ALQOL 9 FOR MEASURING QUALITY OF LIFE IN ALCOHOL DEPENDENCE

A systematic review of quality of life and health-related quality of life as outcomes in substance and behavioural addictions

ISSUES

Consideration of an individual's quality of life (QoL) can benefit assessment and treatment of addictive disorders, however, uncertainty remains over operationalisation of the construct as an outcome and the appropriateness of existing measures for these populations. This systematic review aimed to identify and evaluate QoL and health-related QoL outcome instruments used in addiction-related risk and harm research and map their conceptualised domains.

APPROACH

Three electronic databases and a specialised assessment library were searched on 1 February 2022 for QoL or health-related QoL outcome instruments used with addiction-related risk and harm populations. PRISMA reporting guidance was followed and included outcome instruments were appraised using mixed methods. Psychometric evidence supporting their use was summarised. The COSMIN risk of bias tool was used to assess validation studies.

KEY FINDINGS

A total of 298 articles (330 studies) used 53 outcome instruments and 41 unique domains of QoL. Eleven instruments' psychometric properties were evaluated. No instrument was assessed for any parameter in at least five studies for meta-analytic pooling. Cronbach's alpha (α) internal consistency was the most widely assessed parameter with the AQoLS, WHOQOL-BREF, ALQoL-9, Q-LES-Q-SF, SF-12, DUQoL, QLI and SF-36 displaying promising statistics (α > 0.70).

IMPLICATIONS AND CONCLUSION

Many instruments have been utilised. However, a significant proportion of studies applied a small number of instruments with minimal high-quality validation evidence supporting their use within addiction-related risk and harm. Promising instruments are recommended, however, the paucity of supporting evidence limits confidence in the reliability and validity of QoL measurement in these populations.

Quality of life in patients with alcohol use disorders admitted to de-addiction centers using WHOQOL-BREF scale-A cross-sectional study

BACKGROUND

Alcohol use disorders (AUDs) adversely affect a person's general health and the lives of their family and friends. These disorders are also the most undertreated mental illness with severe implications for public health. Hence, the present study aimed to employ the WHOQOL-BREF to assess the quality of life (QoL) of AUDs patients seeking treatment at de-addiction centers and identify the demographic variables associated with the QoL dimension scores.

MATERIALS AND METHODS

A cross-sectional study was conducted among alcohol dependents taking treatment in de-addiction centers in Dakshina Kannada District, Karnataka. The WHOQOL-BREF questionnaire was administered to 124 subjects. Multiple regression analysis was carried out to identify the demographic variables associated with the QoL dimension scores.

RESULTS

The domain mean scores were between 50 and 60 on the 0 to 100 scale. Age, social class, residential area, marital status, and years of drinking were the demographic variables found to be significantly associated with the dimension scores.

CONCLUSIONS

Physicians should monitor the effect of alcoholism on QoL, and a multidisciplinary treatment plan with elements from the medical, social, and psychiatric fields should be used. The demographic variables should be considered while managing patients with AUDs.

Determinants of health-related quality of life in recently detoxified patients with severe alcohol use disorder

Background

Health-related quality of life (HRQoL) is an important clinical outcome in Alcohol Use Disorder (AUD) and is considered as a relevant indicator of treatment success. While a better understanding of the factors affecting HRQoL would enable to adjust patients’ care to favour treatment outcome, the determinants of HRQoL in AUD remain unclear. This study aims at describing HRQoL in AUD patients and at identifying its best predictors.

Methods

53 recently detoxified patients with severe AUD (sAUD) underwent a cognitive assessment and filled in a HRQoL questionnaire dedicated to AUD patients (Alcohol Quality of Life Scale; AQoLS), as well as questionnaires concerning socio-demographics, alcohol history, sleep quality, depression, anxiety and impulsivity. 38 healthy controls (HC) underwent the same assessment (except AQoLS) in order to identify the altered cognitive and clinical variables that could potentially be determinants of HRQoL in sAUD.

