Prevalence Of Substance Use Disorders Research Articles

Factors Associated with Substance Use Disorder among High-Need Adolescents and Young Adults in North Carolina

Background Prevalence of substance use disorders (SUD) is high among adolescents and young adults (AYAs) with complex medical needs. Little is known about risk factors for SUD in this population. Methods This retrospective cohort study used electronic health record data from a large academic hospital system (2015–2019) to identify adolescents (aged 10–17) and young adults (aged 18–27) with intellectual/developmental disorders, psychiatric conditions, or complex medical conditions. Logistic regression was used to identify demographic, clinical, and neighborhood-level risk factors associated with SUD in this population. Results A total of 149 adolescents and 536 young adults had a SUD diagnosis (6.7% and 20.6%, respectively). Among adolescents, notable risk factors for SUD included age (adjusted odds ratio [aOR] = 1.42, 95% confidence interval [CI] = [1.31, 1.54]), Hispanic ethnicity (aOR = 2.10, 95% CI = [1.10, 3.99]), additional psychoactive medication classes (aOR = 1.27, 95% CI = [1.11, 1.46]), and living in a “high” child opportunity index (COI) (aOR = 2.06, 95% CI [1.02, 4.14]) or a “very high” COI (aOR = 3.04, 95% CI [1.56,5.95]) area. Among young adults, notable risk factors included being male (aOR = 2.41, 95% CI [1.91, 3.05]), being Black (aOR = 1.64, 95% CI [1.28, 2.09]), and additional non-psychoactive (aOR = 1.07, 95% CI [1.03, 1.11]) or psychoactive medication classes (aOR = 1.17, 95% CI [1.07, 1.28]). Limitations These descriptive analyses are limited to one large academic hospital system in North Carolina and may not be representative of all high-need AYAs in the state. Conclusions Several demographic, clinical, and neighborhood risk factors are associated with SUD in high-need AYAs.

Gender differences in illicit drug access, use and use disorder: Analysis of National Survey on Drug Use and Health data

Although gender differences in the prevalence of substance use disorders (SUD) have been well-characterized, little is known about when gender differences emerge along the continuum of substance use. Understanding the contribution of gender to risk at key transition points across this continuum is needed to identify potential mechanisms underlying gender differences and to inform improved gender-responsive interventions. To characterize gender differences in the progression of cannabis, cocaine, and heroin use, the current study used data from the United States-based 2015–2019 National Survey on Drug Use and Health to quantify gender differences in: (1) perceived access to drugs, (2) lifetime drug use among individuals with at least some access, and (3) past-year SUD among those who had ever used each drug. Logistic regressions were conducted for each drug to examine gender differences across all three stages, controlling for sociodemographic factors and survey year. Compared to women, men had higher odds of reporting access to and lifetime use of all three drug types. Men also had higher odds of past-year cannabis and cocaine use disorders compared to women. Results suggest gender differences emerge in the earliest stage of drug use (access) and may accumulate across the stages of use. The magnitude of gender differences varied across stages, with the largest differences observed for odds of drug initiation among those with perceived access to each drug. Longitudinal data will be needed to confirm these findings and to provide insight into potential contributors to gender-specific risk and intervention targets across the continuum of drug use severity.

A Multi-Level Analysis of Biological, Social, and Psychological Determinants of Substance Use Disorder and Co-Occurring Mental Health Outcomes

We explored the intricate interplay of biological, social, and psychological factors contributing to substance use disorder (SUD) and co-occurring psychiatric symptoms. Drug misuse is a global concern, with increasing prevalence rates affecting mental well-being and safety. The spectrum of SUD includes polysubstance users, posing challenges for treatment and associated health outcomes. Various psychoactive substances like cannabis, hallucinogens, opioids, and stimulants impact addiction vulnerability, with marijuana being widely used globally. Gender differences in SUD prevalence have narrowed, with women escalating drug consumption rapidly once initiated. Age disparities in substance use highlight regional variations among adolescents. Comorbidities with psychiatric symptoms are common, with mood and anxiety disorders frequently observed. This study aimed to analyze factors influencing SUD development and maintenance to inform prevention strategies and treatment recommendations. By conducting a systematic search of databases, sixty articles were reviewed, revealing diverse methodologies and geographic locations. Biological factors, including neurotransmitter systems like endocannabinoid and dopaminergic systems, play a significant role in addiction. Genetic and neurobiological factors contribute to cannabis addiction susceptibility. Social factors such as childhood experiences and parenting styles influence substance use behaviors. Psychological factors like personality traits and mental health conditions interact with SUD development. Understanding these multifaceted interactions is crucial for designing effective interventions to address the complexities of SUD and co-occurring psychiatric symptoms.

