Jahn K. Hakes

Non‐medical prescription use increases the risk for the onset and recurrence of psychopathology: results from the National Epidemiological Survey on Alcohol and Related Conditions

AIMS Given the rising rates of the non-medical use of prescription medications (NUPM) and strong cross-sectional associations between psychopathology and NUPM, we examined whether a history of NUPM increased the risk for onset and recurrence of psychopathology. DESIGN Longitudinal data are from waves 1 and 2 of the National Epidemiological Survey on Alcoholism and Related Conditions (NESARC). SETTING The NESARC is a nation-wide, household-based survey. PARTICIPANTS A total of 34,653 US resident participants who completed both NESARC waves were included in analyses. MEASUREMENTS Primary measures were history of NUPM and Axis I psychopathology at wave 1. Wave 1 personality disorder diagnosis and sociodemographic characteristics were used as control variables. FINDINGS Design-based logistic regression analyses indicated that life-time and past year NUPM at wave 1 increased risk for onset of psychopathology among those with no history of psychopathology at baseline, with particular risk for non-NUPM substance use and bipolar disorders. Life-time and past year NUPM were associated with recurrence of alcohol and non-NUPM substance use disorders among those with these diagnoses at baseline. In contrast, life-time and past year NUPM was associated with the onset of all examined disorders among those with a different diagnosis at baseline. CONCLUSIONS Non-medical use of prescription medications is a consistent risk factor for the onset and recurrence of psychopathology.

Patterns of heterotypic continuity associated with the cross-sectional correlational structure of prevalent mental disorders in adults

IMPORTANCE Mental disorders predict future occurrences of both the same disorder (homotypic continuity) and other disorders (heterotypic continuity). Heterotypic continuity is inconsistent with a view of mental disorders as fixed entities. In contrast, hierarchical-dimensional conceptualizations of psychopathology, in which each form of psychopathology is hypothesized to have both unique and broadly shared etiologies and mechanisms, predict both homotypic and heterotypic continuity. OBJECTIVE To test predictions derived from a hierarchical-dimensional model of psychopathology that (1) heterotypic continuity is widespread, even controlling for homotypic continuity, and that (2) the relative magnitudes of heterotypic continuities recapitulate the relative magnitudes of cross-sectional correlations among diagnoses at baseline. DESIGN, SETTING, AND PARTICIPANTS Ten prevalent diagnoses were assessed in the same person twice (ie, in 2 waves separated by 3 years). We used a representative sample of adults in the United States (i.e., 28,958 participants 18-64 years of age in the National Epidemiologic Study of Alcohol and Related Conditions who were assessed in both waves). MAIN OUTCOMES AND MEASURES Diagnoses from reliable and valid structured interviews. RESULTS Adjusting for sex and age, we found that bivariate associations of all pairs of diagnoses from wave 1 to wave 2 exceeded chance levels (P < .05) for all homotypic (median tetrachoric correlation of ρ = 0.54 [range, 0.41-0.79]) and for nearly all heterotypic continuities (median tetrachoric correlation of ρ = 0.28 [range, 0.07-0.50]). Significant heterotypic continuity was widespread even when all wave 1 diagnoses (including the same diagnosis) were simultaneous predictors of each wave 2 diagnosis. The rank correlation between age- and sex-adjusted tetrachoric correlation for cross-sectional associations among wave 1 diagnoses and for heterotypic associations from wave 1 to wave 2 diagnoses was ρ = 0.86 (P < .001). CONCLUSIONS AND RELEVANCE For these prevalent mental disorders, heterotypic continuity was nearly universal and not an artifact of failure to control for homotypic continuity. Furthermore, the relative magnitudes of heterotypic continuity closely mirrored the relative magnitudes of cross-sectional associations among these disorders, consistent with the hypothesis that both sets of associations reflect the same factors. Mental disorders are not fixed and independent entities. Rather, each diagnosis is robustly related to other diagnoses in a correlational structure that is manifested both concurrently and in patterns of heterotypic continuity across time.

