-
American Journal of Men's Health 2019Globally, there is increasing usage and legalization of cannabis. In addition to its reported therapeutic effects, cannabis has several health risks which are not... (Meta-Analysis)
Meta-Analysis
Globally, there is increasing usage and legalization of cannabis. In addition to its reported therapeutic effects, cannabis has several health risks which are not clearly defined. Erectile dysfunction (ED) is the most common male sexual disorder and there are plausible mechanisms linking cannabis use to ED. No attempt has been made to collate the literature on this topic. The aim of this review was to summarize the prevalence and risk of ED in cannabis users compared to controls. A systematic review of major databases from inception to January 1, 2019, without language restriction, was undertaken to identify studies investigating cannabis use and presence of ED. The analysis compared the prevalence of ED in cannabis users versus controls. Consequently, the odds ratio (OR) with 95% confidence intervals (CI) was calculated, applying a random-effect model. Five case-control studies were included with data from 3,395 healthy men, 1,035 using cannabis (smoking) and 2,360 nonusers. The overall prevalence of ED in cannabis users was 69.1% (95% CI: 38.0-89.1), whilst the correspondent figure in controls was 34.7% (95% CI: 20.3-52.7). The OR of ED in cannabis users was almost four times that of controls (OR = 3.83; 95% CI: 1.30-11.28; = .02), even if characterized by high heterogeneity ( = 90%) and the prediction intervals overlapped 1.00 (95% CI: 0.35-7.26). Data suggest that ED is twice as high in cannabis users compared to controls. Future longitudinal research is needed to confirm/refute this and explore if a dose-response relationship between cannabis and ED may be evident.
Topics: Adult; Cannabis; Case-Control Studies; Erectile Dysfunction; Humans; Male; Marijuana Abuse; Middle Aged; Prevalence; Reference Values; Risk Assessment
PubMed: 31795801
DOI: 10.1177/1557988319892464 -
The Cochrane Database of Systematic... Oct 2019This review represents one from a family of three reviews focusing on interventions for drug-using offenders. Many people under the care of the criminal justice system... (Review)
Review
BACKGROUND
This review represents one from a family of three reviews focusing on interventions for drug-using offenders. Many people under the care of the criminal justice system have co-occurring mental health problems and drug misuse problems; it is important to identify the most effective treatments for this vulnerable population.
OBJECTIVES
To assess the effectiveness of interventions for drug-using offenders with co-occurring mental health problems in reducing criminal activity or drug use, or both.This review addresses the following questions.• Does any treatment for drug-using offenders with co-occurring mental health problems reduce drug use?• Does any treatment for drug-using offenders with co-occurring mental health problems reduce criminal activity?• Does the treatment setting (court, community, prison/secure establishment) affect intervention outcome(s)?• Does the type of treatment affect treatment outcome(s)?
SEARCH METHODS
We searched 12 databases up to February 2019 and checked the reference lists of included studies. We contacted experts in the field for further information.
SELECTION CRITERIA
We included randomised controlled trials designed to prevent relapse of drug use and/or criminal activity among drug-using offenders with co-occurring mental health problems.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures as expected by Cochrane .
MAIN RESULTS
We included 13 studies with a total of 2606 participants. Interventions were delivered in prison (eight studies; 61%), in court (two studies; 15%), in the community (two studies; 15%), or at a medium secure hospital (one study; 8%). Main sources of bias were unclear risk of selection bias and high risk of detection bias.Four studies compared a therapeutic community intervention versus (1) treatment as usual (two studies; 266 participants), providing moderate-certainty evidence that participants who received the intervention were less likely to be involved in subsequent criminal activity (risk ratio (RR) 0.67, 95% confidence interval (CI) 0.53 to 0.84) or returned to prison (RR 0.40, 95% CI 0.24 to 0.67); (2) a cognitive-behavioural therapy (one study; 314 participants), reporting no significant reduction in self-reported drug use (RR 0.78, 95% CI 0.46 to 1.32), re-arrest for any type of crime (RR 0.69, 95% CI 0.44 to 1.09), criminal activity (RR 0.74, 95% CI 0.52 to 1.05), or drug-related crime (RR 0.87, 95% CI 0.56 to 1.36), yielding low-certainty evidence; and (3) a waiting list control (one study; 478 participants), showing a significant reduction in return to prison for those people engaging in the therapeutic community (RR 0.60, 95% CI 0.46 to 0.79), providing moderate-certainty evidence.One study (235 participants) compared a mental health treatment court with an assertive case management model versus treatment as usual, showing no significant reduction at 12 months' follow-up on an Addictive Severity Index (ASI) self-report of drug use (mean difference (MD) 0.00, 95% CI -0.03 to 0.03), conviction for a new crime (RR 1.05, 95% CI 0.90 to 1.22), or re-incarceration to jail (RR 0.79, 95% CI 0.62 to 1.01), providing low-certainty evidence.Four studies compared motivational interviewing/mindfulness and cognitive skills with relaxation therapy (one study), a waiting list control (one study), or treatment as usual (two studies). In comparison to relaxation training, one study reported narrative information on marijuana use at three-month follow-up assessment. Researchers reported a main effect < .007 with participants in the motivational interviewing group, showing fewer problems than participants in the relaxation training group, with moderate-certainty evidence. In comparison to a waiting list control, one study reported no significant reduction in self-reported drug use based on the ASI (MD -0.04, 95% CI -0.37 to 0.29) and on abstinence from drug use (RR 2.89, 95% CI 0.73 to 11.43), presenting low-certainty evidence at six months (31 participants). In comparison to treatment as usual, two studies (with 40 participants) found no significant reduction in frequency of marijuana use at three months post release (MD -1.05, 95% CI -2.39 to 0.29) nor time to first arrest (MD 0.87, 95% CI -0.12 to 1.86), along with a small reduction in frequency of re-arrest (MD -0.66, 95% CI -1.31 to -0.01) up to 36 months, yielding low-certainty evidence; the other study with 80 participants found no significant reduction in positive drug screens at 12 months (MD -0.7, 95% CI -3.5 to 2.1), providing very low-certainty evidence.Two studies reported on the use of multi-systemic therapy involving juveniles and families versus treatment as usual and adolescent substance abuse therapy. In comparing treatment as usual, researchers found no significant reduction up to seven months in drug dependence on the Drug Use Disorders Identification Test (DUDIT) score (MD -0.22, 95% CI -2.51 to 2.07) nor in arrests (RR 0.97, 95% CI 0.70 to 1.36), providing low-certainty evidence (156 participants). In comparison to an adolescent substance abuse therapy, one study (112 participants) found significant reduction in re-arrests up to 24 months (MD 0.24, 95% CI 0.76 to 0.28), based on low-certainty evidence.One study (38 participants) reported on the use of interpersonal psychotherapy in comparison to a psychoeducational intervention. Investigators found no significant reduction in self-reported drug use at three months (RR 0.67, 95% CI 0.30 to 1.50), providing very low-certainty evidence. The final study (29 participants) compared legal defence service and wrap-around social work services versus legal defence service only and found no significant reductions in the number of new offences committed at 12 months (RR 0.64, 95% CI 0.07 to 6.01), yielding very low-certainty evidence.
