Comorbidity between mood and substance-related disorders: A systematic review and meta-analysis

Background and Objectives: Evidence indicates that mood disorders often co-occur with substance-related disorders. However, pooling comorbidity estimates can be challenging due to heterogeneity in diagnostic criteria and in the overall study design. The aim of this study was to systematically review and, where appropriate, meta-analyse estimates related to the pairwise comorbidity between mood disorders and substance-related disorders, after sorting these estimates by various study designs. Methods: We searched PubMed (MEDLINE), Embase, CINAHL and Web of Science for publications between 1980 and 2017 regardless of geographical location and language. We meta-analysed estimates from original articles in 4 broadly defined mood and 35 substance-related disorders. Results: After multiple eligibility steps, we included 120 studies for quantitative analysis. In general, regardless of variations in diagnosis type, temporal order or use of adjustments, there was substantial comorbidity between mood and substance-related disorders. We found a sixfold elevated risk between broadly defined mood disorder and drug dependence (odds ratio = 5.7) and fivefold risk between depression and cannabis dependence (odds ratio = 4.9) while the highest pooled estimate, based on period prevalence risk, was found between broadly defined dysthymic disorder and drug dependence (odds ratio = 11.3). Based on 56 separate meta-analyses, all pooled odds ratios were above 1, and 46 were significantly greater than 1 (i.e. the 95% confidence intervals did not include 1). Conclusion: This review found robust and consistent evidence of an increased risk of comorbidity between many combinations of mood and substance-related disorders. We also identified a number of under-researched mood and substance-related disorders, suitable for future scrutiny. This review reinforces the need for clinicians to remain vigilant in order to promptly identify and treat these common types of comorbidity.

The Microbiome–Gut–Brain Axis, a Potential Therapeutic Target for Substance-Related Disorders

Substance addiction is a complex worldwide public health problem. It endangers both personal life and social stability, causing great loss on economy. Substance-related disorder is considered to be a complicated chronic brain disorder. It resulted from interactions among pharmacological properties of addictive substances, individual susceptibility, and social–environmental factors. Unfortunately, there is still no ideal treatment for this disorder. Recent lines of evidence suggest that gut microbiome may play an important role in the pathogenesis of neuropsychiatric disorders, including substance-related disorders. This review summarizes the research on the relationship between gut microbiome and substance-related disorders, including different types of substance, different individual susceptibility, and the occurrence and development of substance-induced mental disorders. We also discuss the potentiation of gut microbiome in the treatment of substance-related disorders, especially in the treatment of substance-induced mental disorders and manipulation on individuals’ responsiveness to addictive substances.

Measuring Substance-Related Disorders Using Canadian Administrative Health Databanks: Interprovincial Comparisons of Recorded Diagnostic Rates, Incidence Proportions and Mortality Rate Ratios

Context Assessing temporal changes in the recorded diagnostic rates, incidence proportions, and health outcomes of substance-related disorders (SRD) can inform public health policymakers in reducing harms associated with alcohol and other drugs. Objective To report the annual and cumulative recorded diagnostic rates and incidence proportions of SRD, as well as mortality rate ratios (MRRs) by cause of death among this group in Canada, according to their province of residence. Methods Analyses were performed on linked administrative health databases (AHD; physician claims, hospitalizations, and vital statistics) in five Canadian provinces (Alberta, Manitoba, Ontario, Québec, and Nova Scotia). Canadians 12 years and older and registered for their provincial healthcare coverage were included. The International Classification of Diseases (ICD-9 or ICD-10 codes) was used for case identification of SRD from April 2001 to March 2018. Results During the study period, the annual recorded SRD diagnostic rates increased in Alberta (2001–2002: 8.0‰; 2017–2018: 12.8‰), Ontario (2001–2002: 11.5‰; 2017–2018: 14.4‰), and Nova Scotia (2001–2002: 6.4‰; 2017–2018: 12.7‰), but remained stable in Manitoba (2001–2002: 5.5‰; 2017–2018: 5.4‰) and Québec (2001–2002 and 2017–2018: 7.5‰). Cumulative recorded SRD diagnostic rates increased steadily for all provinces. Recorded incidence proportions increased significantly in Alberta (2001–2002: 4.5‰; 2017–2018: 5.0‰) and Nova Scotia (2001–2002: 3.3‰; 2017–2018: 3.8‰), but significantly decreased in Ontario (2001–2002: 6.2‰; 2017–2018: 4.7‰), Québec (2001–2002: 4.1‰; 2017–2018: 3.2‰) and Manitoba (2001–2002: 2.7‰; 2017–2018: 2.0‰). For almost all causes of death, a higher MRR was found among individuals with recorded SRD than in the general population. The causes of death in 2015–2016 with the highest MRR for SRD individuals were SRD, suicide, and non-suicide trauma in Alberta, Ontario, Manitoba, and Québec. Discussion Linked AHD covering almost the entire population can be useful to monitor the medical service trends of SRD and, therefore, guide health services planning in Canadian provinces.

