Effects Of Substance Use Disorders Research Articles

A quantitative study on emotional appetite, mindful eating, and risky behaviors in male substance use disorder patients

ABSTRACT Background and Objective To evaluate the emotional appetite, eating awareness and risky behaviors of patients with substance use disorder. Method A total of 292 individuals were enrolled in this study; 142 individuals with a substance use disorder and 150 healthy individuals. Our sample was male. The Mindful Eating Questionnaire (MEQ), Emotional Appetite Questionnaire (EAQ) and Risky Behaviors Scale (RBS) were used. p < .05 was considered statistically significant. Results The results showed that the levels of smoking, emotional appetite, irregular eating habits, school dropout, antisocial behaviors and substance use increased in individuals with a substance use disorder (p < .05). In contrast, there was no significant difference in disinhibition, focus, eating control, eating discipline, mindfulness and interference values related to eating awareness (p > .05). Conclusions This study highlights the effects of substance use disorders on emotional eating and risk behaviors, but not mindful eating. However, more studies are needed.

Impulsivity and self-harm behavior in patients with synthetic cannabinoids dependence

Background Synthetic cannabinoids (SCs) dependence is increasingly prevalent among young individuals globally, with limited understanding of their potential detrimental effects. Therefore, we conducted this comparative study to assess impulsivity and non-suicidal self-harm behavior in patients with SCs dependence. Subjects and method We conducted this comparative, case-control study in the outpatient clinics of (Beni-suef University Hospital). We recruited 30 patients with SCs dependence and the 30 healthy subjects as a control group. Psychometric scales, including Addiction Severity Index (ASI), Barratt Impulsivity Scale-11 (BIS-11), Deliberate Self-harm Inventory-Short Version (DSHI), SCID I, SCID II, and drug urine screen, were applied to compare the two study arms. Results DSHI-s scores were significantly higher between the two study arms (3.23 ± 4.97 vs. 0.0 ± 0.0, p < 0.001, for cases and controls, respectively). Similarly, the mean ± SD score of the BIS scale was significantly higher in cases 68.13 ± 9.75 compared to the control group (45.67 ± 5.12) with a statistically significant difference (p < 0.001). Using the regression analysis, we observed a significant positive linkage between age, duration of substance use, DSHI-s, and the Barratt scale. Conclusion Patients with synthetic cannabis addiction exhibited more impulsivity and self-harm behaviors compared to healthy controls. The adverse effects of substance use disorder escalated, notably in individuals classified as having severe addiction based on the Addiction Severity Index. Age and length of substance use were found to be potential factors influencing the level of impulsivity and self-harm actions.

Effect of schizophrenia and substance use disorder on depressive symptoms and stressful life events

Aim of the studyThe main aim of this study was to examine the mutual effect of schizophrenia and substance use disorder on depression and stress level.Subject or material and methodsThe sample comprised a total of 184 participants, including 51 patients with schizophrenia (S), 45 with dual diagnosis (DD), 44 with substance use disorder (SUD) and 44 healthy controls (HC). The Patient Health Questionnaire-9 and the Hamilton Depression Rating Scale were used to measure depressive symptom severity, while the Social Readjustment Rating Scale was used for the assessment of stressful life events.ResultsWe found a greater main effect of substance use disorder relative to schizophrenia on the severity of depression symptoms and stressful life events. In addition, the observed significant interaction effect for stressful life events suggested that SUD patients experienced their greatest number while HC reported the fewest such incidents. Interestingly, significant links between stressful life events and depressive symptoms emerged in both SUD patients and HC. What is more, disease duration and exacerbations were significantly associated with depressive symptoms in DD and S patients.DiscussionThis study demonstrated the effect of schizophrenia and substance use disorders on depressive symptoms and the severity of stress. The relationship between stressful life events and depressive symptom severity was also investigated.ConclusionsCompared to schizophrenia, substance use disorder has a stronger effect on the presence of depression symptoms and the occurrence of stressful life events. The factors modifying depression symptom severity in both schizophrenia groups differ from those found in SUD patients and HC.

Biological aging markers in blood and brain tissue indicate age acceleration in alcohol use disorder.

