Former inpatients’ narratives of substance use four years after substance use disorder treatment: A qualitative follow-up study

Aim: The aim of this study was to explore the narratives of former substance use disorder (SUD) inpatients about substance use after their discharge from long-term SUD treatment in 2017. Method: We conducted semi-structured in-depth interviews with 11 former inpatients of SUD treatment. The data were analysed using a qualitative, thematic analysis model. Findings: During the analysis, two main themes emerged pertaining to participant reflections on substance use – their experience of non-problematic substance use (that is, substance use without declining into pre-treatment levels of misuse behaviours) and problematic substance use (that is, substance use associated with destructive patterns). All participants except one had engaged in substance use after their discharge three to four years ago. The commonly used substance was alcohol, which also appeared to be the most common substance for which there was consensus among the informants regarding non-problematic use. Conclusions: Most of the participants continued to use substances in some way, and some reported that such use did not affect them negatively. Healthcare providers and therapists in SUD treatment should avoid defining a relapse or failed treatment outcome in concrete terms. What is perceived as an actual relapse or a failed treatment outcome is highly subjective. Furthermore, complete sobriety might not necessarily be the best or the only way to measure the SUD treatment stay. An improvement in the quality of life and well-being, even when core symptoms are still present, may be considered a successful treatment outcome.

Problematic Substance Use in Adolescent Psychiatric Inpatients: Rates, Clinical Correlates and Effects on Therapeutic Outcomes

Aims: : We aimed to document the clinical rates and correlates of problematic substance use among adolescent inpatients. Background: Adolescents referred to psychiatric inpatient care are likely to present family and social risk factors making them at high-risk of substance use disorder Objective: To document the rates, clinical correlates and effects on therapeutic outcomes of associated problematic substance use in adolescents referred to psychiatric inpatient care. Method: The DEP-ADO questionnaire was used to systematically screen out problematic substance use in two 12-18 adolescent inpatient units between January 2017 and December 2018. Inpatients screened positively based on the DEP-ADO questionnaire and/or information gathered from repeated interviews with the youth and his/her family were reported to the liaison addiction unit for diagnosis. Chart-review procedure was used to document clinical correlates (i.e., suicidal behavior, DSM-5 psychiatric diagnoses, the Clinical Global Impression-Severity score) and therapeutic outcomes (i.e., the Clinical Global Impression-Improvement score, change in Children-Global Assessment Scale score during patients’ stay and length of stay). Result: Over two years, 150 adolescents completed the DEP-ADO questionnaire (Mean Age =14.7 ± 1.7; 42% girls). Thirty percent of adolescent inpatients reported some type of problematic substance use, with a higher likelihood of daily tobacco use (OR=2.4), regular cannabis use (OR=2.3) and occasional opioid/heroin use (OR=9.8) compared to general population. Adolescent inpatients who misused illegal substance prior admission were 2.5 times more likely to report suicidal behaviors. A strong association was reported between binge drinking behavior and a discharge diagnosis of bipolar disorder (OR=11.0). Therapeutic outcomes were not statistically different with regards to alcohol or illicit substance use status. Conclusion: Inpatient adolescents were at high-risk of having associated problematic substance use. Patients with co-existing problematics seem to have more severe and chronic forms of mood disturbances, although the response rate to therapeutics provided during their stay were not lower compared to their counterparts without problematic substance use.

Changes in Social, Romantic, and General Life Satisfaction Over the Course of a Substance Use Disorder

