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Introduction: Chronic pain is the most common reason for medical cannabis certification. Data regarding alcohol use and risky drinking among medical cannabis patients with pain is largely unknown. Therefore, we examined the prevalence and correlates of alcohol use and risky drinking in this population., Methods: Participants completed surveys regarding demographics, pain-related variables, anxiety, cannabis use, and past six-month alcohol consumption. Alcohol use groups were defined using the AUDIT-C [i.e., non-drinkers, low-risk drinkers, and high-risk drinkers (≥4 for men and ≥3 for women)] and compared on demographic characteristics, pain measures, anxiety, and cannabis use., Results: Overall, 42% (n=330/780) were non-drinkers, 32% (n=251/780) were low-risk drinkers, and 26% (n=199/780) were high-risk drinkers. Compared to non-drinkers, low- and high-risk drinkers were significantly younger whereas a larger proportion of low-risk drinkers reported being African-American compared to non- or high-risk drinkers. High-risk drinkers reported significantly lower pain severity/interference compared to the other groups; high-risk drinkers were also less likely to be on disability compared to other groups. A multinomial logistic regression showed that patients reporting lower pain severity and less disability had greater odds of being classified a high-risk drinker., Conclusions: High-risk drinking appears common among medical cannabis patients. Future research should examine whether such use is concurrent or consecutive, and the relationship of such co-use patterns to consequences. Nevertheless, individuals treating patients reporting medical cannabis use for pain should consider alcohol consumption, with data needed regarding the efficacy of brief alcohol interventions among medical cannabis patients., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Little is known about the impact of motherhood on alcohol use beyond the acute reductions observed in pregnancy. This study characterizes changes in alcohol use for women who did and did not become mothers over three years., Methods: Data are from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC). Participants were female respondents aged 18-44 years who did not have children and were not pregnant at wave 1, and who reported having at least one drink in the year prior to wave 1 (n=2118). Women were classified as mothers (n=325) if they reported having a child between waves 1 and 2, and non-mothers if they did not (n=1793). At each wave, participants provided information on past-year frequency of alcohol use and heavy episodic drinking, and usual number of alcoholic beverages consumed per occasion., Results: At baseline, women who did and did not become mothers reported similar levels of alcohol use. Women who became mothers reported significant reductions in alcohol use indicators from wave 1 to wave 2 (i.e., 22 fewer drinking days, 15 fewer heavy drinking days, 1 less drink per occasion), whereas women who did not become mothers showed a modest increase in alcohol use frequency (i.e., 7 more drinking days). Motherhood remained significantly associated with reductions in alcohol use after adjusting for sociodemographic variables and baseline alcohol use., Conclusions: The transition to motherhood is associated with marked reductions in alcohol consumption. Similar reductions were not observed for women who did not become mothers., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Research on associations between substances of abuse and suicidal behaviors is a large, complex area. Herein, alcohol, the most commonly abused intoxicant worldwide, is examined with a focus on two topics: (1) acute use of alcohol (AUA) shortly prior to suicidal behavior; and (2) more chronic alcohol use disorder (AUD) and suicidal behavior. First, a brief summary of what is known about AUA, AUD, and suicidal behavior is provided. Next, we draw on preliminary evidence, practical considerations, and our own experience to offer recommendations for intervention research that may lower risk associated with AUA and AUD. The literature on AUD and suicidal behavior is more developed, thus we discuss separately research designed to: (1) prevent individuals with AUD with suicidal ideation from engaging in suicidal behavior; and (2) prevent individuals with AUD who have made a suicide attempt from reattempting. Our focus is on clinical intervention strategies for individuals at risk for suicidal behavior that use alcohol or have developed AUD. We also focus on applied research that may directly lead to practical prevention efforts. Although clinical interventions are important components of a comprehensive suicide prevention strategy, they should be complemented with primary prevention efforts., (Published by Elsevier Inc.)

Background: Driving while intoxicated or under the influence (DUI; for the purposes of this paper, we use the following terms synonymously: driving under the influence, driving while intoxicated, and drunk driving) and engaging in interpersonal violence are two injury-related problems of high public health importance that have both been linked to alcohol consumption. This study sought to estimate the prevalence of DUI and violence in a sample of individuals in treatment for alcohol dependence in Poland. Patient characteristics associated with DUI and violence involvement, with a particular focus on impulsivity, were examined., Methods: Three hundred and sixty-four patients consecutively admitted to four alcohol treatment programs in Warsaw, Poland participated in this study. Questions concerning history of interpersonal violence as well as those about DUI were derived from the Michigan Alcoholism Screening Test. Impulsivity level was measured using the Barratt Impulsiveness Scale 11, the Revised NEO Personality Inventory, and the stop-signal task., Results: Among all participants in the study, 148 (40.1%) had been arrested in the past for DUI, and 196 (55%) reported involvement in a fight under the influence of alcohol (FUI). The DUI group had a significantly earlier onset of alcohol problems, a longer period of heavy alcohol use, and fewer women in comparison to participants without a DUI history. FUI patients were significantly younger, with a younger average age of onset of drinking problems, longer period of heavy drinking, and lower percentage of women than the non-FUI group., Conclusion: Both of the self-reported measures of impulsivity indicated a higher level of impulsivity among participants from the FUI group than those from the non-FUI group., (© 2013 S. Karger AG, Basel.)

