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Hetland J, Lundervold AJ, Erga AH. Cognitive impairment as a predictor of long-term psychological distress in patients with polysubstance use disorders: a prospective longitudinal cohort study. BMC Psychiatry 2024; 24:143. [PMID: 38378466 PMCID: PMC10880353 DOI: 10.1186/s12888-024-05600-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 02/08/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND The association between polysubstance use disorder (pSUD), mental illness, and cognitive impairments is well established and linked to negative outcomes in substance use disorder treatment. However, it remains unclear whether cognitive impairment predicts long-term psychological distress among treatment seeking patients with pSUD. This study aimed to investigate the associations and predictive ability of cognitive impairment on psychological distress one and 5 years after treatment initiation. METHODS N = 164 treatment seeking patients with pSUD were sampled at treatment initiation. We examined associations between cognitive impairment according to Montreal Cognitive Assessment® (MoCA®), Wechsler Abbreviated Scale of Intelligence (WASI), and Behaviour Rating Inventory of Executive Function - Adult version (BRIEF-A) administered at treatment initiation and psychological distress defined by the Symptom Check List-90-Revised (SCL-90-R) at treatment initiation, one and five years later. We ran hierarchical logistic regressions to assess the predictive ability of the respective cognitive instruments administered at treatment initiation on psychological distress measured one and five years later including psychological distress at treatment initiation and substance intake at the time-points of the measurements as covariates. RESULTS The main results was that MoCA® and BRIEF-A predicted psychological distress at years one and five, but BRIEF-A lost predictive power when accounting for psychological distress at treatment initiation. WASI predicted psychological distress at year one, but not at year five. CONCLUSIONS Results from MoCA® and WASI was found to be less sensitive to the effect of psychological distress than BRIEF-A. Cognitive impairment at treatment initiation may hold predictive value on later psychological distress, yet its clinical utility is uncertain.
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Affiliation(s)
- Jens Hetland
- Center for Alcohol and Drug Research (KORFOR), Stavanger University Hospital, P.O. Box 8100, N-4068, Stavanger, Norway.
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.
| | - Astri J Lundervold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Aleksander H Erga
- Center for Alcohol and Drug Research (KORFOR), Stavanger University Hospital, P.O. Box 8100, N-4068, Stavanger, Norway
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
- Institute of Social Sciences, University of Stavanger, Stavanger, Norway
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2
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Park D, Lee E, Yang S, Ware OD. Patterns of Familial and Racial Trauma and Their Associations with Substance Use Disorders among Racial/Ethnic Minority Adults. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01812-1. [PMID: 37814078 DOI: 10.1007/s40615-023-01812-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 09/01/2023] [Accepted: 09/19/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Racial/ethnic minorities in the United States often experience many different types of traumatic events. We examine the patterns of familial and racial trauma and their associations with substance use disorders (SUDs) among racial/ethnic minority adults. METHODS We used data from the National Epidemiologic Survey of Alcohol and Related Conditions-III. The study sample included 17,115 individuals who were Hispanic (43.6%), Black (34.9%), Asian American and Pacific Islander (17.0%), and American Indian or Alaska Native (AI/AN, 4.6%). Latent class analysis models with covariates and distal outcomes were analyzed to investigate patterns of trauma exposure and estimate binary outcomes of SUDs. Familial and racial trauma was measured by ten areas of adverse childhood experiences (ACEs) and six items of racial discrimination. RESULTS We found four distinctive groups: low trauma (Class 1, 62.1%), high discrimination (Class 2, 17.2%), high ACEs (Class 2, 14.9%), and high trauma (Class 4, 5.9%). Compared to Class 1, other groups were more likely to include Black and AI/AN adults. Participants in Class 2 reported greater risks for alcohol and other drug use disorders. Those in Class 3 and 4 reported greater risks for alcohol, opioid, stimulant, and other drug use disorders. CONCLUSION Given a higher risk of trauma exposure in Black and AI/AN adults, racially and ethnically sensitive trauma-focused interventions may help prevent and reduce SUDs in those populations.
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Affiliation(s)
- Daejun Park
- Department of Social Work, Ohio University, Athens, OH, 45701, USA.
| | - Eunwoo Lee
- School of Social Welfare, University at Albany, State University of New York, Albany, NY, 12222, USA
| | - Sejung Yang
- Department of Mathematics & Statistics, The University of Vermont, Burlington, VT, 05405, USA
| | - Orrin D Ware
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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3
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Abstract
Substance use disorders (SUDs) are complex illnesses and may occur in individuals with other physical and mental illnesses. Common comorbidities for SUDs include mental health illness and/or chronic pain. Nurses face additional risk factors for the development of SUD and comorbid illnesses. The relationships among these comorbidities and SUD are multifaceted, requiring understanding of the individual disease processes and how they may impact the manifestations of one another, as well as response to treatment considerations. Understanding the prevalence of these comorbidities and potential relationships is crucial to prevention, management, and treatment outcomes.
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Affiliation(s)
- Christine Bazik Kress
- University of North Carolina Greensboro DNP Nurse Anesthesia Program, 124 East Gate City Boulevard, Greensboro, NC 27406, USA.
| | - Stacey Schlesinger
- University of North Carolina Greensboro DNP Nurse Anesthesia Program, 124 East Gate City Boulevard, Greensboro, NC 27406, USA
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4
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Kushner MD, Polechonski N. President's message. J Addict Dis 2023; 41:1-3. [PMID: 36537312 DOI: 10.1080/10550887.2023.2154497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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5
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Aram JW, Spencer MRT, Garnett MF, Hedegaard HB. Psychological distress and the risk of drug overdose death. J Affect Disord 2022; 318:16-21. [PMID: 36057284 PMCID: PMC9664726 DOI: 10.1016/j.jad.2022.08.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/01/2022] [Accepted: 08/26/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous research has shown an association between psychological distress and overdose death among specific populations. However, few studies have examined this relationship in a large US population-based cohort. METHODS Data from the 2010-2018 NHIS were linked to mortality data from the National Death Index through 2019. Psychological distress was measured using the Kessler 6 scale. Drug overdose deaths were examined, and deaths from all other causes were included as a comparison group. Cox proportional hazards regression was used to estimate mortality risk by psychological distress level. RESULTS The study population included 272,561 adults. Adjusting for demographic covariates and using no psychological distress as the reference, distress level was positively associated with the risk of overdose death: low (HR = 1.8, 95 % CI = 1.1-2.8), moderate (HR = 4.1, 95 % CI = 2.5-6.7), high (HR = 10.3, 95 % CI = 6.5-16.1). A similar pattern was observed for deaths from all other causes: low (HR = 1.2, 95 % CI = 1.1-1.2), moderate (HR = 1.9, 95 % CI = 1.7-2.0), high (HR = 2.6, 95 % CI = 2.4-2.8). LIMITATIONS Limited substance use information prevented adjustment for this potentially important covariate. DISCUSSION Adults with psychological distress were at greater risk of drug overdose death, relative to those without psychological distress. Adults with psychological distress were also at increased risk of death due to other causes, though the association was not as strong.
