DSM-IV Substance Use Research Articles

Attention-deficit/hyperactivity disorder subtypes and substance use and use disorders in NESARC

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is associated with substance use and substance use disorders (SUD). However, relatively little is known about the relationship between DSM-IV ADHD subtypes and substance use or DSM-IV abuse/dependence in epidemiological samples. MethodsData were obtained from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC, N=33,588). Respondents reported on ADHD symptoms (DSM-IV) for the period of time when they were 17years or younger. Lifetime use and DSM-IV abuse/dependence of alcohol, nicotine, cannabis, cocaine, sedatives, stimulants and heroin/opiates were compared across those with ADHD symptoms but no diagnosis (ADHDsx; N=17,009), the Combined (ADHD-C; N=361), Predominantly Inattentive (ADHD-I; N=325), and the Predominantly Hyperactive-Impulsive (ADHD-HI; N=279) ADHD subtypes. Taking a more dimensional approach, inattentive and hyperactive-impulsive symptom counts and their associations with substance use and misuse were also examined. ResultsAfter adjustments for conduct disorder, major depressive disorder, any anxiety disorder and other socio-demographic covariates, substance use and SUD were associated with ADHDsx, ADHD-C, ADHD-I and ADHD-HI. Overall, substance use and SUD were more weakly associated with the ADHDsx group compared to the three ADHD diagnostic groups.Statistically significant differences were not evident across the three diagnostic groups. Hyperactive–impulsive symptoms were more consistently associated with substance use and SUD compared to inattentive symptoms. ConclusionsADHD subtypes are consistently associated with substance use and SUD. The relatively stronger association of hyperactive/impulsive symptoms with substance use and abuse/dependence is consistent with the extant literature noting impulsivity as a precursor of substance use and SUD.

Poster #M176 MESSENGER RNA AND MICRORNA EXPRESSION PROFILING OF PYRAMIDAL NEURONS, PARVALBUMIN-IMMUNOREACTIVE NEURONS, DOPAMINE NEURONS AND OLIGODENDROCYTES IN SCHIZOPHRENIA AND PARKINSON'S DISEASE

The study of military-related mental health has been disproportionately focused on current symptomology rather than potentially more informative life course mental health. Indeed, no study has assessed age-of-onset and projected lifetime prevalence of disorders among reservists.Age-of-onset and projected lifetime DSM-IV anxiety, mood, and substance use disorders were assessed in 671 Ohio Army National Guard soldiers aged 17–60 years. Between 2008 and 2012, face-to-face clinical assessments and surveys were conducted using the Structured Clinical Interview for DSM-IV and Clinician-Administered PTSD Scale.Lifetime prevalence of psychiatric disorders was 61%. Alcohol abuse/dependence (44%) and major depressive disorder (23%) were the most common disorders. The majority (64%) of participants reported disorders antedating enlistment. Median age-of-onset varied with anxiety disorders – particularly phobias and OCD – having the earliest (median=15 years) and mood disorders the latest median age-of-onset (median=21 years).The study was limited by both the retrospective investigation of age-of-onset and the location of our sample. As our sample may not represent the general military population, our findings need to be confirmed in additional samples.Each psychiatric disorder exhibited a distinct age-of-onset pattern, such that phobias and OCD onset earliest, substance use disorders onset during a short interval from late-adolescence to early-adulthood, and mood disorders onset the latest. Our finding that the majority of participants reported disorders antedating enlistment suggests that an assessment of lifetime psychopathology is essential to understanding the mental health burden of both current and former military personnel.

