Measurement invariance of the Marijuana Motives Measure among men and women using Stop Cannabis App

Motives to use cannabis play a central role in the development and maintenance of problematic cannabis use and previous studies stressed sex-related differences on motives to use cannabis. However, motives cannot be validly compared in men and women without first establishing the measurement invariance across sex. Therefore, the aim of the study is to (1) examine for the first time the measurement and structural invariance of the Marijuana Motives Measure (MMM) across sex, and (2) to investigate the motives for cannabis use that best explain problematic use. 2951 (41.7% women) users of the "Stop cannabis" smartphone app of which 99.8% reported having used cannabis in the last three months completed an online MMM and ASSIST to assess the severity of their problematic cannabis use. Multigroup confirmatory factor analyses supported measurement invariance across sex, whereas structural invariance was not confirmed. Indeed, group comparisons indicated that women reported greater coping motives then men whereas men showed greater social motives than women. A multiple linear regression analysis showed that only coping and conformity motives were significantly associated with greater problematic cannabis use, whereas neither sex nor the sex by motives interactions were significantly related to problematic cannabis use. The MMM appears to function comparably across men and women. Therefore, sex-related comparisons on the questionnaire can be considered valid. Coping and conformity motives may play a central role part in the development of marijuana use problems which may hold implications for intervention development and public policy

Community-based addiction treatment: improving access to care for vulnerable groups

Substance use disorders (SUD) are an important health problem and certain patients with SUD find themselves frequently returning to hospital services (1,2). In order to improve access to care, assertive outreach treatment models such as community treatment have been implemented over the last few decades. However, service use remains high for a number of patients with SUD. Different risk factors associated with high service use can be determined. In order to reduce service use, it is important to identify at-risk patients and their needs, which will allow to better adapt community treatment models. A cohort study (3) examining predictors related to the frequency of emergency department (ED) use among 4,731 patients with substance-related disorders found that high ED users presented more complex and severe conditions and mainly visited ED repeatedly for subacute or non-urgent problems. High ED users were more likely men. They more often had a socioeconomic disadvantage, but also some middle income. Another cohort study (4) analyzing 970 admissions of patients with SUD on factors associated with the length of hospital stay, found that higher Health of Nation Outcome Scales admission scores and number of previous hospitalizations predicted longer stays. This implies that these patients presented higher symptom levels and more psychosocial problems on admission. A study (5) on unplanned readmissions among patients with SUD, showed that longer first hospitalizations reduced the risk of unplanned readmission. A systematic review on assertive community treatment (6) found this model overall beneficial for patients with SUD in particular in increasing treatment engagement. Advance statements were found to be feasible and acceptable tools for patients with SUD to reduce treatment disengagement (7). Overall, the studies show that risk factors for high service use among patients with SUD are the presence of more severe and complex disorders, including co-occurring mental disorders/SUD or physical illness, more psychosocial problems and a history of acute service use. They also indicate the benefits of community treatment and advance statements. In the light of these findings, community-based treatments for SUD and co-occurring disorders, addressing social problems, as well as treatment continuity are necessary to improve access to care and reduce high service use. Future research needs to focus on the impact of community treatment models and how to adapt programs to patients at risk of treatment disengagement and also on the development of new recovery-oriented approaches for patients with SUD. </p

Depressive Episode

Frau C., eine 40-jährige alleinstehende Mitarbeiterin eines internationalen Unternehmens, kommt Anfang Dezember zu Ihnen in die Praxis. Sie klagt über eine ­gedrückte Stimmung und fürchtet, erneut in eine ­depressive Phase zu gleiten

Unschuldig unvernünftig

Herr F, 49-jährig, ist seit 14 Jahren wegen einer bipolaren Störung in psychiatrischer Behandlung. Im Rahmen einer manischen Episode hat er vor ca. einem Jahr einen Autokaufvertrag für einen Luxuswagen unterschrieben und hierbei eine gefälschte Bankgarantie hinterlegt

La communauté comme lieu d’intervention dans le traitement des addictions

La mobilité et le déplacement des lieux du traitement vers la communauté sont utiles et nécessaires pour certaines personnes souffrant d’addictions qui n’arrivent pas à adhérer aux programmes de soins traditionnels. L’article présente différentes modalités de soins : les soins dans le milieu (assertive community treatment), le Housing First et des programmes de transition. Les effets principaux des programmes présentés sont une réduction des jours d’hospitalisation et de l’utilisation des services d’urgences, ainsi qu’une amélioration de l’adhérence aux soins ambulatoires. Ce sont des résultats encourageants vu les difficultés importantes de cette population qui présente souvent le phénomène de « porte-tournante » avec des taux de réhospitalisation très importants et des prises en soins chaotiques