Top Studies in Addiction: Research Recap

Prescription drug misuse in adolescents is source driven. Rates of other substance use, SUD, and major depressive disorder (MDD) are elevated in adolescents who use multiple sources, purchases, and theft/fake prescriptions for obtaining prescription drugs. In a study of adolescent controlled prescription drug misuse (PDM), investigators used data from the 2009 to 2014 National Survey on Drug Use and Health, including 103,920 adolescents aged 12 to 17 years, to perform separate analyses for prescription opioids, stimulants, and tranquilizer/sedatives. The most common source of drugs was friends/relatives, for free (29.0%−33.2%). Others were physician sources for opioids (23.9%), purchases for stimulants (23.5%), and tranquilizer/sedatives (22.7%). The use of multiple sources was more frequent among female adolescents than male adolescents. More than 70% of the adolescents who used multiple sources had a past-year SUD, and multiple source use was associated with MDD. Other substance use was more strongly associated with multiple sources, purchases, and theft/fake prescription than with physician source use. The authors concluded that adolescents who use multiple sources, purchases, and theft/fake prescriptions to obtain drugs warrant intervention and those who have other SUD and MDD should be screened for PDM and misuse sources.

Asking frequency questions helps identify problematic substance use in adolescents. Brief screens that use frequency of substance use like those used for adults may accurately identify adolescents with problematic substance use, but for some substances screening cut-points that vary across age groups can optimize screening performance, researchers found. Alcohol use disorder (AUD) was the most prevalent SUD among the 169,986 adolescents in the study sample, followed by tobacco use disorder (TUD), cannabis use disorder (CUD), and other illicit drug use disorders (DUD). The prevalence of TUDs, AUDs, CUDs, and DUDs and of any DSM-IV symptoms of AUDs, CUDs, and DUDs varied by age and sex. The optimal cut-point for screening for TUDs and DUDs was ≥1 day for all age groups (12–15-, 16–17-, and 18–20-year-olds). The optimal cut-points for screening for AUDs and CUDs were ≥3 days for 12–15-year-olds and ≥12 days for older adolescents. The authors suggested that screening for problematic substance use could be optimized by self-administered screening with tablets or kiosks or questionnaires entered into electronic health records with the use of age-specific thresholds.

No reduction in prescription opioid use with medical marijuana legalization. Contrary to the notion that patients would substitute marijuana for prescription opioids, medical marijuana law enactment was not associated with nonmedical prescription opioid use or prescription OUD among prescription opioid users. A cross-sectional study analyzed individual-level restricted data from the 2004 to 2014 US National Survey on Drug Use and Health. Small changes were seen in the prevalence of nonmedical prescription opioid use after medical marijuana law enactment and there was a slight, but not statistically significant, change in prescription OUD prevalence among prescription opioid users. The outcomes did not vary when stratified by age and race/ethnicity. The authors recommended further research to identify mechanisms through which medical marijuana laws might reduce opioid-related harm.

Schizophrenia raises the risk of substance abuse diagnosis. Researchers in Denmark conducted a prospective cohort study of 3,133,968 persons to investigate whether the risk of a substance abuse diagnosis increases with a diagnosis of schizophrenia. During follow up, schizophrenia developed in 14,007 persons and 2885 of them subsequently received a diagnosis of substance abuse, showing a positive association between a diagnosis of schizophrenia and the risk of substance abuse. The associations were affected markedly with adjusting for a co‐abuse; schizophrenia was primarily associated with an increased risk of abuse of cannabis, alcohol, stimulants, and other substances. The association was still significant 10 to 15 years subsequent to a diagnosis of schizophrenia.

Binge drinking behaviors afflict older adults. More than one-tenth of adults aged 65 years or older in the United States are current binge drinkers, according to estimates from the 2015 to 2017 administrations of the US National Survey on Drug Use and Health. In a cross‐sectional analysis, investigators estimated the prevalence of past‐month binge alcohol use (≥5 drinks on the same occasion for men and ≥4 drinks for women). They compared past‐month binge drinkers with drinkers who reported past‐month alcohol use without binge drinking in terms of demographics, substance use, serious mental illness, mental health treatment utilization, chronic disease, and emergency department (ED) use. Binge drinkers were more likely to be male than nonbinge drinkers. The prevalence of current tobacco use or cannabis use or both was higher in binge drinkers and the prevalence of 2 or more chronic diseases was lower. Among past‐month alcohol users, binge drinking prevalence was higher among non‐Hispanic African Americans, tobacco users, cannabis users, and persons who had visited an ED in the past year. The authors suggested that the findings confirm the importance of screening for binge drinking behaviors among older adults.