Polysubstance use among alcoholics.

Contemporary alcoholics often use multiple substances, but there is little systematic research on this. This study examines the drug use comorbidity of alcoholics (DSM diagnosis, frequency and quantity of drug use); the relationship between drinking and drug use; the relative severity of alcohol- and drug-related problems; and the validity of reports of illicit drug use. Data on substance use were collected from 248 treatment-seeking alcoholics using an expanded Time-line Follow-Back (TLFB) interview. Self-reports of substance use were validated with data from biological specimens (urine and hair). Lifetime diagnosis of joint alcohol and drug dependence/abuse was 64%. Two-thirds (68%) reported using drugs in the past 90 days: 33% powder cocaine; 29% crack cocaine; 15% heroin, and 24% cannabis. The mean proportions of exposed days on which users reported consuming a substance were 57% (alcohol), 26% (powder cocaine), 46% (crack cocaine), 47% (heroin), and 29% (cannabis). Subjects reported consuming an average of 14 standard drinks on a drinking day and $67 worth of drugs on a using day. Drug users reported drinking less than nonusers on a drinking day. Frequency of drinking and drug use were positively correlated; almost all drug users reported simultaneous drinking and drug use; and they rated drugs as the bigger problem. Considerable under-reporting of drug use occurred for the previous 3-4 days, but was more accurate for the previous month.     

Convergent validity of the Timeline Followback for persons with comorbid psychiatric disorders engaged in residential substance use treatment

This study examined the convergent validity of the Timeline Followback (TLFB) for individuals with comorbid (Axis I and/or Axis II) psychiatric disorders in a sample of persons (N=150) engaged in residential treatment for substance use disorders (SUDs). Approximately one-half of the sample was diagnosed with at least one comorbid psychiatric disorder. Validity was assessed comparing data from the TLFB with data from the Addiction Severity Index (ASI) and collateral reports. For the entire sample, data from the TLFB was significantly correlated with data from the ASI and collateral reports of substance use. No significant differences were found between those with and those without a comorbid psychiatric disorder, suggesting that the TLFB was equally valid for both groups.     

Male-female differences in the risk of progression from first use to dependence upon cannabis, cocaine, and alcohol

INTRODUCTION: We extend prior reports about the risk of dependence on specific drugs by providing developmental-specific risk estimates for progression from first use to meeting criteria for DSM-III-R dependence upon cannabis, cocaine, or alcohol, as well as male-female differences. METHODS: The data are from the National Comorbidity Survey, with a national probability sample of persons 15-44 years old in the United States, which included many respondents who used cannabis, cocaine and alcohol on at least one occasion (n=3558, 1337, and 6149, for cannabis, cocaine, and alcohol, respectively). Survival analysis procedures provided cumulative risk estimates of progression from first use to dependence upon each drug. RESULTS: The estimated risk of cannabis dependence among male cannabis users was 1% in the first year after first use, and reached a peak at 4% per year 2 years later, before declining. In contrast, the estimated risk of cannabis dependence among female cannabis users remained at 1% per year for 3 years, without the peak. For both male and female cocaine users, the estimated risk for developing cocaine dependence was 5 to 6% within the first year after first use. Thereafter, the estimated risk declined from the peak value, with a somewhat faster decline for females in the next 3 years after first use. For alcohol, the estimated risk period extended for many years after the first drink, with female drinkers becoming alcohol dependent at a rate of about 1% per year; with somewhat higher risk for male drinkers. For both male and female drinkers, the period of risk for developing alcohol dependence extended for a span of more than 20 years since first use; for cannabis and cocaine, the estimated period of risk was much shorter. COMMENT: There are male-female differences in the risk of becoming cannabis dependent during the first several years after initiation of cannabis use, less pronounced male-female differences for alcohol, and relatively smaller male-female differences for cocaine. These results should interest scientists whose focus is upon the origins of male-female differences in the occurrence of drug dependence.     

Drug and alcohol consumption and sexual risk behaviour among young adults: results from a national survey.

