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Sociodemographic characteristics and drug use patterns, according to cocaine and heroin cohorts and current psychiatric morbidity.
Source publication
Drug abuse is a serious public health problem. Moreover, co-occurring mental health and substance abuse disorders are common among drug users. This paper examines psychiatric disorders of young cocaine and heroin users using the World Mental Health Composite International Diagnostic Interview (WMH-CIDI). A cohort of 1266 young (18-30 years) current...
Citations
... 12 In the United States, cocaine use is a significant cause of morbidity and mortality, with consequences ranging from longterm cognitive decline to early death. [13][14][15][16] Cocaine usage is associated with numerous acute and chronic cardiovascular consequences, including aortic dissection, ischemia, hemorrhagic stroke, chest pain, hypertension, acute myocardial infarction (MI), arrhythmias, sudden death, and cardiomyopathy leading to chronic heart failure 17,18 (Figure1). The primary cause of cocaine's cardiovascular (CVS) damage is its significant sympathomimetic action. ...
Cardiovascular diseases are among the major causes of mortality and morbidity worldwide Cardiotoxicity due to drugs is a common and significant adverse effect on cardiovascular health, acting through multifactorial pathological mechanisms. Drug-induced cardiotoxicity limits the use and further development of certain drugs. Keeping this in mind, this review discusses the crucial drug-receptor interactions involved in cardiotoxicity induced by some drugs such as cocaine, trastuzumab, isoproterenol, antidiabetic drugs like pioglitazone, theophylline, ergotamine, methysergide, anthracyclines, fluoropyrimidines, cisplatin, NSAIDs, and antiviral agents. The key receptors involved in the pathological mechanism behind the cardiotoxicity induced by these drugs are discussed, aiming to provide in-depth knowledge for future drug discovery and prevention of drug-induced cardiotoxicity.
... Daily heroin use in the last 3 months was reported by 94.2% of the participants. In the study by Silvia Tortajada et al. in 2012 6 , the majority of the study participants used injection drugs one or two days a week, and only 16.2% used them every day. Nearly one-third of the participants had a family history of substance use. ...
... This difference in the prevalence can be explained by the difference in the measurement tools used in these studies. Studies from the West have reported a lower prevalence of psychiatric morbidities, 52.7% by Angelo Giovanni M. et al. in 2011 10 and 43% by Silvia Tortajada et al. in 2012 6 . Approximately two-thirds of our study participants had more than one psychiatric comorbidity. ...
... OpioidsFrequency Comorbidities P value Odds ratio with 95% CI www.nature.com/scientificreports/ anxiety disorders6,25 . The higher prevalence of anxiety disorders can be explained by the unrest in Kashmir and the COVID-19 pandemic during the study period. ...
The management of people who inject drugs (PWID) is compounded by the presence of psychiatric comorbidities leading to frequent relapses and poor treatment outcomes. Early identification and treatment of psychiatric comorbidities should be included in the management to enhance treatment outcomes. The objective of this study was to estimate the prevalence of psychiatric comorbidities and concurrent substance use among opioid injectors. This hospital-based, cross-sectional study was conducted from March 2021 to August 2022. This study included opioid injectors of all ages and both sexes. The Mini International Neuropsychiatric Interview-7 (MINI-7) and WHO-ASSIST were used to determine psychiatric comorbidities and concurrent substance use, respectively. Both crude and adjusted odds ratios were calculated to assess associations among demographic variables, concurrent substance use and psychiatric comorbidities. Among the 328 opioid injectors, the overall prevalence of psychiatric comorbidities was 88.1%, with the majority (68.6%) having more than one comorbidity. The most common psychiatric comorbidities were panic disorder (41.2%), social anxiety disorder (40.5%), and antisocial personality disorder (39.3%). Concurrent use of alcoholic beverages doubled the risk of ASPD (odds ratio 2.14 (1.24–3.72)). Cocaine (odds ratio 2.36 (1.10–5.03)) and amphetamines (odds ratio 7.68 (2.21–26.65)) increased the risk of OCD. Daily heroin injections were negatively associated (odds ratio 0.18 (0.03–0.94)) with psychotic disorders. Younger age (adjusted odds ratio 0.20 (0.79–0.53)) and never married status (adjusted odds ratio 2.62 (1.06–6.47)) were the only significant variables in the regression analysis. In conclusion, opioid injectors had a higher prevalence of numerous psychiatric comorbidities. The most common comorbidity was anxiety disorders. Concurrent use of tobacco, cannabis, cocaine, inhalants, etc., greatly increased the risk of psychiatric comorbidities.
