Dual Substance Use Research Articles

An In-Depth Investigation into the Co-Occurrence of Substance Use in Individuals with Alcohol Use Disorder and its Association with Sociodemographic Factors

Background: Alcohol Use Disorder (AUD) presents a significant global public health challenge, often accompanied by comorbid substance use, complicating treatment. Understanding the prevalence, patterns, and sociodemographic correlates of dual substance use is crucial for effective intervention. Method: This cross-sectional study examined substance use co-occurrence among individuals diagnosed with AUD. Recruitment occurred through addiction treatment centers and psychiatry outpatient departments. Structured interviews, DSM-5 assessments, and sociodemographic questionnaires were conducted. Statistical analyses explored associations between substance use and sociodemographic factors. Result: Tobacco and cannabis showed significant associations with AUD, while opioids, cocaine, and benzodiazepine use exhibited elevated but non-significant associations. Notably, tobacco and benzodiazepine use correlated positively with AUD, indicating potential co-occurrence. Similarly, cannabis and opioids displayed a positive correlation. Conclusion: The study underscores the importance of addressing comorbid substance use in AUD treatment. Findings suggest robust associations between tobacco, cannabis, and AUD, indicating potential co-use patterns. Sociodemographic factors like age, gender, and marital status also influence substance use behaviors, emphasizing the need for tailored interventions.

Dried Cannabis Use, Tobacco Smoking, and COVID-19 Infection: Findings from a Longitudinal Observational Cohort Study.

The potential impact of cigarette and cannabis smoking on COVID-19 infection outcomes is not well understood. We investigated the association between combustible tobacco use and dried cannabis use with COVID-19 infection in a longitudinal cohort of community adults. The sample comprised 1,343 participants, originally enrolled in 2018, who reported their cigarette and cannabis use in 11 assessments over 44 months, until 2022. COVID-19 infection history were self-reported after the onset of the pandemic. Univariate and multivariate logistic regression analyses were performed. The potentially confounding factor of vaccination status was also considered by stratifying data by booster vaccination self-reporting. Among 1,343 participants, 820 (61.1%) reported any COVID-19 infection. Dried cannabis use (46.3% of participants, n = 721) was associated with higher self-reporting of 2+ COVID-19 infections (13.3% vs. 7.3% in non-users, p = .0004), while tobacco use (18.5% of participants, n = 248) had no significant effect (13.3% vs. 10.0% in no use group, p = .116). When stratified into single or dual substance use groups, dried cannabis-only use was associated with increased reporting of 1 or 2+ COVID-19 infections compared to substance non-users, while tobacco-only use and dual use groups were not significantly different from non-users. To account for differences in vaccination rates between substance use groups, we found that, among individuals with a COVID-19 booster vaccine, dried cannabis use was still associated with increased reporting of 2+ COVID-19 infections (p = .008). Our study suggests that dried cannabis use is associated with a higher likelihood of reporting 2+ COVID-19 infections. Although the study was observational and relied on self-report infection status, our findings support the need for further investigation into the impact of cannabis use on COVID-19 infection, particularly studies employing controlled experimental designs.

Smoking, betel quid chewing, and alcohol use among an indigenous primitive Tribal group in the Kerala State of India: Secondary analysis of a Tribal household survey

Background: In India, indigenous populations, known as Tribes, are among the poorest and most marginalized groups. We estimated the prevalence of smoking, alcohol use, and betel quid chewing and examined the association between gender and smoking, alcohol use, and betel quid chewing among Kattunayakan primitive Tribes who are categorized as a Particularly Vulnerable Tribal Group (PVTG) in the Kerala State of India.Methods: A secondary analysis of a sample of the Wayanad District Tribal Household survey comprising 388 Kattunayakan PVTG households selected through multistage cluster random sampling was undertaken. Binary logistic regression models were used to estimate an association between gender and smoking, alcohol use, and betel quid chewing in these Tribal households.Results: Mean age was 39.2 years (±15.1), more than three-fourths of the respondents were female (75.3%), and approximately 24% of the respondents reported smoking tobacco in past 12 months. A fivefold increased odds of smoking among males compared to smoking among females was observed (OR = 4.92; p < .01). More than 64% reported betel quid chewing. Prevalence of alcohol use was 16%, which significantly varied between males (49%) and females (5.1%; OR = 17.71; p < .01). Among tobacco smokers, 64.1% were involved in betel quid use. Among alcohol users, 62.9% were involved in betel quid use and more than 58% were smoking tobacco. Betel quid chewing was the most prevalent substance use.Conclusion: Single and dual substance use of the three commonest types were disproportionately high among this hard-to-reach Tribal population in the southern state of India, with some gender variations. Alcohol consumption was relatively low. However, the complex nature of substance use, compounded by inaccessible health services, poses a significant challenge to rethink and to reimagine innovative methods of providing mental health care services, for instance, mobile health clinics.

