To estimate the prevalence of self-reported substance use and psychiatric disorders in a highly select chronic nonmalignant pain population within a nonprimary care tertiary referral-only pain clinic.A retrospective, cross-sectional study was accomplished via existing medical record review for 216 consecutive pain patients presenting to an independent neurodiagnostic clinic located in the southeastern United States, specializing in chronic, severe, and complex industrial injuries (e.g., multiple failed fusions, neuropathic pain), involving complex combinations of nocioceptive, neuropathic, and myofascial pain. De-identified self-report data from the Comprehensive Assessment and Psychological Evaluation (a structured diagnostic assessment interview compatible with DSM-IV-TR criteria, which assesses for symptoms of 8 Axis I and 6 Axis II disorders including substance-specific dependence and abuse) were obtained as part of the standard intake procedures for diagnostic determinations. Diagnostic assessment of substance use disorders was also independently verified by a physician certified by the American Society of Addiction Medicine.An extremely low prevalence of substance abuse and dependence diagnoses were found for 1.9% of the population, of which nearly 30% were not currently prescribed opioid medications for pain. One case of alcohol dependence and 3 cases of alcohol abuse were found. Psychiatric diagnoses, excluding substance use disorders, predominated as follows: major depressive disorder, 44.4%; posttraumatic stress disorder, 29.2%; and obsessive-compulsive personality disorder, 62.5%.Certain populations of patients with complex nocioceptive, neuropathic, and myofascial pain syndromes may have a lower prevalence of substance use disorders than the general population. They also may have concurrent psychiatric disorders, which should be evaluated and treated concomitantly as part of their chronic pain treatment. Rates reported for possible obsessive-compulsive personality disorder may be reflective of patients' expected preoccupation with pain complaints. The low prevalence of substance use disorders may be attributable to the severity of their illness, the patients' inability to achieve pain relief and obtain pain medications easily, as well as their persistence in pursuing accurate diagnoses and treatment. Roughly one-third were not currently prescribed opioids at the time of the study, perhaps undercutting risk for opioid use disorder rates. Additionally, due to the tertiary referral nature of this clinic, patients with behaviors believed to be a manifestation of opioid use disorder may have already been selected out prior to referral to this clinic. A major limitation of this study was that it relied on a self-report assessment instrument and there were no drug screen findings to report. Such unique clinic characteristics and study limitations may narrow generalizability of results. Despite the low prevalence of substance use disorders observed for this clinic population, these patients must be continuously monitored for abuse, misuse, and diversion of their medication.
Four hundred seventy-nine drug abusing adolescent patients enrolled in seven Straight, Inc. Adolescent Drug-Abuse Treatment Programs in five geographic regions across the United States were studied to determine the severity and patterns of cocaine abuse. Of these, 341 admitted to cocaine use and became part of this survey. Cocaine use was categorized as heavy, intermediate, or light. Areas examined were the addictive spectrum, psychosocial dysfunction, and psychiatric symptoms. Intermediate and heavy users of cocaine abused significantly less marijuana and inhalants than light cocaine abusers. Heavy and intermediate users were more likely to use cocaine intravenously and to use crack. They developed tachyphylaxis more frequently, progressed to weekly use in less than 3 months more frequently, and became preoccupied with obtaining and using cocaine significantly more frequently. They used more sedative hypnotics to calm themselves and engaged in more criminal behavior, such as stealing from parents and stores and passing bad checks. They had more arrests for possession of drugs, stole more cars, sold more drugs, and were more likely to trade sexual favors to obtain the drug. Heavy and intermediate users were significantly more psychiatrically disturbed than light users, becoming more suspicious, nervous, aggressive, and demonstrating increased symptoms of fatigue, sleeplessness, decreased appetite, and increasing cocaine dysphoria. All of these symptoms could be mistaken for psychiatric disorders. This study suggests that cocaine is as addictive in adolescents as in adults; possibly more so. It also causes psychosocial dysfunction and psychiatric symptoms. Further research into cocaine addiction among adolescents is indicated.