Results

sAUD patients reported that alcohol affects their HRQoL mainly in the “negative emotions”, “control”, “relationships”, and “sleep” domains. Compared to HC, they were impaired on episodic memory, working memory, executive functions, and processing speed tasks. They also reported lower sleep quality, higher depression, anxiety and impulsivity. No association was found between AQoLS total score and socio-demographics, cognitive performance, or sleep quality in patients. We found a significant correlation between HRQoL and depression/anxiety as well as impulsivity. Anxiety and impulsivity were indeed the only significant predictors of HRQoL, explaining 47.7% of the variance.

Conclusion

Anxiety and impulsivity are crucial determinants of HRQoL in recently detoxified sAUD patients. Since anxiety and impulsivity are frequent issues in addiction and especially in AUD, they should be particularly considered by clinicians to favour treatment outcomes.

Psychometric validation of the Japanese version of Alcohol Quality of Life Scale (AQoLS-Japan) in the treatment of patients with alcohol use disorder

Purpose

The Alcohol Quality of Life Scale (AQoLS) is accepted as a useful measure in assessing impact of alcohol use disorders (AUD) on health-related quality of life (HR-QoL) in Western cultures. We aimed to assess the psychometric properties of the Japanese version of the AQoLS (AQoLS-Japan).

Methods

This was a 3-month, observational cohort study in patients undergoing routine treatment for AUD in Japan. HR-QoL was assessed using the AQoLS-Japan (34 items, 7 dimensions). Scale psychometrics were analyzed using correlative techniques.

Results

Data from 132 patients were analyzed. Inter-item and item-scale correlations for the AQoLS-Japan scale were moderate to strong. Confirmatory factor analysis results supported the AQoLS-Japan structure but there was evidence of interdependency among some items and factors. Cronbach’s alpha coefficients for internal consistency ranged from 0.73 to 0.97, and intraclass correlation coefficients for scores between test (baseline) and retest (2 weeks) ranged from 0.65 to 0.82. Convergent and divergent validity and known-groups validity were supported. Evaluation of within-group change demonstrated that the AQoLS-Japan total and domains consistently demonstrated statistically significant improvement (p < 0.001 in all cases) in HR-QoL over time. Estimates for minimal clinically important difference on the AQoLS-Japan total score ranged from 13.2 to 18.2 for group-level change and from 2.4 to 15.7 for a group-level difference.

Conclusions

The AQoLS-Japan is a reliable and valid measure of HR-QoL that is able to demonstrate benefits associated with the routine treatment of AUD in Japan.

Quality of Life and Its Correlates in Alcohol Use Disorder Patients With and Without Depression in China

Objective: Alcohol use disorder (AUD) is a serious issue worldwide and frequently co-occurs with depression. However, the quality of life (QOL) of AUD patients with and without depression is not well studied in the Chinese Han population. The aim of this study was to investigate QOL and its correlates in AUD patients with and without depression in China. Methods: Five hundred and fifteen psychiatric patients diagnosed with AUD were recruited. All these patients completed the Beck Depression Inventory (BDI) to assess depression, the Medical Outcome Study 36-Item Short Form Health Survey (SF-36) to evaluate QOL and the Alcohol Use Disorders Identification Test (AUDIT) to measure the severity of drinking. Results: Compared with AUD patients without depression, those with depression had a lower QOL in all eight domains of the SF-36 (all P < 0.001), but were more willing to have alcohol-related treatment (P < 0.05). Negative correlations were noted between (i) the BDI total score and all eight domains of the SF-36 (all P < 0.001); and (ii) between the AUDIT total score and six domains of the SF-36 (all P < 0.05). Conclusions: Depression impairs QOL in patients with AUD in China. Early intervention in comorbid depression to improve QOL is needed.

