International Diagnostic Interview-Substance Abuse Module Research Articles

Prevalence of Cannabis Use Disorder and Reasons for Use Among Adults in a US State Where Recreational Cannabis Use Is Legal.

Medical and nonmedical cannabis use and cannabis use disorders (CUD) have increased with increasing cannabis legalization. However, the prevalence of CUD among primary care patients who use cannabis for medical or nonmedical reasons is unknown for patients in states with legal recreational use. To estimate the prevalence and severity of CUD among patients who report medical use only, nonmedical use only, and both reasons for cannabis use in a state with legal recreational use. This cross-sectional survey study took place at an integrated health system in Washington State. Among 108 950 adult patients who completed routine cannabis screening from March 2019 to September 2019, 5000 were selected for a confidential cannabis survey using stratified random sampling for frequency of past-year cannabis use and race and ethnicity. Among 1688 respondents, 1463 reporting past 30-day cannabis use were included in the study. Patient survey-reported reason for cannabis use in the past 30 days: medical use only, nonmedical use only, and both reasons. Patient responses to the Composite International Diagnostic Interview-Substance Abuse Module for CUD, corresponding to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition CUD severity (0-11 symptoms) were categorized as any CUD (≥2 symptoms) and moderate to severe CUD (≥4 symptoms). Adjusted analyses were weighted for survey stratification and nonresponse for primary care population estimates and compared prevalence of CUD across reasons for cannabis use. Of 1463 included primary care patients (weighted mean [SD] age, 47.4 [16.8] years; 748 [weighted proportion, 61.9%] female) who used cannabis, 42.4% (95% CI, 31.2%-54.3%) reported medical use only, 25.1% (95% CI, 17.8%-34.2%) nonmedical use only, and 32.5% (95% CI, 25.3%-40.8%) both reasons for use. The prevalence of CUD was 21.3% (95% CI, 15.4%-28.6%) and did not vary across groups. The prevalence of moderate to severe CUD was 6.5% (95% CI, 5.0%-8.6%) and differed across groups: 1.3% (95% CI, 0.0%-2.8%) for medical use, 7.2% (95% CI, 3.9%-10.4%) for nonmedical use, and 7.5% (95% CI, 5.7%-9.4%) for both reasons for use (P = .01). In this cross-sectional study of primary care patients in a state with legal recreational cannabis use, CUD was common among patients who used cannabis. Moderate to severe CUD was more prevalent among patients who reported any nonmedical use. These results underscore the importance of assessing patient cannabis use and CUD symptoms in medical settings.

Validity of the Single-Item Screen–Cannabis (SIS-C) for Cannabis Use Disorder Screening in Routine Care

Cannabis use is prevalent and increasing, and frequent use intensifies the risk of cannabis use disorder (CUD). CUD is underrecognized in medical settings, but a validated single-item cannabis screen could increase recognition. To evaluate the Single-Item Screen-Cannabis (SIS-C), administered and documented in routine primary care, compared with a confidential reference standard measure of CUD. This diagnostic study included a sample of adult patients who completed routine cannabis screening between January 28 and September 12, 2019, and were randomly selected for a confidential survey about cannabis use. Random sampling was stratified by frequency of past-year use and race and ethnicity. The study was conducted at an integrated health system in Washington state, where adult cannabis use is legal. Data were analyzed from May 2021 to March 2022. The SIS-C asks about frequency of past-year cannabis use with responses (none, less than monthly, monthly, weekly, daily or almost daily) documented in patients' medical records. The Diagnostic and Statistical Manual, Fifth Edition (DSM-5) Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM) for past-year CUD was completed on a confidential survey and considered the reference standard. The SIS-C was compared with 2 or more criteria on the CIDI-SAM, consistent with CUD. All analyses were weighted, accounting for survey design and nonresponse, to obtain estimates representative of the health system primary care population. Of 5000 sampled adult patients, 1688 responded to the cannabis survey (34% response rate). Patients were predominantly middle-aged (weighted mean [SD] age, 50.7 [18.1]), female or women (weighted proportion [SE], 55.9% [4.1]), non-Hispanic (weighted proportion [SE], 96.7% [1.0]), and White (weighted proportion [SE], 74.2% [3.7]). Approximately 6.6% of patients met criteria for past-year CUD. The SIS-C had an area under receiver operating characteristic curve of 0.89 (95% CI, 0.78-0.96) for identifying CUD. A threshold of less than monthly cannabis use balanced sensitivity (0.88) and specificity (0.83) for detecting CUD. In populations with a 6% prevalence of CUD, predictive values of a positive screen ranged from 17% to 34%, while predictive values of a negative screen ranged from 97% to 100%. In this diagnostic study, the SIS-C had excellent performance characteristics in routine care as a screen for CUD. While high negative predictive values suggest that the SIS-C accurately identifies patients without CUD, low positive predictive values indicate a need for further diagnostic assessment following positive results when screening for CUD in primary care.

