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Substance Use in Older Adults
By 2050, 85.7 million people in the United States are projected to be 65 or older. Older adults are especially prone to the effects of substances, and a 2021 survey showed that 4 million older adults were dealing with a substance use disorder. As the country's population ages, clinicians will inevitably have to care for a greater number of older adults with substance use disorders, but the literature on the topic—and the evidence base for treatment—is limited.
In Substance Use in Older Adults, more than 20 contributors translate their real-world experience in geriatric psychiatry into an accessible, evidence-based guide to screening for and assessing substance use in older adults. Early chapters discuss not only etiology and epidemiology but also comorbidities and management and subsequent sections address the problematic use of specific substances, including
• Alcohol• Tobacco• Opioids• Sedatives• Stimulants• Cannabinoids
Readers will find guidance on safe prescribing practices for older patients, as well as an examination of the cultural and ethical issues that may arise when working with this patient population.
Rife with case examples that illustrate key points in clinical practice, Substance Use in Older Adults also features numerous tables that can be referenced time and again with information on comorbidities, screening frameworks, and interventions for specific substances; stigma-reducing language; the pharmacological implications of physiological changes in older adults; and more.
Clinicians from psychiatric professionals to primary care providers will benefit from exhaustive listings of additional resources. This guide also includes resources for patients, families, and caregivers that will help to strengthen the partnership between clinician and patient.
eBook
Drugs, Clubs and Young People
In this volume, contributors employ sociological and public health perspectives to offer insights into behaviours common at raves and nightclubs. The volume provides theoretical observations on illicit club drug use and supply, helping to challenge current orthodoxies on the role of drug use within young peoples' lives. Drawing material from the USA, UK and Hong Kong, the volume allows the demystification of stereotypical presentations surrounding young people who attend clubs and/or use club drugs. This work provides a badly needed and objective analysis of youthful drug use, and a foundation from which future sociological and public studies on young people, clubs and drugs - as well as young people themselves - will benefit.
eBook
Drug‐Use Safety Enhancement Model—Theory and Application
ABSTRACT
Harm reduction strategies mitigate the adverse effects of problematic drug use through overdose prevention, disease transmission reduction, and improved access to treatment resources. However, educational resources for safe drug use remain sparse and are predominantly focused on abstinence‐based approaches. This manuscript introduces the Drug‐Use Safety Enhancement Model (DUSEM), a comprehensive framework designed to foster informed and healthy relationships with drugs. Grounded in interdisciplinary research, DUSEM encompasses eight domains: knowledge, motivation, set (mindset), setting, dose, administration, recovery, and evaluation. Each domain offers practical strategies for educators, professionals, and drug consumers to enhance drug‐use safety. For the purpose of this analysis, “drugs” include all psychoactive substances regardless of whether they are legal in the United States. Our approach is rooted in the ethical, legal, and cultural practices common in the United States, particularly those related to best practices for providing care to people who use substances. The American context shaped how we understand and talk about drug use, which reflects the American reality of clinical practice in the fields of mental health and addictions. From the perspective of evaluation of the traditional, American conceptualization of the issues around drug use, our model's development acknowledges the need for a shift from outdated abstinence‐focused paradigms toward empowering individuals with informed practices for safer drug use. While serving as an educational guidepost, the model underscores the necessity for further research to refine its application, efficacy, and curriculum development. Helping professionals, such as teachers, counselors, social workers, and psychologists, can use this model in various educational, clinical, or institutional settings to help their audiences explore their own relationships with drugs. Ultimately, DUSEM aims to destigmatize drug use, foster healthier relationships with drugs, and improve safety for consumers.
