Multiple substance use by alcoholics

New-onset addictions in patients with alcohol dependence: A cross-sectional study

BACKGROUND

Individuals who are addicted to one addiction are at an increased risk for developing another new addiction. New-onset addictions among patients with alcohol dependence needs to be considered for more effective treatment of alcohol dependence.

METHODS

In this cross-sectional study, Japanese outpatients with alcohol dependence were assessed using a comprehensive, originally designed questionnaire to determine whether they were addicted to substances or behaviors other than alcohol. The prevalence rates of new-onset addictions were compared between alcohol-dependent patients who had abstained from alcohol for a year or more and those who had not. Multiple regression analysis was performed to examine the association between the number of new-onset addictions and the demographic and clinical characteristics.

RESULTS

One hundred and nine outpatients with alcohol dependence (54.6±11.0 years; 97 men) participated in the study. The prevalence of new-onset addictions was 41.3%. No significant differences were found in the prevalence of new-onset addictions between the patients who had abstained for a year or more and those who had not. Multiple regression analysis revealed that the number of new-onset addictions was positively associated with the presence of psychiatric comorbidity (β = 0.24; p = 0.02) and use of benzodiazepines (β = 0.20; p = 0.04) with a R2 of 0.153.

CONCLUSION

Alcohol dependent patients with characteristics such as psychiatric comorbidity and use of benzodiazepines should be given more attention to the development of new-onset addictive behaviors. On the other hand, those behaviors could be acceptable for harm-reduction unless excessive and loss of control.

A systematic review of addiction substitution in recovery: Clinical lore or empirically-based?

This systematic review synthesized the literature examining addiction substitution during recovery from substance use or behavioral addictions. A total of 96 studies were included with sample sizes ranging from 6 to 14,885. The most common recovery addictions were opioids (30.21%), followed by cannabis (20.83%), unspecified use (17.71%), nicotine (12.50%), alcohol (12.50%), cocaine (4.17%), and gambling (2.08%). Statistical results were provided by 70.83% of the studies. Of these, 17.65% found support for addiction substitution, whereas 52.94% found support for concurrent recovery. A total of 19.12% found no statistical changes and 10.29% found both significant increases and decreases. The remaining 29.17% of studies provided descriptive data, without statistical tests. Predictors of addiction substitution were provided by 22.92% of the studies and 11.46% included information on impact of addiction substitution on treatment outcomes. Overall, male gender, younger age, greater substance use severity, and presence of mental health disorders were associated with addiction substitution. Addiction substitution was associated with poorer treatment outcomes. A limitation of the present systematic review is the use of significance counting for the quantitative synthesis. More research examining changes in addiction during recovery would aid in the development of more effective treatments for addictive disorders and prevent addiction substitution.

Substitute Addictions in Persons with Substance Use Disorders: A Scoping Review

Substitute addictions, addictive behaviors that sequentially replace each other's functions, have implications for recovery trajectories but remain poorly understood. We sought to scope the extent, range, and characteristics of research on substitute addictions in persons with substance use disorders. Method: Using Arksey and O'Malley's framework for scoping reviews, a systematic search was conducted to identify publications that referenced substitute addictions up to April 2018. Study characteristics were extracted and summarized to provide an overview of the extant literature. Results: The 63 included studies show that substitute addictions are terminologically and conceptually ambiguous. Much of the available literature is concentrated in developed contexts - and in particular the United States of America. While presentations varied, at least two sub-types of substitute addictions appeared: long-term replacement and temporary replacement. Existing theories suggest a multifactorial etiology. Conclusions: The findings suggest a strong need for: increased awareness of substitute addictions and its potential consequences for recovery; interventions that structure prevention and pre-, during-, and post-treatment interactions as well as future research to explore its nature and dynamics drawing on multiple methods.

