Introduction: Posttraumatic stress disorder (PTSD) is highly comorbid with opioid use disorder (OUD) and associated with poorer substance use outcomes, including more severe patterns of substance use, poorer psychosocial functioning, and greater risk of overdose. Recovery capital, or internal and external resources that may be drawn from to initiate and sustain recovery from substance use, has been linked to OUD treatment engagement and long-term recovery outcomes, such as reduced substance use and improved quality of life; however, there is limited research on the association between PTSD and recovery capital. Individual differences in motivation for OUD treatment affect treatment engagement and outcomes and may influence the association between PTSD symptoms and recovery capital. Results: Addressing critical gaps in the literature, the current study used a path analysis model to explicate the pathway from PTSD to recovery capital and assess the potential intermediary role of treatment motivation. Participants were 115 individuals currently in residential substance use treatment (Mage = 38.18 years; 70.4% white). Results: The overall path model demonstrated good fit (χ2[20] = 25.55; p = 0.18; RMSEA = 0.06 [90% CI: 0.00-0.12]; CFI = 0.94, TLI = 0.89). PTSD was negatively associated with recovery capital (B = -0.43, p = 0.030), but this association was not explained by treatment motivation (B = 0.13, p = 0.342). Discussion: Future research is needed to further identify the mechanisms by which PTSD influences recovery capital. Such studies may inform treatment and recovery outcomes for individuals with comorbid PTSD and OUD.
OBJECTIVE:Cocaine use disorder (CocUD) remains a significant public health concern, with elevated mortality rates. Severe psychiatric disorders frequently co-occur with CocUD, possibly associated with an increased frequency of childhood trauma and with lower resilience - the capacity to overcome traumatic life events, compared to the general population. This study aimed to investigate the relationship between psychiatric severity, resilience and childhood trauma in treatment-seeking CocUD outpatients. METHODS:We analyzed the data from a multicenter, cross-sectional study, totalizing 305 CocUD outpatients recruited at specialized addiction care centers. Psychiatric severity was quantified using a custom composite score calculated as the sum of lifetime suicide attempts, psychiatric hospitalizations, and current psychotropic medications. Resilience and childhood trauma were assessed using validated instruments: the Connor-Davidson Resilience Scale (CD-RISC) and the Childhood Trauma Questionnaire (CTQ). The characterization of sociodemographic and clinical characteristics related to CoCUD allowed us to conduct unadjusted and adjusted analyses of associations between trauma, resilience and psychiatric severity. RESULTS:The sample was predominantly male (77%), aged 38 ± 8.7 years. Mean age at onset of CocUD was 28 ± 8 years, and most patients were diagnosed with a comorbid substance use disorder (62% alcohol, 61% cannabis, 43% benzodiazepines and 49% opioid use disorder). Mean psychiatric severity score was 4.2 ± 10.3. Most patients reported at least one childhood abuse type (56.5 +/- 14 for the US version). The mean CD-RISC score was 47.3 ± 13. The mean CTQ score was 47 ± 17. Poisson regression showed a significant inverse relationship between psychiatric severity and total CD-RISC score (p =. 005), with a small effect size (β = -0.01). Psychiatric severity was independently but positively associated with greater CTQ total scores (p = 1.2 x 10-8, β = 0.01), female gender (p = 9.8x10-8, β = 0.41) and comorbid benzodiazepine use disorder (p = 8.7x10-10, β = 0.45). CONCLUSIONS:Although the psychiatric severity score was built arbitrarily, it showed complex interactions with resilience and trauma among CocUD outpatients. These findings underscore the importance of systematically assessing childhood trauma and developing resilience-focused psychotherapies for managing severe CocUD. Psychiatric severity may be measured using simple clinical variables to further tailor these interventions.
