Past-year Substance Use Research Articles

Sexual minorities and substance use treatment utilization: New evidence from a national sample

IntroductionMinority stress theory suggests that sexual minorities would be, on average, less likely than heterosexual individuals to seek out substance use treatment (due to concerns of stigma and rejection). However, prior research on the subject is mixed, and largely dated. In light of historic increases in societal acceptance and legal protections for sexual minorities, the field needs an up-to-date assessment of treatment utilization among this population. MethodsThis study used data from the 2015–2019 National Survey on Drug Use and Health to examine the association between key independent variables (sexual identity, gender) and substance use treatment utilization using binary logistic regression. We conducted analyses using a sample of adults with a past-year substance use disorder (N = 21,926). ResultsControlling for demographic factors, with heterosexual individuals as the comparison group, gay/lesbian individuals (AOR = 2.12, CI = 1.19–3.77) were significantly more likely and bisexual individuals (AOR = 0.49, CI = 0.24–1.00) significantly less likely to report treatment utilization. Bisexual individuals were also less likely than gay/lesbian individuals to report treatment utilization (AOR = 0.10, CI = 0.05–0.23). Interaction tests examining sexual orientation and gender showed no difference in treatment utilization between gay men and lesbian women, and revealed that bisexual identity was associated with decreased likelihood of treatment utilization for men (p = .004) but not for women. ConclusionSexual orientation, particularly in the context of social identity, plays a significant role in substance use treatment utilization. Bisexual men face unique barriers to treatment, which is concerning given the high rates of substance use among this and other sexual minority populations.

Attenuated psychotic symptoms, substance use and self-reported PTSD in adolescence

ABSTRACT Background: The occurrence of attenuated psychotic symptoms (APS) is a major concern in populations with substance use disorders (SUDs). However, APS also frequently develop in the course of Post-Traumatic Stress Disorder (PTSD). This study explores how the prevalence of APS differs between adolescent patients with only SUD, SUD with a history of traumatic experiences (TEs), and with SUD and self-reported PTSD. Methods: We recruited n = 120 treatment-seeking adolescents at a German outpatient clinic for adolescents with SUD. All participants filled out questionnaires assessing APS (PQ-16, YSR schizoid scale), trauma history, PTSD symptoms (both UCLA PTSD Index), and SUD severity (DUDIT) next to an extensive substance use interview. We performed a multivariate analysis of co-variance with the four PQ-16 scales and the YSR scale as outcomes and PTSD status as predictor. Additionally, we performed five linear regressions predicting each PQ-16 score and YSR score based on tobacco, alcohol, cannabis, ecstasy, amphetamine, and methamphetamine use. Results: Participants with co-occurring SUD and self-reported PTSD showed significantly higher APS prevalence rates (PQ-16 score, p = .00002), more disturbed thought content (p = .000004), more perceptual disturbances (p = .002), more negative symptoms (p = .004) and more thought problems (p = .001) compared to adolescents with SUD and a history of trauma and adolescents with only SUD. Past-year substance use was not predictive for APS prevalence (F(75) = 0.42; p = .86; R 2 = .04). Conclusion: Our data suggests that the occurrence of APS in adolescents with SUD is better explained by co-occurring self-reported PTSD than by substance use frequency or substance class. This finding might indicate that APS might be reduced through treating PTSD or focusing on TEs in SUD therapy.

Comparing Behavioral Health Outcomes and Treatment Utilization of Those With and Without Justice Involvement Within the Past Year Among American Indian and Alaska Native Adults.

