Cannabis Use Characteristics Associated with Self-Reported Cognitive Function in a Nationally Representative U.S. sample.

BACKGROUND: With increases in cannabis use and potency, there is a need to improve our understanding of the impact of use on cognitive function. Previous research indicates long-term cannabis use may have a negative effect on executive function. Few studies have examined persistence of it in protracted abstinence, and there is limited evidence of predictors of worse cognitive function in current and former users. In this study, we aim to evaluate the associations between cannabis use status (current, former, and never use) and self-report cognition. Further, we investigate if cannabis use characteristics predict self-report cognitive function. METHODS: Cross-sectional cannabis use data from the National Epidemiological Survey on Alcohol and Related Conditions-III (NESARC-III), a national survey (N = 36,309) conducted in the USA between 2012 and 2013 were used alongside the Executive Function Index scales. The data were analyzed by using Ordinary Least Squares regression. RESULTS: Current (N = 3,681, Female = 37.7%) and former users (N = 7,448, Female = 45.4%) reported poorer cognition than never users (N = 24,956, Female = 56.6%). Self-reported cognition of former users was in-between that of current and never users. Several cannabis use characteristics were associated with self-reported cognition in current and former users. CONCLUSION: While prospective studies are required to confirm, findings suggest cannabis use is linked to worse cognition. There may be some limited recovery of cognition in former users and some cannabis use characteristics predict impairment. These findings add to our understanding of the cognitive impact of cannabis use. As worse cognitive function may impact relapse, findings have implications for personalization of cannabis use disorder treatment.

Sex differences in Cannabis use disorder and associated psychosocial problems among US adults, 2012-2013.

While men show greater prevalence of cannabis use disorder (CUD) than women, whether cannabis use frequency drives this difference is unknown, and little is known about sex differences in problems associated with CUD. We therefore assessed the association of CUD with sex, adjusted for frequency of use, and compared the association of psychosocial and health-related problems with CUD between men and women. We included US adults age ≥ 18 who reported past-year cannabis use in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 3701). Cannabis use frequency, DSM-5 CUD and problems (interpersonal, financial, legal, health-related) were assessed. Associations between psychosocial problems, sex and DSM-5 CUD were assessed using prevalence differences (PD) and 95% confidence intervals (CI) from logistic regression models, controlling for demographics and cannabis use frequency, and effect modification by sex was assessed. We found that the prevalence of CUD among men versus women was not significantly greater after adjusting for use frequency. Women had significantly higher prevalence of interpersonal, financial and health-related problems than men, adjusting for frequency of use. Women showed significantly greater association of CUD with interpersonal problems with a boss or co-workers (p < 0.05) and a neighbor, relative or friend (p < 0.05) compared to men. Lack of sex differences in CUD after adjusting for frequency of use suggests use frequency may be an important target of CUD prevention efforts. CUD showed stronger associations for interpersonal problems among women than men, suggesting the need for particular emphasis on treating interpersonal problems related to cannabis use among women.

Gender Differences in Diagnostic Remission of Posttraumatic Stress Disorder (PTSD): Proportions and Correlates of Remission in a Nationally Representative U.S. Sample.

This study examines differences in a nationally representative sample, in proportions of men and women with lifetime diagnoses of Posttraumatic Stress Disorder (PTSD) who achieved diagnostic remission and gender-specific correlates. Data from the 2012-13 National Epidemiologic Survey on Alcohol and Related Conditions-III included 1,997 adults with a lifetime PTSD diagnosis (70.8% female and 29.2% male). Of these 25.3% of women and 24.3% of men experienced remission (ns). Women who remitted were older than other women, more likely to be retired, and less likely to report disability, past homelessness, suicide attempts, criminal history, violent behavior, or parental histories of drug problems or suicide. Men who remitted were less likely than other men to be separated/divorced, disabled, incarcerated after age 15, and reported fewer violent behaviors. Remission was significantly more strongly associated among women than men with greater age, emergency room visits, trauma and less with schizotypal personality. Although women were twice as likely to be diagnosed with PTSD, there were no significant gender differences in the proportions who experienced remission. Remission was associated with diverse sociodemographic and clinical disadvantages among both men and women but only four were statistically significantly different between genders.

