Association Of Substance Use Disorders Research Articles

Substance use disorders among armed forces veterans with gambling disorder: Insights from an inpatient treatment sample

Armed forces veterans are especially prone to experiencing a variety of addictive disorders, including gambling disorder. Even so, gambling disorder in veterans remains understudied generally, and there remain significant gaps in the research literature with regards to how gambling disorder relates to the experience and expression of comorbid substance use disorders. The present work examines the prevalence, presentation, and clinical associations of substance use disorders in U.S. Armed Forces veterans receiving inpatient treatment for gambling disorder. Participants (N = 664) were veterans from all branches of the U.S. Armed Forces receiving inpatient treatment for gambling disorder through the Department of Veteran Affairs Healthcare System. Clinical data from the time of intake was analyzed. A substantial portion of veterans (36.1%) met current criteria for an SUD, with another 16.5% reporting a history of SUD. Alcohol use disorder was the most commonly reported SUD (76.1% of those with a current SUD), with polysubstance use disorders and stimulant use disorders each occurring in at least 25% of those with SUDs. SUD status was related to greater levels of impulsivity, but there was no evidence that SUD status was related to gambling symptom severity, gambling preferences, or further psychiatric comorbidities.

Association of substance-use disorder with outcomes of major elective abdominal operations: A contemporary national analysis

BackgroundAffecting >20million people in the U.S., including 4 % of all hospitalized patients, substance use disorder (SUD) represents a growing public health crisis. Evaluating a national cohort, we aimed to characterize the association of concurrent SUD with perioperative outcomes and resource utilization following elective abdominal operations. MethodsAll adult hospitalizations entailing elective colectomy, gastrectomy, esophagectomy, hepatectomy, and pancreatectomy were tabulated from the 2016–2020 National Inpatient Sample. Patients with concurrent substance use disorder, comprising alcohol, opioid, marijuana, sedative, cocaine, inhalant, hallucinogen, or other psychoactive/stimulant use, were considered the SUD cohort (others: nSUD). Multivariable regression models were constructed to evaluate the independent association between SUD and key outcomes. ResultsOf ∼1,088,145 patients, 32,865 (3.0 %) comprised the SUD cohort. On average, SUD patients were younger, more commonly male, of lowest quartile income, and of Black race. SUD patients less frequently underwent colectomy, but more often pancreatectomy, relative to nSUD.Following risk adjustment and with nSUD as reference, SUD demonstrated similar likelihood of in-hospital mortality, but remained associated with increased odds of any perioperative complication (Adjusted Odds Ratio [AOR] 1.17, CI 1.09–1.25). Further, SUD was linked with incremental increases in adjusted length of stay (β + 0.90 days, CI +0.68–1.12) and costs (β + $3630, CI +2650–4610), as well as greater likelihood of non-home discharge (AOR 1.54, CI 1.40–1.70). ConclusionsConcurrent substance use disorder was associated with increased complications, resource utilization, and non-home discharge following major elective abdominal operations. Novel interventions are warranted to address increased risk among this vulnerable population and address significant disparities in postoperative outcomes.

The burden of substance use and (mental) distress among asylum seekers: a cross sectional study.

Asylum seekers are a particularly vulnerable population due to a wide range of external stressors. Traumatic events and difficult social/economic prospects can lead to an elevated susceptibility for substance use disorders. The aim of the present study was to determine whether asylum seekers suffering from mental or physical distress present higher levels of substance use disorder (SUD) in a state reception center in Germany and whether there are identifiable risk or protective factors. We performed a hierarchical logistic regression on data of N = 238 people who had applied for asylum in Germany to analyze the SUD variance explanation by (1) sociodemographic, (2) flight-specific, and (3) psychometric (ERQ, SOC-9 L, SCL-K9) variables. On level (4), we included the location of data collection (walk-in clinic or accommodation,) as an indicator of individual's need for a psychologist's or General practitioner's help in order to assess for the participant's (mental) distress. Low educational level, lower sense of coherence, and mental distress (location of data collection in the psychosocial or general medical outpatient clinic) were associated with SUD. Those suffering from SUD seemed to be less aware of external stressors as SUD was also associated with low levels of reported post-migratory stress. The association of SUD with psychological distress and lower education reaffirms the concept that some vulnerable groups are at a higher risk for substance-related difficulties. Strengthening the sense of coherence with targeted interventions might enable at-risk groups to cope better with forthcoming burdens and help with abstaining from current or future consumption.