Objective: This study sought to compare patterns of alcohol use between male veterans and nonveterans., Methods: Data came from the 2004 Behavioral Risk Factor Surveillance System, a U.S. national telephone survey using stratified random sampling. Outcomes were 30-day alcohol use, binge drinking (5+ drinks on one occasion), and heavy drinking (2+ drinks per day). Age-stratified weighted regression analyses compared men who were veterans (n = 36,874) to those who were not (n = 77,056), and veterans who used Veterans Health Administration (VHA) services in the past year (n = 7,606) to veterans who did not, adjusting for potential confounders., Results: Veterans aged 41 to 60 were less likely to binge drink (adjusted odds ratio [AOR] = 0.8) and veterans aged 61 to 70 were more likely to drink heavily compared to same-age men without military experience (AOR = 1.7). There were no significant differences in binge or heavy drinking for other age groups. Among veterans aged 51 to 60, those who used VHA services were more likely to report binge drinking than those who did not (AOR = 1.4)., Conclusions: Male veterans generally have similar patterns of alcohol use as men without a history of military service, but the elevated alcohol use of specific groups of veterans merits concern.

Objective: Current substance use disorder (SUD) treatment guidelines suggest that SUD treatment may be indicated for individuals with elevated levels of alcohol consumption. The Department of Veterans Affairs (VA) considers patients with AUDIT-C scores of ≥8 as candidates for specialty care, however rates of SUD treatment based on AUDIT-C cutoffs remain understudied. We sought to identify SUD treatment rates and to identify patient characteristics that were associated with SUD treatment for VA patients with elevated AUDIT-C scores., Methods: The study sample included 10,384 ambulatory care VA patients with AUDIT-C scores of ≥8, who had not received SUD treatment in the past 60 days. Data were ascertained from the 2005 Survey of Health Experiences of Patients, a confidential mailed patient satisfaction survey (results were not available to providers). The outcome variable was the receipt of VA specialty SUD treatment in the year after the survey completion, as ascertained by VA administrative data. We identified rates of SUD treatment, and conducted unadjusted F tests and adjusted logistic regression analyses to identify patient characteristics that were associated with treatment entry., Results: Approximately 3.9% of veterans with AUDIT-C scores of ≥8 received SUD treatment in the year after being surveyed. Adjusted analyses revealed that treatment was more likely among persons with a mental health diagnosis (OR=3.31, CI=2.30-4.76) and among racial/ethnic minority groups., Conclusions: Very few veterans who reported elevated alcohol consumption on SHEP received specialty SUD treatment in the year after being surveyed. Increased efforts should be made to intervene with patients who have elevated levels of alcohol consumption., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Aims: This study examines whether the severity of baseline alcohol consumption/consequences moderates the effect of an alcohol brief intervention (BI) in the emergency department (ED)., Methods: Injured patients (N = 494) were recruited from an ED, randomly assigned to receive brief advice or not and completed a 12-month follow-up interview., Results: A significant interaction was found between severity of baseline alcohol consumption (i.e. average weekly, binge drinking) and receipt of a BI on alcohol consumption at 12 months. The form of this interaction indicates that the BI group tended to report lower alcohol consumption at follow-up than the untreated group especially in those who had reported high baseline consumption. Severity of alcohol consequences at baseline did not significantly impact the effect of the BI on 12-month outcomes., Conclusion: ED patients with higher alcohol consumption benefit from BI. In some cases, the BI's effects may be enhanced for patients who are heavier drinkers, perhaps due to a greater opportunity to develop a discrepancy between current behavior and future goals.

Background: Limited data exist on the rates and long-term stability of non-problem drinking in individuals who sought help for an alcohol use disorder., Methods: A sample of initially untreated individuals with alcohol use disorders (n=420) was surveyed at baseline and 1 year and was re-assessed at 8 and 16 years., Results: In the 6 months prior to the 1-year assessment, 36% (n=152) of participants reported abstinence from alcohol, 48% (n=200) reported drinking with problems, and 16% (n=68) reported non-problem drinking. At each follow up, 16-21% of the sample reported non-problem drinking. Compared to individuals in the abstinent and problem-drinking groups, individuals who were drinking in a problem-free manner at 1 year had reported, at baseline, fewer days of intoxication, drinks per drinking day, alcohol dependence symptoms, and alcohol-related problems, less depression, and more adaptive coping mechanisms. Over time, 48% of participants who engaged in non-problem drinking at 1 year continued to report positive outcomes (either non-problem drinking or abstinence) throughout the long-term follow-up, whereas 77% of those abstaining at 1 year reported positive outcomes throughout the same time period. Additionally, 43% of individuals with problematic alcohol consumption at 1 year reported positive outcomes over the remaining follow-up interval, a rate that was not significantly different from the rate of positive outcomes of 48% observed in those with initial problem-free drinking., Conclusions: Although some individuals report non-problem drinking a year after initially seeking help, this pattern of alcohol use is relatively infrequent and is less stable over time than is abstinence. An accurate understanding of the long-term course of alcohol use and problems could help shape expectations about the realistic probability of positive outcomes for individuals considering moderate drinking as a treatment goal.

