RESUMEN
Impaired insight in substance use disorder has been argued to reflect a global deficit in using cognitive models to mentally simulate possible future outcomes. The process of mentally simulating outcomes allows us to understand our beliefs about their causes, that is, to have insight and thereby avoid potentially negative outcomes. However, work in humans cannot address whether impaired insight and its neural/neurochemical sequalae are present prior to the development of a substance use disorder, a consequence of substance use, or a combination of both. This is because baseline measurements prior to drug use are not possible in humans. However, if these changes can be directly caused by drug use, then in animal models, a history of drug use should cause impairments in behavioral tasks designed to assess such inferences. Focusing on cocaine use, here we will review several lines of research from our laboratory that have tested this question using learning-theory tasks designed to isolate insight. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Trastornos Relacionados con Sustancias , Animales , Trastornos Relacionados con Sustancias/psicología , Roedores , Modelos Animales de Enfermedad , Humanos , Ratas , Aprendizaje/efectos de los fármacosRESUMEN
Mental health stigma remains a major global problem associated with low self-esteem, social withdrawal, and poor health-seeking behavior in individuals. However, limited published evidence details these challenges in Liberia. Knowledge of public perceptions toward mental illness and key trends in the associations between knowledge of mental, neurological, and substance use disorders (MNSs) and stigma is crucial to designing evidence-based mental health policies and supporting service delivery. This population-representative survey explored and quantified stigma related to MNSs in four health regions in Liberia, using a multistage stratified random sampling of 1,148 residents. Four internationally validated scales were used to assess knowledge, attitudes, and perceptions toward schizophrenia, bipolar disorder, epilepsy, and substance use disorder including the 1) Mental Health Attribution Questionnaire; 2) Five Question Stigma Indicator Questionnaire to assess Community Stigma; 3) Reported Intended Behavioral Scale; and 4) Personal Acceptance Level of Conditions. Data from interviews with 1,140 participants (96% response rate) were analyzed using central tendencies, hypothesis testing with simple logistic regression, and bivariate analysis for association between dependent and independent variables. Low mental health knowledge was found to be a strong predictor of discriminatory behaviors and stigma. Results revealed that exposure to movies or television significantly predicted increased discriminatory tendencies and that a lesser degree of acceptance was shown toward substance use disorder than any of the other conditions. These findings underscore the need for increased awareness and education about mental health to eliminate stigma and promote better care and inclusion for people living with MNSs.
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Conocimientos, Actitudes y Práctica en Salud , Trastornos Mentales , Estigma Social , Trastornos Relacionados con Sustancias , Humanos , Masculino , Femenino , Liberia/epidemiología , Adulto , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/epidemiología , Persona de Mediana Edad , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Encuestas y Cuestionarios , Adulto Joven , Adolescente , Enfermedades del Sistema Nervioso/psicología , Enfermedades del Sistema Nervioso/epidemiologíaRESUMEN
BACKGROUND: Internalizing disorders (IDs), primarily depression and anxiety, are highly prevalent among adolescents receiving community-based treatment for substance use disorders (SUDs). For such clients, interventions that do not holistically address both SUDs and IDs are less effective. OBJECTIVE: This pilot treatment development study aims to develop and test a modular treatment protocol for addressing cooccurring IDs among adolescents (aged 13 to 18 years) enrolled in routine care for substance use problems: Family Support Protocol for Adolescent Internalizing Disorders (Fam-AID). As an adjunctive protocol, Fam-AID will not require clinicians to markedly alter existing base practices for SUD. It will be anchored by 3 evidence-based foundations for treating cooccurring adolescent IDs: family engagement techniques, transdiagnostic individual cognitive behavioral therapy techniques, and family psychoeducation and safety planning. METHODS: This quasi-experimental study will proceed in 2 stages. The pilot stage will use rapid-cycle prototyping methods in collaboration with end-user stakeholders to draft protocol delivery and fidelity guidelines adapted from existing resources, solicit provider and client input on protocol content and delivery via cognitive interviewing, and pilot prototype components on 4 to 6 cases. The second stage will be an interrupted time series study for 60 comorbid SUD+ID cases across 2 sites serving diverse adolescents: 30 will receive treatment as usual (TAU); following clinician training in the protocol, 30 new cases will receive TAU enhanced by Fam-AID. For aim 1, the focus is on evaluating the acceptability of the Fam-AID protocol through therapist and client interviews as well as assessing fidelity benchmarks using therapist- and observer-reported protocol fidelity data. For aim 2, the plan is to compare the effects of TAU only cases versus TAU+Fam-AID cases on family treatment attendance and on adolescent ID and substance use symptoms, with measurements taken at baseline and at 3-month and 6-month follow-ups. RESULTS: Study recruitment will begin in April 2025. CONCLUSIONS: We anticipate that Fam-AID will contain 5 treatment modules that can be delivered in any sequence to meet client needs: family engagement of primary supports in treatment planning and services; relational reframing of family constraints, resiliencies, and social capital connected to the adolescent's ID symptoms; functional analysis of the adolescent's ID symptoms and related behaviors; cognitive behavioral therapy to address the adolescent's ID symptoms and functional needs, featuring 3 core techniques (emotion acceptance, emotional exposure, and behavioral activation) to address negative affect and emotional dysregulation; and family psychoeducation and safety planning focused on education about comorbid SUD+ID and prevention of adolescent self-harm. If the abovementioned modules are found to be feasible and effective, Fam-AID will offer a set of pragmatic interventions to SUD clinicians for treating cooccurring IDs in adolescent clients. TRIAL REGISTRATION: ClinicalTrials.gov NCT06413979; https://www.clinicaltrials.gov/study/NCT06413979. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/64332.
