Drugs Alcohol Research Paper

Alcoholism is an extremely serious problem in our world today that leads to approximately 88,000 deaths each year in the United States alone.1 Alcohol-related deaths are the fourth-leading preventable cause of death in the United States.1 So understanding the dangers and warnings signs of alcoholism could make a big difference in reducing the risk of harm.2 It is also important that those addicted to alcohol and the ones who love them recognize the short- and long-term health effects associated with alcoholism.3

While drinking behavior may seem somewhat ubiquitous, the majority of alcohol consumption—and, consequently, the bulk of the associated harm—occurs in a relatively small portion of the population who drinks. An estimated 71% of Americans reported consuming alcohol in the past year,1 yet more than half of the alcohol in any given year is consumed by the top 10% of drinkers.4

Let’s dig into the data to get a clearer picture of drug addiction and alcoholism in the United States.

Statistics on Alcoholism in the U.S.

People Seek Treatment for Alcohol More than Any Other Substance

Alcohol is the most abused drug among people in recovery, as Recovery Brands revealed with a 2017 survey. The survey found that nearly 70% of people in recovery got help with a drinking problem, and a shocking 52.87% of respondents sought the most treatment for alcohol abuse. Despite the wide variety of abused substances individuals seek treatment for, alcohol seems to cause the most widespread harm. Fortunately, recovery can start with one simple call.

In 2014, more than 16 million adults, or nearly 7% of the American adult population, had an alcohol use disorder.1 In addition, more than 5 million more partake in risky alcohol consumption, such as binge drinking, that could potentially lead to abuse.1

More than 8 million young people between the ages of 12 and 20 reported drinking alcohol beyond a few sips in the previous month they were surveyed.5 This is particularly worrying since compared to adult drinkers who started drinking around age 21, young people who begin drinking before the age of 15 are 4 times more likely to develop dependence on the drug.6

Research shows that the younger a person begins to drink, the more likely they will engage in harmful behaviors.5 In fact, nearly 40% of underage high school seniors have been drunk at some point and almost 20% reported drinking in excess of five drinks over the course of the previous two weeks.6 While rates of binge and heavy alcohol use among underage drinkers declined from 2002 and 2014, there are still more than 5 million youth who report being binge drinkers, and 1.3 million who report being heavy drinkers.7 These numbers reveal an alarmingly extensive problem and underscore the fact that alcohol is the most widely misused substance among America’s youth.8

The Substance Abuse and Mental Health Services Administration estimates that in 2014 almost 57% of adults drank in the month prior to being surveyed and nearly 7% (or 16.3 million) of the American adult population have a drinking problem.1 Additionally, about 6% of seniors are considered heavy users of alcohol, suggesting alcohol-related problems are present among all ages.9

Based on these numbers, it is clear that alcoholism and alcohol abuse are serious problems that affect many people. Sadly, the numbers of those who actually get treatment for alcoholism and other alcohol-related problems are not nearly as high—in 2014, only 1.5 million adults received treatment at a specialized facility.1

By the Numbers: Men vs. Women and Alcoholism

Studies consistently demonstrate that more men than women struggle with alcoholism and alcohol abuse. While 5.7 million women are affected by an alcohol use disorder in the United States, nearly twice as many men—about 10.6 million—are affected.1 With a little less than 6 million women struggling with alcoholism, this gender discrepancy obviously shouldn’t be taken to suggest that women are in the clear. Women may in fact need to be relatively more careful about their alcohol consumption because, due to gender differences in body structure and chemistry that result in them effectively absorbing more alcohol from their drinks, women can become more intoxicated more quickly than men when drinking comparable amounts of alcohol.10 In addition, women are more likely than men to experience problems related to alcohol, such as abusive relationships, unwanted sexual advances, and depression.11

Within the general female population, there are additional demographic groups likely to experience problems resulting from alcohol use and abuse. For example, it is hypothesized that some lesbians use alcohol to cope with the stigma of being gay, as well as with their internalized homophobia,12 and high rates of co-occurring eating disorders and alcohol use also disproportionately affect women.13

High-risk drinking rates are higher among ethnic minorities, too, particularly Native Americans and Hispanics.14 About 27% of Native American women and almost 20% of Black women report being daily heavy drinkers.14

Children Affected by a Parents’ Alcoholism

  • In 2007, an estimated 76 million adult children of alcoholics lived in the United States.15
  • In 2012, more than 10% of U.S. children lived with a parent with alcohol problems.1

Statistics for the Problems Caused by Excessive Drinking

One of the major health issues resulting from excessive or binge drinking is liver disease. And beyond that, alcohol contributes to more than 200 diseases and injury-related health conditions, including cancers and injuries.1

