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Stiltner B, Pietrzak RH, Tylee DS, Nunez YZ, Adhikari K, Kranzler HR, Gelernter J, Polimanti R. Polysubstance addiction patterns among 7,989 individuals with cocaine use disorder. iScience 2023; 26:107336. [PMID: 37554454 PMCID: PMC10405253 DOI: 10.1016/j.isci.2023.107336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/22/2023] [Accepted: 07/06/2023] [Indexed: 08/10/2023] Open
Abstract
To characterize polysubstance addiction (PSA) patterns of cocaine use disorder (CoUD), we performed a latent class analysis (LCA) in 7,989 participants with a lifetime DSM-5 diagnosis of CoUD. This analysis identified three PSA subgroups among CoUD participants (i.e., low, 17%; intermediate, 38%; high, 45%). While these subgroups varied by age, sex, and racial-ethnic distribution (p < 0.001), there was no difference with respect to education or income (p > 0.05). After accounting for sex, age, and race-ethnicity, the CoUD subgroup with high PSA had higher odds of antisocial personality disorder (OR = 21.96 vs. 6.39, difference-p = 8.08✕10-6), agoraphobia (OR = 4.58 vs. 2.05, difference-p = 7.04✕10-4), mixed bipolar episode (OR = 10.36 vs. 2.61, difference-p = 7.04✕10-4), posttraumatic stress disorder (OR = 11.54 vs. 5.86, difference-p = 2.67✕10-4), antidepressant medication use (OR = 13.49 vs. 8.02, difference-p = 1.42✕10-4), and sexually transmitted diseases (OR = 5.92 vs. 3.38, difference-p = 1.81✕10-5) than the low-PSA CoUD subgroup. These findings underscore the importance of modeling PSA severity and comorbidities when examining the clinical, molecular, and neuroimaging correlates of CoUD.
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Affiliation(s)
- Brendan Stiltner
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Robert H. Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Daniel S. Tylee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Yaira Z. Nunez
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Keyrun Adhikari
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Henry R. Kranzler
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Mental Illness Research, Education, and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
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Stiltner B, Pietrzak RH, Tylee DS, Nunez YZ, Adhikari K, Kranzler HR, Gelernter J, Polimanti R. Polysubstance addiction and psychiatric, somatic comorbidities among 7,989 individuals with cocaine use disorder: a latent class analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.08.23285653. [PMID: 36798273 PMCID: PMC9934788 DOI: 10.1101/2023.02.08.23285653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Aims We performed a latent class analysis (LCA) in a sample ascertained for addiction phenotypes to investigate cocaine use disorder (CoUD) subgroups related to polysubstance addiction (PSA) patterns and characterized their differences with respect to psychiatric and somatic comorbidities. Design Cross-sectional study. Setting United States. Participants Adult participants aged 18-76, 39% female, 47% African American, 36% European American with a lifetime DSM-5 diagnosis of CoUD (N=7,989) enrolled in the Yale-Penn cohort. The control group included 2,952 Yale-Penn participants who did not meet for alcohol, cannabis, cocaine, opioid, or tobacco use disorders. Measurements Psychiatric disorders and related traits were assessed via the Semi-structured Assessment for Drug Dependence and Alcoholism. These features included substance use disorders (SUD), family history of substance use, sociodemographic information, traumatic events, suicidal behaviors, psychopathology, and medical history. LCA was conducted using diagnoses and diagnostic criteria of alcohol, cannabis, opioid, and tobacco use disorders. Findings Our LCA identified three subgroups of PSA (i.e., low, 17%; intermediate, 38%; high, 45%) among 7,989 CoUD participants. While these subgroups varied by age, sex, and racial-ethnic distribution (p<0.001), there was no difference on education or income (p>0.05). After accounting for sex, age, and race-ethnicity, the CoUD subgroup with high PSA had higher odds of antisocial personality disorder (OR=21.96 vs. 6.39, difference-p=8.08×10 -6 ), agoraphobia (OR=4.58 vs. 2.05, difference-p=7.04×10 -4 ), mixed bipolar episode (OR=10.36 vs. 2.61, difference-p=7.04×10 -4 ), posttraumatic stress disorder (OR=11.54 vs. 5.86, difference-p=2.67×10 -4 ), antidepressant medication use (OR=13.49 vs. 8.02, difference-p=1.42×10 -4 ), and sexually transmitted diseases (OR=5.92 vs. 3.38, difference-p=1.81×10 -5 ) than the low-PSA CoUD subgroup. Conclusions We found different patterns of PSA in association with psychiatric and somatic comorbidities among CoUD cases within the Yale-Penn cohort. These findings underscore the importance of modeling PSA severity and comorbidities when examining the clinical, molecular, and neuroimaging correlates of CoUD.