AUTHORS' CONCLUSIONS
Therapeutic community interventions and mental health treatment courts may help people to reduce subsequent drug use and/or criminal activity. For other interventions such as interpersonal psychotherapy, multi-systemic therapy, legal defence wrap-around services, and motivational interviewing, the evidence is more uncertain. Studies showed a high degree of variation, warranting a degree of caution in interpreting the magnitude of effect and the direction of benefit for treatment outcomes.
PubMed: 31588993
DOI: 10.1002/14651858.CD010901.pub3 -
Psychological Medicine Oct 2020Risk prediction algorithms have long been used in health research and practice (e.g. prediction of cardiovascular disease and diabetes). However, similar tools have not... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Risk prediction algorithms have long been used in health research and practice (e.g. prediction of cardiovascular disease and diabetes). However, similar tools have not been developed for mental health. For example, for psychotic disorders, attempts to sum environmental risk are rare, unsystematic and dictated by available data. In light of this, we sought to develop a valid, easy to use measure of the aggregate environmental risk score (ERS) for psychotic disorders.
METHODS
We reviewed the literature to identify well-replicated and validated environmental risk factors for psychosis that combine a significant effect and large-enough prevalence. Pooled estimates of relative risks were taken from the largest available meta-analyses. We devised a method of scoring the level of exposure to each risk factor to estimate ERS. Relative risks were rounded as, due to the heterogeneity of the original studies, risk effects are imprecisely measured.
RESULTS
Six risk factors (ethnic minority status, urbanicity, high paternal age, obstetric complications, cannabis use and childhood adversity) were used to generate the ERS. A distribution for different levels of risk based on simulated data showed that most of the population would be at low/moderate risk with a small minority at increased environmental risk for psychosis.
CONCLUSIONS
This is the first systematic approach to develop an aggregate measure of environmental risk for psychoses in asymptomatic individuals. This can be used as a continuous measure of liability to disease; mostly relevant to areas where the original studies took place. Its predictive ability will improve with the collection of additional, population-specific data.
Topics: Adverse Childhood Experiences; Environment; Ethnicity; Female; Humans; Male; Marijuana Abuse; Minority Groups; Obstetric Labor Complications; Paternal Age; Pregnancy; Psychotic Disorders; Risk Assessment; Risk Factors; Urban Population
PubMed: 31535606
DOI: 10.1017/S0033291719002319 -
Adicciones Jan 2020The use of cannabis for recreational purposes has increased worldwide, and the proportion of cannabis users in the adolescent population is high. Susceptibility to... (Meta-Analysis)
Meta-Analysis
The use of cannabis for recreational purposes has increased worldwide, and the proportion of cannabis users in the adolescent population is high. Susceptibility to cannabis use involves various factors, including childhood adversity; however, the effects of different types of violence on cannabis use have not been evaluated. The aim of this review was to analyze the effects of different types of violence on cannabis use in adolescence. We searched electronic databases (PubMed, Science Direct, Web of Science, Ovid and CONRICyT) using the following algorithm: (("Cannabis" OR "Marijuana Smoking" OR "Marijuana Abuse") AND ("Child Abuse" OR "Domestic Violence" AND "Adolescent")), considering all articles published up to November 3th, 2017. Odds ratios (ORs) were calculated for the effects of experiencing different types of violence during childhood on cannabis use. Six studies, which represented 10 843 adolescents of both sexes, were ultimately included in the systematic review and meta-analysis. Three types of early-life adversity were associated with cannabis abuse/dependence: physical abuse (OR: 1.58, 95% CI [1.01-2.46]), sexual abuse (OR: 2.35, 95% CI [1.64-3.35]), and witnessing violence (OR: 3.22, 95% CI [0.63-16.54]). The results indicated that two specific types of child maltreatment, sexual and physical abuse, were critical factors affecting vulnerability to cannabis use in adolescence. The number of studies examining other types of violence was limited. The results highlighted the importance of enhancing efforts to prevent violence, particularly sexual abuse, as part of integral programs designed to prevent cannabis abuse and dependence.
Topics: Adolescent; Adolescent Behavior; Adverse Childhood Experiences; Child Abuse; Exposure to Violence; Female; Humans; Male; Marijuana Abuse
PubMed: 30627731
DOI: 10.20882/adicciones.1050