Lawren Taylor

Recovery and URICA stage-of-change scores in three marijuana treatment studies

Data from three outpatient studies of treatment of marijuana dependence were used to test whether behavior change parallels stage movement in the transtheoretical model of change (TMC). This study examined one putative assumption of the TMC: individuals remaining in the preaction stages of change (i.e., precontemplation and contemplation) across time would show little change in their marijuana use. The University of Rhode Island Change Assessment (URICA) measure and two recent stage assignment algorithms were utilized to assess TMC stage status at baseline and end of treatment. The primary analyses employed paired-sample t tests of statistical equivalence and sign tests, and 34 out of the 36 tests demonstrated that individuals remaining in the preaction stages of change over the treatment period showed clinically important and statistically significant treatment outcomes. Clinicians and researchers should exercise caution in their use of URICA-based indices as meaningful markers of the recovery process. Better methods to measure stage status and test the TMC are needed if the model is to be used to guide substance abuse interventions.

A Gendered Analysis of Canadian Aboriginal Individuals Admitted to Inpatient Substance Abuse Detoxification: A Three-Year Medical Chart Review

This study examined gender differences within a sample of Canadian Aboriginal individuals admitted to an inpatient, hospital-based substance abuse detoxification program. Even though alcohol was the most frequent primary drug of detoxification for both genders, women received proportionately higher rates of cocaine or opiate detoxification diagnoses. In addition to a younger age, females reported higher rates of physical and sexual abuse. Women were also administered antidepressants, antibiotic medication protocols, and more medical evaluation tests. It appears that Canadian Aboriginal women have a diverse set of psychological and medical needs. This study demonstrates the need for detoxification programs to address the substantial rates of intravenous drug use and the associated risk of infectious disease (eg, Hepatitis C, HIV) among this treatment-seeking population.

First -Generation Immigrants and Hospital Admission Rates for Psychosis and Affective Disorders: An Ecological Study in Ontario

Objective: The immigrant population in Canada, and particularly in Ontario, is increasing. Our ecological study first assessed if there was an association between areas with proportions of first-generation immigrations and admissions rates for psychotic and affective disorders. Second, this study examined if area-level risks would persist after controlling for area socioeconomic factors in census-derived geographical areas—Forward Sortation Areas (FSAs)—in Ontario. Methods: Ontarios inpatient admission records from 1996 to 2005 and census data from 2001 were analyzed to derive FSA rates of first admissions for psychotic disorders and affective disorders per 100 000 person-years. Negative binomial regression models were adjusted, first, for FSA age and sex and, second, also for FSA population density and average income. Results: Using age- and sex-adjusted models, admission rates for psychotic disorders were higher in areas with greater proportions of immigrants. These areas were associated with lower admission rates for affective disorders. When FSA average income and population density were added to the models, the influence of immigrants was attenuated to nonsignificant levels in models predicting psychotic disorders admission rates. However, greater proportions of immigrants remained significantly protective when predicting rates of affective disorders. Discussion: Our study provides insight about the influence of area-level variables on risk of admission for psychotic and affective disorders in high immigrant areas. There is a dearth of current Canadian research on immigrant admission for psychotic disorders at the individual or area level. Future area- and individual-level studies may better identify groups at risk and possible explanations.

Another example of an illicit cigarette market: a study of psychiatric patients in Toronto, Ontario.

