Alcohol, cannabis and tobacco use among Australians: a comparison of their associations with other drug use and use disorders, affective and anxiety disorders, and psychosis

Aim . To compare relationships between alcohol, cannabis and tobacco and indicators of mental health problems in the general population.
Method . A survey of a nationally representative sample of 10 641 Australian adults (the National Survey of Mental Health and Well-Being (NSMHWB)) provided data on alcohol, cannabis and tobacco use and mental health (DSM-IV anxiety disorders, affective disorders, other substance use disorders and screening positively for psychosis).
Findings . Alcohol showed a "J-shaped" relationship with DSM-IV affective and anxiety disorders: alcohol users had lower rates of these problems than non-users of alcohol, while those meeting criteria for alcohol dependence had the highest rates. Tobacco and cannabis use were both associated with increased rates of all mental health problems examined. However, after controlling for demographics, neuroticism and other drug use, cannabis was not associated with anxiety or affective disorders. Alcohol dependence and tobacco use remained associated with both of these indicators of mental health. All three types of drug use were associated with higher rates of other substance use problems, with cannabis having the strongest association.
Conclusions . The use of alcohol, tobacco and cannabis are associated with different patterns of co-morbidity in the general population.     

Probability and Predictors of Transition from Abuse to Dependence on Alcohol,Cannabis, and Cocaine: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

Background: Little is known about the transition from substance abuse to substance dependence. Objectives: This study aims to estimate the cumulative probability of developing dependence and to identify predictors of transition to dependence among individuals with lifetime alcohol, cannabis, or cocaine abuse. Methods: Analyses were done for the subsample of individuals with lifetime alcohol abuse (n = 7802), cannabis abuse (n = 2832), or cocaine abuse (n = 815) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Estimated projections of the cumulative probability of transitioning from abuse to dependence were obtained by the standard actuarial method. Discrete-time survival analyses with time-varying covariates were implemented to identify predictors of transition to dependence. Results: Lifetime cumulative probability estimates indicated that 26.6% of individuals with alcohol abuse, 9.4% of individuals with cannabis abuse, and 15.6% of individuals with cocaine abuse transition from abuse to dependence at some point in their lives. Half of the transitions of alcohol, cannabis, and cocaine dependence occurred approximately 3.16, 1.83, and 1.42 years after abuse onset, respectively. Several sociodemographic, psychopathological, and substance use-related variables predicted transition from abuse to dependence for all of the substances assessed. Conclusion: The majority of individuals with abuse do not transition to dependence. Lifetime cumulative probability of transition from abuse to dependence was highest for alcohol, followed by cocaine and lastly cannabis. Time from onset of abuse to dependence was shorter for cocaine, followed by cannabis and alcohol. Although some predictors of transition were common across substances, other predictors were specific for certain substances.     

Drug driving among injecting drug users in Sydney, Australia: prevalence, risk factors and risk perceptions

Aims To examine the prevalence of drug driving, the prevalence of drug‐related motor vehicle accidents, risk perceptions of drug driving and factors associated with drug driving among injecting drug users (IDU). Design Cross‐sectional survey. Setting Sydney, Australia. Participants Three hundred current IDU. Findings Ninety‐five per cent had driven a vehicle, 74% in the previous 12 months (‘current drivers’). Eighty‐seven per cent of life‐time drivers reported having drug driven, and 88% of current drivers had drug driven in the previous 12 months. There were no significant sex differences in life‐time or recent drug driving. The most common drugs used before driving in the preceding year were: cannabis, heroin, amphetamines and cocaine. A third of life‐time drivers reported having had a drug driving accident, with males more likely to have done so, and 9% of current drivers reported a drug driving accident in the previous year. The most common drugs that had been used before the most recent drug driving accident were heroin, cannabis and alcohol. Alcohol was perceived to be the most dangerous substance for driving performance and cannabis the least dangerous. Recent drug drivers perceived drug driving to be less dangerous than non‐drug drivers. Recent drug drivers had driven more frequently over the preceding 12 months, had significantly higher levels of dependence, higher frequency of drug use, more extensive polydrug use and were more likely to have used and/or injected a drug in a car in the previous 12 months. Conclusions Drug driving and drug‐related accidents are large‐scale public health problems among IDU. These behaviours pose serious risks to IDU themselves and to the broader community.     

