Daniel L. Dickerson

Eight weeks of exercise training improves fitness measures in methamphetamine-dependent individuals in residential treatment.

Objectives:Physical exercise has been shown to benefit diverse medical and behavioral conditions. This study assesses the feasibility and efficacy of an 8-week endurance and resistance training program on fitness measures in individuals undergoing residential treatment for methamphetamine (MA) dependence. Methods:A total of 39 MA-dependent individuals were randomized to 3 days/week of exercise training (ET, n = 15) or health education without training (equal attention [EA], n = 14) over 8 weeks. Aerobic performance (O2max) was measured by indirect calorimetry, body composition by skinfolds, muscle strength by 1-repetition maximum (1-RM), and endurance at 85% of 1-RM for both leg press (LP) and chest press (CP). Results:A total of 29 individuals completed the study for a 74% adherence rate. Baseline characteristics (mean ± SD) were balanced between groups: age 31 ± 7 years; height = 1.74 ± 0.07 m; weight 82.0 ± 15.0 kg. The ET group significantly improved O2max by 0.63 ± 0.22 L/min (+21%), LP strength by 24.4 ± 5.6 kg (+40%), and CP strength by 20.6 ± 5.7 kg (+49%). The ET group increased LP and CP endurance by 120% and 96%, respectively and showed significant reductions in body weight of 1.7 ± 2.4 kg (−2%), % body fat of 2.8 ± 1.3% (−15%), and fat weight 2.8 ± 1.8 kg (−18%). All changes were significant (P < 0.001) for ET, and no changes were seen for the EA group. Conclusions:Individuals recovering from MA dependence showed substantial improvements in aerobic exercise performance, muscle strength and endurance, and body composition with ET. These findings demonstrate the feasibility of an ET intervention in these participants and also show excellent responsiveness to the exercise stimulus resulting in physiological changes that might enhance recovery from drug dependency.

Mental health and substance abuse characteristics among a clinical sample of urban American Indian/Alaska native youths in a large California metropolitan area: a descriptive study.

This study analyzes descriptive data among a clinical sample of American Indian/Alaska Native (AI/AN) youths receiving mental health services in a large California metropolitan area. Among 118 urban AI/AN youths, mood disorders (41.5%) and adjustment disorder (35.4%) were the most common mental health diagnoses. Alcohol (69.2%) and marijuana (50.0%) were the most commonly used substances. Witnessing domestic violence (84.2%) and living with someone who had a substance abuse problem (64.7%) were reported. The majority of patients demonstrated various behavior and emotional problems. Enhancing culturally relevant mental health and substance abuse treatment and prevention programs for urban AI/AN youth is suggested.

Exercise Training Improves Heart Rate Variability after Methamphetamine Dependency

PURPOSE Heart rate variability (HRV) reflects a healthy autonomic nervous system and is increased with physical training. Methamphetamine dependence (MD) causes autonomic dysfunction and diminished HRV. We compared recently abstinent methamphetamine-dependent participants with age-matched, drug-free controls (DF) and also investigated whether HRV can be improved with exercise training in the methamphetamine-dependent participants. METHODS In 50 participants (MD = 28; DF = 22), resting heart rate (HR; R-R intervals) was recorded over 5 min while seated using a monitor affixed to a chest strap. Previously reported time domain (SDNN, RMSSD, pNN50) and frequency domain (LFnu, HFnu, LF/HF) parameters of HRV were calculated with customized software. MD were randomized to thrice-weekly exercise training (ME = 14) or equal attention without training (MC = 14) over 8 wk. Groups were compared using paired and unpaired t-tests. Statistical significance was set at P ≤ 0.05. RESULTS Participant characteristics were matched between groups (mean ± SD): age = 33 ± 6 yr; body mass = 82.7 ± 12 kg, body mass index = 26.8 ± 4.1 kg·min. Compared with DF, the MD group had significantly higher resting HR (P < 0.05), LFnu, and LF/HF (P < 0.001) as well as lower SDNN, RMSSD, pNN50, and HFnu (all P < 0.001). At randomization, HRV indices were similar between ME and MC groups. However, after training, the ME group significantly (all P < 0.001) increased SDNN (+14.7 ± 2.0 ms, +34%), RMSSD (+19.6 ± 4.2 ms, +63%), pNN50 (+22.6% ± 2.7%, +173%), HFnu (+14.2 ± 1.9, +60%), and decreased HR (-5.2 ± 1.1 bpm, -7%), LFnu (-9.6 ± 1.5, -16%), and LF/HF (-0.7 ± 0.3, -19%). These measures did not change from baseline in the MC group. CONCLUSIONS HRV, based on several conventional indices, was diminished in recently abstinent, methamphetamine-dependent individuals. Moreover, physical training yielded a marked increase in HRV, representing increased vagal modulation or improved autonomic balance.

