Using polygenic scores for identifying individuals at increased risk of substance use disorders in clinical and population samples

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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Brain Development and the Risk for Substance Abuse

Neurobiology of Mental Illness ◽

10.1093/med/9780199934959.003.0053 ◽

2013 ◽

pp. 706-715

Author(s):

Kristina Caudle ◽

B.J. Casey

Keyword(s):

Substance Abuse ◽

Substance Use ◽

Brain Development ◽

Substance Use Disorders ◽

Animal Studies ◽

Substance Abuse Problem ◽

Increased Risk ◽

Drug And Alcohol ◽

The Brain ◽

Developmental Window

Drug and alcohol dependence affects millions each year. Adolescence is a period of increased risk for substance use disorders. Understanding how the brain is changing during this developmental window relative to childhood and adulthood and how these changes vary across individuals is critical for predicting risk of later substance abuse and dependence. This chapter provides an overview of recent human imaging and animal studies of brain development focusing on changes in corticostriatal circuitry that has been implicated in addiction. Behavioral, clinical, and neurobiological evidence is provided to help elucidate who may be most at risk for developing a substance abuse problem and whenthey may be most vulnerable.

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Clinical impact of COVID-19 on people with substance use disorders

Journal of Public Health ◽

10.1093/pubmed/fdaa181 ◽

2020 ◽

Cited By ~ 1

Author(s):

G Vallecillo ◽

R Perelló ◽

R Güerri ◽

F Fonseca ◽

M Torrens

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Severe Pneumonia ◽

Epidemiological Studies ◽

Urban Hospital ◽

Increased Risk ◽

Disorder Treatment ◽

Low Incidence ◽

The Impact ◽

Larger Sample

Abstract Background People with substance use disorders are considered at increased risk of COVID-19 and its more serious complications, however data on the impact of COVID-19 are lacking. The study aimed to describe the clinical characteristics and outcomes of COVID-19 on people with substance use disorders. Methods an observational study was carried out including patients aged ≥ years with COVID-19 pneumonia admitted to an urban hospital during March 12 to June 21,2020. Results Among 2078 patients admitted, 27 (1.3%) were people with substance use disorders: 23(85.2%) were men with a median age of 56.1 + 10.3 years and. The main SUD were alcohol in 18(66.7%) patients, heroine in 6(22.2%) and cocaine in 3(11.1%) and 24(88.8%) patients were on ongoing substance use disorder treatment. One or more comorbidities associated to COVID-19 risk were observed in 18(66.6%) of patients. During a median length of stay of 10 days (IQR:7-19), severe pneumonia developed in 7(25.9%) patients, acute respiratory distress syndrome in 5 (18.5%) and none died. Conclusion Larger sample sizes and sero-epidemiological studies are needed to confirm the low incidence of severe COVID-19 on patients with SUD.

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Impact of High Fat Diet and Ethanol Consumption on Neurocircuitry Regulating Emotional Processing and Metabolic Function

Frontiers in Behavioral Neuroscience ◽

10.3389/fnbeh.2020.601111 ◽

2021 ◽

Vol 14 ◽

Author(s):

Caitlin R. Coker ◽

Bailey N. Keller ◽

Amy C. Arnold ◽

Yuval Silberman

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Emotional Processing ◽

The United States ◽

Ethanol Consumption ◽

Overweight And Obesity ◽

Anxiety And Depression ◽

Metabolic Function ◽

High Fat ◽

Increased Risk

The prevalence of psychiatry disorders such as anxiety and depression has steadily increased in recent years in the United States. This increased risk for anxiety and depression is associated with excess weight gain, which is often due to over-consumption of western diets that are typically high in fat, as well as with binge eating disorders, which often overlap with overweight and obesity outcomes. This finding suggests that diet, particularly diets high in fat, may have important consequences on the neurocircuitry regulating emotional processing as well as metabolic functions. Depression and anxiety disorders are also often comorbid with alcohol and substance use disorders. It is well-characterized that many of the neurocircuits that become dysregulated by overconsumption of high fat foods are also involved in drug and alcohol use disorders, suggesting overlapping central dysfunction may be involved. Emerging preclinical data suggest that high fat diets may be an important contributor to increased susceptibility of binge drug and ethanol intake in animal models, suggesting diet could be an important aspect in the etiology of substance use disorders. Neuroinflammation in pivotal brain regions modulating metabolic function, food intake, and binge-like behaviors, such as the hypothalamus, mesolimbic dopamine circuits, and amygdala, may be a critical link between diet, ethanol, metabolic dysfunction, and neuropsychiatric conditions. This brief review will provide an overview of behavioral and physiological changes elicited by both diets high in fat and ethanol consumption, as well as some of their potential effects on neurocircuitry regulating emotional processing and metabolic function.