... In addition to pharmacological differences, the types of drugs people use vary with their psychosocial background. For example, Tortajada et al. showed that cocaine users have more precarious living conditions and less social support than heroin users (Tortajada et al., 2012). The choice of drugs across populations also reflects social inequalities. ...
Background
The general aggression model has shown that both individual and situational factors can predict aggression. However, past research has tended to discuss these two factors separately, which might lead to inconsistency. This study addresses this gap by examining the importance of each predictor of aggression in a Chinese compulsory drug treatment population and further explores the predictors of aggression in various substance use disorder populations.
Method
Analyses were conducted using a sample of 894 male participants (mean = 38.30, SD = 8.38) in Chinese compulsory drug rehab. A machine learning model named LightGBM was employed to make predictions. We then used a game-theoretic explanatory technique, SHAP, to estimate the effect of predictors.
Results
In the full-sample model, psychological security, parental conflict, and impulsivity were the top 3 predictors. Depression, childhood abuse, and alexithymia positively predicted aggression, whereas psychological security, family cohesion, and gratitude negatively predicted aggression. There were significant differences in the predictive effects of depressants and stimulants. Although the importance of predictors varied between drug-use groups, several individual and situational factors were consistently the most important predictors.
Limitations
All participants in this study were male, and the data were acquired through self-reports from the participants. Domestic and nondomestic aggression are not distinguished. Additionally, our findings cannot support causal conclusions.
Conclusion
This study tested a series of classical theories of the predictors of aggression in China's compulsory drug treatment context and extended the ideas of the GAM to various substance use disorder groups. The findings have important implications for aggression treatment.
... Por otro lado, en España, hay pocos datos sobre la prevalencia de trastornos psiquiátricos en los consumidores de cocaína. La información de las muestras clínicas y no clínicas (Herrero, Domingo-Salvany, Torrens y Brugal, 2008;Herrero, Domingo-Salvany, Brugal y Torrens, 2011;Tortajada et al., 2012) estima que entre el 42.0 y el 65.0% de los consumidores de cocaína tienen un trastorno psiquiátrico concurrente. ...
... Nuestros resultados mostraron una alta prevalencia actual de diagnósticos psiquiátricos (64.0%), aunque estas cifras fueron inferiores a las encontradas por otros autores, quienes calcularon tasas de prevalencia entre el 73.5 y el 75.0% (Alonso y Lepine, 2007;Andrews, Slade y Issakidis, 2002;Arias et al., 2013;Carroll y Rounsaville, 1992;Chan, Dennis y Funk, 2008;Falck et al., 2004;Grant et al., 2004;Herrero et al., 2008;Kessler, Chiu, Demler, Merikangas y Walters, 2005b;Levin, Evans y Kleber, 1998;Rounsaville et al., 1991;Tortajada et al., 2012;Vergara-Moragues et al., 2012;Ziedonis, Rayford, Bryant y Rounsaville, 1994). Estas diferencias podrían ser el resultado de las variaciones en las variaciones en la metodología de estudio utilizada en la población analizada, incluyendo las herramientas diagnosticas, los criterios de inclusión y otras variables, como los efectos de cohorte. ...
