Drug use and hazardous drinking are associated with PTSD symptoms and symptom clusters in US Army Reserve/National Guard Soldiers.

BACKGROUND AND OBJECTIVES: There is strong evidence of the association between Posttraumatic Stress Disorder (PTSD) symptoms and substance use. Previous work has found sex differences in these associations. With revisions to the DSM, it is important to understand how overall PTSD symptoms and the new symptom clusters relate to substance use among Reserve/Guard soldiers-a high risk group. METHODS: Data are from the baseline assessment of Operation: SAFETY (Soldiers and Families Excelling Through the Years), a longitudinal study of US Army Reserve/National Guard (USAR/NG) soldiers (N = 389 males, N = 84 females). We examined associations between current substance use (drug use, hazardous drinking, and smoking) and overall PTSD symptoms, and symptom clusters. Additionally, we examined PTSD by sex interactions. RESULTS: Greater overall PTSD symptoms were associated with higher odds of drug use (OR = 1.08; 95%CI: 1.05, 1.12) and hazardous drinking (OR = 1.04; 95%CI: 1.02, 1.07). Greater individual symptom cluster scores were associated with higher odds of drug use (ps < .001) and hazardous drinking (ps < .01). Interaction models revealed no differences in these associations on the basis sex (ps > .05). There were no associations between PTSD symptoms or symptom clusters on smoking (ps > .05). DISCUSSION AND CONCLUSION: Soldiers experiencing PTSD symptoms are reporting current drug and hazardous alcohol use, suggestive of self-medication. SCIENTIFIC SIGNIFICANCE: It is imperative to consider the impact of PTSD on substance use broadly, as this work shows that overall symptoms and symptom clusters have an impact on male and female USAR/NG soldiers. (Am J Addict 2019;28:22-28).

Prenatal marijuana exposure predicts marijuana use in young adulthood.

BACKGROUND: Studies have reported effects of prenatal marijuana exposure (PME) on cognitive and behavioral outcomes. An earlier publication from this study found that PME predicted early onset of marijuana use and frequency of marijuana use at age 14. No study has reported the effects of PME on marijuana use in young adulthood. This is a developmental period when substance use peaks, and by which, initiation of substance use has largely occurred. METHODS: Subjects were from a longitudinal cohort. Women were interviewed initially in their fourth prenatal month and women and their offspring were followed through 22 years. Significant covariates of offspring marijuana use at 22 years were identified and controlled for using ordinal logistic regression. RESULTS: PME predicted marijuana use in the offspring at 22 years after controlling for significant covariates. Prenatal alcohol exposure, offspring race, gender, and age were also significant predictors, but family history of substance abuse or disorder, and sociodemographic and psychological characteristics of the mother and offspring were not. This association was not moderated by gender or race. CONCLUSIONS: PME is associated with subsequent marijuana use in young adulthood after considering the effects of other significant factors. These findings have important implications for public health given the recent trend toward legitimization of marijuana use.

Greater prevalence of proposed DSM-5 nicotine use disorder compared to DSM-IV nicotine dependence in treated adolescents and young adults.

AIMS: Compared to DSM-IV nicotine dependence, proposed DSM-5 nicotine use disorder (NUD) would lower the threshold from three to two symptoms, and increase the number of criteria used for diagnosis from seven to 11. The impact of the proposed changes on nicotine disorder prevalence and the concurrent validity of diagnostic criteria were examined. DESIGN: Cross-sectional survey to compare DSM-IV and proposed DSM-5 algorithms. SETTING AND PARTICIPANTS: Adolescent (n = 179) and young adult (n = 292) past-year cigarette users recruited from addictions treatment. MEASUREMENTS: Semi-structured clinical interview to evaluate DSM-IV nicotine dependence, and 10 of the 11 proposed DSM-5 NUD criteria; 30-day time-line follow-back; and the Fagerström Test for Nicotine Dependence (FTND). FINDINGS: Prevalence of proposed DSM-5 NUD (two-symptom threshold) was much higher (adolescents: 68.7%, young adults: 86.0%) than DSM-IV nicotine dependence (33.0% and 59.6%, respectively), although prevalence of DSM-5 severe NUD (four-symptom threshold) was similar to DSM-IV nicotine dependence. Concurrent validity analyses in both samples indicated consistent support for DSM-5 severe NUD diagnosis (four symptoms) but not for the moderate NUD (two symptoms) diagnosis, which had modest relations with only FTND score. IRT analyses indicated strong support for the new craving item, but not for the proposed interpersonal problems and hazardous use items. CONCLUSIONS: The proposed DSM-5 nicotine use disorder criteria have substantial limitations when applied to adolescents and young adults, and appear to have low concurrent validity.

Brief assessment of readiness to change tobacco use in treated youth.

