Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Drug Abuse and Dependence in the United States

Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892-9304, USA.
Archives of General Psychiatry (Impact Factor: 14.48). 05/2007; 64(5):566-76. DOI: 10.1001/archpsyc.64.5.566
Source: PubMed


Current and comprehensive information on the epidemiology of DSM-IV 12-month and lifetime drug use disorders in the United States has not been available.
To present detailed information on drug abuse and dependence prevalence, correlates, and comorbidity with other Axis I and II disorders. Design, Setting, and
Face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule of the National Institute on Alcohol Abuse and Alcoholism in a large representative sample of US adults (N=43093).
Twelve-month and lifetime prevalence of drug abuse and dependence and the associated correlates, treatment rates, disability, and comorbidity with other Axis I and II disorders.
Prevalences of 12-month and lifetime drug abuse (1.4% and 7.7%, respectively) exceeded rates of drug dependence (0.6% and 2.6%, respectively). Rates of abuse and dependence were generally greater among men, Native Americans, respondents aged 18 to 44 years, those of lower socioeconomic status, those residing in the West, and those who were never married or widowed, separated, or divorced (all P<.05). Associations of drug use disorders with other substance use disorders and antisocial personality disorder were diminished but remained strong when we controlled for psychiatric disorders. Dependence associations with most mood disorders and generalized anxiety disorder also remained significant. Lifetime treatment- or help-seeking behavior was uncommon (8.1%, abuse; 37.9%, dependence) and was not associated with sociodemographic characteristics but was associated with psychiatric comorbidity.
Most individuals with drug use disorders have never been treated, and treatment disparities exist among those at high risk, despite substantial disability and comorbidity. Comorbidity of drug use disorders with other substance use disorders and antisocial personality disorder, as well as dependence with mood disorders and generalized anxiety disorder, appears to be due in part to unique factors underlying each pair of these disorders studied. The persistence of low treatment rates despite the availability of effective treatments indicates the need for vigorous educational efforts for the public and professionals.

