Alcohol Use Severity Research Articles

Prevalence and Severity of Alcohol and Cannabis Use Across the Urban-Rural Continuum in the Michigan National Guard.

The National Guard provides critical support both domestically and abroad with soldiers dispersed throughout America and spanning the urban-rural continuum. To determine if location-specific interventions may be needed, we compared the prevalence and severity of cannabis and alcohol use among National Guard members across localities. Michigan National Guard members were enrolled (N=2,746) during drill weekends as part of a larger randomized behavioral trial. Cannabis (ASSIST; prevalence=5%) and alcohol use (AUDIT; prevalence=82%) were compared using hurdle regression models across locality status after adjusting for covariates. Prevalence of cannabis and alcohol use was predicted by locality (adjusted odds ratio [AOR]=0.913, 95% CI: 0.838-0.986, P=.029; AOR=0.963, 95% CI: 0.929-0.998, P=.038, respectively), with more use in urban localities. Neither severity of cannabis nor alcohol use was predicted by locality status. Prevalence of cannabis and alcohol use in the National Guard is differentially elevated across localities with higher prevalence in more central, densely populated areas. Findings may inform future work considering accessibility and utilization of prevention and treatment services for Guard members across the urban-rural continuum.

Psychometric Validation of the Dutch Version of the Desire Thinking Questionnaire (DTQ-D)

Abstract. Desire thinking refers to verbal and imaginal elaboration of a desired target. It predicts escalations in craving intensity and subsequent alcohol use. This article aimed to determine the psychometric properties of the Dutch version of the Desire Thinking Questionnaire (DTQ-D). In Study 1, a confirmatory factor analysis provided support for the original two-factor solution, achieved with adequate internal consistency. The DTQ-D demonstrated partial invariance over time. In Study 2, convergent validity with measures of craving was demonstrated. Discriminant validity with measures of severity of alcohol use and perseverative thinking was satisfactory. Concurrent validity was established by comparing three distinctive groups of alcohol users with increasing levels of drinking: a normative and an out- and in-patient sample. The normative group scored significantly lower on the DTQ-D than the clinical groups. Within the normative sample a low and higher at-risk drinking group could be distinguished. Overall, the DTQ-D possesses reasonable psychometric properties for use with alcohol-drinking samples. However, additional psychometric evaluation in larger clinical samples as well as in other addictions is warranted.

Parental substance use and child reward-driven eating behaviors

Family history of substance use is a well-established risk factor for greater substance use in adolescence and adulthood. The biological vulnerability hypothesis proposes that family history of substance use might also confer risk for obesogenic eating behavior because of similar rewarding characteristics between substances and certain foods (e.g., processed foods high in refined carbohydrates and fat). Indeed, preliminary research shows that family history of substance use is linked with sweet liking and obesity in adults; however, it is unknown whether this factor is linked to eating behavior earlier in development. The present study (n = 52) tested the association of severity of parental nicotine dependence and alcohol use (drinking frequency, drinking quantity, binge drinking, and number of annual drinks consumed) with two types of child [Mage = 10.18 (0.83) years] eating behavior: homeostatic eatingbehavior, or eating regulated by internal satiety cues, and reward-driven eatingbehavior, or eating motivated by pleasure. Results indicated that—over and above the influence of child age, child biological sex, and family income—more severe parental nicotine dependence and frequent and/or heavy, frequent parental alcohol use were associated with significantly greater child reward-driven eating behaviors as indexed by the Food Responsiveness and Enjoyment of Food subscales on the Child Eating Behavior Questionnaire. Parental substance use was not associated with child homeostatic eating behavior as indexed by the Satiety Responsiveness subscale. Family history of substance use may be an important transdiagnostic risk factor that identifies children at risk for obesogenic, reward-driven eating behaviors.

