Parental Substance Abuse As an Early Traumatic Event. Preliminary Findings on Neuropsychological and Personality Functioning in Young Drug Addicts Exposed to Drugs Early.

open5noParental substance use is a major risk factor for child development, heightening the risk of drug problems in adolescence and young adulthood, and exposing offspring to several types of traumatic events. First, prenatal drug exposure can be considered a form of trauma itself, with subtle but long-lasting sequelae at the neuro-behavioral level. Second, parents’ addiction often entails a childrearing environment characterized by poor parenting skills, disadvantaged contexts and adverse childhood experiences (ACEs), leading to dysfunctional outcomes. Young adults born from/raised by parents with drug problems and diagnosed with a Substance Used Disorder (SUD) themselves might display a particularly severe condition in terms of cognitive deficits and impaired personality function. This preliminary study aims to investigate the role of early exposure to drugs as a traumatic event, capable of affecting the psychological status of young drug addicts. In particular, it intends to examine the neuropsychological functioning and personality profile of young adults with severe SUDs who were exposed to drugs early in their family context. The research involved three groups, each consisting of 15 young adults (aged 18–24): a group of inpatients diagnosed with SUDs and exposed to drugs early, a comparison group of non-exposed inpatients and a group of non-exposed youth without SUDs. A neuropsychological battery (Esame Neuropsicologico Breve-2), an assessment procedure for personality disorders (Shedler-Westen Assessment Procedure-200) and the Symptom CheckList-90-Revised were administered. According to present preliminary results, young drug addicts exposed to drugs during their developmental age were characterized by elevated rates of neuropsychological impairments, especially at the expense of attentive and executive functions (EF); personality disorders were also common but did not differentiate them from non-exposed youth with SUDs. Alternative multi-focused prevention and intervention programs are needed for children of drug-misusing parents, addressing EF and adopting a trauma-focused approach.openParolin, Micol; Simonelli, Alessandra; Mapelli, Daniela; Sacco, M.; Cristofalo, P.Parolin, Micol; Simonelli, Alessandra; Mapelli, Daniela; Sacco, M.; Cristofalo, P

Recognition and Stigma of Prescription Drug Abuse Disorder: Personal and Community Determinants

Background Prescription drug abuse (PDA) disorders continue to contribute to the current American opioid crisis. Within this context, our study seeks to improve understanding about stigma associated with, and symptom recognition of, prescription drug abuse. Aims Model the stigma and symptom recognition of PDA in the general population. Methods A randomized, nation-wide, online, vignette-focused survey of the general public (N = 631) was implemented with an oversample for rural counties. Logit estimation was used for analysis, with regional and county-level sociodemographic variables as controls. Results Individual respondents that self-identify as having or having had “a prescription drug abuse issue” were less likely to correctly identify the condition and were 4 times more likely to exhibit stigma. Male respondents were approximately half as likely to correctly identify PDA as female respondents while older respondents (55+) were more likely to correctly identify PDA, relative to those aged 35–54. Being both male and younger was associated with slightly more stigma, in that they were less likely to disagree with the stigma statement. Conclusions In light of the continued risks that individuals with PDA behaviors face in potentially transitioning to illicit opioid use, the findings of this survey suggested a continued need for public education and outreach. Of particular note is the perspective of those who have self-identified with the condition, as this population faces the largest risks of adverse health outcomes from illicit drug use within the survey respondents

Implementation and evaluation of a harm-reduction model for clinical care of substance using pregnant women