Monotonic Association of Increasing Past-Year Substance Use Disorder across a Four-Level Trauma Post-Traumatic Stress Disorder (PTSD) Hierarchy in a Nationwide Sample

Objective There is limited information on the differences in the association of substance use disorders (SUD) with four clinically relevant hierarchical groups based on trauma exposure and its consequences (1-no trauma; 2-trauma but no PTSD; 3-remitted PTSD; and 4-current PTSD). Methods Among adults enrolled in a large nationally representative survey, the National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC III), we compared differences in SUD prevalence between each of the hierarchical trauma group and the prior group adjusting for potentially confounding factors. Results Unadjusted results show that each increase in the hierarchy was associated with a greater likelihood of SUD diagnoses, even after adjusting for potentially confounding variables. However, after adjusting for covariates, comparison of adults with past to those with current PTSD showed persistence of SUD indicators. Conclusion SUD prevalence increased substantially with trauma exposure even without PTSD and monotonically increased further with past and current PTSD, respectively, illustrating the differential effect of the clinical consequences of trauma.

S73 Effect of Substance Abuse on Cholangiocarcinoma Outcomes and Screening in a Large Urban Safety-Net Hospital

Introduction: Patients with substance use disorders are at an increased risk of viral hepatitis and alcohol-related liver disease and, consequently, at higher risk of developing cholangiocarcinoma (CCA). Further, patients with substance abuse are often less compliant with healthcare screening strategies. We performed a retrospective study to evaluate the association of substance use disorders with CCA screening and outcomes. Methods: A manual chart review was performed for all patients diagnosed with CCA at a large urban safety-net hospital from 2010-2019. Patients were divided into two cohorts, CCA patients with and without a history of substance abuse. Patient characteristics, liver disease etiology, and radiologic screening intervals were recorded. CCA outcomes such as mortality rate, disease metastasis, and treatment decision at tumor board were noted. Statistical analyses were performed using Statistical Product and Service Solutions version 26.9 (SPSS, Inc., Chicago, Illinois). Qualitative and quantitative differences between groups were analyzed by Chi-squared or Fisher’s exact tests for categorical variables and t-test for continuous variables. Results: A total of 46 patients were identified with CCA. Among them, 11 patients (23.9%) had a history of substance abuse, while 35 patients (76.1%) did not have a history of substance abuse. CCA patients with a history of substance abuse were significantly younger (mean age 60 vs. 65) at diagnosis (Table). There were no significant differences in the adequacy of screening in CCA patients with or without a history of substance abuse. While not statistically significant, compared to those without substance abuse, patients with CCA and substance abuse trended toward a higher mortality rate (72.7% vs. 54.3%) and were more likely to be recommended a palliative approach at tumor board (72.7% vs. 57.1%) (Figure). Conclusion: Notably, those patients with substance abuse were diagnosed with CCA at a significantly younger age. Therefore, cirrhotic patients with substance abuse may benefit from earlier referral to specialist care with hopes of more adherence to screening exams. There is suggestion of worse outcomes in those with substance abuse, as they had higher deaths in follow up and higher likelihood of referral to palliative care upon diagnosis. Overall, this study emphasizes the need for more multidisciplinary linkage to care for this vulnerable patient population.Figure 1.: Screening adequacy and disease outcome in Cholangiocarcinoma patients with and without substance abuse. Legend: 1Therapeutic treatment options include resection, transplantation, ablation, or Transarterial chemoembolization. 2 Palliative treatment options include chemotherapy and hospice. Table 1. - Baseline characteristics of Cholangiocarcinoma patients with and without substance abuse CCA Total (n=46) Substance Abuse (n=11) No substance abuse (n=35) P-value Age (mean +/- sd) 64.4 +/- 11.1 60.9 +/- 5.4 65.5 +/- 12.2 0.0278 Gender Male 22 (47.8%) 8 (72.7%) 14 (40.0%) 0.0485 Female 24 (52.2%) 3 (27.7%) 21 (60.0%) Race African Americans 14 (30.4%) 2 (18.2%) 12 (34.3%) 0.2064 White 25 (54.3%) 7 (63.6%) 18 (51.4%) Asian 1 (2.2%) 0 (0%) 1 (2.9%) Ethnicity Hispanic 5 (10.9%) 2 (18.2%) 3 (8.6%) 0.2626 Non-Hispanic 41 (89.1%) 9 (81.8%) 32 (91.4%) Insurance Medicaid 14 (30.4%) 4 (36.4%) 10 (28.6%) 0.8376 Medicare 15 (32.6%) 4 (36.4%) 11 (31.4%) Financial Assistance 1 (2.2%) 0 (0%) 1 (2.9%) Private 9 (19.6%) 1 (9.1%) 8 (22.9%) No insurance 7 (15.2%) 2 (18.2%) 5 (14.3%) Liver disease HCV 11 (23.9%) 6 (54.5%) 5 (14.3%) 0.3049 Alcohol 7 (15.2%) 5 (45.5%) 2 (5.7%) NASH 3 (6.5%) 0 (0%) 3 (8.6%) HCV treatment HCV treated 1 (9.1%) 1 (16.7%) 0 (0%) 0.5455 HCV not treated 10 (90.9%) 5 (83.3%) 5 (100%) Abbreviations: HCV hepatitis C virus, NASH = Non-alcoholic steatohepatitis

