On Drugs
The Effect of Medical Marijuana Laws on Marijuana, Alcohol, and Hard Drug Use
Hefei Wen, Jason Hockenberry & Janet Cummings
NBER Working Paper, May 2014
Abstract:
21 states and the District of Columbia currently have laws that permit marijuana use for medical purposes, often termed medical marijuana laws (MMLs). We tested the effects of MMLs adopted in seven states between 2004 and 2011 on adolescent and adult marijuana, alcohol, and hard drug use. We employed a restricted-access version of the National Survey on Drug Use and Health (NSDUH) micro-level data with geographic identifiers. For those 21 and older, we found that MMLs led to a relative increase in the probability of marijuana use of 16 percent, an increase in marijuana use frequency of 12-17 percent, and an increase in the probability of marijuana abuse/dependence of 15-27 percent. For those 12-20 years old, we found a relative increase in marijuana use initiation of 5-6 percent. Among those aged 21 or above, MMLs increased the frequency of binge drinking by 6-9 percent, but MMLs did not affect drinking behavior among those 12-20 years old. MMLs had no discernible impact on hard drug use in either age group. Taken together, MML implementation increases marijuana use mainly among those over 21, where there is also a spillover effect of increased binge drinking, but there is no evidence of spillovers to other substance use.
----------------------
The Dow is Killing Me: Risky Health Behaviors and the Stock Market
Chad Cotti, Richard Dunn & Nathan Tefft
Health Economics, forthcoming
Abstract:
We investigate how risky health behaviors and self-reported health vary with the Dow Jones Industrial Average (DJIA) and during stock market crashes. Because stock market indices are leading indicators of economic performance, this research contributes to our understanding of the macroeconomic determinants of health. Existing studies typically rely on the unemployment rate to proxy for economic performance, but this measure captures only one of many channels through which the economic environment may influence individual health decisions. We find that large, negative monthly DJIA returns, decreases in the level of the DJIA, and stock market crashes are widely associated with worsening self-reported mental health and more cigarette smoking, binge drinking, and fatal car accidents involving alcohol. These results are consistent with predictions from rational addiction models and have implications for research on the association between consumption and stock prices.
----------------------
Life Stress in Adolescence Predicts Early Adult Reward-related Brain Function and Alcohol Dependence
Melynda Casement et al.
Social Cognitive and Affective Neuroscience, forthcoming
Abstract:
Stressful life events increase vulnerability to problematic alcohol use, and they may do this by disrupting reward-related neural circuitry. This is particularly relevant for adolescents because alcohol use rises sharply after mid-adolescence and alcohol abuse peaks at age 20. Adolescents also report more stressors compared to children, and neural reward circuitry may be especially vulnerable to stressors during adolescence due to prefrontal cortex remodeling. Using a large sample of male participants in a longitudinal fMRI study (N = 157), we evaluated whether cumulative stressful life events between the ages of 15 and 18 were associated with reward-related brain function and problematic alcohol use at age 20. Higher cumulative stressful life events during adolescence were associated with decreased response in the medial prefrontal cortex (mPFC) during monetary reward anticipation and following the receipt of monetary rewards. Stress-related decreases in mPFC response during reward anticipation and following rewarding outcomes were associated with the severity of alcohol dependence. Furthermore, mPFC response mediated the association between stressful life events and later symptoms of alcohol dependence. These data are consistent with neurobiological models of addiction that propose that stressors during adolescence increase risk for problematic alcohol use by disrupting reward circuit function.
----------------------
Cannabis use and violence: Is there a link?
Thor Norström & Ingeborg Rossow
Scandinavian Journal of Public Health, June 2014, Pages 358-363
Background: While several studies suggest that cannabis users are at increased risk of interpersonal violence, it is not clear to what extent the association is causal. Our paper aims to assess the association between cannabis use and violence by using a method that diminishes the risk of confounding.
Methods: We analysed data on cannabis use and violent behaviour from the second (1994) and third (1999) waves of the Young in Norway Longitudinal Study (cumulative response rate: 68.1%, n = 2681). We applied fixed-effects modelling to estimate the association between these behaviours, implying that changes in the frequency of violence were regressed on changes in the frequency of cannabis use. The effects of time-invariant confounders were hence eliminated. In addition, we included two time-varying covariates.
