Moral injury and substance use disorders among US combat veterans: results from the 2019–2020 National Health and Resilience in Veterans Study

Abstract Background Exposure to potentially morally injurious events (PMIEs) is associated with increased risk for substance use disorders (SUDs), although population-based studies remain limited. The goal of this study was to better understand the relationships between PMIE exposure and lifetime and past-year alcohol use disorder (AUD), drug use disorder (DUD), and SUD. Methods Data were analyzed from the 2019–2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 1321 combat veterans. Multivariable analyses examined associations between three types of PMIE exposure (perpetration, witnessing, and betrayal), and lifetime and past-year AUD, DUD, and SUD, adjusting for sociodemographic variables, combat exposure severity, prior trauma, and lifetime posttraumatic stress disorder and major depressive disorder. Results Perpetration was associated with increased odds of lifetime AUD (OR 1.15; 95% CI 1.01–1.31) and lifetime SUD (OR 1.18; 95% CI 1.03–1.35). Witnessing was associated with greater odds of past-year DUD (OR 1.20; 95% CI 1.04–1.38) and past-year SUD (OR 1.14; 95% CI 1.02–1.28). Betrayal was associated with past-year AUD (OR 1.20; 95% CI 1.03–1.39). A large proportion of the variance in past-year AUD was accounted for by betrayal (38.7%), while witnessing accounted for 25.8% of the variance in past-year DUD. Conclusions Exposure to PMIEs may be a stronger contributor to SUDs among veterans than previously known. These findings highlight the importance of targeted assessment and treatment of moral injury among veterans with SUDs, as well as attending to specific types of morally injurious experiences when conceptualizing and planning care.

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Tobacco Smoking and the Association With First Incidence of Mood, Anxiety, and Substance Use Disorders: A 3-Year Prospective Population-Based Study

Clinical Psychological Science ◽

10.1177/2167702620959287 ◽

2021 ◽

pp. 216770262095928

Author(s):

Karin Monshouwer ◽

Margreet ten Have ◽

Ron de Graaf ◽

Matthijs Blankers ◽

Margriet van Laar

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Population Based ◽

The Body ◽

Dose Effect ◽

Cross Sectional ◽

Wide Range ◽

Nationally Representative ◽

Prospective Association

There is consistent evidence from cross-sectional studies that smoking is positively associated with mental disorders. The research on the prospective association, however, is inconsistent. In the present study, we aimed to further increase the knowledge of this association by addressing several issues in the body of research. Data used were from a nationally representative, population-based cohort study among 18- to 64-year-olds at baseline. Compared with nonsmokers, smokers at baseline were significantly more likely to experience first incidence of any mood, anxiety, or substance use disorder at 3-year follow-up while controlling for a wide range of confounding factors. The association with incident mood and anxiety disorders was particularly high among heavy smokers. The dose-effect analyses on later substance use disorders showed unclear results, warranting further research. Additional analyses showed that results at 6-year follow-up were very similar, except for a weaker relationship between smoking and substance use disorders.

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Moral injury and suicidal behavior among US combat veterans: Results from the 2019–2020 National Health and Resilience in Veterans Study

Depression and Anxiety ◽

10.1002/da.23145 ◽

2021 ◽

Author(s):

Brandon Nichter ◽

Sonya B. Norman ◽

Shira Maguen ◽

Robert H. Pietrzak

Keyword(s):

National Health ◽

Suicidal Behavior ◽

Combat Veterans ◽

Moral Injury

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Introduction to Special Issue on Advances in the Assessment and Treatment of Adolescent Substance Use Disorders

American Journal on Addictions ◽

10.1080/10550490601100619 ◽

2006 ◽

Vol 15 (s1) ◽

pp. 1-3 ◽

Cited By ~ 14

Author(s):

Michael L. Dennis ◽

Yifrah Kaminer

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Adolescent Substance Use ◽

Special Issue ◽

Adolescent Substance ◽

Assessment And Treatment

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In utero exposure to ritodrine during pregnancy and risk of autism in their offspring until 8 years of age

Scientific Reports ◽

10.1038/s41598-020-80904-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jungsoo Chae ◽

Geum Joon Cho ◽

Min-Jeong Oh ◽

KeonVin Park ◽

Sung Won Han ◽

...

Keyword(s):

National Health ◽

Screening Program ◽

Hazard Analysis ◽

Population Based ◽

In Utero ◽

National Database ◽

Rank Test ◽

In Utero Exposure ◽

Exposure Group ◽

Increased Risk

AbstractBeta-2 adrenergic receptor (B2AR) agonists, used as asthma treatments and tocolytics during pregnancy, have recently been reported to be associated with autism in their offspring. However, the particular link between autism and ritodrine, a common type of B2AR agonist used solely as tocolytics, has never been substantiated with any nationwide database. Thus, we aimed to examine the association between in utero exposure of ritodrine and the risk of autism in their offspring using a national database. This population-based cohort study was conducted by merging the Korea National Health Insurance claims database and National Health Screening Program for Infants and Children database. These databases included all women who had delivered singleton between January 2007 and December 2008 in Korea. Out of the total 770,016 mothers, 30,959 (4.02%) were exposed to ritodrine during pregnancy, and 5583 (0.73%) of their children were identified as having autism, defined until 8 years of age. According to our analysis, the overall cumulative incidence of autism up to 8 years was 1.37% in ritodrine exposure group and 0.70% in ritodrine non-exposure group (p < 0.05, log-rank test). By Cox proportional hazard analysis, use of ritodrine in preterm birth was associated with significantly higher hazard of autism [adjusted hazard ratio: 1.23, 95% CI 1.04–1.47], after adjusting for confounding variables including maternal age, parity, cesarean section, preterm labor, steroid use, birth weight, gender, and preeclampsia. Thus, in utero exposure to ritodrine was associated with an increased risk of autism in their offspring.