Aims: To test separatel the efficacy of a web‐based and a peer‐based brief intervention (BI), compared with an expanded usual care control (EUC) group, among military reserve component members using alcohoI in a hazardous and harmful manner. Design: In the randomized controlled trial, participants were assigned to: [1] web‐based BI with web‐based boosters (BI + web), [2] web‐based BI with peer‐based boosters (BI + peer) or [3] enhanced usual care (EUC). Setting: Michigan, USA. Participants: A total of 739 Michigan Army National Guard members who reported recent hazardous alcohol use; 84% were male, the mean age was 28 years. Intervention: The BI consisted of an interactive program guided by a personally selected avatar. Boosters were delivered either on the web or personally by a trained veteran peer. A pamphlet, given to all participants, included information on hazardous alcohol use and military‐specific community resources and served as the EUC condition. Measurements The primary outcome measure was binge drinking episodes in the past 30 days, measured at 12 months after the BI. Findings All randomized participants were included in the outcome analyses. In adjusted analyses, BI + peer [beta = −0.43, 95% confidence interval (CI) = −0.56 to −0.31, P < 0.001] and BI + web (beta = −0.34, 95% CI = −0.46 to −0.23, P < 0.001) reduced binge drinking compared with EUC. Conclusion: This satudy was a web‐based brief intervention for hazardous alcohol use, with either web‐ or peer‐based boosters, reduced binge alcohol use among Army National Guard members. [ABSTRACT FROM AUTHOR]

Patients entering an inpatient psychiatry program (N = 406) with co-occurring mental health and substance use disorders reported on their social support networks (source, type) at treatment intake, and completed symptom measures at baseline and 3-, 9-, and 15-month follow-ups (77%). Longitudinal growth models found aspects of participants' support networks were associated with specific symptoms over time. Less family support (i.e., more conflict) was the most consistent predictor of mental health and substance use outcomes and was associated with greater psychiatric, depression, Post Traumatic Stress Disorder (PTSD), and drug use severity. More peer support (via mutual-help involvement) was associated with greater initial improvement in alcohol use severity. Findings suggest that to facilitate the benefits of social support for patients with a dual diagnosis returning to the community, specific components of support should be assessed and considered in the treatment plan, rather than viewing support as a general and undifferentiated factor affecting recovery. [ABSTRACT FROM AUTHOR]

Aims Alcohol-related blackouts can result in acute injuries and other negative outcomes. Among underage risky drinkers, we examined longitudinal trajectories of blackout frequency following an emergency department (ED) visit, and identified baseline characteristics associated with blackout trajectory membership. Methods Participants (ages 14–20; N = 836) attending an ED who screened positive for risky drinking and enrolled in a randomized-controlled trial of brief alcohol interventions were assessed at baseline, 3-, 6-, and 12-months. We used group-based trajectory modeling to determine characteristic trajectories of blackout frequency over 12-months in relation to baseline characteristics: demographics, substance use, delinquency, depression/anxiety symptoms, sexual assault, dating violence, and peer and sibling influences. Results We identified four groups: No/Low blackouts (n = 248; 29.7%), Declining blackouts (n = 92; 11.0%), Moderate blackouts (n = 337; 40.3%) and High blackouts (n = 159; 19.0%); group membership did not differ based on intervention receipt. In adjusted analyses, compared to the No/Low group all other groups had higher odds of having an alcohol-related baseline ED visit. Female sex, alcohol consumption, prescription drug misuse, sexual assault while incapacitated due to substances, and negative peer influences were positively associated with membership in the High group; College/Greek life involvement was also highest. Negative peer influences and being in high school (vs. College/Greek life) also distinguished the Moderate group. Conclusion Blackout frequency was largely stable over time and riskier trajectories were marked by risk factors such as negative peer influences and college/Greek life involvement. Findings may inform targeted interventions, particularly for women who were in higher risk trajectories. [ABSTRACT FROM AUTHOR]