OBJECTIVE:The Black population experiences numerous disparities in terms of tobacco use, including lower rates of cessation success relative to other ethnic/racial groups. Moreover, there has been a rise in electronic cigarette (e-cigarette) use in the general population, including the Black community. However, little work has sought to evaluate the impact of dual combustible and e-cigarette use among the Black population in terms of behavioral health problems. The present study examined differences in anxiety, depression, severity of drug use problems, and hazardous drinking between Black individuals who engage in exclusive combustible cigarette use and Black individuals who engage in dual use. METHODS:A total of 498 Black adults who report daily combustible cigarette use (Mage = 45.37, SD = 14.68; 51.4% female) were included. RESULTS:Analyses of covariance, controlling for age, sex, education, and income, showed that Black individuals who engaged in dual use reported statistically significantly higher levels of anxiety, depression, drug use problems, and hazardous drinking compared to Black individuals who engaged in exclusive cigarette smoking. CONCLUSIONS:These findings contribute to a growing body of literature that suggests dual use represents a vulnerable clinical subgroup that may require specialized care.
Objective: Irritable Bowel Syndrome (IBS) is a debilitating chronic pain condition that presents a major and growing public health burden. Combustible cigarette smoking plays a role in the maintenance of IBS, and the co-occurrence of these conditions warrants greater focus. Moreover, given that smoking co-occurs with other substance use behaviors, the impact of these comorbid behaviors on physical and mental health-related outcomes among individuals with IBS who smoke is warranted. The goal of the present cross-sectional study was to assess relationships of risky alcohol, cannabis, and opioid use with IBS severity, anxiety and depression, and smoking-related processes among adults with IBS who smoke. Methods: In total, 263 adults who met Rome IV criteria for IBS and who smoked combustible cigarettes were included in the study. Hierarchical regression analyses were conducted to examine the influence of risky substance uses on IBS symptom severity, IBS-related quality of life, anxiety, depression, perceived barriers for smoking cessation, and cigarette dependence. Results: Results indicated that opioid use was statistically related to all criterion variables, whereas alcohol use was specifically associated with depression and anxiety. Cannabis use showed a statistically significant association only with anxiety symptoms. Conclusions: The present investigation is among the first to explore the role of risky substance use in terms of a wide array of IBS, mental health, and smoking processes among adults with IBS who smoke. The findings suggest that substance use should be a focal point of screening and intervention for the IBS population to optimize outcomes beyond the reach of medical therapies.
Objective: This study investigated current clinical practices, organizational barriers, and resource availability in managing dual diagnosis (co-occurring psychiatric and substance use disorders) among Italian psychiatrists in a healthcare system characterized by service fragmentation between mental health and addiction care. Methods: A structured, self-administered online questionnaire was distributed nationwide to Italian psychiatrists. The survey covered demographic characteristics; organizational aspects and service collaboration; pharmacological and nonpharmacological approaches; and perceived clinical challenges. Data were analyzed descriptively to identify practice patterns and priority intervention areas. Results: Seventy-nine psychiatrists participated from diverse settings (38% addiction services, 25% community mental health services, 14% hospitals, 15% other facilities). While 78% regularly treated dual diagnosis patients, only 38% reported structured protocols between mental health and addiction services. Collaboration was rated as only partially effective by 44%. Integrated treatment was preferred by 61%. The most commonly prescribed medications included mood stabilizers (94%), atypical antipsychotics (68%), anticraving agents (54%), and antidepressants (37%). For depression, trazodone (32%) and serotonergic antidepressants (25%) were used most. For psychosis, aripiprazole (47%) was predominant. Most clinicians (81%) combined pharmacotherapy with psychosocial interventions. Key barriers included insufficient training (67% highlighted need for specialized clinicians), poor service integration, and diagnostic uncertainty. Conclusions: Significant gaps persist in Italian dual diagnosis care despite clinical awareness. Urgent priorities include routine screening, clinician training, national guideline development, organizational reforms promoting service collaboration, and increased availability of structural resources, which was reported as insufficient by 61% of respondents. These improvements are essential for delivering timely, evidence-based, integrated care to this vulnerable population.