Predictors of Post-Treatment Employment for Individuals with Substance Use Disorders

This study examined the influence of gender, post-treatment issue severities, and treatment participation rate on the post-treatment employment status of consumers with substance use disorders. The study analyzed the archival data of 100 unemployed and underemployed participants from a substance abuse intensive outpatient program. We found significant differences in the characteristics of gender, severity of alcohol use, drug use, psychiatric issues, and treatment participation rate. Female gender and low treatment participation rates negatively predicted employment. This study increased understanding about the interplay of alcohol, drug, and psychiatric influences on post-treatment employment status.

Correlates of lifetime cannabis use and cannabis use severity in a Canadian university sample

This study aimed to broaden previous investigations of correlates of lifetime cannabis use and problematic cannabis use among post-secondary students by examining the novel and contemporary issues of medicinal use and deep inhalation practices. The sample included 2212 undergraduate and graduate post-secondary students from Alberta, Canada, who completed the University of Calgary's Campus Experience with Cannabis Survey (average age 23.2, SD = 5.2). Nine variables were entered into the binary logistic regression to examine their differentiation of lifetime users from non-users. A multiple regression model was completed with past six-month users (n = 697), where the continuous dependent variable was cannabis use severity as measured by total scores on the Cannabis Use Disorder Identification Test-Revised. Twenty independent variables were entered simultaneously. Varsity athlete status, family mental illness, severity of alcohol use, greater support for legalization and lower perceived risk associated with regular cannabis use, differentiated lifetime users from non-users. Higher rates of religiosity and living with parents or relatives were associated with lower-lifetime rates. Male gender, earlier age of first cannabis use, cannabis use motives (including coping, enhancement and expansion), past six-month medicinal use and increased frequency of deep inhalation during consumption, were found to be significant correlates of severity. Different factors seem to predict lifetime cannabis use versus severity, and these differences may help inform the development and delivery of prevention efforts. Given that medicinal use and male gender were the largest correlates of severity, populations representing these groups may benefit most from targeted education and prevention.

Naltrexone effects on subjective responses to alcohol in the human laboratory: A systematic review and meta-analysis.

Naltrexone (NTX) has been widely studied for the treatment of alcohol use disorder with overall support for its efficacy. The mechanisms of action of naltrexone are thought to involve attenuation of the hedonic effects of alcohol and potentiation of its aversive effects. In order to provide a quantitative estimate of the effects of naltrexone on subjective response to alcohol, the aims of this meta-analytic review are to examine the effects of naltrexone across four domains of subjective response. Meta-analyses of naltrexone effects on alcohol craving (k=16, N=686), stimulation (k=15, N=675), sedation (k=18, N=777), and negative mood (k=9, N=281) suggested that under laboratory conditions and compared with placebo, naltrexone reduces craving (Hedges g=-0.252; SE=0.054; 95% CI, -0.375 to -0.130; P<0.01), reduces stimulation (g=-0.223; SE=0.067; 95% CI, -0.372 to -0.074; P<0.01), increases sedation (g=0.251; SE=0.064; 95% CI, 0.112-0.389; P<0.01), and increases negative mood (g=0.227; SE=0.047; 95% CI, 0.100-0.354; P<0.01). Results were robust when drinks per month and alcohol dose were added to the models as covariates. The effects of naltrexone varied by severity of alcohol use with medication effects on craving and stimulation being observed in sample of both heavy drinkers and AUD individuals. These results are consistent with the hypothesized mechanisms of action of NTX, although the effects are of small magnitude. This meta-analysis aggregates across multiple human laboratory studies of NTX's effects on subjective response to alcohol, providing a comprehensive summary of a key mechanism of NTX efficacy, namely, alteration of the subjective experience of alcohol.

