Inhalant abuse and dependence among adolescents in the United States

OBJECTIVE: To examine the patterns of inhalant use and correlates of the progression from inhalant use to abuse and dependence among adolescents aged 12 to 17. METHOD: Study data were drawn from the 2000 and 2001 National Household Surveys on Drug Abuse. Multinominal logistic regression was used to identify the characteristics associated with progression to inhalant abuse and dependence. RESULTS: Inhalant use was common among the studied adolescents. Among adolescents aged 12 to 17, 0.4% met DSM-IV inhalant abuse or dependence criteria in the past year. Inhalant abuse and dependence affected adolescents regardless of gender, age, race/ethnicity, and family income. The progression from inhalant use to abuse or dependence was related to early first use, use of multiple inhalants, and weekly inhalant use. Adolescents with inhalant use disorders reported coexisting multiple drug abuse and dependence, mental health treatment, and delinquent behaviors. CONCLUSIONS: Adolescents with an inhalant use disorder may represent a subgroup of highly troubled youths with multiple vulnerabilities. Because early use is associated with progression to abuse and dependence, prevention programs should target elementary school-age children.     

MAPI personality correlates of comorbid substance abuse among adolescent psychiatric inpatients

This study investigated MAPI scale patterns among adolescent psychiatric inpatients along a dimension of substance abuse deviancy; no substance abuse; alcohol abuse only; alcohol and marijuana abuse only; other substance abuse plus alcohol and/or marijuana abuse. The findings showed the most notable distinction involved the issue of non-alcoholic substance abuse. Psychiatric inpatients who abuse alcohol were little different from patients with no substance abuse diagnosis. Conversely, those patients who abuses the more culturally deviant non-alcoholic substance were markedly different than non-substance abusing or alcohol-only abusing patients in several respects; highly negativistic attitudes toward family, authority and conformity; personality styles marked by aggressiveness and labile negativism and low conscientiousness; behavioral trait of impulsivity; poor sense of academic confidence. Only these non-alcoholic substance abusing psychiatric patients may require a distinctively different treatment plan than the protocol for uncomplicated psychiatric disorder.     

Novelty-seeking among schizophrenia patients with comorbid alcohol abuse

Since characterological characteristics of patients with schizophrenia and comorbid alcohol abuse are not well established, we compared outpatients with DSM-IV schizophrenia, with (n = 51) and without alcohol-abuse (n = 51), matched for sex, age, IQ, and symptom severity, using the Temperament and Character Inventory. Dual-diagnosis patients showed highly selective greater novelty seeking.     

Benzodiazepine use, abuse, and dependence

Although benzodiazepines are invaluable in the treatment of anxiety disorders, they have some potential for abuse and may cause dependence or addiction. It is important to distinguish between addiction to and normal physical dependence on benzodiazepines. Intentional abusers of benzodiazepines usually have other substance abuse problems. Benzodiazepines are usually a secondary drug of abuse-used mainly to augment the high received from another drug or to offset the adverse effects of other drugs. Few cases of addiction arise from legitimate use of benzodiazepines. Pharmacologic dependence, a predictable and natural adaptation of a body system long accustomed to the presence of a drug, may occur in patients taking therapeutic doses of benzodiazepines. However, this dependence, which generally manifests itself in withdrawal symptoms upon the abrupt discontinuation of the medication, may be controlled and ended through dose tapering, medication switching, and/or medication augmentation. Due to the chronic nature of anxiety, long-term low-dose benzodiazepine treatment may be necessary for some patients; this continuation of treatment should not be considered abuse or addiction.     

Inhalant use among American Indian youth

According to the U. S. Indian Health Service, substance abuse is the most urgent health problem facing American Indians. Inhalants are among the first drugs used by Indian youth, with first use occurring at approximately the same time as the onset for cigarette smoking. Although prevalence rates vary among Indian subpopulations, Indian youth generally have much higher rates of inhalant use than non-Indian youth. Furthermore, while other drugs are showing a downward trend among Indian youth, inhalant use is increasing slightly. This paper examines this phenomena by reviewing related epidemiological, social, and clinical issues.Research for this paper was supported by a Grant from The National Institute of Child Health and Human Development, #HD07173-07.     

