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Shiraly R, Jazayeri SA, Seifaei A, Jeihooni AK, Griffiths MD. Suicidal thoughts and behaviors among untreated illicit substance users: a population-based study. Harm Reduct J 2024; 21:96. [PMID: 38755587 PMCID: PMC11097468 DOI: 10.1186/s12954-024-01015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/04/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVES Research regarding the contribution of specific psychoactive substances to suicidality has yielded equivocal results. The present study examined the prevalence and factors associated with suicidal thoughts and behaviors among a population-based sample of untreated illicit substance users. METHODS A total of 616 illicit substance users who were recruited from high-risk areas of Shiraz using snowball sampling participated in the study. Eligible participants were individuals aged 18 years and older who regularly used one illicit psychoactive substance (e.g., opioids, heroin, cannabinoids, stimulants, hallucinogens) for at least one year and who had received no treatment for their drug use during the past year. Data were collected regarding socio-demographic characteristics, mental history, and substance use habits. Data regarding suicidal thoughts and behaviors were assessed using the Beck Suicidal Ideation Scale (BSIS) and self-reports of previous suicide attempts. Multiple logistic regression analysis was used to identify independent variables associated with suicidality. RESULTS Among the participants, 23.6% reported having had suicidal thoughts during the past week and 6.7% reported having attempted suicide during the past year. Methamphetamine was reported as the primary substance of use among approximately half of the participants who attempted suicide during past year (49.2%). Multiple logistic regression analysis showed that current suicidal thoughts were independently associated with having no job, a history of mental health condition, previous suicidal attempts, concurrent use of more than one substance, and using methamphetamine and heroin as the primary substances. Suicidal thoughts were not associated with increased odds of regular opium and cannabis use. CONCLUSION Both methamphetamine and heroin use are significantly associated with current suicidal thoughts. Evaluation of the risk of suicidality by physicians and mental health care professionals in both community and outpatient settings would be especially appropriate among those individuals using these psychoactive substances.
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Affiliation(s)
- Ramin Shiraly
- Community Medicine Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Seyed Amin Jazayeri
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Asal Seifaei
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Khani Jeihooni
- Nutrition Research Center, Public Health Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ, UK
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Giugovaz A, Grassi M, Marchetti I. Substance addictions and suicidal thoughts and behaviors: Evidence from a multi-wave epidemiological study. Psychiatry Res 2024; 334:115821. [PMID: 38432116 DOI: 10.1016/j.psychres.2024.115821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 02/18/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
Substance addiction (SA) is a risk factor of suicidal thoughts and behaviors (STB), although it is still unclear which SAs are reliably associated with increased risk for suicidal ideation, planning, and attempt. The current study aimed to meet this goal using data from the National Survey on Drug Use and Health (NSDUH) referring to years from 2008 to 2020. The information extracted included sociodemographic and contextual information, eleven SAs (e.g., nicotine, alcohol, marijuana, cocaine, pain relievers, heroin, inhalants, hallucinogens, sedatives, stimulants, and tranquillizers), and STB. The analysis revealed that SAs for alcohol, pain relievers, marijuana, and cocaine were stable and reliable predictors for STB (e.g., suicidal ideation, planning, and attempt), while cocaine was not a stable predictor for suicide attempt. The selected SAs model showed a greater predictive accuracy than only sociodemographic and contextual factors as well as not selected SAs. Moreover, selected SAs showed comparable predictive accuracy to the full model. Furthermore, SA to alcohol showed to be an extremely effective predictor of STB, having a comparable predictive accuracy to all the other ten SAs together. In conclusion, SAs to pain relievers, alcohol, marijuana, and cocaine can be considered as important risk factors for concurrent STB.
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Affiliation(s)
- Angela Giugovaz
- Department of Life Sciences, Psychology Unit, University of Trieste, Italy
| | - Michele Grassi
- Department of Life Sciences, Psychology Unit, University of Trieste, Italy
| | - Igor Marchetti
- Department of Life Sciences, Psychology Unit, University of Trieste, Italy.
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3
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Stiltner B, Pietrzak RH, Tylee DS, Nunez YZ, Adhikari K, Kranzler HR, Gelernter J, Polimanti R. Polysubstance addiction patterns among 7,989 individuals with cocaine use disorder. iScience 2023; 26:107336. [PMID: 37554454 PMCID: PMC10405253 DOI: 10.1016/j.isci.2023.107336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/22/2023] [Accepted: 07/06/2023] [Indexed: 08/10/2023] Open
Abstract
To characterize polysubstance addiction (PSA) patterns of cocaine use disorder (CoUD), we performed a latent class analysis (LCA) in 7,989 participants with a lifetime DSM-5 diagnosis of CoUD. This analysis identified three PSA subgroups among CoUD participants (i.e., low, 17%; intermediate, 38%; high, 45%). While these subgroups varied by age, sex, and racial-ethnic distribution (p < 0.001), there was no difference with respect to education or income (p > 0.05). After accounting for sex, age, and race-ethnicity, the CoUD subgroup with high PSA had higher odds of antisocial personality disorder (OR = 21.96 vs. 6.39, difference-p = 8.08✕10-6), agoraphobia (OR = 4.58 vs. 2.05, difference-p = 7.04✕10-4), mixed bipolar episode (OR = 10.36 vs. 2.61, difference-p = 7.04✕10-4), posttraumatic stress disorder (OR = 11.54 vs. 5.86, difference-p = 2.67✕10-4), antidepressant medication use (OR = 13.49 vs. 8.02, difference-p = 1.42✕10-4), and sexually transmitted diseases (OR = 5.92 vs. 3.38, difference-p = 1.81✕10-5) than the low-PSA CoUD subgroup. These findings underscore the importance of modeling PSA severity and comorbidities when examining the clinical, molecular, and neuroimaging correlates of CoUD.
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Affiliation(s)
- Brendan Stiltner
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Robert H. Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Daniel S. Tylee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Yaira Z. Nunez
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Keyrun Adhikari
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Henry R. Kranzler
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Mental Illness Research, Education, and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
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Choi NG, Choi BY, Marti CNC, Baker DS. Cocaine-involved suspected suicide attempts in individuals age 50 and older reported to United States Poison Centers. Clin Toxicol (Phila) 2023; 61:602-610. [PMID: 37585276 PMCID: PMC10592320 DOI: 10.1080/15563650.2023.2244666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/18/2023]
Abstract
CONTEXT Despite a rapidly growing number of older cocaine users, the link between cocaine use and suicide attempt in older adults has not been examined. We examined associations between co-used other substances and (1) suspected suicide attempts versus other intentional misuse, and (2) major medical outcomes (major effect or death) of suspected suicide attempts and other intentional misuse. METHODS We used the 2015-2021 United States National Poison Data System (N = 5,191 cases age 50 and older). Descriptive statistics and generalized linear models for a Poisson distribution with a log link function were used to examine the study questions. RESULTS Cocaine exposures steadily increased from 2015 through 2021. Over the seven years, 52.3% and 47.7% were suicide attempts and other intentional misuse cases, respectively. Co-use of alcohol (incidence rate ratios = 1.24, 95% confidence interval = 1.14-1.35) and psychotropic (e.g., antidepressants: incidence rate ratios = 1.37, 95% confidence interval = 1.24-1.53) and cardiovascular medications were associated with a higher likelihood of suicide attempt, but co-use of prescription opioids, heroin, or other illicit drugs was associated with a lower likelihood of suicide attempt compared to other intentional misuse. Prescription opioids and amfetamine were associated with a higher likelihood of major effect or death in both suicide attempts and intentional misuse and heroin use and injection use were associated with a higher likelihood of major effect/death among intentional misuse cases. CONCLUSIONS These findings show that significant proportions of older cocaine users who attempted suicide also used psychotropic and cardiovascular medications. We suggest that healthcare providers screen for suicidal ideation among cocaine users, with special attention to an increased risk of suicide attempts among those who co-use cocaine with alcohol and psychotropic and other prescription medications.