Feasibility and acceptability of integrated psychological therapy versus treatment as usual for people with bipolar disorder and co-morbid alcohol use: A single blind randomised controlled trial

BackgroundAlcohol use is a common problem in bipolar disorder (BD) and evidence indicates more promising outcomes for alcohol use than other substances. No trials have evaluated individual integrated motivational interviewing and cognitive behaviour therapy (MI-CBT) for problematic alcohol use in BD. We therefore assessed the feasibility and acceptability of a novel MI-CBT intervention for alcohol use in BD. MethodsA single blind RCT was conducted to compare MI-CBT plus treatment as usual (TAU) with TAU only. MI-CBT was delivered over 20 sessions with participants followed up at 3, 6, 9 and 12 months post-randomisation. Primary outcomes were the feasibility and acceptability of MI-CBT (recruitment to target, retention to follow-up and therapy, acceptability of therapy and absence of adverse events). We also conducted preliminary analyses of alcohol and mood outcomes (frequency and severity of alcohol use and time to mood relapse). Results44 participants were recruited with 75% retention to 6 and 12 months follow-up. Therapy participants attended a mean of 17.6 (SD 4.5) sessions. Therapy alliance and treatment fidelity were acceptable. Qualitative interviews indicated the intervention was experienced as collaborative, and helpful, in addressing mood and alcohol issues, although risk of overconfidence following therapy was also identified. Clinical outcomes did not differ between arms at 12 months follow-up. LimitationsAs a feasibility and acceptability trial any secondary results should be treated with caution. ConclusionsIntegrated MI-CBT is feasible and acceptable, but lack of clinical impact, albeit in a feasibility study, suggests need for further development. Potential adaptations are discussed.

Mental Health Status, Need, and Unmet Need for Mental Health Services Among U.S. Pacific Islanders.

This study examined the mental health status, need for services, and unmet need of community-dwelling Native Hawaiian and other Pacific Islanders (NHPI). Survey data were collected from 223 NHPI adults of Samoan or Marshallese heritage. Surveys were translated into Samoan and Marshallese by using back-translation, with feedback from cultural experts. Severity of depression, anxiety, and alcohol use were measured, as were perceived need for and avoidance of, or delay in, seeking mental health services. Logistic regressions calculated adjusted odds ratios for past-year perceived need for services and avoidance or delay of needed services, controlling for depression, anxiety, and alcohol use. Participants' screened prevalence of major depression, generalized anxiety disorder, and alcohol use disorder was 21%, 12%, and 22%, respectively. In the past year, 35% and 26% of participants reported needing services and avoiding or delaying needed services, respectively. Urban Samoan and rural Marshallese participants did not differ significantly in measures of depression, anxiety, or alcohol use, even though the groups had significant demographic differences. Female gender and greater familiarity-contact with persons with mental illness were significant predictors of both reporting service need and reporting avoiding or delaying services. Community-dwelling NHPIs reported a heavy burden of depression, anxiety, and alcohol use, and high perceived need for services, yet low levels of help-seeking. The large unmet need in the sample suggests that a gap may exist between service need and engagement in U.S. NHPI communities that could be targeted with culturally tailored approaches that promote engagement in care.

The Association Between Negative Trauma-Related Cognitions and Pain-Related Functional Status Among Veterans With Posttraumatic Stress Disorder and Alcohol Use Disorder.

Among veterans with posttraumatic stress disorder (PTSD), alcohol use disorders (AUDs) are highly prevalent. Furthermore, PTSD frequently co-occurs with chronic pain (CP), and CP is associated with an increased risk of AUD. Pain-related beliefs and appraisals are significantly associated with poorer pain-related functional status, yet few studies have examined negative trauma-related cognitions and their impact on pain-related functional disability in veterans with co-occurring PTSD and AUD. Accordingly, we examined the association between negative trauma-related cognitions and pain severity and pain disability in 137 veterans seeking treatment for PTSD and AUD. Using hierarchical multiple linear regression, we found that higher levels of negative trauma-related cognitions (e.g., "I am completely incompetent") were associated with a higher level of pain severity, after controlling for PTSD symptom severity and frequency of alcohol use, total R2 = .07, ΔR2 = .06. Additionally, as hypothesized, we found that higher levels of negative trauma-related cognitions were associated with higher levels of pain disability, after controlling for PTSD symptom severity, frequency of alcohol use, and pain severity, total R2 = .46, ΔR2 = .03. Given that negative trauma-related cognitions contributed to pain severity and pain disability, even when controlling for PTSD severity and frequency of alcohol use, future studies should explore the potential impact of interventions that address negative trauma-related cognitions (e.g., prolonged exposure or cognitive processing therapy) on pain severity and disability.