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Terapia Familiar , Humanos , Adolescente , Proyectos Piloto , Femenino , Masculino , Terapia Familiar/métodos , Trastornos Relacionados con Sustancias/terapia , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/epidemiología , Terapia Cognitivo-Conductual/métodos , Apoyo FamiliarRESUMEN
INTRODUCTION: People with substance use disorder (SUD) face challenges like stigma and discrimination, impacting their healthcare experiences. AIM: This study aims to: (i) assess physicians' clinical practices and stigma toward SUD patients among healthcare personnel and (ii) explore the relationship among stigma, psychological well-being, and burnout. METHODS: A survey covering sociodemographic data, physicians' clinical practices, stigmatizing attitudes, psychological well-being, and burnout was completed by 1,796 employees of the Veneto's Local Health Units (Italy). RESULTS: Healthcare professionals reported increased stigma towards SUDs (p-values<0.05). Stigma consistently correlated with variables such as sex, profession, department, and levels of burnout (p-values<0.05). Notably, high burnout levels were associated with increased stigma. Staff in addiction departments displayed lower stigma levels compared to other departments. No significant differences were found in physicians' clinical practices. CONCLUSIONS: Targeted training for healthcare professionals is crucial to reduce stigma, enhance attitudes toward SUDs, and broaden overall knowledge of the condition.
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Actitud del Personal de Salud , Agotamiento Profesional , Personal de Salud , Estigma Social , Trastornos Relacionados con Sustancias , Humanos , Italia , Masculino , Femenino , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Persona de Mediana Edad , Personal de Salud/psicología , Agotamiento Profesional/epidemiología , Agotamiento Profesional/psicología , Encuestas y Cuestionarios , Médicos/psicologíaRESUMEN
Objective: Intimate partner violence (IPV) perpetrators with alcohol and/or other drug use problems (ADUPs) have been identified as one of the main high-risk and highly resistant groups of perpetrators requiring special attention in intervention programs for IPV perpetrators. This randomized controlled trial (RCT) aimed to evaluate whether an individualized motivational plan adjusted to ADUPs (IMP-ADUPs) was superior to standard motivational strategies (IMP) in reducing ADUPs, and IPV and increasing treatment adherence in IPV perpetrators. Method: Data from a full sample of IPV perpetrators (n = 140) and a subsample of participants with ADUPs (n = 55) were collected at pre- and post-intervention and 12-month follow-up. Final outcomes included alcohol, cocaine, and cannabis use, self-reported IPV, risk of recidivism assessed by facilitators, and official IPV recidivism. Proximal outcomes included treatment adherence (stage of change, intervention dose, active participation, and dropout). Results: Both intent-to-treat (ITT) and per-protocol (PP) analyses were conducted. The IMP-ADUPs condition was superior to the IMP in reducing alcohol use at post-intervention in both the full sample and ADUPs subsample. The full sample of participants in the IMP-ADUPs condition were in a more advanced stage of change post-intervention and showed increased active participation during the intervention process than IMP participants. All participants were in a more advanced stage of change at post-intervention and reduced their alcohol use and their risk of recidivism at post-intervention and 12-month follow-up. Conclusions: These results underscore the need to develop individualized treatment approaches to address participants' risks and needs and promote their motivation to change.
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Violencia de Pareja , Motivación , Trastornos Relacionados con Sustancias , Humanos , Violencia de Pareja/psicología , Violencia de Pareja/prevención & control , Masculino , Femenino , Adulto , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/terapia , Persona de Mediana Edad , Entrevista Motivacional/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: There is limited research examining latent profiles of gamers based on emotional variables, which has implications for prevention efforts. The study sought to identify young adult gamer profiles based on depression, anxiety, and stress, and to examine differences between the latent profiles in other addictive behaviors (i.e., tobacco, alcohol, cannabis, illegal substance use, gaming, and gambling). METHODS: A total of 1209 young adults (Mage = 19.37, SD = 1.62; 55.3%males) reported past-year gaming. A latent profile analysis (LPA) was performed to identify distinct profiles, and a set of ANOVA and chi-square analyses characterized the profiles in terms of sociodemographic, addictive behaviors, and emotional variables. RESULTS: LPA suggested a three-profile solution: profile 1 (n = 660, 'low emotional distress'), profile 2 (n = 377, 'moderate emotional distress'), and profile 3 (n = 172, 'high emotional distress'). Participants with 'moderate' and 'high emotional distress' were mostly women, showed greater gaming severity, higher prevalence of past-month substance use (i.e., tobacco and illegal drugs), and greater consequences of alcohol use. LIMITATIONS: The cross-sectional nature of the study and sample being university students. CONCLUSION: Findings revealed three distinct profiles of gamers, which differed in emotional, gaming, and substance use severity. Transdiagnostic prevention programs have the potential to provide significant benefits to college students by addressing the core processes (e.g., emotion regulation) that underlie substance use and gaming.
