Substance Abuse

Risk and resilience for substance abuse among adolescents and adults with LD.

Cosden M. J Learn Disabil. 2001 Jul-Aug;34(4):352-8. Gevirtz Graduate School of Education, University of California , Santa Barbara 93106 , USA .

Substance abuse is a major problem affecting the health and well-being of many people in our society. Although anecdotal evidence concerning linkages between learning disabilities (LD) and substance abuse has been common, this association is not well documented or understood. This article reviews the current research on substance abuse for adolescents and adults with LD, interpreting findings within a risk and resilience framework. Integrating these studies with the broader literatures on substance abuse and the needs of individuals with LD, the author develops hypotheses regarding specific risk and protective factors that could affect the occurrence of substance abuse for adolescents and adults with LD. Potential risk factors include a poor understanding of one’s disability, a lack of skills for developing peer relationships, and the need for prolonged family support. Future directions for research in relation to prevention of and intervention regarding substance abuse among individuals with LD are discussed.

 

Risk factors for adolescent substance abuse.

Weinberg NZ. J Learn Disabil. 2001 Jul-Aug;34(4):343-51. Division of Epidemiology, Services, and Prevention Research, National Institute of Drug Abuse, National Institutes of Health, Bethesda, MD 20892-9589, USA.

Reviews research on risk factors for adolescent substance use disorders (SUD) and discusses possible relationships between SUDs and learning disabilities (LD). Individual level factors (genetic, biologic, other familial, and psychiatric) emerge as very important in the risk equation, as well as the interaction between individual risk and environmental conditions. Commonalities between SUD risk and LD include prenatal substance exposure, family history of SUD, conduct disorder, social skills deficits, and academic failure; however, further research is needed to establish whether individuals with LD face a specific risk for SUDs, and if so, what the nature of that risk might be.

 

Smoking prevalence and knowledge of associated risks in adult attenders at day centres for people with learning disabilities.

Taylor NS, Standen PJ, Cutajar P, Fox D, Wilson DN. J Intellect Disabil Res. 2004 Mar;48(Pt 3):239-44. Highbury Hospital , Nottingham , UK .

Background: Increased longevity among people with learning disabilities is accompanied by an increase in morbidity. A possible explanation is that living in the community and a move to greater independence may bring higher health risks through obesity and smoking. The study aimed to see if rates of smoking have increased from earlier published rates and to ascertain the awareness of the risks of smoking among people with learning disabilities.

Methods: A total of 435 people attending four social services day centres in a large urban area were assisted to complete a questionnaire.

Results: Twenty-seven (6.2%) reported that they currently smoked. Those with mild disabilities were much more likely to smoke than those with more severe disabilities and they also reported smoking more heavily. For those with mild levels of learning disability, a higher than expected proportion living in hospital and staffed housing smoked, a lower proportion living with parents smoked but for those living independently the proportion who smoked was no higher than expected. Smokers were more knowledgeable about the risks than non-smokers even if the level of learning disability was controlled for. Only a third of smokers were concerned about the risks.

Conclusion: The study provides no evidence that rates of smoking are increasing among people with learning disabilities nor that those living independently were more likely to smoke. Knowledge of health risks is poor across the group, but higher among the smokers who were unlikely to express concern about the risks. This may indicate that more support may be needed along with health education in this group.

 

Substance use, substance abuse, and LD among adolescents with a childhood history of ADHD.

Molina BS, Pelham WE. J Learn Disabil. 2001 Jul-Aug;34(4):333-42, 351. University of Pittsburgh , School of Medicine , USA .

A clinic-referred sample of 109 children with attention-deficit/hyperactivity disorder (ADHD) was followed into adolescence for the ascertainment of alcohol and other drug use and abuse. Learning disability (reading or math) in childhood was examined as a predictor of adolescent substance use and substance use disorder for alcohol and marijuana. No statistically significant group differences for children with LD versus those without LD emerged even after using different methods to compute LD. IQ/achievement discrepancy scores were similarly not predictive of later use or abuse. However, children with ADHD who had higher IQs and higher levels of academic achievement in childhood were more likely to try cigarettes, to smoke daily, and to have their first drink of alcohol or first cigarette at an early age. Children with ADHD who had higher reading achievement scores were less likely to have later alcohol use disorder. Although these findings are necessarily preliminary, due to the small number of children interviewed, the pattern of results suggests that level of cognitive functioning—rather than discrepancy between IQ and achievement—is important for the prediction of later substance use and abuse, at least in this clinic-referred sample of children with ADHD. Further, different mechanisms of risk related to cognitive functioning may be operating for experimentation with legal drugs such as alcohol and tobacco, regular cigarette smoking, and problematic alcohol use.