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Affiliation(s)
- Namkee G. Choi
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Bryan Y. Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine & Bayhealth Medical Center, Dover, DE, USA
| | - C. Nathan C. Marti
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
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Stiltner B, Pietrzak RH, Tylee DS, Nunez YZ, Adhikari K, Kranzler HR, Gelernter J, Polimanti R. Polysubstance addiction and psychiatric, somatic comorbidities among 7,989 individuals with cocaine use disorder: a latent class analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.08.23285653. [PMID: 36798273 PMCID: PMC9934788 DOI: 10.1101/2023.02.08.23285653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Aims We performed a latent class analysis (LCA) in a sample ascertained for addiction phenotypes to investigate cocaine use disorder (CoUD) subgroups related to polysubstance addiction (PSA) patterns and characterized their differences with respect to psychiatric and somatic comorbidities. Design Cross-sectional study. Setting United States. Participants Adult participants aged 18-76, 39% female, 47% African American, 36% European American with a lifetime DSM-5 diagnosis of CoUD (N=7,989) enrolled in the Yale-Penn cohort. The control group included 2,952 Yale-Penn participants who did not meet for alcohol, cannabis, cocaine, opioid, or tobacco use disorders. Measurements Psychiatric disorders and related traits were assessed via the Semi-structured Assessment for Drug Dependence and Alcoholism. These features included substance use disorders (SUD), family history of substance use, sociodemographic information, traumatic events, suicidal behaviors, psychopathology, and medical history. LCA was conducted using diagnoses and diagnostic criteria of alcohol, cannabis, opioid, and tobacco use disorders. Findings Our LCA identified three subgroups of PSA (i.e., low, 17%; intermediate, 38%; high, 45%) among 7,989 CoUD participants. While these subgroups varied by age, sex, and racial-ethnic distribution (p<0.001), there was no difference on education or income (p>0.05). After accounting for sex, age, and race-ethnicity, the CoUD subgroup with high PSA had higher odds of antisocial personality disorder (OR=21.96 vs. 6.39, difference-p=8.08×10 -6 ), agoraphobia (OR=4.58 vs. 2.05, difference-p=7.04×10 -4 ), mixed bipolar episode (OR=10.36 vs. 2.61, difference-p=7.04×10 -4 ), posttraumatic stress disorder (OR=11.54 vs. 5.86, difference-p=2.67×10 -4 ), antidepressant medication use (OR=13.49 vs. 8.02, difference-p=1.42×10 -4 ), and sexually transmitted diseases (OR=5.92 vs. 3.38, difference-p=1.81×10 -5 ) than the low-PSA CoUD subgroup. Conclusions We found different patterns of PSA in association with psychiatric and somatic comorbidities among CoUD cases within the Yale-Penn cohort. These findings underscore the importance of modeling PSA severity and comorbidities when examining the clinical, molecular, and neuroimaging correlates of CoUD.
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Kassie GM, Lemu YM, Biresaw MS, Dessie GM, Tadesse GT, Gared WM, Belay MW. Suicidal ideation and attempt and associated factors among patients with substance use disorder: institution-based cross-sectional study. BJPsych Open 2022; 8:e150. [PMID: 35912979 PMCID: PMC9380183 DOI: 10.1192/bjo.2022.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND No published research in Ethiopia has examined the prevalence of suicidal ideation and suicide attempts and associated factors among patients with substance use disorder. AIMS The main aim of this study was to assess the prevalence of suicidal ideation, suicide attempt and associated factors among patients with substance use disorders. METHOD An institution-based cross-sectional study was conducted from 5 May to 13 June 2019 in Addis Ababa. A total of 408 patients were identified using a systematic sampling technique. Data were collected through interviews using the suicidality module of the Composite International Diagnostic Interview. Data were entered into EpiData and analysed using SPSS. Logistic regression analyses were employed. Variables with P < 0.05 were considered to be statistically significant with 95% confidence intervals. RESULTS Prevalence rates of suicidal ideation and attempt were found to be 39.5% and 18.6%, respectively. Family history of mental illness (adjusted odds ratio (AOR) = 3.60, 95% CI: 2.17, 5.97), comorbid mental illness (AOR = 3.61, 95% CI: 2.11, 6.16), perceived stigma related to substance misuse (AOR = 4.00, 95% CI: 2.26, 7.07) and alcohol use (AOR = 7.49, 95% CI: 1.99, 28.19) were associated with suicidal ideation. Being female (AOR = 2.46, 95% CI: 1.08, 5.70), family history of suicide (AOR = 3.08, 95% CI: 1.68, 5.64), comorbid mental illness (AOR = 4.09, 95% CI: 2.23, 7.49) and khat use (AOR = 3.73, 95% CI: 1.24, 11.17) were associated with suicide attempt. CONCLUSIONS The prevalence of suicidal ideation and attempt were both found to be high. In particular, patients who had a comorbid mental illness were at high risk of both suicidal ideation and attempt. Therefore, special attention should be given to those with a family history of suicide or comorbid mental illness.
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Affiliation(s)
- Gebeyaw Molla Kassie
- Department of Psychiatry, College of Health Science, Aksum University, Aksum, Ethiopia
| | - Yohanes Mirekena Lemu
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mengesha Srahbzu Biresaw
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | | | | | - Woredaw Minichil Gared
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mesele Wonde Belay
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Armoon B, SoleimanvandiAzar N, Fleury MJ, Noroozi A, Bayat AH, Mohammadi R, Ahounbar E, Fattah Moghaddam L. Prevalence, sociodemographic variables, mental health condition, and type of drug use associated with suicide behaviors among people with substance use disorders: a systematic review and meta-analysis. J Addict Dis 2021; 39:550-569. [PMID: 33896407 DOI: 10.1080/10550887.2021.1912572] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We assessed the prevalence, sociodemographic variables, mental health condition, and type of drug use associated with suicide behaviors among patients with substance use disorders (SUD). Studies in English published from January 1, 1995 to December 31, 2020 were searched on PubMed, Scopus, Cochrane and Web of Science to identify studies on variables associated with suicidal behaviors (ideations and attempts) among patients with SUD. After reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria: (i) population: patients with SUD; (ii) intervention: suicide behaviors in the past year; (iii) comparator: SUD who had not suicide behaviors; (iv) outcome: suicide ideations or attempts in the last year; and (v) study type: cross-sectional, cohort, and case-control studies. Out of 10,810 articles, 48 studies met eligibility criteria. Our findings showed a pooled prevalence rate of suicide ideations of 35% (95% CI, 22% 48%) and suicide attempts of 20% (95% CI, 17% 23%) in the last year among patients with SUD. Smoking, previous history of sexual abuse, depression, and alcohol and cannabis use disorders were significantly associated with suicide ideations. Study findings also showed that being female, smoking, history of physical and sexual abuse, depression and alcohol, cannabis, cocaine, amphetamine use disorders, and polysubstance abuse were significantly associated with suicide attempts among patients with SUD. These findings have implications for developing prevention programs. Appropriate initiatives for reducing the risk of suicide behaviors like systematic assessments of changes in drug use pattern at the emergency departments or at other key health providers may be more broadly implemented. Motivational therapy to improve help-seeking, increased information on adverse consequences of heavy substance use, and crisis plan resolutions to face suicide behaviors could also be consolidated.
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Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Neda SoleimanvandiAzar
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir-Hossein Bayat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elahe Ahounbar
- Substance Abuse and Dependence Research Center, the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ladan Fattah Moghaddam
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
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Levine D, Horesh D. Suicidality in Fibromyalgia: A Systematic Review of the Literature. Front Psychiatry 2020; 11:535368. [PMID: 33173505 PMCID: PMC7538832 DOI: 10.3389/fpsyt.2020.535368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/27/2020] [Indexed: 11/13/2022] Open
Abstract
Fibromyalgia (FM), a poorly understood rheumatic condition, is characterized by chronic pain and psychiatric comorbidities, most notably depression and anxiety. Additional symptoms include sleep difficulties, fatigue, and various cognitive impairments. Furthermore, FM is surrounded by social stigma, due to the unclear nature and etiology of this condition. While there is widespread evidence for the emotional and psychological suffering of those with FM, the scope of suicidality, as well as the underlying factors that are associated with suicidal ideation and behavior among this population, are not well understood. The present review, which is the first of its kind, aims to summarize existing data on the prevalence of suicide-related outcomes among FM patients, highlight factors associated with suicidal ideation and behavior in FM, and identify gaps in the literature to better inform research and clinical care. Studies were extracted from the literature that measured suicidal ideation, attempted suicide, and/or completed suicide among FM patients. Results indicated that both suicidal ideation and suicidal behavior were prevalent among individuals suffering from FM. Psychiatric comorbidity, sleep difficulties, and inpatient hospitalization were associated with both suicidal ideation and suicidal behavior. Functional impairment was associated with suicidal ideation in FM. Factors associated with higher levels of suicidal behavior in FM included female gender, unemployment and lower income, medical comorbidity, and drug dependence. While an understanding of currently recognized risk factors is important for improving FM research and clinical care, some clear methodological and conceptual limitations of the reviewed studies were identified. Future work should focus on longitudinal studies, as well as on gaining a better biological and psychological understanding of the underpinnings of FM and suicidality.
