Lifetime Drug Dependence Research Articles

Borderline personality disorder symptoms in treatment-naïve actively drinking alcoholics.

Borderline personality disorder (BPD) is often a complicating comorbid factor in alcohol use disorders and substance use disorders. Previous work showed that abstinent alcoholics endorsed lifetime and current symptoms of most of the BPD criteria at much higher rates than controls, with much higher symptom counts for short-term abstinent alcoholic (STAA) women than men, which is consistent with such symptoms negatively affecting female alcoholics' ability to maintain abstinence. Because prior work has also shown that treatment-naïve alcoholics (TNA) are not the same as treated alcoholics observed earlier in their alcohol dependence, but rather are a different population with potentially lower psychiatric comorbidity, in this study we compared BPD symptom criteria between TNA samples of comparable age to the control and STAA samples, including both men and women and individuals dependent on alcohol only or with lifetime dependence on both alcohol and drugs. BPD symptoms were obtained using the SCID-II, and endorsed symptoms were classified as current or lifetime. Logistic regression analyses were used to test for effects of group, sex, presence of a lifetime drug dependence diagnosis, and their interactions for lifetime and current symptom endorsement for each BPD criteria. Groups were compared pairwise (TNA vs. NSAC, and STAA vs. TNA). The effect of a lifetime drug dependence diagnosis was not significant for any BPD symptom variable, consistent with the alcohol groups' BPD symptoms being unaffected by the presence of a comorbid drug dependence. The primary result presented here is that TNA women have borderline symptomatology more similar to that of treated STAA than to NSAC, while TNA men have borderline symptomatology more similar to NSAC than to STAA. A visual examination of co-occurring BPD symptoms showed that while more BPD symptoms are likely to be present in TNA and STAA vs. NSAC, there is no grouping of criteria (i.e., symptom cluster) that is characteristic of TNA or STAA.

Lifetime and current mood and anxiety disorders in short-term and long-term abstinent alcoholics.

A high prevalence of comorbid mood and anxiety disorders has been demonstrated in alcoholics. We examined lifetime and current mood and anxiety diagnoses and symptoms in long-term (mean 7.6years; n=110) and short-term (mean 10.1weeks; n=101) abstinent alcoholics (LTAA and STAA) and nonsubstance abusing controls (NSAC; n=82). All alcoholics met DSM-IV lifetime alcohol dependence criteria. About half of each alcoholic group had lifetime drug dependence. Alcohol use was assessed using timeline follow-back methodology, and drug and alcohol use disorders were diagnosed using the AUDADIS-IV. Lifetime and current mood and anxiety disorder diagnoses and symptom counts were gathered using the computerized Diagnostic Interview Schedule. Over 60% of STAA and LTAA had a lifetime internalizing diagnosis versus about 15% of NSAC, with no difference between STAA and LTAA. The group effect on lifetime diagnoses was independent of comorbid drug dependence or gender and was of comparable size for mood and anxiety disorders. Current diagnoses showed a similar pattern, except that STAA had more current mood diagnoses than LTAA. Excluding individuals with lifetime internalizing diagnoses, alcoholics still had more mood and anxiety symptoms than controls. (i) The presence of a lifetime mood or anxiety diagnosis or of a current anxiety diagnosis did not differ between STAA and LTAA, suggesting that such diagnoses do not impact one's ability to achieve or maintain abstinence. (ii) Prevalence of mood and anxiety diagnoses was unaffected by presence of a comorbid substance use disorder, and (iii) excluding individuals with a mood or anxiety diagnosis does not eliminate mood and anxiety symptom count differences between groups.

Gait and balance in treatment-naïve active alcoholics with and without a lifetime drug codependence.

Disturbed gait and balance are among the most consistent sequelae of chronic alcoholism. However, although a majority of alcoholics have never sought treatment, most investigations showing ataxia in alcohol-dependent individuals have relied on samples drawn from treated populations. In addition, few studies have addressed the associations of codependence on other drugs with alcoholic gait and balance disturbance. This study employed the Walk-a-Line Ataxia Battery (Fregly et al. Alcohol Clin Exp Res 1972;43:395-399) to assess gait and balance in treatment-naïve, actively drinking alcohol-dependent men and women (TNA; n = 69) who were dependent on alcohol only (ALC; n = 43), or who also had a lifetime drug dependence (ALC + DRG; n = 26; i.e., methamphetamine, cocaine, opiates, and/or marijuana), compared with nonsubstance abusing controls (NSAC; n = 74).We also examined associations between lifetime alcohol use and age with gait and balance measures. Our main findings were (i) no evidence of disturbed gait and balance in ALC versus NSAC and (ii) significantly disturbed gait and balance in ALC + DRG, relative to both NSAC and ALC, along with steeper age-associated decline in gait and balance performance in ALC versus ALC + DRG. Our results provide evidence consistent with previous studies that TNA (without a lifetime drug codependence) may represent a population that is different and less impaired (including in gait and balance) than treated alcoholics. Additionally, we provide evidence that ALC + DRG, with greater alcohol use and family drinking density than ALC, have an accelerated effect of age on gait and balance disturbance compared with both NSAC and ALC. The ALC + DRG group likely represents a subset of TNA with different characteristics than ALC.

