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What Matt didn't realize-until much later-was that (drug use) only exacerbated his problems. He says, "As soon as I was off whatever I was on, my problems were 50 times worse and I couldn't control myself. I'd get sad and agitated. I went off on people. I busted holes in walls. I still have a door in my closet that I literally punched through everywhere but the corners. I just sat there and beat up my door because I hated myself. That's why I wanted to be high all the time."
Source: Drugstory.org
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Chronic use of some drugs of abuse can cause long-lasting changes in the brain, which may lead to paranoia, depression, aggression, and hallucinations.
| Drugs that can cause mental health problems: |
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| Selected Research Findings on the Mental Health Effects of Drug Abuse |
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Antisocial Psychopathy and HIV Risk Among Alcohol and Other Drug (AOD) Abusing Adolescent Offenders
While the consensus is that HIV prevalence has remained low among adolescent offenders, the prevalence of STDs and HIV transmission risk behaviors is alarming, particularly for those abusing alcohol and other drugs and those displaying antisocial or conduct disorder characteristics. In the current study, 269 male and 110 female inner city, culturally diverse alcohol and other drug (AOD) abusing adolescent offenders completed measures of (a) psychopathy, using the Millon Adolescent Clinical Inventory (MACI) (b) HIV transmission risk behavior, (c) prevention skills and attitudes and (d) social desirability. Results showed that those with high levels of psychopathy reported more AOD use, overall unprotected sex and more sexual activity when influenced by alcohol and/or marijuana. High psychopathy adolescent offenders also reported lower self-efficacy and sexual response-efficacy, less favorable safer sex and condom attitudes and less favorable intentions to engage in safer sex behaviors, when controlling for social desirability. Data suggest that adolescent offenders, who are either in court-ordered treatment or detention, should be assessed for psychopathy and provided with tailored risk reduction interventions, geared toward attitudinal and behavioral change. A discussion of integrating neurobiological measures to improve the next generation of tailored interventions for this risk group is offered in conclusion. Malow, R.M., Devieux, J., Rosenberg, R., Nair, M., McMahon, R., Brown, E.J., and Kalichman, S.C. Antisocial Psychopathy and HIV Risk Among Alcohol and Other Drug (AOD) Abusing Adolescent Offenders. American Journal of Infectious Diseases, 3(4), pp. 230-239, 2007.
HIV Risk Behavior Among Patients with Co-Occurring Bipolar and Substance Use Disorders: Associations with Mania and Drug Abuse
Bipolar and substance use disorders frequently co-occur, and both are associated with impulsivity, impaired judgment, and risk-taking. In this study, Dr. Meade and colleagues at Harvard Medical School and McLean Hospital, aimed to: (1) describe the rates of HIV sexual and drug risk behaviors among patients with co-occurring bipolar and substance use disorders, (2) test whether acute mania, psychiatric severity, and drug severity independently predict HIV risk, and (3) examine the relationship between specific substance dependencies and sexual risk behaviors. Participants (N=101) were assessed for psychiatric diagnoses, substance abuse, and HIV risk behavior using structured clinical interviews and self-report questionnaires. The majority (75%) were sexually active in the past 6 months and reported high rates of sexual risk behaviors, including unprotected intercourse (69%), multiple partners (39%), sex with prostitutes (24%, men only), and sex trading (10%). In a multivariate linear regression model, recent manic episode, lower psychiatric severity, and greater drug severity were independent predictors of total HIV risk. Cocaine dependence was associated with increased risk of sex trading. Results underscore the importance of HIV prevention for this population. Meade, C.S., Graff, F.S., Griffin, M.L., and Weiss, R.D. HIV Risk Behavior Among Patients with Co-occurring Bipolar and Substance Use Disorders: Associations with Mania and Drug Abuse. Drug and Alcohol Dependence, 92(1-3), pp. 296-300, 2008.
