In Alcohol-Dependent Drinkers, What Does the Presence of Nicotine Dependence Tell Us About Psychiatric and Addictive Disorders Comorbidity?

AIM: To examine the pattern of psychiatric comorbidity associated with nicotine dependence among alcohol-dependent respondents in the general population.

METHODS: Drawn from a US national survey of 43,000 adults who took part in a face-to-face interview (The National Epidemiologic Survey on Alcohol and Related Conditions), data were examined on the 4782 subjects with lifetime alcohol dependence, and comparisons were made between those with and those without nicotine dependence.

RESULTS: Nicotine dependence was reported by 48% of the alcohol-dependent respondents. They reported higher lifetime rates of

• panic disorder,
• specific and social phobia,
• generalized anxiety disorder,
• major depressive episode,
• manic disorder,
• suicide attempt,
• antisocial personality disorder and
• all addictive disorders than those without nicotine dependence.

After controlling for the effects of any psychiatric and addictive disorder, alcohol-dependent subjects with nicotine dependence were more than twice as likely as non-nicotine-dependent, alcohol-dependent subjects to have at least one other lifetime addiction diagnosis (adjusted odds ratio 2.36; 95% confidence interval 2.07-2.68).

CONCLUSIONS: Nicotine dependence represents a general marker of psychiatric comorbidity, particularly of addictive comorbidity. It may be used as a screening measure for psychiatric diagnoses in clinical practice as well as in future trials.

Research report; Le Strat Y, Ramoz N, Gorwood P. In Alcohol-Dependent Drinkers, What Does the Presence of Nicotine Dependence Tell Us About Psychiatric and Addictive Disorders Comorbidity? Alcohol Alcohol. 2010 Jan 20.

• See also;
• Alcoholic, Addictive Behaviors
• Wernicke-Korsakoff Syndrome
• Are Families Affected by Alcoholism?
• What are the Styles of Enablers?
• Hazelden Books and Resources

Those under age 25 are particularly vulnerable to dual abuse.

Men and women with alcohol use disorders (AUD’s) are 18 times more likely to report nonmedical use of prescription drugs than people who don’t drink at all, according to researchers at the University of Michigan. Dr. Sean Esteban McCabe and colleagues documented this link in two NIDA-funded studies; they also discovered that young adults were most at risk for concurrent or simultaneous abuse of both alcohol and prescription drugs.

“The message of these studies is that clinicians should conduct thorough drug use histories, particularly when working with young adults,” says Dr. McCabe. “Clinicians should ask patients with alcohol use disorders about nonmedical use of prescription drugs [NMUPD] and in turn ask nonmedical users of prescription medications about their drinking behaviors.” The authors also recommend that college staff educate students about the adverse health outcomes associated with using alcohol and prescription medications at the same time.

TWO STUDIES

The authors’ first study looked at the prevalence of AUD’s and NMUPD in 43,093 individuals 18 and older who participated in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) between 2001 and 2005. Participants lived across the United States in a broad spectrum of household arrangements and represented White, African-American, Asian, Hispanic, and Native American populations. Although people with AUD’s constituted only 9 percent of NESARC’s total sample, they accounted for more than a third of those who reported NMUPD.

Since the largest group of alcohol/prescription drug abusers were between the ages of 18 and 24, the team’s second study focused entirely on this population and involved 4,580 young adults at a large, public, Midwestern university. The participants completed a self-administered Web survey, which revealed that 12 percent of them had used both alcohol and prescription drugs nonmedically within the last year but at different times (concurrent use), and 7 percent had taken them at the same time (simultaneous use).

When alcohol and prescription drugs are used simultaneously, severe medical problems can result, including alcohol poisoning, unconsciousness, respiratory depression, and sometimes death. In addition, college students who drank and took prescription drugs simultaneously were more likely than those who did not to blackout, vomit, and engage in other risky behaviors such as drunk driving and unplanned sex.

Prescription drug misuse rises with drinking severity. Increases are most pronounced in adults aged 18-24.