To study the association of the consumption of alcohol and other psychoactive drugs with sexual risk behaviour for HIV infection, data from a representative sample of the Spanish population aged 18-39 years were analysed. A national household survey was carried out in 1996 using a combination of face-to-face interviews and self-administered questionnaires. The survey included 5253 subjects aged 18-39 years who provided information on alcohol and drug consumption, number of sexual partners and condom use with the steady partner and with casual partners in the 12 months before the survey. Of those surveyed, 27.4% had been drunk at least once and 20.5% had consumed drugs. Both behaviours were associated with male sex, younger age, higher educational level, being single and having had more than one sexual partner. In the logistic regression analysis adjusting for the sociodemographic variables, the greater frequency of drunkenness and cannabis use were associated with having more than one sexual partner. Regular condom use was significantly less frequent among cocaine users and more frequent among opiate users, but was not associated with the use of other drugs. Sexual risk behaviour (i.e. more than one partner and failure to use a condom regularly) was more frequent among persons who had been drunk or used cannabis or cocaine. Excessive consumption of alcohol, and cannabis and cocaine use are independently associated with sexual behaviour involving greater risk of HIV infection or transmission.     

Substance Dependence Severity Scale: reliability and validity for ICD-10 substance use disorders.

The Substance Dependence Severity Scale (SDSS) is a semistructured interview that assesses the severity of the DSM-IV diagnoses of dependence and abuse and the ICD-10 diagnoses of substance dependence and harmful use across a wide range of substances. Previous research has demonstrated that the SDSS' DSM-IV dependence scales are reliable and valid indicators of diagnostic severity. However, the ICD-10 scales have not been psychometrically tested. This study investigated the test-retest reliability, internal consistency, diagnostic concordance, and concurrent validity of the SDSS' ICD-10 dependence and harmful use scales in 180 (112 male and 68 female) treated substance users. Test-retest reliabilities for the ICD-10 dependence scales ranged from good to excellent for alcohol, cocaine, heroin, and cannabis. Test-retest reliabilities for the SDSS' ICD-10 harmful use scales were in the good range for alcohol, cocaine, and heroin and the poor to fair range for cannabis. Internal consistency, diagnostic concordance, and concurrent validity results were comparable to the test-retest findings. These results support the use of the SDSS for assessing the severity of the ICD-10 dependence and harmful use diagnoses.     

Validity of Timeline Follow-Back for self-reported use of cannabis and other illicit substances--systematic review and meta-analysis

Background

Timeline Follow-Back (TLFB) is a widely used, calendar-based measure of self-reported use of (among other things) illicit substances. We examined agreement between TLFB and biological measures for illicit substances.

Methods

PubMed, PsycINFO, Cochrane CENTRAL, and EMBASE were searched in December 2010. 16,633 papers screened to identify those that measured illicit substance use by both TLFB and biological measures. We extracted data on agreement between TLFB and biological measures, sample size, study type, inclusion criteria of participants, and length of recall of TLFB.

Results

Twenty-nine papers were included, almost exclusively in substance-use-disorder populations. Some studies reported several overall agreement rates, e.g. over time. Lowest and highest weighted average agreement rates were: for cannabis, 87.3% (95% confidence interval 86.9% to 87.7%) and 90.9% (90.5% to 91.4%); for cocaine, 79.3% (79.1% to 79.6%) and 84.1% (83.9% to 84.2%); for opiates 94.0% (93.5% to 94.5%) for both weighted averages; and for studies not distinguishing between substances, 88.5% (88.4 to 88.7%) and 91.0% (90.7% to 91.2%). Higher agreement was found in populations without psychiatric comorbidity, and lower agreement in randomized controlled trials. Publication bias or selective outcome reporting bias was not detected.

Conclusions

TLFB validly detects use of illicit substances in populations with substance use disorders. Using TLFB may limit the need for biological samples, making information on illicit substance use easier and less costly to obtain and analyze.     