Early adolescent patterns of alcohol, cigarettes, and marijuana polysubstance use and young adult substance use outcomes in a nationally representative sample

BackgroundAlcohol, tobacco and marijuana are the most commonly used drugs by adolescents in the U.S. However, little is known about the patterning of early adolescent substance use, and its implications for problematic involvement with substances in young adulthood. We examined patterns of substance use prior to age 16, and their associations with young adult substance use behaviors and substance use disorders in a nationally representative sample of U.S. adolescents. MethodUsing data from Wave 4 of the Add Health Survey (n=4245), we estimated the prevalence of various patterns of early adolescent use of alcohol, cigarettes, and marijuana use individually and in combination. Then we examined the effects of patterns of early use of these substances on subsequent young adult substance use behaviors and DSM-IV substance use disorders. ResultsWhile 34.4% of individuals reported no substance use prior to age 16, 34.1% reported either early use of both alcohol and marijuana or alcohol, marijuana and cigarettes, indicating the relatively high prevalence of this type of polysubstance use behavior among U.S. adolescents. Early adolescent use of all three substances was most strongly associated with a spectrum of young adult substance use problems, as well as DSM-IV substance use disorder diagnoses. ConclusionsThis research confirms the elevated prevalence and importance of polysubstance use behavior among adolescents prior to age 16, and puts early onset of alcohol, marijuana and cigarette use into the context of use patterns rather than single drug exposures.

One year follow-up of alcohol and illicit substance use in first-episode psychosis: Does gender matter?

Longitudinal studies on first-episode psychosis (FEP) patients have shown a decrease of substance use disorders (SUDs) over the first years of illness, but there has been less focus on the gender aspect. The present study examines stability of alcohol and illicit substance use, with specific focus on gender, in a one year follow-up investigation of 154 FEP patients (91 men, 63 women) in Oslo, Norway, using criteria for DSM-IV substance use disorder diagnosis, the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT). The results show that cannabis was the most frequently used illicit substance at both times. Significantly more men (34%) than women (13%) had a current illicit SUD at baseline. At follow-up, the rate of illicit SUDs was significantly reduced in men (18%) but not in women (11%). There were no significant gender differences in the rate of current alcohol use disorders (AUD) (men 14%; women 8%) at baseline, and no significant reduction in AUD in any of the genders at follow-up. At follow-up, total AUDIT and DUDIT scores were reduced in men only. In conclusion, the high and persistent rate of SUDs, particularly of cannabis, among men and women during the first year of treatment for psychosis should be addressed in the clinical management of the patients. Female FEP patients who are also substance users may be particularly vulnerable in this regard and warrant closer attention.

C-reactive protein and substance use disorders in adolescence and early adulthood: A prospective analysis

BackgroundDysregulated immune function and elevated inflammation markers are seen in adults with chronic diseases, including some psychiatric disorders, but evidence on inflammation in the case of drug abuse is conflicting. ObjectiveTo test the concurrent and predictive relations between C-reactive protein (CRP) and use and abuse of alcohol, nicotine and cannabis in a longitudinal, population sample of adolescents and young adults, at the period of highest increase in drug use. MethodsData from the prospective population-based Great Smoky Mountains Study (N=1420) were used, covering children in the community assessed at ages 9–16, 19, and 21. Structured interviews were used to assess substance abuse symptoms and DSM-IV substance use disorders. Bloodspots were collected at each assessment and assayed for CRP. ResultsCRP levels were higher in the presence of nicotine, alcohol, and cannabis use and nicotine dependence. In prospective analyses, higher CRP levels predicted cannabis use and nicotine dependence, and nicotine use predicted higher CRP levels, once covariates were included in the models. Significant covariates were age, race (American Indian), and obesity. ConclusionsThe inter-relationship of CRP and substance abuse has implications for the later health risks associated with early drug and alcohol use and abuse.

