Co-occurrence Of Substance Use Research Articles

Co-occurrence of tobacco product use, substance use, and mental health problems among youth: Findings from wave 1 (2013–2014) of the population assessment of tobacco and health (PATH) study

IntroductionCigarette use is associated with substance use and mental health problems among youth, but associations are unknown for non-cigarette tobacco product use, as well as the increasingly common poly-tobacco use. MethodsThe current study examined co-occurrence of substance use and mental health problems across tobacco products among 13,617 youth aged 12–17years from Wave 1 (2013–2014) of the nationally representative Population Assessment of Tobacco and Health (PATH) Study. Participants self-reported ever cigarette, e-cigarette, smokeless tobacco, traditional cigar, cigarillo, filtered cigar, hookah, and other tobacco product use; alcohol, marijuana, and other drugs; and lifetime substance use, internalizing and externalizing problems. ResultsIn multivariable regression analyses, use of each tobacco product was associated with substance use, particularly cigarillos and marijuana (AOR=18.9, 95% CI: 15.3–23.4). Cigarette (AOR=14.7, 95% CI: 11.8–18.2) and cigarillo (AOR=8.1, 95% CI: 6.3–10.3) use were strongly associated with substance use problems and tobacco users were more likely to report internalizing (AOR=1.6, 95% CI: 1.4–1.8) and externalizing (AOR=1.4, 95% CI: 1.3–1.6) problems. Female tobacco users were more likely to have internalizing problems than male tobacco users. Poly-tobacco users were more likely than exclusive users to use substances (AOR=3.4, 95% CI: 2.7–4.3) and have mental health (AOR=1.2, 95% CI: 1.0–1.5) and substance use (AOR=4.7, 95% CI: 3.4–6.6) problems. ConclusionsRegardless of the tobacco product used, findings reveal high co-occurrence of substance use and mental health problems among youth tobacco users, especially poly-tobacco users. These findings suggest the need to address comorbidities among high risk youth in prevention and treatment settings.

Outcomes of a family-based HIV prevention intervention for substance using juvenile offenders

Approximately 80% of all arrested youth are diverted from detention and supervised in the community through probation, specialty courts and other community-based diversion efforts. Justice-involved youth have greater psychiatric impairment, substance use and sexual risk behaviors than their non-justice-involved peers. Family-based interventions to address mental health, substance use and recidivism have been successful in improving these youth outcomes; but the lack of integration of HIV/STI prevention is notable given the co-occurrence of substance use, delinquency and sexual risk-taking behaviors among justice-involved youth. Moreover, emotion dysregulation may be an important and understudied underlying construct of these co-occurring risk behaviors for justice-involved youth. Study participants were 47 caregiver-youth dyads enrolled in a juvenile drug court program. As part of a pilot efficacy trial, dyads were randomized to a 5-session family-based integrated substance use and HIV/STI prevention intervention that relied on affect management strategies for risk reduction or an adolescent-only psychoeducation condition matched for time and attention. Data collected at baseline and 3months post-intervention suggest that a family-based integrated affect management substance use and HIV prevention pilot intervention may lead to justice-involved youths' enhanced motivation to change their marijuana use, decreased marijuana use and decreased risky sexual behavior over time. Future research is required to replicate these pilot trial findings and should also examine family-level mediators and moderators of treatment response, particularly with respect to HIV prevention efforts for these youth.

Factors associated with having a medical marijuana card among Veterans with recent substance use in VA outpatient treatment

Psychiatric symptoms, somatic problems, and co-occurring substance use have been associated with medical marijuana consumption among civilian patients with substance use disorders. It is possible that these factors may impact Veterans' ability to engage in or adhere to mental health and substance use disorder treatment. Therefore, we examined whether psychiatric functioning, substance use, and somatic problems were associated with medical marijuana use among Veterans receiving substance use disorder and/or mental health treatment. Participants (n=841) completed screening measures for a randomized controlled trial and 67 (8%) reported that they had a current medical marijuana card. Most of these participants (78%) reported using marijuana to treat severe/chronic pain. Significant bivariate differences revealed that, compared to participants without a medical marijuana card, those with a card were more likely to be in a middle income bracket, unemployed, and they had a significantly higher number of recent days of marijuana use, synthetic marijuana use, and using sedatives prescribed to them. Additionally, a significantly higher proportion of participants with a medical marijuana card scored above the clinical cutoff for posttraumatic stress disorder (PTSD) symptoms, had significantly higher severity of sleep-related problems, and reported a higher level of pain. These findings highlight the co-occurrence of substance use, PTSD symptoms, sleep-related problems, and chronic pain among Veterans who use medical marijuana. Future research should investigate the inter-relationships among medical marijuana use and other clinical issues (e.g., PTSD symptoms, sleep, pain) over time, and potential implications of medical marijuana use on treatment engagement and response.