Screening in Trauma for Opioid Misuse Prevention (STOMP): Results from a prospective cohort of victims of traumatic injury

BackgroundTraumatic injury frequently requires opioid analgesia to manage pain and avoid catastrophic complications. Risk screening for opioid misuse and the development of use disorder remains uninvestigated. MethodsParticipants were Trauma/Orthopedic Surgical Services patients at a Level I Trauma Center who were English speaking, aged 18–75, received an opioids prescription at discharge, and were under control of their own medications at discharge. Baseline measures included validated self-report instruments for psychosocial factors, such as anxiety, depression, pain coping, and social support. Health record data included diagnosis codes, procedures, Injury Severity Score, and pain severity (0–10 scale). Opioid use disorder (by Clinical International Diagnostic Interview-Substance Abuse Module) or opioid misuse (Current Opioid Misuse Measure (COMM) and survey items) were assessed at 24 weeks post-discharge. Results295 patients enrolled with 237 completing the 24 week assessments. Stepwise regression modeling demonstrated pre-injury PTSD symptoms, Opioid Risk score, medication use behaviors, social support, and length of stay predicted opioid misuse. Pre-injury PTSD symptoms, pain coping, and length of stay predicted use disorder. The final regression models for opioid misuse by COMM, opioid misuse via survey items, and for opioid use disorder had highly favorable areas under the receiver operating curve (0.880, 0.790, and 0.943 respectively). ConclusionsPre-injury presence of PTSD-related symptoms, impaired pain coping, social support, and hospitalization > 6 days predicted opioid misuse and opioid addiction at 6 months after hospital discharge. Behavioral screening and management strategies appear warranted in the population of traumatic injury victims to reduce opioid-related risks.

A Longitudinal Study of Suicidality in a Homeless Population Sample

Objective Little research has been conducted on the timing of the onset and course of suicidality relative to the timing of the onset and temporal status of homelessness. Therefore, this longitudinal study investigated suicidal ideation and plans and suicide attempts in a homeless population in relation to housing attainment, psychiatric disorders, and substance use/disorders. Method Prospective longitudinal follow-up data were collected from a representative sample of literally homeless adults in St. Louis (N = 255) using the Diagnostic Interview Schedule/Homeless Supplement, the Composite International Diagnostic Interview-Substance Abuse Module, and urine drug screens. Associations among suicidal symptom variables, housing status, psychiatric/substance use disorders, and substance use were examined at baseline and longitudinally. Results Lifetime prevalence of suicidal ideation/plan and suicide attempts in this homeless population were much higher than in the general population. Onset of suicidal symptoms had typically preceded onset of homelessness. Few individuals experienced suicidal ideation/plans or attempted suicide during this study, and even fewer experienced new suicidal symptoms after baseline. Securing stable housing during the study follow-up was associated with lower rates of suicidal ideation/plans. Conclusions This study’s findings contradict assumptions that the high prevalence of suicidal symptoms in homeless populations can be explained by the difficulties and miseries of homelessness. Psychiatric illness, substance abuse, and psychosocial factors associated with homelessness may be direct contributors to suicidal symptoms and thus represent strategic intervention targets. HIGHLIGHTS Most suicidality reported at baseline first emerged long before first homelessness After baseline, few reported new suicidal symptoms or had active suicidal symptoms Significantly fewer reports of suicidal ideation/plans over time were found in those with the most stable housing outcome

Orbitofrontal cortex thickness and substance use disorders in emerging adulthood: causal inferences from a co-twin control/discordant twin study.

