Using cluster analysis of alcohol use disorders to investigate 'diagnostic orphans': subjects with alcohol dependence symptoms but no diagnosis

The purpose of this paper is to examine the characteristics of community subjects with one or two alcohol dependence symptoms who did not satisfy the criteria for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) alcohol dependence or abuse (sub-diagnostic group or diagnostic orphans). Variables not included in the DSM-IV alcohol abuse and dependence criteria are used to compare the different alcohol statuses. The results indicate that the sub-diagnostic group ‘diagnostic orphans’ formed a cluster distinct from that of the non-problem drinkers group, and appeared to be closer to those with alcohol abuse than to those with alcohol dependence. The diagnosis of DSM-IV alcohol dependence (with three, four, or five or more symptoms) appeared to be its own entity. The findings lend credence to the requirement of three symptoms (in any 12 months) for the diagnosis of alcohol dependence in DSM-IV. However, those with one or two symptoms of alcohol dependence should be considered along with alcohol abuse as an entity in future DSM classifications.     

The effect of alcohol on sexual risk-taking among young men and women

The current study investigated the effects of alcohol and gender on the intentions of engaging in sexual risk-taking. Young adults (101 men, 99 women) were randomly assigned to the alcohol, placebo, or no-alcohol conditions. Participants listened to an audiotaped scenario that presented a romantic situation between a man and a woman who had just met. Participants were asked to imagine that they were one of the individuals in the scenario and then judged their intentions to engage in sexual risk-taking. Similar previous studies (e.g., Abbey, Saenz, & Buck, 2005) employing a vignette in which the couple had known each other prior to the romantic encounter found that intoxicated individuals reported a greater willingness to engage in sexual activity than those in the placebo and control groups. In contrast, the current study's results showed that intoxicated and placebo-treated women reported a greater intention of engaging in sex than sober women (b = 4.92, t = 2.42, p < 05). Conversely, intoxicated and placebo-treated men reported less willingness to engage in sex than sober men (b = −4.66, t = −2.14, p < .05). Neither alcohol nor gender predicted participants' intention to use a condom if they chose to engage in sex. However, those who used condoms more frequently were more likely to report intending to use a condom in this scenario (b = −1.60, t = −2.17, p < .05). The results demonstrated the complex processes underlying the effects of alcohol on engaging in casual sex by revealing a gender-specific psychological effect of alcohol.     

The social context of cannabis use: Relationship to cannabis use disorders and depressive symptoms among college students

Few studies have investigated the association between the social context of cannabis use and cannabis use disorder (CUD). This longitudinal study of college students aimed to: develop a social context measure of cannabis use; examine the degree to which social context is associated with the transition from non-problematic cannabis use to CUD; and, examine the association between social context of cannabis use and depressive symptoms. The analytic sample consisted of 322 past-year cannabis users at baseline. Four distinct and internally consistent social context scales were found (i.e., social facilitation, emotional pain, sex seeking, and peer acceptance). Persistent CUD (meeting DSM-IV criteria for CUD at baseline and 12 months later) was associated with using cannabis in social facilitation or emotional pain contexts, controlling for frequency of cannabis use and alcohol use quantity. Students with higher levels of depressive symptoms were more likely to use cannabis in an emotional pain or sex-seeking context. These findings highlight the importance of examining the social contextual factors relating to substance use among college students.     

Effects of alcohol cues and alcohol intoxication on drug use expectancies among men who have sex with men

Although alcohol and drug use have been identified as HIV-risk factors for men who have sex with men (MSM), little is known about how they interact. An alcohol administration paradigm was used to examine alcohol's cue and pharmacological effects on perceived drug use benefits and consequences in 117 MSM. Planned contrasts indicated that those in the alcohol cue (i.e., placebo) condition reported lower perceived drug consequences compared to controls. No cue effects were found for drug benefits. There was no pharmacological effect of alcohol as compared to alcohol cue on either outcome. Findings suggest that alcohol cues may influence the perception of consequences related to drug use, which has implications for health interventions targeting substance use and HIV risk.     

Meta-analysis of depression and substance use among individuals with alcohol use disorders

The relationships of depression with alcohol and drug use and impairment were examined. Additional analyses were conducted to examine moderators of these associations. Empirical reports on adults with alcohol abuse or dependence published in English in peer-reviewed journals since 1986 that contained data on depression and substance use variable(s) were obtained using a systematic search. The search yielded 74 studies including 58 reports from clinical venues, 10 that were community based, and 6 with subjects from both settings. As hypothesized, the analyses showed that depression is associated with concurrent alcohol use and impairment and drug use and impairment. Effect sizes were small. Depression was also related to future alcohol use and impairment, an earlier age of onset of an alcohol use disorder, and higher treatment participation. Age moderated the association between depression and alcohol use and impairment such that the association was stronger in older samples.     