Objective: Mental and behavioral disorders due to psychoactive substance use, as defined by ICD-10 codes F10-F19, include a spectrum of substance use disorders such as acute intoxication, withdrawal, harmful use, and dependence related to alcohol, opioids, stimulants, cannabis, tobacco, and other substances. These conditions significantly increase the risk of suicide, yet national trends in suicide-related mortality among affected individuals remain underexplored. This study aimed to evaluate national trends in suicide and self-harm mortality among individuals with these disorders from 1999 to 2023. Methods: We conducted a retrospective analysis of U.S. death certificate data from the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) database (1999-2023). Decedents with mental and behavioral disorders due to psychoactive substance use were identified using ICD-10 codes F10-F19, encompassing acute intoxication, withdrawal, harmful use, and dependence. Suicide and self-harm deaths were defined by ICD-10 codes U03, X60-X84, and Y87. Age-adjusted mortality rates (AAMRs) per million and average annual percentage changes (AAPCs) were estimated using Joinpoint regression. Analyses were stratified by sex, age, race/ethnicity, and metropolitan status. Results: Between 1999 and 2023, 37,473 suicide-related deaths were identified among U.S. individuals with mental and behavioral disorders due to psychoactive substance use. AAMRs increased from 2.2 to 5.7 per million (AAPC: 3.31; p < .01). Males had higher mortality than females (6.6 vs. 2.9), though females had a steeper rate of increase over time. Middle-aged adults had the highest AAMR (8.2), followed by younger (6.9), older adults (3.4) and children and adolescents (1.1). Non-Hispanic (NH) American Indian/Alaska Native individuals (AI/AN) had the highest AAMR (13.5), followed by NH White (6.2), Hispanic/Latino (1.6), NH Black (1.6), and NH Asian/Pacific Islander (API) (1.4). From 1999 to 2000, non-metropolitan areas had higher AAMRs than metropolitan areas (6.5 vs. 4.3), with significant increases in both settings. Conclusions: Suicide-related mortality among individuals with mental and behavioral disorders due to psychoactive substance use has increased significantly increased in the United States from 1999 to 2023, demonstrating substantial disparities by sex, age, race/ethnicity, and geographic region. These findings highlight the critical need for integrated approaches in suicide prevention and substance-related treatment settings.
Objective: Individuals with opioid use disorder (OUD) are disproportionately at risk for suicide. Residential OUD treatment programs routinely assess suicide risk factors. However, the degree to which patients consistently self report lifetime suicide attempts (LSAs) on these measures is unknown. Using patient data from electronic health records, we examined the prevalence of self-reported LSAs, consistency of reporting on assessment measures within one treatment episode and across multiple episodes, and predictors of consistent reporting. Methods: Our sample consisted of all patient records for residential OUD treatment from 12/01/2020- 11/30/2021 with data on LSAs (N = 1,206). Three self-report assessments conducted by clinical staff during the treatment episodes measured LSAs. Results: LSAs were reported during 22% of residential treatment episodes on at least one measure. Within one treatment episode, 13% of individuals inconsistently self-reported LSAs across the different measures, and across multiple episodes, 23%. Those who were younger, female, identified as LGB, endorsed co-occurring anxiety or depressive symptoms and reported lifetime intravenous opioid use were more likely to inconsistently self report LSAs. Conclusions: These results suggest that single administration self-report instruments may be insufficient to adequately assess LSAs in patients with OUD. Care should be taken to assess suicide in this population that is already at increased risk.
OBJECTIVE:Concurrent alcohol use and smoking exert super-additive toxic effects that accelerate hepatic injury in people living with hepatitis C (HCV). Objectives of this study were to estimate the prevalence of concurrent alcohol use and active smoking at the population-level over the last decade among adults living with HCV in the United States (U.S.), examine trends in the prevalence of concurrent alcohol use and active smoking, and to identify risk factors associated with concurrent alcohol use and active smoking. METHODS:We conducted a repeated cross-sectional analysis using six NHANES cycles (2007-2018). The study population included adults aged ≥20 years with current HCV infection, defined as detectable HCV RNA with confirmatory anti-HCV seropositivity, and complete data on alcohol use and smoking status. Analyses incorporated NHANES' complex survey design (strata, primary sampling units, and MEC examination weights). Prevalence estimates and temporal trends were derived using design-based methods, with linear regression applied to test for trends. Associations were examined using design-adjusted multinomial logistic regression to calculate adjusted odds ratios (aORs). RESULTS:The pooled, survey-weighted prevalence of concurrent alcohol use and active smoking among adults living with HCV in the U.S. between 2007 and 2018 was 39.5%. Trends in the prevalence of concurrent alcohol use and active smoking did not decrease but instead remained relatively high over the 11-year period (Trend P = 0.71). In multivariate analysis, current marijuana use (aOR = 2.88, 95% CI 2.84-2.92), lifetime substance use (aOR = 5.98, 95% CI 5.87-6.10), depression (aOR = 2.59, 95% CI 2.55-2.63), and a history of cancer (aOR = 1.50, 95% CI 1.45-1.54) were positively associated with concurrent alcohol use and active smoking. CONCLUSIONS:Markedly high and non-decreasing rates of concurrent alcohol use and active smoking at the population-level may contribute to higher incident cases of HCV-related morbidity and mortality in the near future.