"Dual use of alcohol and cannabis among college students: A reinforcer pathologies approach." Correction to Reed et al. (2021).

Reports an error in "Dual use of alcohol and cannabis among college students: A reinforcer pathologies approach" by Gideon P. Naudé, Derek D. Reed, Tyler J. Thornton and Michael Amlung (Experimental and Clinical Psychopharmacology, 2021[Aug], Vol 29[4], 407-417). In the original article, in the Method section under Principal Components Analyses, it reads "We used a loading of ≥ 4.0 ... " when it should read "≥ 0.40." The correct loading criterion is listed in the Table 3 note. Analyses were run using the correct criterion. In Table 3, the loading for BP1 under the alcohol amplitude factor is "-0.4" when it should be "-0.04." The online version of this article has been corrected. (The following abstract of the original article appeared in record 2020-25392-001). The reinforcer pathologies model proposes 2 behavioral economic constructs interact in addiction: operant demand and delay discounting. These constructs manifest as behavioral markers of addiction in the form of excessive reinforcer value and strong preference for immediate access and consumption of this reinforcer despite suboptimal long-term outcomes. The first aim of this investigation was to identify the degree to which delay discounting (of money and alcohol) and demand for alcohol differ between college student drinkers (N = 185) who do and do not co-use cannabis. As a second aim, we sought to replicate the 2-factor solution for alcohol and cannabis demand within a college sample. Results suggest dual users have significantly stronger Persistence and Amplitude for alcohol, demonstrate steeper delay discounting of alcoholic drinks, and are at greater risk for alcohol use disorder than individuals who drink yet do not use cannabis. These results provide further support for the reinforcer pathologies model and contribute to the literature on dual-substance use in the college population. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Dual use of alcohol and cannabis among college students: A reinforcer pathologies approach.

The reinforcer pathologies model proposes 2 behavioral economic constructs interact in addiction: operant demand and delay discounting. These constructs manifest as behavioral markers of addiction in the form of excessive reinforcer value and strong preference for immediate access and consumption of this reinforcer despite suboptimal long-term outcomes. The first aim of this investigation was to identify the degree to which delay discounting (of money and alcohol) and demand for alcohol differ between college student drinkers (N = 185) who do and do not co-use cannabis. As a second aim, we sought to replicate the 2-factor solution for alcohol and cannabis demand within a college sample. Results suggest dual users have significantly stronger Persistence and Amplitude for alcohol, demonstrate steeper delay discounting of alcoholic drinks, and are at greater risk for alcohol use disorder than individuals who drink yet do not use cannabis. These results provide further support for the reinforcer pathologies model and contribute to the literature on dual-substance use in the college population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Inhibitory Control and Craving in Dual Disorders and Recurrent Substance Use. Preliminary Findings