Dependence May Result When Alcohol Used to Self-Medicate

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessDependence May Result When Alcohol Used to Self-MedicateJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:10 Jul 2013https://doi.org/10.1176/appi.pn.2013.6b1AbstractSubjects who had used alcohol to self-medicate their symptoms were three times more likely to develop alcohol dependence than subjects who had not done so.Using alcohol to self-medicate mood symptoms can be risky, a new study reported May 1 in JAMA Psychiatry suggests. The study was headed by Rosa Crum, M.D., a professor of epidemiology, psychiatry, and mental health at the Johns Hopkins Medical Institutions.Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), which was conducted by the National Institute on Alcohol Abuse and Alcoholism. It consisted of face-to-face interviews with a nationally representative sample of about 43,000 Americans to learn whether they had DSM-IV psychiatric or substance use disorders. The initial surveying took place in 2001 and 2002. The survey was again conducted in 2004 and 2005 with as many of the original subjects as possible—some 35,000 people. Crum and her colleagues used data from both the initial and follow-up surveys for their study.Caption: no caption necessaryChristin Slavkov/Shutterstock.comFirst Crum and colleagues focused on the approximately 4,200 subjects who had been found in the first NESARC survey to have mood symptoms but not alcohol dependence and who had been asked whether they used alcohol to self-medicate their mood symptoms. Then, from the second survey, they evaluated whether subjects who had used alcohol to self-medicate their mood symptoms were more likely to develop alcohol dependence than were subjects who had not used alcohol to self-medicate mood symptoms.The researchers found that subjects who had used alcohol to self-medicate their symptoms were three times more likely to develop alcohol dependence than were subjects who had not used alcohol to self-medicate. Moreover, 12 percent of the individuals who developed alcohol dependence could possibly attribute their dependence to self-medicating their mood symptoms with alcohol.In addition, Crum and colleagues focused on about 1,500 subjects who had been found during the first NESARC survey to have both mood symptoms and alcohol dependence and who had been asked whether they used alcohol to self-medicate their mood symptoms.Using data from the second survey, the researchers assessed whether subjects in this second group who had used alcohol to self-medicate mood symptoms were more likely to remain alcohol dependent than subjects who had not used alcohol to self-medicate their symptoms.This turned out to be the case. Those who had used alcohol to self-medicate were three times more likely to remain alcohol dependent as were subjects who had not used alcohol to self-medicate. Furthermore, 31 percent of subjects who had been alcohol dependent and were still dependent at the time of the second NESARC survey could possibly attribute their persistent dependence to self-medicating their mood symptoms with alcohol.Finally, the researchers assessed whether this link between self-medication and alcohol dependence or the link between self-medication and persistent alcohol dependence differed for various subgroups within the two cohorts—men and women, young and old, individuals of various ethnic or racial backgrounds, those with few mood symptoms or a lot of symptoms, and those who had received treatment for their mood symptoms and those who had not.They found that similar links existed for all of these subgroups.The two results that surprised them, Crum told Psychiatric News, were that the link held even among individuals who had received treatment for their mood symptoms and was found as well among individuals who did not meet full criteria for a mood disorder.The findings have clinical implications, Crum suggested. “Individuals who report mood symptoms should have an evaluation to assess whether clinical treatment is needed, but should not drink alcohol to help themselves feel better. Patients with mood symptoms in psychiatric treatment may need to be educated regarding the potential risks of using alcohol for self-medication, as well as assessed for the presence of alcohol disorders.”The study was funded by the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, the Canadian Institutes of Health Research, the Manitoba Health Research Council, and the Johns Hopkins School of Medicine. ■An abstract of “A Prospective Assessment of Reports of Drinking to Self-Medicate Mood Symptoms With the Incidence and Persistence of Alcohol Dependence” is posted at http://archpsyc.jamanetwork.com/article.aspx?articleid=1684867. ISSUES NewArchived

Using Cloninger's Temperament Scales to Predict Substance‐Related Behaviors in Adolescents: A Prospective Longitudinal Study

We tested one of Cloninger's temperament theories - that high novelty seeking (NS), along with low harm avoidance (HA), reward dependence (RD), and persistence (PE), predicts early-onset substance problems. In a community-based sample of 777 adolescents examined at two time points (mean age 13 and 18, respectively), we examined whether Cloninger's four temperament dimensions at wave 1 predicted five substance-related outcomes at wave 2: age of initiation for cigarettes, alcohol, and illicit drugs, number of substance classes tried, and total number of DSM-IV substance use disorder (SUD) symptoms. Cloninger's predicted temperament pattern did significantly predict the number of SUD symptoms at wave 2. For initiation of cigarettes/illicit drugs and number of substance classes tried, HA/NS/PE fit the pattern, but RD did not. For onset of alcohol, only NS and PE fit Cloninger's prediction. Results for NS and PE were most consistent. Overall, this study provides evidence that Cloninger's theory may hold true for predicting problem use more than for predicting "use" or experimentation. In addition, youth with high novelty seeking and low persistence may find substances especially reinforcing, and identifying these youth and intervening before initiation has occurred may reduce the risk of future substance-related problems.

