Multiple Substance Use Research Articles

Do psychological features distinguish those who sexually offend against different age groups from those who are stable in victim age?

Aim/Background Victim age polymorphism occurs when someone offends against victims that span multiple age groups (e.g., child and adult victims). There is a need to better understand the correlates of age polymorphism, as clinicians are often asked about risk of offending against victims who may differ from the index offence victim as part of their risk formulation. The present study examines several potential correlates of age polymorphism: psychopathy, sexual preoccupation, multiple paraphilias, psychosis, and substance use disorders. Materials/Method Analyses were conducted using secondary clinical assessment data from a provincial forensic sexual behaviour program. The sample included 387 men with two or more contact sexual offence victims. The assessment data in the archival database included comprehensive information about victim age, as well as standardized assessment measures and diagnostic/clinical impressions. Results There were no significant associations between age polymorphism and psychopathy, multiple paraphilias, sexual preoccupation, psychosis, and substance use disorders. The only significant difference that emerged was that men who offended against victims 16 or older had a higher mean score on a measure of drug misuse than those who offended against victims 6 to 11. Most of the analyses produced small effects. Conclusion Our findings did not identify significant correlates of age polymorphism when restricting analyses to those men who offended against two or more victims. We consider key methodological differences that may have impacted our findings, as well as the need for rigorously designed research to develop a comprehensive model of age polymorphism.

COVID-19-related treatment service disruptions among people with single- and polysubstance use concerns

Individuals with substance use disorders (SUDs), including those in long-term recovery, and their loved ones are facing rapid changes to treatment and support services due to COVID-19. To assess these changes, the Addiction Policy Forum fielded a survey to their associated patient and family networks between April 27 and May 13, 2020. Individuals who reported a history of use of multiple substances were more likely to report that COVID-19 has affected their treatment and service access, and were specifically more likely to report both use of telehealth services and difficulties accessing needed services. These findings suggest that individuals with a history of using multiple substances may be at greater risk for poor outcomes due to COVID-19, even in the face of expansion of telehealth service access.

Using genetic information to inform policy on cannabis

Using genetic information to inform policy on cannabis

Long-Term Substance Use Can Cause Irreversible Photopic Vision Changes in Substance Use Disorder in Remission.

ObjectiveSubstance use has such effects on pupil diameter. Although there is knowledge about the acute effects of substances on pupils, studies showing their chronic effects are limited. The aim of the present study was to evaluate the effect of long-term substance use on scotopic, mesopic, and photopic vision. MethodsThe present study with cross-sectional desgn was conducted at the Adiyaman Training and Research Hospital for Psychiatry in Adiyaman. This study involved 110 substance use disorder (SUD) patients and 46 healthy volunteers as the control. The parameters were measured and recorded automatically by a device. ResultsThe mean age was 23.44±5.53 years in the SUD group and 24.26±5.38 years in healthy controls (p=0.420). The mean age of onset of the substance was 17.74±3.89 years and the mean duration of substance use was 3.54±2.9 years. It was determined that the patients had not used any substance for a mean of 121.73±117.49 days. There was no significant difference between patient and control groups in terms of scotopic and mesopic measurements of both eyes (p>0.05). Photopic measurements were significantly higher in the patient group than in the control group (p<0.05). Photopic measurements were significantly higher in the opioid, cannabis, ecstasy, and multiple substance use groups than in the control group (p<0.05). Conclusion The most important topic of this study is that photopic vision is permanently impaired in patients with a history of chronic substance use. This was attributed to disrupted sympathetic-parasympathetic hierarchy.

Alcohol- and drug-related consequences across latent classes of substance use among American Indian adolescents

