unhealthy alcohol use in other drug users identified by screening in primary care
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Unhealthy alcohol use in other drug users identified by screening in primary care. Christine Maynié-François Debbie Cheng Jeffrey Samet Christine Lloyd-Travaglini Tibor Palfai Judith Bernstein Richard Saitz. Secondary analysis of ASPIRE trial data Funded by NIDA 1 R01 DA025068

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unhealthy alcohol use in other drug users identified by screening in primary care

Unhealthy alcohol use in other drug users identified by screening in primary care

Christine Maynié-François

Debbie Cheng

Jeffrey Samet

Christine Lloyd-Travaglini

Tibor Palfai

Judith Bernstein

Richard Saitz

Secondary analysis of ASPIRE trial data

Funded by NIDA 1 R01 DA025068

with support from SAMHSA.

Clinicaltrials.gov ID NCT00876941

background
Background
  • Alcohol use common in other drug users
  • Negative impact on
    • Other drug use
    • Alcohol and other drug (AOD) use consequences (unsafe sex, injury, fatal overdoses)
  • Most studies on patients in substance abuse treatment, community
  • Few data on primary care patients, identified by screening
slide3
Aims
  • Primary: Describe alcohol use in patients screening positive for other drug use in primary care
  • Secondary: Evaluate the association between unhealthy alcohol use and
    • Other drug use
    • AOD-use related consequences
hypothesis
Hypothesis

In this primary care cohort of patients screening positive for drug use, there will be an association between unhealthy alcohol use and drug use/consequences.

methods
Methods
  • Cross-sectional design
  • Secondary analysis
  • Cohort recruited by systematic screening in primary care for randomized controlled trial (ASPIRE study)
  • Main eligibility criteria : ASSIST drug-specific score ≥2 (once or twice over past 3 months)

ASPIRE = Assessing Screening Plus brief Intervention’s Resulting Efficacy to stop drug use.

ASSIST = Alcohol, Smoking and Substance Involvement Screening Test

predictors unhealthy alcohol use
Predictors: unhealthy alcohol use

Primary

Any past month heavy drinking day (HDD)

(≥4♀ or ≥5♂ drinks in a day)

Secondary

Secondary

  • AUDIT-C score (past year)
  • 0 = abstinent
  • 1- 2/3 (♀/♂)= low-risk
  • 3/4 - 9 (♀/♂) = risky use
  • 10+ = probable dependence
  • Number of past month HDD
  • None / 1-4 / >4

AUDIT-C = Alcohol Use Disorder Identification Test – Consumption

outcomes other drug use and aod use related consequences
Outcomes:other drug use and AOD use related consequences

Primary

Past month # days use Drug Of Most Concern = DOMC (determined by patient)

Secondary: Use

Secondary: Consequences

  • Past 3 months:
  • Injection drug use
  • -Use of more than one drug
  • - Any drug dependence (ASSIST 27+)
  • Past 3 months:
  • Drug use related problems
  • (SIP-D score)
  • -Unsafe sex
  • -Injury
  • -Arrest/incarceration

ASSIST = Alcohol, Smoking and Substance Involvement Screening Test

SIP-D = Short Inventory of Problems - Drugs

analysis
Analysis
  • Negative binomial regression models for count outcomes
  • Logistic regression models for binary outcomes
  • Adjusted for
    • Demographics : age, sex, race/ethnicity, employment, homelessness, partner, children
    • Psychiatric co morbidity: PHQ-9 (depression symptoms)

PHQ-9 = Patient Health Questionnaire 9 items

alcohol use
Alcohol use

Heavy drinking day = ≥4♀ or ≥5♂ drinks in a day

AUDIT-C = Alcohol Use Disorder Identification Test – Consumption

DOMC = Drug Of Most Concern

other drug use
Other drug use

DOMC = Drug Of Most Concern

ASSIST = Alcohol, Smoking and Substance Involvement Screening Test

alcohol and other drug use related consequences
Alcohol and Other Drug use related consequences

SIP-D = Short Inventory of Problems - Drugs

primary predictor primary outcome
Primary predictor/ Primary outcome

DOMC = Drug Of Most Concern

Result given in adjusted IRR. Model adjusted for baseline covariates: age, sex, race/ethnicity, employment, tobacco use, homelessness, partner, children and PHQ-9.