Background and Aims Limited information is available regarding links between specific substance use disorders (SUDs) and suicide mortality; however, the preliminary evidence that is available suggests that suicide risk associated with SUDs may differ for men and women. This study aimed to estimate associations between SUDs and suicide for men and women receiving Veterans Health Administration (VHA) care. Design A cohort study using national administrative health records. Setting National VHA system, USA. Participants All VHA users in fiscal year (FY) 2005 who were alive at the beginning of FY 2006 ( n = 4 863 086). Measurements The primary outcome of suicide mortality was assessed via FY 2006-2011 National Death Index (NDI) records. Current SUD diagnoses were the primary predictors of interest, and were assessed via FY 2004-2005 VHA National Patient Care Database (NPCD) records. Findings In unadjusted analyses, a diagnosis of any current SUD and the specific current diagnoses of alcohol, cocaine, cannabis, opioid, amphetamine and sedative use disorders were all associated significantly with increased risk of suicide for both males and females [hazard ratios (HRs)] ranging from 1.35 for cocaine use disorder to 4.74 for sedative use disorder for men, and 3.89 for cannabis use disorder to 11.36 for sedative use disorder for women]. Further, the HR estimates for the relations between any SUD, alcohol, cocaine and opioid use disorders and suicide were significantly stronger for women than men ( P < 0.05). After adjustment for other factors, most notably comorbid psychiatric diagnoses, associations linking SUDs with suicide were attenuated markedly and the greater suicide risk among females was observed for only any SUD and opioid use disorder ( P < 0.05). Conclusions Current substance use disorders (SUDs) signal increased suicide risk, especially among women, and may be important markers to consider including in suicide risk assessment strategies. None the less, other co-occurring psychiatric disorders may partially explain associations between SUDs and suicide, as well as the observed excess suicide risk associated with SUDs among women. [ABSTRACT FROM AUTHOR]

Rates of past-year partner and non-partner violence perpetration (VP) in substance use disorder (SUD) treatment samples exceed 50%, with studies showing rates of past-year VP exceeding 70% when considering violence occurring with either intimate partners or non-partners. However, SUD treatment programs typically do not include VP prevention interventions, and the few studies examining the impact of SUD interventions on VP have focused exclusively on partner VP. This study summarizes results of a randomized controlled pilot study of an Integrated Violence Prevention Treatment (IVPT) designed to address VP across partner and non-partner relationships as well as predictors of post-treatment VP. Participants were men (70%) and women (30%) in SUD treatment reporting past-year VP who were randomized to either IVPT or a control condition. The IVPT involved a Motivational Interviewing session targeting interpersonal conflicts, followed by five cognitive-behavioral therapy sessions focusing on VP prevention skills. The control condition included a session including a videotape and discussion of anger management, followed by five psycho-educational sessions common for SUD settings. Results showed that VP (total, partner, and non-partner) and cocaine use significantly decreased between baseline and 3-month follow-up for both conditions, and the IVPT group showed a significant decline in alcohol use. Analyses focusing on VP during follow-up revealed that baseline cocaine use and drinking during the follow-up predicted post-treatment VP. Together, these findings suggest that IVPT is a promising intervention (feasible, appears to impact drinking, an important factor related to violence) but that additional continuing care approaches may be indicated to sustain positive outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Cannabis has been legalized for medical use in almost half of the states in the U.S. Although laws in these states make the distinction between medical and recreational use of cannabis, the prevalence of people using medical cannabis and how distinct this group is from individuals using cannabis recreationally is unknown at a national level.Methods: Data came from the 2013 National Survey on Drug Use and Health (NSDUH). All adults endorsing past year cannabis use who reported living in a state that had legalized medical cannabis were divided into recreational cannabis use only and medical cannabis use. Demographic and clinical characteristics were compared across these two groups.Results: 17% of adults who used cannabis in the past year used cannabis medically. There were no significant differences between those who used medically versus recreationally in race, education, past year depression and prevalence of cannabis use disorders. In adjusted analyses, those with medical cannabis use were more likely to have poorer health and lower levels of alcohol use disorders and non-cannabis drug use. A third of those who reported medical cannabis use endorsed daily cannabis use compared to 11% in those who reported recreational use exclusively.Conclusions: Adults who use medical and recreational cannabis shared some characteristics, but those who used medical cannabis had higher prevalence of poor health and daily cannabis use. As more states legalize cannabis for medical use, it is important to better understand similarities and differences between people who use cannabis medically and recreationally. [ABSTRACT FROM AUTHOR]