Co-occurrence of Substance Use and Eating Disorders: An Approach to the Adolescent Patient in the Context of Family Centered Care. A Literature Review

ABSTRACTIn this review article, the co-occurrence of substance use and eating disorders will be discussed with a specific emphasis on the approach to the adolescent patient in the context of family centered care. The evidence to date suggests that the associations between eating and substance use disorders are multifactorial. Balancing between confidential health care for substance use and family centered health care for eating disorders is a real challenge in the management of adolescent patients with co-occurring eating and substance use disorders. Reconciling confidential health care with parental involvement should be considered with individually determined limits of confidentiality.

Perceived support, substance use, suicidal ideation, and psychological distress among military-connected adolescents

abstractMilitary-connected adolescents may be at increased risk for poor behavioral health outcomes related to the stressors of war. This study examined the co-occurrence of substance use and mental health problems among military-connected youth compared to their non-military-connected counterparts. Data from youth in ninth- and eleventh-grade classes in six military-connected school districts completed the California Healthy Kids Survey in 2011 (n = 9,122). Latent class analysis was utilized to examine co-occurring substance use and mental health issues. Military connection (parent, sibling, or none) and five measures of perceptions of school and community support were included in the model. The analysis revealed four different groups. As the probability of co-occurrence increased, the chance that youth had a sibling serving and that they perceived lower support from the military and other military families increased. These findings support a need for additional research on the adolescent siblings of military service persons. Clinicians should add questions to ascertain close family member service and screening for co-occurring substance use and mental health to their standards of practice related to working with military connected youth.

The association between alcohol, marijuana use, and new and emerging tobacco products in a young adult population

BackgroundYoung adults have the highest rates of alcohol, tobacco, and other drug use relative to any other age group. Few studies have examined the co-occurrence of substance use with new and emerging tobacco products in this vulnerable group, or the underlying personality factors that may explain these associations. To address this gap, this study examined the association of current alcohol and marijuana use with the use of cigarettes and emerging tobacco products in a nationally representative sample of young adults. MethodsData were drawn from 18 to 24year olds in Wave 4 (January 2013; n=1609) of the Legacy Young Adult Cohort, a nationally-representative sample of men and women. Never, ever (lifetime), and past 30-day use of little cigars/cigarillos (LCCs), hookah, e-cigarettes, and cigarettes were assessed separately in current (everyday or some days) alcohol and marijuana users. ResultsUsing weighted estimates, multivariable multinomial logistic regression models showed that current alcohol and marijuana use were associated with lifetime and past 30-day use of cigarettes, LCCs, e-cigarettes, and hookah, with different magnitudes of association found across each product. Post-hoc exploratory analyses showed that sensation-seeking traits moderated the relationship of alcohol (but not marijuana) use to current use of select tobacco products. DiscussionMarijuana and alcohol use may enhance risk for emerging tobacco products use in young adulthood. Prevention and intervention programs may need to target poly-use of alcohol, marijuana, and tobacco rather than focusing on a single risk behavior during these critical years.

Co-occurring mental illness in emergency department and hospital inpatient encounters related to substance abuse in Maryland

Background Mental illness and substance abuse are highly comorbid conditions. At the individual level, symptoms of one can influence symptoms of the other and therefore demand treatment approaches specific to the combination of substance abused and mental illness. At the population level, co-occurring substance use and mental illness challenge public health prevention efforts and decrease treatment system effectiveness. However, due to the scarcity of integrated data, there has not been a thorough understanding of co-occurrence of substance use and mental illness. This study examines prevalence and trends of mental illness among substance abuse-related emergency department (ED) and hospital inpatient encounters.