Objective: In Dual Disorders (DD), which involves the co-occurrence of a disorder in substance use and a mental disorder, recurrent struggles with addictive behavior are frequent. Neuropsychological knowledge concerning the profile of inhibitory control and the irresistible urge to use substances (craving) within the DD patient group may contribute to the prevention of this recurrent addictive behavior.Methods: Inhibitory control and craving were assessed in 25 patients with DD and 25 healthy controls (HC). Inhibitory control tasks (Go/No-go task and Stop Signal Task) were performed combined with brain measurements (Event Related Potentials) mapping inhibitory control. Moreover, implicit and explicit measures concerning craving were administered. Statistical DD and HC comparisons, correlational and regression analyses on exploratory base were conducted.Results: DD patients committed more inhibitory control errors than HC when confronted with (alcohol) consumption-related picture stimuli. Furthermore, patients with DD showed higher levels of implicit and explicit craving. The number of inhibitory control errors was positively related to levels of implicit and explicit craving. Moreover, explicit craving and impulsivity (as a dimension of inhibitory control) predicted the severity of addictive behavior. Event Related Potential analyses did not show differences in inhibitory control-associated brain activity between DD patients and HC; both groups showed reduction of P300 amplitudes in response to alcohol pictures.Conclusions: Impulsivity and craving are elevated in DD patients and show predictive value for the severity of addictive behavior. One's level of impulsive action tendency may trigger less effort to control (recurrent) substance use. The findings may contribute to existing DD treatment indications by the promotion of impulse control training via “stop-think-act” methods for DD patients.

Dual Substance Use of Electronic Cigarettes and Alcohol.

Electronic cigarettes (ECs) are a modern nicotine delivery system that rapidly grew in widespread use, particularly in younger populations. Given the long history of the comorbidity of alcohol and nicotine use, the rising prevalence of ECs raises the question as to their role in the consumption of alcohol. Of the numerous models of ECs available, JUUL is the most popular. This narrative review aims to determine current trends in literature regarding the relationship between EC and alcohol dual use, as well as hypothesize potential pathogenic tissue damage and summarize areas for future study, including second-hand vapor exposure and calling for standardization among studies. In summary, EC users are more likely to participate in hazardous drinking and are at higher risk for alcohol use disorder (AUD). We surmise the pathogenic damage of dual use may exhibit an additive effect, particularly in pathogen clearance from the lungs, increased inflammation and decreased immune response, physical damage to epithelial cells, and exacerbation of chronic obstructive pulmonary disease (COPD)-like illnesses. A better understanding of pathogenic damages is critical to understand the risks placed on dual users when exposed to respiratory pathogens, such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Polysubstance abuse associated with more frequent opioid use among patients in rural primary care settings.

Opioid use is a continuing problem for the United States. Individuals who use opioids have a high risk of misuse, especially with prescription opioids. Substances that are often used in combination with opioids include methamphetamines, sedatives, and benzodiazepines, as well as tobacco, alcohol, and marijuana, but not in a medical setting. We sought to determine (a) the relationship between various drugs (eg, methamphetamine, benzodiazepines) and opioid use, as well as (b) the relationship between polysubstance use and opioid use. We created a screening instrument that requested the patients seeking medical care at Federally Qualified Health Centers (FQHC) and Veterans Affairs (VA) hospitals in West Alabama self-report their substance usage. This study took place in outpatient primary care settings (FQHCs and VA hospitals) in west Alabama. De-identified electronic health records for 346 adults were obtained from consenting medical facilities. Missing data were found in 33 of the records obtained. The final usable sample for this study was 311. The screening tool was comprised of five sections: demographics, tobacco use, alcohol abuse, drug use, and mental health. The primary outcome measure of this study was the number of days of opioid use in the past 30 days. Thirteen individuals (4.18 percent) reported opioid use in the last 30 days. While polysubstance or dual sub-stance use was not in the majority of the participant responses, the significant substances that were used in conjunction with opioids were methamphetamine, hallucinogens, and benzodiazepines. Individuals who are polysubstance users have a higher likelihood of opioid use. Interventions that target opioid use would serve the population stronger by including screenings and potential treatments for polysubstance use additionally.

Cross-fading motives for simultaneous alcohol and marijuana use: Associations with young adults’ use and consequences across days

