Comparison of the prevalence of substance use and psychiatric disorders between government- and self-employed commercial drivers

Five hundred and five city government-employed bus drivers (GED) and 506 self-employed drivers (SED) who were primarily taxi drivers attending annual health check-ups were studied. A two-step survey was applied. Data on basic demographics were collected, the 12-item Chinese Health Questionnaire (CHQ), Michigan Alcoholism Screening Test (MAST), Drug Abuse Screen Test (DAST) questionnaires were administered and urine drug screening for amphetamine and benzodiazepines was performed in all subjects. Subjects with MAST scores > or =3, DAST > or =5 from both groups and CHQ > or =4 for the GED group and CHQ > or =7 for the SED group were regarded as a high-risk group; and subjects with normal MAST, DAST and CHQ results serving as the comparison group were invited for further interview by psychiatric specialists using the Mini International Neuropsychiatric Interview. The mean CHQ scores were 0.94 +/- 1.53 for the GED group and 2.08 +/- 2.42 for the SED group. The mean MAST scores for the GED and SED groups were 0.23 +/- 0.58 and 0.38 +/- 1.12; and the mean DAST scores were 1.03 +/- 0.85 and 1.41 +/- 1.89, respectively. The positive rate for benzodiazepines in urine screening by enzyme immunoassay was 8.3% for the GED group, and 8.5% for the SED group. After specification using liquid chromatography, this rate reduced to 4.6% and 3.7%, respectively. Only one subject in the SED group tested positive for urine amphetamine. The SED group had a higher rate of neurotic problems, psychiatric diagnosis and a higher frequency of substance use than the GED group. These findings suggest that different work style of commercial drivers may contribute to this phenomenon. The rate of psychiatric diagnosis was significantly higher in the high-risk subjects from both groups. Questionnaires such as CHQ, DAST and MAST are useful tools to screen out subjects at high risk of psychiatric disorders during routine health checks in labor workers.     

Ecstasy and drug consumption patterns: a Canadian rave population study.

OBJECTIVE: This study investigates the drug consumption patterns of a sample of rave attendees in the city of Montreal, Quebec, and seeks to identify the prevalence of 3,4-methylendioxymethamphetamine (MDMA) and other drug use in this population. METHOD: We administered a self-report questionnaire to 210 respondents. For various licit and illicit substances, participants reported their age of first use, number of lifetime uses, and usage in the previous 30 days. RESULTS: We found a significant rank order for the sequence of first use: 1) alcohol, 2) nicotine, 3) cannabis, 4) LSD, 5) psilocybin, 6) amphetamine, 7) cocaine, 8) MDMA, 9) gamma-hydroxybutyrate (GHB), 10) ephedrine, 11) ketamine. Alcohol and cannabis were the most commonly used substances, both in cumulative number of lifetime uses and in usage in the preceding 30 days. MDMA and amphetamine were also notable as the next 2 most popular drugs for use in the preceding 30 days and in terms of those who had tried the drugs at least once. We identified a progressive rank order of experimentation, with early alcohol or cannabis use (or both) associated with the early use of all other drugs tried by more than 25% of the sample. We found MDMA and amphetamine use to be prevalent, as was general experimentation with all drugs studied, other than heroin. CONCLUSION: Drug consumption levels were substantial in this "rave" population, particularly with respect to recent use of MDMA, amphetamine, cannabis, and alcohol. Results also indicate that the sequence of drug experimentation in this population follows an identifiable pattern.     

Patients who use drugs during inpatient substance abuse treatment.

