthOhio University College of Health Sciences and ProfessionsAthens, Ohio

Dr. Cronin

Cory E. Cronin PhD
Department of Social and Public Health
Ohio University College of Health Sciences and Professions
Athens, Ohio

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: One of my primary areas of research is exploring how hospitals interact with their local communities. My own background is in health administration and sociology, and I have been working with colleagues in the Heritage College of Osteopathic Medicine here at Ohio University (Berkeley Franz, Dan Skinner and Zelalem Haile) to conduct a series of studies looking at questions related to these hospital-community interactions.

This particular question occurred to us because of the timeliness of the opioid epidemic. In analyzing data collected from the American Hospital Association and other sources, we identified that the number of hospitals offering in-patient and out-patient substance use disorder services actually dropped in recent years, in spite of the rising number of overdoses due to opioid use. Other factors seemed to matter more in regard to whether a hospital offered these services or not.

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Gender Nonconformity Strongly Associated With Substance Abuse Among Male Students

MedicalResearch.com Interview with:

Michelle M Johns, MPH, PhD Health Scientist Division of Adolescent and School Health CDC

Dr. Johns

Michelle M Johns, MPH, PhD
Health Scientist
Division of Adolescent and School Health
CDC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Gender nonconformity is an under-researched area of adolescent health that is often linked to negative health outcomes. To address this gap, we analyzed Youth Risk Behavior Survey data to describe the associations between gender nonconformity and risk behaviors, including mental distress, and substance use.

Gender nonconformity was associated with feeling sad and hopeless, as well as suicidal thoughts and/or behaviors among female and male students. In addition, gender nonconformity was strongly associated with substance use among male students.

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More Medicaid Enrollees Receiving Treatment for Opioid Use Disorder, But Disparities Remain

MedicalResearch.com Interview with:

Bradley D. Stein MD PhD Senior Physician Policy Researcher Pittsburgh Office Rand Corporation

Dr. Stein

Bradley D. Stein MD PhD
Senior Physician Policy Researcher
Pittsburgh Office
Rand Corporation

MedicalResearch.com: What is the background for this study?

Response: Increasing use of medication treatment for individuals with opioid use disorders, with medications like methadone and buprenorphine, is a critical piece of the nation’s response to the opioid crisis. Buprenorphine was approved by the FDA in 2002 for treatment of opioid use disorders, but there was little information about to what extent buprenrophine’s approval increased the number of Medicaid-enrollees who received medication treatment in the years following FDA approval nor to what extent receipt of such treatment was equitable across communities.

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Opioid Use Increases Alcohol Relapse Risk

MedicalResearch.com Interview with:

Dr. Katie Witkiewitz PhD Professor, Department of Psychology  University of New Mexico

Dr. Witkiewitz

Dr. Katie Witkiewitz PhD
Professor, Department of Psychology
University of New Mexico

MedicalResearch.com: What are the main findings?

Response: The main findings from our study indicate that individuals with alcohol dependence who misused opioids (e.g., used without a prescription or not as prescribed) had a significantly higher likelihood of relapse to heavy drinking during alcohol treatment and were drinking more alcohol during and following alcohol treatment. Continue reading

American Indian 8th Grade Students Have High Rates of Substance Abuse

MedicalResearch.com Interview with:
Randall C. Swaim, Ph.D.
Senior Research Scientist and Director
Linda R. Stanley, Ph.D.
Senior Research Scientist

Tri-Ethnic Center for Prevention Research
Department of Psychology
Colorado State University                          

MedicalResearch.com: What is the background for this study?

Response: American Indian adolescents consistently report the highest levels of substance use compared with other US racial/ethnic groups. The harm associated with these high rates of use include higher risk of developing a substance use disorder, more alcohol-related problems, including alcohol-attributable death, and other negative outcomes such as school failure. These findings point to the importance of continuing to monitor this group, particularly given changing trends in perceived harmfulness of illicit substances as new statutes alter access to medical and recreational use of cannabis.

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Children with ADHD Found To Abuse Drugs and Alcohol At Early Age

MedicalResearch.com Interview with:

Brooke S. G. S Molina, PhD Professor of Psychiatry, Psychology and Pediatrics University of Pittsburgh 

Dr. Molina

Brooke S. G. S Molina, PhD
Professor of Psychiatry, Psychology and Pediatrics
University of Pittsburgh 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There has been inconsistency across previous studies of children with ADHD and their risk of substance use in adolescence and in adulthood. This study closely examined substance use by children with and without ADHD over a long period of time, considering that experimenting with some substances, such as alcohol and cigarettes, is typical after teens reach high-school age.