A Cross-Sectional Study On Psychiatric Disorders among Poor Academic Performance Primary School (6-12 Years) Children with Substance Use Disorders in Their Parents

Abstract Background: Psychiatric disorders are more prevalent among children with poor academic performance. There is limited literature on the impact of substance use disorders (SUD) in parents on psychiatric symptoms of these children. Objectives: (1) To assess the psychiatric disorders in primary school (6–12 years) children with poor academic performance. (2) To assess the prevalence and type of SUD in parents of these children. Materials and Methods: A cross-sectional study was conducted on children with poor academic performance. Simple randomization was adopted and 115 children and their parents were included in the study. Mini International Neuropsychiatry Interview-Kid (M.I.N.I. Kid) was used to screen psychiatric symptoms and various scales were used to assess the severity of symptoms. Parents of these children were interviewed for the presence of SUD. The diagnosis was made as per the International Classification of Diseases tenth revision (ICD-10). The association between psychiatric disorders and parental SUD was assessed using Chi-square test. Results: The prevalence of psychiatric disorders was 54.78% and most prevalent disorder was emotional disorders with onset specific to childhood with prevalence of 21.74%. Prevalence of SUD among parents of these children was found to be 18.26% and alcohol dependence syndrome (ADS) was more common type (12.17%). There was no significant association between psychiatric disorders in these children and SUD in their parents (χ2-2.93, df-10, P = 2013-.98). Conclusion: Emotional disorders with onset specific to childhood are more commonly prevalent psychiatric disorders among children with poor academic performance. A study found no significant association between SUD among parents of these children and psychiatric symptoms.

Person-centered hospital discharge data: Essential existing infrastructure to enhance public health surveillance of maternal substance use disorders in the midst of a national maternal overdose crisis

ObjectivesAs crises of drug-related maternal harms escalate, US public health surveillance capacity remains suboptimal for drug-related maternal morbidities. Most state hospital discharge databases (HDDs) are encounter-based, and thus limit ascertainment of morbidities to delivery visits and ignoring those occurring during the 21 months spanning pregnancy and postpartum year. This study analyzes data from a state that curates person-centered HDD to compare patterns of substance use disorder (SUD) diagnoses at delivery vs. the full 21 pregnancy/postpartum months, overall and by maternal social position. MethodsAmong people who experienced an in-hospital birth in New York State between 9/1/2016 and 1/1/2018 (N = 330,872), we estimated SUD diagnosis (e.g., opioids, stimulants, benzodiazepines, cannabis) prevalence at delivery; across the full 9 months of pregnancy and 12 postpartum months; and by trimester and postpartum quarter. Risk ratio and risk difference estimated disparities by race/ethnicity, age, rurality, and payor. ResultsThe 21-month SUD prevalence rate per 100,000 was 2671 (95% CI 2616–2726), with 31% (29.5%−31.5%) missing SUD indication when ascertained at delivery only (1866; 95% CI 1820–1912). Quarterly rates followed a roughly J-shaped trajectory. Structurally marginalized individuals suffered the highest 21-month SUD prevalence (e.g., Black:White risk ratio=1.80 [CI:1.73–1.88]). ConclusionBy spanning the full 21 months of pregnancy/postpartum, person-centered HDD reveal than the maternal SUD crisis is far greater than encounter-based delivery estimates had revealed. Generating person-centered HDD will improve efforts to tailor interventions to help people who use drugs survive while pregnant and postpartum, and eliminate inequities.

Comorbidity Burden and Health Care Utilization by Substance use Disorder Patterns among People with HIV in Florida.