Alcohol use disorder (AUD) is associated with increased mortality and morbidity risk. A reason for this could be accelerated biological aging, which is strongly influenced by disease processes such as inflammation. As recent studies of AUD show changes in DNA methylation and gene expression in neuroinflammation-related pathways in the brain, biological aging represents a potentially important construct for understanding the adverse effects of substance use disorders. Epigenetic clocks have shown accelerated aging in blood samples from individuals with AUD. However, no systematic evaluation of biological age measures in AUD across different tissues and brain regions has been undertaken. As markers of biological aging (BioAge markers), we assessed Levine's and Horvath's epigenetic clocks, DNA methylation telomere length (DNAmTL), telomere length (TL), and mitochondrial DNA copy number (mtDNAcn) in postmortem brain samples from Brodmann Area 9 (BA9), caudate nucleus, and ventral striatum (N = 63-94), and in whole blood samples (N = 179) of individuals with and without AUD. To evaluate the association between AUD status and BioAge markers, we performed linear regression analyses while adjusting for covariates. The majority of BioAge markers were significantly associated with chronological age in all samples. Levine's epigenetic clock and DNAmTL were indicative of accelerated biological aging in AUD in BA9 and whole blood samples, while Horvath's showed the opposite effect in BA9. No significant association of AUD with TL and mtDNAcn was detected. Measured TL and DNAmTL showed only small correlations in blood and none in brain. The present study is the first to simultaneously investigate epigenetic clocks, telomere length, and mtDNAcn in postmortem brain and whole blood samples in individuals with AUD. We found evidence for accelerated biological aging in AUD in blood and brain, as measured by Levine's epigenetic clock, and DNAmTL. Additional studies of different tissues from the same individuals are needed to draw valid conclusions about the congruence of biological aging in blood and brain.

Joint effects of substance use disorders and recent substance use on HIV viral non-suppression among people engaged in HIV care in an urban clinic, 2014-2019.

To estimate the joint effects of substance use disorder (SUD) and recent substance use on human immunodeficiency virus (HIV) non-suppression. Retrospective clinical cohort study with repeated observations within individuals. Baltimore, Maryland, United States. 1881 patients contributed 10 794 observations. The primary independent variable was the combination of history of SUD and recent substance use. History of SUD was defined as any prior International Classification of Diseases 9/10 code for cocaine or opioid disorder. Recent substance use was defined as the self-report of cocaine or non-prescribed opioid use on the National Institute of Drug Abuse-modified Alcohol, Smoking and Substance Involvement Screening Test or clinician-documented cocaine or opioid use abstracted from the medical record. The outcome was viral non-suppression, defined as HIV RNA >200 copies/mL on the first viral load measurement within 1year subsequent to each observation of substance use. We adjusted for birth sex, Black race, age, HIV acquisition risk factors, years in care and CD4 cell count. In secondary analyses, we also adjusted for depressive, anxiety and panic symptoms, cannabis use and cannabis use disorder. On their first observation, 31% of patients had a history of an SUD and 18% had recent substance use. Relative to no history of SUD and no recent substance use, the 1-year fully adjusted risk difference (RD) for viral non-suppression associated with cocaine and opioid use disorder and recent substance use was 7.7% (95% CI = 5.3%-10.0%), the RD was 5.5% (95% CI = 1.2%-9.7%) for history of cocaine use disorder without recent substance use, and the RD was 4.6% (95% CI = 2.7%-6.5%) for recent substance use without a SUD. Substance use and substance use disorders appear to be highly prevalent among, and independently associated with, viral non-suppression among people with HIV.

Health Outcomes by Neighborhood (HON): Effects of Neighborhood, Social Instability, and Health Factors on 12-Month Trajectories of Substance-Use Disorder Symptoms