IntroductionSubstance use among American Indian (AI) adolescents is a significant public health concern, as they report greater health disparities related to substance use compared to other racial/ethnic groups. The present study examines differences across classes of substance use behaviors regarding alcohol- and drug-related consequences. MethodsThe current study was a secondary analysis of the dataset used by Stanley and Swaim (2018). AI adolescents (n = 3498, 47.8% female, Mage = 14.8) completed a survey including substance use and related consequences. Protocols were approved by institutional IRB, tribal authority, school boards, and parental consent/child assent were obtained. ResultsIn line with Stanley and Swaim (2018), we identified four classes of substance use: no past month substance use; marijuana and cigarette use only; alcohol, marijuana, and cigarette use only; and polysubstance use. Cross-class comparisons revealed that adolescents in classes characterized by the use of a greater number of substances also reported experiencing greater alcohol- and drug-related consequences with one exception: the class characterized by marijuana and cigarette use reported greater drug-related consequences compared to the class characterized by alcohol, marijuana, and cigarette use. ConclusionsAI adolescents who engage in the use of multiple substances should be provided with psychoeducation around the increased risk of associated negative consequences. Given the health disparity experienced by AI adolescents, interventions to alleviate the burden of negative consequences are necessary.

Opioid analgesic use and its sequelae: Opioid and other substance use disorders.

While use of opioids is a well-established risk factor for opioid use disorder (OUD), its association with lifetime use of other addictive substances and the emergence of other lifetime substance use disorders (SUDs) has not been studied. We used data from 36 309 US adults in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III to identify those with lifetime opioid use (n=4090; 11.3%). Of these individuals, we quantified use of other addictive substances; development of OUD and other SUDs; and whether use of opioids and development of OUD came before or after use of other substances and the emergence of other SUDs. Of the 11.3% of adults who reported any opioid use, 98.2% of such users reported use of other addictive substances. Of these opioid users, 18.1% met criteria for lifetime OUD but only 3.5% had OUD alone; 47.6% had SUDs other than OUD and 14.6% had OUD plus another SUD. In most instances, opioid use followed use of other substances and OUD followed development of other SUDs. Opioid use is typically linked to use of multiple substances and while less than 20% developed OUD, more than half developed either OUD or another SUD. Opioid use and OUD most often followed other substance use and the emergence of other SUDs. Early intervention in OUD should consider potential complications of other present or past SUDs, and both prevention and treatment development efforts should focus on the multi-morbid dimensions of the current opioid epidemic.

Club Drugs: Psychotropic Effects and Psychopathological Characteristics of a Sample of Inpatients.

BackgroundGrowing evidence supports the possibility of significant psychiatric consequences related to novel and traditional psychoactive substance consumption. The problem of differential diagnosis has hampered research on specific psychopathologies with unclear outcomes. The aim of our study was to report psychiatric and clinical features of subjects admitted to a psychiatric ward in Ibiza, Spain, with a clinical diagnosis of substance abuse or intoxication.MethodsA survey was administered to a sample of inpatients hospitalized due to psychiatric symptoms related to recent use of psychoactive substances. The questionnaire investigated sociodemographic factors, familiar and personal anamnesis, substance use habits, general and psychopathological features. Urine samples were collected and analyzed in a toxicology laboratory using gas chromatography and mass spectrometry.ResultsA total of 110 patients were included in the study. Most patients (70%) declared multiple substance use, and 33% of patients reported more than two substances; nevertheless, it was possible to identify 17 (15%) depressor users, 44 (40%) stimulant users and 49 (45%) psychodysleptics users. A positive association with a lifetime diagnosis of bipolar disorder was found (two-tailed Fisher’s exact test: p = 0.013). Psychomotor agitation, reference, and paranoid delusions, affective symptoms, consciousness disorders, and aggressiveness represented some of the most frequent symptoms at entry evaluation.ConclusionsIn this study, we described the acute psychiatric presentations related to recreational drug use in subjects on holiday in Ibiza. The use of psychoactive substances was characterized by poly-use of both traditional and novel substances, with several psychopathological consequences. Future research should focus on a better understanding of the psychopathological effects of specific substances, defining signs and symptoms to help make a differential diagnosis and prospectively examine long-term effects.

Psychiatric Multimorbidity in a Specialized Program for Severely Mentally Ill Veterans.