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Abstract 228: National Prevalence of Substance Use Disorders Among Hospitalized Heart Failure Patients

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.11.suppl_1.228 ◽

2018 ◽

Vol 11 (suppl_1) ◽

Author(s):

Sarah C Snow ◽

Gregg C Fonarow ◽

Joseph A Ladapo ◽

Donna L Washington ◽

Katherine Hoggatt ◽

...

Keyword(s):

Heart Failure ◽

Substance Use ◽

Native American ◽

Drug Use ◽

Substance Use Disorders ◽

Age Groups ◽

Opioid Use ◽

Drug Use Disorders ◽

Increased Risk ◽

Drug Use Disorder

Background: Several cardiotoxic substances contribute to the development of heart failure (HF). The burden of comorbid substance use disorders (SUD) among patients with HF is under-characterized. Objectives: To describe the national burden of comorbid SUD (tobacco, alcohol, or drug use disorders) among hospitalized HF patients in the U.S. Methods: We used data from the 2014 National Inpatient Sample to calculate the proportion of hospitalizations for a primary HF admission with tobacco, alcohol, or drug use disorder diagnoses, accounting for demographic factors. Drug use disorder analysis was further sub-divided into specific illicit substance categories. Results: There were a total of 989,080 HF hospitalizations of which 35.3% (n=348,995) had a documented SUD. Tobacco use disorder (TUD) was most common (n= 327,220, 33.1%) followed by drug use disorder (DUD) (n=34,600, 3.5%) and alcohol use disorder (AUD) (n=34,285, 3.5%). Female sex was associated with less TUD (OR 0.59; 95% CI, 0.58-0.60), AUD (OR 0.23; 95% CI, 0.22-0.25) or DUD (OR 0.58; 95% CI 0.55-0.62). Tobacco, alcohol, cocaine, and opioid use disorders were highest among HF patients age 45 to 55, while cannabis and amphetamine use was highest in those <45 years. Native American race (versus White) was associated with increased risk of AUD (OR 1.67; 95% CI 1.27-2.20). Black race was associated with increased risk of AUD (OR 1.09; 95% CI 1.02-1.16) or DUD (OR 1.63; 95% CI 1.53-1.74). Medicaid insurance (versus Medicare) was associated with greater TUD (OR 1.27; 95% CI 1.23-1.32), AUD (OR 1.74; 95% CI 1.62-1.87), and DUD (OR 2.15; 95% CI 2.01-2.30). Decreasing quartiles of median household income were associated with increasing SUD. Conclusions: Comorbid SUD disproportionately affects certain HF populations, including men, younger age groups, lower SES patients, and race/ethnic minorities. Further research on interventions to improve prevention and treatment of SUD among hospitalized HF patients are needed given the high rates of SUD in this population. Systematically screening hospitalized HF patients for SUD may reveal opportunities for treatment and secondary prevention.

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927-P: Risk of Substance Use Disorders among Adolescents and Emerging Adults with Type 1 Diabetes: A Population-Based Cohort Study

Diabetes ◽

10.2337/db21-927-p ◽

2021 ◽

Vol 70 (Supplement 1) ◽

pp. 927-P

Author(s):

ANA CREO ◽

SWETHA SRIRAM ◽

LISA VAUGHAN ◽

AMY WEAVER ◽

SEEMA KUMAR

Keyword(s):

Substance Use ◽

Type 1 Diabetes ◽

Cohort Study ◽

Emerging Adults ◽

Substance Use Disorders ◽

Population Based

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Adolescent cannabis use, baseline prodromal symptoms and the risk of psychosis

The British Journal of Psychiatry ◽

10.1192/bjp.2017.52 ◽

2018 ◽

Vol 212 (4) ◽

pp. 227-233 ◽

Cited By ~ 21

Author(s):

Antti Mustonen ◽

Solja Niemelä ◽

Tanja Nordström ◽

Graham K. Murray ◽

Pirjo Mäki ◽

...

Keyword(s):

Substance Use ◽

General Population ◽

Birth Cohort ◽

Psychotic Disorders ◽

Temporal Order ◽

Population Based ◽

Cannabis Use ◽

Prodromal Symptoms ◽

Increased Risk ◽

Icd 10

BackgroundThe association between cannabis use and the risk of psychosis has been studied extensively but the temporal order still remains controversial.AimsTo examine the association between cannabis use in adolescence and the risk of psychosis after adjustment for prodromal symptoms and other potential confounders.MethodThe sample (n = 6534) was composed of the prospective general population-based Northern Finland Birth Cohort of 1986. Information on prodromal symptoms of psychosis and cannabis use was collected using questionnaires at age 15–16 years. Participants were followed up for ICD-10 psychotic disorders until age 30 years using nationwide registers.ResultsThe risk of psychosis was elevated in individuals who had tried cannabis five times or more (hazard ratio, (HR) = 6.5, 95% CI 3.0–13.9). The association remained statistically significant even when adjusted for prodromal symptoms, other substance use and parental psychosis (HR = 3.0, 95% CI 1.1–8.0).ConclusionsAdolescent cannabis use is associated with increased risk of psychosis even after adjustment for baseline prodromal symptoms, parental psychosis and other substance use.Declaration of interestNone.

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