Longitudinal study of parental movie restriction on teen smoking and drinking in Germany

Aims To determine if adolescents who report that their parents restrict viewing movies based on rating have a lower risk of trying smoking and drinking alcohol in the future. Design Prospective observational study. A cohort of 2110 German adolescents younger than 15 years who had never smoked or drunk alcohol at baseline were surveyed 12–13 months later to determine smoking and binge drinking initiation. Risk of substance use was assessed as a function of parental restriction on viewing FSK‐16 movies (movies that only those aged 16 years and over would be allowed to see in theaters). Findings The percentage of students who tried smoking was 16.3%, 10.9% initiated binge drinking and 5.0% used both substances during the follow‐up period. There was a significant effect of parental movie restriction on each substance use outcome measure after controlling for covariates. Compared with adolescents whose parents never allowed them to view FSK‐16 movies, the adjusted relative risk [(RR) (95% confidence interval (CI)] for use of both substances were 1.64 (1.05–2.58) for adolescents allowed to view them once in a while, 2.30 (1.53–3.45) for sometimes and 2.92 (1.83–4.67) for all the time. FSK‐16 restrictions were associated with lower viewership of all classes of movies, but especially FSK‐16/18 movies; in addition, FSK‐16 restrictions were associated with substantially lower exposure to movie depiction of tobacco and alcohol use, suggesting a mediational mechanism for the association. Conclusions Among young adolescents, parental restriction from viewing movies rated for older adolescents/adults decreases the risk of substance use in the future.     

Probability and predictors of remission from life-time nicotine, alcohol, cannabis or cocaine dependence: results from the National Epidemiologic Survey on Alcohol and Related Conditions

Aim To estimate the general and racial/ethnic specific cumulative probability of remission from nicotine alcohol cannabis or cocaine dependence, and to identify predictors of remission across substances. Design Data were collected from structured diagnostic interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule—DSM‐IV version. Setting The 2001–2002 National Epidemiological Survey of Alcohol and Related Conditions (NESARC) surveyed a nationally representative sample from US adults (n = 43 093) selected in a three‐stage sampling design. Participants The subsamples of individuals with life‐time DSM‐IV diagnosis of dependence on nicotine (n = 6937), alcohol (n = 4781), cannabis (n = 530) and cocaine (n = 408). Measurements Cumulative probability estimates of dependence remission for the general population and across racial/ethnic groups. Hazard ratios for remission from dependence. Findings Life‐time cumulative probability estimates of dependence remission were 83.7% for nicotine, 90.6% for alcohol, 97.2% for cannabis and 99.2% for cocaine. Half of the cases of nicotine, alcohol, cannabis and cocaine dependence remitted approximately 26, 14, 6 and 5 years after dependence onset, respectively. Males, Blacks and individuals with diagnosis of personality disorders and history of substance use comorbidity exhibited lower hazards of remission for at least two substances. Conclusions A significant proportion of individuals with dependence on nicotine, alcohol, cannabis or cocaine achieve remission at some point in their life‐time, although the probability and time to remission varies by substance and racial/ethnic group. Several predictors of remission are shared by at least two substances, suggesting that the processes of remission overlap. The lower rates of remission of individuals with comorbid personality or substance use disorders highlight the need for providing coordinated psychiatric and substance abuse interventions.     