Maternal Substance Use Disorders and Accidental Drug Poisonings in Children

Risk factors for accidental drug poisonings in children are poorly understood, including the association with maternal substance use. This study seeks to determine whether maternal substance use disorders before birth are associated with the future risk of accidental drug poisonings in young children. This study was a longitudinal cohort analysis of 1,032,209 children aged <5 years between 2006 and 2020 in Quebec, Canada. The main exposure included maternal substance use disorders before or during pregnancy. The outcome was hospitalization for drug poisonings before age 5 years, including opioids, cannabis, sedatives/hypnotics, stimulants, and other drugs. Adjusted Cox proportional hazards regression was used to compute hazard ratios and 95% CIs for the association of substance use disorders with child drug poisonings during 4,523,003 person-years of follow-up. Analyses were conducted in 2020. Hospitalization rates for drug poisoning before age 5 years were greater for children of mothers with substance use disorders versus no substance use disorder (84.8 vs 20.7 per 100,000 person-years). Maternal substance use disorders before birth were associated with 2.28 times the risk of future drug poisonings in children (95% CI=1.63, 3.20). The association was stronger for maternal opioid use disorders (hazard ratio=4.16, 95% CI=2.38, 7.27) than other drug use disorders. Associations with child poisonings were stronger between age 1 and 2 years (hazard ratio=3.26, 95% CI=2.09, 5.10) and for poisonings involving opioids, cannabis, and sedative/hypnotic drugs. Maternal substance use disorders before childbirth may be markers of future risk of drug poisonings in young children.

Neonatal Outcomes of Infants Born to Pregnant Women With Substance Use Disorders: A Multilevel Analysis of Linked Data