Objective: Chronic pain and problematic alcohol use commonly co-exist, as the use of alcohol is commonly considered a useful pain self-management strategy. The purpose of this study was to characterize pain and pain-related problems in a group of primary alcohol-dependent individuals entering treatment facilities. Method: A sample of 366 (73.5% men and 26.5% women) alcohol-dependent (according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria) subjects was recruited in alcohol treatment centers in Warsaw, Poland. Information was obtained about demographics, social functioning, sexual and physical abuse during childhood, and severity of alcohol and sleep problems as well as level of impulsivity and general psychopathology. The study group was divided into a "mild or no pain" group and a "moderate or greater pain" group. Results: Among the study group, 34.4% of individuals reported moderate or greater physical pain during the last 4 weeks. The statistical analysis revealed that the experience of physical pain was significantly associated with lower level of education, unemployment, experience of sexual abuse before 18 years of age, and severity of alcohol dependence as well as other potential predictors of relapse (impulsivity, sleep problems, general psychopathology). When entered into logistic regression analysis with other dependent variables, the level of general psychopathology, severity of sleep problems, age, and education were all significantly associated with pain severity. Conclusions: Physical pain is a prevalent and potentially impairing experience in adults seeking treatment for alcohol dependence. Therapeutic interventions aimed at reducing pain in alcohol-dependent individuals should be studied to evaluate their impact on improving overall treatment outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Background: Prior studies of Veterans have linked posttraumatic stress disorder (PTSD) with an increased risk of mortality. Other studies of Veterans have found that substance use disorders (SUDs) are associated with an excess risk of mortality among those with psychiatric disorders. It is not known whether having an SUD increases the risk of mortality among Veterans with PTSD, and whether the association differs by mortality type or varies by age cohort. Methods: A cohort of patients who received Veterans Health Administration services during fiscal year (FY) 2004 and diagnosed with PTSD (n =272,509) were followed from FY 2005 through FY 2007 for the main outcomes of mortality and cause of death. Results: SUD was positively associated with mortality during follow-up (adjusted hazards ratio: 1.70; 95% confidence interval: 1.64, 1.77). SUD was a stronger predictor of non-injury-related mortality for the <45 years group compared with the 45–64 or ≥65 group. SUD predicted injury-related mortality for all age groups. Conclusions: Among Veterans with PTSD, the association between SUD and mortality was most pronounced for the youngest age group, which included Iraq/Afghanistan Veterans. For older age groups, which included Vietnam-era Veterans, SUD was a greater predictor of injury-related mortality. The findings could be useful for identifying PTSD patients at excess risk of mortality. [Copyright &y& Elsevier]

Aims: Acute alcohol intoxication itself may act as a trigger for suicidal thoughts and attempts among individuals at risk and may influence the potential lethality of the suicide attempt. This study in alcohol-dependent patients compared the correlates of suicide attempts during a heavy drinking episode with those of suicide attempts during relative sobriety. Methods: In two outpatient and two residential alcohol treatment programs in Warsaw, Poland, 113 patients who reported a suicide attempt during their lifetime were interviewed. The analyses focused on the patients’ most serious suicide attempts and on whether these occurred during a heavy drinking episode. Results: Over two-thirds of the patients reported that their most serious suicide attempt occurred during a period of heavy drinking. A multivariable logistic model indicated that the following factors significantly distinguished those patients whose most serious suicide attempt occurred during a heavy drinking episode: male gender, younger current age, greater severity of alcohol dependence and the attempt being unplanned. Conclusion: Among the patients in treatment for alcohol dependence who made a suicide attempt, the most serious attempt was likely to have been unplanned and committed by men when it occurred during a heavy drinking episode. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: Several studies have reported high rates of alcohol misuse and low rates of substance use treatment among OEF/OIF military service members. This study assessed the prevalence and correlates of alcohol misuse and the factors associated with treatment utilization among recently returned National Guard service members. Methods: The sample included 585 members of the National Guard who volunteered to complete an anonymous survey assessing mental health and substance use problems, functional status, and past treatment experiences. Bivariate and multivariate logistic regression analyses were performed examining the significance of associations between alcohol misuse and mental health service use as outcomes and demographic variables, mental health symptoms, and military service characteristics as predictors. Barriers to treatment and factors facilitating treatment were also examined. Results: Thirty-six percent of the service members met criteria for alcohol misuse. Of those misusing alcohol, 31% reported receiving any mental health treatment and 2.5% reported receiving specific substance use treatment in the past year. The barrier to treatment most commonly endorsed by those misusing alcohol was concern that the information about treatment would appear in their records. Among those misusing alcohol who had received services, spouses were most commonly endorsed as facilitating the pursuit of care. Conclusions: Rates of alcohol misuse are high and rates of substance use treatment are low among National Guard service members. Additional research is needed to identify means of overcoming barriers to care and establish more effective approaches to facilitate linkage to care and receipt of appropriate interventions. [Copyright &y& Elsevier]

