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Evidence of a meta-memory deficit among chronic methamphetamine users
Abstracts / Drug and Alcohol Dependence 140 (2014) e169–e251
NPOU and 59% of those reported NPSU in the past 6 months. Among those with lifetime NPOU or NPSU, 28% met criteria for dependence or abuse and 42% were at moderate or high risk for problems related to prescription opiates or sedatives respectively. Correlates of lifetime NPOU included identifying as Caucasian and cocaine use. Correlates of lifetime NPSU included Caucasian race, cocaine use, current depression, alcohol misuse and peer violence. Conclusions: Among adolescents and young adults that have used drugs in the past 6 months, NPOU and NPSU is common, with over 25% meeting criteria for dependence and abuse. Financial support: NIDA R01DA024646. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.671 Changes in the age distribution of admissions to substance abuse treatment for opioid abuse in the U.S. from 2000 to 2010 J.C. Willis, Howard Chilcoat Risk Management and Epidemiology, Purdue Pharma, L.P., Stamford, CT, United States Aims: In recent years there have been substantial increases in substance abuse treatment episodes with opiates as the primary drug of abuse in the US. This study examines changes in the age distribution and associated characteristics of these individuals over time. Methods: Data from the 2000 to 2010 Treatment Episode Data Set (TEDS) were used to estimate the numbers of people entering treatment with prescription opioids as primary drug of abuse in publicly funded treatment centers in the US. Trends in the numbers and distributions over time were compared by age, as well as characteristics including route of administration, source of referral and frequency of use. Results: Number of treatment entries increased 5-fold from 2000 to 2010. There was a shift in the distribution towards younger ages in more recent surveys. In 2000, peak prevalence was in 35–39 year olds versus 25–29 year olds in 2010. 58% of people entering treatment in 2000 were above age 35 compared to 28% by 2010. In contrast, 31% of people entering treatment in 2010 were under age 25 versus 13% in 2000. There was a difference in the primary route of administration by age between 2000 and 2010: 14% of 18–20 year olds reported inhalation as their primary route in 2000 as compared with 35% in 2010. In contrast patterns of injecting showed little change over time, with 16% of 18–20 year olds reporting injection as their primary route. Adolescents were more likely to be infrequent users than older individuals with little change in patterns of frequency by age over time. Criminal justice was a major source of referral for younger age groups, 23% of people under age 20 were referred via criminal justice in 2010. Conclusions: Between 2000 and 2010 there was a large increase in treatment episodes among younger individuals, who are less likely to represent patients who were taking the medicine as directed following a prescription. The differences in the characteristics of younger compared to older patients require different prevention and treatment strategies to address the changing age demographics. Financial support: Funded by Purdue Pharma, L.P. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.672
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The association between adhd and nicotine in a prospective sample of youth Ken Winters, S. Lee, A. Symmes Psychiatry, University of Minnesota, Minneapolis, MN Aims: To describe pattern of nicotine involvement (age of onset, frequency and dependence symptoms) in a relatively large, community-identified sample of children with ADHD who have been assessed longitudinally from childhood through late adolescence (up to age 22). Methods: We present findings from our multi-dimensional and standardized follow-up assessments at waves 4–6 (ages 18–22). Three rigorously diagnosed groups that were epidemiologically identified during childhood in 1991: ADHD-externalizing (n = 90), ADHD-only (n = 29), and matched controls (n = 93). The follow-up battery consisted of standardized measures of nicotine involvement. Results: After controlling for the effects of the covariates (stimulant medication and education level), we found that the childhood ADHD-externalizing (oppositional defiant disorder or conduct disorder) group was significantly associated with higher levels of nicotine use, a greater number of nicotine dependence symptoms, and an earlier onset of nicotine use compared to the ADHD-only and control groups (all levels of significance > .01). These findings were found at all three time points and in both boys and girls. Conclusions: The results of the present study indicate that individuals who met diagnostic criteria for ADHD with an externalizing disorder as a child reported a higher rate of nicotine use and more nicotine addiction symptoms during their late adolescent and young adult years when compared to individuals in the ADHDonly and non-ADHD groups. This major finding is consistent with both the general drug abuse risk literature that the relation between ADHD and substance use, including nicotine, outcomes may be partially or fully accounted for by the co-existence of ADHD and externalizing disorders. Thus, the study results support the view that ADHD without an externalizing disorder does not give rise to additional risk for nicotine use beyond the risk found in non-ADHD youth, a pattern that held across the late adolescent and young adulthood data points. Financial support: This study was supported by grants K02 DA015347 and R01 DA0112995 from the National Institute on Drug Abuse. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.673 Evidence of a meta-memory deficit among chronic methamphetamine users S.P. Woods, Kaitlin Blackstone, E.E. Morgan, D.R. Franklin, I. Grant Psychiatry, UCSD, San Diego, CA, United States Aims: Chronic methamphetamine (MA) use is associated with moderate deficits in learning and memory; poor awareness of these deficits may increase the risk of errors in real-world outcomes (e.g., automobile driving). The current study evaluated the hypothesis that MA use is associated with decreased awareness of memory deficits, as has been observed in other clinical populations in which prefrontal neural systems are injured. Methods: 195 participants with lifetime MA dependence diagnoses and 195 non-MA-using comparison subjects underwent comprehensive neuropsychiatric research assessments, including performance-based and self-report measures of episodic memory.