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Alcohol, other psychoactive substance use disorders, and suicide

Oxford Textbook of Suicidology and Suicide Prevention ◽

10.1093/med/9780198834441.003.0033 ◽

2021 ◽

pp. 275-284

Author(s):

Tine Maes ◽

Geert Dom

Keyword(s):

Substance Abuse ◽

Substance Use ◽

Life Events ◽

Substance Use Disorders ◽

Population Level ◽

Psychoactive Substance ◽

Increased Risk ◽

Psychoactive Substance Use ◽

The Relationship ◽

Behavioural Addictions

Up to 90% of the individuals who complete suicide meet criteria for a psychiatric disorder. Specifically, substance use disorders (SUD) are highly prevalent and frequently associated with an increased risk of suicidal behaviours. Growing evidence shows that this also counts for behavioural addictions, such as gambling. Comorbidity of psychiatric disorders such as major depression, bipolar disorder, schizophrenia, and personality disorder, with SUD, increase the risk. Pathways underlying the relationship between substance abuse and suicidality are multifactorial; the short-term effect of intoxication, impulsivity as trait and state, neurobiological consequences of chronic substance abuse, and accumulating adverse life events all contribute. Assessment and management of suicidality within SUD patients are mandatory for suicide prevention. Further, the evidence is growing that treatment of SUD in itself can reduce suicidality risk. Finally, and from a prevention perspective, decreasing substance use on a general population level is associated with decreases of population-level suicidality.

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Psychiatric Co-Occurring Disorders

ASAM Handbook of Addiction Medicine ◽

10.1093/med/9780197506172.003.0015 ◽

2020 ◽

pp. 349-378

Author(s):

Kenneth B. Stoller

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Addiction Treatment ◽

Negative Symptoms ◽

Psychiatric Symptoms ◽

Antidepressant Medication ◽

Diagnostic Process ◽

Post Traumatic Stress ◽

Psychiatric Illnesses ◽

Increased Risk

Substance use disorders commonly co-occur with psychiatric disorders. Psychiatric illnesses are associated with substance use disorders. Recognition of psychiatric symptoms, especially suicidal ideation, is essential. Factors such as substance use or withdrawal, related psychosocial stressors, and co-occurring somatic health problems complicate the diagnostic process. Addressing psychiatric symptoms is essential to optimize treatment of substance use disorders. Medications can help but may be unnecessary once substance use is stabilized. Other approaches include counseling, psychotherapy, case coordination, and inpatient/residential care. The affective disorders, especially bipolar disorder, are associated with substance use disorders. Depression is common and often improves with addiction treatment. For those who do not improve, antidepressant medication or psychotherapy may help. Anxiety disorders and post-traumatic stress disorder are associated with substance use disorders. If left unaddressed, persistent worry and anxiety worsen treatment outcomes. Although there are effective pharmacotherapies, psychotherapeutic approaches are a mainstay of treatment. Schizophrenia is particularly disabling and associated with an increased risk for substance use disorders. Antipsychotic medications can be effective, but persistent “negative” symptoms warrant comprehensive, supportive approaches with sufficient ancillary services. Those with personality disorders have high rates of substance use disorders and can be a challenge to treat. A strong team-based approach, psychosocial treatments, and sometimes medications can improve outcomes. Those with attention-deficit/hyperactivity disorder are at increased risk for substance use disorders. Impairing symptoms of inattention and impulsivity may persist into adulthood, complicating substance use disorder treatment engagement and outcomes. Medications can be helpful, but care must be taken when considering prescribing stimulants.

