Polydrug use disorders in individuals with opioid use disorder

Hassan, Ahmed; Foll, Bernard Le

doi:10.1016/j.drugalcdep.2019.01.031

Cited by 74 publications

(58 citation statements)

References 44 publications

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“…There is substantial evidence to suggest that the number of substances used is more predictive of suicide than the specific type of substance used (Borges et al, 2000), and risk for suicide increases as the number of SUDs increases (Borges et al, 2000; Hakansson et al, 2011; Polimanti et al, 2021; G. W. Smith et al, 2011). It is estimated that of individuals with OUD, greater than 90% have used more than two other substances and over 25% met criteria for at least two comorbid SUDs within the same time period (Hassan & Le Foll, 2019). Another possibility is that some proportion of the suicide death cases were due to drug overdoses, which may also have contributed to the higher genetic correlation between suicide death and OUD (Docherty et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Exploring the genetic overlap of suicide-related behaviors and substance use disorders

Colbert¹,

Hatoum²,

Shabalin

et al. 2021

Preprint

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Background: Suicide-related behaviors are heterogeneous and transdiagnostic, and may demonstrate varying levels of genetic overlap with different substance use disorders (SUDs). Methods: We used linkage disequilibrium score regression and genomic structural equation models to examine the genetic relationships between several SUDs and suicide-related behaviors. Our analyses incorporated summary statistics from the largest genome-wide association studies (GWAS) of problematic alcohol use (PAU), the Fagerstrom Test for Nicotine Dependence (FTND), cannabis use disorder (CUD), and opioid use disorder (OUD; Ns ranging from 46,213-435,563) and GWAS of ever self-harmed, suicide attempt, and suicide death (Ns ranging from 18,223-117,733). We also accounted for genetic liability to depression (N=500,199) and risk tolerance (N=315,894). Results: Ever self-harmed correlated most strongly with CUD (rg=0.60) and suicide death correlated most strongly with OUD (rg=0.53). Suicide attempt correlated similarly with all SUDs. Simultaneously correlating a common SUD factor with each specific suicide indicator while controlling for depression and risk tolerance revealed significant, positive genetic correlations between all SUDs and suicide-related behaviors (rg=0.26-0.46). Discussion: Our findings suggest that genetic and behavioral contributions to suicide death may somewhat differ from non-lethal suicide-related behaviors. Additionally, we identify a general level of genetic overlap between SUDs and suicide-related behaviors which is independent of depression and risk tolerance.

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Section: Discussionmentioning

confidence: 99%

Exploring the genetic overlap of suicide-related behaviors and substance use disorders

Colbert¹,

Hatoum²,

Shabalin

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…Having multiple comorbid substance use disorders (SUDs), described as polysubstance use, is one of the most prominent risk factors for opioid overdose [7–9]. Comorbid SUD is common in patients with opioid use disorder (OUD), with more than 57% of adults with OUD having an additional comorbid SUD among US adults [10]. Beyond the impact on overdose risk, comorbid SUDs among patients with OUD are associated with numerous other negative health and legal consequences and increased health‐care utilization [11,12].…”

Section: Introductionmentioning

confidence: 99%

Polysubstance use and association with opioid use disorder treatment in the US Veterans Health Administration