Aims To describe the association between alcohol use disorders (AUDs) and mortality and to examine risk factors for and all-cause, injury-related and non-injury-related mortality among those diagnosed with an AUD. Setting Department of Veterans Affairs, Veterans Health Administration (VHA). Participants A cohort of individuals who received health care in VHA during the fiscal year (FY) 2001 ( n = 3 944 778), followed from the beginning of FY02 through the end of FY06. Measurements Demographics and medical diagnoses were obtained from VHA records. Data on mortality were obtained from the National Death Index. Findings Controlling for age, gender and race and compared to those without AUDs, individuals with AUDs were more likely to die by all causes [hazard ratio (HR) = 2.30], by injury-related (HR = 3.29) and by non-injury-related causes (HR = 2.21). Patients with AUDs died 15 years earlier than individuals without AUDs on average. Among those with AUDs, Caucasian ethnicity and all mental illness diagnoses that were assessed were associated more strongly with injury-related than non-injury-related mortality. Also among those with AUDs, individuals with medical comorbidity and older age were at higher risk for non-injury related compared to injury-related mortality. Conclusions In users of a large health-care system, a diagnosis of an AUD is associated significantly with increased likelihood of dying by injury and non-injury causes. Patients with a diagnosis of an AUD who die from injury differ significantly from those who die from other medical conditions. Prevention and intervention programs could focus separately upon selected groups with increased risk for injury or non-injury-related death. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to examine relationships between genetic markers of central serotonin (5-HT) and dopamine function, and risk for post-treatment relapse, in a sample of alcohol-dependent patients. Methods: The study included 154 patients from addiction treatment programs in Poland, who met DSM-IV criteria for alcohol dependence. After assessing demographics, severity of alcohol use, suicidality, impulsivity, depression, hopelessness, and severity of alcohol use at baseline, patients were followed for approximately 1 year to evaluate treatment outcomes. Genetic polymorphisms in several genes ( TPH2, SLC6A4, HTR1A, HTR2A, COMT, and BDNF) were tested as predictors of relapse (defined as any drinking during follow-up) while controlling for baseline measures. Results: Of 154 eligible patients, 123 (80%) completed follow-up and 48% ( n = 59) of these individuals relapsed. Patients with the Val allele in the Val66Met BDNF polymorphism and the Met allele in the Val158Met COMT polymorphism were more likely to relapse. Only the BDNF Val/Val genotype predicted post-treatment relapse [odds ratio (OR) = 2.62; p = 0.019], and time to relapse (OR = 2.57; p = 0.002), after adjusting for baseline measures and other significant genetic markers. When the analysis was restricted to patients with a family history of alcohol dependence ( n = 73), the associations between the BDNF Val/Val genotype and relapse (OR = 5.76, p = 0.0045) and time to relapse (hazard ratio = 4.93, p = 0.001) were even stronger. Conclusions: The Val66Met BDNF gene polymorphism was associated with a higher risk and earlier occurrence of relapse among patients treated for alcohol dependence. The study suggests a relationship between genetic markers and treatment outcomes in alcohol dependence. Because a large number of statistical tests were conducted for this study and the literature on genetics and relapse is so novel, the results should be considered as hypothesis generating and need to be replicated in independent studies. [ABSTRACT FROM AUTHOR]

Background: The present study examined the patient intake and treatment-related risk factors associated with a suicide attempt in the 30 days before a 1-year posttreatment assessment. Methods: A national sample of 8,807 patients presenting for treatment of substance use disorders (SUDs) in the Department of Veterans Affairs healthcare system were assessed at treatment intake and follow-up. Using the MacArthur Model, the risk and protective factors for suicide attempt were identified at baseline and during treatment. Results: At follow-up, 4% (314/8,807) of the patients reported a suicide attempt within the past 30 days. Baseline predictors of a suicide attempt before follow-up included elevated suicidal/psychiatric symptoms, more recent problematic alcohol use, and longer duration of cocaine use. Contact with the criminal justice system was a protective factor that reduced the likelihood of a future suicide attempt. Greater engagement in SUD treatment was also associated with a reduction in suicide risk. Conclusions: More involvement in SUD treatment reduced the likelihood of a future suicide attempt in high-risk patients. Substance use disorder treatment providers interested in reducing future suicidal behavior may want to concentrate their efforts on identifying at-risk individuals and actively engaging these patients in longer treatment episodes. [ABSTRACT FROM AUTHOR]

The article cites a study which explores the relationship of self-efficacy and coping strategies, which is considered an important determinant of functioning for substance use disorder patients. The research was conducted on male participants from 15 residential substance disorder programs who were evaluated at treatment entry, discharge, and 5-year follow-up. The study reveals that patients with low self-efficacy and reliance on avoidance coping strategies have negative alcohol use outcomes.

Objective: To understand better the relationship between substance-use disorder treatment and abstinence self-efficacy, more information is needed about what factors predict greater abstinence self-efficacy.Method: Participants (n = 2,350) from 88 community residential facilities were assessed at treatment entry and 1-year follow-up. Treatment providers reported on patients' engagement in specific components of treatment. After examining univariate associations with self-efficacy, a multiple regression analysis was used to test a model of patient- and treatment-related predictors of self-efficacy 1 year after treatment.Results: More years of education, lower baseline substance- related problems, and higher baseline confidence in abstinence were associated with higher posttreatment self-efficacy. After controlling for these patient factors, patients who were more engaged in skills-training activities and who inspired providers' confidence in their ability to remain abstinent had higher 1-year self-efficacy.Conclusions: The development of higher levels of posttreatment abstinence self-efficacy is driven not only by what a patient brings to treatment but by the activities a patient engages in during treatment. Because of the close relationship between self-efficacy and treatment outcomes, providers may want to target patients with low self- efficacy for interventions that focus on skills-training techniques. [ABSTRACT FROM AUTHOR]