Alcohol,tobacco and coffee consumption and liver disease severity among individuals with Chronic Hepatitis B infection in North America

Introduction and objectivesThe prevalence of alcohol, tobacco, and coffee use and association with liver health among North Americans with Chronic Hepatitis B (CHB) infection has not been well described.Materials and methodsThe Hepatitis B Research Network includes an observational study of untreated CHB adults enrolled at 21 sites in the United States and Canada. Alcohol use was categorized as none, moderate, and at-risk based on the definition from the National Institute on Alcohol Abuse and Alcoholism; tobacco use as never, current and former; coffee use as none, 1–2 cups/day, and ≥3 cups/day. Linear regression and linear mixed models were used to associate lifestyle behaviors with ALT and FIB-4 values.Results1330 participants met eligibility: 53% males, 71% Asian and the median age was 42 years (IQR: 34–52). Median ALT was 33 U/L (IQR: 22–50), 37% had HBV DNA <10³ IU/mL, 71% were HBeAg negative, and 65% had a FIB-4 <1.45. At baseline, 8% of participants were at-risk alcohol drinkers, 11% were current smokers and 92% drank <3 cups of coffee/day. Current tobacco and ‘at-risk’ alcohol use, were significantly associated with elevated ALT levels in univariable analyses, however, these associations were not statistically significant when controlling for sociodemographic and HBV characteristics.ConclusionsIn this large diverse cohort of untreated CHB participants, at-risk alcohol use, current tobacco use and limited coffee consumption did not have an association with high ALT and FIB-4 values. In contrast, significant associations were found between the frequency of these lifestyle behaviors and sociodemographic factors.     

Knowledge and Misconceptions Among Inner-City African-American Mothers Regarding Alcohol and Drug Use

Alcohol and drug knowledge of inner-city mothers was evaluated following an educational mailing, and the relationship between knowledge and alcohol and illicit drug use during pregnancy was tested. Eighty-four postpartum African-American mothers with known alcohol and drug use during pregnancy received a U.S. Department of Education publication, Growing Up Drug Free: A Parent's Guide to Prevention. Results of a phone-administered quiz from this booklet were compiled, and alcohol and drug use subgroups were compared. the average score was 50%. Half of the women did not know that alcohol is the most commonly used drug in the United States. Few identified alcohol, tobacco, and marijuana as the three drugs most commonly used by children. Lack of teenage substance use experience was perceived to increase the risk of chemical dependency. Drinkers and drug users were fourfold more likely to answer at least six questions correctly (p =. 03 each, logistic regression). Parental knowledge of substance use, particularly of alcohol, remains inadequate. We suggest that appropriate parental education tools are still needed for optimal primary prevention of substance use by inner-city children.     

A comparison of results from an alcohol survey of a prerecruited Internet panel and the National Epidemiologic Survey on Alcohol and Related Conditions

Background: Given today’s telecommunications environment, random digit dial (RDD) telephone surveys face declining response rates and coverage, and increasing costs. As an alternative to RDD, we surveyed participants in a randomly recruited standing Internet panel supplemented with a randomly sampled telephone survey of nonpanel members for a study of associations between onset of alcohol use and later alcohol‐related problems. The purpose of this paper was to compare results from our survey with results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a face‐to‐face probability sample survey of 43,093 adults, with a focus on associations between demographics, age of drinking onset, and alcohol dependence. Methods: Demographic and drinking characteristics from our survey of 4,021 ever‐drinkers between the ages of 18 and 39 years were compared with the characteristics of 11,549 similarly aged ever‐drinkers from the NESARC. Weighted analyses accounting for sampling design compared these 2 samples on drinking characteristics over the past year and during a respondent’s heaviest period of drinking, and in multivariate models examining associations between demographics, age of drinking onset, and lifetime alcohol dependence. Results: Participants in the supplemented Internet panel were similar to the national population of 18‐ to 39‐year‐old ever drinkers on gender, education, and race/ethnicity, while adults who were aged 18 to 25 years were under‐represented in the Internet panel. The supplemented Internet panel reported higher rates of moderate risk drinking over the past 12 months, lifetime high‐risk drinking, and lifetime (ever) alcohol dependence. Estimates of the associations between alcohol dependence and age of drinking onset, risky drinking, and family history of alcohol problems did not significantly differ between the supplemented Internet sample and the NESARC survey. Conclusions: Randomly recruited Internet‐based panels may provide an alternative to random digit dial telephone surveys and in‐person surveys for some studies of factors associated with alcohol‐related problems.     