OBJECTIVE:The aim of the current study was to investigate relations between posttraumatic (PTSD) symptom severity, negative and positive emotional avoidance, and alcohol use and related harm amongst an adult community sample of Asian Americans. METHODS:An adult sample of Asian Americans (N = 105, 67.6% women) participated in a study examining emotional experiences, including negative and positive emotional avoidance, PTSD symptom severity, and alcohol use and related harm, across different racial and ethnic groups. RESULTS:There was a significant indirect effect of PTSD symptom severity on alcohol use and related harm through the pathway of positive (β = -0.02, 95% CI [-0.10, 0.02]), but not negative emotional avoidance (β = 0.10, 95% CI [0.02, 0.19]). CONCLUSIONS:The current study builds upon emerging evidence for the critical role of positive emotional experiences in the co-occurrence of PTSD and alcohol use and related harm in an underrepresented population of Asian Americans. Findings suggest that amongst Asian Americans, positive emotional avoidance may play a key role in the association between PTSD and alcohol use and related harm. Thus, it may be beneficial to address positive emotional avoidance in interventions aimed at reducing alcohol use and related harm amongst Asian Americans experiencing PTSD symptoms.
Objective: Substance use disorders (SUDs) frequently co-occur with serious mental illness (SMI) and remain undertreated, in part due to limited pharmacologic options for many substances. Dopamine receptor-modulating agents (DRMAs), particularly antipsychotics with partial agonist activity, have been investigated for their potential to influence craving, reward processing, and relapse. This commentary reviews the evolving evidence for dopamine receptor modulation in SUDs, with particular emphasis on second-generation antipsychotics (SGAs) and the D3-preferring partial agonist cariprazine. Methods: A narrative review of preclinical, clinical, and observational literature was conducted, focusing on dopamine receptor antagonists and partial agonists studied in populations with SUDs, including individuals with co-occurring SMI. Particular attention was given to pharmacologic mechanisms involving D2 versus D3 receptor activity and to emerging evidence regarding cariprazine. Results: Early studies of first-generation antipsychotics, characterized by potent and sustained D2 receptor antagonism, generally demonstrated limited benefit or worsening of substance use outcomes. SGAs have shown more heterogeneous effects, likely reflecting variability in receptor-binding profiles and study methodologies. Increasing evidence highlights the role of the dopamine D3 receptor in substance-related motivation, reward, and cue reactivity. Cariprazine, the only currently approved antipsychotic with high affinity and preferential activity at the D3 receptor, has demonstrated potential benefits across preclinical models, case reports, and observational studies. Reported improvements include reductions in substance use, craving, and relapse-particularly for stimulant and cannabis use disorders-alongside improvements in psychiatric symptoms and functioning. However, most clinical evidence remains limited to small samples, non-randomized designs, and variable outcome measures. Conclusions: Dopamine receptor modulation, particularly targeting the D3 receptor, represents a promising but still emerging strategy for the treatment of SUDs, especially in individuals with co-occurring psychiatric disorders. Cariprazine's unique pharmacologic profile and broad clinical indications position it as a compelling candidate for further investigation. Rigorous randomized controlled trials using standardized substance use outcomes are needed to clarify its efficacy and role in integrated treatment models for dual diagnosis populations.
