Conditional substance abuse and dependence by diagnosis of mood or anxiety disorder or schizophrenia in the U.S. Population

Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD 21205-1900, USA.
Drug and alcohol dependence (Impact Factor: 3.42). 06/2011; 119(1-2):28-36. DOI: 10.1016/j.drugalcdep.2011.05.010
Source: PubMed


Little is known about the association of various psychiatric disorders with the risk of developing dependence or abuse among users of various psychoactive substances (conditional dependence, CD; conditional abuse, CA).
Evaluate the association of psychiatric disorders with CA only, CD only and CA+CD.
Secondary analysis of data from 43,093 non-institutionalized US adults in the first wave (2001-2002) of the National Epidemiological Survey on Alcohol and Related Conditions. A structured diagnostic interview allowed classification by lifetime psychiatric diagnosis (DSM-IV criteria) and psychoactive substance use. Data were analyzed using weighted proportions, 95% CIs, and weighted logistic regression models to generate odds ratios (OR) adjusted for socio-demographic characteristics.
Psychiatric disorders were associated with higher prevalence of psychoactive substance use, regardless of type of disorder or substance. CA, CD and CA+CD prevalence rates were generally higher than unconditional prevalence rates among respondents with and without psychiatric disorders. Respondents with multiple disorders (mainly mood and anxiety disorders) had higher rates of CA+CD on most, but not all, psychoactive substances (e.g., not heroin), while schizophrenia was associated only with higher rates of tranquilizer CA+CD. Psychiatric disorders had few associations with CA only and CD only on psychoactive substances.
Study findings suggest that mood and anxiety disorders are associated with increased prevalence of substance use and increased transition from use to CA and CD, while schizophrenia is associated with increased transition from abstinence to use, especially for marijuana. Findings did not support the self-medication hypothesis of substance use disorders.