Results: The elasticity estimate implies that a 10% increase in cannabis use frequency is associated with a 0.4% increase in frequency of violence (p=.024).
Conclusions: Analyses of panel data on Norwegian youths reveals a statistically significant association between cannabis use and violence.
----------------------
Is Smoking Inferior? Evidence from Variation in the Earned Income Tax Credit
Donald Kenkel, Maximilian Schmeiser & Carly Urban
NBER Working Paper, May 2014
Abstract:
In this paper we estimate the causal income elasticity of smoking participation, cessation, and cigarette demand conditional upon participation. Using an instrumental variables (IV) estimation strategy we find that smoking appears to be a normal good among low-income adults: higher instrumented income is associated with an increase in the number of cigarettes consumed and a decrease in smoking cessation. The magnitude and direction of the changes in the income coefficients from our OLS to IV estimates are consistent with the hypothesis that correlational estimates between income and smoking related outcomes are biased by unobservable characteristics that differentiate higher income smokers from lower income smokers.
----------------------
Joseph Schuermeyer et al.
Drug and Alcohol Dependence, forthcoming
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 (2003-2011) 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.
----------------------
The Changing Face of Heroin Use in the United States: A Retrospective Analysis of the Past 50 Years
Theodore Cicero et al.
JAMA Psychiatry, forthcoming
Design, Setting, and Participants: Using a mixed-methods approach, we analyzed (1) data from an ongoing study that uses structured, self-administered surveys to gather retrospective data on past drug use patterns among patients entering substance abuse treatment programs across the country who received a primary (DSM-IV) diagnosis of heroin use/dependence (n = 2797) and (2) data from unstructured qualitative interviews with a subset of patients (n = 54) who completed the structured interview.
Main Outcomes and Measures: In addition to data on population demographics and current residential location, we used cross-tabulations to assess prevalence rates as a function of the decade of the initiation of abuse for (1) first opioid used (prescription opioid or heroin), (2) sex, (3) race/ethnicity, and (4) age at first use. Respondents indicated in an open-ended format why they chose heroin as their primary drug and the interrelationship between their use of heroin and their use of prescription opioids.
Results: Approximately 85% of treatment-seeking patients approached to complete the Survey of Key Informants’ Patients Program did so. Respondents who began using heroin in the 1960s were predominantly young men (82.8%; mean age, 16.5 years) whose first opioid of abuse was heroin (80%). However, more recent users were older (mean age, 22.9 years) men and women living in less urban areas (75.2%) who were introduced to opioids through prescription drugs (75.0%). Whites and nonwhites were equally represented in those initiating use prior to the 1980s, but nearly 90% of respondents who began use in the last decade were white. Although the “high” produced by heroin was described as a significant factor in its selection, it was often used because it was more readily accessible and much less expensive than prescription opioids.
Conclusion and Relevance: Our data show that the demographic composition of heroin users entering treatment has shifted over the last 50 years such that heroin use has changed from an inner-city, minority-centered problem to one that has a more widespread geographical distribution, involving primarily white men and women in their late 20s living outside of large urban areas.
----------------------
Portrayal of Alcohol Consumption in Movies and Drinking Initiation in Low-Risk Adolescents
Reiner Hanewinkel et al.
Pediatrics, forthcoming
Objectives: To investigate the hypothesis that exposure to alcohol consumption in movies affects the likelihood that low-risk adolescents will start to drink alcohol.
Methods: Longitudinal study of 2346 adolescent never drinkers who also reported at baseline intent to not to do so in the next 12 months (mean age 12.9 years, SD = 1.08). Recruitment was carried out in 2009 and 2010 in 112 state-funded schools in Germany, Iceland, Italy, Netherlands, Poland, and Scotland. Exposure to movie alcohol consumption was estimated from 250 top-grossing movies in each country in the years 2004 to 2009. Multilevel mixed-effects Poisson regressions assessed the relationship between baseline exposure to movie alcohol consumption and initiation of trying alcohol, and binge drinking (≥ 5 consecutive drinks) at follow-up.
