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Stetsiv K, McNamara IA, Nance M, Carpenter RW. The Co-occurrence of Personality Disorders and Substance Use Disorders. Curr Psychiatry Rep 2023; 25:545-554. [PMID: 37787897 PMCID: PMC10798162 DOI: 10.1007/s11920-023-01452-6] [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] [Accepted: 09/03/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE OF REVIEW Despite significant negative outcomes, the co-occurrence of personality disorders (PDs) and substance use disorders (SUDs) continues to be underrecognized, and the mechanisms contributing to this co-occurrence remain unclear. This review summarizes recent work on PD-SUD co-occurrence, with a focus on borderline and antisocial PDs, general substance use patterns among those with PDs, and the association of personality traits with SUDs. RECENT FINDINGS The prevalence of co-occurring PD-SUD is generally high, with estimates ranging depending on the type of PD and SUD, the population assessed, and the sampling methods and measures used. Current theoretical explanations for co-occurrence include shared etiology and predisposition models, with research highlighting the importance of transactional processes. Potential underlying mechanisms include personality traits and transdiagnostic characteristics. Recent research has increased focus on substances besides alcohol, dimensional models of personality pathology, and transactional explanations of co-occurrence, but more research is needed to disentangle the nuanced PD-SUD relationship.
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Affiliation(s)
- Khrystyna Stetsiv
- Department of Psychological Sciences, University of Missouri, St. Louis, USA
| | - Ian A McNamara
- Department of Psychological Sciences, University of Missouri, St. Louis, USA
| | - Melissa Nance
- Department of Psychological Sciences, University of Missouri, St. Louis, USA
| | - Ryan W Carpenter
- Department of Psychological Sciences, University of Missouri, St. Louis, USA.
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Ellis JD, Pasman E, Brown S, Lister JJ, Agius E, Resko SM. An examination of correlates of simultaneous opioid and benzodiazepine use among patients in medication treatment for opioid use disorder in a small midwestern community. J Addict Dis 2022; 40:542-551. [PMID: 35285423 PMCID: PMC9969715 DOI: 10.1080/10550887.2022.2042152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Concurrent and/or simultaneous use of opioids and benzodiazepines has been associated with increased risk of accident and injury, as well as with co-occurring psychopathology. Objectives: The purpose of the present study was to explore potential correlates of simultaneous opioid and benzodiazepine use in a small community, including perceived risk, positive screens for psychiatric symptoms, and opioid-related consequences. Methods: A sample of 267 participants were recruited from a medication treatment provider that serves a small Midwestern community. Multinomial logistic regression was used to explore demographic and mental health correlates associated with self-reports of past-year simultaneous use. Zero-inflated Poisson regression was used to explore past-year consequences associated with reported simultaneous benzodiazepine and opioid use. Results: Intentional simultaneous use of opioids and benzodiazepines was associated with greater anxiety and depression symptoms, greater likelihood of a positive PTSD screen, and low self-perceived risk of simultaneous use. Individuals reporting opioid/benzodiazepine simultaneous use were also more likely to report opioid-related consequences. Conclusions: Results highlight the importance of assessing and treating simultaneous opioid/benzodiazepine co-use, as well as relevant comorbidities.
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Affiliation(s)
- Jennifer D. Ellis
- Johns Hopkins University School of Medicine, Baltimore, MD
- Wayne State University School of Social Work, Detroit, MI
| | - Emily Pasman
- Wayne State University School of Social Work, Detroit, MI
| | - Suzanne Brown
- Wayne State University School of Social Work, Detroit, MI
| | - Jamey J. Lister
- Wayne State University School of Social Work, Detroit, MI
- Rutgers School of Social Work, New Brunswick, NJ
| | | | - Stella M. Resko
- Wayne State University School of Social Work, Detroit, MI
- Wayne State University Merrill Palmer Skillman Institute, Detroit, MI
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Ellis JD, Rabinowitz JA, Wells J, Liu F, Finan PH, Stein MD, Ii DGA, Hobelmann GJ, Huhn AS. Latent trajectories of anxiety and depressive symptoms among adults in early treatment for nonmedical opioid use. J Affect Disord 2022; 299:223-232. [PMID: 34871638 PMCID: PMC8766934 DOI: 10.1016/j.jad.2021.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Understanding the course of anxiety and depressive symptoms in early opioid use disorder (OUD) treatment may inform efforts to promote positive early treatment response and reduce treatment attrition. METHODS Persons in treatment for nonmedical opioid use were identified from 86 addiction treatment facilities. Growth mixture modeling was used to identify trajectories of anxiety and depression symptoms during the first month of treatment among individuals who screened positive for depression (N = 3016) and/or anxiety (N = 2779) at intake. RESULTS A three-class solution best fit the data for anxiety symptoms and included the following trajectories: (1) persistent moderate-to-severe anxiety symptoms, (2) remitting severe anxiety symptoms, and (3) persistent minimal-to-mild anxiety symptoms. Similarly, a three-class solution best fit the data for depressive symptoms and included trajectories characterized by (1) persistent moderate-to-severe depressive symptoms, (2) persistent moderate depressive symptoms, and (3) mild/remitting depressive symptoms. Persistent moderate-to-severe anxiety and depressive symptoms were predicted by female gender and heavy past-month benzodiazepine co-use. LIMITATIONS Fine grained-information about substance use was not collected. Results may not be generalizable to individuals receiving treatment outside of specialty addiction clinics. CONCLUSIONS Analysis of anxiety and depression symptom trajectories in early treatment suggest that a subset of individuals entering treatment for opioid use experienced persistent and significant anxiety and depressive symptoms, whereas others experience a remission of symptoms. Interventions designed to target individuals at the greatest risk, such as women and individuals reporting opioid/benzodiazepine co-use, may help improve mental health symptoms in early OUD treatment.
