Bipolar Disorder in a Population of Adolescents with Alcohol Use Disorders

ABSTRACT

Objectives: The objective of this paper is to present the prevalence of Bipolar Disorder (BPD) in a population of adolescents and young adults with alcohol use disorders (AUD) and to compare salient alcohol use, mood, and diagnostic variables between adolescents with BPD, those with Major Depressive Disorder (MDD), and those with AUD without a mood disorder.

Methods: The subjects were 452 adolescents and young adults, age 12.9 to 28.3 years, who met DSM-IV criteria for a lifetime history of either alcohol abuse or alcohol dependence. DSM-IV psychiatric and AUD diagnoses were obtained by semi-structure interviews (K-SADS and SCID) to discern the possible effect of comorbid BPD on alcohol and other drug variables, we compared adolescents or young adults who met DSM-IV criteria for concurrent BPD and AUD with adolescents with MDD plus AUD and those with AUD and no mood disorder. Following one-way ANOVA comparing across the 3 groups, we proceeded with post hoc analysis comparing the BPD+AUD group with either the MDD + AUD or AUD only group.

Results: 6.4% of the subjects met criteria for BPD. While there were no differences between groups on the alcohol consumption variables, subjects with BPD had a significantly earlier onset of an AUD diagnosis than either the MDD group or the AUD only group. The BPD + AUD group had a significantly greater percentage of subjects meeting criteria for alcohol dependence than the AUD only group.

Conclusions: Comorbid mood disorders, particularly Bipolar Disorder, may have an important effect on alcohol and substance use variables and diagnosis. More research is needed to determine the effect of treatments for mood disorder on both mood and substance use variables.     

Trying to Lose Weight and Alcohol Misuse Among High School Girls: Findings From the U.S. National 2011 Youth Risk Behavior Survey

Background: Trying to lose weight has been associated with alcohol use among college-aged females. Excessive drinking along with purging as a method for weight control has been documented in this population. However, little is known about the relationship between alcohol use and trying to lose weight among high school girls. Objectives: To examine the relationship between trying to lose weight and past 30-day (1) alcohol use and (2) binge drinking (separately). Methods: Using data from the National 2011 YRBS, we examined these relationships among 5,106 girls aged 14–18+ who reported ever using alcohol. Survey-weighted iterative logistic regression models were conducted. Results: 44.0% of girls reported current alcohol use with 27.8% reporting binge drinking. While a significant relationship was not found between trying to lose weight and current alcohol use in the final multivariable model, a significant relationship was found between trying to lose weight and binge drinking (AOR: 1.24, 95% CI: 1.02–1.52). Additional variables that were found to be associated with an increased odds of binge drinking included: being in 11th and 12th grades compared to being in 9th grade, screening positively for depression, and current cigarette use. Variables associated with a decreased odds included: talking to an adult/teacher about a problem, and identifying as Black/African American compared to White. Conclusions/Importance: Understanding the relationship between trying to lose weight and binge drinking among high school students is important, as these behaviors may be a precursor to risk behaviors later in life and need to be more fully examined.     

Alcohol and Drug Use and Aberrant Drug-Related Behavior Among Patients on Chronic Opioid Therapy

Objective: To better identify individuals on chronic opioid therapy (COT) at high risk for aberrant-drug related behavior (ADRB). We examine whether patients with low level alcohol and drug use have similar characteristics to those with alcohol and drug disorders. We then examined the relationship of alcohol and drug use to ADRBs among COT patients. Methods: The sample was 972 randomly selected COT patients (age 21–80 years old) from a large health system in Northern California, USA, and interviewed in 2009. Logistic regression models were used to model the dependent variables of: alcohol use, illicit drug use, alcohol disorders, illicit drug disorders, and ADRBs. Results: The odds of daily/weekly alcohol use were lower for those with a high daily opioid dose (120+ mg/day vs. <20 mg/day) (OR = 0.32, p < 0.010). Illicit drug disorders were associated with depression (OR = 2.31, p < .001) and being on a high daily opioid dose (OR = 5.51, p < .01). Participants with illicit drug use had higher odds of giving (OR = 2.57, p < 0.01) and receiving opioids from friends or family (OR = 3.25, p < 0.001), but disorder diagnoses were not associated with ADRBs. Conclusions: Findings reinforce that illicit drug use should be of high concern to clinicians prescribing opioids, and suggest it should be considered separately from alcohol use and alcohol disorders in the evaluation of ADRBs. Frequent alcohol use is low, but not uncommon, and suggests a need to discuss specific issues regarding safe use of opioids among persons who use alcohol that may differ from their risk of drug use.     