Results: Overall, 40% of the sample initiated alcohol use and 6% initiated binge drinking by follow-up. Estimated mean exposure to movie alcohol consumption was 3653 (SD = 2448) occurrences. After age, gender, family affluence, school performance, TV screen time, personality characteristics, and drinking behavior of peers, parents, and siblings were controlled for, exposure to each additional 1000 movie alcohol occurrences was significantly associated with increased relative risk for trying alcohol, incidence rate ratio = 1.05 (95% confidence interval, 1.02–1.08; P = .003), and for binge drinking, incidence rate ratio = 1.13 (95% confidence interval, 1.06–1.20; P < .001).
Conclusions: Seeing alcohol depictions in movies is an independent predictor of drinking initiation, particularly for more risky patterns of drinking. This result was shown in a heterogeneous sample of European youths who had a low affinity for drinking alcohol at the time of exposure.
----------------------
Renske Koordeman, Doeschka Anschutz & Rutger Engels
Alcoholism, forthcoming
Background: This study examined the effects of alcohol portrayals on transportation and attitude toward a movie. In addition, we examined whether positive and negative movie alcohol portrayals affect transportation into and attitude toward the movie.
Methods: A within-subject design was used in which participants were exposed to 8 different movie clips containing alcohol (positive or negative context) or no alcohol portrayals in a controlled laboratory setting. A total of 159 college students (84 males and 75 females) ages 18 to 30 participated in the experiment. Transportation and attitude toward the movie were measured after each movie clip.
Results: Participants were more transported into and had a more positive attitude toward movie clips with alcohol portrayals compared to the same movie clips with no alcohol portrayal. In addition, participants were more transported into movie clips with negative alcohol (NA) portrayals compared to clips with positive alcohol (PA) portrayals. For attitude toward the movie, opposite results were found. Participants had a more positive attitudes toward clips with PA portrayals compared to clips with NA portrayals.
Conclusions: The way alcohol is portrayed in movies may contribute to how people evaluate and get transported in movies.
----------------------
Tobacco use vs. helminths in Congo basin hunter-gatherers: Self-medication in humans?
Casey Roulette et al.
Evolution and Human Behavior, forthcoming
Abstract:
We tested a novel hypothesis that recreational use of neurotoxic plants helps defend against parasites. Specifically, we investigated the relationship between smoking and helminthiasis among the Aka, a remote population of Central African foragers who are avid tobacco smokers, suffer high rates of helminthiasis, and have little-to-no access to commercial anthelmintics. Two hundred and six healthy Aka men provided saliva and stool samples. Saliva samples were assayed for cotinine, a nicotine metabolite; a subsample was genotyped for the CYP2A6 enzyme, which metabolizes nicotine. Stool samples were assayed for intestinal helminth eggs as an index of worm burden. After 1 year, a subsample of participants was located and provided additional saliva and stool samples. We found (1) an exceptionally high prevalence of tobacco use, (2) a strong negative correlation between cotinine (a nicotine metabolite) and worm burden, (3) that treating helminths with albendazole, a commercial anthelmintic, reduced cotinine concentration two weeks later, compared to placebo controls, (4) among treated participants, higher cotinine concentrations in year 1 predicted less reinfection by year 2, and (5) younger and older participants with slow nicotine-metabolizing CYP2A6 alleles had lower worm burdens compared to those with extensive metabolizing alleles. These results provide the first evidence of a link between helminthiasis and smoking. They also suggest that, in populations where intestinal helminths are endemic, tobacco use might protect against helminth infection and reduce worm burden among infected individuals, and that individuals modulate nicotine exposure in response to infection. The results thus support the hypothesis that substance use helps defend against parasites.
----------------------
Steven Haas & David Schaefer
Journal of Health and Social Behavior, June 2014, Pages 126-143
Abstract:
This study investigates whether peer influence on smoking among adolescents is asymmetrical. We hypothesize that several features of smoking lead peers to have a stronger effect on smoking initiation than cessation. Using data from the National Longitudinal Study of Adolescent Health we estimate a dynamic network model that includes separate effects for increases versus decreases in smoking, while also controlling for endogenous network change. We find that the impact of peer influence is stronger for the initiation of smoking than smoking cessation. Adolescents rarely initiate smoking without peer influence but will cease smoking while their friends continue smoking. We discuss the implications of these results for theories of peer influence and health policy.