Journal Article
Doctors by nature : how ants, apes, and other animals heal themselves
\"What happens when animals get sick? Do they rely exclusively on their bodies own defense systems to protect them, or are there other behaviors they can use to heal themselves? Humans have been using plants, fungi, and other natural mechanisms to treat ailments and disease for millennia--why not animals too? It turns out they do! In 1987, primatologist Michael Huffman noticed an ill chimpanzee collecting shoots of a plant called Vernonia amygdalina, which humans in the area used to treat stomach upset and fever. The ill chimpanzee removed the plant's outer bark and sucked on the soft inner branches. Within 24 hours, she appeared to have largely recovered. Although there have been stories about animals medicating themselves, and traditional healers have looked to animals to help develop treatments for years, Huffman's observations are widely considered the first official scientific evidence of an animal actively medicating itself to treat disease. Since then, scientists have found conclusive evidence for medication in all manner of species--including bees, ants and butterflies, as well as monkeys, birds, apes, and elephants. Self-medication behaviors (for which scientists have developed a rigorous field definition) range from prophylactic consumption of anti-parasitic berries by monkeys and therapeutic use of alkaloids by woolly bear caterpillars, to blue jays' use of ant-produced formic acid as bug-repellent. In Animal Doctors, Professor of Biology and science communicator Jaap de Roode will provide an overview of the scientific study of animal self-medication, drawing on both the scientific literature and first-person interviews with key contributors to the field to ask how animals use medication against the parasites and pathogens that ail them\"-- Provided by publisher.
BOOK
Changes in recreational drug use, reasons for those changes and their consequence during and after the COVID-19 pandemic in the UK
Changes in drug use in the general population during the COVID-19 pandemic and their long-term consequences are not well understood. We employed natural language processing and machine learning to analyse a large dataset of self-reported rates of and reasons for drug use during the pandemic, along with their associations with anxiety, depression and substance use problems post-pandemic. Our findings revealed a transient decrease in drug use at the pandemic's peak, primarily attributed to reduced social opportunities. Conversely, some participants reported increased drug use for self-medication, boredom, and lifestyle disruptions. While users of psychedelics and MDMA had anxiety and depression rates similar to non-users, users of opioid agonists and depressants—representing one in ten active drug users—reported greater mental health challenges post-pandemic. These results suggest that a subset of active drug users with distinct profiles faces elevated risks, particularly for anxiety and depression, and may benefit from targeted support.
•After restrictions eased, recreational drug use returned to pre-pandemic levels.•A minority increased recreational drug use for self-medication amid the pandemic.•Pandemic recreational drug use correlated with greater anxiety and depression.•Post-pandemic opioid and benzodiazepine use is tied to mental health burdens.•Post-pandemic psychedelics and MDMA use show lowest anxious and depressive symptoms.
Journal Article
Ten storey love song : a novel
\"Ten storey love song is a cutting but characteristally charismatic portrait of a deeply dysfunctional, creative, and drug-sodden world, delivered with great beauty and abandon\"--Cover p. [4].
Book
Evaluation of a fentanyl drug checking service for clients of a supervised injection facility, Vancouver, Canada
Background
British Columbia, Canada, is experiencing a public health emergency related to opioid overdoses driven by consumption of street drugs contaminated with illicitly manufactured fentanyl. This cross-sectional study evaluates a drug checking intervention for the clients of a supervised injection facility (SIF) in Vancouver.
Methods
Insite is a facility offering supervised injection services in Vancouver’s Downtown East Side, a community with high levels of injection drug use and associated harms, including overdose deaths. During July 7, 2016, to June 21, 2017, Insite clients were offered an opportunity to check their drugs for fentanyl using a test strip designed to test urine for fentanyl. Results of the drug check were recorded along with information including the substance checked, whether the client intended to dispose of the drug or reduce the dose and whether they experienced an overdose. Logistic regression models were constructed to assess the associations between drug checking results and dose reduction or drug disposal. Crude odds ratios (OR) and 95% confidence intervals (CI) were reported.
Results
About 1% of the visits to Insite during the study resulted in a drug check. Out of 1411 drug checks conducted by clients, 1121 (79.8%) were positive for fentanyl. Although most tests were conducted post-consumption, following a positive pre-consumption drug check, 36.3% (
n
= 142) of participants reported planning to reduce their drug dose while only 11.4% (
n
= 50) planned to dispose of their drug. While the odds of intended dose reduction among those with a positive drug check was significantly higher than those with a negative result (OR = 9.36; 95% CI 4.25–20.65), no association was observed between drug check results and intended drug disposal (OR = 1.60; 95% CI 0.79–3.26). Among all participants, intended dose reduction was associated with significantly lower odds of overdose (OR = 0.41; 95% CI 0.18–0.89).
Conclusions
Although only a small proportion of visits resulted in a drug check, a high proportion (~ 80%) of the drugs checked were contaminated with fentanyl. Drug checking at harm reduction facilities such as SIFs might be a feasible intervention that could contribute to preventing overdoses in the context of the current overdose emergency.
Journal Article