Discounting, Cognitive Inflexibility, and Antisocial Traits as Predictors of Adolescent Drug Involvement

Cognitive impairments, such as steep delay discounting, have been correlated with substance-related disorders. However, antisocial traits, cognitive inflexibility, and loss discounting have been barely considered despite having a high relationship with problematic consumption. This study aims to identify the predictive power of these variables in four types of drug use. Fifty-two adolescents (age range of 13 to 19 years) were assessed with a substance involvement test, four discounting tasks using $3,000, a card sorting test, and antisocial screening. Discriminant analysis with simultaneous estimation and varimax rotation was carried out. Function one included discounting of both losses, function two AT and CI, and function three probabilistic gains. The three functions explained 60.1% of the variance. The results show that preference for small and soon punishments and larger and unlikely punishments distinguished non-use and experimental use of moderate consumption and problematic consumption. High antisocial traits and low cognitive inflexibility distinguished experimental use groups of non-use. Risk-taking did not discriminate effectively between moderate consumption and problematic consumption. A replication of this study with a larger sample size is recommended to verify the results.

Co-morbid gambling disorder in a local drug and alcohol service: an audit to determine prevalence

AimsNational surveys show that over 56% of adults in England gamble annually, and of those surveyed, 0.5% were problem gamblers, equating to 300,000 problem gamblers at any point. The prevalence of problem gambling in patients with a substance misuse disorder ranges from 20.5% to 55%.The audit aims to improve the care of patients with comorbid substance misuse and gambling disorder by assessing the extent to which the service currently enquires about and records problem gambling in its patient cohort.It is hypothesised that as no formal recording process is in place locally, this information will not be recorded systematically and in a way that is easily retrievable by the service.The audit will allow the service to assess whether changes need to be made to the initial assessment pathways into treatment for substance-related disorders to adequately record this information so that further assessment and onward referral can take place.MethodAll active patients (n = 2824) within the service had both their electronic initial assessments and their entire electronic notes screened for terms such as ‘betting’ and ‘gambling’ and this was recorded using an Excel spreadsheet. Prevalence rates across the teams (opiates, non-opiates and alcohol) were then calculated.ResultThe results showed that 0% of patients had any entries in their initial screening noting any gambling activity. Further scrutiny of the records revealed that only 3.5% (n-99) had ever discussed gambling with a worker in any of the services.ConclusionThe majority (n = 52) of patients who had discussed gambling only had one positive search result, suggesting this was not followed-up in a systematic fashion. Recommendations are to revise the common assessment pro-forma to include a validated brief screening tool (lie/bet), where one positive answer triggers a further assessment with an appropriate clinician for consideration of referral to the local NHS gambling service.

Bibliometric Insights in Genetic Factors of Substance-Related Disorders: Intellectual Developments, Turning Points, and Emerging Trends

Substance-related disorders are a group of medical conditions that affect a person's brain and behavior and lead to an inability to control the use of legal or illegal drug(s) or medication. Substance-related disorder is a serious public health and society problem worldwide. Genetic factors have been proven to have an important role. Researchers have carried out a lot of work in this field, and a large number of research results have been published in academic journals around the world. However, there are few overviews of research progress, presentation, and development trends in this field. In this study, a total of 636 articles related to genetic factors of substance-related disorders were retrieved from the Web of Science (WoS) database from 1997 to 2018, and the scientific literatures were analyzed by bibliometrics. The study found that the United States (US) has maintained a leading position in the field of research, with many core institutions and plenty of high-quality research results. Alcohol use disorder is still the most concerning issue in this field. Over the past 20 years, new techniques such as genome-wide association study (GWAS) based on high-throughput sequencing technology have replaced family studies, twin studies, and retrospective studies in this field. We believe that it is urgent to study the genetic factors of substance-related disorders, which can greatly deepen the understanding of the pathogenesis of substance-related disorders and may provide potential targets for precise treatment of such diseases.

O IMPACTO DO USO DE SUBSTÂNCIAS PSICOATIVAS E SUAS REPERCUSSÕES NA CAVIDADE BUCAL: REVISÃO INTEGRATIVA

RESUMO Introdução: O consumo de drogas pode promover consequências para o organismo, sobretudo a cavidade bucal. Objetivo: Verificar quais são as substâncias psicoativas mais utilizadas e suas repercussões na cavidade bucal. Metodologia: Foi realizada uma revisão de literatura na base de dados Medical Publications (PubMed) com os descritores “Transtornos Relacionados ao Uso de Substâncias (Substance-Related Disorders)” e “Odontologia (Dentistry)” com o operador booleano “And”. Resultados: A amostra foi composta por 5 artigos selecionados, onde a maconha, cocaína e o crack foram as substâncias psicoativas mais utilizadas pelos usuários de drogas, sendo a perda dentária, presença de cárie dentária e doença periodontal as principais repercussões bucais. Conclusões: O consumo de substâncias psicoativas aumenta o limiar de dor, podendo mascarar a sintomatologia dolorosa das manifestações bucais e postergar a busca por tratamento odontológico, agravando, por vezes, a condição bucal do indíviduo. Sendo portanto, de extrema importância o conhecimento e atuação do cirurgião dentista frente ao usuário de drogas, desde a prevenção, diagnóstico e tratamento do caso. Palavras-Chave: Transtornos relacionados ao uso de substâncias; Odontologia, Manifestações bucais.