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Affiliation(s)
- Jonathan W Aram
- Division of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention.
| | - Merianne Rose T Spencer
- Division of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention
| | - Matthew F Garnett
- Division of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention
| | - Holly B Hedegaard
- Division of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention
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6
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Akeman E, White E, Wolitzky-Taylor K, Santiago J, McDermott TJ, DeVille DC, Stewart JL, Paulus M, Taylor CT, Aupperle RL. Amplification of Positivity Therapy for Co-occurring Alcohol Use Disorder with Depression and Anxiety Symptoms: Pilot Feasibility Study and Case Series. Behav Modif 2022; 46:1021-1046. [PMID: 34253077 PMCID: PMC8752639 DOI: 10.1177/01454455211030506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Positive valence system dysregulation is a relatively unexplored transdiagnostic mechanism and potential treatment target underpinning alcohol use and anxiety and depression symptoms. The current study examined the feasibility and potential benefit of a behavioral intervention focused on amplification of positivity (AMP) with eight adults (five female) diagnosed with alcohol use disorder and clinically significant depression or anxiety (ClinicalTrials.gov: NCT04278365). AMP for alcohol use (AMP-A) was delivered in 11 individual sessions involving positive activity interventions integrated alongside psychoeducation and alcohol use monitoring. Case descriptions are provided to illustrate treatment implementation. Treatment credibility and acceptability, participant endorsement of the therapy, and homework compliance were rated moderate to high. Exploratory, intent-to-treat analyses suggested medium to large effect sizes for post-treatment improvements in alcohol use, depression, anxiety, and positive affect. Results provide initial evidence of feasibility and acceptability of AMP-A and will be useful for informing future randomized clinical trials to examine clinical efficacy.
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Affiliation(s)
| | - Evan White
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | | | | | - Timothy J. McDermott
- Laureate Institute for Brain Research, Tulsa, OK, USA,The University of Tulsa, OK, USA
| | - Danielle C. DeVille
- Laureate Institute for Brain Research, Tulsa, OK, USA,The University of Tulsa, OK, USA
| | - Jennifer L. Stewart
- Laureate Institute for Brain Research, Tulsa, OK, USA,The University of Tulsa, OK, USA
| | - Martin Paulus
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | | | - Robin L. Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, USA,The University of Tulsa, OK, USA
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7
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López-Toro E, Wolf CJH, González RA, van den Brink W, Schellekens A, Vélez-Pastrana MC. Network Analysis of DSM Symptoms of Substance Use Disorders and Frequently Co-Occurring Mental Disorders in Patients with Substance Use Disorder Who Seek Treatment. J Clin Med 2022; 11:jcm11102883. [PMID: 35629008 PMCID: PMC9145186 DOI: 10.3390/jcm11102883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/10/2022] [Accepted: 05/15/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Substance use disorders (SUD) often co-occur with other psychiatric conditions. Research on SUD and comorbid disorders generally flows from a categorical diagnostic or dimensional latent variable perspective, where symptoms are viewed as independent indicators of an underlying disorder. In contrast, the current study took a network analysis perspective to examine the relationships between DSM symptoms of SUD, ADHD, conduct disorder (CD), depression (MDD), and borderline personality disorder (BPD). In addition, we explored possible gender differences in the network structures of these symptoms. Method: In a sample of 722 adult treatment-seeking patients with SUD from the International ADHD in Substance Use Disorders Prevalence Study (IASP) we estimated the network structure for 41 symptoms of SUD, ADHD, CD, MDD, and BPD. We described the structure of symptom networks and their characteristics for the total sample, and we compared the symptom networks for males and females. Results: Network analyses identified seven clusters of symptoms, largely corresponding with the DSM diagnostic categories. There were some connections between clusters, mainly between some hyperactivity symptoms and CD and depressive symptoms. ADHD hyperactivity was most central in the symptom network. Invariance tests revealed no significant gender differences in the structure of symptom networks. Conclusions: The current findings support the categorical DSM classification of mental disorders in treatment-seeking patients with SUD. Future network analyses should include a broader range of symptoms and prospectively explore changes in the symptoms network of patients during treatment.
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Affiliation(s)
- Edith López-Toro
- PhD Program in Clinical Psychology, Universidad Carlos Albizu, P.O. Box 9023711, San Juan, PR 00902-3711, USA;
| | - Casper J. H. Wolf
- Department of Psychiatry, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (C.J.H.W.); (A.S.)
- Department of Cognitive Neuroscience, Donders Institute for Brain Cognition and Behaviour, Radboud University, 6525 EN Nijmegen, The Netherlands
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), 6525 HR Nijmegen, The Netherlands
| | - Rafael A. González
- National Adoption and Fostering Service & National Conduct Problems Team, Michael Rutter Centre, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK;
- Centre for Psychiatry, Imperial College London, London W12 0NN, UK
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands;
| | - Arnt Schellekens
- Department of Psychiatry, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (C.J.H.W.); (A.S.)
