Quality of life in a community sample of young cocaine and/or heroin users: the role of mental disorders

Purpose: Drug addiction and psychiatric disorders are frequently concomitant; however, few studies have investigated the impact of psychiatric disorders other than substance use disorder (SUD) on Health-Related Quality of Life (HRQoL) in drug users not in treatment. We studied the association of psychiatric disorders other than SUD with HRQoL in a street-recruited sample of cocaine and/or heroin users.Methods Cross-sectional study in 287 young users of cocaine and/or heroin in Barcelona, Spain. HRQoL was assessed with the Nottingham Health Profile (NHP). Patterns of drug use and mental disorders were assessed using theSpanish version of the Psychiatric Research Interview for Substance and Mental Disorders-IV (PRISM); and degree of dependence through the Severity of Dependence Scale (SDS). The association of mental disorders with HRQoL was assessed through a Tobit regression analysis.Results: The overall NHP score was 23.9 (SD=20.5, range 0 to 91.7). Sixty-one percent of the sample had two or more SUDs; 22% had at least one non-SUD Axis I disorder (anxiety, mood, psychotic oreating disorder) and 27.2% had a Borderline Personality Disorder (BPD)and/or Antisocial Personality Disorder. Variables negatively associated with the global NHP score were psychosis (transformed beta coefficient: 15.23; 95% Confidence Interval [CI]:4.48-25.97), BPD (9.55; 95%CI:2.95-16.15), severity of dependence (8.12; 95%CI:3.37-12.87), having two or more SUDs (for two or three SUDs: 6.83; 95%CI:2.08-11.59) (>3 SUDs: 7.70; 95%CI:1.72-13.68) and the intravenous use of some substance (10.20; 95%CI:6.00-14.40).Conclusions: HRQoL among street-recruited illegal substance users was impaired, particularly among those with psychiatric comorbidity, psychosis and Borderline Personality Disorder being especially relevant.The field work was financed by Fundación para la Investigación y la Prevencio´n del Sida en España (Fipse 486 3035/99) and Plan Nacional Sobre Drogas (PNSD 2001 and 2004). The analysis and writing of this article was made possible by grants EPY-020/029 (ISCIII) and RD06/0001/1018, and (RTA) RD12/0028/0018 and RD12/0028/0009. Further financial support was provided by the Age`ncia de Gestió d’Ajuts Universitaris i de Recerca (AGAUR 2009 SGR 718). Albert Sánchez-Niubò was supported by the Instituto de Salud Carlos III Grant No. A08/00214

Comparison of health-related quality of life among men with different co-existing severe mental disorders in treatment for substance use

Abstract Background Patient-perceived health-related quality of life has become an important outcome in health care as an indicator of treatment effectiveness and recovery for patients with substance use disorder. As no study has assessed health-related quality of life among male patients with substance use disorder and co-existing severe mental illness, we compared health-related quality of life among patients with substance use disorder and the following severe mental illness diagnosis in Barcelona, Spain: schizophrenia, bipolar disorder, major depressive disorder, and examined the associations with clinically related variables. Additionally, we compared results for health-related quality of life in patients with substance use disorder and severe mental illness, with Spanish population norms. Methods We assessed 107 substance use disorder male patients using the 36-Item Short Form Health Survey comparing results across three groups with: comorbid schizophrenia (n = 37), comorbid bipolar disorder (n = 34), and comorbid major depressive disorder (n = 36). Multiple analyses of variance were performed to explore health-related quality of life by the type of co-existing SMI and linear regression analyses examined clinical correlates for the 36-Item Short Form Health Survey dimensions for each group. Results There were differences in Physical Functioning, Vitality and the Physical Composite Scale among groups. Poorer Physical Functioning was observed for patients with comorbid schizophrenia (80.13±3.27) and major depressive disorder (81.97±3.11) compared with comorbid bipolar disorder patients (94.26±1.93). Patients with substance use disorder and schizophrenia presented lower scores in Vitality (41.6±2.80) than those with co-existing bipolar disorder (55.68±3.66) and major depressive disorder (53.63±2.92). Finally, results in the Physical Composite Scale showed lower scores for patients with comorbid schizophrenia (51.06±1.41) and major depressive disorder (51.99±1.87) than for those with bipolar disorder (60.40±2.17). Moreover, all groups had poorer health-related quality of life, especially Social Functioning, Role-Emotional and Mental Health, compared with population norms. Different clinical variables (e.g. medical disease comorbidity, severity of addiction, psychiatric symptomatology, suicide attempts, drug relapses) were related to different health-related quality of life dimensions depending on the co-existing severe mental illness. Conclusions Among male patients with substance use disorder, co-existing severe mental illness may influence some health-related quality of life dimensions and clinically related variables. Such differences may require tailored therapeutic interventions

Assessing the validity and reliability of the Turkish versions of craving beliefs and beliefs about substance use questionnaire in patients with heroin use disorder: demonstrating valid tools to assess cognition-emotion interplay

Background: Cognitions associated with craving and substance use are important contributors for the psychological theories of Substance use disorders (SUD), as they may affect the course and treatment. In this study, we aimed to validate Turkish version of two major scales 'Beliefs About Substance Use'(BSU) and 'Craving Beliefs Questionnaire'(CBQ) in patients with heroin use disorder and define the interaction of these beliefs with patient profile, depression and anxiety symptoms, with an aim to use these thoughts as targets for treatment. Methods: One hundred seventy-six inpatients diagnosed with heroin use disorder and 120 participants in the healthy comparison group were evaluated with CBQ, BSU, Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and sociodemographic data questionnaire. Patient group was also evaluated with Addiction Profile Index. Reliability and validity analysis for scales were conducted. Linear regression analysis was conducted to evaluate the determinants of BSU and CBQ scores. Results: Cronbach alpha level was 0.93 for BSU and 0.94 for CBQ. Patient group showed significantly higher CBQ, BSU, BAI and BDI scores (p < 0.001). BSU score significantly correlated with API-substance use profile score, API-diagnosis, BAI, BDI and CBQ (p < 0.005), whereas CBQ scores significantly correlated with API-diagnosis, API-impact on life, API-craving, API-total score, BSU, BAI, BDI and amount of cigarette smoking (p < 0.002). Number of previous treatments and age of onset for substance use were not correlated with either BSU or CBQ. BAI and BDI scores significantly predicted BSU score, however only BDI score predicted CBQ score (p < 0.003). Conclusions: Craving beliefs were highly correlated with addiction profile. Anxiety and depression are significant modulators for patients' beliefs about substance use and depression is a modulator for craving and maladaptive beliefs, validating emotion-cognition interplay in addiction