Commentary on Salom et al. (2015): Examining the developmental underpinnings of comorbid mental health and substance use outcomes in young adults.

Keywords: Alcohol abuse; Comorbidity; mental health; substance use; emerging adulthood; adolescence

Implementing a Harm Reduction Approach to Substance Use in an Intimate Partner Violence Agency: Practice Issues in an Irish Setting

There has been growing recognition of the co-occurrence of substance use and intimate partner violence (IPV) victimization in women’s and men’s lives, yet many IPV service providers have not developed an integrated response to these issues. Fewer still have implemented substance use services from a harm reduction approach. This article outlines the approach, policy changes, initial outcomes, and learning points for an IPV agency in Ireland, which implemented a harm reduction response to female IPV survivors who were also using substances problematically. Barriers and challenges for staff and management seeking to coordinate and integrate service delivery on the dual issues are also presented.

Co-Occurrence of Substance Use and Study Difficulty Among University Students

This study examined co-occurrence of substance use and study difficulty among students of University of Abuja, Nigeria. Participants (n = 600) were 3rd and 4th year full time undergraduate students of the University, selected through a multistage sampling technique. Results indicated that life time prevalence rates of the various substances were highest for alcohol (57.3 %), stimulants (35.7 %) and tobacco (24.0 %), with the least being heroin (1.7 %). The previous year and 30 days prevalence rates followed similar patterns but with lower rates than the life time use. Consolidated life-time substance use was 67.7 %, while that of current use was 46 %. Psychoactive substance use was significantly associated with study difficulty to varied extents. These findings underscore the need for further exploration of the socio-cultural underpinnings of substance use as well as robust mental health policies and intervention at the university and other educational levels in Nigeria, with a view toward stemming the tides of unmitigated substance use by students.

Taste clusters of music and drugs: evidence from three analytic levels

This article examines taste clusters of musical preferences and substance use among adolescents and young adults. Three analytic levels are considered: fixed effects analyses of aggregate listening patterns and substance use in US radio markets, logistic regressions of individual genre preferences and drug use from a nationally representative survey of US youth, and arrest and seizure data from a large American concert venue. A consistent picture emerges from all three levels: rock music is positively associated with substance use, with some substance-specific variability across rock sub-genres. Hip hop music is also associated with higher use, while pop and religious music are associated with lower use. These results are robust to fixed effects models that account for changes over time in radio markets, a comprehensive battery of controls in the individual-level survey, and concert data establishing the co-occurrence of substance use and music listening in the same place and time. The results affirm a rich tradition of qualitative and experimental studies, demonstrating how symbolic boundaries are simultaneously drawn around music and drugs.

Substance Use Among HIV-Infected Patients Engaged in Primary Care in the United States: Findings From the Centers for AIDS Research Network of Integrated Clinical Systems Cohort

The purpose of this study was to better understand substance use behaviors and deleterious health consequences among individuals with HIV. We examined a multicenter cohort of HIV-infected patients (n = 3,413) receiving care in 4 US cities (Seattle, Birmingham, San Diego, Boston) between December 2005 and April 2010 in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS). We used generalized estimating equations to model specific substance use outcomes. Overall, 24% of patients reported recent use of marijuana; 9% reported amphetamine use, 9% reported crack-cocaine use, 2% reported opiate use, 3.8% reported injection drug use, and 10.3% reported polydrug use. In adjusted multivariable models, those who reported unprotected anal sex had higher odds of marijuana, amphetamine, injection drug, and polydrug use. An increased number of distinct vaginal sexual partners was associated with polydrug and crack-cocaine use. Nonadherence to antiretroviral therapy was associated with the use of all substances other than marijuana. The co-occurrence of substance use, unprotected intercourse, and medication nonadherence could attenuate the public health benefits of test, treat, and link to care strategies. Prevention programs are needed that address these coprevalent conditions.