Patterns of alcohol dependence in Thai drinkers: a differential item functioning analysis of gender and age bias

In Caucasians, the patterns of alcohol use disorders in women and adolescents are likely to be different from those in men and adults, respectively. The authors examined these differences in a Southeast Asian sample of Thai people living in communities. A two-parameter logistic model of the IRT log-likelihood-ratio (IRTLR) test for differential item functioning (DIF) procedure was used. Participants were a subsample of 3718 current drinkers participating in the 2008 Thai National Mental Health Survey (n = 17,140). The 1-year prevalence rates of alcohol dependence were 1.4% in women and 13.7% in men. Based on the Mini International Neuropsychiatric Interview (MINI), alcohol dependence and abuse module, all current drinkers were interviewed for a yes/no response to each of seven alcohol dependence criteria. Confirmatory factor analysis suggested a single-factor model of alcohol dependence criteria (χ2 = 211.51, RMSEA = 0.06, SRMR = 0.03 and CFI = 0.96). Compared with 3174 men, 544 women had a significantly higher threshold estimate for quit/control problems and a lower threshold value for drinking despite physical/mental problems (b parameter difference of 0.25 and − 0.30, respectively). Thai adolescents (n = 272) and Thai adults (n = 3446) had no statistically significant DIF on any criterion. The criterion of time spent drinking had significantly high discrimination estimates in women, men, adolescent and adults (a parameters of 2.50, 2.08, 2.33 and 2.16, respectively). Gender bias on alcohol dependence criteria can be found in Thai drinkers. Time spent drinking may be the most useful criterion for discriminating the severity of alcohol dependence across age and gender groups of Thai drinkers.     

Associations between substance use disorder sub-groups, life expectancy and all-cause mortality in a large British specialist mental healthcare service

Background

People with substance use disorders (SUDs) have increased risk of mortality but risk in sub-groups is poorly understood.

Methods

SUD cases, aged 15 years or older, were identified in the South London and Maudsley Case Register which contains over 150,000 specialist mental healthcare and addictions service users linked to regular national mortality tracing. Standardized mortality ratios (SMRs) for the period 2007-2009 were calculated based on expected numbers of deaths for England and Wales in 2008 then stratified by gender, age, ethnicity, and type of substance use disorder. Life expectancies at birth were estimated.

Results

We detected 10,927 cases with a primary substance use disorder diagnosis prior to 2010, who were active to South London and Maudsley NHS Foundation Trust services between 2007 and 2009. Alcohol and opioid use disorders were the most common disorders (45.4% and 44.2% of the SUD cohort respectively) and were associated with increased mortality (SMRs 4.04 and 4.85 respectively). Subgroups at particularly high risk were women with opioid use disorder (SMR 7.32) and those under the age of 45 years with alcohol use disorder (SMR 9.25). SMRs associated with alcohol and opioid use disorders diminished with age. Life expectancies of individuals with alcohol and opioid use disorders were reduced by 9-17 years compared to national norms.

Conclusions

Those under 45 years with alcohol use disorder and women with opioid use disorder are at particularly high risk of mortality. More targeted health care is required to address the specific needs of these vulnerable subgroups.     

Alcohol and drug use and related consequences among gay,lesbian and bisexual college students: Role of experiencing violence,feeling safe on campus,and perceived stress

Objective

To examine differences between gay, lesbian, and bisexual (GLB) and non-GLB university students in alcohol and other drug use (AOD) and related consequences as well as the relevance of violence, perceived safety, and stress to any such differences in AOD use and related concerns.

Methods

A random representative sample of university students (n = 988) were recruited via email for an online survey. Linear regression models assessed associations between identifying as GLB and AOD use and related consequences.

Results

Regression models (adjusted for gender) indicated that, in comparison to heterosexual students, GLB students were more likely to report recent illicit drug use (AOR = 2.0; 95% CI: 1.1–3.9), more frequent negative AOD consequences (β = 5.5, SE = 1.4, p < 0.0001), and having seriously thought about/attempted suicide due to AOD use in the past year (AOR = 6.6; 95% CI: 3.0–14.3). Study findings also suggested that violence, safety, and stress variables partially contribute to AOD use and related concerns among GLB students.

Conclusions

Findings highlight the need for future efforts to investigate and address mechanisms, including aspects of campus life, which contribute to AOD related risks among GLB students.     