In the United States, binge drinking is defined as a pattern of drinking that brings your blood alcohol concentration level to 0.08 g/dL or above within two hours.5 According to national surveys, about 92% of American adults who drink excessively reported binge drinking in the past 30 days.3 And although many binge drinkers are not dependent on alcohol, their drinking habits still make them prone to many health problems.3

  • Binge drinking is more common among young adults between the ages of 18 and 34 years.3
  • About 90% of alcohol consumed by underage drinkers is in the form of binge drinking.3

Excessive underage drinking has many consequences that affect college students across the United States, whether or not they choose to drink:

  • Academic problems: Approximately 25% of college students reported falling behind, missing class, doing poorly on papers and exams, and receiving low grades as a result of drinking.16
  • Alcohol abuse and dependence: About 20% of students meet the criteria for an alcohol use disorder.16
  • Assault: About 696,000 students aged 18 to 24 became victims of assault; the perpetrators in these cases were other students who had been drinking.16
  • Death: About 1,825 college students aged 18 to 24 die from unintentional injuries related to alcohol.16
  • Drunk driving: 85% of alcohol-impaired driving is associated with binge drinking.17
  • Alcohol poisoning: Each year thousands of college students are transported to the emergency room because of alcohol poisoning, which can result in permanent brain damage or even death.16
  • Health problems and suicide attempts: Suicide attempts are significantly higher in those who drink heavily compared with those who do not drink.17 Liver and other organ damage can result from long-term excessive drinking.16
  • Injury: An estimated 10% of college students are injured because of drinking.17
  • Police involvement: An estimated 112,000 students were arrested for an alcohol-related offense in a single year.18
  • Property damage and vandalism: Many colleges in the United States have major or moderate problems with property damage resulting from alcohol use; making these claims are more than 50% of administrators from colleges with high drinking levels among students, and more than 25% of administrators from colleges with low student drinking levels.18
  • Sexual abuse: Approximately 97,000 students aged 18 to 24 reported experiencing sexual assault or date rape as a result from alcohol use.16
  • Unsafe sex: An estimated 8% of college students had unprotected sex as a result of their drinking.17

Given some of these consequences, it is clear that there is a strong relationship between crime and alcohol use. About 3 million violent crimes occur annually in the United States, and alcohol plays a role in 40% of them.19 Two-thirds of victims who have suffered domestic or partner violence reported there had been alcohol involved, and among cases of spousal violence, 3 out of 4 incidents involved an offender who had been under the influence of alcohol.19

Alcoholism and Health Problems

The health problems related to alcohol abuse and alcoholism vary, but they are of great concern because of their severity. For example, a Harvard School of Public Health study showed that having 2 or more drinks a day increases the risk of developing breast cancer.20 Heavy alcohol use directly affects brain function and has been shown to induce mental disorders such as mood, anxiety, psychotic, sleep, and dementia disorders.21

In addition to mood and behavior changes, alcohol can affect thought, memory, and coordination. Excessive alcohol use can affect other organs such as the heart, liver, and pancreas, contributing to cardiomyopathy, irregular heartbeat, stroke, and high blood pressure.

  • Liver cirrhosis can occur from heavy drinking as can alcohol hepatitis and liver fibrosis.
  • Alcohol causes inflammation and swelling of the pancreas (pancreatitis), which can be painful and debilitating, and can prevent proper digestion.
  • Alcohol abuse increases the risk of developing certain cancers of the mouth, esophagus, throat, liver, and breast as well as weakening the immune system, making the body more susceptible to various diseases like pneumonia and tuberculosis.22
  • Aside from injury, violence, alcohol poisoning, susceptibility to certain diseases, and mental health problems, alcohol dependence or alcoholism can develop from long-term use and result in social problems, such as job loss, family issues, and lost productivity to name a few.3
  • Pregnant women who drink are at risk for miscarriage, stillbirth, or fetal alcohol spectrum disorders.3
  • Alcohol use can interact with certain medications, increasing the risk of additional health problems or even death.3
  • In adolescents, alcohol use can interfere with brain development.1

Deaths Due to Alcoholism

  • In 2013, almost half of the 72,559 liver disease deaths, including those resulting specifically from cirrhosis of the liver, involved alcohol.1
  • Excessive alcohol use results each year in approximately 2.5 million years of potential life lost, or an average loss of 30 years for each fatality.3
  • In 2010, more than 2.6 million hospitalizations were related to alcohol.23
  • About 1/3 of deaths resulting from alcohol problems take the form of suicides and such accidents as head injuries, drowning incidents, and motor vehicle crashes.24
  • About 20% of suicide victims in the United States involve people with alcohol problems.25
  • In 2014, 30% of the country’s fatal traffic incidents were related to alcohol-impaired driving.26
  • Among youth, underage drinking is responsible for more than 4,300 deaths each year and 189,000 emergency room visits for alcohol-related injuries and other conditions.8
  • Excessive drinking was responsible for 1 in 10 deaths among adults between 20 and 64 years.
  • In 2010, the economic impact of excessive alcohol use in the United States approached an estimated $249 billion.3

Financial Policies and Facility Offerings Are Important

In 2016, Recovery Brands collected data that asked patients who were leaving an addiction rehabilitation center what facility features they viewed as important things to take into account when considering treatment. The highest-rated priority was the facility’s financial policies, such as payment options, financial support, and insurance accepted. They also prioritized the facility’s offerings (recreation, comforts, quality of food) much more after experiencing treatment. If you’re looking for treatment, you may want to consider a program’s financial practices as well as the the facility’s offerings to help with your final treatment choice.