Psychiatric comorbidity and quality of life in South African alcohol use disorder patients

BACKGROUND

Understanding the psychopathology accompanying alcohol use disorder (AUD) is important as it impacts negatively on quality of life (QoL) with subsequent implications for treatment and recovery. We evaluated the association of psychiatric comorbidity with QoL among treatment-seeking South African AUD patients.

METHODS

Cross-sectional assessment of 101 (Male, n = 65; 64.5%) patients with AUD was done using the World Health Organisation Quality of Life (WHOQoL)-Bref, the World Health Organisation Disability Assessment Scale (WHODAS) and Mini-International Neuropsychiatric Interview (MINI) to collect QoL, disability and psychopathology data, respectively.

RESULTS

Psychiatric comorbidity was noted in 63 (62.3%) of the patients with most (55.6%) having more than one disorder. Mood (39; 61.9%) and anxiety (33; 52.4%) were the most common co-occurring disorders. Disability scores were not significantly different between comorbidity and gender groups However, QoL scores were significantly lower for participants with comorbidity in three of the four WHOQOL domains and declined with increasing number of psychiatric disorders. Focussing on the two main psychopathologies, participants with anxiety alone consistently had the lowest QoL scores compared to those with neither or both disorders (p < 0.05).

CONCLUSION

The results confirm the well-known high rate of psychiatric comorbidity in patients with AUD and the negative impact it has on QoL. The results should alert clinicians managing AUD patients to screen for comorbid psychopathology and include findings into their treatment plan as this may impact on the patient's QoL.

The Effect of the Cognitive-behavioral Model-based Psychoeducation and Exercise Intervention on Quality of Life in Alcohol Use Disorder

PURPOSE

The aim of the study was to assess the effect of the cognitive behavior model (CBM)-based psychoeducation and exercise intervention on quality of life (QoL) in alcohol use disorder (AUD).

DESIGN

This study was a non-randomized controlled trial.

METHODS

CBM-based psychoeducation and exercise intervention was applied to the experimental group four times a week for 6weeks; no intervention was applied to the control group.

FINDINGS

No difference was seen between the points of pretest QoL of the experimental and control groups (p>0.05). However, according to the posttest, the experimental group's mean score of QoL was higher than the control groups (p<0.05).

CONCLUSION

It was found that CBM-based psychoeducation and exercise intervention applied to individuals with AUD affected the QoL positively.

CLINICAL RELEVANCE

CBM-based psychoeducation and exercise intervention can be used by nurses to improve AUD individuals' quality of life.

The effects of patient and physician characteristics on early outpatient satisfaction with substance dependence care: results of the SUBUSQOL study

BACKGROUND

Although patient perceptions of health care have increasingly been explored in the literature, little is known about care satisfaction among individuals with substance dependence. This exploratory study assessed the relationships between patient and physician characteristics and early outpatient satisfaction with care for alcohol and opioid dependence.

METHODS

Satisfaction was assessed using a multidimensional, self-administered and validated questionnaire during the early care process among a prospective outpatient cohort. In addition to measuring satisfaction and obtaining sociodemographic and clinical data, this study collected data on the self-reported health status and physician characteristics at inclusion. Cross-sectional analysis with multiple linear regression was performed to identify the variables associated with satisfaction level.

RESULTS

A total of 249 outpatients were included, and 63.8% completed the satisfaction questionnaire. Patients without a history of previous care for substance dependence were more satisfied with the appointment-making process (β=7.2; P=0.029) and with the doctor consultation (β=10.3; P=0.003) than those who had received care previously. Neither sociodemographic characteristics nor self-reported health status was associated with outpatient satisfaction.

CONCLUSION

The factors that affect patients' ratings of early satisfaction with the care that they receive should be studied further because increased understanding of the factors that negatively affect these ratings might enable caregivers and outpatient management facilities to improve the patient experience during the early stages of care, which might in turn improve treatment adherence, continuity of care, and other health-related outcomes.

