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BackgroundSubstance use disorders (SUD) elevate the risk for COVID-19 hospitalization, but studies are inconsistent on the relationship of SUD to COVID-19 mortality.MethodsVeterans Health Administration (VHA) patients treated in 2019 and evaluated in 2020 for COVID-19 (n=5,556,315), of whom 62,303 (1.1%) tested positive for COVID-19 (COVID-19+). Outcomes were COVID-19+ by 11/01/20, hospitalization, ICU admission, or death within 60 days of a positive test. Main predictors were any ICD-10-CM SUDs, with substance-specific SUDs (cannabis, cocaine, opioid, stimulant, sedative) explored individually. Logistic regression produced unadjusted and covariate-adjusted odds ratios (OR; aOR).ResultsAmong COVID-19+ patients, 19.25% were hospitalized, 7.71% admitted to ICU, and 5.84% died. In unadjusted models, any SUD and all substance-specific SUDs except cannabis use disorder were associated with COVID-19+(ORs=1.06-1.85); adjusted models produced similar results. Any SUD and all substance-specific SUDs were associated with hospitalization (aORs: 1.24-1.91). Any SUD, cocaine and opioid disorder were associated with ICU admission in unadjusted but not adjusted models. Any SUD, cannabis, cocaine, and stimulant disorders were inversely associated with mortality in unadjusted models (OR=0.27-0.46). After adjustment, associations with mortality were no longer significant. In ad hoc analyses, adjusted odds of mortality were lower among the 49.9% of COVID-19+ patients with SUD who had SUD treatment in 2019, but not among those without such treatment.ConclusionsIn VHA patients, SUDs are associated with COVID-19 hospitalization but not COVID-19 mortality. SUD treatment may provide closer monitoring of care, ensuring that these patients received needed medical attention, enabling them to ultimately survive serious illness.

Background and Aims: Hallucinogen use is potentially harmful. Information on whether such use has increased in recent decades is lacking. This study assessed overall and age‐specific time trends in the prevalence of 12‐month hallucinogen use in the US general population. Design: Cross‐sectional. Setting: Data from the US National Survey on Drug Use and Health, 2002–19. Participants: Respondents aged ≥ 12 years (n = 1 006 051). Measurements Predictors were continuous years. Outcome variables included any hallucinogen use and use of lysergic acid diethylamide (LSD), ecstasy and phencyclidine (PCP) in the past year. Socio‐demographic variables (gender, age, race/ethnicity, educational level and family income) were covariates. Findings Overall, hallucinogen use increased between 2015 and 2019 [prevalence difference (PD) = +0.44, P < 0.05]. Since 2002, hallucinogen use has increased in adults aged ≥ 26 years (PD, 2002–14 = +0.24, P < 0.05; PD, 2015–19 = +0.45, P < 0.001) and decreased in adolescents aged 12–17 years (PD, 2002–14 = −1.60, P < 0.0001; PD, 2015–19 = −0.73, P < 0.001). Ecstasy use has decreased in adolescents (PD, 2002–14 = −0.56, P < 0.001), adults aged 18–25 years (PD, 2015–19 = −0.96, P < 0.01) and ≥ 26 years (PD, 2015–19 = −0.13, P < 0.05). LSD use between 2002 and 2019 increased overall (PD = +0.71, P < 0.0001) and in all age groups (12–17: PD = +0.67, P < 0.001; 18–25: PD = +3.12, P < 0.0001; ≥ 26: PD = +0.36, P < 0.0001). Conversely, PCP use between 2002 and 2019 decreased overall (PD = –0.06, P < 0.001), in adolescents (PD = –0.24, P < 0.001) and young adults (PD = –0.32, P < 0.0001). Conclusions: Since 2002, hallucinogen use in the United States has decreased among adolescents but increased in adults and is now estimated to affect more than 3 million adults aged 26+ years and more than 5.5 million adults aged 18+ years. [ABSTRACT FROM AUTHOR]

Background: The DSM‐5 definition of alcohol use disorder (AUD) has been well validated, but information is lacking on the extent to which alcohol use, comorbidity, and impairment are associated with the 3 DSM‐5‐defined AUD severity levels: mild, moderate, and severe. This study examined clinical and functional characteristics as predictors (validators) of these severity levels. Methods: Participants aged ≥18 years reporting current problem substance use (N = 588) were recruited between 2016 and 2019 and assessed for DSM‐5 AUD and a set of potential validators: indicators of alcohol use severity (i.e., craving, binge drinking frequency, problematic use, and harmful drinking), psychiatric disorders, and functional impairment. Multinomial logistic regression models examined the association between the predictors and the 3 AUD severity levels (mild, moderate, and severe) vs the reference group, no AUD, controlling for sociodemographic characteristics and other substance use. Results: All alcohol use validators were associated with a greater likelihood of all 3 AUD severity levels compared with the no‐AUD group. However, psychiatric disorders were associated only with severe AUD and participants with major depression (aOR = 2.44), posttraumatic stress disorder (aOR = 1.65), borderline personality disorder (aOR = 1.99), and antisocial personality disorder (aOR = 1.78) had a greater likelihood of severe AUD than the no‐AUD group. Functioning validators were also associated only with severe AUD and participants with social (aOR = 1.87), physical (aOR = 1.62), or mental (aOR = 1.84) impairment had a greater likelihood of severe AUD than the no‐AUD group. Many alcohol‐related, psychiatric, and functioning validators were associated with greater odds of severe AUD than mild or moderate AUD. Conclusion: This study supports the criterion validity of the DSM‐5 tri‐categorical measure of AUD. Specifically, results fully supported the validity of severe AUD by its associations with all predictors, whereas the validity of mild and moderate AUD was supported only by alcohol use predictor variables. Findings suggest the value of using severity‐specific interventions utilizing the DSM‐5 AUD. [ABSTRACT FROM AUTHOR]