  1. National Institute on Alcohol Abuse and Alcoholism. (2016). Alcohol Facts and Statistics.
  2. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Rethinking Drinking, Alcohol & your health: What are symptoms of an alcohol use disorder?
  3. Centers for Disease Control and Prevention. (2016). Fact Sheets – Alcohol Use and Your Health.
  4. Ingraham, C. (2014). Think you drink a lot? This chart will tell you.
  5. National Institute on Alcohol Abuse and Alcoholism. (2016). Underage Drinking.
  6. National Institute on Alcohol Abuse and Alcoholism. (2006). Underage Drinking: Why Do Adolescents Drink, What Are the Risks, and How Can Underage Drinking Be Prevented?
  7. National Institute on Drug Abuse. (2016). DrugFacts: High School and Youth Trends.
  8. Substance Abuse and Mental Health Services Administration. (2015). Underage Drinking.
  9. Rigler, S. K. (2000). Alcoholism in the Elderly. American Family Physician, 61(6), 1710–1716.
  10. Centers for Disease Control and Prevention. (2016). Fact Sheets – Excessive Alcohol Use and Risks to Women’s Health.
  11. National Institute on Alcohol Abuse and Alcoholism. (2015). Alcohol: A Women’s Health Issue.
  12. Centers for Disease Control and Prevention. (2016). Substance Use.
  13. Grilo C. M., Rajita S. & O’Malley S. S. (2002). Eating Disorders and Alcohol Use Disorders.
  14. Chartier K. & Caetano R. (n.d.). Ethnicity and Health Disparities in Alcohol Research.
  15. The Free Library. (2014). Risk factors among adult children of alcoholics.
  16. National Institute on Alcohol Abuse and Alcoholism. (2015). College Drinking.
  17. Jewett A., Shults R. A., Banerjee T. & Bergen G. (2015). Alcohol-Impaired Driving Among Adults—United States, 2012. Morbidity and Mortality Weekly Report, 64(30), 814–817.
  18. Task Force of the National Advisory Council on Alcohol Abuse and Alcoholism. (2002). High-Risk Drinking in College: What We Know and What We Need to Learn, Final Report of the Panel on Contexts and Consequences.
  19. National Council on Alcoholism and Drug Dependence. (2016). Alcohol, Drugs and Crime.
  20. Harvard School of Public Health. (n.d.). Alcohol: Balancing Risks and Benefits.
  21. Shivani R., Goldsmith R. J. & Anthenelli R. M. (2002). Alcoholism and Psychiatric Disorders: Diagnostic Challenges.
  22. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Alcohol’s Effects on the Body.
  23. National Institute on Alcohol Abuse and Alcoholism. (2013). Alcohol-Related Emergency Department Visits and Hospitalizations And Their Co-Occurring Drug-Related, Mental Health, And Injury Conditions In The United States: Findings From The 2006-2010 Nationwide Emergency Department Samples (NEDS) And Nationwide Inpatients Samples (NIS).
  24. Centers for Disease Control and Prevention. (n.d.). Alcohol-Related Disease Impact (ARDI).
  25. Mental Health America. (n.d.). Suicide.
  26. U.S. Department of Transportation. (2014). Traffic Safety Facts 2014: A Compilation of Motor Vehicle Crash Data from the Fatality Analysis Reporting System and the General Estimates System.

Marisol S. Castaneto | David A. Gorelick | Nathalie A. Desrosiers | Rebecca L. Hartman | Sandrine Pirard | Marilyn A. Huestis