----------------------
Nathalie Holz et al.
JAMA Psychiatry, forthcoming
Objective: To clarify the influence of maternal smoking during pregnancy (hereafter referred to as prenatal smoking) on the neural circuitry of response inhibition and its association with related behavioral phenotypes such as ADHD and novelty seeking in the mother’s offspring.
Design, Setting, and Participants: Functional magnetic resonance imaging was performed for the offspring at 25 years of age during a modified Eriksen flanker/NoGo task, and voxel-based morphometry was performed to study brain volume differences of the offspring. Prenatal smoking (1-5 cigarettes per day [14 mothers] or >5 cigarettes per day [24 mothers]) and lifetime ADHD symptoms were determined using standardized parent interviews at the offspring’s age of 3 months and over a period of 13 years (from 2 to 15 years of age), respectively. Novelty seeking was assessed at 19 years of age. Analyses were adjusted for sex, parental postnatal smoking, psychosocial and obstetric adversity, maternal prenatal stress, and lifetime substance abuse. A total of 178 young adults (73 males) without current psychopathology from a community sample followed since birth (Mannheim, Germany) participated in the study.
Results: Participants prenatally exposed to nicotine exhibited a weaker response in the anterior cingulate cortex (t168 = 4.46; peak Montreal Neurological Institute [MNI] coordinates x = −2, y = 20, z = 30; familywise error [FWE]–corrected P = .003), the right inferior frontal gyrus (t168 = 3.65; peak MNI coordinates x = 44, y = 38, z = 12; FWE-corrected P = .04), the left inferior frontal gyrus (t168 = 4.09; peak MNI coordinates x = −38, y = 36, z = 8; FWE-corrected P = .009), and the supramarginal gyrus (t168 = 5.03; peak MNI coordinates x = 64, y = −28, z = 22; FWE-corrected P = .02) during the processing of the NoGo compared to neutral stimuli, while presenting a decreased volume in the right inferior frontal gyrus. These findings were obtained irrespective of the adjustment of confounders, ADHD symptoms, and novelty seeking. There was an inverse relationship between inferior frontal gyrus activity and ADHD symptoms and between anterior cingulate cortex activity and novelty seeking.
Conclusions and Relevance: These findings point to a functional involvement of prenatal exposure to tobacco smoke in neural alterations similar to ADHD, which underlines the importance of smoking prevention treatments.
----------------------
Smoking Bans, Maternal Smoking and Birth Outcomes
Prashant Bharadwaj, Julian Johnsen & Katrine Løken
Journal of Public Economics, July 2014, Pages 72–93
Abstract:
An important externality of smoking is the harm it might cause to those who do not smoke. This paper examines the impact on birth outcomes of children of female workers who are affected by smoking bans in the workplace. Analyzing a 2004 law change in Norway that extended smoking restrictions to bars and restaurants, we find that children of female workers in restaurants and bars born after the law change saw significantly lower rates of being born below the very low birth weight (VLBW) threshold and were less likely to be born pre-term. We do not find an effect of the ban along other birth outcomes like APGAR scores and birth defects. Using detailed data on smoking status during pregnancy we find that most of the health benefits come from changes in smoking behavior of the mother. Using individual tax data, we find that the law change did not result in changes in earnings or employment opportunities for those affected, suggesting that the effects seen are likely a direct result of changes in smoke exposure in utero.
----------------------
Understanding the links between education and smoking
Vida Maralani
Social Science Research, forthcoming
Abstract:
This study extends the theoretical and empirical literature on the relationship between education and smoking by focusing on the life course links between experiences from adolescence and health outcomes in adulthood. Differences in smoking by completed education are apparent at ages 12 to 18, long before that education is acquired. I use characteristics from the teenage years, including social networks, future expectations, and school experiences measured before the start of smoking regularly to predict smoking in adulthood. Results show that school policies, peers, and youths’ mortality expectations predict smoking in adulthood but that college aspirations and analytical skills do not. I also show that smoking status at age 16 predicts both completed education and adult smoking, controlling for an extensive set of covariates. Overall, educational inequalities in smoking are better understood as a bundling of advantageous statuses that develops in childhood, rather than the effect of education producing better health.
