Specific Substance Use Disorders Research Articles

Comorbidity of Borderline Personality Disorder and Lifetime Substance Use Disorders in a Nationally Representative Sample.

Borderline personality disorder (BPD) is comorbid with substance use disorders (SUDs). However, most epidemiological work on BPD and SUDs has collapsed nonalcohol substances into a drug use disorder indicator, potentially obscuring patterns of association between BPD and individal SUDs. Using a nationally representative sample (National Epidemiologic Survey on Alcohol and Related Conditions; N = 34,481), the authors examined the association between lifetime BPD and nine lifetime SUDs. First, the authors examined the bivariate association of BPD and each SUD. BPD was associated with all nine SUDs. Second, they added relevant covariates (demographic variables, additional psychopathology) to each model. Seven SUDs remained significant. Finally, to account for shared variance across SUDs, the authors conducted a multivariate logistic regression with the nine SUDs and covariates as predictors. Alcohol, cocaine, and opiate use disorder were the only significant SUD predictors, indicating a unique association between BPD and these three SUDs. Future research should explore factors involved in the association of BPD with these specific SUDs.

Comorbidity of Migraine and Psychiatric Disorders Among Substance‐Dependent Inpatients

Limited and conflicting data exist regarding the prevalence of psychiatric disorders, particularly substance use disorders (SUDs), among migraineurs in inpatient clinical settings. As part of a larger cross-sectional study, 181 substance-dependent inpatients completed a structured psychiatric interview and measures of psychiatric symptoms and migraine. Standardized mean differences were used to quantify differences between inpatients with and without migraine across 4 domains of predictors (demographic variables, non-SUD psychiatric diagnoses, specific SUDs, and self-reported psychiatric symptoms). The predictors within each domain that best discriminated between the migraine and no-migraine groups were identified using a classification tree approach with Bonferroni corrections. These candidate predictors were subsequently entered into a multivariate logistic regression to predict migraine status, which was then replicated using bootstrapping of 500 samples. Associations between migraine status and SUD treatment dropout were also examined. Forty-four of the 181 (24.3%) participants met criteria for migraine. Migraineurs were more likely to be female (34.8% vs. 18.3%) and reported higher levels of current anxiety symptoms (mean [standard deviation]: 19.7 [11.0] vs. 11.3 [10.3]). Having a lifetime diagnosis of generalized anxiety disorder (56.8% vs. 27%, odds ratio 3.47, 95% confidence interval [CI] 1.39-10.58) or a current diagnosis of alcohol dependence (45.5% vs. 24.1%, odds ratio 3.79, 95% CI 1.63-13.62) was associated with more than a 3-fold risk of migraine. These 4 variables in combination were forced into the final multivariate model, which differentiated well between those with and without migraine (area under the receiver operating characteristic curve = 0.81; 95% CI 0.73-0.88). Migraine was not differentially associated with increased risk for SUD treatment dropout (13.6% vs. 16.1% dropout among those without migraine). A history of generalized anxiety disorder, high levels of current anxiety symptoms, and current alcohol dependence are the strongest psychiatric predictors of migraine status among substance-dependent inpatients. However, migraine status is not associated with SUD treatment dropout.

Substance Use Disorder Prevalence among Female State Prison Inmates

Background: Substance use disorders (SUDs) are prevalent among female inmates. As the female state prison population continues to increase, describing the specific clinical and demographic characteristics of female prisoners remains of paramount importance to better define women’s needs in the state prison system. Objectives: To determine the prevalence and patterns of current DSM-IV SUDs and explore whether particular demographic characteristics are more strongly associated with specific SUD categories. Methods: Data were derived from routine clinical assessments of 801 female inmates incarcerated in the Minnesota Department of Corrections state prison system. The Substance Use Disorder Diagnostic Schedule-IV (Hoffmann NG, Harrison PA. SUDDS-IV: Substance Use Disorder Diagnostic Schedule-IV. Smithfield, RI: Evince Clinical Assessments, 1995) was administered to all inmates as a computer-prompted interview on admission to the prison. Results: Of the inmates, 70.0% were dependent on at least one substance, and 7.9% met criteria for substance abuse. Alcohol dependence (30.2%) and cocaine dependence (30.1%) were the two most prevalent SUDs. The remaining substance dependence diagnoses that predominated were as follows: stimulant dependence, 24.1%; marijuana dependence, 15.6%; and heroin dependence, 9.6%. Over half (56.9%) were dependent on a substance other than alcohol. Prevalence of cocaine dependence [odds ratio (OR) = 2.83, 95% confidence interval (CI) = 1.92–4.16] was significantly higher among African Americans, whereas prevalence of stimulant dependence (OR = 9.24, 95% CI = 5.40–15.80) was significantly higher among Caucasians. Prevalence of alcohol (OR = 2.12, 95% CI = 1.38–3.25) and heroin (OR = 2.67, 95% CI = 1.50–4.77) dependence was significantly higher among Native Americans. Conclusions and Scientific Significance: SUDs in general, and illicit drug use disorders in particular, are prevalent among female inmates entering a state prison system. Membership to a particular ethnic group may identify a set of inmates at elevated risk for the presence of substance-specific dependence diagnoses.