© 2014. Background: Synthetic cannabinoids (SC) are a heterogeneous group of compounds developed to probe the endogenous cannabinoid system or as potential therapeutics. Clandestine laboratories subsequently utilized published data to develop SC variations marketed as abusable designer drugs. In the early 2000s, SC became popular as "legal highs" under brand names such as Spice and K2, in part due to their ability to escape detection by standard cannabinoid screening tests. The majority of SC detected in herbal products have greater binding affinity to the cannabinoid CB 1 receptor than does δ 9 -tetrahydrocannabinol (THC), the primary psychoactive compound in the cannabis plant, and greater affinity at the CB 1 than the CB 2 receptor. In vitro and animal in vivo studies show SC pharmacological effects 2-100 times more potent than THC, including analgesic, anti-seizure, weight-loss, anti-inflammatory, and anti-cancer growth effects. SC produce physiological and psychoactive effects similar to THC, but with greater intensity, resulting in medical and psychiatric emergencies. Human adverse effects include nausea and vomiting, shortness of breath or depressed breathing, hypertension, tachycardia, chest pain, muscle twitches, acute renal failure, anxiety, agitation, psychosis, suicidal ideation, and cognitive impairment. Long-term or residual effects are unknown. Due to these public health consequences, many SC are classified as controlled substances. However, frequent structural modification by clandestine laboratories results in a stream of novel SC that may not be legally controlled or detectable by routine laboratory tests. Methods: We present here a comprehensive review, based on a systematic electronic literature search, of SC epidemiology and pharmacology and their clinical implications.

Christopher M. Jones

Background: Heroin use and overdose deaths have increased in recent years. Emerging information suggests this is the result of increases in nonmedical use of opioid pain relievers and nonmedical users transitioning to heroin use. Understanding this relationship is critically important for the development of public health interventions. Methods: Combined data from the 2002-2004 National Surveys on Drug Use and Health were compared to the 2008-2010 surveys to examine patterns of heroin use and risk behaviors among past year nonmedical users of opioid pain relievers. Results: Between 2002-2004 and 2008-2010, past year heroin use increased among people reporting past year nonmedical use (PYNMU) of opioid pain relievers (p < 0.01), but not among those reporting no PYNMU. Frequent nonmedical users - people reporting 100-365 days of PYNMU - had the highest rate of past year heroin use and were at increased risk for ever injecting heroin (aOR 4.3, 95% CI 2.5-7.3) and past year heroin abuse or dependence (aOR 7.8, 95% CI 4.7-12.8) compared to infrequent nonmedical users (1-29 days of PYNMU). In 2008-2010, 82.6% of frequent nonmedical users who used heroin in the past year reported nonmedical use of opioid pain relievers prior to heroin initiation compared to 64.1% in 2002-2004. Conclusions: Heroin use among nonmedical users of opioid pain relievers increased between 2002-2004 and 2008-2010, with most reporting nonmedical use of opioid pain relievers before initiating heroin. Interventions to prevent nonmedical use of these drugs are needed and should focus on high-risk groups such as frequent nonmedical users of opioids. © 2013.

Erin L. Sutfin | Thomas P. McCoy | Holly E R Morrell | Bettina B. Hoeppner | Mark Wolfson

Background: Electronic cigarettes, or e-cigarettes, are battery operated devices that deliver nicotine via inhaled vapor. There is considerable controversy about the disease risk and toxicity of e-cigarettes and empirical evidence on short- and long-term health effects is minimal. Limited data on e-cigarette use and correlates exist, and to our knowledge, no prevalence rates among U.S. college students have been reported. This study aimed to estimate the prevalence of e-cigarette use and identify correlates of use among a large, multi-institution, random sample of college students. Methods: 4444 students from 8 colleges in North Carolina completed a Web-based survey in fall 2009. Results: Ever use of e-cigarettes was reported by 4.9% of students, with 1.5% reporting past month use. Correlates of ever use included male gender, Hispanic or "Other race" (compared to non-Hispanic Whites), Greek affiliation, conventional cigarette smoking and e-cigarette harm perceptions. Although e-cigarette use was more common among conventional cigarette smokers, 12% of ever e-cigarette users had never smoked a conventional cigarette. Among current cigarette smokers, e-cigarette use was negatively associated with lack of knowledge about e-cigarette harm, but was not associated with intentions to quit. Conclusions: Although e-cigarette use was more common among conventional cigarette smokers, it was not exclusive to them. E-cigarette use was not associated with intentions to quit smoking among a sub-sample of conventional cigarette smokers. Unlike older, more established cigarette smokers, e-cigarette use by college students does not appear to be motivated by the desire to quit cigarette smoking. © 2013 Elsevier Ireland Ltd.

Leonieke C. Van Boekel | Evelien P.M. Brouwers | Jaap Van Weeghel | Henk F.L. Garretsen