Background Previous studies have shown that environment and health can influence drug use trajectories and the effects of substance use disorder (SUD) treatments. We hypothesized that trajectories of drug use-related problems, based on changes in DSM-5 symptoms, would vary by type(s) of drugs used, health factors, and neighborhood characteristics. Methods We assessed mental and physical health, stress, social instability, neighborhood characteristics (disorderliness and home value), and DSM-5 symptom counts at two study visits, 12 months apart, in a community sample (baseline N = 735) in Baltimore, MD. Three prominent categories of drug-use trajectory were identified with K-means cluster analysis of symptom counts: Persistent (4 or more symptoms at both visits or at Visit 2), Improved (decrease from 4 or more symptoms at Visit 1 to 3 or fewer symptoms at Visit 2), and Low-Stable (3 or fewer symptoms at both visits). Baseline health and neighborhood measures were tested as predictors of trajectory in mediation and moderation models. Results Among people with current opioid- and/or stimulant-use, odds of an Improved trajectory were (1) decreased with neighborhood disorder and social instability, or (2) increased with home value and social instability. Odds of a Low-Stable trajectory were decreased by social instability and stress but increased in those who were older or self-identified as white. Conclusions Trajectories of drug use-related problems are influenced by sociodemographic variables, neighborhood factors, and health. Assessing DSM-5 symptom counts as an outcome measure may be valuable in monitoring or predicting long-term trajectories and treatment effectiveness.

How deep is the cancerous cut of substance use disorders on human rights? The effects of substance use disorders from a human rights perspective: The thinking of Developmental Clinical Social Work

ABSTRACT Developmental Clinical Social Work (DCSW) involves the integration of social development approaches to the prevention, assessment, diagnosis, and treatment of psychological, behavioral, emotional, and medical disorders through social work methods. In doing so, it also covers the predispositions that occur over time in one’s life course. Utilising the thinking of Developmental Clinical Social Work, the paper explores the effects of substance use disorders from a human rights perspective. The human rights to health, adequate housing, food and nutrition, development, clean and healthy environment, occupational health and safety, education, parental and children rights have been discussed considering the effects of substance use disorders. The article stimulates the realization that investment in the prevention of substance use disorders advances for the attainment and enjoyment of the above-mentioned human rights. To its end, the paper contradicts with the notion that the use of drugs is a “human right”. It justifies the need for court sanctioned substance use disorder treatment facilities that are evidence-based and adhere to human rights. It should be noted that this is a conceptual reflection of three academics, two of whom have taught on the advanced substance use and treatment course and one has taught on developmental social work courses.

Effects of substance use disorder on oxidative and antioxidative stress markers: A systematic review and meta-analysis.

Recently, it has been suggested that central and peripheral toxicities identified in persons with substance use disorder (SUD) could be partially associated with an imbalance in reactive oxygen species and antioxidant defenses. We conducted a systematic review and meta-analysis to investigate whether SUD is associated with oxidative stress and to identify biomarkers possibly more affected by this condition. We have included studies that analysed oxidant and antioxidant markers in individuals with SUD caused by stimulants, alcohol, nicotine, opioids, and others (cannabis, inhalants, and polysubstance use). Our analysis showed that persons with SUD show higher oxidant markers and lower antioxidant markers than healthy controls. SUD was associated specifically with higher levels of oxidant markers malondialdehyde, thiobarbituric acid reactive substances and lipid peroxidation. Conversely, the antioxidant superoxide dismutase and the total antioxidant capacity/status were lowered in the SUD group. A meta-regression analysis revealed that persons with alcohol use disorder had higher oxidative stress estimates than those with stimulant use disorder. Moreover, individuals evaluated during abstinence showed smaller antioxidant effect sizes than non-abstinent ones. Our findings suggest a clear oxidative imbalance in persons with SUD, which could lead to cell damage and result in multiple associated comorbidities, particularly accelerated aging.

Telehealth interventions for substance use disorders in low- and- middle income countries: A scoping review.