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Abstracts / Drug and Alcohol Dependence 140 (2014) e169–e251
Results: MA diagnosis was independently associated with lower scores on performance-based measures of visual and verbal learning and memory, as well as elevated memory complaints in daily life (ps < .05). The concordance between performance-based and self-report of memory problems was lower in the MA group (44% accurate) versus non-users (63% accurate), independent of other clinical factors, including current depressive symptoms (p < .05). Within the MA group, meta-memory inaccuracy was uniquely associated with higher rates of dependence in instrumental activities of daily living and psychomotor slowing (ps < .05). Conclusions: Chronic MA use is associated with reduced awareness of objective deficits in memory acquisition and retention, including both over- and under-evaluations of current levels of memory functioning that may increase concurrent risk of disability in normal daily activities. Cognitive neurorehabilitation efforts to enhance meta-memory accuracy and deployment of appropriate compensatory mnemonic strategies may confer some benefits for substance abuse treatment outcomes. Financial support: The authors report no conflicts of interest. This research was supported by National Institutes of Health grants T32-DA31098, P01-DA12065, P50-DA026306, L30-DA032120. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.674 Buprenorphine-naloxone vs. methadone: Equal HIV risk reduction in start George E. Woody 1 , D. Bruce 2 , T. Korthuis 3 , S. Chhatre 4 , M. Hillhouse 5 , Petra Jacobs 6 , J. Sorenson 7 , A. Saxon 8 , Walter Ling 5 1
Psychiatry, University of Pennsylvania, Philadelphia, PA, United States 2 Yale University School of Medicine, New Haven, CT, United States 3 Oregon Health & Science University, Portland, OR, United States 4 Treatment Research Institute, Philadelphia, PA, United States 5 University of California, Los Angeles, CA, United States 6 National Institute on Drug Abuse, Bethesda, MD, United States 7 University of California San Francisco, San Francisco, CA, United States 8 Veterans Affairs Puget Sound Health Care, Seattle, WA, United States Aims: Compare reductions in HIV injection and sexual risk behaviors in patients treated with methadone (MET) or buprenorphine–naloxone (BUP). Methods: Secondary analysis of HIV risk from a study aimed to evaluate transaminase differences following randomization to a 6-month course of MET or BUP in nine methadone programs participating in the NIDA Clinical Trials Network. Participants were consenting, treatment seeking, opioid addicted individuals who remained in their assigned condition for 24 weeks and had 4 or more monthly blood draws. The Risk Behavior Survey measured past 30-day HIV risk at baseline and at weeks 12 and 24. Results: Among 731 evaluable participants (BUP = 340; MET = 391), 700 completed the 12-week follow-ups and 705 completed 24-week follow-ups. Highly significant reductions in injecting risk (p < 0.0001) were seen across time in both groups with no differences between groups in the number of times heroin, speed-ball, or other opiates were injected and the total times injected. Additionally, there was no difference in the times
needles shared, times needles were not cleaned with bleach prior to sharing, shared cooker, engaged in front/back load, and needle risk composite score. Less pronounced, but also significant (p < 0.03–0.05) were reductions seen in the number of multiple sex partners, instances of unsafe sex and sex risk composite score, with more reduction of the sex risk composite (p < 0.05) in MET than BUP patients. Conclusions: Equal and marked reductions in HIV injecting risk, with significant but less striking reductions in sex risk occurred among patients who remained on BUP and MET. Financial support: DA U10-013043 NIDA. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.675 Gender differences in substance use treatment utilization the year prior to deployment in army service members Nikki R. Wooten 1 , B.A. Mohr 2 , L.M. Lundgren 3 , R.S. Adams 2 , E. Merrick 4 , D.D. Jeffery 4 , T.V. Williams 2 , Mary Jo Larson 2 1 College of Social Work, University of South Carolina, Columbia, SC, United States 2 Institute of Behavioral Health, Heller School, Brandeis University, Waltham, MA, United States 3 School of Social Work, Boston University, Boston, MA, United States 4 Health Affairs, TRICARE Management Activity, Defense Health Costs and Program Evaluation (DHCAPE), Department of Defense, Falls Church, VA, United States