Psychometric support for contemporaneous and retrospective youth and parent reports of adolescent marijuana use frequency in an adolescent outpatient treatment population

Little is known about the reliability and validity of self-and collateral reports of adolescent drug use frequency within adolescent treatment samples. Therefore, in the present study drug counselors systematically obtained contemporaneous reports of adolescent marijuana use frequency from 31 conduct-disordered and drug abusing youth, and separately, their parents, during each outpatient treatment session for 6 months. A urine drug screen was also scheduled to occur during each treatment session. At the conclusion of treatment, a blind assessor obtained retrospective reports of the youths' frequency of marijuana use during each of the six months of treatment from both the adolescents and their parents using the Timeline Follow-Back (TLFB) procedure. With only one exception (i.e., parents reported that their children had used marijuana more often in the first month of treatment according to the retrospective TLFB method, as compared with the contemporaneous method), contemporaneous and retrospective reporting methods yielded similar information throughout each of the 6 months of treatment for both youth and their parents. A significant positive relationship between urinalysis testing and youth reports of their drug use was found for each of the 6 months of treatment. Similar relationships with urinalysis testing were generally found to exist in both parent report methods (i.e., contemporaneous, retrospective) across the 6 months of treatment. The results suggest adolescents and their parents provide consistent reports of marijuana use frequency throughout treatment, and that these reports are corroborated utilizing standardized retrospective reporting methods and urinalysis testing. Future directions are discussed in light of these findings.     

The relationship between risk networks' patterns of crack cocaine and alcohol consumption and HIV-related sexual behaviors among adult injection drug users: a prospective study

Social context may be an important determinant of drug and alcohol consumption and HIV-related behaviors. To assess the influence of peers on drug users' risk behaviors this study examined the association between individual level and group level behaviors. This analysis reports on the prospective association between baseline self-reported drug and alcohol use of the network members of injection drug users, and self-reported sexual behaviors and alcohol use at 5-month follow-up, Participants were a nontreatment sample of inner-city injection drug users who volunteered for a network-oriented HIV preventive intervention. They were predominately unemployed, African American males. Of the 71 index participants who completed both the baseline and follow-up interviews, 227 of their drug network members were enrolled in the study. At baseline indexes' sexual risk behaviors were significantly associated with their drug network members' level of crack cocaine use. At follow-up higher levels of alcohol and crack use among drug network members were associated with indexes' reports of multiple sex partners and increased alcohol consumption. Higher levels of crack use among the drug network members were associated with the indexes' reporting casual sex partners at follow-up. These results highlight the importance of studying the role of peer group influence and the social context of risk behaviors.     

Measuring Current Drug Use in Female Sex Workers and Their Noncommercial Male Partners in Mexico: Concordance Between Data Collected From Surveys Versus Semi-Structured Interviews

Background: Self-reports are commonly used to assess prevalence and frequency of drug use, but it is unclear whether qualitative methods like semi-structured interviews are as useful at obtaining such information as quantitative surveys. Objectives: This study compared drug use occurrence and frequency using data collected from quantitative surveys and qualitative interviews. We also examined whether combining data from both sources could result in significant increases in percentages of current users and whether the concordance between the two sets of data was associated with the type of drug use, age, gender and socioeconomic status. Methods: Self- reports of recent marijuana, heroin, crack, cocaine, crystal/methamphetamine, inhalant, and tranquilizer use were collected using both methods from a cohort of Mexican female sex workers and their non-commercial male partners (n = 82). Results: Participants were significantly less likely to report marijuana, cocaine and tranquilizer use and frequency of use during the qualitative interviews than during the quantitative surveys. Agreement on frequency of drug use was excellent for crystal/methamphetamine, heroin and inhalant use, and weak for cocaine, tranquilizers and marijuana use. Older participants exhibited significantly higher concordance than younger participants in reports of marijuana and methamphetamine use. Higher monthly income was significantly associated with higher concordance in crack use but lower concordance with marijuana use. Conclusions: Although use of such data can result in an underreporting of drug use, qualitative data can be quantified in certain circumstances to triangulate and confirm the results from quantitative analyses and provide a more comprehensive view of drug use.     

Validation of self-reported cannabis use by urine analysis

A study of 113 young multiple drug users, interviewed at one year follow-up, was designed to assess the validity of self-reported cannabis use. Subjects provided information about the recency, frequency and typical dose of their use of cannabis in the preceding 30 days. Urine samples were collected and analyzed for delta 9 THC metabolites. Recency of use was the best predictor of urine test result, but a measure of frequency of use significantly increased the proportion of variance accounted for. The results strongly supported the validity of self-reported cannabis use and indicate that valid self-reports of drug consumption can be obtained from multiple drug users in treatment.     

