Lauren R. Pacek

Perceived risk of regular cannabis use in the United States from 2002 to 2012: Differences by sex, age, and race/ethnicity

INTRODUCTION Cannabis is one of the most widely used psychoactive substances in the United States (U.S.). Perceived risk of use is associated with substance use; the recent debate surrounding medicalization and legalization of cannabis in the U.S. has the potential to impact perceived risk of use. Recent estimates are needed to assess temporal changes in, and identify correlates of, perceived risk of cannabis use. METHODS Utilizing data from the 2002-2012 survey years of the National Survey on Drug Use and Health, chi-squared statistics and logistic regression were used to describe temporal changes in perceived risk of regular cannabis use (i.e., once or twice a week), to explore correlates of perceived risk, and to report frequency of cannabis use. RESULTS Between 2002 and 2012, perceived great risk of regular cannabis use varied significantly overall (p < 0.001). The prevalence of past year non-daily (p < 0.001) and daily use varied significantly during this time (p < 0.001). Controlling for survey year and other confounders, characteristics associated with increased odds of perceived great risk of regular cannabis use included: female sex; Non-White race/ethnicity; age 50+; and family income of

The bidirectional relationships between alcohol, cannabis, co-occurring alcohol and cannabis use disorders with major depressive disorder: Results from a national sample

20,000-49,999. Characteristics associated with decreased odds of perceived great risk included: ages 12-17 and 18-25; high school education or greater; total family income of

Race/ethnicity differences between alcohol, marijuana, and co-occurring alcohol and marijuana use disorders and their association with public health and social problems using a national sample.

75,000+; past year non-daily and daily cannabis use; and survey years 2008-2012. CONCLUSIONS Findings characterize trends of perceived risk of regular cannabis use, and past year non-daily and daily cannabis use. Longitudinal studies of the influence of legal status of cannabis at the state-level are needed.

Cigarette smoking and drug use among a nationally representative sample of HIV-positive individuals

INTRODUCTION Alcohol use disorders (AUD) and cannabis use disorders (CUD) are common in the United States (US), and are associated with major depressive disorder (MDD). Co-occurring alcohol and cannabis use/use disorders (AUD+CUD), though understudied, have been found to be associated with greater adverse outcomes than alcohol or cannabis use/use disorders alone. There is a paucity of research on the co-occurring relationships of the two disorders with depression. METHODS Data came from Waves 1 and 2 of the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), a population-based longitudinal survey of the adult non-institutionalized, civilian population in the US. Logistic regression analyses were used to assess the associations between: 1) baseline AUD, CUD, and co-occurring AUD+CUD with incident MDD at follow-up and 2) baseline MDD with incident AUD, CUD, and co-occurring AUD+CUD at follow-up, adjusted for potential confounding variables. RESULTS For Aim 1, most of the AUD and CUD were positively associated with MDD. The strongest associations with incident MDD were observed for cannabis dependence (OR=6.61, CI=1.67-26.21) and co-occurring alcohol and cannabis dependence (OR=2.34, CI=1.23-4.48). For Aim 2, baseline MDD was significantly associated with comparatively fewer cases of incident AUD and CUD but the strongest association was observed for new onset co-occurring alcohol and cannabis dependence (OR=4.51, CI=1.31-15.60). LIMITATIONS The present study is limited by the potential for social desirability and recall biases. DISCUSSION Positive associations between AUD, CUD and MDD were observed bidirectionally. Findings have implications for preventive and treatment programs and initiatives.

Substance Use Disorders and Adolescent Psychopathology

BACKGROUND Alcohol and marijuana are commonly used and misused in the United States, both singly and together. Despite this, few studies examine their co-occurring use and the corresponding association with public health and other problems. Moreover, there is a lack of investigation into differences in these associations on the basis of race/ethnicity. METHODS The present study estimated the frequency of alcohol use disorder, marijuana use disorder, and co-occurring alcohol and marijuana use disorder and their associated public health and social problems in Whites, African Americans, and Hispanics. This cross-sectional study included 13,872 individuals and used data from the 2005-2007 National Survey on Drug Use and Health. Frequency was calculated and multinomial regression was used to assess associations between substance use disorder and psychosocial, adverse consequences such as history of being arrested, substance use treatment, and sexually transmitted infection. RESULTS Alcohol use disorder was comparable between, and most prevalent among, Whites and Hispanics compared to African Americans, whereas marijuana use disorder was greatest among African Americans compared to other race/ethnicities. Co-occurring alcohol and marijuana use disorders were most prevalent for African Americans versus Whites and Hispanics, and similar in Whites and Hispanics. In general, major depressive episode was more prevalent for respondents with co-occurring use disorders or single marijuana use disorders. However, race/ethnicity differences in associations between substance use disorder and psychosocial correlates and adverse consequences were observed. CONCLUSIONS Findings have implications for race/ethnicity appropriate integrated prevention and treatment of single and co-occurring use disorders and psychiatric comorbidities.