Association between Adverse Life Events and Addictive Behaviors among Male and Female Adolescents

Adverse life events have been associated with gambling and substance use as they can serve as forms of escapism. Involvement in gambling and substance use can also place individuals in adversely stressful situations. To explore potential male-female differences in the association between addictive behavior and adverse life events among an urban cohort of adolescents. The study sample comprised of 515 adolescent participants in a randomized prevention trial. With self-reported data, four addictive behavior groups were created: nonsubstance users and nongamblers, substance users only, gamblers only, and substance users and gamblers. Multinomial logistic regression analyses with interaction terms of sex and adverse life events were conducted. Adverse life events and engaging in at least one addictive behavior were common for both sexes. Substance users and gamblers had more than twice the likelihood of nonsubstance users and nongamblers to experience any event as well as events of various domains (ie, relationship, violence, and instability). Neither relationship nor instability events' associations with the co-occurrence of substance use and gambling significantly differed between sexes. Conversely, females exposed to violence events were significantly more likely than similarly exposed males to report the co-occurrence of substance use and gambling. Findings from the current study prompt future studies to devote more attention to the development of effective programs that teach adaptive coping strategies to adolescents, particularly to females upon exposure to violence.

Understanding the Relationship between Substance Use and Self-Injury in American Indian Youth

Background: American Indian communities compared to other US populations are challenged by the largest health disparities in substance abuse and suicidal behavior among youth ages 15–24. Objectives: This article examines the co-occurrence of substance use and self-injury among reservation-based youth in the US. Methods: White Mountain Apache tribal leaders and Johns Hopkins University formed a partnership to address self-injury and substance abuse among Apache youth. Data on suicide (deaths, attempts, ideation), non-suicidal self-injury, and substance use were analyzed from the White Mountain Apache tribally mandated self-injury surveillance registry from 2007 to 2010, including 567 validated incidents from 352 individuals aged 15–24 years. Findings regarding characteristics of co-occurrence – including differences in the type of self-harm behavior, gender, and reported reasons for the act – were interpreted through a community-based participatory research process. Results: From 2007 to 2010, 64% (n = 7/11) of Apache youth ages 15–24 were “drunk or high” at the time of suicide death with data missing for 2/11 deaths; 75.7% (n = 118/156) were “drunk or high” during suicide attempt; 49.4% (n = 83/168) during suicidal ideation; and 49.4% (81/166) during non-suicidal self-injury. Co-occurrence of substance use was higher for more lethal acts and among males. Conclusion: High rates of co-occurring self-injury and substance use within this population highlight the importance of research to understand relationships between these behaviors to design preemptive and integrated interventions. Scientific Significance: Tribal-specific and culturally informed data on the co-occurrence of self-injury and substance use hold promise for reducing the combined toll of years of productive life lost among American Indian youth.

The co-occurrence of substance use and bullying behaviors among U.S. adolescents: Understanding demographic characteristics and social influences

This study examined the co-occurrence of subtypes of substance use and bullying behaviors using latent class analysis and evaluated latent class differences in demographic characteristics, peer and parental influences. Self-reported questionnaire data were collected from a nationally representative sample (N = 7508) of 6–10th grade adolescents in the United States. Four latent classes were identified: the non-involved (57.7%), substance users (19.4%), bullies (17.5%), and substance-using bullies (5.4%). Older and Hispanic adolescents were more likely to be substance users and substance-using bullies, whereas younger and African American adolescents were more likely to be bullies. Females were more likely to be substance users, whereas males were more likely to be bullies and substance-using bullies. Spending more evenings with peers posed greater risks for substance use, bullying, and the co-occurrence of both problem behaviors. Paternal knowledge exerted protective effects over-and-above the effects of maternal knowledge. Implications for prevention and intervention efforts are discussed.

A Comparison of Treatment Outcomes for Individuals with Substance Use Disorder Alone and Individuals with Probable Dual Diagnosis

The co-occurrence of substance use and mental health problems, often referred to as dual diagnosis (DD), is increasingly recognised as commonplace within substance abuse treatment programs. Two-hundred and thirty-four individuals from 9 Australian Salvation Army drug and alcohol rehabilitation programs completed a 3-month post-discharge telephone follow-up. Using a cut-off score from the Psychiatric Subscale of the Addiction Severity Index (5th ed.), 66.7% were classified as likely to have DD and 33.3% as substance use disorder only (SUD). Both groups reported comparable and decreased substance use levels at follow-up, yet DD individuals perceived less improvement in substance use problems. Comparable improvements were reported in the areas of: symptom distress and recovery from symptoms. This was despite greater scope for improvement in individuals with DD. Duration of treatment and access to post treatment services were also assessed. Understanding factors effecting treatment outcomes is imperative for the implementation of effective, evidence based treatment programs.