Substance use disorder (SUD), a common comorbidity among people with HIV (PWH), adversely affects HIV clinical outcomes and HIV-related comorbidities. However, less is known about the incidence of different chronic conditions, changes in overall comorbidity burden, and health care utilization by SUD status and patterns among PWH in Florida, an area disproportionately affected by the HIV epidemic. We used electronic health records (EHR) from a large southeastern US consortium, the OneFlorida + clinical research data network. We identified a cohort of PWH with 3 + years of EHRs after the first visit with HIV diagnosis. International Classification of Diseases (ICD) codes were used to identify SUD and comorbidity conditions listed in the Charlson comorbidity index (CCI). A total of 42,271 PWH were included (mean age 44.5, 52% Black, 45% female). The prevalence SUD among PWH was 45.1%. Having a SUD diagnosis among PWH was associated with a higher incidence for most of the conditions listed on the CCI and faster increase in CCI score overtime (rate ratio = 1.45, 95%CI 1.42, 1.49). SUD in PWH was associated with a higher mean number of any care visits (21.7 vs. 14.8) and more frequent emergency department (ED, 3.5 vs. 2.0) and inpatient (8.5 vs. 24.5) visits compared to those without SUD. SUD among PWH was associated with a higher comorbidity burden and more frequent ED and inpatient visits than PWH without a diagnosis of SUD. The high SUD prevalence and comorbidity burden call for improved SUD screening, treatment, and integrated care among PWH.

The prevalence of substance use disorders among people in Norwegian, Danish and Swedish prisons: A multi-national cohort study, 2010-19.

We estimated the prevalence of substance use disorders (SUDs) in the Norwegian, Danish and Swedish prison populations and compared the prevalence of SUDs in the national prison populations with country-specific general population prevalence rates. A multi-national cohort study using data from the National Prison Registries linked to the National Patient Registries in Norway, Denmark and Sweden. We used data from the PriSUD-Nordic study, including national prison populations aged 19 years and older in Norway (2010-19), Denmark (2010-18) and Sweden (2010-13). A total of 119 507 Individuals (108 971 men and 10 536 women) contributing to 191 507 incarcerations were included in the study (Norway: 45432 men; 5429 women, Denmark: 42 162 men; 3370 women, Sweden: 21 377 men; 1737 women). We calculated a study prevalence and prevalence at entry to prison for all types of SUDs before imprisonment each consecutive year of observation in each prison population. We also extracted country-specific 1-year prevalence rates from the Global Burden of Diseases database to calculate comparative national prevalence ratios. The study prevalence of any SUD was approximately 40% [Norway: 44.0%, 95% confidence interval (CI) = 43.6-44.5%; Denmark: 39.9%, CI = 39.5-40.4%; Sweden: 39.1%, CI = 38.4-39.7%] in all three countries. Women had a significantly higher study prevalence of any SUD compared with men (Norway: 55.8 versus 42.6%, P < 0.001; Denmark 43.1 versus 39.7%, P = 0.004; Sweden: 51.7 versus 38.0%, P < 0.001). Prevalence estimates were higher for SUDs among people in prison than in the general population. We observed an increasing proportion of people with SUDs entering prison in Norway (P = 0.003), while the proportion was more stable in Denmark and Sweden. Substance use disorders (SUDs) appear to be highly prevalent among the Scandinavian prison populations compared with the general population, especially among women. In Norway, there was a relative increase in SUDs from 2010 to 2019.

Prevalence and associated factors of substance use disorders among people who use drugs: a population-based cross-sectional study in the Western Province of Sri Lanka

Introduction: This study aimed to assess the prevalence of substance use disorders and associated factors among people who use drugs in the Western Province of Sri Lanka. Methods: A cross-sectional study was conducted in the Western Province of Sri Lanka, using a respondent-driven sampling technique. Sampling was initiated with 20 seeds and peers were recruited by peers through handing out coupons. The number of recruited participants was proportional to the estimated number of people who use drugs in each district of Western Province. A total of 870 people who use drugs participated in the study. A validated Sinhala version of the Drug Abuse Screening Test was used to assess the drug use severity among the participants and a pre-tested validated questionnaire was used to collect data to assess the associated factors. RDS Analyst software version 0.64 was used to assess frequency estimates. To assess factors associated with substance use disorders multiple logistic regression analysis was performed using SPSS software version 22. Results: The median age of the study sample was 39 years. The incidence of substance use disorder among the sample was 88.4%. Being employed, using heroin as a psychoactive drug, using drugs daily, using more than one drug, being a heavy alcohol user, buying drugs, stealing money or exchanging goods to get drugs, spending a substantial amount per month on drugs (Rs &gt; 40,001), past or present medical history of tuberculosis and those who had disclosed their drug use behavior to their immediate family were found to be significantly associated with an increased risk of having a substance use disorder. Conclusion: A high prevalence of substance use disorder was found in the sample with multiple economic, behavioral, and health-related risk factors.