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    • "Across studies, lesbian gay and bisexual youth have been more likely to report past month cannabis use than heterosexual youth (Marshall et al., 2009). Associations between mental health and substance use disorders have been documented theoretically (Wills and Shiffman, 1985), epidemiologically (Armstrong and Costello, 2002; Compton et al., 2007), and neurobiologically (Brady and Sinha, 2005), and populations living with HIV/AIDS have been characterized by increased risk for psychiatric and substance use co-morbidities (Bing et al., 2001; Chandler et al., 2006; Walkup et al., 2008). High levels of stress and co-morbid mental health or substance use disorders associated with disease management have been found among adults living with HIV/AIDS (Brown and Vanable, 2008), yet the precise relationship between cannabis and different mood disorders is not well understood (Crippa et al., 2009). "
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    ABSTRACT: In addition to individual characteristics, there may be a wide range of environmental or neighborhood stressors that contribute to elevated cannabis use in groups of youth living with HIV/AIDS (YLHIV); however, the effects of social disorganization on cannabis use in YLHIV to date have not been studied. We examined the effects of individual-level and neighborhood-level factors by developing hierarchical generalized linear models estimating odds of current cannabis use (any use during the past 3 months) and daily cannabis use among a sample of YLHIV (N=1921) currently receiving medical care. The final model for daily cannabis use in the past 3 months included significant positive effects associated with hostility (O.R.=1.08, 95% C.I.: 1.05, 1.11), being older (O.R.=1.12, 95% C.I.: 1.05, 1.20), being a bisexual male (O.R.=1.72, 95% C.I.: 1.10, 2.70), and residing in a community with a murder rate in the highest quartile (O.R.=1.91, 95% C.I.: 1.27, 2.87), second highest quartile (O.R.=1.62, 95% C.I.: 1.06, 2.46), or third highest quartile (O.R.=1.52, 95% C.I.: 1.01, 2.30). This paper advances our knowledge of the multilevel factors associated with elevated cannabis use among groups of YLHIV and furthers our understanding of social and structural determinants of health in this population. Future research into cannabis use among YLHIV should consider, not only cannabis use within the context of the adjustment of living with HIV/AIDS, but also the stressors that characterize the environments in which groups of YLHIV live. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Drug and alcohol dependence 03/2015; 151. DOI:10.1016/j.drugalcdep.2015.03.017 · 3.42 Impact Factor
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    • "The rates of the study participants who had ASPD (40%) and BPD (20%) respectively, represent dozens of times the rates in the general population in China (Grant et al., 2008, 2004a; Huang et al., 2009; Lenzenweger et al., 2007). Similar to the current study, high prevalence of ASPD, BPD, mood disorders as well as other substance use co-morbidities has been found in other studies and settings (Brooner et al., 1997; Compton et al., 2003, 2007; Darke et al., 2007; Grella et al., 2009; Mackesy- Amiti et al., 2012; Öhlin et al., 2011). While the current study showed comparable rates of ASPD and BPD to those among western in-treatment heroin individuals, the rate of mood disorders, specifically MDD, were found to be relatively lower than in western study populations (Brooner et al., 1997; Chen et al., 2011; Ross et al., 2005). "
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    ABSTRACT: Background: The strong comorbidity of psychiatric and substance use disorders is well documented outside of China, however it has not been studied extensively among drug using individuals in China. This study evaluated patterns of co-occurring psychiatric and substance use disorders among heroin dependent individuals in Changsha, China. Methods: Participants were 1002 individuals consecutively admitted between March 10 and October 30, 2008 into two compulsory and one voluntary drug rehabilitation centers in Changsha. The Structured Clinical Interview for DSM-IV-TR Axis I Disorders-Patient Edition (SCID-I/P) and the Structured Clinical Interview for DSM-IV-TR Axis II personality Disorders (SCID-II) were used. Results: Mental health disorders were highly prevalent among study participants: 29.6% had at least one lifetime DSM-IV Axis I and 19.5% had at least one current (past month) Axis I mental health disorder. Antisocial (40.7%) and Borderline (22.6%) Personality Disorders were most prevalent DSM-IV Axis II lifetime diagnoses and a mood disorder (19.1%) was the most prevalent Axis I lifetime disorder; 57.8% had other substance use disorder in addition to opioid dependence. Study results indicate that females in compulsory settings have lower socio-economic status than males in compulsory settings, and that males in compulsory settings have higher rates of co-morbidities, including personality, mood disorders, substance use co-morbidities, and lower socio-economic status than males in the voluntary setting. Conclusions: The study findings suggest an urgent need to expand and improve diagnostic and treatment capabilities in compulsory rehabilitation settings in China and a need for additional services and interventions specific for female rehabilitants.
    Drug and Alcohol Dependence 02/2015; 149. DOI:10.1016/j.drugalcdep.2015.01.028 · 3.42 Impact Factor
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    • "It is possible that we would observe a reduction in overall alcohol preference under those conditions in b-EP-transplanted rats. Alcoholism and anxiety disorders are frequently comorbid and alcoholics often report consuming alcohol to " self-medicate " or to reduce anxiety and other withdrawal symptoms (Compton et al., 2007; Zimmerman and Chelminski, 2003). We report that b-EP neuronal transplantation reduces anxiety-like behavior in both male and female P rats, although the effects of the transplantation, even under repeated stress conditions, on alcohol preference were very minimal and seemed to depend on whether the stress is acutely present or whether access to alcohol is freely available. "
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    ABSTRACT: Background Alcohol exposure has adverse effects on stress physiology and behavioral reactivity. This is suggested to be due, in part, to the effect of alcohol on β-endorphin (β-EP)-producing neurons in the hypothalamus. In response to stress, β-EP normally provides negative feedback to the hypothalamic–pituitary–adrenal axis and interacts with other neurotransmitter systems in the amygdala to regulate behavior. We examined whether β-EP neuronal function in the hypothalamus reduces the corticosterone response to acute stress, attenuates anxiety-like behaviors, and modulates alcohol drinking in rats.Methods To determine whether β-EP neuronal transplants modulate the stress response, anxiety behavior, and alcohol drinking, we implanted differentiated β-EP neurons into the paraventricular nucleus (PVN) of the hypothalamus of normal, prenatal alcohol-exposed, and alcohol-preferring (P) and alcohol-non-preferring (NP) rats. We then assessed corticosterone levels in response to acute restraint stress and other markers of stress response in the brain and anxiety-like behaviors in the elevated plus maze and open-field assays.ResultsWe showed that β-EP neuronal transplants into the PVN reduced the peripheral corticosterone response to acute stress and attenuated anxiety-like behaviors. Similar transplants completely reduced the hypercorticosterone response and elevated anxiety behaviors in prenatal alcohol-exposed adult rats. Moreover, we showed that β-EP reduced anxiety behavior in P rats with minimal effects on alcohol drinking during and following restraint stress.Conclusions These data further establish a role of β-EP neurons in the hypothalamus for regulating physiological stress response and anxiety behavior and resemble a potential novel therapy for treating stress-related psychiatric disorders in prenatal alcohol-exposed children and those genetically predisposed to increased alcohol consumption.
    Alcoholism Clinical and Experimental Research 01/2015; 39(1). DOI:10.1111/acer.12611 · 3.21 Impact Factor
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