Aims: The impact of the current wars on Army veterans has increased concerns about substance use (SU) and the need for SU treatment (SUT). Gender may be important for understanding SUT utilization before deployment given both gender differences and similarities in military and deployment experiences. This study examined gender differences in SUT utilization the year prior to deployment for Army service members to determine: the rates of substance use diagnosis (SUDX) and SUT before deployment and if the odds of receiving military-provided SUT the year before deployment differ by gender. Methods: A retrospective cohort design was used to analyze military health system claims data to examine gender differences in both substance use diagnosis (SUDX) and SUT in 152,447 Army service members who returned from deployments in FY2010. Results: Propensity score analysis indicated that women had lower odds (AOR: 0.91, 95% CI: 0.86–0.96) of military lifetime SUDX. After adjusting for factors of the Gelberg-Andersen Behavioral Model for Vulnerable Populations and military lifetime SUDX in logistic regression, women also had lower odds (AOR: 0.61; 95% CI: 0.54–0.70) of using SUT the year prior to deployment. Conclusions: Army women may have reduced access to SUT the year prior to deployment compared to men, even after controlling for epidemiological differences associated with gender. Findings suggest gender disparities in military-provided SUT, and the need for military leaders and SUT professionals to consider whether military SU assessment protocols are sensitive to gender differences. Financial support: NIDA #R01DA030150; Data sponsorship from DHCAPE. The opinions or assertions herein are those of the authors and do not necessarily reflect the view of the US Army, Department of Defense. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.676
NPOU and 59% of those reported NPSU in the past 6 months. Among those with lifetime NPOU or NPSU, 28% met criteria for dependence or abuse and 42% were at moderate or high risk for problems related to prescription opiates or sedatives respectively. Correlates of lifetime NPOU included identifying as Caucasian and cocaine use. Correlates of lifetime NPSU included Caucasian race, cocaine use, current depression, alcohol misuse and peer violence. Conclusions: Among adolescents and young adults that have used drugs in the past 6 months, NPOU and NPSU is common, with over 25% meeting criteria for dependence and abuse. Financial support: NIDA R01DA024646. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.671 Changes in the age distribution of admissions to substance abuse treatment for opioid abuse in the U.S. from 2000 to 2010 J.C. Willis, Howard Chilcoat Risk Management and Epidemiology, Purdue Pharma, L.P., Stamford, CT, United States Aims: In recent years there have been substantial increases in substance abuse treatment episodes with opiates as the primary drug of abuse in the US. This study examines changes in the age distribution and associated characteristics of these individuals over time. Methods: Data from the 2000 to 2010 Treatment Episode Data Set (TEDS) were used to estimate the numbers of people entering treatment with prescription opioids as primary drug of abuse in publicly funded treatment centers in the US. Trends in the numbers and distributions over time were compared by age, as well as characteristics including route of administration, source of referral and frequency of use. Results: Number of treatment entries increased 5-fold from 2000 to 2010. There was a shift in the distribution towards younger ages in more recent surveys. In 2000, peak prevalence was in 35–39 year olds versus 25–29 year olds in 2010. 