It has been suggested that psychiatric multimorbidity may better characterize severely impaired psychiatric patients than individual severe mental illness (SMI) diagnoses, and that these patients may be better served by centers offering integrated co-located, psychiatric and social services than in conventional clinics providing one-to-one care. We tested the hypothesis that multimorbidity is a critical characteristic of Veterans treated at a co-located multi-service Veteran's Health Administration (VHA) program originally established to treat Veterans living with SMI. Administrative data from the VA Connecticut Health Care System from fiscal year 2012 were used to compare veterans using diverse mental health and social services at the Errera Community Care Center (ECCC), an integrated "one-stop shop" for SMI veterans, and those seen exclusively at standard outpatient mental health clinics. Bivariate and multiple logistic regression analyses were used to compare groups on demographic characteristics, psychiatric and medical diagnoses, service utilization, and psychotropic medication fills. Results: Of the 11,092 veterans included in the study, 2281 (20.6%) had been treated at the ECCC and 8811 (79.4%) had not. Multivariable analysis highlighted the association of treatment in the ECCC and younger age, lower income, homelessness, and especially multimorbidity including both multiple substance use and multiple psychiatric diagnoses. Programs originally designed to address the diverse needs of patients living with SMI and homelessness may be usefully characterized as treating patients with psychiatric multimorbidity, a term of greater clinical relevance. Effectiveness research is needed to evaluate the one-stop shop approach to their treatment.

A Meta-Analysis of Cue Reactivity in Tobacco Cigarette Smokers.

The cue reactivity paradigm allows for systematic evaluation of motivational responses to drug-related cues that may elicit drug use. The literature on this topic has grown substantially in recent decades, and the methodology used to study cue reactivity has varied widely across studies. The present research provided a meta-analytic investigation of variables that have an impact on cue reactivity effects to enhance our understanding of this key feature of tobacco use disorders. A total of 128 publications yielded 249 effect sizes, which were analyzed to investigate the magnitude of the cue reactivity effect and potential moderators. Craving generated a moderate-to-large effect size (Hedges' g = 0.71, p < .001), indicating that drug cues produced significantly greater craving than neutral cues. However, physiological variables yielded significantly lower or nonsignificant effect sizes. Analyses of a variety of empirically and theoretically relevant moderator variables showed that cue modality, cue personalization, cue reactivity environment, and the use of multiple assessments of cue reactivity were significantly associated with the magnitude of cue-specific craving effects (ps < .001). Effect sizes were not significantly related to abstinence status, gender, cigarettes per day, and treatment-seeking status. The results underscored the strength of self-reported craving as an index of cue reactivity across studies, which support theories that posit cue reactivity is core to the addictive process for daily tobacco cigarette smokers. The present research further elucidates the variables that alter the cue reactivity effects across studies and provides recommendations for future cue reactivity research. A core feature of addiction is that drug-related cues can have a major impact on motivational responses across multiple substance use disorders, including tobacco cigarettes. This paper describes a meta-analysis updating and synthesizing cue reactivity research with tobacco cigarette smokers over the last 20 years, a time of rapid growth for this literature. The study leads to a better understanding of the cue reactivity paradigm across different self-report and physiological variables and identifies factors that may modulate addictive motivation for tobacco cigarettes.

Polysubstance use among youth experiencing homelessness: The role of trauma, mental health, and social network composition

BackgroundSubstance use is common among youth experiencing homelessness (YEH). However, less is known about the use of multiple substances (polysubstance use), or factors associated with polysubstance use among YEH. The present study sought to identify subgroups of YEH based on their recent polysubstance use behavior, and investigate traumatic experiences, mental health and social network composition as predictors. MethodsYEH (N = 1,032; Mage = 21.3) from three drop-in centers in Los Angeles completed an in-person survey and social network interview between October 2011 and June 2013. Latent class analysis (LCA) was used to identify subgroups of youth based on nine types of substance use in the past 30 days; latent class logistic regression was used to identify variables associated with class membership. ResultsFive polysubstance use classes were identified: heavy alcohol and marijuana (33.6 %), illicit drug use (4.9 %), high all polysubstance use (14.9 %), primarily marijuana (18.1 %), and low use (28.5 %). Relative to the low use class, traumatic experiences were associated with membership in every polysubstance use class. Suicide attempts were associated with membership in the high all class (OR = 9.41). Number of substance-using, homeless network members was associated with membership in the heavy alcohol and marijuana use class (OR = 1.35). Number of non-substance-using network members (homeless [OR = 0.29] and housed [OR = 0.73]) was associated with lower odds of membership in the high all class. ConclusionsDistinct groups of YEH can be identified by their recent polysubstance use patterns. Traumatic experiences, suicidality, and social network composition are important correlates of polysubstance use among YEH.