The increasing prevalence and magnitude of harmful effects of substance use disorders (SUDs) in low- and middle-income countries (LMICs) make it imperative to embrace interventions which are acceptable, feasible, and effective in reducing this burden. Globally, the use of telehealth interventions is increasingly being explored as possible effective approaches in the management of SUDs. Using a scoping review of literature, this article summarizes and evaluates evidence for the acceptability, feasibility, and effectiveness of telehealth interventions for SUDs in LMICs. Searches were conducted in five bibliographic databases: PubMed, Psych INFO, Web of Science, Cumulative Index of Nursing and Allied Professionals and the Cochrane database of systematic review. Studies from LMICs which described a telehealth modality, identified at least one psychoactive substance use among participants, and methods that either compared outcomes using pre- and post-intervention data, treatment versus comparison groups, post-intervention data, behavioral or health outcome, and outcome of either acceptability, feasibility, and/or effectiveness were included. Data is presented in a narrative summary using charts, graphs, and tables. The search produced 39 articles across 14 countries which fulfilled our eligibility criteria over a period of 10 years (2010 to 2020). Research on this topic increased remarkably in the latter five years with the highest number of studies in 2019. The identified studies were heterogeneous in their methods and various telecommunication modalities were used to evaluate substance use disorder, with cigarette smoking as the most assessed. Most studies used quantitative methods. The highest number of included studies were from China and Brazil, and only two studies from Africa assessed telehealth interventions for SUDs. There has been an increasingly significant body of literature which evaluates telehealth interventions for SUDs in LMICs. Overall, telehealth interventions showed promising acceptability, feasibility, and effectiveness for SUDs. This article identifies gaps and strengths and suggests directions for future research.

1.115 The 20-Year Impact of Medical Society Instruments on Overcoming Barriers to Adolescent Substance Use Disorder Treatment

The effects of substance use disorder (SUD) in adolescents are profound, but due to lack of resources, only 10% to 15% of those who require treatment eventually receive care. One obstacle is denial of insurance benefits for a higher level of care. Reasons for denial are often unclear. If a health plan denies a medical service, consumers in California are able to apply for independent medical review (IMR) to pursue overturning the initial denial through the California Department of Managed Health Care (CDMHC).

Substance Use Disorders Are Independently Associated with Hospital Readmission Among Patients with Brain Tumors

Research on the effects of substance use disorders (SUDs) on postoperative outcomes within neurosurgical oncology has been limited. Therefore, the present study sought to quantify the effect of having a SUD on hospital length of stay, postoperative complication incidence, discharge disposition, hospital charges, 90-day readmission rates, and 90-day mortality rates following brain tumor surgery. The present study used data from patients who received surgical resection for brain tumor at a single institution between January 1, 2017, and December 31, 2019. The Mann-Whitney U test was used for bivariate analysis of continuous variables and Fisher exact test was used for bivariate analysis of categorical variables. Multivariate analysis was conducted using logistic regression models. Our study cohort included a total of 2519 patients, 124 (4.9%) of whom had at least 1 SUD. More specifically, 90 (3.6%) patients had an alcohol use disorder, 27 (1.1%) had a cannabis use disorder, and 12 (0.5%) had an opioid use disorder. On bivariate analysis, 90-day hospital readmission was the only postoperative outcome significantly associated with a SUD (odds ratio 2.21, P= 0.0011). When controlling for patient age, sex, race, marital status, insurance, brain tumor diagnosis, 5-factor modified frailty index score, American Society of Anesthesiologists score, and surgery number, SUDs remained significantly and independently associated with 90-day readmission (odds ratio 1.82, P= 0.013). In patients with brain tumor, SUDs significantly and independently predict 90-day hospital readmission after surgery. Targeted management of patients with SUDs before and after surgery can optimize patient outcomes and improve the provision of high-value neurosurgical care.

Hospital Admission Rate, Cumulative Hospitalized Days, and Time to Admission Among Older Persons With Substance Use and Psychiatric Conditions.