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), 6525 HR Nijmegen, The Netherlands
| | - María C. Vélez-Pastrana
- PhD Program in Clinical Psychology, Universidad Carlos Albizu, P.O. Box 9023711, San Juan, PR 00902-3711, USA;
- Correspondence: ; Tel.: +1-787-725-6500
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8
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Targeting maladaptive reactivity to negative affect in emerging adults with cannabis use disorder: A preliminary test and proof of concept. Behav Res Ther 2022; 150:104032. [DOI: 10.1016/j.brat.2022.104032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/27/2021] [Accepted: 01/05/2022] [Indexed: 11/22/2022]
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9
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Pavarin RM, Sanchini S, Tadonio L, Domenicali M, Caputo F, Pacetti M. Suicide mortality risk in a cohort of individuals treated for alcohol, heroin or cocaine abuse: Results of a follow-up study. Psychiatry Res 2021; 296:113639. [PMID: 33352416 DOI: 10.1016/j.psychres.2020.113639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
Cohort study. This follow-up study (from 1975 to 2016) was aimed to estimate the mortality risk for suicide in a cohort of patients presenting to a public treatment centre for addiction (SERD) with Alcohol Use Disorder (AUD), Heroin Use Disorder - HUD or Cocaine Use Disorder (CUD), also relating to their access to a Mental Heath Service. Crude Mortality Rates for suicide were higher for patients with AUDs, for men and subjects 45-64 years old. Hanging was the main cause of suicide death. We highlight an increase in mortality in the period 2009-2012, which coincides with the economic recession, and in the year of first contact with a SERD. The Standardized Mortality Ratios (SMRs) were 4.9, higher among females than males. From the multivariate analysis, a higher risk for patients that were separated or divorced was observed. The results of our study provide some guidance on the features of subjects at greatest risk of death from suicide, which may be useful in reducing and preventing suicide and gaining a better clinical management of patients with SUDs.
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Affiliation(s)
- Raimondo Maria Pavarin
- Epidemiological Monitoring Center on Addiction, Azienda USL Bologna, Mental Health DSM-DP, Bologna, Italy; Italian Society on Addiction (SITD);.
| | - Samantha Sanchini
- Epidemiological Monitoring Center on Addiction, Mental Health DSM-DP, Azienda USL Romagna, Italy.
| | - Leonardo Tadonio
- Monitoring Center on Addiction, Mental Health DAISM-DP, Azienda USL Parma, Italy.
| | - Marco Domenicali
- Internal Medicine S.Maria delle Croci Hospital, Ravenna, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.
| | - Fabio Caputo
- Department of Internal Medicine, SS Annunziata Hospital, Cento (Ferrara), Italy University of Ferrara, Italy; Italian Society on Alcohol (SIA).
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10
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Cance JD, Saavedra LM, Wondimu B, Scaglione NM, Hairgrove S, Graham PW. Examining the Relationship between Social Connection and Opioid Misuse: A Systematic Review. Subst Use Misuse 2021; 56:1493-1507. [PMID: 34139948 DOI: 10.1080/10826084.2021.1936056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
METHODS We used a Boolean search strategy of PubMed, PsycINFO, and Embase to identify eligible publications from January 1990 to March 2020 and narrative analysis to synthesize the evidence. RESULTS The database search identified 1267 independent citations; 29 publications met inclusion criteria. Nearly all the studies demonstrated high risk of bias, most often due to selection and confounding bias. Most of the studies in the review (k = 20, 69%) found at least one significant association between social connection and opioid outcomes. Although no two studies included the same measures of social connection or opioid misuse, and social connection was both positively and negatively associated with opioid misuse, results support that social connection is an important correlate of opioid misuse. CONCLUSIONS This review highlights the importance of social connection as a correlate to opioid misuse. However, the extensive variability among research studies points to a need for standardization of measurement and larger studies with diverse populations to allow for consequential recommendations for prevention or treatment of opioid misuse. Evidence regarding the associations between social connection and opioid misuse or disorder is sparse. We provide suggestions for advancing this research, including clarification of the complex influences between social connections and opioid misuse.
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Affiliation(s)
- Jessica Duncan Cance
- RTI International, Center for Behavioral Health Epidemiology, Implementation, and Evaluation Research, Durham, North Carolina, USA
| | - Lissette M Saavedra
- RTI International, Center for Behavioral Health Epidemiology, Implementation, and Evaluation Research, Durham, North Carolina, USA
| | - Betselot Wondimu
- RTI International, Center for Behavioral Health Epidemiology, Implementation, and Evaluation Research, Durham, North Carolina, USA
| | - Nichole M Scaglione
- Department of Health Education and Behavior, University of Florida, Gainesville, Florida, USA
| | - Sara Hairgrove
- RTI International, Center for Behavioral Health Epidemiology, Implementation, and Evaluation Research, Durham, North Carolina, USA
| | - Phillip W Graham
- RTI International, Center for Behavioral Health Epidemiology, Implementation, and Evaluation Research, Durham, North Carolina, USA
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11
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Saing CH, Prem K, Uk P, Chann N, Chhoun P, Mun P, Tuot S, Yi S. Prevalence and social determinants of psychological distress among people who use drugs in Cambodia. Int J Ment Health Syst 2020; 14:77. [PMID: 33292352 PMCID: PMC7640420 DOI: 10.1186/s13033-020-00411-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/29/2020] [Indexed: 01/04/2023] Open
Abstract
Background People who use drugs are at a disproportionately higher risk of mental disorders due to prolonged exposure to psychosocial challenges. However, studies on mental health among people who use drugs in resource-constrained countries are scarce. This study sheds light on the prevalence and correlates of psychological distress among people who use drugs in Cambodia. Methods We conducted this cross-sectional study in the capital city and 11 provinces in 2017. The Respondent Driven Sampling method was adapted to recruit 1677 people who used drugs for face-to-face interviews using a structured questionnaire. Psychological distress was measured using the General Health Questionnaire (GHQ-12). A total score of GHQ-12 > 2 indicated high psychological distress. We performed a multiple logistic regression analysis to identify factors associated with psychological distress. Results We included 1598 participants in the analyses, with a mean age of 28.6 years (SD = 7.8). Of the total, 42% had high psychological distress – 50% in women and 37% in men. The adjusted odds of having high psychological distress were significantly higher among participants who were 25–34 years old and 35 years and above, had been to a drug rehabilitation center, had been insulted by family members, and had been sexually harassed/abused by someone when they were growing up. The odds of having high psychological distress were significantly lower among participants who were male, lived in their own dwelling, reported injecting as the mode of the first drug use, and had someone taking care of them when they got sick. Conclusions This study documents a high prevalence of psychological distress among people who use drugs in Cambodia. Intervention programs that attempt to address mental health problems among people who use drugs in resource-limited settings should be gender- and age-sensitive and target more marginalized subpopulations. Mental health services can be integrated into HIV and harm-reduction programs for people who use drugs.
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Affiliation(s)
- Chan Hang Saing
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.,Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ponha Uk
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Navy Chann
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Phalkun Mun
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore. .,KHANA Center for Population Health Research, Phnom Penh, Cambodia. .,Center for Global Health Research, Touro University California, Vallejo, CA, USA. .,School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia.