This study found that children with attention deficit hyperactivity disorder (ADHD) engaged in substance use at a younger age than those without ADHD and had a significantly higher prevalence of regular marijuana and cigarette use into adulthood.

We also found that children diagnosed with ADHD had a faster progression of substance use during childhood and adolescence.

We confirmed a finding for the ADHD group that is widely replicated in the general population – that early substance use strongly predicts adult substance use.  However, more of the children with ADHD were found to be early substance users, such as having a drink of alcohol before the age of 15.

We did not find higher rates of binge alcohol consumption among young adults with ADHD.  However, alcohol use is still an important part of the bigger picture.

The amount of alcohol consumption was self-reported in a questionnaire where the average age of all participants was 25. Binge drinking is very common in early adulthood, but given our findings of children with ADHD starting to drink at younger ages, it’s important to continue this research so we know how many young drinkers with ADHD continue to have serious, chronic problems with drinking as they age.

MedicalResearch.com: What should readers take away from your report?

Response: It’s very important to understand from our findings that substance abuse begins at a young age – often before high school.  Parents and providers need to understand this and continually assess risk.

We are concerned about the long-term consequences of these substance use patterns.  We do not know how many of these individuals will experience painful and expensive middle age outcomes of chronic substance abuse and associated problems such as divorce, employment problems, injuries, poor health and shortened life expectancy.  Some will be resilient and decrease their substance use.  We need to learn what predicts these outcomes. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: The marijuana use finding is also concerning given the increasing availability of cannabis in the United States and the risk and consequences for children with ADHD needs further study. 

MedicalResearch.com: Is there anything else you would like to add?

Response: These results suggest a crucial need for routine clinical practice to include early screening and interventions to prevent early substance use, including cigarette smoking, among children with ADHD.

Many children with ADHD end up being cared for in primary care settings, so pediatricians are the front-line treatment care providers and conversations about substance use need to begin early. When children with ADHD are being treated, we need to start monitoring their potential risk for substance use at a young age, and not only treating with medication, but considering the range of factors that increase their risk for becoming dependent on nicotine and for developing substance use disorders. 

Citations:

J Child Psychol Psychiatry. 2018 Jan 8. doi: 10.1111/jcpp.12855. [Epub ahead of print]

Substance use through adolescence into early adulthood after childhood-diagnosed ADHD: findings from the MTA longitudinal study.

Molina BSG1, Howard AL2, Swanson JM3, Stehli A3, Mitchell JT4, Kennedy TM5, Epstein JN6, Arnold LE7, Hechtman L8, Vitiello B9, Hoza B10. 

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Intermittent Explosive Disorder Linked To Higher Risk of Substance Abuse

MedicalResearch.com Interview with:

Emil F. Coccaro, M.D. Ellen C. Manning Professor Department of Psychiatry and Behavioral Neuroscience The University of Chicago Chicago, Illinois 60637

Dr. Emil Coccaro

Emil F. Coccaro, M.D.
Ellen C. Manning Professor
Department of Psychiatry and Behavioral Neuroscience
The University of Chicago
Chicago, Illinois 60637

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Aggressive behavior and drug use have been related for years but this study shows people with problematic aggression (Intermittent Explosive Disorder: IED) are in fact at risk for developing alcohol, tobacco, and cannabis use disorders and that the onset of problematic aggression (IED) begins before the onset of the drug use.

The increased risk for alcohol use disorder was nearly six-fold higher, the increased risk for cannabis use disorder was seven-fold higher, and the increased risk for tobacco use disorder  was four-fold higher. In addition, the presence of IED increased the severity of the substance use disorder.

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Brief Screening Guages Teenage Substance Abuse risk

Sharon Levy, M.D., M.P.H. Director, Adolescent Substance Abuse Program Assistant Professor in Pediatrics Boston Children’s HospitaMedicalResearch.com Interview with:
Sharon Levy, M.D., M.P.H.
Director, Adolescent Substance Abuse Program
Assistant Professor in Pediatrics
Boston Children’s Hospital

 
Medical Research: What are the main findings of the study?