Objective This study examines the associations of substance use disorders in pregnancy with a set of neonatal outcomes. Methods This is a quantitative retrospective study. Three linked datasets of a 10-year period (2007–2016) from New South Wales, Australia, were examined. Pregnant women were identified positive for substance use disorders when at least one hospital admission during pregnancy or delivery had opioid-, or cannabis-, or stimulant-, or alcohol- or two or more of the four substance groups- related ICD-10-AM diagnostic code. As there was a hierarchical structure in the dataset, the adjusted odds ratio (AOR) was estimated using multilevel logistic regression. Findings Of the 622,640 birth records, 1677 (0.27%) women had opioid-related, 1857 (0.30%) had cannabis-related, 552 (0.09%) had stimulant-related, 595 (0.10%) had alcohol-related and 591 (0.09%) had polysubstance-related ICD-10-AM diagnostic codes. There were significant relationships between opioid use in pregnancy and neonatal health outcomes including preterm birth (AOR 3.2; 95% CI 2.8, 3.7) and admission to the neonatal intensive care unit (NICU) (AOR 10.0; 95% CI 8.8, 11.3). Substance use disorders due to cannabis, stimulants, alcohol or polysubstance were significantly associated with preterm birth, low birthweight, low APGAR score and admission to NICU. Also, alcohol and polysubstance use disorders in pregnancy were found to be significantly associated with stillbirth. Conclusion Results demonstrate that substance use disorders in pregnancy are associated with an increased risk of adverse neonatal outcomes. Early identification of substance use disorders through screening and adherence to pharmacotherapy and other psychosocial interventions could improve neonatal outcomes.

Association of Substance Use Disorders with Engagement in Care and Mortality among a Clinical Cohort of People with HIV in Washington, DC.

Substance use disorders (SUDs) are common among people with HIV and can prevent achievement of optimal health outcomes. Using data from a longitudinal HIV cohort study in the District of Columbia (2011-2018), we calculated the prevalence and correlates of SUD (alcohol, stimulant, and/or opioid use disorders) and determined the association of SUD with engagement in HIV care, ART prescription, viral suppression, and mortality. Of 8420 adults, 3168 (37.6%) had a history of any SUD, most commonly history of alcohol use disorder (29.6%). SUDs disproportionately affected Black individuals (aOR 1.33) and heterosexuals (aOR 1.18), and women had a lower risk of SUD (aOR 0.65). SUD was not associated with engagement in care, ART prescription, or viral suppression. SUD was associated with mortality (aHR 1.31). Addressing alcohol use disorder and preventable causes of death among people with HIV and substance use disorders should be priorities for clinical care and public health.

Association of substance use disorders and drug overdose with adverse COVID-19 outcomes in New York City: January-October 2020.

ABSTRACTBackgroundEvidence suggests that individuals with history of substance use disorder (SUD) are at increased risk of COVID-19, but little is known about relationships between SUDs, overdose and COVID-19 severity and mortality. This study investigated risks of severe COVID-19 among patients with SUDs.MethodsWe conducted a retrospective review of data from a hospital system in New York City. Patient records from 1 January to 26 October 2020 were included. We assessed positive COVID-19 tests, hospitalizations, intensive care unit (ICU) admissions and death. Descriptive statistics and bivariable analyses compared the prevalence of COVID-19 by baseline characteristics. Logistic regression estimated unadjusted and sex-, age-, race- and comorbidity-adjusted odds ratios (AORs) for associations between SUD history, overdose history and outcomes.ResultsOf patients tested for COVID-19 (n = 188 653), 2.7% (n = 5107) had any history of SUD. Associations with hospitalization [AORs (95% confidence interval)] ranged from 1.78 (0.85–3.74) for cocaine use disorder (COUD) to 6.68 (4.33–10.33) for alcohol use disorder. Associations with ICU admission ranged from 0.57 (0.17–1.93) for COUD to 5.00 (3.02–8.30) for overdose. Associations with death ranged from 0.64 (0.14–2.84) for COUD to 3.03 (1.70–5.43) for overdose.DiscussionPatients with histories of SUD and drug overdose may be at elevated risk of adverse COVID-19 outcomes.

ARE SUBSTANCE USE DISORDERS ASSOCIATED WITH FRAILTY IN US OLDER VETERANS WITH COGNITIVE IMPAIRMENT?