Chronic exposure to cocaine is associated with persistent behavioral disturbances. A cross-sectional dimensional study in outpatients with multiple substance use disorders.

Behavioral disturbances (BD) are prevalent in patients with substance use disorders (SUD). To test the hypothesis that chronic exposure to cocaine could favor the acquisition of BD that were not present in childhood. We used child and adult ADHD self-report screening scales (WURS-25 and ASRS-6, respectively, with their usual threshold) as assessment tools for significant BD. In a cross-sectional assessment of 382 patients with multiple SUD, we investigated BD and then "de novo" BD (i.e., by restricting the sample to patients below the threshold for childhood BD) (N = 214). We also tested for a gradient effect between patients' lifetime DSM IV cocaine and opioid dependence status and the prevalence of BD. BD were found in 188/382 (42.9%) subjects and in 74/214 (34.6%) subjects. Three clinical factors were associated with BD in the whole sample: the number of cocaine dependence criteria (OR = 1.36 [1.14-1.64], p = 0.001), the number of opioid dependence criteria (OR = 0.69 [0.52-0.91], p = 0.010), and a personal history of using cocaine through rapid routes of administration (OR = 0.41 [0.19-0.88], p = 0.022). The same three factors were associated with "de novo" BD in the restricted sample: OR = 1.35 ([1.11-1.63], p = 0.002), OR = 0.83 ([0.70-0.99], p = 0.046), and OR 0.37 ([0.16-0.86], p = 0.022), respectively. There were significant gradients for BD according to the cocaine exposure categories in the whole (Mantel-Haenszel, p < 0.001) and in the restricted sample (Mantel-Haenszel, p = 0.002). Cocaine exposure was positively associated with behavioral disturbances in a dose-dependent manner in this clinical sample, whilst opioid exposure showed a negative association.

Utilization of Outpatient and Intensive Treatment Services By Adults with Multiple Substance Use Disorders in the Medicaid Population

Research ObjectiveUse of multiple substances is common among adults who misuse opioids. Adverse consequences of drugs are more severe among multisubstance relative to single drug users. It is not known whether adults with multiple substance use disorders (multi‐SUD) including opioid use disorder (OUD) receive treatment at the same level compared with those with OUD only. If not, additional emphasis in interventions may be needed to target this population. This study sought to (1) assess whether adults with multi‐SUD are as likely to receive outpatient or intensive treatment compared with adults with OUD only and (2) determine whether any particular drug use combinations are at risk for not receiving treatment.Study DesignWe conducted a retrospective longitudinal study using IBM® MarketScan® Multi‐State Medicaid Database enrollment and claims data (2016‐2017). We used adjusted logistic regression to measure the association between clinical characteristics and receipt of treatment.Population StudiedThe sample included non‐Medicare‐eligible adults aged 18‐64 years who were continuously enrolled in Medicaid and had at least one claim in 2016 with a primary OUD diagnosis.Principal FindingsOf the 58,745 Medicaid enrollees with an initial OUD diagnosis in 2016, 29,478 had no other SUDs. The remaining 29,267 had additional SUD diagnoses. In the year following diagnosis, adults with multi‐SUD were less likely to receive OUD outpatient services or medication treatment than adults with OUD only (OR = 0.931, P = .0006). Adults with co‐occurring alcohol (OR = 0.774, P &lt; .0001), cannabis (OR = 0.848, P &lt; .0001), or stimulant (OR = 0.829, P &lt; .0001) disorder were significantly less likely to receive OUD outpatient treatment than adults with OUD only. Adults with a co‐occurring sedative, hypnotic, or anxiolytic use disorder (SHA) were the only group meaningfully more likely to receive OUD outpatient treatment (OR = 1.179, P &lt; .0001).Adults with multi‐SUD were more likely to use all types of higher intensity services than those with OUD only. Other than for detoxification services, individuals with OUD and a cocaine use disorder were most likely to experience all‐cause use of intensive treatment services. Individuals with OUD and alcohol use disorder were most likely to receive detoxification services (OR = 2.260, P &lt; .0001). Individuals with co‐occurring SHA and OUD used inpatient, emergency department, residential, and detoxification services more heavily compared with other multi‐SUD combinations.Only adults with co‐occurring SHA and OUD used outpatient mental health services and medication to a larger extent than those with OUD only. Those with OUD and a stimulant use disorder were significantly less likely to use such services (OR = 0.937, P = .0105).ConclusionsOur findings suggest that there are barriers to outpatient OUD and mental health treatment for adults with multi‐SUD. Adults with co‐occurring alcohol, cannabis, and stimulant misuse are particularly at risk for not receiving services. Adults with multi‐SUD receive more intensive services, which may reflect severity and lack of outpatient treatment before misuse escalation. Intensive services are expensive and should be provided along with outpatient OUD treatment to be most effective.Implications for Policy or PracticePrograms should account for barriers in connecting people with multi‐SUD to OUD treatment and implement best practices for treatment of non‐OUD SUDs.Primary Funding SourceSAMHSA.

