Predictors of violence following Emergency Department visit for cocaine-related chest pain

This study examined 1-year violence outcomes among non-injured patients treated in the Emergency Department (ED) for cocaine-related chest pain. An urban Level I ED required patients with chest pain (age 60 and younger) provide a urine sample for cocaine testing. Cocaine-positive consenting patients (n=219) were interviewed in the ED; 80% completed follow-up interviews over 12-months (n=174; 59% male, 79% African-American, mean age=38.8, standard deviation 9.06; range=19-60). Baseline rates of past year violent victimization and perpetration history were: 38% and 30%, respectively. During the 12-month follow-up, rates of victimization and perpetration outcomes were 35% and 30%, respectively. Predictors of violence outcomes (either victimization or perpetration) in the year post-ED visit based on characteristics were measured at baseline or during the follow-up period (i.e., gender, age, psychological distress, binge drinking days, cocaine use days, marijuana use days, substance abuse/dependence diagnosis, victimization/perpetration history). Victimization during the follow-up was related to younger age, more frequent binge drinking and marijuana use at baseline, and victimization history, and to substance abuse/dependence, more frequent binge drinking, and psychiatric distress at follow-up. Specifically, participants who reported victimization at baseline were approximately 3 times more likely to report victimization at 12-month follow-up. Perpetration during the follow-up was related to younger age and more frequent binge drinking at baseline, and to substance abuse/dependence, more frequent binge drinking, and psychiatric distress at follow-up. Overall, no significant gender differences were observed in violence; however, women were more likely than men to report injury during the most severe partner violence incident. Violence is a common problem among patients presenting to an inner-city ED for cocaine-related chest pain, with younger age and frequency of binge drinking being a consistent marker of continued violence involvement. Intervention approaches to link these not-in-treatment cocaine users to services and reduce cocaine use must take into account concomitant alcohol misuse and violence.     

The longitudinal association between alcohol use and intimate partner violence among ethnically diverse community women

Research has consistently demonstrated a strong link between substance misuse and the perpetration of intimate partner violence (IPV). However, studies examining whether substance misuse is associated with IPV victimization have been mixed. Using data collected from 835 low-income ethnically diverse community women, this study extends previous research by utilizing a longitudinal design, considering men's and women's alcohol use, and examining multiple forms of abuse. Despite overall decreases in drinking and abuse, the frequency of male partners' drinking continued to be associated with their perpetration of threats, violence, and sexual aggression. Women's alcohol use frequency was associated with sustaining physical violence, but not threats of violence or sexual aggression.     

Cross-lagged relationships between substance use and intimate partner violence among a sample of young adult women

OBJECTIVE: The goal of this study was to examine the longitudinal relationship between substance use and intimate partner violence (IPV) victimization and perpetration among a sample of young adult women. METHOD: A sample of 509 women who participated in Waves 8 (age 23) and 9 (age 29) of a multiyear panel study and who indicated they were living with a partner or spouse at both time points provided the data for this investigation. Path analysis was used to examine the cross-lagged relationships between women's substance use and IPV victimization and perpetration over the two waves of data. RESULTS: Although strong within- and across-time associations between substance use and IPV victimization and perpetration were found at the bivariate level, substance use did not predict women's subsequent IPV victimization or perpetration in the cross-lagged model. Instead, victims of IPV at age 23 were found to be at an increased risk for later heavy drinking. Perpetrators of IPV at age 23 were less likely than nonperpetrators to report heavy drinking at age 29. CONCLUSIONS: The results suggest that substance use does not increase women's long-term risk of experiencing or perpetrating IPV but that victimization by IPV puts women at risk for subsequent heavy drinking.     

The interplay between substance use and intimate partner violence perpetration: A meta-ethnography