Similar to other populations, worse health, increased emergency healthcare utilization, and heightened substance misuse are correlated with higher justice involvement among American Indian/Alaska Native (AI/AN) populations. The historical context and resulting contemporary injustices for AI/AN populations have directly contributed to higher rates of these health and behavioral health conditions among this population. As a result, AI/AN individuals have disproportionate rates of incarceration in the USA, with young AI/AN males having the highest odds of incarceration when compared to any other group. American Indian and Alaska Native populations are overrepresented in the criminal justice system across different touchpoints. However, there remains a scarcity of data and research on AI/AN peoples' involvement with the justice system, and what their lives look like prior to, during, and after justice involvement. The current study addresses this gap in the literature by exploring rates of substance use and mental health diagnoses and treatment utilization among justice-involved and non-justice-involved AI/AN samples. Further, we examined correlates associated with past-year service utilization. Data from the 2015-2019 National Survey on Drug Use and Health (N = 214,505 adults aged 18+) was used. For this study, we examined a subsample of 3068 AI/AN adults. Quantitative data analyses using STATA 16 were run to test for differences on service utilization, mental health status, and substance misuse between AI/AN non-justice-involved and justice-involved samples. Among adults in the sample, 446 (15%) reported justice involvement in the past year. Justice-involved AI/AN individuals were significantly more likely to use the emergency department, utilize mental health treatment, and access substance use treatment in the past year. Additionally, justice-involved AI/AN individuals reported significantly higher rates of mental illness and past-year substance use disorder. In regression models, justice involvement was significantly associated with past-year substance use treatment and past-year mental health treatment. The findings from this work highlight the differences among substance use, mental illness, and treatment utilization between justice-involved and non-justice-involved AI/AN individuals. Findings suggest that justice-involved individuals fair worse in all areas and argue for the consideration of interventions that incorporate both culturally sensitive and justice-responsive models to improve the behavioral health outcomes of these populations. Lastly, while justice-involved AI/AN populations utilize treatment services at higher and disproportionate levels, there is reason to believe that there continues to be a mismatch of need and utilization and further exploration is warranted.

Heterogeneity In Women’s Trauma Histories: Impact On Substance Use Disorder Severity

ABSTRACT Trauma and substance use disorders (SUDs) frequently co-occur, especially in women. Previous studies have attempted to determine if individual differences in trauma histories could be meaningfully categorized but few studies have focused solely on women, especially those reporting substance use problems. A total of 130 women (M age = 30.7, SD = 7.9) self reporting past-year substance use problems completed comprehensive measures assessing lifetime exposure to a variety of traumatic events as well as substance use patterns and severity. Using latent class analysis, three classes emerged, a Low Lifetime Interpersonal Trauma class (40%, n = 52), a Moderate Lifetime Interpersonal Trauma class (23.8%, n = 31) and a High Lifetime Interpersonal Trauma class (36.2%, n = 47). Groups did not vary on daily/almost daily use of different types of substances and polysubstance use frequency but were significantly different on SUD severity, with the Moderate and the High Lifetime Interpersonal Trauma classes reporting severe SUD severity in comparison to moderate severity for the Low Interpersonal Trauma class. The findings of the current study indicate that women experiencing substance use problems should receive SUD treatment in a trauma-informed manner but that not all may require integrated trauma and substance use interventions.

A latent class analysis of patterns of tobacco and cannabis use in Australia and their health-related correlates.

The shifting landscape in Australia's tobacco and cannabis policies and emerging new products and modes of administration may increase experimentation and the risks of addiction to these drugs. We analysed cross-sectional data from the 2019 National Drug Strategy and Household Survey (n=22,015) of Australians aged 14 and above. Latent class analysis was used to identify distinct groups based on types of tobacco and cannabis products used. The socio-demographic, health-rated correlates and past-year substance use of each latent class was examined. A four-class solution was identified: co-use of tobacco and cannabis (2.4%), cannabis-only (5.5%), tobacco-only (8.0%) and non-user (84.0%). Males (odds ratio [OR] range 1.5-2.9), younger age (OR range 2.4-8.4), moderate to high psychological distress (OR range 1.3-3.0), using illicit substances in the last year (OR range 1.41-22.87) and high risk of alcohol use disorder (OR range 2.0-21.7) were more likely to be in the tobacco/cannabis use classes than non-users. Within the co-use class, 78.4% mixed tobacco with cannabis and 89.4% had used alcohol with cannabis at least once. Approximately 16% of respondents used tobacco or cannabis, or both substances, and no major distinct subgroups were identified by the use of different product types. Mental health issues and the poly-substance use were more common in the class who were co-users of cannabis and tobacco. Existing policies need to minimise cannabis and tobacco-related harms to reduce the societal burden associated with both substances.

