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Borderline personality disorder and brief intervention for drug use in HIV primary care
Abstracts / Drug and Alcohol Dependence 171 (2017) e2–e226
interest in quitting and likelihood of making a post-intervention quit attempt. Methods: T-tests and ANOVA were conducted to compare continuous data while chi-square analyses were used to compare categorical data. Results: Participants with ≤12 years of education (n = 368) vs. those with > 12 years of education (n = 471) were more likely to be male (62 vs.54%, p < 0.05), African American (47 vs 32%, p < 0.001), and menthol smokers (64 vs.52%, p < 0.01). At baseline, participants with lower educational attainment reported smoking more cigarettes per day (18.4 vs 16.1, p < 0.001), began smoking daily at an earlier age (18.1 vs 19.3, p < 0.01), were less likely to have ever made a quit attempt (61 vs 78%, p < 0.001) and were less interested in quitting in the next 6 months (19 vs 26%, p < 0.05) than those with higher educational attainment. Participation in the study increased motivation to quit in both groups (p < 0.001) and increased it to a greater extent in the more educated participants (p < 0.05 for the interaction). Those with higher educational attainment trended towards a greater number of actual quit attempts after the trial (20 vs 26%, p = 0.08). Conclusions: Data from this trial provide further corroboration that smokers with lower educational attainment are a vulnerable population, reporting smoking initiation at a younger age, greater cigarette exposure, less interest in quitting and fewer quit attempts. A 6-week intervention with very low nicotine cigarettes increased motivation to quit in both lower-and higher-educated participants. Novel, multi-modal public health interventions are needed to help this vulnerable population quit smoking. Financial support: U54DA031659. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.156 The transition to recovery: Key predictors and how they relate to aging Michael L. Dennis 1,∗ , Christy K. Scott 1 , John G. Csernansky 2 , Hans C. Breiter 2 1 Lighthouse Inst., Chestnut Health Systems, Normal & Chicago, IL, United States 2 Dep. of Psych. and Beh. Sci., Northwestern University School of Medcine, Chicago, IL, United States
Aims: To (1) Identify predictors of transitioning from substance use to abstinence in the community one year later; and (2) Examine how these predictors of the transition are related to aging. Methods: Data are from 678 adults interviewed annually for 17 years post intake to substance use treatment: 93% alcohol, 64% opioids, 36% stimulants, and 36% cannabis. The sample was 62% female and 76% African-American, with a median age of 48. Univariate and multivariate logistic regression were conducted on 49 variables to predict the probability of transitioning from use to abstinence in the community by the end of the next year. Results: Logistic regression analysis identified 15 variables associated with increasing the probability of transitioning from using to abstinence in the community: Female; years of abstinence; % days abstinence; less than weekly use of any substance, alcohol, or marijuana; and no past year use of opioids, stimulates or tobacco; all clean and sober friends; mod+ level of self-help engagement; mod+ physical health problems; any ER visits; high health care utilization costs; and lower quality of life. Another 5 variables were associated with decreasing the probability; past year substance disorder; past year opioid use disorder; symptoms of withdrawal; high level of craving; and a history of child abuse. Multivariate logistic stepwise regression simplified this to 9 variables: female, % days
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of abstinence, opioid disorder, no use of marijuana, craving, selfhelp engagement, cognitive impairment, and child abuse. Age was related to trends in many of these variables, but varied in direction. Conclusions: Contrary to expectation, aging was not a main effect that explained the transition from using to abstinence a year later. However, aging was associated with multiple factors (particularly health and physical deterioration) that in turn predicted abstinence. Transition to abstinence may be a last resort for some people if they want to live. Financial support: NIDA grant DA015523. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.157 Borderline personality disorder and brief intervention for drug use in HIV primary care Jennifer Derri 2,∗ , Aline Le 2 , Deborah S. Hasin 1,2 , Efrat Aharonovich 1,2 1 Psychiatry, Columbia University Medical Center, New York, NY, United States 2 New York State Psychiatric Institute, New York, NY, United States
Aims: Brief intervention for drug use in health settings is increasingly popular. Substance use disorders (SUD) are often co-morbid with borderline personality disorder (BPD). Among persons living with HIV, patients with SUD and BPD are considered “triply diagnosed.” Because BPD is associated with substance use persistence, medication non-adherence, and poor interpersonal functioning, the need for intensive intervention appears indicated. Brief intervention may be sufficient and more readily available, yet efficacy has not been studied. Methods: Data were drawn from a randomized controlled trial (n = 190) of a brief intervention for non-injection drug use in HIV primary care. Exploratory factor analysis of responses to the AUDADIS-IV diagnostic module was used to characterize endorsement of BPD. We used mixed-effect modeling to explore differences between patients with and without BPD in number of days of drug use during the study. Differences in treatment retention were assessed using chi-square analysis. Results: 20 (10.5%) patients met criteria for BPD. An exploratory factor analysis revealed a single diagnostic factor. Patients showed statistically significant reductions in days of use at end of treatment (60 days, p < 0.0001) and end of study (12 months, p < 0.0001). No differences were observed in reduction of days of use between patients with and without BPD. A higher number of endorsed symptoms did not impact the reduction in days of use. Retention during the treatment was high (82.6%), and no significant difference in retention was found between patients with and without BPD. Conclusions: Our findings indicate that HIV+ individuals with BPD who are engaged in HIV primary care responded as well to brief intervention for drug use as those without BPD. More intensive treatments such as DBT are shown to be efficacious with this population, yet briefer and more cost-efficient treatments may be sufficient and should be considered. Financial support: R01DA024606, NYS Psychiatric Institute. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.158