Objective: U.S. veterans experience comorbid posttraumatic stress disorder and substance use disorders (PTSD-SUD) at high rates, resulting in poorer psychosocial outcomes when compared to the effects of either condition alone. However, it is unclear how veterans with PTSD and a current or remitted SUD compare to those with PTSD alone. Methods: This study compared post-9/11 era veterans with PTSD only, PTSD + current SUD, and PTSD + remitted SUD on psychological outcomes and treatment history. Results: Veterans with PTSD + current SUD reported greater suicidality, PTSD symptom severity, and psychiatric distress, compared to those with PTSD only and PTSD + remitted SUD. Veterans with PTSD only and PTSD + remitted SUD reported comparable symptom levels. Conclusions: Findings highlight that the combination of PTSD and a current SUD is a potential risk factor for suicidality. Enhancing the effectiveness of and access to PTSD-SUD interventions may be an important pathway to suicide risk reduction.
OBJECTIVE:Obsessive-compulsive disorder (OCD) and substance use disorders (SUDs) are serious psychiatric conditions that frequently co-occur, complicating diagnosis and treatment. However, data on their comorbidity in Middle Eastern populations remains limited. This study investigated the prevalence of OCD and its psychiatric comorbidities among inpatient substance users in Iranian psychiatric hospitals. METHODS:This cross-sectional study included 250 inpatients diagnosed with SUDs in Tehran between 2019 and 2022. Demographic, clinical, and psychiatric data were extracted from medical records. Logistic regression was used to examine associations between OCD and demographic/clinical variables. RESULTS:The prevalence of OCD in the study population was 8.8%. The most commonly used substances were nicotine (91.6%), opioids (90%), and stimulants (79.2%). Comorbid psychiatric conditions were prevalent, with 32% diagnosed with Cluster B personality disorders, 14% with major depressive disorder (MDD), 10.8% with bipolar disorder, 9.6% with attention-deficit/hyperactivity disorder (ADHD), and 3.2% with post-traumatic stress disorder (PTSD). Among patients with OCD, MDD (22.7%), ADHD (13.6%), and PTSD (9.1%) were more common, although these differences were not statistically significant. Logistic regression analysis showed no significant associations between OCD and gender (OR = 1.44, 95% CI [0.57, 3.65], p = .447), age (OR = 0.97, 95% CI [0.92, 1.02], p = .221), or family history of psychiatric disorders (OR = 0.44, 95% CI [0.14, 1.33], p = .143). CONCLUSION:OCD is relatively prevalent among individuals with SUDs and is frequently accompanied by other psychiatric disorders. Although no demographic predictors were statistically significant, these findings emphasize the need for routine OCD screening in addiction treatment settings to improve integrated care strategies.
OBJECTIVE:More than one-third of adults with opioid use disorder (OUD) have co-occurring major depressive disorder. Yet existing antidepressant pharmacotherapies have shown limited efficacy in this population. Emerging evidence suggests that buprenorphine treatment may reduce depression symptoms among those without OUD, but there is a need to better understand the impacts of buprenorphine on depression symptoms in those with OUD. We conducted a scoping review of the literature exploring the effect of buprenorphine treatment on depression symptoms among adults with OUD. METHODS:Online databases (e.g., PubMed) were used to identify papers published through September 2024 following PRISMA-ScR guidelines. We included 48 full-text articles from 36 unique studies that included a depression outcome at ≥ 2 time points in adults receiving buprenorphine for OUD treatment. RESULTS:Mean depression scores at baseline (largely before initiation) were generally above clinical cutoffs and reduced with buprenorphine treatment. In most cases, depression symptoms rapidly decreased upon buprenorphine initiation. Yet a subgroup of patients (20-37%) receiving buprenorphine appears to experience persistent depression symptoms. CONCLUSIONS:Most individuals with OUD treated with buprenorphine experienced rapid decreases in depression symptoms upon treatment initiation. However, most studies included in the review were not designed to assess the effect of buprenorphine on depression symptoms. Challenges to synthesizing and interpreting study results included small sample sizes, suboptimal measures of depression symptoms and assessment schedules, and widespread exclusion of higher severity subgroups (e.g., individuals with suicidal ideation) in included studies. Future work is needed to explore the mechanisms underlying the antidepressant effects of buprenorphine in people with OUD and to investigate optimal antidepressant treatments for patients who experience persistent depression during buprenorphine treatment.