BackgroundSubstance use among older persons occurs with medical and psychiatric comorbidities. This study examined the associations of substance use disorder (SUD), psychiatric, and dual diagnoses with 12-month cumulative hospitalized days, hospital admission rate and number of days to first hospitalization.MethodsThe cohort of 3,624 individuals (28.2% women) aged 50 years or older was assessed for substance use severity in 65 Swedish municipalities during March 2003–May 2017. Addiction Severity Index data were linked to hospital discharge records and crime statistics. The outcomes were (a) 12-month cumulative hospitalized days; (b) Hospital admission rate, and (c) days to first hospitalization. Generalized linear regression techniques investigated associations between outcomes and SUD, psychiatric and dual diagnoses at admission.ResultsDuring 2003–2017, 73.5% of the participants were hospitalized. Twelve-month hospitalized days were positively associated with SUD (Incidence rate ratio (IRR) = 1.41, 95%CI: 1.26–1.58), dual diagnosis (IRR = 2.03, 95%CI: 1.74–2.36), and psychiatric diagnoses (IRR = 2.51, 95%CI: 2.09–3.01). Hospital admission rate was positively associated with SUD (IRR = 4.67, 95%CI: 4.28–5.08), dual diagnosis (IRR = 1.83, 95%CI: 1.64–2.04), and psychiatric diagnoses (IRR = 1.73, 95%CI: 1.55–1.92). Days to first hospitalization were negatively associated with SUD (IRR = 0.52, 95%CI: 0.47–0.58), dual diagnosis (IRR = 0.57, 95%CI: 0.50–0.65), and psychiatric diagnoses (IRR = 0.83, 95%CI: 0.73–0.93). The marginal effects of SUD and/or mental disorders increased with age for all outcomes, except for days to first hospitalization.ConclusionThree of four older persons assessed for substance use severity were later hospitalized. Substance use disorders, dual diagnoses and other mental disorders were the primary reasons for hospitalization and were associated with longer stays, earlier hospitalization, and repeated admissions. Sensitizing service providers to old age substance use and sharing data across the care continuum could provide multiple points of contact to reduce the risk of hospitalizations among older persons with problematic substance use.

Effects of Substance Use Disorder on In-Hospital Outcomes of Young Patients Presenting With a Cardiovascular Event: A Nationwide Analysis.

BackgroundSubstance use is widely prevalent among young adults and is associated with increased cardiovascular morbidity and mortality such as sudden cardiac arrest, acute coronary syndrome, arrhythmias, and cardiomyopathy. However, they are limited studies analyzing the impact of substance use disorder on in-hospital outcomes among young patients with cardiovascular events.MethodsAll patients aged 18-39 years admitted primarily for major cardiovascular events including acute myocardial infarction (AMI), arrhythmia, cardiac arrest, acute ischemic stroke, and venous thromboembolic events in 2019 were identified in the National Inpatient Sample database. They were then categorized into those with and without concomitant substance use disorder (SUD). The primary outcome was in-hospital mortality. Unadjusted and adjusted analysis was performed on appropriate variables of interest.ResultsOf 57,985 hospitalizations with cardiac events, 12,115 (20%) of young adults had concomitant SUD. SUD was significantly associated with cardiac arrest (OR 3.3; CI 2.4-4.4), atrial fibrillation (OR 1.5; CI 1.3-1.7), AMI (OR 1.3; CI 1.2-1.6), heart failure (OR 2.6; CI 2.4-3.0) (all p<0.05) despite a lower prevalence of traditional cardiovascular risk factors than non-users. Logistic regression showed acute kidney injury (aOR 1.5; CI 1.3-1.8; p<0.001) and inpatient mortality (aOR 1.6; CI 1.2-2.2; p<0.001) were also significantly higher in young patients presenting with cardiac events and concomitant SUD. There was no difference in the length of stay or incidence of gastrointestinal bleed between the two groups.ConclusionIn young patients presenting with a cardiovascular event, concurrent substance use disorder was associated with increased in-hospital mortality despite significantly lower comorbidities.

Outcomes of Infrainguinal Bypass in Patients with Cannabis vs Opioid Use Disorder

