Albert Sánchez-Niubò

Severity of Dependence Scale as a Diagnostic Tool for Heroin and Cocaine Dependence

Aims: Our aim was to further assess the Severity of Dependence Scale (SDS) validity and to identify the cut-off score for a DSM-IV diagnosis of heroin and cocaine dependence through a cross-sectional survey in Barcelona, Spain. Methods: The Psychiatric Research Interview for Substance and Mental Disorders (PRISM) was used as the gold standard. 146 young (18–30 years old) heroin users were recruited from outside the healthcare context, 135 of whom were also current cocaine users. SDS scores were correlated to quantity, frequency and length of drug use. Results: The SDS cut-off point at which there was optimal discrimination of a DSM-IV diagnosis presence was found to be 3 (i.e., a score of 3 or more) for heroin dependence and 4 for cocaine dependence. Conclusions: The study gives further support to SDS dimensional properties and to its validity for rapid assessment of current heroin and cocaine dependence.

Psychometric properties of the CAST and SDS scales in young adult cannabis users

AIM To assess the validity of two cannabis use severity scales among young cannabis users and to evaluate their ability to detect Substance Use Disorders (SUD). PARTICIPANTS 241 volunteers (18-25 years), with a wide spectrum of cannabis use in the last 12 months. MEASUREMENTS The Cannabis Abuse Screening Test (CAST) and Severity of Dependence Scale (SDS) were self-administered. The Psychiatric Interview for Substance and Mental Disorders (PRISM) was used as gold standard for cannabis use disorders according to DSM-IV. Reliability and validity were assessed for two different CAST coding algorithms (b-binary and f-full) and for the SDS. In addition, the cannabis use diagnostic criteria contained in the PRISM were grouped to approximate forthcoming proposed DSM-V criteria to further evaluate these scales. FINDINGS 26.6% (95% CI: 21.0-32.2) of the subjects met criteria for cannabis dependence, and 49.0% (95% CI: 42.7-55.3) for cannabis use disorders. For both scales internal consistency (Cronbachs alpha>0.71) and test-retest intraclass correlation coefficients (>0.80) were good. The score 12 in the CAST-full discriminated better than others between presence and absence of dependence (27.0%; 95% CI: 21.4-32.6) while the score for discrimination of SUD was 9 (51.5%; 95% CI: 45.1-57.8). For the SDS the values were 7 (22.0%; 95% CI: 16.8-27.2) and 3 (64.7%; 95% CI: 58.7-70.8), respectively. According to proposed DSM-V criteria, for moderate and severe addiction the values for the CAST-f were 7 (68.5%; 95% CI: 62.5-74.3) and 12 (27%; 95% CI: 21.3-32.6) and for the SDS, 3 (65.0%; 95% CI: 58.7-70.8) and 7 (22%; 95% CI: 17.0-34.3), respectively. CONCLUSIONS The CAST and SDS applied to young cannabis users are reliable and valid measures to detect cannabis use disorders when compared to both DSM-IV and proposed DSM-V criteria.

Sex differences in the cumulative incidence of substance use by birth cohort

BACKGROUND Men present higher overall rates of substance use and abuse than women; yet, evidence suggests that an increase of substance use by the younger cohorts of women in recent decades is narrowing this gap in western societies. Moreover, younger cohorts may also be reporting earlier initiation of substance use, representing an increased risk for developing substance-related problems. With this study we intend to identify changes in the patterns of substance use of men and women in Spain for public health policy, planning and intervention. METHODS Sex differences in the cumulative incidence of alcohol, tobacco, cannabis and cocaine were examined by birth cohort using a combined sample of individuals aged 15-64 years from eight editions of the Spanish National Survey on Drugs (1995-2009). RESULTS Initiation of substance use in Spain is progressively taking place at younger ages, particularly among women. The gender-gap of life-time occurrence of substance use is narrowing (cannabis and cocaine) almost closing (alcohol) and even reversing (tobacco) in the youngest cohort. CONCLUSION These results reflect the particular evolution and trends of Spanish society regarding substance use. Womens increased use of substances and the earlier age of initiation of substance use by both sexes present particular challenges for prevention and treatment of future substance-related problems. The trends registered for legal and illegal substances would require re-evaluation of existing prevention policies.

Economic crisis and changes in drug use in the Spanish economically active population.