Driving under the influence of cannabis, alcohol, and illicit drugs among adults in the United States from 2016 to 2020

ObjectiveDriving under the influence (DUI) of substances increases motor vehicle crash risk. Understanding current national trends of driving under the influence of alcohol (DUIA), cannabis (DUIC), and drugs other than cannabis (DUID) can inform public health efforts. Herein, we provide updated trends among United States (US) adults regarding DUIA, DUIC, DUID, and DUI of any substance. MethodWe used nationally-representative National Survey on Drug Use and Health (2016-2020) data to derive prevalence estimates of past-year DUIC, DUIA, DUID, and DUI of any substance among non-institutionalized US adults and among those reporting respective past-year substance use. Prevalence estimates and adjusted logistic regressions characterized temporal trends of these behaviors among US adults, among those with respective past-year substance use, and among stratified demographic subpopulations. ResultsOver 1 in 10 US adults reported DUI of any substance annually from 2016 to 2020.DUIA was most prevalent among all US adults (8.7% in 2017); however, this behavior is decreasing (AOR:0.96; 95%CI:0.94,0.98). No change in DUIC among the US adult population was found, but a decrease was found among those with past-year cannabis use (AOR:0.95; 95%CI:0.93,0.98), which coincided with a 29.1% increase in past-year cannabis use. There were no significant changes in overall DUID; however, females, those ages 26-34 and 65 or older with past-year use displayed increasing trends. DUI of any substance decreased among the US adult population. ConclusionsDUI remains a salient public health concern in the US and results indicate population subgroups who may benefit from impaired driving prevention interventions.

Concordance between substance use self-report and hair analysis in community-based adolescents

ABSTRACT Background: Accurate drug use identification through subjective self-report and toxicological biosample (hair) analysis are necessary to determine substance use sequelae in youth. Yet consistency between self-reported substance use and robust, toxicological analysis in a large sample of youth is understudied. Objectives: We aim to assess concordance between self-reported substance use and hair toxicological analysis in community-based adolescents. Methods: Hair results by LC-MS/MS and GC-MS/MS and self-reported past-year substance use from an Adolescent Brain Cognitive Development (ABCD) Study subsample (N = 1,390; ages 9–13; 48% female) were compared. The participants were selected for hair selection through two methods: high scores on a substance risk algorithm selected 93%; 7% were low-risk, randomly selected participants. Kappa coefficients the examined concordance between self-report and hair results. Results: 10% of youth self-reported any past-year substance use (e.g. alcohol, cannabis, nicotine, and opiates), while a mostly non-overlapping 10% had hair results indicating recent substance use (cannabis, alcohol, non-prescription amphetamines, cocaine, nicotine, opiates, and fentanyl). In randomly selected low-risk cases, 7% were confirmed positive in hair. Combining methods, 19% of the sample self-reported substance use and/or had a positive hair sample. Kappa coefficient of concordance between self-report and hair results was low (kappa = 0.07; p = .007). Conclusions: Hair toxicology identified substance use in high-risk and low-risk ABCD cohort subsamples. Given low concordance between hair results and self-report, reliance on either method alone would incorrectly categorize 9% as non-users. Multiple methods for characterizing substance use history in youth improves accuracy. Larger representative samples are needed to assess the prevalence of substance use in youth.

The Association of Vaping With Social/Emotional Health and Attitudes Toward COVID-19 Mitigation Measures in Adolescent and Young Adult Cohorts During the COVID-19 Pandemic.

Vaping is a major health risk behavior which often occurs socially. Limited social activity during the COVID-19 pandemic contributed to worsening social and emotional health. We investigated associations among youth vaping, and reports of worsening mental health, loneliness, and relationships with friends and romantic partners (ie, social health), as well as perceived attitudes toward COVID-19 mitigation measures. From October 2020 to May 2021, a clinical convenience sample of adolescents and young adults (AYA) reported on their past-year substance use, including vaping, their mental health, COVID-19 related exposures and impacts, and their attitudes toward non-pharmaceutical COVID-19 mitigation interventions, via a confidential electronic survey. Multivariate logistic regressions were used to estimate associations among vaping and social/emotional health. Of 474 AYA (mean age = 19.3 (SD = 1.6) years; 68.6% female), 36.9% reported vaping in the prior 12 months. AYA who self-reported vaping were more likely than non-vaping AYA to report worsening: anxiety/worry (81.1%; P = .036), mood (78.9%; P = .028), eating (64.6%; P = .015), sleep (54.3%; P = .019), family discord (56.6%; P = .034), and substance use (54.9%; P < .001). Participants who vaped also reported easy access to nicotine (63.4%; P < .001) and cannabis products (74.9%; P < .001). No difference in perceived change in social wellbeing was seen between the groups. In adjusted models, vaping was associated with symptoms of depression (AOR = 1.86; 95% CI = 1.06-3.29), less social distancing (AOR = 1.82; 95% CI = 1.11-2.98), lower perceived importance of proper mask wearing (AOR = 3.22; 95% CI = 1.50-6.93), and less regular use of masks (AOR = 2.98; 95% CI = 1.29-6.84). We found evidence that vaping was associated with symptoms of depression and lower compliance with non-pharmaceutical COVID-19 mitigation efforts among AYA during the COVID-19 pandemic.

