Predictors of Treatment Contact Among Individuals with Cannabis Dependence Where have they been? Service use of regular substance users with and without abuse and dependence Need and Non-Need Factors Associated with Addiction Treatment Utilization in a Cohort of Homeless and Housed Urban Poor The efficacy of two adolescent substance abuse treatments and the impact of comorbid depression: results of a small randomized controlled trial. Substance use in young adults with schizophrenic disorders. Mindfulness-based relapse prevention for substance craving. Characteristics and problems of 600 adolescent cannabis abusers in outpatient treatment. Dual diagnosis of mental illness and substance use disorder and injury in adults recently released from prison: a prospective cohort study. A preliminary study of the neural effects of behavioral therapy for substance use disorders. An organizational readiness intervention and randomized controlled trial to test strategies for implementing substance use disorder treatment into primary care: SUMMIT study protocol Enhancing the effectiveness of juvenile drug courts by integrating evidence-based practices. Maternal smoking and drinking during pregnancy and the risk for child and adolescent psychiatric disorders. Mental disorders as risk factors for substance use, abuse and dependence: results from the 10-year follow-up of the National Comorbidity Survey. Does temperament moderate treatment response in adolescent substance use disorders? Substance abuse and personality disorders in homeless drop-in center clients: symptom severity and psychotherapy retention in a randomized clinical trial. Addiction to Highly Pleasurable Food as a Cause of the Childhood Obesity Epidemic: A Qualitative Internet Study Social-Cognitive Skill Development with Sixth Graders and its Initial Impact on Substance Use Distinct mechanism for antidepressant activity by blockade of central substance P receptors. Comparison of self-report versus agency records of service utilization in a community sample of individuals with alcohol use disorders. Childhood externalizing and internalizing psychopathology in the prediction of early substance use. Maximizing Effectiveness Trials in PTSD and SUD Through Secondary Analysis: Benefits and Limitations Using the National Institute on Drug Abuse Clinical Trials Network "Women and Trauma" Study as a Case Example. Cost-effectiveness of assertive community treatment versus standard case management for persons with co-occurring severe mental illness and substance use disorders. Outcomes with the ARISE Approach to Engaging Reluctant Drug‐ and Alcohol‐Dependent Individuals in Treatment
Epidemiological studies have repeatedly shown that cannabis is the most commonly used illegal drug in the United States . Furthermore , individuals with cannabis dependence have high rates of comorbid substance use disorders and depression . A significant proportion of individuals with addictive disorders develop withdrawal symptoms , can not control their drug use despite substantial adverse psychosocial consequences , and frequently have a coexisting psychiatric disorder . Nevertheless , only a minority of persons with cannabis dependence ever seek treatment . We were unable to locate epidemiological reports regarding treatment seeking behavior among persons with cannabis dependence . Epidemiological studies of population s with substance disorders have observed that employment , higher educational level , previous use of treatment , major depression , and a co‐occurring substance dependency increased the probability of seeking treatment for alcohol dependence . Thus we hypothesized that the same variables would predict service use among persons with cannabis dependence . The main findings of this study were that persons with cannabis dependence were more likely to contact a professional during the past year if they previously sought treatment and had alcohol dependence with major depression . Prospect i ve , longitudinal studies of adolescents would increase our underst and ing of the processes by which individuals identify themselves as having problems related to their habitual use of marijuana , and why some seek help while others do not Objective To present lifetime rates of service use  for psychological and substance use related problems among regular substance users and to examine factors associated with service use . Method Data come from a prospect ive-longitudinal , epidemiological study of a community sample of adolescents and young adults ( n = 2548 , age 14–24 years at baseline ) in Munich , Germany . The Munich-Composite International Diagnostic Interview ( M-CIDI ) was used at baseline and at two follow-ups to assess substance use and service use . Results Cumulated lifetime incidence of any substance abuse or dependence was 43.7 % . Of those with abuse and dependence 23 % had ever used any services for psychological or substance use related problems . Illicit substance users especially those with dependence had the highest rates of lifetime service use ( 52.1 % ) . Psychotherapists and counseling services were contacted most frequently among regular substance users over their lifetimes . Utlilisation rates of substance abuse services were low ( 2 % ) . Comorbid anxiety disorders and distressing life events were associated with increased lifetime service use . Conclusions Only a minority