Public health impact of substance use

Background: Most severe substance use disorders (SUDs) are connected with attention deficit hyperactivity disorder (ADHD) and other mental health problems. Therapeutic communities (TCs) provide a suitable option for the treatment of severe SUDs. The relationship between ADHD, the severity of the SUD, and other comorbidities in residential TCs is unknown. Objective: To estimate the prevalence of ADHD among clients with an SUD in residential rehab, and to compare the mental health of clients with and without ADHD. Methods: A cohort study was conducted in 5 residential TCs (N = 180, 76.7% male, 53.9% 25–34 years, 79.2% diagnosed with methamphetamine use disorder). We assessed ADHD symptoms, substance use, mental health problems, and psychiatric symptoms. Results: ADHD was found in 51% of the clients who showed significantly higher scores for their psychiatric status composite score (ASI-PSY) (F = 9.08, p < 0.001; t = 5.05, p < 0.001), the positive psychiatric symptoms total (SCL-PST) (F = 3.36, p < 0.05; t = 3.15, p < 0.01), and the global severity index (SCL-GSI) (F = 3.27, p < 0.05; t = 3.18, p < 0.01). The ASI-PSY and SCL correlated significantly with the symptoms of attention deficit disorder (Pearson’s r’s = 0.30–0.42, p’s < 0.001) and the symptoms of hyperactivity disorder (r’s = 0.24–0.30, p’s < 0.01). Even when severity of substance use was accounted for, ADHD was confirmed as a significant predictor of ASI-PSY (B= 0.14, p < 0.001 for combined disorder; B = 0.20, p < 0.001 for attention disorder) and partially of SCL-PST (B = 8.12, p < 0.05 for attention disorder). Conclusions: The ADHD prevalence in TCs was nearly 10-fold compared to the globally recorded values. ADHD diagnostic procedures and interventions should become an integral part of the standard diagnostic and treatment process.

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“…Clients of Czech TCs do not constitute a large population. Combined, all certified TCs provide treatment to ∼300 clients per year [25, 26].…”

Section: Methodsmentioning

confidence: 99%

Attention Deficit Hyperactivity Disorder among Clients Diagnosed with a Substance Use Disorder in the Therapeutic Communities: Prevalence and Psychiatric Comorbidity

Miovský¹,

Lukavská²,

Rubášová³

et al. 2020

Eur Addict Res

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“…MA has a unique position in the Czech drug scene [3], which is influenced by nearly 50 years’ history of use [4] and its high popularity compared to the use of other types of stimulants, such as amphetamine or cocaine, which is of a very low prevalence [5]. The majority of Czech MA users (approximately 80%) inject the drug [6].…”

Section: Introductionmentioning

confidence: 99%

Prenatal Methamphetamine Exposure and Adverse Neonatal Outcomes: A Nationwide Cohort Study

et al. 2020

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Background: There is limited knowledge on the adverse outcomes in newborns after maternal methamphetamine (MA) use during pregnancy. Objectives: To compare neonatal outcomes in newborns exposed to MA with the newborns of opioid-exposed mothers and of mothers from the general population (GP). Method: A cohort study using nationwide registries in Czechia (2000–2014). Women hospitalized with a main diagnosis of MA use disorder during pregnancy (n = 258) and their newborns were defined as MA-exposed. The comparison groups consisted of women (n = 199) diagnosed with opioid use disorder during pregnancy, defined as opioid-exposed, and women (n = 1,511,310) with no substance use disorder diagnosis (GP). The neonatal outcomes studied were growth parameters, gestational age, preterm birth, and Apgar score. To explore the associations between MA exposure and neonatal outcomes, regression coefficients (b) and odds ratios from multivariable linear and binary logistic regression were estimated. Results: MA-exposed women had similar socio-economic characteristics to opioid-exposed, both of which were worse than in the GP. After adjustment, MA exposure was associated with a more favourable birthweight when compared to the opioid-exposed (adjusted mean differences [aMD] b = 122.3 g, 95% CI: 26.0–218.5) and length (aMD b = 0.6 cm, 0.0–1.1). Unadjusted results from the comparison with the GP showed that the MA group had poorer neonatal outcomes, especially in the growth parameters. Adjustment for background characteristics had a profound effect on the comparison with the GP. After adjustment, MA exposure was associated only with a slightly reduced birthweight (aMD b = −63.0 g, −123.0 to −3.1) and birth length (aMD b = −0.3 cm, −0.6 to 0.0). Conclusions: Although the observed negative outcomes were large in the MA-exposed newborns, the adjustment had a profound effect on the comparison with the GP, indicating the large influence of lifestyle and socio-economic factors in these high-risk pregnancies. MA-exposed newborns had better neonatal outcomes compared to opioids-exposed.