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Affiliation(s)
- Daniella Levine
- Department of Psychology, New York University, New York, NY, United States.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel.,Department of Psychiatry, New York University Langone Medical Center, New York, NY, United States
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López-Goñi JJ, Fernández-Montalvo J, Arteaga A, Haro B. Suicidal attempts among patients with substance use disorders who present with suicidal ideation. Addict Behav 2019; 89:5-9. [PMID: 30237111 DOI: 10.1016/j.addbeh.2018.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/24/2018] [Accepted: 09/05/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Patients with addictions have a great risk of suicidal ideation and attempts. Suicidal behaviour is a continuum that begins with ideation and may continue with planning, attempts and suicide completion. Investigating the specific risk characteristics for suicidal attempts in patients with addiction problems who present with suicidal ideation is crucial for developing prevention strategies. The main aims of this study were to determine the prevalence rate of suicide attempts among patients with lifetime suicidal ideation receiving treatment for addiction, and to explore the differential characteristics for suicide ideators with and without suicide attempts. METHODS A sample of 149 patients with suicidal ideation (110 male and 39 female) who sought treatment for addiction in a Spanish clinical centre was assessed. MEASUREMENTS Information concerning socio-demographic characteristics, addiction severity, and psychopathological symptoms was obtained. RESULTS In total, 39.6% of the patients had attempted suicide (95% Confidence Interval: 32.1%-47.6%). Although all patients with suicidal behaviours presented a high severity in their addiction, patients with both suicidal ideation and suicide attempts showed a more severe addiction profile and more maladjustment to everyday life than patients with only suicidal ideation. Specifically, three psychopathological variables were related to suicide attempts: worse psychiatric state, previous hospitalization for psychological problems, and history of delirium. CONCLUSIONS According to the results, a systematic screening of suicidal risk in patients seeking treatment for addiction problems is recommended. Addiction treatment centres should develop treatment strategies to prevent suicidal ideators from attempting suicide, mainly in those cases with a worse lifetime psychiatric condition.
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López-Goñi JJ, Fernández-Montalvo J, Arteaga A, Haro B. Suicidal ideation and attempts in patients who seek treatment for substance use disorder. Psychiatry Res 2018; 269:542-548. [PMID: 30199695 DOI: 10.1016/j.psychres.2018.08.100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/24/2018] [Accepted: 08/24/2018] [Indexed: 11/24/2022]
Abstract
Patients with substance dependence have a great risk of suicidal ideation and attempts. The study of the specific risk characteristics of patients with substance use disorders who present with suicidal ideation and/or attempts becomes a crucial clinical issue in order to develop prevention strategies. The main goals of this study were to determine the prevalence rate of both suicidal ideation and attempts among patients receiving treatment for substance use disorder and to analyse the differential characteristics between these patients with and without suicidal behaviours. A sample of 334 patients (263 men-71 women) who sought treatment for substance use disorder in a Spanish clinical centre was assessed. In total, 43.7% of the patients presented with lifetime suicidal ideation (8.7% in the last month) and 17.7% with suicide attempts (1.5% in the last month). Patients with suicidal ideation or attempts showed a more severe addiction profile (assessed by the EuropASI), and more psychopathological symptoms (assessed by the SCL-90-R). Moreover the rate of suicidal ideation and attempts was significantly higher in inpatients than in outpatients. According to these results, systematic screening of suicidal risk in patients seeking treatment for substance use disorders is recommended, especially in those with a greater addiction severity.
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Affiliation(s)
- José J López-Goñi
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra, 31006 Pamplona, Spain.
| | | | - Alfonso Arteaga
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra, 31006 Pamplona, Spain
| | - Begoña Haro
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra, 31006 Pamplona, Spain
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Rodríguez-Cintas L, Daigre C, Braquehais MD, Palma-Alvarez RF, Grau-López L, Ros-Cucurull E, Rodríguez-Martos L, Abad AC, Roncero C. Factors associated with lifetime suicidal ideation and suicide attempts in outpatients with substance use disorders. Psychiatry Res 2018; 262:440-445. [PMID: 28951146 DOI: 10.1016/j.psychres.2017.09.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/24/2017] [Accepted: 09/09/2017] [Indexed: 12/11/2022]
Abstract
Risks factors for suicide are multiple and highly prevalent in addicted patients (previous suicide attempts, substance abuse, impulsivity, history of sexual abuse and other factors). The aim of this study is to identify and to compare the clinical and socio-demographic profile of SUD outpatients with lifetime suicidal behavior (previous suicidal ideation and/or suicide attempts) and to analyze the factors related to it. A retrospective cohort study of 696 addicted patients, according to DSM-IV-TR criteria (APA, 2000) were collected from the Addiction Unit of Vall d'Hebron University Hospital. Lifetime suicidal ideation in addicted patients is associated with presence of: borderline personality disorder (BPD), depressive disorders, sexual abuse, polydrug abuse, attention-deficit hyperactivity disorder, and motor impulsivity. The factors associated with suicide attempts were: borderline personality disorder, lifetime abuse (whether emotional, physical or sexual), co-occurrent psychotic disorders, polydrug abuse, anxiety disorders and depressive symptoms. We conclude that previous suicidal ideation and lifetime suicide attempts should be considered in the clinical care of addicted patients. Factors related to both suicidal behaviors share similarities and differences according to our findings and need to be deeply explored in the future.
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Affiliation(s)
- Laia Rodríguez-Cintas
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain; Department of Psychiatry, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Constanza Daigre
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain; Department of Psychiatry, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Dolores Braquehais
- Department of Psychiatry, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Raúl Felipe Palma-Alvarez
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain; Department of Psychiatry, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain
| | - Lara Grau-López
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain; Department of Psychiatry, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Ros-Cucurull
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain; Department of Psychiatry, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lola Rodríguez-Martos
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain; Department of Psychiatry, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain
| | - Alfonso Carlos Abad
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain; Department of Psychiatry, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain
| | - Carlos Roncero
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain; Department of Psychiatry, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Østergaard MLD, Nordentoft M, Hjorthøj C. Associations between substance use disorders and suicide or suicide attempts in people with mental illness: a Danish nation-wide, prospective, register-based study of patients diagnosed with schizophrenia, bipolar disorder, unipolar depression or personality disorder. Addiction 2017; 112:1250-1259. [PMID: 28192643 DOI: 10.1111/add.13788] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/28/2016] [Accepted: 02/08/2017] [Indexed: 11/26/2022]
Abstract
AIM To estimate and test associations between substance use disorders (SUDs) and both completed suicides and suicide attempts in a population with severe mental illness. DESIGN Register-based cohort study with adjusted Cox regression of substance use disorders as time-varying covariates. SETTING Denmark. PARTICIPANTS People born in Denmark since 1955 with a diagnosis of schizophrenia (n = 35 625), bipolar disorder (n = 9279), depression (n = 72 530) or personality disorder (n = 63 958). MEASUREMENTS Treated SUDs of alcohol and illicit substances identified in treatment registers; suicide attempt identified in treatment registers; and completed suicides identified in the Cause of Death register. Covariates were sex and age at diagnosis. FINDINGS Having any SUD was associated with at least a threefold increased risk of completed suicide when compared with those having no SUD. Alcohol misuse was associated with an increased risk of completed suicide in all populations with hazard ratios (HR) between 1.99 [95% confidence interval (CI) = 1.44-2.74] and 2.70 (95% CI = 2.40-3.04). Other illicit substances were associated with a two- to threefold risk increase of completed suicide in all populations except bipolar disorder, and cannabis was associated with increased risk of attempted suicide only in people with bipolar disorder (HR = 1.86, 95% CI = 1.15-2.99). Alcohol and other illicit substances each displayed strong associations with attempted suicide, HR ranging from 3.11 (95% CI = 2.95-3.27) to 3.38 (95% CI = 3.24-3.53) and 2.13 (95% CI = 2.03-2.24) to 2.27 (95% CI = 2.12-2.43), respectively. Cannabis was associated with suicide attempts only in people with schizophrenia (HR = 1.11, 95% CI = 1.03-1.19). CONCLUSION Substance use disorders are associated strongly with risk of completed suicides and suicide attempts in people with severe mental illness.
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Affiliation(s)
- Marie L D Østergaard
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Copenhagen and Aarhus, Denmark
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Copenhagen and Aarhus, Denmark
| | - Carsten Hjorthøj
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Copenhagen and Aarhus, Denmark
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Hallgren KA, Ries RK, Atkins DC, Bumgardner K, Roy-Byrne P. Prediction of Suicide Ideation and Attempt Among Substance-Using Patients in Primary Care. J Am Board Fam Med 2017; 30:150-160. [PMID: 28379821 PMCID: PMC5505267 DOI: 10.3122/jabfm.2017.02.160264] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/20/2016] [Accepted: 11/15/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Suicide is a major public health concern, particularly among people who use illicit substances and/or non-prescribed medications. METHODS The present study prospectively assessed the incidence and predictors of suicidal ideation (SI) and suicide attempt (SA) among 868 substance-using patients over 12 months after receiving primary care within seven public primary care clinics. RESULTS Participants reported a high incidence of SI (25.9%) and SA (7.1%) over the year following primary care visits. Suicidality was elevated in patients who were female; lacked a high school diploma; were unemployed; reported depression, anxiety, hallucinations, concentration difficulty, or violent behavior; used nicotine or stimulants; used the emergency department or mental health services in the past 90 days; reported current quality-of-life impairment in mobility or usual activities; or reported recent SI or lifetime SA at baseline. In multiple regression analyses, only past 30-day SI, any lifetime SA, past 90-day violent behavior, and current impairment due to anxiety or depression at baseline uniquely predicted SI or SA beyond other variables. CONCLUSIONS Results support the need for screening for suicidality among primary care patients who use illicit substances and identify key of these patients who are at particularly elevated risk for suicidality.