BackgroundThe relationship between intimate partner violence (IPV) perpetration and substance use is not well understood. We conducted a meta-ethnography of qualitative studies to explore how substance use features in survivors’ and perpetrators’ accounts of IPV perpetration.MethodsQualitative studies from 1995 to 2016 were identified from PsycINFO, ASSIA and Web of Science, with an update in PsycINFO and ASSIA to December 2017. 7654 abstracts were screened for accounts of heterosexual IPV perpetration, then full-texts were screened for mentions of substance use. Key concepts from 26 qualitative studies (363 female survivors’ and 219 male perpetrators’ views) were synthesised to develop a grounded theory that put similarities and differences between studies into an interpretive order.ResultsSix themes emerged: five related to the complex interplay between substance use and IPV perpetration in the context of intoxication, withdrawal and addiction, impact on relationship and wider dynamics of power and control and psychological vulnerabilities; a final theme related to survivors’ agency and resistance to IPV perpetration. Survivors and perpetrators noted how both intoxication and withdrawal could pre-empt IPV perpetration. Survivors, however, were more likely to see intoxication and withdrawal as part of a pattern of abusive behaviour, whereas perpetrators tended to describe a causal relationship between intoxication and discrete incidents of IPV perpetration. Irritability and frustration during withdrawal from or craving alcohol, heroin and stimulants, and/or a failure or partner refusal to procure money for drugs increased the likelihood of violence. Survivors were more likely than perpetrators to identify abuse in relation to the impact of substance use on their relationship and dynamics of power and control.ConclusionThe interplay between substance use and IPV perpetration occurs at numerous contextual levels and is perceived differently by perpetrators and survivors. Behaviour change interventions must address the meanings behind divergent narratives about IPV perpetration and substance use.     

Problem drinking and intimate partner violence

OBJECTIVE: This study examined the role of problem drinking in intimate partner violence (IPV) perpetration and victimization for men and women. We assessed (1) whether the relationship between problem drinking and IPV was spurious and (2) if relationship dissatisfaction and partner drinking mediated the effects of problem drinking on IPV. METHOD: Five waves of longitudinal data from a nonclinical sample (N = 725; 400 women), aged 12 through 31 years, were analyzed to determine the effects of problem drinking on IPV after controlling for eight common risk factors. Regression analyses were conducted to determine whether relationship dissatisfaction and partner drinking patterns mediated the effects of problem drinking on IPV after controlling for these same risk factors. RESULTS: With controls, problem drinking significantly predicted perpetration and victimization for men and women. Partner drinking was not related to perpetration or victimization for men. For women, partner drinking was strongly related to perpetration and victimization. It fully mediated the effects of problem drinking on perpetration, but did not mediate these effects on victimization. Relationship dissatisfaction fully mediated the effects of problem drinking on male and female perpetration and partially mediated the effects on male victimization. Relationship dissatisfaction did not mediate the effects of problem drinking on female victimization. CONCLUSIONS: The relationship between problem drinking and IPV was not spurious for men or women. Heavier drinking by partners put women at greater risk for perpetration and victimization and mediated the effects of their own problem drinking on perpetration. Programs that prevent and treat problem drinking among young men should have a beneficial impact on reducing IPV.     

Factors associated with partner violence among female alcoholic patients and their male partners

OBJECTIVE: This study described the extent of partner violence victimization and perpetration among married or cohabiting female alcoholic patients and the factors associated with it. METHOD: Male-to-female and female-to-male physical partner violence were examined for 103 female alcoholic patients seeking couples-based outpatient alcoholism treatment. Partner violent (PV) and nonpartner violent (NPV) groups were compared on hypothesized risk factors. RESULTS: In the year before treatment, about two thirds of the women were victimized by their male partners, and a similar proportion engaged in violence toward their male partners. Severe violence also was high, with 22% victimization and 50% perpetration prevalence. Women committed more violent acts overall and were more likely to commit severely violent acts than the men in these couples. Risk factors for PV in both the victimization and perpetration models were as predicted: less education, lower income, greater relationship problems, stronger beliefs in the link between relationship problems and the female patient's drinking, greater cocaine use by the perpetrator of violence and greater emotional distress of the men. Greater alcohol and drug use and more severe alcohol problems also distinguished male perpetrators from their nonviolent counterparts in the female victimization model. Predictions that female patients in the PV group would report greater substance use and problems, childhood violence exposure and emotional distress than their female counterparts in the NPV group were not supported for either victimization or perpetration models. CONCLUSIONS: Partner violence is a serious problem for women in alcoholism treatment. More research is needed to increase understanding of risk factors and explanatory models for such violence.     