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12
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Donmez Z, Gica S, Unubol B, Iyisoy MS, Gulec H. The effect of attention deficit hyperactivity disorder comorbidity on cognitive functions and severity of addiction in opioid use disorder. J Ethn Subst Abuse 2020; 20:295-315. [PMID: 32838695 DOI: 10.1080/15332640.2020.1808870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study is to determine the changes in social cognition and other cognitive domains in ADHD comorbidity and to investigate the possible moderation role of these changes in OUD. A hundered inpatients with OUD were included in the study. Cognitive functions, severity of addiction and symptomatology of ADHD were evaluated. ASRS and API scores were in positive correlation and ASRS scores had a moderating effect on the relationship between craving score and emotion recognition. Our study shows that changes in social environment/cognition play an important role in the follow-up/treatment of patients.
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Affiliation(s)
- Zeliha Donmez
- Department of Psychiatry, Istanbul Umraniye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Sakir Gica
- Department of Psychiatry, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Basak Unubol
- Department of Psychiatry, Istanbul Erenkoy Mental Health and Neurological Disease Education and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - M Sinan Iyisoy
- Department of Medical Education and Informatics, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Huseyin Gulec
- Department of Psychiatry, Istanbul Erenkoy Mental Health and Neurological Disease Education and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
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13
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Bezerra-Karounis MA, Krahe TE, Maisonnette S, Landeira-Fernandez J. Alcohol intake in Carioca High- and Low-conditioned Freezing rats. Pharmacol Biochem Behav 2020; 197:173019. [PMID: 32827503 DOI: 10.1016/j.pbb.2020.173019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 11/28/2022]
Abstract
Evidence from clinical and epidemiological studies point towards an association between generalized anxiety disorder (GAD) and alcohol abuse. In the present study we investigated whether a similar relationship could be observed in an animal model of GAD. Specifically, we evaluated the alcohol intake of Carioca High- and Low-conditioned Freezing rats (CHF and CLF, respectively). Sex differences in alcohol drinking behavior were also studied. Male and female rats from randomized crossbreeding populations served as controls (CTL). Free- and forced-choice protocols were used to measure alcohol consumption, and quinine and saccharin were used as taste control solutions. Our results indicate that CHF rats consumed more alcohol than CLF and CTL ones in both the free-choice (6 and 10% concentrations) and the forced-choice (10% concentration) conditions. CHF female rats exhibited the highest amount of alcohol intake in the forced-choice condition. CHF females also consumed more quinine than CHF male rats. Finally, CHF rats exhibited lower saccharin consumption compared to CLF and CTL animals. Altogether, these results support the hypothesis that there is a positive relationship between anxiety and alcohol intake, and provide further evidence for the use of CHF rats as a model of GAD.
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Affiliation(s)
| | - Thomas E Krahe
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Silvia Maisonnette
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - J Landeira-Fernandez
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil.
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14
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Susukida R, Mojtabai R, Amin-Esmaeili M. Validation of Addiction Severity Index (ASI) for Assessment of Psychiatric Comorbidity in Multi-Site Randomized Controlled Trials. J Dual Diagn 2020; 16:312-321. [PMID: 32254003 DOI: 10.1080/15504263.2020.1741755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective: This study aimed to assess the validity of the psychiatric problems subscale of the Addiction Severity Index (ASI-psych) to ascertain psychiatric comorbidity among individuals participating in randomized controlled trials (RCTs) of substance use disorder (SUD) treatments.Methods: The ASI-psych score among 1,660 RCT participants of National Institute of Drug Abuse Clinical Trials Network studies was compared against diagnosis of any serious mental disorder based on the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (SCID) or Mini-International Neuropsychiatric Interview (MINI). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) for detecting any serious mental disorders were estimated by the receiver operating characteristic (ROC) analysis.Results: Based on the overall sample, the AUC score for any serious mental disorder was 0.72 (95% confidence interval [CI], [0.69, 0.75]) with the optimal ASI-psych score of 24.6. There was no statistically significant difference in AUCs based on the SCID and MINI (χ2 = 0.05, p = .82) or by target drugs of RCTs (χ2 =1.33, p = .72).Conclusions: Results support the utility of the ASI in screening for psychiatric comorbidity among patients receiving SUD treatments in RCT settings.
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Affiliation(s)
- Ryoko Susukida
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Masoumeh Amin-Esmaeili
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
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15
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Ganz O, Rimal RN, Johnson AL, Cohn AM, Horn K, Delnevo CD, Villanti AC. Tobacco use and the interplay of internalizing, externalizing and substance use problems: A latent class analysis of data from the Population Assessment of Tobacco and Health Study. Drug Alcohol Depend 2019; 205:107686. [PMID: 31706253 DOI: 10.1016/j.drugalcdep.2019.107686] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/04/2019] [Accepted: 10/14/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cigarette smoking is disproportionately high among adults with two or more psychiatric disorders (psychiatric comorbidities), yet research on non-cigarette tobacco use among this population is scant. Additionally, most studies on tobacco use this among this population rely on psychiatric diagnoses rather than individual symptoms, potentially excluding individuals with symptom-specific issues that increase their risk for tobacco use but do not meet the criteria for diagnosis. The objectives of this study were to identify unique classes of individuals based on symptoms of psychiatric disorders and to assess differences in demographic characteristics and tobacco use behaviors between classes. METHODS This study used data from Wave 2 of the Population Assessment of Tobacco and Health Study adult dataset. Latent class analysis was used to classify individuals based on internalizing, externalizing and substance use problems. Bivariate and multivariable models examined the association between latent class membership and current use of cigarettes, cigar products, electronic nicotine delivery systems, pipe, hookah and smokeless tobacco products. Poly tobacco use was also examined. RESULTS Three latent classes were identified. The "normative" class reported low prevalence of all symptoms, the "severe internalizing and non-violent externalizing" class reported severe internalizing problems and non-violent externalizing problems and the "severe" class reported high prevalence of all symptoms. Tobacco use was highest for the "severe" class and lowest for the "normative" class across products. CONCLUSIONS Individuals in the "severe" class may be at elevated risk of tobacco-related morbidity and mortality and would likely benefit from targeted tobacco control interventions.