Association of the Military Transition to an All-Volunteer Force and Subsequent Zero-Tolerance Drug Policy with Characteristics of Male Veterans in the Vietnam, Post-Vietnam and Subsequent Post-Post Vietnam Cohorts.

In the 1970s, following the Vietnam Conflict, the U.S. military transitioned to an All-Volunteer Force (AVF). In the 1980's military benefits increased and a zero-tolerance policy for illicit drugs was instituted. Changes in characteristics of veterans deserve study. National survey data from 2012 to 2013 compare vetderan-non-veteran differences in three age cohorts: the Vietnam cohort; the AVF (Post-Vietnam) cohort; and volunteers under the no tolerance policy (Post-Post-Vietnam). Comparisons addressed socio-demographic, behavioral, and substance use and psychiatric diagnoses. Multivariate interaction analyses between veteran status and age cohorts were used to identify significant veteran-non-veteran differences between the first and second, and second and third cohorts. Significant interactions showed that veteran-non-veteran comparisons for the Post-Vietnam cohort as compared to Vietnam cohort reveal later veterans to be relatively more likely to be black, disabled, with lower incomes, less health insurance, more homelessness, incarceration, and suicide attempts with greater substance use diagnosis. In contrast interactions show veteran-non-veteran comparisons for the Post-Post-Vietnam cohort as compared to Post-Vietnam cohort were less likely to be black, more likely to be married, retired, with incomes over $40,000, more education and private health insurance. They were less likely to have been homeless, incarcerated or to have made suicide attempts. The veteran cohort serving in the first years of the AVF showed significant socio-economic and behavioral disadvantage (e.g homelessness) compared to their predecessors while their successors, under no tolerance drug policy, showed reversal of these trends. Military recruitment and disciplinary policies significantly affect veteran economic and health status.

Associations of PTSD, chronic pain, and their comorbidity on cannabis use disorder: Results from an American nationally representative study.

BACKGROUND: Cannabis can be prescribed for posttraumatic stress disorder (PTSD) and chronic pain, and comorbid cannabis use disorder (CUD) can occur in both conditions. Research demonstrates that PTSD and chronic pain commonly co-occur. METHODS: Data were acquired from the National Epidemiologic Survey on Alcohol and Related Conditions-III (N = 36,309). Past-year CUD and PTSD were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. Past-year physician-confirmed chronic pain was self-reported and classified as musculoskeletal (e.g., arthritis), digestive (e.g., pancreatitis), and nerve (e.g., reflex sympathetic dystrophy) pain. Weighted cross-tabulations assessed sociodemographic, psychiatric, and chronic pain condition variables among those with PTSD versus no PTSD, among the entire sample and among those with CUD and chronic pain. Multiple logistic regressions examined the relationship between PTSD and chronic pain with CUD. CUD characteristics were also evaluated across PTSD and chronic pain groups. RESULTS: Rates of CUD were elevated in PTSD (9.4%) compared to those without (2.2%). The odds of CUD were greater for PTSD+digestive pain, PTSD+nerve pain, and PTSD+any chronic pain compared to having neither PTSD nor chronic pain (odds ratio range: 1.88-2.32). PTSD with and without comorbid chronic pain was associated with overall elevated rates of adverse CUD characteristics, including earlier age of onset, greater usage, and greater CUD severity. CONCLUSIONS: PTSD with and without chronic pain is associated with elevated rates and severity of CUD. These results may have implications for prescribing practices and understanding individuals at risk for developing CUD.

Differences by Veteran/civilian status and gender in associations between childhood adversity and alcohol and drug use disorders.