Introduction Substance use disorders are common in US Veterans receiving care at Veteran health care facilities. Substance use disorders are associated with unhealthy lifestyles, mental and physical multimorbidity, increased healthcare utilization and higher mortality. Substance use disorders have also been implicated in the development of cognitive impairment. The pernicious effects of substance use disorders may lead to frailty, a state of increased vulnerability to stressors due to multiple physiological dysfunctions. However, the association of substance use disorders and frailty is unknown. The purpose of the study was to determine whether substance use disorders were associated with frailty in Older Veterans with cognitive impairment enrolled at a VA Memory Disorders Clinic. Methods Participants and Setting: Cognitively impaired US Veterans enrolled in a VA Memory Disorders Clinic during a period of 2016-2019. Study design: Cross-sectional study. Measures and Outcomes: We constructed a 44-item frailty index using all potential variables such as demographics, comorbidities, number of medications, laboratory tests, and activities of daily living. Patients were categorized into non-frail (FI Results Two-hundred twenty-seven, cognitively impaired Veterans enrolled in a VA Memory Disorders Clinic were included in the study. Patients were 54.6% (n=124) white, and 75.3% (n=171) non-Hispanic, 114 (50.0%) had mild cognitive impairment, and 113 (50.7%) had dementia. The mean age was 75.5 (SD=8.4) years. The proportion of frail and non-frail patients was 47.1% (n=107) and 52.9% (n=120) respectively. Veterans with a history of substance use disorders represented 17.6% (n=40) of the sample. Substance use disorders included alcohol (14.1%, n=32), cannabis (1.3%, n=3), opioids (0.4%, n=1) and cocaine (2.6%, n=6). Substance use disorder was associated with an increased risk of frailty, unadjusted OR: 2.44 95%CI: 1.14-5.22, p=0.02). However, after adjusting for covariates, substance use disorder was no longer associated with frailty in cognitively impaired Veterans, OR: 2.17 95%CI: 0.94-5.01, p=0.06). Conclusions Conclusion: Substance use disorder was not cross-sectionally associated with frailty in cognitively impaired Veterans after controlling for known covariates. This research was funded by: No funding

Shared and specific associations of substance use disorders on adverse outcomes: A national prospective study

Background and aimsSubstance use disorders (SUD) frequently co-occur and are associated with numerous adverse outcomes and lower quality of life. The goal of this study was to examine whether the associations of SUD with adverse outcomes occur through a shared liability or are disorder-specific even after taking into account their frequent co-occurrence. Basic proceduresData were drawn from the National Epidemiological Survey on Alcohol and Related Conditions. The association between nine SUDs assessed at Wave 1 (2001–2002) and a broad range of outcomes (divorce/separation, violence, unemployment, financial crisis, legal problems, problems with a neighbor, friend, or relative, and quality of life) at Wave 2 (2005−2005) were estimated separately and simultaneously using a latent variable model to account for their co-occurrence and identify potential disorder-specific effects. Main findingsSUD at Wave 1 were associated with increased prevalence of all adverse outcomes at Wave 2 (p < .05). With the exception of nicotine dependence and tranquilizer use disorder, we found no specific associations of any SUD with any adverse outcome. Rather, associations occurred primarily through the latent variable representing the shared effects of the different SUDs. Conclusions and relevanceOur findings underscore the importance of adopting dimensional approaches to model the co-occurrence of SUD. Because SUD increases the risk of adverse outcomes mainly through a general predisposition representing mechanisms shared across SUD rather than through drug-specific mechanisms, this dimension should be considered as a therapeutic target to substantially advance prevention of adverse outcomes caused by SUD.

Prescription contraception use and adherence by women with substance use disorders.