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Affiliation(s)
- Kevin A Hallgren
- From the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.
| | - Richard K Ries
- From the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - David C Atkins
- From the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Kristin Bumgardner
- From the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Peter Roy-Byrne
- From the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
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McCullumsmith CB, Clark CB, Perkins A, Fife J, Cropsey KL. Gender and racial differences for suicide attempters and ideators in a high-risk community corrections population. CRISIS 2013. [PMID: 23195454 DOI: 10.1027/0227-5910/a000160] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Community corrections populations are a high-risk group who carry multiple suicide risk factors. AIMS To identify factors correlated with historical suicide attempts and ideation among African-American men, African-American women, White men, and White women in a community corrections population. METHOD Self-report data from 18,753 enrollees in community corrections were analyzed. Multinomial logistic regression analyses were conducted to determine associations between historical suicidal ideation and attempts among the four demographic groups. RESULTS Participants with historical suicide attempts tended to be younger, White, female, be taking psychotropic medication, have a history of physical or sexual abuse, and meet criteria for dependence on alcohol, amphetamines, cocaine, opioids, or sedatives. Five variables were commonly associated with suicide attempts for all four race/gender groups: younger age, being on disability or retirement, taking psychotropic medication, history of sexual or physical abuse, and cocaine dependence. Other demographic variables had race or gender specificities as risk factors for suicide attempts. CONCLUSIONS Participants had high rates of historical suicide attempts with unique correlates differentiating attempters from ideators among different racial and gender groups. Cocaine dependence was universal predictor of suicide attempts, while other substance dependencies show specific racial and gender profiles associated with suicide attempts.
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García-Nieto R, Blasco-Fontecilla H, Paz Yepes M, Baca-García E. Traducción y validación de la Self-Injurious Thoughts and Behaviors Interview en población española con conducta suicida. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2013; 6:101-8. [DOI: 10.1016/j.rpsm.2012.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 06/22/2012] [Accepted: 07/02/2012] [Indexed: 10/28/2022]
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16
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Translation and validation of the “Self-Injurious Thoughts and Behaviours Interview” in a Spanish population with suicidal behaviour. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.rpsmen.2012.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Tarantino N, Kuperminc GP, Parrott DJ, Latzman RD. Family Support Mediates the Association Between Substance Use Severity and Suicidal Ideation in Early Adult Emergency Department Patients. Int J Ment Health Addict 2013. [DOI: 10.1007/s11469-013-9444-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Trivedi MH, Morris DW, Wisniewski SR, Nierenberg AA, Gaynes BN, Kurian BT, Warden D, Stegman D, Shores-Wilson K, Rush AJ. Clinical and sociodemographic characteristics associated with suicidal ideation in depressed outpatients. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:113-22. [PMID: 23442899 DOI: 10.1177/070674371305800209] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify clinical and sociodemographic characteristics associated with suicidal ideation (SI) among patients seeking care for depression in routine primary and psychiatric care settings. METHODS We examined data from 4041 treatment-seeking outpatients with major depressive disorder (MDD) to compare baseline sociodemographic and clinical characteristics of those with and without SI, and the presence or absence of baseline depressive symptoms and psychiatric comorbidities in those with SI. RESULTS SI was significantly (P < 0.01) associated with numerous sociodemographic characteristics (that is, lower level of education, Caucasian or African American, male, unemployed, and treated in psychiatric care) and clinical features (that is, previous suicide attempt, younger age of MDD onset, greater baseline depressive symptom severity, greater number of depressive symptoms, and presence of agoraphobia and [or] generalized anxiety disorder). Elevated levels of SI at baseline were associated with decreased remission rates. CONCLUSIONS Consistent with past findings, increased rates of SI were associated with greater depressive symptom severity as well as other features suggestive of severity of illness. Our results confirm previous findings of associations between SI and panic and (or) phobic symptoms and anxiety, but did not confirm previous findings of an association between SI and alcohol or drug use and (or) dependence. While selective serotonin reuptake inhibitor monotherapy appeared significantly helpful in reducing SI during the course of treatment, the presence of SI at baseline was found to be a associated with decreased treatment response, with patients reporting SI at the start of treatment being less likely to achieve remission. CLINICAL TRIAL REGISTRATION NUMBER Sequenced Treatment Alternatives to Relieve Depression, NCT00021528.
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Affiliation(s)
- Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Kuramoto SJ, Chilcoat HD, Ko J, Martins SS. Suicidal ideation and suicide attempt across stages of nonmedical prescription opioid use and presence of prescription opioid disorders among U.S. adults. J Stud Alcohol Drugs 2012; 73:178-84. [PMID: 22333325 DOI: 10.15288/jsad.2012.73.178] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study compares the likelihood of suicidal ideation and suicide attempt across stages of nonmedical prescription opioid use and by presence of prescription opioid disorders (dependence and/or abuse) among adult respondents. METHOD In the 2009 National Survey on Drug Use and Health, 37,933 adult respondents were asked if they had thought about suicide or had attempted suicide in the past year. The likelihood of ideation and attempt were compared across the following four categories: (a) those who never used prescription opioids, (b) former users, (c) persistent users, and (d) recent-onset users. Weighted multinomial logistic regressions were used to examine if these stages and presence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for prescription opioid disorders were associated with suicidal ideation and suicide attempt. RESULTS Five percent of respondents (n = 2,021) reported suicidal ideation; of these, 15% (n = 310) reported attempt. Former and persistent nonmedical prescription opioid users had greater odds of suicidal ideation than those who never used these medications nonmedically. The stages of prescription opioid use were not associated with suicide attempt. Presence of prescription opioid disorders among past-year prescription opioid users was associated with suicidal ideation but not suicide attempt. CONCLUSIONS The risk for suicidal ideation was greater in those who no longer used prescription opioids, in persistent users, and among nonmedical users who had a prescription opioid disorder compared with users without the disorder. The results suggest a need to continue monitoring for suicide risk even among those who have stopped using prescription opioids.
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Affiliation(s)
- S Janet Kuramoto
- American Psychiatric Institute for Research and Education, Arlington, Virginia 22209, USA.
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Petit A, Reynaud M, Lejoyeux M, Coscas S, Karila L. Addiction à la cocaïne : un facteur de risque de suicide ? Presse Med 2012; 41:702-12. [DOI: 10.1016/j.lpm.2011.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Revised: 10/14/2011] [Accepted: 12/06/2011] [Indexed: 10/28/2022] Open
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Fiedler KK, Kim N, Kondo DG, Renshaw PF. Cocaine use in the past year is associated with altitude of residence. J Addict Med 2012; 6:166-71. [PMID: 22531819 PMCID: PMC4586105 DOI: 10.1097/adm.0b013e31824b6c62] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Recently, increased rates of suicide in US counties at higher altitudes have been noted. Because of the documented association between cocaine use and suicide, we hypothesized that there would be a correlation between incidence of cocaine use and altitude of residence. METHODS Cocaine use data were obtained from the Substate Substance Abuse Estimates from the 1999-2001 National Surveys on Drug Use and Health. Data related to the percentages of people 12 years or older who used cocaine in the past year. Average elevation for US counties was calculated using the Shuttle Radar Topography Mission elevation data set, and subject region elevation was calculated by averaging the weighted elevations of each region's relevant counties. The correlation between elevation of a substate region and incidence of cocaine use in that region was calculated using Pearson correlation coefficients. RESULTS A significant correlation exists between mean altitude of a substate region and incidence of cocaine use in that region (r = 0.34; P < 0.0001). Regression analysis controlling for age, sex, race, education level, income, unemployment, and population density was performed. Altitude remained a significant factor (P = 0.007), whereas male sex (P = 0.008) and possessing less than a college education (P < 0.0001) were also significant predictors of self-reported cocaine use in the past year. It is important to note that cocaine use was assessed in isolation of other drugs of abuse, an additional confounding variable. CONCLUSIONS This study demonstrates a significant correlation between altitude of substate region of residence and incidence of cocaine use. It is possible that stress response due to hypoxia is responsible; however, this requires further investigation. However, because other substance use was not assessed, specificity of this association is unknown. In addition, this correlation may help explain the increased rate of suicide in areas of higher elevation.