Measuring the impact of alcohol-related disorders on quality of life through general population preferences

OBJECTIVE

To estimate the intangible effects of alcohol misuse on the drinker's quality of life, based on general population preferences METHODS: The most important effects (dimensions) were identified by means of two focus groups conducted with patients and specialists. The levels of these dimensions were combined to yield different scenarios. A sample of 300 people taken from the general Spanish population evaluated a subset of these scenarios, selected by using a fractional factorial design. We used the probability lottery equivalent method to derive the utility score for the evaluated scenarios, and the random-effects regression model to estimate the relative importance of each dimension and to derive the utility score for the rest of scenarios not directly evaluated.

RESULTS

Four main dimensions were identified (family, physical health, psychological health and social) and divided into three levels of intensity. We found a wide variation in the utilities associated with the scenarios directly evaluated (ranging from 0.09 to 0.78). The dimensions with the greatest relative importance were physical health (36.4%) and family consequences (31.3%), followed by psychological (20.5%) and social consequences (11.8%).

CONCLUSIONS

Our findings confirm the benefits of adopting a heterogeneous approach to measure the effects of alcohol misuse. The estimated utilities could have both clinical and economic applications.

Alcohol Dependence, Co-occurring Conditions and Attributable Burden

AIMS

Alcohol dependence is associated with high rates of co-occurring disorders which impact health-related quality of life (HRQoL) and add to the cost-of-illness. This study investigated the burden of alcohol dependence and associated co-occurring conditions on health and productivity.

METHODS

A cross-sectional survey was conducted in eight European countries. Physicians (Psychiatrists and General Practitioners) completed patient record forms, which included assessment of co-occurring conditions, and patients completed matching self-completion forms. Drinking risk level (DRL) was calculated and the relationship between DRL, co-occurring conditions, work productivity, hospitalisations and rehabilitation stays was explored.

RESULTS

Data were collected for 2979 alcohol-dependent patients (mean age 48.8 ± 13.6 years; 70% male). In total, 77% of patients suffered from moderate-to-severe co-occurring psychiatric and/or somatic conditions. High DRL was significantly associated with depression, greater work productivity losses, increased hospitalisations and rehabilitation stays. Co-occurring conditions were significantly associated with poorer HRQoL and decreased work productivity, with a statistical trend towards an increased frequency of rehabilitation stays.

CONCLUSIONS

Alcohol-dependent patients manifest high rates of co-occurring psychiatric and somatic conditions, which are associated with impaired work productivity and HRQoL. The continued burden of illness observed in these already-diagnosed patients suggests an unmet need in both primary and secondary care.

Using the SF-6D to measure the impact of alcohol dependence on health-related quality of life

Alcohol dependence not only reduces life expectancy, but also causes considerable loss of quality of life of the dependents of and persons around those with alcohol dependence. This article presents new evidence on the impact of alcohol dependence on health-related quality of life in Spain. Three samples were recruited: 150 alcoholics and 64 family members of alcoholics, with both samples taken from an alcoholism treatment unit, and 600 persons from the general population. We used the short form 6D, a preference-based generic instrument, applying the utility scores estimated for Spain. It was found that the annual mean loss of quality-adjusted life years associated with alcohol dependence was 0.144 and 0.083 for the alcoholics and their close family members, respectively. This impact becomes more notable after controlling for socio economic variables and was higher than that estimated in similar studies. Possible explanations for these differences are discussed. The results from this work can be applied to economic evaluation studies measuring benefits from policies targeted at reducing the prevalence of alcohol dependence.

Health-related quality of life in alcohol dependence: a systematic literature review with a specific focus on the role of depression and other psychopathology

BACKGROUND

Health-related quality of life (HRQOL) is considered a valid measure of treatment effectiveness in addictions. However, alcohol research has lagged behind other biomedical fields in using HRQOL outcomes as primary or secondary endpoints. Previous work has suggested that psychiatric co-morbidity may mediate the relationship between alcohol dependence and HRQOL.

AIM

The goal was to summarize the literature on HRQOL and its domains in the context of alcohol dependence. A specific focus was on the impact of depression and other psychopathology on these areas of life.

