Stinson FS, Grant BF, Dawson DA, Ruan WJ, Huang B, Saha T. Comorbidity between DSM-IV alcohol and specific drug use disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug Alcohol Depend 80: 105-116

Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892-9304, USA.
Drug and Alcohol Dependence (Impact Factor: 3.42). 11/2005; 80(1):105-16. DOI: 10.1016/j.drugalcdep.2005.03.009
Source: PubMed


To date, there have been no published data on 12-month comorbidity of DSM-IV alcohol and drug use disorders in the general U.S. population. The purposes of the present study were to examine the prevalence and comorbidity of alcohol and specific drug use disorders, and to identify sociodemographic and psychopathologic correlates and treatment seeking among three groups of respondents: (1) those with alcohol use disorders only; (2) those with drug use disorders only; (3) those with comorbid alcohol and drug use disorders.
Information on 12-month alcohol and specific drug use disorders in the United States was derived from face-to-face interviews in the National Institute on Alcohol Abuse and Alcoholism's (NIAAA) 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC: n = 43,093).
Prevalences were 7.35% for alcohol use disorders only, 0.90% for drug use disorder only and 1.10% for comorbid alcohol and drug use disorders. Sociodemographic and psychopathologic correlates of these three groups were quite different, with the drug use disorder and comorbid groups significantly more likely to be young, male, never married and of lower socioeconomic status than the alcohol use disorder only group. Associations between current alcohol use disorders and 25 specific drug use disorders were generally positive and statistically significant. The 12-month prevalence of treatment seeking significantly increased from 6.06% for those with an alcohol use disorder only to 15.63% for those with a drug use disorder only, and to 21.76% for those with comorbid alcohol and drug use disorders.
This study provides detailed data on the homotypic comorbidity of alcohol use disorders and 25 different drug use disorders and confirms the high levels of association seen in previous studies based on lifetime measures. Implications of this study are discussed in terms of integrating alcohol and drug treatment services and refining prevention and intervention efforts.