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Ansiedad , Conducta Adictiva , Depresión , Estrés Psicológico , Humanos , Femenino , Masculino , Adulto Joven , Estrés Psicológico/epidemiología , Estrés Psicológico/psicología , Ansiedad/epidemiología , Ansiedad/psicología , Depresión/epidemiología , Depresión/psicología , Conducta Adictiva/epidemiología , Conducta Adictiva/psicología , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Adulto , Adolescente , Análisis de Clases Latentes , Juego de Azar/epidemiología , Juego de Azar/psicología , Estudiantes/estadística & datos numéricos , Estudiantes/psicología , Distrés PsicológicoAsunto(s)
Tutoría , Trastornos Relacionados con Sustancias , Humanos , Tutoría/métodos , Trastornos Relacionados con Sustancias/terapia , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/prevención & control , Conducta Adictiva/psicología , Conducta Adictiva/terapiaRESUMEN
This study aims to find out how adolescents' consumption of toxic substances such as tobacco and alcohol is influenced by the Positive Mental Health. A quantitative methodology with a cross-sectional design has been used to achieve the final conclusions. The intervention was carried out by applying the Positive Mental Health Questionnaire developed by Teresa Lluch to a group of adolescents from Don Juan Manuel High School in Guadalajara (Spain). Our results shows that the Positive Mental Health of adolescents have a great impact on the tobacco and alcohol consumption. The scientific literature consulted signs that people who do not consume substances tend to have better Positive Mental Health.
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Salud Mental , Humanos , Estudios Transversales , Adolescente , Masculino , Femenino , España , Encuestas y Cuestionarios , Consumo de Bebidas Alcohólicas/psicología , Conducta del Adolescente/psicología , Fumar/psicología , Fumar/epidemiología , Trastornos Relacionados con Sustancias/psicologíaRESUMEN
OBJECTIVE: Polysubstance use among adults has been a public health concern in the U.S. and is associated with adverse consequences. This study aimed to identify the longitudinal trajectory of polysubstance use and test whether internalizing and externalizing problems predict it. METHODS: Data of adults aged 18 and older (N = 15076) were extracted from the Waves 1-5 Population Assessment of Tobacco and Health Study (2013-2019). Group-Based Trajectory Modeling was performed to identify the trajectory of polysubstance use. Examined substances included use of cigarettes, e-cigarettes, excessive alcohol, cannabis, painkillers, and cocaine in past 30 days from all waves. Weighted multinomial logistic regressions were conducted to investigate the associations between internalizing and externalizing problems and the trajectory of polysubstance use, controlling for demographic variables. RESULTS: Five trajectory groups were identified: (1) No to minimal polysubstance use risk (45.6 %); (2) Polysubstance use-low risk (10.7 %); (3) Cigarette-leading polysubstance use-high risk (23.5 %); (4) Cigarette-cannabis co-leading polysubstance use-high risk (12.3 %); and (5) Cannabis-leading polysubstance use-high risk (7.8 %). Compared with Group 1, higher internalizing problems predicted the membership of Group 3 [Relative risk ratio (RRR) range: 1.07-1.17] and Group 4 (RRR range: 1.04-1.21). Compared with Group 1, higher externalizing problems predicted the membership of Group 5 (RRR range: 1.01-1.10). CONCLUSIONS: Prevention efforts should consider internalizing problems and associated trajectories of high-risk polysubstance use (e.g., cigarette-leading and cigarette-cannabis co-leading) as well as externalizing problems and associated trajectories of high-risk polysubstance use (e.g., cannabis-leading), when designing interventions to prevent polysubstance use.