PURPOSE: To examine differences by US military Veteran status and gender in associations between childhood adversity and DSM-5 lifetime alcohol and drug use disorders (AUD/DUD). METHODS: We analyzed nationally representative data from 3119 Veterans (n = 379 women; n = 2740 men) and 33,182 civilians (n = 20,066 women; n = 13,116 men) as provided by the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III). We used weighted multinomial logistic regression, tested interaction terms, and calculated predicted probabilities by Veteran status and gender, controlling for covariates. To test which specific moderation contrasts were statistically significant, we conducted pairwise comparisons. RESULTS: Among civilians, women had lower AUD and DUD prevalence than men; however, with more childhood adversity, this gender gap narrowed for AUD and widened for DUD. Among Veterans, in contrast, similar proportions of women and men had AUD and DUD; with more childhood adversity, AUD-predicted probability among men surpassed that of women. Childhood adversity elevated AUD probability among civilian women to levels exhibited by Veteran women. Among men, Veterans with more childhood adversity were more likely than civilians to have AUD, and less likely to have DUD. CONCLUSIONS: Childhood adversity alters the gender gap in AUD and DUD risk, and in ways that are different for Veterans compared with civilians. Department of Defense, Veterans Affairs, and community health centers can prevent and ameliorate the harmful effects of childhood adversity by adapting existing behavioral health efforts to be trauma informed, Veteran sensitive, and gender tailored.

Association Between Lifetime Posttraumatic Stress Disorder and Past Year Alcohol Use Disorder Among American Indians/Alaska Natives and Non-Hispanic Whites.

BACKGROUND: Posttraumatic stress disorder (PTSD) and alcohol use disorder disproportionately impact certain populations including American Indians/Alaska Natives (AIAN). While PTSD and alcohol use disorder have been studied both separately and in tandem, less is known about the association in AIAN. The objective was to examine the association between lifetime PTSD and past year alcohol use disorder among AIAN and non-Hispanic Whites (NHW). METHODS: Data come from the 2012 to 2013 U.S. National Epidemiologic Survey on Alcohol and Related Conditions-III. We used logistic regression to estimate odds of AUD among adults with and without PTSD by race. RESULTS: A total of 19,705 participants, of whom 511 were AIAN and 19,194 were NHW, were included in this study. The percentage of PTSD among AIAN was 22.9% (n = 117) compared to 11.7% (n = 2,251) in NHW (p-value <0.0001). The percentage of past year alcohol use disorder among AIAN was 20.2% (n = 103) compared to 14.2% (n = 2,725) in NHW (p-value <0.0001). The percentage of comorbid past year alcohol use disorder with lifetime PTSD among AIAN was 6.5% (n = 33) compared to 2.4% (n = 457) in NHW (p-value <0.0001). Regarding the joint distribution of PTSD and AUD, AIAN men have greater than 3 times the percentage compared to NHW men (9.5% vs. 3.1%). When stratifying by race (after adjusting for age, sex, depression, and education), among AIAN, the odds of past year alcohol use disorder with (vs. without) lifetime PTSD were 1.76 (95% CI 1.07, 2.90) and among NHW, the odds were 1.59 (95% CI 1.41, 1.80). CONCLUSIONS: PTSD is significantly associated with alcohol use disorder in the study populations. Despite a lack of pre-PTSD measures of alcohol use disorder, these findings show a trend indicating that AIAN exposed to PTSD are more burdened with alcohol use disorder compared to NHW in the general U.S.

Dimensionality of DSM-5 posttraumatic stress disorder and its association with suicide attempts: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III.