Background: Though high rates of co-occurring cannabis use and depression are well-documented, data regarding the association between cannabis use and dysthymia is scarce. The aim of this cross-sectional study was to explore clinical correlations of cannabis use among individuals with dysthymia, as well as the changes in the association between cannabis use and dysthymia across six decades of birth cohorts.Methods: Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III; 2012-2013; N = 36,309). Participants were divided into six birth cohorts (1940s-1990s), based on their decade of birth, and individuals with dysthymia were further categorized by 3 levels of lifetime cannabis use: non-users, non-CUD users, and CUD-users. We compared rates of co-occurring psychiatric and substance use disorders among cannabis users vs non-users and conducted logistic regression analyses in order to determine the odds of dysthymia among cannabis users across six decades.Results: Rates of several psychiatric disorders, such as personality disorders, and substance use disorders were higher among individuals with dysthymia who used cannabis compared to those who did not. The interaction between cannabis use (without a CUD) and birth cohort was associated with a decrease in the odds of dysthymia (OR=0.90, 95% CI 0.84-0.97) and remained significant after controlling for confounding variables. Similar changes over time were not demonstrated for CUD users.Limitations: Likelihood for recall bias and misclassification based on cross-sectional nature of the study and on respondents' self-reports of symptoms throughout their lifetime.Conclusions and Implications: Our study's findings demonstrate that the association between cannabis use (but not CUDs) and dysthymia has weakened over time. These findings highlight the need for further research examining changes over time in the relationship between cannabis use and associated psychiatric disorders. [ABSTRACT FROM AUTHOR]

Background: In DSM-5, definitions of substance use disorders (SUD) were changed considerably from DSM-IV, yet little is known about how well DSM-IV and DSM-5 SUD diagnoses agree among substance users. Because data from many studies are based on DSM-IV diagnostic criteria, understanding the agreement between DSM-5 and DSM-IV SUD diagnoses and reasons for discordance between these diagnoses is crucial for comparing results across studies.Measurements: Prevalences and chance-corrected agreement of DSM-5 SUD and DSM-IV substance dependence were evaluated in 588 substance users in a suburban inpatient addiction program and an urban medical center, using a semi-structured interview (PRISM-5). Alcohol, tobacco, cannabis, cocaine, heroin, opioid, sedative, and stimulant use disorders were examined. Cohen's kappa was used to assess agreement between DSM-5 and DSM-IV SUD (abuse or dependence), DSM-5 SUD and DSM-IV dependence, and DSM-5 moderate/severe SUD and DSM-IV dependence.Results: Agreement between DSM-5 and DSM-IV SUD was excellent for all substances (κ = 0.84-0.99), except for cannabis and tobacco (κ = 0.75; 0.80, respectively). The most common reason for diagnostic discrepancies was a positive DSM-5 SUD diagnosis but no DSM-IV diagnosis, due to the lowered DSM-5 SUD threshold. Agreement between DSM-5 SUD and DSM-IV dependence was excellent for all substances (κ = 0.88-0.94), except for alcohol, tobacco, and cannabis (κ = 0.63-0.75). Agreement between moderate/severe DSM-5 SUD and DSM-IV dependence was excellent across all substances.Conclusion: While care should be used in interpreting results of studies using different methods, studies relying on DSM-IV or DSM-5 SUD diagnostic criteria offer similar information and thus can be compared when accumulating a body of evidence. [ABSTRACT FROM AUTHOR]

Background: In recent decades, the US religious landscape has undergone considerable change such as a decline in religious service attendance. These changes may indicate that religious social support structures have deteriorated, possibly leading to a decrease in strengths of associations with substance use. Considering this, and given limitations of past studies (e.g., limited control for potential confounders), large-scale general population studies are needed to reexamine associations between religiosity domains and substance use.Methods: This cross-sectional study used data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (N = 36,309). In unadjusted and adjusted models, controlling for religiosity domains and other covariates, we examined associations between three religiosity domains (importance of religiosity/spirituality, service attendance, and religious affiliation) and DSM-5 SUD. Focusing on service attendance, we also examined associations with other substance use-related outcomes.Results: Among religiosity domains, only frequency of service attendance was associated with SUD across most substances. Frequent service attendees had lower odds of alcohol use disorder (adjusted OR [aOR] = 0.4, 95 % CI 0.33,0.51), tobacco use disorder (aOR = 0.3, 95 % CI 0.22,0.33) and cannabis use disorder (aOR = 0.4, 95 % CI 0.24,0.68), compared to non-service attendees. For alcohol and tobacco, the protective effect of frequent service attendance was more robust for SUD than for respective substance use.Conclusions: Despite decreasing rates of religious belief and practice in the US, service attendance independently lowered the odds of substance use and SUD across multiple substances. Results may inform religious leaders and clinicians about the value of utilizing religious social support structures in the prevention and treatment of substance use and SUD. [ABSTRACT FROM AUTHOR]