BackgroundMany young adults engage in simultaneous alcohol and marijuana (SAM) use so that their effects overlap. Little is known about motivations for dual substance use and associations with use and consequences. This study examined daily-level associations between cross-fading motives and levels of alcohol and marijuana use and consequences. MethodsYoung adults who reported SAM use in the month prior were surveyed in two 14-day bursts. Data included 1049 SAM use days from 281 young adults (age 18–25; M age = 21.80, SD = 2.16; 50 % women). Multilevel models assessed between- and within-person effects of cross-fading motives (i.e., to enhance the effects of marijuana and/or alcohol use by using them simultaneously) on alcohol and marijuana use and consequences, after adjusting for general enhancement, social, coping, and conformity motives and the amount of alcohol and marijuana used that day. ResultsOn 76 % of SAM use days, participants endorsed cross-fading motives (i.e., to enhance the effect of alcohol or marijuana or to get drunk and high at the same time). Having stronger cross-fading motives was associated with greater alcohol use, perceived intoxication, and positive alcohol consequences at the between- and within-person levels. In addition, between-person, individuals who reported stronger cross-fading motives on average reported more negative alcohol consequences and positive marijuana consequences on average. Cross-fading motives on a given day were not associated with marijuana use or marijuana consequences that day. ConclusionsCross-fading motives were common and varied from day to day. Understanding the motivational context for dual substance use may support future interventions for cross-fading.

Prison-based harm reduction services are needed to address the dual substance use disorder and infectious disease epidemics in US prisons

Prison-based harm reduction services are needed to address the dual substance use disorder and infectious disease epidemics in US prisons

Cross-sectional associations of food insecurity with smoking cigarettes and heavy alcohol use in a population-based sample of adults

BackgroundSmoking, alcohol abuse and dual substance use represent significant public health problems and are thought to contribute to significant disparities in morbidity and mortality in the United States. Associations of food insecurity with these substances are poorly characterized, particularly concerning heavy alcohol consumption and dual substance use. Additionally, demographic factors may moderate these associations. MethodsIn a cross-sectional, representative sample of Wisconsin adults (n = 1616), logistic regression was used to examine whether food insecurity was associated with cigarette smoking, heavy alcohol use and dual substance use. Interactions of food insecurity with gender, marital status and age group tested moderation by demographic factors. Principal FindingsFood insecurity was associated with cigarette smoking in men and women (odds ratio (OR) = 3.0, 95% confidence interval (CI) = 2.1–4.4); however, only among men was food insecurity associated with heavy alcohol use (OR = 1.5; 95% CI = 1.0–2.2) and dual substance use (OR = 5.2; 95% CI = 1.5–18.6). Marital status and age group did not moderate associations of food insecurity with substance use. ConclusionsFood insecurity and substance use are highly correlated. Heavy alcohol consumption and dual use were positively correlated with food insecurity among men, but not among women. Longitudinal analyses are needed to disentangle temporality and underlying pathways of observed associations. Additionally, future work should determine whether interventions and policies targeting food insecurity can simultaneously reduce cigarette and alcohol use.

Mental Health Symptoms and Parenting Among Father-Only and Dual Substance Use Disorder Couples.

In the present study, we examined associations between fathers' and mothers' mental health symptoms as related to their own and their partner's parenting in couples in which fathers (n = 38 families) or both partners (n = 30 families) had substance use disorder (SUD). Each partner reported on symptoms of depression, anxiety, and hostility; children reported on each parent's parenting behaviors, including acceptance, psychological control, and knowledge of children. Actor-partner interdependence models indicated that when substance-abusing fathers have more symptoms of anxiety and depression, non-substance-abusing mothers report greater knowledge of children, whereas non-substance-abusing mothers' mental health symptoms were related to less paternal knowledge of children. In dual SUD couples, mothers' depressive symptoms were associated with more paternal knowledge of children. These preliminary findings offer select support for family systems theory.

Parenting Efficacy and Support in Mothers With Dual Disorders in a Substance Abuse Treatment Program