Research linking orbitofrontal cortex (OFC) structure and substance use disorders (SUDs) is largely correlational and often implies a causal effect of addiction/substance exposure on the brain, but familial risk factors (e.g. genetic liability) may confound these associations. We tested whether associations between alcohol, cannabis and tobacco use disorders and OFC thickness reflected the potential causal effects of familial risk or SUDs-related consequences (e.g. substance exposure). A co-twin control/discordant twin design separated familial risk confounding from SUD-related consequences. A population-based sample of 436 24-year-old twins (62% monozygotic) from the Minnesota Twin Family Study, USA. Alcohol, cannabis and tobacco use disorders were assessed using the Composite International Diagnostic Interview-Substance Abuse Module. Cortical thickness of the medial and lateral OFC (mOFC and lOFC, respectively) was assessed using magnetic resonance imaging (MRI). Lower mOFC (P-values ≤0.006) but not lOFC (P-values ≥0.190) thickness was observed in diagnosed individuals (n=185) relative to non-SUD controls (n=251). Co-twin control analyses offered evidence that mOFC associations were consistent with familial risk across SUDs (between-pair effect: P-values ≤0.047) and the independent consequences of having an alcohol or cannabis use disorder (within-pair effect: P-values ≤ 0.024). That is, within alcohol/cannabis discordant twin pairs, affected twins had significantly lower mOFC thickness compared with their unaffected co-twins. A confounder-adjusted analysis of the Minnesota Twin Family Study appeared to indicate that, beyond a substance use disorders general familial risk effect, the experience of an alcohol or cannabis use disorder in emerging adulthood reduces the thickness of the medial orbitofrontal cortex, a region associated with value-guided decision-making.

Prevalence of Nonmedical Use of Prescription Opioids and Association With Co-occurring Substance Use Disorders Among Adolescents in Substance Use Treatment

PurposeWe sought to describe the prevalence of the nonmedical use of prescription opioids (NMUPO) and its association with co-occurring substance use disorders in a sample of adolescents in substance treatment. MethodsAdolescents in two substance treatment programs were recruited for participation between 2009 and 2013. The Composite International Diagnostic Interview—Substance Abuse Module (CIDI-SAM) was administered to assess substance use patterns and lifetime abuse or dependence. ResultsA total of 378 adolescents completed the CIDI-SAM (mean age 16.1 [standard deviation = 1.1], 78% male, 50% white, non-Hispanic). Of the 378 adolescents, 62 (16.4%) reported NMUPO and 59 (15.6%) were diagnosed with opioid/heroin abuse or dependence. The mean age at first NMUPO was 14.3 (standard deviation = 1.4). NMUPO was associated with a 3.31-fold (95% confidence interval: 2.83–3.79) increase in having three or more co-occurring substance use diagnoses. ConclusionsNMUPO is quite prevalent among adolescents in substance use treatment. Intervention to interrupt NMUPO from progressing to heroin use or developing into a disorder is critical.

An electronic screen for triaging adolescent substance use by risk levels.

Screening adolescents for substance use and intervening immediately can reduce the burden of addiction and substance-related morbidity. Several screening tools have been developed to identify problem substance use for adolescents, but none have been calibrated to triage adolescents into clinically relevant risk categories to guide interventions. To describe the psychometric properties of an electronic screen and brief assessment tool that triages adolescents into 4 actionable categories regarding their experience with nontobacco substance use. Adolescent patients (age range, 12-17 years) arriving for routine medical care at 2 outpatient primary care centers and 1 outpatient center for substance use treatment at a pediatric hospital completed an electronic screening tool from June 1, 2012, through March 31, 2013, that consisted of a question on the frequency of using 8 types of drugs in the past year (Screening to Brief Intervention). Additional questions assessed severity of any past-year substance use. Patients completed a structured diagnostic interview (Composite International Diagnostic Interview-Substance Abuse Module), yielding Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) substance use diagnoses. For the entire screen and the Screening to Brief Intervention, sensitivity and specificity for identifying nontobacco substance use, substance use disorders, severe substance use disorders, and tobacco dependence were calculated using the Composite International Diagnostic Interview-Substance Abuse Module as the criterion standard. Of 340 patients invited to participate, 216 (63.5%) enrolled in the study. Sensitivity and specificity were 100% and 84% (95% CI, 76%-89%) for identifying nontobacco substance use, 90% (95% CI, 77%-96%) and 94% (95% CI, 89%-96%) for substance use disorders, 100% and 94% (95% CI, 90%-96%) for severe substance use disorders, and 75% (95% CI, 52%-89%) and 98% (95% CI, 95%-100%) for nicotine dependence. No significant differences were found in sensitivity or specificity between the full tool and the Screening to Brief Intervention. A single screening question assessing past-year frequency use for 8 commonly misused categories of substances appears to be a valid method for discriminating among clinically relevant risk categories of adolescent substance use.