OBJECTIVE: Drug use by patients during inpatient substance abuse treatment is frequently a cause of premature hospital discharge. The authors examined the histories of patients who used drugs while in inpatient substance abuse treatment, the methods used to detect drug use, and the temporal relationship of drug use episodes. METHOD: The authors reviewed the charts of patients admitted consecutively to an inpatient substance abuse treatment unit between 1981 and 1988. Of 729 patients, 42 were found to have used drugs while receiving inpatient treatment. The diagnoses and clinical histories of these 42 patients were compared with those of all other patients. Methods of detection and circumstances of drug use were recorded, and drug use episodes were plotted on a time line that was examined for temporal clustering. RESULTS: Significantly more of the patients who used drugs during inpatient substance abuse treatment had primarily used heroin or methadone before treatment. Random urine screens, self-report, and staff observation together detected approximately 85% of the patients who used drugs during treatment. Episodes of drug use did cluster in time, but within clusters the hospital stays of the patients who used drugs did not necessarily overlap. CONCLUSIONS: Temporal clustering of drug use episodes may occur because drug use by one patient heralds drug availability and stimulates craving in other inpatients. Clinicians should be aware that one episode of drug use may be followed by others. Multiple detection methods, including random comprehensive urine screens, should be used to test for drug use on inpatient units.     

Validation of the alcohol use disorders identification test and the drug abuse screening test in first episode psychosis

OBJECTIVE: To determine the validity and reliability of the Alcohol Use Disorders Identification Test (AUDIT) and Drug Abuse Screening Test (DAST) for detecting alcohol and drug use disorders, respectively, in a population with first-episode psychosis (FEP). METHOD: Subjects with FEP completed the AUDIT and DAST and were divided into groups according to the presence or absence of a Structured Clinical Interview for DSM-IV (SCID) diagnosis of either current alcohol or drug misuse. The data were analyzed to see whether AUDIT and DAST scores were predictive of SCID diagnosis. RESULTS: Patients with alcohol-related SCID diagnoses and those with drug-related SCID diagnoses scored significantly higher on the AUDIT and DAST, respectively, than the group without the respective SCID diagnosis (P < 0.001 in both cases). The AUDIT functioned best with a problem drinking cut-off score of 10 (sensitivity, 85%; specificity, 91%). The DAST functioned best with a problem drug use cut-off score of 3 (sensitivity, 85%; specificity, 73%). The area under the receiver operating characteristic curve was 0.86 for the AUDIT and 0.83 for the DAST. CONCLUSION: The DAST and AUDIT may reliably identify FEP patients with substance abuse.     

Aspirin and Clopidogrel for Prevention of Ischemic Stroke

Cerebrovascular disorders contribute to the morbidity and disability associated with illicit drug use. Drug abusers have an increased risk of both hemorrhagic and ischemic stroke. In geographic areas with a high prevalence of illicit drug use, drug abuse is a frequent cause of stroke in the young adult. The illicit drugs more commonly associated with stroke are psychomotor stimulants, such as amphetamine and cocaine. Less commonly implicated are opioids and psychotomimetic drugs, including cannabis. Toxicology screening for illicit drugs should be done in young patients with stroke with no obvious cause, or if suggested by history or examination. Although in some patients the mechanism of stroke is identified using neuroimaging and other modern diagnostic tools, in a sizeable fraction of cases the mechanism of stroke remains unclear. Further studies are needed to elucidate the role of hemodynamic and immunologic mechanisms in these cases.     

Danske Psykiateres Organisation: Formandsberetning

Background: Estimates of psychoactive substance use among acutely admitted psychiatric patients vary among studies, and few have used comprehensive laboratory methods. Aims: This study used chromatography-based analyses of blood and urine to identify the rates of substance use among acute psychiatric admissions, and to study the associations with socio-demographic variables, clinical characteristics and patients’ reports of symptoms, substance use and need for treatment. Methods: A cross-sectional study was conducted in 2006/2007 in Oslo, Norway. Blood and urine samples were collected from 298 acute psychiatric admissions and extensively analysed for alcohol, medicinal and illicit drugs. Psychotic symptoms were assessed with the positive subscale of the Positive and Negative Syndrome Scale. Patient self-report questionnaires included the Alcohol and Drug Use Disorder Identification Tests. Patients were also asked if they needed professional help for substance use. Results: Psychoactive substances were detected in 63% of the 298 admissions, medicinal drugs in 46%, alcohol in 12% and illicit drugs in 28%. Patients using alcohol had a high suicidal risk score at admission and the shortest length of stay (median 1 day). Use of illicit drugs was associated with psychotic symptoms and readmission. Self-report questionnaires indicated harmful use of alcohol for half of the patients and of other substances for one-third. A need for professional help for substance use was reported by one-third of patients. Conclusion: Given the high rates of substance use and the important clinical associations, drug screening seems warranted in acute psychiatric settings. Interventions designed for substance-using patients should be developed and integrated.     

