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Aim: To examine dual trajectories of anxiety/depression symptoms and alcohol use among drug-using youth seeking care from an urban emergency department (ED), their baseline correlates and co-occurring trajectories of severe violence., Short Summary: There were five characteristic dual trajectories of alcohol use and depression/anxiety symptoms. Community violence exposure was highest among individuals with high-depression/anxiety symptom trajectories. Individuals with concurrently high-alcohol use and depression/anxiety symptom trajectories reported that the most delinquent peer affiliations, and had the highest rates of severe violence over time., Methods: We analyzed data from 599 drug-using (primarily marijuana) youth ages 14-24 (349 assault-injured) recruited from December 2009 to September 2011 into a 24-month longitudinal study at a Level-1 ED in Flint, Michigan. Youth self-reported substance use, depression and anxiety symptoms, peer/parental behaviors, and severe violence involvement at baseline and four biannual follow-up assessments. Bivariate latent trajectory models identified homogeneous groups with similar trajectories on alcohol use and anxiety/depression symptoms; we compared baseline characteristics of each trajectory group and concurrent trajectories of severe violence (victimization and aggression)., Results: Our model identified five trajectory groups: Low drinking/No symptoms (LN; 10.4%; n = 62), No drinking/Moderate symptoms (NM; 15.7%; n = 94), Low drinking/Moderate symptoms (LM; 30.2%; n = 181), Low drinking/High symptoms (LH; 16.4%; n = 98) and High drinking/High symptoms (HH; 27.5%; n = 164). The HH group was characterized by more delinquent peer associations, and rates of community violence were higher among the high symptom groups. The HH group had the highest severe violence perpetration and victimization rates across time points; the LH group had similar violence rates to the LM and NM groups and the LN group had the lowest violence rates across time., Conclusions: Among drug-using youth, alcohol use interventions could benefit from a focus on peer influences, and those with a joint focus on violence involvement may be improved via inclusion of content related to mental health and community violence exposure.