<p>Abstract</p> <p>Background</p> <p>Methamphetamine (MA) use during pregnancy is associated with many pregnancy complications, including preterm birth, small for gestational age, preeclampsia, and abruption. Hawaii has lead the nation in MA use for many years, yet prior to 2007, did not have a comprehensive plan to care for pregnant substance-using women. In 2006, the Hawaii State Legislature funded a pilot perinatal addiction clinic. The Perinatal Addiction Treatment Clinic of Hawaii was built on a harm-reduction model, encompassing perinatal care, transportation, child-care, social services, family planning, motivational incentives, and addiction medicine. We present the implementation model and results from our first one hundred three infants (103) seen over 3 years of operation of the program.</p> <p>Methods</p> <p>Referrals came from community health centers, hospitals, addiction treatment facilities, private physician offices, homeless outreach services and self-referral through word-of-mouth and bus ads. Data to describe sample characteristics and outcome was obtained prospectively and retrospectively from chart abstraction and delivery data. Drug use data was obtained from the women's self-report and random urine toxicology during the pregnancy, as well as urine toxicology at the time of birth on mothers, and urine and meconium toxicology on the infants. Post-partum depression was measured in mothers with the Edinburgh Post-Partum depression scale. Data from Path clinic patients were compared with a representative cohort of women delivering at Kapiolani Medical Center for Women and Children during the same time frame, who were enrolled in another study of pregnancy outcomes. Ethical approval for this study was obtained through the University of Hawaii Committee for Human Studies.</p> <p>Results</p> <p>Between April 2007 and August 2010, 213 women with a past or present history of addiction were seen, 132 were pregnant and 97 delivered during that time. 103 live-born infants were delivered. There were 3 first-trimester Spontaneous Abortions, two 28-week intrauterine fetal deaths, and two sets of twins and 4 repeat pregnancies. Over 50% of the women had lost custody of previous children due to substance use. The majority of women who delivered used methamphetamine (86%), either in the year before pregnancy or during pregnancy. Other drugs include marijuana (59.8%), cocaine (33%), opiates (9.6%), and alcohol (15.2%). Of the women served, 85% smoked cigarettes upon enrollment. Of the 97 women delivered during this period, all but 4 (96%) had negative urine toxicology at the time of delivery. Of the 103 infants, 13 (12.6%) were born preterm, equal to the state and national average, despite having many risk factors for prematurity, including poverty, poor diet, smoking and polysubstance use. Overwhelmingly, the women are parenting their children, > 90% retained custody at 8 weeks. Long-term follow-up showed that women who maintained custody chose long-acting contraceptive methods; while those who lost custody had a very high (> 50%) repeat pregnancy rate at 9 months post delivery.</p> <p>Conclusion</p> <p>Methamphetamine use during pregnancy doesn't exist is isolation. It is often combined with a multitude of other adverse circumstances, including poverty, interpersonal violence, psychiatric comorbidity, polysubstance use, nutritional deficiencies, inadequate health care and stressful life experiences. A comprehensive harm reduction model of perinatal care, which aims to ameliorate some of these difficulties for substance-using women without mandating abstinence, provides exceptional birth outcomes and can be implemented with limited resources.</p

Про особливості роботи з електронними інформаційними ресурсами

Щодо визначення напрямів зменшення трафіку передачі даних при збереженні обсягу переданої інформації.Об определении направлений уменьшения трафика передачи данных при сохранении объема передаваемой информации.As to determination of main directions in decreasing of data transmission traffic when the volume of transmitted information is saved

Utilisation non médicale des médicaments d’ordonnance chez les adolescents utilisant des drogues au Québec