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Uthurralt N, Miao Cao F, Reid SE, Nithyanandam L, Burns L, Day CA. Characteristics of clients entering women-only substance use treatment services in New South Wales. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231200133. [PMID: 37921428 PMCID: PMC10625314 DOI: 10.1177/17455057231200133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/23/2023] [Accepted: 08/22/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Women experiencing substance use disorders face barriers to treatment, including childcare, stigma and lack of gender/trauma-informed programming. Several non-government organizations in New South Wales run women-only treatment services to address these needs. OBJECTIVES We aim to assess characteristics of women entering treatment in these services. DESIGN Data on client characteristics from six women-only non-government organization substance use disorder treatment services in New South Wales between 2014 and 2018 were extracted from a database containing demographics, drug use and treatment characteristics and psychological distress (Kessler-10 scale) of women entering the services. Logistic regression models were used to estimate unadjusted odds ratio and adjusted odds ratio for treatment completion and different drugs on entry. RESULTS Data were available for 1357 women. Most (91%) episodes were for residential treatment. Women's mean age was 35.4 years (standard deviation = 9.8; range = 17-67). Residential clients tended to be younger than non-residential clients (35.1 vs 38.5 years, p < 0.001). Methamphetamine (43%) and alcohol (32%) were the most reported principal drug of concern. Women (89%) reported high levels of psychological distress (median Kessler-10 scale score = 27.5, range = 10-50), highest for women reporting alcohol as their principal drug. Overall, 43% of episodes resulted in treatment completion, most commonly for women entering residential treatment (45% vs 22%, p < 0.001) and for alcohol treatment (adjusted odds ratio = 1.42; confidence interval = 1.07-1.90; p < 0.001). Women with Kessler-10 scale scores indicating anxiety or depression at treatment entry were less likely to complete treatment than those with lower scores (adjusted odds ratio = 0.56; confidence interval = 0.38-0.80; p < 0.001). CONCLUSION Women entering women-only residential treatment tend to be younger and report methamphetamine as principal drug of concern. Women enter treatment with high degrees of psychological distress. Women's services need to ensure their programmes can respond to diverse needs of younger women presenting with methamphetamine use disorder and older women with alcohol use disorder experiencing high levels of psychological distress.
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Affiliation(s)
- Natalia Uthurralt
- Specialty of Addiction Medicine, Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
| | - Felicia Miao Cao
- Specialty of Addiction Medicine, Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Sharon E Reid
- Specialty of Addiction Medicine, Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
| | | | - Lucy Burns
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia
| | - Carolyn A Day
- Specialty of Addiction Medicine, Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
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Mefodeva V, Carlyle M, Walter Z, Chan G, Hides L. Polysubstance use in young people accessing residential and day-treatment services for substance use: substance use profiles, psychiatric comorbidity and treatment completion. Addiction 2022; 117:3110-3120. [PMID: 35851706 PMCID: PMC9804256 DOI: 10.1111/add.16008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/27/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS People with substance use disorders (SUDs) frequently present to treatment with polysubstance use and mental health comorbidities. Different combinations of substance use and mental health problems require different treatment approaches. Our study aimed to: (i) identify the shared substance use classes among young people at treatment admission, (ii) determine which mental health symptoms, quality of life (QoL) and service types were associated with the identified substance use classes, and (iii) prospectively determine which substance use classes and service types were more likely to complete treatment. DESIGN Cross-sectional and prospective study using service and outcome data. SETTING Substance use treatment services in Queensland and New South Wales, Australia. PARTICIPANTS De-identified service and outcome measure data were extracted from the files of 744 clients aged 18-35 years (48% male) admitted into seven residential and four day-treatment programmes. MEASUREMENTS Substance use and severity among tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants, opioids, sedatives and inhalants. Other variables included: depression, anxiety, post-traumatic stress and psychotic symptoms, as well as QoL. FINDINGS Latent class analysis identified three polysubstance use classes: wide-ranging polysubstance users (WRPU; 22.45%), primary amphetamine users (56.45%) and alcohol and cannabis users (21.10%). The WRPU class had higher odds of psychotic symptoms than the alcohol and cannabis use class [odds ratio (OR) = 1.30; 95% confidence interval (CI) = 1.11-1.11]; and double the odds of residential programme enrolment than those in the amphetamine use class (OR = 2.35; 95% CI = 1.50-3.68). No other class differences on mental health or QoL variables were found. Clients enrolled in day-programmes had higher odds of completing treatment. CONCLUSIONS There appear to be high levels of polysubstance use among young people entering substance use treatment in Australia. Wide-ranging polysubstance users were more likely to report psychotic symptoms and be enrolled into a residential programme than primary amphetamine users and alcohol and cannabis users.
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Affiliation(s)
- Valeriya Mefodeva
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Molly Carlyle
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Zoe Walter
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Gary Chan
- National Centre for Youth Substance Use Research (NCYSUR)University of QueenslandBrisbaneQueenslandAustralia
| | - Leanne Hides
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia,National Centre for Youth Substance Use Research (NCYSUR)University of QueenslandBrisbaneQueenslandAustralia
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Bourgault Z, Rubin-Kahana DS, Hassan AN, Sanches M, Le Foll B. Multiple Substance Use Disorders and Self-Reported Cognitive Function in U.S. Adults: Associations and Sex-Differences in a Nationally Representative Sample. Front Psychiatry 2021; 12:797578. [PMID: 35095610 PMCID: PMC8791062 DOI: 10.3389/fpsyt.2021.797578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/13/2021] [Indexed: 11/24/2022] Open
Abstract
Polysubstance use is a growing public health concern that has been associated with poor clinical outcomes. Compared to single-drug users, this population suffers greater deficits in cognitive function, which hinder treatment success and recovery. Despite its high prevalence and poor prognosis, epidemiological research on polysubstance use and accompanying cognitive profile is lacking. We investigated associations between numbers of past-year co-occurring substance use disorders (SUDs) and self-reported cognitive function using data from the National Epidemiologic Survey for Alcohol and Related Conditions III (NESARC-III). Regression analyses revealed a significant negative association between cognitive scores and numbers of past-year SUDs, which was moderated by sex. After adjusting for confounding variables, greater numbers of SUDs were associated with declining self-reported cognitive function, and this relationship was stronger among females. Our findings expand on current literature on cognitive impairments among polysubstance users and provide a novel, nuanced description of this relationship among the general population. We highlight the need for targeted and individualized treatment approaches in order to improve outcomes in this population.
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Affiliation(s)
- Zoe Bourgault
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Dafna Sara Rubin-Kahana
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Child and Youth Mental Health Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Ahmed Nabeel Hassan
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Marcos Sanches
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Biostatistics Core, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Departments of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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