Substance use disorder of equimolar oxygen-nitrous oxide mixture in French sickle-cell patients: results of the PHEDRE study

BackgroundIn many countries, nitrous oxide is used in a gas mixture (EMONO) for short-term analgesia. Cases of addiction, with significant misuse, have been reported in hospitalized patients. Patients suffering from sickle cell disease (SCD) could represent a high-risk population for substance use disorder (SUD) due to their significant pain crisis and repeated use of EMONO. The objective of the PHEDRE study was to assess the prevalence of SUD for EMONO in French SCD patients.ResultsA total of 993 patients were included. Among 339 EMONO consumers, only 38 (11%) had a SUD, with very few criteria, corresponding mainly to a mild SUD due to a use higher than expected (in quantity or duration) and relational tensions with the care teams. Almost all patients (99.7%) were looking for an analgesic effect, but 68% of patients were also looking for other effects. The independent risks factors associated with at least one SUD criterion were: the feeling of effects different from the expected therapeutic effects of EMONO, at least one hospitalization for vaso occlusive crisis in the past 12 months and the presence of a SUD for at least one other analgesic drug.ConclusionsThe use of EMONO was not problematic for the majority of patients. Manifestations of SUD that led to tensions with healthcare teams should alert and lead to an evaluation, to distinguish a true addiction from a pseudoaddiction which may be linked to an insufficient analgesic treatment related to an underestimation of pain in SCD patients.Trial registration: Clinical Trials, NCT02580565. Registered 16 October 2015, https://clinicaltrials.gov/

Occurrence and Prevention of Substance Use Disorder Among Anaesthesiology and Intensive Care Medicine Residents in Indonesia: A Pilot Study

Background: Substance use disorders (SUD) in the population of anaesthesiology and intensive care medicine (ICM) residents have the potential to cause fatal occupational risks. Currently, there are no epidemiological reports regarding the prevalence of SUD among doctors in Indonesia and anaesthesiologists in particular. The purpose of this study was to estimate the occurrence of SUD among anaesthesiology and ICM residents in Indonesia and to recognize the SUD prevention strategy implemented in each teaching hospital. Methods: This was a survey-based observational study using a three-part questionnaire consisting of 20 binary questions, which was pertained to the sociodemographic details, the occurrence and prevention of SUD. Participants were recruited from 16 residency programs with a total of 1 127 active residents registered at the Indonesian College of Anaesthesiology and Intensive Care. All returned surveys were reviewed and scored by hand. The data were compiled and analyzed with numbers and percentages. Results: Returned surveys from 353 residents yielded a 31.3% response rate. Residents from 13 out of 16 registered residency programs in Indonesia participated in this survey. The occurrence of SUD among anaesthesiology and ICM residents in Indonesia was 0.5%. As much as 77.3% of respondents never had toxicological screening. Moreover, 18.2% of respondents were not aware of any routine toxicology screening in their program. Conclusions: The majority of anaesthesiology and ICM residents in Indonesia have risk factors for developing SUD. The need for policies, training, education, and SUD prevention strategies must be immediately addressed.

Substance Use Disorders among Adolescents in the United States: 2000-2019.

