Changes in opiate and stimulant use through 10 years: The role of contextual factors, mental health disorders and psychosocial factors in a prospective SUD treatment cohort study.

AIM: To examine temporal changes in opiate and stimulant use among patients in substance abuse treatment over a ten-year observation period and to explore the role of contextual factors, mental health disorders and psychosocial factors on these changes. METHODS: A cohort of 481 patients was prospectively interviewed at admission to treatment and after 1, 2, 7 and 10 years. The sample was recruited from 20 facilities in the Greater Oslo region, Norway. RESULTS: The majority of patients were poly-drug users and 80% had used both opiates and stimulants the last 30 days prior to treatment admission. Last-month use of heroin, other opiates, cocaine and amphetamines declined from 80% to 34% at the end of the observation period. The most substantial reduction was observed between baseline and one-year follow-up. Use of heroin decreased the most from 62% to 16% after 10 years (a reduction of 74%), and the reduction continued from one-year follow-up throughout the observation period. The most important multivariate risk factors for sustained use of these drugs were male gender, having one or both biological parents with severe alcohol or drug problems, having an antisocial personality disorder, and living together with a person who abuses alcohol or drugs. Employment was associated with reduced risk of drug use at 7-year follow-up. CONCLUSIONS: There was a substantial reduction in opiate and stimulant use from baseline to all follow-up assessments, most greatly for heroin. Findings regarding sustained use could suggest familial transmission and the challenges of preventive strategies and treatment efforts in an intergenerational context. Co-occurrence between drug abuse and mental health problems highlights the need of highly specialized competence in SUD treatment.

Minimization of Childhood Maltreatment Is Common and Consequential: Results from a Large, Multinational Sample Using the Childhood Trauma Questionnaire.

Childhood maltreatment has diverse, lifelong impact on morbidity and mortality. The Childhood Trauma Questionnaire (CTQ) is one of the most commonly used scales to assess and quantify these experiences and their impact. Curiously, despite very widespread use of the CTQ, scores on its Minimization-Denial (MD) subscale-originally designed to assess a positive response bias-are rarely reported. Hence, little is known about this measure. If response biases are either common or consequential, current practices of ignoring the MD scale deserve revision. Therewith, we designed a study to investigate 3 aspects of minimization, as defined by the CTQ's MD scale: 1) its prevalence; 2) its latent structure; and finally 3) whether minimization moderates the CTQ's discriminative validity in terms of distinguishing between psychiatric patients and community volunteers. Archival, item-level CTQ data from 24 multinational samples were combined for a total of 19,652 participants. Analyses indicated: 1) minimization is common; 2) minimization functions as a continuous construct; and 3) high MD scores attenuate the ability of the CTQ to distinguish between psychiatric patients and community volunteers. Overall, results suggest that a minimizing response bias-as detected by the MD subscale-has a small but significant moderating effect on the CTQ's discriminative validity. Results also may suggest that some prior analyses of maltreatment rates or the effects of early maltreatment that have used the CTQ may have underestimated its incidence and impact. We caution researchers and clinicians about the widespread practice of using the CTQ without the MD or collecting MD data but failing to assess and control for its effects on outcomes or dependent variables.

Co-occurrence between mental distress and poly-drug use: a ten year prospective study of patients from substance abuse treatment.

INTRODUCTION: Longitudinal research investigating psychiatric trajectories among patients with poly-drug use patterns remains relatively scant, even though this specific population is at elevated risk for multiple negative outcomes. The present study examined temporal associations between poly-drug use (i.e. heroin, cannabis, tranquilizers, and amphetamines) and mental distress over a 10-year period. METHODS: A clinical cohort of 481 patients was recruited from substance use treatment facilities in Norway, and prospectively interviewed 1, 2, 7 and 10years after the initial data collection at treatment admission. At each assessment participants completed a questionnaire addressing their substance use and mental distress. Longitudinal growth models were used to examine whether, and if so, how, levels of drug use were associated with the level and rate of change in mental distress over time. RESULTS: Results from the longitudinal growth models showed a co-occurrence between active poly-drug use and mental distress, such that there was a dose-response effect where mental distress increased both in magnitude and over time with the number of drugs used. Reduction in mental distress during the 10-year study period was evident only in the no-drug use condition. Use of multiple drugs and mental distress appear strongly co-related over time. CONCLUSIONS: Pre-treatment assessment should carefully identify individuals manifesting poly-drug use and mental disorders. Treatment and follow-up services should be tailored to their specific needs.

Completion of long-term inpatient treatment of drug abusers: a prospective study from 13 different units.

UNLABELLED: Completion of treatment is an important predictor of favourable outcome. We need more knowledge about predictors of completion in the inpatient psychosocial treatment modality. This prospective study from 13 such programmes follows a consecutive sample of clients (n = 307) from admission to completion/dropout. INSTRUMENTS: EuropASI, MCMI II, SCL-25. The mean completion rate was 40% (20-71%), with no difference between clients with no ('debutants') or previous ('veterans') inpatient stays. Among 'debutants', the number of years of heroin use was negatively related to completion. Among 'veterans', age and amphetamine use were positively related, while the presence of a personality disorder and number of previous inpatient treatments were negatively related to completion. Specific strategies for involving clients with personality disorders are needed. After three inpatient stays, other types of treatment should be offered.

[Opiate users in methadone-assisted rehabilitation one year and two years after admission]. / Opiatmisbrukere i metadonassistert rehabilitering ett og to år etter inntak.

BACKGROUND: Norway has recently established a nationwide system for methadone-assisted rehabilitation of opiate users, but few studies have been undertaken to investigate outcome. MATERIAL AND METHODS: 75 opiate users in Oslo were interviewed at start of treatment and at follow-ups one and two years later in 1999-2002. The main instruments at all three points were EuropASI and SCL-25. MCMI-II was additionally used at the start. RESULTS: Five patients (7%) died during the two-year observation period; 24 patients (34%) dropped out of treatment. A significant and stable reduction in the use of opiates, as well as for criminality and prostitution, was found. No changes in the use of other substances, economic status and employment status were found. Depressive symptoms increased significantly during the last year. INTERPRETATION: The data indicate that the speed at which new patients started treatment came at the sacrifice of psychosocial rehabilitation.