Additive burdens of malnutrition, poverty, and substance abuse

Globalization and Disability Addiction in Working Populations: Unlocking the Global Correlates to Disability Addiction Calls for the Healthicization of Society

Addiction behavior and the resulting short-term or long-term disabilities continue to increase globally, especially during the current COVID pandemic. We analyze how national measures of 38 global indices correlate with national addiction-related disability rates resulting from four primary addictive substances: alcohol, tobacco, drugs, and food. We utilized a canonical correspondence analysis to explore the relationships between 38 political, economic, and cultural characteristics and years of life lived with a short-term or long-term health loss in 78 countries. The model selection approach reduced 38 global indices to 13 explanatory variables (final model: F 13 = 5·64, p < 0.001 after 1000 permutations). Results show that the following factors are correlated with increased addiction disabilities stemming from obesity, alcohol, drug, and tobacco use: political stability; voice and accountability; control of corruption; economic freedom; women economic opportunity; Human Development Index; individuality; masculinity; long-term orientation; indulgence; uncertainty avoidance; personal contact; and religious diversity. Health care policy makers should consider that national culture, political attributes, and economic characteristics can influence national disability rates resulting from addictions.

Sucrose subjective response and eating behaviors among individuals with opioid use disorder

BACKGROUND

While opioid agonists represent the most efficacious treatment for opioid use disorder (OUD), they may enhance the reinforcing effects of sweets, placing individuals at risk for weight gain and associated consequences. We examined sucrose subjective response among adults receiving opioid agonist treatment vs. a comparison sample without OUD.

METHODS

Forty adults with (OUD+) and 40 without OUD (OUD-) completed an intake battery of eating behaviors and body mass index. During two same-day sessions, participants sampled six experimenter-administered sucrose solutions (0, 0.10, 0.25, 0.50, 0.75, 1.0 M), each three times, under double-blind conditions and rated the pleasantness and intensity of each.

RESULTS

OUD + participants presented with a higher prevalence of obesity and unhealthy eating behaviors vs. OUD- participants (p's < 0.05). They rated sucrose solutions as less pleasant than OUD- participants (p < 0.001), though this effect was limited to the three lowest concentrations (0, 0.10, 0.25M). There were no group differences on intensity ratings (p = 0.35). A change from baseline (placebo) analysis indicated a higher magnitude of change in pleasantness ratings and a lower magnitude of change in intensity ratings from 0M in OUD+ vs. OUD- (p's < 0.05).

CONCLUSIONS

OUD+ participants exhibited a higher magnitude of change in pleasantness ratings from placebo vs. OUD-, which was largely driven by pronounced differences in perceived pleasantness of essentially unsweet solutions. OUD+ participants presented with a consistently more severe profile in regard to eating behaviors. These data highlight the risk factors experienced by OUD+ individuals that extend beyond drug-related risks and may inform future efforts to improve health outcomes.

Associations between neighborhood-level factors and opioid-related mortality: A multi-level analysis using death certificate data

AIM

To identify associations between opioid-related mortality and neighborhood-level risk factors.

DESIGN

Cross-sectional study.

SETTING

Massachusetts, USA.

PARTICIPANTS

Using 2011-14 Massachusetts death certificate data, we identified opioid-related (n = 3089) and non-opioid-related premature deaths (n = 8729).

MEASUREMENTS

The independent variables consisted of four sets of neighborhood-level factors: (1) psychosocial, (2) economic, (3) built environment and (4) health-related. At the individual level we included the following compositional factors: age at death, sex, race/ethnicity, marital status, education, veteran status and nativity. The primary outcome of interest was opioid-related mortality.

FINDINGS

Multi-level models identified number of social associations per 10 000 [odds ratio (OR) = 0.84, P = 0.002, 95% confidence interval (CI) = 0.75-0.94] and number of hospital beds per 10 000 (OR = 0.78, P < 0.001, 95% CI = 0.68-0.88) to be inversely associated with opioid-related mortality, whereas the percentage living in poverty (OR = 1.01, P = 0.008, 95% CI = 1.00-1.01), food insecurity rate (OR = 1.21, P = 0.002, 95% CI = 1.07-1.37), number of federally qualified health centers (OR = 1.02, P = 0.028, 95% CI = 1.02-1.08) and per-capita morphine milligram equivalents of hydromorphone (OR = 1.05, P = 0.003, 95% CI = 1.01-1.08) were positively associated with opioid-related mortality.