of adolescents and young adults with substance use disorders have ever sought professional help . Specialized substance abuse services play only a minor role . The core role of psychotherapists and non-substance abuse specialized services needs critical research attention . Linkages between psychotherapists and the substance use service system should be strengthened to detect and intervene at early developmental stages of abuse and dependence Background : Research on addiction treatment  utilization in indigent sample s mainly has been retrospective , without measures of addictive consequences , social network influences , and motivation . Prospect i ve assessment of factors influencing utilization could inform policy and clinical care . Objective : We sought to identify factors associated with utilization of addiction treatment and mutual help groups among substance-dependent persons with high rates of homelessness . Research and Methods : This was a prospect i ve cohort of patients detoxified from alcohol or drugs at baseline who were followed for 2 years in a r and omized clinical trial of linkage to primary care ( n = 274 ) . Outcomes included utilization of Inpatient/Residential , Outpatient , Any Treatment , and Mutual Help Groups .  Predictor variables in longitudinal regression analyses came from the literature and clinical experience , organized according to theoretical categories of Need , and non-Need ( eg , Predisposing and Enabling ) . Results : Many subjects used Inpatient/Residential ( 72 % ) , Outpatient ( 62 % ) , Any Treatment ( 88 % ) or Mutual Help Groups ( 93 % ) at least once . In multivariable analyses , addictive consequences ( odds ratio [ OR ] 1.38 , 95 % confidence interval [ CI ] 1.12–1.71 ) , motivation ( OR 1.32 , 95 % CI 1.09–1.60 ) , and female gender ( OR 1.80 , 95 % CI 1.13–2.86 ) were associated with most treatment types ( ORs are for Any Treatment ) . Homelessness was associated with Residential/Inpatient ( for Chronically Homeless vs. Housed , OR 1.75 , 95 % CI 1.04–2.94 ) . Living with one 's children ( OR 0.51 , 95 % CI 0.31–0.84 ) and substance-abusing social environment ( OR 0.65 , 95 % CI 0.43–0.98 ) were negatively associated with Any Treatment . Conclusions : In this cohort of substance-dependent persons , addictive consequences , social network variables , and motivation were associated with treatment utilization . Non-need factors , including living with one 's children and gender , also were significant OBJECTIVE The purpose of this r and omized trial was to investigate the efficacy of 2 behavioral treatments focusing on different change mechanisms in ameliorating a borderline personality disorder constellation of behaviors and substance use in adolescents referred by juvenile diversion programs . METHODS Forty adolescents 14 - 17 years of age and meeting Diagnostic and Statistical Manual of Mental Disorders ( 4th ed . ) criteria for borderline personality disorder and substance use disorders were r and omized to integrative borderline personality disorder-oriented adolescent family therapy ( I-BAFT ) or individual drug counseling . This design allowed a comparison of 2 manualized interventions , 1 family based and 1 individually oriented . Profiles of clinical change were used to detect impact and estimate treatment effect sizes . RESULTS Primary analyses showed that both interventions had a clinical ly significant impact on borderline personality disorder behaviors 12 months after baseline but with no differential treatment effects . The impact on substance use was more complex . Subgroup analyses revealed that adolescents with depression had significantly more severe profiles of borderline personality disorder and substance use . These youths were the only group to show reductions in substance use , but they only did so if they received the I-BAFT intervention . Study data also documented the high dosage of intensive residential treatment needed by this population . CONCLUSIONS AND IMPLICATION S FOR PRACTICE Results highlight the intensive treatment needs of juvenile justice-involved youths with co-occurring substance use and borderline personality disorder including depression , the hybrid outpatient and residential treatment often required by this population , and the promise of a family-oriented approach , particularly for youths with severe symptoms and co-occurring depression . ( PsycINFO Data base Use of nonprescribed mood altering substances is pervasive and problematic in young adults with serious mental illnesses in community care . Fifty-eight percent of young adult clients with clearly defined schizophrenia or schizophrenia-related disorders participating in a long-term community treatment study were rated by staff or themselves as using alcohol , cannabis , or other street drugs several times a week or more . We interviewed in depth a r and om sample of these " significant users " to obtain their perspective on their frequencies , patterns , histories , contributing factors to , and effects of substance use and their related treatment experiences . Results revealed these clients ' substance use to be of long duration and deeply entrenched , with current use often involving multiple substances including both street drugs and substances of " everyday life " ( e.g. , caffeine , nicotine ) . Clients reported compelling reasons for use including anxiety reduction , relief of boredom , and a means for social contact . Staff and clients clearly view substance use quite differently , with the latter focusing at least as much on consequences of symptom relief as symptom exacerbation . Treatment implication s are discussed Craving , defined as the subjective experience of an urge or desire to use substances , has been identified in clinical , laboratory , and pre clinical studies as a significant predictor of substance use , substance use disorder , and relapse following treatment for a substance use disorder . Various models of craving have been proposed from biological , cognitive , and /or affective perspectives , and , collectively , these models of craving have informed the research and treatment of addictive behaviors . In this article we discuss craving from a mindfulness perspective , and specifically how mindfulness-based relapse prevention ( MBRP ) may be effective in reducing substance craving . We present secondary analyses of data from a r and omized controlled trial that examined  MBRP as an aftercare treatment for substance use disorders . In the primary analyses of the data from this trial , Bowen and colleagues ( 2009 ) found that individuals who received MBRP  reported significantly lower levels of craving following treatment , in comparison to a treatment-as-usual control group , which mediated subsequent substance use outcomes . In the current study , we extend these findings to examine potential mechanisms by which MBRP might be associated with lower levels of craving . Results indicated that a latent factor representing scores on measures of acceptance , awareness , and nonjudgment significantly mediated the relation between receiving MBRP and self-reported levels of craving immediately following treatment . The mediation findings are consistent with the goals of MBRP and highlight the importance of interventions that increase acceptance and awareness , and help clients foster a nonjudgmental attitude toward their experience . Attending to these processes may target both the experience of and response to craving AIMS Risk factors among adolescent substance abusers have been shown to correlate with substance use severity . Characteristics related to severity , such as demographic and family factors , peer influences , psychiatric co-morbidity and HIV risk behaviors , are examined for a sample of adolescent cannabis users entering treatment . DESIGN These data are from a clinical trial study utilizing blocked r and om assignment of clients to one of five treatment conditions . The study targeted adolescents entering outpatient treatment for primarily cannabis abuse or dependence . SETTING Treatment and research facilities in four metropolitan areas of the US were used to recruit study participants . Treatment was delivered in outpatient drug-free setting s. PARTICIPANTS Participants were 600 clients , ages 12 - 18 , admitted to outpatient substance abuse treatment programs for cannabis problems , 96 % with DSM-IV diagnoses of substance abuse or dependence , with the remaining 4 % having at least one symptom of dependence plus significant problems indicating need for treatment . MEASUREMENTS The Global Appraisal of Individual Needs ( GAIN ) was used to collect the information presented in this paper . The GAIN incorporates DSM-IV criteria for substance use disorders , conduct disorder and attention deficit hyperactivity disorder , as well as dimensional ( scale ) measures for physical and mental health . FINDINGS All participants reported at least one symptom of substance use disorders , and 46 % met the DSM-IV criteria for substance dependence , while 50 % met criteria for a diagnosis of abuse . Only 20 % of the participants perceived any need for help with problems associated with their drug or alcohol use . Clients participating in the study typically presented multiple problems at treatment entry , most often including conduct disorder , attention deficit hyperactivity disorder ( ADHD ) , internal ( mental ) distress , and physical health distress . The co-occurrence of conduct disorder and ADHD was found in 30 % of the sample . Clients meeting criteria for substance dependence tended to have more co-occurring problems and significantly less denial at admission . CONCLUSIONS The characteristics of this sample exemplify the complex nature of adolescent substance use and abuse among adolescents entering outpatient treatment programs . Patterns of co-occurring problems are at rates comparable to those found in other clinical studies . Those with more severe substance use disorders tend to manifest more problems of social functioning , more mental health problems , and physical health problems . Implication s of these findings are discussed in terms of treatment needs , challenges , and prognostic implication BACKGROUND People with mental illness and substance use disorder are over-represented in prisons .  