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Affiliation(s)
- Ollie Ganz
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Washington, DC 20052, United States.
| | - Rajiv N Rimal
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Washington, DC 20052, United States; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States
| | - Amanda L Johnson
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Oklahoma City, Oklahoma 73104, United States
| | - Amy M Cohn
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Oklahoma City, Oklahoma 73104, United States; Department of Oncology, Georgetown University Medical Center, 3800 Reservoir Rd. NW, Washington D.C. 20057, United States
| | - Kimberly Horn
- Department of Population Health Sciences, Virginia Tech Carilion Research Institute, 2 Riverside Circle, Roanoke, VA 24016, United States
| | - Cristine D Delnevo
- Center for Tobacco Studies, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, United States
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, University of Vermont, 1 South Prospect Street, Burlington, VT 05401, United States; Department of Psychiatry, University of Vermont, 1 South Prospect Street, Burlington, VT 05401, United States
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16
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Kneeland ET, Griffin ML, Taghian N, Weiss RD, McHugh RK. Associations between pain catastrophizing and clinical characteristics in adults with substance use disorders and co-occurring chronic pain. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:488-494. [DOI: 10.1080/00952990.2019.1581793] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Elizabeth T. Kneeland
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Margaret L. Griffin
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Nadine Taghian
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA, USA
| | - Roger D. Weiss
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - R. Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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17
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Asadullin AR, Yuldashev VL, Asadullina GM, Akhmetova EA, Ishchenko KA. The safety and efficacy of alimemazine (teraligen) in relieving anxiety in patients with alcohol addiction. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:39-44. [DOI: 10.17116/jnevro20181181239-44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Domenico LH, Lewis B, Hazarika M, Nixon SJ. Characterizing Anxiety Among Individuals Receiving Treatment for Alcohol and Substance Use Disorders. J Am Psychiatr Nurses Assoc 2018; 24:343-351. [PMID: 29126358 PMCID: PMC5930139 DOI: 10.1177/1078390317739106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite high prevalence of generalized anxiety disorder (GAD) substance use disorder (SUD) comorbidity, little is known regarding demographic characteristics associated with GAD in SUD treatment seekers. OBJECTIVE To characterize demographic differences between inpatient SUD treatment seekers reporting varying levels of GAD symptomatology. DESIGN General linear models, chi-square test, t test, and correlational analyses were utilized to assess group differences. Groups included those with no history of significant anxiety (No GAD; n = 256), subclinical anxiety (Subclinical; n = 85), and those meeting GAD diagnostic criteria (GAD; n = 61). RESULTS The No GAD group differed substantially from Subclinical and GAD individuals. With the exception of polysubstance use, no differences were found regarding Subclinical and GAD groups. CONCLUSION Individuals with subclinical GAD symptoms and those meeting diagnostic criteria were nearly identical regarding precursors to problematic substance use, severity of use, and key mental health indicators. Findings suggest subclinical levels of GAD should not be overlooked when assessing and treating SUDs.
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Affiliation(s)
- Lisa H Domenico
- 1 Lisa H. Domenico, PhD, University of Florida, Gainesville, FL, USA
| | - Ben Lewis
- 2 Ben Lewis, PhD, University of Florida, Gainesville, FL, USA
| | - Mythili Hazarika
- 3 Mythili Hazarika, PhD, Gauhati Medical College Hospital, Guwahati, Assam, India
| | - Sara Jo Nixon
- 4 Sara Jo Nixon, PhD, University of Florida, Gainesville, FL, USA
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19
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Madrid Study (Spain) on the Prevalence and Characteristics of Outpatients With Dual Disorders. ADDICTIVE DISORDERS & THEIR TREATMENT 2017. [DOI: 10.1097/adt.0000000000000119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Campêlo SR, Barbosa MA, Dias DR, Caixeta CC, Leles CR, Porto CC. Association between severity of illicit drug dependence and quality of life in a psychosocial care center in BRAZIL: cross-sectional study. Health Qual Life Outcomes 2017; 15:223. [PMID: 29149893 PMCID: PMC5693571 DOI: 10.1186/s12955-017-0795-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 11/02/2017] [Indexed: 11/26/2022] Open
Abstract
Background Quality of life must be one of the main purposes for the treatment of drug users, requiring a better understanding of the association between the quality of life and the severity of dependency. This study aimed to investigate the correlation between severity of substance use in various areas of human functioning and quality of life of illicit drug users in a psychosocial care center for alcohol and drugs. Methods This cross-sectional study included 60 participants – illicit drug users – treated at a psychosocial care center for alcohol and drugs. Participants were evaluated with the short version of World Health Organization Quality of Life (WHOQOL-Bref) instrument to measure the quality of life, the 6th version of Addiction Severity Index (ASI-6) to assess the severity of dependence in several areas and the Mini International Neuropsychiatric Interview (MINI) to identify the presence of psychiatric disorders. Pearson and Spearman correlation tests and linear regression were applied to verify the association between the severity of dependence and the quality of life, and Student’s t-test to compare the mean quality of life between individuals with and without psychiatric comorbidities. Results Negative correlation was found between the severity of dependence on the drugs dimensions: alcohol, psychiatric, medical, legal, family/social support and family/social problems of ASI-6, and the quality of life domains measured by the WHOQOL-Bref. The evidence was strongest in the psychiatric and medical dimensions. There was a significant difference in the quality of life mean among participants presenting or not presenting psychiatric comorbidities, for the psychological domain in anxiety disorders, and for the physical and psychological domains in mood disorders. Conclusion The quality of life decreased as the severity of dependence increased, with different results in the various areas of the participant’s life. This result emphasizes the need for training the professional team which works in the substance use disorders area for more comprehensive diagnostic evaluations and more appropriate therapeutic interventions for each area. The associations were more evident in the medical and psychiatric fields, indicating the need for greater attention to be paid in relation to medical and psychiatric comorbidities. Electronic supplementary material The online version of this article (10.1186/s12955-017-0795-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Selva Rios Campêlo
- Medical School, Federal University of Goiás, Rua B4, Qd 5, Lt 6, Casa 2, Setor Bueno CEP, Goiás, 74210-103, Brazil.