 

The epidemiology of attention-deficit/hyperactivity disorder (ADHD): a public health view.

Rowland AS , Lesesne CA , Abramowitz AJ. Ment Retard Dev Disabil Res Rev. 2002;8(3):162-70. MPH Program, Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA. arowland@salud.unm.edu

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder of childhood. However, basic information about how the prevalence of ADHD varies by race/ethnicity, sex, age, and socio-economic status remains poorly described. One reason is that difficulties in the diagnosis of ADHD have translated into difficulties developing an adequate case definition for epidemiologic studies. Diagnosis depends heavily on parent and teacher reports; no laboratory tests reliably predict ADHD. Prevalence estimates of ADHD are sensitive to who is asked what, and how information is combined. Consequently, recent systematic reviews report ADHD prevalence estimates as wide as 2%-18%. The diagnosis of ADHD is complicated by the frequent occurrence of comorbid conditions such as learning disability, conduct disorder, and anxiety disorder. Symptoms of these conditions may also mimic ADHD. Nevertheless, we suggest that developing an adequate epidemiologic case definition based on current diagnostic criteria is possible and is a prerequisite for further developing the epidemiology of ADHD. The etiology of ADHD is not known but recent studies suggest both a strong genetic link as well as environmental factors such as history of preterm delivery and perhaps, maternal smoking during pregnancy. Children and teenagers with ADHD use health and mental health services more often than their peers and engage in more health threatening behaviors such as smoking, and alcohol and substance abuse. Better methods are needed for monitoring the prevalence and understanding the public health implications of ADHD. Stimulant medication is the treatment of choice for treating ADHD but psychosocial interventions may also be warranted if comordid disorders are present. The treatment of ADHD is controversial because of the high prevalence of medication treatment. Epidemiologic studies could clarify whether the patterns of ADHD diagnosis and treatment in community settings is appropriate. Population-based epidemiologic studies may shed important new light on how we understand ADHD, its natural history, its treatment and its consequences.

 

Medicaid managed care, substance abuse treatment, and people with disabilities: review of the literature.

Bachman SS, Drainoni ML, Tobias C. Health Soc Work. 2004 Aug;29(3):189-96.
School of Social Work , Boston University , MA 02215 , USA . sbachman@bu.edu

Most states enroll individuals with disabilities who receive Supplemental Security Income (SSI) in Medicaid managed care plans. The impact of managed care on these individuals, especially those with substance abuse disorders, is not well understood. A review of the literature related to substance abuse, disability, and Medicaid managed care suggests that substance abuse is a serious issue for individuals with disabilities. More research is needed to determine how the substance abuse treatment needs of individuals with disabilities can be met through Medicaid managed care. The authors identified topics for a research agenda on the needs of individuals with disabilities who also experience co-occurring substance abuse disorders. Implications for social work policy and practice are discussed.

 

State policy and practice regarding substance abuse treatment services for medicaid recipients with disabilities.

Bachman SS, Drainoni ML, Tobias C. Am J Addict. 2003 Mar-Apr;12(2):166-76.
Boston University School of Social Work, Boston , Massachusetts 02215 , USA . sbachman@bu.edu

This article presents the results of an exploratory study conducted to identify best practice Medicaid managed care models for people with disabilities who need substance abuse treatment services. These results suggest that there is wide variation in the managed care strategies that states use to provide substance abuse treatment services to the SSI disabled population, that state policymakers are often focused on general program management issues rather than addressing specific issues related to providing substance abuse treatment services to people with disabilities, and that although managed care theoretically offers opportunities for creativity, this practice does not appear to be widespread under current Medicaid managed care arrangements for people with disabilities.

 

Disabilities, quality of life, and mental disorders associated with smoking and nicotine dependence.

Schmitz N, Kruse J, Kugler J. A m J Psychiatry. 2003 Sep;160(9):1670-6. Clinic for Psychosomatic Medicine and Psychotherapy, Heinrich-Heine-University, Bergisch Landstrasse 2, H19, D-40605 Duesseldorf , Germany . schmitzn@uni-duesseldorf.de

Objective: Epidemiological studies have reported an association between smoking and mental disorders. However, little is known about the impairment associated with nicotine dependence.