The DSM-5 definition of cannabis use disorder (CUD) differs from DSM-IV by combining abuse and dependence criteria (without the legal criterion) and including withdrawal and craving criteria. Information on construct validity of the DSM-5 CUD diagnosis and severity levels is lacking. This study examines the associations between DSM-5 CUD and severity classification and a set of concurrent validators. Adults with problematic substance use were recruited from two settings: a research setting in an urban medical center and a suburban inpatient addiction treatment program. Participants who reported past-year cannabis use (n = 392) were included in this study and completed a semi-structured, clinician-administered diagnostic interview. Regression models estimated the associations between binary DSM-5 CUD and severity levels with a set of validators, including cannabis use variables, psychopathology, and functional impairment. DSM-5 CUD and all severity levels were associated with cannabis use validators, including number of days used, self-reporting that cannabis use was a major problem, and greater cannabis craving. DSM-5 CUD and severe CUD were associated with other psychiatric disorders and social impairment. Findings add information about the validity of DSM-5 CUD diagnosis and severity levels, with severe CUD receiving the strongest support from its association with validators across all domains, as distinct from the mild and moderate CUD measures that were associated with cannabis-specific validators alone. Severe CUD is likely to require more intensive treatment to bolster physical, psychiatric, and social functioning, whereas the mild and moderate severity thresholds provide useful information for identifying less severe disorders for prevention and brief intervention. [ABSTRACT FROM AUTHOR]

Objective: We examined the prevalence of risky alcohol and cannabis use among Brazilian varsity college athletes and whether this group had a greater likelihood of risky use than non-athletes. Methods: In 2009, Brazilian college students (n=12,711) were recruited for a national stratified random survey. Their sociodemographic characteristics, mental health, substance use, and participation in varsity sports were assessed. Binary logistic regression models were used to examine the association between varsity athlete status and moderate to high-risk alcohol and cannabis use. Results: Among varsity athletes, 67.6 and 10.7% reported risky alcohol and cannabis use, respectively. Varsity athletes had greater odds of risky alcohol consumption than non-athletes (aOR = 2.02, 95%CI 1.08-3.78). Varsity athletes also had greater odds of risky cannabis use than non-athletes in unadjusted analyses (OR = 2.57, 95%CI 1.05-6.28), although this relationship was attenuated after covariate adjustment. Conclusions: Among college students in Brazil, varsity athletes had a higher prevalence of risky alcohol and cannabis use than non-athletes. The rates were considerably higher than those observed among samples of U.S. college athletes. Future research should examine the use of these substances among varsity college athletes in other middle-income countries since these findings will likely guide prevention and treatment efforts. [ABSTRACT FROM AUTHOR]

Background: Substance use disorders (SUD) elevate the risk for COVID-19 hospitalization, but studies are inconsistent on the relationship of SUD to COVID-19 mortality.Methods: Veterans Health Administration (VHA) patients treated in 2019 and evaluated in 2020 for COVID-19 (n=5,556,315), of whom 62,303 (1.1%) tested positive for COVID-19 (COVID-19+). Outcomes were COVID-19+ by 11/01/20, hospitalization, ICU admission, or death within 60 days of a positive test. Main predictors were any ICD-10-CM SUDs, with substance-specific SUDs (cannabis, cocaine, opioid, stimulant, sedative) explored individually. Logistic regression produced unadjusted and covariate-adjusted odds ratios (OR; aOR).Results: Among COVID-19+ patients, 19.25% were hospitalized, 7.71% admitted to ICU, and 5.84% died. In unadjusted models, any SUD and all substance-specific SUDs except cannabis use disorder were associated with COVID-19+(ORs=1.06-1.85); adjusted models produced similar results. Any SUD and all substance-specific SUDs were associated with hospitalization (aORs: 1.24-1.91). Any SUD, cocaine and opioid disorder were associated with ICU admission in unadjusted but not adjusted models. Any SUD, cannabis, cocaine, and stimulant disorders were inversely associated with mortality in unadjusted models (OR=0.27-0.46). After adjustment, associations with mortality were no longer significant. In ad hoc analyses, adjusted odds of mortality were lower among the 49.9% of COVID-19+ patients with SUD who had SUD treatment in 2019, but not among those without such treatment.Conclusions: In VHA patients, SUDs are associated with COVID-19 hospitalization but not COVID-19 mortality. SUD treatment may provide closer monitoring of care, ensuring that these patients received needed medical attention, enabling them to ultimately survive serious illness. [ABSTRACT FROM AUTHOR]