Marijuana and opioids are commonly used illicit drugs in the United States and their use continues to rise. Cannabis use disorder (CUD) and Opioid use disorder (OUD) are associated with adverse effects on public health and postoperative outcomes. However, their impact on vascular surgery, specifically infrainguinal bypass repair (IIB). is not well described in the literature. Therefore, our study aimed to assess perioperative outcomes in patients with CUD and OUD who underwent IIB. A retrospective analysis of the National Inpatient Sample database for the years 2005 to 2018 was performed. Using the International Classification of Diseases Clinical Modification, Ninth and Tenth revisions, patients who were diagnosed with peripheral artery disease and underwent IIB repair.were identified. Our primary outcome was the comparison of rates of in-hospital complications between the groups, and the secondary outcomes included analysis of total hospital charges and length of stay. A 1:1 propensity score matching (PSM) CUD and OUD patients to their control groups without the disease was conducted using the nearest-neighbor method. The matching was based on select patient demographics and comorbidities included in our analyses. A total of 190,794 patients were identified: 972 patients with CUD and 682 patients with OUD. In the matched cohorts, patients with a diagnosis of CUD had a higher incidence of in-hospital cardiac complications (adjusted Odds Ratio [aOR], 1.76; 95% Confidence Interval [CI], 0.99-3.12) and acute kidney injury (AKI) (aOR, 1.51; CI, 1.09-2.08). Additionally, total hospital charges and mean length of stay were higher in the CUD group (P < 0.001). Those with OUD had a higher incidence of postoperative respiratory complications (aOR, 1.92; CI, 1.23-2.99), sepsis (aOR, 2.39; CI, 1.32-4.34), infection (aOR, 3.55; CI, 1.16-10.84), AKI (aOR, 2.11; CI,1.47-3.04), major amputations (aOR, 1.69; CI, 1.07-2.69), along with higher total charges and mean length of stay (P < 0.001). Both CUD and OUD have increased incidence of postoperative complications following IIB. The OUD group had generally worse outcomes compared to patients with CUD. Both were associated with a substantial increase in total hospital charges and length of hospital stay. A further prospective study is warranted to provide better insight on the effects of substance use disorders on the procedure's short- and long-term outcomes.

Effects of substance misuse and current family history of substance use disorder on brain structure in adolescents and young adults with attention-deficit/hyperactivity disorder

BackgroundAlterations in brain structure in attention-deficit/hyperactivity disorder (ADHD) show considerable overlap with those observed in substance use disorder (SUD). These overlapping structural alterations in ADHD and SUD might be explained by family history (FH-trait) effects of SUD, and/or substance misuse (state) effects. Our aim was to investigate effects of 1) current parental SUD (SUD-FH) and 2) recent substance misuse (SM) on brain structure in a cohort of ADHD patients and controls. DesignCortical thickness and subcortical volumes were measured using structural MRI. We compared ADHD subjects and controls with or without SUD-FH (aim 1) and additionally explored differences between SUD-FH- and SUD-FH + subjects with one versus two parents with SUD. We also compared ADHD groups with and without SM (ADHD + SM and ADHD-only, respectively) and controls (aim 2). FindingsThere was no association between SUD-FH and brain structure. Exploratory analysis on SUD-FH showed decreased IFG thickness (p = 0.032) and nucleus accumbens (NAcc) volume (p = 0.017) in subjects with two versus one SUD parent, regardless of ADHD. ADHD + SM showed decreased inferior frontal gyrus (IFG) thickness compared to controls (pars opercularis p = 0.025, pars orbitalis p = 0.010, pars triangularis p = 0.049), while no difference was found between ADHD-only and either ADHD + SM or controls. ConclusionsDespite negative findings in the primary trait-analysis, exploratory trait-analysis on SUD-FH loading suggested potential SUD trait-effects on IFG thickness and NAcc volume. Substance misuse state effects in ADHD were linked to lower IFG thickness. Future studies should confirm these findings and investigate their clinical relevance, including the functional consequences of decreased IFG thickness.

Substance use disorders and adherence to antituberculosis medications in Southwest Ethiopia: a prospective cohort study

ObjectivesIn Ethiopia, little is known about the association between substance use disorders and adherence to antituberculosis (anti-TB) medications. Therefore, the objective of this study was to assess the effect of...

Effects of Substance Use Disorder on Women's Roles and Occupational Participation

Authors: Rawat,H ;Petzer, S.L. ;Gurayah,T. Ethical Clearance Number: HSS/0199/018H Affiliation: School of Health Sciences, University of Kwa-Zulu Natal Introduction: Literature regarding the psychosocial sequelae of substance abuse is largely androcentric and limited regarding the negative effects on women’s functioning. This study aims to explore the effects of substance abuse on the roles and occupations of women. Methods: This phenomenological qualitative study utilized a purposive snowball sampling strategy to recruit women with a history of substance abuse. Semi-structured interviews were conducted with six participants. Findings: Six main themes emerged. The themes alluded to the participants’ neglect of self-care, sleep, and IADL (instrumental activities of daily living) responsibilities. They were socially isolated, and their work lives suffered because of their substance abuse. Conclusion: The study concluded that substance abuse negatively affects a woman’s ability to engage in her daily occupations and unique roles. Inadequate self-care, debt, neglect of child-rearing roles and work underperformance were some consequences of their abuse. However, it was found that the adoption of new roles associated with advocacy and altruism facilitated the recovery process. The findings can be used to create gender specific interventions for women with substance use disorders.

