Substance Use in Review: 8 New Findings

Most persons who could benefit from the FDA-approved medications for opioid use disorder (OUD)-methadone, buprenorphine, and extended-release naltrexone-do not receive them and access is inequitable, says a new report. Barriers to OUD medication use include misunderstanding and stigma toward drug addiction, persons who have OUD, and the treatments; inadequate education and training of treatment providers; current regulations not supported by evidence; and a fragmented care system.

Investigators assessed associations among alcohol use disorder (AUD), social anxiety disorder (SAD), generalized anxiety disorder, panic disorder, agoraphobia, and specific phobias. SAD had the strongest link with AUD, predicted AUD more than other anxiety disorders and, unlike other anxiety disorders, was prospectively associated with AUD. There was a slightly elevated risk of later anxiety disorders other than SAD with AUD. SAD prevention and treatment interventions may help prevent AUD.

In a cross-sectional survey of the US adult population, the prevalence of hepatitis C, chronic obstructive pulmonary disease, heart disease, and diabetes were elevated among persons who reported resolving an alcohol and other drug (AOD) problem. The primary substance used and sex were factors in the likelihood of having a lifetime diagnosis of a specific disease. Quality of life was lower in persons who had physical disease histories than in those who did not.

More than one-fifth of survey respondents said they have used drugs or alcohol in the workplace. Most frequently used during work hours were alcohol (66%); recreational marijuana (22%); Oxycontin and Vicodin (about 10%); and codeine, Adderall, and Ritalin (about 8%). Respondents also reported on-the-job use of valium, cocaine, heroin, and methamphetamine. Abuse of drugs or alcohol was more common in those who work from home at least part of the time than those who work in an office.

In a CDC study, military personnel reported spending more days a year consuming alcohol than workers in any other industry. Armed forces employees ranked highest, with at least 1 drink every 2.8 days of the year, followed by mining industry and construction workers. US alcohol consumption has declined overall, but military personnel consumed alcohol on 34 more days in 2017 than in 2013. They also led in binge-drinking, having at least 4 or 5 alcoholic beverages a day in 1 sitting at least 41 days a year.

From a review of comorbid SUD/severe mental illness (SMI) interventions: Schizophrenia and SUD-clozapine is effective, depot atypical antipsychotic paliperidone palmitate is promising. Bipolar disorder and SUD-valproate is the treatment of choice; lithium and quetiapine may not be effective. SMI and AUD-naltrexone is the most effective anticraving agent. SMI and OUD-opioid substitution therapy had favorable outcomes. SMI and tobacco smoking-varenicline is promising.

About one-third of US adults in recovery from a significant AOD problem reported experiencing drinking/drug-using dreams (DDUD). The DDUD were predicted by more severe clinical history variables, such as earlier age of onset. They attenuated in frequency over time in recovery, possibly indicating “increased biopsychosocial stability that reduces neurocognitive reverberation and psychological angst regarding relapse risk.” Increased knowledge about DDUD could inform patients and psychiatrists about what to anticipate in recovery.

Hearing loss is independently associated with SUDs in persons aged 49 years and younger, especially in prescription OUDs in the 18 to 34 years age-group. For the group aged 35 to 49 years, hearing loss increased the likelihood of both an AUD and a prescription OUD. The information may have implications for the use of prescription opioids for pain management in patients with hearing loss.