Medicaid Expansion and Racial-Ethnic Health Care Coverage Disparities Among Low-Income Adults With Substance Use Disorders.

In light of historical racial-ethnic disparities in health care coverage, the authors assessed changes in coverage in nationally representative samples of Black, White, and Hispanic low-income adults with substance use disorders after the 2014 Affordable Care Act Medicaid expansion. Data from 12 years of the annual National Survey on Drug Use and Health (2008-2019) identified low-income adults ages 18-64 years with alcohol, cannabis, cocaine, or heroin use disorder (N=749,033). Trends in coverage focused on non-Hispanic Black, non-Hispanic White, and Hispanic individuals. Age- and sex-adjusted difference-in-differences analysis assessed effects of expansion state residence on insurance coverage for the three groups. Before Medicaid expansion (2008-2013), 38.5% of Black, 37.6% of White, and 51.2% of Hispanic low-income adults with substance use disorders were uninsured. After expansion (2014-2019), these proportions significantly declined for Black (24.2%), White (22.0%), and Hispanic (34.5%) groups. Decreases in rates of individuals without insurance and increases in Medicaid coverage tended to be more pronounced for those in expansion states than for those in nonexpansion states. In nonexpansion states, the proportions of those without insurance significantly decreased among Black and White individuals but not among Hispanic individuals. Proportions receiving past-year substance use treatment did not significantly change and remained low postexpansion: Black, 10.7%; White, 14.6%; and Hispanic, 9.0%. After Medicaid expansion, coverage increased for low-income Black, White, and Hispanic adults with substance use disorders. For all three groups, Medicaid coverage disproportionately increased among those living in expansion states. However, coverage remained far from universal, especially for Hispanic adults with substance use disorders.

Predictors of cigarette smoking in pregnant women with substance use disorders

Background Cigarette smoking is common among pregnant women with substance use disorders (SUD) and may contribute to more adverse health consequences for the infant than alcohol and illicit drug use. However, most studies focused on stopping illicit drug use and paid little attention to cigarette smoking in pregnant women with SUD. Purpose To identify predictors of current smoking among pregnant women with SUD, given past-month psychological distress, alcohol use and illicit drug use, the receipt of past-year mental health and substance use treatment controlling for potential confounders. Methods Secondary analysis of cross-sectional data from the National Survey on Drug Use and Health (NSDUH) 2015–2019 was conducted. The NSDUH included 3,540 pregnant women aged 18–44 years; among them were 195 lifetime smokers with SUD. Multiple logistic regression modeling was used to examine the probability of prenatal smoking. Results Sixty-one percent of pregnant women with SUD reported current cigarette smoking. The likelihood of prenatal smoking increased with a higher level of past-month psychological distress (Adjusted Odds Ratio [AOR] 1.14; 95% Confidence Interval [CI]: 1.02–1.28), past-month illicit drug use (AOR: 5.68; 95% CI: 1.59–20.21), and past-year substance use treatment receipt (AOR: 5.73; 95% CI: 1.88–17.45). Conclusion The receipt of substance use treatment markedly increased the probability of smoking in pregnant women with SUD. Treatment and policy initiatives are required to address and integrate cigarette smoking within other substance use treatment modalities for pregnant women with SUD.