OBJECTIVE:Black individuals in the United States have high rates of obesity and cigarette smoking, both of which increase health risks. One factor that has demonstrated significant relations to cigarette smoking outcomes is anxiety sensitivity. Yet, work examining these relations among Black individuals with obesity who smoke is nonexistent. Therefore, the present study examined the role of anxiety sensitivity in relation to several smoking outcomes among Black individuals with obesity who smoke. METHODS:Participants were 161 Black adults with obesity who endorsed daily combustible cigarette smoking (Mage = 47.1 years, SD = 14.19, age range 19-73 years; 65.2% female). RESULTS:Results indicated that greater levels of anxiety sensitivity were statistically significantly and positively related to increased cigarette dependence, severity of problems when trying to quit, perceived barriers to smoking cessation, and smoking abstinence expectancies, including negative mood, somatic symptoms, and harmful consequences. Importantly, findings were observed above and beyond the variance accounted for by age, sex, education, income, perceived physical health, average number of cigarettes smoked per day, hazardous drinking, and cannabis use. CONCLUSIONS:These findings suggest that Black individuals with obesity who smoke and exhibit higher levels of anxiety sensitivity may be at increased risk for processes known to sustain smoking behavior and impede quitting success.
BACKGROUND:The COVID-19 pandemic prompted a rapid expansion of telehealth services in patients with substance use disorders (SUD) and comorbid mental health conditions (dual diagnosis). However, evidence on the effectiveness and utilization of hybrid care (combining in-person and telehealth modalities) in this population remains limited. OBJECTIVE:This study aims to analyze the use of a hybrid treatment (telehealth and in-person treatment) among patients with dual pathology across three distinct periods-before, during, and after COVID-19-related public health measures-and to assess the impact of hybrid care on treatment dropout rates. METHODS:A retrospective observational study was conducted using electronic health records (EHR) from 6,365 outpatients diagnosed with SUD and comorbid mental disorders, between March 2018 and September 2023. Patients were classified by treatment modality (in-person vs. hybrid) and period of care. Bivariate statistics and Cox regression analyses were performed to identify predictors of treatment dropout, accounting for demographic and clinical variables. RESULTS:Hybrid care utilization increased significantly during the pandemic and remained elevated post-pandemic. Women and patients with opioid use disorder were more likely to receive hybrid care. Patients receiving hybrid therapy had significantly lower dropout rates and longer treatment durations. Also, patients in coordinated care (addiction and mental health centers) show lower rates of dropout. Cox regression confirmed that hybrid care was the strongest predictor of reduced treatment dropout across all periods. CONCLUSIONS:Hybrid care models enhance treatment retention among dual diagnosis patients, underscoring the need to maintain and optimize telehealth options for this high-risk group even beyond pandemic-related restrictions.
OBJECTIVE:There are high rates of unemployment among individuals with substance use disorders (SUDs) and unemployment can increase the risk of relapse. Additionally, SUD relapse can increase the chance of job loss. However, there is a dearth of research related to the feasibility and acceptability of employment counseling strategies for individuals with SUDs. METHODS:This study is a secondary sub-group analysis of data attained from a pre-post trial (no control group) of the Conversing with Others intervention, a direct skills teaching (DST) approach designed to enhance confidence with workplace conversational skills. The brief, small-group intervention was administered to 68 participants with SUDs among which 43 (63.2%) had dual diagnoses in community agency settings. RESULTS:From pre- to post-intervention, participants reported greater confidence with and increased knowledge of having a conversation with others in the workplace. Furthermore, participants reported high levels of overall satisfaction with the quality of the intervention. CONCLUSIONS:Securing employment can positively impact the lives of people with SUDs and foster recovery. Brief, targeted soft skills training for enhancing workplace conversational confidence and knowledge may be feasible and acceptable to implement among individuals with SUDs and dual diagnoses in community settings. Findings also have implications for mental health practitioners, multidisciplinary practice, policy makers, and researchers.