Identifying risk factors involved in the common versus specific liabilities to substance use: A genetically informed approach.

Individuals most often use several rather than one substance among alcohol, cigarettes or cannabis. This widespread co‐occurring use of multiple substances is thought to stem from a common liability that is partly genetic in origin. Genetic risk may indirectly contribute to a common liability to substance use through genetically influenced mental health vulnerabilities and individual traits. To test this possibility, we used polygenic scores indexing mental health and individual traits and examined their association with the common versus specific liabilities to substance use.We used data from the Avon Longitudinal Study of Parents and Children (N = 4218) and applied trait‐state‐occasion models to delineate the common and substance‐specific factors based on four classes of substances (alcohol, cigarettes, cannabis and other illicit substances) assessed over time (ages 17, 20 and 22). We generated 18 polygenic scores indexing genetically influenced mental health vulnerabilities and individual traits. In multivariable regression, we then tested the independent contribution of selected polygenic scores to the common and substance‐specific factors.Our results implicated several genetically influenced traits and vulnerabilities in the common liability to substance use, most notably risk taking (b standardised = 0.14; 95% confidence interval [CI] [0.10, 0.17]), followed by extraversion (b standardised = −0.10; 95% CI [−0.13, −0.06]), and schizophrenia risk (b standardised = 0.06; 95% CI [0.02, 0.09]). Educational attainment (EA) and body mass index (BMI) had opposite effects on substance‐specific liabilities such as cigarette use (b standardised‐EA = −0.15; 95% CI [−0.19, −0.12]; b standardised‐BMI = 0.05; 95% CI [0.02, 0.09]) and alcohol use (b standardised‐EA = 0.07; 95% CI [0.03, 0.11]; b standardised‐BMI = −0.06; 95% CI [−0.10, −0.02]). These findings point towards largely distinct sets of genetic influences on the common versus specific liabilities.

Co-occurring Use of Cannabis and Tobacco and the Presence of Acute Respiratory Symptoms among Young Adult Light and Intermittent Smokers

Background Cannabis use and intermittent smoking are becoming increasingly prevalent among young adults. Thus, identifying health consequences of co-occurring use of these substances represents an emerging research priority. Purpose/Objectives: This study evaluated the relationship between tobacco/cannabis co-use and acute symptoms of respiratory illness among young adult intermittent smokers. We hypothesized that tobacco/cannabis co-use would be more strongly associated with respiratory symptoms relative to use of neither or one product. Methods: A secondary analysis of a three-year observational study was conducted. Non-daily smokers (n = 563) aged 18–24 were recruited via social media and completed electronic surveys at baseline and annually for two years, producing three total assessments. Past-two-week use of tobacco and cannabis was measured at each assessment, as was severity of six acute respiratory symptoms. The respiratory measure was dichotomized to indicate the presence or absence of symptoms. Results: Tobacco/cannabis co-use decreased from 54.8% at baseline to 43.4% at year two (p < .001). Mean respiratory symptoms also declined significantly over time (ps < .05). At each timepoint, co-use was more strongly associated with presence of respiratory symptoms than the use of neither product (aORs = 2.73–4.39, ps ≤ .013). Co-users were also 38%–183% more likely to endorse the presence of respiratory symptoms than single product users at each timepoint (aORs = 1.38–2.83, ps = .023–.212). Conclusions/Importance: Although co-occurring use of tobacco and cannabis by young adults may represent experimental use of multiple substances, it may also promote or exacerbate acute symptoms of respiratory illness. Further exploration with more granular patterns of co-use and across different routes of administration is warranted.