Methods: The authors assessed health-related quality of life, disability, and psychiatric comorbidity in adults with and without nicotine dependence. The analysis was based on data from 3,293 respondents, ages 18 to 65, from the German National Health Interview and Examination Survey, a nationally representative multistage probability survey conducted from 1997 to 1999. The authors assessed rates of smoking and health-related quality of life (Medical Outcomes Study 36-item Short-Form Health Survey) by questionnaires. Nicotine dependence and other mental disorders were assessed with a modified version of the Composite International Diagnostic Interview.

Results: The population prevalence of current smoking was 36.2% and the 1-year prevalence of nicotine dependence was 9.4%. Nicotine-dependent smokers reported a poorer quality of life than the subjects without nicotine dependence. These relationships were stable after adjustment for sociodemographic characteristics. More than half of the subjects with nicotine dependence fulfilled criteria for at least one other mental disorder. Subjects suffering from nicotine dependence reported greater disability in the last month and in the last year.

Conclusion: Smokers with nicotine dependence should be distinguished from other smokers in evaluations of the health status of populations.

 

Health problems of women with severe mental illness.

Perese EF, Perese K. J Am Acad Nurse Pract. 2003 May;15(5):212-9. University at Buffalo, State University of New York , USA . perese@buffalo.edu

Purpose: To provide a review of the health problems of women with severe mental illness (SMI) that are related to their psychiatric disorders and disabilities, prolonged use of psychotropic medications, and high-risk lifestyle practices.

Data Sources: Review of current literature uncovered through MEDLINE, Cumulated Index to Nursing and Allied Health, and Psychological Abstracts as well as the authors’ clinical experiences.

Conclusion: Women with SMI are at increased risk for obesity as well as cardiovascular, endocrine, and infectious disorders. They also experience psychotropic medication-related disorders such as amenorrhea, galactorrhea, sexual dysfunction, breast cancer, and osteoporosis. High-risk lifestyle practices, excessive weight gain, low physical activity, substance abuse and unprotected sexual activity increase risk for health problems. The mental illness, residual disabilities, sequelae of childhood abuse, poverty, limited social support and health knowledge deficits affect their ability to maintain optimum health.

Implications for Practice: Knowledge about women with SMI and their health problems will enable nurse practitioners to better meet the needs of this vulnerable population.

 

Impact of substance abuse on the course and treatment of bipolar disorder.

Salloum IM, Thase ME. Bipolar Disord. 2000 Sep;2(3 Pt 2):269-80. Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine , PA 15213 , USA . salloumim@msx.upmc.edu

Objective: The objectives of this article are to review the prevalence, natural history, pathophysiology, and treatment of comorbid bipolar disorder with alcoholism and other psychoactive substance use disorders (PSUDs).

Methods: All identified bibliographies through a literature search of all Medline files and bibliographies of selected articles focusing on the prevalence, natural history, course, prognosis, inter-relationship, and treatment of bipolar disorder with comorbid alcoholism and other PSUDs were reviewed.

Results and Conclusion: Comorbidity of bipolar disorder and alcoholism and other PSUDs is highly prevalent. The presence of this so called ‘dual diagnoses’ creates a serious challenge in terms of establishing an accurate diagnosis and providing appropriate treatment interventions. The inter-relationship between these disorders appears to be mutually detrimental. The course, manifestation, and treatment of each condition are significantly compounded by the presence of the other condition. Substance abuse and alcoholism appear to significantly complicate the course and prognosis of bipolar disorder resulting in increased suffering, disability, and costs. On the other hand, bipolar disorder may be a risk factor for developing PSUDs. Although, there are a number of hypotheses explaining the pathophysiological mechanism involved in such comorbidities, our understanding of the exact nature of such neurobiological mechanisms is still limited. While the antikindling agents and targeted psychotherapeutic techniques may be useful intervention strategies, there is still a significant lack of empirically based treatment options for these patients.

 

Performance assessment in community mental health care and at-risk populations.

Holmes AM, Deb P. Health Care Financ Rev. 2004 Fall;26(1):75-84. Indiana University-Purdue University , Indianapolis , USA .

We examine whether community mental health care centers (CMHCs) differ in their ability to serve at-risk populations, including clients with dual diagnoses for substance abuse, comorbid disabilities, and particularly severe functional impairment. Our analysis uses data from Indiana ’s public mental health system. Although at-risk clients experience, on average, worse outcomes than other clients, we find that some CMHCs achieve statistically significantly better outcomes than others. Although this information is useful to consumers and providers who wish to identify the most effective providers and treatment models for at-risk clients, it is not generated in standard performance assessments.

