Elizabeth Conroy

Child maltreatment as a risk factor for opioid dependence: Comparison of family characteristics and type and severity of child maltreatment with a matched control group.

OBJECTIVE To examine the prevalence, characteristics and risk factors for child maltreatment among opioid-dependent persons compared to a community sample of similar social disadvantage. METHOD The study employed a case-control design. Cases had a history of opioid pharmacotherapy. Controls were frequency matched to cases with regard to age, sex and unemployment and were restricted to those with a lifetime opioid use of less than five times. The interview covered child maltreatment, family environment, drug use and psychiatric history. RESULTS This study found a high prevalence of child maltreatment among both cases and controls. Despite the elevated prevalence among controls, opioid-dependent males had a higher prevalence of physical and emotional abuse; female cases had a higher prevalence and greater severity of sexual abuse. The prevalence of neglect was similar for both groups. Early parental separation was more prevalent among female cases compared to female controls; otherwise the prevalence of the risk factors was comparable for both groups. The risk factors significantly associated with child maltreatment were also similar for both cases and controls. CONCLUSIONS Given the documented association between child maltreatment and adult mental disorder, child maltreatment may be an important antecedent of current psychological distress in persons presenting to treatment for opioid dependence. Apart from a possible association between early parental separation and sexual abuse among female cases, the increased prevalence of child maltreatment associated with opioid dependence did not appear to be related to differences in early childhood risk factors considered in this paper. Other risk factors may be more pertinent for those with opioid dependence. PRACTICE IMPLICATIONS The high prevalence of child maltreatment among the opioid-dependent sample has implications for the assessment and treatment of clients presenting with opioid dependence. Assessment of child maltreatment history could help inform the development of individual treatment plans to better address those factors contributing to the development and maintenance of opioid dependence. Specifically, management of co-morbid mental disorder associated with child maltreatment could be the focus of relapse prevention programmes and also have a positive influence on treatment retention.

Infant mortality among women on a methadone program during pregnancy.

INTRODUCTION AND AIMS The rate and correlates of infant death in those born to opioid-dependent women are unclear. This study aims to determine the infant mortality rate of infants born to women on a methadone program during pregnancy and to identify any modifiable risk factors. DESIGN AND METHODS A retrospective study of live births to all women in New South Wales, Australia during the period 1995-2002. Using record linkage four groups were compared: (i) live births to women on a methadone program during pregnancy who subsequently died during infancy; (ii) live births to women not on a methadone program who subsequently died during infancy; (iii) live births to women on a methadone program during pregnancy who did not die during infancy; and (iv) live births to women not on a methadone program who did not die during infancy. RESULTS, DISCUSSION AND CONCLUSION The infant mortality rate was higher among infants whose mothers were on methadone during pregnancy (24.3 per 1000 live born infants in group 1 and 4.0 per 1000 live born infants in group 2) compared with infants of all other mothers. The single main cause of death for all infants was Sudden Infant Death Syndrome. There was a higher rate of smoking among women on methadone. The findings suggest that methadone and non-methadone infant-mother pairs have different symptom profiles, diagnostic procedures and/or different patterns of access to care.

Was an increase in cocaine use among injecting drug users in New South Wales, Australia, accompanied by an increase in violent crime?

