American Journal on Addictions

We explored links between childhood sexual abuse (CSA), childhood physical abuse (CPA), posttraumatic stress disorder (PTSD)/depression, and women injection drug users' (IDUs') risk in 113 women recruited from two syringe exchange sites. More than half (56%) reported CSA, 68% CPA, 23% likely were depressed‐only, and 53% likely had PTSD/depression. CSA was associated with sexual (p = 0.003) and drug risk (p = 0.05); CPA was not. CSA was associated with PTSD/depression (p = 0.03); PTSD/depression was associated with sexual (p < 0.01) and drug (p < 0.03) risk. After PTSD/depression adjustment, CSA was no longer associated with sexual or drug risk. These results suggest that women IDUs' CSA‐to‐risk path is mediated by PTSD/depression.

Tobacco use disproportionately affects lower socioeconomic status (SES) groups. Current explanations as to why lower SES groups respond less robustly to tobacco control efforts and tobacco dependence treatment do not fully account for this disparity. The identification of factors that predict relapse in this population might help to clarify these differences. Good candidates for novel prognostic factors include the constellation of behaviors associated with executive function including self‐control/impulsiveness, the propensity to delay reward, and consideration and planning of future events. This study examined the ability of several measures of executive function and other key clinical, psychological, and cognitive factors to predict abstinence for highly dependent lower SES participants enrolled in intensive cognitive‐behavioral treatment for tobacco dependence. Consistent with predictions, increased discounting and impulsiveness, an external locus of control as well as greater levels of nicotine dependence, stress, and smoking for negative affect reduction predicted relapse. These findings suggest that these novel factors are clinically relevant in predicting treatment outcomes and suggest new targets for therapeutic assessment and treatment approaches.(Am J Addict 2012;21:221–232)

The authors determined psychiatric diagnoses in 207 cocaine abusers seeking outpatient treatment, using the Diagnostic Interview Schedule (DIS) developed by the National Institute of Mental Health. A major proportion of subjects (62%) met diagnostic criteria for a current psychiatric disorder, and nearly three‐quarters (73%) met lifetime criteria for at least one psychiatric disorder other than substance abuse. Antisocial personality disorders, affective disorders, and anxiety disorders accounted for most of the psychiatric illnesses. Women were found to have significantly higher rates of current and lifetime psychopathology than men. The temporal relationship between substance abuse and the onset of affective and anxiety disorders was examined, with the particular finding that onset of anxiety disorders substantially predated regular cocaine use.

Cravings for alcohol are identified as a trigger for relapse, though laboratory studies of cravings produce mixed results in predicting relapse. The objective of this analysis is to assess the usefulness of craving as a predictor of relapse by assessing 218 adult, alcohol‐dependent patients admitted to two separate residential addiction treatment programs. Days craving reported in the week prior to discharge predicted alcohol use at three‐month follow‐up. Admission spirituality, alcohol‐refusal self‐efficacy, and depression levels differentiated cravers from non‐cravers. Patients who crave alcohol in residential treatment may be at higher relapse risk and identified by intake assessments of self‐efficacy, depression, and spirituality.

This 6‐month follow‐up study of 43 of 72 patients who entered a 6‐week randomized clinical trial of pharmacotherapy for cocaine dependence found that self‐reported cocaine abstinence during the 6 months was significantly greater in patients treated with desipramine (44%) than in those treated with lithium (19%) or placebo (27%). The placebo group had more occurrences of depression (36% vs. 6%) and daily alcohol abuse (36% vs. 15%) than the medicated groups. The ability to abstain from cocaine use during the clinical trial was the strongest predictor of continued abstinence during the follow‐up, which showed that 53% remained abstinent after 6 months.

In this prospective longitudinal study, the authors investigated the association between marijuana use over a period of 13 years and subsequent health problems at age 27. A community sample of 749 participants from upstate New York was interviewed at mean ages of 14, 16, 22, and 27 years. Marijuana use over time was significantly associated with increased health problems by the late twenties, including respiratory problems, general malaise, neurocognitive problems, and lower academic achievement and functioning. Effective prevention and intervention programs should consider the wide range of adverse physiological and psychosocial outcomes associated with marijuana use over time.