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Vaszari JM, Bradford S, Callahan O'Leary C, Ben Abdallah A, Cottler LB. Risk factors for suicidal ideation in a population of community-recruited female cocaine users. Compr Psychiatry 2011; 52:238-46. [PMID: 21497216 PMCID: PMC3806049 DOI: 10.1016/j.comppsych.2010.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 06/25/2010] [Accepted: 07/09/2010] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Suicide, as the 11th leading cause of death in America, is a significant public health concern. Previous studies have shown that drug users are a population at especially high risk for suicidal ideation (SI). Although most people who think about killing themselves do not ultimately commit suicide, identifying those at risk for such thoughts is important. METHODS In this analysis, data from a sample of 462 cocaine-using women (87% African American) recruited using street outreach methods for a National Institute on Drug Abuse-funded study were examined to identify risk factors for lifetime SI. Sociodemographic factors, adverse childhood experiences, sexual behaviors, psychiatric comorbidities, and drug abuse and dependence were examined as potential risk factors using both bivariate and logistic regression analysis. RESULTS Fifty percent of the sample met at least one criterion for lifetime SI, and 32% of the sample reported a lifetime suicide attempt. In the final logistic regression model, childhood physical abuse, childhood sexual abuse, rape after the age of 15 years, posttraumatic stress disorder, and number of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, depression criteria met emerged as significant independent predictors of lifetime SI. CONCLUSION These findings identify important risk factors for SI among female substance abusers in community settings.
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Affiliation(s)
- John M Vaszari
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63108, USA.
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Lyne J, O'Donoghue B, Clancy M, Kinsella A, O'Gara C. Concurrent cocaine and alcohol use in individuals presenting to an addiction treatment program. Ir J Med Sci 2009; 179:233-7. [PMID: 19597917 DOI: 10.1007/s11845-009-0385-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Accepted: 06/22/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND National population surveys and information from the National Drug Treatment Reporting System indicate cocaine use is increasing. There is a paucity of studies focusing on comorbid cocaine and alcohol use in Ireland. AIMS The aims of the study are to examine comorbid cocaine and alcohol use patterns in those under 45 years, presenting to a national addiction treatment unit for alcohol and drug dependence. METHODS A retrospective review of the substance misuse behavior of 465 individuals participating in an addiction rehabilitation programme for alcohol dependence. RESULTS Cocaine use among this population rose significantly between 1995 (8%) and 2006 (37.9%). There was a significant association between lifetime reported cocaine use and both psychotic disorders and deliberate self harm. Overall, the use was highest among younger age group and this declined steadily with age. CONCLUSIONS Cocaine use among the alcohol-dependent population is an increasing problem in the Republic of Ireland, and poses a problem of higher toxicity associated with concurrent cocaine and alcohol use.
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Affiliation(s)
- J Lyne
- Addiction Department, St John of God Hospital, Stillorgan, Co Dublin, Ireland.
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YALDIZLI ÖZGÜR, KUHL HANSCHRISTIAN, GRAF MARC, WIESBECK GERHARDA, WURST FRIEDRICHM. Risk factors for suicide attempts in patients with alcohol dependence or abuse and a history of depressive symptoms: A subgroup analysis from the WHO/ISBRA study. Drug Alcohol Rev 2009; 29:64-74. [DOI: 10.1111/j.1465-3362.2009.00089.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Purselle DC, Heninger M, Hanzlick R, Garlow SJ. Differential association of socioeconomic status in ethnic and age-defined suicides. Psychiatry Res 2009; 167:258-65. [PMID: 19395050 PMCID: PMC2736599 DOI: 10.1016/j.psychres.2008.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Revised: 02/04/2008] [Accepted: 02/06/2008] [Indexed: 11/26/2022]
Abstract
Suicide rates vary among racel- and age-defined groups, yet little is known about how suicide risk factors differentially impact individual groups. This study assessed differential associations of socioeconomic status among age- and race-defined groups of suicide victims. A database containing demographic information on declared suicides in Fulton County, GA, from 1 January 1988 through 31 December 2003 was combined with annual per capita income by zip code in Atlanta, GA. Analyses were performed to evaluate differential associations of socioeconomic status among age- and race-defined groups of suicide victims. Compared with the respective ethnic populations of Fulton County, white suicide victims lived in areas with lower per capita income ($51,232 vs. $35,893); African American suicide victims did not ($17,384 vs. $18,179). Elderly suicide victims (>or= 65 years) were more likely to live in the lowest per capita income areas compared with other age groups (OR 1.80, 95% C.I. 1.14, 2.84). Cox proportional hazards models showed increasing income increased the instantaneous risk of suicide among adolescents (HR 2.76; 95% C.I. 2.15, 3.53), particularly African American adolescents (HR 4.22; 95% C.I. 2.19, 8.11), and decreased risk among the elderly (HR 0.58; 95% C.I. 0.50, 0.68). Socioeconomic status had differential associations among age- and race-defined groups of suicide victims.
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Affiliation(s)
- David C. Purselle
- Mental Health Service Line, Atlanta VA Medical Center, 116A, 1670 Clairmont Road, Atlanta, GA 30033, USA, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael Heninger
- Fulton County Medical Examiner's Office, Atlanta, GA, USA, Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Randy Hanzlick
- Fulton County Medical Examiner's Office, Atlanta, GA, USA, Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven J. Garlow
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
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Williamson A, Darke S, Ross J, Teesson M. The association between cocaine use and short-term outcomes for the treatment of heroin dependence: findings from the Australian Treatment Outcome Study (ATOS). Drug Alcohol Rev 2009; 25:141-8. [PMID: 16627303 DOI: 10.1080/09595230500537381] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of this study was to determine the prevalence of cocaine use among individuals presenting for treatment for heroin dependence, describe the clinical profile of heroin users who also use cocaine and to establish the effects of cocaine use on short term outcomes for the treatment for heroin dependence. A longitudinal follow-up of 549 heroin users recruited in Sydney for the Australian Treatment Outcome Study was conducted at 3-month post-baseline interview. At baseline, current cocaine use was common (39%) and was associated with increased drug use, needle risk taking and criminality. The 3-month prevalence of cocaine use declined significantly to 19%. Thirty-five per cent of those who had used cocaine at baseline continued to use at 3 months, while 9% of the sample had commenced cocaine use. Those who entered residential rehabilitation at baseline were less likely than other treatment entrants and the non-treatment group to have used cocaine at follow-up. Treatment retention was not affected by baseline cocaine use status; however, baseline cocaine users (CU) displayed higher levels of heroin use, polydrug use and drug-related problems. A poorer outcome was associated with the commencement or continuation of cocaine use, while cessation of cocaine use resulted in significant improvements on these measures. Cocaine use was common among individuals seeking treatment for heroin dependence and was an important moderator of treatment outcome. It appears that cocaine use has a strong negative effect on treatment outcome over and above that caused by polydrug use generally.
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Affiliation(s)
- Anna Williamson
- National Drug and Alcohol Research Centre, University of NSW, Australia.
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De Oliveira LG, Barroso LP, Silveira CM, Sanchez ZVDM, De Carvalho Ponce J, Vaz LJ, Nappo SA. Neuropsychological assessment of current and past crack cocaine users. Subst Use Misuse 2009; 44:1941-57. [PMID: 20001290 DOI: 10.3109/10826080902848897] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cognitive changes due to crack cocaine consumption remain unclear. METHODS For clarification, 55 subjects were assigned to three groups: control group, crack cocaine current users, and ex-users. Participants were submitted to Mini-Mental State Examination (MMSE) and tasks evaluating executive functioning and verbal memory. Mood state was also measured. Intergroup comparisons were carried out. RESULTS Control group performance on the MMSE was better than that of users and ex-users. Verbal memory performance for logical memory of users was impaired. Ex-users scored lower on DSST and Trail Making Test (Part B). CONCLUSION Chronic crack cocaine use seems to disrupt general cognitive functioning (MMSE), verbal memory, and attentional resources, but findings suggest that some of these effects could be reversed by abstinence.
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Affiliation(s)
- Lúcio Garcia De Oliveira
- Department of Psychiatry, Medical School, Universidade de São Paulo (USP), São Paulo (SP), Brazil. [corrected]
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Diehl A, Laranjeira R. Suicide attempts and substance use in an emergency room sample. JORNAL BRASILEIRO DE PSIQUIATRIA 2009. [DOI: 10.1590/s0047-20852009000200003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: Describe suicide attempts assisted in an emergency room (ER) and acute substance consumption or dependence on these individuals. METHODS: Descriptive epidemiologic study was carried out during one year, evaluating suicide attempts assisted at Embu das Artes ER, São Paulo, Brazil. Patients were scheduled to a non structured psychiatric interview. Main outcomes measures were: socio demographic data, suicide attempt method, drugs or alcohol acute use in the six hours prior to attempt, patients with ICD-10 substance dependence diagnosis. The descriptive analyses and chi-square test (p < 0.05) were used to verify associations between the variables studied. RESULTS: sample was formed of 80 patients, mean age of 26.9 years (SD = 8.91), predominantly female (72.5%) and 21.2% adolescents. Most suicide attempts were made through medicine ingestion (62.5%). Approximately 21.2% and 7.5% related to have used alcohol and an illicit drug respectively within 6 hours prior to attempt and 10% were found to be substance dependent. All substance dependents had attempted suicide previously (p-value = 0.4). There was a significant association between suicide attempt through medicine ingestion and psychiatric treatment history (p = 0.02). CONCLUSION: More national studies are necessary to consider the role of alcohol and drug in suicide attempts assisted in ER, especially in chemical dependents whose suicidal behavior is relevant.