Dr. Levy: We found that questions that asked about the frequency of alcohol, tobacco and drug use accurately triaged adolescents into “risk categories”.  In other words, kids who reported using alcohol or marijuana “once or twice” last year were unlikely to have a substance use disorder, those who reported “monthly” use were very likely to meet diagnostic criteria for a “mild” or “moderate” substance use disorder while those who reported use weekly or more were very likely to meet diagnostic criteria for a “severe” substance use disorder.
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Tool Identifies ER Patients With Substance Abuse Issues

Wendy Macias Konstantopoulos, MD, MPH Department of Emergency Medicine Division of Global Health & Human Rights Massachusetts General Hospital Harvard Medical SchoolMedicalResearch.com Interview with:
Wendy Macias Konstantopoulos, MD, MPH
Department of Emergency Medicine
Division of Global Health & Human Rights
Massachusetts General Hospital
Harvard Medical School

Medical Research: What are the main findings of the study?

Dr. Macias-Konstantopoulos: Nearly two-thirds (64%) of 3240 emergency department (ED) patients who endorsed using drugs in the last 30 days, met criteria for problematic drug use (DAST-10 score ≥3). Of patients who identified their primary drug of use as being a substance other than cannabis, approximately 91% met criteria for problematic drug use, including nearly 94% of those using illicit drugs and 76% of those using pharmaceuticals. Compared to those who used cannabis primarily, primary non-cannabis users had an almost 15 times higher odds of meeting criteria for problematic drug use. Finally, we know from previous studies that drug-using individuals are more likely to access medical care through the ED and more likely to require hospitalization than their non-drug using counterparts. Our study found that drug-using ED patients who met criteria for problematic drug use tended to have ED triage levels associated with higher levels of severity or resource utilization when compared to drug-using ED patients who did not meet criteria for a drug problem.

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Methamphetamine Users: Do Brain Function Differences Predispose to Risky Behavior?

MedicalResearch.com Interview with
Dr. Edythe  D.London PhD Professor, Departments of Psychiatry and Biobehavioral Sciences, and Molecular and Medical Pharmacology David Geffen School of Medicine, UCLA Dr. Edythe  D.London PhD
Professor, Departments of Psychiatry and Biobehavioral Sciences, and Molecular and Medical Pharmacology
David Geffen School of Medicine, UCLA

MedicalResearch: What are the main findings of the study?

Dr. London: Brain function related to risky decision-making was different in stimulant users  (methamphetamine users) than in healthy control subjects. In healthy controls, activation in the prefrontal cortex (right dorsolateral prefrontal cortex) during risk-taking in the laboratory was sensitive to the level of risk. This sensitivity of cortical activation was weaker in stimulant users, who instead had a stronger sensitivity of striatum activation. The groups also differed in circuit-level activity (network activity) when they were not performing a task but were “at rest.”  Stimulant users showed greater connectivity within the mesocorticolimbic system, a target of abused drugs. This connectivity was negatively related to sensitivity in the prefrontal cortex to risk during risky decision-making. In healthy control subjects, connectivity between the right dorsolateral prefrontal cortex and striatum was positively related to sensitivity of prefrontal cortical activation to risk during risky decision-making.
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How Does Stimulant Medication for ADHD in Children Affect Later Substance Use?

Kathryn L. Humphreys, M.A., Ed.M.  Clinical Psychology Doctoral Student UCLA Department of Psychology 1285 Franz Hall, Box 951563 Los Angeles, CA 90095MedicalResearch.com eInterview with Kathryn L. Humphreys, M.A., Ed.M.

Clinical Psychology Doctoral Student
UCLA Department of Psychology
1285 Franz Hall, Box 951563
Los Angeles, CA 90095

MedicalResearch.com: What are the main findings of the study?

Response: Our primary question was to answer whether the use of stimulant medication in the treatment of ADHD was associated with increased or decreased risk for a variety of substance use (ever tried) and substance use disorder (abuse or dependence) outcomes (alcohol, cocaine, marijuana, nicotine, and non-specific drug use).

Prior research from individual studies of children have provided mixed evidence (i.e., some found medication increased later risk, some found medication decreased risk, and still others found no difference in risk). We examined available longitudinal studies (i.e., medication treatment preceded measurement of substance outcome) together using meta-analysis, a technique that aggregates findings from a number of studies, in order to examine this question in a much larger sample of individuals.

Our main finding was that children with ADHD who received medication treatment did not differ in risk for lifetime substance use or abuse or dependence compared to those children with ADHD who did not receive medication treatment.
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