Alcohol Use Disorders and Depression: Protective Factors in the Development of Unique versus Comorbid Outcomes

This study examines protective factors for young adult alcohol use disorders, depression, and comorbid alcohol use disorders and depression. Participants were recruited from all fifth-grade students attending 18 Seattle elementary schools. Of the 1,053 students eligible, 808 (77%) agreed to participate. Youths were surveyed when they were 10 years old in 1985 and followed to age 21 years in 1996 (95% retention). Protective factors were measured at age 14 years. Young adult disorders were assessed with the Diagnostic Interview Schedule. Alcohol refusal skills, academic skills, school and family bonding, parental rewards, school rewards, and family cohesion at age 14 years were associated with decreased risk for comorbidity at age 21 years.     

Association of Alcohol Use Biomarkers and Cognitive Performance in Veterans With Problematic Alcohol Use and Posttraumatic Stress Disorder: Data From the Mind Your Heart Study

The authors conducted a study of alcohol use biomarkers and cognitive performance among 85 veterans with problematic alcohol use and posttraumatic stress disorder (PTSD). All analyses were adjusted for demographics, depression, anxiety, and PTSD symptoms. Elevated levels of aspartate aminotransferase were associated with worse performance on the Trail Making Test Part A and Hopkins Verbal Learning Test. Two other biomarkers were not associated with any neurocognitive measures. Indirect alcohol use biomarkers (e.g., aspartate aminotransferase) may have a specific role in identifying veterans with problematic alcohol use and PTSD who show a change in psychomotor speed and immediate verbal memory performance.     

Intercorrelation of Alcohol and Other Drug Use Disorders among a National Sample of Drivers

This study examined the relationship between alcohol, marijuana, cocaine, and painkiller use disorders in a sample of drivers. We studied nighttime drivers aged 16 to 87 (n = 4,277) from the 2007 National Roadside Survey who reported substance use behaviors and provided breath tests for alcohol. Logistic regression analyses assessed the relationships between (1) substance (i.e., alcohol/marijuana/cocaine/pain killer) use disorders; (2) demographic characteristics; and (3) BAC levels. Overall, 13.2% of participants met criteria for marijuana use disorder, 7% met criteria for cocaine use disorder, and 15.4% met criteria for extra-medicinal painkiller use disorder. When self-report data were analyzed, three reciprocal associations emerged: (1) marijuana use disorders and alcohol use disorders were correlated; (2) marijuana use disorders and cocaine use disorders were correlated; and (3) cocaine use disorders and painkiller use disorders were correlated. BAC data revealed that marijuana and cocaine use disorders were both associated with positive BAC levels, but only cocaine use disorders were associated with BAC levels over the legal limit. Results suggest significant poly-substance use disorders in a sample of nighttime drivers, with variations by demographic characteristics. The individual and public health consequences of multiple substance use disorders among drivers are significant.     

Depression and Anxiety Subgroups Across Alcohol Use Disorder and Substance Use in a National Epidemiologic Study

Abstract

Objective: The high prevalence of alcohol/substance use among individuals with psychiatric disorders elucidates the import of investigations into associations between types and severity of psychiatric symptoms and alcohol/substance use. This study examined the likelihood of alcohol use disorder and substance use among individuals with varying depression and anxiety symptoms and severity thereof. Differences across sex were also examined.

Methods: Using data from the National Epidemiological Survey on Alcohol and Related Conditions, a nationally representative sample from the United States (N?=?43,093), separate logistic regressions estimated the odds of lifetime alcohol use disorder, depressant, stimulant, hallucinogen, and comorbid substance use across psychiatric symptom clusters controlling for age, sex, and ethnicity.

