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Background: Adverse childhood experiences (ACEs) show a graded association with the development of substance use disorders (SUDs) and engagement in risky substance use behaviors. Women are overrepresented among individuals with more severe childhood adversity (≥4 types of ACEs) and may be at particular risk for aberrant substance use. Objectives: To assess the prevalence of ACEs among men and women with cannabis, opioid, cocaine, and tobacco use disorders. Methods: Non-treatment-seeking individuals participating in clinical addiction research at a single site completed the ACE questionnaire and provided a detailed substance use history. Data were analyzed using proportional odds models and logistic regression. Results: Most participants (424/565; 75%) reported at least one ACE, and more than one-quarter (156/565; 27%) reported severe childhood adversity. Relative to men ( n  = 283), women ( n  = 282) reported more ACEs (OR = 1.49; p  = .01) and more experiences of emotional/physical abuse (OR = 1.52; p  = .02), sexual abuse (OR = 4.08; p  = .04), and neglect (OR = 2.30; p  < .01). Participants in the cocaine (OR = 1.87; n = .01) and opioid (OR = 2.21; p  = .01) use disorder, but not cannabis use disorder (OR = 1.46; p  = .08), studies reported more severe adversity relative to the tobacco group. Relative to tobacco users, emotional/physical abuse (OR = 1.92; p  = .02) and neglect (OR = 2.46; p  = .01) scores were higher in cocaine users and household dysfunction scores were higher in opioid users (OR = 2.67; p  = .01). Conclusion: The prevalence of ACEs differs with respect to both participant gender and primary substance used. Novel SUD treatment strategies that incorporate ACEs may be uniquely beneficial in specific subpopulations of people with SUDs.

Memories are often conceptualized as permanent entities; however, retrieval of memories via stimulus prompts can return them to an active state, which initiates a period of lability before the memories are reconsolidated into long-term storage. Importantly, during this period, memories can be disrupted/altered. A growing body of work has focused on translating animal and experimental science into reconsolidation-based interventions for clinical disorders maintained by maladaptive memories. Interventions targeting reward-based and fear-based memories undergirding substance use and anxiety-related disorders, respectively, have shown significant potential. There are several promising pharmacological agents and behavioral approaches that have been used to therapeutically target memory reconsolidation. Here, we discuss the current state of science with special emphasis on the clinical utility of these approaches., (Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)

Background: Consolidated memories can undergo enduring modification through retrieval-dependent treatments that modulate reconsolidation. This represents a potentially transformative strategy for weakening or overwriting the maladaptive memories that underlie substance use and anxiety/trauma-related disorders. However, modulation of naturalistic maladaptive memories may be limited by 'boundary conditions' imposed on the reconsolidation process by the nature of these memories., Methods: We conducted a systematic review and meta-analyses of behavioural and pharmacological studies examining retrieval-dependent modulation of reward- and threat-related memories in (sub) clinical substance use and anxiety/trauma, respectively., Results: Of 4938 publications assessed for eligibility, 8 studies of substance use and 10 of anxiety (phobia)- and trauma-related symptoms were included in the meta-analyses. Overall, the findings were in the predicted direction, with most studies favouring the 'retrieval + treatment' condition. However, the magnitude of effects was dependent upon the nature of treatment, with pharmacological interventions showing a medium-sized effect (g = 0.59, p = 0.03) and behavioural treatments, a relatively small effect (g = 0.32, p = 0.10) in studies of phobia/trauma. Among studies of substance use, post-retrieval behavioural interventions yielded a larger effect (g = 0.60, p < 0.001) relative to pharmacological treatments (g = - 0.03, p = 0.91), with treatment type being a statistically significant moderator (χ 2 (1) = 4.20, p = 0.04)., Conclusion: Modification of naturalistic maladaptive memories during reconsolidation appears to be a viable treatment strategy for substance use and phobias/trauma disorders. However, high levels of heterogeneity and methodological variation limit the strength of conclusions that can be drawn from the reviewed studies at this stage.

This study empirically examined opinions of treatment providers regarding contingency management (CM) programs while controlling for experience with a specific efficacious CM program. In addition to empirically describing provider opinions, we examined whether the opinions of providers at the sites that implemented the CM program were more positive than those of matched providers at sites that did not implement it. Participants from 7 CM treatment sites (n = 76) and 7 matched nonparticipating sites (n = 69) within the same nodes of the National Institute of Drug Abuse Clinical Trials Network completed the Provider Survey of Incentives (PSI), which assesses positive and negative beliefs about incentive programs. An intent-to-treat analysis found no differences in the PSI summary scores of providers in CM program versus matched sites, but correcting for experience with tangible incentives showed significant differences, with providers from CM sites reporting more positive opinions than those from matched sites. Some differences were found in opinions regarding costs of incentives, and these generally indicated that participants from CM sites were more likely to see the costs as worthwhile. The results from the study suggest that exposing community treatment providers to incentive programs may itself be an effective strategy in prompting the dissemination of CM interventions., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Posttraumatic stress disorder (PTSD) is common among treatment-seeking substance abusers. Despite the high prevalence of these co-occurring conditions, few PTSD screening tools have been evaluated for their utility in identifying PTSD in substance use disorder (SUD) populations. The present study evaluated the psychometric properties of the Impact of Event Scale-Revised (IES-R) in a sample of 124 substance dependent individuals. All participants had a history of a DSM-IV Criterion A traumatic event, and 71 individuals met diagnostic criteria for PTSD. Participants with comorbid PTSD reported significantly more symptoms of anxiety, depression, and PTSD compared to substance dependent individuals without PTSD. Acceptable internal consistency and convergent validity of the IES-R were established among a substance dependent sample. Examination of diagnostic effectiveness suggested a cutoff value of 22 as optimal for a substance using population, resulting in adequate classification accuracy, sensitivity, and specificity.