 

Posttraumatic stress disorder in primary care: a hidden diagnosis.

Lecrubier Y. J Clin Psychiatry. 2004;65 Suppl 1:49-54. Hopital la Salpetriere, INSERM, Paris , France . lecru@ext.jussieu.fr

Posttraumatic stress disorder (PTSD) is common worldwide, with prevalence rates ranging from 1% to nearly 40%, depending on the population studied. The disability and natural course of PTSD in psychiatric patients have been well characterized. However, even though the primary care setting has been described as the “de facto mental health care system,” surprisingly little is known about PTSD in primary care. Available data from primary care clinics in the United States and Israel suggest that PTSD may be as prevalent in this setting as has been reported in large epidemiologic studies. Patients may be unlikely to endorse traumatic experiences or may not consider them related to their current psychological problems. The prevalence of PTSD in primary care may indeed be higher than expected because of underreporting of domestic violence and other histories of trauma. Recognition of PTSD in primary care could be greatly improved if simple trauma histories were integrated into routine medical examinations. Primary care clinicians who maintain a high index of suspicion for PTSD in their patients with positive histories of trauma plus symptoms of depression or anxiety or other signs of psychological distress, suicidal thoughts or actions, alcohol or substance abuse, or excessive health care service utilization may increase the recognition rate of this disorder in their practices.

 

Smoking and quitting: a qualitative study with community-living psychiatric clients.

Lawn SJ, Pols RG, Barber JG. Soc Sci Med. 2002 Jan;54(1):93-104. Southern Mental Health, Community Care Team, Marion , SA, Australia sharon.at.home@bigpond.com

This paper reports the findings of a study investigating the smoking behaviours of a community-based psychiatric population. Using a qualitative, grounded theory approach, the four diagnostic categories of schizophrenia, bi-polar affective disorder, depression, and personality disorder were studied (24 interviews in total) in order to identify similarities and differences in smoking behaviours and perceptions of links between illness and cigarette smoking. A number of theoretical constructs emerged from the data, many of which confirm and enhance current understandings of issues, such as the role of cigarettes in managing the symptoms of illness. However, several themes not found in the existing literature also emerged. Smoking was found to play a significant existential role in the lives of participants: alleviating the effects of stigma, promoting positive and negative freedoms, and providing core needs as part of quality of life decisions. Perceptions of the nature and degree of interaction between psychiatric symptoms and the ‘need’ to smoke were also found to be significant. Variations in smoking between the different diagnostic groups were also found, in particular in the process of smoking itself the nature of the nicotine dependence as predominantly physical or psychological, attitudes towards the quitting process and sense of control, and the degree of significance of existential factors. The research findings suggest that we may be able to add new methods to our current ways of intervening to assist people with a mental illness who want to quit smoking. Differences in perceptions and patterns of use suggest that intervention may be more effective if psychiatric diagnosis is also taken into consideration. Because the paper is descriptive and hypothesis generating, its findings need to be tested using a larger sample.

 

The long-term treatment outcomes of depression and anxiety comorbid with substance abuse.

Bovasso G. J Behav Health Serv Res. 2001 Feb;28(1):42-57. Treatment Research Center , Philadelphia , USA . gbovasso@mail.med.upenn.edu

The impact of the comorbidity of psychiatric disorder and substance abuse on treatment outcomes was estimated using data from a longitudinal survey of 1,920 individuals who were followed nearly 15 years. Individuals with anxiety or depression symptoms at baseline generally experienced increased distress at follow-up; those who received mental health treatment experienced decreased distress at follow-up. Individuals with substance abuse/dependence symptoms who received treatment at baseline had a higher risk of follow-up disability; treated individuals with substance abuse who had comorbid anxiety and depression symptoms at baseline were at lower risk of disability at follow-up. Individuals with anxiety and depression symptoms at baseline had a higher incidence of chronic illness during follow-up; those who received treatment or had substance abuse symptoms did not. The results may improve understanding of the degree to which treatment of a primary disorder may prevent the incidence or reduce the prevalence of a secondary comorbid disorder.

 

Three-year outcomes of long-term patients with co-occurring bipolar and substance use disorders.