Unraveling neuroHIV in the Presence of Substance Use Disorders.

This special issue contains 10 invited review papers that highlighted and extended the presentations at the NIDA-sponsored workshop "Unraveling NeuroAIDS in the Presence of Substance Use Disorders" at the 25th Society on NeuroImmune Pharmacology conference in 2019. The topics covered by these papers focused on the interactive, additive or synergistic effects of substance use disorders (SUD) with HIV infection on the immune system and onneuropathogenesis. These papers reviewed four categories of substances of abuse (opioids, tobacco, stimulants, and cannabis) and how comorbid HIV infection (including models with HIV proteins, HIV transgenic rodent models and SIV) might further impact the dysregulated dopaminergic and immune systems, and the subsequent neuropathogenesis and behavioral disorders known as HIV-associated neurological disorders (HAND). These reviews provided detailed background knowledge regarding how each of theseaddictive substances and HIV individually or collectively affected the immune system at the cellular, molecular and system levels, and the subsequent clinical and behavioral outcomes. The authors also identified gaps, confounds or constraints in the current disease models and approaches, and proposed future research directions.

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

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

Khat and Alcohol Use Disorders Predict Poorer Adherence to Anti-Tuberculosis Medications in Southwest Ethiopia: A Prospective Cohort Study

Introduction: Tuberculosis is one of the infectious diseases causing public health crisis in low income countries and it remained among the top ten causes of mortality. Non-adherence to anti tuberculosis (anti-TB) medication greatly contributes to the rise in multi-drug resistance tuberculosis which is associated with high rates of mortality. Substance use is frequently seen among patients with poor adherence, however, little is known about the effect of substance use on adherence to anti-TB medications in Ethiopia. Therefore, we aimed to assess the effect of substance use disorders on adherence to anti-TB medications in Southwest Ethiopia. Methods: A prospective cohort study was conducted among 268 patients with tuberculosis attending services at 26 health institutions in Southwest Ethiopia between October 2017 and October 2018. A structured questionnaire translated to local language was used to assess substance use disorders, adherence and other potential risk factors for non-adherence. Patients were followed for six months and data were collected on three occasions during the follow-up. Generalized linear mixed model was used to identify the effect of substance use disorder on adherence to anti-TB medications. The model fitting was checked using Bayesian Information Criterion (BIC) while the covariate selection was based on a directed acyclic graph (DAG). Results: The overall prevalence of non-adherence among patients with substance use disorders was 16⋅4% (n=22), 41⋅7 % (n=48), and 45⋅7% (n=59) at baseline, two month, and six month respectively. The odds of non-adherence to anti-TB medications among patients with khat use disorder was nearly four times that of patients who did not use khat (aOR 3⋅8, 95%CI=1⋅8-8⋅0). Also patients who have alcohol use disorder were 3⋅2 times likely to have poor adherence compared to their counterparts (aOR=3⋅2, 95%CI=1⋅6-6⋅6). In addition, being educated (aOR =4⋅4, 95%CI=1⋅7-11⋅3), and being merchant (aOR=6⋅1, 95%CI=1⋅2-3⋅0) were associated with non-adherence to anti-TB medications. Interpretation: Khat and alcohol use disorders predict greater likelihood of non-adherence to anti-TB medication. This implies that there is a need to integrate management for substance use disorders into the existing tuberculosis treatment services. Funding Statement: Jimma University and IPPG. Declaration of Interests: All authors declare that they have no conflict of interests. Ethics Approval Statement: Ethical clearance was obtained from the Ethical Review Board of Jimma University (IHRPGC1095/2017) and LMU (Nr: 18-017). The study was discussed in detail and written informed consent was obtained from each participants. The anonymity of the study participants was kept at all stages of data processing and write-up of the manuscript.