Abstract : OBJECTIVE: To determine the prevalence and factors associated with nonmedical use of prescription medication (NMUPM) among adolescents who use drugs (ages 12 to 17 years) in Quebec. METHOD: Secondary data analyses were carried out with data from a 6-month study, namely, the 2010-2011 Quebec Health Survey of High School Students-a large-scale survey that sought to gain a better understanding of the health and well-being of young Quebecers in high school. Bivariate and multivariate logistic regression analyses were conducted to study NMUPM among adolescents who use drugs, according to sociodemographic characteristics, peer characteristics, health indicators (anxiety, depression, or attention-deficit disorder [ADD] with or without hyperactivity), self-competency, family environment, and substance use (alcohol and drug use) factors. RESULTS: Among adolescents who had used drugs in the previous 12 months, 5.4% (95% CI 4.9% to 6.0%) reported NMUPM. Based on multivariate analyses, having an ADD (adjusted odds ratio [AOR] 1.47; 95% CI 1.13 to 1.91), anxiety disorder (AOR 2.14; 95% CI 1.57 to 2.92), low self-esteem (AOR 1.62; 95% CI 1.26 to 2.08), low self-control (AOR 1.95; 95% CI 1.55 to 2.45), low parental supervision (AOR 1.43; 95% CI 1.11 to 1.83), regular alcohol use (AOR 1.72; 95% CI 1.36 to 2.16), and polysubstance use (AOR 4.09; 95% CI 3.06 to 5.48) were associated with increased odds of reporting NMUPM. CONCLUSIONS: The observed prevalence of NMUPM was lower than expected. However, the associations noted with certain mental health disorders and regular or heavy use of other psychoactive substances are troubling. Clinical implications are discussed.OBJECTIF: Déterminer la prévalence de l’utilisation non médicale des médicaments d’ordonnance (UNMMO) et les facteurs qui y sont associés chez les adolescents (de 12 à 17 ans) qui utilisent des drogues au Québec. MÉTHODE: Des analyses de données secondaires ont été exécutées avec les données d’une étude de 6 mois, l’Enquête québécoise sur la santé des jeunes du secondaire 2010-2011, une enquête de grande envergure visant à obtenir une meilleure compréhension de la santé et du bien-être des jeunes québécois du secondaire. Des analyses de régression logistique bivariée et multivariée ont été menées pour étudier l’UNMMO chez les adolescents qui utilisent des drogues, selon les facteurs des caractéristiques sociodémographiques, des caractéristiques des pairs, des indicateurs de la santé (anxiété, dépression, ou trouble de déficit de l’attention [TDA] avec ou sans hyperactivité), de l’autoefficacité, de l’environnement familial, et de l’utilisation de substances (utilisation d’alcool et de drogues). RÉSULTATS: Parmi les adolescents qui avaient utilisé des drogues dans les 12 mois précédents, 5,4 % (IC à 95 % 4,9 % à 6,0 %) déclaraient une UNMMO. Selon les analyses multivariées, un TDA (ratio de cotes ajusté [RCC] 1,47; IC à 95 % 1,13 à 1,91), un trouble anxieux (RCC 2,14; IC à 95 % 1,57 à 2,92), une faible estime de soi (RCC 1,62; IC à 95 % 1,26 à 2,08), un faible autocontrôle (RCC 1,95; IC à 95 % 1,55 à 2,45), une faible supervision parentale (RCC 1,43; IC à 95 % 1,11 à 1,83), une utilisation d’alcool régulière (RCC 1,72; IC à 95 % 1,36 à 2,16), et une utilisation de polysubstances (RCC 4,09; IC à 95 % 3,06 à 5,48) étaient associés à des probabilités accrues de déclarer une UNMMO. CONCLUSIONS: La prévalence observée de l’UNMMO était plus faible que prévu. Cependant, les associations notées entre certains troubles de santé mentale et l’utilisation régulière ou intensive d’autres substances psychoactives sont inquiétantes. Les implications cliniques sont discutées

Depressive Symptoms, Gender, and Growth in Cigarette Smoking among Indigenous Adolescents

This study reports findings from two-level growth curve modeling of cigarette smoking and depressive symptoms based on the first three waves of data from a longitudinal study of Indigenous adolescents and their parents/caretakers in the northern Midwest and Canada. The 743 adolescents were aged 10–13 years at Wave 1 and 12–15 years at Wave 3. Over the three years of the study the overall retention rate was 93%. By Wave 3, 39% of the adolescent girls and 25% of the boys had smoked cigarettes in the past 12 months. The growth curve results indicated that smoking increased for both adolescent boys and girls across time. Depressive symptoms were associated with an increase in cigarette smoking for girls but not boys

“Hitting the wall”: Lived experiences of mental health crises

Background : As Norway moves toward the provision of home-based crisis response, knowledge is needed about understandings of mental health crisis and effective ways of addressing crises within the home. Objective : To elicit and learn from service users&#x2019; experiences about the subjective meanings of crisis and what kind of help will be most effective in resolving mental health crises. Theoretical : A phenomenological-hermeneutic cooperative inquiry method was used to elicit and analyse focus group responses from mental health service users who had experienced crises. Results : Findings clustered into three themes: (1) Crisis as multifaceted and varied experiences; (2) losing the skills and structure of everyday life; and (3) complexities involved in family support. Conclusion : Several aspects of crises require an expansion of the biomedical model of acute intervention to include consideration of the personal and familial meaning of the crisis, attention to the home context, and activities of daily living that are disrupted by the crisis, and ways for the person and the family to share in and learn from resolution of the crisis