Substance use among individuals with mild intellectual disability or borderline intellectual functioning in residential care: Examining the relationship between drinking motives and substance use.

BackgroundThis study examined the relationship between substance use motives (i.e., social, conformity, coping and enhancement) and substance use in individuals with mild intellectual disability or borderline intellectual functioning (MID‐BIF).MethodData were collected among 163 clients with MID‐BIF using interactive questionnaires with visual cues on a tablet with a web application.ResultsResults show that social motives were positively related to frequency of alcohol use, while conformity, coping and enhancement motives were positively related to severity of alcohol use. Results for drug use show that social motives were positively related to frequency of cannabis and hard drug use and that conformity motives were negatively related to frequency of cannabis use. Coping motives were positively related to severity of drug use.ConclusionsInsight in substance use motives should be used when adapting interventions, as it could contribute to the prevention and reduction of substance use disorders in individuals with MID‐BIF.

Correlates and Treatment Outcome of Risky Sexual Behaviour in Young Males with ADHD and Comorbid Alcohol Use Disorder: A Prospective Study

Background: Attention-deficit/hyperactivity disorder (ADHD) is associated with risky sexual behavior (RSB). Alcohol use and high perceived stress in young adulthood contributes to this association. Previous studies have not found methylphenidate to reduce RSB in ADHD, as the population had comorbidities such as mood disorders and antisocial personality disorder. We aimed to study (a) the association of RSB with ADHD and severity of alcohol use among adolescents and young adult males with ADHD who had comorbid alcohol use disorder and (b) the effect of treatment of ADHD using methylphenidate on RSB in this population at 3- and 6-month follow-ups. Methodology: The study had 31 participants who were selected by screening for RSBs using the sexual behavior section of the HIV Risk-taking Behavior Scale (HRBS) manual among a cohort of individuals with ADHD and early onset alcohol use. These individuals were also administered WHO ADHD self-report scale (ASRS), alcohol-use disorders identification test (AUDIT), perceived stress scale (PSS), and HRBS-sexual behavior section. They were then treated with methylphenidate and these assessments were repeated at 3 and 6 months. Results: Those having ADHD with RSB had higher total ADHD score ( P = .007) and inattention score ( p = .0001) than those without RSB. There was a significant correlation between the ADHD total score with alcohol-use severity ( r = 0.47), with RSB ( r = 0.34), and ADHD hyperactivity scores with alcohol-use severity ( r = 0.49) and with RSB ( r = 0.34). There was also a significant reduction of ADHD total, inattention and hyperactivity scores, alcohol-use severity scores, RSB and perceived stress scores with use of methylphenidate at 3- and 6-month follow-ups. Multiple logistic regression predicted reduction in ADHD total scores to reduce RSB (odds ratio [OR] = 1.26, P = .01). Conclusion: RSB was associated with severity of ADHD and alcohol use. Methylphenidate not only reduced ADHD severity but also alcohol-use severity and RSB, whose reduction was predicted by reduction in ADHD severity.

Examination of the indirect effect of alcohol expectancies on ethnic identity and adolescent drinking outcomes.