Common Genetic Contributions to Alcohol and Cannabis Use and Dependence Symptomatology

Background: Despite mounting evidence that use of and dependence on alcohol and cannabis are influenced by heritable factors, the extent to which heritable influences on these phenotypes overlap across the 2 substances has only rarely been explored. In the current study, we quantified cross‐substance overlap in sources of variance and estimated the degree to which within‐substance associations between use and dependence measures are attributable to common genetic and environmental factors for alcohol and cannabis. Methods: The sample was comprised of 6,257 individuals (2,761 complete twin pairs and 735 singletons) from the Australian Twin Registry, aged 24 to 36 years. Alcohol and cannabis use histories were collected via telephone diagnostic interviews and used to derive an alcohol consumption factor, a frequency measure for cannabis use, and DSM‐IV alcohol and cannabis dependence symptom counts. Standard genetic analyses were conducted to produce a quadrivariate model that provided estimates of overlap in genetic and environmental influences across the 4 phenotypes. Results: Over 60% of variance in alcohol consumption, cannabis use, and cannabis dependence symptoms, and just under 50% of variance in alcohol dependence (AD) symptoms were attributable to genetic sources. Shared environmental factors did not contribute significantly to the 4 phenotypes. Nearly complete overlap in heritable influences was observed for within‐substance measures of use and dependence symptoms. Genetic correlations across substances were 0.68 and 0.62 for use and dependence symptoms, respectively. Conclusions: Common heritable influences were evident for alcohol and cannabis use and for AD and cannabis dependence symptomatology, but findings indicate that substance‐specific influences account for the majority of the genetic variance in the cannabis use and dependence phenotypes. By contrast, the substantial correlations between alcohol use and AD symptoms and between cannabis use and cannabis dependence symptoms suggest that measures of heaviness of use capture much of the same genetic liability to alcohol‐ and cannabis‐related problems as dependence symptomatology.     

Treating adolescent drug abuse: a randomized trial comparing multidimensional family therapy and cognitive behavior therapy

Aim To examine the efficacy of two adolescent drug abuse treatments: individual cognitive behavioral therapy (CBT) and multidimensional family therapy (MDFT). Design A 2 (treatment condition) x 4 (time) repeated‐measures intent‐to‐treat randomized design. Data were gathered at baseline, termination, 6 and 12 months post‐termination. Analyses used latent growth curve modeling. Setting Community‐based drug abuse clinic in the northeastern United States. Participants A total of 224 youth, primarily male (81%), African American (72%), from low‐income single‐parent homes (58%) with an average age of 15 years were recruited into the study. All youth were drug users, with 75% meeting DSM‐IV criteria for cannabis dependence and 13% meeting criteria for abuse. Measurements Five outcomes were measured: (i) substance use problem severity; (ii) 30‐day frequency of cannabis use; (iii) 30‐day frequency of alcohol use; (iv) 30‐day frequency of other drug use; and (v) 30‐day abstinence. Findings Both treatments produced significant decreases in cannabis consumption and slightly significant reductions in alcohol use, but there were no treatment differences in reducing frequency of cannabis and alcohol use. Significant treatment effects were found favoring MDFT on substance use problem severity, other drug use and minimal use (zero or one occasion of use) of all substances, and these effects continued to 12 months following treatment termination. Conclusion Both interventions are promising treatments. Consistent with previous controlled trials, MDFT is distinguished by the sustainability of treatment effects.     