精神活性物质所致精神障碍

1病史摘要 患者，男，35岁，因“反复使用冰毒4年，易激惹2个月，猜疑，耳闻入语伴失眠10d”第二次入住上海市精神卫生中心戒毒科。患者于2006年在朋友影响下，因好奇开始吸食冰毒（甲基苯丙胺），当时人很兴奋，不停地说话。最初1～2个月才使用一次。2007年使用频率增加，有时隔几天一次，后来几乎每天使用，每次1～6条，剂量不等。     

Drug abuse and stroke]

Today, drug abuse pervade all over the world. Drug abusers are increasing year after year also in recent Japan especially among young people. Ischemic and hemorrhagic stroke frequently occur after use of illegal drugs. We reported two cases of young stroke associated with drug misuse. Case 1 used amphetamine, cocaine, marijuana and LSD for few yaers, and developed occlusion of a middle cerebral artery. Case 2 presented aphasia shortly after marijuana smoking. His protein S activity was low. He did not have other risk factor of cerebrovascular disease. Marijuana may have accelerated stroke onset, but essential cause of stroke in this case must be protein S mutation. Medical examination for young stroke should include screening of drug abuse and searching for coagulation disorder.     

A randomized, double-blind, placebo-controlled, trial of lamotrigine therapy in bipolar disorder, depressed or mixed phase and cocaine dependence

Bipolar disorder is associated with very high rates of substance dependence. Cocaine use is particularly common. However, limited data are available on the treatment of this population. A 10-week, randomized, double-blind, placebo-controlled trial of lamotrigine was conducted in 120 outpatients with bipolar disorder, depressed or mixed mood state, and cocaine dependence. Other substance use was not exclusionary. Cocaine use was quantified weekly by urine drug screens and participant report using the timeline follow-back method. Mood was assessed with the Hamilton rating scale for depression, quick inventory of depressive symptomatology self-report, and young mania rating scale. Cocaine craving was assessed with the cocaine-craving questionnaire. Data were analyzed using a random regression analysis that used all available data from participants with at least one postbaseline assessment (n=112). Lamotrigine and placebo groups were similar demographically (age 45.1±7.3 vs 43.5±10.0 years, 41.8% vs 38.6% women). Urine drug screens (primary outcome measure) and mood symptoms were not significantly different between groups. However, dollars spent on cocaine showed a significant initial (baseline to week 1, p=0.01) and by-week (weeks 1-10, p=0.05) decrease in dollars spent on cocaine, favoring lamotrigine. Few positive trials of medications for cocaine use, other than stimulant replacement, have been reported, and none have been reported for bipolar disorder. Reduction in amount of cocaine use by self-report with lamotrigine suggests that a standard treatment for bipolar disorder may reduce cocaine use. A study limitation was weekly assessment of urine drug screens that decreased the ability to detect between-group differences.     

Illicit drug use in patients with psychotic disorders compared with that in the general population: a cross-sectional study

Objective: Prevalence estimates of illicit drug use in psychotic disorders vary between studies, and only a few studies compared prevalence estimates with those in the general population. Method: Cross‐sectional study comparing 148 stable‐phase patients with schizophrenia or bipolar disorder with 329 representative general citizens of Oslo. A total of 849 patients from the same hospital department in the same time period constituted a patient reference group. Results: Lifetime illicit drug use was 44% higher (P < 0.001) in study patients than in the general population sample; while lifetime use of amphetamine/cocaine was 160% higher (P < 0.001). No differences were found between user groups for sociodemographic characteristics. Conclusion: Patients with psychotic disorders in stable phase had a markedly higher lifetime use of any illicit substance, especially amphetamine/cocaine, than the general population. They also seemed to use drugs more periodically. The same sociodemographic characteristics were associated with increased illicit drug use in both groups.     