Smoking and suicidal behaviours in a sample of US adults with low mood: a retrospective analysis of longitudinal data

Objective To investigate whether: (1) smoking predicts suicide-related outcomes (SROs), (2) prior SRO predicts smoking, (3) smoking abstinence affects the risk of SRO and (4) psychiatric comorbidity modifies the relationship between smoking and SRO. Design Retrospective analysis of longitudinal data obtained in wave 1 (2001–2002) and wave 2 (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Setting Face-to-face interviews conducted with persons in the community. Participants US adults (N=43 093) aged 18 years or older were interviewed in wave 1 and reinterviewed (N=34 653) 3 years later. For the present study, the sample was the subset of persons (N=7352) who at the wave 2 interview reported low mood lasting 2 weeks or more during the past 3 years and were further queried regarding SRO occurring between waves 1 and 2. Outcome measures SRO composed of any of the following: (1) want to die, (2) suicidal ideation, (3) suicide attempt, reported at wave 2. Current smoking reported at wave 2. Results Current and former smoking in wave 1 predicted increased risk for wave 2 SRO independently of prior SRO, psychiatric history and socio-demographic characteristics measured in wave 1 (adjusted OR (AOR)=1.41, 95% CI 1.28 to 1.55 for current smoking; AOR=1.32, 95% CI 1.21 to 1.43 for former smoking). Prior SRO did not predict current smoking in wave 2. Compared with persistent never-smokers, risk for future SRO was highest among relapsers (AOR=3.42, 95% CI 2.85 to 4.11), next highest among smoking beginners at wave 2 (AOR=1.82, 95% CI 1.51 to 2.19) and lowest among long-term (4+ years) former smokers (AOR=1.22, 95% CI 1.12 to 1.34). Compared with persistent current smokers, risk for SRO was lower among long-term abstainers (p<0.0001) but not among shorter-term abstainers (p=0.26). Conclusions Smoking increased the risk of future SRO independently of psychiatric comorbidity. Abstinence of several years duration reduced that risk.

Quality of life and risk of psychiatric disorders among regular users of alcohol, nicotine, and cannabis: An analysis of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC).

Research is limited on the effects of regular substance use on mental health-related outcomes. We used a large nationally representative survey to examine current and future quality of life and risk of psychiatric disorders among past-year regular (weekly) users of alcohol, nicotine, and cannabis. Data on psychiatric disorders and quality of life from two waves (Wave 1 N = 43,093, Wave 2 N = 34,653) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) were used to test study aims. In cross-sectional analyses, regular nicotine and cannabis use were associated with higher rates of psychiatric disorder, though regular alcohol use was associated with lower rates of disorders. Prospective analyses found that regular nicotine use predicted onset of anxiety, depressive, and bipolar disorders. Regular alcohol use predicted lower risk of these disorders. Regular cannabis use uniquely predicted the development of bipolar disorder, panic disorder with agoraphobia, and social phobia. Lastly, regular alcohol use predicted improvements in physical and mental health-related quality of life, whereas nicotine predicted deterioration in these outcomes. Regular cannabis use predicted declines in mental, but not physical health. These data add to the literature on the relations between substance use and mental and physical health and suggest increased risk of mental health problems among regular nicotine and cannabis users and better mental and physical health among regular alcohol users. Examination of mechanisms underlying these relationships is needed.

