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 Centre for Addictionand Mental Health |
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Research updateCrossCurrentsMark de la Hey
There is strong evidence that individual and group cognitive-behavioural therapy (CBT) can decrease psychological harm among
children and adolescents exposed to traumatic events, according to a study from the Centers for Disease Control and Prevention
in Atlanta, Georgia. Researchers reviewed published studies that evaluated various treatments for children and adolescents
exposed to trauma, including individual CBT, group CBT, play therapy, art therapy, psychodynamic therapy, pharmacologic therapy
and psychological debriefing. Treatment with individual CBT proved effective in reducing psychological harm, leading to decreases
in anxiety, post-traumatic stress disorder (PTSD), depression and externalizing and internalizing symptoms. Group CBT resulted
in reductions in anxiety, depression and PTSD. However, the authors found insufficient evidence to determine the effectiveness
of the other therapies, often due to the limited number of studies available. They recommend that health care providers treating
children exposed to traumatic events should use treatments with proven effectiveness, such as individual and group CBT. The
authors note that unfortunately, according to a recent U.S. study, only 23 per cent of clinicians preferred CBT to treat traumatized
children and adolescents. The authors call for future research to determine the effectiveness of those treatments for which
there is currently insufficient evidence. American Journal of Preventive Medicine, September 2008, v. 35: 287–313. Holly R. Wethington et al., National Center for Health Marketing, Centers for Disease Control
and Prevention, Atlanta, Georgia.
Cannabis use may be associated with the early onset of psychosis, according to researchers at Santiago Apóstol Hospital in
Vitoria, Spain. Researchers looked at 131 individuals who required inpatient treatment for a first episode of psychosis over
a two-year period. They found that the more dependent an individual was on cannabis, the younger that person typically was
at the first episode of psychosis. Compared with non-users, age at the time of first psychosis decreased by seven years for
cannabis users, 8.5 years for cannabis abusers and 12 years for those who were dependent on cannabis. The effect of cannabis
on age at onset could not be explained by gender or the use of other drugs. The results were similar for the youngest individuals
(under age 30), indicating that the relationship between cannabis use and age at onset was not due to chance. One possible
explanation for the relationship between cannabis use and age at onset is that cannabis may precipitate the psychosis. Conversely,
it is also possible that early onset of psychosis increases the risk of cannabis use. The authors note that cannabis use is
believed to account for approximately 10 per cent of all cases of psychosis. They conclude that their results show cannabis
to be “a dangerous drug in young people at risk of developing psychosis.” Journal of Clinical Psychiatry, August 2008, v. 69: 1210–1216, Ana González-Pinto et al., Department of Psychiatry, Santiago Apóstol Hospital, CIBERSAM,
Vitoria, Spain.
The average first year university student believes that non-medical use of prescription stimulants and painkillers is safer
than cocaine use but more dangerous than smoking marijuana or binge drinking, according to research from the University of
Maryland. The study was based on personal interviews with 1,253 first-year students over one year. Approximately one quarter
believed that occasional non-medical use of stimulants or painkillers entailed great risk of harm. Conversely, one quarter
believed the risk was low and were about 10 times more likely to engage in non-medical use of prescription medication than
those who saw the risk as high. By comparison, 72 per cent of participants saw cocaine use as very risky, whereas only 7 per
cent believed that marijuana use was very risky. Seventeen per cent believed there was great risk in binge drinking (having
five or more drinks once or twice every weekend). Most participants limited substance use when they perceived the risk as
high, but this did not always hold true for participants who were classified as sensation-seekers. The authors conclude that
for the average student, education about the risks of non-medical use of prescription medication could be a promising strategy
for reducing abuse. However, since sensation-seekers may show less of a benefit from such a strategy, alternative prevention
strategies may be needed for these students. Prevention Science, September 2008, v. 9: 191–201. Amelia M. Arria et al., Center for Substance Abuse Research (CESAR), University of Maryland,
College Park, Maryland.
Continuing care for a substance use disorder after inpatient psychiatric treatment reduces the risk of early rehospitalization
among individuals who have both psychiatric and substance use disorders, according to research from the Department of Veterans
Affairs in Ann Arbor, Michigan. Researchers examined the treatment records of 26, 826 individuals with co-occurring psychiatric
and substance use disorders who were discharged from inpatient psychiatric treatment. The records were examined in order to
determine rates of rehospitalization after 90 days and 12 months. Twenty-three per cent of individuals were readmitted to
hospital within 90 days of initial discharge. Only 31 per cent received continuing care for a substance use disorder during
the first month following discharge from inpatient treatment. Those who did receive continuing care were 16 per cent less
likely to be rehospitalized. There was no comparable benefit from continuing care for psychiatric disorders alone. Over the
12 months following initial discharge, continuing care for substance use disorders resulted in an eight per cent reduction
in the rate of rehospitalization. Rehospitalization rates were higher among individuals who were younger; unmarried; or who
had been diagnosed with schizophrenia, schizoaffective disorder or bipolar disorder, suggesting that those with fewer personal
resources and those with a psychotic disorder are at greater risk of readmission. The authors recommend that, where integrated
treatment services are not available, health care providers should consider referring patients with co-occurring psychiatric
and substance use disorders to stand-alone substance use disorder programs after discharge from inpatient treatment. Psychiatric Services, September 2008, v. 59: 982–988. Mark A. Ilgen et al., Health Services Research and Development, Department of Veterans Affairs, Ann Arbor, Michigan. |
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Last updated: December 22, 2008 2:27 PM Published: July 01, 2011 6:50 AM ID#41366-R |