----------------------
Trends in drug use among drivers killed in U.S. traffic crashes, 1999–2010
Toni Rudisill et al.
Accident Analysis & Prevention, September 2014, Pages 178–187
Objective: Driving under the influence of drugs is a global traffic safety and public health concern. This trend analysis examines the changes in general drug usage other than alcohol, broad categories, and typical prescription and illegal drugs among drivers fatally injured in motor vehicle crashes from 1999 to 2010 in the U.S.
Methods: Data from the Fatality Analysis Reporting System were analyzed from 1999 to 2010. Drug prevalence rates and prevalence ratios (PR) were determined comparing rates in 2009–2010 to 1999–2000 using a random effects model. Changes in general drug usage, broad categories, and representative prescription and illegal drugs including, methadone, oxycodone, hydrocodone, barbiturates, benzodiazepines, and cocaine, were explored.
Results: Comparing 2009–2010 to 1999–2000, prevalence of drug usage increased 49% (PR = 1.49; 95% confidence interval [CI] 1.42, 1.55). The largest increases in broad drug categories were narcotics (PR = 2.73; 95% CI 2.41, 3.08), depressants (PR = 2.01; 95% CI 1.80, 2.25), and cannabinoids (PR = 1.99; 95% CI 1.84, 2.16). The PR were 6.37 (95% CI 5.07, 8.02) for hydrocodone/oxycodone, 4.29 (95% CI 2.88, 6.37) for methadone, and 2.27 (95% CI 2.00, 2.58) for benzodiazepines. Barbiturates declined in rate over the 12-year period (PR = 0.53; 95% CI 0.37, 0.75). Cocaine use increased until 2005 then progressively declined, though the rate remained relatively unchanged (PR = 0.94; 95% CI 0.84, 1.06).
Conclusions: While more drivers are being tested and found drug-positive, there is evidence that a shift from illegal to prescription drugs may be occurring among fatally injured drivers in the U.S. Driving under the influence of prescription drugs is a growing traffic concern.
----------------------
Trends in fatal motor vehicle crashes before and after marijuana commercialization in Colorado
Stacy Salomonsen-Sautel et al.
Drug and Alcohol Dependence, forthcoming
Background: Legal medical marijuana has been commercially available on a widespread basis in Colorado since mid-2009; however, there is a dearth of information about the impact of marijuana commercialization on impaired driving. This study examined if the proportions of drivers in a fatal motor vehicle crash who were marijuana-positive and alcohol-impaired, respectively, have changed in Colorado before and after mid-2009 and then compared changes in Colorado with 34 non-medical marijuana states (NMMS).
Methods: Thirty-six 6-month intervals (1994–2011) from the Fatality Analysis Reporting System were used to examine temporal changes in the proportions of drivers in a fatal motor vehicle crash who were alcohol-impaired (≥ 0.08 g/dl) and marijuana-positive, respectively. The pre-commercial marijuana time period in Colorado was defined as 1994–June 2009 while July 2009–2011 represented the post-commercialization period.
Results: In Colorado, since mid-2009 when medical marijuana became commercially available and prevalent, the trend became positive in the proportion of drivers in a fatal motor vehicle crash who were marijuana-positive (change in trend, 2.16 (0.45), p < 0.0001); in contrast, no significant changes were seen in NMMS. For both Colorado and NMMS, no significant changes were seen in the proportion of drivers in a fatal motor vehicle crash who were alcohol-impaired.
Conclusions: Prevention efforts and policy changes in Colorado are needed to address this concerning trend in marijuana-positive drivers. In addition, education on the risks of marijuana-positive driving needs to be implemented.
----------------------
John Kingsbury, Frederick Gibbons & Meg Gerrard
British Journal of Health Psychology, forthcoming
Objectives: Many interventions targeting college student drinking have focused on negative health effects of drinking heavily; however, some research suggests that social factors may have a stronger influence on the drinking behaviour of young people. Moreover, few studies have examined message framing effects in the context of alcohol consumption. This study investigated the effects of social and health consequence framing on college students' intentions to engage in heavy drinking.