(Mis)understanding trauma informed approaches in mental health

The Journal of Mental Health has a history of publishing articles that explore the ways traumatic experiences lead to mental distress, and the experiences of trauma survivors (Cooke, 2016; Harper, Stalker, Palmer, & Gadbois, 2008; Karatzias, Ferguson, Gullone, & Cosgrove, 2016; Kucharska, 2017; Mueser & Rosenberg, 2003; Salter & Richters 2012; Xie, Jiuping, & Zhibin, 2017). These articles join other evi- dence demonstrating that large numbers of people in con- tact with mental health services have experienced traumatic events (Khalifeh et al., 2015), that these experiences are causal in the development of mental distress (Felitti et al., 1998; Morrison, Frame, & Larkin, 2003) and that there is a relationship between the severity, frequency and range of adverse experiences, and the subsequent impact on mental health (Dillon, Johnstone, & Longden, 2012). For instance, there is evidence of a strong link between childhood trauma and adulthood psychosis (Varese et al., 2012), and intimate partner violence and depression (Devries et al., 2013). It is also argued that social factors such as poverty and racism can be considered forms of trauma and that traumatic expe- riences are more common within ethnic minority and socially disadvantaged groups (Hatch & Dohrenwend, 2007; Paradies, 2006). This, coupled with evidence of iatrogenic harm in psychiatric services, has led to the development of trauma-informed approaches. Despite growing international interest, trauma-informed approaches can seem fuzzy, complex, something that service providers already do, or a theorised call for practitioners to “be nicer.” However, writing as trauma survivors and aca- demics/clinician, the more we learn about trauma-informed approaches, the more we argue that these approaches have the potential to lead to a fundamental shift in how mental health services are organised and delivered, meaning that they are better able to meet the needs of service users. In this editorial, we will explore the central drivers for trauma- informed approaches, outline the key principles of the approach, discuss some common misconceptions and high- light some of the dangers associated with trauma-informed practices. We conclude by arguing for the need for survivor organisations to have a key role in shaping the agenda

Genetic and environmental risk factors in the non-medical use of over-the-counter or prescribed analgesics, and their relationship to major classes of licit and illicit substance use and misuse in a population-based sample of young adult twins

Background and Aims: The non-medical use of over-the-counter or prescribed analgesics (NMUA) is a significant public health problem. Little is known about the genetic and environmental etiology of NMUA and how these risks relate to other classes of substance use and misuse. Our aims were to estimate the heritability NMUA and sources of genetic and environmental covariance with cannabis and nicotine use, cannabis and alcohol use disorders and nicotine dependence in Australian twins. Design: Biometrical genetic analyses or twin methods using structural equation univariate and multivariate modeling. Setting: Australia. Participants: A total of 2007 young adult twins [66% female; μ\ua0=\ua025.9, standard deviation (SD)\ua0=\ua03.6, range\ua0=\ua018–38] from the Brisbane Longitudinal Twin Study retrospectively assessed between 2009 and 2016. Measurements: Self-reported NMUA (non-opioid or opioid-based), life-time nicotine, cannabis and opioid use, DSM-V cannabis and alcohol use disorders and the Fagerström Test for Nicotine Dependence. Findings: Life-time NMUA was reported by 19.4% of the sample. Univariate heritability explained 46% [95% confidence interval (CI)\ua0=\ua00.29–0.57] of the risks in NMUA. Multivariate analyses revealed that NMUA is moderately associated genetically with cannabis (r\ua0=\ua00.41) and nicotine (r\ua0=\ua00.45) use and nicotine dependence (r\ua0=\ua00.34). In contrast, the genetic correlations with cannabis (r\ua0=\ua00.15) and alcohol (r\ua0=\ua00.07) use disorders are weak. Conclusions: In young male and female adults in Australia, the non-medical use of over-the-counter or prescribed analgesics appears to have moderate heritability. NMUA is moderately associated with cannabis and nicotine use and nicotine dependence. Its genetic etiology is largely distinct from that of cannabis and alcohol use disorders