Substance Dependence Severity Scale (SDSS): reliability and validity of a clinician-administered interview for DSM-IV substance use disorders

No existing diagnostic interview assesses severity of dependence based on DSM-IV criteria across a range of substances. The Substance Dependence Severity Scale (SDSS) was designed to serve this purpose, consisting of substance-specific scales of both severity and frequency of DSM-IV criteria. This study investigated the reliability and validity of the SDSS. The test-retest reliability of the SDSS in 175 (112 male and 63 female) treated substance users ranged from good to excellent for alcohol, cocaine, heroin and sedatives (interclass correlation coefficients (ICCs)=0.75-0.88 for severity, 0.67-0.85 for frequency). Results for cannabis were lower, ranging from fair to good (ICCs=0.50-0.62). Results for joint rating and internal consistency reliability were comparable to test-retest findings. In addition to indicators of concurrent validity, scale applications are presented and discussed.     

Examining possible gender differences among cocaine-dependent outpatients

Potential differences in sociodemographics, drug use, and measures of treatment outcome were examined among 137 male and 51 female cocaine-dependent outpatients. More women than men were unemployed, received public assistance, and were living with their children. Women reported fewer years of regular cocaine use, spending less money per week on cocaine, less prior treatment for cocaine abuse, and were more likely than men to test positive for cocaine at intake. With respect to other drug use, fewer women than men reported using sedatives and tested positive for sedatives at intake. Women reported a lower frequency of alcohol use before intake, and fewer women than men met criteria for cannabis dependence. Men and women experienced comparable improvement during the course of treatment and follow-up.     

Associations between self-reported cannabis use frequency,potency, and cannabis/health metrics

BackgroundResearch shows that cannabis use frequency is associated with cannabis dependence and health metrics. However, much less is known about how self-reported cannabis potency (THC and CBD) may be associated with the same metrics, and whether any associations exist after accounting for frequency of cannabis use. Moreover, even less is known about how these relations may differ across cannabis product forms. This exploratory study examined 1) associations between cannabis frequency, potency, and cannabis/health metrics, and 2) whether associations between potency and cannabis/health metrics remained after controlling for frequency of use.MethodsUsing a sample of adult recreational cannabis users in Colorado (N = 300), we tested the relationship between self-reported cannabis use metrics of frequency and potency of flower, edible, and concentrate products with separate measures of problematic cannabis use (i.e., dependence, withdrawal, craving), depression, anxiety, and general perceived health.ResultsGreater frequency of flower and concentrate (but not edible) use were associated with greater problematic cannabis use, and greater concentrate use frequency was also associated with more mental health problems. Partial correlations controlling for average frequency of use across all product forms and CBD potency per product showed that one significant association between THC potency and cannabis/health metrics remained (i.e., higher THC concentrate potency with better health), and one emerged (i.e., higher THC concentrate potency with lower cannabis withdrawal).ConclusionsFrequency of use is reliably associated with problematic cannabis use for flower and concentrates, but it did not account for all observed associations in this study. Differences in patterns of associations between frequency and potency and cannabis/health metrics across cannabis forms suggest a need for better understanding user reports of THC and CBD potency, individual differences among users, and improved measurement.     

Using interactive voice response technology and timeline follow-back methodology in studying binge eating and drinking behavior: different answers to different forms of the same question?

As part of a study of the relationship of binge eating, alcohol use, mood, and stressors, we compared the results of two forms of reporting on binge eating and drinking behavior. Forty-three first-year college women participated in an interactive voice response (IVR) study for 12 weeks. Participants answered computer-administered questions daily via IVR technology on number of eating binges and number of alcoholic drinks consumed. After 12 weeks, participants completed a Timeline Follow-back (TLFB) interview retrospectively for number of binges and drinks in the past 12 weeks. Results of this distally retrospective methodology (commonly used in drinking research and applied here also to binge eating) were compared to the results of daily IVR reporting. There was convergence across measures for drinking behavior, but divergence between IVR and TLFB for binge eating reports. TLFB reports underrepresented actual binge eating frequency, which calls into question the validity of applying this methodology to the assessment of binge eating.     