This study examined the concurrent and predictive validity of four brief measures of readiness to change tobacco use for use with adolescents in clinical practice (Readiness Ruler, Thoughts About Abstinence, motivation to abstain, and confidence to abstain) and a single-item measure of difficulty to abstain. Participants were 154 adolescent smokers recruited from outpatient addictions treatment, who completed assessments shortly after admission and at 6- and 12-month follow-up. Concurrent validity analyses indicated that the four readiness measures were moderately correlated at each time point. Predictive validity analyses indicated that the Ruler and the motivation to abstain ratings predicted number of cigarettes smoked at 6 and 12 months. Perceived difficulty to abstain predicted cigarette use over and above the readiness to change measures. Results support the clinical utility of the Ruler and motivation to abstain as brief measures of readiness to change, and perceived difficulty to abstain as a tool to aid adolescent tobacco cessation.

Characteristics and consequences of heroin use among older adults in the United States: a review of the literature, treatment implications, and recommendations for further research.

This review reports on the results of a comprehensive literature search of studies examining the physical and mental health characteristics of older adults in the United States who use heroin. Multiple databases were searched for papers meeting the inclusion criteria of heroin users who were age 50 years or older. A total of 14 articles covering 9 different studies met the review inclusion criteria. All of the studies were convenience samples, and seven of the nine studies (77.8%) were entirely drawn from substance abuse treatment programs, primarily methadone maintenance programs. Findings from the qualitative studies suggest that the marginalization of older heroin users was a predominant experience that impacted the intent to seek treatment as well as treatment retention. While articles reported high levels of physical and psychological/psychiatric comorbidities with substance misuse, research on heroin use and methadone treatment among older adults is scant and the quantitative findings are inconsistent. The articles reviewed in this study demonstrate that the needs of this population will be significant, yet the development of appropriate interventions and treatment for older adult heroin users will be contingent on empirical research that adequately describes mental and physical health problems.

The longitudinal association between multiple substance use discrepancies and marital satisfaction.

AIMS: The objective of this work was to examine the relation between patterns of substance use among newly married couples and marital satisfaction over time. In particular, this work examined if differences between husbands' and wives' heavy alcohol use and cigarette smoking, rather than simply use per se, predicted decreases in marital satisfaction over the first 7 years of marriage. METHODS: Married couples (n = 634 couples) were assessed on a variety of substance use and relationship variables at the time of marriage and again at the first, second, fourth and seventh years of marriage. RESULTS: After controlling for key socio-demographic variables, discrepancies in husband and wife cigarette smoking and heavy alcohol use were related to significant reductions in marital satisfaction. Importantly, couples who were discrepant on both substances experienced the greatest declines in marital satisfaction over time. CONCLUSIONS: Patterns of substance use among newly married couples are important predictors of changes in marital functioning over time. It was not simply the heavy alcohol use or cigarette smoking that predicted dissatisfaction but, rather, differences between husbands' and wives' substance use that impacted the relationship.

Predictors of marijuana use among married couples: the influence of one's spouse.

With the transition into marriage, marijuana and other substance use tends to decline; however, this is not true for all individuals. The objective of this work was to examine the impact of premarital individual and partner psychological health and substance use behaviors on the likelihood of using marijuana over the first four years of marriage. Couples' (N=634) marijuana use, other substance use, and psychological variables were assessed at the time they applied for their marriage license and then again at the first, second and fourth anniversaries. Generalized estimating equation models were used to estimate the risk for using marijuana over the first four years of marriage after controlling for the natural decrease in risk associated with time and other relevant sociodemographic variables. Smoking prior to marriage and heavy alcohol use was associated with an increased risk for using marijuana over the first four years of marriage for both husbands and wives. After considering the impact of time and individual risk factors, a spouse's use of marijuana prior to marriage was a strong predictor of increased risk for marijuana use during the first four years of marriage.

Divalproex utility in bipolar disorder with co-occurring cocaine dependence: a pilot study.

OBJECTIVE: The aim of this open-label pilot study was to evaluate the utility of divalproex in decreasing cocaine use and stabilizing mood symptoms among patients with bipolar disorder with comorbid cocaine dependence. METHOD: Fifteen patients enrolled in the study and seven met final inclusion criteria of DSM-IV/SCID diagnoses of bipolar I disorder and comorbid cocaine dependence with active cocaine use. Patients were started on open-label divalproex. After stabilization on divalproex sodium, weekly assessments were undertaken for 8weeks. Subjects also attended dual recovery counseling. RESULTS: The results revealed significant improvement on % cocaine abstinent days, dollars spent on cocaine, ASI's drug use severity index, % alcohol abstinent days, drinks per drinking day, marijuana use and cigarettes smoking. They also had significant improvement on manic, depressive, and sleep symptoms and on functioning. There were no reported adverse events or increases in liver function tests. CONCLUSION: The results of this open-label study point to the potential utility of divalproex in patients with bipolar disorder and primary cocaine dependence. Double-blind, placebo-controlled studies to fully evaluate the efficacy of divalproex in this high risk clinical population are warranted.

Multidimensional assessment of nicotine dependence in adolescents.

