Drug Abuse and Mental Illness: Which Comes First?

1. Drug Abuse and Mental Illness: Which Comes First? Jake M Najman, PhD FASSA Professor and Director

2. Major focus on research • Does substance (licit and illicit) use lead to mental illness? • Need to test for the possibility that substance use represents ‘self-medication’ i.e. Emotionally disturbed individuals who use drugs for relaxation and relief

3. What needs to be known • Age of onset • Duration of disorder • Duration to first and subsequent recurrences • Frequency of recurrence • Factors which determine onset • Factors which determine recurrences • Natural history over the life course • Impact of help seeking and treatment on the natural history

4. Disorders which are the focus of our research • Alcohol abuse/dependence • Nicotine abuse/dependence • Illicit drug use disorders • Cannabis • Amphetamines

5. Previous population based research using the Composite International Diagnostic Interview (CIDI) has found high frequencies of mental illness in the population and remarkably young ages of onset for many mental illnesses

6. National Comorbidity Survey Replication (NCSR Kessier et al, 2005) National representative sample of persons 18yrs + in the USA Face-to-face interviews. Feb 2001 – April 2003 Diagnostic assessment using the World Mental Health Composite International Diagnostic Interview (WMH-CIDI) Produces DSM-IV and ICD-10 Diagnoses

7. Retrospective age-of-onset reports “Can you remember your exact age the very first time you HAD THE SYNDROME?” For those who answered NO = probe of time found eg. “Was it before you started school?” Upper end of bound used if bound was selected.

8. Age of Onset of CIDI-II Disorders (NCSR Kessler et al, 2005)

11. Mater-University of Queensland Study of Pregnancy (MUSP) • Began in January 1981 - December 1983. • All public patients enrolled at their First (Obstetrical) Clinic Visit (FCV). • In all, 8556 consecutive patients invited to participate; 8458 agreed to participate in the study. • Of the 8,458 agreeing to participate in the study, about 7,332 infants were discharged alive from the study hospital. There were some 170 miscarriages, and 300 mothers moved to another location for the birth.

12. At entry • Questionnaire administered average 18 weeks gestation at first clinic visit • At birth • Questionnaire administered 3-5 days after the birth • At 6 months • Questionnaire administered via telephone follow-up • About 90 per cent of mothers giving birth responded to this questionnaire

13. At 5 years • Questionnaire administered in hospital or at home to mothers • Child assessed by Paediatric Researcher • About 70 per cent of mothers giving birth responded to this questionnaire • At 14 years • Questionnaire administered in hospital or at home tomother and child • Child assessed by Paediatric Researcher • About 70 per cent of mothers and children participated in this phase

14. At 21 year F/U Questionnaire administered at home to mother and youth Physical assessments Blood pressure Lung function Physique CIDI – computer administered

15. MUSP27 is currently underway. It involves a 27 year follow up of the mothers with a focus on mental and physical health of the women as they progress through menopause

16. MUSP30 is scheduled to begin January 2011. It is a 30 year follow up of the children with a focus on cardiovascular disease, metabolic syndrome, mental illness and substance use and abuse. It involves the collection of blood samples and a study gene-environment interactions.

27. MUSP Findings

28. DSM-IV Diagnoses at 21yr Follow-up *Sample sizes vary between 2,549 – 2,572.

29. CIDI-II – Anxiety Disorders at 21 Yr Follow-up – MUSP

30. CIDI-II –Depression at 21 Yr Follow-up – MUSP

31. CIDI-II – Alcohol Use Disorder at 21 Yr Follow-up – MUSP

32. CIDI-II – Nicotine Use Disorder at 21 Yr Follow-up – MUSP

33. CIDI-II – Cannabis Use Disorder at 21 Yr Follow-up – MUSP

34. CIDI-II – Amphetamine Use Disorder at 21 Yr Follow-up – MUSP

35. Mean age of onset

36. What occurs first; mental illness (anxiety or depression) or substance use disorders?

37. By age 21, 34.1% of those with anxiety disorder and 30.2% of those with alcohol disorder have had both disorders 631 with Anxiety712 with Alcohol

38. 81.3% Anxiety preceded Alcohol • 7.5% Anxiety and Alcohol in same year • 11.2% Alcohol preceded anxiety 214 with Anxiety and Alcohol

39. By age 21, 31.5% of those with anxiety disorder and 47.6% of those with nicotine disorder have had both disorders 641 with Anxiety424 with Nicotine

40. 82.6% Anxiety precedes Nicotine • 7.2% Anxiety and Nicotine in same year • 10.3% Nicotine precedes Anxiety 195 with Anxiety and Nicotine

41. By age 21, 28.8% of those with an anxiety disorder and 32.5% of those with a cannabis disorder have had both disorders 628 with Anxiety557 with Cannabis

42. 77.2% Anxiety precedes Cannabis • 7.2%Anxiety precedes Cannabis in same year • 15.6% Cannabis precedes Anxiety 180 with Anxiety and Cannabis Use

43. By age 21, 4.3% of those with an anxiety disorder and 25.7% of those with an amphetamine disorder have experienced both disorders 629 with Anxiety105 with Amphetamine

44. 77.8% Anxiety precedes Amphetamine Use • 3.7% Anxiety precedes Amphetamine Use same year • 18.5% Amphetamine Use precedes Anxiety 27 with Anxiety and Amphetamine Use

45. Anxiety almost always precedes: • Alcohol disorder • Nicotine disorder • Cannabis use disorder • Amphetamine use disorder

46. 546 with Depression711 with Alcohol By age 21, 36.1% of those with depression and 27.7% of those with an alcohol disorder have had both disorders

47. 40.1% Depression precedes Alcohol • 23.9% Depression and Alcohol in same year • 36.0% Alcohol precedes Depression 197 with Depression and Alcohol

48. 550 with Depression421 with NicotineBy age 21, 30.2% of those with depression and 39.4% of those with a nicotine disorder have had both disorders

49. 50.6% Depression precedes Nicotine • 21.1% Depression and Nicotine in same year • 28.3% Nicotine precedes Depression 166 with Depression and Nicotine

50. 545 with Depression557 with CannabisBy age 21, 31.7% of those with depression AND 31.1% of those with cannabis disorders have experienced both disorders