Polysubstance Use,Social Anxiety,and Length of Treatment for Alcohol Use Disorders

Objective: The purpose of the present study was to examine the interactive effects of social anxiety and psychosocial factors (i.e., group attendance, polysubstance use) on substance use treatment for men with a primary diagnosis of alcohol use disorder. Social anxiety and alcohol use disorders often co-occur, but it is currently unclear how having high social anxiety might affect aspects of substance use treatment, such as group participation and length of stay. Methods: This study compared men with alcohol use disorder only versus those with alcohol plus other drug disorders in a residential treatment facility. Measures included demographics, self-reported social anxiety, self-reported drug history, attendance at treatment groups, and total number of days in treatment. Results: Of 128 participants, 39 (30.5%) used only alcohol, while 89 (69.5%) used alcohol and other substances. Hierarchical linear regression showed only one significant interaction with social anxiety and length of treatment: people who used alcohol only or alcohol in addition to other substances (p < .05). Simple effects analyses revealed a positive relationship between social anxiety and length of stay among men who used only alcohol, but not among men who used more than one substance. Conclusions: Currently, the distinction between those who use only alcohol and those who use other substances as well is not often examined in the literature. However, the present study shows that this assumption of homogeneity may be inaccurate, given the differential relationships that these groups may have with factors such as social anxiety.     

Smoking Cessation Outcomes and Predictors Among Individuals With Co-occurring Substance Use and/or Psychiatric Disorders

Objective: Individuals with substance use and psychiatric disorders have a high prevalence of tobacco use disorders and are disproportionately affected by tobacco-related morbidity and mortality. However, it is unclear how having co-occurring disorders affects tobacco cessation. Our aim was to examine smoking cessation outcomes and relevant predictors of smoking cessation among smokers with substance use and/or psychiatric disorders. Methods: Data from medical records of 674 participants in a tobacco treatment program within mental health and addictions services in Vancouver, Canada, were analyzed. The 26-week treatment program included an 8-week structured behavioral counseling group, an 18-week support group, and 26 weeks of no-cost pharmacotherapy. Information on demographics, tobacco use and history, type of pharmacotherapy received, nicotine dependence, importance of and confidence in quitting smoking, expired carbon monoxide level, substance use and psychiatric disorder history, and total program visits were gathered. Results: Approximately 67% (n = 449) of participants had co-occurring substance use and psychiatric disorders, while 20% (n = 136) had substance use disorder only, 10% (n = 67) had psychiatric disorder only, and 3% (n = 22) had tobacco dependence only. Rates of tobacco cessation (i.e., 7-day point prevalence of abstinence verified by expired carbon monoxide of ≤8 ppm) by group in the 522 people who completed treatment were as follows: 38.2% for those with co-occurring disorders, 47.1% for those with tobacco dependence only, 47.1% for those with substance use disorder only, and 41.8% for those with psychiatric disorder only. Length of treatment was a significant predictor of smoking cessation for those with co-occurring disorders and substance use disorder only. In the final stratified multivariate analysis, for individuals with co-occurring disorders, having an opiate use disorder (as compared to an alcohol use disorder) and higher nicotine dependence scores at baseline were predictive of poor cessation outcomes, while greater length of treatment was predictive of successful smoking cessation. Conclusions: Tobacco cessation treatment for individuals with co-occurring substance use and psychiatric disorders is likely to be as effective as for smokers with either disorder alone. Treatment duration predicts success among these smokers so strategies to enhance engagement and retention are needed.     