Methods: One hundred and twenty-four college students (74 women; Mage = 18.9) participated in this study for course credit. Participants read vignettes that were ostensibly written by a recent graduate from the university, who described an episode of drinking in which he or she experienced either social or health consequences. These consequences were framed as either a gain (i.e., positive consequences of not drinking heavily) or a loss (i.e., negative consequences of drinking heavily). After reading the vignette, participants completed a measure of heavy drinking intentions.
Results: Regression analyses revealed that social consequences were associated with lower heavy drinking intentions when framed as a loss and that health consequences were associated with lower heavy drinking intentions when framed as a gain. These effects were stronger among those who reported higher (vs. lower) levels of previous drinking.
Conclusions: Results suggest that interventions that focus on the negative health effects of heavy drinking may be improved by instead emphasizing the negative social consequences of drinking heavily and the positive health consequences of avoiding this behaviour.
----------------------
Yan Wang et al.
Journal of Adolescent Health, forthcoming
Purpose: To examine how prenatal drug exposure (PDE) to heroin/cocaine and behavioral problems relate to adolescent drug experimentation.
Methods: The sample included African-American adolescents (mean age = 14.2 years, SD = 1.2) with PDE (n = 73) and a nonexposed community comparison (n = 61). PDE status was determined at delivery through toxicology analysis and maternal report. Internalizing/externalizing problems were assessed during adolescence with the Behavior Assessment System for Children, Second Edition. Drug experimentation was assessed by adolescent report and urine analysis. Logistic regression evaluated the likelihood of drug experimentation related to PDE and behavioral problems, adjusting for age, gender, PDE, perceived peer drug use, and caregiver drug use. Interaction terms examined gender modification.
Results: Sixty-seven subjects (50%) used drugs: 25 (19%) used tobacco/alcohol only and 42 (31%) used marijuana/illegal drugs. Ninety-four subjects (70%) perceived peer drug use. PDE significantly increased the risk of tobacco/alcohol experimentation (odds ratio = 3.07, 95% confidence interval [CI] 1.09–8.66, p = .034) but not after covariate adjustment (adjusted odds ratio [aOR] = 1.16, 95% CI .31–4.33, p > .05). PDE was not related to the overall or marijuana/illegal drug experimentation. The likelihood of overall drug experimentation was doubled per SD increase in externalizing problems (aOR = 2.28, 95% CI 1.33–3.91, p = .003) and, among girls, 2.82 times greater (aOR = 2.82, 95% CI 1.34–5.94, p = .006) per SD increase in internalizing problems. Age and perceived peer drug use were significant covariates.
Conclusions: Drug experimentation was relatively common (50%), especially in the context of externalizing problems, internalizing problems (girls only), older age, and perceived peer drug use. Findings support the Problem Behavior Theory and suggest that adolescent drug prevention addresses behavioral problems and promotes prosocial peer groups.
----------------------
Self-Reported Lifetime Marijuana Use and Interleukin-6 Levels In Middle-Aged African Americans
Larry Keen, Deidre Pereira & William Latimer
Drug and Alcohol Dependence, forthcoming
Background: Research examining the relationship between marijuana and cytokine function has been well developed in the biochemical literature. However, scant literature exists regarding this relationship between inflammatory markers and marijuana use in public health or behavioral studies and is virtually nonexistent in non-neurologically compromised African American samples.
Methods. The current study examined the differences in serum interleukin-6 (IL-6), a proinflammatory cytokine, between non-drug users (n = 78), marijuana only users (n = 46) and marijuana plus other drugs users (n = 45) in a community-based sample of middle aged, African Americans. Participants included 169 African American adults (50.30% female), with a mean age of 45.68 years (SD = 11.72 years) from the Washington, DC metropolitan area. Serum was drawn upon entry into the study and the participants completed a demographic questionnaire, which included questions regarding drug use history.
Results. After adjusting for demographic and physiological covariates, analysis of covariance revealed a significant difference between the three groups, F(2,158) = 3.08, p = 0.04). Post hoc analyses revealed lifetime marijuana only users had significantly lower IL-6 levels (M = 2.20 pg/mL, SD = 1.93) than their lifetime nonuser counterparts (M = 3.73 pg/mL, SD = 6.28). No other comparisons among the groups were statistically significantly different.