Injury-related mortality is elevated in people released from prison , and both mental illness and substance use disorder are risk factors for injury . Effective care coordination during the transition between criminal justice and community service providers improves health outcomes for people released from prison . However , the health outcomes and support needs of people with dual diagnosis ( co-occurring mental illness and substance use disorder ) released from prison are poorly understood . Here we aim to examine the association between dual diagnosis and non-fatal injury in adults released from prison . METHODS  Pre-release interview data  collected between Aug 1 , 2008 , and July 31 , 2010 , from a representative sample of sentenced adults ( ≥18 years ) in Queensl and , Australia , were linked , retrospectively and prospect ively , to person-level , state-wide emergency department and hospital records . We identified dual diagnoses from inpatient , emergency department , and prison medical records . We modelled the association between mental health status and all injury result ing in hospital contact by fitting a multivariate Cox regression , adjusting for sociodemographic , health , and criminogenic covariates , and replacing missing covariate data by multiple imputation . FINDINGS In 1307 adults released from prison , there were 2056 person-years of follow-up ( median 495 days , IQR 163 - 958 ) . The crude injury rates were 996 ( 95 % CI 893 - 1112 ) per 1000 person-years for the dual diagnosis group , 538 ( 441 - 657 ) per 1000 person-years for the mental illness only group , 413 ( 354 - 482 ) per 1000 person-years for the substance use disorder only group , and 275 ( 247 - 307 ) per 1000 person-years for the no mental disorder group . After adjusting for model covariates , the dual diagnosis ( adjusted hazard rate ratio 3·27 , 95 % CI 2·30 - 4·64 ; p<0·0001 ) and mental illness only ( 1·87 , 1·19 - 2·95 ; p=0·0071 ) groups were at increased risk of injury after release from prison compared with the group with no mental health disorders . INTERPRETATION People released from prison experience high rates of injury compared with the general population . Among people released from prison , dual diagnosis is associated with an increased risk of injury . Contact with the criminal justice system is a key opportunity to prevent subsequent injury morbidity in people with co-occurring mental health disorders . Engagement with integrated psychiatric and addiction treatment delivered without interruption during the transition from prison into the community might prevent the injury-related disparities experienced by this vulnerable group . The development of targeted injury prevention strategies for people with dual diagnosis released from prison is warranted . FUNDING National Health and Medical Research Council BACKGROUND The mechanisms by which behavioral therapies for substance use disorders ( SUDs ) exert their effects and the components of treatment that contribute most to substance use outcome remain unclear . Disruptions to aspects of impulse control and attention have been hypothesized to contribute to the development and maintenance of addiction ; moreover , alterations in these processes may underlie responses to treatment . METHODS Individuals participating in a r and omized clinical trial evaluating computer-assisted cognitive behavioral therapy ( CBT ) for substance abuse participated in fMRI Stroop before and after treatment .  A non-substance-using comparison group performed the same task under test-retest conditions . RESULTS The patient group demonstrated decreased Stroop-related BOLD signal in regions including the anterior cingulate , inferior frontal gyrus and midbrain at post-treatment relative to pre-treatment , and displayed a greater decrease in the subthalamic nucleus and surrounding regions compared to healthy controls following test-retest . CONCLUSIONS Behavioral therapies may be associated with reduction in substance use and effects on neural systems involved in cognitive control , impulsivity , motivation and attention Background Millions of people who need treatment for substance use disorders ( SUD ) do not receive it . Evidence -based practice s for treating SUD exist , and some are appropriate for delivery outside of specialty care setting s. Primary care is an opportune setting in which to deliver SUD treatment because many individuals see their primary care providers at least once a year . Further , the Patient Protection and Affordable Care Act ( PPACA ) increases coverage for SUD treatment and is increasing the number of individuals seeking primary care services . In this article , we present the protocol for a study testing the effects of an organizational readiness and service delivery intervention on increasing the uptake of SUD treatment in primary care and on patient outcomes . Methods / design In a r and omized controlled trial , we test the combined effects of an organizational readiness intervention consisting of implementation tools and activities and an integrated collaborative care service delivery intervention based on the Chronic Care Model on service system ( patient-centered care , utilization of substance use disorder treatment , utilization of health care services and adoption and sustainability of evidence -based practice s ) and patient ( substance use , consequences of use , health and mental health , and satisfaction with care ) outcomes . We also use a repeated measures design to test organizational changes throughout the study , such as acceptability , appropriateness and feasibility of the practice s to providers , and provider intention to adopt the practice s. We use provider focus groups , provider and patient surveys , and administrative data to measure outcomes . Discussion The present study responds to critical gaps in