BackgroundA sharp reduction in heroin supply in Australia in 2001 was followed by a large but transient increase in cocaine use among injecting drug users (IDU) in Sydney. This paper assesses whether the increase in cocaine use among IDU was accompanied by increased rates of violent crime as occurred in the United States in the 1980s. Specifically, the paper aims to examine the impact of increased cocaine use among Sydney IDU upon police incidents of robbery with a weapon, assault and homicide.MethodsData on cocaine use among IDU was obtained from the Illicit Drug Reporting System (IDRS). Monthly NSW Police incident data on arrests for cocaine possession/use, robbery offences, homicides, and assaults, were obtained from the Bureau of Crime Statistics and Research. Time series analysis was conducted on the police data series where possible. Semi-structured interviews were conducted with representatives from law enforcement and health agencies about the impacts of cocaine use on crime and policing.ResultsThere was a significant increase in cocaine use and cocaine possession offences in the months immediately following the reduction in heroin supply. There was also a significant increase in incidents of robbery where weapons were involved. There were no increases in offences involving firearms, homicides or reported assaults.ConclusionThe increased use of cocaine among injecting drug users following the heroin shortage led to increases in violent crime. Other States and territories that also experienced a heroin shortage but did not show any increases in cocaine use did not report any increase in violent crimes. The violent crimes committed did not involve guns, most likely because of its stringent gun laws, in contrast to the experience of American cities that have experienced high rates of cocaine use and violent crime.

Factors associated with violent victimisation among homeless adults in Sydney, Australia

Objective: To determine the prevalence and correlates of violent victimisation among homeless people in inner‐Sydney.

Examining links between cocaine use and street-based sex work in New South Wales, Australia.

We examined potential links between cocaine use and street‐based sex work in New South Wales, Australia, following reports of increased cocaine use among injection drug users (IDU). Police data on prostitution and possession/use of cocaine was analysed using time series analysis. Interviews with key informants and IDU were also conducted, and data on cocaine use from ongoing monitoring systems targeted at IDU were analyzed. There was a clear increase in cocaine use among IDU which occurred in 2001. This occurred at the same time as an increase in prostitution offenses. Qualitative data suggested a greater number of primary heroin users were engaging in street‐based sex work, which was driven in part by the increases in cocaine use among this group. Subsequent reductions in cocaine availability led to decreased cocaine use and possession offenses, along with reductions in prostitution offenses.

An examination of the quality of life among rural and outer metropolitan injecting drug users in NSW, Australia

This article aims to explore the relationship between quality of life (QOL) and health-related behaviours among rural and metropolitan injecting drug users (IDU) using a new scale developed specifically for use with IDU.One-hundred and sixty-four rural and 96 metropolitan IDU from seven different NSW Area Health Services were interviewed using a cross-sectional survey, including the Injection Drug Use Quality of Life (IDUQOL) scale. The mean domain-based IDUQOL score was 59.4 (SD 22.3). The life areas most commonly selected by participants as important in determining their QOL were family, health, money, housing and partnerships. Rural participants were less likely to choose “housing” compared to those from the metropolitan areas, but were more likely to select “independence”. Rural participants also gave a lower mean rating to “money” (33.1 vs. 47.0) and to “partnerships” (53.8 vs. 71.1), suggesting differences in the composition of QOL among rural and metropolitan IDU. Compared to metropolitan participants, rural participants had a lower domain-based QOL score (56.1 vs. 64.5). No association was found between QOL and health-related behaviours such as drug use or sexual and injecting practices. IDU subjective assessment of QOL is mediated by a range of factors. Disparity between rural and metropolitan IDU appears to be influenced by non-health related areas such as partnerships and money, highlighting the need for a more holistic approach to the management of substance use problems.

The association between childhood maltreatment, psychopathology, and adult sexual victimization in men and women: results from three independent samples

BACKGROUND Childhood maltreatment (CM) has consistently been linked with adverse outcomes including substance use disorders and adult sexual revictimization. Adult sexual victimization itself has been linked with psychopathology but has predominately been studied in women. The current investigation examines the impact of CM and co-occurring psychopathology on adult sexual victimization in men and women, replicating findings in three distinct samples. METHOD We investigated the association between continuous CM factor scores and adult sexual victimization in the Childhood Trauma Study (CTS) sample (N = 2564). We also examined the unique relationship between childhood sexual abuse (CSA) and adult sexual victimization while adjusting for co-occurring substance dependence and psychopathology. We replicated these analyses in two additional samples: the Comorbidity and Trauma Study (CATS; N = 1981) and the Australian Twin-Family Study of Alcohol Use Disorders (OZ-ALC; N = 1537). RESULTS Analyses revealed a significant association with CM factor scores and adult sexual victimization for both men and women across all three samples. The CSA factor score was strongly associated with adult sexual victimization after adjusting for substance dependence and psychopathology; higher odds ratios were observed in men (than women) consistently across the three samples. CONCLUSIONS A continuous measure of CSA is independently associated with adult sexual trauma risk across samples in models that included commonly associated substance dependence and psychopathology as covariates. The strength of the association between this CSA measure and adult sexual victimization is higher in magnitude for men than women, pointing to the need for further investigation of sexual victimization in male community samples.