BACKGROUND: Emerging confirmatory factor analytic (CFA) studies suggest that posttraumatic stress disorder (PTSD) as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is best characterized by seven factors, including re-experiencing, avoidance, negative affect, anhedonia, externalizing behaviors, and anxious and dysphoric arousal. The seven factors, however, have been found to be highly correlated, suggesting that one general factor may exist to explain the overall correlations among symptoms. METHODS: Using data from the National Epidemiologic Survey on Alcohol and Related Conditions-III, a large, national survey of 36,309 U.S. adults ages 18 and older, this study proposed and tested an exploratory bifactor hybrid model for DSM-5 PTSD symptoms. The model posited one general and seven specific latent factors, whose associations with suicide attempts and mediating psychiatric disorders were used to validate the PTSD dimensionality. RESULTS: The exploratory bifactor hybrid model fitted the data extremely well, outperforming the 7-factor CFA hybrid model and other competing CFA models. The general factor was found to be the single dominant latent trait that explained most of the common variance (~76%) and showed significant, positive associations with suicide attempts and mediating psychiatric disorders, offering support to the concurrent validity of the PTSD construct. CONCLUSIONS: The identification of the primary latent trait of PTSD confirms PTSD as an independent psychiatric disorder and helps define PTSD severity in clinical practice and for etiologic research. The accurate specification of PTSD factor structure has implications for treatment efforts and the prevention of suicidal behaviors.

The association of stroke with mental and physical disorders in US adults: A nationally representative study.

Stroke has been linked to various physical and mental disorders, with both stroke and its comorbidities significantly impacting public health. In this population-based study, we evaluate the relationships between stroke, physical conditions, mental disorders, and their effect on quality of life. Data were gathered from a nationally representative sample of 36,309 civilian participants aged 18 years and older in the National Epidemiologic Survey on Alcohol and Related Conditions-III. We examined the prevalence of past-year stroke, its sociodemographic characteristics, and its associations with past-year mental disorders (according to the DSM-5) and physical conditions. Furthermore, we explored the connections between stroke and health-related quality of life, accounting for comorbidities. The past 12-month stroke prevalence was estimated at 0.82%. Participants with stroke exhibited a significantly higher past 12-month mental disorder prevalence than those without stroke. Specifically, individuals with stroke faced a higher risk of mood disorders, anxiety disorders, tobacco use disorder, and opioid use disorder compared to those without stroke. Stroke was also positively associated with 24 out of the 27 physical conditions assessed in this study. Participants with stroke experienced lower mental and physical quality of life compared to those without stroke. Stroke was significantly related to numerous mental and physical disorders. The association of stroke with diminished health-related quality of life was not only mediated by these comorbidities but should also be considered as inherently linked to stroke itself.

Cannabis use, cannabis use disorder and mental health disorders among pregnant and postpartum women in the US: A nationally representative study.

BACKGROUND: Cannabis use and cannabis use disorder (CUD) are associated with mental health disorders, however the extent of this matter among pregnant and recently postpartum (e.g., new moms) women in the US is unknown. Associations between cannabis use, DSM-5 CUD and DSM-5 mental health disorders (mood, anxiety, personality and post-traumatic stress disorders) were examined among a nationally representative sample of pregnant and postpartum women. METHODS: The 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III was used to examine associations between past-year cannabis use, CUD and mental health disorders. Weighted logistic regression models were used to estimate unadjusted and adjusted odds ratios (aORs). The sample (N=1316) included 414 pregnant and 902 postpartum women (pregnant in the past year), aged 18-44 years old. RESULTS: The prevalence of past-year cannabis use and CUD was 9.8% and 3.2%, respectively. The odds of cannabis use (aORs range 2.10-3.87, p-values<0.01) and CUD (aORs range 2.55-10.44, p-values< 0.01) were higher among women with versus without any past-year mood, anxiety or posttraumatic stress disorders or any lifetime personality disorder. aORs for the association of cannabis use with specific mood, anxiety or personality disorders ranged from 1.95 to 6.00 (p-values<0.05). aORs for the association of CUD with specific mood, anxiety or personality disorders ranged from 2.36 to 11.60 (p-values<0.05). CONCLUSIONS: From pregnancy up to one year postpartum is a critical period where women may be particularly vulnerable to mental health disorders, cannabis use and CUD. Treatment and prevention are essential.

