Patterns of use of other drugs among those with alcohol dependence: Associations with drinking behavior and psychopathology

Abstract

INTRODUCTION Alcohol dependence (AD) presents with substantial clinical heterogeneity, including concurrent use of non-alcohol drugs. Here, we examine specific patterns of concurrent non-alcohol substance use during the previous year among a nationally representative sample of adults with DSM-IV AD, and estimate their population prevalence in the U.S. We then evaluate alcohol use behavior and comorbid psychopathology among respondents with AD according to their patterns of concurrent non-alcohol substance use. METHODS These analyses utilized data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Latent class analyses classified respondents with AD into four clinically-meaningful patterns of concurrent substance use: 1) Use of alcohol only; 2) Use of alcohol and tobacco only; 3) Use of alcohol, tobacco and cannabis; and 4) Use of alcohol, tobacco, cannabis, cocaine and other illicit drug(s). RESULTS Among AD respondents, the most prevalent pattern was the use of alcohol and tobacco only (weighted percentage 32.4%), followed by the use of alcohol only (weighted percentage 27.5%). AD respondents who used alcohol, tobacco, cannabis, cocaine and other illicit drug(s) (weighted percentage 25.3%) manifested the most severe pattern of alcohol consumption, and had significant overrepresentations of major depression, panic and other anxiety disorder, and paranoid, schizotypal, borderline, antisocial, and histrionic personality disorders, compared to those with those who used alcohol alone. CONCLUSIONS Specific patterns of concurrent substance use convey important information regarding the clinical presentation and prognosis for AD. In particular, concurrent use of illicit drugs over the past year by AD individuals was associated with greater severity and comorbid psychopathology. These data suggest the need for pragmatic trials of AD interventions that take into account patterns of substance use behavior in addition to an AD diagnosis.

Dual disorders in individuals under treatment for both alcohol and cocaine: Madrid study on the prevalence of dual disorders

“…Patients in the Alc group showed however significant a higher proportion of MDD and a lower proportion of PTSD compared to the Alc + Coc group. These findings support previous results in the United States (Brady et al, 1995;Hedden et al, 2009;Johnson et al, 2010;Moss et al, 2015;Stinson et al, 2005) and in the Thai samples (Suttajit et al, 2012). This higher proportion of dual disorders renders concurrent alcohol and cocaine SUD patients more vulnerable.…”

“…This heterogeneity could explain the differences with results obtained in our study. In this respect, individuals with both alcohol and cocaine SUD were previously associated (Moss et al, 2015;Suttajit et al, 2012) with higher proportion of depressive disorders than alcoholics without cocaine SUD, and this was not replicated in our sample. This difference could be explained by the fact that MDD is linked to female sex and ageing, which is present in higher proportion in the Alc group.…”

“…Up to 60-80% of either alcohol or cocaine treatment-seeking individuals share both SUDs (Carroll et al, 1993). To date, results show that this comorbidity associates differential socio-demographic characteristics (Walsh et al, 1991;Windle & Miller-Tutzauer, 1991) and higher rates of drug use, depression, anxiety, and drug-related problems (Brown et al, 1994;Hedden et al, 2009;Moss et al, 2015;Stinson et al, 2005;Suttajit et al, 2012;Windle & Miller-Tutzauer, 1991) compared to single addiction.…”

“…The co-occurrence of alcohol and cocaine is frequently found in dual disorders samples, and it has been studied as a separate subgroup both in general population (Carroll, Rounsaville, & Bryant, 1993;Grant & Harford, 1990;Hedden, Malcolm, & Latimer, 2009;Johnson, Cottler, O'Leary, & Abdallah, 2010;Moss, Goldstein, Chen, & Yi, 2015;Stinson et al, 2005;Suttajit, Kittirattanapaiboon, Junsirimongkol, Likhitsathian, & Srisurapanont, 2012;Windle & Miller-Tutzauer, 1991) and clinical (Brady, Sonne, Randall, Adinoff, & Malcolm, 1995;Brown, Seraganian, & Tremblay, 1994;Heil, Badger, & Higgins, 2001;Vanek et al, 1996;Walsh et al, 1991) settings. Up to 60-80% of either alcohol or cocaine treatment-seeking individuals share both SUDs (Carroll et al, 1993).…”

Effects of naltrexone are influenced by childhood adversity during negative emotional processing in addiction recovery

“…This distinction was made due to evidence showing that individuals dependent on alcohol and drugs have more severe psychopathology, 34 and differences in brain function 44 and structure 45 compared with individuals dependent on alcohol alone. Control participants with a history of heavy alcohol or drug use were also excluded due to known associated functional and structural abnormalities.…”