Results: Symptom severity was a more important correlate of alcohol use disorder and substance use than symptom type. In particular, the odds ratio of lifetime use of depressants, stimulants, hallucinogens, or any combination of these types of substances were higher for individuals with either severe depression or severe depression and anxiety relative to a healthy control. Moreover, the odds of having a diagnosis of lifetime alcohol use disorder were higher for individuals with severe symptoms of depression, anxiety, and both depression and anxiety, relative to healthy individuals. Those with mild depression were more likely to engage in substance use than individuals with anxiety alone. Patterns of association among males and females were highly consistent.

Conclusions: The findings highlight an enhanced risk of alcohol and substance use among individuals with severe depression and/or anxiety symptoms above what is seen among individuals with less severe symptomatology. In addition, this study shows a unique risk posed by the presence of depression on substance use. This study offers a framework for future studies to examine the causal mechanisms explaining the connection between psychiatric symptoms and alcohol/substance use.     

Self-Reported Drug and Alcohol Use and Attitudes Toward Drug Testing in High Schools With Random Student Drug Testing

Many schools implement random student drug testing (RSDT) programs as a drug prevention strategy. This study analyzes self-report surveys of students in eight secondary schools with well-established RSDT programs, comparing students who understood they were subject to testing and students who understood they were not subject to testing. Students subject to testing reported significantly less marijuana and other illegal drug use than students in the same schools who were not subject to testing, and also had more positive attitudes toward testing. Alcohol use, which was not tested for in seven of the eight schools, did not differ between groups. This study provides evidence that awareness of eligibility for drug testing in schools with well-established RSDT programs is associated with lower rates of drug use.     

Comorbidity of mental disorders and alcohol- and drug-use disorders: analysis of New South Wales inpatient data

Introduction and Aims. Alcohol‐ and other drug‐use disorders have been found to be associated with mental disorders, however, complete characteristics of these comorbid mental disorders are not completely clear in early population based studies. This study aimed to explore the extent and profiles of comorbid mental disorders with alcohol‐ and other drug‐use disorders using a large inpatient dataset. Methods. The data source was the New South Wales (NSW) Inpatient Statistic Data Collection which collects the clinical data of hospital admissions in NSW, Australia. The data were coded using the International Classification of Diseases—10th Revision (ICD‐10). The data were from 1 July 2005 to 30 June 2006 the Australian financial year and statistical analysis was performed using SAS. Results. Of 1 592 156 patients admitted, 91 510 (6%) had at least one mental disorder diagnosis and 18 283 (1.1%) had at least one alcohol‐ or other drug‐related diagnosis. Of these patients, an overall 9.6% had dual diagnoses. Comorbidity was nearly five times higher in alcohol‐ and other drug‐use disorders than in mental health disorders (52.4% vs. 10.5%). Comorbidity was higher in males than females (12% vs. 7.1%) and was the most common in patients aged from 20 to 49 regardless of sex. There was a significantly increased risk of developing a comorbid condition in all age groups above 10 years. The most common mental health disorders were major depressive disorders, followed by dementia, anxiety and severe stress. Alcohol‐use disorder was the most common diagnosis, followed by cannabis and opioids. Discussion and Conclusion. This study shows the characteristics of comorbid mental and alcohol‐ or other drug‐use disorders. The study extends our understanding of issues addressed in previous population studies.[Lai HMX, Huang QR. Comorbidity of mental disorders and alcohol‐ and drug‐use disorders: Analysis of New South Wales inpatient data. Drug Alcohol Rev 2009]     

Functioning of Alcohol Use Disorders Criteria Among Middle-Aged and Older Adults: Implications for DSM-5

This study explored dimensionality and rank-order severity of the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) alcohol use disorder (AUD) criteria among adults 50+ years old. Secondary analysis was performed on data from individuals 50+ (N = 3,412) from the 2009 National Survey of Drug Use and Health. Confirmatory factor analyses (CFA) and item response theory (IRT) analyses were performed on the 11 AUD criteria. DSM-IV and DSM fifth edition (DSM-5) classifications were compared. CFA revealed a one-factor model. IRT analyses revealed that AUD criteria identify only severe cases of AUD. Overall, 5.8% met criteria for a DSM-IV AUD; 7.5% met criteria for DSM-5 AUD.     