The Shorter PROMIS Questionnaire: further validation of a tool for simultaneous assessment of multiple addictive behaviours

There is both a theoretical and clinical need to develop a questionnaire that assesses a range of addictive behaviours. The Shorter PROMIS Questionnaire (SPQ) is a 16-scale self-report instrument assessing the use of nicotine, recreational drugs, prescription drugs, gambling, sex, caffeine, food bingeing, food starving, exercise, shopping, work, relationships dominant and submissive, and compulsive helping dominant and submissive. Clinical cut-off scores using the 90th percentile were derived from a normative group of 508 individuals. These cut-offs correctly identified 78-100% of cases within clinical criterion groups of specific disorders. The clinical sample also completed other validated scales assessing gambling, eating, alcohol, and drug use. Correlations were typically.7 with relevant SPQ scales. The SPQ food, drug, and alcohol scales were at least equivalent to validated comparison scales in the strength of their relationship to relevant clinical criterion groups. Internal consistency was high for all scales, and test-retest reliability was generally good. This clinically useful instrument provides a broad assessment of addictive problems, thereby benefiting both the treatment provider and the client.

Diagnostic conundrums in substance abusers with psychiatric symptoms: variables suggestive of dual diagnosis

Patients with substance dependence and psychiatric symptoms often present a diagnostic conundrum because each of these problems may mutually and reciprocally complicate the other. This may challenge the ability to identify dual-diagnosis patients who have both a substance abuse disorder and a definitive symptom-based psychiatric disorder. The main purpose of this explorative study was to identify variables suggestive of dual diagnosis in the population of substance-dependent patients with psychiatric symptoms. A secondary purpose was to examine the subgroups in this population for their distinctiveness from one another. Based upon clinical experience and the literature, seven independent variables were hypothesized as suggestive of dual diagnosis. Seventy-nine patients with substance dependence and psychiatric symptoms of depression, anxiety, and/or psychosis were assessed for symptom and disorder status generating three subgroups: I) 20 patients with psychiatric symptoms not meeting thresholds for clinical significance; II) 36 patients exhibiting a psychiatric disorder (dual diagnosis); and III) 23 patients with psychiatric symptoms meeting thresholds for clinical significance but not for a disorder. Odds ratios were calculated to examine the risk for dual diagnosis using the seven independent variables. A persistent increased risk for dual diagnosis was observed in patients who were positive for the seven variables. The seven variables were combined into an overall measure of patients' risk for dual diagnosis. Mean scores were significantly different for the three groups F(2, 76) = 8.4, p < .001. This study indicates variables that may be suggestive of dual diagnosis and finds subgroup distinctiveness in this sample. Both of these findings have treatment implications.

Tolerance to hexobarbital induced by short-term treatments with diazepam and tested with an EEG-threshold test in male rats

Male Mol: SPRD rats were treated with 5 or 20 mg/kg of diazepam for 4 days. The treatment was repeated at two different ages. Diazepam was either dissolved in Intralipid (KABI, Sweden) or dispersed in gummi arabicum. Tolerance induced by the treatment was tested with an EEG-threshold technique where hexobarbital was infused intravenously on day 1, 4, 7 and 14 of the abstinence. The threshold was the dose of hexobarbital needed to induce a burst suppression of 1 sec. or more (silent second). After the first diazepam treatment significant increase in the hexobarbital threshold doses were recorded in all but one of the diazepam treated groups. The pattern varied depending on dose, age and solvent. After the second treatment tolerance was seen only when diazepam had been dissolved in Intralipid. Short term treatment with diazepam can induce cross-tolerance to hexobarbital which probably is due to an increased excitation (physical dependence) in abstinence after treatment with diazepam.