Alcohol and Drug Use,Smoking, and Gambling Among Psychiatric Outpatients: A 1-Year Prevalence Study

ABSTRACT

Background and Aims: Studies of alcohol habits in general psychiatric populations are scarce. The objective was to investigate alcohol and drug use, smoking, and gambling in a clinical sample of psychiatric outpatients. A further aim was to study age and gender differences in the rates of these habits. Methods: Data were collected among psychiatric outpatients with mainly mood (47%) and anxiety (35%) disorders. A questionnaire package was distributed, including AUDIT (Alcohol Use Disorders Identification Test), DUDIT (Drug Use Disorders Identification Test), tobacco items, and gambling items. Two major drinking categories were formed: “Nonhazardous alcohol use” (NH) and “Alcohol use above hazardous levels” (AH). Results: In total, 2160 patients (65% females) responded to the questionnaire package. The AH rate was high among psychiatric outpatients (28.4%), particularly among young females (46.6%). Young female patients also reported a high prevalence of problematic drug use (13.8%). Problematic drug use, daily smoking, and problematic gambling were frequent. The unhealthy habits were linked to AH. Conclusions: Alcohol and drug use, smoking, and gambling are all highly prevalent among psychiatric outpatients. Young females are in particular need of attention. Interventions should be tailored for co-occurring psychiatric disorders and applied within routine psychiatric care.     

Tobacco use and psychiatric comorbidity among adolescents in substance abuse treatment

Adolescents in substance abuse treatment have approximately four times higher rates of tobacco use compared with adolescents in the general population, yet many substance abuse treatment programs do not provide tobacco cessation interventions. This study examined change in tobacco use among 151 adolescents in state-funded substance abuse treatment from intake to 12-month follow-up in relation to psychiatric comorbidity and substance use. Most adolescents (67.5%) used tobacco at intake and follow-up. Having a diagnosis of a mood, anxiety, or behavioral disorder was significantly associated with change in tobacco use. Individuals with a psychiatric disorder were less likely to be nonusers of tobacco than to be individuals who continued tobacco use (adjusted odds ratio [OR] = 0.153, 95% confidence interval [CI] = 0.040-0.587, p < .01), and they were less likely to have initiated tobacco use at follow-up than individuals who continued tobacco use (adjusted OR = 0.320, 95% CI = 0.105-0.970, p < .05). Contrary to the hypothesis, alcohol use and drug use during the 12-month follow-up was not significantly related to change in tobacco use. Adolescents in substance abuse treatment with comorbid psychiatric disorders may be particularly vulnerable to continuing tobacco use.     

Understanding comorbidity between substance use,anxiety and affective disorders: Broadening the research base

In this paper, we argue that the research base for understanding comorbidity between substance use and other mental disorders needs to be broadened. We specifically advocate for: 1) more prospective epidemiological studies of relationships between alcohol and other drug use disorders and anxiety and mood disorders; 2) greater use of twin study designs to disentangle shared genetic and environmental contributions to comorbidity; 3) prospective neuroimaging studies of the effects of early and sustained alcohol and drug use on the developing adolescent brain; 4) a greater focus on the effects on comorbidity of primary and secondary prevention interventions for substance use, anxiety, affective and conduct disorders among children and adolescents; and 5) better evaluations of the impact of treatment upon persons with comorbid substance use and other mental disorders.     

Reprint of “Understanding comorbidity between substance use,anxiety and affective disorders: Broadening the research base”

In this paper, we argue that the research base for understanding comorbidity between substance use and other mental disorders needs to be broadened. We specifically advocate for: 1) more prospective epidemiological studies of relationships between alcohol and other drug use disorders and anxiety and mood disorders; 2) greater use of twin study designs to disentangle shared genetic and environmental contributions to comorbidity; 3) prospective neuroimaging studies of the effects of early and sustained alcohol and drug use on the developing adolescent brain; 4) a greater focus on the effects on comorbidity of primary and secondary prevention interventions for substance use, anxiety, affective and conduct disorders among children and adolescents; and 5) better evaluations of the impact of treatment upon persons with comorbid substance use and other mental disorders.     