Although overall rates of alcohol use tend to be lower among racial/ethnic minority youth compared to White youth, consequences associated with use tend to be more severe. Identifying factors that prevent alcohol use is crucial to reducing its impact among minority adolescents. One such factor is ethnic identity, which involves gaining clarity about one's ethnic background and regard toward one's ethnic group. Strong ethnic identity has been found to work through antidrug beliefs to decrease minority youth's substance use. The current study extends previous literature by examining whether specific alcohol cognitions-alcohol expectancies-explain the promotive effect of ethnic identity on alcohol use and severity of alcohol use among minority youth. Participants were 113 ethnic minority youth ages 12-18 (M = 15.27). Most participants were male (66%) and identified as non-Hispanic African American/Black (70%), followed by Hispanic/Latino (15%), multiracial (12%), and American Indian/Native American (3%). Participants completed self-report measures of ethnic identity, positive and negative alcohol expectancies, and hazardous drinking, which were analyzed in an indirect effects model. Results indicated that ethnic identity was inversely related to negative alcohol expectancies. A significant indirect effect of ethnic identity on severity of alcohol use through negative alcohol expectancies was found. However, no indirect effect was found for positive alcohol expectancies. Findings suggest that strong ethnic identity serves as a promotive factor preventing alcohol use for ethnic minority youth, in part through more negative alcohol expectancies, and may be a beneficial target for intervention programs to reduce alcohol use among this group. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Resting state connectivity best predicts alcohol use severity in moderate to heavy alcohol users.

BackgroundIn the United States, 13% of adults are estimated to have alcohol use disorder (AUD). Most studies examining the neurobiology of AUD treat individuals with this disorder as a homogeneous group; however, the theories of the neurocircuitry of AUD call for a quantitative and dimensional approach. Previous imaging studies find differences in brain structure, function, and resting-state connectivity in AUD, but few use a multimodal approach to understand the association between severity of alcohol use and the brain differences.MethodsAdults (ages 22–60) with problem drinking patterns (n = 59) completed a behavioral and neuroimaging protocol at the National Institutes of Health. Alcohol severity was quantified with the Alcohol Use Disorders Identification Test (AUDIT). In a 3 T MRI scanner, participants underwent a structural MRI as well as resting-state, monetary incentive delay, and face matching fMRI scans. Machine learning was applied and trained using the neural data from MRI scanning. The model was tested for generalizability in a validation sample (n = 24).ResultsThe resting state-connectivity features model best predicted AUD severity in the naïve sample, compared to task fMRI, structural MRI, combined MRI features, or demographic features. Network connectivity features between salience network, default mode network, executive control network, and sensory networks explained 33% of the variance associated with AUDIT in this model.ConclusionsThese findings indicate that the neural effects of AUD vary according to severity. Our results emphasize the utility of resting state fMRI as a neuroimaging biomarker for quantitative clinical evaluation of AUD.

Personality Profile and Severity of Alcohol Use in Patients with Alcohol Dependence Syndrome: A Cross-Sectional Study from Central Rural India

Personality Profile and Severity of Alcohol Use in Patients with Alcohol Dependence Syndrome: A Cross-Sectional Study from Central Rural India

Longitudinal Reciprocal Associations Between Anxiety, Depression, and Alcohol Use in Adolescent Girls.

Depression, anxiety, and alcohol misuse predict adverse social, academic, and emotional outcomes, and their relations to one another increase during adolescence-particularly in girls. However, evidence on the directions of these relations is mixed. Longitudinal models of internalizing problem-alcohol use links may identify promising prevention targets. Accordingly, we examined reciprocal associations between anxiety severity and alcohol use, as well as between depression severity and alcohol use, in adolescent girls. Data were drawn from a population-based longitudinal study of female adolescents. The current sample comprised 2,100 participants (57.1% Black, 42.9% White) assessed annually between ages 13 and 17. Girls self-reported depression severity, anxiety severity, and frequency of alcohol use (consumption of ≥1 full drink) in the past year. Primary caregivers reported on socioeconomic and neighborhood factors; these were included with race, early puberty, and conduct problems (youth-report) as covariates. Anxiety and depression severity were included within a single cross-lagged panel model, along with alcohol use, to isolate their independent and reciprocal links to drinking behavior. Higher depression severity modestly predicted increased likelihood of subsequent alcohol use from ages 13 to 17. However, inconsistent relations emerged for the reverse pathway: Alcohol use modestly predicted decreased depression severity at ages 14 and 16; associations were nonsignificant in other lagged associations. Anxiety severity and alcohol use were not consistently associated. Results highlight the key role of depression, relative to anxiety, in predicting later alcohol use. Future studies may examine whether depression prevention programs yield secondary reductions in alcohol use in adolescent girls.