Unintended pregnancy rates are high among women with substance use disorders (SUDs), which could be explained partly by lower use of and adherence to contraception. We aimed to test: (1) the association of SUD with prescription contraceptive use, contraceptive method selection and adherence; (2) whether practices participating in the Patient-Centered Medical Home Initiative (PCMHI) had better contraceptive use and adherence for patients with SUD; and (3) for differences in the association of SUD with adherence by type of contraceptive used. Retrospective cohort analysis of claims and encounter data. Massachusetts, USA. A total of 47 902 women aged 16-45years enrolled in Medicaid or Commonwealth Care in Massachusetts between 2010 and 2014. We examined three dependent variables: (1) use of a reversible prescription contraceptive during 2012; (2) the contraceptive methods used; and (3) the proportion of days covered by a prescription contraceptive in the year following the first prescription contraceptive claim. The primary predictor was diagnosed SUD, defined as at least one claim for an alcohol or drug use disorder. SUD was associated with lower rates of prescription contraceptive use during 2012 [19.2 versus 23.9%; adjusted odds ratio (aOR)=0.79, P<0.001]. SUD was associated with decreased selection of long-acting reversible contraception (LARC) compared with short-acting contraception (SARC) (42.8 versus 44.5%; aOR=0.83, P=0.011). There was no significant association between SUD and adherence (aOR=0.84, P=0.068). PCMHI enrollment did not alter the relationship between SUD and contraceptive use or adherence. Contraceptive method did not impact the relationship between SUD and adherence. Women with substance use disorders are less likely to use prescription contraceptives, especially long-acting methods, but are not significantly less likely to adhere to them once prescribed than women without substance use disorders.

Study of Association of Substance Use Disorders with Family Members' Psychological Disorders.

Substance Use Disorders (SUDs) represents a serious problem in Iranian community that may lead to psychological disorders in families. This study was conducted to investigate the association of SUDs with family members' psychological disorders. The sample size of the study consisted of 724 people referred to a counseling and psychology clinic in Shahrekord, southwest Iran. For data gathering, random method was adopted. After the relationship was established with the patients during the counseling and their confidence was gained, development of SUDs and related effect on the referred patient's family members were investigated by a pre-developed checklist. The statistical tests used to analyse the data were chi-square, Fisher's exact test, and odds ratio. The most frequent disorder noted was depression (40.5%) followed by generalized anxiety disorder (21%), minor interpersonal and children's behavioural problems (15%), and hysteria (8%). Depression, hysteria, and minor interpersonal and children's behavioural problems in the women and men were reported 48% vs. 20%, 9% vs. 5%, and 10% vs. 27%, respectively. A significant association was seen between SUDs in the patients' spouses and children as well as in their families, and gender, marital status, and occupation, but not place of residence and education. An association was seen between the psychiatric disorders in the people referring the studied center and SUDs in their families. Addiction in family plays an important role in developing or recurring psychiatric disorders in other family members.

Association of Traffic Injuries, Substance Use Disorders, and ED Visit Outcomes among Individuals Aged 50+ Years

Objectives: Motor vehicle traffic (MVT) injury is the second most frequent type of injury among older emergency department (ED) patients. We examined the role of substance use disorders (SUD) in ED visit outcomes among older MVT injury patients either as drivers, passengers, or pedestrians. Methods: Using the 2012 U.S. National Emergency Department Sample, we employed multinomial logistic regression to analyze the association of SUD with ED visit outcomes among 171,145 ED events by MVT injury patients aged 50+. We estimated marginal probabilities of ED outcomes in three age groups (50–64, 65–74, and 75+) by SUD status. Results: MVT injuries were 2.31%, 1.46%, and 0.73% of ED visits in the 50–64, 65–74, and 75+ age groups, and SUDs were found in 4.08%, 1.92%, and 0.94% of the MVT-injury visits in these age groups. SUD had small to medium effects on the risk of hospital admission (RRR = 3.39, 95% CI = 3.14–3.66), transfer to a facility or discharge with initiation of home health care (RRR = 3.18, 95% CI = 2.28–4.44), relative to treat-and-release. Conclusions: A larger proportion of those with SUD than those without SUD had multiple and more severe injuries that required hospitalization and institutional care. It is important to include MVT injury prevention in the treatment of older substance misusers.

Anxiety and substance use disorders: co-occurrence and clinical issues.