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Low prevalence of substance use in people with 22q11.2 deletion syndrome

The British Journal of Psychiatry ◽

10.1192/bjp.2018.258 ◽

2019 ◽

Vol 215 (5) ◽

pp. 661-667 ◽

Cited By ~ 3

Author(s):

Claudia Vingerhoets ◽

Mathilde J.F. van Oudenaren ◽

Oswald J.N. Bloemen ◽

Erik Boot ◽

Esther D.A. van Duin ◽

...

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Psychotic Disorders ◽

22Q11.2 Deletion Syndrome ◽

Deletion Syndrome ◽

Healthy Controls ◽

22Q11.2 Deletion ◽

Comt Genotype ◽

Cross Sectional ◽

Increased Risk

Background22q11.2 deletion syndrome (22q11DS), one of the most common recurrent copy number variant disorders, is associated with dopaminergic abnormalities and increased risk for psychotic disorders.AimsGiven the elevated prevalence of substance use and dopaminergic abnormalities in non-deleted patients with psychosis, we investigated the prevalence of substance use in 22q11DS, compared with that in non-deleted patients with psychosis and matched healthy controls.MethodThis cross-sectional study involved 434 patients with 22q11DS, 265 non-deleted patients with psychosis and 134 healthy controls. Psychiatric diagnosis, full-scale IQ and COMT Val158Met genotype were determined in the 22q11DS group. Substance use data were collected according to the Composite International Diagnostic Interview.ResultsThe prevalence of total substance use (36.9%) and substance use disorders (1.2%), and weekly amounts of alcohol and nicotine use, in patients with 22q11DS was significantly lower than in non-deleted patients with psychosis or controls. Compared with patients with 22q11DS, healthy controls were 20 times more likely to use substances in general (P < 0.001); results were also significant for alcohol and nicotine use separately. Within the 22q11DS group, there was no relationship between the prevalence of substance use and psychosis or COMT genotype. Male patients with 22q11DS were more likely to use substances than female patients with 22q11DS.ConclusionsThe results suggest that patients with 22q11DS are at decreased risk for substance use and substance use disorders despite the increased risk of psychotic disorders. Further research into neurobiological and environmental factors involved in substance use in 22q11DS is necessary to elucidate the mechanisms involved.Declaration of interestNone.

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Negative Affect–Related Factors Have the Strongest Association with Prescription Opioid Misuse in a Cross-Sectional Cohort of Patients with Chronic Pain

Pain Medicine ◽

10.1093/pm/pnz249 ◽

2019 ◽

Vol 21 (2) ◽

pp. e127-e138 ◽

Cited By ~ 2

Author(s):

Gadi Gilam ◽

John A Sturgeon ◽

Dokyoung S You ◽

Ajay D Wasan ◽

Beth D Darnall ◽

...

Keyword(s):

Chronic Pain ◽

Substance Use ◽

Negative Affect ◽

Substance Use Disorders ◽

Opioid Misuse ◽

Related Factors ◽

Opioid Prescription ◽

Increased Risk ◽

Patient Reported ◽

Opioid Medications

Abstract Objective Increased opioid prescription to relieve pain among patients with chronic pain is associated with increased risk for misuse, potentially leading to substance use disorders and overdose death. We aimed to characterize the relative importance and identify the most significant of several potential risk factors for the severity of self-reported prescribed opioid misuse behaviors. Methods A sample of 1,193 patients (mean age ± SD = 50.72 ± 14.97 years, 64.04% female) with various chronic pain conditions completed a multidimensional registry assessing four pain severity measures and 14 physical, mental, and social health status factors using the National Institutes of Health’s Patient-Reported Outcomes Measurement Information System (PROMIS). A validated PROMIS measure of medication misuse was completed by 692 patients who endorsed currently taking opioid medication. Patients taking opioid medications were compared across all measures with those who do not take opioid medications. Subsequently, a data-driven regression analysis was used to determine which measures best explained variability in severity of misuse. We hypothesized that negative affect–related factors, namely anxiety, anger, and/or depression, would be key predictors of misuse severity due to their crucial role in chronic pain and substance use disorders. Results Patients taking opioid medications had significantly greater impairment across most measures. Above and beyond demographic variables, the only and most significant predictors of prescribed opioid misuse severity were as follows: anxiety (β = 0.15, P = 0.01), anger (β = 0.13, P = 0.02), Pain Intensity–worst (β = 0.09, P = 0.02), and depression (β = 0.13, P = 0.04). Conclusions Findings suggest that anxiety, anger, and depression are key factors associated with prescribed opioid misuse tendencies in patients with chronic pain and that they are potential targets for therapeutic intervention.