health care services for people with substance use disorders , including the need for greater access to SUD treatment and greater uptake of evidence -based practice s in primary care . We design ed a multi-level study that combines implementation tools to increase organizational readiness to adopt and sustain evidence -based practice s ( EBPs ) and tests the effectiveness of a service delivery intervention on service system and patient outcomes related to SUD services . Trial registration Current controlled trials : OBJECTIVE The primary purpose of this study was to test a relatively efficient strategy for enhancing the capacity of juvenile drug courts ( JDC ) to reduce youth substance use and criminal behavior by incorporating components of evidence -based treatments into their existing services . METHOD Six JDCs were r and omized to a condition in which therapists were trained to deliver contingency management in combination with family engagement strategies ( CM-FAM ) or to continue their usual services ( US ) . Participants included 104 juvenile offenders ( average age = 15.4 years ; 83 % male ; 57 % White , 40 % African American , 3 % Biracial ) . Eighty-six percent of the youths met criteria for at least 1 substance use disorder , and co-occurring psychiatric diagnoses were highly prevalent . Biological and self-report measures of substance use and self-reported delinquency were assessed from baseline through 9 months postrecruitment . RESULTS CM-FAM was significantly more effective than US at reducing marijuana use , based on urine drug screens , and at reducing both crimes against persons and property offenses . Such favorable outcomes , however , were not observed for the self-report measure of substance use . Although some variation in outcomes was observed between courts , the outcomes were not moderated by demographic characteristics or co-occurring psychiatric disorders . CONCLUSIONS The findings suggest that JDC practice s can be enhanced to improve outcomes for participating juvenile offenders . A vehicle for promoting such enhancements might pertain to the development and implementation of program certification st and ards that support the use of evidence -based interventions by JDCs . Such st and ards have been fundamental to the successful transport of evidence -based treatments of juvenile offenders OBJECTIVE To examine the relative importance of prenatal exposure to cigarettes and alcohol and familial/genetic susceptibility for alcohol dependence in the etiology of childhood psychopathology . METHOD A longitudinal prospect i ve study of 150 children/adolescents ( 51.3 % male ) , who were at either high or low risk for developing alcohol dependence because of their familial loading for alcoholism , provided multiple diagnostic assessment s ( N = 318 ) of these subjects . High-risk families were identified through the presence of two adult alcoholic sisters ; low-risk control families were selected from the community . Annual assessment s of offspring from these families included an in-depth psychiatric interview of each child and his/her parent to determine the presence or absence of childhood disorders . Mothers were interviewed concerning their prenatal use of substances , and information was gathered concerning their personal and familial loading for psychiatric disorders . RESULTS Using conventional logistic regression analyses , internalizing and externalizing disorders were found to be associated with familial loading for alcoholism and prenatal exposure to cigarettes and alcohol . In addition , a specialized statistical analysis , a multivariate confounder score approach , was conducted using familial risk status and the child 's exposure to maternal prenatal use of alcohol and cigarettes . This analysis demonstrated that only one relationship between a single variable and a childhood disorder was significant while controlling for the other two variables : Oppositional disorder remained significant in association with familial risk status . Three additional analyses were performed to evaluate the effects of familial risk status , prenatal alcohol exposure and prenatal cigarette exposure  on childhood psychopathology while controlling for two known risk factors ( SES and parental ASPD ) for externalizing disorders . Results of these analyses revealed that the only childhood disorder that was elevated was ADHD , and that this was the result of the familial risk variable only . CONCLUSIONS Familial loading for alcohol dependence is an important risk factor for the development of childhood psychopathology and may account for the previously reported associations between prenatal exposure to nicotine and alcohol . Studies of substance abuse/dependence etiology and childhood psychopathology need to include consideration of both prenatal exposures and familial loading for alcohol dependence and other psychiatric disorders AIMS The comorbidity of mental disorders and substance dependence is well documented , but prospect i ve investigations in community sample s are rare . This investigation examines the role of primary mental disorders as risk factors for the later onset of nicotine , alcohol and illicit drug use , abuse and dependence with abuse . DESIGN The National Comorbidity Survey ( NCS ) was a nationally representative survey of mental and substance disorders in the United States carried out in 1990 - 92 . The NCS-2 re-interviewed a probability sub sample of NCS respondents in 2001 - 03 , a decade after the baseline survey . PARTICIPANTS A total of 5001 NCS respondents were re-interviewed in the NCS-2 ( 87.6 % of baseline sample ) . RESULTS Aggregate analyses demonstrated significant prospect i ve risks posed by baseline mental disorders for the onset of nicotine , alcohol and illicit drug dependence with abuse over the follow-up period . Particularly strong and consistent associations were observed for behavioral disorders and previous substance use conditions , as well as for certain mood and anxiety disorders . Conditional analyses demonstrated that many observed associations were limited to specific categories of use , abuse or dependence , including several mental disorders that were non-significant predictors in the aggregate analyses . CONCLUSIONS Many mental disorders are associated with an increased risk of later substance use conditions , but important differences in these associations are observed across the categories of use , abuse and dependence with abuse . These prospect i ve findings have implication s for the precision of prevention and treatment strategies targeting substance use disorders To assess whether temperament moderates response to treatment for substance use disorders ( SUD ) , n = 88 consecutively referred adolescents with SUD were r and omized to cognitive- behavioral ( CBT ) or psychoeducational ( PET ) therapies . Principal components analyses reduced the 10-attribute Dimensions of Temperament Revised ( DOTS-R ) to three factors ( Rhythmicity , Activity/Flexibility , and Mood/Sociability ) . Three response domains ( Alcohol Use , Other Substance Use , and Psychological Function ) from the Teen Addiction Severity Index ( T-ASI ) were assessed at baseline and at 3-month post-treatment completion . There was a significant moderator effect on Treatment only for Rhythmicity on T-ASI Alcohol and Psychological domains . For Alcohol use , for youth with poor levels of Rhythmicity , only PET effected significant improvement , whereas for youth with good levels of Rhythmicity , no treatment differences emerged . For Psychological function , for youth with good levels of Rhythmicity , only CBT effected significant improvement , whereas for youth with poor levels of Rhythmicity , no treatment differences emerged . Implication s of these findings are discussed This study evaluated the psychiatric symptoms , psychosocial problems , and treatment response of personality-disordered substance abusers receiving services within a homeless drop-in center . Fifty-two homeless clients were assessed after program admission and r and omly assigned to receive either individual psychotherapy focused on personality disorder and substance abuse relapse prevention ( dual-focus schema therapy [ DFST ] ) or st and ard group substance abuse counseling ( SAC ) .  Client functioning was assessed using measures of personality disorder , psychiatric symptoms , early maladaptive schemas , interpersonal problems , and addiction-related psychosocial impairment . Therapy retention ( total weeks in treatment ) and utilization ( number of weeks in which sessions were attended ) were the primary outcomes . Although rates of cluster B personality disorders were comparable to other substance dependent sample s , clusters A and C disorders were disproportionately more common . Clients reported significant psychiatric symptoms , criminality , and psychosocial impairment , yet made limited lifetime use of mental health services . Overall , there was greater utilization of individual DFST  than group SAC . However , clients with more severe personality disorder symptoms demonstrated better utilization of SAC  than DFST An interactive , open-access website was launched as an overweight intervention for teens and preteens , and was generally unsuccessful . An underst and ing was needed of the reasons for weight loss failures versus successes in youth using the site .  Bulletin board posts , chat room transcripts , and poll responses were prospect ively gathered and qualitatively and quantitatively analyzed over a ten-year period . Many respondents , ages 8 to 21 , exhibited DSM-IV substance dependence ( addiction ) criteria when describing their relationship with highly pleasurable foods . Further research is needed on possible addiction to highly pleasurable foods in youth . Incorporating substance dependence methods may improve the success rate in combating the childhood obesity epidemic A primary prevention research project is described which tests an intervention model based on cognitive and interpersonal skill enhancement .  