The co-occurrence of substance use disorders (SUDs) and anxiety disorders has been now well established. This association is frequent and can be explained by three models: the shared vulnerability factors model, the self-medication model, and the substance-induced model. General population epidemiological studies provide strong evidence of the frequency of the association for the most used substances: tobacco, alcohol, cannabis, and to a lesser extent sedatives, opiates, and cocaine. For substances that are less commonly used in the general population, the frequency of the co-occurrence can more precisely be studied in clinical samples. We provide the most recent literature results on the association of SUDs and anxiety, and evidence for one explicative model or the other when available. For substances with sedative properties (alcohol, benzodiazepines, cannabis, opioids), both evidence for a self-medication and for a toxic effect exist. For substances with psychostimulant properties (tobacco, cocaine, and amphetamines), the literature favors the toxic hypothesis to explain the association with anxiety disorders. We give practical steps for the recognition of these dual diagnoses and present therapeutic issues, although the strategies are rarely evidence based.

Substance use disorders in association with attention-deficit/hyperactivity disorder, co-morbid mental disorders, and medication in a nationwide sample

BackgroundThe association of substance use disorders (SUD) with attention-deficit disorder (ADHD), co-morbid mental disorders, and medication has only been studied in isolation and in rather small samples. ProcedureData were based on four Danish national registers covering a total of 20,742 patients with ADHD, their dispensed medications, co-morbid mental disorders, and associated SUD between 1994 and 2010. The analyses considered the risk of various medications (methylphenidate only, antidepressants only, antipsychotic only, mixed medication) in comparison to a control group of non-medicated patients with ADHD, various co-morbid disorders, duration of medication, age at diagnosis, year of birth, and sex for developing SUD. ResultsThe observation period of the cohort ranged between 2.25 and 66.21 years and the prevalence for SUD was 9.51%. The SUD rates were significantly higher prior to, compared to following the onset of medication in the methylphenidate and the mixed medication subgroup, whereas they were significantly higher following onset of medication in the antidepressants and the antipsychotics subgroups. However, the SUD rates were significantly higher in all drug conditions except for methylphenidate after onset of medication compared to the non-medicated subgroup. Risk factors obtained by regression analysis did not include methylphenidate but did include antidepressants, antipsychotics, and mixed medications, in combination with co-morbid mood, anxiety, personality, and conduct disorders, and older age at diagnosis. Longer duration of medication and female sex were protective factors. ConclusionsThis representative study based on a large nationwide psychiatric sample provides solid evidence into the patterns of SUD in patients with ADHD based on medication use and co-morbidities.

A six‐year study of substance use and mental health disorders: ascertaining the prevalence of comorbidity

PurposeCharacteristics of substance use disorders (SUDs) comorbid with mental health disorders (MHDs) are not completely clear in early population based studies. The objective of this paper is to examine the association of SUDs comorbid with MHDs and vice‐versa using a large inpatient dataset.Design/methodology/approachThe data (1 July 2001 to 30 June 2007) were extracted from the New South Wales Inpatient Statistic Data Collection. Statistical analysis was performed using SAS.FindingsThere was a total of 10,211,596 (4,671,243 males (45.75 per cent) and 5,540,353 females (54.25 per cent)) admissions. Over the six years, between 9.4 per cent and 12.6 per cent of the patients with MHDs were diagnosed as having SUDs. Of the patients diagnosed with SUDs, between 42.5 per cent and 57.4 per cent also had a diagnosis of MHDs. Overall, the comorbidity for both MHDs and SUDs was between 8.4 per cent and 11.3 per cent. The odds ratio for either SUDs or MHDs compared to the general population was between 13.0 to 20.8.Originality/valuePatients with SUDs are highly likely to have a mental health problem. This is the first largest study and the findings imply that different efforts towards the prevention, care and management of comorbidity may be warranted.