Mental illness and housing outcomes among a sample of homeless men in an Australian urban centre

Objective: The over-representation of mental illness among homeless people across the globe is well documented. However, there is a dearth of Australian literature on the mental health needs of homeless individuals. Furthermore, longitudinal research examining the factors that contribute to better housing outcomes among this population is sparse. The aim of this research is to describe the mental illness profile of a sample of homeless men in an Australian urban centre (in Sydney) and examine the factors associated with better housing outcomes at 12-month follow-up. Methods: A longitudinal survey was administered to 253 homeless men who were involved in the Michael Project: a 3-year initiative which combined existing accommodation support services with assertive case management and access to coordinated additional specialist allied health and support services. A total of 107 participants were followed up 12 months later. The survey examined the demographics of the sample and lifetime mental disorder diagnoses, and also included psychological screeners for current substance use and dependence, psychological distress, psychosis, and post-traumatic stress. Results: Consistent with existing literature, the prevalence of mental illness was significantly greater amongst this sample than the general Australian population. However, mental illness presentation was not associated with housing situation at 12-month follow-up. Instead, type of support service at baseline was the best predictor of housing outcome, wherein participants who received short to medium-term accommodation and support were significantly more likely to be housed in stable, long-term housing at the 12-month follow-up than participants who received outreach or emergency accommodation support. Conclusions: This study provides evidence to support an innovative support model for homeless people in Australia and contributes to the limited Australian research on mental illness in this population.

Main reasons for hospital admissions by women with a history of methadone maintenance.

INTRODUCTION AND AIMS Although clinical studies have noted that women with opioid use disorders use have high levels of mental and physical health disorders and are exposed to high levels of violence, it is not known whether this occurs at a level of severity that warrants hospital admission. DESIGN AND METHODS Administrative data from a jurisdictional methadone program were linked with hospital inpatient records from 1998 to 2002 to determine the main reasons for hospital admission for a cohort of women with a prior or ongoing history of methadone maintenance. Rates of hospital admissions by the cohort were compared with hospitalisations by all women without an opioid-related hospital diagnosis from 1998 to 2002. RESULTS After controlling for age, country of birth and marital status, women with a history of methadone maintenance had more frequent hospital admissions for the mental and behavioural disorders [relative risk (RR) 3.9 (95% confidence intervals (CI): 3.7, 4.0)], diseases of the skin and subcutaneous tissue [RR 2.1 (95% CI: 1.9, 2.3)]; injuries and poisonings [RR 2.0 (95% CI: 1.9, 2.1)] and infectious and parasitic diseases [RR 1.4 (95% CI: 1.2, 1.6)]. At a more detailed level of diagnostic specificity, the methadone cohort was admitted more often for hepatitis C, septicaemia and head injuries. DISCUSSION AND CONCLUSION The elevated risk of hospital admission for a number of disorders suggests that women with a history of methadone maintenance experience these health events at a level of severity warranting hospital admission. Further contextual work is necessary to determine the effective preventive and management strategies.[Burns L, Conroy E, Mattick RP. Main reasons for hospital admissions by women with a history of methadone maintenance.

The variance shared across forms of childhood trauma is strongly associated with liability for psychiatric and substance use disorders.

Forms of childhood trauma tend to co‐occur and are associated with increased risk for psychiatric and substance use disorders. Commonly used binary measures of trauma exposure have substantial limitations.