Social Support,Family Empowerment,Substance Use,and Perceived Parenting Competency during Pregnancy for Women with Substance Use Disorders

Background: Parenting self-efficacy has been linked to positive parent and child outcomes however, little research exists on factors that influence parenting self-efficacy among pregnant women with substance use disorders. Objectives: This study explored substance use severity, social support, and family empowerment as predictors of parenting self-efficacy among pregnant women (N = 71) entering SUD treatment. Methods: The study used a quantitative cross-sectional design. Results: Statistically significant positive correlations emerged between social support and parenting self-efficacy as well as family empowerment and parenting self-efficacy. Family empowerment and social support were also correlated. A backward elimination regression analysis revealed family empowerment to be the strongest predictor of parenting self-efficacy. No relationships were found among substance use severity and the study variables. Conclusions: When promoting parenting self-efficacy, both social support and family empowerment are important domains to consider for treatment planning and resource development among pregnant women with substance use disorders.     

People Who Inject Drugs and Have Mood Disorders—A Brief Assessment of Health Risk Behaviors

Background: People who inject drugs have a greater risk of infectious disease and mortality than other substance abusers and nondrug users. Variation in risk behavior among people who inject drugs is likely associated with comorbid mental health disorders. Objectives: Examine the association between a history of mood disorder and recent risk behavior among people who inject drugs. Methods: With baseline data from a behavioral HIV prevention clinical trial in a population of people who inject drugs, we used logistic regression models to compare the risk behaviors of people who report a past diagnosis of bipolar disorder (n = 113) or depression (n = 237) to a comparison group with no history of diagnosed mental illness (n = 446). We also assessed differences between groups before and after adjusting for demographic characteristics and current depressive symptoms. Results: While there were no differences between groups in frequency of drug use, people who inject drugs who report a history of mood disorders reported more injection risk behaviors, drug overdoses, sex exchanges, and multiple partners than those with no history of mental illness. Adjusting the comparison for demographic characteristics and current depressive symptoms had little impact on these findings. Variation in risk between depression and bipolar disorder groups was minimal. Conclusions/Importance: People who inject drugs and have mood disorders have unique and significant social, clinical, and risk reduction needs. Despite the limited validity of self-reported mental health history, simply asking about a history of mood disorder may be effective for identifying a particularly vulnerable population of people who inject drugs.     

Discrimination from family and substance use for multiracial individuals

Whereas Multiracial people exhibit heightened rates of substance use, existing research has yet to account for why. The current study examines whether Multiracial people's experiences of discrimination from family may explain their substance use behaviors, and furthermore, whether compromised mental health indirectly explains relationships between familial discrimination and substance use. Online cross-sectional survey data was collected from (N = 466) Multiracial participants. Negative binomial regression analysis indicated that discrimination from family predicted drug use above and beyond general discrimination. Results of bootstrapping analysis revealed that the pathway from discrimination from family to drug use is partially explained by anxiety and depressive symptoms. The implications of these findings for addressing heightened rates of substance abuse among the Multiracial population are discussed.     

Predictors of craving and substance use among patients with alcohol,tobacco, cannabis or opiate addictions: Commonalities and specificities across substances

IntroductionCraving has been proposed as a major contributor to addiction relapse and the influence of mood on craving and substance use has been extensively documented. However, information is lacking concerning the extent to which the magnitude of these effects may vary according to different types of substances. The aim of the present study was to compare the prospective links between emotions, craving and substance use in four groups of patients beginning treatment for alcohol, tobacco, cannabis, or opiate addiction.MethodsEcological Momentary Assessment (EMA) was used over a two-week period. Data were analyzed using hierarchical linear modeling (HLM).Results159 participants were recruited (67.3% male; M = 36.7 years). The average response rate to the EMA assessments was 83.1%. The findings confirmed the strong predictive role of craving intensity on substance use reported at the next assessment of the day among the alcohol (γ = 0.224; p = .018), tobacco (γ = 0.133; p = .013) and cannabis groups (γ = 0.266; p = .019), but not for opiates (γ = 0.098; p = .142). Craving intensity was itself predicted by greater anxious mood (γ = 0.108; p = 0,029) and event negativity (γ = 0.107; p = .003) among tobacco patients, lower sad mood among cannabis patients (γ = −0.248; p = 0,002), and lower event negativity among opiate patients (γ = −0.201; p = .002).ConclusionWhile these results support the benefit of targeting craving in addiction treatment regardless of substance type, the substance-specific emotional risk factors for craving identified in this study may provide important insights for the development of personalized treatment strategies.     