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Trastornos Relacionados con Sustancias , Humanos , Masculino , Femenino , Adulto , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Adulto Joven , Persona de Mediana Edad , Adolescente , Estudios Longitudinales , Estados Unidos/epidemiología , Fumar Cigarrillos/epidemiología , Vapeo/epidemiología , Vapeo/psicología , Control Interno-Externo , AncianoRESUMEN
Substance use disorder (SUD) is a heterogeneous disorder, where severity, symptoms, and patterns of use vary across individuals. Yet, when rats self-administer cocaine under short-access conditions, their behavior tends to be well-regulated, though individual differences can emerge with long- or intermittent-access. In contrast, significant individual differences emerge when rats self-administer 3,4-methylenedioxypyrovalerone (MDPV), even under short-access conditions, wherein ~30 % of rats exhibit high levels of drug-taking. This study assessed SUD-like phenotypes of male and female rats self-administering MDPV or cocaine by comparing level of drug intake, responding during periods of signaled drug unavailability, and sensitivity to footshock punishment to determine whether: (1) under short-access conditions, rats that self-administer MDPV will exhibit a more robust SUD-like phenotype than rats that self-administer cocaine; (2) female rats will have a more severe phenotype than male rats; and (3) compared to short-access, long- and intermittent-access to MDPV or cocaine self-administration will result in a more robust SUD-like phenotype. Compared to cocaine, rats that self-administered MDPV exhibited a more severe phenotype, even under short-access conditions. Long- and intermittent-access to cocaine and MDPV temporarily altered drug-taking patterns but did not systematically change SUD-like phenotypes. Behavioral and quantitative autoradiography studies suggest phenotypic differences are not due to expression of dopamine transporter, dopamine D2 or D3 receptors, or 5-HT1B, 5-HT2A, or 5-HT2C receptors. This study suggests individuals who use synthetic cathinones may be at greater risk for developing a SUD, and short-access MDPV self-administration may provide a useful method to study the transition to disordered substance use in humans.
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Benzodioxoles , Cocaína , Fenotipo , Pirrolidinas , Autoadministración , Cathinona Sintética , Animales , Benzodioxoles/administración & dosificación , Femenino , Masculino , Ratas , Pirrolidinas/administración & dosificación , Cocaína/administración & dosificación , Trastornos Relacionados con Sustancias/psicología , Ratas Sprague-Dawley , Caracteres Sexuales , Trastornos Relacionados con CocaínaRESUMEN
OBJECTIVE: There is growing interest in how peers' genotypes may influence health (i.e., peer social genetic effects). The authors sought to clarify the nature of peer social genetic effects on risk for drug use disorder, alcohol use disorder (AUD), major depression, and anxiety disorder. METHOD: Cox models were used with data from a population-based Swedish cohort (N=655,327). Outcomes were drug use disorder, AUD, major depression, and anxiety disorder registrations between ages 17 and 30 from medical, criminal, and pharmacy registries. The authors indexed peer social genetic effects with peers' family genetic risk scores (FGRSs) for the same disorders, which are personalized measures of genetic risk inferred from diagnoses in first- to fifth-degree relatives. RESULTS: Across disorders, peer FGRSs predicted increased risks of proband registration (hazard ratio range, 1.01-1.59), with stronger effects for drug use disorder and AUD than for major depression and anxiety disorder. Peer social genetic effects were stronger for school classmates than for geographically proximal peers, and for peers from upper secondary school (ages 16-19) versus peers from lower secondary school (ages 7-16). Peer social genetic effects remained significant following statistical control for sociodemographic confounders, whether peers were affected, and peers' FGRS for educational attainment. Peer social genetic effects were more pronounced for probands at higher genetic risk. CONCLUSIONS: The genetic makeup of adolescents' peers has long-reaching consequences on risks for drug use disorder, AUD, major depression, and anxiety disorder. Individuals at high genetic risk are more sensitive to social genetic effects. Alternative hypotheses such as sociodemographic stratification, exposure to affected peers, and genetic predispositions for educational attainment did not explain the risk associated with peer social genetic effects for substance use and psychiatric disorders.
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Trastornos de Ansiedad , Trastorno Depresivo Mayor , Grupo Paritario , Trastornos Relacionados con Sustancias , Humanos , Suecia/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/genética , Trastornos Relacionados con Sustancias/psicología , Trastorno Depresivo Mayor/genética , Trastorno Depresivo Mayor/epidemiología , Trastorno Depresivo Mayor/psicología , Masculino , Femenino , Adolescente , Trastornos de Ansiedad/genética , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/psicología , Adulto , Adulto Joven , Modelos de Riesgos Proporcionales , Sistema de Registros , Predisposición Genética a la Enfermedad/genética , Factores de RiesgoRESUMEN
Heinz et al. (2024) recently criticised habit/compulsion theory of human addiction but nevertheless concluded that 'habit formation plays a significant role in drug addiction'. To challenge this causal claim, the current article develops four further methodological criticisms, that publications supporting the habit/compulsion account of human addiction: (1) under-report contradictory observations; (2) exaggerate the process purity of positive observations; (3) under-emphasise the low quality of epidemiological support for a causal hypothesis; (4) recapitulate the social injustice of racial intelligence era by prematurely attributing lower task performance to drug user group membership (endophenotype) without having adequately tested social, psychological, economic and environmental inequalities. Methodological guidelines are recommended to address each concern, which should raise evidence standards, incorporate social justice and improve accuracy of estimating any specific effect of addiction history on task performance. Given that construing drug users as intellectually impaired could promote stigma and reduce their recovery potential, it is recommended that scientific discourse about habit/compulsive endophenotypes underpinning addiction is avoided until these higher evidence standards are met.