Long-term impact of the U.S. Armed forces Zero-Tolerance drug policy on female veterans.

BACKGROUND: In 1980, the U.S. military instituted a zero-tolerance policy for illicit substance use that led to a reduction in such use during military services. Long-term post-military effects have not been studied. METHODS: National survey data from 2012-2013 were used to compared veteran versus non-veteran differences in sociodemographic, behavioral and substance use and psychiatric diagnoses among women by cohort (i.e., those younger than 52 who would have entered the military under the no tolerance policy, and those older than 52 who would have entered before this policy was implemented). Multivariate interaction analyses between cohorts and veteran status were used to identify significant changes in veteran-non-veteran differences between these age cohorts on during the decades following the implementation of the zero-tolerance policy. RESULTS: Significant interactions primarily involved substance use diagnoses which were less frequent among veterans than non-veterans in the younger group of women, in contrast to the older group in which veterans had greater rates of substance use than non-veterans. These patterns were less robust for alcohol than substance use disorders and were not significant for psychiatric disorders. CONCLUSION: The zero-tolerance policy appears to have had a long-term effect resulting in less substance use disorder and, to some extent, less alcohol use disorder among veterans as compared to non-veterans who served in the military after the zero-tolerance policy was implemented.

Medical Cannabis and Past-Year Cannabis Use Disorder Among Adult Recreational Users in the United States: Results From a Nationally Representative Sample.

Introduction: With the increasing number of cannabis users and more jurisdictions allowing medical cannabis, more evidence-based knowledge about the prevalence of cannabis use disorder (CUD) among medical users is greatly needed. Objectives: To examine and compare the prevalence and severity of CUD and the prevalence of different CUD criteria among two groups: those who combine recreational and medical use vs. those who exclusively use cannabis recreationally. To examine the association between CUD and sociodemographic characteristics, medical conditions, and psychiatric comorbidities between these two groups. Methods: The National Epidemiological Survey on Alcohol and Related Conditions III data were used, a US nationally representative in-person interview of 36,309 adults aged ≥18 years collected in 2012-2013. The statistical examination included proportion comparison hypothesis testing and linear regressions, all using complex survey design analysis procedures. Results: Recreational users who used cannabis also for medical purposes had a higher prevalence of CUD in general, as well as mild and moderate CUD than users who used cannabis only for recreational purposes. CUD is more prevalent in recreational, medical users with the following characteristics: young, male, non-white, living in the Midwest, using a greater amount of cannabis, having a concurrent mental disorder, and had CUD before the past year. Conclusion: Recreational, medical cannabis users have a higher likelihood of having CUD. Although the results should be taken with caution, given the lack of established validity of CUD among medical users, health care professionals who prescribe or recommend the use of cannabis for medical purposes should take this into consideration while evaluating the risks/benefits ratio of cannabis. They need to assess patients' recreational cannabis use, screen for CUD, and educate users about the possible complications caused by cannabis use.

The Association between Racial Discrimination, Posttraumatic Stress Disorder, and Cardiovascular-Related Conditions Among Non-Hispanic Blacks: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III).

OBJECTIVES: To test the association between racial discrimination and cardiovascular-related conditions and whether PTSD mediates this relationship in a nationally representative sample of non-Hispanic Blacks. METHODS: We used data from the 2013 National Epidemiologic Survey on Alcohol and Related Conditions to conduct logistic regression analyses to examine the association between racial discrimination, PTSD, and cardiovascular-related conditions. We also performed mediation analyses to assess whether the association between racial discrimination and cardiovascular conditions was partly explained by PTSD. RESULTS: Racial discrimination was positively associated with both PTSD and cardiovascular-related conditions. Additionally, PTSD was positively associated with cardiovascular conditions. Results from the fully adjusted mediation models suggest that PTSD significantly mediated the association between racial discrimination and cardiovascular conditions. CONCLUSIONS: Our results demonstrate an association between racial discrimination and cardiovascular-related conditions that is significantly mediated by PTSD. To improve cardiovascular functioning among non-Hispanic Blacks, health care professionals in conjunction with Black communities must adopt culturally competent screening for and treatment for PTSD. To address racial differences in cardiovascular conditions, public health efforts must address institutional policies that negatively alter health opportunities among the Black population.