et al. 2020

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Aims To understand the role of comorbid substance use disorders (SUDs), or polysubstance use, in the treatment of opioid use disorder (OUD), this study compared patients with OUD only to those with additional SUDs and examined association with OUD treatment receipt. Design, setting and participants Retrospective national cohort study of Veterans diagnosed with OUD (n = 65 741) receiving care from the US Veterans Health Administration (VHA) in fiscal year (FY) 2017. Measurements Patient characteristics were compared among those diagnosed with OUD only versus those with one other SUD (OUD + 1 SUD) and with multiple SUDs (OUD + ≥ 2 SUDs). The study examined the relationship between comorbid SUDs and receipt of buprenorphine, methadone and SUD outpatient treatment during 1‐year follow‐up, adjusting for patient demographic characteristics and clinical conditions. Findings Among the 65 741 Veterans with OUD in FY 2017, 41.2% had OUD only, 22.9% had OUD + 1 SUD and 35.9% had OUD + ≥ 2 SUDs. Common comorbid SUDs included alcohol use disorder (41.3%), cocaine/stimulant use disorder (30.0%) and cannabis use disorder (22.4%). Adjusting for patient characteristics, patients with OUD + 1 SUD [adjusted odds ratio (aOR) = 0.87, 95% confidence interval (CI) = 0.82–0.93] and patients with OUD +≥ 2 SUDs (aOR = 0.65, 95% CI = 0.61–0.69) had lower odds of receiving buprenorphine compared with OUD only patients. There were also lower odds of receiving methadone for patients with OUD + 1 SUD (aOR = 0.91, 95% CI = 0.86–0.97)and for those with OUD + ≥2 SUDs (aOR = 0.79, 95% CI = 0.74–0.84). Patients with OUD + 1 SUD (aOR = 1.85, 95% CI = 1.77–1.93) and patients with OUD + ≥2 SUDs (aOR = 3.25, 95% CI = 3.103.41) were much more likely to have a SUD clinic visit. Conclusions The majority of Veterans in the US Veterans Health Administration diagnosed with opioid use disorder appeared to have at least one comorbid substance use disorder and many have multiple substance use disorders. Despite the higher likelihood of a substance use disorder clinic visit, having a non‐opioid substance use disorder is associated with lower likelihood of buprenorphine treatment, suggesting the importance of addressing polysubstance use within efforts to expand treatment for opioid use disorder.

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“…Since the establishment of opioid substitution in the 1960s, this treatment strategy for opioid use—that is highly prevalent in PUD (75)—went hand-in-hand with psychosocial interventions. Accordingly, international clinical guidelines list psychosocial rehabilitation as crucial in this area (76).…”

Section: Introductionmentioning

confidence: 99%

“…Therein, polydrug use seems to be more prevalent in young men than young women (89, 90) and comorbid mental disorders seem to be more prevalent in young adults with PUD compared to those with another SUD (91). Importantly, while polydrug use is highly prevalent in individuals with opioid use disorder, individuals with this pattern of drug use also show a high prevalence of comorbid posttraumatic stress disorder (PTSD) (75). Therein, PTSD and PUD may be connected by “an ‘additive’ self-medication model” (p. 39) (92).…”

Section: Introductionmentioning

confidence: 99%

The Role of Attachment in Poly-Drug Use Disorder: An Overview of the Literature, Recent Findings and Clinical Implications

Hiebler‐Ragger

Unterrainer

2019

Front. Psychiatry

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Background: Substance use disorders (SUDs) represent a worldwide epidemic with extensive costs to the individual and to society. Occasionally described as an attachment disorder, they have been linked to various impairments in self-regulation and social functioning. However, while there have been significant advances in the development and validation of treatment strategies for SUD in recent years, the components of these treatment approaches have yet to be fully explored. The characteristics of polydrug use disorder (PUD) especially need to be addressed in more detail, as this diagnosis is highly common in individuals seeking treatment, while simultaneously being associated with poor treatment success. Aim and Scope: This review aims at further exploring the relevance of attachment in PUD and its treatment. To this end, this review provides a concise summary of relevant theories on the development and treatment of SUD in general, including related parameters of attachment, emotion regulation, and neuroscience. Furthermore, several studies focused specifically on PUD are described in more detail. These studies explored the connections between attachment, personality structure, primary and higher emotions (including spirituality), as well as structural and functional neural parameters in inpatients with PUD as well as in healthy controls. Most notably, the described studies highlight that insecure attachment and impairments in personality structure are present in inpatients with PUD. In addition, these characteristics are paralleled by extensive impairments in white matter integrity, especially in tracts connected to facets of emotion regulation. Conclusions: Based on our findings, we emphasize conceptualization of PUD as an Attachment Disorder, on a behavioral as well as on a neural level. Furthermore, we point out the importance of an integrated bio-psycho-social approach in this research area. Consequently, future studies might more closely focus on the influence of attachment-based interventions on emotion regulation abilities as well as a potentially related neuroplasticity. Neuroplastic changes, which are still rather unexplored, might represent important parameters for the assessment of treatment outcomes especially in long-term SUD treatment.

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Polydrug use disorders in individuals with opioid use disorder

Cited by 74 publications

References 44 publications

Exploring the genetic overlap of suicide-related behaviors and substance use disorders

Exploring the genetic overlap of suicide-related behaviors and substance use disorders

Polysubstance use and association with opioid use disorder treatment in the US Veterans Health Administration

The Role of Attachment in Poly-Drug Use Disorder: An Overview of the Literature, Recent Findings and Clinical Implications

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