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Justicia Social , Humanos , Conducta Adictiva/psicología , Racismo , Trastornos Relacionados con Sustancias/psicología , Motivación , Conducta Compulsiva , Teoría Psicológica , HábitosRESUMEN
Introduction: Medical students experience high levels of stress due to their rigorous training, which can negatively affect their mental health. This study aimed to investigate substance use habits of medical students at Istanbul University-Cerrahpasa and the association on their mental health and demographic factors. Methods: This cross-sectional survey study was conducted in March-April 2022 among preclinical medical students (years 1-3 of a 6-year program). A confidential, anonymous online survey consisting of four sections on sociodemographic and educational characteristics, nicotine use and dependence [Fagerström Test for Nicotine Dependence (FTND)], alcohol use [Alcohol Use Disorders Identification Test (AUDIT)], mental health status [12-item General Health Questionnaire (GHQ-12)], was distributed to 1131 students via WhatsApp and Telegram text messages. Mann-Whitney U and Kruskal Wallis tests compared variables' distribution in the questionnaire categories. Spearman's correlation assessed associations between scales. Significance was p < 0.05. Results: The study included 190 medical students. A total of 26.3% of the participants were smokers, with 8.4% showing moderate to high levels of nicotine dependence. An estimated 45.8% and 8.4%reported low-risk consumption and risky usage of alcohol, respectively. There were statistically significant associations between substance use and demographic factors such as sex, GPA, and religious belief. The study found a statistically significant correlation between FTND scores and GHQ-12 scores, and, between FTND scores and AUDIT scores. Conclusion: The findings of this study will inform the development of interventions to improve the mental health and academic performance of medical students at Istanbul University-Cerrahpasa. Furthermore, it will raise awareness about the importance of addressing substance use among medical students in Turkey.
Introduction: Les étudiants en médecine sont assujettis à des niveaux élevés de stress en raison de leur formation rigoureuse, ce qui peut avoir un impact négatif sur leur santé mentale. Cette étude avait pour but d'étudier les habitudes de consommation de substances des étudiants en médecine de l'Université d'Istanbul-Cerrahpasa et l'association avec leur santé mentale et les facteurs démographiques. Méthodes: Cette étude transversale a été menée en mars-avril 2022 parmi les étudiants en médecine au pré-clinique (années 1 à 3 d'un programme de 6 ans). Un questionnaire en ligne confidentiel et anonyme comprenant quatre sections sur les caractéristiques sociodémographiques et éducatives, l'usage et la dépendance à la nicotine [Test de Fagerström pour la dépendance à la nicotine (FTND)], la consommation d'alcool [Test d'identification des troubles liés à la consommation d'alcool (AUDIT)], l'état de santé mentale [Questionnaire général sur la santé en 12 points (GHQ-12)], a été distribué à 1131 étudiants au moyen de messages texte WhatsApp et Telegram. Les tests de Mann-Whitney U et de Kruskal Wallis ont comparé la distribution des variables dans les catégories du questionnaire. La corrélation de Spearman a évalué les associations entre les échelles. Le niveau de signification statistique était p<0,05. Résultats: L'étude a porté sur 190 étudiants en médecine. Au total, 26,3 % des participants étaient des fumeurs, dont 8,4 % présentaient des niveaux modérés à élevés de dépendance à la nicotine. On estime que 45,8 % et 8,4 % des participants ont déclaré une consommation d'alcool à faible risque et une consommation d'alcool à risque, respectivement. Des associations statistiquement significatives ont été observées entre la consommation de substances et des facteurs démographiques tels que le sexe, la moyenne générale et les croyances religieuses. L'étude a mis en évidence une corrélation statistiquement significative entre les scores FTND et les scores GHQ-12, ainsi qu'entre les scores FTND et les scores AUDIT. Conclusion: Les résultats de cette étude permettront d'élaborer des interventions visant à améliorer la santé mentale et les résultats universitaires des étudiants en médecine de l'université d'Istanbul-Cerrahpasa. En outre, elle sensibilisera à l'importance de la prise en charge de l'utilisation de substances chez les étudiants en médecine en Turquie.