MATERIALS AND METHODS

A database search of MEDLINE and PsychINFO was performed within the scope of PARADISE (Psychosocial fActors Relevant to brAin DISorders in Europe); a European Commission funded coordination action. Using pre-defined eligibility criteria, 42 studies were identified. A systematic approach to data collection was employed.

RESULTS AND CONCLUSIONS

Alcohol dependence was shown to affect overall HRQOL and its domains, including general health, physical and mental health, general and social functioning, activities of daily living, pain and sleep. The evidence demonstrating that alcohol dependence is a primary cause of impairments in overall HRQOL, general health, mental and physical health and social functioning was fairly strong. Treatment interventions helped improve HRQOL and its aforementioned domains. The reduction or cessation of alcohol use facilitated these improvements; however, it was not reported to be predictive of improvement in all instances where improvement was reported. Depression was associated with further decreases in HRQOL. Personality disorders contributed to the severity of social functioning impairment.

A validation study of the English version of the AlQol 9 to measure quality of life

BACKGROUND

Quality of life (QoL) is an important clinical and research outcome within the drug and alcohol abuse context. The AlQoL 9 is a specific questionnaire designed to assess health- and non-health-related consequences of alcoholism. The English version of the AlQoL 9 has not been validated using a larger sample.

OBJECTIVES

The aim of this study was to assess the psychometric properties of the English version of AlQoL 9 in a sample of treatment-seeking individuals in Australia.

METHODS

A sample of 138 participants from inpatient and outpatient treatments facilities completed the AlQoL 9 test and the World Health Organisation Quality of Life Assessment-BREF (WHOQOL-BREF). The study's investigative parameters included the demographic characteristics of the sample, internal structure, and convergent validity. Furthermore, correlations between the AlQoL 9 scale scores and the scores obtained from the WHOQOL-BREF test were investigated using Pearson product-moment correlation analyses.

RESULTS

The English version of the AlQoL 9 attained a significant Cronbach's alpha of 0.825. The mean score obtained in the test was 21.92 (SD = 6.79). Using Varimax rotation, the AlQoL 9 yielded one principal factor that had accounted for 37.85% of variance. Convergent validity analysis demonstrated significant correlations (p < 0.001) between the AlQoL 9 scores and the scores of all four dimensions of the WHOQOL-BREF questionnaire.

CONCLUSION

The present study demonstrated that the English version of the AlQoL 9 constitutes a valid and reliable research instrument for evaluating quality of life among alcohol-dependent individuals.

Quality of life among hazardous and harmful drinkers: EQ-5D over a 1-year follow-up period

PURPOSE

To investigate the ability of the EQ-5D to discriminate between levels of alcohol risk in a large sample of hazardous and harmful drinkers, and to explore the relationship between transitions between alcohol risk levels and changes in EQ-5D up to 12 months.

METHODS

This is a web-based randomised controlled trial evaluating a novel intervention for hazardous and harmful alcohol consumption. EQ-5D scores were compared among groups of drinkers at baseline (low/medium/high risk according to self-reported past week alcohol consumption), and changes in EQ-5D scores were estimated as a function of changes in alcohol consumption level.

RESULTS

Baseline EQ-5D scores were dominated by problems with anxiety/depression, which increased with alcohol risk level, whilst high-risk drinkers also experienced more problems with physical HRQoL dimensions. However, the tool demonstrated a considerable ceiling effect. At follow-up, despite considerable reductions in alcohol consumption across the sample, significant changes in aggregated EQ-5D index scores were only observed for high-risk drinkers at baseline who reduced their drinking, with small improvements (0.04-0.06) compared to those who did not reduce.

CONCLUSIONS

Our results suggest that the three-option EQ-5D may not be an optimal primary end point for measuring clinical and cost-effectiveness in randomised controlled trials of interventions among hazardous and harmful alcohol users, although further testing of the sensitivity of the tool in these populations is needed.