Dose-related effects for the precipitation of psychopathology by opioid or tranquilizer/sedative nonmedical prescription use: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

Objectives: Recent work offers evidence that nonmedical use of prescription medications (NUPM) may precipitate the development and recurrence of psychopathology. This work further explores this relationship by examining the dose-related effects of past year opioid and pooled tranquilizer/sedative NUPM on incidence and recurrence of psychopathology. Methods: Data are from waves 1 and 2 of the National Epidemiological Survey on Alcohol and Related Conditions, a national, household-based survey of US adults. Participants who completed both waves (N = 34,653) were included in analyses. Design-based multivariate logistic regression tested the effects of past-year NUPM frequency on the incidence and recurrence of psychopathology, separately for opioids and tranquilizers/sedatives. Results: Recurrence of alcohol use disorder and incidence and recurrence of non-NUPM substance use disorder were less likely in non–past-year users, with any increasing risk of NUPM. For mood and anxiety disorders, elevated risk occurred in 8 of 12 cases for weekly/daily users, though in 3 cases, non–past-year users were also at higher risk than monthly or less frequent users. Incidence of bipolar disorder related to opioid NUPM and incidence of anxiety disorders related to tranquilizer/sedative NUPM evidenced a stepwise risk progression based on the NUPM frequency. Conclusions: Any opioid or tranquilizer/sedative NUPM may increase risk for alcohol use disorder and non-NUPM substance use disorder, with weekly/daily opioid or tranquilizer/sedative nonmedical users appearing to be most vulnerable to the incidence and recurrence of depressive, bipolar, and anxiety disorders. This work highlights the importance of screening for the NUPM by clinicians, and it highlights the need for further research to better understand the psychopathology–NUPM interaction.

Tobacco Use and Suicide Attempt: Longitudinal Analysis with Retrospective Reports

Background Suicide has been associated with smoking/tobacco use but its association of and change in smoking/tobacco use status with suicide attempt (SA) is not well established. Methods We investigated whether persistent, former tobacco use, initiation, quitting tobacco use, relapse to tobacco use, and DSM-IV nicotine dependence predict independently SA using Wave 1 and 2 data of the National Epidemiologic Survey of Alcohol and Related Conditions. Data from 34,653 US adults interviewed at Wave 1 (2001-02) and Wave 2 (2004-05) were analyzed. The main outcome measure was SA between Wave 1 and Wave 2 as reported at Wave 2. Results Among the 1,673 respondents reporting lifetime SA at Wave 2, 328 individuals reported SA between Wave 1 and Wave 2. Current and former tobacco use at Wave 1 predicted Wave 2 SA independently of socio-demographic characteristics, psychiatric history, and prior SA (Adjusted Odds Ratio (AOR): 1.49; 95% CI: 1.13-1.95, AOR: 1.31; 95% CI:1.01-1.69, respectively versus never tobacco users). The strongest association with SA was observed among former tobacco users who relapsed after Wave 1 (AOR: 4.66; 95% CI: 3.49-6.24) and among tobacco use initiators after Wave 1 (AOR: 3.16; 95% CI: 2.23-4.49). Persistent tobacco use (current tobacco use at both Wave 1 and Wave 2) also had an increased risk of SA (AOR: 1.89; 95% CI: 1.47-2.42). However, former tobacco users in both Waves 1 and 2 did not show a significantly elevated risk for SA in Wave 2 (AOR:1.09, 95% CI: 0.78-1.52) suggesting that the risk resided mainly in Wave 1 former tobacco users who relapsed to tobacco use by Wave 2. DSM-IV nicotine dependence did not predict SA at Wave 2. Conclusion In a representative sample of US adults, relapse, tobacco use initiation, and persistent tobacco use, which are amenable to intervention, were associated with risk of SA.

Probability and Correlates of Dependence Among Regular Users of Alcohol, Nicotine, Cannabis, and Cocaine: Concurrent and Prospective Analyses of the National Epidemiologic Survey on Alcohol and Related Conditions

