Grethe Lauritzen

Minimization of childhood maltreatment is common and consequential: results from a large, multinational sample using the childhood trauma questionnaire

Childhood maltreatment has diverse, lifelong impact on morbidity and mortality. The Childhood Trauma Questionnaire (CTQ) is one of the most commonly used scales to assess and quantify these experiences and their impact. Curiously, despite very widespread use of the CTQ, scores on its Minimization-Denial (MD) subscale—originally designed to assess a positive response bias—are rarely reported. Hence, little is known about this measure. If response biases are either common or consequential, current practices of ignoring the MD scale deserve revision. Therewith, we designed a study to investigate 3 aspects of minimization, as defined by the CTQ’s MD scale: 1) its prevalence; 2) its latent structure; and finally 3) whether minimization moderates the CTQ’s discriminative validity in terms of distinguishing between psychiatric patients and community volunteers. Archival, item-level CTQ data from 24 multinational samples were combined for a total of 19,652 participants. Analyses indicated: 1) minimization is common; 2) minimization functions as a continuous construct; and 3) high MD scores attenuate the ability of the CTQ to distinguish between psychiatric patients and community volunteers. Overall, results suggest that a minimizing response bias—as detected by the MD subscale—has a small but significant moderating effect on the CTQ’s discriminative validity. Results also may suggest that some prior analyses of maltreatment rates or the effects of early maltreatment that have used the CTQ may have underestimated its incidence and impact. We caution researchers and clinicians about the widespread practice of using the CTQ without the MD or collecting MD data but failing to assess and control for its effects on outcomes or dependent variables.

Completion of Long-Term Inpatient Treatment of Drug Abusers: A Prospective Study from 13 Different Units

Completion of treatment is an important predictor of favourable outcome. We need more knowledge about predictors of completion in the inpatient psychosocial treatment modality. This prospective study from 13 such programmes follows a consecutive sample of clients (n = 307) from admission to completion/dropout. Instruments: EuropASI, MCMI II, SCL-25. The mean completion rate was 40% (20–71%), with no difference between clients with no (‘debutants’) or previous (‘veterans’) inpatient stays. Among ‘debutants’, the number of years of heroin use was negatively related to completion. Among ‘veterans’, age and amphetamine use were positively related, while the presence of a personality disorder and number of previous inpatient treatments were negatively related to completion. Specific strategies for involving clients with personality disorders are needed. After three inpatient stays, other types of treatment should be offered.

A Nationwide Study of Norwegian Drug Abusers in Treatment: Methods and findings

The National Institute for Alcohol and Drug Research (SIFA) has completed the first nationwide survey of drug abusers in treatment in Norway. Experiences from the study have contributed to the creation and initial implementation of a monitoring system for treatment demands and treatment measures in the country. This article presents the approach and methods used in the SIFA study. It provides an overview of the material and focusses on describing clients from long-term residential and outpatient treatment modalities. The results are presented within seven areas: socio-demographics, substance abuse, mental health and significant problems, risk behaviour, social functioning, social network, and biographical data on childhood/adolescence. These areas are analysed by the variables of gender, age, urban Oslo/outside Oslo clients, and client populations from residential/outpatient treatment. The authors reflect upon the prospects opened by such comprehensive documentation concerning preventive strategies, planning of treatment, and further research in Norway.

Co-occurrence between mental distress and poly-drug use: A ten year prospective study of patients from substance abuse treatment