Quality of life determinants in patients of a Psychosocial Care Center for alcohol and other drug users

Quality of life assessments in patients receiving treatment for substance dependence can serve as one predictor of response to treatment. This study aimed to identify determinants of quality of life in patients of a Psychosocial Care Center for alcohol and other drug users (CAPSad). The sample consisted of 77 patients with a diagnosis of substance dependence being treated at CAPSad for more than six months. Severity of substance dependence was assessed using the Addiction Severity Index (ASI-6), quality of life was assessed using the World Health Organization Quality of Life assessment instrument-short version (WHOQOL-BREF), and depressive symptoms were assessed by the Beck Depression Inventory (BDI). Data on CAPSad activities, psychiatric diagnoses, and medications used were collected from the medical records. Quality of life was significantly impaired in more severe cases of substance dependence and in those with more severe depressive symptoms. As for other variables, poorer quality of life was significantly associated with a greater number of years of education, unemployment, use of medications, and greater use of individual sessions with the reference professional. Linear regression analysis revealed depressive symptom severity to be an independent determinant of quality of life impairment, accounting for over 50% of the variation in physical and psychological domains. These results demonstrate the need to consider other factors, such as depressive symptoms and quality of life, in the treatment of substance dependence.

A review of the measurement properties of the 36-item short-form health survey (SF-36) to determine its suitability for use in an alcohol-dependent population

A psychometric evaluation of the 36-item short-form health survey (SF-36) was undertaken in contemporary studies to assess its suitability for use in an alcohol-dependent population. Three criteria were used to try and determine this: factor analysis, internal consistency reliability and test-retest reliability. Factor analysis revealed that it is mainly consistent with a bidimensional model, internal consistency reliability showed that it consistently provided scores above the recommended threshold and test-retest reliability of the SF-36 highlights that it too provided higher than suggested scores. A conclusion was reached recommending the SF-36 as a reliable screening tool in an alcohol-dependent population, but this is given in caution as no studies were found analysing the instrument in this population.

The importance of quality of life in patients with alcohol abuse and dependence

LEARNING OBJECTIVES

After participating in this educational activity, the reader should be better able to identify the instruments that are currently being used to measure quality of life (QoL) in alcohol abuse and dependence; determine the impact of alcohol abuse and dependence on QoL; and evaluate the impact of treating alcohol abuse and dependence on QoL.

OBJECTIVE

Quality of life, which consists of the physical, mental, and social domains, has been shown to be negatively affected by alcohol abuse and dependence. This review aims to examine QoL in alcohol abuse and dependence by reviewing the instruments used to measure it and by analyzing the impact of alcohol abuse and dependence and of treatment on QoL.

METHODS

Studies were identified using a database search of PubMed and PsycINFO from the past 40 years (1971-2011) using the following keywords: abuse OR dependence, OR use AND alcohol, AND Quality of Life, QoL, Health-related quality of life, HRQOL. Two authors agreed independently on including 50 studies that met specific selection criteria.

RESULTS

Although several global measures of QoL have established reliability and validity, many alcohol-specific measures of QoL have not yet been validated. Nevertheless, QoL has been shown to be significantly impaired in those with alcohol abuse and dependence, particularly in the domains of mental health and social functioning, the very areas that show the greatest improvement with abstinence and its maintenance. Moreover, the literature demonstrates the utility of using QoL measures throughout assessment and treatment as a motivational tool and as a marker for treatment efficacy.

CONCLUSIONS

Measuring and monitoring QoL during assessment and treatment can add important value to patient recovery, for QoL improves with treatment and successful abstinence. Therefore, targeted, disease-specific assessments of QoL are warranted to address the impairments in the physical, mental, and social domains in alcohol abuse and dependence, thereby improving long-term outcomes.

Quality of life among alcohol-dependent patients: how satisfactory are the available instruments? A systematic review

AIM

The purpose of this systematic review was to compare quality-of-life instruments used as outcome measures in randomized clinical trials for alcohol-dependence treatment.