58% of people entering treatment in 2000 were above age 35 compared to 28% by 2010. In contrast, 31% of people entering treatment in 2010 were under age 25 versus 13% in 2000. There was a difference in the primary route of administration by age between 2000 and 2010: 14% of 18–20 year olds reported inhalation as their primary route in 2000 as compared with 35% in 2010. In contrast patterns of injecting showed little change over time, with 16% of 18–20 year olds reporting injection as their primary route. Adolescents were more likely to be infrequent users than older individuals with little change in patterns of frequency by age over time. Criminal justice was a major source of referral for younger age groups, 23% of people under age 20 were referred via criminal justice in 2010. Conclusions: Between 2000 and 2010 there was a large increase in treatment episodes among younger individuals, who are less likely to represent patients who were taking the medicine as directed following a prescription. The differences in the characteristics of younger compared to older patients require different prevention and treatment strategies to address the changing age demographics. Financial support: Funded by Purdue Pharma, L.P. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.672
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The association between adhd and nicotine in a prospective sample of youth Ken Winters, S. Lee, A. Symmes Psychiatry, University of Minnesota, Minneapolis, MN Aims: To describe pattern of nicotine involvement (age of onset, frequency and dependence symptoms) in a relatively large, community-identified sample of children with ADHD who have been assessed longitudinally from childhood through late adolescence (up to age 22). Methods: We present findings from our multi-dimensional and standardized follow-up assessments at waves 4–6 (ages 18–22). Three rigorously diagnosed groups that were epidemiologically identified during childhood in 1991: ADHD-externalizing (n = 90), ADHD-only (n = 29), and matched controls (n = 93). The follow-up battery consisted of standardized measures of nicotine involvement. Results: After controlling for the effects of the covariates (stimulant medication and education level), we found that the childhood ADHD-externalizing (oppositional defiant disorder or conduct disorder) group was significantly associated with higher levels of nicotine use, a greater number of nicotine dependence symptoms, and an earlier onset of nicotine use compared to the ADHD-only and control groups (all levels of significance > .01). These findings were found at all three time points and in both boys and girls. Conclusions: The results of the present study indicate that individuals who met diagnostic criteria for ADHD with an externalizing disorder as a child reported a higher rate of nicotine use and more nicotine addiction symptoms during their late adolescent and young adult years when compared to individuals in the ADHDonly and non-ADHD groups. This major finding is consistent with both the general drug abuse risk literature that the relation between ADHD and substance use, including nicotine, outcomes may be partially or fully accounted for by the co-existence of ADHD and externalizing disorders. Thus, the study results support the view that ADHD without an externalizing disorder does not give rise to additional risk for nicotine use beyond the risk found in non-ADHD youth, a pattern that held across the late adolescent and young adulthood data points. Financial support: This study was supported by grants K02 DA015347 and R01 DA0112995 from the National Institute on Drug Abuse. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.673 Evidence of a meta-memory deficit among chronic methamphetamine users S.P. Woods, Kaitlin Blackstone, E.E. Morgan, D.R. Franklin, I. Grant Psychiatry, UCSD, San Diego, CA, United States Aims: Chronic methamphetamine (MA) use is associated with moderate deficits in learning and memory; poor awareness of these deficits may increase the risk of errors in real-world outcomes (e.g., automobile driving). The current study evaluated the hypothesis that MA use is associated with decreased awareness of memory deficits, as has been observed in other clinical populations in which prefrontal neural systems are injured. Methods: 195 participants with lifetime MA dependence diagnoses and 195 non-MA-using comparison subjects underwent comprehensive neuropsychiatric research assessments, including performance-based and self-report measures of episodic memory.