| | | | | | | | | | - Celmo Celeno Porto
- Medical School, Federal University of Goiás, Rua B4, Qd 5, Lt 6, Casa 2, Setor Bueno CEP, Goiás, 74210-103, Brazil
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21
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Blanco C, Wall MM, Wang S, Olfson M. Examining heterotypic continuity of psychopathology: a prospective national study. Psychol Med 2017; 47:2097-2106. [PMID: 28399956 DOI: 10.1017/s003329171700054x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Individuals with one psychiatric disorder are at increased risk for incidence and recurrence of other disorders. We characterize whether the magnitude of such heterotypic continuity varies based on whether the first disorder remits or persists over time. METHOD Cohorts were selected from participants in the National Epidemiologic Survey on Alcohol and Related Conditions wave 1 (2001-2002) and wave 2 (2004-2005) surveys with ⩾1 mood, anxiety, or substance use disorder at wave 1. Among respondents remitting (n = 6719) or not remitting (n = 3435) from ⩾1 of disorder at wave 2, the analyses compared the odds of developing new disorders. RESULTS As compared with adults whose disorders persisted from wave 1 to wave 2, those with ⩾1 remission had lower odds of incidence or recurrence of another disorder. Remission from alcohol dependence [odds ratio (OR) 0.4, 95% confidence interval (CI) 0.3-0.5] and drug dependence (OR 0.4, 95% CI 0.3-0.6) were associated with the lowest odds of incidence of another disorder. Social anxiety disorder was associated with the lowest adjusted odds of recurrence (adjusted OR = 0.2, 95% CI 0.1-0.6). Remission of disorders within one class (mood, anxiety, substance use) was consistently associated with lower odds of incidence or recurrence of disorders from the same class than with developing disorders from the other classes. CONCLUSIONS Remission from common psychiatric disorders tends to decrease the risk for incidence or recurrence of disorders and this effect is stronger within than across disorder classes. These results do not support the concept of heterotypic continuity as a substitution of one disorder for another.
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Affiliation(s)
- C Blanco
- Division of Epidemiology,Services and Prevention Research,National Institute on Drug Abuse (NIDA),Bethesda,MD,USA
| | - M M Wall
- Department of Psychiatry,Columbia University/New York State Psychiatric Institute,1051 Riverside Drive,New York,NY 10032,USA
| | - S Wang
- Department of Psychiatry,Columbia University/New York State Psychiatric Institute,1051 Riverside Drive,New York,NY 10032,USA
| | - M Olfson
- Department of Psychiatry,Columbia University/New York State Psychiatric Institute,1051 Riverside Drive,New York,NY 10032,USA
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22
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Korsgaard HO, Torgersen S, Wentzel-Larsen T, Ulberg R. Substance abuse and personality disorder comorbidity in adolescent outpatients: are girls more severely ill than boys? Child Adolesc Psychiatry Ment Health 2016; 10:8. [PMID: 27069507 PMCID: PMC4827187 DOI: 10.1186/s13034-016-0096-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Substance use disorders (SUDs) constitute a major health problem and are associated with an extensive psychiatric comorbidity. Personality disorders (PDs) and SUDs commonly co-occur. Comorbid PD is characterized by more severe addiction problems and by an unfavorable clinical outcome. The present study investigated the prevalence of SUDs, PDs and common Axis I disorders in a sample of adolescent outpatients. We also investigated the association between PDs and SUDs, and how this association was influenced by adjustment for other Axis I disorders, age and gender. METHODS The sample consisted of 153 adolescents, aged 14-17 years, who were referred to a non-specialized mental health outpatient clinic with a defined catchment area. SUDs and other Axis I conditions were assessed using the mini international neuropsychiatric interview. PDs were assessed using the structured interview for DSM-IV personality. RESULTS 18.3 % of the adolescents screened positive for a SUD, with no significant gender difference. There was a highly significant association between number of PD symptoms and having one or more SUDs; this relationship was practically unchanged by adjustment for gender, age and presence of Axis I disorders. For boys, no significant associations between SUDs and specific PDs, conduct disorder (CD) or attention deficit hyperactivity disorder (ADHD) were found. For girls, there were significant associations between SUD and BPD, negativistic PD, more than one PD, CD and ADHD. CONCLUSIONS We found no significant gender difference in the prevalence of SUD in a sample of adolescents referred to a general mental health outpatient clinic. The association between number of PD symptoms and having one or more SUDs was practically unchanged by adjustment for gender, age and presence of one or more Axis I disorders, which suggested that having an increased number of PD symptoms in itself may constitute a risk factor for developing SUDs in adolescence. The association in girls between SUDs and PDs, CD and ADHD raises the question if adolescent girls suffering from these conditions may be especially at risk for developing SUDs. In clinical settings, they should therefore be monitored with particular diligence with regard to their use of psychoactive substances. Trial registration The regional committee for medical research ethics for eastern Norway approved the study protocol in October 2004 (REK: 11395). Address correspondence and reprint requests to: Hans Ole Korsgaard, The Nic Waal Institute, Lovisenberg Diakonale Hospital, P.O. Box 2970 Nydalen, N-0440 Oslo, Norway; E-mail hansole.korsgaard@tele5.no.
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Affiliation(s)
- Hans Ole Korsgaard
- Department for Child and Adolescent Mental Health (The Nic Waal Institute), Lovisenberg Diakonale Hospital, Oslo, Norway
| | | | - Tore Wentzel-Larsen
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway ,Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Randi Ulberg
- Vestfold Hospital Trust, Tønsberg, Norway ,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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23
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Ferrer E, Conger RD, Robins RW. Longitudinal Dynamics of Substance Use and Psychiatric Symptoms in Count Data with Zero Inflation. MULTIVARIATE BEHAVIORAL RESEARCH 2016; 51:279-295. [PMID: 27049692 DOI: 10.1080/00273171.2016.1144501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We examine the dynamics of substance use and psychiatric symptoms from childhood to adolescence using a longitudinal study of Mexican-origin families (N = 674). We present a longitudinal model capturing the trajectories of substance use and psychiatric symptoms (depression, conduct disorder), as well as the interrelations between these trajectories over time. Such a model is an extension of latent change score models designed to account for the occurrence of psychiatric symptoms while also accommodating a large amount of zeros for nonoccurrence and characterizing the changes over time in the count data. We compare this model with a more traditional approach based on a log transformation of the data. We describe differences between these approaches and highlight the benefits of using the two-part model when the data include a large amount of zeros for nonoccurrence of the behavior.