Self‐Reported Psychotic Disorders among Individuals with Substance Use Disorders: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions

Background and Objectives : Comorbidity of substance use disorders (SUDs) and psychotic disorders (PDs) presents many challenges in diagnosis and treatment. Most reports to‐date focus on the prevalence of SUDs among clinical populations of patients with PDs, and there is a lack of data pertaining to rates of PDs among individuals with substance use and SUDs. Methods : We analyzed data on 43,093 respondents age 18 and above from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative US survey (Wave 1, 2001–2002). Cross‐tabulations were used to derive prevalence estimates of PDs among individuals with 12‐month substance use or SUDs across 10 categories of substances. Odds ratios (ORs) were derived from bivariate logistic regression analyses to examine the relationships between lifetime PDs and 12‐month substance use or SUDs for the specific categories of substances. Results : Among individuals with 12‐month substance use, prevalence of PDs was found to be elevated in 8 of 10 categories of substances, particularly among amphetamine (OR = 8.8) and cocaine (OR = 10.3) users compared to nonusers. Among individuals with SUDs, prevalence of PDs was elevated in 9 of 10 categories of substances compared to individuals without SUDs. Conclusions and Scientific Significance : Our findings on the increased rates of PDs among substance users and individuals with SUDs across a wide range of substances emphasize the importance of screening for PDs while treating patients with substance use and SUDs. This may allow for early intervention and adequate referral to appropriate settings. (Am J Addict 2012;21;531–535)     

Substance use among adolescents with juvenile rheumatoid arthritis

Objective . To determine the prevalence of substance use among adolescents with juvenile rheumatoid arthritis and to assess available opportunities for rheumatologists to identify high risk teens. Methods . Fifty-two teens (mean age 13.9 years, 86% female) completed questionnaires regarding substance use (alcohol, tobacco, marijuana, and other illicit substances), functional disability, and frequency of health care contacts. Results . Alcohol use was reported by 30.7% of teens, including 23.5% of those for whom methotrexate was prescribed; 15.4% reported tobacco use in the last year, and 13.4% reported other illicit substance use in their lifetime, although most use was experimental. No teen reported marijuana use. The majority reported regular contact with their rheumatologist but only 26.9% were ever interviewed alone. Conclusion . Many teens with juvenile rheumatoid arthritis, including those prescribed methotrexate, used substances, especially alcohol. When rheumatologists see adolescents, particularly in situations where methotrexate may be prescribed, a clinical setting conducive to confidentiality, physician comfort in asking about sensitive topics such as substance abuse, and referral relationships with skilled adolescent health and substance abuse counseling providers are essential.     

Alcohol, marijuana, cocaine use, and relationship quality among HIV serodiscordant male couples

The association between substance use and relationship quality was explored in a sample of 117 serodiscordant male couples. Several measures of relationship quality were used including dyadic satisfaction, affection, commitment, sexual satisfaction, and domestic violence. Although frequency of use was assessed for several substances, only alcohol, marijuana, and cocaine were used frequently enough for statistical analyses. The highest frequency of use within the couple in the past 2 months as well as the discrepancy in the frequency of use between the 2 members of the couple were considered. Although daily substance use was relatively rare in this sample, alcohol use was reported by 79%, marijuana use by 35%, and cocaine use by 15% of the men. Domestic violence was not associated with any substance use variable. Marijuana use was generally not associated with relationship quality. Alcohol and cocaine use were moderately associated with several indicators of poorer relationship quality.     