OBJECTIVE:This study examined the associations between COVID-19 related stress and alcohol use outcomes, and the role of impulsive personality traits in moderating these associations. PARTICIPANTS:Participants were college students from a large public university in the southwestern United States (n = 425; 74.9% female) and a private mid-size institution in the southeastern United States (N = 114; 74.6% female). METHODS:Students completed self-report assessments during fall 2020. Hierarchical multiple regression models were conducted. RESULTS:Main effects of COVID-19 related stress, negative urgency, and sensation seeking on both alcohol consumption and alcohol use disorder (AUD) symptoms emerged. The association between COVID-19 related stress and AUD symptoms was greater among students with higher negative urgency. CONCLUSIONS:The association between COVID-19 related stress and drinking is evident across the undergraduate student body. Findings demonstrate that students higher in negative urgency may be particularly vulnerable to AUD pathology during periods of heightened stress.
OBJECTIVE:Intimate partner violence is highly prevalent, with approximately one in two women reporting experiences of intimate partner violence (IPV) at some point in their lifetime. Posttraumatic stress disorder (PTSD) is etiologically tied to trauma-including experiences of IPV-and is associated with drug use-related harm. Women of color experience higher rates of IPV, PTSD, and drug use-related harm compared to their white counterparts; however, a dearth of research has been conducted on the relation between PTSD symptoms and drug use-related harm among women of color experiencing IPV. Moreover, little research has identified factors that may ameliorate the association between PTSD symptoms and drug use-related harm. To advance this research, this study investigated the role of ethnic-racial identity as a moderator in the relation between PTSD symptoms and drug use-related harm. METHOD:Participants were 103 women of color currently experiencing IPV who were recruited from the community. Regression analyses examined whether ethnic-racial identity facets of affirmation, exploration, and resolution attenuated the relation between PTSD symptoms and drug use-related harm. RESULTS:The affirmation component of ethnic-racial identity moderated the relation between PTSD symptoms and drug use-related harm (B = -0.02, p = .02), such that PTSD symptoms were significantly associated with drug use-related harm at higher (b = 0.10, p < .001), but not lower (b = 0.01, p = .52), levels of ethnic-racial identity affirmation. No moderating effects were detected for ethnic-racial identity exploration and resolution. CONCLUSION:Results of this study suggest that bolstering the ethnic-racial identity facet of affirmation among women of color who experience IPV may attenuate the relation between PTSD symptoms and drug use-related harm.
OBJECTIVE:This study examined differences in self-stigma between patients with cannabis-induced first-episode psychosis (C-FEP, n = 10) and non-cannabis-induced first-episode psychosis (NC-FEP, n = 10). METHODS:We used three core measures: the Self-Stigma of Mental Illness Scale (SSMIS), the Rosenberg Self-Esteem Scale (RSES), and qualitative interviews. RESULTS:Despite similar levels of stereotype awareness, C-FEP patients showed significantly lower stereotype concurrence (p < .01) and self-application (p < .05) than NC-FEP patients. C-FEP patients attributed their symptoms to cannabis use rather than inherent vulnerability, potentially buffering against internalized stigma, but expressed greater disclosure concerns. Self-esteem was higher in the C-FEP group (p < .05). CONCLUSIONS:These findings suggest that causal attribution influences self-stigma manifestation, with important implications for tailored stigma interventions in early psychosis.
OBJECTIVE:Psychiatric and substance use disorders commonly co-occur, yet treatment is often siloed. To improve treatment utilization for individuals with co-occurring disorders in the psychiatric setting it important to understand current practices. This study analyzed adults seen by community-based psychiatric emergency services with co-occurring disorders to identify: (1) reason for visit; (2) prevalence of suicidality and past attempts; (3) whether suicidality predicted future psychiatric emergency department (ED) presentation. METHODS:Retrospective chart review of patients seen by the Boston Emergency Services Team with first encounters between 2017-2021 (N = 352). RESULTS:The sample had an average age of 38 years old, 66% male, 57% White. Thirty-eight percent of patients reported suicidal ideation (SI), of whom 25% described SI involving overdose. Sixty patients had attempted suicide, 35 by overdose. In a Cox Regression model, suicidality in the first visit did not predict future psychiatric ED use. CONCLUSIONS:The high co-occurrence of SUDs with suicidality indicates the importance of screening and intervention in specialty mental health and addiction treatment settings.