A pilot study assessing client understanding and use of fentanyl test strips for harm reduction

BackgroundThe Centers for Disease Control and Prevention reported a sharp increase in overdose deaths from illicitly manufactured fentanyls (IMFs) occurring between 2020 and 2021 in the United States. Approximately 4 in 10 drug overdose deaths involved opioids and stimulants. Fentanyl test strips (FTS), used to test drug product before use, can be a powerful harm reduction tool to promote safer use behaviors. ObjectivesThis pilot study assessed treatment-seeking service users’ knowledge and understanding of IMFs and motivation to use FTS to prevent overdose. MethodsClients receiving residential-based or office-based substance use treatment services were recruited from a community mental health center in the midwestern United States to complete a harm reduction-focused survey. Eligibility criteria included clients aged 18-89 years with self-reported drug use in the past year. A 20-question survey was administered verbally, both in person and via phone to assess knowledge of IMFs and FTS. ResultsOf respondents (N = 30), 80% agreed that IMFs cause more overdoses than heroin. Most (73%) indicated concern about a friend overdosing owing to IMFs, and half (53%) expressed concern about personal risk of overdose. Most (73%) would like to be able to detect whether there is fentanyl in their drug before use, but only 17% indicated that they feel confident in their ability to use FTS. ConclusionMany respondents who were receiving services for past-year substance use lacked understanding of how to use FTS for harm reduction. Clients who primarily use nonopioid (stimulant) drug products are at even greater risk of IMF overdose and would benefit the most from increased access and education surrounding the use of FTS. Our health care system must rapidly continue to explore and expand on overdose prevention efforts, including access to FTS, given that urgent action is needed to reduce the continued rise in overdose deaths in the United States.

Mutual Help Group Participation for Alcohol and Drug Problems: Uncovering Latent Subgroups

Objective: This report aims to identify US mutual help group (MHG) participants’ psycho-socio-behavioral profiles. Method: We used data from the 2015–2018 National Survey on Drug Use and Health and the sample included 1022 adults with past-year substance use disorders (SUD). We conducted a latent class analysis to identify subgroups of MHG participants and estimated multinomial logistic regression models to examine the associations between sociodemographic/intrapersonal characteristics and class membership. Results: Analyses identified three latent classes. Class 1 (Low-Risk group, 54%) reported low risks in all correlates except for serious psychological distress (SPD, 33%). Class 2 (Psychological Distress group, 30%) demonstrated high risks of major depressive episodes (86%) and SPD (93%). Class 3 (Criminal Justice System Involvement group, 16%) showed high involvement in arrests (100%) and drug-related arrests (67%) and moderate risks for SPD (54%) and behavioral problems, e.g., drug selling (46%) and theft (35%). Compared to Class 1, Class 2 was more likely to be female, out of the labor force, and to show high risk propensity, and Class 3 was more likely to have lower education and drug use disorders. Class 3 was also less likely to be older, belong to the “other” racial/ethnic category, have lower English proficiency, and report alcohol use disorder. Conclusions: The three subgroups of the US MHG participant population illustrate the complex and heterogeneous psycho-social-behavioral profiles of MHG participants with SUD. MHG referral’s effectiveness may be augmented by tailoring it to the patient/client’s specific psycho-socio-behavioral profile.

Study Links Long-Term Cannabis Use, Cognitive Deficits

Study Links Long-Term Cannabis Use, Cognitive Deficits

Immigration policies as political determinants of alcohol and drug misuse among US-born Latinos.

The role of immigration policies as political determinants of health among US-born Latinos is significantly understudied. Immigration policies can produce immigration-related stressors that have 'spill over' effects on the health behaviors of US-born Latinos. However, less is known about how immigration-related stressors relate to substance misuse among US-born Latinos. 1,784 US-born Latinos were recruited via web-panels in September 2021 to complete an online questionnaire. Inclusion criteria included: (1) self-identifying as Latino; (2) born in the US; and (3) being 18 years of age or older. Participants were asked 14-items related to immigration-related stressors and past-year substance use behaviors. Dependent variables included past-year: heavy drinking, high intensity drinking, illicit drug use, prescription drug misuse, cannabis use, cocaine use, methamphetamine use, prescription sedative misuse, and prescription opioid misuse. Two separate multivariable logistic regression models were conducted for each outcome to investigate associations between (1) specific immigration-related stressors and substance misuse; and (2) experiencing greater (vs. fewer) number of immigration-related stressors and substance misuse. On average, US-born Latinos reported experiencing 3 immigration-related stressors. In multivariable analyses, being fearful or worried about being detained for immigration reasons was associated with increased odds of engaging in heavy drinking, high intensity drinking, and illicit drug use. Having ever feared or worried about being potentially deported for immigration reasons and having ever witnessed or experienced an immigration raid was associated with high intensity drinking. Parental detentions and deportations in childhood were independently associated with high intensity drinking, illicit drug use, and prescription drug misuse. Notably, greater number of immigration-related stressor experiences increased the odds of substance misuse. Punitive immigration and enforcement policies give rise to multiple stressors that may render US-born Latinos vulnerable to misusing substances as a way of coping. Policies and public health interventions aimed at preventing and treating substance misuse should consider how immigration policies impact the behaviors of US-born Latinos.