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    • "Therefore, we took a broad approach and created items that referred to " drugs " in general. This approach is also consistent with the clinical epidemiology of many secondary and tertiary care facilities where patients appearing for treatment often abuse multiple substances (Stinson et al., 2005). Substance use may vary over time as a function of availability of different drugs, resources for procuring drugs, periods of incarceration , and other life circumstances. "
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    ABSTRACT: Background: Two item banks for substance use were developed as part of the Patient-Reported Outcomes Measurement Information System (PROMIS(®)): severity of substance use and positive appeal of substance use. Methods: Qualitative item analysis (including focus groups, cognitive interviewing, expert review, and item revision) reduced an initial pool of more than 5300 items for substance use to 119 items included in field testing. Items were written in a first-person, past-tense format, with 5 response options reflecting frequency or severity. Both 30-day and 3-month time frames were tested. The calibration sample of 1336 respondents included 875 individuals from the general population (ascertained through an internet panel) and 461 patients from addiction treatment centers participating in the National Drug Abuse Treatment Clinical Trials Network. Results: Final banks of 37 and 18 items were calibrated for severity of substance use and positive appeal of substance use, respectively, using the two-parameter graded response model from item response theory (IRT). Initial calibrations were similar for the 30-day and 3-month time frames, and final calibrations used data combined across the time frames, making the items applicable with either interval. Seven-item static short forms were also developed from each item bank. Conclusions: Test information curves showed that the PROMIS item banks provided substantial information in a broad range of severity, making them suitable for treatment, observational, and epidemiological research in both clinical and community settings.
    Drug and alcohol dependence 10/2015; 156. DOI:10.1016/j.drugalcdep.2015.09.008 · 3.42 Impact Factor
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    • "Briefly, exclusions were neurological and psychiatric disorders which affect neurobiology or neurocognition, but not hepatitis C, type-2 diabetes, hypertension, and unipolar mood disorder, highly prevalent in addiction (Hasin et al., 2007; Stinson et al., 2005). Thirty-one LD (25 nonsmokers, 6 smokers) recruited from the community served as controls. "
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    ABSTRACT: Background Brain perfusion is altered in both alcohol dependence and stimulant dependence. Although most substance users also abuse/depend on alcohol concurrently (polysubstance users; PSU), rigorous perfusion research in PSU is limited. Also, the relationships of perfusion abnormalities with cognition, impulsivity or decision making are not well known. Methods Arterial spin labeling MRI and neuropsychological measures assessed perfusion levels and neurocognition in 20 alcohol dependent individuals with comorbid stimulant dependence (PSU), 26 individuals dependent on alcohol only (ALC), and 31 light/non-drinking controls (LD). The patient groups included smokers and non-smokers. Results ALC had lower perfusion than LD in subcortical and cortical brain regions including the brain reward/executive oversight system (BREOS). Contrary to our hypothesis, regional perfusion was generally not lower in PSU than ALC. However, smoking PSU had lower perfusion than smoking ALC in several regions, including BREOS. Lower BREOS perfusion related to greater drinking severity in smoking substance users and to greater smoking severity in smoking ALC. Lower regional perfusion in ALC and PSU correlated with worse performance in different cognitive domains; smoking status affected perfusion-cognition relationships in ALC only. Lower BREOS perfusion in both substance using groups related to higher impulsivity. Conclusion Although regional perfusion was not decreased in PSU as a group, the combination of cigarette smoking and polysubstance use is strongly related to hypoperfusion in important cortical and subcortical regions. As lower perfusion relates to greater smoking severity, worse cognition and higher impulsivity, smoking cessation is warranted for treatment-seeking PSU and ALC.
    Drug and alcohol dependence 02/2015; 150. DOI:10.1016/j.drugalcdep.2015.02.022 · 3.42 Impact Factor
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    • "While past research indicates cooccurrence between alcohol and cannabis use in adolescence and young adulthood (Flory et al., 2004; Jackson et al., 2008; Mason et al., 2013), there have been comparatively few prospective studies using diagnostic data of either AUDs or CUDs (e.g., Hayatbakhsh et al., 2009; Stinson et al., 2005). Hayatbakhsh et al. (2009) investigated early risk factors of CUDs in young adulthood but did not include relations with AUDs, and Stinson et al. (2005) documented the 12-month prevalence of AUDs, other substance use disorders (SUDs), and comorbidity of different SUDs in the U.S. population. Research is extremely limited on the comorbid relations between AUDs and CUDs during different developmental periods, specifically from youth through early adulthood. "
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    ABSTRACT: Background: Alcohol and cannabis are among the most widely used and abused drugs in industrialized societies. Investigations of patterns in comorbidity and temporal sequencing between alcohol use disorders (AUDs) and cannabis use disorders (CUDs) from childhood to adulthood are important for understanding the etiologies of these disorders. Methods: The sample comprised 816 individuals (59% male, 89% white). Dichotomous measures indicated whether or not a participant was in an AUD or CUD episode during three developmental periods-youth (childhood through adolescence), early adulthood, and adulthood. Structural equation modeling was used to determine relations between AUDs and CUDs across the three developmental periods, and to test for gender differences. Results: Concurrent associations between AUD and CUD were significant. Both AUD and CUD in previous developmental periods significantly predicted the same substance disorders in subsequent periods. Cross-lagged paths from youth AUD to young adult CUD and youth CUD to young adult AUD were both significant. However, only the cross-lagged path from youth CUD to adult AUD was significant. The cross-lagged paths from young adult AUD to adult CUD and young adult CUD to adult AUD were both nonsignificant. Males and females were mostly similar with only three differences found between genders. Conclusions: Comorbidity of AUDs and CUDs was evident from youth through adulthood but the strength of the relationship lessened in adulthood. Temporal sequencing influences of AUDs and CUDs on each other were similar in youth and adulthood but not young adulthood. Same substance stability was greatest in adulthood.
    Drug and Alcohol Dependence 01/2015; 149. DOI:10.1016/j.drugalcdep.2015.01.025 · 3.42 Impact Factor
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