Introduction: Chronic pain is the most common reason for medical cannabis certification. Data regarding alcohol use and risky drinking among medical cannabis patients with pain is largely unknown. Therefore, we examined the prevalence and correlates of alcohol use and risky drinking in this population., Methods: Participants completed surveys regarding demographics, pain-related variables, anxiety, cannabis use, and past six-month alcohol consumption. Alcohol use groups were defined using the AUDIT-C [i.e., non-drinkers, low-risk drinkers, and high-risk drinkers (≥4 for men and ≥3 for women)] and compared on demographic characteristics, pain measures, anxiety, and cannabis use., Results: Overall, 42% (n=330/780) were non-drinkers, 32% (n=251/780) were low-risk drinkers, and 26% (n=199/780) were high-risk drinkers. Compared to non-drinkers, low- and high-risk drinkers were significantly younger whereas a larger proportion of low-risk drinkers reported being African-American compared to non- or high-risk drinkers. High-risk drinkers reported significantly lower pain severity/interference compared to the other groups; high-risk drinkers were also less likely to be on disability compared to other groups. A multinomial logistic regression showed that patients reporting lower pain severity and less disability had greater odds of being classified a high-risk drinker., Conclusions: High-risk drinking appears common among medical cannabis patients. Future research should examine whether such use is concurrent or consecutive, and the relationship of such co-use patterns to consequences. Nevertheless, individuals treating patients reporting medical cannabis use for pain should consider alcohol consumption, with data needed regarding the efficacy of brief alcohol interventions among medical cannabis patients., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Little is known about the impact of motherhood on alcohol use beyond the acute reductions observed in pregnancy. This study characterizes changes in alcohol use for women who did and did not become mothers over three years., Methods: Data are from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC). Participants were female respondents aged 18-44 years who did not have children and were not pregnant at wave 1, and who reported having at least one drink in the year prior to wave 1 (n=2118). Women were classified as mothers (n=325) if they reported having a child between waves 1 and 2, and non-mothers if they did not (n=1793). At each wave, participants provided information on past-year frequency of alcohol use and heavy episodic drinking, and usual number of alcoholic beverages consumed per occasion., Results: At baseline, women who did and did not become mothers reported similar levels of alcohol use. Women who became mothers reported significant reductions in alcohol use indicators from wave 1 to wave 2 (i.e., 22 fewer drinking days, 15 fewer heavy drinking days, 1 less drink per occasion), whereas women who did not become mothers showed a modest increase in alcohol use frequency (i.e., 7 more drinking days). Motherhood remained significantly associated with reductions in alcohol use after adjusting for sociodemographic variables and baseline alcohol use., Conclusions: The transition to motherhood is associated with marked reductions in alcohol consumption. Similar reductions were not observed for women who did not become mothers., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Internationally, sporting events represent a specific context in which heavy episodic drinking is common. The current study assessed determinants of heavy episodic drinking among tailgaters (i.e., individuals engaging in pre-game social festivities) prior to American football games at two large universities. A total of 466 individuals at two universities completed a short interview and provided a breathalyzer sample to estimate breath alcohol content (BrAC) during the tailgating window (150min prior to and 10min after the start of the game). The plurality of participants, 48.5% at the southeastern university (School1) and 58.8% at the midwestern university (School2), engaged in heavy episodic drinking. Only 54 individuals (11.6%) from the combined sample at both universities abstained from alcohol (confirmed via BrAC). In total, 40.2% of participants at School1 and 31.9% at School2 produced breath samples over the legal limit for driving (i.e., BrAC=0.08 or higher). In site-specific regression analyses, younger ages, males, and non-students at School1, and younger ages and non-game attendance at School2 were associated with self-reported heavy episodic drinking and higher levels of estimated BrAC (p<0.05). Given the widespread participation in heavy episodic drinking among both students and non-students in this sample, public health interventions should be implemented both on- and off-campus to promote safety and to discourage heavy episodic drinking at American football games and other high-profile sporting events., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Introduction: There is evidence suggesting that certain subgroups of people who use tobacco do not receive tobacco pharmacology as consistently as others.Methods: This retrospective, cohort study examined the trend in the use of cessation pharmacotherapy from 2004 to 2013 using Veterans Health Administration (VHA) administrative data. Among Veterans who used tobacco in the fiscal year (FY) 2011 and had not received pharmacotherapy in the prior year, multivariable Cox regression was used to assess the independent associations between patient clinical and demographic characteristics and pharmacotherapy initiation in the 6-months follow-up period.Results: Smoking cessation pharmacotherapy in the VHA increased from 13.8% in 2004 to 25.6% in 2013. In 2011, Veterans (N = 838309) who were more likely to newly receive pharmacotherapy included those with psychiatric disorders (depression, bipolar disorder, non-alcohol substance use disorder, other anxiety, and post-traumatic stress disorder), chronic pulmonary disease, peripheral vascular disorders, and younger Veterans (adjusted rate ratios (ARRs) ranged from 1.03 to 1.92, all p < .001). Veterans less likely to receive pharmacotherapy were those with schizophrenia or other psychosis, males, Hispanics, and those with a medical condition (uncomplicated diabetes, uncomplicated hypertension, fluid and electrolyte disorders, cardiac arrhythmia, valvular disease, hypothyroidism, acquired immunodeficiency syndrome/human immunodeficiency virus, deficiency anemia, renal failure, paralysis, coagulopathy, metastatic cancer, and other neurological disorders) (ARRs ranged from 0.74 to 0.93, all p < .001).Conclusions: Although VHA cessation pharmacotherapy use nearly doubled from 13.8% in 2004 to 25.6% in 2013, reaching undertreated subgroups, especially those with medical comorbidities, may improve cessation outcomes.Implications: Despite evidence that demographics influence the use of pharmacotherapy in smoking cessation, there is limited and contradictory information regarding how psychiatric and chronic medical illnesses affect pharmacotherapy use. Administrative data were used to determine trends and patient characteristics of those receiving pharmacotherapy to aid in smoking cessation in the Veterans Health Administration. From 2004 to 2013, pharmacotherapy use increased from 13.8% to 25.6% of current smokers. Factors associated with increased pharmacotherapy initiation were psychiatric disorders, chronic pulmonary disease, peripheral vascular disorders, and younger age. Veterans with schizophrenia or other psychosis, males, Hispanics, and most medical conditions were less likely to receive pharmacotherapy. [ABSTRACT FROM AUTHOR]