Role of conduct problems in the relation between Attention-Deficit Hyperactivity disorder, substance use, and gaming

Known comorbidities for Attention-Deficit Hyperactivity Disorder (ADHD) include conduct problems, substance use disorder and gaming. Comorbidity with conduct problems may increase the risk for substance use disorder and gaming in individuals with ADHD. The aim of the study was to build a causal model of the relationships between ADHD and comorbid conduct problems, and alcohol, nicotine, and other substance use, and gaming habits, while accounting for age and sex. We used a state-of-the-art causal discovery algorithm to analyze a case-only sample of 362 ADHD-diagnosed individuals in the ages 12–24 years. We found that conduct problem severity mediates between ADHD severity and nicotine use, but not with more severe alcohol or substance use. More severe ADHD-inattentive symptoms lead to more severe gaming habits. Furthermore, our model suggests that ADHD severity has no influence on severity of alcohol or other drug use. Our findings suggest that ADHD severity is a risk factor for nicotine use, and that this effect is fully mediated by conduct problem severity. Finally, ADHD-inattentive severity was a risk factor for gaming, suggesting that gaming dependence has a different causal pathway than substance dependence and should be treated differently. By identifying these intervention points, our model can aid both researchers and clinicians.

Social Capital as a Moderator of the Relationship Between Perceived Discrimination and Alcohol and Cannabis Use Among Immigrant and Non-immigrant Adolescents in Israel.

Literature highlights the relationship between perceived discrimination and frequency and severity of alcohol and cannabis use. One mechanism for explaining this is the nature of perceived discrimination as a potentially traumatic interpersonal stressor, which can lead to the depletion of social and personal resources. Within a Recovery Capital (RC) framework, the current study explores whether the existence of social capital in the form of parental monitoring, friend and teacher support can buffer the relationship between perceived discrimination and alcohol and cannabis use among immigrant and non-immigrant adolescents, by replenishing the depleted resources. The study included a representative sample of 8,598 students in Israel, aged 11–18, from the Health Behaviors of School Aged Children (HBSC) 2013–2014 data: 1503 immigrant adolescents from the Former Soviet Union [FSU] (N = 955) and Ethiopia (N = 548) and 7086 non-immigrants. Results confirmed that perceived discrimination was positively related to substance use; all three forms of social capital were negatively related to alcohol and cannabis use and moderated the relationship between perceived discrimination and substance use, with the exception of friend support in the case of alcohol use. When all three social capital measures were included together, the adult social capital measures were significant predictors of substance use. Results suggest that levels of social capital, especially as provided by parents and teachers, can help young people, both immigrant and majority group adolescents, to cope with perceived discrimination.

Commonalities in the Association of Behavioral Activation and Behavioral Inhibition with Problem Gambling and Alcohol Use in Young Adult College Students.