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“…This study has several limitations. First, the respondents in this analysis reported higher participation on the supply side of the cannabis market (15–50% sold their cannabis and 9–47% had attempted to grow it) than is likely to be the case among cannabis users in the general population (e.g., among the people who used cannabis in the last year, only 10% in the U.S. reported that they sold it, Caulkins & Pacula, 2006, and 6% in Czechia reported that they grew it, Mravčík et al, 2014). The respondents basically self-selected into the study when they decided to contact the interviewers, and the information handed to them referred to a study of “marijuana/cannabis markets” in all but the Spanish substudy (which emphasized the phenomenon of CSCs).…”

Section: Discussionmentioning

confidence: 62%

“The Good, the Bad, and the Ugly Weed”: How Consumers in Four Different Policy Settings Define the Quality of Illicit Cannabis

Běláčková

2020

Contemporary Drug Problems

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With proliferating efforts to regulate the quality of cannabis on legalized markets, and recent discussions about drug quality assessment by darknet buyers, it seems timely to explore definitions of the quality of cannabis among consumers. An inductive analysis of in-depth interviews with people who had used cannabis in the past 12 months was conducted, which focused on the respondents’ subjective definitions and assessments of the quality of cannabis. The data are drawn from convenience samples in four localities (Florida [United States], Czechia, Spain, and New South Wales [Australia]) where cannabis was illegal or decriminalized. The findings suggest that the respondents across all four localities used a range of visual and sensory indicators to assess the quality of cannabis. For many respondents, these were independent indicators of the quality of cannabis suggesting that cannabis was not merely an “experience” good. For others, visual and sensory assessments were used as indirect indicators of quality in that they represented the effect of the cannabis. The desired effect was more complex than simple potency (strength) and several respondents preferred mild and not-sedating cannabis. Across the four localities, the respondents also included “proxy” indicators of the safety of cannabis in their definitions of quality. In other words, high-quality cannabis was defined as not causing excessive intoxication or physical harm. Altogether, cannabis was a specific “credence” good when its quality was seen as a result of cultivation techniques, production location, or producers’ (profit) motivations - depending on the locality. These findings suggest that cannabis policies that regulate the cultivation process can be relevant to people who use cannabis. Given that consumers take the safety of cannabis into consideration when assessing its quality, their involvement in the development of quality standards is warranted. Consumer-led self-regulation should also be considered in policies that seek to regulate cannabis supply.

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Public health impact of substance use

Cited by 4 publications

References 20 publications

Attention Deficit Hyperactivity Disorder among Clients Diagnosed with a Substance Use Disorder in the Therapeutic Communities: Prevalence and Psychiatric Comorbidity

Attention Deficit Hyperactivity Disorder among Clients Diagnosed with a Substance Use Disorder in the Therapeutic Communities: Prevalence and Psychiatric Comorbidity

Prenatal Methamphetamine Exposure and Adverse Neonatal Outcomes: A Nationwide Cohort Study

“The Good, the Bad, and the Ugly Weed”: How Consumers in Four Different Policy Settings Define the Quality of Illicit Cannabis

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