OBJECTIVE Research on the progression from substance use to dependence typically relies on lifetime retrospective reports of dependence among ever users. We sought to evaluate probability and correlates of dependence among recent (past-year) weekly users of alcohol, nicotine, cannabis, and cocaine through cross-sectional and prospective analyses. METHODS Data on substance use (assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV) and DSM-IV psychiatric disorders were assessed in 2 waves (Wave 1, N = 43,093; Wave 2, N = 34,653) through the National Epidemiologic Survey on Alcohol and Related Conditions. RESULTS Conditional risk of dependence varied by frequency of substance use, although it was relatively stable for nicotine use. Among weekly past-year substance users at Wave 1, rates of dependence when rates of past-year dependence at Wave 1 were combined with new cases of dependence reported at Wave 2 were 15.6% for alcohol, 25.0% for cannabis, and 67.3% for nicotine. For past-year weekly users of cocaine at Wave 1, 49.9% met criteria for past-year dependence. Multiple demographic characteristics and past-year psychiatric disorders were correlated with past-year dependence, even among daily users. Men were generally more likely than women to be dependent on alcohol, cannabis, and cocaine, although women were more likely to be dependent on nicotine. Prospective analyses indicated that depressive disorders at Wave 1 predicted subsequent development of alcohol dependence (odds ratio [OR] = 1.40; 95% CI, 1.19-1.65; P < .05). Further, 33.5% of weekly tobacco smokers who were nondependent at Wave 1 developed dependence later on. CONCLUSIONS The present findings highlight the importance of frequency of use when determining the addictiveness of substances and suggest that certain demographic variables and psychiatric disorders are associated with substance dependence even among regular substance users.

Work and Non-Pathological Gambling

Most economists believe that people would value an additional

Gambling and physical intimate partner violence: Results from the national epidemiologic survey on alcohol and related conditions (NESARC): Gambling and Interpersonal Violence

1,000 in income more if they were poor than if rich, but if so, people should not gamble according to standard expected utility theory. Thus, economists have been challenged to explain the pervasiveness of gambling in human behavior. A recently proposed solution to this theoretical challenge (Nyman 2004; Nyman et al. in Journal of Socio-Economics 37:2492–2504, 2008) suggests that, because having to work for one’s income is a fact of life in market economies, many individuals view the winnings from gambling not only as additional income, but as additional income for which one does not need to work. As a result, individuals, and especially those who are disadvantaged in the labor market, attach a utility premium to gambling winnings and gamble because of that. This utility premium would explain the pervasiveness of gambling in society, especially among the economically disadvantaged. This paper reviews the economic approaches to explaining non-pathological gambling, presents an overview of the new theory, and uses data from the National Epidemiological Survey of Alcohol and Related Conditions from 2001 to test it. The results indicate that the respondent’s work characteristics explain the decision to gamble in a way that is consistent with theory.

Pathological and problem gambling in substance use treatment: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

BACKGROUND AND OBJECTIVES Links between intimate partner violence (IPV) and gambling problems are under researched in general population samples. Understanding these relationships will allow for improved identification and intervention. We investigated these relationships and sought to determine whether links were attenuated by axis I and II disorders. METHODS This study examined data from waves 1 and 2 (N = 25,631) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC); a nationally representative survey of U.S. adults. Gambling symptoms and other psychiatric disorders were measured at wave 1 by the Alcohol Use Disorder and Associated Disability Interview Schedule-DSM-IV Version (AUDADIS-IV). Physical IPV victimization and perpetration in the last 12 months were assessed 3 years later at wave 2 using items from the Conflict Tactics Scale-R. Binary logistic regression models were used to examine associations separately for males and females. RESULTS Problem gambling was associated with increased odds of both IPV perpetration for males (OR = 2.62, 95%CI = 1.22-5.60) and females (OR = 2.87, 95%CI = 1.29-6.42), and with IPV victimization for females only (OR = 2.97, 95%CI = 1.31-6.74). Results were attenuated with inclusion of axis I and axis II disorders; links between gambling and IPV were weaker than those involving other mental health conditions. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE There are prospective associations with gambling problems and physical IPV which have implications for identification, spontaneous disclosure, and treatment seeking. The links between gambling problems and violence are complex and should not be considered independently of co-occurring mental health and substance use disorders. (Am J Addict 2018;27:7-14).