Background: Healthcare professionals are crucial in the identification and accessibility to treatment for people with substance use disorders. Our objective was to assess health professionals' attitudes towards patients with substance use disorders and examine the consequences of these attitudes on healthcare delivery for these patients in Western countries. Methods: Pubmed, PsycINFO and Embase were systematically searched for articles published between 2000 and 2011. Studies evaluating health professionals' attitudes towards patients with substance use disorders and consequences of negative attitudes were included. An inclusion criterion was that studies addressed alcohol or illicit drug abuse. Reviews, commentaries and letters were excluded, as were studies originating from non-Western countries. Results: The search process yielded 1562 citations. After selection and quality assessment, 28 studies were included. Health professionals generally had a negative attitude towards patients with substance use disorders. They perceived violence, manipulation, and poor motivation as impeding factors in the healthcare delivery for these patients. Health professionals also lacked adequate education, training and support structures in working with this patient group. Negative attitudes of health professionals diminished patients' feelings of empowerment and subsequent treatment outcomes. Health professionals are less involved and have a more task-oriented approach in the delivery of healthcare, resulting in less personal engagement and diminished empathy. Conclusions: This review indicates that negative attitudes of health professionals towards patients with substance use disorders are common and contribute to suboptimal health care for these patients. However, few studies have evaluated the consequences of health professionals' negative attitudes towards patients with substance use disorders. © 2013 Elsevier Ireland Ltd.

Susan Calcaterra | Jason Glanz | Ingrid A. Binswanger

Background: Pharmaceutical opioid related deaths have increased. This study aimed to place pharmaceutical opioid overdose deaths within the context of heroin, cocaine, psychostimulants, and pharmaceutical sedative hypnotics examine demographic trends, and describe common combinations of substances involved in opioid related deaths. Methods: We reviewed deaths among 15-64 year olds in the US from 1999-2009 using death certificate data available through the CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) Database. We identified International Classification of Disease-10 codes describing accidental overdose deaths, including poisonings related to stimulants, pharmaceutical drugs, and heroin. We used crude and age adjusted death rates (deaths/100,000 person years [p-y] and 95% confidence interval [CI] and multivariable Poisson regression models, yielding incident rate ratios; IRRs), for analysis. Results: The age adjusted death rate related to pharmaceutical opioids increased almost 4-fold from 1999 to 2009 (1.54/100,000 p-y [95% CI 1.49-1.60] to 6.05/100,000 p-y [95% CI 5.95-6.16; p < 0.001). From 1999 to 2009, pharmaceutical opioids were responsible for the highest relative increase in overdose death rates (IRR 4.22, 95% CI 3.03-5.87) followed by sedative hypnotics (IRR 3.53, 95% CI 2.11-5.90). Heroin related overdose death rates increased from 2007 to 2009 (1.05/100,000 persons [95% CI 1.00-1.09] to 1.43/100,000 persons [95% CI 1.38-1.48; p < 0.001). From 2005-2009 the combination of pharmaceutical opioids and benzodiazepines was the most common cause of polysubstance overdose deaths (1.27/100,000 p-y (95% CI 1.25-1.30). Conclusion: Strategies, such as wider implementation of naloxone, expanded access to treatment, and development of new interventions are needed to curb the pharmaceutical opioid overdose epidemic. © 2012 Elsevier Ireland Ltd.

William J. Panenka | Ric M. Procyshyn | Tania Lecomte | G. William MacEwan | Sean W. Flynn | William G. Honer | Alasdair M. Barr

Methamphetamine (MA) is a highly addictive psychostimulant drug that principally affects the monoamine neurotransmitter systems of the brain and results in feelings of alertness, increased energy and euphoria. The drug is particularly popular with young adults, due to its wide availability, relatively low cost, and long duration of psychoactive effects. Extended use of MA is associated with many health problems that are not limited to the central nervous system, and contribute to increased morbidity and mortality in drug users. Numerous studies, using complementary techniques, have provided evidence that chronic MA use is associated with substantial neurotoxicity and cognitive impairment. These pathological effects of the drug, combined with the addictive properties of MA, contribute to a spectrum of psychosocial issues that include medical and legal problems, at-risk behaviors and high societal costs, such as public health consequences, loss of family support and housing instability. Treatment options include pharmacological, psychological or combination therapies. The present review summarizes the key findings in the literature spanning from molecular through to clinical effects. © 2012 Elsevier Ireland Ltd.

Adam R. Winstock | Monica J. Barratt

Background: The last decade has seen the appearance of myriad novel psychoactive substances with diverse effect profiles. Synthetic cannabinoids are among the most recently identified but least researched of these substances. Methods: An anonymous online survey was conducted in 2011 using a quantitative structured research tool. Missing data (median 2%) were treated by available-case analysis. Results: Of 14,966 participants, 2513 (17%) reported use of synthetic cannabis. Of these, 980 (41% of 2417) reported its use in the last 12 months. Almost all recent synthetic cannabis users (99% of 975) reported ever use of natural cannabis. Synthetic cannabis reportedly had both a shorter duration of action (. z=. 17.82, p < . .001) and quicker time to peak onset of effect (. z=. -9.44, p < . .001) than natural cannabis. Natural cannabis was preferred to synthetic cannabis by 93% of users, with natural cannabis rated as having greater pleasurable effects when high (. t(930). =. -37.1, p < . .001, d=. -1.22) and being more able to function after use (. t(884). =. -13.3, p < . .001, d=. -0.45). Synthetic cannabis was associated with more negative effects (. t(859). =. 18.7, p < . .001, d=. 0.64), hangover effects (. t(854). =. 6.45, p < . .001, d=. 0.22) and greater paranoia (. t(889). =. 7.91, p < . .001, d=. 0.27). Conclusions: Users report a strong preference for natural over synthetic cannabis. The latter has a less desirable effect profile. Further research is required to determine longer term consequences of use and comparative dependence potential. © 2013 .