Context: Contingency management interventions that provide tangible incentives based on objective indicators of drug abstinence are efficacious in improving outcomes in substance abusers, but these treatments have rarely been implemented in community-based settings., Objective: To evaluate the efficacy of an abstinence-based contingency management intervention as an addition to usual care in community treatment settings., Design: Random assignment to usual care or usual care plus abstinence-based incentives for 12 weeks., Setting: Eight community-based outpatient psychosocial drug abuse treatment programs., Participants: A total of 415 cocaine or methamphetamine users beginning outpatient substance abuse treatment., Intervention: All participants received standard care, and those assigned to the abstinence-based incentive condition also earned chances to win prizes for submitting substance-free urine samples; the chances of winning prizes increased with continuous time abstinent., Main Outcome Measures: Retention, counseling attendance, total number of substance-free samples provided, percentage of stimulant- and alcohol-free samples submitted, and longest duration of confirmed stimulant abstinence., Results: Participants assigned to the abstinence-based incentive condition remained in treatment for a mean +/- SD of 8.0 +/- 4.2 weeks and attended a mean +/- SD of 19.2 +/- 16.8 counseling sessions compared with 6.9 +/- 4.4 weeks and 15.7 +/- 14.4 sessions for those assigned to the usual care condition (P<.02 for all). Participants in the abstinence-based incentive condition also submitted significantly more stimulant- and alcohol-free samples (P<.001). The abstinence-based incentive group was significantly more likely to achieve 4, 8, and 12 weeks of continuous abstinence than the control group, with odds ratios of 2.5, 2.7, and 4.5, respectively. However, the percentage of positive samples submitted was low overall and did not differ between conditions., Conclusion: The abstinence-based incentive procedure, which provided a mean of 203 dollars in prizes per participant, was efficacious in improving retention and associated abstinence outcomes.

The present study examined the effects of substance dependence and posttraumatic stress disorder (PTSD) on perpetration of partner violence. Participants were 72 men and 124 women diagnosed with and/or without PTSD and cocaine or alcohol dependence. Participants were interviewed with the Structured Clinical Interview for the DSM-IV (SCID-IV) and completed the Conflict Tactics Scale-2 (CTS-2). Analyses indicated that participants with comorbid cocaine dependence and PTSD reported the highest frequency of partner violence relative to all other groups. Main effects were also detected for drug dependence and PTSD. Results suggest that substance dependence and PTSD alone are associated with increased violence in couples, and most importantly, the presence of PTSD serves to further potentiate the perpetration of partner violence among cocaine-dependent individuals.

This study examined posttraumatic stress disorder (PTSD) symptom severity as a predictor of cue-elicited craving among alcohol- and cocaine-dependent individuals with a history of at least one physical and/or sexual assault. Approximately half of the sample had current PTSD. Severity of PTSD symptoms was measured via the Impact of Events Scale-Revised (IES-R) total severity score. Subjects listened to four trials of a brief narrative imagery script followed by the presentation of an in vivo cue. The script presentation consisted of a description of either the subject's worst traumatic event or a neutral scene. The in vivo cues consisted of the presentation of either the subject's preferred drug or neutral cues. Craving was measured in response to both the script and in vivo cues. Results indicated a high degree of correlation between self-report craving and (a) PTSD symptom severity, (b) type of substance use disorder (SUD) [alcohol dependence (AD) vs. cocaine dependence (CD)], and (c) sex and race of participant. A series of stepwise multiple regressions indicated that PTSD severity was significantly predictive of trauma cue-elicited craving and drug cue-elicited craving. The results are discussed in the context of current research, theory, and clinical practice.