Prevalence of Novel Psychoactive Substance (NPS) Use in Patients Admitted to Drug Detoxification Treatment.

BackgroundAbout 15 years ago, a diverse group of new recreational psychotropic substances began to emerge, which were marketed for example as “legal highs,” “research chemicals,” or “designer drugs.” These substances were later subsumed under the label “Novel Psychoactive Substances” (NPS). Important NPS classes are cathinones, synthetic cannabimimetics, phenethylamines, and herbal drugs. The health care system for psychotropic substance use disorders (SUDs) traditionally focused on a few substances, such as alcohol, heroin, cocaine, amphetamines, or cannabis. Users of illicit substances often engage in polydrug use. However little is known about the prevalence of NPS use within the group of “classical” illicit substance users.ObjectiveWe investigated lifetime and recent use of NPS and other drugs in patients who underwent in-patient detoxification treatment from illicit drugs in Germany.MethodsIn a multicenter study with eight participating facilities, patients admitted to treatment underwent a standardized interview at admission, concerning their past and current substance use. The interview comprised classical substances of abuse, NPS, and rarely used substances such as LSD. In addition, participating sites had the opportunity to analyze their patients’ routine drug screenings by means of gas chromatography/mass spectrometry (GC/MS), which permitted detection of NPS.ResultsInterviews from 295 patients could be analyzed. Most patients were opiate dependent and multiple substance users. About 32% reported use of synthetic cannabimimetics during lifetime, but usually only a few times. An important reason for their use was that NPS were not detected by drug testing in prisons or drug treatment facilities. Cathinones, herbal drugs or other NPS had rarely been used during lifetime. NPS use during the last 30 days before admission was nearly zero. This was confirmed by urine analysis results. In contrast, lifetime and current use of opiates, alcohol, cocaine, benzodiazepines, and cannabis was high. In addition, 18% reported of regular unprescribed pregabalin use during lifetime, and 20% had recently used pregabalin.ConclusionPatients admitted to drug detoxification treatment showed multiple substance use, but this did not include NPS use. The diversion of legal medications such as pregabalin in this group is a serious concern.

Polysubstance use and association with opioid use disorder treatment in the US Veterans Health Administration.

To understand the role of comorbid substance use disorders (SUDs), or polysubstance use, in the treatment of opioid use disorder (OUD), this study compared patients with OUD only to those with additional SUDs and examined association with OUD treatment receipt. Retrospective national cohort study of Veterans diagnosed with OUD (n=65 741) receiving care from the US Veterans Health Administration (VHA) in fiscal year (FY) 2017. Patient characteristics were compared among those diagnosed with OUD only versus those with one other SUD (OUD+1 SUD) and with multiple SUDs (OUD+≥2 SUDs). The study examined the relationship between comorbid SUDs and receipt of buprenorphine, methadone and SUD outpatient treatment during 1-year follow-up, adjusting for patient demographic characteristics and clinical conditions. Among the 65 741 Veterans with OUD in FY 2017, 41.2% had OUD only, 22.9% had OUD+1 SUD and 35.9% had OUD+≥2 SUDs. Common comorbid SUDs included alcohol use disorder (41.3%), cocaine/stimulant use disorder (30.0%) and cannabis use disorder (22.4%). Adjusting for patient characteristics, patients with OUD+1 SUD [adjusted odds ratio (aOR)=0.87, 95% confidence interval (CI)=0.82-0.93] and patients with OUD+≥2SUDs (aOR=0.65, 95% CI=0.61-0.69) had lower odds of receiving buprenorphine compared with OUD only patients. There were also lower odds of receiving methadone for patients with OUD+1 SUD (aOR=0.91, 95% CI=0.86-0.97)and for those with OUD+≥2SUDs (aOR=0.79, 95% CI=0.74-0.84). Patients with OUD+1 SUD (aOR=1.85, 95% CI=1.77-1.93) and patients with OUD+≥2SUDs (aOR=3.25, 95% CI=3.103.41) were much more likely to have a SUD clinic visit. The majority of Veterans in the US Veterans Health Administration diagnosed with opioid use disorder appeared to have at least one comorbid substance use disorder and many have multiple substance use disorders. Despite the higher likelihood of a substance use disorder clinic visit, having a non-opioid substance use disorder is associated with lower likelihood of buprenorphine treatment, suggesting the importance of addressing polysubstance use within efforts to expand treatment for opioid use disorder.