ABSTRACTObjective: Approximately 73% of women entering treatment for substance use disorders are mothers of children younger than 18, and the high rate of mental health disorders among mothers with substance use disorders increases their vulnerability to poor parenting practices. Parenting efficacy and social support for parenting have emerged as significant predictors of positive parenting practices among families at risk for child maltreatment. The purpose of the current study was to examine the impact of parenting support and parenting efficacy on the likelihood of out-of-home placement and custody status among the children of mothers with dual substance use and mental health disorders. Methods: This study examined the impact of parenting efficacy and assistance with childcare on the likelihood of child out-of-home placement and custody status among 175 mothers with diagnosed dual substance and mental health disorder and in treatment for substance dependence. Logistic regression was utilized to assess the contributions of parenting efficacy and the number of individuals in mothers’ social networks who assist with childcare to the likelihood of out-of-home placement and custody loss of children. Parenting efficacy was also examined as a mediator using bootstrapping in PROCESS for SPSS. Results: Greater parenting efficacy was associated with lower likelihood of having at least one child in out-of-home placement (B = −.064, SE = .029, p = .027) and lower likelihood of loss of child custody (B = −.094, SE = .034, p = .006). Greater number of children in the 6 to 18 age range predicted greater likelihood of having at least one child in the custody of someone else (B = .409, SE = .171, p = .017) and in out-of-home placement (B = .651, SE = .167, p < .001). In addition, mothers who identified as African American were less likely to have a child in out-of-home placement (B = .927, SE = .382, p = .015) or to have lost custody of a child (B = −1.31, SE = .456, p = .004). Finally, parenting efficacy mediated the relationship between parenting support and likelihood of out-of-home placement (effect = −.0604, SE = .0297, z = 2.035, p = .042) and between parenting support and likelihood of custody loss (effect = −.0332, SE = .0144, z = −2.298, p = .022). Conclusions: Implications for practice include the utilization of personal network interventions, such as increased assistance with childcare, and increased attention to efficacy among mothers with dual disorders.

Antisocial Personality Disorder and Physical Partner Violence Among Single and Dual Substance-Abusing Couples

The current study examined how antisocial personality disorder (APD) and substance use disorder contributed to partners’ reports of physical partner violence among single and dual substance-abusing couples. Participants were 69 heterosexual couples entering treatment in which one or both partners met criteria for substance use disorder. APD diagnosis of the male partner was linked to significantly higher male-to-female and female-to-male perpetration of physical partner violence and victimization. Female partner’s APD diagnosis was associated with women’s reports of victimization by their male partners. Dual substance use diagnosis emerged as a moderator, in which the effect of men’s APD diagnosis on men’s perpetration of physical partner violence and victimization was significantly reduced if both partners had substance use disorder. Findings underscore the importance of both partners’ APD diagnosis and substance use status for understanding physical partner violence among single and dual substance-abusing couples.

State Prisoner Misconduct: Contribution of Dual Psychiatric and Substance Use Disorders

Using self-report data from American state prisoners (N = 14,499; 79.8% male) and negative binomial regression, this study found prisoners with preadmission dual serious mental and substance use disorders reported greater diversities and numbers of disciplinary infractions in general compared to inmates without dual disorders. Findings were mixed for diversity and number of assaultive infractions. Variety and numbers of charges for infractions in general and assault were strongly associated with previous and current incarceration experiences with assault victimization. The article concludes with suggestions for corrections policies such as screening for dual disorders, PTSD, and assault victimization, and future research.

Affective Temperaments in Alcohol and Opiate Addictions

Temperament is considered as a biological disposition reflected by relatively stable features related to mood and reactivity to external and internal stimuli, including variability in emotional reactions. The aim of the present study is to test the hypothesis that affective temperaments might differ according to co-occurring mood disorders among patients with alcohol and/or opiate dependence; to explore the relationship between temperaments and dual substance use disorders (SUDs, alcohol and other drugs). Ninety-two patients attending an alcohol addiction treatment facility and 47 patients in an opiate addiction treatment facility were assessed for SUDs, mood disorders and affective temperaments using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego 39-item auto-questionnaire. Comparison of patients with bipolar disorder, depressive unipolar disorder and no (or substance-induced) mood disorder revealed significant differences for the cyclothymic subscale, with highest scores among patients with bipolar disorder. No difference was observed for the depressive, irritable, hyperthymic and anxious subscales. After adjustment for age, gender and bipolar disorder, irritable temperament was a significant risk factor for past or present history of drug use disorders in patients treated for alcohol addiction (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.05-1.93). Anxious temperament was a significant risk factor for history of alcohol use disorders in patients treated for opiate addiction (OR 3.30, 95% CI 1.36-7.99), whereas the hyperthymic subscale appeared as a significant protective factor (OR 0.65, 95% CI 0.42-0.99). The results highlight the need to consider temperamental aspects in further research to improve the long-term outcome of patient with addictive disorders, who often present complex comorbidity patterns.