Prevalence and Correlates of Cannabis Use and Cannabis Use Disorder Among U.S. Veterans: Results From the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III).

OBJECTIVE: The authors sought to estimate the prevalence of past-12-month and lifetime cannabis use and cannabis use disorder among U.S. veterans; to describe demographic, substance use disorder, and psychiatric disorder correlates of nonmedical cannabis use and cannabis use disorder; and to explore differences in cannabis use and cannabis use disorder prevalence among veterans in states with and without medical marijuana laws. METHODS: Participants were 3,119 respondents in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) who identified as U.S. veterans. Weighted prevalences were calculated. Logistic regression analyses tested associations of nonmedical cannabis use and cannabis use disorder with demographic and clinical correlates and examined whether prevalence differed by state legalization status. RESULTS: The prevalences of any past-12-month cannabis use and cannabis use disorder were 7.3% and 1.8%, respectively. Lifetime prevalences were 32.5% and 5.7%, respectively. Past-12-month and lifetime cannabis use disorder prevalence estimates among nonmedical cannabis users were 24.4% and 17.4%, respectively. Sociodemographic correlates of nonmedical cannabis use and use disorder included younger age, male gender, being unmarried, lower income, and residing in a state with medical marijuana laws. Nonmedical cannabis use and use disorder were associated with most psychiatric and substance use disorders examined. CONCLUSIONS: Among veterans, the odds of nonmedical cannabis use and use disorder were elevated among vulnerable subgroups, including those with lower income or psychiatric disorders and among survey participants residing in states with medical marijuana laws. The study findings highlight the need for clinical attention (e.g., screening, assessment) and ongoing monitoring among veterans in the context of increasing legalization of cannabis.

Religiosity and substance use in U.S. adults: Findings from a large-scale national survey.

BACKGROUND: In recent decades, the US religious landscape has undergone considerable change such as a decline in religious service attendance. These changes may indicate that religious social support structures have deteriorated, possibly leading to a decrease in strengths of associations with substance use. Considering this, and given limitations of past studies (e.g., limited control for potential confounders), large-scale general population studies are needed to reexamine associations between religiosity domains and substance use. METHODS: This cross-sectional study used data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (N = 36,309). In unadjusted and adjusted models, controlling for religiosity domains and other covariates, we examined associations between three religiosity domains (importance of religiosity/spirituality, service attendance, and religious affiliation) and DSM-5 SUD. Focusing on service attendance, we also examined associations with other substance use-related outcomes. RESULTS: Among religiosity domains, only frequency of service attendance was associated with SUD across most substances. Frequent service attendees had lower odds of alcohol use disorder (adjusted OR [aOR] = 0.4, 95 % CI 0.33,0.51), tobacco use disorder (aOR = 0.3, 95 % CI 0.22,0.33) and cannabis use disorder (aOR = 0.4, 95 % CI 0.24,0.68), compared to non-service attendees. For alcohol and tobacco, the protective effect of frequent service attendance was more robust for SUD than for respective substance use. CONCLUSIONS: Despite decreasing rates of religious belief and practice in the US, service attendance independently lowered the odds of substance use and SUD across multiple substances. Results may inform religious leaders and clinicians about the value of utilizing religious social support structures in the prevention and treatment of substance use and SUD.

Psychosocial and health problems associated with alcohol use disorder and cannabis use disorder in U.S. adults.