Psychiatric Symptoms,Parental Attachment,and Reasons for Use as Correlates of Heavy Substance Use Among Treatment-Seeking Hispanic Adolescents

In early adolescence, Hispanics self-report higher drug use rates compared to White and African American peers. Among adolescent users, heavy users have more negative behavioral and health consequences. The purpose of this cross-sectional study is to examine whether psychiatric symptoms, parental attachment, and reasons for use predict heavy alcohol and illicit drug use (more than 10 times in the past three months) among Hispanic adolescents. Methods: This study examines baseline data from a study evaluating a family based substance abuse treatment program for Hispanic adolescents. Participants were 14–17 years old (N = 156, 44% female). Adolescent reports on the Diagnostic Interview Schedule for Children Predictive Scales measured psychiatric symptoms of major depressive disorder, attention deficit hyperactivity disorder, conduct disorder, and anxiety. The Personal Experiences Inventory measured type and amount of drug use, as well as perceived social and psychological benefits of drug use. The Inventory of Parent and Peer Attachment measured trust, communication, and alienation between adolescents and their mothers. Logistic regression identified correlates of heavy alcohol use and heavy illicit drug use among Hispanic adolescents. Results: Higher social benefits were associated with increased likelihood of heavy alcohol use. Conduct disorder, higher levels of maternal attachment, lower levels of acculturation, and higher levels of psychological benefits of use were associated with an increased likelihood of heavy illicit drug use. Conclusion: These findings support the assumption that substance use treatment among Hispanic adolescents must be capable of addressing co-occurring psychiatric disorders, familial relationships, and the individual reasons/motivators to use.     

Anger,anxiety, and depressive affect as predictors of stress-induced cortisol production in khat and tobacco users

IntroductionGlucocorticoid activity is disrupted in substance users including khat chewers who also use tobacco. Anger, dysphoria, and anxiety can mediate this relationship. The aim of this study was to contrast emotion dysregulation and substance use variables as predictors of post-stress cortisol output.Materials and methodsComparable numbers of males (n = 90) and females (n = 85) including controls, khat only, and concurrent khat and tobacco users participated in a stress study. Depressive affect, anxiety, anger, substance use patterns, and saliva samples were collected following a standardized laboratory stress manipulation.ResultsRegression analysis showed that high depression and low anxiety was associated with high post-stress cortisol, but only in co-users of tobacco and khat. Males, but not females, showed a significant association between co-use of khat and tobacco and cortisol, which appears to be mediated by frequency of use. The link between anxiety and post-stress cortisol in the co-users remained significant after controlling for nicotine dependence and substance use frequency.ConclusionAnxiety predicted the neuroendocrine consequences of concurrent use of tobacco and khat above and beyond sex, nicotine dependence, anger, and substance use frequency. Sex differences, however, are related to differences in nicotine dependence.     

Drug Use in Soldiers: Family and Peer Contextual Associations

Background: Given the stressful nature of military life, people in the armed forces are vulnerable to substance use. Objectives: The aim of this study was to explore the relationship between family and peers with drug use among military forces in Iran. Methods: Convenience sampling was used to recruit a total of 422 draftees doing military service in army units in Tehran, Iran. Measures of family and peers' risk and protective factors, alcohol use, and other drug use were administered. Results: Findings indicated significant relationships between family (i.e., family models for risk behavior, parent sanctions, and family controls) and peers (i.e., peer modeling for risk behavior, peer controls, support from friends) with drug use. A multiple regression analysis revealed that peer modeling for risk behavior, family models for risk behavior, and parent sanctions were significant predictors of drug use in soldiers. Conclusions: These results were consistent with the influence of family and peer on drug use amongst soldiers. Programs designed to reduce alcohol and other drug use may benefit from tailoring to fit risk and protective files amongst peer and family networks.     