Drake RE, Xie H, McHugo GJ, Shumway M. Biol Psychiatry. 2004 Nov 15;56(10):749-56. Department of Psychiatry and Community, Dartmouth Medical School , Lebanon , New Hampshire 03766 , USA . Robert.E.Drake@Dartmouth.edu

Little is known about the long-term outcomes of patients in the public mental health system who are disabled by co-occurring bipolar and substance use disorders. This article reports on the 3-year course of 51 patients with co-occurring bipolar and substance use disorders in the New Hampshire Dual Diagnosis Study. Participants received integrated dual disorders treatments in the state mental health system and were independently assessed with standardized measures at baseline and every 6 months for 3 years. Though psychiatric symptoms improved only modestly, participants improved steadily in terms of remission from substance abuse (61% in full remission at 3 years); they also achieved greater independent living (average 239 days in third year), competitive employment (49% in third year), regular social contacts with nonsubstance abusers (46% at 3 years), and quality of life (56% satisfied with life at 3 years). Different domains of outcome were only weakly related to each other. Long-term, disabled patients with co-occurring bipolar and substance use disorders have potential for remission from substance abuse and substantial improvements in functioning and quality of life.

 

Use of substance abuse treatment services by persons with mental health and substance use problems.

Wu LT, Ringwalt CL, Williams CE. Psychiatr Serv. 2003 Mar;54(3):363-9. Center for Risk Behavior and Mental Health Research, Research Triangle Institute, Research Triangle Park , North Carolina 27709 , USA . liwu@rti.org

Objective: This study provided population estimates of mental syndromes and substance use problems and examined whether the co-occurrence of mental health and substance use problems was associated with the use of substance abuse treatment services.

Methods: Study data were drawn from the 1997 National Household Survey on Drug Abuse.

Results: Of the total sample of 16,661 adults, 2 percent reported using services for alcohol or drug use problems in the previous year. Among the 3,474 (17 percent) who reported at least one alcohol or drug use problem, 6 percent used substance abuse services. Only 4 percent of persons who reported substance use problems alone received any substance abuse treatment service in the previous year. Only 3 percent of persons who reported alcohol use problems alone received such services. Among persons with one or more substance use problems, the prevalence of service use was 11 percent among persons who reported one co-occurring mental syndrome and 18 percent among those who reported two or more mental syndromes. Multiple logistic regression analyses identified a number of subgroups who might have needed substance abuse services but did not receive them, including women, Asians and Pacific Islanders, college graduates, persons employed full-time, persons who abused alcohol only, and persons with substance use problems who reported no coexisting mental syndromes.

Conclusion: The rate of help seeking among persons with alcohol use problems is low, which is a public health concern.

 

Retention in publicly funded methadone maintenance treatment in two Western States.

Deck D, Carlson MJ. J Behav Health Serv Res. 2005 Jan-Mar;32(1):43-60. RMC Research Corporation, 522 SW Fifth Ave, Suite 1407 , Portland , OR 97204 , USA . dennis_deck@rmccorp.com

This study examined individual and system characteristics associated with retention in methadone maintenance treatment among Medicaid-eligible adults in treatment for opiate use in Oregon and Washington. Logistic regression was used to examine the contributions of predisposing, need, and enabling characteristics on 365 day retention in methadone maintenance treatment. Older patients, patients with a history of methadone maintenance treatment, and persons with stable Medicaid eligibility had higher rates of retention than did patients with disabilities, polysubstance users, and those with an arrest record. In Oregon, which delivers methadone maintenance treatment through managed care, retention rose sharply from 28% to 51% between 1994 and 1998 and then leveled off. During the same time period, retention in Washington State grew from 28% to 34%. The higher rates of retention in Oregon , in part, can be explained by differences in service delivery influenced by financing. Faced with long waiting lists, Washington providers were more than twice as likely to administratively discharge patients for rule violations as their Oregon counterparts. Given the importance of retention, policies and practices that influence retention should be carefully considered. Because Medicaid eligibility has a dramatic impact on retention, policies that help extend eligibility or stabilize eligibility among individuals actively engaged in treatment should be carefully considered.

 

Alcohol and drug abuse among persons with multiple sclerosis.

Bombardier CH, Blake KD, Ehde DM, Gibbons LE, Moore D, Kraft GH. Mult Scler. 2004 Feb;10(1):35-40. Department of Rehabilitation Medicine, Box 359740, Harborview Medical Center, 325 9th Avenue, Seattle, WA 98104, USA. chb@u.washington.edu

Objective: To examine the one-month prevalence and impact of substance abuse in a large community sample of persons with multiple sclerosis (MS).

Methods: Members of the Multiple Sclerosis Society of King County were surveyed by mail. This multifaceted health survey included questions pertaining to substance abuse. Seven hundred and thirty-nine out of 1374 potential participants (54%) returned the survey, while 708 reported a medically confirmed diagnosis of MS and provided sufficient data.