Norepinephrine transporter gene variation modulates acute response to D-amphetamine.

BACKGROUND: Individual differences in subjective responses to stimulant drugs such as amphetamine may influence risk of abuse as well as clinical-treatment response to these drugs. Because the effects of amphetamine are mediated in part by the norepinephrine transporter (SLC6A2), we examined interindividual differences in mood response to amphetamine in relation to SLC6A2 gene polymorphisms. METHODS: Ninety-nine healthy volunteers participated in three sessions in which they randomly received either placebo or D-amphetamine (10 mg or 20 mg) under double-blind conditions. Every subject completed self-report measures on subjective effects (Profile of Mood States). Afterward, all individuals were genotyped for eight SLC6A2 gene polymorphisms. Individual genotypes and haplotypes were investigated. RESULTS: The intronic 36001C/C (rs47958) genotype was associated with increases in positive mood and elation after 20 mg of D-amphetamine. Positive mood and elation levels were also found to be associated with the haplotype GCC formed from 28257G/C (rs36017), 28323C/T (rs2270935), and 36001A/C (rs47958). These findings remained significant after adjustment for multiple testing. CONCLUSIONS: Polymorphisms in the SLC6A2 gene were associated with mood responses to D-amphetamine. If confirmed, this observation may contribute to a better understanding of interindividual variations in the clinical response to amphetamine and in the risk of becoming addicted to amphetamine.     

A 33-year follow-up of narcotics addicts

BACKGROUND: This study examined longitudinal patterns of heroin use, other substance use, health, mental health, employment, criminal involvement, and mortality among heroin addicts. METHODS: The sample was composed of 581 male heroin addicts admitted to the California Civil Addict Program (CAP) during the years 1962 through 1964; CAP was a compulsory drug treatment program for heroin-dependent criminal offenders. This 33-year follow-up study updates information previously obtained from admission records and 2 face-to-face interviews conducted in 1974-1975 and 1985-1986; in 1996-1997, at the latest follow-up, 284 were dead and 242 were interviewed. RESULTS: In 1996-1997, the mean age of the 242 interviewed subjects was 57.4 years. Age, disability, years since first heroin use, and heavy alcohol use were significant correlates of mortality. Of the 242 interviewed subjects, 20.7% tested positive for heroin (with additional 9.5% urine refusal and 14.0% incarceration, for whom urinalyses were unavailable), 66.9% reported tobacco use, 22.1% were daily alcohol drinkers, and many reported illicit drug use (eg, past-year heroin use was 40.5%; marijuana, 35.5%; cocaine, 19.4%; crack, 10.3%; amphetamine, 11.6%). The group also reported high rates of health problems, mental health problems, and criminal justice system involvement. Long-term heroin abstinence was associated with less criminality, morbidity, psychological distress, and higher employment. CONCLUSIONS: While the number of deaths increased steadily over time, heroin use patterns were remarkably stable for the group as a whole. For some, heroin addiction has been a lifelong condition associated with severe health and social consequences.     