Abuse of multiple substances can coexist in many patients who present with symptoms indistinguishable from any Bipolar Disorder. Failure to recognize and treat this coexistent substance abuse may preclude the proper management of the bipolar disorder.
Adolescent Drug-Abuse Treatment Programs in five geographic regions across the United States were studied to determine the severity and patterns of cocaine abuse. Of these, 341 admitted to cocaine use and became part of this survey. Cocaine use was categorized as heavy, intermediate, or light. Areas examined were the addictive spectrum, psychosocial dysfunction, and psychiatric symptoms. Intermediate and heavy users of cocaine abused significantly less marijuana and inhalants than light cocaine abusers. Heavy and intermediate users were more likely to use cocaine intravenously and to use crack. They developed tachyphylaxis more frequently, progressed to weekly use in less than 3 months more frequently, and became preoccupied with obtaining and using cocaine significantly more frequently. They used more sedative hypnotics to calm themselves and engaged in more criminal behavior, such as stealing from parents and stores and passing bad checks. They had more arrests for possession of drugs, stole more cars, sold more drugs, and were more likely to trade sexual favors to obtain the drug. Heavy and intermediate users were significantly more psychiatrically disturbed than light users, becoming more suspicious, nervous, aggressive, and demonstrating increased symptoms of fatigue, sleeplessness, decreased appetite, and increasing cocaine dysphoria. All of these symptoms could be mistaken for psychiatric disorders. This study suggests that cocaine is as addictive in adolescents as in adults; possibly more so. It also causes psychosocial dysfunction and psychiatric symptoms. Further research into cocaine addiction among adolescents is indicated.
A structured diagnostic interview (Practical Adolescent Dual Diagnostic Interview, or PADDI) designed to gather basic information about substance use disorders, other mental health conditions, and related experiences was administered to 284 adolescents in several juvenile justice settings. PADDI data were analyzed to assess the ability of the questions to identify mental health and substance use problems and to provide a preliminary exploration of interrelationships between those conditions. Results indicated that PADDI subscales possess adequate to excellent internal consistency reliability, with coefficients ranging from .624 to more than .900. A vast majority of delinquent adolescents manifested indications of multiple problems. Although there were high correlations among some conditions with respect to severity, conduct disorder and substance dependence did not correlate highly on measurements of severity. Furthermore, although most conditions displayed bimodal distributions, conduct disorder displayed a continuous distribution of symptoms. Utility of the instrument for routine clinical use is also discussed.
The records of 101 cocaine and/or heroin drug abusing patients admitted consecutively to Fair Oaks Hospital were evaluated for history of IV drug abuse, antigen and serum antibody evidence of hepatitis A and B infection, and elevation of serum SGPT. One patient, an IV user, had hepatitis B antigen present in his blood. No patient had acute hepatitis A (IgM) antibody present. Forty-five out of fifty-three (84.9%) IV abusers were Hep B Ab positive, while two out of twenty-nine non-IV abusers (6.9%) were positive. Twenty of fifty-three (43.4%) IV users had positive hepatitis A Ab while one of twenty-nine (3.4%) of non-IV users were positive. Thirty-five of fifty-five (63.6%) IV users had elevated SGPT compared to five of forty-one (12.2%) in non-IV users. IV users tended to be older than non-IV users. The data presented in this article indicate that there is a greatly increased incidence of both hepatitis A and B in IV drug users compared to non-IV users and that the hepatitis B incidence is increased in a far greater amount than could be expected in a normal population. The type of drug injected (heroin, other opiates, or cocaine) was not an important determinant. The presence of hepatitis B antibodies in any drug abusing patient who denies IV use is a strong indication that they may not be telling the truth about their past drug abuse. It makes little difference whether drug abusing patients live in the inner city or the suburbs.(ABSTRACT TRUNCATED AT 250 WORDS)
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