The impact of sociodemographics, comorbidity and symptom recency on health-related quality of life in alcoholics.

To obtain estimates of the relationship between alcoholism and health-related quality of life (HRQL) in twin pairs discordant for alcohol dependence. In 1995, 1,258 male-male twin pair members of the Vietnam Era Twin Registry (total Registry N = 7.375 pairs) were administered a modified Medical Outcomes Study 36 Item Short Form (SF-36) and the Diagnostic Interview Schedule (DIS) to obtain measures of HRQL and a DSM-III-R criteria lifetime diagnosis of alcohol dependence. Mean within pair differences on eight separate SF-36 subscales were calculated for 436 remitted (no alcohol symptoms in the past 5 years) alcohol-dependent discordant twin pairs and for 194 recent (at least one alcohol symptom in the past 5 years) alcohol-dependent discordant pairs before and after adjustment for covariates. Covariates included lifetime physical illness, lifetime psychiatric disorders, lifetime drug dependence, lifetime nicotine dependence, current marital status, current income and severity. In the unadjusted analysis remitted alcoholic twins compared to their nonalcoholic co-twins reported significantly lower mean scores for six of eight SF-36 subscales. Recent alcoholic twins, compared to their nonalcoholic co-twins, reported significantly lower mean scores for all of the SF-36 subscales. However, after simultaneous adjustment for all covariates, no SF-36 subscale mean, except "vitality" among recent alcoholic twins, was significantly different between alcoholic twins and their nonalcoholic co-twins. Differences in HRQL between alcoholic and nonalcoholic co-twins is due to covariation from physical and psychiatric problems, drug and nicotine dependence, marital status, income and severity.

Validity of Self-Report of Drug Use Among STD Patients, ER Patients, and Arrestees

This paper examines the validity of self-report of drug use in several important high-risk samples by comparing survey answers with urinalysis results. The analyses include data obtained from face-to-face interviews with 1536 patients in sexually transmitted disease (STD) clinics, 1564 patients in hospital emergency rooms (ERs), and 2034 recent arrestees in jails. Using urinalysis as the criterion measure, considerable underreporting was observed, particularly among STD and ER subjects using cocaine and opiates. A logistic regression analysis on factors related to the underreporting was conducted for both cocaine and opiates. The results showed that a lower degree of underreporting was associated with subjects at jail sites (compared to STD subjects) and those who self-reported lifetime drug dependence.

The impact of domestic violence on women's mental health

AbstractThis longitudinal study aimed to establish a firmer scientific basis for recognition and treatment of post-traumatic psychiatric morbidity associated with domestic violence. The study used a sample of 335 women (mean age 45.5 years) recruited from the Royal Brisbane Hospital Emergency Department. This paper reports baseline data. The outcome measures of lifetime psychiatric diagnoses (DSM-111-R classification), showed that women who reported lifetime adult intimate abuse (n=162) received significantly more diagnoses of generalised anxiety, dysthymia, depression, phobias, current harmful alcohol consumption and psychoactive drug dependence than those who reported no abuse ever (n=173). Of the 191 women tested for lifetime post-traumatic stress disorder, those who reported lifetime abuse (n=115) received significantly more diagnoses than those who reported no abuse (n=76). Crude prevalence rates of psychiatric diagnoses for women who reported double abuse as child and adult were significantly higher than for women who reported adult intimate abuse only. Adjusted rates showed that doubly abused women had significantly greater risk of current harmful alcohol consumption and lifetime drug dependence than women who reported adult abuse only. A significant independent factor for lifetime psychiatric diagnoses was reporting abuse between a woman's parents. Measurement of the population attributable risk found that one-third of the psychiatric diagnoses were attributable to domestic violence.

Polydrug dependence and psychiatric comorbidity among heroin injectors

The prevalence of diagnoses of substance dependence, anxiety disorders and depressive disorders were estimated in a sample of 222 heroin injectors, using the Composite International Diagnostic Interview. Subjects had a median of three lifetime substance diagnoses and two current diagnoses. A total of 60% met the criteria for a lifetime anxiety disorder, and 51% had a current anxiety disorder. A depressive disorder was diagnosed in 41% of subjects, with 30% having a current diagnosis. There were significant positive correlations between the number of lifetime drug dependence diagnoses and the number of lifetime anxiety and affective disorders ( r = 0.41), and the number of current drug dependence diagnoses and the number of current comorbid diagnoses ( r = 0.32). After controlling for other variables, the only significant independent predictor of the number of lifetime and current dependence diagnoses was the number of comorbid diagnoses.