Licit and illicit drug use across trimesters in pregnant women endorsing past-year substance use: Results from National Survey on Drug Use and Health (2009-2019).

Given the health consequences, perinatal substance use is a significant public health concern, especially as substance use rates increase among women; ongoing data regarding the rates of substance use across trimesters of pregnancy is needed. The present study utilized cross-sectional population-based data from the National Survey of Drug Use and Health (NSDUH) between 2009 and 2019. We aimed to explore both licit and illicit substance use assessed within each trimester among women endorsing past-year substance use. The NSDUH sample included 8,530 pregnant women. Perinatal substance use was less prevalent among women in later trimesters; however, past-month substance use was observed for all substances across trimesters. The prevalence of past-month licit substance use among pregnant women ranged from 5.77 to 22.50% and past-month illicit substance use ranged from 4.67 to 14.81%. In the second trimester, lower odds of past-month substance use were observed across tobacco, alcohol, and marijuana (odds ratios [ORs] ranging from 0.29 to 0.47), when compared to the first trimester. A similar lower rate of past-month substance use was observed in the third trimester compared to the first trimester, across tobacco, alcohol, and marijuana use, as well as cocaine, prescription pain medication, and tranquilizer use (ORs ranging from 0.02 to 0.42). The likelihood of polysubstance use was lower among women in the second and third trimesters compared to the first trimester (ORs ranging from 0.09 to 0.46). Findings indicate that a minority of women continue to use substances across all trimesters. This is especially true among women using licit substances and marijuana. These results highlight the need for improved interventions and improved access to treatment for these women.

Clusters of Adversity Types Among U.S. Youth: Associations With Mental Health

Childhood adversities are risk factors for subsequent mental health problems. Research commonly focuses on adverse childhood experiences, despite evidence that other exposures, such as neighborhood violence or peer victimization, co-occur with adverse childhood experiences and are associated with similar mental health outcomes. This study explored the clustering of these exposures and examined the associations with mental health. Data were a nationally representative sample of U.S. children aged 10-17 years (N=1,959), collected in 2013-2014. Latent class analysis was conducted on 22 types of childhood adversity. Regression models examined associations with mental health and substance use. These secondary analyses were conducted in 2021. A total of 5 classes were identified: Low all (59% of the sample), Abuse (29%), High multiple adversities (5%), Peer adversity (4%), and Neighborhood violence (4%). All classes had poorer mental health and a higher prevalence of substance use than Low all, with particularly harmful levels in High multiple adversities. Neighborhood violence was not significantly different from High multiple adversities on mental health symptoms and showed a greater proportion of past-year substance use than all other classes except High multiple adversities. Peer adversity and Abuse classes did not differ significantly in any outcomes. Findings highlight the particularly deleterious impact of neighborhood violence and highly co-occurring adversity types on mental health and substance use. It is important to extend our conceptualization of adverse childhood experiences to include peer adversity and neighborhood violence and shift from a siloed approach to examining all these exposures.