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24
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Erickson J, Kinley DJ, Afifi TO, Zamorski MA, Pietrzak RH, Stein MB, Sareen J. Epidemiology of generalized anxiety disorder in Canadian military personnel. JOURNAL OF MILITARY VETERAN AND FAMILY HEALTH 2015. [DOI: 10.3138/jmvfh.2014-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: This study examined the prevalence, clinical characteristics, help seeking patterns, and military experiences associated with past-year generalized anxiety disorder (GAD) using a representative sample of military personnel. Methods: Data were from the Canadian Community Health Survey–Canadian Forces Supplement ( n = 5,115 Regular Force, n = 3,286 Reserve Force), conducted by Statistics Canada on behalf of the Department of National Defence in 2002. GAD and other mental disorders were assessed using the World Mental Health Composite International Diagnostic Interview. Clinical features of GAD of interest included mean age of onset and episode length, symptoms, degree of impairment and co-occurring disorders, and perceived need for help and help seeking. Multivariate logistic regression models were conducted to examine the sociodemographic, military characteristics, and mental disorders correlated with past-year GAD. Results: Past-year and lifetime prevalence rates of GAD were 1.7% and 4.4%, respectively. The majority of military personnel with past-year GAD reported being severely impaired at work and in their relationships and social life. Those with past-year GAD, relative to those without it, had higher odds of having another mental disorder. Of military personnel with past-year GAD, 72.2% had sought help. Regular Force personnel, relative to reservists, had higher odds of having past-year GAD, as did individuals who witnessed atrocities. Discussion: GAD is modestly prevalent in the Canadian military and is associated with considerable functional impairment. Nevertheless, high rates of help seeking for GAD may speak to the availability, accessibility, and acceptability of mental health care in the Canadian Armed Forces.
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Affiliation(s)
- Julie Erickson
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - D. Jolene Kinley
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tracie O. Afifi
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mark A. Zamorski
- Directorate of Mental Health, Canadian Forces Health Services Group Headquarters, Ottawa, Ontario, Canada
- Deceased August 17, 2018
| | - Robert H. Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Murray B. Stein
- Departments of Psychiatry and Family and Preventative Medicine, University of California, San Diego, California, USA
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
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Abstract
Anxiety disorders commonly co-occur with substance use disorders both in the general population and in treatment-seeking samples. This co-occurrence is associated with greater symptom severity, higher levels of disability, and poorer course of illness relative to either disorder alone. Little research has been conducted, however, on the treatment of these co-occurring disorders. This gap may not only leave anxiety untreated or undertreated but also increase the risk for relapse and poor substance use outcomes. The aim of this article is to review the current state of the literature on treating co-occurring anxiety and substance use disorders. In addition to presenting a brief overview of the epidemiology of this co-occurrence, the article discusses the challenges in assessing anxiety in the context of a substance use disorder, the evidence for various treatment approaches, and recent advances and future directions in this understudied area. Also highlighted is the need for future research to identify optimal behavioral and pharmacologic treatments for co-occurring anxiety and substance use disorders.
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26
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Blanco C, Okuda M, Wang S, Liu SM, Olfson M. Testing the drug substitution switching-addictions hypothesis. A prospective study in a nationally representative sample. JAMA Psychiatry 2014; 71:1246-53. [PMID: 25208305 PMCID: PMC4797944 DOI: 10.1001/jamapsychiatry.2014.1206] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Adults who remit from a substance use disorder (SUD) are often thought to be at increased risk for developing another SUD. A greater understanding of the prevalence and risk factors for drug substitution would inform clinical monitoring and management. OBJECTIVE To determine whether remission from an SUD increases the risk of onset of a new SUD after a 3-year follow-up compared with lack of remission from an SUD and whether sociodemographic characteristics and psychiatric disorders, including personality disorders, independently predict a new-onset SUD. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study where data were drawn from a nationally representative sample of 34 653 adults from the National Epidemiologic Survey on Alcohol and Related Conditions. Participants were interviewed twice, 3 years apart (wave 1, 2001-2002; wave 2, 2004-2005). MAIN OUTCOMES AND MEASURES We compared new-onset SUDs among individuals with at least 1 current SUD at wave 1 who did not remit from any SUDs at wave 2 (n = 3275) and among individuals with at least 1 current SUD at wave 1 who remitted at wave 2 (n = 2741). RESULTS Approximately one-fifth (n = 2741) of the total sample had developed a new-onset SUD at the wave 2 assessment. Individuals who remitted from 1 SUD during this period were significantly less likely than those who did not remit to develop a new SUD (13.1% vs 27.2%, P < .001). Results were robust to sample specification. An exception was that remission from a drug use disorder increased the odds of a new SUD (odds ratio [OR] = 1.46; 95% CI, 1.11-1.92). However, after adjusting for the number of SUDs at baseline, remission from drug use disorders decreased the odds of a new-onset SUD (OR = 0.66; 95% CI, 0.46-0.95) whereas the number of baseline SUDs increased those odds (OR=1.68; 95% CI, 1.43-1.98). Being male, younger in age, never married, having an earlier age at substance use onset, and psychiatric comorbidity significantly increased the odds of a new-onset SUD during the follow-up period. CONCLUSIONS AND RELEVANCE As compared with those who do not remit from an SUD, remitters have less than half the risk of developing a new SUD. Contrary to clinical lore, achieving remission does not typically lead to drug substitution but rather is associated with a lower risk of new SUD onsets.
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Affiliation(s)
- Carlos Blanco
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York
| | - Mayumi Okuda
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York
| | - Shuai Wang
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York
| | - Shang-Min Liu
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York
| | - Mark Olfson
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York
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Brook JS, Lee JY, Rubenstone E, Brook DW, Finch SJ. Triple comorbid trajectories of tobacco, alcohol, and marijuana use as predictors of antisocial personality disorder and generalized anxiety disorder among urban adults. Am J Public Health 2014; 104:1413-20. [PMID: 24922120 DOI: 10.2105/ajph.2014.301880] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES We modeled triple trajectories of tobacco, alcohol, and marijuana use from adolescence to adulthood as predictors of antisocial personality disorder (ASPD) and generalized anxiety disorder (GAD). METHODS We assessed urban African American and Puerto Rican participants (n = 816) in the Harlem Longitudinal Development Study, a psychosocial investigation, at 4 time waves (mean ages = 19, 24, 29, and 32 years). We used Mplus to obtain the 3 variable trajectories of tobacco, alcohol, and marijuana use from time 2 to time 5 and then conducted logistic regression analyses. RESULTS A 5-trajectory group model, ranging from the use of all 3 substances (23%) to a nonuse group (9%), best fit the data. Membership in the trajectory group that used all 3 substances was associated with an increased likelihood of both ASPD (adjusted odds ratio [AOR] = 6.83; 95% CI = 1.14, 40.74; P < .05) and GAD (AOR = 4.35; 95% CI = 1.63, 11.63; P < .001) in adulthood, as compared with the nonuse group, with control for earlier proxies of these conditions. CONCLUSIONS Adults with comorbid tobacco, alcohol, and marijuana use should be evaluated for use of other substances and for ASPD, GAD, and other psychiatric disorders. Treatment programs should address the use of all 3 substances to decrease the likelihood of comorbid psychopathology.
