C. Nathan Marti’s research while affiliated with University of Texas at Austin and other places

Using data from the 2022 and 2023 National Survey on Drug Use and Health, we examined factors associated with treatment use for substance use disorder (SUD), perceived SUD treatment needs, and reasons for treatment non-use. Of U.S. adults, 18.1% had any past-year SUD (alcohol use disorder [AUD] and/or any drug use disorder [DUD]), 14.4% of those with SUD received SUD treatment in the past year, and 5.5% of those who did not receive treatment had a perceived need for treatment. Treatment use was significantly associated with AUD and DUD severities (aOR = 3.85, 95% CI = 2.82–5.26 for severe AUD; aOR = 2.82, 95% CI = 2.27–3.47 for severe DUD), problem self-perception (aOR = 2.12, 95% CI = 1.74–2.58), and mental health treatment use (aOR = 6.07, 95% CI = 4.73–7.78). Perceived treatment needs among those who did not use treatment were also significantly associated with AUD and DUD severities, problem self-perception, and any mental illness. The most frequently reported reasons for treatment non-use among those with perceived need were self-sufficiency beliefs, lack of readiness to stop using or start treatment, stigma-related concerns, and health insurance/cost problems. The findings underscore the importance of screening SUD and educating about the harms of untreated SUD in increasing motivation and readiness for treatment use among people with SUD.

Objectives: To examine the direct effect of a homebound state (defined as never/rarely going outside the home in the preceding month) on depressive/anxiety symptoms and the mediation effect of loneliness and psychological well-being on the associations between homebound state and depressive/anxiety symptoms. Methods: Data came from the 2023 National Health and Aging Trend Study (N = 7,547 community-dwelling Medicare beneficiaries age 65+). We fitted a path model to examine the research questions. To test the statistical significance of the mediation effect, we used bootstrapped analysis to obtain estimates of the indirect effects and their 95% CIs. Results: We found significant direct and indirect effects. The ratio of the indirect effect of loneliness on a homebound state (0.13) to the total effect of a homebound state on depressive/anxiety symptoms was 0.14. The ratio of the indirect effect of psychological well-being on a homebound state (0.28) to the total effect of a homebound state on depressive/anxiety symptoms was 0.26. Conclusions: Loneliness and psychological well-being, or lack thereof, significantly mediate the relationship between homebound state and depression/anxiety in homebound older adults. Clinical implications: Interventions to decrease loneliness and improve psychological well-being among homebound older adults are needed to alleviate their depression/anxiety.

Background and aims After a slight decline in suicide rates during the COVID-19 pandemic, suicide rates and suicide attempts in the U.S. have been increasing again in 2022 and 2023. Compared to younger age groups, the 50+ age group has significantly higher rates of serious medical outcomes from suicide attempts. In this study, we examined the medical outcome severities associated with different classes of substances involved in suicide attempt cases age 50 and older who were reported to poison centers. Methods We used the America's Poison Center's National Poison Data System from 2016 to 2023 (N = 335,171 cases age >50). Following descriptive statistics on the characteristics of suicide attempters and involved substances by medical outcomes (no/minimal effects, moderate effects, major effects, death, and unable to follow), we fitted multinomial and binary logistic regression models to examine the associations of medical outcomes with involved substances. Results Of all cases, 22.5% used antidepressants, 21.1% benzodiazepines, 16.4% cardiovascular drugs, and 12.5% prescription opioids; 44.1% had no/minimal effect, 37.9% had a moderate effect, 12.5% had a major effect, 1.2% resulted in death, and 4.4% were unable to follow, but the proportions of major effects and death were higher in 2022–2023 than in 2016–2017. Tricyclic antidepressants were associated with the highest risks of major effects [relative risk ratios (RRR) = 5.57, 95% CI = 5.26–5.90] and death (RRR = 4.26, 95% CI = 3.67–4.94). Large RRRs were also shown for bupropion and serotonin-norepinephrine reuptake inhibitors for major outcomes and death. Cardiovascular drugs, opioids, and muscle relaxants were also associated with consistently higher risks of moderate and major effects and death. Our results also show that older ages were associated with higher death rates and that female sex was associated with higher odds of moderate/major effects compared to minimal effects but lower odds of major effects/death. Implications Healthcare providers, including pharmacists, can play an important role in promoting medication safety for older adults. Healthcare workers need training in assessing and recognizing signs of suicide risk in older adults who are prescribed antidepressants and sedatives. Our findings also point to the importance of better non-pharmacological chronic pain management than reliance on opioids.

Using data from the 2022 and 2023 National Survey on Drug Use and Health, we examined factors associated with treatment use for substance use disorder (SUD), perceived SUD treatment needs, and reasons for treatment non-use. Of U.S. adults, 18.1% had any past-year SUD (alcohol use disorder [AUD] and/or any drug use disorder [DUD]), 14.4% of those with SUD received SUD treatment in the past year, and 5.5% of those who did not receive treatment had a perceived need for treatment. Treatment use was significantly associated with AUD and DUD severities (aOR=3.85, 95% CI=2.82-5.26 for severe AUD; aOR=2.82, 95% CI=2.27-3.47 for severe DUD), problem self-perception (aOR=2.12, 95% CI=1.74-2.58), and mental health treatment use (aOR=6.07, 95% CI=4.73-7.78). Perceived treatment needs among those who did not use treatment were also significantly associated with AUD and DUD severities, problem self-perception, and any mental illness. The most frequently reported reasons for treatment non-use among those with perceived need were self-sufficiency beliefs, lack of readiness to stop using or start treatment, stigma-related concerns, and health insurance/cost problems. The findings underscore the importance of screening SUD and educating about the harms of untreated SUD in increasing motivation and readiness for treatment use among people with SUD.