AIMS To examine changes in the use of alcohol, cannabis and hypnotics/sedatives between two periods (before and during Spains economic crisis), and to identify differences in the change between employed and unemployed individuals. DESIGN Using cross-sectional data from four editions of the Spanish Household Survey on Alcohol and Drugs, we selected economically active individuals aged 16-64 years (total sample = 62 440) and defined two periods, pre-crisis [period 1 (P1) = 2005-07] and crisis (P2 = 2009-11). Poisson regression models with robust variance were fitted to obtain prevalence ratios (PR) of heavy and binge drinking and multinomial regression models to obtain relative risk ratios (RRR) of cannabis and hypnotic/sedative use between the two periods, also considering the interaction between period and employment status. FINDINGS While the prevalence of alcohol use remained stable, heavy drinking declined in P2 in men both overall [PR = 0.73; 95% confidence interval (CI) = 0.67-0.79] and in the two age groups (16-34 and 35-64 years), and also in women overall (PR = 0.86; 95% CI = 0.75-0.99) and in the older age group. In contrast, binge drinking increased overall in P2 in men (PR = 1.17; 95% CI = 1.12-1.22) and in women (PR = 1.62; 95% CI = 1.49-1.76), and in both age groups. No differences in the change were observed between employed and unemployed individuals. Overall cannabis use remained stable in P2, but unemployed men and women of the older age group were more likely to have increased sporadic use compared to their employed counterparts (RRR = 2.24; 95% CI = 1.36-3.68 and RRR = 3.21; 95% CI = 1.30-7.93, respectively). Hypnotic/sedative use remained stable in P2 in men, but unemployed men were less likely to have increased heavy use in P2 compared with employed men (RRR = 0.69; 95% CI = 0.49-0.97). In women, heavy use increased in P2 overall and in the older age group, irrespective of employment status. CONCLUSION During a period of economic recession in Spain, heavy drinking decreased and binge drinking increased. Sporadic cannabis use increased among older unemployed men and women. Heavy use of hypnotics/sedatives increased among employed men while older women increased use irrespective of employment status.

Two methods to analyze trends in the incidence of heroin and cocaine use in Barcelona [Spain]

OBJECTIVES To describe 2 statistical methods for estimating trends in the incidence of heroin and cocaine use in Barcelona. METHODS Admissions for treatment of heroin and cocaine consumption recorded by the Barcelona Drug Information System between 1991 and 2003 were used. We selected 4,367 subjects initiating treatment for the first time for heroin use, and 2,147 for cocaine use. Two statistical techniques were employed: Reporting Delay Adjustment (RDA) and the Log-linear Model (LLM). RDA was used in subjects who initiated drug consumption between 1991 and 2003, and LLM for those who began heroin use between 1967 and 2003 and cocaine use between 1971 and 2003. In addition, for each drug and method the latency period (LP) was determined (years between first consumption and first treatment). RESULTS Comparison of the distributions of the LP for each drug revealed that heroin users initiated treatment for the first time sooner than cocaine users, regardless of the method employed. In general, the estimated incidence of heroin use in Barcelona fell progressively after 1982. In contrast, the incidence of cocaine use rose rapidly until 1998, and has been irregular since. The incidence of cocaine use began to be substantial in the early 1990s, but took several years to manifest itself as problematic. CONCLUSION The estimated incidence was underestimated by RDA compared with LLM, but the incidence of heroin use could be biased before 1991 due to changes in treatment provisions. Although the estimated incidence is relative to individuals who are admitted for treatment at some time in their life, trends in incidence can be used to plan future actions.

Dos métodos para analizar la evolución de la incidencia de consumo de heroína y cocaína en Barcelona

Objectives: To describe 2 statistical methods for estimating trends in the incidence of heroin and cocaine use in Barcelona. Methods: Admissions for treatment of heroin and cocaine consumption recorded by the Barcelona Drug Information System between 1991 and 2003 were used. We selected 4,367 subjects initiating treatment for the first time for heroin use, and 2,147 for cocaine use. Two statistical techniques were employed: Reporting Delay Adjustment (RDA) and the Log-linear Model (LLM). RDA was used in subjects who initiated drug consumption between 1991 and 2003, and LLM for those who began heroin use between 1967 and 2003 and cocaine use between 1971 and 2003. In addition, for each drug and method the latency period (LP) was determined (years between first consumption and first treatment). Results: Comparison of the distributions of the LP for each drug revealed that heroin users initiated treatment for the first time sooner than cocaine users, regardless of the method employed. In general, the estimated incidence of heroin use in Barcelona fell progressively after 1982. In contrast, the incidence of cocaine use rose rapidly until 1998, and has been irregular since. The incidence of cocaine use began to be substantial in the early 1990s, but took several years to manifest itself as problematic. Conclusion: The estimated incidence was underestimated by RDA compared with LLM, but the incidence of heroin use could be biased before 1991 due to changes in treatment provisions. Although the estimated incidence is relative to individuals who are admitted for treatment at some time in their life, trends in incidence can be used to plan future actions.