Problem Gambling and Homelessness: Results from an Epidemiologic Study

The purpose of this study was to investigate the prevalence of gambling disorder and comorbid psychiatric disorders in a homeless population and identify features related to potential subtypes. At baseline, participants were administered a structured interview including socio-demographic sections of the National Comorbidity Study (NCS) interview; seven diagnostic sections of the Diagnostic Interview Schedule (DIS); the alcohol and drug abuse sections of the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM); and the Homeless Supplement to the DIS. At nine months post-baseline assessment, participants were administered additional NCS family history questions and the South Oaks Gambling Screen (SOGS). Participants were an epidemiologic sample of 275 predominately African-American homeless individuals, grouped as lifetime non-gamblers (n = 60), recreational gamblers (n = 152), and problem gamblers (n = 63), recruited on the street and through homeless shelters. Results indicate that lifetime rates of sub-clinical problem (46.2%) and disordered (12.0%) gambling were significantly higher than in the general population. Problem gamblers were more likely than non-problem gamblers to meet diagnostic criteria for antisocial personality disorder, post-traumatic stress disorder, bipolar disorder, and any psychiatric disorder, and more likely than non-gamblers to use illicit drugs or meet criteria for abuse/dependence for nicotine, alcohol, or any substance. This study provides evidence that problem gambling is a significant public health issue among the African-American homeless population. Homeless services should include assessment for problem gambling along with psychiatric disorders and referrals to resources and treatment programs. Future studies should explore the relationship of the onset and course of problem gambling and other psychiatric disorders with homelessness as well as racial differences in gambling patterns and problem severity over time.

Comparing Alcohol Screening Measures Among HIV‐Infected and ‐Uninfected Men

Brief measures of unhealthy alcohol use have not been well validated among people with HIV. We compared the Alcohol Use Disorders Identification Test (AUDIT) to reference standards for unhealthy alcohol use based on 30-day Timeline Follow Back (TLFB) and Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM), among 837 male HIV-infected and -uninfected patients in the Veterans Aging Cohort Study. Three reference standards were (i) Risky drinking-based on TLFB >14 drinks over 7 consecutive days or >4 drinks on 1 day; (ii) Alcohol dependence-based on a CIDI-SAM diagnosis; and (iii) Unhealthy alcohol use-risky drinking or a CIDI-SAM diagnosis of abuse or dependence. Various cutoffs for the AUDIT, AUDIT-C, and heavy episodic drinking were compared with the reference standards. Mean age of patients was 52 years, 53% (444) were HIV-infected, and 53% (444) were African American. Among HIV-infected and -uninfected patients, the prevalence of risky drinking (14 vs. 12%, respectively), alcohol dependence (8 vs. 7%), and unhealthy alcohol use (22 vs. 20%) was similar. For risky drinking and alcohol dependence, multiple cutoffs of AUDIT, AUDIT-C, and heavy episodic drinking provided good sensitivity (≥80%) and specificity (≥90%). For unhealthy alcohol use, few cutoffs provided sensitivity ≥80%; however, many cutoffs provided good specificity. For all 3 alcohol screening measures, sensitivity improved when heavy episodic drinking was included with the cutoff. Sensitivity of measures for risky drinking and unhealthy alcohol use was lower in HIV-infected than in uninfected patients. For identifying risky drinking, alcohol dependence, and unhealthy alcohol use, AUDIT-C performs as well as AUDIT and similarly in HIV-infected and -uninfected patients. Cutoffs should be based on the importance of specific operating characteristics for the intended research or clinical use. Incorporating heavy episodic drinking increased sensitivity for detecting alcohol dependence and unhealthy alcohol use.