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Rothman RB, Blough BE, Baumann MH. Dual dopamine/serotonin releasers: potential treatment agents for stimulant addiction. Exp Clin Psychopharmacol 2008; 16:458-74. [PMID: 19086767 PMCID: PMC2683464 DOI: 10.1037/a0014103] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
"Agonist therapy" for cocaine and methamphetamine addiction involves administration of stimulant-like medications (e.g., monoamine releasers) to reduce withdrawal symptoms and prevent relapse. A significant problem with this strategy is that many candidate medications possess abuse liability because of activation of mesolimbic dopamine (DA) neurons in the brain. One way to reduce DA-mediated abuse liability of candidate drugs is to add in serotonin (5-HT) releasing properties, since substantial evidence shows that 5-HT neurons provide an inhibitory influence over mesolimbic DA neurons. This article addresses several key issues related to the development of dual DA/5-HT releasers for the treatment of substance use disorders. First, the authors briefly summarize the evidence supporting a dual deficit in DA and 5-HT function during withdrawal from chronic cocaine or alcohol abuse. Second, the authors discuss data demonstrating that 5HT release can dampen DA-mediated stimulant effects, and the "antistimulant" role of 5-HT-sub(2C) receptors is considered. Next, the mechanisms underlying potential adverse effects of 5-HT releasers are described. Finally, the authors discuss recently published data with PAL-287, a novel nonamphetamine DA/5-HT releasing agent that suppresses cocaine self-administration but lacks positive reinforcing properties. It is concluded that DA/5-HT releasers could be useful therapeutic adjuncts for the treatment of cocaine and alcohol addictions, as well as for obesity, attention-deficit disorder, and depression.
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Affiliation(s)
- Richard B Rothman
- Clinical Psychopharmacology Section, IRP/NIDA/NIH, Clinical Psychopharmacology Section, Suite 4500, Triad Building, 333 Cassell Drive, Baltimore, MD 21224, USA.
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Differences in Addiction Severity Between Social and Probable Pathological Gamblers Among Substance Abusers in Treatment in Rio de Janeiro. Int J Ment Health Addict 2008. [DOI: 10.1007/s11469-008-9183-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Suicidal Ideation Among Drug-Dependent Treatment-Seeking Inner-City Pregnant Women. ACTA ACUST UNITED AC 2008; 3:53-64. [PMID: 21796240 DOI: 10.1300/j126v03n02_07] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The current retrospective study compared the psychiatric and lifestyle characteristics of two groups of treatment-seeking pregnant, opiate and/or cocaine dependent women admitted to the Center for Addiction and Pregnancy (CAP). Women reporting past and/or current suicidal ideation (SI) (46%; n = 35) were compared to women who did not report thoughts of suicidal ideation (NSI) (54%; n = 41). SI women were more likely to be homeless (p = .020), to report histories of emotional (p = .022), physical (p < 001), sexual abuse (p = .002) and psychiatric treatment (p < .001), and less likely to be married (p = .024) than NSI women. Psychiatrically, SI women were more likely to have co-morbid current and lifetime disorders than NSI women. These findings highlight the need to identify women with histories of suicidal ideation, recognize the potential relapse risk imposed by emotional distress, and confront these issues in treatment.
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Ries RK, Yuodelis-Flores C, Comtois KA, Roy-Byrne PP, Russo JE. Substance-induced suicidal admissions to an acute psychiatric service: Characteristics and outcomes. J Subst Abuse Treat 2008; 34:72-9. [PMID: 17574802 DOI: 10.1016/j.jsat.2006.12.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Revised: 12/04/2006] [Accepted: 12/09/2006] [Indexed: 10/23/2022]
Abstract
The degree of substance-induced syndrome (SIS) was evaluated in 5,116 acutely hospitalized suicidal psychiatric inpatients. Admission and discharge severity ratings were made by academic attendings using structured forms. Outcome variables analyzed include ratings of psychiatric symptom severity on admission and discharge, length of stay, severity of SIS, and severity of alcohol/drug problems. Suicidal inpatients rated with a high degree of SIS were more likely to be homeless, to be unemployed, to be uncooperative, to have shorter lengths of stay, and to show a more rapid improvement in symptoms. These patients represent a subgroup of the co-occurring disorders population having a high degree of addiction severity with temporary substance-induced suicidal syndromes and are subjected to the most expensive level of care in the mental health system. Implications of these findings include the fact that psychiatric inpatient services need to provide intensive addiction intervention treatment and that outpatient addiction services need improved capability and capacity to care for suicidal patients.
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Affiliation(s)
- Richard K Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98104, USA.
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Complexities of Cocaine Users Presenting to the Emergency Department with Chest Pain: Interactions Between Depression Symptoms, Alcohol Use, and Race. J Addict Med 2007; 1:213-21. [DOI: 10.1097/adm.0b013e31815b32df] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Williamson A, Darke S, Ross J, Teesson M. The effect of baseline cocaine use on treatment outcomes for heroin dependence over 24 months: Findings from the Australian Treatment Outcome Study. J Subst Abuse Treat 2007; 33:287-93. [PMID: 17889301 DOI: 10.1016/j.jsat.2006.12.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Revised: 12/19/2006] [Accepted: 12/25/2006] [Indexed: 11/17/2022]
Abstract
AIMS The aim of this study was to determine the effects of baseline cocaine use on treatment outcomes for heroin dependence over a 24-month period. DESIGN A longitudinal cohort (24 months) study was carried out. Interviews were conducted at baseline, 3, 12, and 24 months. SETTING The study setting was Sydney, Australia. PARTICIPANTS Six hundred fifteen heroin users were recruited for the Australian Treatment Outcome Study. FINDINGS Cocaine use was common at baseline (40%) but decreased significantly over the study period. Even after taking into account age, sex, treatment variables, current heroin use, and baseline polydrug use, baseline cocaine use remained a significant predictor of poorer outcomes across a range of areas. Baseline cocaine users were more likely to report heroin use, unemployment, needle sharing, criminal activity, and incarceration over the 24-month study period. CONCLUSIONS Cocaine consumption among heroin users has repercussions across a range of areas that persist far beyond the actual period of use. Consequently, treatment providers should regard cocaine use among clients as an important marker for individuals who are at risk of poorer treatment outcome.
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Affiliation(s)
- Anna Williamson
- National Drug and Alcohol Research Centre, University of New South Wales, New South Wales 2052, Australia.
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Garlow SJ, Purselle DC, Heninger M. Cocaine and alcohol use preceding suicide in African American and white adolescents. J Psychiatr Res 2007; 41:530-6. [PMID: 16203014 DOI: 10.1016/j.jpsychires.2005.08.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2005] [Revised: 08/15/2005] [Accepted: 08/17/2005] [Indexed: 11/20/2022]
Abstract
The goal of this investigation was to determine whether cocaine and ethanol use was a differentiating factor between African American and white teenage suicide victims. This is a retrospective analysis of medical examiner's records of all completed suicides in Fulton County, GA from 01/1989 to 12/2003, and included 1296 cases. There were 79 suicide victims aged 19 and younger during the study interval, and of this group, 49 (62%) were African American, 26 (33%) were white, and 4 (5%) other race, compared to adults (20 years) where 28.5% were African American, 68.6% white and 2.9% other race (chi(2)=42.678, d.f.=2, p<0.0001). Of the black teenaged victims, 82.2% had no cocaine or alcohol detected at autopsy, while 41.7% of the white victims were positive for one or both substance (chi(2)=4.633, d.f.=1, p=0.04). Only 8.9% of the black teenage suicide victims had used cocaine prior to death compared to 28% of the whites (chi(2)=4.432; d.f.=1; p<0.04). The suicide rate (suicide/100,000/year) for black teens was 5.48 compared to 4.16 for whites, but the rate of cocaine positive teen suicides was 1.12 for whites and 0.45 for blacks. The pattern of cocaine use changes dramatically in the adult group, with 27% of African American suicide victims compared to 7.7% of whites being positive (chi(2)=73.272; d.f.=1; p<0.001). Use of intoxicating substances does differentiate teenage suicide victims, as only a small proportion of black teenagers had used cocaine or alcohol prior to death compared to almost half of all whites.