Thirty-two classrooms of sixth grade students were r and omly assigned to either Program or Control conditions , with Program classrooms receiving a twelve-session cognitive skill development curriculum aim ed at reducing rates of substance use as measured by a drug use survey . Students in Program classrooms showed greater decision-making skills , including the ability to generate alternatives and to consider consequences and risks , greater ability to utilize social networks , and greater underst and ing of group roles , behavior , and alternatives . In addition , Program students reported less use of tobacco in the past year than Control Group students , but no differences between groups were found in use of alcohol , marijuana , or other drugs except for a tendency on the part of Program students to show greater experimentation with alcohol . The effectiveness of the intervention in promoting skill development and factors influencing the impact of the intervention on substance use behavior are discussed The localization of substance P in brain regions that coordinate stress responses and receive convergent monoaminergic innervation suggested that substance P antagonists might have psychotherapeutic properties . Like clinical ly used antidepressant and anxiolytic drugs , substance P antagonists suppressed  isolation-induced vocalizations in guinea pigs . In a placebo-controlled trial in patients with moderate to severe major depression , robust antidepressant effects of the substance P antagonist MK-869 were consistently observed . In pre clinical studies , substance P antagonists did not interact with monoamine systems in the manner seen with established antidepressant drugs . These findings suggest that substance P may play an important role in psychiatric disorders Health services research has become an important area for evaluating the cost effectiveness of interventions . When used in treatment outcome research , the accuracy of self-report data is essential . The reliability and validity of self-report service utilization among alcohol and drug addicted individuals is question able and largely unexplored . This study assessed the  accuracy  of  self-report utilization of services compared to service record abstract ion in a sample of treatment seeking individuals with alcohol use disorders . The results of the comparative analysis found that the level of agreement for some services , particularly medical , psychiatric and substance abuse inpatient admissions , and social service involvement was good . There was less agreement in emergency room visits and arrests . Factors related to discrepancies between self-report and records were explored AIMS To examine the prospect i ve relationships between childhood externalizing and internalizing disorders and substance use in early adolescence . DESIGN Longitudinal , community-based study of twins ( aged 11 at intake ; aged 14 at follow-up ) . SETTING AND PARTICIPANTS The sample was composed of twins participating in the Minnesota Twin Family Study , an epidemiological sample of twins and their families representative of the state population of Minnesota . A total of 699 twin girls and 665 twin boys participated at both time-points . MEASUREMENTS Twins participated in in-person , life-time diagnostic assessment s of the following childhood DSM III-R externalizing and internalizing disorders at age 11 : conduct disorder , oppositional defiant disorder , attention deficit hyperactivity disorder , major depressive disorder and in addition , for girls only , overanxious disorder and separation anxiety disorder . At ages 11 and 14 , substance use and abuse were assessed . FINDINGS Externalizing psychopathology predicted having tried alcohol , nicotine and cannabis by age 14 as well as regular and advanced experience with these substances . Internalizing disorders showed weak effects , with only major depression at age 11 showing a significant relationship with substance use at age 14 . CONCLUSION The results suggest that externalizing psychopathology is a robust prospect i ve predictor of a variety of early onset substance use behaviors and is systematic ally related to degree of substance use involvement . The results also suggest that depression may predict initiation of licit substance use in early adolescence Recent federal legislation and a renewed focus on integrative care models underscore the need for economical , effective , and science-based behavioral health care treatment . As such , maximizing the impact and reach of treatment research is of great concern . Behavioral health issues , including the frequent co-occurrence of substance use disorders ( SUD ) and posttraumatic stress disorder ( PTSD ) , are often complex , with a myriad of factors contributing to the success of interventions . Although treatment guides for comorbid SUD/PTSD exist , most patients continue to suffer symptoms following the prescribed treatment course . Further , the study of efficacious treatments has been hampered by method ological challenges ( e.g. , overreliance on " superiority " design s ( i.e. , design s structured to test whether or not one treatment statistically surpasses another in terms of effect sizes ) and short term interventions ) . Secondary analyses of r and omized controlled clinical trials offer potential benefits to enhance underst and ing of findings and increase the personalization of treatment . This paper offers a description of the limits of r and omized controlled trials as related to SUD/PTSD population s , highlights the benefits and potential pitfalls of secondary analytic techniques , and uses a case example of one of the largest effectiveness trials of  behavioral treatment for co-occurring SUD/PTSD conducted within the National Drug Abuse Treatment Clinical Trials Network ( NIDA CTN ) and producing 19 publications . The paper concludes with implication s of this secondary analytic approach to improve addiction research ers ' ability to identify best practice s for community-based treatment of these disorders . Innovative methods are needed to maximize the benefits