Other- and self-directed forms of violence and their relationships to DSM-IV substance use and other psychiatric disorders in a national survey of adults

ObjectiveTo examine associations between DSM-IV psychiatric disorders and other- and self-directed violence in the general population. MethodsData were obtained from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 & 2 (n=34,653). Four violence categories were derived from a latent class analysis (LCA) of 5 other-directed and 4 self-directed violent behavior indicators. Multinomial logistic regression examined class associations for gender, race–ethnicity, age and DSM-IV substance use, mood, anxiety, and personality disorders. ResultsApproximately 16% of adults reported some form of violent behavior distributed as follows: other-directed only, 4.6%; self-directed only, 9.3%; combined self- and other-directed, 2.0%; and no violence, 84.1%. The majority of the DSM-IV disorders included in this study were significantly and independently related to each form of violence. Generally, other-directed violence was more strongly associated with any substance use disorders (81%) and any personality disorders (42%), while self-directed violence was more strongly associated with mood (41%) and anxiety disorders (57%). Compared with these two forms of violence, the smaller group with combined self- and other-directed violence was more strongly associated with any substance use disorders (88%), mood disorders (63%), and personality disorders (76%). ConclusionFindings from this study are consistent with recent conceptualizations of disorders as reflecting externalizing disorders and internalizing disorders. The identification of the small category with combined forms of violence further extends numerous clinical studies which established associations between self- and other-directed violent behaviors. The extent to which the combined violence category represents a meaningful and reliable category of violence requires further detailed studies.

Temporal associations between physical illnesses and mental disorders—Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

Clinical and epidemiologic evidence has documented the significant associations between medical illnesses and psychiatric disorders. However, extensive research has focused on the comorbidity of medical conditions and depression, and most were cross sectional, focused on clinical samples, and grounded in DSM-III or DSM-III-R diagnostic criteria.The current prospective investigation examined associations among medical conditions at baseline and incident psychiatric disorders over a 3-year follow-up, using data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).Overall, the 3-year incidence rates of DSM-IV substance use, mood and anxiety disorders ranged from 0.65% (bipolar II) to 5.2% (alcohol abuse). Multiple regression analysis was conducted to examine the prospective physical–mental associations, while controlling for sociodemographic characteristics, psychological stress and health-related risk factors, and comorbid physical and psychiatric disorders.The present study represents, to our knowledge the largest population-based prospective study examining the physical–mental associations. Our results showed distinctly different patterns of comorbidity of medical illnesses with substance use, mood, and anxiety disorders. Stomach ulcer/gastritis, hypertension and arthritis emerged to be significant predictors of incident psychiatric disorders.

First-incidence of DSM-IV mood, anxiety and substance use disorders and its determinants: Results from the Netherlands Mental Health Survey and Incidence Study-2

BackgroundProspective studies measuring first-incidence of DSM-IV mood, anxiety and substance use disorders in the general population are rare. We assessed these incidence rates in the Dutch population; and identified baseline sociodemographic, physical and psychopathological variables, and negative changes in sociodemographics and physical health between baseline and follow-up, as determinants of first-onset main categories of disorders. MethodData are from NEMESIS-2, a representative face-to-face survey including 5303 subjects aged 18–64 interviewed twice (2007–2009; 2010–2012) with the CIDI 3.0. ResultsIn three years, 8.86% of adults without prior psychopathology experienced any mental disorder, corresponding with 3.09 cases per 100 person-years. Incidence was highest for anxiety (1.69 per 100 person-years) and mood disorder (1.65), and lowest for substance use disorder (0.97). For the separate disorders, incidence was highest for major depression (1.58), specific phobia (0.79) and alcohol abuse (0.73). For mood and anxiety disorder, incidence rate was higher among women and for substance use disorder it was higher among men. Age was inversely related to all disorder categories. Changes in sociodemographics, like no longer living with a partner and decrease in income, were stronger determinants than the corresponding sociodemographics. Incident mood disorder was predicted by baseline anxiety and substance use disorder, incident anxiety disorder by mood and substance use disorder, and incident substance use disorder by adult ADHD. LimitationsValidity of lifetime diagnoses can be questioned because of difficulty of accurate recall. Only determinants of categories of disorders were studied, due to low numbers of incident cases of most separate disorders. ConclusionFirst-onset of mental disorders in a 3-year period is not an uncommon phenomenon. Results about determinants of incident disorders are important for prevention and early intervention initiatives aimed at reducing burden of mental disorders.

