Symptomatic Exposures among California Inmates 2011-2013

Prisoners have a high prevalence of substance misuse and abuse, but few studies have examined symptomatic exposures among incarcerated populations. We sought to further characterize the nature of these exposures among this population using the California Poison Control System data. Keyword searches identified inmate cases in 2011-2013 for patients 20+ years old exposed to a single substance and taken to hospital from jail, prison, or police custody. 

Comparisons were made with non-inmate cases during the same period, using similar limitations. Body stuffers and body packers were analyzed as a subgroup. Seven hundred four inmate cases were compared to 106,260 non-inmate cases. Inmates were more likely to be younger, male, and to have engaged in drug misuse or abuse. They most commonly ingested methamphetamine, heroin, acetaminophen, and anticonvulsants. Inmates were more likely to receive activated charcoal, whole bowel irrigation, undergo endotracheal intubation, and to experience a major clinical outcome or death. 

When body stuffers and packers were removed, clinical findings were similar, though the odds of a major outcome or death became statistically non-significant. Body stuffers and body packers primarily used methamphetamine and heroin, and compared with other inmates had significantly higher odds of both adverse clinical effects and poor outcome. 

This large series provides a profile of symptomatic exposures among inmates, a little-studied population. The potential for high morbidity among body stuffers and packers suggests that a high index of suspicion of such ingestions be maintained when evaluating patients prior to incarceration.

Via:  http://ht.ly/S6INw

By: Butterfield M1, Al-Abri S, Huntington S, Carlson T, Geller RJ, Olson KR.
1Department of Internal Medicine, Tulane University Medical Center, New Orleans, LA, USA

Adolescent Substance Misusers With & Without Delinquency: Death, Mental & Physical Disorders & Criminal Convictions from Age 21 to 45

Little is known about adult outcomes of males who as adolescents sought treatment for alcohol misuse or drug use, and who additionally were engaging or not engaging in other forms of delinquency. Since the rates of negative outcomes vary in the general population, the study determined whether the sub-groups of clinic attendees fared differently as compared to males of the same age who had not sought treatment for substance misuse from age 21 to 45. 

Adolescent males who consulted the only substance misuse clinic in a Swedish city between 1968 and 1971 were divided into four groups: ALCOHOL no drug use, no criminal offending (n=52); ALCOHOL+D no drug use, plus criminal offending (n=105); DRUG use, no criminal offending (n=92); and DRUG+D plus criminal offending (n=474). These four groups were compared to a general population sample (GP) of males matched on age and birthplace, who did not seek treatment for SM in adolescence. National Swedish registers provided data on death, hospitalizations for substance misuse (SM), mental and physical disorders, and criminal convictions. 

Compared to the GP, and after controlling for co-occurring adult outcomes:

• ALCOHOL showed elevated risks for SM hospitalization and convictions for violent crimes, and DRUG showed elevated risks for SM hospitalization, convictions for non-violent crimes, and hospitalization for psychosis. 
• ALCOHOL+D and DRUG+D showed increased risk for SM hospitalization, violent and non-violent convictions, and DRUG+D additionally, for death, and hospitalizations for psychosis and physical illness. 
• Misuse of alcohol without drug use or other delinquency in adolescence was associated with increased risk for convictions for violent crimes during the subsequent 25 years, in addition to SM, while adolescent drug use without other forms of delinquency was associated with increased risks for convictions for non-violent crimes, hospitalizations for SM, and non-affective psychosis. 
• Cannabis use, with and without delinquency, was associated with subsequent hospitalization for non-affective psychosis. 

Consistent with contemporary studies, most adolescents treated for SM from 1968-1971 presented delinquency that was associated with an increase in risk of all adverse outcomes to age 45.

Via: http://ht.ly/S0wpi

By: Larm P1, Silva TC2, Hodgins S3.

• 1Maria Ungdom Research Centre, Karolinska Institutet, Stockholm County Council, Stockholm, Sweden; Centre for Clinical Research Västerås, Uppsala University, Västmanland County Hospital Västerås, Västerås, Sweden. Electronic address: peter.larm@ltv.se.
• 2Center for Developmental Research, Örebro University, Örebro, Sweden.
• 3Maria Ungdom Research Centre, Karolinska Institutet, Stockholm County Council, Stockholm, Sweden; Département de Psychiatrie, Université de Montréal, Montréal, Canada.

Violent and non-violent methods of attempted and completed suicide in Swedish young men: The role of early risk factors

Below:  Time-lag between the first suicide attempt and subsequent suicide in 133 men, expressed in years

Below:  Survival curves for suicide in attempters and non-attempters

A total of 1195 (2.4 %) men had made a suicide attempt and of these, 133 (11.1 %) committed suicide later. The number of suicide victims among the non-attempters was 482 (1 %). Half of the suicides occurred during the same year as the attempt. Suicide victims had earlier onset of suicidal behaviour and had more often used hanging as a method of attempted suicide than those who did not later commit suicide. The early risk factors for both violent and non-violent methods of suicide attempt were quite similar.