The State of Support for Research on the Epidemiology,Prevention, and Treatment of Drug Use and Drug Use Disorders in the USA

This article describes the challenge of sustaining a balanced agenda for drug use research in the USA to advance understanding of the nature and extent of drug use and drug use disorders in a population; the processes and mechanisms that underlie onset, continuing, and stopping drug dependence; how to effectively prevent the onset of and early drug use as well as the social and health consequences of such use; and how to treat and maintain those with drug use disorders. This review concludes with recommendations to achieve sustained stability of funding for and to promote the progress of epidemiologic, prevention, and treatment policy research.     

Indicators of Sense of Coherence and Alcohol Consumption-Related Problems: The 2000 U.S. National Alcohol Survey

This paper assesses the relationship of Sense of Coherence (SOC) and alcohol consumption-related problems in the 2000 U.S. National Alcohol Survey (4,630 current drinkers). Measures include a 3-item SOC scale, a 15-item social consequences scale, and DSM-IV alcohol dependence. Using logistic regression, a strong SOC was significantly related to not reporting either consequences or dependence. Results underscore the importance of using theoretically-based approaches to examine nonproblematic drinking. The development of interventions that could strengthen SOC deserves future research attention. The study's limitations are noted. Funded by a National Alcohol Research Center Grant (AA-05595-16) from the U.S. National Institute on Alcohol Abuse and Alcoholism to the Alcohol Research Group.     

Use of Naltrexone in the Treatment of Alcohol Use Disorders in Patients with Concomitant Major Mental Illness

Abstract

We report the use of naltrexone for treatment of alcohol use disorder in patients with major psychiatric illness. We reviewed the records of 72 mentally ill outpatients treated with naltrexone for alcohol use disorders at a community mental health center. The psychiatric diagnoses included major depression (n = 37), schizophrenia (n = 17), bipolar illness (n = 11), schizoaffective disorder (n = 7), and gender identity disorder (n = 4). Sixty-one patients (85%) had histories of psychiatric hospitalization. Total retention in naltrexone treatment for at least eight weeks was 81.9%: 5 (6.9%) were lost to follow-up, and 8 (11.1%) discontinued the medication because of side effects, primarily nausea. Patients showed good clinical response to naltrexone, with 82% reducing their drinking by at least 75%, and only 17% relapsing at eight weeks. We conclude that naltrexone is useful in the treatment of dually-disordered patients. The hypothesis that clinical response to naltrexone is facilitated by active alcohol drinking during treatment is discussed.     

Survey of Alcohol Use in the U.S. Army

ABSTRACT

The objective of this study was to collect data that would provide information about the frequency, attitudes, and consequences of alcohol use in the U.S. Army. A questionnaire was used to assess the frequency of alcohol consumption, attitudes related to the use of alcohol, and adverse consequences experienced with alcohol use. The survey was conducted at Walter Reed Army Medical Center in Washington, D.C. Survey participants included both military employees working at Walter Reed Army Medical Center and military patients. No attempt was made to identify the medical status of the participants. The investigators distributed 1,200 questionnaires. Following distribution, the investigators received 1,010 completed questionnaires, resulting in an 84% return rate. Thirty-four percent of the survey participants (n = 335) were deployed to an area of combat operations. There was a significant difference in binge drinking between military personnel assigned to an area of combat operations and those not assigned to an area of combat operations (p = 0.023). Multiple regression results showed that age, marital status, and deployment status were correlated with four or more drinks at one time (p < 0.001). In other words, binge drinking is more likely to occur among military personnel who are younger, experiencing marital problems, and recently returned from an area of combat operations. Significant differences between the two groups also emerged in terms of other specific consequences associated with consumption. Deployment to an area of combat operations seems to influence consumption patterns, alcohol related attitudes, and behaviors. This could be a consequence of wartime experiences. This study should help guide the clinical screening of alcohol use disorders, which may complicate emotional recovery from traumatic experiences if undetected.     