Childhood Adversities and First Onset of Psychiatric Disorders in a National Sample of US Adolescents

Although childhood adversities (CAs) are known to be highly co-occurring, most research examines their associations with psychiatric disorders one at a time. However, recent evidence from adult studies suggests that the associations of multiple CAs with psychiatric disorders are nonadditive, arguing for the importance of multivariate analysis of multiple CAs. To our knowledge, no attempt has been made to perform a similar kind of analysis among children or adolescents. To examine the multivariate associations of 12 CAs with first onset of psychiatric disorders in a national sample of US adolescents. A US national survey of adolescents (age range, 13-17 years) assessing DSM-IV anxiety, mood, behavior, and substance use disorders and CAs. The CAs include parental loss (death, divorce, and other separations), maltreatment (neglect and physical, sexual, and emotional abuse), and parental maladjustment (violence, criminality, substance abuse, and psychopathology), as well as economic adversity. Dual-frame household-school samples. In total, 6483 adolescent-parent pairs. Lifetime DSM-IV disorders assessed using the World Health Organization Composite International Diagnostic Interview. Overall, exposure to at least 1 CA was reported by 58.3% of adolescents, among whom 59.7% reported multiple CAs. The CAs reflecting maladaptive family functioning were more strongly associated than other CAs with the onset of psychiatric disorders. The best-fitting model included terms for the type and number of CAs and distinguished between maladaptive family functioning and other CAs. The CAs predicted behavior disorders most strongly and fear disorders least strongly. The joint associations of multiple CAs were subadditive. The population-attributable risk proportions across DSM-IV disorder classes ranged from 15.7% for fear disorders to 40.7% for behavior disorders. The CAs were associated with 28.2% of all onsets of psychiatric disorders. Childhood adversities are common, highly co-occurring, and strongly associated with the onset of psychiatric disorders among US adolescents. The subadditive multivariate associations of CAs with the onset of psychiatric disorders have implications for targeting interventions to reduce exposure to CAs and to mitigate the harmful effects of CAs to improve population mental health.

Stimulant use disorders: Characteristics and comorbidity in an Australian population sample

To describe the correlates of stimulant use disorders (abuse, dependence) in an Australian population sample, to compare the characteristics of stimulant users with and without stimulant use disorders and to describe the patterns of service use and help-seeking in people with stimulant use disorders. Data were drawn from the 2007 National Survey of Mental Health and Wellbeing, which sampled 8841 residents of private dwellings in Australia in 2007. Lifetime DSM-IV substance use and mental disorder diagnoses were obtained from interviews conducted by lay interviewers, using the Composite International Diagnostic Interview (CIDI). Socio-demographic, socio-economic and clinical correlates of stimulant use disorders were identified using binary logistic regression models. Stimulant users with and without stimulant use disorders were compared to non-stimulant users via multinomial logistic regression models. Compared to Australians without stimulant use disorder, people with stimulant use disorders were younger, more likely to be male, of non-heterosexual orientation and born in Australia, but were not more socially disadvantaged. Lifetime comorbidity rates were high: 79% of persons with stimulant use disorders had a lifetime alcohol use disorder, 73% a lifetime cannabis use disorder, and more than one third a lifetime mood or anxiety disorder. Stimulant use disorders were associated with a family history of substance use, affective disorders and psychosis. One in five people with lifetime stimulant use disorders had been imprisoned, homeless or hospitalised for substance or mental health problems, and 13% reported at least one symptom of psychosis. Nearly half had sought help for substance or mental health problems, primarily from General Practitioners (GPs), psychologists or psychiatrists. Stimulant use disorders in a representative population sample are associated with significant comorbidity and harm. Many persons with stimulant use disorders had sought care and found this helpful. There is scope for screening and intervention in this group.