Drinking Correlates of DSM-IV Alcohol Use Disorder Diagnostic Orphans in College Students

One major limitation of the DSM-IV criteria for alcohol abuse and dependence is that a cluster of individuals who endorse a subthreshold number of dependence criteria and no abuse criteria do not receive a formal diagnosis; despite elevated risk for alcohol-related problems relative to those with an abuse diagnosis. These individuals have been referred to as diagnostic orphans. The primary aim of this study was to examine alcohol use correlates of a group of diagnostic orphans in a sample of 396 nontreatment seeking college students who reported drinking on at least one occasion in the last 90 days. DSM-IV criteria were assessed using a modified version of the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM). Diagnostic orphans represented 34.1% (n = 135) of the original sample who did not receive a formal diagnosis; with the most frequently endorsed dependence criteria being tolerance and drinking larger/longer amounts than intended. Diagnostic orphans reported a range of alcohol-related negative consequences and reported greater frequencies of social and enhancement drinking motives in comparison to coping motives. They were similar to alcohol abusers and dissimilar to those with dependence or those without a diagnosis on alcohol consumption, alcohol problem severity, drinking motives and restraint variables. The present findings indicate that diagnostic orphans in college students represent a distinct group of drinkers who may be at risk for the development of alcohol use disorders and may be in need of intervention, given their similarity to those with an abuse diagnosis. Prevention and intervention efforts across college campuses should target this group to prevent escalation of alcohol problem severity.

Genetic etiology of the common liability to drug dependence: Evidence of common and specific mechanisms for DSM-IV dependence symptoms

BackgroundWe investigated the etiological nature of comorbid alcohol, tobacco, and cannabis DSM-IV dependence symptoms in late adolescence and young adulthood while accounting for gender differences in the magnitude of genetic and environmental influences. MethodsUnivariate and multivariate twin modeling was used to determine the heritability of each substance and the etiology of multiple drug problems in a sample of 2484 registrants of the Center for Antisocial Drug Dependence who provided data at the second wave of an ongoing longitudinal study. We report on mean and prevalence levels of whole-life DSM-IV dependence symptoms that were assessed with the Composite International Diagnostic Interview-Substance Abuse Module. Biometrical analyses were limited to age-adjusted DSM-IV dependence symptom counts from a subset of twins that reported using alcohol, tobacco, or cannabis in their lifetime. ResultsMale and female alcohol, tobacco, and cannabis DSM-IV symptoms are indicators of a heritable unidimensional latent continuous trait. Additive genetic factors explain more than 60% of the common liability to drug dependence. A larger proportion of the variation in each substance is attributable to substance-specific genetic and environmental factors. ConclusionsThese data suggest that both common and substance-specific genetic and environmental factors contribute to individual differences in the levels of DSM-IV alcohol, tobacco, and cannabis dependence symptoms.

Shared Decision-Making: Increases Autonomy in Substance-Dependent Patients

This study examines the effect of a shared decision-making intervention (SDMI) on patients’ and clinicians’ self-perceived interpersonal behavior. Clinicians (n = 34) in three addiction treatment centers in the Netherlands were randomly assigned to SDMI or treatment decision-making as usual. Patients receiving inpatient treatment in 2005–2006 were included (n = 212). Baseline characteristics were measured by the European Addiction Severity Index (EuropASI) and the Composite International Diagnostic Interview—Substance Abuse Module (CIDI-SAM). Treatment goals were assessed using the Goals of Treatment Questionnaire (GoT-Q) plus a Q-sort ranking procedure. Interpersonal behavior was measured by Interpersonal Checklist—Revised (ICL-R) at baseline, end of treatment, and 3-month follow-up. Repeated measures analyses of variance and multiple hierarchical linear regression analysis were used. The key finding of this study was that SDMI is associated with an increase of patient autonomy (independent behavior) and control behavior. The study limitations have been noted.

The Moderating Effect of Religiosity on the Genetic Variance of Problem Alcohol Use

Previous studies have demonstrated that the heritability of alcohol-related phenotypes depends upon the social background in which it is measured (e.g., urbanicity, marital status, and religiosity). The aim of the current study was to identify whether religiosity moderated the genetic variance of problem alcohol use in men and women at two time points: adolescence and early adulthood. Participants were 312 male MZ pairs, 379 female MZ pairs, 231 male DZ pairs, 235 female DZ pairs, and 275 opposite sex DZ pairs participating in the University of Colorado Center on Antisocial Drug Dependence. Religiosity was measured using the Value on Religion Scale (Jessor and Jessor, 1977), and problem alcohol use was measured using the Composite International Diagnostic Interview-Substance Abuse Module (Cottler et al., 1989). Data were analyzed using a model-fitting approach to the twin data. In adolescence, genetic variance of problem alcohol use decreased significantly with increasing levels of religiosity in both men and women, whereas in early adulthood, religiosity did not moderate the genetic variance of problem alcohol use in either men or women. Religiosity appears to moderate the genetic effects on problem alcohol use during adolescence, but not during early adulthood. The reduced genetic variance for problem alcohol use in adolescence may be the consequence of greater social control in adolescence than in young adulthood.