Identifying patterns of co-occurring substance use disorders and mental illness in a jail population

Although the co-occurrence of mental health and substance use disorders (SUDs) is well documented among correctional populations, less explored are the actual patterns that exist between specific SUDs and additional mental health disorders in combination. This study examines prevalence and correlates of psychiatric comorbidity in incarcerated men who screened positive for a SUD and the ability of a practical structured interview to document diagnostic indications of SUDs and co-occurring disorders. Comprehensive Addictions and Psychological Evaluation (CAAPE) interview data from 176 substance-dependent male inmates incarcerated in a local jail facility were analyzed. The most common substance dependence diagnoses were for alcohol (81%) and cocaine (35%). Posttraumatic stress disorder (PTSD) was the most common co-occurring mental health condition (55%), followed by antisocial personality disorder and major depressive episodes (51% each). Patterns related to the presence of PTSD and major depressive episodes accounted for a vast majority of inmates with both two and three diagnostic indications. Cronbach's alphas for the individual CAAPE diagnostic subscales ranged from 0.74 to 0.97. The design and implementation of treatment programs for substance-dependent inmates must consider co-occurring mental health issues. Several of the diagnostic categories evinced a bimodal pattern of responses in terms of severity. Negative correlations among many of the SUDs suggest that those with a greater level of severity involving some substances are less likely to manifest dependence and high severity for other substances. The observed Cronbach's alphas for the various subscales demonstrated acceptable preliminary support for the use of the CAAPE as a practical instrument in indentifying co-occurring disorders in a jail setting.

P-106 - Risk of mental disorders in children of parents with alcohol or heroin dependence: a controlled high risk study

Children of patients with substance use disorders (SUD) are at high risk for mental disorders. The effects of specific SUD in both parents on the risk of psychopathology in offspring have hardly been studied. To gain a better understanding of the morbid risk of these children. To assess, 1) the associations between alcohol dependence (AD) or heroin dependence (HD) in patients and psychopathology in their children; 2) the morbid risk conferred by having a second parent with SUD. The sample included 276 children aged from 6 to 17.9 years (mean age = 11.5): 23 children of 15 patients with HD, 101 offspring of 50 patients with AD, 152 children of 81 orthopedic patients (controls) and 158 biological co-parents of the children. Subjects were interviewed by psychologists blind to patient diagnoses, using a semi-structured diagnostic interview. 1) Children of HD or AD patients had largely elevated rates of recurrent major depressive disorder and children of HD patients were also at an increased risk for ADHD and SUD; 2) There were interactions between drug disorders and alcohol disorders in both parents to increase the risk of early SUD in offspring. The early manifestations of mental disorders in children of SUD patients emphasize the need for prompt identification and treatment of these disorders. The involvement of co-parental disorders in the development of offspring psychopathology highlights the need to pay clinical attention not only to the patient, but also to the co-parent in order to optimize prevention in offspring.

Substance Use Disorders: Findings from a Longitudinal Study of Individuals with and without a History of Developmental Language Disorders

Objective: To study the prevalence and types of substance use disorders (SUDs) in adults diagnosed during childhood as having a developmental language disorder (DLD). Patients and Methods: The prevalence rates and types of SUDs in a clinical sample of 469 individuals diagnosed during childhood as having a DLD were compared with SUDs in 2,345 matched controls from the general population without a known history of DLD using data from the nationwide Danish Psychiatric Central Register (DPCR). The average observation time was 34.7 years, and the mean age at follow-up was 35.8 years. Results:Of the 469 individuals with DLD, 12 (2.6%) appeared in the DPCR with an SUD diagnosis, compared with 46 (2.0%) in the control group (p = 0.41; OR 1.3; 95% CI 0.7–2.5). Specific SUDs occurred with a low frequency in both groups. Only cocaine-related disorders were significantly associated with DLD (p = 0.03). Variables at assessment in childhood, i.e. gender, IQ, the presence of a receptive language disorder, and the degrees of receptive and expressive language disorders were not associated with an SUD diagnosis in the DPCR at follow-up. Conclusion: Our findings do not support the hypothesis that DLD is a risk factor for SUD in adulthood.