WHO, WHAT, AND WHEN

The prescription drugs that were combined with alcohol in order of prevalence included prescription opiates (e.g., Vicodin, OxyContin, Tylenol 3 with codeine, Percocet), stimulant medication (e.g., Ritalin, Adderall, Concerta), sedative/anxiety medication (e.g., Ativan, Xanax, Valium), and sleeping medication (e.g., Ambien, Halcion, Restoril). The college study asked about the respondent’s use of medications prescribed for other people while the NESARC explored both use of someone else’s prescription medications as well as the use of one’s own prescription medications in a manner not intended by the prescribing clinician (e.g., to get high).

The researchers found that the more alcohol a person drank and the younger he or she started drinking, the more likely he or she was to report NMUPD. Compared with people who did not drink at all, drinkers who did not binge were almost twice as likely to engage in NMUPD; binge drinkers with no AUD’s were three times as likely; people who abused alcohol but were not dependent on alcohol were nearly seven times as likely; and people who were dependent on alcohol were 18 times as likely to report NMUPD (see figure, page 8).

While the majority of the respondents in both studies were White (71 percent in NESARC and 65 percent in the college group), an even higher percentage of the simultaneous polydrug users in the college study were White males who had started drinking in their early teens. The NESARC study also found that Whites in general were two to five times more likely than African-Americans to report NMUPD during the past year. Native Americans were at increased risk for NMUPD, and the authors indicated that this subpopulation should receive greater research attention in the future.

Dr. McCabe emphasizes that many people who simultaneously drink alcohol and use prescription medications have no idea how dangerous the interactions between these substances can be. “Passing out is a protective mechanism that stops people from drinking when they are approaching potentially dangerous blood alcohol concentrations,” he explains. “But if you take stimulants when you drink, you can potentially override this mechanism and this could lead to life-threatening consequences.”

Dr. James Colliver, formerly of NIDA’s Division of Epidemiology, Services and Prevention Research, offers perspective on these studies. “Prescription sedatives, tranquilizers, painkillers, and stimulants are generally safe and effective medications for patients who take them as prescribed by a clinician,” Dr. Colliver states. “They are used to treat acute and chronic pain, attention deficit hyperactivity disorder, anxiety disorders, and sleep disorders.

“The problem is that many people think that, because prescription drugs have been tested and approved by the Food and Drug Administration, they are always safe to use; but they are safe only when used under the direction of a physician for the purpose for which they are prescribed.”

Nonmedical Use of Prescription Drugs

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), sponsored by the National Institutes of Health, defines nonmedical use as follows:

Using drugs that were not prescribed to you by a doctor, or using drugs in a manner not intended by the prescribing clinician (e.g., to get high). Nonmedical use does not include taking prescription medications as directed by a health practitioner or the use of over the- counter medications.

NIDA Research Findings; Vol. 21, No. 5 (March 2008)

See also;

• Brief-TSF can assist patients cease alcohol consumption.
• Alcohol & Medication Interactions

Sleep problems – real and perceived – get in the way of alcoholism recovery

Doctors and patients should discuss and address sleep issues as part of recovery

The first few months of recovery from an alcohol problem are hard enough. But they’re often made worse by serious sleep problems, caused by the loss of alcohol’s sedative effects, and the long-term sleep-disrupting impact that alcohol dependence can have on the brain.

Now, a new study gives further evidence that insomnia and other sleep woes may actually get in the way of recovery from alcohol problems. In fact, a person’s perception of how bad their sleep problems are may be just as important as the actual sleep problems themselves, the study suggests.

The study is published in the journal Alcoholism: Clinical and Experimental Research, by a team from the University of Michigan’s Department of Psychiatry. They report the results of a small but thorough evaluation of sleep, sleep perception and alcohol relapse among 18 men and women with insomnia who were in the early stages of alcohol recovery.

The authors say their results show how important it is for alcohol recovery patients, and those who are helping them through their recovery, to discuss sleep disturbances and seek help. Often, sleep isn’t discussed in alcohol recovery programs – but it should be, they stress.

In fact, members of the U-M team have now launched a new study that aims to help those who have just entered treatment for alcohol problems, and are having trouble sleeping. Instead of using sleep medications, which can carry their own risk of addiction, it’s based on a series of “talk therapy” sessions with a trained sleep therapist who can help patients change behaviors and patterns of thinking that contribute to sleep problems.

In the meantime, the newly published results add to the understanding of how alcohol and sleep intertwine.