... Otro problema es que las muestras de consumidores de cocaína pueden estar sujetas a efectos rápidos de cohorte, ya que los cambios en el precio de la cocaína, la disponibilidad y las actitudes sociales alteran su penetración en diferentes grupos demográficos. En segundo lugar, nuestro estudio pone de relieve la prevalencia actual, mientras que otros estudios han considerado la prevalencia a lo largo de la vida vida (Arias et al., 2013;Carroll y Rounsaville, 1992;Falck et al., 2004;Herrero et al., 2008;Herrero et al., 2011;Tortajada et al., 2012;Vergara-Moragues et al., 2012). En tercer lugar, la mayoría de variables del estudio fueron de auto-informe, lo que podría constituir un sesgo de recuerdo. ...
The objective of this study was to estimate the current prevalence of psychiatric disorders in cocaine-dependent patients who attend different treatment centres in the Community of Madrid. A prospective multicentre study was used, and a total of 197 cocainedependent subjects were assessed. The assessment instrument used for diagnosis was the Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV). The main findings of this study were a high prevalence of psychiatric comorbidity in cocaine-dependent patients seeking treatment (64.0%). The most common Non Substance Use Disorders found were attention-deficit/hyperactivity Disorders (34.5%) and depressive disorders (13.7%). The most common Substance Use Disorder was alcohol dependence (28.4%). Cocaine-dependent patients who had a depressive disorder and were alcohol dependent presented a more severe clinical profile and a higher degree of psychopathology, measured using different assessment tools, than the patients who were only cocaine dependent. These data suggest that the presence of psychiatric comorbidity could constitute a risk factor associated with the severity of cocaine dependence. The clinical heterogeneity found also indicates the need to search for individualised treatments that more specifically fit the needs of this population.
... Nevertheless, it is expected that patients who seek treatment in an outpatient drug clinic would be more dysfunctional than cocaine-dependent consumers not seeking treatment. Research focused on street drug users found higher severity/ greater dysfunction in those in clinical settings versus those not receiving treatment626364. Because of this, it is possible to hypothesize that drug users not in treatment should present lower neuroticism scores. ...
Background
Cocaine consumption can induce transient psychotic symptoms, which has been correlated with more severe addiction and aggressive behavior. However, little is known about the nature of the relationship between personality traits and psychotic symptoms in cocaine-dependent patients. This study examined the relationship between neuroticism and cocaine-induced psychosis.
Methods
A total of 231 cocaine-dependent patients seeking treatment were recruited to the study. Personality was evaluated by the Zuckerman-Kuhlman Personality Questionnaire. Cocaine-induced psychosis questionnaire, SCID-I, and SCID-II were used to evaluate comorbidity and clinical characteristics. Data analysis was performed in three steps: descriptive, bivariate, and multivariate analyses.
Results
Cocaine-induced psychosis was reported in 65.4% of the patients and some personality disorder in 46.8%. Two personality dimensions (Neuroticism-Anxiety and Aggression-Hostility) presented a significant effect on the risk of experiencing psychotic symptoms (t(229) = 2.69, p = 0.008; t(229) = 2.06, p = 0.004), and patients with psychotic symptoms showed higher scores in both variables. On the multivariate analysis, only Neuroticism remained as a significant personality factor independently associated with psychotic symptoms (Wald = 7.44, p<0.05, OR = 1.08, CI 95% 1.02–1.16) after controlling for age, gender and number of consumption substances.
Conclusions
An association between high neuroticism scores and presence of psychotic symptoms induced by cocaine has been found, independently of other consumption variables. Personality dimensions should be evaluated in cocaine-dependent patients in order to detect high scores of neuroticism and warn patients about the risk of developing cocaine-induced psychotic symptoms.
... Firstly, physicians' concerns about adherence, other co-morbidities including HIV co-infection, treatment side-effects and the potential for reinfection may lead to treatment being withheld [5,10,21,22]. Secondly, poverty, psychiatric co-morbidities, poor social support and stigma are common among PWID and may result in HCV treatment not being viewed as a priority for them [23][24][25]. Other barriers may relate to educational level, problems with accessing diagnostic tests (e.g. in non-urban regions or when access to primary care is difficult), and entering specialist referral pathways [26,27]. ...