primary outcome secondary predictors
Primary outcome Secondary predictors

HDD = Heavy Drinking Day

AUDIT-C = Alcohol Use Disorder Identification Test – Consumption

Results given in adjusted IRR. Model adjusted for baseline covariates: age, sex, race/ethnicity, employment, tobacco use, homelessness, partner, children and PHQ-9.

secondary predictor of heavy drinking days
Secondary predictor #of heavy drinking days
  • No association found with
  • Injection Drug Use
  • Any injury

Results given in adjusted OR or IRR. Model adjusted for baseline covariates: age, sex, race/ethnicity, employment, tobacco use, homelessness, partner, children and PHQ-9. *p<0.05 **p<0,01 ***p<0.0001

primary predictor secondary outcomes
Primary predictor Secondary outcomes
  • No significant association with:
  • Injection Drug Use
  • Any injury
  • Any injury with Alcohol or Drug intake 2 hours prior
  • Any arrest or incarceration

Results given in adjusted OR or IRR. Model adjusted for baseline covariates: age, sex, race/ethnicity, employment, tobacco use, homelessness, partner, children and PHQ-9. *p<0.05 **p<0,01

secondary predictor audit c score
Secondary predictor AUDIT-C score
  • No significant association found with:
  • Injection Drug Use
  • Use of more than one drug
  • Any unsafe sex
  • Any injury (+ with Alcohol or Drug intake 2 hours prior)
  • Any arrest or incarceration

Results given in adjusted OR or IRR. Model adjusted for baseline covariates: age, sex, race/ethnicity, employment, tobacco use, homelessness, partner, children and PHQ-9. *p<0.05 **p<0,01

summary of findings
Summary of findings
  • Unhealthyalcohol use (UAU) common in patients screening positive for drug use in primary care.
  • Unable to detect an association between UAU and # days use DOMC (primary)
  • UAU associated with more severe other drug use and consequences.
  • More of these associations detected when using # of heavy drinking days as the marker for UAU
limitations
Limitations
  • External validity out of urban hospital-based primary care
    • No reason to think that the association between unhealthy alcohol use and outcomes wouldn’t be the same in other settings
  • Separate role of alcohol and other drugs uncertain on AOD use related consequences
    • Role of alcohol on unsafe sex
    • No exploration of synergistic effect
implications
Implications
  • Attention should be given to unhealthy alcohol use in people identified as other drug users in primary care (screening?)
  • Past month heavy drinking days appear to be a useful marker for other drug use severity and consequences
acknowledgements
Acknowledgements
  • CARE Unit,Boston University, Boston Medical Center
    • Mentor : Dr Richard Saitz
    • Debbie Cheng
    • Christine Lloyd-Travaglini
    • Jeffrey Samet
    • Judith Bernstein
    • Tibor Palfai
stratification by domc
Stratification by DOMC
  • Bivariate analysis
  • A few significant results with DOMC cocaine
    • 1+ HDD / Any unsafe sex
    • AUDIT-C score / ASSIST 27+
  • AUDIT-C / # days use DOMC:
    • Opioids: with low risk / unhealthy alcohol use (mean 10 days)
    • Cocaine: with alcohol dependence (mean 8 days)
    • MJ: with abstinence (mean 19 days)
regression results primary predictor any heavy drinking day
Regression results: Primary predictor= Any heavy drinking day

Results given in adjusted OR or IRR. Model adjusted for baseline covariates: age, sex, race/ethnicity, employment, tobacco use, homelessness, partner, children and PHQ-9. *p<0.05 **p<0,01

regression results second predictor number of heavy drinking days
Regression results: Second. predictor= Number of heavy drinking days

Results given in adjusted OR or IRR. Model adjusted for baseline covariates: age, sex, race/ethnicity, employment, tobacco use, homelessness, partner, children and PHQ-9. *p<0.05 **p<0,01 ***p<0.0001

regression results second predictor audit c score
Regression results: Second.predictor = AUDIT-C score

Results given in adjusted OR or IRR. Model adjusted for baseline covariates: age, sex, race/ethnicity, employment, tobacco use, homelessness, partner, children and PHQ-9. *p<0.05 **p<0,01

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