“What we found is that those patients who had the biggest differences between their perception of how they slept and their actual sleep patterns were most likely to relapse,” says lead author Deirdre Conroy, Ph.D., who led the study as a fellow in the U-M Addiction Research Center. “This suggests that long-term drinking causes something to happen in the brain that interferes with both sleep and perception of sleep. If sleep problems aren’t addressed, the risk of relapse may be high.”

“We are now interested in what brain mechanisms are involved in the disrupted sleep of alcohol-dependent individuals,” says Brower, who has previously led studies illustrating the prevalence of sleep disorders among people with alcohol dependence and abuse issues, and their correlation with relapse back into drinking. He is the executive director of the U-M Addiction Treatment Services, which provides alcohol and drug treatment to hundreds of patients each year.

The new study involved women who had volunteered for a randomized clinical trial of gabapentin, an experimental treatment for alcohol dependence. Each one started the trial when they had been off alcohol for about a week.

The volunteers spent two separate nights in the sleep-monitoring area of the U-M General Clinical Research Center, wearing electrodes on their head and body that measured their brain waves during sleep, as well as their breathing, muscle activity and heart rhythm. The detailed measurements, which together make up a procedure called polysomnography, allowed the researchers to determine when the volunteers were sleeping, when they were awake, and which stage of sleep they were in.

These sleep data were compared with the participants’ answers on morning evaluations of how they slept – including how long they thought it took them to fall asleep, how long they were awake in the night, and other measures. The two nights of sleep monitoring were done several weeks apart. The researchers also asked the participants to report any alcohol they drank during the six weeks following each sleep test.

In all, the patients overestimated how long it took them to fall asleep, but thought they had been awake in the middle of the night for far less time than they actually were. These perceptions about how they slept were actually more accurate in predicting their potential for relapse to alcohol use than were the actual sleep measurements.

“Our study suggests that in early recovery from alcoholism, people perceived that it took them a long time to fall asleep and that they slept through the night,” says Conroy. “The reality was that it did not take them as long to fall asleep as they thought it did, and their brain was awake for a large portion of the night. On average, the participants that were less accurate about how they were sleeping were more likely to return to drinking.”

Conroy explains that poor sleep quality can lead to mood disturbances. “If recovering alcoholics are irritable because they are not getting quality sleep at night, they might be more vulnerable to return to drinking,” she says. “Previous studies show that non-alcoholics with insomnia actually think they are sleeping worse than they are, so they may be more likely to seek appropriate treatment.

Our study shows that an alcoholic in early recovery has a lot of wakefulness in the night but they are not necessarily picking up on this. It is important for the clinician working with the alcohol-dependent patient to have a differential of poor sleep quality in the back of their mind as a potential challenge for the patient throughout alcohol recovery.”

Kara Gavin | Source: EurekAlert!

Self-reported mental illness in a dental school clinic population

The purpose of this study is to assess the prevalence of mental illness in a university-based dental clinic population. Dentists routinely review the patient’s medical history to identify any physical disease or condition that may impact dental treatment.

Mental illness may also affect dental treatment and patient management.

This study examined the degree to which patients seeking routine dental care report these diagnoses.

Data was gathered from records of 508 consecutive new patients whose treatment plans were submitted for faculty approval.

The patient’s self-reported mental illness was obtained from the patient questionnaire and physical evaluation forms of the dental record.

• One hundred thirty-six patients (27%) reported at least one mental illness.
• Of all diseases and disorders recorded in the medical history, self-reported depression was second only to hypertension in frequency.
• Substance abuse (alcoholism, addiction, medication), anxiety, anorexia, bulimia, insomnia, bipolar disorder, and post-traumatic stress disorder (PTSD) were also common findings.

This study establishes the need for training of dental students to recognize and manage psychologically compromised patients. The dental curriculum must address these issues.

J Dent Educ. 2003 May;67(5):500-4. Self-reported mental illness in a dental school clinic population. Woods CD.

See also;

• Brief-TSF can assist patients cease alcohol consumption.
• Twelve Step Facilitation
• Subscribe to Twelve Step Facilitation by e-Mail

Relapse Prevention Counseling Workbook: Managing High-Risk Situations by Terence T. Gorski Read more about this title…