Utilizing drumming for American Indians/Alaska Natives with substance use disorders: a focus group study.

Background: Drumming has been utilized among American Indian/Alaska Native (AI/AN) tribes for centuries to promote healing and self-expression. Drum-Assisted Recovery Therapy for Native Americans (DARTNA), currently under development, is a substance abuse treatment utilizing drumming as a core component. Objectives: Focus groups were conducted to assist in the development of the DARTNA protocol. Feedback obtained from these focus groups will inform a subsequent pretest of DARTNA and an empirical study analyzing its effectiveness. Methods: Three focus groups were conducted among AIs/ANs with substance use disorders (n = 6), substance abuse treatment providers (n = 8), and a community advisory board (n = 4) to solicit feedback prior to a pretest of the DARTNA protocol. Results: Overall, participants indicated that DARTNA could be beneficial for AIs/ANs with substance use disorders. Four overarching conceptual themes emerged across the focus groups: (1) benefits of drumming, (2) importance of a culture-based focus, (3) addressing gender roles in drumming activities, and (4) providing a foundation of common AI/AN traditions. Conclusions: The DARTNA protocol is a potentially beneficial and culturally appropriate substance abuse treatment strategy for AIs/ANs. In order to optimize the potential benefits of a substance abuse treatment protocol utilizing drumming for AIs/ANs, adequate attention to tribal diversity and gender roles is needed. Scientific Significance: Due to the shortage of substance abuse treatments utilizing traditional healing activities for AIs/ANs, including drumming, results from this study provide an opportunity to develop an intervention that may meet the unique treatment needs of AIs/ANs.

Integrating Motivational Interviewing and Traditional Practices to Address Alcohol and Drug Use Among Urban American Indian/Alaska Native Youth

American Indians/Alaska Natives (AI/AN) exhibit high levels of alcohol and drug (AOD) use and problems. Although approximately 70% of AI/ANs reside in urban areas, few culturally relevant AOD use programs targeting urban AI/AN youth exist. Furthermore, federally-funded studies focused on the integration of evidence-based treatments with AI/AN traditional practices are limited. The current study addresses a critical gap in the delivery of culturally appropriate AOD use programs for urban AI/AN youth, and outlines the development of a culturally tailored AOD program for urban AI/AN youth called Motivational Interviewing and Culture for Urban Native American Youth (MICUNAY). We conducted focus groups among urban AI/AN youth, providers, parents, and elders in two urban communities in northern and southern California aimed at 1) identifying challenges confronting urban AI/AN youth and 2) obtaining feedback on MICUNAY program content. Qualitative data were analyzed using Dedoose, a team-based qualitative and mixed methods analysis software platform. Findings highlight various challenges, including community stressors (e.g., gangs, violence), shortage of resources, cultural identity issues, and a high prevalence of AOD use within these urban communities. Regarding MICUNAY, urban AI/AN youth liked the collaborative nature of the motivational interviewing (MI) approach, especially with regard to eliciting their opinions and expressing their thoughts. Based on feedback from the youth, three AI/AN traditional practices (beading, AI/AN cooking, and prayer/sage ceremony) were chosen for the workshops. To our knowledge, MICUNAY is the first AOD use prevention intervention program for urban AI/AN youth that integrates evidence-based treatment with traditional practices. This program addresses an important gap in services for this underserved population.

American Indians/Alaska Natives and Substance Abuse Treatment Outcomes: Positive Signs and Continuing Challenges

ABSTRACT Limited information is known with regard to substance abuse treatment outcomes among AI/ANs. Data retrieved from the Treatment System Impact (TSI) project and Methamphetamine Treatment Project (MTP) were used to compare treatment measures between a sample of AI/ANs and a matched comparison group. Our results revealed no significant differences between AI/ANs and the matched comparison group in treatment outcomes at 12-months post-treatment based on legal, employment, medical, and psychiatric measures. AI/ANs also received more family-related services (29.9% vs. 17.1%) and abuse-related services (21.3% vs. 7.6%). Addressing barriers to receiving substance abuse treatment and enhancing screening methods for AI/ANs are suggested.