CONCLUSIONS

Opioid-related deaths between 2011 and 2014 in the state of Massachusetts appear to be positively associated with the percentage living in poverty, food insecurity rate, number of federally qualified health centers and per-capita morphine milligram equivalents of hydromorphone, but inversely associated with number of social associations per 10 000 and number of hospital beds per 10 000.

Skeletal muscle mass index and phase angle are decreased in individuals with dependence on alcohol and other substances

OBJECTIVE

The aim of this study was to evaluate whether low skeletal muscle mass index (SMI) and low phase angle (PhA) are associated with demographic, clinical, lifestyle, and nutritional status in patients dependent on alcohol and other substances.

METHODS

We prospectively included 63 individuals dependent on alcohol and other substances and 71 age- and sex-matched healthy controls. Body composition was assessed by bioelectrical impedance analysis. Subjective global assessment was used to evaluate malnutrition. All included participants underwent a psychiatric evaluation, including the administration of the Mini-International Neuropsychiatric Interview. Univariate and multivariate analysis were performed to evaluate associations between low skeletal muscle mass index (SMI) and low phase angle (PhA) and nutritional, lifestyle, and alcohol use and cocaine/crack use variables, controlling for sex and age.

RESULTS

Low SMI and low PhA were identified in 11.1% and 44.5% of the substance dependents, respectively. Low midarm muscle circumference (r = 0.58; P < 0.001), low midarm muscle area (r = 051; P < 0.001), and reduced PhA (r = 0.59; P < 0.001) were positively correlated with low SMI. Multivariate analysis showed that heavy alcohol consumption (≥80 g·d· ≥5 y^-1; odds ratio [OR], 2.33; 95% confidence interval [CI], 1.12-4.84; P = 0.02) and sedentary lifestyle (OR, 4.39; 95% CI, 1.29-14.89; P = 0.02) were independently associated with reduced SMI. Low PhA was independently associated with heavy alcohol consumption (OR, 3.64; 95% CI, 1.62-8.15; P = 0.002) and cocaine or crack use (OR, 3.97; 95% CI, 1.05-15.11; P = 0.04) in multivariate analysis.

CONCLUSIONS

Low SMI and low PhA are independently associated with heavy alcohol consumption. Low PhA is independently associated with cocaine or crack use.

Characteristics of Medicaid recipients in Methadone Maintenance Treatment: A comparison across the lifespan

Methadone Maintenance Treatment (MMT) is utilized by an increasingly broad age-range of individuals with opioid use disorders. The present study aims to (1) describe health, behavioral, and psychosocial characteristics among adults aged 50 years and older compared with younger adults enrolled in MMT, (2) describe socioeconomic and clinical characteristics by age and time in MMT and (3) investigate whether age influences the associations between duration of MMT and health and psychosocial characteristics. Our sample consisted of 1364 recipients from four MMT programs (age ranged from 18 to 77 years; mean: 38 years: standard deviation: 11.1 years) in Southern New England Using descriptive analysis and logistic regression, we determined that one-third (33%) of adults 50 years of age and older had been admitted or readmitted into MMT within the previous 6 months, 27% had been in treatment for 7-47 months, while 40% had been in treatment for at least 4 years. Psychosocial problems and smoking were both common (>80%) at the time of MMT enrollment but declined with longer duration of MMT for all age groups. The prevalence of metabolic conditions was associated with increased duration of MMT for younger adults for both age (1.03; CI 1.02-1.05; p < 0.001) and time in treatment (1.29; 1.12-1.44; p < 0.001; interaction term 0.0996; CI 0.993-0.998). Tailored strategies to enhance engagement, retention, and prevention among MMT recipients should include considerations of age, health status upon enrollment, duration of treatment, and developmental context.