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Affiliation(s)
- Judith S Brook
- Judith S. Brook, Jung Yeon Lee, Elizabeth Rubenstone, and David W. Brook are with the Department of Psychiatry, New York University School of Medicine, New York, NY. Stephen J. Finch is with the Department of Applied Mathematics & Statistics, Stony Brook University, Stony Brook, NY
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28
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Verdura Vizcaíno EJ, Fernández-Navarro P, Petry N, Rubio G, Blanco C. Differences between early-onset pathological gambling and later-onset pathological gambling: data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Addiction 2014; 109:807-13. [PMID: 25006638 DOI: 10.1111/add.12461] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To examine differences between early-onset versus later-onset pathological gamblers in socio-demographic characteristics, rates of Axis I and II disorders, preferred type of gambling and rates of treatment-seeking in a large nationally representative survey of adults in the United States. DESIGN Data were collected from face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM-IV version IV (AUDADIS-IV). SETTING AND MEASUREMENT: The study drew on data from the United States' National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). PARTICIPANTS All individuals with a DSM-IV diagnosis of pathological gambling (PG). To be consistent with prior studies, age of onset of PG was dichotomized as 25 years and younger (early-onset) versus 26 years and older (later-onset). FINDINGS Individuals with early-onset PG were more likely than individuals with later-onset PG to be male [odds ratio (OR) = 2.86; 95% confidence interval (CI) = 1.20, 6.82], never married (OR = 3.51; 95% CI = 1.39, 8.84), to have income below US$70 000 (OR = 0.09; 95% CI = 0.01, 0.61), to belong to younger cohorts (OR = 0.93; 95% CI = 0.89, 0.97) and to have a cluster B personality disorder (OR = 4.11; 95% CI = 1.77, 9.55), but less likely to have a mood disorder (OR = 0.42; 95% CI = 0.19, 0.94). There were no differences between individuals with early- and later-onset PG regarding rates of treatment-seeking (OR = 0.71; 95% CI = 0.20, 2.43) or preferred type of gambling (OR = 2.00; 95% CI = 0.55, 7.3). All results remained significant after adjusting for age, sex and race, except the difference in the prevalence for mood disorders, which was no longer significant. CONCLUSIONS Individuals with early-onset versus later-onset pathological gambling differ in several socio-demographic and clinical characteristics, but not in their preferred types of game. Individuals from more recent cohorts appear to be at significantly increased risk for developing early-onset pathological gambling.
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Affiliation(s)
| | - Pablo Fernández-Navarro
- Cancer and Environmental Epidemiology Unit; National Center for Epidemiology (Carlos III Institute of Health); Madrid Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP); Madrid Spain
| | - Nancy Petry
- University of Connecticut Health Center; Farmington CT USA
| | - Gabriel Rubio
- Psychiatry Service; Hospital 12 de Octubre de Madrid/Universidad Complutense de Madrid; Madrid Spain
- Red de Trastornos Adictivos (RTA); Madrid Spain
| | - Carlos Blanco
- Department of Psychiatry; New York State Psychiatric Institute/Columbia University; New York NY USA
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Association of comorbid generalized anxiety disorder and alcohol use disorder symptoms with health-related quality of life: results from the National Epidemiological Survey on Alcohol and Related Conditions. J Addict Med 2014; 7:394-400. [PMID: 24145158 DOI: 10.1097/adm.0b013e31829faa1c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although prior studies have documented the co-occurrence of generalized anxiety disorder (GAD) and alcohol use disorder (AUD) disorder, there is a paucity of research assessing the patterns of alcohol involvement among individuals with GAD symptoms. This study investigated subtypes, or classes, of comorbid AUD and GAD symptoms, and assessed the association of class membership with health-related quality of life. METHODS Using data from the Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions, a latent class analysis was performed on the subset of individuals who were current drinkers and had reported ever experiencing a 6-month episode of feeling tense, nervous, or worried most of the time. We examined the association of these latent classes with physical and mental health-related quality of life measured by the Short Form-12, version 2. RESULTS Latent class analysis identified a 5-class model of AUD and GAD symptoms. A significant graded relationship was observed between the ordered classes and severity of impairment on the mental health scale of the Short Form-12, version 2, but no significant relationship was found with the physical health scale. CONCLUSIONS Mental, but not physical, health-related quality of life in this population is associated with both the number and pattern of comorbid GAD and AUD symptoms.
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Chang YP, Compton P. Management of chronic pain with chronic opioid therapy in patients with substance use disorders. Addict Sci Clin Pract 2013; 8:21. [PMID: 24341916 PMCID: PMC3904483 DOI: 10.1186/1940-0640-8-21] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 12/05/2013] [Indexed: 01/02/2023] Open
Abstract
Substance use disorders (SUDs), whether active or in remission, are often encountered in patients with chronic nonmalignant pain. Clinicians are challenged when managing chronic pain while facing substance abuse issues during the course of chronic opioid therapy (COT). Further, the interrelated behavioral symptomatology of addiction and chronic pain suggests that if one disorder is untreated, effective treatment of the other in not possible. Incomplete understanding of the overlapping presentations of the two disorders, coupled with insufficient management of both conditions, leads to undertreated pain and premature discharge of SUD patients from pain treatment. In order to achieve pain relief and optimal functionality, both conditions need to be carefully managed. This paper reviews the prevalence of SUDs in chronic pain patents; the overlapping presentation of the two disorders; risk factors and stratification for addiction; identification of addiction in the chronic pain population; and suggestions for treating patients with COT, with an emphasis on relapse prevention. With appropriate assessment and treatment, COT for chronic pain patients with a history of SUD can be successful, leading to improved functionality and quality of life.
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Affiliation(s)
- Yu-Ping Chang
- University of Buffalo School of Nursing, Buffalo, 3435 Main Street Wende Hall 201E, Buffalo, NY 14221, USA.
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