Screening for Alcohol Misuse and Alcohol-Related Behaviors Among Combat Veterans

Screening for Alcohol Misuse and Alcohol-Related Behaviors Among Combat Veterans

Subjective effects to marijuana associated with marijuana use in community and clinical subjects

Introduction Marijuana is the most commonly used illicit drug among adolescents. Marijuana use induces both psychological and physiological responses, which can be interpreted by an individual in a variety of ways (i.e. subjective effects). We have examined subjective effects in adolescent, young adult community, and clinical populations to determine how patterns of use may be predicted by an individual's subjective experiences with the drug. Method Participants were community and clinical sample subjects drawn from the Colorado Center of Antisocial Drug Dependence (CADD) and a sample of adjudicated youth from the Denver metropolitan area (aged 11–30). They were evaluated with the Composite International Diagnostic Interview—Substance Abuse Module (CIDI-SAM) and the Lyons battery for subjective effects. Scales for subjective effects were created using Mokken scale analysis. Multivariate linear and logistic regression was used to examine associations between the subjective scales and marijuana outcomes. Results Mokken scaling revealed two subjective effects scales, positive and negative. Both scales were significantly positively associated with marijuana abuse or dependence in both the community and clinical sample and regular use in the community sample. The negative scale was negatively associated with past six-month use in the community sample ( p < 0.05) and clinical sample, after controlling for age and gender effects. Conclusions These findings suggest that diverse subjective experiences with marijuana can be ordered hierarchically and that the resulting short scales can be used in either clinical or community settings. Further, they suggest that the potential for marijuana use problems is related to the type of subjective experience from marijuana exposure.

The Alcohol Use Disorders Identification Test (AUDIT) as a screening instrument for adolescents

Background The Alcohol Use Disorders Identification Test (AUDIT) is an international screening instrument extensively employed in adult target groups. However, there is scarce information on screening with the AUDIT in adolescent populations. The purpose of this study was to determine the cut-off point for hazardous, harmful, and dependent alcohol use through the validation of the AUDIT in a Chilean adolescent sample. Methods The original English version of the AUDIT was translated into Spanish, using the procedure recommended by the World Health Organization. The text was then back-translated and sent to one of the original authors (Thomas Babor), who approved the translation. Students attending public schools in Santiago, Chile, self-administered the AUDIT, and those older than 15 years completed the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM), which served as a gold standard. Between 1 and 4 weeks after the CIDI-SAM, participants answered a second AUDIT. Results A total of 42 female and 53 male adolescents (mean age: 15.9 [SD = 1.2]) completed the AUDIT, with a mean score of 4.3. Reliability according to Cronbach's alpha was 0.83. Test–retest correlation was also satisfactory (intra-class correlation 0.81 [95% CI 0.73–0.87]). Analysis of the receiver operating characteristic (ROC) curve yielded cut-off points for hazardous, harmful, and dependent alcohol use of 3, 5, and 7 points, respectively. Conclusions The Chilean version of the AUDIT is a valid and reliable tool for identifying adolescents with hazardous, harmful, and dependent alcohol use. The suggested cut-off points make screening with the AUDIT more accurate for adolescent populations.

The role of conduct disorder in explaining the comorbidity between alcohol and illicit drug dependence in adolescence

Background Conduct disorder (CD), alcohol dependence (AD), and illicit drug dependence (IDD) frequently co-occur. This paper describes the result of an investigation of the extent to which comorbid alcohol and illicit drug dependence in adolescents are explained by etiological factors in common with conduct disorder. Methods Participants were 645 MZ twin pairs, 702 DZ twin pairs, 429 biological sibling pairs, and 96 adoptive sibling pairs, aged 12–18 years, from a community based sample. Conduct disorder was measured using the Diagnostic Interview Schedule for Children-IV. Alcohol and illicit drug dependence were assessed using the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM). For each outcome, subjects were categorized into those with no symptoms, those with one or more symptoms but no diagnosis, and those with a diagnosis. Results The heritability estimates for CD, AD, and IDD were 58, 66, and 36%, respectively. The genetic correlation between AD and IDD was partially explained by the genetic risk they both share with conduct disorder. Conclusions We conclude that conduct disorder in adolescents explains, in part, the co-occurrence of alcohol and illicit drug dependence. Specifically, the genetic contribution to their covariation is explained partially by the genetic contribution in common with conduct disorder.