Substance use disorders (SUDs) are characterized by impairment caused by the recurrent use of alcohol, illicit drugs, or both. SUDs are pervasive and endemic among US adolescents, with potentially negative health and social consequences. Although the term experimentation normalizes adolescent substance abuse, the long-term consequences of this behavior beginning in adolescence can be detrimental to not only the adolescent but also the adult into which he or she develops. Our objective was to examine the epidemiology of SUD among hospitalized US adolescents, 13 to 19 years of age, during the time period 2000-2019. A case-control study was conducted using 5,260,104 hospital discharge records (394,952 SUD and 4,865,152 non-SUD) from the 2000-2019 Kids' Inpatient Database. SUD and clinical outcomes variables were identified based on the International Classification of Diseases, Ninth/Tenth Revisions, Clinical Modification, coding. SUD rates (per 1000 discharges) were calculated and adjusted odds ratios (aORs) with their 95% confidence intervals (CIs) were computed using logistic regression models for predictors of SUDs among hospitalized adolescents. The prevalence of SUDs was estimated to be 75.10 cases per 1000 discharges (95% CI 74.86-75.31). Demographically, the highest crude rates (per 1000 discharges) were seen among Native American (139.58) and White (91.97) patients. Adolescent patients who experienced SUD were twice as likely as nonusers to be 16 to 19 years of age (aOR 2.2, 95% CI 2.13-2.19) or to be male (aOR 2.2, 95% CI 2.22-2.27). SUD was significantly associated with cooccurring conditions, including anxiety (aOR 2.5, 95% CI 2.48-2.53), depression (aOR 2.3, 95% CI 2.30-2.35), mood disorder (aOR 2.17, 95% CI 2.14-2.20), schizophrenia (aOR 2.6, 95% CI 2.52-2.64), sexually transmitted infections (aOR 2.3, 95% CI 2.23-2.45), hepatitis (aOR 3.0, 95% CI 2.87-3.15), and suicide (aOR 1.33, 95% CI 1.30-1.35). The study examined the epidemiology, risk factors, and common characteristics of hospitalized adolescent patients with SUDs. The high burden of psychiatric and medical comorbidities observed among this patient group warrants designing effective and comprehensive substance use prevention and treatment programs for youths.

Epidemiological Association of Parental Substance Use History and Mental Health Disorders in Central Morocco

This cross-sectional study investigated the prevalence of substance use disorders and explored associations between parental substance use disorder history and mental health disorders among psychiatric hospital inpatients in central Morocco. A total of 723 participants were included in the study. Data were collected using a structured questionnaire and medical records, covering psychiatric diagnoses, sociodemographic characteristics, substance use disorders among patients and their parents, as well as the patient's psychiatric history and length of hospital stay. Participants were divided into two groups: those with parental history of substance use disorders (PSUD) and those without. Patients' mean ages were 34.40 years (± 11) and 35.5 years (± 12), respectively. The prevalence of substance use was notably high among participants, with cannabis use being the most prevalent (90.6%). Educational level was associated with PSUD, with participants having no formal education showing a higher likelihood of having parents with SUD (unadjusted odds ratio, UOR = 2.11, 95% CI = 1.1 to 4.03). Polysubstance use was also associated with the PSUD group (UOR = 2.42, 95% CI = 1.73 to 3.40). Regarding psychiatric disorders, one in five patients in the PSUD group had schizophrenia (21.35%), followed by acute psychotic episodes (20.5%), depression (20.29%), and anorexia (8.24%). The study revealed a high overall prevalence of substance use among participants with mental health disorder, highlighting the significance of parental SUD history as a predictor for patients' mental health disorders. This suggests the need for special attention and preventive measures. [ Psychiatr Ann . 2024;54(2):e56–e66.]

Prevalence of probable substance use disorders among children in Ugandan health facilities

BackgroundGlobally, there is a concerning surge in the prevalence of substance use among adolescents and children, creating a substantial public health problem. Despite the magnitude of this issue, accessing healthcare explicitly for substance use remains challenging, even though many substance users frequently visit healthcare institutions for other health-related issues. To address this gap, proactive screening for substance use disorders has emerged as a critical strategy for identifying and engaging patients at risk of substance use. The purpose of this study was to investigate the prevalence of probable alcohol and other substance use disorders, and associated factors, among children aged 6 to 17 years old attending health facilities in Mbale, Uganda.MethodsWe conducted a health facility cross-sectional study, involving 854 children aged 6–17 years. The prevalence of probable alcohol and other substance use disorders was assessed using a validated Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) screening tool. Univariable and multivariable modified Poisson regression analyses were performed using STATA 15 software.ResultsThe overall prevalence of probable alcohol use disorders (AUD) and other substance use disorders (SUD) was 27.8% (95% CI 1.24–1.31) while that of probable AUD alone was 25.3% (95% CI 1.22–1.28). Peer substance use (APR = 1.24, 95% CI 1.10–1.32), sibling substance use (APR = 1.14, 95% CI 1.06–1.23), catholic caregiver religion (APR = 1.07 95% CI 1.01–1.13), caregiver income of more than $128 (APR = 0.90, 95% CI 0.82–0.98), having no parental reprimand for substance use (APR = 1.05, 95% CI 1.01–1.10) and having no knowledge of how to decline an offer to use substances (APR = 1.06, 95% CI 1.01–1.12) were found to be significantly associated with probable AUD/SUD.ConclusionsOur findings suggest a high prevalence of probable AUD and SUD among children and adolescents visiting healthcare facilities for other conditions, along with a strong link between AUD and SUD prevalence and social factors. The implication for our healthcare system is to actively screen for and treat these conditions at primary healthcare facilities.