Incidence of Drug Problems in Young Adults Exposed to Trauma and Posttraumatic Stress Disorder
Most estimated associations of posttraumatic stress disorder (PTSD) with DSM-IV drug dependence and abuse are from cross-sectional studies or from prospective studies of adults that generally do not take into account suspected causal determinants measured in early childhood. This study examined risk for incident drug disorders associated with prior DSM-IV PTSD. A multiwave longitudinal study was conducted among a sample of young adults first assessed at entry to first grade of primary school in the fall semesters of 1985 and 1986, with 2 young adult follow-up assessments. Participants were young adults (n = 988; aged 19-24 years) free of clinical features of DSM-IV drug use disorders at the first young adult assessment and therefore at risk for newly incident drug use disorders during the 1-year follow-up period. During the 12-month interval between the 2 young adult follow-up assessments, several outcomes were assessed, including: newly incident (1) DSM-IV drug abuse or dependence; (2) DSM-IV drug abuse; (3) DSM-IV drug dependence; and (4) emerging dependence problems (1 or 2 newly incident clinical features of DSM-IV drug dependence), among subjects with no prior clinical features of drug use disorders. Prior PTSD (but not trauma only) was associated with increased risk for drug abuse or dependence (adjusted relative risk, 4.9; 95% confidence interval, 1.6-15.2) and emerging dependence problems (adjusted relative risk, 4.9; 95% confidence interval, 1.2-20.1) compared with the no-trauma group controlling for childhood factors. Subjects with PTSD also had a greater adjusted relative risk for drug abuse or dependence compared with subjects exposed to trauma only (adjusted relative risk, 2.0; 95% confidence interval, 1.1-3.8) controlling for childhood factors. Association of PTSD with subsequent incident drug use disorders remained substantial after statistical adjustment for early life experiences and predispositions reported in previous studies as carrying elevated risk for both disorders. Posttraumatic stress disorder might be a causal determinant of drug use disorders, possibly representing complications such as attempts to self-medicate troubling trauma-associated memories, nightmares, or painful hyperarousal symptoms. Reed, P., Anthony, J., and Breslau, N. Incidence of Drug Problems in Young Adults Exposed to Trauma and Posttraumatic Stress Disorder: Do Early Life Experiences and Predispositions Matter? Arch. Gen. Psychiatry, 64(12), pp. 1435-1442, 2007.
Social Anxiety and Risk for Alcohol and Cannabis Dependence
Social anxiety disorder (SAD) is highly comorbid with alcohol use disorders (AUDs) and cannabis dependence. However, the temporal sequencing of these disorders has not been extensively studied to determine whether SAD serves as a specific risk factor for problematic substance use. The present study examined these relationships after controlling for theoretically-relevant variables (e.g., gender, other Axis I pathology) in a longitudinal cohort over approximately 14 years. The sample was drawn from participants in the Oregon Adolescent Depression Project., who were originally recruited as adolescents from high schools in 1987-89, at a mean age of 16.6 years. The sample, half female, was followed at ages 24 and 30; the final data point was collected from 816 participants, 59% women, 59% Caucasian. After excluding those with substance use disorders at baseline, SAD at study entry was associated with 6.5 greater odds of cannabis dependence (but not abuse) and 4.5 greater odds of alcohol dependence (but not abuse) at follow-up after controlling for relevant variables (e.g., gender, depression, conduct disorder). The relationship between SAD and alcohol and cannabis dependence remained even after controlling for other anxiety disorders. Other anxiety disorders and mood disorders were not associated with subsequent cannabis or alcohol use disorder after controlling for relevant variables. Among the internalizing disorders, SAD appears to serve as a unique risk factor for the subsequent onset of cannabis and alcohol dependence. Buckner, J., Schmidt, N., Lang, A., Small, J., Schlauch, R., and Lewinsohn, P. Specificity of Social Anxiety Disorder as a Risk Factor for Alcohol and Cannabis Dependence. J. Psychiatr. Res., 42(3), pp. 230-239, 2008.
Depressive Symptomatology in Young Adults with a History of MDMA Use: A Longitudinal Analysis
Research suggests that methylenedioxymethamphetamine (MDMA)/ ecstasy can cause serotonin depletion as well as serotonergic neurodegradation that may result in depression. This longitudinal study used the Beck Depression Inventory (BDI-II) to assess depressive symptomatology every six months over a two-year period among a community sample of young adult MDMA/ecstasy users (n = 402). Multilevel growth modeling was used to analyze changes in BDI scores. Between baseline and 24 months, the mean BDI score declined from 9.8 to 7.7. Scores varied significantly across individuals at baseline and declined at a rate of 0.36 points every six months. Persons with higher baseline scores were more likely to have their scores decrease over time. Several factors were significantly associated with score levels, independent of time: gender - men's scores were lower than women's; ethnicity - whites' scores were lower than those of non-whites; education - persons with at least some university education had scores that were lower than those without any college experience; benzodiazepines - current users' scores were higher than non-users; opioids - current users' scores were higher than non-users; and cumulative ecstasy use - people who had used MDMA more than 50 times had scores that were higher than persons who had used the drug less often. The results reported here show low levels of depressive symptoms among a sample that, after 24 months, consisted of both current and former MDMA users. The low and declining mean scores suggest that for most people MDMA/ecstasy use does not result in long-term depressive symptomatology. Falck, R., Jichuan Wang, and Carlson, R. Depressive Symptomatology in Young Adults with a History of MDMA Use: A Longitudinal Analysis. J. Psychopharmacol., 22(1), pp. 47-54, 2008.