The high rate of posttraumatic stress disorder (PTSD) among substance use disorder (SUD) patients has been documented in research protocols, but there is evidence that it is markedly under-diagnosed in clinical settings. To address the need for a brief self-report measure to identify SUD patients who may benefit from further assessment and/or treatment for PTSD, the psychometric properties of a modified version of the PTSD Symptom Scale Self-Report (PSS-SR) were examined in a treatment-seeking SUD sample (N = 118). The modified version of the PSS-SR, which measures both frequency and severity of PTSD symptoms, demonstrated good internal consistency reliability and was correlated with other self-report measures of trauma-related symptomatology. Comparisons between a structured PTSD diagnostic interview and the modified PSS-SR indicated that 89% of the PTSD positive patients were correctly classified by the modified PSS-SR. The clinical relevance of these findings was discussed.

Researchers have documented that approximately three-quarters of all patients in treatment for a substance use disorder (SUD) report a history of sexual or physical assault and that at least 25% of treatment-seeking SUD patients suffer from crime-related posttraumatic stress disorder (CR-PTSD). To address the pressing need to accurately evaluate symptoms associated with victimization, a battery of self-report instruments and a semi-structured interview were administered to 114 SUD patients. More than 90% of the SUD patients reported some type of victimization and approximately 38% met criteria for current CR-PTSD. The self-report battery correctly classified CR-PTSD status in 79% of the respondents with a sensitivity rate of 82% and a specificity rate of 74%. The results indicate that: (a) there is a high prevalence of CR-PTSD in SUD patients, (b) CR-PTSD should be evaluated in every SUD patient, and (c) the self-report battery utilized in the present study may serve as a valid tool for an initial CR-PTSD screening or to supplement a clinical interview.

The goal of the present investigation was to evaluate whether the process of assessing posttraumatic stress disorder (PTSD) in substance abuse/dependence inpatients (N = 95) as part of a research protocol influenced the diagnostic assessment conducted by clinical staff. The prevalence of current crime-related PTSD (CR-PTSD) observed with a research interview was 40% (n = 38), whereas the rate of current CR-PTSD documented in (the same) patients' discharge summaries was 15% (n = 14). An even lower CR-PTSD prevalence rate of 8% (n = 5) was obtained from a new sample of patient discharge summaries (N = 59) collected after the cessation of the research project. On chart intake reports, clinical staff documented a history of sexual and/or physical assault in approximately one-half of these patients, but PTSD was not evaluated. PTSD appears to be under-diagnosed by clinical staff in patients with substance use disorders.

There is a paucity of studies concerning the prevalence of crime-related posttraumatic stress disorder (CR-PTSD) in individuals with substance use disorders, despite documentation of particularly high prevalence rates of sexual and physical assault in this population. A central objective of the present investigation was to assess victimization experiences and CR-PTSD among individuals receiving inpatient treatment for substance use disorders and evaluate gender and racial differences in assault characteristics CR-PTSD prevalence rates. A total of 95 inpatients (34 men and 61 women; 41 African-Americans, 52 Caucasians, and 2 other minorities) were administered a structured interview to assess substance abuse/dependence, trauma, and PTSD. Approximately 90% of the participants had a lifetime history of sexual and/or physical assault, and approximately 50% had CR-PTSD. With the exception of rape, no gender differences in assault or CR-PTSD prevalence rates were observed. Women were more likely than men to perceive their life as endangered during a rape. Men were younger than women when they experienced their first (or only) aggravated assault and were more likely to have been assaulted by a family member. No racial differences were detected for assault or PTSD, although African-American patients were significantly more likely to identify cocaine as their primary drug than Caucasian patients. Given the strikingly high rate of comorbid CR-PTSD among substance use disordered patients, exploration of the type and timing of interventions would be of clinical interest.

While there is high level of comorbidity of PTSD and substance use disorders (SUDs), little research has focused on the overlapping symptom constellation characteristic of both PTSD and substance use/withdrawal. This report describes two preliminary investigations that address this area. In the first study, the pattern of PTSD symptoms in a sample of women (n = 28) seeking treatment for a SUD and comorbid with PTSD was compared with the symptom pattern of a sample of women (n = 28) with PTSD only. The PTSD + SUD group evidenced significantly more symptoms in the avoidance and arousal symptom clusters than the PTSD-only group. At the individual symptom level, the PTSD + SUD group reported significantly more sleep disturbance than the PTSD-only group. It was also determined that the PTSD + SUD group reported greater traumatic-event exposure than the PTSD-only group. In the second study, PTSD symptoms were compared in a sample of alcohol- dependent and a sample of cocaine-dependent individuals with PTSD. The alcohol- dependent group exhibited significantly more arousal symptoms than the cocaine-dependent group. Implications of the results for the assessment of individuals with comorbid PTSD and SUDs are discussed.

A structured interview with behaviorally specific probes was used to assess victimization and posttraumatic stress disorder (PTSD) in a clinical and a national, epidemiologic sample of women who had received treatment for a substance use disorder. Separate clinical and epidemiologic approaches to evaluating substance use disorders were compared. More than 80% of women in both samples had a history of sexual and/or physical assault and approximately one-quarter had current PTSD. The similarity in patterns of victimization, PTSD, and substance use across two samples suggests that telephone structured interviews are a valid method of collecting data/information about these important phenomena.