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Estudiantes de Medicina , Trastornos Relacionados con Sustancias , Humanos , Estudios Transversales , Turquía/epidemiología , Estudiantes de Medicina/estadística & datos numéricos , Estudiantes de Medicina/psicología , Masculino , Femenino , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Adulto Joven , Encuestas y Cuestionarios , Adulto , Tabaquismo/epidemiología , Tabaquismo/psicología , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/psicología , Salud Mental/estadística & datos numéricosRESUMEN
BACKGROUND: Stigma is a barrier to treatment and harm reduction seeking in people who use drugs. Most stigma reduction interventions offer psychotherapy or psychoeducation in group-based clinical settings, failing to reach people who are not in treatment. SMS text messaging is an effective and acceptable modality for delivering health information to people who use drugs and may be a suitable conduit for providing information and advice to understand and cope with stigma. OBJECTIVE: This paper presents the protocol for a study that aims to determine the feasibility, acceptability, and preliminary effectiveness of a 4-week automated SMS text message intervention to increase stigma resistance and reduce self-stigma in people who use drugs. METHODS: We designed a novel automated SMS text message intervention to address the four personal-level constructs of stigma resistance: (1) not believing stigma and catching and challenging stigmatizing thoughts, (2) empowering oneself through learning about substance use and one's recovery, (3) maintaining one's recovery and proving stigma wrong, and (4) developing a meaningful identity and purpose apart from one's substance use. Theory-based messages were developed and pilot-tested in qualitative elicitation interviews with 22 people who use drugs, resulting in a library of 56 messages. In a single-group, within-subjects, community-based pilot trial, we will enroll 30 participants in the Resisting Stigma and Revaluating Your Thoughts (RESTART) intervention. Participants will receive 2 daily SMS text messages for 4 weeks. Implementation feasibility will be assessed through recruitment, enrollment, retention, and message delivery statistics. User feasibility and acceptability will be assessed at follow-up using 23 survey items informed by the Theoretical Framework of Acceptability. Primary effectiveness outcomes are changes in self-stigma (Substance Abuse Self-Stigma Scale) and stigma resistance (Stigma Resistance Scale) from baseline to follow-up measured via a self-administered survey. Secondary outcomes are changes in hope (Adult Dispositional Hope Scale) and self-esteem (Rosenberg Self-Esteem Scale). Feasibility and acceptability will be assessed with descriptive statistics; effectiveness outcomes will be assessed with paired 2-tailed t tests, and group differences will be explored using ANOVA. Overall, 12 participants will also be selected to complete acceptability interviews. RESULTS: This pilot study was funded by the National Institute on Drug Abuse in April 2023 and received regulatory approval in January 2024 by the University of North Carolina-Chapel Hill Institutional Review Board. Recruitment and enrollment began in March 2024. Follow-up visits are expected to conclude by May 2024. Results will be disseminated in relevant peer-reviewed journals. CONCLUSIONS: To the best of our knowledge, this is the first study to address substance use stigma via a self-help SMS text messaging program. Results will add to the nascent literature on stigma reduction in people who use drugs. This protocol may interest researchers who are considering text messaging to address psychosocial needs in hard-to-reach populations. TRIAL REGISTRATION: ClinicalTrials.gov NCT06281548; https://clinicaltrials.gov/ct2/show/NCT06281548. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/59224.
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Estigma Social , Trastornos Relacionados con Sustancias , Envío de Mensajes de Texto , Adulto , Femenino , Humanos , Masculino , Estudios de Factibilidad , Proyectos Piloto , Autoimagen , Trastornos Relacionados con Sustancias/psicologíaRESUMEN
INTRODUCTION: Substance use disorder (SUD) poses a significant public health challenge globally, with substantial impacts on physical and social well-being. This study investigates the interplay between abstinence self-efficacy (ASE), locus of control (LOC), perceived social support (PSS), and various socio-demographic and psychosocial factors among individuals undergoing SUD rehabilitation. METHODS: Researchers obtained permission from drug rehabilitation centers in Assam, India, and conducted orientation programs for prospective participants. A total of 144 participants, aged 18-65 years, predominantly from rural areas participated in the study. Data was collected through one-to-one interviews, covering socio-demographic history, drug abuse, and administering scales for ASE, LOC and PSS. Collected data underwent digitization and subsequent descriptive and inferential statistical analyses. RESULTS: Significant associations were found between ASE and socio-demographic variables, family dynamics, and drug use history, highlighting the importance of considering these factors in SUD rehabilitation. Disturbed family relationships were linked to diminished ASE and higher risk of relapse, emphasizing the role of family support in recovery. Additionally, a negative correlation was observed between ASE and LOC, suggesting that individuals with higher ASE tend to have a more internal locus of control, which positively influences recovery outcomes. Moreover, positive correlations were found between ASE and PSS, particularly from family members, underscoring the importance of social support in fostering recovery. Regression analysis further elucidated the relationships between ASE, LOC, and PSS, emphasizing the predictive value of LOC and the impact of family support on ASE. CONCLUSION: Findings of this study have several implications for developing targeted interventions aimed at strengthening ASE, promoting internal locus of control, and enhancing social support systems.
Substance use disorder (SUD) is a major public health concern today, characterized by the compulsive and prolonged use of harmful psychoactive substances, leading to various physical and social dysfunctions. This study explores the relationships between abstinence self-efficacy (ASE), locus of control (LOC), perceived social support (PSS), and various socio-demographic factors in individuals undergoing SUD rehabilitation in Assam, India. The focus of the study is to find out various factors which can facilitate the process of drug rehabilitation. Data from 144 participants aged 1865 were collected through interviews and standardized scales. Results indicate that ASE is significantly associated with socio-demographic variables, family dynamics, and drug use history. Disturbed family relationships were linked to lower ASE and higher risk of relapse, while a higher ASE was correlated with an internal LOC and greater PSS, especially from family. The study highlights the clinical significance of considering background factors like marital status, employment status, family relationship dynamics, and abstinence period in treatment planning to provide personalized care.