Conclusion. The current findings extend previous cellular and biochemical literature, which identifies an inverse association between IL-6 and marijuana use. Examining this relationship in the psychological and behavioral literature could be informative to the development of clinical interventions for inflammatory diseases.
----------------------
The effect of retirement on alcohol consumption: Results from the US Health and Retirement Study
Xu Wang, Jessica Steier & William Gallo
European Journal of Public Health, June 2014, Pages 485-489
Background: Prior research examining the association between retirement and alcohol consumption is inconsistent with respect to salience, direction and magnitude. Reasonable conceptual arguments for both positive (e.g. coping, introduction of leisure time) and negative (e.g. severance of work-related social relationships) changes further complicate investigations of this critical association, as do differences in study design, national setting and measurement of alcohol use.
Methods: This prospective longitudinal study analyses 2-year wave-pairs drawn from seven waves (14 years) of data from the US Health and Retirement Study to assess the effect of complete retirement on weekly alcohol consumption (n = 9979 observations; 4674 unique participants). We use multiple regression analysis in a two-period follow-up design and account for potential selection bias and reverse causality not addressed in prior research on this topic.
Results: We find that retirement is positively associated with subsequent weekly alcohol consumption for men who reported drinking at both follow-up and the prior study wave (β = 1.9, 95% confidence interval = 0.43–3.36). No association was observed among women.
Conclusion: Our results suggest that health care professionals should monitor the drinking habits of retired men, as older individuals are particularly susceptible to the adverse effects of heavy alcohol use.
----------------------
A Smartphone Application to Support Recovery From Alcoholism: A Randomized Clinical Trial
David Gustafson et al.
JAMA Psychiatry, May 2014, Pages 566-572
Objective: To determine whether patients leaving residential treatment for alcohol use disorders with a smartphone application to support recovery have fewer risky drinking days than control patients.
Design, Setting, and Participants: An unmasked randomized clinical trial involving 3 residential programs operated by 1 nonprofit treatment organization in the Midwestern United States and 2 residential programs operated by 1 nonprofit organization in the Northeastern United States. In total, 349 patients who met the criteria for DSM-IV alcohol dependence when they entered residential treatment were randomized to treatment as usual (n = 179) or treatment as usual plus a smartphone (n = 170) with the Addiction–Comprehensive Health Enhancement Support System (A-CHESS), an application designed to improve continuing care for alcohol use disorders.
Interventions: Treatment as usual varied across programs; none offered patients coordinated continuing care after discharge. A-CHESS provides monitoring, information, communication, and support services to patients, including ways for patients and counselors to stay in contact. The intervention and follow-up period lasted 8 and 4 months, respectively.
Main Outcomes and Measures: Risky drinking days — the number of days during which a patient’s drinking in a 2-hour period exceeded 4 standard drinks for men and 3 standard drinks for women, with standard drink defined as one that contains roughly 14 g of pure alcohol (12 oz of regular beer, 5 oz of wine, or 1.5 oz of distilled spirits). Patients were asked to report their risky drinking days in the previous 30 days on surveys taken 4, 8, and 12 months after discharge from residential treatment.
Results: For the 8 months of the intervention and 4 months of follow-up, patients in the A-CHESS group reported significantly fewer risky drinking days than did patients in the control group, with a mean of 1.39 vs 2.75 days (mean difference, 1.37; 95% CI, 0.46-2.27; P = .003).
Conclusions and Relevance: The findings suggest that a multifeatured smartphone application may have significant benefit to patients in continuing care for alcohol use disorders.
----------------------
Alice Welch et al.
Drug and Alcohol Dependence, forthcoming
Background: Exposure to 9/11 may have considerable long-term impact on health behaviors, including increased alcohol consumption. We examined the association between frequent binge drinking, posttraumatic stress disorder (PTSD), and number of 9/11-specific experiences among World Trade Center Health Registry (Registry) enrollees five-to-six years after 9/11.