Despite the critical importance of adolescent smoking, the assessment of nicotine dependence during this developmental period has been the subject of relatively little research. In this study, 301 adolescents (ages 12 through 18 years) reporting daily smoking were recruited for a project on alcohol use disorders (AUDs). The sample included 140 females and 161 males, 251 subjects from clinical and 50 from community sources, and 176 subjects with AUDs at the baseline assessment. Subjects were evaluated with the Nicotine Dependence Syndrome Scale (NDSS), the Fagerstrom Test for Nicotine Dependence (FTND) and a determination of average number of cigarettes per day (cigarettes/day). A varimax factor analysis of 27 NDSS items revealed four factors: (1) Drive/Tolerance (13 items; Cronbach alpha = 0.91); (2) Continuity (five items; Cronbach alpha = 0.67); (3) Priority (three items; Cronbach alpha = 0.64); (4) Stereotypy (five items; Cronbach alpha = 0.66). The NDSS total score, refined by the removal of four items, was also examined (23 items; Cronbach alpha = 0.90). Predicting cigarettes/day at follow-up, initial smoking rate was the best predictor, with the FTND and NDSS Total score showing significant and similar predictive validity. The NDSS Total showed incremental validity in the prediction of smoking progression in a model including demographic characteristics, initial smoking rate and FTND. The findings suggest that the NDSS has acceptable psychometric properties when applied to adolescents, complementing smoking rate and FTND in a multidimensional smoking assessment.

General-medical conditions in older patients with serious mental illness.

OBJECTIVE: The burden of medical comorbidities was compared between older (> or =60 years) and younger patients with serious mental illness. METHODS: Patients (N=8,083) diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder in 2001 were identified from VA facilities in the mid-Atlantic region. Medical comorbidities were identified by an ICD-9-based clinical classification algorithm. RESULTS: Older, versus younger, patients were more likely to be diagnosed with cardiovascular or pulmonary conditions, and less likely to be diagnosed with substance-use disorders or hepatic conditions. CONCLUSIONS: More aggressive detection and management of general-medical comorbidities in older patients with serious mental illness is paramount.

Childhood risk categories for adolescent substance involvement: a general liability typology.

Childhood risks for adolescent substance involvement include parental substance use disorders (SUDs), psychological dysregulation and early tobacco and alcohol experimentation. This study was designed to identify childhood risk categories predicting accelerated adolescent substance involvement across drug types and stages. The index subjects were 560 children recruited from high risk (n = 266) or low risk (n = 294) families based on fathers' SUDs. Assessments were conducted at approximately ages 11 (baseline), 13, 16, and 19 years. Childhood predictors included parent SUDs, early tobacco or alcohol use (i.e., substance use), and neurobehavior disinhibition (ND) as determined by indicators of cognitive, affective and behavioral disinhibition. A cluster analysis defined five risk categories based on baseline characteristics as follows: (1) High (n = 31; 100% had both parents with SUDs, 100% had early substance use, and the mean ND score = 58.9); (2) Intermediate-High (n = 76; 45% had one parent with SUD, 100% early substance use and ND = 51.9); (3) Intermediate (n = 76; 100% both parents with SUDs, 0% early substance use and ND = 51.4); (4) Intermediate-Low (n = 161; 100% with one SUD parent; 0% early substance use and ND = 49.9) and; (5) Low (n = 216; no parental SUD, no early substance use and ND = 47.5). Compared with all other groups, children in the High risk group had significantly accelerated substance involvement across all substance types and stages. The ordering of risk categories from low to high was also consistent for all substance involvement outcomes. The findings indicate that these five risk categories constitute general liability classes for adolescent substance involvement, and may identify homogeneous groups of children requiring distinct preventive interventions.

Antenatal risk factors associated with postpartum comorbid alcohol use and depressive symptomatology.

BACKGROUND: High rates of comorbid depression and alcohol use disorders have been reported in epidemiological studies; little work has considered comorbidity in women during the perinatal period. The goal of this work was to identify prenatal factors (at each trimester) that predicted postpartum comorbid depressive symptoms and alcohol use in women. METHODS: The data are from an ongoing longitudinal study of pregnancy outcome that is now in its 16th year of follow-up. The first four assessments were used in this study (fourth and seventh prenatal months, delivery, and 8 months after delivery; n = 595). Prenatal variables in five domains (psychological, substance use, social, obstetrical, and demographic) were considered in analyses to predict postpartum comorbid depressive symptoms and alcohol use in women. RESULTS: At each trimester, higher rates of depressive symptoms, binge drinking (four or more drinks per occasion), and tobacco use were significantly associated with comorbidity at the eighth postpartum month. Third-trimester anxiety was also significantly associated with postpartum comorbidity. Prenatal social support, obstetrical complications, and demographic factors were not related to an increased risk for postpartum comorbidity. CONCLUSIONS: Women with more depressive symptoms, who binge-drink, or who smoke cigarettes at any time during their pregnancies are at risk for postpartum comorbidity. Women should be screened for depressive symptoms and substance use, and treatment should be initiated when women exhibit the risk factors described.