Results: Fourteen per cent of the sample screened positive for possible alcohol abuse or dependence, and 7.4% reported misusing illicit drugs or prescription medications within the previous month. Possible alcohol abuse and drug misuse were associated with younger age, less severe MS related disability and being employed, as well as greater self-reported depressive symptomatology. Most persons with alcohol problems indicated interest in learning more about ways to stop or cut down.

Conclusion: Substance abuse may be present in up to 19% of this sample and contribute to high rates of depression. There may be greater risk of harm due to substance abuse in people with MS because of the potential magnification of motor and cognitive impairments. Comprehensive MS care should include substance abuse screening and advice to cut down or abstain.

 

Smoking status and quality of life: a longitudinal study among adults with disabilities.

Mitra M, Chung MC, Wilber N, Klein Walker D. Am J Prev Med. 2004 Oct;27(3):258-60.
Massachusetts Department of Public Health, Boston , Massachusetts 02108 , USA .
monika.mitra@state.ma.us

Background: Current research suggests that people with disabilities are more likely to use tobacco, less likely to quit, and less likely to be screened for tobacco use. However, little is known about the impact of changes in smoking status on the health-related quality of life (HRQL) of people with disabilities.

Objective: The primary objective of this paper is to examine the association between changes in HRQL and smoking status over time among people with disabilities.

Methods: The study data were derived from the Massachusetts Survey of Secondary Conditions, a longitudinal survey of adults with disabilities; Phase I was conducted in 1996-1998, Phase II in 1998-1999, and Phase III in 1999-2000. The main outcome measure was HRQL as measured by the Medical Outcomes Study Short Form-36 (SF-36). Analysis was primarily done in 2003.

Results: Current smokers and those who began smoking during follow-up had significantly poorer HRQL compared with nonsmokers with disabilities. Longitudinal analysis suggests that controlling for age, gender, race/ethnicity, education, and activities of daily living, changes in HRQL scores over time were associated with changes in smoking status. Compared to smokers, those who quit smoking during follow-up experienced a significant improvement in mean SF-36 scores over time for the dimensions of mental health, energy and vitality, and general health.

Conclusion: Findings from this study highlight a strong need to inform public health programs, people with disabilities and healthcare providers about the association between tobacco cessation and improved health-related quality of life among people with disabilities.

 

Patterns of alcohol and substance use and abuse in persons with spinal cord injury: risk factors and correlates.

Tate DG, Forchheimer MB , Krause JS, Meade MA, Bombardier CH. Arch Phys Med Rehabil. 2004 Nov;85(11):1837-47. Model Spinal Cord Injury Care System, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor 48109-0491, USA. dgtate@umich.edu

Objective: To investigate patterns of alcohol consumption and abuse and substance use among persons with spinal cord injury (SCI), relating these patterns to demographic and injury-related characteristics, as well as to key medical and psychosocial outcomes.

Design: Retrospective cross-sectional.

Participants: Subjects with traumatic SCI (N=3041) with dates of injury between June 6, 1975 , and June 23, 2002 , who were interviewed between November 2000 and March 2003.

Setting: Sixteen Model Spinal Cord Injury Systems participating in this collaborative study during the 2000-2005 grant cycle.

Interventions: Not applicable.

Main Outcome Measures: Alcohol consumption, substance use, CAGE questionnaire, Satisfaction With Life Scale, Craig Handicap Assessment Reporting Technique, and pain. Data were analyzed using chi-square tests, analysis of variance, analysis of covariance, and logistic regression models.

Results: Fourteen percent of the subjects were classified as likely to have an alcohol abuse issue, based on the CAGE, and 11% reported using illegal drugs or prescription medications for nonmedical reasons. Demographic and injury characteristics were associated with alcohol consumption patterns, abuse, and substance use. At-risk drinkers and substance users tended to be younger, single, male, and less educated. Those who were CAGE positive and substance users reported more pain and lower satisfaction with life. Persons who drank without indication of problem drinking had superior occupation outcomes. Pressure ulcers were associated with substance use.

Conclusion: Alcohol abuse and substance use were related to a number of adverse outcomes. The specific role of drinking with increased work activity deserves further exploration.

 

The relationship of spinal cord injury trauma to alcohol misuse: a study of monozygotic twins.