... The proportion of PWID with diagnosed chronic infection entering antiviral treatment was 1-19% (median 9.5, IQR 3.5-15) in six non-clinical observational studies (four countries, total sample size 3,017) [105,107,152,196,199,201]. An increasing proportion is seen by setting and study type with progressively selected study populations, with a median of 23% (IQR 17-31) in nine intervention non-clinical studies, 28% (IQR [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] in seven observational clinical studies [22,103,115,131,198,200,204] and 47% in one intervention clinical study [126]. Four studies with non-clinical recruitment settings provided a proportion of antibody positive PWID self-reporting having ever been treated, with a median of 4.7% (3.4-37, IQR 4.3-13, n = 868) [79,146,165,202]. ...
Background:
People who inject drugs (PWID) are a key population affected by hepatitis C virus (HCV). Treatment options are improving and may enhance prevention; however access for PWID may be poor. The availability in the literature of information on seven main topic areas (incidence, chronicity, genotypes, HIV co-infection, diagnosis and treatment uptake, and burden of disease) to guide HCV treatment and prevention scale-up for PWID in the 27 countries of the European Union is systematically reviewed.
Methods and findings:
We searched MEDLINE, EMBASE and Cochrane Library for publications between 1 January 2000 and 31 December 2012, with a search strategy of general keywords regarding viral hepatitis, substance abuse and geographic scope, as well as topic-specific keywords. Additional articles were found through structured email consultations with a large European expert network. Data availability was highly variable and important limitations existed in comparability and representativeness. Nine of 27 countries had data on HCV incidence among PWID, which was often high (2.7-66/100 person-years, median 13, Interquartile range (IQR) 8.7-28). Most common HCV genotypes were G1 and G3; however, G4 may be increasing, while the proportion of traditionally 'difficult to treat' genotypes (G1+G4) showed large variation (median 53, IQR 43-62). Twelve countries reported on HCV chronicity (median 72, IQR 64-81) and 22 on HIV prevalence in HCV-infected PWID (median 3.9%, IQR 0.2-28). Undiagnosed infection, assessed in five countries, was high (median 49%, IQR 38-64), while of those diagnosed, the proportion entering treatment was low (median 9.5%, IQR 3.5-15). Burden of disease, where assessed, was high and will rise in the next decade.
Conclusion:
Key data on HCV epidemiology, care and disease burden among PWID in Europe are sparse but suggest many undiagnosed infections and poor treatment uptake. Stronger efforts are needed to improve data availability to guide an increase in HCV treatment among PWID.
... 2008; 21:14-18. [50] Tortajada S, Herrero MJ, Domingo-Salvany A, et al. Psychiatric morbidity among cocaine and heroin users in the community. ...
Background:
No study has examined ketamine users' psychiatric morbidity using structured diagnostic instruments. The aim of this study was thus to determine the psychiatric comorbidity of community-based ketamine users using the Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), Axis I Disorders (SCID).
Methods:
A convenience sample of 200 frequent ketamine users was recruited from community organizations in Hong Kong. Participants were screened with the Severity of Dependence Scale (SDS), Beck Depression Inventory (BDI), Anxiety subscale of the Hospital Anxiety Depression Scale (HADSA), and SCID psychotic symptoms. Those who scored above the threshold (cutoff point of 8/9 on the BDI and 4/5 on HADSA) or displayed evidence of psychotic symptoms were referred for a structured clinical interview conducted by a psychiatrist.
Results:
One hundred and seventy participants scored above the cutoff point on 1 or more of the scales, and 115 participants attended the SCID interview. Fifty-one of these 115 participants received a psychiatric diagnosis of 1 or more comorbidities for the month preceding the interview. Mood disorders accounted for 80.4% of the diagnoses, anxiety disorders for 33.3%, and psychotic disorders for 7.8%.