Gender,history of alcohol use and number of drinks consumed predict craving among drinkers in a field setting

To the extent that craving serves to compel excessive drinking, it would be important to predict the intensity of an individual's craving over the course of a drinking episode. Previous research indicates that regular alcohol use (measured by the AUDIT) and the number of drinks individuals have already consumed that evening independently predict craving to drink (Schoenmakers & Wiers, 2010). The current study aims to replicate those findings by testing whether these same variables predict craving to drink in a sample of 1320 bar patrons in a naturalistic setting. In addition, we extend those findings by testing whether regular alcohol use and self-reported number of drinks consumed interact to predict craving, and whether gender independently predicts craving or interacts with other variables to predict craving. Results indicate that for men, AUDIT score alone predicted craving, whereas for women, AUDIT score and number of drinks consumed interacted to predict craving, with craving highest among women with either high AUDIT scores or relatively high consumption levels. Our findings have implications for targeted intervention and prevention efforts, as women who have a history of harmful alcohol use and consume several drinks in an evening might be at the greatest risk for continued alcohol consumption.     

Gender differences in physical and mental health outcomes among an aging cohort of individuals with a history of heroin dependence

Background

This paper examines the health status and functioning of an aging cohort of individuals with a history of heroin dependence with a focus on gender differences.

Method

Study subjects were originally sampled from methadone maintenance clinics in California in the 1970s and completed follow-up interviews in 2005-09. Out of the original study sample (N = 914), 343 participants (44.3% female) were interviewed (70.6% of those not deceased). Bivariate analyses examined gender differences in participants' overall health status and physical and mental health problems. Scores on SF-36 scales were compared with general population norms by gender and age, as well as between participants in the study sample who did and did not report past-year drug use.

Results

Average age of the study sample was 58.3 (SD = 4.9) years for males and 55.0 (SD = 4.1) years for females. There were no significant gender differences in past-year drug use (38% of sample) or injection drug use (19%). Women reported significantly more chronic health problems and psychological distress compared with men, and overall poorer health and functioning compared with general population norms. Men under 65 had poorer physical health and social functioning compared with population norms. Men in the study sample reporting past-year substance use had poorer physical functioning, but less bodily pain, than non-users, whereas women with past-year substance use had poorer mental health than other women.

Conclusion

Individuals with a history of heroin dependence have poorer health and functioning than their counterparts in the general population. At a younger age, women reported poorer overall health status and more chronic health and mental health problems than men. Study findings may inform interventions for this population, particularly related to gender-specific treatment needs.     

Gender differences in the use of alcohol and prescription drugs in relation to job insecurity. Testing a model of mediating factors

BackgroundThe results of several studies suggest that economy-related stressors are less distressing for women compared with men. This study proposed to examine the relationship of perceived job insecurity with the use of licit drugs using a theoretical model that considered antecedents and mediators of this association, in order to identify differences between working men and women.MethodsUsing information from the Catalan Health Survey (2010–2014), we selected working individuals aged 16–64 who were primary providers of household income (N = 5315). The outcomes were two measures of alcohol consumption (heavy drinking and binge drinking) and the use of hypnotics/sedatives. As antecedents of the exposure to job insecurity we considered the type of contractual relationship and occupational class. The mediating factors were poor mental health, household structure and the hours of housework per week. The theoretical model was assessed using path analysis where the moderating effect of gender was considered in all the associations.ResultsNo differences in the prevalence of job insecurity were found between men and women (17%). Job insecurity (Odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.23–1.48) and house workload (OR = 1.01, 95% CI = 1.00–1.02) were positively associated with poor mental health, with no significant interactions with gender. Poor mental health was significantly associated with binge drinking (OR = 1.23, 95% CI = 1.13–1.33) and with the use of hypnotics/sedatives (OR = 1.71, 95% CI = 1.53–1.91). House workload showed a direct negative association with binge drinking (OR = 0.99, 95% CI = 0.98–1.00), while those in households with no children were more likely to be binge drinkers, with no significant interactions with gender. An alternative model had better fitting results for heavy drinking.ConclusionNo gender differences were found in the association of job insecurity with mental health nor with the use of substances among primary providers of household income, emphasising the importance of social roles when assessing differences in mental health among men and women.     

Comorbidity of posttraumatic stress disorder with alcohol dependence among US adults: Results from National Epidemiological Survey on Alcohol and Related Conditions

Background

Despite the high rates of comorbidity of post-traumatic stress disorder (PTSD) and alcohol dependence (AD) in clinical and epidemiological samples, little is known about the prevalence, clinical presentation, course, risk factors and patterns of treatment-seeking of co-occurring PTSD-AD among the general population.

Methods

The sample included respondents of the Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Weighted means, frequencies and odds ratios (ORs) of sociodemographic correlates, prevalence of psychiatric disorders and rates of treatment-seeking were computed.