Patterns of alcohol consumption in bipolar patients comorbid for alcohol abuse or dependence

OBJECTIVES: Despite a high prevalence rate, patients with bipolar disorder and active alcohol use are routinely excluded from controlled clinical trials leaving clinicians with little evidence-based medicine to guide treatment. This report evaluates preliminary data of alcohol consumption patterns utilizing the Alcohol Timeline Followback (TLFB) method in actively drinking patients with bipolar disorder. METHODS: A sample of 30 patients underwent a Structured Diagnostic Interview for DSM-IV (SCID-IV) as well as completing various measures of alcohol use and associated morbidity. RESULTS: In the month prior to study entry, the TLFB reported 18.4/30+/-9.12 drinking days, 9.9+/-4.73 drinks per drinking day and 169.4+/-101.71 total standard drinks for this study group. There was a significant difference in the number of drinks per drinking day between those diagnosed with rapid cycling than non-rapid cycling bipolar disorder and those with a new diagnosis versus established diagnosis of bipolar disorder. DISCUSSION: This study highlights heavy alcohol use in patients with bipolar disorder and alcohol comorbidity. The TLFB method provides 'real world' quantification of use. Further studies are encouraged to elucidate implications of heavy drinking patterns as found in our rapid cycling and newly diagnosed cohorts.     

Family transmission of marijuana use,abuse, and dependence

OBJECTIVE: To examine the familial aggregation of marijuana use, abuse, and dependence. METHOD: Adolescents recruited from residential and day treatment programs for youths with conduct and substance problems, matched controls, and all available family members were interviewed with structured research instruments. A total of 2,546 individuals from 781 families were interviewed. Risk ratios of relatives of clinical cases were calculated, compared with controls, for marijuana use, abuse, or dependence. Spousal, parent-offspring, and sibling correlations and the proportion of variance attributable to parent-offspring transmission were estimated using structural equation modeling. RESULTS: For all three measures, the risk ratios were elevated in the family members of clinical probands, with estimates ranging from 1.5 to 3.3. Spousal correlations ranged from 0.33 to 0.70. Parent-offspring correlations ranged from 0.17 to 0.30. Sibling correlations ranged from 0.34 to 0.44. The proportion of variance attributable to factors transmitted from parents to children ranged between 25% and 44%. CONCLUSIONS: Familial aggregation of marijuana use, abuse, and dependence is present for all three measures. The results suggest significant parent-offspring transmission of risk, sibling environmental influences, and assortative mating for all three levels of marijuana use.     

Prevalence of use,abuse and dependence on legal and illegal psychotropic substances in an adolescent inpatient psychiatric population

OBJECTIVE: To examine the prevalence of use, abuse, and dependence on legal and illegal psychotropic substances in an adolescent in-patient psychiatric population in relation to age and gender. METHODS: Participants were all consecutive admissions (patients aged from 14 to 17) to the adolescent psychiatric in-patient unit. Of the 86 patients who met all the criteria for taking part in the study 70 were interviewed, giving a response rate of 81%. Prevalence of use and of substance use disorders were assessed through structured diagnostic interviews (M-CIDI), conducted from March 2000 through July 2000. RESULTS: We found high prevalence of use and of the diagnosis of legal and illegal psychotropic substances. Around 76% reported a regular use of tobacco, 44% regular alcohol use, and 40% regular use of illegal substances. Diagnosis (abuse or dependence) was found in 50% of cases for nicotine, 29% for alcohol, and 26% for illegal substances. CONCLUSIONS: The adolescent in-patient psychiatric population is at high risk of use, abuse, and dependence on legal and illegal psychotropic substances. It is important to diagnose these disorders (anamnesis, screening tools) and to install preventive and therapeutic programs in clinical therapeutic settings.     

Mental health and medical problems and service use among adolescent substance users

OBJECTIVE: Adolescents entering the substance abuse treatment system frequently exhibit mental health and medical problems. Because little is known about whether these youths receive services to address these problems, this study examined the services received by youths admitted to substance abuse treatment. METHOD: Admission and 3-month follow-up reports of mental health, medical problems, and service use were examined within a large cohort (N = 1,088) of 12-19-year-olds admitted to seven inpatient and outpatient substance abuse treatment programs across the United States between 1998 and 2001. RESULTS: High levels of mental health problems were found at both time points, but few received mental health treatment. In contrast, there were lower rates of medical problems, and more than half received services. Logistic regression predicting mental health treatment receipt found females in residential settings with more current and baseline distress to be more likely to receive services. Ethnicity, baseline behavioral problems, and whether or not currently in substance abuse treatment did not predict service use. A logistic regression predicting medical services showed that females in residential treatment were also more likely to receive medical treatment. CONCLUSION: Although these results require replication and validation, they suggest that more could be done to take advantage of the opportunity to link youths entering substance use treatment with mental health services.     