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Affiliation(s)
- Jennifer D Ellis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Room 2717, Baltimore, MD 21224, USA
| | - Jill A Rabinowitz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jonathan Wells
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA USA
| | - Fangyu Liu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Room 2717, Baltimore, MD 21224, USA
| | - Michael D Stein
- Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, MA, USA
| | - Denis G Antoine Ii
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Room 2717, Baltimore, MD 21224, USA
| | - Gregory J Hobelmann
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Room 2717, Baltimore, MD 21224, USA; Ashley Addiction Treatment, Havre de Grace, MD, USA
| | - Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Room 2717, Baltimore, MD 21224, USA; Ashley Addiction Treatment, Havre de Grace, MD, USA.
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Peltier MR, Roberts W, Verplaetse TL, Zakiniaeiz Y, Burke C, Moore KE, McKee SA. Sex Differences across Retrospective Transitions in Posttraumatic Stress and Substance Use Disorders. J Dual Diagn 2022; 18:11-20. [PMID: 34965199 PMCID: PMC9086923 DOI: 10.1080/15504263.2021.2016027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives: Concurrent substance use disorder (SUD) and posttraumatic stress disorder (PTSD) occur at high rates and are typically associated with poor treatment outcomes in both sexes. However, women have a propensity to cope with increased negative affect via substance use in comparison to men; thus, it is important to elucidate the sex-specific bidirectional relationships between SUD and PTSD to improve our understanding of concurrent SUD/PTSD in men and women. Methods: Using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-Wave 3; n = 36,309), the present study evaluated the impact of sex on the relationship between past-year SUDs (new, remitted, ongoing), including alcohol and drug use, and retrospective transitions in new vs. absent and ongoing vs. remitted diagnoses of PTSD. Additionally, the impact of sex was explored in models examining past year PTSD (new, remitted, ongoing) and retrospective transitions in new vs. absent and ongoing vs. remitted diagnosis of SUDs. Diagnostic transitions were based on retrospective reporting. Results: Results indicated that new, remitted, and ongoing SUDs increase the likelihood of new PTSD diagnoses (OR range = 2.53-8.11; p < 0.05). Among individuals with ongoing drug use disorders (DUD), there were greater odds of ongoing PTSD (OR = 2.10, p < 0.01). When examining the relationship reciprocally, new, remitted, and ongoing PTSD increased the likelihood of new SUDs (OR range = 2.50-8.22; p < 0.05), and ongoing PTSD increased the likelihood of ongoing SUD and DUD (OR = 1.40, 1.70, respectively; p < 0.05). Sex-specific analyses revealed that the relationship between PTSD and SUDs varies between sexes, particularly among women. For instance, women with new PTSD had higher odds of SUDs, and women with ongoing PTSD were almost 2.5 times more likely to have an ongoing DUD. Women with a new PTSD diagnosis were more likely to be diagnosed with a new SUD (OR = 3.27) and an ongoing DUD (OR = 3.08). Conclusions: Results indicate a bidirectional relationship between PTSD and SUD that is in many instances larger in women. Thus, illustrating potential sex-specific differences in underlying mechanisms implicated in SUD/PTSD, warranting additional research.
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Affiliation(s)
- MacKenzie R Peltier
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Walter Roberts
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Terril L Verplaetse
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Yasmin Zakiniaeiz
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Catherine Burke
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kelly E Moore
- Department of Psychology, Eastern Tennessee State University, Johnson City, Tennessee, USA
| | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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Wojciechowski T. Antisocial Personality Disorder as a Risk Factor for Opioid Use: The Dual Mediating Roles of Antisocial Attitudes and Self-Control. JOURNAL OF DRUG ISSUES 2020. [DOI: 10.1177/0022042620979630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Antisocial personality disorder is a risk factor for opioid use. There is a dearth of research which examines self-control and moral disengagement as potential mediators of this relationship. This study utilized data from the Pathways to Desistance study in analyses. Generalized structural equation modeling was utilized to test for mediation of the relationship between antisocial personality disorder and opioid use. Bootstrapped standard errors were computed so that a Clogg Z test could be estimated to determine if identified mediation effects significantly differed. Results indicated that a likely diagnosis of antisocial personality disorder increased risk for opioid use. Inclusion of moral disengagement and self-control into the model resulted in attenuation of this effect to non-significance and reduced the magnitude of the effect by around 45%. The contribution of both constructs to the total indirect effect did not significantly differ and only the total indirect effect was significant.
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Abstract
PURPOSE OF REVIEW Women with opioid use disorder (OUD) face unique challenges the moment they enter treatment. This narrative review focused on recent literature regarding sex- and gender-based issues that could affect treatment outcomes in women with OUD. RECENT FINDINGS Women respond differently to opioids based on hormonal factors, are more likely to present to treatment with mental health conditions, especially depression, and are more likely to have experienced trauma via intimate partner violence compared with men. Women also face stigma when entering OUD treatment, particularly if they have children. Future research to improve OUD treatment outcomes in women should account for sex as a biological variable and gender as a social construct. Women have a fundamentally different experience than men during the course of OUD and upon treatment entry. Programs that address childcare/family support, mental health, and trauma are warranted for women with OUD.
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Affiliation(s)
- Andrew S Huhn
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA.
| | - Kelly E Dunn
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
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