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Control Interno-Externo , Autoeficacia , Apoyo Social , Trastornos Relacionados con Sustancias , Humanos , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/rehabilitación , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Masculino , Femenino , Persona de Mediana Edad , Adolescente , Anciano , India , Adulto JovenRESUMEN
OBJECTIVE: This systematic review aims to assess the feasibility, acceptability, and efficacy of exercise-based interventions in reducing craving levels among individuals with drug dependency. METHODS: This study included randomized controlled trials that investigated the effects of exercise on craving levels in individuals with drug dependence. We searched for relevant literature in PubMed, Web of Science, EMbase, The Cochrane Library, CNKI, China Biomedicine, Wanfang, and VIP databases from their inception until July 2024. Two researchers independently reviewed the literature. The quality of the studies was assessed using the PEDro scale, and the GRADE profiler software was utilized to evaluate the strength of the evidence. A qualitative synthesis was performed to describe the findings. RESULTS: We included 26 studies involving a total of 1381 participants, with 787 in the experimental group and 594 in the control group. These studies were mainly conducted in China, the United States, and the United Kingdom, and were published mostly after 2018. The participants had typically been dependent on drugs for more than 5 years. The review found that exercise interventions were feasible and well-accepted, and effectively reduced drug cravings. Among the 26 studies, 22 showed positive outcomes in reducing cravings. The type of exercise appears to be a crucial factor. Aerobic exercises were more effective than resistance exercises. Out of 18 studies that included aerobic exercises, 17 reported significant reductions in cravings. In contrast, among the 4 studies that included resistance exercises, 3 did not find a significant impact on cravings. CONCLUSION: Exercise is highly feasible and acceptable, significantly contributing to the reduction of drug cravings among individuals with drug dependency. The specific type of exercise appears to be a key determinant of the intervention's effectiveness. Aerobic exercises were more effective than resistance exercises. The evidence supporting these findings is of high quality, with an average score of 6.92 on the PEDro scale. OTHERS: The research was supported by the Shanghai Key Laboratory of Human Performance, with the project number 11DZ2261100. Registration details can be found on PROSPEO under the number CRD42024525700 at www.crd.york.ac.uk.
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Ansia , Terapia por Ejercicio , Trastornos Relacionados con Sustancias , Humanos , Terapia por Ejercicio/métodos , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto , Ejercicio Físico/psicologíaRESUMEN
Sleep difficulties and misuse of drugs/alcohol have been associated with suicidal ideation in young people. Using cross-sectional representative surveys of adolescents in the United States, we conducted adjusted logistic regression modeling to assess the relationships between sleep difficulties, substance use, and suicidal ideation among adolescents with a history of depression (n = 38,418) between 2015 and 2020. Sleep difficulties were associated with thinking about (aOR=1.6,95%CI:1.3-1.9), planning (aOR=1.8,95%CI:1.2-2.6), or attempting (aOR=1.7,95%CI:1.2-2.5) suicide. In those reporting alcohol abuse/dependence, sleep difficulties were associated with attempting suicide (aOR=3.1,95%CI:1.2-8.5). In those reporting illicit drug abuse/dependence, sleep difficulties were associated with thinking about (aOR=2.1,95%CI:1.1-4.1) and attempting (aOR=2.2,95%CI:1.2-4.1) suicide.
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Depresión , Trastornos Relacionados con Sustancias , Ideación Suicida , Humanos , Adolescente , Masculino , Femenino , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Estudios Transversales , Depresión/epidemiología , Estados Unidos/epidemiología , Intento de Suicidio/estadística & datos numéricos , Drogas Ilícitas , Alcoholismo/epidemiología , Trastornos del Sueño-Vigilia/epidemiologíaRESUMEN
The label "deaths of despair" for rising US mortality related to drugs/alcohol/suicide seems to implicate emotional distress as the cause. However, a Durkheimian approach would argue that underlying structural factors shape individuals' behavior and emotions. Despite a growing literature on deaths of despair, no study has directly compared the effects of distress and structural factors on deaths of despair versus other causes of mortality. Using data from the Midlife in the United States study with approximately 26 years of mortality follow-up, we evaluated whether psychological or economic distress, employment status, and social integration were more strongly associated with drug/alcohol/suicide mortality than with other causes. Cox hazard models, adjusted for potential confounders, showed little evidence that psychological or economic distress were more strongly associated with mortality related to drugs/alcohol/suicide than mortality from other causes. While distress measures were modestly, but significantly associated with these deaths, the associations were similar in magnitude for many other types of mortality. In contrast, detachment from the labor force and lower social integration were both strongly associated with drug/alcohol/suicide mortality, more than for many other types of mortality. Differences in the estimated percentage dying of despair between age 25 and 65 were larger for employment status (2.0% for individuals who were neither employed nor retired versus only 0.6% for currently employed) and for social integration (1.9% for low versus 0.7% for high integration) than for negative affect (1.2% for high versus 0.8% for no negative affect). Most of the association between distress and drug/alcohol/suicide mortality appeared to result from confounding with structural factors and with pre-existing health conditions that may influence both the perception of distress and mortality risk. While deaths of despair result from self-destructive behavior, our results suggest that structural factors may be more important determinants than subjective distress.