Risk of Inpatient Stay for Mental Illness Among Individuals With Substance Use Disorders

Whereas most studies of inpatient stay for mental illness examine whether substance use is present, this study identified types or combinations of abused substances that most increased hospitalization risk. Logistic regression of data from the 2007 National Survey of Drug Use and Health (N=37,654) was used to predict past-year hospitalization of individuals with DSM-IV substance use disorders. Even after the inclusion of control variables, adults with four types of substance abuse or dependence were more likely to be hospitalized than adults without substance abuse or dependence. High-risk disorders included abuse of or dependence on opioid analgesics (odds ratio [OR]=6.85, p<.001), cocaine (OR=2.65, p<.05), alcohol and cocaine (OR=2.58, p<.05), and alcohol and marijuana (OR=3.10, p<.01). Researchers examining inpatient stays may find it beneficial to look at abuse of specific substances or combinations of substances, and efforts to prevent inpatient stays could target people with high-risk substance use disorders.

Initial RCT of a distress tolerance treatment for individuals with substance use disorders

BackgroundPsychological distress tolerance, the ability to persist in goal directed activity when experiencing psychological distress, is associated with poor substance use treatment outcomes including drug and alcohol treatment dropout and relapse. ObjectiveThe current study examines if a brief distress tolerance intervention that was specifically developed as an adjunctive treatment for patients in residential substance abuse treatment shows efficacy in improving the patients’ distress tolerance. MethodsSeventy-six individuals who were receiving treatment at a residential substance use treatment facility and indexed low distress tolerance on laboratory distress tolerance measures were randomized into three conditions: treatment-as-usual (TAU), six sessions of Supportive Counseling (SC), or six sessions of the novel distress tolerance treatment, Skills for Improving Distress Intolerance (SIDI). MeasuresPatients were assessed at baseline for DSM-IV psychiatric diagnoses, DSM-IV substance use disorders, distress tolerance, and depressive symptoms. Patients were again assessed at posttreatment. Therapeutic alliance and treatment expectancies and credibility were also assessed at posttreatment. ResultsPatients who received SIDI (n=28) evidenced significantly greater improvements than SC (n=24) and TAU participants (n=24) on the distress tolerance laboratory measures, even when controlling for changes in negative affect (in the form of depression). Additionally, a higher percentage of patients in SIDI reached clinically significant improvement compared to patients in SC and TAU. ConclusionThis study supports the efficacy of SIDI in improving distress tolerance levels among individuals with drug and alcohol use disorders currently receiving residential substance use treatment. SIDI appears to be a brief and feasible intervention for use within inpatient substance use facilities.

Estimating the Prevalence of DSM-IV Mental Illness in the Australian General Population Using the Kessler Psychological Distress Scale

The aim of this study was to present scoring rules for predicting DSM-IV mental illness in the previous 12 months using the Kessler Psychological Distress Scale in the Australian population. The method described in Kessler et al. was closely followed using data from the 2007 Australian Survey of Mental Health and Wellbeing. A series of 93 nested logistic regression models were generated and compared to estimate the predicted probabilities of mental illness for each survey respondent using scores on the Kessler Psychological Distress Scale. The best model was selected using information theoretic criteria. Concordance between the predicted probabilities of mental illness generated by the best models with DSM-IV defined mental illness, assessed using the Composite International Diagnostic Interview, was determined using receiver operating characteristic analysis. The best fitting models were found to contain the quadratic form of the Kessler Psychological Distress Scale (both 6 item and 10 item versions). Age was found to be significant in the model predicting mood, anxiety, and substance use with serious impairment using the 6 item version whilst age and gender was found to be significant in the model for the 10 item version. The concordance between the predicted probabilities of mood, anxiety, and substance use with serious impairment generated from the best models and DSM-IV mood, anxiety, and substance use with serious impairment was within an acceptable level for both versions. Results were similar when predicting DSM-IV mood, anxiety, and substance use without seriousness indicators and DSM-IV anxiety and depression. The performance of predicted probabilities was then examined in various sub-populations of the Australian population. Using a logistic regression model, the Kessler Psychological Distress Scale can be used to generate predicted probabilities of mental illness with an acceptable level of agreement in Australian-based population studies where it is not feasible to conduct a comprehensive assessment.