Recovery Support and Capacity Assessment Using the Calculating an Adequate System Tool: Two Case Studies.

There are multiple, reliable, and authoritative federally managed data sources for understanding the incidence and prevalence of substance use disorder (SUD) and its sequela. However, there remains a gap in metrics representing the need and capacity for treatment and related supports within local communities. To address this challenge, Calculating an Adequate System Tool (CAST) was developed in 2016 by an interdisciplinary group of researchers at the Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality to assess the capacity of the SUD care system within a defined geographic area. It allows for risk assessment of local social and community determinants of substance abuse, as well as an assessment of local service needs across the continuum of SUD care. This article describes the application of the CAST to 2 counties in Ohio and 1 county in Montana. The purpose of using CAST for each area, results of the application, and experiences in utilizing the tool are described. Application of the CAST demonstrated unique findings within each of the geographic areas. In Ohio, recovery support services were lacking in both counties assessed, while differences in crime rate and alcohol outlet density were attributed to varying rates of drug-related hospitalization. Notable findings in Montana included an oversaturation of coalitions focused on substance use prevention and gaps in the areas of detoxification services, partial day treatment, recovery residences, and peer support specialists. CAST is a useful tool for guiding decision-making relative to substance use care needs and capacities for local geographic areas. Findings should be interpreted thoughtfully and in the context of data availability. CAST continues to be enhanced and further expanded for assessing capacity of local and statewide substance use care systems.

Primary care nurse practitioner work environments and emergency department utilization among older adults with substance use disorders in rural areas

IntroductionThe prevalence of substance use disorders (SUDs) is growing among older adults, and older adults in rural areas face disparities in access to SUD care. Rural older adults with SUDs commonly have comorbid chronic conditions that puts them at risk for frequent acute healthcare utilization. In rural areas, primary care for patients with SUDs are increasingly provided by nurse practitioners (NPs), and quality primary care services may decrease ED visits in this population. Yet, NP-delivered primary care for rural older adults with SUDs may be limited by work environment barriers, which include lack of support, autonomy, and visibility. This study assessed the relationship between the NP work environment and ED utilization among rural older adults with SUDs. MethodsThis was a secondary analysis of cross-sectional data from a large survey of NPs in six U.S. states merged with Medicare claims. The study measured the NP work environment by the four subscales of the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ), which measure 1) independent practice and support, 2) NP-physician relations, 3) NP-administration, and 4) professional visibility. Multilevel logistic regression models, adjusted for practice and patient covariates, assess the relationship between the NP work environment and all-cause ED use. ResultsThe sample included 1152 older adults with SUDs who received care at 126 rural NP primary care practices. NP independent practice and support at the practice was associated with 49 % lower odds of all-cause ED visits among older adults with SUDs. There were no relationships between the other NP-PCOCQ subscales and all-cause ED visits. ConclusionsOrganizational support for NP independent practice is associated with lower odds of all-cause ED utilization among rural older adults with SUDs. Practice administrators should ensure that NPs have access to support and resources to enhance their ability to care for rural older adults with SUDs. Ultimately, these practice changes could reduce ED utilization and health disparities in this population.

Alcohol, Smoking and Substance Involvement Screening Test validity in bipolar and psychotic disorders.

Patients with multi-episode bipolar and psychotic disorders have a high prevalence of substance use disorders, with negative consequences. A brief, easily administered screening test such as the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is needed to identify those at risk in order to intervene appropriately. However, the ASSIST has not yet been validated in this population. This article aims to determine the validity and reliability of the ASSIST in detecting substance use disorders in patients with multi-episode bipolar and psychotic disorders. Western Cape Province, South Africa. The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Health Disorders, 4th Edition (DSM-IV) Axis I Disorders (SCID-I) was used as the gold standard for detecting substance abuse and dependence. Cronbach's alpha was used to determine the internal consistency of the ASSIST, and receiver operating characteristic analysis was used to evaluate its screening properties. Optimal cut off scores were calculated to maximise sensitivity and specificity. A total substance involvement lifetime score of ≥13 was found to have optimal sensitivity and specificity of just over 74%. The optimal cutoff score for alcohol was ≥4 and for cannabis, methamphetamine, and 'other drugs' was ≥3. The area under the curve was 0.7 or above for both the total and specific substance involvement scores. The ASSIST is a psychometrically sound screening test for substance use disorders in patients with multi-episode bipolar and psychotic disorders. This is the first study to validate the ASSIST in this population.

