Do Substance Type and Diagnosis Make a Difference? A Study of Remission From Alcohol- Versus Drug-Use Disorders Using the National Epidemiologic Survey on Alcohol and Related Conditions
University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, California 90025, USA. Journal of studies on alcohol and drugs
(Impact Factor: 2.76).
08/2008; 69(4):491-5. DOI: 10.15288/jsad.2008.69.491
This study examined rates of remission from substance-use disorders based on type of disorder (abuse vs dependence), type of substance (alcohol vs other drug), and polysubstance involvement (alcohol or drug vs alcohol and drug).
Participants in the National Epidemiologic Survey on Alcohol and Related Conditions were included if they met criteria for a prior-to-past-year alcohol- and/ or drug-use disorder (N = 12,297). Odds ratios were computed to examine differences in the rate of remission as of the past year.
Individuals with a prior-to-past-year diagnosis of abuse were more likely to be remitted, compared with those with a diagnosis of dependence. Individuals with both prior-to-past-year alcohol- and drug-use disorders were less likely to be remitted, compared with those with only an alcohol- or drug-use disorder. No differences were observed in remission rates comparing individuals with a prior-to-past-year alcohol-use disorder with those with a drug-use disorder.
The findings support prior research in suggesting a worse prognosis for individuals with a diagnosis of dependence and problematic use of both alcohol and drugs. In contrast with results from treatment samples, these general population data indicate that alcohol-use and drug-use disorders have a similar prognosis.
Available from: Silvia Saboia Martins
- "Whereas, extant research has classified subtypes of drug use in various populations (Agrawal et al., 2007; Lynskey et al., 2006; Cuffel et al., 1993; Hasin et al., 2007; Regier et al., 1990; Whitesell et al., 2006; Stinson et al., 2005) few studies have focused on subtypes of concurrentdrug users in the adult alcohol dependent population. Existing studies of concurrent drug use in alcohol dependent individuals often categorize individuals as concurrent drug users without differentiating between drug type (Curran et al., 2008; Karno et al., 2008). Studies on concurrent drug use in alcohol dependence which do differentiate between drug type often focus on a particular illegal drug of interest such as alcohol and the concurrent use of marijuana (Norton and Colliver, 1988) or cocaine (Brady et al., 1995; Grant and Harford, 1990; Hedden et al., 2009). "
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ABSTRACT: The use of illegal drugs is common in alcohol dependence and significant psychological and social consequences are associated with the concurrent use of alcohol and illegal drugs. However, little literature has examined the patterns of concurrent-drug use in alcohol dependent individuals. A latent class analysis (LCA) was used to determine whether patterns of past year illegal drug use existed in a national sample of 6059 alcohol dependent respondents of the combined 2005, 2006 and 2007 National Survey on Drug Use and Health. Multinomial logistic regression was then used to determine whether demographic variables, mental health disturbance and social consequences were predictive of drug use classes. Results of the LCA demonstrated a 5-class solution with optimal fit deduced by Bayesian Information Criterion minima. The five classes included: a close to zero probability of illegal drug use (class 1: 65%), medium marijuana, medium sedatives/tranquilizers and high analgesics (class 2: 7%), high marijuana, medium cocaine use (class 3: 21%), high probabilities of marijuana, cocaine, sedatives and analgesic use (class 4: 6%) and a high concurrent-drug use except other hallucinogens (class 5: 1%). Regression results suggest that younger age, comorbidity, engaging in deviant behaviors, sexually transmitted infection and incarceration are associated with concurrent illegal drug use in alcohol dependent individuals. Findings advocate that more intense psychiatric and drug dependence treatment resources may be needed for concurrent-drug using alcohol dependent populations and provide evidence for targeted prevention and treatment interventions.
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ABSTRACT: We examined whether patient subgroups with differing substance use disorders (SUDs) and psychiatric severity levels varied on engagement in continuing care and abstinence outcomes, the association of continuity of care practices to engagement, and the association of engagement to abstinence.
Staff in 28 Veterans Affairs SUD treatment programs used the Addiction Severity Index to assess 865 (98% male) patients' alcohol, other drug, and psychiatric problems at treatment entry. At discharge, staff supplied data on patients' treatment, motivation, and continuity of care practices. Administrative data assessed continuing care engagement. Six months after discharge, 673 patients completed a self-reported Addiction Severity Index. The sample comprised four SUD subgroups (abstinent from alcohol and other drugs, used alcohol only, used other drugs only, used alcohol and other drugs) and two psychiatric severity subgroups (high and moderate to low).
Patients receiving more continuity of care services engaged in continuing care longer. This association was weaker for the high psychiatric severity subgroup than for the moderate-to-low psychiatric severity subgroup. Engagement in continuing care was the most important predictor of abstinence overall. The positive association between engagement in continuing care and abstinence was strongest for the SUD subgroup using both alcohol and other drugs. This group had the lowest likelihood of abstinence if they engaged in little or no continuing care but showed the greatest increase in abstinence with longer continuing care engagement.
Subgroups' differential responsiveness to continuity of care services and engagement highlights the crucial importance of continuing care interventions to improve abstinence outcomes for certain subgroups of patients who use both alcohol and other drugs.
Available from: Lauren Renee Pacek
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ABSTRACT: Background: Alcohol and marijuana are commonly used and misused in the United States, both singly and together. Despite this, few studies examine their co-occurring use and the corresponding association with public health and other problems. Moreover, there is a lack of investigation into dif-ferences in these associations on the basis of race/ethnicity. Methods: The present study estimated the frequency of alco-hol use disorder, marijuana use disorder, and co-occurring alcohol and marijuana use disorder and their associated public health and social problems in Whites, African Amer-icans, and Hispanics. This cross-sectional study included 13,872 individuals and used data from the 2005–2007 Na-tional Survey on Drug Use and Health. Frequency was calculated and multinomial regression was used to assess associations between substance use disorder and psychoso-cial, adverse consequences such as history of being ar-rested, substance use treatment, and sexually transmitted infection. Results: Alcohol use disorder was comparable between, and most prevalent among, Whites and Hispanics com-pared to African Americans, whereas marijuana use dis-order was greatest among African Americans compared to other race/ethnicities. Co-occurring alcohol and marijuana use disorders were most prevalent for African Americans versus Whites and Hispanics, and similar in Whites and Hispanics. In general, major depressive episode was more prevalent for respondents with co-occurring use disorders or single marijuana use disorders. However, race/ethnicity differences in associations between substance use disorder and psychosocial correlates and adverse consequences were observed. Conclusions: Findings have implications for race/ethnicity appropriate integrated prevention and treatment of single
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