Patterns of concurrent alcohol,tobacco, and cannabis use in Germany: Prevalence and correlates

Aims: This study investigated past month patterns and risk factors of alcohol, tobacco and cannabis use by level of intensity in the German general population.

Methods: Data from the 2006 German Epidemiological Survey of Substance Abuse (ESA) were used. The cross-sectional random sample consisted of N?=?7912 adults aged 18–64 years. The response rate was 45%. Intensive use of each substance was measured applying substance-specific cut-off points: alcohol: >20/30?g pure ethanol daily for women/men; tobacco: ≥20 cigarettes daily; cannabis: on ≥6 occasions monthly.

Findings: The majority of substance users reported no intensive use of any of the three substances (77.5%) and 19.4% had used one of the three substances intensively. A total of 3.1% engaged in intensive use of multiple substances with alcohol and tobacco (2.3%) as the most prevalent pattern. A higher risk for intensive use of multiple substances was found among males, older individuals and those with a substance use disorder.

Conclusions: Results of this study call for an integrated view on substance use and related disorders in prevention and treatment, taking diverse use patterns and specific needs of substance abusers into account.     

Dual Diagnosis and Drinking Behaviors in an Outpatient Treatment Seeking Sample of Adolescents with Alcohol Use Disorders

ABSTRACT

Objectives: Co-occurring psychiatric disorders are common in adolescents with substance abuse. While many studies have explored the prevalence of psychiatric disorders in adolescent substance using samples, few have explored the relationship between comorbid psychiatric disorders and drinking behaviors. This study examined this relationship to investigate whether certain psychiatric disorders impact severity of drinking behaviors in adolescents with alcohol use disorders.

Methods: We examined 34 outpatient adolescents with alcohol use disorders for comorbid psychiatric disorders using the K-SADS. Their drinking behavior patterns were examined using the Time-Line Follow-Back. The alcohol drinking parameters were (1) drinks per drinking day (DDD), (2) percent heavy drinking days (PHD), (3) percent heavy drinking days when drinking (PHDD), and (4) percent days abstinent (PDA).

Results: The diagnoses that afforded sufficient power to examine the effect of that diagnosis on drinking behavior were any mood or anxiety disorder vs. neither; oppositional defiant disorder (ODD) vs. no ODD; and attention-deficit hyperactivity disorder (ADHD) vs. no ADHD. Results revealed no significant effect of either ODD or any mood/anxiety disorder on drinking indices, both p values > .10; MANOVA revealed a significant effect of ADHD diagnosis, p = .04. Univariate analysis showed that for all four drinking indices, the group with ADHD had more severe alcohol use, all p values < .05.

Conclusions: Our results suggest that adolescents with ADHD who meet diagnostic criteria for alcohol use disorders have greater drinking severity than those without ADHD.     

Anxiety and Substance Use During Adolescence

ABSTRACT. Background: The primary goal of this study was to examine the relationship between anxiety symptomatology and substance use (alcohol use and drug use) during adolescence, systematically by gender and race/ethnicity. Methods: Self-report surveys were administered to 905 15–17-year-old adolescents (54% girls) in the spring of 2007. Results: Results from multiple group analyses indicated that the relationship between anxiety and substance use differs by gender and race/ethnicity. For Caucasian and African American boys, higher levels of social anxiety and separation anxiety were related to less substance use. In contrast, higher levels of generalized anxiety disorder and panic disorder were associated with more substance use for African American boys. The pattern was much less striking for girls. For Caucasian girls, higher levels of significant school avoidance were linked to more substance use, and consistent with the results for boys, higher levels of separation anxiety were associated with less substance use. None of the anxiety disorders were related to substance use for African American girls or Hispanic girls or boys. Conclusions: Findings from this study highlight the need to distinguish between different anxiety disorders. In addition, they underscore the importance of considering both gender and race/ethnicity when examining the relationship between anxiety and substance use during adolescence.     