Janette L. Smith | Richard P. Mattick | Sharna D. Jamadar | Jaimi M. Iredale

© 2014 Elsevier Ireland Ltd. Aims: Deficits in behavioural inhibitory control are attracting increasing attention as a factor behind the development and maintenance of substance dependence. However, evidence for such a deficit is varied in the literature. Here, we synthesised published results to determine whether inhibitory ability is reliably impaired in substance users compared to controls. Methods: The meta-analysis used fixed-effects models to integrate results from 97 studies that compared groups with heavy substance use or addiction-like behaviours with healthy control participants on two experimental paradigms commonly used to assess response inhibition: the Go/NoGo task, and the Stop-Signal Task (SST). The primary measures of interest were commission errors to NoGo stimuli and stop-signal reaction time in the SST. Additionally, we examined omission errors to Go stimuli, and reaction time in both tasks. Because inhibition is more difficult when inhibition is required infrequently, we considered papers with rare and equiprobable NoGo stimuli separately. Results: Inhibitory deficits were apparent for heavy use/dependence on cocaine, MDMA, methamphetamine, tobacco, and alcohol (and, to a lesser extent, non-dependent heavy drinkers), and in pathological gamblers. On the other hand, no evidence for an inhibitory deficit was observed for opioids or cannabis, and contradictory evidence was observed for internet addiction. Conclusions: The results are generally consistent with the view that substance use disorders and addiction-like behavioural disorders are associated with impairments in inhibitory control. Implications for treatment of substance use are discussed, along with suggestions for future research arising from the limitations of the extant literature.

Howard Barry Moss | Chiung M. Chen | Hsiao ye Yi

Background: Alcohol, tobacco and marijuana are the most commonly used drugs by adolescents in the U.S. However, little is known about the patterning of early adolescent substance use, and its implications for problematic involvement with substances in young adulthood. We examined patterns of substance use prior to age 16, and their associations with young adult substance use behaviors and substance use disorders in a nationally representative sample of U.S. adolescents. Method: Using data from Wave 4 of the Add Health Survey (n= 4245), we estimated the prevalence of various patterns of early adolescent use of alcohol, cigarettes, and marijuana use individually and in combination. Then we examined the effects of patterns of early use of these substances on subsequent young adult substance use behaviors and DSM-IV substance use disorders. Results: While 34.4% of individuals reported no substance use prior to age 16, 34.1% reported either early use of both alcohol and marijuana or alcohol, marijuana and cigarettes, indicating the relatively high prevalence of this type of polysubstance use behavior among U.S. adolescents. Early adolescent use of all three substances was most strongly associated with a spectrum of young adult substance use problems, as well as DSM-IV substance use disorder diagnoses. Conclusions: This research confirms the elevated prevalence and importance of polysubstance use behavior among adolescents prior to age 16, and puts early onset of alcohol, marijuana and cigarette use into the context of use patterns rather than single drug exposures. © 2013.

Joseph Schuermeyer | Stacy Salomonsen-Sautel | Rumi Kato Price | Sundari Balan | Christian Thurstone | Sung Joon Min | Joseph T. Sakai

© 2014 Elsevier Ireland Ltd. Background: In 2009, policy changes were accompanied by a rapid increase in the number of medical marijuana cardholders in Colorado. Little published epidemiological work has tracked changes in the state around this time. Methods: Using the National Survey on Drug Use and Health, we tested for temporal changes in marijuana attitudes and marijuana-use-related outcomes in Colorado (2003-11) and differences within-year between Colorado and thirty-four non-medical-marijuana states (NMMS). Using regression analyses, we further tested whether patterns seen in Colorado prior to (2006-8) and during (2009-11) marijuana commercialization differed from patterns in NMMS while controlling for demographics. Results: Within Colorado those reporting "great-risk" to using marijuana 1-2 times/week dropped significantly in all age groups studied between 2007-8 and 2010-11 (e.g. from 45% to 31% among those 26 years and older; p= 0.0006). By 2010-11 past-year marijuana abuse/dependence had become more prevalent in Colorado for 12-17 year olds (5% in Colorado, 3% in NMMS; p= 0.03) and 18-25 year olds (9% vs. 5%; p= 0.02). Regressions demonstrated significantly greater reductions in perceived risk (12-17 year olds, p= 0.005; those 26 years and older, p= 0.01), and trend for difference in changes in availability among those 26 years and older and marijuana abuse/dependence among 12-17 year olds in Colorado compared to NMMS in more recent years (2009-11 vs. 2006-8). Conclusions: Our results show that commercialization of marijuana in Colorado has been associated with lower risk perception. Evidence is suggestive for marijuana abuse/dependence. Analyses including subsequent years 2012+ once available, will help determine whether such changes represent momentary vs. sustained effects.