Neuropsychological functions in Han Chinese patients in Taiwan with bipolar II disorder comorbid and not comorbid with alcohol abuse/alcohol dependence disorder

Objective

Studies exploring neuropsychological functions of bipolar disorder (BP) specifically include patients comorbid with alcohol abuse (AB), alcohol dependence (AD), or both (AB/AD). Contradictory assessments of neuropsychological impairment may be caused by not excluding the confounding effects of comorbid AB/AD. Most of the literature discusses BP without subtyping, which overlooks that BP-II may be a valid diagnosis different from BP-I. Because neuropsychological functions are involved in overall BP-II outcomes, we hypothesized that the neuropsychological functions of patients with BP-II comorbid with AD (BP^+ AD) are significantly different from and more impaired than those of patients with BP-II not comorbid with AD (BP^− AD).

Methods

Using DSM-IV criteria, the study included 69 patients with BP-II (19 with BP^+ AD; 28 with BP^− AD) and 22 healthy controls compared using a battery of neuropsychological tests that assessed memory, psychomotor speed, and certain aspects of frontal executive function. All BP-II patients were in an inter-episode period (a period of remission between states of mania, hypomania, and depression).

Results

BP^+ AD patients had lower scores than did BP^− AD patients and controls in verbal memory, visual memory, attention, psychomotor speed, and executive function. Working memory was poorer for BP^+ AD than BP^− AD patients and for both BP groups than for controls.

Conclusions

BP^+ AD patients manifested wide neuropsychological dysfunctions, and BP^− AD patients showed a reduction in working memory, which suggested that working memory might be related to a history of BP-II. Neuropsychological dysfunctions seemed more strongly associated with AB/AD than with BP-II in inter-episode periods.     

Physical and sexual abuse issues among youths with substance use problems.

OBJECTIVES: To evaluate the prevalence of reported physical and sexual abuse among youths with substance use problems, to explore whether youths report relying on substances to cope with the abuse, and to examine whether individual factors related to substance use were associated with the outcome measures of reported physical abuse, sexual abuse, and using substances to cope. METHOD: We assessed 287 male and female youths (age 14 to 24 years) who presented for help for substance use problems, using a semistructured interview that focused on substance use, history of previous sexual and physical abuse, and coping strategies. RESULTS: One-half of the female youth substance abusers reported having been sexually abused (50.0%), while male youth substance users reported a significantly lower rate (10.4%). Similarly, one-half of the female youths had a history of physical abuse (50.5%), and males again had a lower rate (26.0%). Of those who endorsed a history of abuse, more females (64.7%) than males (37.9%) reported using substances to cope with the trauma. Specific associations between the outcome measures and substance use variables were found for youths in both sexes. CONCLUSION: These findings underscore the importance of why clinicians should explore abuse issues with substance-using youth of both sexes. Identifying concurrent factors will help provide better intervention strategies. Suggestions for assessing sexual and physical abuse in youths with substance use disorders are provided.     

Alcohol use, abuse, and related problems among children of problem drinkers: findings from a national survey of college alcohol use

The purpose of this study was to estimate the prevalence of parental problem drinking reported by a national sample of college students and to examine the relations between such reports and respondents' patterns of drinking, alcohol abuse, abstinence, and utilization of treatment/counseling. Responses to mailed questionnaires completed by a random sample of 17,592 students at a representative national sample of 140 four-year colleges were analyzed using logistic regression. About 10% of college students reported problem-drinking parents. These children of problem drinkers (COPDs) exhibited a bimodal pattern of drinking behavior, showing higher than normal odds of past year abstinence or heavy episodic drinking. Males were more likely than females to report heavy episodic drinking, and children of affected mothers were at greatest risk. Approximately 23% of COPDs met proxy DSM-IV alcohol abuse criteria COPDs in college are a heterogeneous group showing both vulnerability and resistance. Those reporting treatment are more likely to be abstainers.     