Validation of a brief screener for broad-spectrum mental and substance-use disorders in South Africa.

In low-resource settings, valid mental health screening tools for non-specialists can be used to identify patients with psychiatric disorders in need of critical mental health care. The Mental Wellness Tool-13 (mwTool-13) is a 13-item screener for identifying adults at risk for common mental disorders (CMDs) alcohol-use disorders (AUDs), substance-use disorders (SUD), severe mental disorders (SMDs), and suicide risk (SR). The mwTool-13 is administered in two steps, specifically, only those who endorse any of the initial three questions receive the remaining ten questions. We evaluated the performance of mwTool-13 in South Africa against a diagnostic gold standard. We recruited a targeted, gender-balanced sample of adults, aged ≥18 years at primary and tertiary healthcare facilities in Eastern Cape Province. Of the 1885 participants, the prevalence of CMD, AUD, SMD, SR, and SUD was 24.4%, 9.5%, 8.1%, 6.0%, and 1.6%, respectively. The mwTool-13 yielded high sensitivities for CMD, SMD, and SR, but sub-optimal sensitivities for AUD and SUD (56.7% and 64.5%, respectively). Including a single AUD question in the initial question set improved the tool's performance in identifying AUD and SUD (sensitivity > 70%), while maintaining brevity, face-validity, and simplicity in the South African setting.

Which substances pose the greatest risk of substance use disorder after controlling for polysubstance use?

Both physiological and epidemiological research suggest that certain psychoactive substances have a greater potential for abuse (e.g. heroin) than others (e.g. hallucinogens). The use of multiple substances is also associated with a higher risk of substance use disorder (SUD). The goal of the present study was to evaluate the association between the use of different substances and the risk of SUD while accounting for polysubstance use. Data from the 2021 National Survey on Drug Use and Health (n = 58,034, unweighted) were used. Eight different substances (i.e. Alcohol, Cannabis, Cocaine, Inhalants, Hallucinogens, Heroin, Methamphetamine, and Opiate Misuse) were compared with respect to their typical frequency of use; the prevalence of SUD among individuals using each substance; the odds of SUDs when controlling for polysubstance use; and the rate of other substance use among those with a substance-specific SUD. Notable differences were found regarding the frequency of use and the rate of SUD among individuals reporting past year use. Heroin and methamphetamine were associated with the highest risk of SUD across all analyses. In contrast, hallucinogens and inhalants were consistently identified as having the lowest risk. The present results confirm that certain substances appear to have an inherently greater association with SUD compared to other substances. While these findings are not fundamentally divergent from prior epidemiological studies or ranking systems, they provide a more solid empirical foundation for assumptions of differential risk.

The prevalence of substance use disorders in chiropractic patients in the United States: a descriptive study of two national datasets

ABSTRACTBackground and ObjectiveIndividuals commonly seek chiropractic care for pain with concurrent substance use. However, the prevalence of substance use disorder (SUD) diagnosis in adults utilizing chiropractic care is unknown. This descriptive study assessed the prevalence of adult (≥18 years) chiropractic patients with a SUD diagnosis.MethodsSelf-reported survey data from the All of Us Research Program and electronic health records from the TriNetX Research Network were queried in August 2023. The number of chiropractic patients and the number of chiropractic patients with a SUD diagnosis were calculated for each dataset. The prevalence of chiropractic patients with a SUD diagnosis was calculated for each dataset by dividing the number of chiropractic patients with a SUD diagnosis by the number of chiropractic patients.ResultsThe prevalence of chiropractic patients with a SUD diagnosis in the All of Us Research Program data was 6.8%. The prevalence of chiropractic patients with a SUD diagnosis in the TriNetX Research Program data was 7.8%.ConclusionsChiropractors commonly encounter patients with a SUD diagnosis. Given the individual and societal burden of SUDs, it is imperative that chiropractors are trained to recognize individuals living with SUDs and facilitate referral to appropriate treatment for those in need.