BACKGROUND: Although the problems associated with alcohol use disorder (AUD) are well known, little is known about the psychosocial problems associated with cannabis use disorder (CUD), and the harmfulness of CUD relative to AUD. We compared the odds of psychosocial and health-related problems between individuals with DSM-5 AUD-only, CUD-only and co-occurring AUD+CUD. METHODS: The 2012-2013 NESARC-III, a nationally representative cross-sectional survey of non-institutionalized US adults (n = 36,309), assessed participants for DSM-5 AUD, CUD, and psychosocial (interpersonal, financial, legal) and health-related problems. Based on their responses, participants were categorized into mutually exclusive groups: no AUD/CUD, AUD-only, CUD-only, and AUD+CUD. Multivariable logistic regression models examined the associations between psychosocial problems and the four AUD/CUD groups, adjusting for sociodemographic characteristics. RESULTS: People with AUD-only, CUD-only, and AUD+CUD had higher odds of most interpersonal problems (adjusted odds ratio [aORs] 1.07-4.01), financial problems (aORs 1.53-4.28), legal problems (aORs 3.34-7.71), and health-related problems (aORs 1.29-1.92). The odds of psychosocial and health-related problems were similar for CUD-only and AUD-only in direct comparisons. Compared to those with AUD-only, those with AUD+CUD had higher odds of most problems examined (aORs 1.42-2.31). In contrast, there were few differences when comparing AUD+CUD with CUD-only. CONCLUSIONS: AUD and CUD were similarly associated with interpersonal, financial, and legal problems, emergency treatment and suicide attempt. People with AUD+CUD had higher odds of certain problems than individuals with either AUD-only or CUD-only. Although most people who use cannabis do not experience harms, our results indicate that CUD does not appear to be less harmful than AUD.

Probability and correlates of transition from cannabis use to DSM-5 cannabis use disorder: Results from a large-scale nationally representative study.

INTRODUCTION AND AIMS: It has been previously reported that more than 34% of individuals who use cannabis may qualify for a diagnosis of DSM-IV cannabis abuse or dependence throughout their lifetime. The introduction of the DSM-5 cannabis use disorder (CUD) diagnostic criteria reflects several intrinsic changes in the perception of substance use disorders. However, little is known about the probability of transition from cannabis use to CUD over time nor about the sociodemographic and clinical correlates associated with this transition. DESIGN AND METHODS: Participants were individuals ≥18 years interviewed in the National Epidemiologic Survey on Alcohol and Related Conditions-III in 2012-2013. Measurements included univariable and multivariable discrete-time survival analyses performed to examine the association between previously reported cannabis dependence predictors and the hazards of transitioning from cannabis use to CUD. Survival plots assessed the probability of transition from cannabis use to CUD over time since age of first use and differences in probability between predictor levels. RESULTS: Among lifetime cannabis users (N = 11 272), lifetime probability of transition to CUD was approximately 27%. A higher probability of transition from cannabis use to CUD was observed in the following: men, participants belonging to an ethnic minority group, early-onset cannabis users and individuals who reported experiencing three or more childhood adverse events. DISCUSSION AND CONCLUSIONS: This is the first study to explore transition from cannabis use to the DSM-5 CUD diagnosis. The current study identified specific predictors of this transition, which may assist in targeting at-risk populations.

Childhood adversity and mental health comorbidity in men and women with opioid use disorders.