Dimensions of Depressive Symptoms and Smoking Cessation
Dr. Leventhal and colleagues conducted this study to evaluate whether certain dimensions of depressive symptoms have a greater influence on smoking cessation than others. Certain psychopathologic components of depressive symptoms [negative affect (NA), somatic features (SF), low positive affect/anhedonia (PA), and interpersonal disturbance (IP)] were examined in a sample of 157 non-clinically depressed social drinkers enrolled in a clinical trial for smoking cessation. The subscales of the Center for Epidemiologic Studies Depression Scale (CESD) were used to predict (a) baseline tobacco dependence severity and motives for smoking, (b) abstinence-provoked nicotine withdrawal, and (c) smoking abstinence over the follow-up period. From a clinical standpoint, the findings suggest that interventions targeting anhedonia and low positive affect may be useful for smokers trying to quit. Leventhal, A.M., Ramsey, S.E., Brown, R.A., LaChance, H.R., and Kahler, C.W. Dimensions of Depressive Symptoms and Smoking Cessation. Nicotine & Tobacco Research, 10(3), pp. 507-517, 2008.
Co-morbid Medical and Psychiatric Illness and Substance Abuse in HCV-infected and Uninfected Veterans
Comorbidities may affect the decision to treat chronic hepatitis C virus (HCV) infection. The authors undertook this study to determine the prevalence of these conditions in HCV-infected persons compared with HCV-uninfected controls. Demographic and comorbidity data were retrieved for HCV-infected and -uninfected subjects from the VA National Patient Care Database using ICD-9 codes. Logistic regression was used to determine the odds of comorbid conditions in the HCV-infected subjects. HCV-uninfected controls were identified matched on age, race/ethnicity and sex. Authors identified 126,926 HCV-infected subjects and 126,926 controls. The HCV-infected subjects had a higher prevalence of diabetes, anemia, hypertension, chronic obstructive pulmonary disease (COPD)/asthma, cirrhosis, hepatitis B and cancer, but had a lower prevalence of coronary artery disease and stroke. The prevalence of all psychiatric comorbidities and substance abuse was higher in the HCV-infected subjects. In the HCV-infected persons, the odds of being diagnosed with congestive heart failure, diabetes, anemia, hypertension, OPD/asthma, cirrhosis, hepatitis B and cancer were higher, but lower for coronary artery disease and stroke. After adjusting for alcohol and drug abuse and dependence, the odds of psychiatric illness were not higher in the HCV-infected persons. The prevalence and patterns of comorbidities in HCV-infected veterans are different from those in HCV-uninfected controls. The association between HCV and psychiatric diagnoses is at least partly attributable to alcohol and drug abuse and dependence. These factors should be taken into account when evaluating patients for treatment and designing new intervention strategies. Butt, A., Khan, U., McGinnis, K. Et al. J. Viral Hepat.14, pp. 890-896, 2007.
| Relevant NIDA Meetings |
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Drs. Lisa Onken, Steve Grant, Nicolette Borek, Cecelia Spitznas and Melissa Riddle, from NIDA's Division of Clinical Neuroscience and Behavioral Research, with Dr. Elizabeth Ginexi from NIDA's Division of Epidemiology, Services, and Prevention Research organized a meeting, "Social Neuroscience: Developing More Powerful Behavioral Interventions." The meeting was held October 1 & 2, 2007 in Bethesda, Maryland. The goal of this meeting was to discuss current research and emerging issues in social neuroscience, and to identify the potential for translating social neuroscience knowledge into research on developing and/or improving behavioral treatment interventions and/or prevention interventions.
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