The effects of perceived parenting style on the propensity for illicit drug use: the importance of parental warmth and control

Introduction and Aims . Research in adolescents has shown that parental warmth and control are important factors in drug use. The present study focused upon investigating perceived parental warmth and control in a sample of post‐adolescent ecstasy/polydrug users, and investigating their relationship to severity of drug use. Design and Methods . A total of 128 (65 male) ecstasy/polydrug users, 51 (17 male), cannabis‐only users and 54 (13 male) non‐users were recruited from a university population. All participants completed the parenting styles and drug use questionnaires. Results . Compared to non‐users, a greater proportion of ecstasy/polydrug users characterised their parents' style as neglectful. The modal style endorsed by non‐users was authoritative. Those who rated their parents' style as authoritative had significantly lower lifetime consumption and average dose of ecstasy relative to those describing their parents as neglectful. Again, relative to those describing their parents as neglectful, participants from authoritarian backgrounds had significantly smaller lifetime consumption of ecstasy and cocaine and significantly smaller average doses of cannabis, ecstasy and cocaine. Contrary to expectation, there was no significant association between perceived parental warmth and the severity of ecstasy use. Discussion and Conclusions . The present study is, to our knowledge, the first to quantify drug use, and relate it to perceived parental practices in a post‐adolescent sample of ecstasy/polydrug users. The results provide further support for the relationship between perceived parental control and drug use.     

Smoking tobacco along with marijuana increases symptoms of cannabis dependence

AIM: User practices/rituals that involve concurrent use of tobacco and marijuana - smoking blunts and "chasing" marijuana with tobacco - are hypothesized to increase cannabis dependence symptoms. DESIGN: Ethnographers administered group surveys to a diverse, purposive sample of marijuana users who appeared to be 17-35 years old. SETTING: New York City, including non-impoverished areas of Manhattan, the transitional area of East Village/Lower East Side, low-income areas of northern Manhattan and South Bronx, and diverse areas of Brooklyn and Queens. PARTICIPANTS: 481 marijuana users ages 14-35, 57% male, 43% female; 27% White, 30% Black, 19% Latino, 5% Asian, 20% of other/multiple race. MEASUREMENTS: Among many other topics, group surveys measured cannabis dependence symptoms; frequencies of chasing, blunt smoking, joint/pipe smoking, using marijuana while alone, and general tobacco use; and demographic factors. FINDINGS: Blunt smoking and chasing marijuana with tobacco were each uniquely associated with five of the seven cannabis dependence symptoms. Across symptoms, predicted odds were 2.4-4.1 times greater for participants who smoked blunts on all 30 of the past 30 days than for participants who did not smoke blunts in the past 30 days. Significant increases in odds over the whole range of the five-point chasing frequency measure (from never to always) ranged from 3.4 times to 5.1 times. CONCLUSIONS: Using tobacco with marijuana - smoking blunts and "chasing" marijuana with tobacco - contributes to cannabis dependence symptoms. Treatment for cannabis dependence may be more effective it addresses the issue of concurrent tobacco use.     

Quantifying cannabis use with the Timeline Followback approach: A psychometric evaluation

Background

In the absence of a standardized cannabis unit, self-report instruments are inadequate for accurate quantification of cannabis use. The study extends the feasibility of using a cannabis substitute to reliably and validly measure quantity of cannabis use.

Method

Ninety-eight adult Australian cannabis users (M age = 27.98, SD = 11.10; 65.31% male) completed a 90-day Timeline Followback interview regarding their cannabis use, utilizing the cannabis substitute Marijuanilla to report on quantity of use. Ninety-two of these individuals completed the interview at two time-points, and 56 of these participants had collaterals corroborate their cannabis use reports.

Results

Inter-rater reliability was excellent, while test–retest reliability was good to excellent. Intra-class correlation coefficients between participant and collateral reports, while similar to previous research, were unacceptable. Quantity of cannabis use statistically significantly added to frequency of use in predicting cannabis problems and dependence severity. Concurrent and discriminant validity were established with single-item and positive impression management measures, respectively. In addition, Marijuanilla appeared similar to one specimen of street seized cannabis, but not to two others. Importantly, participants’ cravings to use cannabis did not increase as a result of using the cannabis substitute to report on their cannabis use.