Abstract: Although motivational readiness to change predicts alcohol use disorder (AUD) treatment outcomes, little is known about treatment aspects that are helpful for patients with low motivation. We examined whether a positive therapeutic alliance is particularly beneficial for patients entering AUD treatment with low motivation. Among Project MATCH outpatients (n = 753), we tested the influence of motivation, therapeutic alliance, and their interaction on 6-month and 1-year alcohol use. The impact of motivation on alcohol use varied depending on therapists'' perceptions of alliance. Interactions involving treatment compliance did not mediate the Motivation × Alliance interaction. Thus, a positive therapeutic relationship may be particularly important for patients with low motivation, but mechanisms underlying this possible patient–treatment “match” remain to be determined. [Copyright &y& Elsevier]

Objective: High abstinence self-efficacy reliably predicts better treatment outcomes for patients with alcohol use disorders, but little is known about aspects of treatment that may be particularly beneficial for patients who enter treatment with low self-efficacy. This study examines whether the relationship between self-efficacy and treatment outcomes is influenced by the quality of the therapeutic alliance in Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), a multisite clinical trial of three treatments for alcohol use disorders. Method: Information on 785 patients in the outpatient sample of Project MATCH was used to test for an interaction between baseline self-efficacy and therapeutic alliance in relation to 1-year alcohol use outcomes. Results: A significant interaction was found between self-efficacy and the therapists' perception of the therapeutic alliance predicting 1-year drinking outcomes. Patients with low self-efficacy who established a strong treatment alliance, as judged by the therapist, experienced 1-year outcomes that were superior to those of patients with low self-efficacy with poorer treatment alliance and comparable with those of patients with high self-efficacy. Therapeutic alliance was not strongly related to the outcomes of patients with high baseline self-efficacy. Conclusions: In patients who are treated for alcohol-use disorders, a positive therapeutic alliance may counteract the negative impact of a low baseline self-efficacy. Potential reasons why the therapist's perception of the alliance may be particularly important for patients with low self-efficacy are discussed. [ABSTRACT FROM AUTHOR]

Objective: Numerous studies report high rates of sub- stance-related problems and psychopathology in substance use disorder (SUD) patients with a history of a suicide attempt. However, little is known about the response of suicidal SUD patients to treatment. This study examined the treatment outcomes of suicidal and nonsuicidal SUD patients who were followed for 5 years. Method: A total of 2099 male SUD patients were recruited from 15 Department of Veterans Affairs residential alcohol and drug treatment programs and were assessed at four points (treatment entry discharge, and 1 and 5 years later). Approximately 7% (n = 156) of the patients reported a suicide attempt in the 3 months prior to the start of treatment. Results: Although patients with a recent suicide attempt reported severe patterns of alcohol use and elevated psychiatric symptoms at baseline, they showed significant improvements in both of these domains at discharge from residential treatment, and these improvements were still evident at 1-year and 5-year follow-ups. Suicidal SUD patients were no more likely to leave teatment early than were nonsuicidal patients, and they received slightly longer and more individualized treatment Conclusions: Despite a more severe pattern of alcohol use and psychiatric symptoms at baseline, suicidal SUD patients benefitted substantially from residential SUD teatment. These findings imply that suicidal SUD patients can be treated effectively within SUD treatment settings. [ABSTRACT FROM AUTHOR]

Background: Compared to civilians, little is known about cannabis use among Veterans in the general United States (US) population. This study aimed to examine the prevalence and correlates of recent medical and non-medical cannabis use among this important US sub-population.Method: Data came from the 2014 National Survey on Drug Use and Health. Bivariate and multivariable analyses were conducted that were weighted to account for the complex survey design.Results: Approximately 9% of Veterans in the US reported past year cannabis use. Older, and female, Veterans had lower odds of past year cannabis use. Veterans who were unmarried, out of the work force, had greater functioning disability, nicotine dependence, heavy episodic alcohol use, alcohol use disorder, and drug use had greater odds of past year cannabis use. In states where medical cannabis was legal in 2014, approximately 41% of Veterans who used cannabis in the past year used medically. Those who used medically were older and less likely to engage in recent heavy episodic drinking or to meet criteria for alcohol abuse/dependence, compared to Veterans using non-medically.Conclusion: Compared to non-Veterans in the US general population, recent cannabis use was similar or slightly lower among Veterans. However, among those with past year use, the proportion of those using medically was more than double that of the general population. Because only non-medical cannabis use was associated with higher rates of heavy episodic alcohol use and alcohol use disorder, it may be important to address problematic alcohol consumption among this high-risk group. [ABSTRACT FROM AUTHOR]