Gender Differences in Substance Use,Consequences, Motivation to Change,and Treatment Seeking in People With Serious Mental Illness

Gender differences in patterns and consequences of substance use, treatment-seeking, and motivation to change were examined in two samples of people with serious mental illness (SMI) and comorbid substance use disorders (SUDs): a community sample not currently seeking substance abuse treatment (N = 175) and a treatment-seeking sample (N = 137). In both groups, women and men demonstrated more similarities in the pattern and severity of their substance use than differences. However, treatment-seeking women showed greater readiness to change their substance use. Mental health problems and traumatic experiences may prompt people with SMI and SUD to enter substance abuse treatment, regardless of gender.     

Epidemiology of hallucinogen use in the U.S. results from the National epidemiologic survey on alcohol and related conditions III

BackgroundPopulation-based data regarding the epidemiology of hallucinogen use and co-occurring psychiatric disorders is largely absent from the literature. We aim to present findings on the prevalence, sociodemographic correlates, psychiatric comorbidity, treatment utilization, social support and associated disability of hallucinogen use using nationally representative data.MethodWe analyzed data from the National Epidemiologic Study on Alcohol and Related Conditions-III (2011–2012, N = 36,309). We conducted multivariate logistic regression analyses in unadjusted and adjusted models in order to explore the odds of psychiatric disorders and associated disability among hallucinogen users.ResultsPrevalence of twelve-month and lifetime hallucinogen use was 0.62% and 9.32%, respectively. Hallucinogen use was found to be significantly associated with mood disorders, anxiety disorders, eating disorders, personality disorders and substance use disorders. Following adjustment, significant associations were retained with several substance use disorders (adjusted odds ratio (AOR) for heroin use disorder = 4.89 (95% CI, 1.90–12.58), personality disorders (AOR = 2.10 (95% CI, 1.81–2.44)), Post-Traumatic Stress Disorder (AOR = 1.86, 95% CI 1.00–3.45) and past suicide attempts (AOR = 1.49, 95% CI 1.21–1.85).ConclusionsLifetime hallucinogen use in the US is prevalent and highly comorbid with other substance use and psychiatric disorders. Hallucinogen Use Disorder is relatively uncommon, with a low risk of development following exposure to hallucinogens. There are significant associations between hallucinogen use and substance use disorders, personality disorders, PTSD and past suicide attempts. The evolving therapeutic utility of this class of substances requires further assessment of short- and long-term risks of use, before large scale clinical application is pursued.     

Drug Use and Incarceration among Rural Appalachian Women: Findings From a Jail Sample

Background/Objective: The purpose of this paper is to examine drug use and incarceration history among rural Appalachian women. Methods: This study involved random selection, screening, and interviews with rural women from local jails in Appalachia. Results: Of the women randomly selected and screened, 97% met criteria for substance use intervention. Significant factors associated with incarceration history included age, education, custody status, and mental health. A significant interaction was observed between male sex partners and drug use on incarceration history. Conclusions: Study findings suggest that the drug/crime relationship among rural Appalachian women is associated with their high-risk home environment, partner relationships, and mental health. Specifically, in addition to drug use, factors such as family and child relationships, anxiety, victimization, and relationships with partners should also be considered in the trajectory of criminal careers among rural Appalachian women.     

Pharmacotherapy of Comorbid Mood,Anxiety, and Substance Use Disorders

Mood and anxiety disorders commonly co-occur with substance use disorders. Exploration of the neurobiology of substance use disorders and mood and anxiety disorders have found that the neural circuitry in mood, anxiety, and substance use disorders is clearly overlapping. These discoveries have encouraged the exploration of a number of pharmacotherapeutic agents in the treatment of co-occurring mood, anxiety, and substance use disorders. In this article, recent data on the pharmacotherapeutic treatment of mood and anxiety disorders in individuals with substance use disorders are reviewed. Some of the barriers to the use of pharmacotherapy in individuals with substance use disorders are discussed.