Results

In the general population, the lifetime prevalence of PTSD only, AD only and PTSD-AD was 4.83%, 13.66% and 1.59%, respectively. Individuals with comorbid PTSD-AD were more likely than those with PTSD or AD only to have suffered childhood adversities and had higher rates of Axis I and II disorders and suicide attempts. They also met more PTSD diagnostic criteria, had earlier onset of PTSD and were more likely to use drugs and alcohol to relieve their PTSD symptoms than those with PTSD only; they also met more AD diagnostic criteria than those with AD only and had greater disability. Individuals with PTSD-AD had higher rates of treatment seeking for AD than those with AD only, but similar rates than those with PTSD only.

Conclusion

PTSD-AD is associated with high levels of severity across a broad range of domains even compared with individuals with PTSD or AD only, yet treatment-seeking rates are very low. There is a need to improve treatment access and outcomes for individuals with PTSD-AD.     

Model minority stereotype and the diagnosis of alcohol use disorders: Implications for practitioners working with Asian Americans

This study investigated the priming effects of the model minority stereotype on 122 clinicians in training regarding their diagnostic accuracy on Asian Americans compared to Whites. It was hypothesized that clinicians in training would be less likely to diagnose Asian Americans with alcohol use disorder and would perceive them to have fewer clinical symptoms than Whites due to the model minority stereotype. Consistent with the hypotheses, clinicians in training were less likely to assign alcohol use disorder to Asian Americans compared to Whites, as well as to the unprimed condition versus the condition primed with the stereotype. Implications regarding cultural competence and future research are discussed.     

Risks of major depressive disorder and anxiety disorders among Thais with alcohol use disorders and illicit drug use: Findings from the 2008 Thai National Mental Health survey

Little is known about the risks of mood and anxiety disorders among Asians with alcohol use disorders and the effect of illicit drug use in this population. All participants from the 2008 Thai National Mental Health survey (N=17,140) were assessed for current major depressive disorder, anxiety disorders, and alcohol use disorders by using the Mini International Neuropsychiatric Interview (MINI) and were interviewed for illicit drug use within one year prior to their assessment. Logistic regression modeling was used to determine (a) whether alcohol use disorders were associated with major depressive disorder and anxiety disorders and (b) whether the use of illicit drugs increased these associations. Sex, age, marital status, region, and educational level were found to be significantly associated with major depressive disorder and anxiety disorders and were taken into account in the regression analysis. Compared with the general population, individuals with alcohol use disorders alone had significantly increased risks of major depressive disorder (OR 2.49, 95%CI 1.76-3.53 in men and OR 4.09, 95%CI 2.31-7.26 in women) and anxiety disorders (OR 2.21, 95%CI 1.46-3.36 in men and OR 4.34, 95%CI 2.35-8.03 in women). The risks became higher among individuals with both alcohol use disorders and illicit drug use (OR 3.62, 95% CI 1.64-8.01 in men and OR 11.53, 95%CI 1.32-100.65 in women for major depressive disorder, and OR 3.20, 95%CI 1.36-7.51 in men and OR 13.10, 95%CI 1.48-115.60 in women for anxiety disorders). In conclusion, alcohol use disorders were significantly associated with major depressive disorder and anxiety disorders. Illicit drug use was an important factor in increasing these associations, especially in women. Screening for depression, anxiety, and illicit drug use should be done in individuals with alcohol use disorders.     

Correlates of alcohol use in adults with ADHD and comorbid alcohol use disorders: exploratory analysis of a placebo-controlled trial of atomoxetine

Abstract

Background:

Attention-deficit/hyperactivity disorder (ADHD) and substance use disorder are often comorbid in adults. The effects of ADHD treatment on comorbid alcohol use disorder have not been extensively studied.     

The associations between early alcohol use and suicide attempts among adolescents with a history of major depression

Objective

Previous studies have identified significant associations between alcohol initiation before the age of 13 years and risk for suicide attempts. However, these associations have not been extensively tested using data obtained from populations with clinically significant psychopathology. The current study seeks to extend knowledge of the associations between early alcohol initiation and risk for suicide by identifying the associations between age of first alcohol use and suicide attempts among a sample of youth age 13 to 15 years with a history of major depression.

Methodology

Data were obtained from the National Study of Drug Use and Health (NSDUH), a household-based survey of U.S. adolescents and adults age 12 years and older.

Results

Results from these analyses confirm previous reports of significant associations between age of first alcohol use and suicide attempts and extend previous understanding of risk by using data obtained from a household-based survey and from adolescents with clinically relevant psychopathology.

Conclusions

These findings provide further support for the implementation, enforcement, and continued support of both targeted and universal prevention strategies designed to reduce underage drinking.