Intimate Partner Violence Among Individuals in Methadone Maintenance Treatment

ABSTRACT. Background: Intimate partner violence (IPV) is a highly prevalent and concerning problem among methadone maintenance populations, and previous studies have shown a relationship between a history of IPV and increased substance use and affective disturbances. Methods: The current study examined (1) the association between recent IPV victimization and alcohol and cocaine use and (2) the relationship between recent IPV victimization and depression in a sample of smokers (N = 203) in methadone maintenance treatment (MMT). Participants in this study completed a battery of assessments that included standard questionnaires of trauma, alcohol and substance use, and depression. Parallel logistic and linear regression models were used to estimate the adjusted association of IPV victimization and depressive symptoms and evaluate the adjusted association of victimization with recent substance use. Results: Participants recently victimized by partners were shown to have significantly higher mean Center for Epidemiologic Studies Depression Scale (CES-D) scores (b = 0.54, 95% confidence interval [CI]: [0.07; 1.02], P <.05) and were found to have a 6 times greater likelihood of cocaine use (odds ratio [OR] = 6.65, 95% CI: [1.61; 27.46], P <.01) after controlling for age, gender, education, opiate use, and ethnicity. Conclusions: These findings support the notion that IPV victimization can potentially increase depression and other substance use among MMT patients, which can have a deleterious impact on treatment.     

Substance Use and Violence Among Youth: A Daily Calendar Analysis

Background: While researchers have identified factors that contribute to youth violence, less is known about the details of violent incidents. In addition, substance use has been linked to youth violence; however, little is known about actual substance use on days in which violence occurs. Objective: This study examined reasons for peer violence and the association between substance use and violence using daily calendar-based analyses among at-risk urban youth. Methods: Data were collected from Emergency Department (ED) patients (ages 14–24; n = 599; 59% male, 65% African American) who screened positive for substance use in the past 6 months. Daily data regarding past 30-day substance use and violence and reasons for violent incidents were obtained via semi-structured interviews. Multi-level multinomial regression models were conducted to test the associations between substance use and peer violence incidents (i.e., none, moderate and severe). Results: Conflict over ‘personal belongings’ was a common reason for violence among males; ‘jealousy’/‘rumors’ were common reasons among females. Moderate victimization was more likely to be reported on days in which participants reported alcohol and cocaine use. Severe victimization was more likely to be reported on days in which participants reported alcohol use. Moderate or severe aggression was more likely to be reported on days in which participants reported alcohol and non-medical sedative use. Conclusions: Results suggest that youth violence prevention that addresses differential reasons for violence among males and females as well as substance use would be beneficial.     

Gender differences in abusers of amphetamine-type stimulants and ketamine in southwestern China

The objective of this study was to investigate abuse conditions of new-type drugs for users who are seeking treatment, gender differences, and differences between the amphetamine-type stimulants (ATS) users and mixed amphetamine-type stimulants and ketamine (ATS + K) poly-drug users. A retrospective analysis was conducted of patients with a final diagnosis of the substance use disorder according to the Diagnoses and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) who underwent treatment for exposure to new-type drugs at the mental health center of the West China Hospital from March 2009 to May 2011. A questionnaire was used to collect information about socio-demographics, drug abuse conditions and psychiatric co-morbidities. Male subjects were older (p = 0.026), had low level education (p = 0.003), were less previously married (p < 0.001), were more likely to be employed and to hold higher status jobs (p = 0.007); 77.1% of subjects had a psychotic disorder, 28.0% of subjects had a mood disorder, 39.7% had an anxiety disorder, and 45.0% had a cognitive impairment disorder. More men used methamphetamine MA (p < 0.001), tobacco (p = 0.014) and more than one drug substance (p = 0.004) compared to women; women were more vulnerable to mood disorders (p = 0.034) than men. For the males, the ATS + K patients were more likely to use 3, 4-methylenedioxymethamphetamine MDMA (p < 0.001) and develop more psychotic disorders (p = 0.04) than the ATS patients; for females, the ATS + K patients were more likely to use MDMA (p = 0.002), alcohol (p = 0.014) and develop more cognitive impairment disorder (p = 0.034). The present study found that the new-type drug patients have a high degree of psychiatric morbidities; more men were using MA, tobacco and multi-substance and more women patients experience mood disorder in the gender differences. For the males, the ATS + K patients were more likely to use MDMA (3, 4-methylenedioxymethamphetamine) and develop more psychotic disorders than the ATS patients; for females, the ATS + K patients were more likely to use MDMA, alcohol and develop more cognitive impairment disorder. These results suggested that the psychiatrists should focus on the mood disorder among females, psychotic disorders among males who abuse ATS and ketamine, and cognitive impairment disorder for the females who abuse ATS and ketamine.     