INTRODUCTION Longitudinal research investigating psychiatric trajectories among patients with poly-drug use patterns remains relatively scant, even though this specific population is at elevated risk for multiple negative outcomes. The present study examined temporal associations between poly-drug use (i.e. heroin, cannabis, tranquilizers, and amphetamines) and mental distress over a 10-year period. METHODS A clinical cohort of 481 patients was recruited from substance use treatment facilities in Norway, and prospectively interviewed 1, 2, 7 and 10years after the initial data collection at treatment admission. At each assessment participants completed a questionnaire addressing their substance use and mental distress. Longitudinal growth models were used to examine whether, and if so, how, levels of drug use were associated with the level and rate of change in mental distress over time. RESULTS Results from the longitudinal growth models showed a co-occurrence between active poly-drug use and mental distress, such that there was a dose-response effect where mental distress increased both in magnitude and over time with the number of drugs used. Reduction in mental distress during the 10-year study period was evident only in the no-drug use condition. Use of multiple drugs and mental distress appear strongly co-related over time. CONCLUSIONS Pre-treatment assessment should carefully identify individuals manifesting poly-drug use and mental disorders. Treatment and follow-up services should be tailored to their specific needs.

Changes in opiate and stimulant use through 10 years: the role of contextual factors, mental health disorders and psychosocial factors in a prospective SUD treatment cohort study.

Aim To examine temporal changes in opiate and stimulant use among patients in substance abuse treatment over a ten-year observation period and to explore the role of contextual factors, mental health disorders and psychosocial factors on these changes. Methods A cohort of 481 patients was prospectively interviewed at admission to treatment and after 1, 2, 7 and 10 years. The sample was recruited from 20 facilities in the Greater Oslo region, Norway. Results The majority of patients were poly-drug users and 80% had used both opiates and stimulants the last 30 days prior to treatment admission. Last-month use of heroin, other opiates, cocaine and amphetamines declined from 80% to 34% at the end of the observation period. The most substantial reduction was observed between baseline and one-year follow-up. Use of heroin decreased the most from 62% to 16% after 10 years (a reduction of 74%), and the reduction continued from one-year follow-up throughout the observation period. The most important multivariate risk factors for sustained use of these drugs were male gender, having one or both biological parents with severe alcohol or drug problems, having an antisocial personality disorder, and living together with a person who abuses alcohol or drugs. Employment was associated with reduced risk of drug use at 7-year follow-up. Conclusions There was a substantial reduction in opiate and stimulant use from baseline to all follow-up assessments, most greatly for heroin. Findings regarding sustained use could suggest familial transmission and the challenges of preventive strategies and treatment efforts in an intergenerational context. Co-occurrence between drug abuse and mental health problems highlights the need of highly specialized competence in SUD treatment.

Rusmisbruk, angst og depresjon etter 10 år: En prospektiv undersøkelse av stoffmisbrukere med og uten LAR-behandling

Substance abuse, anxiety and depression after 10 years: A prospective study of drug users in and outside OMT treatment Aims The national Opiate Maintenance Treatment (OMT) program in Norway started officially in 1998. The same year a treatment study was initiated, including the most used treatment measures for drug users in Norway. The main aim in the present study was to investigate the prevalence of live OMT patients in the total sample after 10 years, and to compare the outcome of primarily substance abuse, anxiety and depression among OMT patients versus non-OMT patients. Design & Methods Four hundred and seven patients, in Oslo and the nearby regions, who started in 16 different in- and outpatients programs, were followed from intake to treatment and during ten years (1998-2009). Patients in the sample were interviewed after one, two, seven and ten years, and they were divided into three different treatment groups: inpatient residency for grown-ups, outpatient psychiatric youth teams and youths living in collectives. Data was collected through use of EuropASI and HSCL-25 at all follow-ups. Results After ten years 15 % were deceased. Of the 333 persons left, 73 % (n=248) were interviewed after ten years. Forty percent (n=99) were then in OMT. After ten years there were no gender differences regarding attendance to OMT, but the OMT-group was older (30 vs .28 yrs, p<0.05), and they used more benzodiazepines (p<0.000) and cannabis (p<0.01) than the others. The OMT-group reported to a larger extent more anxiety and depression throughout the total observation period than the non OMT participants. Use of heroin and criminality were significantly reduced in both groups. Conclusions In spite of reduced use of heroin, the OMT patients seemed to have more difficulties in reducing the use of benzodiazepines and cannabis, whereas the anxiety and depression scores were high and stable through the total observation time.