Tamara M. Haegerich | Leonard J. Paulozzi | Brian J. Manns | Christopher M. Jones

© 2014. Background: Drug overdose deaths have been rising since the early 1990s and is the leading cause of injury death in the United States. Overdose from prescription opioids constitutes a large proportion of this burden. State policy and systems-level interventions have the potential to impact prescription drug misuse and overdose. Methods: We searched the literature to identify evaluations of state policy or systems-level interventions using non-comparative, cross-sectional, before-after, time series, cohort, or comparison group designs or randomized/non-randomized trials. Eligible studies examined intervention effects on provider behavior, patient behavior, and health outcomes. Results: Overall study quality is low, with a limited number of time-series or experimental designs. Knowledge and prescribing practices were measured more often than health outcomes (e.g., overdoses). Limitations include lack of baseline data and comparison groups, inadequate statistical testing, small sample sizes, self-reported outcomes, and short-term follow-up. Strategies that reduce inappropriate prescribing and use of multiple providers and focus on overdose response, such as prescription drug monitoring programs, insurer strategies, pain clinic legislation, clinical guidelines, and naloxone distribution programs, are promising. Evidence of improved health outcomes, particularly from safe storage and disposal strategies and patient education, is weak. Conclusions: While important efforts are underway to affect prescriber and patient behavior, data on state policy and systems-level interventions are limited and inconsistent. Improving the evidence base is a critical need so states, regulatory agencies, and organizations can make informed choices about policies and practices that will improve prescribing and use, while protecting patient health.

Joseph Studer | Stéphanie Baggio | Meichun Mohler-Kuo | Petra Dermota | Jacques Gaume | Nicolas Bertholet | Jean Bernard Daeppen | Gerhard Gmel

Background: Non-response is a major concern among substance use epidemiologists. When differences exist between respondents and non-respondents, survey estimates may be biased. Therefore, researchers have developed time-consuming strategies to convert non-respondents to respondents. The present study examines whether late respondents (converted former non-participants) differ from early respondents, non-consenters or silent refusers (consent givers but non-participants) in a cohort study, and whether non-response bias can be reduced by converting former non-respondents. Methods: 6099 French- and 5720 German-speaking Swiss 20-year-old males (more than 94% of the source population) completed a short questionnaire on substance use outcomes and socio-demographics, independent of any further participation in a cohort study. Early respondents were those participating in the cohort study after standard recruitment procedures. Late respondents were non-respondents that were converted through individual encouraging telephone contact. Early respondents, non-consenters and silent refusers were compared to late respondents using logistic regressions. Relative non-response biases for early respondents only, for respondents only (early and late) and for consenters (respondents and silent refusers) were also computed. Results: Late respondents showed generally higher patterns of substance use than did early respondents, but lower patterns than did non-consenters and silent refusers. Converting initial non-respondents to respondents reduced the non-response bias, which might be further reduced if silent refusers were converted to respondents. Conclusion: Efforts to convert refusers are effective in reducing non-response bias. However, converted late respondents cannot be seen as proxies of non-respondents, and are at best only indicative of existing response bias due to persistent non-respondents. © 2013 Elsevier Ireland Ltd.

Nicole H. Weiss | Matthew T. Tull | Michael D. Anestis | Kim L. Gratz

Background: Despite elevated rates of posttraumatic stress disorder (PTSD) among substance use disorder (SUD) patients, as well as the clinical relevance of this co-occurrence, few studies have e xamined psychological factors associated with a PTSD-SUD diagnosis. Two factors worth investigating are emotion dysregulation and impulsivity, both of which are associated with PTSD and SUDs. Therefore, this study examined associations between PTSD and facets of emotion dysregulation and impulsivity within a sample of trauma-exposed SUD inpatients. Methods: Participants were an ethnically diverse sample of 205 SUD patients in residential substance abuse treatment. Patients were administered diagnostic interviews and completed a series of questionnaires. Results: Patients with PTSD (. n=. 58) reported significantly higher levels of negative urgency (i.e., the tendency to engage in impulsive behaviors when experiencing negative affect) and lower sensation seeking, as well as higher levels of emotion dysregulation and the specific dimensions of lack of emotional acceptance, difficulties engaging in goal-directed behavior when upset, difficulties controlling impulsive behaviors when distressed, limited access to effective emotion regulation strategies, and lack of emotional clarity. Further, overall emotion dysregulation emerged as a significant predictor of PTSD status, accounting for unique variance in PTSD status above and beyond facets of impulsivity (as well as other relevant covariates). Conclusions: Results suggest that emotion dysregulation may contribute to the development, maintenance, and/or exacerbation of PTSD and highlight the potential clinical utility of targeting emotion dysregulation among SUD patients with PTSD. © 2012 Elsevier Ireland Ltd.