Objectives: To examine older adults' cannabidiol (CBD) use and its associations with cannabis use and physical/mental health and other substance use problems. Methods: Using the 2022 National Survey on Drug Use and Health (N = 10,516 respondents age 50+), we fitted generalized linear models (GLM) with Poisson and log link using CBD as the dependent variable in the 50-64 and the 65+ age groups. Results: In the 50-64 age group, 18.3% and 18.0% reported past-year CBD and cannabis, respectively, use. In the 65+ age group, the percentages were 14.3% and 8.0%. GLM results showed significant positive associations with both medical and non-medical cannabis use in both age groups. CBD use was positively associated with physical/mental health and illicit drug use problems in the 50-64 age group and with disordered psychotherapeutic drug use in the 65+ age group. Minoritized older adults had a lower likelihood of CBD use. Conclusions: CBD use is common, more so than cannabis especially in the 65+ age group and positively correlated with both medical and nonmedical cannabis use. Clinical implications: Research is needed to examine therapeutic benefits and negative effects of CBD use in late life. Public health education is needed for growing numbers of older-adult CBD users.

Using the 2022 National Health and Aging Trend Study data, we examined the digital divide among homebound and semi-homebound older adults. About 11% of older Medicare beneficiaries in 2022 were homebound or semi-homebound. Compared to non-homebound older adults, homebound older adults were significantly less likely to own a cellphone. Among those with any information and communication technology (ICT) device, homebound older adults were also less likely to have used email/texting and gone online. Older age, low income, dementia diagnosis, and moderate/severe depressive/anxiety symptoms contributed to the digital divide. Among homebound older adults, Hispanic older adults or those with limited English proficiency were less likely to have used ICT. To reduce the digital inequity among homebound older adults who are low-income, racial/ethnic minority, limited English proficient, and/or residents in non-metropolitan areas, social/structural inequities in accessibility and affordability, along with individual-level barriers, need to be addressed.

Abstracts Background Cannabidiol (CBD) use has been increasing for its putative therapeutic potential for various health conditions. Research using a nationally representative sample is needed to examine characteristics of CBD users. Methods Data came from the adult sample (N=47,100) of the 2022 U.S. National Survey on Drug Use and Health. We fitted generalized linear models to examine the sociodemographic, health, other substance use, and cannabis risk perception as correlates of CBD-only use and CBD-cannabis co-use, compared to cannabis-only use. Results In 2022, 20.6 % and 23.0 % of U.S. adults reported using CBD and cannabis, respectively, in the preceding 12 months, and 63 % of CBD users also used cannabis. CBD use was significantly higher among women (CBD-only vs. cannabis-only use: IRR=1.43, 95 % CI=1.31–1.57), but significantly lower among Black and Hispanic individuals compared to non-Hispanic White individuals (CBD-only vs. cannabis-only use: IRR=0.71, 95 % CI=0.60–0.85 for Black individuals; IRR=0.79, 95 % CI=0.65–0.96 for Hispanic individuals). Older ages, higher SES, chronic medical conditions, mental illness, and high cannabis risk perception were also associated with higher likelihood of CBD-only use versus cannabis-only use. CBD-cannabis co-users were at most risk in terms of chronic illness, mental illness, cannabis use disorder, and other substance use problems. Conclusions The high prevalence of self-reported CBD use among those with physical and mental health problems warrants public health warnings about potential side effects and drug interactions. The high CBD-cannabis co-use rate also calls for more research on potential benefits and negative effects of the co-use.

The purpose of the study was to examine trajectories in hookah use behaviors across young adulthood and socio-demographic correlates of the trajectories. Data were drawn from Project M-PACT for the years 2014-2019. Participants were 5,220 college students aged 18 to 25 years at baseline. Growth curve models with an accelerated design were fit to examine four hookah use trajectories across ages 18 to 30, adjusted for covariates. Prevalence of current hookah use decreased between 2014 and 2019, from 17% to 7% and the frequency of use decreased by almost one day a month. Trajectories of hookah use alone and concurrent with cigarettes or with e-cigarettes also decreased as students increased in age. Current hookah users were likely to be young, male, racial/ethnic minority, and attending a four-year college. Observed disparities among hookah users have implications, in particular regarding the role of social context, race, and ethnicity, in tailoring smoking interventions.

Background: Despite widespread consensus on the need to reduce benzodiazepine (BZD) use in older adults, prescription rates in the U.S. have paradoxically increased over the past few decades. Objective: We examined (1) the characteristics of the BZD adverse reaction cases in patients aged 50 and older that were admitted to a healthcare facility (HCF) and experienced major effects/death, and (2) the associations between the concomitant use of opioids and/or antidepressants and HCF admission and major effects/death among BZD cases. Methods: We used the 2015-2022 National Poison Data System (NPDS), which contained data from 55 America's Poison Centers. We fitted two multivariable logistic regression models to examine the associations between the co-use of opioids and/or antidepressants and HCF admission and major effects/death. Results: Of the BZD cases that were examined (N = 1979), 14.9% or 295 cases were admitted to healthcare facilities, and 8.5% of those who were followed up (77 out of 893 cases) experienced major effects or death. The number of co-used substances, co-use of opioids and antidepressants, atypical antipsychotics, anticonvulsants, muscle relaxants, and Gabapentin were associated with greater odds of healthcare admission. Co-use of opioids and healthcare admission were associated with greater odds of major effects/death. Conclusions: Adverse reactions and healthcare admissions are likely to be prevented when healthcare providers limit and carefully monitor BZD prescribing, especially for those who are on other medications, including prescription opioids and antidepressants.