The DrugCheck Problem List: A new screen for substance use disorders in people with psychosis

Despite considerable recent interest in the issue of comorbid substance use disorders in people with serious mental illness, there remains a need to refine approaches to screening. This paper describes the development and testing of a new screen for substance-related comorbidity, the 12-item DrugCheck Problem List (PL). Exploratory factor analysis with inpatient samples suggested a single-factor structure, although confirmatory factor analysis in a further sample found similar fit from a two-factor model. Sensitivity and specificity in detecting DSM-IV substance use disorders were both high and comparable to performances of the Severity of Dependence Scale and Alcohol Use Disorders Identification Test (Australian version). The list of problem areas provided by the PL has utility in driving further assessment and treatment planning, and offers suggested foci for motivational interviewing. While further testing is indicated, these data provide strong initial support for its use.

Overweight and Obesity in Childhood and Risk of Mental Disorder: a 20-Year Cohort Study

Very little is known about whether overweight and obese children have long-term risk for mental health problems. This study examined the association between overweight and obesity in childhood and DSM-IV mood, anxiety, and substance use disorders in young adulthood. Participants in a national Australian school survey when aged 7-15 years in 1985 were re-interviewed 20 years later as young adults aged 26-36 years (1135 women, 1108 men). Body mass index (BMI) was calculated from measured height and weight in childhood and adulthood. Children were classified as overweight or obese based on a BMI ≥85th centile for age and sex-specific height and weight. Obesity in adulthood was defined as BMI of ≥30. Twelve-month DSM-IV diagnoses of mood, anxiety and substance use disorders were obtained from the Composite International Diagnostic Interview. The relative risk (RR) for each class of mental disorder was estimated for childhood overweight/obesity versus non-overweight, and for four weight trajectories: non-overweight in childhood and non-obese in adulthood; overweight in childhood and non-obese in adulthood; non-overweight in childhood and obese in adulthood; and overweight in childhood and obese in adulthood. Childhood overweight and obesity was associated with an increased risk of mood disorder in adulthood (RR = 1.54, 95%CI 1.06-2.23, p = 0.03), with a similar risk observed among girls and boys. When weight in adulthood was taken into consideration, increased risk of mood disorder was observed only among overweight girls who were obese in adulthood (adjusted RR = 2.03, 95%CI 1.22-3.66, p = 0.006), with childhood overweight or obesity in non-obese adults not associated with any mental disorder. Childhood overweight may increase risk for mood disorder in adulthood, especially among overweight girls who become obese women. These results suggest that prevention of childhood overweight is equally important in both sexes for reducing risk of diagnosed mood disorder in adulthood.

Temporal relationships between overweight and obesity and DSM-IV substance use, mood, and anxiety disorders: results from a prospective study, the National Epidemiologic Survey on Alcohol and Related Conditions.

