Karriker-Jaffe Katherine J, Subbaraman Meenakshi S, Greenfield Thomas K, Kerr William C
Alcohol Research Group, Public Health Institute, Emeryville, CA, USA.
Nordisk Alkohol Nark. 2018 Dec;35(6):428-442. doi: 10.1177/1455072518806122. Epub 2018 Dec 14.
Combined use of alcohol with drugs elevates risk for problems including injury and intoxicated driving. We assessed contributions of heavy drinking (5+ men/4+ women), drug use (cannabis and other drugs) and simultaneous co-use to DSM-5 alcohol use disorder (AUD) and drug abuse (DA). We expected co-use to increase risk for AUD and DA.
Using population-weighted data from adults in the 2014-15 National Alcohol Survey who had never been to treatment (N=3386 drinkers, 50% male, 13% Hispanic, 11% Black, mean age 45; N=439 drug users, 56% male, 20% Hispanic, 15% Black, mean age 36), we tested hypotheses using logistic regression adjusting for demographics, family history of alcohol problems and impulsivity.
10% of drinkers and 26% of drug users met criteria for mild AUD; <1% of drinkers and 4% of drug users met criteria for DA. Heavy drinking significantly increased risk for AUD, as did monthly or weekly use of cannabis. When simultaneous co-use was added, increased risk associated with cannabis use was reduced to non-significance. Weekly cannabis use, weekly use of other drugs and simultaneous drug and alcohol co-use were associated with significantly elevated risk of DA. In bivariate analyses, simultaneous co-use was associated with significantly greater endorsement of each of the separate AUD and DA symptom domains, including alcohol craving, tolerance and withdrawal, as well as drug and alcohol social and physical health problems.
Healthcare providers should screen for simultaneous co-use of alcohol and drugs to help identify patients who may benefit from substance abuse treatment.
酒精与药物联合使用会增加包括受伤和醉酒驾驶等问题的风险。我们评估了重度饮酒（男性饮酒量≥5次/女性饮酒量≥4次）、药物使用（大麻和其他药物）以及同时使用这两者对《精神疾病诊断与统计手册》第5版（DSM - 5）中酒精使用障碍（AUD）和药物滥用（DA）的影响。我们预计同时使用会增加患AUD和DA的风险。
利用2014 - 2015年全国酒精调查中从未接受过治疗的成年人的人口加权数据（饮酒者N = 3386人，50%为男性，13%为西班牙裔，11%为黑人，平均年龄45岁；药物使用者N = 439人，56%为男性，20%为西班牙裔，15%为黑人，平均年龄36岁），我们使用逻辑回归进行假设检验，并对人口统计学、酒精问题家族史和冲动性进行了调整。
10%的饮酒者和26%的药物使用者符合轻度AUD标准；<1%的饮酒者和4%的药物使用者符合DA标准。重度饮酒显著增加了患AUD的风险，每月或每周使用大麻也会增加风险。当加入同时使用这一因素时，与大麻使用相关的风险增加不再显著。每周使用大麻、每周使用其他药物以及同时使用药物和酒精与DA风险显著升高相关。在双变量分析中，同时使用与AUD和DA各自独立症状领域的显著更多认可相关，包括酒精渴望、耐受性和戒断反应，以及药物和酒精对社会和身体健康的问题。
医疗保健提供者应筛查酒精和药物的同时使用情况，以帮助识别可能从药物滥用治疗中受益的患者。