Psychiatric and Substance Use Disorders Are Independent Predictors of Treatment Response and Outcomes in United States Veterans with Newly Diagnosed Acute Myeloid Leukemia Treated with Venetoclax Combinations

BACKGROUND: Venetoclax (VEN) combinations have become the standard frontline therapy for patients with newly diagnosed acute myeloid leukemia (AML) who are deemed unable to tolerate intensive induction chemotherapy, either due to age or comorbidities. However, outcomes in the real-world setting have been inferior to those observed in clinical trials. Preexisting psychiatric diagnoses and substance use disorders (SUDs) have previously been associated with increased mortality in patients with cancer, but their prognostic influence in veterans with AML is unclear. The aim of this study was to measure the prevalence of psychiatric and SUDs in veterans with AML treated with VEN combinations, determining the impact of these conditions on treatment response and outcomes. METHODS: This was a retrospective cohort study of veterans with newly diagnosed AML who received frontline therapy with VEN combinations within the national Veterans Affairs (VA) Healthcare System. To measure the prevalence of psychiatric and SUDs, we used the Centers for Medicare and Medicaid Services (CMS) Chronic Conditions Data Warehouse algorithm, which tracks health conditions by administrative claims data with International Classification of Diseases (ICD) diagnostic and procedural codes. Our endpoints were rates of complete remission or complete remission with incomplete marrow recovery (CR/CRi), early mortality (EM, or death within 60 days of treatment initiation), intensive care unit (ICU) admissions, and overall survival (OS). We evaluated the relationship between comorbid medical conditions and outcomes using Kaplan-Meier analysis and Cox proportional hazards regression models, first unadjusted, and then adjusted for all covariates. Patients who underwent allogeneic stem cell transplantation (HSCT) were excluded from statistical analyses. RESULTS: We identified 452 veterans treated with VEN up to April 1, 2022 (Table 1). In combination with VEN, 60% (n=270) received azacitadine, 37% (n=168) received decitabine, and 3% (n=14) received low-dose cytarabine. Median age was 74.3 years (IQR: 71.2-78.5) with 52% ≥75 years. By European LeukemiaNet (ELN) 2017 risk classification, 61% (n=274) were classified as adverse risk. Forty-six percent (n=206) of veterans had a preexisting psychiatric diagnosis, and 19% (n=84) had SUDs; 11% (n=49) had both comorbidities. Psychiatric disorders were significantly more prevalent in younger veterans (68% in &amp;lt;65 years vs 50% in 65-74 years vs 39% in ≥75 years, p&amp;lt;0.003); same was true for SUDs (38% in &amp;lt;65 years vs 26% in 65-74 years vs 9% in ≥75 years, p&amp;lt;0.001). For the entire cohort, CR/CRi was achieved by 57% (n=257), and only 3% (n=12) received HSCT. Zero veterans with SUDs and 8 with psychiatric diagnoses were transplanted. At the end of study period, 69% (n=310) had died. Median OS was 216 days (95% CI: 195-254). The 60-day mortality rate was 20% (n=87), of which 8 veterans had primary refractory AML. ICU admissions after treatment initiation was significantly higher in veterans with SUDs compared to those without history of SUDs (5.0 versus 2.2 per 5 person-years, p&amp;lt;0.001). On multivariable analyses (Table 2), both psychiatric and SUDs were independently associated with decreased odds of CR/CRi. Veterans with psychiatric disturbances had a 1.97 times higher hazard of EM (95% CI: 1.16-3.39, p=0.01) and a 1.28 times higher hazard of death (95% CI: 1.00-1.64, p=0.05) compared to veterans without concurrent psychiatric disorders. CONCLUSION: Psychiatric diagnoses and SUDs were not only prevalent among veterans with AML, but they also negatively impacted treatment response, EM, and OS-independently of age, sociodemographic variables, markers of disease risk, and VEN combination. Veterans with SUDs also had significantly higher ICU admissions after treatment initiation for AML. Compared to published clinical trials data, veterans experienced inferior outcomes. Veterans with psychiatric and SUDs may have difficulty adhering to regimens, reemergence of their mental instability and illness that is triggered by AML diagnosis and its treatment, or biologic mechanisms associated with these comorbidities. Better understanding of these factors contributing to health disparities and targeting these comorbidities with supportive care interventions alongside AML-specific therapy may improve outcomes and warrant further study.