To present nationally representative findings on the prospective relationships between overweight and obesity and DSM-IV substance use, mood, and anxiety disorders. A nationally representative sample of 34,653 US adults was interviewed in Wave 1 (2001-2002) and Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. The target population was the civilian population residing in households and group quarters, with gathered data adjusted to be representative of the civilian population of the United States on the basis of the 2000 Decennial Census. The main outcome measures were the incidence of DSM-IV substance use, mood, and anxiety disorders and changes in body mass index status during the 3-year follow-up period. Regression analyses that controlled for a wide array of covariates showed that overweight and obese women were at increased risk (P < .05) for incident major depressive disorder during the follow-up period (adjusted OR [AOR] = 1.3 [95% CI, 1.02-1.56] and AOR = 1.2 [95% CI, 1.02-1.51], respectively). Overweight men and obese men were at decreased risk (P < .05) of incident drug abuse and alcohol dependence (AOR = 0.7 [95% CI, 0.44-0.96] and AOR = 0.7 [95% CI, 0.52-0.97]), respectively. Obese women had a decreased risk (P < .05) of incident alcohol abuse and drug dependence (AOR = 0.6 [95% CI, 0.45-0.88] and AOR = 0.4 [95% CI, 0.21-0.91], respectively). Men with drug dependence and women with specific phobia had a decreased risk (P < .05) of becoming overweight or obese during the follow-up period (AOR = 0.4 [95% CI, 0.19-0.99] and AOR = 0.8 [95% CI, 0.66-0.95], respectively). Increased risk of major depressive disorder among overweight and obese women could be attributed to stigma and greater body dissatisfaction among women in Western cultures. Overweight and obesity may serve as protective factors against developing incident substance use disorders, possibly due to shared neural functions in the brain underlying addictions to numerous substances. Results are discussed in terms of their clinical implications, including the need to update treatment guidelines for the management of overweight, obesity, and major depressive disorder.

Three-Year Incidence and Predictors of First-Onset of DSM-IV Mood, Anxiety, and Substance Use Disorders in Older Adults

The aim of this study was to determine the incidence rates of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mood disorders, anxiety disorders, and substance use disorders in older adults and to identify sociodemographic, psychopathological, health-related, and stress-related predictors of onset of these disorders. A nationally representative sample of 8,012 community-dwelling adults aged 60 and above was interviewed twice over a period of 3 years, in 2000-2001 and 2004-2005. First incidence of mood, anxiety, and substance use disorders was assessed over a period of 3 years using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. The 3-year incidence rates of DSM-IV mood, anxiety, and substance use disorders were highest for nicotine dependence (3.38%) and major depressive disorder ([MDD] 3.28%) and lowest for drug use disorder (0.29%) and bipolar II disorder (0.34%). Incidence rates were significantly greater among older women for MDD (99% CI, 1.22-3.13) and generalized anxiety disorder (GAD; 99% CI, 1.20-4.26) and greater among older men for nicotine dependence and alcohol abuse and dependence. Posttraumatic stress disorder predicted incidence of MDD, bipolar I disorder, panic disorder, specific phobia, and GAD, while Cluster B personality disorders predicted incident MDD, bipolar I and II disorders, panic disorder, social phobia, GAD, nicotine dependence, and alcohol dependence. Poor self-rated health increased the risk for the onset of MDD, whereas obesity decreased the incidence of nicotine dependence. Information about disorders that are highly incident in late life and risk factors for the onset of psychiatric disorders among older adults are important for effective early intervention and prevention initiatives.

The Association Between Social Isolation andDSM-IVMood, Anxiety, and Substance Use Disorders

The objective of this study is to document the prevalence of social isolation from close friends and religious group members and to test the association of having infrequently contacted close friends and members of religious groups with the current DSM-IV mood, anxiety, and substance use disorders. We conducted a secondary data analysis based on a cross-sectional, population-based study conducted in 2004-2005 that consists of a nationally representative sample of 34,653 American community-dwelling adults aged 18 years and older. Mood, anxiety, and substance use disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version. Due to missing values for social network characteristics, we focused on 33,368 subjects in this study. We found that many Americans lacked frequently contacted close friends (10.1%; 95% CI, 9.6%-10.6%) or religious group members (58.7%; 95% CI, 57.5%-59.9%) in their social network. After adjusting for sociodemographic variables, lifetime diagnosis of the disorder in question, and social isolation in terms of 10 other social ties, we found that the absence of close friends was associated (P < .01) with an increased risk of major depressive disorder, dysthymic disorder, social phobia, and generalized anxiety disorder; the absence of frequently contacted religious group members in a network was positively related (P < .01) to alcohol abuse and dependence, drug abuse, and nicotine dependence. These results suggest that social isolation is common in the United States and is associated with a higher risk of mental health problems. Results provide valuable information for prevention and treatment.