Substance abuse among subjects screened out from an alcoholism research program

Three hundred and eight subjects were screened over the phone for admission to an inpatient alcohol treatment research unit. Using a structured interview, the prospective patients were asked questions regarding demographics, drinking history, previous treatments, physical health, family history, and a detailed history of past and present substance use. Drug use was studied as regular use versus no use or brief experimental use of five drug categories: cannabinoids, stimulants, sedatives, opiates, and hallucinogens. Fifty-one percent of the men and 48% of the women reported regular use of one or more of the drugs in addition to alcohol. For women, the amount of alcohol intake was positively correlated with use of stimulants (r = .32, p = .001), cannabinoids (r = .24, p = .019), sedatives (r = .30, p = .003), and hallucinogens (r = .30, p = .003). For men, correlations between the amount of alcohol intake and drug use were weaker but significant for stimulants (r = .21, p = .002), opiates (r = .15, p = .028), and hallucinogens (r = .15, p = .029). Women with alcoholic mothers displayed higher alcohol intake than women with nonalcoholic mothers (p = .02) and also showed more frequent use of most drugs. Although men with alcoholic fathers also showed greater alcohol intake compared to men with nonalcoholic fathers, the two groups did not differ in drug use. Younger subjects of both sexes were more likely to use cannabinoids, stimulants, opiates, and hallucinogens. Alcohol and sedative use was relatively constant across all age groups.

Physician failure to record alcohol use history when prescribing benzodiazepines

The purpose of this pilot study was (1) to determine the proportion of patients in an ambulatory medical clinic who have an alcohol history recorded when prescribed benzodiazepines, and (2) to assess the adequacy of the alcohol history when obtained. Medical records of 35 outpatients who obtained prescriptions for benzodiazepines at a large inner-city teaching hospital medical clinic were audited. In none of the records was there evidence that the physician had sufficient knowledge of the patient's alcohol use to safely prescribe a benzodiazepine. In 57% of the records, no information about alcohol use was recorded. In the remaining 15 medical records, the information recorded was limited. The implications of prescribing benzodiazepines without knowledge of drinking status are discussed.

Drug misuse in alcoholics

Concurrent drug misuse is an increasing trend among alcoholics. It is occurring in an age-dependent manner so that the younger the age, the higher the incidence of concurrent misuse. Drugs concurrently misused by alcoholics, in decreasing order of frequency, are marijuana, cocaine and other sympathomimetics, phencyclidine, benzodiazepines, barbiturates, and psychedelics. Because of increasing prevalence of concurrent misuse, evaluation for alcohol detoxification should always include consideration of other drugs. Concurrent alcohol/drug addiction in alcoholics as well as increased incidence in alcoholism in families of drug addicts suggest a common genetic vulnerability to alcoholism and drug addiction.

Alcohol and secobarbital effects as a function of familial alcoholism: acute psychophysiological effects

Previous research has demonstrated response differences following administration of alcohol between adult males with a positive (FHP) versus negative (FHN) family history of alcoholism. These response differences are thought to reflect differences in vulnerability to dependence on alcohol. Thus, the role of positive family alcoholism history in increasing risk of addiction to a variety of drug classes might be studied by determining whether FHP subjects show different responses to drug classes other than alcohol. This was done in the present study by determining dose-effect functions for a variety of physiological (heart rate, skin conductance, skin temperature), subjective (analog mood and drug effect, Subjective High Assessment Scale), and psychomotor measures (hand tremor, body sway, Digit Symbol Substitution Test, eye-hand coordination, and numeric recall) in FHP and FHN college-aged males for secobarbital (0, 100, 200 mg by mouth) and ethanol (1 g/kg). FHP and FHN subjects were matched on light-to-moderate drinking patterns, anthropometric dimensions, age, years of schooling, and drug use. At equivalent blood alcohol levels family-history positive subjects reported greater effects of ethanol than did family-history negative subjects on almost all subjective measures. Following the high dose of secobarbital, FHP but not FHN subjects showed elevated subjective effects; these effects were substantially less and were evident in fewer measures than following ethanol. In contrast to effects on the subjective measures, ethanol and secobarbital produced comparable impairment in both groups of subjects for most psychomotor responses. Group differences were not obtained on any physiological measures.(ABSTRACT TRUNCATED AT 250 WORDS)