Carlos Blanco | Yang Xu | Kathleen Brady | Gabriela Pérez-Fuentes | Mayumi Okuda | Shuai Wang

Background: Despite the high rates of comorbidity of post-traumatic stress disorder (PTSD) and alcohol dependence (AD) in clinical and epidemiological samples, little is known about the prevalence, clinical presentation, course, risk factors and patterns of treatment-seeking of co-occurring PTSD-AD among the general population. Methods: The sample included respondents of the Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Weighted means, frequencies and odds ratios (ORs) of sociodemographic correlates, prevalence of psychiatric disorders and rates of treatment-seeking were computed. Results: In the general population, the lifetime prevalence of PTSD only, AD only and PTSD-AD was 4.83%, 13.66% and 1.59%, respectively. Individuals with comorbid PTSD-AD were more likely than those with PTSD or AD only to have suffered childhood adversities and had higher rates of Axis I and II disorders and suicide attempts. They also met more PTSD diagnostic criteria, had earlier onset of PTSD and were more likely to use drugs and alcohol to relieve their PTSD symptoms than those with PTSD only; they also met more AD diagnostic criteria than those with AD only and had greater disability. Individuals with PTSD-AD had higher rates of treatment seeking for AD than those with AD only, but similar rates than those with PTSD only. Conclusion: PTSD-AD is associated with high levels of severity across a broad range of domains even compared with individuals with PTSD or AD only, yet treatment-seeking rates are very low. There is a need to improve treatment access and outcomes for individuals with PTSD-AD. © 2013 Elsevier Ireland Ltd.

Jonathan B. Bricker | Kristin E. Mull | Julie A. Kientz | Roger Vilardaga | Laina D. Mercer | Katrina J. Akioka | Jaimee L. Heffner

© 2014 Elsevier Ireland Ltd. Background: There is a dual need for (1) innovative theory-based smartphone applications for smoking cessation and (2) controlled trials to evaluate their efficacy. Accordingly, this study tested the feasibility, acceptability, preliminary efficacy, and mechanism of behavioral change of an innovative smartphone-delivered acceptance and commitment therapy (ACT) application for smoking cessation vs. an application following US Clinical Practice Guidelines. Method: Adult participants were recruited nationally into the double-blind randomized controlled pilot trial (n= 196) that compared smartphone-delivered ACT for smoking cessation application (SmartQuit) with the National Cancer Institute's application for smoking cessation (QuitGuide). Results: We recruited 196 participants in two months. SmartQuit participants opened their application an average of 37.2 times, as compared to 15.2 times for QuitGuide participants (p < 0001). The overall quit rates were 13% in SmartQuit vs. 8% in QuitGuide (OR = 2.7; 95% CI = 0.8-10.3). Consistent with ACT's theory of change, among those scoring low (below the median) on acceptance of cravings at baseline (n= 88), the quit rates were 15% in SmartQuit vs. 8% in QuitGuide (OR = 2.9; 95% CI = 0.6-20.7). Conclusions: ACT is feasible to deliver by smartphone application and shows higher engagement and promising quit rates compared to an application that follows US Clinical Practice Guidelines. As results were limited by the pilot design (e.g., small sample), a full-scale efficacy trial is now needed.

Karen Miotto | Joan Striebel | Arthur K. Cho | Christine Wang

Bath salts are designer drugs with stimulant properties that are a growing medical and psychiatric concern due to their widespread availability and use. Although the chemical compounds in the mixtures referred to as "bath salts" vary, many are derivatives of cathinone, a monoamine alkaloid. Cathinones have an affinity for dopamine, serotonin, and norepinephrine synapses in the brain. Because of the strong selection for these neurotransmitters, these drugs induce stimulating effects similar to those of methamphetamines, cocaine, and 3,4-methylenedioxy-N-methylamphetamine (MDMA). Much of the emerging information about bath salts is from emergency department evaluation and treatment of severe medical and neuropsychiatric adverse outcomes. This review consists of a compilation of case reports and describes the emergent literature that illustrates the chemical composition of bath salts, patterns of use, administration methods, medical and neuropsychiatric effects, and treatments of patients with bath salt toxicity. © 2013 Elsevier Ireland Ltd.

Harry Man Xiong Lai | Michelle Cleary | Thiagarajan Sitharthan | Glenn E. Hunt


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