Suicidal ideation and suicide attempts in five groups with different severities of gambling: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions

BACKGROUND AND OBJECTIVES Problem and pathological gamblers show high rates of suicidal behavior. However, previous research of suicide among this population has been inconsistent. Discrepancies may stem from methodological issues, including variable use of suicide nomenclature and selection bias in study samples. Furthermore, earlier research has rarely examined gambling severity aside from problem or pathological categories. This study utilized subgroups derived from a nationally representative data set, examining different characteristics of suicidal behavior and several gambling levels, including subclinical groups. METHODS Participants included 13,578 individuals who participated in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and provided information on gambling behavior, lifetime suicidal ideation, and/or lifetime suicide attempts. Five gambling groups were derived using DSM-IV criteria for pathological gambling; non-gambling, low-risk gambling, at-risk gambling, problem gambling, and pathological gambling. RESULTS Problem gambling was associated with suicidal ideation [adjusted odds ratio (AOR) = 1.64, 95% confidence interval (CI) = 1.19-2.26] and suicide attempts [(AOR) = 2.42, 95% (CI) = 1.60-3.67] after adjustment for sociodemographic variables. Pathological gambling was associated with suicidal ideation [(AOR) = 2.86, 95% (CI) = 1.98-4.11] and suicide attempts [(AOR) = 2.77, 95% (CI) = 1.72-4.47) after adjustment for sociodemographic variables. DISCUSSION, CONCLUSIONS, AND SCIENTIFIC SIGNIFICANCE Our results from this population sample reinforce increased rates of suicidal behavior amongst smaller, clinical samples of problem and pathological gamblers. Education for providers about gambling is recommended, including screening for gambling-related symptoms such as suicidal behavior.

Coricidin HBP abuse: patient characteristics and psychiatric manifestations as recorded in an inpatient psychiatric unit.

Abstract Coricidin HBP®, a cold medication containing dextromethorphan, has become a popular agent abused among adolescents. This retrospective chart review examines the potential psychiatric manifestations of Coricidin HBP®misuse and patterns of use among patients treated in an inpatient child and adolescent psychiatric unit. Coricidin HBP® use was documented in 47 patient. The data revealed that Coricidin HBP® use was associated with: (a) predominantly depressive symptomatology; (b) transient substance-induced psychosis; (c) cardiac toxicity; and (d) greater quantities used per episode by Caucasians. Clinicians treating adolescents need to be aware of the abuse potential and psychiatric manifestations of this dextromethorphan-containing product.

Impact of an exercise intervention on methamphetamine use outcomes post-residential treatment care.

BACKGROUND We examined the efficacy of an 8-week exercise intervention on posttreatment methamphetamine (MA) use among MA-dependent individuals following residential treatment. METHODS 135 individuals newly enrolled in treatment were randomly assigned to a structured 8-week exercise intervention or health education control group. Approximately 1 week after completion of the intervention, participants were discharged to the community. Interview data and urine samples were collected at 1-, 3-, and 6-months post-residential care. Of the sample, 54.8% were classified as higher severity users (using MA more than 18 days in the month before admission) and 45.2% as lower severity users (using MA for up to 18 days in the month before admission). Group differences in MA use outcomes were examined over the 3 timepoints using mixed-multivariate modeling. RESULTS While fewer exercise participants returned to MA use compared to education participants at 1-, 3- and 6-months post-discharge, differences were not statistically significant. A significant interaction for self-reported MA use and MA urine drug test results by condition and MA severity was found: lower severity users in the exercise group reported using MA significantly fewer days at the three post-discharge timepoints than lower severity users in the education group. Lower severity users in the exercise group also had a lower percentage of positive urine results at the three timepoints than lower severity users in the education group. These relationships were not present in the comparison of the higher severity conditions. CONCLUSION Results support the value of exercise as a treatment component for individuals using MA 18 or fewer days/month.

Beyond Health Equity: Achieving Wellness Within American Indian and Alaska Native Communities

The author discusses the need for the improvement of health disparities among Native Americans living in the U.S (or American Indians and Alaska Natives). Topics include the life expectancy of Native Americans, which is the lowest of any racial or ethnic group in the U.S., the efforts of tribal communities and the National Institutes of Health (NIH) to implement the Interventions for Health Promotion and Disease Prevention in Native American Populations initiative, and the mistrust for medical research of many tribal communities.