What Happens After Treatment? Long-Term Effects of Continued Substance Use, Psychiatric Problems and Help-Seeking on Social Status of Alcohol-Dependent Individuals

Karriker‐Jaffe, Katherine J.; Witbrodt, Jane; Subbaraman, Meenakshi S.; Kaskutas, Lee Ann

doi:10.1093/alcalc/agy025

Cited by 5 publications

(4 citation statements)

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“…Possible consequences of such misuse, especially when co-occurring with multiple psychoactive prescription medications or other non-prescription substances include altered brain development, substance/medication-induced mental disorders, a potential for lifelong addiction, a ‘downward drift’ (ie, a descending social migration and/or loss of social status) and various substance-related diseases. 16 Individuals with mood and anxiety disorders may engage in drug use to self-medicate or as a mechanism to cope with their mental health disorder. 17 Misuse of psychoactive prescription medications may however make youth and young adults more susceptible to other substance use problems, a phenomenon called the ‘gateway’ effect.…”

Section: Discussionmentioning

confidence: 99%

Medical use and misuse of psychoactive prescription medications among US youth and young adults

2021

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ObjectiveTo investigate prevalence and correlates of medical use and misuse of psychoactive prescription medications among US youth and young adults.DesignCross-sectional, self-reported surveys from the 2015–2018 National Survey of Drug Use and Health. Sampling was probabilistic and nationally representative.SettingThe target population included individuals from households, non-institutional group quarters (eg, college dormitories) and civilians living on military bases. Questionnaires were completed using computer-assisted self-interview methods.ParticipantsOur analytical sample included youth and young adults aged 12–25 years (n=110 556). Psychoactive prescription medication misuse was a report by the respondent that they had used psychoactive prescription medications in the past year in any way not directed or prescribed for them. Medical use was defined as past-year use without a report of misuse. Because certain variables were assessed only among adults, our multivariable analysis to identify correlates of misuse was restricted to young adults aged 18–25 years (n=55 690).ResultsAmong US youth aged 12–17 years, 25.0% reported use of any psychoactive prescription medication assessed, and 5.7% reported past-year use of at least two psychoactive prescription medications. Among youth who used any psychoactive prescription medications, 20.9% (1.3 million) reported misuse; 3.4% were classified as having substance use disorder. Past-year use of each psychoactive prescription medication was: opioids (19.0%), stimulants (7.2%), tranquillisers (4.3%) and sedatives (2.2%). Among users of each psychoactive prescription medication, the estimated percentage reporting misuse was as follows: opioids (17.6%, 0.8 million), stimulants (24.2%, 0.4 million), tranquillisers (40.1%, 0.4 million) and sedatives (14.2%, 80 000). Among users of each psychoactive prescription medication, the estimated percentage having substance use disorder was as follows: opioids 2.6%, stimulants 3.0%, tranquillisers 7.0% and sedatives 3.6%. Analyses among young adults aged 18–25 years revealed that, compared with never users of non-prescription substances (including alcohol, tobacco, marijuana, cocaine, heroin), opioid misuse increased with: more recent use of non-prescription substances (adjusted prevalence ratios (APRs)=8.26, 2.75 and 2.41 for past ≤30-day, ≤12-month and >12-month use, respectively); and a higher number of substances used (APRs=1.69, 3.44, 6.82, 10.60 and 20.60 for 1, 2, 3, 4 and 5+ substances, respectively) (all p<0.05). Similar patterns were seen for stimulants, tranquillisers and sedatives.ConclusionsIt is important to monitor the diversity of medication misuse behaviours among youth and young adults, given their potential for abuse liability. Modifiable risk factors for prescription substance misuse, such as tobacco and other non-prescription substance use, underscore the need for comprehensive approaches towards health promotion among youth and young adults.

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Section: Discussionmentioning

confidence: 99%

Medical use and misuse of psychoactive prescription medications among US youth and young adults