Violent and Nonviolent Suicide in Veterans With Substance-Use Disorders

Substance-use disorders (SUDs) increase the risk of suicide. Examining risk factors for violent or nonviolent suicide in those with SUDs could improve suicide-prevention efforts in these individuals. We examined the demographic and clinical predictors of violent and nonviolent suicide among patients with SUDs. This study examined Veterans Affairs (VA) patients with SUDs who were alive at the beginning of Fiscal Year (FY) 2002 and died by suicide during FYs 2002 through 2006 (n = 854) and a random sample of 4,228 SUD patients who did not die by suicide during this period. Data were obtained from VA medical records and the National Death Index. Patients were considered to have an SUD if they received two or more diagnoses of the same SUD from FY 1997 to FY 2001. Of those who died by suicide, 70% (n = 600) used violent means. Diagnoses of depressive, other anxiety, bipolar and posttraumatic stress disorders, schizophrenia, and personality disorders were associated with increased risk of both violent and nonviolent suicide; however, these associations were stronger for nonviolent than violent suicide deaths. Risk of nonviolent suicide was greater among patients with opioid-use disorders or a clinical diagnosis of abuse or dependence (according to the International Classification of Diseases, Tenth Revision) on multiple substances. Most VA patients with SUDs who died from suicide used violent means. No specific SUD was associated with increased risk of violent suicide, but several SUD diagnoses were associated with increased risk of nonviolent suicide. Concurrent psychopathology increased risk for both suicide types; however, the relationship was strongest for nonviolent suicide.

The Romanian Mental Health Study

The article shows the findings of Mental Health Survey – Romania 2007, regarding the lifetime prevalence, the age group variation, the onset age of mental disorders, the projected risk by 75 years, and the comparison of the projected risk with the observed lifetime prevalence the proportion of those making initial treatment contacts in the year of onset and by 75 years. The lifetime prevalence for any mental disorders, among those of 18 years old and older is 13.4% with the onset in the adolescence or early adulthood. Among the mental disorders the highest prevalence can be found for anxiety disorders. For some of the anxiety disorders (specific phobia, social phobia, posttraumatic stress disorders, panic disorders, and alcohol abuse with or without dependence) can be noticed an increase of prevalence in adulthood compared to younger ages, following a decrease at 65 years or older ages. The major depressive episode registers continuous increase reaching the highest prevalence at elderly people. The projected lifetime risk shows higher values compared to the observed lifetime prevalence. The proportion of those making initial treatment contact in the year of onset is 32-63% for those with bipolar disorder, dysthymia, drug abuse, 10,2-24,6% for mood disorders and agoraphobia and under 10% for major depressive episode, panic disorder specific phobia alcohol abuse and substance use disorders. Keywords: mental health, mental disorders, lifetime prevalence, services use

Transitions from first substance use to substance use disorders in adolescence: Is early onset associated with a rapid escalation?

BackgroundEarly substance use (SU) in adolescence is known to be associated with an elevated risk of developing substance use disorders (SUD); it remains unclear though whether early SU is associated with more rapid transitions to SUD. ObjectiveTo examine the risk and speed of transition from first SU (alcohol, nicotine, cannabis) to SUD as a function of age of first use. MethodsN=3021 community subjects aged 14–24 years at baseline were followed-up prospectively over 10-years. SU and SUD were assessed using the DSM-IV/M-CIDI. Results(1) The conditional probability of substance-specific SU-SUD transition was the greatest for nicotine (36.0%) and the least for cannabis (18.3% for abuse, 6.2% for dependence) with alcohol in between (25.3% for abuse; 11.2% for dependence). (2) In addition to confirming early SU as a risk factor for SUD we find: (3) higher age of onset of any SU to be associated with faster transitions to SUD, except for cannabis dependence. (4) Transitions from first cannabis use (CU) to cannabis use disorders (CUD) occurred faster than for alcohol and nicotine. (5) Use of other substances co-occurred with risk and speed of transitions to specific SUDs. ConclusionType of substance and concurrent use of other drugs are of importance for the association between age of first use and the speed of transitions to substance use disorders. Given that further research will identify moderators and mediators affecting these differential associations, these findings may have important implications for designing early and targeted interventions to prevent disorder progression.

PHARMACOLOGIC TREATMENTS FOR DRUG AND ALCOHOL DEPENDENCE

Pharmacotherapy remains a relatively underused strategy for the treatment of patients with psychoactive substance-use disorders. This is partly because of a widely held view among the public and the substance-abuse treatment community that substance-use disorders are non-medical and should be treated through nonpharmacologic means. Furthermore, the pharmaceutical industry has been slow in developing medications for the treatment of patients with these disorders because of skepticism over the potential profitability of such medications. These factors have limited research activity in this area, with much of the impetus for study of these medications coming from the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, where the substantial public health implications of medications development for substance-use disorders have been recognized. Despite limitations, considerable advances in medication development for patients with substance-use disorders have occurred in recent years, and more can be expected in the near future. This is most evident in the treatment of patients with nicotine and opioid dependence, for whom several pharmacologic options exist. Recently renewed interest in the pharmacologic treatment of patients with alcohol dependence is likely to advance that therapeutic area substantially with time. Ongoing efforts should focus on identifying new compounds, systematically assessing them for activity in specific substance-use disorders, and educating the public and the treatment community about the substantial benefits that can accrue from medication development for patients with substance-use disorders.