Association of Smokeless Tobacco Use With the Use of Other Illicit Drugs in the United States

BackgroundThere has been an increase in the use of smokeless tobacco recently. Whether smokeless tobacco use may predispose individuals to use other addictive substances is unknown. The use of multiple addictive substances may compound an individual's adverse health effects. MethodsIn a cross-sectional analysis, we used the 2016-2017 Behavioral Risk Factor Surveillance System (BRFSS) survey database to identify all individuals who reported the use of smokeless tobacco and extracted data regarding baseline and demographic patterns, as well as information regarding the use of other addictive substances. Weighted multivariable logistic regression models adjusting for age, gender, race/ethnicity, poverty level, education, employment status, and marital status were used to determine the odds ratios (ORs) for use of alcohol, cigarettes, e-cigarettes, and marijuana among smokeless tobacco users. ResultsWe identified 30,395 (3.38%) individuals in our study population who reported smokeless tobacco use. Compared with non-users, smokeless tobacco users were more likely to be unmarried, male, Caucasian, belonging to the lower socioeconomic strata, and did not have a formal college education (P <0.01). In multivariable analyses, smokeless tobacco use was associated with a higher likelihood of cigarettes use (OR: 1.76 [95% confidence interval {CI}: 1.66-1.86, P <0.01]), e-cigarette use (OR: 1.61 [95% CI: 1.52-1.71, P <0.01]), and heavy alcohol consumption (OR:2.36 [95% CI: 2.17-2.56, P <0.01]) but not marijuana use (OR: 1.11 [95% CI: 0.90-1.38, P = 0.33]). ConclusionIn a large, nationally representative sample, smokeless tobacco use was associated with the increased use of cigarettes, e-cigarettes, and alcohol. Simultaneous use of these substances may compound the adverse health effects of smokeless tobacco use. Public health interventions addressing this concerning trend are warranted.

Who Turns to Amazonian Medicine for Treatment of Substance Use Disorder? Patient Characteristics at the Takiwasi Addiction Treatment Center

Complementary medicines are an emergent field in the treatment of substance use disorders (SUDs) and include Amazonian medicines, such as ayahuasca. The aim of this multimodal cross-sectional study was to investigate characteristics of people who seek treatment for SUDs at an accredited healthcare facility that applies Amazonian medicines along with conventional psychotherapy. We collected clinical and sociodemographic data of consecutive admissions at the Takiwasi Addiction Treatment Center (Tarapoto, Peru) using structured questionnaires, interviews, and letters submitted upon program application describing motivation for treatment. The sample of 50 male participants admitted between 2014 and 2016 was culturally heterogeneous, including patients from Peru (42%), other Latin American countries (34%), and North America/Europe (24%). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria indicated dependencies on cannabis (72%), alcohol (52%), cocaine/base paste (48%), and others; multiple substance use was common (84%). Self-reported depression and anxiety scores showed moderate elevation. Comparison of Addiction Severity Index composite scores to a large U.S. sample suggested somewhat more severe problems in the drug and psychiatric domains. Common motives for selecting the program included interest in Amazonian medicine, the Takiwasi concept of treatment, and unfavorable experiences with past treatments. Being motivated by family, a desire for self-transformation, and spiritual/existential motives were common themes for treatment initiation. Our results suggest that the Amazonian medicine-based therapy attracts a diverse patient group not limited to regional residents and may be particularly appealing to more impaired SUD patients with a history of unsuccessful treatment. The sample's cultural diversity suggests an existing interest in such therapies among international SUD treatment-seeking patients. These findings are relevant in light of the need for improved SUD therapies and contribute to the emergent research literature on ayahuasca-based treatments.