CPNP 2022 Annual Meeting Poster Abstracts

CPNP 2022 Annual Meeting Poster Abstracts

Substance Use Disorders Among Medicare Beneficiaries: Prevalence, Mental and Physical Comorbidities, and Treatment Barriers

This study aimed to determine the prevalence of treated and untreated substance use disorders among Medicare beneficiaries, the characteristics of Medicare beneficiaries with substance use disorders, and reasons for their unmet needs. This study used data from the National Survey of Drug Use and Health, 2015-2019. Substance use disorder was defined based on DSM-IV dependence or abuse criteria. Descriptive analyses were conducted in 2021, including testing for differences in unadjusted means. Approximately 1.7 million Medicare beneficiaries were estimated to have past-year substance use disorder (8% of Medicare beneficiaries aged <65 years and 2% aged ≥65 years). Overall, 77% had an alcohol use condition, 16% had a prescription drug use condition, and 10% had a marijuana use condition. Of those who had past-year substance use disorder, 11% received treatment for their condition. Common reasons for not receiving treatment were lack of motivation (41%), financial barriers (33%), concern about what others might think (24%), logistical barriers such as lack of transportation (21%), and uncertainty about treatment efficacy (13%). Medicare beneficiaries with substance use disorders were more than twice as likely to have past-year serious psychological distress as those without substance use disorders (44% vs 21%, p<0.001 for those aged <65 years; 14% vs 4%, p<0.001 for those aged ≥65 years). Percentages of past-year suicidal ideation were also much higher among Medicare beneficiaries with substance use disorders than without (24% vs 6%, p<0.001 for those aged <65 years; 7% vs 2%, p=0.006 for those aged ≥65 years). Few Medicare beneficiaries who need substance use disorder treatment receive it. Reducing Medicare coverage gaps and stigma may help meet this need.

Substance use and misuse patterns and disability status in the 2020 US National Alcohol Survey: A contributing role for chronic pain

BackgroundEvidence about substance use and misuse among adults with disabilities is still emerging, despite increased risk of chronic pain and mental health problems, which are in turn risk factors for substance use and misuse. ObjectiveWe examined substance use and misuse among adults with selected self-reported disability (versus without), controlling for sociodemographics, depression/anxiety, physical health, and chronic pain, and assessed whether associations could be attributed to chronic pain. MethodsData are from the nationally representative 2020 US National Alcohol Survey. Disability indicators included sensory or mobility impairment, receiving Medicare before age 65, and/or unemployment due to disability. Regression analyses determined associations of disability with past-year substance use and misuse. Mediation analyses examined the role of chronic pain. ResultsApproximately 18% met 1+ disability criterion, representing 42.8 million adults. Disability was associated with reduced odds of current drinking (OR = 0.77, p < 0.01), but greater odds of daily nicotine use (OR = 1.43, p < 0.01), any drug use (OR = 1.32 p < 0.01), prescription drug misuse (OR = 1.99, p < 0.001), and other drug use (OR = 2.02, p < 0.001). Disability was not associated with high-intensity drinking or marijuana use. Chronic pain accounted for 17–38% of the association between disability and nicotine use, any drug use, prescription drug misuse, and other drug use. ConclusionsFindings indicated higher rates of substance use and misuse among people with disabilities, accounting for depression/anxiety, physical health, and chronic pain, with pain being a significant mediator. Substance use screening, brief intervention, and treatment should include appropriate accommodations for disabilities, inclusive of comprehensive pain management options.

Self-reported changes in alcohol and tobacco use during COVID-19: findings from the eastern part of WHO European Region.

BackgroundThe COVID-19 pandemic might impact substance use behaviours around the globe. In this study, we investigate changes in alcohol and tobacco use in the second half of 2020 in countries of the eastern part of the WHO European Region.MethodsSelf-reported changes in alcohol and tobacco use among 11 295 adults from 18 countries in the eastern part of the WHO European Region were collected between August 2020 and January 2021. The non-probabilistic sample was weighted for age, gender and education. For each country, proportions of respondents reporting a decrease, no change or increase in substance use over the past 3 months were examined, and multinomial regression models were used to test associations with age, gender and past-year alcohol use.ResultsIn most countries, about half of the respondents indicating past-year alcohol or tobacco use reported no change in their substance use. Of those alcohol users who reported changes in their alcohol use, a larger proportion reported a decrease than an increase in most countries. The opposite was true for tobacco use. Women, young adults and past-year harmful alcohol users were identified as being more likely to change their substance use behaviour.ConclusionWe found diverging overall trends for alcohol and tobacco use in the second half of 2020. The patterns of change vary according to age, gender and past-year substance use. Individuals at risk to increase their substance use during the COVID-19 pandemic require most policy considerations.