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Empleo , Integración Social , Humanos , Masculino , Femenino , Persona de Mediana Edad , Estados Unidos/epidemiología , Adulto , Empleo/psicología , Empleo/estadística & datos numéricos , Anciano , Suicidio/estadística & datos numéricos , Suicidio/psicología , Distrés Psicológico , Estrés Financiero/psicología , Estrés Psicológico/psicología , Modelos de Riesgos Proporcionales , Trastornos Relacionados con Sustancias/mortalidad , Trastornos Relacionados con Sustancias/psicología , Causas de Muerte/tendenciasRESUMEN
According to biopsychosocial models, experiencing parental child abuse increases susceptibility to adulthood psychopathology. However, there is a paucity of studies examining potential mechanisms of the parental child abuse and adulthood psychopathology relationship. The purpose of the current study was to determine if Time 2 (T2) trait self-esteem mediated levels of Time 1 (T1) retrospectively recalled parental child abuse predicting (T3) past-year major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder (PD), alcohol use disorder (AUD), and substance use disorder (SUD) symptoms. The 18-year Midlife Development in the United States (MIDUS) study included participants (N = 3294; T1 average age of 45.62 years) assessed at three different time points, each spaced about nine years apart. We performed structural equation mediation modeling analyses to determine how maternal and paternal child abuse at T1 would independently predict T3 MDD, GAD, PD, AUD, and SUD symptoms. We also examined whether T2 self-esteem mediated these relations while controlling for adulthood T1 psychopathology symptoms, demographics, socioeconomic status, somatic symptoms, and parental psychopathology. Consistent with our hypotheses, higher T1 maternal and paternal abuse predicted increased T3 GAD, PD, AUD, and SUD symptoms via diminished T2 self-esteem as the mediator (% proportion mediated = 33.0-100). However, childhood paternal, but not maternal, abuse predicted adulthood MDD symptoms via reduced self-esteem. Findings remained after adjusting for covariates. Our research highlights the importance of understanding retrospectively recalled parental child abuse-adulthood psychopathology relations, their potential mechanisms, and self-esteem as a malleable treatment target for adults with heightened child abuse.
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Trastornos de Ansiedad , Trastorno Depresivo Mayor , Autoimagen , Trastornos Relacionados con Sustancias , Humanos , Femenino , Masculino , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/epidemiología , Persona de Mediana Edad , Adulto , Trastornos de Ansiedad/psicología , Trastornos de Ansiedad/epidemiología , Trastorno Depresivo Mayor/psicología , Trastorno Depresivo Mayor/epidemiología , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Adultos Sobrevivientes del Maltrato a los Niños/estadística & datos numéricos , Trastorno de Pánico/psicología , Trastorno de Pánico/epidemiología , Maltrato a los Niños/psicología , Maltrato a los Niños/estadística & datos numéricos , Estados Unidos/epidemiología , Niño , Ansiedad/psicología , Ansiedad/epidemiología , Depresión/psicología , Depresión/epidemiología , Alcoholismo/psicología , Alcoholismo/epidemiologíaRESUMEN
INTRODUCTION: Substance use disorder (SUD) and problematic substance use are global public health concerns with significant multifaceted implications for physical health and psychosocial well-being. The impact of SUD extends beyond the individual to their family while imposing financial and social burdens on the community. Though family-centred interventions have shown promise in addressing SUD, their implementation and impact in low-income and middle-income countries (LMICs) remain underexplored. METHODS AND ANALYSIS: Per Joanna Briggs Institute's scoping review protocol, a systematic search strategy was employed across OVID Medline, Embase, PsycINFO, Web of Science-Core Collection, Global Health and CINAHL from 22 February 2024 to 26 February 2024, to identify relevant studies focused on family-centred interventions for SUD in LMIC, devoid of publication time and language constraints. Two independent reviewers will screen the titles, abstracts and full texts, with discrepancies resolved through discussion or third-party reviews. The extracted data charted in a structured form will be visualised by diagrams or tables, focusing on the feasibility and impact of family-centred interventions for SUD in LMIC. For qualitative studies, the findings will be synthesised and presented in thematic clusters, and for studies that report quantitative outcomes, specific health, including SUD and psychosocial, outcomes will be synthesised, aligning with the Population, Concept and Context framework. ETHICS AND DISSEMINATION: These data on substance use, psychosocial outcomes and perspectives of individuals with SUD and their families will be presented in narrative format, highlighting patterns and identifying research gaps. This review aims to synthesise the existing evidence on family-centred interventions for improving substance use and/or psychosocial outcomes in individuals with SUD in LMIC and seeks to inform future policy and practice. Ethics approval is not required for this scoping review, and modifications to the review protocol will be disclosed. Findings will be disseminated through conference proceedings and peer-reviewed publication.