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Affiliation(s)
- Steven J Garlow
- Mood and Anxiety Disorders Program, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1841 Clifton Road, 4th floor, Atlanta, GA 30322, USA.
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Rothman RB, Baumann MH. Balance between dopamine and serotonin release modulates behavioral effects of amphetamine-type drugs. Ann N Y Acad Sci 2007; 1074:245-60. [PMID: 17105921 DOI: 10.1196/annals.1369.064] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The abuse of illicit stimulants is a worldwide crisis, yet few medicines are available for treating stimulant addiction. We have advocated the idea of "agonist therapy" for cocaine dependence. This strategy involves administration of stimulant-like medications (e.g., monoamine releasers) to alleviate cocaine withdrawal symptoms and prevent relapse. A chief limitation of this strategy is that many candidate medicines possess high abuse liability due to activation of mesolimbic dopamine (DA) neurons in reward pathways. Evidence suggests that serotonin (5-HT) neurons can provide an inhibitory influence over mesolimbic DA neurons. Thus, it might be predicted that the balance between DA and 5-HT transmission is a critical variable when developing medications with reduced stimulant side effects. In this article, we review recent studies from our laboratory that examined neurochemical and behavioral effects of a series of monoamine releasers which displayed different potencies at DA and 5-HT transporters. The data show that increasing 5-HT release can attenuate stimulant effects mediated by DA release, such as motor stimulation and drug self-administration. Our findings support the work of others and indicate that elevated synaptic 5-HT can dampen certain behavioral effects of DA-releasing agents. Moreover, the relationship between DA and 5-HT releasing potency is an important determinant in developing new agonist medications with reduced stimulant properties.
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Affiliation(s)
- Richard B Rothman
- CPS, IRP, NIDA, NIH, 5500 Nathan Shock Drive, Baltimore, MD 21224, USA.
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Rothman RB, Blough BE, Baumann MH. Dual dopamine/serotonin releasers as potential medications for stimulant and alcohol addictions. AAPS JOURNAL 2007; 9:E1-10. [PMID: 17408232 PMCID: PMC2751297 DOI: 10.1208/aapsj0901001] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We have advocated the idea of agonist therapy for treating cocaine addiction. This strategy involves administration of stimulant-like medications (eg, monoamine releasers) to alleviate withdrawal symptoms and prevent relapse. A major limitation of this approach is that many candidate medicines possess significant abuse potential because of activation of mesolimbic dopamine (DA) neurons in central nervous system reward circuits. Previous data suggest that serotonin (5-HT) neurons can provide an inhibitory influence over mesolimbic DA neurons. Thus, it might be predicted that the balance between DA and 5-HT transmission is important to consider when developing medications with reduced stimulant side effects. In this article, we discuss several issues related to the development of dual DA/5-HT releasers for the treatment of substance use disorders. First, we discuss evidence supporting the existence of a dual deficit in DA and 5-HT function during withdrawal from chronic cocaine or alcohol abuse. Then we summarize studies that have tested the hypothesis that 5-HT neurons can dampen the effects mediated by mesolimbic DA. For example, it has been shown that pharmacological manipulations that increase extracellular 5-HT attenuate stimulant effects produced by DA release, such as locomotor stimulation and self-administration behavior. Finally, we discuss our recently published data about PAL-287 (naphthylisopropylamine), a novel non-amphetamine DA-/5-HT-releasing agent that suppresses cocaine self-administration but lacks positive reinforcing properties. It is concluded that DA/5-HT releasers might be useful therapeutic adjuncts for the treatment of cocaine and alcohol addiction, obesity, and even attention deficit disorder and depression.
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Affiliation(s)
- Richard B Rothman
- Clinical Psychopharmacology Section, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, Baltimore, MD 21224, USA.
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Rothman RB, Blough BE, Baumann MH. Dual dopamine-5-HT releasers: potential treatment agents for cocaine addiction. Trends Pharmacol Sci 2006; 27:612-8. [PMID: 17056126 DOI: 10.1016/j.tips.2006.10.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2006] [Revised: 09/04/2006] [Accepted: 10/10/2006] [Indexed: 11/21/2022]
Abstract
Biogenic amine transporters (BATs) are integral membrane proteins that translocate biogenic amine neurotransmitters [norepinephrine, dopamine (DA) and 5-hydroxytryptamine (5-HT)] across cell membranes. BATs are the principal sites of action for many psychotropic drugs, including abused stimulants such as cocaine and methamphetamine. Preclinical and human data demonstrate that withdrawal from long-term cocaine administration produces a dual deficit of synaptic DA and 5-HT in the brain, indicating the advantage of developing medications that normalize impairments in both neurotransmitter systems. In this article, we review data supporting the notion that stimulant effects normally produced by increased levels of extracellular DA can be antagonized by concurrent increases in levels of extracellular 5-HT. Accordingly, nonselective BAT substrates that can release both DA and 5-HT, such as the novel compound PAL287, have low abuse potential while maintaining the ability to suppress drug-seeking behavior. The collective findings indicate that such drugs will provide neurochemical normalization therapy for cocaine addiction and might also be useful for treating depression, obsessive-compulsive disorder, attention deficit disorder and obesity.
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Affiliation(s)
- Richard B Rothman
- Clinical Psychopharmacology Section, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, PO Box 5180, 5500 Nathan Shock Drive, Baltimore, MD 21224, USA.
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Williamson A, Darke S, Ross J, Teesson M. The effect of persistence of cocaine use on 12-month outcomes for the treatment of heroin dependence. Drug Alcohol Depend 2006; 81:293-300. [PMID: 16154714 DOI: 10.1016/j.drugalcdep.2005.08.010] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Revised: 07/29/2005] [Accepted: 08/08/2005] [Indexed: 10/25/2022]
Abstract
AIMS To determine the effects of cocaine use across the study period on outcomes of treatment for heroin dependence 12 months post-treatment entry. DESIGN Longitudinal cohort (12 months). Interviews were conducted at baseline, 3 and 12 months. SETTING Sydney, Australia. PARTICIPANTS Four hundred ninety-five heroin users recruited for the Australian Treatment Outcome Study and re-interviewed at 12-month follow-up. FINDINGS Cocaine was widely used among treatment entrants in NSW, with almost all having a lifetime history of cocaine use and almost half having used in the month preceding baseline. While there was an overall decline in cocaine use across the study period, individual use patterns varied widely. Approximately half of the cohort did not report cocaine use at any data point, with the remainder reporting having used at one (29%), two (12%), or at all three (5%) points. Cocaine use across the study period was an independent predictor of most major treatment outcomes, with more cocaine use points predicting poorer outcome. Persistent cocaine use predicted a higher prevalence of homelessness, heroin use, daily injecting, needle sharing and injection-related health problems at 12 months as well as more extensive recent polydrug use. CONCLUSIONS Cocaine use was common among individuals seeking treatment for primary heroin dependence in NSW. Any cocaine use over the study period was associated with poorer outcomes in virtually all areas. Persistent cocaine use over the study period, however, appeared particularly detrimental. Cocaine use among clients should evidently be a cause for concern amongst treatment providers and may warrant being specifically targeted during treatment.
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Affiliation(s)
- Anna Williamson
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick Campus, 22-32 King St., Randwick, NSW 2052, Australia.
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Cottler LB, Campbell W, Krishna VAS, Cunningham-Williams RM, Abdallah AB. Predictors of high rates of suicidal ideation among drug users. J Nerv Ment Dis 2005; 193:431-7. [PMID: 15985836 PMCID: PMC1350972 DOI: 10.1097/01.nmd.0000168245.56563.90] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Several studies have attempted to understand the link among substance abuse, depression, and suicidal ideation (SI). Assessment of this link is important to develop specific interventions for persons in substance abuse treatment. This association was tested among 990 drug users in and out of treatment with significant criminal justice histories from two National Institute on Drug Abuse studies. The Diagnostic Interview Schedule and Substance Abuse Module assessed DSM-III-R depression, number of depression criteria met, antisocial personality disorder (ASPD), and substance use disorders. Compared with men, women were twice as likely to report depression (24% vs. 12%), whereas men were nearly twice as likely to report ASPD (42% vs. 24%). High rates of SI were found, with women more likely than men to report thoughts of death (50% vs. 31%), wanting to die (39% vs. 21%), thoughts of committing suicide (47% vs. 33%), or attempting suicide (33% vs. 11%); 63% of women and 47% of men reported at least one of these suicidal thoughts or behaviors. Male and female ideators were more likely than nonideators to report depressed mood and to meet criteria for depression, ASPD, and alcohol use disorders. Male ideators were more likely than male nonideators to meet criteria for cocaine use disorders. Using logistic regression, SI among men was predicted by alcohol use disorder (OR = 1.60), ASPD (OR = 1.59), and number of depression criteria (OR = 9.38 for five criteria). Among women, SI was predicted by older age, marital status, alcohol use disorder (OR = 2.77), and number of depression criteria (OR = 9.12 for five criteria). These original findings point out the need to discuss suicidal thoughts among depressed drug users for early treatment and prevention.