Sub-Clinical Trauma in the Treatment of Partner Violent Offenders with Substance Dependence.

With an established association between PTSD and the perpetration of intimate partner violence, evaluating the effectiveness of emerging integrated treatments for dual substance use and partner violent behavior on individuals with a significant trauma history may serve to improve treatment outcomes for clients with axis I psychopathology. This paper examined the association between sub-clinical trauma, treatment compliance, and recidivism in a sample of male, substance dependent intimate partner violence offenders. The described investigation utilized violence perpetration, substance use, and trauma data collected during a larger, randomized control treatment evaluation study. Data was collected from 56 participants at 4 time points throughout treatment. Participants with a significant trauma history comprised 33.9% of the sample and demonstrated poorer treatment attendance, as well as heightened partner violence recidivism throughout treatment, as compared to participants who denied experiencing a significant trauma. This finding held across participants receiving substance treatment only and combined treatment addressing substance use and violence. IPV perpetrators often have a trauma history themselves. The association between sub-clinical trauma symptomatology and poor treatment outcomes calls for the adaptation of current partner violence intervention models to accommodate the large subset of clients who suffer from either sub-clinical or clinically significant trauma. This paper is the first to address the potential influence of sub-clinical trauma on the integrated treatment of substance use and partner violence within a forensic sample. Suggestions are offered to adapt existing treatment models to accommodate dual diagnosed clients.

A systematic review of the impact of brief interventions on substance use and co-morbid physical and mental health conditions

To summarise the relevant published evidence on the health and behavioural impact of brief interventions in individuals with recognised co-morbidity. A pre-specified search strategy was applied to Medline and Embase from 1999 to 2009 inclusive. We also scanned the reference lists of key reviews in the field and carried out text-word searches of Google and Google-Scholar. Two authors independently abstracted data, assessed trial quality and recorded study outcomes. Analysis took the form of a qualitative evidence synthesis due to the heterogeneity of studies in this field. We identified 14 trials meeting our inclusion criteria. The majority of this research focused on substance use and mental health problems (n = 8) whilst the remaining trials focused on substance use and physical health problems (n = 3) and dual substance use (n = 3). The evidence-base was very heterogeneous and it was not possible to quantitatively pool the trial outcome data. There were generally positive outcomes of brief intervention ...

A report on the ‘Keep Your Head Together’ project: a dual diagnosis population health prevention initiative undertaken in Western Sydney, Australia

Dual diagnosis is common among substance-using adolescent populations. Increasingly, young people are presenting to mental health and drug and alcohol service providers with dual diagnosis issues. Early intervention and treatment services are being researched and developed. However, there are few programmes established in the area of prevention. A comprehensive population health-based dual diagnosis prevention project incorporating community education, resource development, community awareness raising, and professional training was undertaken in Western Sydney, Australia. Evaluations demonstrated that a multifaceted strategy was effective in raising community awareness, generating help-seeking behaviour in individuals concerned about dual diagnosis, increasing knowledge and confidence of professionals working in the field, and establishing sustaining partnerships to extend the reach of the project beyond initial funding parameters. Potentially sensitive issues such as dual diagnosis and substance use can ...

A Pilot Study of a Dual Processing Substance User Treatment Intervention with Adults

This study responds to the identified need for evidence-based substance abuse interventions by examining the effects of an innovative dual processing substance use intervention aimed at decreasing the risk for substance relapse by targeting emotional regulation capacity. The study was completed in partnership with a Latino-serving community-based substance user treatment agency in a rural Northeastern region of the United States in 2005–2006 and was supported with pilot monies from the University at Albany School of Social Welfare NIDA-funded research center. The sample (N = 29) was comprised of adults with a diagnosis of substance dependence seeking treatment in an outpatient program. Study findings indicated that individuals who participated in the dual-processing treatment group decreased their craving with a trend toward increased self-efficacy over time in treatment and did not show treatment response differences across Latino and non-Latino clients, suggesting that treatment application was similar across these groups. The study's limitations are noted.