Substance Use Disorder and the Risk of Open-angle Glaucoma

To test the hypothesis that cocaine use (abuse and/or dependency) is associated with open-angle glaucoma. A case-control study. Potential case patients were identified from the Veterans Health Administration national clinical database using International Classification of Disease, Version 9, Clinical Modification for open-angle glaucoma for fiscal year 2009. Inclusion criteria included consecutive prescriptions for 1 or more topical antiglaucoma medications. Cocaine exposure was identified through International Classification of Disease, Version 9, Clinical Modification codes. The odds of cocaine exposure were compared with the overall outpatient population of national Veterans Health Administration beneficiaries and adjusted for age and other illicit drug use. A nested case-control study was conducted to examine the confounding influence of race. Age-adjusted odds ratios of cocaine exposure among patients with glaucoma were statistically significant for both men [3.52 (95% confidence interval, CI: 3.21-3.86)] and women [1.87 (95% CI: 1.79-1.96)], and did not change significantly when analyzed according to drug-dependency status. Subset analysis adjusted for age, other illicit drugs, and race remained significant for men [1.45 (95% CI: 1.27-1.66)], but not women. Persons with substance use disorder and glaucoma were nearly 18 years younger than glaucoma patients without a drug exposure history. This pilot study suggests the use of cocaine and possibly other illicit drugs are predictive of glaucoma. Should the association of substance use disorder (cocaine or cocaine/poly-drug abuse) and open-angle glaucoma be verified, it represents a potentially modifiable risk factor for vision loss.

The relationship of comorbidity of mental and substance use disorders with suicidal behaviors in the Nigerian Survey of Mental Health and Wellbeing

Mental and substance use disorders are often associated with an elevated risk for suicidal behaviors. The role of the co-occurrence of multiple disorders in this association is still unclear. The Nigerian Survey of Mental Health and Wellbeing is a community survey of mental and substance use disorders as well as of suicidal outcomes. Face-to-face assessment was conducted using the World Health Organization's Composite International Diagnostic Interview, version 3. A total of 6,752 adults, aged 18 years and over, were interviewed. Persons with lifetime suicide attempt were more likely than those without attempt to have experienced lifetime DSM-IV disorders. Lifetime attempters were also more likely to have comorbid conditions. Compared with only 0.4% of persons with no history of lifetime attempts, over 11% of persons with lifetime attempt had three or more co-occurring disorders. Multivariate analysis controlling for the effects of comorbid conditions suggests that while mood disorder is independently associated with suicidal outcomes, comorbidity partly explains the association of anxiety disorders and almost fully accounts for the association of substance use disorders with suicidal outcomes. Comorbidity is an important factor in the association of mental and substance use disorders with suicidal behavior.

Association of Substance Use Disorders With Childhood Trauma but not African Genetic Heritage in an African American Cohort

Genetic variation influences differential vulnerability to addiction within populations. However, it remains unclear whether differences in frequencies of vulnerability alleles contribute to disparities between populations and to what extent ancestry correlates with differential exposure to environmental risk factors, including poverty and trauma. The authors used 186 ancestry-informative markers to measure African ancestry in 407 addicts and 457 comparison subjects self-identified as African Americans. The reference group was 1,051 individuals from the Human Genome Diversity Cell Line Panel, which includes 51 diverse populations representing most worldwide genetic diversity. African Americans varied in degrees of African, European, Middle Eastern, and Central Asian genetic heritage. The overall level of African ancestry was actually smaller among cocaine, opiate, and alcohol addicts (proportion=0.76-0.78) than nonaddicted African American comparison subjects (proportion=0.81). African ancestry was associated with living in impoverished neighborhoods, a factor previously associated with risk. There was no association between African ancestry and exposure to childhood abuse or neglect, a factor that strongly predicted all types of addictions. These results suggest that African genetic heritage does not increase the likelihood of genetic risk for addictions. They highlight the complex interrelation between genetic ancestry and social, economic, and environmental conditions and the strong relation of those factors to addiction. Studies of epidemiological samples characterized for genetic ancestry and social, psychological, demographic, economic, cultural, and historical factors are needed to better disentangle the effects of genetic and environmental factors underlying interpopulation differences in vulnerability to addiction and other health disparities.