Symptom Endorsement of Alcohol and Other Substance Abuse and Dependence Criteria Among American-Indian Adolescents in Residential Substance Abuse Treatment

Objective. This study addresses the prevalence of DSM-IV substance abuse and dependence and the endorsement of specific symptoms of these disorders among American-Indian adolescents admitted to a residential substance abuse treatment program. Method. We interviewed 89 American Indian adolescents using the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM). Results. The most frequent diagnoses included marijuana dependence (51.7%), followed by alcohol abuse and dependence (33.7% each) and marijuana abuse (32.6%). Among the three substances with the highest prevalence of any use disorder (alcohol, marijuana, and stimulants), the most frequently endorsed abuse criterion was Impaired Role Obligations. The two most frequently endorsed dependence criteria were Use Despite Substance-Related Psychological/Physical Problems and Unsuccessful Attempts to Quit/Cut down on substance use. Conclusions. These American-Indian adolescents presented to a residential substance abuse treatment program with serious, highly complex substance use disorders that represent substantial challenges to effective treatment.

Factors associated with the transition from abuse to dependence among substance abusers: Implications for a measure of addictive liability

This study was conducted to test the validity of a measure that has potential to bridge research on the addictive liability of drugs and on individuals’ liability to addiction, which to date have evolved in largely parallel arenas. The length of time between onset of abuse and dependence (LOTAD) has evolved from recent findings on transitions through levels of addiction; it was hypothesized that shorter LOTAD is indicative of greater addictive liability. Hypotheses were based on animal studies and human studies. Retrospective data from the DSM-IV Substance Use Disorders Work Group were reanalyzed using configural frequency analysis, survival curves, bivariate Kendall's tau associations, and linear regression. The sample consisted of participants recruited from community and clinical settings. The measure was the Composite International Diagnostic Interview–Substance Abuse Module (CIDI–SAM). The shortest LOTADs were observed for disorders related to use of cocaine and opiates, followed by cannabis and then alcohol regardless of the subsample that was analyzed. As hypothesized, females and early initiators of drug use had shorter LOTADs compared to men and other initiators of drug use; no consistent differences in LOTAD were observed between African–Americans and Caucasians. None of the LOTAD variance associated with differences between drugs could be accounted for by gender, early use of the drug, or ethnicity. Specific areas of research where LOTAD might be useful as well as how LOTAD might be improved are discussed.

Race/Ethnic Disparity and Correlates of Substance Abuse Service Utilization and Juvenile Justice Involvement Among Adolescents with Substance Use Disorders

ABSTRACT This study examines correlates of level of specialty alcohol/drug services care and juvenile justice system involvement for adolescents with substance use disorders. Participants were 420 adolescents 13-18 years of age randomly sampled from all youths active in at least one of five youth sectors of care in San Diego County, California. Adolescents were assessed using structured diagnostic interviews including the Diagnostic Interview Schedule for Children-IV and the Composite International Diagnostic Interview-Substance Abuse Module. Analyses examined effects of age, sex, race/ethnicity, mental health disorders, functional impairment, and type and number of substance use disorders in relation to specialty and non-specialty services. Non-Caucasian youths were less likely to receive the least restrictive services and more likely to be found in juvenile justice settings. A number of SUDs (substance use disorders) were positively associated with outpatient, residential, and JJ (juvenile justice) services. Marijuana use disorder was positively associated and stimulant use disorder negatively associated with use of outpatient services. Ethnic disparities exist in relation to restrictiveness of specialty care and juvenile justice system involvement. Type of substance use disorder is also differentially associated with specialty care. Standardized assessment and treatment planning should be implemented across youth sectors of care in order to decrease racial/ethnic disparities and allow for appropriate services for youths with substance use disorders.