Female alcoholics. I. Alcohol dependence and problems associated with prescribed psychotropic drug use

A case note study of 518 alcohol-dependent (DSM-III) inpatients examined their reported past history of prescribed psychotropic drug use patterns between 1973-1985. The subjects were cross-matched for gender, age and admission date and stratified into 3 time periods. The characteristics of psychotropic medication recipients were compared with those patients who reported no use of licit medications. Statistical analysis by logistic regression indicated that there was a significant relationship between the past use of psychotropic drugs with a parental history of excessive alcohol intake, the higher levels of MAST scores and the occurrence of past parasuicide events. Patients in their middle years (35-54) tended to have received significantly less psychotropic drugs than the younger or older age groups. The female (70%) to male (48%) ratio of past psychotropic use was 1.4:1. Gender differences were also noted in the use of antidepressants and illicit substances.

Schedule-induced ethanol dependence and phenobarbital preference

Rats exposed to a daily 3-hr session of intermittent food delivery ingested physical-dependence-produced levels of 5% ethanol solution. Although this schedule induced a chronic, voluntary, daily overindulgence, this had no effect on 21-hr home-cage phenobarbital preference. The substitution of water for 5% ethanol during the daily 3-hr binge session did not change home-cage phenobarbital preference, which remained stable and similar to that of a control group of non-binging animals. This experiment and others indicate that physical dependence on ethanol does not play a major role in the maintenance of ethanol abuse or cross-abuse of the barbiturates.

Associations among alcoholism, drug abuse, and antisocial personality: a review of literature

Current practice through both diagnostic systems and clinical approaches tends to view alcoholism, drug abuse, and antisocial personality as completely distinct systems. In the course of research with other goals, the authors noted the apparent associations of each pair within this triad. As prior reviews of the literature on associations among these did not deal with implications of frequent association, this literature was re-evaluated with a more comprehensive assessment of the studies and reports bearing on these associations. After a broad search, studies were examined that reponed statistics indicating an association or none between one or more of the pairs of the triad. About 75% to 80% of the studies meeting the criteria showed positive associations between pairs. Also, a common etiological matrix may predispose one to behaviors diagnostic of each aspect of the triad: alcoholism, drug abuse, and antisocial personality. Although many studies contained methodological difficulties, the review suggests where diagnosis of one aspect is made, the other two should be suspected and the patient so evaluated.

Concurrent Multiple Drug Use: Review and Implications

Evidence supporting individual generalized tendencies to use psychoactive drugs is reviewed. As a given drug is used or abused more heavily, a wider range of other drugs tends to be used in concurrent patterns. Multiple drug use must enter our conceptions of abuse, as the acute and chronic consequences attributed to a given drug are often confounded by the concurrent use of other drugs. Indeed, the use of one drug may be a contributing cause of the use of others. Social policies directed toward intervention and prevention of single drugs must be reconsidered.

Effects of combined alcohol and benzodiazepine: a review

Both human and animal studies relating to the combined effects of alcohol and benzodiazepine (BZD) are reviewed. Although the combination of alcohol and BZD is sometimes associated with drug-induced deaths, drug overdoses and traffic accidents or fatalities, epidemiological information is lacking on the true extent of the combined abuse and on the patterns and prevalence of use of these two drugs. Since BZD are widely used for the short- and long-term treatment of alcoholics, these patients are deemed more at risk of developing BZD or alcohol/BZD dependence than the general population. There is a dire need for large-scale controlled studies concerning the efficacy of BZD in the long-term treatment of alcoholics. Compared to men, women are at a higher risk as far as the potential for BZD addiction is concerned, since they tend to use BZD more often. Epidemiologic studies on the patterns of use of BZD, alcohol or alcohol/BZD in pregnant women are called for. Animal models are also needed to ascertain whether prenatal exposure to both alcohol and BZD can impart long-lasting behavioral changes in the progeny. It is possible that BZD can exacerbate the damaging prenatal effects of alcohol.