METHODS

Randomized controlled clinical trials, indexed in the EMBASE, PubMed and PsycINFO databases since 1981, which aimed at improving the quality of life in alcohol-dependent patients and used as instrument to measure the quality of life, as specifically designated by the authors, were included.

RESULTS

Of the 331 articles screened, 18 studies were included in the review. Eight different quality-of-life instruments were used as outcome measures. Twenty-seven life domains were explored. Between-scale heterogeneity was high. The scale most frequently used was the medical outcomes study 36-item short-form health survey (SF-36). Only 1 clinical trial demonstrated a significant difference between intervention groups at all endpoints, using the quality of life enjoyment and satisfaction questionnaire (Q-LES-Q).

CONCLUSION

Because many different instruments were used, it is difficult to compare quality-of-life improvement between trials. The most frequently used instrument was a generic health status measure that may not be well suited as a quality-of-life measure for subjects with alcohol dependence. The construction and validation of a specific patient-reported outcome based on alcohol-dependent patients' concerns would effectively contribute to the assessment of treatment efficacy.

Gender differences in health-related quality of life among cannabis users: results from the National Epidemiologic Survey on Alcohol and Related Conditions

BACKGROUND

Cannabis is the most widely used illicit substance worldwide. The aim of the present study was to assess self-reported Quality of Life (QoL) among cannabis users in a large representative sample.

METHODS

We analyzed data from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC, n=43,093). Health-related QoL was assessed using the Short-form 12-item Health Survey (SF-12). The contribution of cannabis use and cannabis use disorders (CUD) to SF-12 scores was assessed using multiple linear regressions models.

RESULTS

The prevalence of cannabis use and CUD in the last 12 months was 4.1% and 1.5%, respectively. Mean SF-12 mental summary scores were significantly lower (indicating a lower QoL) among female and male cannabis users compared to non-users (by 0.6 standard deviations (SD) and 0.3 SD, respectively), and among females and males with CUD compared to those without CUD (by 0.9 SD and 0.4 SD, respectively). Controlling for sociodemographic variables and mental illness, each joint smoked daily was associated with a greater decrease in mental QoL summary scores in females (0.1 SD) compared to males (0.03 SD).

CONCLUSIONS

Cannabis use and CUD were associated with lower self-reported mental QoL. Specifically, our findings showed that cannabis use and CUD have a more significant effect on self-reported mental health QoL among female users. Assessing severity of cannabis use and impact of CUD should take into account functional and emotional outcomes. This may particularly aid in detecting the impact of cannabis use and CUD on mental health-related QoL among females.

Lifetime PTSD and quality of life among alcohol-dependent men: impact of childhood emotional abuse and dissociation

The aim of this study was to investigate the impact of lifetime posttraumatic stress disorder (PTSD), dissociation and a history of childhood trauma on quality of life (QoL) among men with alcohol dependency. A consecutive series of alcohol-dependent men (N=156) admitted to an inpatient treatment unit were screened using the Michigan Alcoholism Screening Test, the Clinician Administered PTSD Scale, the Dissociative Experiences Scale, and the Childhood Trauma Questionnaire. QoL was assessed using the Medical Outcomes Study Short-Form 36-item health survey. Fifty (32.1%) patients had lifetime diagnosis of PTSD. Besides problems related to severity of alcohol use, the lifetime PTSD group was impaired on several physical and mental components of QoL. While the lifetime PTSD group and remaining patients did not differ on reports of childhood trauma and dissociation, in lifetime PTSD group, dissociative patients had higher scores of childhood emotional abuse than those of the non-dissociative patients. In multivariate covariance analysis, both dissociation and lifetime PTSD predicted impairment in physical functioning, general health, vitality, and mental health components of QoL. Among alcohol-dependent men with lifetime PTSD, a history of childhood emotional abuse contributes to impairment of QoL through its relationship with dissociation.