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Abstracts / Drug and Alcohol Dependence 140 (2014) e169–e251
Results: MA diagnosis was independently associated with lower scores on performance-based measures of visual and verbal learning and memory, as well as elevated memory complaints in daily life (ps < .05). The concordance between performance-based and self-report of memory problems was lower in the MA group (44% accurate) versus non-users (63% accurate), independent of other clinical factors, including current depressive symptoms (p < .05). Within the MA group, meta-memory inaccuracy was uniquely associated with higher rates of dependence in instrumental activities of daily living and psychomotor slowing (ps < .05). Conclusions: Chronic MA use is associated with reduced awareness of objective deficits in memory acquisition and retention, including both over- and under-evaluations of current levels of memory functioning that may increase concurrent risk of disability in normal daily activities. Cognitive neurorehabilitation efforts to enhance meta-memory accuracy and deployment of appropriate compensatory mnemonic strategies may confer some benefits for substance abuse treatment outcomes. Financial support: The authors report no conflicts of interest. This research was supported by National Institutes of Health grants T32-DA31098, P01-DA12065, P50-DA026306, L30-DA032120. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.674 Buprenorphine-naloxone vs. methadone: Equal HIV risk reduction in start George E. Woody 1 , D. Bruce 2 , T. Korthuis 3 , S. Chhatre 4 , M. Hillhouse 5 , Petra Jacobs 6 , J. Sorenson 7 , A. Saxon 8 , Walter Ling 5 1
Psychiatry, University of Pennsylvania, Philadelphia, PA, United States 2 Yale University School of Medicine, New Haven, CT, United States 3 Oregon Health & Science University, Portland, OR, United States 4 Treatment Research Institute, Philadelphia, PA, United States 5 University of California, Los Angeles, CA, United States 6 National Institute on Drug Abuse, Bethesda, MD, United States 7 University of California San Francisco, San Francisco, CA, United States 8 Veterans Affairs Puget Sound Health Care, Seattle, WA, United States Aims: Compare reductions in HIV injection and sexual risk behaviors in patients treated with methadone (MET) or buprenorphine–naloxone (BUP). Methods: Secondary analysis of HIV risk from a study aimed to evaluate transaminase differences following randomization to a 6-month course of MET or BUP in nine methadone programs participating in the NIDA Clinical Trials Network. Participants were consenting, treatment seeking, opioid addicted individuals who remained in their assigned condition for 24 weeks and had 4 or more monthly blood draws. The Risk Behavior Survey measured past 30-day HIV risk at baseline and at weeks 12 and 24. Results: Among 731 evaluable participants (BUP = 340; MET = 391), 700 completed the 12-week follow-ups and 705 completed 24-week follow-ups. Highly significant reductions in injecting risk (p < 0.0001) were seen across time in both groups with no differences between groups in the number of times heroin, speed-ball, or other opiates were injected and the total times injected. Additionally, there was no difference in the times
needles shared, times needles were not cleaned with bleach prior to sharing, shared cooker, engaged in front/back load, and needle risk composite score. Less pronounced, but also significant (p < 0.03–0.05) were reductions seen in the number of multiple sex partners, instances of unsafe sex and sex risk composite score, with more reduction of the sex risk composite (p < 0.05) in MET than BUP patients. Conclusions: Equal and marked reductions in HIV injecting risk, with significant but less striking reductions in sex risk occurred among patients who remained on BUP and MET. Financial support: DA U10-013043 NIDA. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.675 Gender differences in substance use treatment utilization the year prior to deployment in army service members Nikki R. Wooten 1 , B.A. Mohr 2 , L.M. Lundgren 3 , R.S. Adams 2 , E. Merrick 4 , D.D. Jeffery 4 , T.V. Williams 2 , Mary Jo Larson 2 1 College of Social Work, University of South Carolina, Columbia, SC, United States 2 Institute of Behavioral Health, Heller School, Brandeis University, Waltham, MA, United States 3 School of Social Work, Boston University, Boston, MA, United States 4 Health Affairs, TRICARE Management Activity, Defense Health Costs and Program Evaluation (DHCAPE), Department of Defense, Falls Church, VA, United States
Aims: The impact of the current wars on Army veterans has increased concerns about substance use (SU) and the need for SU treatment (SUT). Gender may be important for understanding SUT utilization before deployment given both gender differences and similarities in military and deployment experiences. This study examined gender differences in SUT utilization the year prior to deployment for Army service members to determine: the rates of substance use diagnosis (SUDX) and SUT before deployment and if the odds of receiving military-provided SUT the year before deployment differ by gender. Methods: A retrospective cohort design was used to analyze military health system claims data to examine gender differences in both substance use diagnosis (SUDX) and SUT in 152,447 Army service members who returned from deployments in FY2010. Results: Propensity score analysis indicated that women had lower odds (AOR: 0.91, 95% CI: 0.86–0.96) of military lifetime SUDX. After adjusting for factors of the Gelberg-Andersen Behavioral Model for Vulnerable Populations and military lifetime SUDX in logistic regression, women also had lower odds (AOR: 0.61; 95% CI: 0.54–0.70) of using SUT the year prior to deployment. Conclusions: Army women may have reduced access to SUT the year prior to deployment compared to men, even after controlling for epidemiological differences associated with gender. Findings suggest gender disparities in military-provided SUT, and the need for military leaders and SUT professionals to consider whether military SU assessment protocols are sensitive to gender differences. Financial support: NIDA #R01DA030150; Data sponsorship from DHCAPE. The opinions or assertions herein are those of the authors and do not necessarily reflect the view of the US Army, Department of Defense. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.676