Same-Day Substance Use in Men and Women Charged With Felony Domestic Violence Offenses

This archival study reviewed 196 closed felony domestic violence files from a large southern city from the years 1999—2006. The purpose was to provide information on the co-occurrence of substance use and intimate partner violence (IPV) for male and female perpetrators on the day of the violent incident. Results indicated that of the 141 of 196 cases in which there was documentation about drug or alcohol involvement, 67.4% ( n = 95) of the cases confirmed that there was drug or alcohol use on the day of the incident. Male perpetrators were significantly more likely to have been involved with alcohol and/or drugs the day of the violent episode than were female perpetrators. Sex of offender and race analyses revealed that the percentage of female IPV perpetrators (42.9%) was substantial and African Americans, particularly women, were overrepresented in IPV felony charges. Implications and suggestions for further research are discussed.

Psychological treatments for comorbidity across the life course

Background. The co-occurrence of substance use and mental illness (dual diagnosis) is a common clinical problem and one that is often not adequately addressed therapeutically. Aims. To review the literature on psychological treatments for dual diagnosis, and make recommendations for clinicians regarding to deployment of such interventions tailored to the age and developmental stage of the individual. Method. Selective literature review. Results. Despite significant methodological problems in conducting research into treatments for dual diagnosis, a number of specific approaches have an emerging evidence base in this patient population. These include motivational interviewing, cognitive behavioural therapy, contingency management, social skills training, problem solving, psychosocial education, case management and family/carer support. A few studies have attempted to integrate some or most of these elements into a comprehensive intervention. Conclusions. Existing psychological treatments for dual diagnosis...

Co-occurring risk behaviors among White, Black, and Hispanic US high school adolescents with suicide attempts requiring medical attention, 1999–2007: Implications for future prevention initiatives

To identify subtypes of adolescent suicide attempters by examining risk profiles related to substance use, violent behavior, and depressive symptoms. To examine the relationship between these subtypes and having had two or more suicide attempts during the past year. To explore race and gender differences across subtypes of suicide attempters. Data were combined from five nationally representative cohorts of the US Youth Risk Behavior Surveillance System (YRBSS) and focused on a subpopulation of youth who reported a suicide attempt requiring medical attention. Latent class analysis was used to identify subtypes of suicide attempters. Analysis yielded three classes of youth who attempted suicide, distinguishable by their levels of substance use and violent behaviors: low substance use and violent behaviors, high substance use and violent behaviors, and extreme substance use and violent behaviors. All three classes had a high propensity for endorsing depressive symptoms. The proportion of youth with two or more suicide attempts during the past year increased across subgroup of attempters with higher levels of substance use and violent behaviors. Racial and gender differences were found across subtypes of suicide attempters. Preventing and treating the co-occurrence of substance use and violent behaviors may serve as essential strategies for reducing suicide attempts, especially among male youth. The use of public health strategies for suicide prevention should take into account the different needs of youth at risk for suicide.

A Multiprocess Latent Class Analysis of the Co-Occurrence of Substance Use and Sexual Risk Behavior Among Adolescents

To assess the co-occurrence of patterns of adolescent substance use and sexual behavior and test for potential moderating effects of gender. The 2005 Youth Risk Behavior Survey sample of 13,953 high school students was used in this study. Latent class analyses were conducted to examine the relation between patterns of substance use and sexual risk behavior in a nationally representative adolescent sample. The final model controlled for demographic covariates and an interaction between gender and substance-use classes. Four class solutions to each behavior provided optimal fit. Substance-use classes were nonusers (27%), alcohol experimenters (38%), occasional polysubstance users (23%), and frequent polysubstance users (13%). Sexual risk classes were abstainers (53%), monogamous (15%), low-frequency multipartner (18%), and high-frequency multipartner (14%). Substance-use class had a strong association with sexual behavior even when controlling for demographic covariates. African Americans were less likely to use substances but more likely to report sexual risk behaviors. interaction effects indicated that substance use among females was associated with increased sexual risk behavior compared with males. The results of this study provide impetus for the development of preventive interventions targeting change across multiple risk behaviors, and also for targeting particular high-risk groups or patterns of behavior.