Conclusions:
Female gender and history of psychiatric/psychological clinic attendance were significantly associated with comorbid psychiatric disorders, whereas ketamine dependence had a borderline association.
... Daily cocaine consumption, unstable living conditions and low social support were variables highly associated with psychiatric morbidity in a study conducted in Spain among 705 current regular cocaine users aged 18-30. During the last 12 months, 22 % of this sample had depression and specific phobia (Tortajada et al., 2012). ...
This study reveals the substantial levels of morbidity related to cocaine use, translated into the large number of cocaine cases seen in various emergency settings in European countries. This health burden is often not captured by other traditional drug indicators. The report also points to the potential for early prevention, assessment and referral opportunities that may currently be overlooked, including the referral of some patients who may benefit from specific counseling or treatment.
This study provides a review of the monitoring of drug-related acute emergencies in 30 European countries.
Although the cardiotoxic effects of cocaine are universally recognized, the association between cocaine and cardiomyopathy and/or heart failure is poorly understood. To conduct a comprehensive review and meta-analysis on the association between cocaine, heart failure, and cardiomyopathy, we first conducted a broad-term search in PubMed, Embase, Web of Science, and Scopus for human studies containing primary data on the relationship between cocaine and heart failure or cardiomyopathy. We were interested in studies with data beyond acute coronary syndromes. Retrieved studies were grouped into different categories based on possible hypotheses to test by meta-analysis. A second search with specific terms was then conducted. For grouped studies with sufficient clinical and methodological homogeneity, effect sizes were calculated and combined for meta-analysis by the Random Effects model. There is in general a need for more primary data studies that investigate heart failure and/or cardiomyopathy in cocaine users for mechanisms independent of ischemia. There were, however, enough studies to combine by meta-analyses that showed that chronic cocaine use is associated with anatomical and functional changes more consistent with diastolic heart failure instead of the commonly taught dilated cardiomyopathy pathway. In patients without a history of ACS, chronic cocaine use was not associated with significantly reduced EF. The few studies on acute cocaine had conflicting results on whether single-dose intravascular cocaine results in acute heart failure. Studies identified that included beta-blockade therapy in cocaine users with cardiac disease suggest that beta-blockers are not unsafe and that may be effective in the treatment of cocaine-associated heart failure. Chronic cocaine use is associated with anatomical and physiological changes of the heart muscle that are potentially reversible with beta-blockade therapy.
Objectives:
Although cocaine binges and mental health problems have both been identified as significant risk factors for different health hazards, little is known about the relationship between mental health and cocaine binging. Hence, the aim of this study is to examine the association between psychiatric disorders and cocaine binge.
Methods:
Participants were part of a prospective cohort study of individuals who either smoke or inject cocaine. The dependent variable, namely a cocaine binge within the past month, was defined as the repetitive use of large quantities of cocaine until the individual was unable to access more of the drug or was physically unable to keep using. Psychiatric disorders were assessed using the Composite International Diagnostic Interview and the Diagnostic Interview Schedule questionnaires. Logistic regression models were performed to examine the association between cocaine binging and psychiatric disorders, adjusting for potential confounders.
Results:
Of the 492 participants, 24.4% reported at least 1 cocaine binging episode during the prior month. Among the study population, 48.0% met the criteria for antisocial personality disorder (ASPD), 45.5% for anxiety disorders, and 28.2% for mood disorders. Participants with ASPD were more likely to binge (adjusted odds ratio 1.73, 95% confidence interval 1.10-2.73), whereas those with a mood disorder were not. The association between anxiety disorders and cocaine binging was significant only in univariate analyses.
Conclusion:
ASPD increased the odds of reporting cocaine binge in our study population. These results highlight the need for a better understanding of the specific dimensions of ASPD that contribute to the increased risk of unsafe drug use behaviors.