Attention-deficit/hyperactivity disorder subtypes and substance use and use disorders in NESARC

Background

Attention-deficit/hyperactivity disorder (ADHD) is associated with substance use and substance use disorders (SUD). However, relatively little is known about the relationship between DSM-IV ADHD subtypes and substance use or DSM-IV abuse/dependence in epidemiological samples.

Methods

Data were obtained from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC, N = 33,588). Respondents reported on ADHD symptoms (DSM-IV) for the period of time when they were 17 years or younger. Lifetime use and DSM-IV abuse/dependence of alcohol, nicotine, cannabis, cocaine, sedatives, stimulants and heroin/opiates were compared across those with ADHD symptoms but no diagnosis (ADHDsx; N = 17,009), the Combined (ADHD-C; N = 361), Predominantly Inattentive (ADHD-I; N = 325), and the Predominantly Hyperactive-Impulsive (ADHD-HI; N = 279) ADHD subtypes. Taking a more dimensional approach, inattentive and hyperactive-impulsive symptom counts and their associations with substance use and misuse were also examined.

Results

After adjustments for conduct disorder, major depressive disorder, any anxiety disorder and other socio-demographic covariates, substance use and SUD were associated with ADHDsx, ADHD-C, ADHD-I and ADHD-HI. Overall, substance use and SUD were more weakly associated with the ADHDsx group compared to the three ADHD diagnostic groups.Statistically significant differences were not evident across the three diagnostic groups. Hyperactive–impulsive symptoms were more consistently associated with substance use and SUD compared to inattentive symptoms.

Conclusions

ADHD subtypes are consistently associated with substance use and SUD. The relatively stronger association of hyperactive/impulsive symptoms with substance use and abuse/dependence is consistent with the extant literature noting impulsivity as a precursor of substance use and SUD.     

Acute alcohol use temporally increases the odds of male perpetrated dating violence: A 90-day diary analysis

Objective

Despite an extensive theoretical literature on acute alcohol intoxication likely increasing the odds of aggression between intimate partners, there have been few temporal studies on the relation between alcohol use and increased odds of intimate partner violence (IPV). Moreover, the literature on the temporal relation between marijuana use and IPV is in its infancy. The existing temporal research has yet to examine in the same study the three distinct types of IPV that occur most often between partners: physical, psychological, and sexual. Thus, the present study examined the temporal relationship between acute alcohol use, marijuana use, and male perpetrated physical, psychological, and sexual dating violence.

Method

College men who had consumed alcohol in the previous month and were in a current dating relationship participated (N = 67). Men completed daily surveys that assessed their alcohol use, marijuana use, and violence perpetration (psychological, physical, and sexual) for up to 90 consecutive days.

Results

On any alcohol use days, heavy alcohol use days (5 or more standard drinks), and as the number of drinks increased on a given day, the odds of physical and sexual aggression perpetration increased. The odds of psychological aggression increased on heavy alcohol use days only. Marijuana use days did not increase the odds of any type of aggression.

Conclusions

These findings contribute to a growing body of research on the temporal relation between acute alcohol use and IPV perpetration among college men. Combined with previous research, our findings suggest that dating violence intervention and prevention programs should target reductions in alcohol use.     

The relation between interpersonal violence and substance use among a sample of university students: Examination of the role of victim and perpetrator substance use

Objective

To examine the relation between interpersonal violence and substance use and to describe the role of victim and perpetrator substance use within such incidents among university students.

Methods

A random sample of students (N = 1197) participating in this cross-sectional study completed an online survey. Logistic regression models assessed the relation between substance use and sexual and physical victimization. Victim and perpetrator substance use at the time of incident were described.

Results

Females were more likely to report sexual violence compared to males, whereas males were more likely to report physical victimization (p's < 0.05). In logistic regression models, all forms of substance use were significantly associated with physical victimization among males (OR's = 2.0–5.1). Among females, most forms of substance use were associated with sexual victimization (OR's = 2.4–4.7). Both males and females reported high rates of perpetrator and own substance use during victimization incidents.

Conclusions

Findings suggest that previous documentation among victimization studies of a relation between substance use and subsequent risk for victimization may also be attributable to the substance use behavior of the perpetrator.     