Seltz M, Radnitz C, Bauman WA . J Spinal Cord Med. 2004;27(1):18-21. Fairleigh Dickinson University , Teaneck , New Jersey 07666 , USA

Background: Substance misuse frequently is correlated with serious trauma such as spinal cord injury (SCI). Two hypotheses to this effect are (a) substance abuse predates injury and is a risk factor or trigger for serious injury such as SCI; or (b)substance abuse begins postinjury, and alcohol or other drugs are used to ameliorate the physical and emotional distress that result from SCI.

Methods: To test these two hypotheses, 1 4 pairs of monozygotic twins, in which 1 of each pair had sustained an SCI, were studied. The twin without SCI was used as a control for preinjury substance misuse status for the twin with SCI.

Results: No significant differences between SCI and non-SCI co-twins’ substance use patterns were found.

Conclusion: These findings suggest that drinking patterns might not be significantly affected by SCI and that substance misuse might precede injury.

 

Physical inaccessibility negatively impacts the treatment participation of persons with disabilities.

West SL, Luck RS, Capps CF. Addict Behav. 2007 Jul;32(7):1494-7. Epub 2007 Jan 29. Department of Rehabilitation Counseling, Virginia Commonwealth University, P. O. Box 980330, Richmond, VA 23298-0330, United States.

This research assessed the impact that physical inaccessibility of provider locations has on the substance abuse treatment participation of two groups of persons with disabilities. A random sample of treatment providers in the Mid-Atlantic region were surveyed and asked if they had declined services to persons with spinal cord (SCI) or traumatic brain (TBI) injuries due to the inaccessibility of their practices. Over half of those who had been approached by persons with SCI and nearly half of those approached by persons with TBI were unable to provide services due to physical barriers. The inability to serve such individuals was not related to practice affiliation (public or private) or practice type (hospital based, non-medical residential, or outpatient). These findings support earlier research indicating the treatment participation of persons with disabilities is negatively affected by physical accessibility concerns.

 

A typology of alcohol use patterns among persons with recent traumatic brain injury or spinal cord injury: implications for treatment matching.

Turner AP, Bombardier CH, Rimmele CT. Arch Phys Med Rehabil. 2003 Mar;84(3):358-64. Veterans Administration Puget Sound Health Care System Center for Excellence in Substance Abuse Treatment and Education, Seattle , WA , USA .

Objective: To describe empirically valid and clinically meaningful types of alcohol use among persons with recent traumatic brain or spinal cord injury.

Design: Cross-sectional cohort survey.

Setting: Acute inpatient rehabilitation program in a level I trauma center.

Participants: A total of 218 (87%) of 250 consecutive initial admissions who met inclusion criteria and completed interviews.

Interventions: Not applicable.

Main Outcome Measures: Alcohol and drug use questionnaires, alcohol problem questions, admission toxicology results, readiness to change, and treatment preference questions.

Results: Participants were on average 37 years old, 84% were men, and 82% were white. Four types were identified by using k-means cluster analysis based on preinjury alcohol consumption, alcohol problems, and alcohol dependence. Cluster groups differed on extrinsic variables such as drug use, readiness to change, and interest in treatment or in attending Alcoholics Anonymous. The 4 types corresponded to those with a history of (1) alcohol abuse; (2) alcohol dependence; (3) alcohol dependence in remission, partial remission, or relapsed; and (4) normal or nondrinkers.

Conclusion: More effective care may be possible if clinicians match common patient types to specific interventions such as education, motivational interventions, formal substance abuse treatment, and relapse prevention.

 

Post-injury substance abuse among persons with brain injury and persons with spinal cord injury.

Kolakowsky-Hayner SA, Gourley EV 3rd, Kreutzer JS, Marwitz JH, Meade MA, Cifu DX.
Brain Inj. 2002 Jul;16(7):583-92. Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Medical College of Virginia, Richmond, Virginia 23298-0542, USA.
sakolako@hsc.vcu.edu

Objective: To identify the patient population at greatest risk for post-injury adjustment problems, the present study independently examines and compares alcohol and drug use rates in patients with traumatic brain injury (TBI) and patients with spinal cord injury.

Research Design: The two samples were matched with regard to age, gender and mechanism of injury. The study provides a description of post-injury use rates for each population, and describes similarities and differences between the two groups.

Methods: Participants included 30 consecutive Model Systems spinal cord injury (SCI) patients seen for follow-up neuropsychological testing between October 1996-June 1999. An equivalent number of Model Systems TBI patients were matched from a larger sample comprised of 440 consecutive hospital admissions, that returned for a 1-year follow-up neuropsychological evaluation between February 1989-December 1998. All participants were treated in an urban Level I trauma centre and associated inpatient rehabilitation programmes. Information regarding patient demographics, as well as pre- and post-injury psychiatric, employment, academic, criminal, and medical history was obtained via the General Health and History Questionnaire.