Patterns of substance use in adolescents attending a mental health department

This study aimed to describe patterns of substance use in adolescents initiating mental health treatment and analyse factors associated with a high-risk pattern of substance use differentially by gender. Two hundred and thirty-seven 12- to 17-year-old new patients in an urban public mental health service were prospectively recruited and evaluated using semi-structured interviews and standardized questionnaires to obtain socio-demographic, psychopathological, family, school and substance use data. The most prevalent primary diagnoses among males were attention deficit disorder and conduct disorder, while among females they were eating disorders, affective and conduct disorders. Substance use disorder was diagnosed as follows: cannabis in 10.1% of the sample, alcohol in 3.4% and other drugs in 0.4%. A pattern of substance use with high risk of developing problems (at least regular use of alcohol or occasional use of cannabis or other illegal drugs) was found in 48.9% of the sample. After adjusting for age in the multivariate logistic regression, this pattern of risky use of drugs was found to be associated with Youth Self-Report scales of thought problems, delinquent and aggressive behaviour, in both genders. Altered family structure, having had to repeat a school grade and Youth Self-Report attention problems were only significantly associated with risky drug consumption in females. The high prevalence of risky and problematic substance use in adolescents entering mental health treatment warrants early systematic screening and specific preventive and therapeutic interventions, addressing mental health psychoeducation and motivation to avoid drugs, as well as differential associated risk factors for males and females.     

Recidivism among male subjects incarcerated for illicit drug use in Taiwan

Illicit drug users are generally considered both patients and criminals in Taiwan. This study presents drug use behaviors and criminal recidivism of male subjects incarcerated for illicit drug use in Taiwan after detoxification at a detention center. This study also examined the relationship between drug use behaviors and subsequent recidivism. Charts and crime records of 794 male patients from the acute detoxification unit in a detention center in northern Taiwan were reviewed. These subjects were incarcerated for methamphetamine or/and heroin use. The authors examined the relationship between the variables collected during detoxification and subsequent recidivism of illicit drug use in the following 5 years after detoxification. Of 794 subjects, 539 (67.9%) were repeat offenders during the following 5 years after detoxification. Their recidivism occurred primarily within the first 2 years after being released into the community. The recidivism rate for heroin users was significantly higher than that of methamphetamine users. Aged under 30 years, a previous criminal record, and a positive urine analyses test for illicit drugs upon entering the detoxification unit were significantly associated with recidivism. Recidivism rates of illicit drug users in Taiwan after detoxification in the detention center were substantially high. The efficacy of detoxification programs at detention centers in Taiwan needs to be re-evaluated.     

Social functioning, psychopathology, and medication side effects in relation to substance use and abuse in schizophrenia

OBJECTIVE: To identify correlates of self-reported substance use and problems associated with that use in people with schizophrenia. METHODS: A sample of 404 patients with schizophrenia, schizoaffective disorder, or schizophreniform disorder and longitudinal assessments of substance use were examined. Three groups were formed according to consistency of substance use over time: No/Low Alcohol, Alcohol Only, and Drug Use (with or without alcohol use). Similar groups were formed regarding problems associated with alcohol use. Groups were compared on demographics, psychiatric history, psychopathology, medication side effects, and social functioning. RESULTS: Substance users were more likely to be young, male, and to have lower levels of education. Substance users generally had fewer negative symptoms, more social contacts, and better social-leisure functioning. However, substance users, especially drug users, also were rated as having more interpersonal and family problems, had an earlier age at first psychiatric hospitalization, and were more likely to have been recently hospitalized. Patients reporting problems with alcohol use reported more frequent alcohol and drug use, greater severity of akathisia, and problems in interpersonal, family, and self-efficacy domains. CONCLUSIONS: Many of the same variables that correlate with substance use disorder also correlated with moderate substance use in this sample of people with schizophrenia. Although moderate users of alcohol and drugs may have better social functioning in some areas, they also are likely to have substantial problems in interpersonal relationships, especially those involving family members.     

Psychological symptoms and drug use severity among Israeli adolescents presenting for outpatient drug abuse treatment

The objective of this study was to assess the rates of externalizing and internalizing symptoms, and the relation between psychological symptoms and drug use severity, among 117 Israeli adolescents presenting for outpatient drug abuse treatment. Psychological symptoms were assessed via both adolescent self-report and parent report. Drug use was assessed using both adolescent self-report and urinalysis. Results showed that 58% of the sample evidenced clinical levels of psychological symptoms, with girls evidencing higher rates of externalizing and mixed symptomatology than boys. Parents' report of adolescents' internalizing symptoms predicted severity of drug use. These findings suggest that treatment for this population should be multidimensional, and address not only drug use per se, but also psychological risk factors.     