interest in quitting and likelihood of making a post-intervention quit attempt. Methods: T-tests and ANOVA were conducted to compare continuous data while chi-square analyses were used to compare categorical data. Results: Participants with ≤12 years of education (n = 368) vs. those with > 12 years of education (n = 471) were more likely to be male (62 vs.54%, p < 0.05), African American (47 vs 32%, p < 0.001), and menthol smokers (64 vs.52%, p < 0.01). At baseline, participants with lower educational attainment reported smoking more cigarettes per day (18.4 vs 16.1, p < 0.001), began smoking daily at an earlier age (18.1 vs 19.3, p < 0.01), were less likely to have ever made a quit attempt (61 vs 78%, p < 0.001) and were less interested in quitting in the next 6 months (19 vs 26%, p < 0.05) than those with higher educational attainment. Participation in the study increased motivation to quit in both groups (p < 0.001) and increased it to a greater extent in the more educated participants (p < 0.05 for the interaction). Those with higher educational attainment trended towards a greater number of actual quit attempts after the trial (20 vs 26%, p = 0.08). Conclusions: Data from this trial provide further corroboration that smokers with lower educational attainment are a vulnerable population, reporting smoking initiation at a younger age, greater cigarette exposure, less interest in quitting and fewer quit attempts. A 6-week intervention with very low nicotine cigarettes increased motivation to quit in both lower-and higher-educated participants. Novel, multi-modal public health interventions are needed to help this vulnerable population quit smoking. Financial support: U54DA031659. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.156 The transition to recovery: Key predictors and how they relate to aging Michael L. Dennis 1,∗ , Christy K. Scott 1 , John G. Csernansky 2 , Hans C. Breiter 2 1 Lighthouse Inst., Chestnut Health Systems, Normal & Chicago, IL, United States 2 Dep. of Psych. and Beh. Sci., Northwestern University School of Medcine, Chicago, IL, United States
Aims: To (1) Identify predictors of transitioning from substance use to abstinence in the community one year later; and (2) Examine how these predictors of the transition are related to aging. Methods: Data are from 678 adults interviewed annually for 17 years post intake to substance use treatment: 93% alcohol, 64% opioids, 36% stimulants, and 36% cannabis. The sample was 62% female and 76% African-American, with a median age of 48. Univariate and multivariate logistic regression were conducted on 49 variables to predict the probability of transitioning from use to abstinence in the community by the end of the next year. Results: Logistic regression analysis identified 15 variables associated with increasing the probability of transitioning from using to abstinence in the community: Female; years of abstinence; % days abstinence; less than weekly use of any substance, alcohol, or marijuana; and no past year use of opioids, stimulates or tobacco; all clean and sober friends; mod+ level of self-help engagement; mod+ physical health problems; any ER visits; high health care utilization costs; and lower quality of life. Another 5 variables were associated with decreasing the probability; past year substance disorder; past year opioid use disorder; symptoms of withdrawal; high level of craving; and a history of child abuse. Multivariate logistic stepwise regression simplified this to 9 variables: female, % days
e53
of abstinence, opioid disorder, no use of marijuana, craving, selfhelp engagement, cognitive impairment, and child abuse. Age was related to trends in many of these variables, but varied in direction. Conclusions: Contrary to expectation, aging was not a main effect that explained the transition from using to abstinence a year later. However, aging was associated with multiple factors (particularly health and physical deterioration) that in turn predicted abstinence. Transition to abstinence may be a last resort for some people if they want to live. Financial support: NIDA grant DA015523. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.157 Borderline personality disorder and brief intervention for drug use in HIV primary care Jennifer Derri 2,∗ , Aline Le 2 , Deborah S. Hasin 1,2 , Efrat Aharonovich 1,2 1 Psychiatry, Columbia University Medical Center, New York, NY, United States 2 New York State Psychiatric Institute, New York, NY, United States
Aims: Brief intervention for drug use in health settings is increasingly popular. Substance use disorders (SUD) are often co-morbid with borderline personality disorder (BPD). Among persons living with HIV, patients with SUD and BPD are considered “triply diagnosed.” Because BPD is associated with substance use persistence, medication non-adherence, and poor interpersonal functioning, the need for intensive intervention appears indicated. Brief intervention may be sufficient and more readily available, yet efficacy has not been studied. Methods: Data were drawn from a randomized controlled trial (n = 190) of a brief intervention for non-injection drug use in HIV primary care. Exploratory factor analysis of responses to the AUDADIS-IV diagnostic module was used to characterize endorsement of BPD. We used mixed-effect modeling to explore differences between patients with and without BPD in number of days of drug use during the study. Differences in treatment retention were assessed using chi-square analysis. Results: 20 (10.5%) patients met criteria for BPD. An exploratory factor analysis revealed a single diagnostic factor. Patients showed statistically significant reductions in days of use at end of treatment (60 days, p < 0.0001) and end of study (12 months, p < 0.0001). No differences were observed in reduction of days of use between patients with and without BPD. A higher number of endorsed symptoms did not impact the reduction in days of use. Retention during the treatment was high (82.6%), and no significant difference in retention was found between patients with and without BPD. Conclusions: Our findings indicate that HIV+ individuals with BPD who are engaged in HIV primary care responded as well to brief intervention for drug use as those without BPD. More intensive treatments such as DBT are shown to be efficacious with this population, yet briefer and more cost-efficient treatments may be sufficient and should be considered. Financial support: R01DA024606, NYS Psychiatric Institute. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.158