2021

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“…11 Without support and engagement in these comprehensive care systems, it is unlikely that clients will be able to make substantial changes in their neighborhood environments on their own. 83 The individuals in the Chronic/High class were the most complex in terms of co-morbidities (use of other drugs, psychiatric problems), but they also continued to be involved with heavy-drinking social networks and they lived in highrisk neighborhoods. Although they continued to receive suggestions that they should seek help and they repeatedly re-engaged with the treatment system, their levels of dependence symptoms remained high over time.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Testing a Socioecological Model of Relapse and Recovery from Alcohol Problems

et al. 2020

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This study tests a socioecological model of relapse and recovery using latent class growth mixture modeling to identify neighborhood, social network and individual-level predictors of alcohol dependence trajectories among a large, longitudinal sample of problem drinkers recruited from substance use treatment settings. We identified four distinct alcohol dependence trajectories: Stable Recovery/Low (Class 1); Relapsing/Rising (Class 2); Late Recovery/Declining (Class 3); and Chronic/High (Class 4). Neighborhood context (poverty and density of bars), social network characteristics (less involvement with Alcoholics Anonymous [AA], continued affiliation with heavy drinkers), and individual predisposing (psychiatric severity) and need (returning to treatment) characteristics each distinguished individuals in the Relapsing/Rising class from individuals in the Stable Recovery/Low class. Social network characteristics (AA involvement and continued affiliation with heavy drinkers) were the primary distinguishing factors for individuals in the Chronic/High class compared to the Late Recovery/Declining class. Study findings can be used to promote recovery and help prevent relapse by: guiding development of community-level interventions to improve social and physical environments; identifying potentially modifiable factors (social network support for sobriety, participation in self-help) to reduce negative consequences among problem drinkers who remain in high-risk neighborhoods; and contributing to ongoing discussions about new and continued licensing of alcohol outlets and regulation of alcohol sales to prevent alcohol problems in high-risk areas and among high-risk people.

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“…Воздействуя только на психику больного, они не учитывают, что этанол и его метаболиты вызывают тяжелейшие изменения внутренних органов, от которых эти больные и погибают. Вместе с тем, большинство психиатров-наркологов признают, что лишь 3-5% больных излечиваются от алкоголизма, но никак не объясняют причину такой стабильно низкой эффективности их лечения [3]. И, тем не менее, усилия наркологов всего мира направлены на борьбу именно с алкоголизмом, т. е. с болезнью, которая перешла грань, за которой излечение уже невозможно.…”

Section: Introductionunclassified

Cardiac and vascular changes in the patho- and morphogenesis of alcohol use disorder

Кириллов

Ерохин

et al. 2020

Cardiovasc Ther Prev

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Aim. To reveal the patho- and morphogenesis of microvascular injury, cardiac and vascular changes in individuals with alcohol use disorder (AUD) and the role of cardiovascular pathology in the thanatogenesis of patients with chronic alcohol intoxication.Material and methods. The study was carried out using the data of 1118 autopsies of patients with AUD. We used histological, immunohistochemical, electron microscopic and biochemical methods, as well as morphometrics with statistical processing of the results.Results. Most patients with binge drinking developed alcoholic cardiomyopathy, cardiac hypertrophy, myocardial fatty degeneration, microvascular arteriolosclerosis and hyalinosis, diffuse focal sclerosis, as well as mitochondrial swelling and fragmentation of cristae in cardiomyocytes (CMC). The proportion of damaged CMC was 30,9±0,6%. Sclerosis affected 20,1±0,9% of the stroma. If alcohol was abandoned or consumed within the basal metabolic rate, these changes were reversible. With alcoholism, alcoholic cardiomyopathy, arteriosclerosis and arteriolosclerosis progressed. Compared with the binge drinking, the proportion of damaged CMC (44,8±1,1%) and the cardiosclerosis area (28,1±0,5%) significantly increased. Mallory bodies with autoantigen properties were detected. Morphological changes became irreversible.Conclusion. The data obtained identified the need for AUD isolation as an independent nosological entity with stage-by-stage pathogenesis. In the stage of binge drinking, the compensatory and adaptive capabilities of the body are preserved. With appropriate treatment, this stage of AUD is treatable. In the stage of alcoholism, changes in organs and tissues are irreversible, and it is more advisable for addiction medicine physicians to deal with palliative treatment of such patients.

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What Happens After Treatment? Long-Term Effects of Continued Substance Use, Psychiatric Problems and Help-Seeking on Social Status of Alcohol-Dependent Individuals

Abstract: Specialty addiction treatment alone was not sufficient to have positive long-term impacts on social status and social integration of most alcohol-dependent people.

Cited by 5 publications

References 38 publications

Medical use and misuse of psychoactive prescription medications among US youth and young adults

Medical use and misuse of psychoactive prescription medications among US youth and young adults

Testing a Socioecological Model of Relapse and Recovery from Alcohol Problems

Cardiac and vascular changes in the patho- and morphogenesis of alcohol use disorder

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