A history of sexual, emotional, or physical abuse predicts adjustment during opioid maintenance treatment

This study examined how having a history of sexual, physical, or emotional abuse is related to overall functioning as assessed by the Addiction Severity Index during short-term opioid maintenance treatment with either buprenorphine/naloxone or methadone. Furthermore, the relation between abuse history and overall functioning by sex was explored. Participants (N = 268) were opioid-dependent adults entering an outpatient randomized clinical trial with buprenorphine/naloxone and methadone. Latent growth modeling indicated that females with an abuse history entered treatment with more problems in the psychiatric and family domains as compared with females without an abuse history. Over the course of treatment, a history of abuse predicted problems in the psychiatric and alcohol domains. Furthermore, a history of abuse predicted slower recovery times and less recovery overall for females in some domains. Males with an abuse history entered treatment with more severe psychiatric and family problems as compared with males with no history of abuse. Victims of abuse may present to substance abuse treatment with weaknesses in the areas of family relations, psychiatric status, and alcohol use. The nature of these problems and their trajectory over time differed by sex.     

Bullying Perpetration and Victimization as Externalizing and Internalizing Pathways: A Retrospective Study Linking Parenting Styles and Self-Esteem to Depression,Alcohol Use,and Alcohol-Related Problems

Background: Emerging research suggests significant positive associations between bullying and substance use behaviors. However, these studies typically focused either on the link between substance use and bullying perpetration or victimization, and few have conceptualized bullying perpetration and/or victimization as mediators. Objective: In this study, we simultaneously tested past bullying perpetration and victimization as mediational pathways from retrospective report of parenting styles and global self-esteem to current depressive symptoms, alcohol use, and alcohol-related problems. Methods: Data were collected from a college sample of 419 drinkers. Mediation effects were conducted using a bias-corrected bootstrap technique within a structural equation modeling framework. Results: Two-path mediation analyses indicated that mother and father authoritativeness were protective against bully victimization and depression through higher self-esteem. Conversely, having a permissive or authoritarian mother was positively linked to bullying perpetration, which in turn, was associated with increased alcohol use, and to a lesser degree, more alcohol-related problems. Mother authoritarianism was associated with alcohol-related problems through depressive symptoms. Three-path mediation analyses suggested a trend in which individuals with higher self-esteem were less likely to report alcohol-related problems through lower levels of bullying victimization and depression. Conclusions/Importance: Results suggested that bullying perpetration and victimization may, respectively, serve as externalizing and internalizing pathways through which parenting styles and self-esteem are linked to depression and alcohol-related outcomes. The present study identified multiple modifiable precursors of, and mediational pathways to, alcohol-related problems which could guide the development and implementation of prevention programs targeting problematic alcohol use.     

Prenatal and postnatal cocaine exposure predict teen cocaine use

Preclinical studies have identified alterations in cocaine and alcohol self-administration and behavioral responses to pharmacological challenges in adolescent offspring following prenatal exposure. To date, no published human studies have evaluated the relation between prenatal cocaine exposure and postnatal adolescent cocaine use. Human studies of prenatal cocaine-exposed children have also noted an increase in behaviors previously associated with substance use/abuse in teens and young adults, specifically childhood and teen externalizing behaviors, impulsivity, and attention problems. Despite these findings, human research has not addressed prior prenatal exposure as a potential predictor of teen drug use behavior. The purpose of this study was to evaluate the relations between prenatal cocaine exposure and teen cocaine use in a prospective longitudinal cohort (n = 316) that permitted extensive control for child, parent and community risk factors. Logistic regression analyses and Structural Equation Modeling revealed that both prenatal exposure and postnatal parent/caregiver cocaine use were uniquely related to teen use of cocaine at age 14 years. Teen cocaine use was also directly predicted by teen community violence exposure and caregiver negativity, and was indirectly related to teen community drug exposure. These data provide further evidence of the importance of prenatal exposure, family and community factors in the intergenerational transmission of teen/young adult substance abuse/use.     