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Available from: Silvia Saboia Martins
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    • "This comorbidity is not uncommon. The National Epidemiological Survey on Alcohol and Related Conditions (NESARC) in the USA reported that the lifetime prevalence of substance abuse or dependence in schizophrenic patients was 36.8% for alcohol, 17.5% for marijuana and 16.0% for amphetamines (Martins and Gorelick, 2011). Compared to the general population, people with severe psychotic disorders have 3.5–4.6 "
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    ABSTRACT: Co-occurring substance use in psychotic patients causes many subsequences including increased illness severity, decreased medication compliance, higher relapse rates, more hospitalizations, and legal problems. We aim to investigate the prevalence, patterns, associated factors and severity of substance use risk among psychotic patients in southern Thailand. Psychotic out-patients were screened with the Alcohol, Smoking, Substance Involvement Screening Test (ASSIST) for their history of substance use in the past three months and categorized as None-to-Low Risk (NLR) or Moderate-to-High Risk (MHR) levels. Multivariate logistic regression was used to examine the associated factors of substance use risk-level. The associations between substance use risk-level and emotional and behavioural symptoms, functional status and family functional status were examined using multivariate linear regression analysis. Of 663 participants screened, 322 (48.6%) used at least one substance in the past three months. Tobacco was the most common substance used (47.2%). The factors associated with a higher risk of any substance use were male gender, young age group, low level of education, being employed and being diagnosed with schizophrenia. A higher number of emotional and behavioural symptoms was significantly associated with higher substance use risk-level. In conclusion, the prevalence of substance use in psychotic patients was high and associated with their emotional and behavioural symptoms. Recommendations for implementation of screening and early intervention programs of substance-related problems in psychotic patients are important for preventing unwanted outcomes.
    Full-text · Article · Nov 2014 · Asian Journal of Psychiatry
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    • "Gene polymorphisms that modulate serotonin signaling may increase susceptibility to multiple psychopathologies marked by heightened emotional reactivity and poor affect regulation (Buckholtz and Meyer-Lindenberg, 2012). These symptoms characterize both drug addiction and major depression, highly comorbid psychiatric illnesses (Martins and Gorelick, 2011) that exhibit shared perturbations in brain regions and circuits mediating emotional regulation (Bogdan et al., 2013; Goldstein and Volkow, 2011). Of the candidate serotonin-associated genes that modulate serotonin neurotransmission and could influence emotional dysregulation in addiction, two genes likely to play prominent roles include those encoding the serotonin transporter (SLC6A4) and monoamine catabolic enzyme monoamine oxidase A (MAOA). "
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    ABSTRACT: Background Gene polymorphisms that affect serotonin signaling modulate reactivity to salient stimuli and risk for emotional disturbances. Here, we hypothesized that these serotonin genes, which have been primarily explored in depressive disorders, could also have important implications for drug addiction, with the potential to reveal important insights into drug symptomatology, severity, and/or possible sequelae such as dysphoria. Methods Using an imaging genetics approach, the current study tested in 62 cocaine abusers and 57 healthy controls the separate and combined effects of variations in the serotonin transporter (5-HTTLPR) and monoamine oxidase A (MAOA) genes on processing of aversive information. Reactivity to standardized unpleasant images was indexed by a psychophysiological marker of stimulus salience (i.e., the late positive potential (LPP) component of the event-related potential) during passive picture viewing. Depressive symptomatology was assessed with the Beck Depression Inventory (BDI). Results Results showed that, independent of diagnosis, the highest unpleasant LPPs emerged in individuals with MAOA-Low and at least one ‘Short’ allele of 5-HTTLPR. Uniquely in the cocaine participants with these two risk variants, higher unpleasant LPPs correlated with higher BDI scores. Conclusions Taken together, these results suggest that a multilocus genetic composite of monoamine signaling relates to depression symptomatology through brain function associated with the experience of negative emotions. This research lays the groundwork for future studies that can investigate clinical outcomes and/or pharmacogenetic therapies in drug addiction and potentially other psychopathologies of emotion dysregulation.
    Full-text · Article · Jul 2014 · Drug and Alcohol Dependence
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    • "However, when comparing psychiatric populations that exhibit such symptoms, schizophrenia patients are amongst those with the highest rates of cigarette smoking (Ziedonis et al., 2008). Finally, the most commonly abused substances in schizophrenia [tobacco, cannabis, alcohol and cocaine (DeQuardo et al., 1994; Drake et al., 1990; Martins and Gorelick, 2011; Schneier and Siris, 1987; Strakowski et al., 1994; Westermeyer and Schneekloth, 1999)] have different—sometimes opposite—effects on mood, cognition and behaviour, resulting in differential abilities to modulate schizophrenia symptoms or medication side effects. "
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    ABSTRACT: Individuals with schizophrenia are at very high risk for drug abuse and addiction. Patients with a coexisting drug problem fare worse than patients who do not use drugs, and are also more difficult to treat. Current hypotheses cannot adequately account for why patients with schizophrenia so often have a co-morbid drug problem. I present here a complementary hypothesis based on evidence showing that chronic exposure to antipsychotic medications can induce supersensitivity within the brain's dopamine systems, and that this in turn can enhance the rewarding and incentive motivational effects of drugs and reward cues. At the neurobiological level, these effects of antipsychotics are potentially linked to antipsychotic-induced increases in the striatal levels of dopamine D2 receptors and D2 receptors in a high-affinity state for dopamine, particularly at postsynaptic sites. Antipsychotic-induced dopamine supersensitivity and enhanced reward function are not inevitable consequences of prolonged antipsychotic treatment. At least two parameters appear to promote these effects; the use of antipsychotics of the typical class, and continuous rather than intermittent antipsychotic exposure, such that silencing of dopaminergic neurotransmission via D2/3 receptors is unremitting. Thus, by inducing forms of neural plasticity that facilitate the ability of drugs and reward cues to gain control over behaviour, some currently used treatment strategies with typical antipsychotics might contribute to compulsive drug seeking and drug taking behaviours in vulnerable schizophrenia patients.
    Full-text · Article · Jun 2013 · Progress in Neuro-Psychopharmacology and Biological Psychiatry
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