Background: The pandemic has highlighted the importance of social connection for health and well-being. Satisfaction across domains of life is associated with substance use outcomes, such as risk of relapse and mortality. Previous work has delineated the relationship between substance use and social connections, yet there is a lack of research exploring the relationship between substance use and satisfaction with domains of life over time.Methods: We retrospectively assessed satisfaction with social life, romantic life, and general life across five phases of substance use among 339 adults, of whom 289 identify as formerly having a problem with substance use, and a comparison group of 50 who report no history of problematic drug use. We compared those whose primary drug of choice was alcohol, marijuana, methamphetamine, non-prescription opioids, and prescription opioids.Results: Those who used prescription opioids reported a larger drop in satisfaction in social life, romantic life, and general life during the course of substance use than those who used other drugs. However, we report no significant differences in current satisfaction, social well-being, or quality of life between people in recovery and people with no history of problematic substance use.Conclusions: These findings—alongside neuropsychological work on the opioid system and sociality—paint a picture that those who formerly used prescription opioids may experience lower satisfaction across life domains during the course of their substance use than those who used other substances. However, people in prolonged recovery—regardless of their drug of choice—all show similar levels of satisfaction compared to people with no history of problematic substance use.

The Substance Abuse Program for African-Canadian and Caribbean Youth (SAPACCY): An Innovative Program Serving the Mental Health Needs of African, Caribbean, and Black Youth

Black youth experience disproportionately poor health outcomes throughout Ontario's healthcare system, including the mental health and addictions system. The Substance Abuse Program for African Canadian and Caribbean Youth (SAPACCY) at the Centre for Addiction and Mental Health (CAMH) seeks to address this disparity by providing clinical services to youth who identify as Black and/or as having African and/or Caribbean heritage, and their families, who are struggling with problematic substance use and/or mental health concerns. The clinical team works from an Afrocentric, culturally responsive lens to promote recovery and support Black youth in working through their mental health and addiction concerns. The program offers mental health and addictions counselling and psychotherapy, psychiatric consultation, psychoeducation, resource navigation, advocacy, and case management services to assist youth and their families/caregivers in reducing harm, moving toward recovery, and making healthy choices for themselves and their family. This paper will discuss SAPACCY’s approach to helping clients build resilience and resistance to anti-Black racism.

Implication of problematic substance use in poststroke depression: an hospital-based study

The prevalence of clinically defined problematic substance use among stroke patients is overlooked and its association with post-stroke depression (PSD) is unknown. Our aims were to: (1) estimate the proportion of stroke patients with a problematic substance use as defined by clinical screening scales; (2) determine the proportion of PSD at three months of follow-up; (3) explore if the baseline severity in substance use and its evolution are independent predictors of PSD. A cohort of first-ever non-severe stroke adult patients was screened at baseline and three months post-stroke using recommended cut-off scores of standardized scales for tobacco, alcohol and cannabis abuse. PSD was defined using the Center of Epidemiological Studies Depression scale score. Out of the 244 eligible patients, 74 (30.3%) presented a problematic substance use, including 21 (8.6%) polydrug abusers. Among these patients, the prevalence of PSD was 50.8%, including 29.5% of severe depression. The severity of tobacco dependence at baseline was found to double the risk (OR 1.59, 95% CI 1.05–2.43) of presenting a PSD, independently of previously reported risk factors. We found no significant evidence for an effect of the evolution in substance use at follow-up. Addictive disorders are part of the critical unmet needs that should be addressed in the management of PSD.

Executive functions and parenting stress in mothers with problematic substance use

A growing body of research has shown that executive functions play an important role in effective and sensitive parenting. No studies have examined this relation in mothers with problematic substance use, who may be at particular risk given biological, psychological, and contextual risks that may undermine executive functions and increase parenting stress. The purpose of this study was to investigate the relation between three executive functions and parenting stress. Sixty-five mothers attending substance use treatment completed tasks assessing updating, inhibition, and shifting executive functions and questionnaires assessing parenting stress, reflecting both relational and household chaos definitions of the construct. Controlling for SES and age of youngest child, lower performance on both inhibition and updating tasks was associated with increased parenting stress, when a relational definition was employed. However, no significant relations were found between executive functions and household chaos definitions of parenting stress, after depression and SES were controlled for. These preliminary results suggest a role for executive functions in parenting stress in mothers with problematic substance use, but highlight the importance of considering the type of executive function assessed and the definition of parenting stress employed. Directions for future research and clinical implications are discussed.