Methods: Participants included 41,284 lower Manhattan residents, workers, passers-by and rescue/recovery workers aged 18 or older without a pre-9/11 PTSD diagnosis who completed Wave 1 (2003-04) and Wave 2 (2006-07) interviews. Frequent binge drinking was defined as consuming five or more drinks on five or more occasions in the prior 30 days at Wave 2. Probable PTSD was defined as scoring 44 or greater on the PTSD Checklist. 9/11 exposure was measured as the sum of 12 experiences and grouped as none/low (0-1), medium (2-3), high (4-5) and very high (6 + ).
Results: Frequent binge drinking was significantly associated with increasing 9/11 exposure and PTSD. Those with very high and high exposures had a higher prevalence of frequent binge drinking (13.7% and 9.8%, respectively) than those with medium and low exposures (7.5% and 4.4%, respectively). Upon stratification, very high and high exposures were associated with frequent binge drinking in both the PTSD and no PTSD subgroups.
Conclusions: Our findings suggest that 9/11 exposure had an impact on frequent binge drinking five-to-six years later among Registry enrollees. Understanding the effects of traumatic exposure on alcohol use is important to identify risk factors for post-disaster alcohol misuse, inform policy, and improve post-disaster psychological and alcohol screening and counseling.
----------------------
Spicing up the military: Use and effects of synthetic cannabis in substance abusing army personnel
Denise Walker et al.
Addictive Behaviors, July 2014, Pages 1139–1144
Abstract:
Synthetic cannabis (SC) use has been increasing within the United States. Due to difficulties with its detection through standard testing, it may be an attractive substance of abuse for military personnel. However, few studies have examined the consequences of its use in this population, including evidence for its potential for abuse and dependence. Participants included 368 active-duty Army personnel who expressed interest in participating in a “check-up” around their alcohol or substance use, of whom 294 (80%) met DSM-IV criteria for substance abuse or dependence (including alcohol, illicit drugs, and prescription medications) and were not engaged in substance abuse treatment. Forty-one participants (11%) reported using SC in the last 90 days. Of those, 27 listed SC as their drug of choice. There were no significant differences in race, ethnicity, deployment history, or religion between SC users and others. Users of SC were generally younger and had less education and income than those who used only alcohol. Among SC users, 12% met criteria for drug abuse and 68% for dependence. Participants perceived SC use to be significantly more prevalent among military personnel than among civilians. Results suggest that SC is prevalent among substance-using soldiers and that DSM-IV criteria for abuse and dependence apply to SC. In addition, results highlight the importance of assessing and treating SC use among active-duty military personnel.
----------------------
Marcus Bachhuber, William Southern & Chinazo Cunningham
Medical Care, May 2014, Pages 428-434
Objective: To compare the proportion of for-profit, nonprofit, and public opioid treatment programs offering comprehensive services, which are not mandated by government regulations.
Design, Setting, and Participants: Cross-sectional analysis of opioid treatment programs offering outpatient care in the United States (n=1036).
Main Outcome Measure: Self-reported offering of communicable disease (HIV, sexually transmitted infections, and viral hepatitis) testing, psychiatric services (screening, assessment and diagnostic evaluation, and pharmacotherapy), and social services support (assistance in applying for programs such as Medicaid). Mixed-effects logistic regression models were developed to adjust for several county-level factors.
Results: Of opioid treatment programs, 58.0% were for profit, 33.5% were nonprofit, and 8.5% were public. Nonprofit programs were more likely than for-profit programs to offer testing for all communicable diseases [adjusted odds ratios (AOR), 1.7; 95% confidence interval (CI), 1.2, 2.5], all psychiatric services (AOR, 8.0; 95% CI, 4.9, 13.1), and social services support (AOR, 3.3; 95% CI, 2.3, 4.8). Public programs were also more likely than for-profit programs to offer communicable disease testing (AOR, 6.4; 95% CI, 3.5, 11.7), all psychiatric services (AOR, 25.8; 95% CI, 12.6, 52.5), and social services support (AOR, 2.4; 95% CI, 1.4, 4.3).
Conclusions: For-profit programs were significantly less likely than nonprofit and public programs to offer comprehensive services. Interventions to increase the offering of comprehensive services are needed, particularly among for-profit programs.