Work-related stress factors associated with problem drinking: A study of the Spanish working population

BACKGROUND Workers may drink to cope with stress or to overcome negative emotions arising from an aversive working context, but results of previous studies are inconclusive on the specific work features affecting alcohol use. METHODS A cross-sectional study was designed with data on 13,005 working individuals from the Household Survey on Alcohol and Drugs in Spain (EDADES)-2007. We examined the associations between two drinking patterns and four measures of work-related stress factors. RESULTS Moderate and high levels of exposure to a noxious working environment (OR = 2.15 [95% CI = 1.51-3.06] and OR = 2.23 [95% CI = 1.49-3.36]) and a high level of lack of social support (OR = 1.62 [95% CI = 1.16-2.28]) were associated with heavy drinking, and precariousness with binge drinking for both moderate (OR = 1.22 [95% CI = 1.01-1.46]) and high (OR = 1.33 [95% CI = 1.04-1.70]) levels (OR = 1.21; 95% CI = 1.04-1.40) in men. Significant associations among women were only found when stress factors were analyzed separately. CONCLUSIONS Preventive practices in the workplace targeting alcohol abuse should consider specific production processes and organizational features.

Initial medication non‐adherence: prevalence and predictive factors in a cohort of 1.6 million primary care patients

AIMS Adherence to medicines is vital in treating diseases. Initial medication non-adherence (IMNA) - defined as not obtaining a medication the first time it is prescribed - has been poorly explored. Previous studies show IMNA rates between 6 and 28% in primary care (PC). The aims of this study were to determine prevalence and predictive factors of IMNA in the most prescribed and expensive pharmacotherapeutic groups in the Catalan health system. METHODS This is a retrospective, register-based cohort study which linked the Catalan PC System (Spain) prescription and invoicing databases. Medication was considered non-initiated when it was not collected from the pharmacy by the end of the month following the one in which it was prescribed. IMNA prevalence was calculated using July 2013-June 2014 prescription data. Predictive factors related to patients, general practitioners and PC centres were identified through multilevel logistic regression analyses. Missing data were attributed using simple imputation. RESULTS Some 1.6 million patients with 2.9 million prescriptions were included in the study sample. Total IMNA prevalence was 17.6% of prescriptions. The highest IMNA rate was observed in anilides (22.6%) and the lowest in angiotensin-converting-enzyme (ACE) inhibitors (7.4%). Predictors of IMNA are younger age, American nationality, having a pain-related or mental disorder and being treated by a substitute/resident general practitioner in a resident-training centre. CONCLUSIONS The rate of IMNA is high when all medications are taken into account. Attempts to strengthen trust in resident general practitioners and improve motivation to initiate a needed medication in the general young and older immigrant population should be addressed in Catalan PC.

A multi-state model to estimate incidence of heroin use

BackgroundExisting incidence estimates of heroin use are usually based on one information source. This study aims to incorporate more sources to estimate heroin use incidence trends in Spain between 1971 and 2005.MethodsA multi-state model was constructed, whereby the initial state “heroin consumer” is followed by transition to either “admitted to first treatment” or to “left heroin use” (i.e. permanent cessation or death). Heroin use incidence and probabilities of entering first treatment ever were estimated following a back-calculation approach.ResultsThe highest heroin use incidence rates in Spain, around 1.5 per 1,000 inhabitants aged 10–44, occurred between 1985 and 1990; subdividing by route of administration reveals higher incidences of injection between 1980 and 1985 (a mean of 0.62 per 1.000) and a peak for non-injectors in 1990 (0.867 per 1,000).ConclusionsA simple conceptual model for heroin users’ trajectories related to treatment admission, provided a broader view of the historical trend of heroin use incidence in Spain.

Psychiatric morbidity among young-adults cannabis users

Este estudio transversal tiene como objetivo determinar la prevalencia vida de trastornos psiquiatricos (incluyendo los trastornos por uso de sustancias, �TUS y los otros trastornos no por uso de sustancias, �No-TUS) entre 289 jovenes (18-30 anos) consumidores regulares de cannabis durante el ultimo ano, reclutados fuera del entorno asistencial en Barcelona. Se administro la version espanola de la Psychiatric Interview for Substance and Mental Disorders (PRISM). Solo el 28% de los participantes no presento ningun trastorno psiquiatrico, y el 65% tenia algun TUS, el mas comun relacionado con el cannabis (62%). Casi el 27% presento trastornos no-TUS. Una edad de inicio mas temprana en el consumo de alcohol se asocio con la presencia de algun TUS. Haber consumido un numero mayor de �porros� en el ultimo mes se asocio con la presencia de trastornos psiquiatricos (TUS y no-TUS). Mientras tres cuartas partes de los pacientes con trastornos no-TUS habian recibido algun tipo de tratamiento, solo el 28% de las personas con cualquier TUS habian recibido tratamiento. Dada la baja percepcion de necesidad de tratamiento, se hacen necesarias estrategias de prevencion y poder ofrecer terapias adaptadas y dirigidas a los consumidores jovenes de cannabis.