Conclusions

These data suggest that utilizing Marijuanilla to facilitate the reporting of grams of cannabis use may be reliable and valid; however, such comprehensive assessment may only be necessary for clinical trials and epidemiological studies, which rely on precise estimates of cannabis use.     

Surveying drug consumption: Assessing reliability and validity of the European Web Survey on Drugs questionnaire

BackgroundThe European Web Survey on Drugs aimed to obtain in-depth data on consumption of cannabis, ecstasy/MDMA, cocaine, and amphetamines in different populations of drug users in 16 European countries. This paper examines test-retest reliability, the consistency and the comprehensibility of the prevalence and frequency of use questions in the Czech part of the survey.MethodsA baseline web survey was performed (N = 610) with follow-up data collection in a sub-sample of volunteers providing email addresses (N = 158). The baseline sample was self-selecting, responding to advertisements made available through multiple channels designed to attract diverse samples of drug users. Test-retest analysis was conducted for core questionnaire items.ResultsRespondents to the follow-up were predominantly socially integrated; 91% reported last year cannabis use, 42% used Ecstasy/MDMA, 23% amphetamines, and 27% reported cocaine use. Test-retest reliability was rated moderate to good (reliability coefficients between 0.55–0.87) for most prevalence items with sufficient sample sizes. Items assessing frequency of use were more reliable for most substances when asking about the exact number of days used, compared to categorical items that implicitly assume a regular pattern of use and were interpreted differently by different respondents.ConclusionsSimplicity and unambiguity of questions increase the reliability of results. Tools measuring drug consumption need to take into consideration the irregularity of drug using patterns. Question testing is important to increase validity and support a correct interpretation of the data.     

Screening for drugs in oral fluid: illicit drug use and drug driving in a sample of Queensland motorists

Police Services in a number of Australian states have indicated random roadside drug testing will be implemented to target drug driving. This paper outlines research conducted to provide an estimate of the prevalence of drug driving in a sample of Queensland drivers. Oral fluid samples were collected from 781 drivers who volunteered to participate at Random Breath Testing (RBT) sites in a large Queensland regional area. Illicit substances tested for included cannabis (delta 9 tetrahydrocannibinol [THC]), amphetamine type substances, heroin and cocaine. Drivers also completed a self-report questionnaire regarding their drug-related driving behaviour. Samples that were drug-positive at initial screening were sent to a government laboratory for confirmation. Oral fluid samples from 27 participants (3.5%) were confirmed positive for at least one illicit substance. The most common drugs detected in oral fluid were cannabis (delta 9 THC) (n = 13) followed by amphetamine type substances (n = 11). A key finding was that cannabis was also confirmed as the most common self-reported drug combined with driving and that individuals who tested positive to any drug through oral fluid analysis were also more likely to report the highest frequency of drug driving. Furthermore, a comparison between drug vs drink driving detection rates for the study period revealed a higher detection rate for drug driving (3.5%) vs drink driving (0.8%). This research provides evidence that drug driving is relatively prevalent on Queensland Roads. The paper will further outline the study findings and present possible directions for future drug driving research. [Davey J, Leal N, Freeman J. Screening for drugs in oral fluid: illicit drug use and drug driving in a sample of Queensland motorists. Drug Alcohol Rev 2007;26:301 - 307]     

Daily stressor sensitivity, abuse effects, and cocaine use in cocaine dependence

This study highlights respondent sensitivity to daily hassles as it relates to situational cocaine use and perceived long-term effects of adverse events in childhood. Data were drawn from a larger study on stress reactivity in cocaine dependent individuals. Participants (n=104) were cocaine dependent men and women without comorbid posttraumatic stress disorder (PTSD). They completed the Early Trauma Inventory (ETI), the Daily Hassles Scale (DHS), the Inventory of Drug-Taking Situations (IDTS), and the Time-Line Follow-Back (TLFB; for 90 days prior to interview). There were no gender differences in the amount or frequency of cocaine use, although the patterns of use differed between male and female users. Overall, there were some associations in the patterns of cocaine use and sensitivity to daily hassles, particularly the use in response to conflict with others. Early negative life events were positively related to response to daily hassles, but current triggers were more relevant. Reactivity to cocaine cues was related to daily hassle sensitivity among women only. Limitations and implications of the findings are discussed.