In a previous study of young adult college students (age 18-25), we found an association among 157 past year gamblers between gambling severity as measured by the Problem Gambling Severity Index and negative affect as measured by the total score on the 21-item Depression Anxiety and Depression Scales. An inverse association between the behavioral activation system reward responsiveness scale and gambling severity was found, as was an inverse association between reward and negative affect. In addition, an association between the behavioral inhibition system scale and negative affect was observed. Theoretical models such as Shaffer's Syndrome Addiction model posit that problem behaviors are expressions of a common underlying etiology. In the current paper, we present results from the previous database regarding the severity of alcohol use among 286 past year drinkers as measured by the Alcohol Use Disorders Identification Test. As with gambling severity, reward responsiveness was inversely associated with alcohol use severity both directly and indirectly through negative affect. Severity was also directly associated with the BAS fun seeking scale. As previously found, negative affect was associated with inhibition. Among 125 students engaging in each behavior, scores for each severity index were also correlated. These findings suggest that a reward oriented coping approach may be protective against both more severe gambling and alcohol use problems. An inhibitory or escapist approach may lead to more severe problems. They also suggest that behaviors are co-occurring in a significant number of students, and levels of severity in one behavior are associated with levels in the other. It is hoped these results can inform future research and interventions.

Dialectical Behavior Therapy Skills Training in Alcohol Dependence Treatment: Findings Based on an Open Trial

ABSTRACTBackground: Dialectical behavior therapy (DBT) has demonstrated efficacy in treating disorders such as alcohol dependence that are characterized by emotional dysregulation. Preliminary evidence has revealed the feasibility of DBT skills training (ST) as a stand-alone treatment for such disorders. Although emotional dysregulation plays a significant role in alcohol dependence, there are no previous reports of using DBT-ST to treat it. Objectives: The aim of this study was to evaluate the duration of abstinence and changes in emotional regulation in a 3-month DBT-ST program for alcohol-dependent patients and to look for relations between abstinence and emotional regulation. Methods: We administered the Difficulties in Emotion Regulation Scale (DERS) and used urine toxicology screening to monitor alcohol/substance intake among the 244 subjects admitted to the program. Results: Among the 157 patients who completed the treatment, 73.2% were abstinent at the end of the program, and their emotional regulation improved. Improvement was independent of the initial severity of both alcohol use and emotional dysregulation. For substance use outcomes, we found a partial mediation role of improved emotional regulation. Conclusions: This is the first open trial to show improved alcohol-related behavior and emotional regulation in alcohol-dependent patients treated with DBT-ST and to posit a partial but significant relation between improved emotional regulation and alcohol use outcomes. In the treatment of alcohol dependence, emotional regulation may be a relevant factor for therapists to consider.

Substance use and homelessness among emergency department patients

BackgroundHomelessness and substance use often coexist, resulting in high morbidity. Emergency department (ED) patients have disproportionate rates of both homelessness and substance use, yet little research has examined the overlap of these issues in the ED setting. We aimed to characterize alcohol and drug use in a sample of homeless vs. non-homeless ED patients. MethodsA random sample of urban hospital ED patients were invited to complete an interview regarding housing, substance use, and other health and social factors. We compared substance use characteristics among patients who did vs. did not report current literal (streets/shelter) homelessness. Additional analyses were performed using a broader definition of homelessness in the past 12-months. ResultsPatients who were currently homeless (n = 316, 13.7%) versus non-homeless (n = 1,993, 86.3%) had higher rates of past year unhealthy alcohol use (44.4% vs. 30.5%, p < .0001), any drug use (40.8% vs. 18.8%, p < .0001), heroin use (16.7% vs. 3.8%, p < .0001), prescription opioid use (12.5% vs. 4.4%, p < .0001), and lifetime opioid overdose (15.8% vs. 3.7%, p < .0001). In multivariable analyses, current homelessness remained significantly associated with unhealthy alcohol use, AUDIT scores among unhealthy alcohol users, any drug use, heroin use, and opioid overdose; past 12-month homelessness was additionally associated with DAST-10 scores among drug users and prescription opioid use. ConclusionsPatients experiencing homelessness have higher rates and greater severity of alcohol and drug use than other ED patients across a range of measures. These findings have implications for planning services for patients with concurrent substance use and housing problems.