Treatable comorbid conditions and use of VA health care services among patients with dementia

OBJECTIVE: Although dementia is a progressive degenerative disease, treatable comorbid symptoms, such as pain, aggression, depression, and psychosis, occur among more than 60 percent of patients with dementia. Compared with age-matched controls, patients with dementia use 70 percent more health services and account for 50 percent more managed care costs. This prospective study examined the longitudinal relationship between use of health care services and treatable comorbid conditions among patients with dementia. METHODS: Ninety-nine patient-caregiver dyads from the Michael E. DeBakey Veterans Affairs (VA) Medical Center in Houston, Texas, completed a one-time interview. Patients' VA records were reviewed one year later to examine the relationships between the study variables and three types of service use: inpatient medical stays, outpatient medical visits, and outpatient psychiatric visits. RESULTS: Pain was positively associated with all types of service use. Depression was associated with outpatient psychiatric visits. Psychosis and aggression were not significantly associated with future use of health care services. CONCLUSIONS: The results of this study confirm previous findings that pain and depression are associated with increased use of health care services. Although the other treatable comorbid symptoms, with the exception of pain, are associated with increased service use, their impact varies depending on the type of services provided. Interventions to improve the assessment and treatment of comorbid symptoms, especially pain, among patients with dementia may reduce service needs and thus reduce medical care costs.     

Panic attacks, panic disorder, and agoraphobia: Associations with substance use, abuse, and dependence

Anxiety and substance use disorders frequently co-occur. Despite the clinical importance of this co-occurrence, theory and research addressing the relations between anxiety-substance use disorder comorbidity remain limited. The present commentary is intended to briefly review and summarize key aspects of this literature, with a specific focus on panic-spectrum psychopathology (panic attacks, panic disorder, and agoraphobia) and its associations with tobacco, alcohol, and marijuana use, abuse, and dependence. A heuristic theoretical model for better understanding the panic-substance use relations also is offered. Extant data suggest clinically meaningful bidirectional associations are evident between panic problems and premorbid risk factors for such problems and various forms of tobacco, alcohol, and marijuana use. Key clinical implications and future directions are outlined based upon the review.     

Bipolar disorder with comorbid substance abuse: diagnosis, prognosis, and treatment

Alcohol and drug abuse occur frequently in individuals with bipolar disorder, but clinicians may often feel ill-prepared to identify such multi-diagnosis syndromes, to contextualize drug abuse alongside affective symptoms, and to formulate appropriate treatment strategies. Plausible explanations for high comorbidity rates between bipolar illness and substance use disorders are complex and likely embrace numerous factors that extend beyond simple, older theories about drug use as sheer "self-medication." Evidence from epidemiologic, family-genetic, pharmacologic, psychosocial, and clinical psychopathology studies suggest that a majority of bipolar patients are at risk for developing lifetime drug or alcohol-related problems, which may in turn contribute to more varied and complex clinical presentations, accelerated relapses, worsening of depressive features, poorer lithium response, functional disability, and elevated suicide risk. In this article, the author reviews essential concepts about the phenomenology and treatment outcome of bipolar illness with substance use comorbidities and offers a systematic approach to the diagnosis and management of patients with such dual diagnoses.     

Actions of delta-9-tetrahydrocannabinol in cannabis: Relation to use,abuse, dependence

Cannabis use disorders have been recently identified as a relevant clinical issue: a subset of cannabis smokers seeks treatment for their cannabis use, yet few succeed in maintaining long-term abstinence. The rewarding and positive reinforcing effects of the primary psychoactive component of smoked cannabis, delta-9-tetrahydrocannabinol (THC) are mediated by the cannabinoid CB1 receptor. The CB1 receptor has also been shown to mediate cannabinoid dependence and expression of withdrawal upon cessation of drug administration, a phenomenon verified across species. This paper will review findings implicating the CB1 receptor in the behavioural effects of exogenous cannabinoids with a focus on cannabinoid dependence and reinforcement, factors that contribute to the maintenance of chronic cannabis smoking despite negative consequences. Opioidergic modulation of these effects is also discussed.