Narcotic use in southeast Asia and afterward. An interview study of 898 Vietnam returnees.

From all US Army enlistees leaving Vietnam in September 1971, a random sample of 943 men was selected. Of these, 470 represented a "general" sample of all enlistees returning at that time, and 495 represented a "drug positive" sample whose urine samples had been positive for opiates at the time of departure. We attempted to locate and personally interview all of the men in the samples. Results indicate that before arrival, hard drug use was largely casual, and less than 1% had ever been addicted to narcotics. In Vietnam, almost half of the general sample tried narcotics and 20% reported opiate addiction. After return, usage and addiction essentially decreased to pre-Vietnam levels. We discuss the use of nonnarcotic drugs, predictors and correlates of drug use in the samples, and the relationship of drugs to post-Vietnam social adjustment.     

The prevalence of psychiatric disorders in patients with alcohol and other drug problems

A survey evaluated the lifetime and current prevalence of mental disorders in 501 patients seeking assistance with alcohol and other drug problems at an addiction research and treatment facility. Information was gathered using the National Institute of Mental Health Diagnostic Interview Schedule (DIS) and computer diagnoses were generated according to DSM-III criteria. Four fifths (78%) of the sample had a DIS lifetime psychiatric disorder in addition to substance use, and two thirds (65%) had a current DIS mental disorder. Excluding the unreliably diagnosed generalized anxiety disorder, the most common lifetime disorders were antisocial personality disorder, phobias, psychosexual dysfunctions, major depression, and dysthymia. Patients who abused both alcohol and other drugs were the most psychiatrically impaired. Patients with DIS psychiatric disorders had more severe alcohol and other drug problems. Barbiturate/sedative/hypnotic, amphetamine, and alcohol abusers were the most likely to have a DIS mental disorder.     

Nicotine treatment produces persistent increases in amphetamine-stimulated locomotor activity in periadolescent male but not female or adult male rats

Nicotine is a popular addictive drug used among the adolescent population, and it has long been questioned whether nicotine use in adolescence may lead to the use of other psychostimulant drugs. It is not fully understood, however, how nicotine alters behavior and brain neurochemistry in the adolescent age cohort and how this may affect subsequent illicit drug use. In the current study, periadolescent and adult male and female rats were treated with nicotine for 7 days. One day or 30 days after this treatment, the effects of amphetamine on locomotor activity were studied. Sensitization to nicotine occurred in periadolescent female and adult male and female rats, but not in periadolescent male rats over the course of the 7-day treatment period. On day 8 (1 day after treatment with nicotine ended) and on day 37 (30 days after treatment with nicotine ended), nicotine-pretreated periadolescent male rats were sensitized to the locomotor-activating effects of amphetamine. The response to amphetamine of periadolescent female and adult male and female rats was unchanged at either time point after nicotine pretreatment. Thus, adolescent males are more sensitive than adults or females to the stimulant effects of amphetamine after exposure to nicotine, and this effect is long-lasting. These data suggest that nicotine use during adolescence may carry a greater risk than during adulthood and that male adolescent smokers may be particularly vulnerable to the risk of stimulant abuse.     

The prevalence of psychotic symptoms in homeless adolescents

This study was designed to gather data on psychotic symptoms in a sample of homeless adolescents. The sample included adolescents who were located in street sites as well as adolescents who were currently using shelter services. Ninety-six adolescents participated in this study (mean age = 16.1 years). The results indicated that 29% of the sample reported the experience of four or more psychotic symptoms on the Diagnostic Interview Schedule psychotic symptom index. These results suggested that the endorsement of psychotic symptoms is a relatively prominent feature of the self-report of psychopathology among homeless adolescents. These symptoms did not only include reports of paranoid ideation, which may be generally elevated as part of the stress of street life, but also included reports of ideas of reference and auditory hallucinations. Moreover, these symptoms were correlated with reports of affective disturbance, abusive life experience, and a particular type of substance use.