Substance Use Profiles Among Urban Adolescents: The Role of Family-Based Adversities

The purpose of this study is to advance our understanding of family-based adversities and adolescent well-being by examining variability in substance use profiles among urban, low-income and predominantly African American adolescents (n = 2858). Latent class analysis and regressions were used to identify the nature and correlates of heterogeneity in substance use patterns among adolescents in the Mobile Youth Survey (MYS). Analyses revealed the presence of four underlying subgroups of youth: non-users (48.4%), alcohol users (17.6%), alcohol and marijuana users (31.6%), and polysubstance users (2.5%). Membership in classes varied by age and gender, with older youth and males being more likely to belong to groups characterized by the use of multiple substances. Youth who reported that someone in their household had been arrested were more likely to belong to one of the substance using groups than the non-use group, and youth who reported not having a father figure were more likely to belong to groups characterized by the use of multiple substances relative to the non-use group. Youth who reported living with two biological parents were less likely to belong to either the alcohol or the alcohol and marijuana classes than the non-use group. Results further indicated that youth in classes characterized by the use of multiple substances were more likely to exhibit externalizing problems and internalizing distress than other youth. Findings underscore the importance of identifying heterogeneity even in seemingly homogeneous samples and suggest a number of new directions for future research.

Association of OPRM1 Functional Coding Variant With Opioid Use Disorder

With the current opioid crisis, it is important to improve understanding of the biological mechanisms of opioid use disorder (OUD). To detect genetic risk variants for OUD and determine genetic correlations and causal association with OUD and other traits. A genome-wide association study of electronic health record-defined OUD in the Million Veteran Program sample was conducted, comprising 8529 affected European American individuals and 71 200 opioid-exposed European American controls (defined by electronic health record trajectory analysis) and 4032 affected African American individuals and 26 029 opioid-exposed African American controls. Participants were enrolled from January 10, 2011, to May 21, 2018, with electronic health record data for OUD diagnosis from October 1, 1999, to February 7, 2018. Million Veteran Program results and additional OUD case-control genome-wide association study results from the Yale-Penn and Study of Addiction: Genetics and Environment samples were meta-analyzed (total numbers: European American individuals, 10 544 OUD cases and 72 163 opioid-exposed controls; African American individuals, 5212 cases and 26 876 controls). Data on Yale-Penn participants were collected from February 14, 1999, to April 1, 2017, and data on Study of Addiction: Genetics and Environment participants were collected from 1990 to 2007. The key result was replicated in 2 independent cohorts: proxy-phenotype buprenorphine treatment in the UK Biobank and newly genotyped Yale-Penn participants. Genetic correlations between OUD and other traits were tested, and mendelian randomization analysis was conducted to identify potential causal associations. Main outcomes were International Classification of Diseases, Ninth Revision-diagnosed OUD or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision-diagnosed OUD (Million Veteran Program), and DSM-IV-defined opioid dependence (Yale-Penn and Study of Addiction: Genetics and Environment). A total of 114 759 individuals (101 016 men [88%]; mean [SD] age, 60.1 [12.8] years) were included. In 82 707 European American individuals, a functional coding variant (rs1799971, encoding Asn40Asp) in OPRM1 (μ-opioid receptor gene, the main biological target for opioid drugs; OMIM 600018) reached genome-wide significance (G allele: β = -0.066 [SE = 0.012]; P = 1.51 × 10-8). The finding was replicated in 2 independent samples. Single-nucleotide polymorphism-based heritability of OUD was 11.3% (SE = 1.8%). Opioid use disorder was genetically correlated with 83 traits, including multiple substance use traits, psychiatric illnesses, cognitive performance, and others. Mendelian randomization analysis revealed the following associations with OUD: risk of tobacco smoking, depression, neuroticism, worry neuroticism subcluster, and cognitive performance. No genome-wide significant association was detected for African American individuals or in transpopulation meta-analysis. This genome-wide meta-analysis identified a significant association of OUD with an OPRM1 variant, which was replicated in 2 independent samples. Post-genome-wide association study analysis revealed associated pleiotropic characteristics. Recruitment of additional individuals with OUD for future studies-especially those of non-European ancestry-is a crucial next step in identifying additional significant risk loci.