Tobacco taxation is a key mechanism for reducing smoking consumption and prevalence in the general population. Few studies, however, have acknowledged the disproportionately heavy tobacco tax burden placed upon some groups—usually poor, marginalized populations—in the drive for population-based public health goals.1 Shelley et al.2 recently examined the relations between a large tax increase in New York State and the development of a pervasive, illicit cigarette market in a low-income minority community and described the financial burden of smoking among the poor who had not quit. Our letter extends these qualitative findings in 2 ways: by examining similar issues in a different marginalized, low-income population—psychiatric patients in one of Canada’s largest psychiatric hospitals—and by quantifying the relative magnitude of illicit cigarette consumption in this population. Approximately 60% to 80% of people with schizophrenia and other severe mental illnesses smoke cigarettes3,4—a rate of roughly 4 times higher than that of the general population in Canada.5 Smoking plays an important role in the significantly higher rates of coronary heart disease morbidity and mortality found among people with severe mental illnesses, and coronary heart disease screening and smoking-cessation programs are much needed for this population.6 Our study involved the collection of cigarette butts from 3 sites in Toronto, Ontario: a 436-bed inpatient psychiatric hospital (where 70–75% of the patients have a primary diagnosis of schizophrenia), an addiction and mental health research and outpatient facility, and a large general hospital. In addition, a garbage audit was performed at the inpatient psychiatric facility to extract cigarette packages from 1 week’s worth of garbage. The collected cigarette butts were then sorted according to their filter-tip logos. In Ontario, an unbranded cigarette filter almost always indicates an illicit brand. The inpatient psychiatric hospital had a dramatically higher rate of “unbranded” cigarette butts: 54% versus 16% at the research facility and 6% at the general hospital site (Figure 1 ▶). The garbage audit resulted in the extraction of 320 cigarette packages. Approximately 80% of the packages were from illicit tobacco brands—a rate dramatically higher than that found in a recent, city-wide garbage audit in Toronto.7 FIGURE 1— Patterns of branding on cigarette butts collected at an inpatient psychiatric hospital (n = 1288 butts), an addiction and mental health research and outpatient treatment facility (n = 1271 butts), and a general hospital (n = 1784 butts). Similar to the findings of Shelley et al., our study demonstrated that cigarette taxation policies appear to place a disproportionate burden on some marginalized groups. As a result, it is important to assess and ensure principles of taxation equity for such populations,8 especially given that higher cigarette prices may paradoxically increase the availability of cheap (but illicit) cigarettes and undermine smoking-related interventions.

A national survey of primary methamphetamine-related admissions to youth residential substance abuse treatment facilities in Canada, 2005 to 2006.

Objective: Adolescent methamphetamine use has become a key issue for Canadian media and governments. Empirical studies, however, have not yet established the national scope of adolescent methamphetamine use or its impact on treatment services in Canada. The objective of the current study was to provide results from a national survey of primary methamphetamine-related admissions to Canadian residential substance abuse treatment facilities for youth. Method: We developed a comprehensive list of all Canadian residential substance abuse treatment facilities for youth, and then, we asked the executive director (or equivalent) of each facility about the sites annual caseload and the proportion of primary methamphetamine-related admissions during the previous 12 months. Results: Responses were received from 46 of the 50 centres on our final master list. About 20% (1109/5169) of all national admissions to youth residential substance abuse treatment facilities were reported to be primarily due to methamphetamine use. A large majority of primary methamphetamine-related admissions occurred in British Columbia and Alberta. Conclusions: Adolescent methamphetamine use has had a major impact on entries into residential substance abuse treatment facilities in British Columbia and Alberta, while only a few centres outside these 2 western provinces have experienced elevated rates of primary methamphetamine-related admissions. Given the paucity of studies on adolescent methamphetamine treatment, future research needs to focus on developing effective clinical strategies in this area.

Mobility patterns of Aboriginal injection drug users between on-and off-reserve settings in northern British Columbia, Canada

Objectives. In Canada, public health policymakers and Aboriginal health service leaders have warned that the reciprocal movement of Aboriginal injection drug users (IDUs) between urban and rural settings may serve as a critical vector for the continuing spread of HIV among Aboriginal peoples. The current study aimed to describe the mobility patterns of Aboriginal injection drug users between on-and off-reserve locations in northern British Columbia. Study Design. Retrospective medical-chart review of inpatient detoxification records. Methods. We employed a medical-chart review of all self-reported Aboriginal IDUs (n = 302) admitted at least twice to an adult inpatient hospital-based substance-abuse detoxification treatment centre between 4 January 1999 and 31 December 2005, and analysed place-of-residence transitions between on-and off-reserve settings. Results. Over the course of the 7-year study period, 26% (n = 73) of Aboriginal IDUs changed their primary residence from an off-reserve to an on-reserve location. Almost all (96%, n = 23) of those living on-reserve at their first IDU-related admission had moved to an off-reserve setting at a subsequent visit. Conclusions. The high rates of reciprocal movement between on-and off-reserve locations are a critical public health concern. The results show that the problems associated with both IDU and infectious disease are not limited to urban centres. Our results stand as a clear call for support of Aboriginal-directed, culturally appropriate and accessible services to reduce IDU-related harms. The specifics of such programs are a topic for Aboriginal health care leaders and the communities themselves to discuss, develop and implement.