of clinical studies and better support SUD/PTSD treatment options for both specialty and non-specialty healthcare setting s. Moving forward , planning for and description of secondary analyses in r and omized trials should be given equal consideration and care to the primary outcome analysis OBJECTIVE To determine the cost-effectiveness of Assertive Community Treatment ( ACT ) in comparison to St and ard Case Management ( SCM ) for persons with severe mental illness and substance use disorders . DATA SOURCES AND STUDY SETTING Original data on the effectiveness and social costs of ACT and SCM that were collected between 1989 and 1995 . Seven community mental health centers in New Hampshire provided both types of treatment . STUDY DESIGN Persons with schizophrenia , schizoaffective disorder , or bipolar disorder and a concurrent substance use disorder were r and omly assigned to ACT or SCM and followed for three years . The primary variables assessed were substance use , psychiatric symptoms , functioning , quality of life , and social costs . DATA COLLECTION METHODS Effectiveness data were obtained from interviews at six-month intervals with persons enrolled in treatment and with their service providers . Social cost and service utilization data came from client reports ; interviews with informal caregivers ; provider information systems and Medicaid cl aims ; law enforcement agencies ; courts ; and community service providers . PRINCIPAL FINDINGS Participants in both groups showed significant reductions in substance use over time . Focusing on quality of life and substance use outcomes , ACT and SCM were not significantly different in cost-effectiveness over the entire three-year study period . Longitudinal analyses showed that SCM tended to be more efficient during the first two years but that ACT was significantly more efficient than SCM during the final year of the study . CONCLUSIONS In an adequately funded system , ACT is not more cost-effective than SCM . However , ACT efficiency appears to improve over time Our goal was to explore , through a Stage I NIH clinical study , the effectiveness of a manual‐driven , timely response method for helping the “ concerned other ” get resistant substance abusers into treatment/self‐help with minimum professional time/effort . A manual‐driven protocol , “ A Relational Sequence for Engagement ( ARISE ) , ” was applied with 110 consecutive , initial calls/contacts from concerned others ; no cases excluded for research , refusal , or other reasons . The research was conducted at two upstate New York outpatient drug/alcohol clinics . Participants were concerned others who called regarding a cocaine , alcohol , or “ other drug ” abuser ( N = 110 ) ; participating family/friends : 11 ARISE clinicians ; and 110 substance abusers . ARISE is a graduated continuum starting with the least dem and ing option/stage , increasing effort as needed to engage substance abusers in treatment/self‐help . Stage I : Coaching the concerned other to arrange a meeting of significant others , inviting the substance abuser ; Stage II : 1 to 5 additional meetings ( median = 2 ) ; Stage III : A modified Johnson “ Intervention . ” Primary outcome variables were substance abuser engagement ( or not ) in treatment/self‐help ; days between first call and engagement ; clinician time/effort . Predictors were concerned other , substance abuser , and clinician demographics ; number of participants per case ; and Collateral Addiction Severity Index . ARISE result ed in an 83 % success rate ( 55 % at Stage I ) . Median days to engagement was 7 ( IQR = 2 to 14 ) . Average total time ( telephone , sessions ) per case was 1.5 hours . Treatment/self‐help chosen was 95 % treatment and 5 % self‐help . Number of family/friends involved correlated 0.69 with a success/efficiency index . Conclusions . A call from a family member or concerned other for help in getting a loved one into treatment is a rich opportunity for treatment professionals and agencies to engage substance abusers in treatment . These initial calls are similar to referral calls from EAPs or probation officers looking to get an individual started in treatment . ARISE provides an effective , swift , and cost‐efficient option for engaging substance abusers in treatment or self‐help . The more significant others involved , the greater the success of treatment engagement
Polymorphisms of the DRD2 , ANKK1 , DAT1 , DBH , and DRD4 genes have been found to moderate the effects of pharmacotherapy  of alcohol , opioid , and cocaine use disorders .
The integration of genetic information with clinical data will inform health professionals of the most efficacious pharmacotherapeutic intervention for substance use disorders .
Substance use disorders have significant personal , familial , and societal consequences .
Despite the serious consequences of substance use , only a few therapies are effective in treating substance use disorders , thus highlighting a need for improved treatment practice s. Substance use treatment response depends on multiple factors such as genetic , biological , and social factors .
It is essential that each component is represented in treatment plans .
The dopaminergic system plays a critical role in the pharmacotherapy for addictions , and an underst and ing of the role of variation of genes involved in this system is essential for its success .