INTRODUCTION: To examine gender differences in associations between mental health comorbidity and adverse childhood experiences (ACE) among adults with DSM-5 lifetime opioid use disorders (OUD). METHODS: In 2018, we analyzed 2012-13 nationally-representative data from 388 women and 390 men with OUD (heroin, prescription opioid misuse). Using weighted multinomial logistic regression, we examined factors associated with mental health comorbidity, tested a gender-by-childhood-adversity interaction term, and calculated predicted probabilities, controlling for covariates. RESULTS: Among adults with OUD, women are more likely than men to have comorbid mood or anxiety disorders (odds ratio [95% CI] 1.72 [1.20, 2.48]), and less likely to have conduct disorders. More women than men have prescription OUD (3.72 [2.24, 6.17]), and fewer have heroin use disorder (0.39 [0.27, 0.57]). Among both genders, ACE prevalence is high (>80%) and more than 40% are exposed to ≥3 types of ACE. Women more than men are exposed to childhood sexual abuse (4.22 [2.72, 6.56]) and emotional neglect (1.84 [1.20, 2.81]). Comorbid mood or anxiety disorders are associated with female gender (1.73 [1.18, 2.55]) and exposure to ≥3 types of ACE (3.71 [2.02, 6.85]), controlling for covariates. Moreover, exposure to more ACE elevates risk for comorbid mood or anxiety disorders more among women than men. CONCLUSION: Among adults with OUD, ACE alters the gender gap in risk for comorbid mood or anxiety disorders. Using gender-tailored methods to address the harmful effects ACE on the mental health of individuals with OUD may help to prevent and ameliorate the current opioid epidemic.

Prevalence and correlates of HIV testing and HIV-positive status in the US: Results from the National Epidemiological Survey on Alcohol and Related Conditions III (NESARC-III).

We used the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III), a nationally representative sample of US adults (n = 34,653), to estimate the prevalence and correlates of HIV testing and HIV status. The diagnostic interview used was the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-5 Version. We found that in 2012-2013, the prevalence of a history of HIV testing was 53.0% among females and 47.0% among males. Among individuals tested, the prevalence of HIV was 1.06%, resulting in a known estimated prevalence of 0.54% in the full sample. In adjusted results, being non-white, aged 30-44, having college, being non-heterosexual, having history of unprotected sex or history of childhood sexual abuse and lower mental health-related quality of life increased the odds of having been tested, whereas being foreign-born, 45 years or older, family income ≥$20,000, being unemployed or a student, living in a rural setting and older age at first sex lowered those odds. Among those tested, being 30-64, being non-heterosexual, having history of unprotected sex or having a sexually transmitted disease in the last year was associated with greater odds of being HIV+. Having some college decreased those odds. In the adjusted results all psychiatric disorders were associated with increased rates of HIV testing, but only a lifetime history of drug use disorder and antisocial personality disorders were associated with HIV status among those tested. Despite CDC recommendations, only about half of US adults have ever been tested for HIV, interfering with efforts to eradicate HIV infection.

Self- and other-directed forms of violence and their relationship with lifetime DSM-5 psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol Related Conditions-III (NESARC-III).

A combined history of violence toward self and others has been reported in clinical and incarcerated populations. Psychiatric disorders have been implicated as risk factors. This study examines the lifetime prevalence of this combined violence in the general population and its associations with DSM-5 psychiatric disorders in comparison with other- and self-directed violence. Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) were analyzed, including 36,309 U.S. adults ages 18 and older. Violent behavior was defined by suicide attempts; recurrent suicidal behavior; gestures, threats, or self-mutilating behavior (self-directed); and multiple items of violence toward others (other-directed) in four categories: none, self-directed only, other-directed only, and combined self-/other-directed. Multinomial logistic regression examined these violence categories in association with sociodemographics and lifetime DSM-5 psychiatric disorders. Results show that approximately 18.1% of adults reported violent behavior, including self-directed only (4.4%), other-directed only (10.9%), and combined self- and other-directed violence (2.8%). DSM-5 psychiatric disorders significantly associated with the violence typology include alcohol, tobacco, cannabis, and other drug use disorders; mood disorders; posttraumatic stress disorder; and schizotypal, antisocial, and borderline personality disorders. Findings extend the clinical literature regarding the co-occurrence of self- and other-directed violent behaviors to the general population.