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A whole-of-population study of the prevalence and patterns of criminal offending in people with schizophrenia and other mental illness

Psychological Medicine ◽

10.1017/s0033291712002887 ◽

2012 ◽

Vol 43 (9) ◽

pp. 1869-1880 ◽

Cited By ~ 13

Author(s):

V. A. Morgan ◽

F. Morgan ◽

G. Valuri ◽

A. Ferrante ◽

D. Castle ◽

...

Keyword(s):

Mental Illness ◽

Substance Use ◽

Substance Use Disorders ◽

Psychiatric Illness ◽

Diagnostic Category ◽

Epidemiological Studies ◽

Case Register ◽

People With Mental Illness ◽

Increased Risk ◽

History Of

BackgroundLarge epidemiological studies are needed to better understand the prevalence and profile of offending by people with mental illness. This study used a whole-of-population design to examine the prevalence, type and pattern of offending across all psychiatric diagnoses, including schizophrenia, compared to the general population.MethodWe used whole-of-population longitudinal record-linked data for a cohort of all Western Australians born 1955–1969 to determine arrest history over the period 1985–1996 and to ascertain recorded history of psychiatric illness. Of the cohort, 116 656 had been arrested and 40 478 were on the psychiatric case register.ResultsThe period prevalence of arrest for people with any psychiatric illness was 32.1%. The highest arrest prevalence, by diagnostic category, was for substance use disorders (59.4%); the prevalence for schizophrenia was 38.7%. Co-morbid substance use disorders significantly increased risk of arrest in people with schizophrenia. The prevalence of mental illness among offenders was 11.1%: 6.5% of offenders had substance use disorders and 1.7% had schizophrenia. For the majority of offenders with a psychiatric illness, first arrest preceded first contact with mental health services; for schizophrenia only, this proportion was increasing over time. The mean percentage annual change in the number of arrests during 1985–1996 rose significantly for offenders with a psychiatric illness other than schizophrenia and dropped significantly for those with no mental illness. Compared to non-psychiatric offenders, offenders with schizophrenia were more likely to offend alone, to offend in open places and to target strangers.ConclusionsOur findings open the way to an informed approach to the management of offenders with mental illness.

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Childhood Maltreatment and Development of Substance Use Disorders

Trauma Violence & Abuse ◽

10.1177/1524838015584370 ◽

2016 ◽

Vol 17 (5) ◽

pp. 454-467 ◽

Cited By ~ 34

Author(s):

Hanie Edalati ◽

Marvin D. Krank

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Childhood Maltreatment ◽

Cognitive Abilities ◽

Cognitive Impairments ◽

Mediating Effect ◽

Self Report ◽

Negative Effects ◽

Increased Risk ◽

The Relationship

Exposure to childhood maltreatment (CM) is associated with increased risk for developing substance use disorders (SUDs). CM exerts negative effects on cognitive abilities including intellectual performance, memory, attention, and executive function. Parallel cognitive impairments have been observed in SUDs. Hence, limited studies have examined the mediating effect of cognitive impairments in the relationship between CM and SUDs. In addition, most studies used concurrent self-report assessments in adult populations. Longitudinal studies that investigated the long-term consequences of CM on psychopathology, including SUDs, throughout childhood, adolescence, and adulthood are rare. Thus, the underlying developmental pathways between CM and SUDs are not clearly understood. In this article, we review the evidence that cognitive impairments mediate, at least in part, the relationship between CM and development of SUDs and propose a model that explains how CM increases the risk for SUDs through the development of a cognitive framework of vulnerability.

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