Background and Aims Limited information is available regarding links between specific substance use disorders (SUDs) and suicide mortality; however, the preliminary evidence that is available suggests that suicide risk associated with SUDs may differ for men and women. This study aimed to estimate associations between SUDs and suicide for men and women receiving Veterans Health Administration (VHA) care. Design A cohort study using national administrative health records. Setting National VHA system, USA. Participants All VHA users in fiscal year (FY) 2005 who were alive at the beginning of FY 2006 ( n = 4 863 086). Measurements The primary outcome of suicide mortality was assessed via FY 2006-2011 National Death Index (NDI) records. Current SUD diagnoses were the primary predictors of interest, and were assessed via FY 2004-2005 VHA National Patient Care Database (NPCD) records. Findings In unadjusted analyses, a diagnosis of any current SUD and the specific current diagnoses of alcohol, cocaine, cannabis, opioid, amphetamine and sedative use disorders were all associated significantly with increased risk of suicide for both males and females [hazard ratios (HRs)] ranging from 1.35 for cocaine use disorder to 4.74 for sedative use disorder for men, and 3.89 for cannabis use disorder to 11.36 for sedative use disorder for women]. Further, the HR estimates for the relations between any SUD, alcohol, cocaine and opioid use disorders and suicide were significantly stronger for women than men ( P < 0.05). After adjustment for other factors, most notably comorbid psychiatric diagnoses, associations linking SUDs with suicide were attenuated markedly and the greater suicide risk among females was observed for only any SUD and opioid use disorder ( P < 0.05). Conclusions Current substance use disorders (SUDs) signal increased suicide risk, especially among women, and may be important markers to consider including in suicide risk assessment strategies. None the less, other co-occurring psychiatric disorders may partially explain associations between SUDs and suicide, as well as the observed excess suicide risk associated with SUDs among women. [ABSTRACT FROM AUTHOR]

Purpose: To examine the prevalence and correlates of vaporization (i.e., "vaping") as a route of cannabis administration in a sample of medical cannabis patients.Procedures: Adults ages 21 and older (N=1485M age=45.1) who were seeking medical cannabis certification (either for the first time or as a renewal) at medical cannabis clinics in southern Michigan completed a screening assessment. Participants completed measures of route of cannabis administration, cannabis use, alcohol and other substance use.Findings: An estimated 39% (n=511) of the sample reported past-month cannabis vaping, but vaping as the sole route of cannabis administration was rare. Specifically, only 30 participants (2.3% of the full sample and 5.9% of those who reported any vaping) indicated vaping as the sole route of cannabis administration. The majority (87.3%) of those who reported vaping also reported smoking (combustion) as a route of cannabis administration. Being younger than age 44, having more than a high school education, engaging in nonmedical stimulant use, being a returning medical cannabis patient, and greater frequency of cannabis use were associated with higher odds of vaping at the bivariate level and with all variables considered simultaneously.Conclusions: Vaping appears to be relatively common among medical cannabis patients, but is seldom used as the sole route of cannabis administration.Results: highlight the importance of monitoring trends in vaping and other substance use behaviors in this population and underscore the need for longitudinal research into the motives, correlates, and consequences of cannabis vaping in medical cannabis patients. [ABSTRACT FROM AUTHOR]

Background: There is limited data on the extent to which indicated alcohol interventions are delivered in U.S. ambulatory care settings.Objective: To assess the receipt of alcohol-related services, including assessment of use, advice to reduce drinking, and information about alcohol treatment, during ambulatory care visits.Design: Secondary data analysis of the 2013 National Survey on Drug Use and Health, a cross-sectional, nationally representative survey of civilians in the non-institutionalized U.S. general population (response rate 71.7 %).Participants: Adult ambulatory care users in the public use data file who did not obtain emergency or inpatient services (n = 17,266).Main Measures: Measurements included respondents' alcohol consumption, heavy episodic drinking, alcohol use disorder, healthcare use, and receipt of alcohol-related interventions.Key Results: Approximately 71.1 % of ambulatory care users received an alcohol assessment. Among past-month heavy episodic drinkers without an alcohol use disorder who reported receiving an alcohol assessment, 4.4 % were advised to cut back. Among individuals with alcohol abuse and alcohol dependence who reported receiving an alcohol assessment, 2.9 % and 7.0 %, respectively, were offered information about treatment.Conclusions: Rates of alcohol screening and assessment were relatively high among adults who attended healthcare visits, but rates of intervention were low, even when individuals were assessed for use. Efforts are needed to expand delivery of interventions when patients are identified as positive for risky drinking, hazardous alcohol use, and alcohol use disorders during ambulatory care visits. [ABSTRACT FROM AUTHOR]