Gender and race/ethnicity differences for initiation of alcohol-related service use among persons with alcohol dependence

BACKGROUND AND OBJECTIVES Among HIV-positive populations, the prevalence of cigarette smoking remains disproportionately high and is associated with significant morbidity and mortality. Little is known about this topic among HIV-positive persons in the general population. METHODS Data came from the 2005 to 2011 National Survey on Drug Use and Health (NSDUH) public use data files. Unadjusted and adjusted multinomial logistic regression analyses explored the associations between socio-demographic, drug and alcohol use, and drug and/or alcohol treatment characteristics with smoking status among HIV-positive individuals (n = 349). RESULTS More than 40% of the sample was current smokers. In adjusted analyses, females (aRRR = .11, 95% CI = .03-.41) and participants who had never been married (aRRR = .19, 95% CI = .05-.58), were more likely to be former smokers than never smokers. Females (aRRR = .37, 95% CI = .14-.96) and individuals older than age 35 (aRRR = .37, 95% CI = .16-.89) were less likely to be current smokers than never smokers. Conversely, previously married persons (aRRR = 5.72, 95% CI = 1.40-23.31), participants reporting binge drinking (aRRR = 5.96, 95% CI = 2.27-15.64), and lifetime drug or alcohol treatment (aRRR = 5.12, 95% CI = 2.09-12.55) were more likely to be current smokers than never smokers. CONCLUSIONS Findings help confirm the high prevalence of smoking among HIV-positive persons suggesting the need for integrated substance use and smoking cessation treatment among HIV-positives. SCIENTIFIC SIGNIFICANCE The present findings have implications for the development and implementation of targeted smoking cessation programs for HIV-positive smokers.

Cigarette smoking, illicit drug use, and routes of administration among heroin and cocaine users

Adolescence is a vulnerable developmental stage where significant changes occur in a youth’s body, brain, environment and socialization, which may increase vulnerability to substance use, development of addiction, and psychiatric disorders. A co-occurrence of mental and behavioral disturbances with drug involvement in adolescence is common, as reflected in both a high risk for drug use in youth with mental illness and a high frequency of psychopathology among drug users. In this review we provide a broad and basic overview of some of the research evidence indicating a strong co-occurrence of drug use disorders (abuse and dependence) with externalizing and internalizing disorders, as well as a few other serious mental health conditions among adolescents. Increasing awareness and knowledge of the high probability of the co-occurrence of mental and behavioral disturbances with drug involvement informs the understanding of the etiology, course, and treatment of psychiatric problems among adolescents.

Childhood abuse and neglect and transitions in stages of alcohol involvement among women: A latent transition analysis approach

BACKGROUND Prior studies on treatment for alcohol-related problems have yielded mixed results with respect to gender and race/ethnicity disparities. Additionally, little is known about gender and racial differences in time to first alcohol-related service contact amongst persons with alcohol dependence. This study explored gender and race/ethnicity differences for first alcohol-related service utilization in a population-based sample. METHODS Primary analyses were restricted to Blacks, Whites and Hispanics, ages 18-44, with lifetime alcohol dependence (n=3311) in Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions. We compared time to service use among men and women within and across race/ethnicity strata using multivariable Cox proportional hazard methods. RESULTS In the sample of individuals age <45 with alcohol dependence, only 19.5% reported alcohol-related service use. Overall, women were less likely than men to receive alcohol-related services in their lifetime. However, women who did receive treatment were younger at first service utilization and had a shorter interval between drinking onset and service use than men. Gender differences were consistent across racial/ethnic groups but only statistically significant for Whites. There were no appreciable race/ethnicity differences in hazard ratios for alcohol-related service use or time from drinking initiation to first service contact. Results of sensitivity analyses for persons ≥45 years old are discussed. CONCLUSIONS There are important gender differences in receipt of and time from drinking initiation to service utilization among persons with alcohol dependence. Increased recognition of these differences may promote investigation of factors underlying differences and identification of barriers to services.

Effects of 6-week use of reduced-nicotine content cigarettes in smokers with and without elevated depressive symptoms

Cigarette smoking is ubiquitous among illicit drug users. Some have speculated that this may be partially due to similarities in the route of administration. However, research examining the relationship between cigarette smoking and routes of administration of illicit drugs is limited. To address this gap, we investigated sociodemographic and drug use factors associated with cigarette smoking among cocaine and heroin users in the Baltimore, Maryland community (N=576). Regular and heavy cigarette smokers were more likely to be White, have a history of a prior marriage, and have a lower education level. Regular smoking of marijuana and crack was associated with cigarette smoking, but not heavy cigarette smoking. Injection use was more common among heavy cigarette smokers. In particular, regular cigarette smokers were more likely to have a lifetime history of regularly injecting heroin. Optimal prevention and treatment outcomes can only occur through a comprehensive understanding of the interrelations between different substances of abuse.

Comorbid Alcohol Dependence and Anxiety Disorders: A National Survey

BACKGROUND Childhood abuse and neglect have been linked with alcohol disorders in adulthood yet less is known about the potential of early trauma to influence transitions in stages of alcohol involvement among women. Study aims were to (1) identify stages of womens alcohol involvement, (2) examine the probability of transitions between stages, and (3) investigate the influence of four domains of childhood abuse and neglect (sexual abuse, physical abuse, neglect, and witness to domestic violence), assessed individually and as poly-victimization, on transitions. METHODS The sample consisted of 11,750 adult female current drinkers identified in Wave 1 (2001-2002) and re-interviewed in Wave 2 (2004-2005) of the National Epidemiological Survey on Alcohol and Related Conditions. RESULTS Three stages of alcohol involvement emerged from latent class analysis of 11 DSM-IV abuse/dependence criteria: severe (1.5% at Wave 1, 1.9% at Wave 2), hazardous (13.6% at Wave 1, 16.0% at Wave 2), and non-problem drinking (82.1% at Wave 1, 84.5% at Wave 2). Adjusted latent transition analyses determined transition probabilities between stages across waves. Women reporting any childhood abuse and neglect were more likely to advance from the non-problem drinking class at Wave 1 to severe (AOR=3.90, 95% CI=1.78-8.53) and hazardous (AOR=1.56, 95% CI=1.22-2.01) drinking classes at Wave 2 relative to women without this history. Associations were also observed between individual domains and transition from no problems to severe alcohol stage. CONCLUSIONS Results suggest a long-term impact of childhood abuse and neglect as drivers of progression in womens alcohol involvement.