Late‐Life Alcohol Consumption and 20‐Year Mortality

Background: Growing epidemiological evidence indicates that moderate alcohol consumption is associated with reduced total mortality among middle‐aged and older adults. However, the salutary effect of moderate drinking may be overestimated owing to confounding factors. Abstainers may include former problem drinkers with existing health problems and may be atypical compared to drinkers in terms of sociodemographic and social‐behavioral factors. The purpose of this study was to examine the association between alcohol consumption and all‐cause mortality over 20 years among 1,824 older adults, controlling for a wide range of potential confounding factors associated with abstention. Methods: The sample at baseline included 1,824 individuals between the ages of 55 and 65. The database at baseline included information on daily alcohol consumption, sociodemographic factors, former problem drinking status, health factors, and social‐behavioral factors. Abstention was defined as abstaining from alcohol at baseline. Death across a 20‐year follow‐up period was confirmed primarily by death certificate. Results: Controlling only for age and gender, compared to moderate drinkers, abstainers had a more than 2 times increased mortality risk, heavy drinkers had 70% increased risk, and light drinkers had 23% increased risk. A model controlling for former problem drinking status, existing health problems, and key sociodemographic and social‐behavioral factors, as well as for age and gender, substantially reduced the mortality effect for abstainers compared to moderate drinkers. However, even after adjusting for all covariates, abstainers and heavy drinkers continued to show increased mortality risks of 51 and 45%, respectively, compared to moderate drinkers. Conclusions: Findings are consistent with an interpretation that the survival effect for moderate drinking compared to abstention among older adults reflects 2 processes. First, the effect of confounding factors associated with alcohol abstention is considerable. However, even after taking account of traditional and nontraditional covariates, moderate alcohol consumption continued to show a beneficial effect in predicting mortality risk.     

Polydrug Use in Adolescent Drinkers with and without DSM-IV Alcohol Abuse and Dependence

Alcohol and other substance use disorders are highly comorbid, but little is known about patterns of polydrug use in adolescents with different levels of alcohol involvement. This research examined patterns and correlates of polydrug use in 176 adolescent drinkers with DSM-IV alcohol dependence ( n = 61), alcohol abuse ( n = 57), and no alcohol diagnosis ( n = 58). Alcohol and other Substance Use Disorders were assessed using a modified version of the Structured Clinical Interview for the DSM. Lifetime histories of alcohol use and other drug use were assessed using a structured interview. Subjects also completed a questionnaire measure of the frequency of use of specific alcohol-drug combinations. The total number of illicit drugs ever used was greater in the alcohol dependence (mean = 3.8, SD = 2.1) and abuse groups (mean = 3.0, SD = 2.1), compared with the no-alcohol diagnosis group (mean = 1.9, SD = 1.3). Consistent with previous findings, there was a consistent pattern in the age of onset of psychoactive substance use: alcohol, followed by marijuana, followed by other drugs. The recent use of alcohol and other drugs in combination was reported by a greater percentage of subjects in the alcohol dependence (69%) and abuse groups (72%), compared with drinkers without an alcohol diagnosis (45%). The most common alcohol-drug combination was alcohol with marijuana (58% of the total sample), followed by alcohol-hallucinogens (16%). The frequency and extent of polydrug use was associated with being older and having higher levels of behavioral undercontrol and negative emotionality. Adolescent polydrug use, particularly the use of alcohol and other drugs in combination, is an important area for research, treatment, and prevention.     

Associations Between Drug and Alcohol Use Patterns and Sexual Risk in a Sample of African American Men Who Have Sex with Men

Men who have sex with men (MSM) are the largest risk group in the US HIV epidemic and African American MSM (AA MSM) are disproportionately affected. Substance-abusing sexual minorities warrant attention as they are at elevated risk for HIV, yet are not a homogeneous risk group. The purpose of this study was to use latent class analysis to identify patterns of drug and alcohol use in a sample of 359 AA MSM and examine associations with sexual risk. Three classes were identified: Individuals who used multiple substances (poly-users) (18 %), alcohol/marijuana users (33 %) and individuals who had low probability of reporting drug or problematic alcohol use (50 %). Results from multivariate analysis indicate that poly-users were older and more likely to report sex exchange and recent sexually transmitted infection compared to the other classes. Alcohol and poly-users were more likely to report sex under the influence. Identifying and defining substance use patterns can improve specification of risk groups and allocation of prevention resources.