Background: Driving under the influence of cannabis (DUIC) is a public health concern among those using medical cannabis. Understanding behaviors contributing to DUIC can inform prevention efforts. We evaluated three past 6-month DUIC behaviors among medical cannabis users with chronic pain.Methods: Adults (N = 790) seeking medical cannabis certification or recertification for moderate/severe pain were recruited from February 2014 through June 2015 at Michigan medical cannabis clinics. About half of participants were male (52%) and 81% were White; their Mean age was 45.8 years. Participants completed survey measures of DUIC (driving within 2 h of use, driving while "a little high," and driving while "very high") and background factors (demographics, alcohol use, etc.). Unadjusted and adjusted logistic regressions were used to examine correlates of DUIC.Results: For the past 6 months, DUIC within 2 h of use was reported by 56.4% of the sample, DUIC while a "little high" was reported by 50.5%, and "very high" was reported by 21.1%. Greater cannabis quantity consumed and binge drinking were generally associated with DUIC behaviors. Higher pain was associated with lower likelihood of DUIC. Findings vary somewhat across DUIC measures.Conclusions: The prevalence of DUIC is concerning, with more research needed on how to best measure DUIC. Prevention messaging for DUIC may be enhanced by addressing alcohol co-consumption. [ABSTRACT FROM AUTHOR]

Background: The primary aim of this study was to examine the efficacy of two motivational interviewing-based alcohol brief interventions (BIs) among adults presenting to an emergency department (ED). The secondary aim was to evaluate moderators of intervention effects.Methods: Participants were 750 ED patients reporting recent alcohol misuse. Participants were randomly assigned to: 1) computer-delivered BI (Computer BI), 2) therapist-delivered BI with computer guidance (Therapist BI-CG), or 3) control. The BIs focused on reduction of alcohol use and risk behaviors. The outcome measure was trajectories of alcohol consumption (measured by the AUDIT-C) across baseline, 3-, 6- and 12-month follow-up assessments, analyzed using latent growth curve modeling. Moderation of intervention effect by gender, age, and baseline alcohol use disorder severity was examined.Results: Across the full sample (40% males, mean age = 35.8, SD = 12.3), there was an overall reduction in alcohol consumption across 12 months. The main effects of the Therapist and Computer BI were not significant relative to control. Moderation analysis revealed that the impact of Therapist BI-CG, relative to control, was greater on reductions in alcohol consumption in participants with moderate to severe symptoms of alcohol use disorder compared to those with mild symptoms. The effect of the Computer BI on alcohol use, relative to control, was greater among younger participants compared to older participants.Conclusions: While no overall effect was shown, ED-based Therapist BI-CG with computer guidance may be effective among patients with moderate-severe drinking patterns, whereas Computer BIs may be more effective for younger participants. [ABSTRACT FROM AUTHOR]

Background Psychiatry inpatients frequently have co-occurring substance use and mental health disorders, which are related to poor post-discharge outcomes. Telephone monitoring is effective in specialty substance use disorder treatment settings in increasing continuing care and 12-step program utilization and improving substance use outcomes. This study examined the effectiveness of telephone monitoring among psychiatry inpatients with co-occurring substance use and mental health disorders. Methods This randomized controlled trial (n = 406) compared usual care to usual care plus telephone monitoring (one in-person session during the inpatient stay, followed by weekly telephone contact for three months post-discharge). Follow-ups were conducted at end-of-intervention (three months post-baseline) and nine and 15 months post-baseline (73% followed). Primary outcomes were number of days out of the past 30 of drinking alcohol, using drugs, and experiencing psychological problems. Secondary outcomes were outpatient substance use treatment, and 12-step group, utilization. Results Longitudinal modeling found that patients in both conditions improved over time on each primary outcome. Improvement was comparable between conditions on alcohol and drug use and psychological problems. Receipt of outpatient treatment decreased over the follow-up period and was not related to condition. Likelihood of attending 12-step group meetings did not change over follow-ups, and was not related to condition. Conclusions Improvement over time was evident regardless of condition assignment. Patients maintained attendance at 12-step groups from pre- to post-discharge. Short-term telephone monitoring in addition to usual care for patients with co-occurring substance use and mental health disorders may not be sufficiently intensive to achieve additional improvements on outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To examine the prevalence and correlates of vaporization (i.e., "vaping") as a route of cannabis administration in a sample of medical cannabis patients.Procedures: Adults ages 21 and older (N=1485M age=45.1) who were seeking medical cannabis certification (either for the first time or as a renewal) at medical cannabis clinics in southern Michigan completed a screening assessment. Participants completed measures of route of cannabis administration, cannabis use, alcohol and other substance use.Findings: An estimated 39% (n=511) of the sample reported past-month cannabis vaping, but vaping as the sole route of cannabis administration was rare. Specifically, only 30 participants (2.3% of the full sample and 5.9% of those who reported any vaping) indicated vaping as the sole route of cannabis administration. The majority (87.3%) of those who reported vaping also reported smoking (combustion) as a route of cannabis administration. Being younger than age 44, having more than a high school education, engaging in nonmedical stimulant use, being a returning medical cannabis patient, and greater frequency of cannabis use were associated with higher odds of vaping at the bivariate level and with all variables considered simultaneously.Conclusions: Vaping appears to be relatively common among medical cannabis patients, but is seldom used as the sole route of cannabis administration.Results: highlight the importance of monitoring trends in vaping and other substance use behaviors in this population and underscore the need for longitudinal research into the motives, correlates, and consequences of cannabis vaping in medical cannabis patients. [ABSTRACT FROM AUTHOR]