The prominence of smoking-related mortality among individuals with alcohol- or drug-use disorders

INTRODUCTION AND AIMS Even though individuals with substance-use disorders have a high prevalence of tobacco smoking, surprisingly little is known about smoking-related mortality in these populations. The current retrospective cohort study aims to address this gap. DESIGN AND METHODS The study sample included cohorts of individuals hospitalised in California between 1990 and 2005 with alcohol- (n = 509 422), cocaine- (n = 35 276), opioid- (n = 53 172), marijuana- (n = 15 995) or methamphetamine-use (n = 36 717) disorders. Death records were linked to inpatient data. Age-, race- and sex-adjusted standardised mortality ratios (SMR) were generated for 19 smoking-related causes of death. RESULTS Smoking-related conditions comprised 49% (79 188/163 191) of total deaths in the alcohol, 40% (1412/3570) in the cocaine, 39% (4285/11 091) in the opioid, 42% (554/1332) in the methamphetamine and 36% (1122/3095) in the marijuana cohorts. The SMRs for all smoking-linked diseases were: alcohol, 3.57 (95% confidence interval [CI] = 3.55 to 3.58); cocaine, 2.40 (95% CI = 2.39 to 2.41); opioid, 4.26 (95% CI = 4.24 to 4.27); marijuana, 3.73 (95% CI = 3.71 to 3.74); and methamphetamine, 2.58 (95% CI = 2.57 to 2.59). The SMRs for almost all of the 19 cause-specific smoking-related outcomes were elevated across cohorts. DISCUSSION AND CONCLUSIONS Given the current findings, addressing tobacco smoking among persons with substance-use disorders should be a critical concern, especially given the heavy smoking-related mortality burden and the currently limited attention devoted to smoking in these populations. [Callaghan RC, Gatley JM, Sykes J, Taylor L. The prominence of smoking-related mortality among individuals with alcohol- or drug-use disorders. Drug Alcohol Rev 2018;37:97-105].

Is stage-matched process-use associated with the transition from the preparation to action stage among smokers? A longitudinal test of the transtheoretical model

This longitudinal study tested the predictions of the Transtheoretical Model (TTM) regarding process-use and progressive stage-transition from the preparation stage to the action stage in relation to smoking behavior. We provided a secondary data-analysis of a longitudinal study of callers to a smoking-cessation hotline (Segan C, Borland R, Greenwood KM. 2002. Do transtheoretical model measures predict the transition from preparation to action in smoking cessation? Psychology and Health, 17:417–435). The results did not support the predictions of the TTM. In comparison to individuals who remained in the preparation stage over the course of the study, individuals making a transition to the action stage manifested: a similar pattern of stage-matched behavioral processes-of-change and a statistically significant decrease in stage-matched experiential process-use. Given the lack of support for the predicted longitudinal relations between process-use and forward transition from the preparation stage to the action stage, the results undermine the TTMs central tenet that stage-matched processes-of-change stand as the primary mechanisms of stage-progression.

Prevalence of Primary Methamphetamine-Related Cases and Treatment-Centre Preparedness Among Youth Outpatient Substance Abuse Treatment Centres in British Columbia, Canada

Adolescent methamphetamine use is a prominent concern for Canadian media and government. Few empirical studies, however, have established the scope of adolescent methamphetamine use or associated outpatient substance abuse treatment utilization. The current study aimed to answer the following questions: (1) What was the overall proportion of primary methamphetamine-related cases seen at youth outpatient substance abuse treatment centres in British Columbia in 2005–2006?; (2) What kind of treatment programming did these treatment centres offer primary methamphetamine users?; and (3) How prepared were these treatment programs to provide services to primary methamphetamine users? We developed a comprehensive list of all sites offering outpatient substance-abuse treatment programs for youth in British Columbia. We asked the Executive Director (or designate) of each facility about the program’s annual caseload, proportion of primary methamphetamine-related cases, treatment approach, and preparedness to provide effective treatment for methamphetamine users. Responses were received from 68 of the 80 centres on our final master list. Approximately 11% (780/6,840) of all cases at the sites were due primarily to methamphetamine use. The proportion of primary methamphetamine-related cases varied widely across sites in B.C., with contacted centres reporting between 0–65% of their caseload in 2005–2006 as primarily methamphetamine-related. Almost all facilities integrated primary-methamphetamine users into treatment-as-usual, and few centres (12%) felt inadequately prepared to offer treatment for methamphetamine users. The current study found a substantial proportion of all cases seen at youth outpatient substance abuse treatment centres in British Columbia in 2005–2006 were primarily due to methamphetamine misuse. While most treatment sites integrated youth methamphetamine users into regular treatment programming and few treatment directors indicated that their programs were inadequately prepared to offer treatment services to methamphetamine-using clients, more evidence is needed to ascertain the most effective treatment strategies for methamphetamine users.