A System for Evaluating Local Alcohol and Drug Use Prevention Initiatives

Local alcohol and drug use prevention in Sweden has witnessed a substantial surge in recent years, with government funding for local coordinators in every municipality. Whether this has contributed to the recent decline in alcohol use among young people is unknown. The ESAPP project evaluates local alcohol and drug prevention in the 18 municipalities that comprise Stockholm. In order to obtain knowledge of prevention activities and their role in outcomes and to stimulate sharing of experiences, a Web-based reporting system was developed in collaboration with the local coordinators. There has been considerable variation in the use of this reporting system and its potential has not been realized.     

Stability of Comorbid Psychiatric Diagnosis Among Youths in Treatment and Aftercare for Alcohol Use Disorders

Abstract

Objectives: To examine the stability of comorbid psychiatric diagnoses among a sample of 50 adolescents in cognitive-behaviorally-based treatment for alcohol and other substance use disorders (AOSUD).

Methods: A standardized psychiatric interview was administered at baseline and 12 month later to obtain current comorbid psychiatric disorders. Chi square and Wilconxon sign tests coefficients were used to examine changes in threshold status by type of disorder. Pearson's coefficients were used to identify correlates with improvements in threshold status, include the need for alcohol treatment and alcohol consumption at follow-up.

Results: Diagnostic status changes considerably over time. Prevalence rates for comorbid disorders overall declined. Only declines in mood and externalizing disorders achieved statistical significance. Improvements were positively correlated with mental health service utilization and negatively correlated with the need for alcohol treatment and consumption at 12 months.

Conclusions: Further investigation on the stability and change in diagnostic status of AOSUD youths is warranted.     

High Socioeconomic Status Predicts Substance Use and Alcohol Consumption in U.S. Undergraduates

Background: In health sociology, the prevailing consensus is that socioeconomic status (SES) lowers illness risk. This model neglects the fact that unhealthful consumption patterns may covary with affluence. The current study examines consumption of drugs and alcohol among affluent U.S. college students. Objectives: The article tests the hypothesis that undergraduate students from high-SES households have higher rates and levels of drug and alcohol consumption than their peers. Methods: The study used self-report data from 18,611 18- to 24-year-old undergraduates across 23 public and private U.S. institutions from the Healthy Minds 2016 dataset. Results: I found that high-SES undergraduates were more likely than peers to use marijuana, choose varied drugs, consume alcohol frequently, and use alcohol and substances to cope with stress. The first three results were robust after controlling for gender, race, residence type, and relationship status. Marital status and race were stronger predictors than SES. Asians and married students were the least likely to use alcohol and drugs. Conclusions/Importance: Findings supported the main hypotheses, and the effects were robust to controls. Consumption of illicit drugs and alcohol may be one hitherto neglected reason for downward mobility among economically privileged college students.     

Alcohol use/abuse and help-seeking among U.S. adults: The role of racial-ethnic origin and foreign-born status

We used data from Wave 1 and Wave 2 of the National Epidemiological Survey on Alcohol and Related Conditions to examine racial-ethnic and nativity-based variations in alcohol use/abuse and treatment seeking while accounting for acculturation, stress, and social integration factors. The dependent variables included alcohol use, risky drinking, DSM-IV alcohol use disorder, and treatment seeking in the past 12 months. Racial-ethnic categories included African, European, Asian/Pacific Islander, Mexican, Puerto Rican, and other Hispanic/Latino. Acculturation, social stress, and social integration were assessed with previously validated, detailed measures. Bivariate probit models with sample selection were estimated for women and men. Immigrant status and origin associations with alcohol use/abuse and treatment seeking were strong and largely unaffected by other social factors. Europeans and men of Mexican origin had the highest while women of African, Asian/Pacific Islander, and Puerto Rican origins had the lowest rates of alcohol use/abuse. Years in the United States was associated with a higher risk of alcohol use/abuse for all immigrant groups. Foreign-born individuals were no less likely than U.S. natives to seek treatment if they were abusing or were dependent on alcohol. Further modeling of these relationships among specific immigrant groups is warranted. These findings inform alcohol rehabilitation and mental health services for racial-ethnic minorities and immigrants.