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Affiliation(s)
- Linda B Cottler
- Department of Psychiatry, School of Medicine, Washington University, St. Louis, MI, USA.
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Rothman RB, Blough BE, Woolverton WL, Anderson KG, Negus SS, Mello NK, Roth BL, Baumann MH. Development of a Rationally Designed, Low Abuse Potential, Biogenic Amine Releaser That Suppresses Cocaine Self-Administration. J Pharmacol Exp Ther 2005; 313:1361-9. [PMID: 15761112 DOI: 10.1124/jpet.104.082503] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Convergent lines of evidence support a dual deficit model of stimulant withdrawal, where reductions in synaptic dopamine (DA) and 5-hydroxytryptamine (serotonin) (5-HT) contribute to dysphoria, drug craving, and relapse. Thus, we predicted that a nonamphetamine compound with substrate activity at DA and 5-HT transporters (i.e., a dual DA/5-HT releaser) would be an effective medication for treating stimulant addictions. Ideally, this type of medication would alleviate withdrawal symptoms, suppress cocaine self-administration, and lack side effects commonly associated with central nervous system stimulants. In the present work, more than 350 compounds were screened in vitro for activity as substrate-type releasing agents at DA, 5-HT, and norepinephrine transporters. These efforts identified PAL-287 (1-napthyl-2-aminopropane) as a nonamphetamine compound with potent substrate activity at biogenic amine transporters. In vivo microdialysis in rats demonstrated that PAL-287 (1-3 mg/kg i.v.) increased extracellular DA and 5-HT in frontal cortex, but effects on 5-HT were somewhat greater. PAL-287 induced substantially less locomotor stimulation than (+)-amphetamine, a drug that increases only extracellular DA. Administration of high-dose (+)-methamphetamine or (+/-)-3,4-methylenedioxymethamphetamine to rats produced long-lasting depletion of cortical 5-HT, whereas PAL-287 (18 mg/kg i.p. x 3) did not. PAL-287 displayed little or no reinforcing properties in rhesus monkeys trained to self-administer cocaine, yet PAL-287 produced a dose-dependent decrease in responding for cocaine when infused at a dose of 1.0 mg/kg/h. Collectively, the findings reported here demonstrate that nonamphetamine monoamine releasing agents such as PAL-287 might be promising candidate medications for the treatment of stimulant dependence.
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Affiliation(s)
- Richard B Rothman
- Clinical Psychopharmacology Section, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, USA
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Tarter RE, Kirisci L, Reynolds M, Mezzich A. Neurobehavior disinhibition in childhood predicts suicide potential and substance use disorder by young adulthood. Drug Alcohol Depend 2004; 76 Suppl:S45-52. [PMID: 15555816 DOI: 10.1016/j.drugalcdep.2004.08.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2004] [Accepted: 08/04/2004] [Indexed: 10/26/2022]
Abstract
The objectives of this study were to (a) determine whether two factors that are established components of the risk for substance use disorder (SUD) also impact on the risk for suicide; and (2) evaluate whether SUD manifest by early adulthood predicts suicide propensity. Neurobehavior disinhibition assessed in 227 boys at ages 10-12 and 16 and parental history of SUD were prospectively evaluated to determine their association with the risk for SUD and suicide propensity between ages 16 and 19. The results indicated that neurobehavior disinhibition at age 16 predicts suicide propensity between ages 16 and 19 (p = .04). A trend was observed (p = .08) for SUD manifest between ages 16 and 19 to predict suicide propensity during the same period. Maternal SUD is directly associated with son's SUD risk but not suicide propensity. Paternal SUD predicts son's neurobehavior disinhibition that, in turn, predisposes to SUD. A direct relation between paternal SUD and son's suicide propensity was not observed. These findings suggest that neurobehavior disinhibition, a component of the liability of SUD, is also associated with suicide risk. These results are discussed within a neurobehavioral framework in which prefrontal cortex dysfunction is hypothesized to underlie the risk for these two outcomes.
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Affiliation(s)
- R E Tarter
- Center for Education and Drug Abuse Research, Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, 711 Salk Hall, Pittsburgh, PA 15261, USA.
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Wines JD, Saitz R, Horton NJ, Lloyd-Travaglini C, Samet JH. Suicidal behavior, drug use and depressive symptoms after detoxification: a 2-year prospective study. Drug Alcohol Depend 2004; 76 Suppl:S21-9. [PMID: 15555813 DOI: 10.1016/j.drugalcdep.2004.08.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2004] [Accepted: 08/04/2004] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Individuals with substance-related disorders are at increased risk for suicidal behavior. Identifying those at higher risk for suicide among this population is difficult and informed mainly on the basis of cross-sectional data. METHODS We examined factors associated with drug-related suicidal behavior using multivariable regression analyses in a 2-year prospective study of 470 inpatients enrolled from an unlocked, detoxification unit. Suicidal behavior included suicidal ideation (SI) and suicide attempt (SA). RESULTS Lifetime prevalence for SI was 28.5%, and for SA, 21.9%. During the 2-year follow-up, 19.9% of the sample endorsed suicidal ideation and 6.9% reported a suicide attempt. Correlates of lifetime suicidal behavior included younger age, female, Hispanic, greater depressive symptoms, past sexual abuse, and problem sedative or alcohol use. Factors associated with suicidal behavior at follow-up included past suicidal behavior, more depressive symptoms, and more frequent benzodiazepine and alcohol use. Cocaine and heroin use did not reach statistical significance. CONCLUSIONS Suicidal behavior is common among individuals with substance-related disorders. Differences in "suicide potential" may exist between drug categories with CNS depressants increasing the risk. These findings highlight the importance of addressing the recurrent 'suicide risk' of patients with substance-related disorders and regular monitoring for changes in depressive symptoms and drug use. Based on the prevalence and severity of this problem, the role of universal suicide screening of individuals with substance-related disorders merits greater attention.
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Affiliation(s)
- James D Wines
- Alcohol and Drug Abuse Research Center (ADARC), McLean Hospital-Harvard Medical School, Boston, MA 02478, USA.
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Abstract
The pharmacotherapy of cocaine dependence is a rapidly developing field of research that may soon produce efficacious medications. Expanding research on reward-related brain circuitry, which is acutely activated and chronically dysregulated by cocaine, has helped reveal the neurobiological features of cocaine dependence and is guiding pharmacologic strategies that have significant potential to improve clinical outcome. Cocaine dependence is a multifaceted disorder with distinct clinical components that may respond to different pharmacologic approaches. Pharmacologic strategies for this disorder include blocking euphoria, reducing withdrawal and negative mood symptoms, ameliorating craving, and enhancing the prefrontal cortical function that seems to be impaired in cocaine-dependent patients. One medication may not be sufficient to treat these diverse elements of cocaine dependence because preliminary studies report efficacy with medications that have opposite actions on reward-related circuits. This review highlights pertinent advances in cocaine neurobiology, recent clinical trials, and controversies in the pharmacologic treatment of cocaine dependence.
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Affiliation(s)
- Charles A Dackis
- University of Pennsylvania Treatment Research Center, 3900 Chestnut Street, Philadelphia, PA 19104, USA.
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Abstract
A sample of 183 current cocaine users, 120 primary injecting cocaine users (ICUs), and 63 primary noninjecting cocaine users (NICUs) were administered a structured interview to ascertain attempted suicide histories, methods used, and factors associated with suicide attempts. All respondents were volunteers and current cocaine users recruited through a wide range of sources. The mean age of participants was 30.1 years, and 65% were male. The ICUs were older (32.3 vs. 26.7 years, respectively), more likely to be male (72% vs. 54%, respectively), to be unemployed (84% vs. 23%, respectively) and to have a prison history (53% vs. 1%, respectively) compared to NICUs. Of the sample, 31% had attempted suicide, 18% had done so on more than one occasion, and 8% had made an attempt in the preceding 12 months. Overall, 28% of the sample had been treated by a medical practitioner after an attempt. ICUs (38%) were significantly more likely than NICUs (10%) to have attempted suicide and to have done so on more than one occasion (23% vs. 3%, respectively). The most common method used among both groups was self-poisoning (ICUs 28%, NICUs 8%), primarily by drug overdose. Violent methods had been used by 22% of ICUs and 3% of NICUs. Multivariate analyses revealed that injecting, female gender, and more extensive polydrug use were independent predictors of a suicide attempt. The prevalence of suicide in this study indicates that it represents a major clinical issue among ICUs and to a lesser extent among noninjectors of the drug. Those treating cocaine users for drug dependence need to be aware of the salience of suicide as a problem, among injectors in particular.
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, New South Wales, Australia.
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