Sociodemographic and Substance Use Disorder Determinants of HIV Sexual Risk Behavior in Men and Women in Outpatient Drug Treatment in the NIDA National Drug Abuse Treatment Clinical Trials Network

Background: Sexual risk behavior is now the primary vector of HIV transmission among substance users in the United States with gender as a crucial moderator of risk behavior. Objectives: The purpose of this study was to examine gender differences in factors (age, race/ethnicity, education) that predict main-partner unprotected sexual occasions (USO) using the unique platform of two parallel NIDA National Drug Abuse Treatment Clinical Trials Network gender-specific safer sex intervention trials. Methods: Baseline assessments of male (N = 430) and female (N = 377) participants included demographic characteristics; past 3-month sexual activity; and a diagnostic assessment for alcohol, cocaine/stimulant, and opioid use disorders. Using mixed effects generalized linear modeling of the main outcome USO, two-way interactions of gender with age, race/ethnicity, and education were evaluated and adjusted by alcohol, cocaine/stimulant, or opioid use disorder. Results: When adjusted for alcohol use disorder, the interaction of education and gender was significant. For men, a high school or greater education was significantly associated with more USO compared to men with less than high school. For women, greater than high school education was significantly associated with less USO compared to women with a high school education. None of the other interactions were significant when adjusted for cocaine/stimulant or opioid use disorder. Conclusions/Importance: This study demonstrates gender differences in the relationship of education, alcohol use disorder, and main-partner USO in individuals in substance abuse treatment. This underscores the importance of considering demographic and substance use factors in HIV sexual risk behavior and in crafting prevention messages for this population.     

Followup of cocaine-dependent men and women with antisocial personality disorder

Long-term outcomes following drug treatment were examined for cocaine-dependent men (N = 453) and women (N = 254) with and without antisocial personality disorder (ASP). In-depth assessments were conducted at treatment intake in 1991-93 and at 1 and 5 years following treatment discharge. Overall, 47.2% of the males and 34.3% of females were diagnosed with ASP using DSM-III-R criteria derived from the Diagnostic Interview Schedule. All groups reduced their cocaine, marijuana, and alcohol use; reduced their levels of psychological distress; and improved in functioning (e.g., employment, arrests, residential status). At Year 5 ASP was associated with an increased likelihood of heavy alcohol use and additional substance abuse treatment among men, whereas women with ASP were more likely to report psychological problems and to receive mental health treatment and other services than either women without ASP or men with ASP. The findings suggest the need to address the specific treatment needs of male and female cocaine abusers with ASP.     

Sex Differences in Guanfacine Effects on Drug Craving and Stress Arousal in Cocaine-Dependent Individuals

Currently, no FDA-approved medication exists for the treatment of cocaine use disorder. Furthermore, as women become increasingly more at risk for the consequences of cocaine addiction, the need to establish better-tailored treatment medications is paramount. We examine the effects of the alpha2 adrenergic agonist, guanfacine HCl, on responses to stress and drug cue in a group of cocaine-dependent men and women who also abuse alcohol and nicotine. Forty early abstinent treatment-seeking cocaine-dependent males and females were randomly assigned to receive either daily placebo (12 M/7 F) or guanfacine (2 or 3 mg) (15 M/6 F) for 3 weeks. In week 4, they participated in a laboratory experiment and were exposed to three 10-min guided imagery conditions (stress/stress, cue/cue, and stress/cue), one per day, consecutively in a random, counterbalanced order. Craving, negative emotion, anxiety, and cardiovascular function were assessed at baseline, immediately following imagery exposure, and at various recovery time points. Guanfacine significantly attenuated cocaine craving, alcohol craving, anxiety, and negative emotion following exposure to all three imagery conditions in females, but not males. Guanfacine did, however, reduce sympathetic tone as well as stress and cue-induced nicotine craving and systolic blood pressure (SBP) in both males and females. These findings highlight sex-specific effects of guanfacine on drug craving, anxiety, and negative mood with significant effects in women and not men. The findings suggest further evaluation of guanfacine in the treatment of cocaine use disorder with a specific focus on sex differences in treatment response.     

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.     

A family history and direct interview study of the familial aggregation of substance abuse: the adolescent substance abuse study

The adolescent substance abuse (ASA) study collected information concerning drug use and psychopathology on male adolescent probands in treatment for substance abuse and also on matched control adolescents, as well as all available family members of both groups. Information was obtained through direct interview and the family history method of assessment. Both methods revealed greater alcohol and drug use, conduct disorder (CD) and antisocial personality disorder (ASP) in the relatives of treatment probands as compared with control relatives. These results suggest familial transmission, not only for alcohol abuse, but also for non-alcohol substance abuse. Familial transmission for CD and ASP is also evident for both male and female relatives, although the prevalence of these disorders is significantly greater in males than females.