Abstract: Background: Prior studies of Veterans have linked posttraumatic stress disorder (PTSD) with an increased risk of mortality. Other studies of Veterans have found that substance use disorders (SUDs) are associated with an excess risk of mortality among those with psychiatric disorders. It is not known whether having an SUD increases the risk of mortality among Veterans with PTSD, and whether the association differs by mortality type or varies by age cohort. Methods: A cohort of patients who received Veterans Health Administration services during fiscal year (FY) 2004 and diagnosed with PTSD (n =272,509) were followed from FY 2005 through FY 2007 for the main outcomes of mortality and cause of death. Results: SUD was positively associated with mortality during follow-up (adjusted hazards ratio: 1.70; 95% confidence interval: 1.64, 1.77). SUD was a stronger predictor of non-injury-related mortality for the <45 years group compared with the 45–64 or ≥65 group. SUD predicted injury-related mortality for all age groups. Conclusions: Among Veterans with PTSD, the association between SUD and mortality was most pronounced for the youngest age group, which included Iraq/Afghanistan Veterans. For older age groups, which included Vietnam-era Veterans, SUD was a greater predictor of injury-related mortality. The findings could be useful for identifying PTSD patients at excess risk of mortality. [Copyright &y& Elsevier]

Background: Driving under the influence of cannabis (DUIC) is a public health concern among those using medical cannabis. Understanding behaviors contributing to DUIC can inform prevention efforts. We evaluated three past 6-month DUIC behaviors among medical cannabis users with chronic pain.Methods: Adults (N = 790) seeking medical cannabis certification or recertification for moderate/severe pain were recruited from February 2014 through June 2015 at Michigan medical cannabis clinics. About half of participants were male (52%) and 81% were White; their Mean age was 45.8 years. Participants completed survey measures of DUIC (driving within 2 h of use, driving while "a little high," and driving while "very high") and background factors (demographics, alcohol use, etc.). Unadjusted and adjusted logistic regressions were used to examine correlates of DUIC.Results: For the past 6 months, DUIC within 2 h of use was reported by 56.4% of the sample, DUIC while a "little high" was reported by 50.5%, and "very high" was reported by 21.1%. Greater cannabis quantity consumed and binge drinking were generally associated with DUIC behaviors. Higher pain was associated with lower likelihood of DUIC. Findings vary somewhat across DUIC measures.Conclusions: The prevalence of DUIC is concerning, with more research needed on how to best measure DUIC. Prevention messaging for DUIC may be enhanced by addressing alcohol co-consumption. [ABSTRACT FROM AUTHOR]

Background: Compared to civilians, little is known about cannabis use among Veterans in the general United States (US) population. This study aimed to examine the prevalence and correlates of recent medical and non-medical cannabis use among this important US sub-population.Method: Data came from the 2014 National Survey on Drug Use and Health. Bivariate and multivariable analyses were conducted that were weighted to account for the complex survey design.Results: Approximately 9% of Veterans in the US reported past year cannabis use. Older, and female, Veterans had lower odds of past year cannabis use. Veterans who were unmarried, out of the work force, had greater functioning disability, nicotine dependence, heavy episodic alcohol use, alcohol use disorder, and drug use had greater odds of past year cannabis use. In states where medical cannabis was legal in 2014, approximately 41% of Veterans who used cannabis in the past year used medically. Those who used medically were older and less likely to engage in recent heavy episodic drinking or to meet criteria for alcohol abuse/dependence, compared to Veterans using non-medically.Conclusion: Compared to non-Veterans in the US general population, recent cannabis use was similar or slightly lower among Veterans. However, among those with past year use, the proportion of those using medically was more than double that of the general population. Because only non-medical cannabis use was associated with higher rates of heavy episodic alcohol use and alcohol use disorder, it may be important to address problematic alcohol consumption among this high-risk group. [ABSTRACT FROM AUTHOR]

Objectives: Cannabis has been legalized for medical use in almost half of the states in the U.S. Although laws in these states make the distinction between medical and recreational use of cannabis, the prevalence of people using medical cannabis and how distinct this group is from individuals using cannabis recreationally is unknown at a national level.Methods: Data came from the 2013 National Survey on Drug Use and Health (NSDUH). All adults endorsing past year cannabis use who reported living in a state that had legalized medical cannabis were divided into recreational cannabis use only and medical cannabis use. Demographic and clinical characteristics were compared across these two groups.Results: 17% of adults who used cannabis in the past year used cannabis medically. There were no significant differences between those who used medically versus recreationally in race, education, past year depression and prevalence of cannabis use disorders. In adjusted analyses, those with medical cannabis use were more likely to have poorer health and lower levels of alcohol use disorders and non-cannabis drug use. A third of those who reported medical cannabis use endorsed daily cannabis use compared to 11% in those who reported recreational use exclusively.Conclusions: Adults who use medical and recreational cannabis shared some characteristics, but those who used medical cannabis had higher prevalence of poor health and daily cannabis use. As more states legalize cannabis for medical use, it is important to better understand similarities and differences between people who use cannabis medically and recreationally. [ABSTRACT FROM AUTHOR]