Main Outcomes and Results: With regard to post-injury alcohol use rates, persons with spinal cord injury were more likely to drink on a daily basis. Although not statistically significant, pre-injury drinking rates differed from post-injury rates for both groups. With regard to illicit drug use, persons with TBI differed significantly from persons with SCI. A significant difference was also noted between pre-injury drug use and post-injury drug use for both groups.

Conclusion: Persons who drink post-injury are unlikely to be ‘light’ or social drinkers. Either people choose to abstain completely or appear to use alcohol frequently.

 

Age-related health risk behaviors of adolescents with physical disabilities.

Steele CA , Kalnins IV, Rossen BE, Biggar DW, Bortolussi JA, Jutai JW. Soz Praventivmed. 2004;49(2):132-41. Bloorview MacMillan Centre, Toronto .

Objective: To investigate age-related differences in health risk behaviors in 11-12-, 13-14-, and 15-16-year-old adolescents with physical disabilities.

Methods: Health survey data from 319 adolescents with physical disabilities were compared with the same data from 7,020 adolescents in a national sample.

Results: Significant age-related differences were found for having tried smoking, smoking, having tasted an alcoholic drink, having been drunk, and using prescription drugs for recreational purposes. However, changes were modest and engagement of 15-16-year-old adolescents with physical disabilities was similar to 11-12-year-olds in the general population. Analysis of associations between disability status and health risk behaviors while controlling for age and sex showed that disability is associated with a lower likelihood of having tried smoking, smoking, having tasted an alcoholic drink, drinking, having been drunk, having used drugs, having used prescription drugs for recreational purposes, and eating sweets; a higher likelihood of not engaging in physical exercise, not eating fresh produce, and eating high-fat foods; and non-significant for seat-belt use.

Conclusion: Health promotion programs about health risk behaviours designed for adolescents in the general population may not be appropriate for adolescents with physical disabilities.

 

Comparative research on substance abuse and self-perception among adolescents with physical handicap.

Janekovic K. Coll Antropol. 2003 Dec;27(2):479-89. Center for Education and Rehabilitation, Dubrava, Zagreb , Croatia .

The research on substance (alcohol, tobacco and drug) abuse and on self-perception was done by comparing a test group of physically disabled adolescents and a test group of non-disabled adolescents. The respondents of the experimental group were students of the only special high school for physically handicapped persons in Croatia , Zagreb . The respondents of the control group were the students of two regular high schools in the capital of Croatia . The instrument used in this research was a self-reported, anonymous questionnaire. The respondents completed the questionnaire in the classroom. The data analysis regarding alcohol abuse indicated that physically disabled adolescents drink more often and out of quite different motives than their non-disabled peers. Regarding the prevalence, frequency, quantity and motives for smoking, no statistically significant difference has been found between the tested groups. On the contrary, significant differences between handicapped and non-disabled adolescents were evident regarding drug abuse. Only one physically disabled examinee used a drug—marijuana, only a few times a year. On the other hand, almost one quarter of the non-disabled adolescents use at least one, five at the most, type of drug sometimes or often. The results on the self-perception scale show that adolescents with physical disabilities have a much more negative attitude toward themselves than non-disabled controls. Their self-esteem and self-confidence are seriously diminished. Described findings could have a mighty impact on ways of preventing substance abuse, and on ways of increasing self-esteem among disabled and non-disabled adolescents.

 

Self-reported smoking and alcohol use among adolescents with intellectual disabilities.

Emerson E, Turnbull L. J Intellect Disabil. 2005 Mar;9(1):58-69. Lancaster University, UK, eric.emerson@lancaster.ac.uk.

Self-reported smoking and alcohol use were examined among 95 adolescents (aged 11-15) with intellectual disabilities and 4069 adolescents who did not have intellectual disabilities. Results indicated that adolescents with intellectual disabilities reported increased rates of smoking and decreased rates of using alcohol at least once a month. There were no marked differences between the two groups on smoking seven or more cigarettes a day, having ever smoked at all and having ever used alcohol. Elevated levels of smoking appeared to be an artefact of increased rates of poverty among adolescents with intellectual disabilities. Distinct patterns of risk were associated with smoking and alcohol use among adolescents with intellectual disabilities. Smoking was closely associated with the experience of poverty and adolescent mental health. Alcohol use was associated with less punitive child management practices and carer mental health. Results are discussed in the context of health promotion.