Violent suicide attempts, especially by hanging, are associated with a clearly elevated suicide risk in men and require special clinical and public health attention. The early risk factors related to the choice of either a violent or a non-violent suicide attempt method are interlinked and circumstantial factors temporally close to the suicide attempt, such as access to a specific method, may partly explain the choice of method.

Read more at:  http://ht.ly/QUFnG HT @karolinskainst 

Patient Valuation of Primary Care-Based Treatment Options for Substance Use & Mental Health Disorders

Below:  Unadjusted self-reported willingness to enter treatment, by treatment type and price

Most individuals with substance use and mental health disorders do not receive treatment. If treatment options were more attractive, treatment rates might increase. Although the advantages of novel approaches, including primary care-based treatment and collaborative care in a primary care setting, have been documented, less is known about consumers’ valuation of these options. Contingent valuation methods were used to assess monetary valuation of these treatment types relative to usual care in specialty treatment using a national randomized experiment. Participants valued a primary care-based treatment visit over usual care by $9.00 and a collaborative care visit over usual care by $5.85.

Read more at:  http://ht.ly/QL716 HT @PennMedicine 

Adolescent Substance Use: The Role of Demographic Marginalization and Socioemotional Distress

Below:  Conceptual model of relationships among race/ethnic marginalization, socioemotional distress, and substance use with student gender, race/ethnicity, and schoolwide race/ethnic diversity as moderators.

We investigated the links between race/ethnic marginalization (i.e., having few same-race/ethnic peers at school) and adolescents’ socioemotional distress and subsequent substance use (alcohol and marijuana) initiation and use. Data from 7,731 adolescents (52% females; 55% White, 21% African American, 16% Latino, 8% Asian American) were drawn from the National Longitudinal Study of Adolescent to Adult Health (Add Health). In our path analysis model, we found that adolescents who were racial/ethnically marginalized at school (i.e., who had less than 15% same-ethnic peers) reported poorer school attachment, which was linked to greater depressive symptoms. More depressive symptoms were associated with higher levels of subsequent marijuana and alcohol use. These relationships showed some variation by students’ gender, race/ethnicity, and age. Findings suggest that the influence of school demographics extends beyond the academic domain into the health and well-being of young people.

Via:   http://ht.ly/QrTez   HT @UTAustin

Gendered Pathways: Violent Childhood Maltreatment, Sex Exchange, and Drug Use

Below:  Parameter Estimates for Direct-Indirect Effects Model in Women and Men

Note: Unstandardized regression weights (and standard errors) for women are left of the diagonal and in bold; estimates for men are right of the diagonal and in regular font. Correlations between the independent variables are not shown, but are similar to those reported in Table 1.

First, structural equation modeling revealed that childhood sexual and physical abuse were related to increased drug engagement in women and men, respectively, above the influence of early childhood contextual variables (e.g., neighborhood, family) and age. Second, sexual abuse was related to sex exchange, which in turn was related to drug use symptoms in women but not men.

These data provide empirical support for distinct trauma-related pathways to drug use problems in men and women, which has implications for gendered explanations and prevention approaches.

Via:   http://ht.ly/QngMt  HT @USouthFlorida 

Alcohol Dependence and Treatment Utilization in Europe

Below:  Prevalence of alcohol dependence diagnoses by GP or CIDI, stratified by age categories. Figure displaying age effect on alcohol dependence categories. Legend: (Blue bars) Diagnosis by GP, (Red bars) Diagnosis by CIDI, (Dashed line) Regression line GP diagnosis, (Continuous line) Regression line CIDI diagnosis

Alcohol dependence (AD) was prevalent among patients in European primary health care settings (8.7 %, 95 % confidence interval (CI): 8.1-9.3 %). Treatment rates were low (22.3 % of all AD cases, 95 % CI: 19.4-25.2 %). For both prevalence and treatment utilization, considerable country variations were observed. AD was associated with a number of socio-economic disadvantages (e.g. higher unemployment rate) and higher physical (e.g., liver disease, hypertension) and mental comorbidities (e.g., depression, anxiety). Liver problems, mental distress and daily amount of alcohol used were higher among treated versus untreated male patients with AD.

A minority of people identified as having AD received treatment, showing heavier drinking patterns and a higher level of co-morbidity. Different types of treatment, depending on severity of AD, should be considered.

Via:   http://ht.ly/Qgng7  HT @CAMHnews