A high prevalence of lifetime psychiatric disorders among help-seeking substance abusers has been clearly established. However, the long-term course of psychiatric disorders and mental distress among help-seeking substance abusers is still unclear. The aim of this research was to examine the course of mental distress using a six-year follow-up study of treatment-seeking substance-dependent patients, and to explore whether lifetime Axis I and II disorders measured at admission predict the level of mental distress at follow-up, when age, sex, and substance-use variables measured both at baseline and at follow-up are controlled for. A consecutive sample of substance dependent in- and outpatients (n = 287) from two counties of Norway were assessed at baseline (T1) with the Composite International Diagnostic Interview (Axis I), Millon's Clinical Multiaxial Inventory (Axis II), and the Hopkins Symptom Checklist (HSCL-25 (mental distress)). At follow-up (T2), 48% (137/287 subjects, 29% women) were assessed with the HSCL-25, the Alcohol Use Disorders Identification Test, and the Drug Use Disorders Identification Test. The stability of mental distress is a main finding and the level of mental distress remained high after six years, but was significantly lower among abstainers at T2, especially among female abstainers. Both the number of and specific lifetime Axis I disorders (social anxiety disorder, generalized anxiety disorder, and somatization disorder), the number of and specific Axis II disorders (anxious and impulsive personality disorders), and the severity of substance-use disorder at the index admission were all independent predictors of a high level of mental distress at follow-up, even when we controlled for age, sex, and substance use at follow-up. These results underscore the importance of diagnosing and treating both substance-use disorder and non-substance-use disorder Axis I and Axis II disorders in the same programme.

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Axis I and II disorders as long-term predictors of mental distress: a six-year prospective follow-up of substance-dependent patients.

Co-occurrence between mental distress and poly-drug use: a ten year prospective study of patients from substance abuse treatment.

As the Focal Point to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), one of the core tasks of the Institute on Drugs and Drug Addiction (IDT, I.P.) is the elaboration of this Annual Report, which structure and contents are mandatorily defined by the EMCDDA (to allow comparability of data among National Focal Points). This year report describes the national situation in 2010 as well as new developments and trends regarding 2011. The report is divided in three main parts: summary, new developments and trends and selected issues.

New Development, Trends and in-depth information on selected issues

Author(s): Rafful, Claudia; Orozco, Ricardo; Rangel, Gudelia; Davidson, Peter; Werb, Dan; Beletsky, Leo; Strathdee, Steffanie A | Abstract: AIM:To assess the effect of involuntary drug treatment (IDT) on non-fatal overdose among people who inject drugs (PWID). DESIGN:Longitudinal study. SETTING:Tijuana, Mexico. PARTICIPANTS:Baseline sample of 671 PWID included 258 (38.4%) women and 413 (61.6%) men. MEASUREMENTS:Primary independent variables were reported recent (i.e. past 6nmonths) non-fatal overdose event (dependent variable) and IDT. Substance use the day of the non-fatal overdose was also examined. FINDINGS:From 2011 to 2017, 213 participants (31.7%) reported a recent non-fatal overdose and 103 (15.4%) reported recent IDT. Heroin, in combination with methamphetamine and tranquilizers, were the drugs most reported at the day of the event. IDT significantly increased the odds of reporting a non-fatal overdose event [adjusted odds ratio (aOR)n=n1.76; 95% confidence interval (CI)n=n1.04-2.96]. Odds of non-fatal overdose also increased independently for each additional injection per day (aORn=n1.05; 95% CIn=n1.02-1.08), recent tranquilizer use (aORn=n1.92; 95% CIn=n1.41-2.61) and using hit doctors (aORn=n1.68; 95% CIn=n1.29-2.18) and decreased with age (aORn=n0.97 per year, 95% CIn=n0.95-0.99). CONCLUSIONS:Recent involuntary drug treatment in Mexico is a risk factor for non-fatal drug overdose.

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Increased non-fatal overdose risk associated with involuntary drug treatment in a longitudinal study with people who inject drugs.

This study investigated cause of death, mortality rates and explored if baseline characteristics were associated with risk of death in patients with alcohol use disorder alone or poly-substance use disorders. This was a prospective, longitudinal study of patients followed for 19 years after entering specialized treatment for substance use disorders. At baseline 291 patients (mean age 38.3 years, standard deviation 11.4 years, 72% male) with high psychiatric co-morbidity were recruited; 130 (45%) had lifetime alcohol use disorder alone, while 161 (55%) had poly-substance use disorders. Time and causes of death were gathered from the Norwegian Cause of Death Registry. Lifetime psychiatric symptom disorders and substance use disorders at baseline were measured with The Composite International Diagnostic Interview and personality disorders at baseline were measured with The Millon Clinical Multiaxial Inventory II. Patients with alcohol use disorder alone more often died from somatic diseases (58% versus 28%, p = 0.004) and more seldom from overdoses (9% versus 33%, p = 0.002) compared with patients with poly-substance use disorders. The crude mortality rate per 100 person year was 2.2 (95% confidence interval: 1.8–2.7), and the standardized mortality rate was 3.8 (95% confidence interval: 3.2–4.6) in the entire cohort during 19 years after entering treatment. Having lifetime affective disorder at baseline was associated with lower risk of death (Hazard Ratio 0.58, 95% confidence interval: 0.37–0.91). Older age was associated to increased risk of death among men (p < 0.001) and non-significantly among patients with poly-substance use (p = 0.057). The difference in association between age and risk of death was significantly different between men and women (p = 0.011) and patients with alcohol use disorder alone and poly-substance use disorders (p = 0.041). Patients with alcohol use disorder alone died more often from somatic disease than patients with poly-substance use disorders, and all subgroups of patients had an increased risk of death compared with the general population. Men with long-lasting substance use disorders are a priority group to approach with directed preventive measures for somatic health before they reach 50 years of age.

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Mortality, cause of death and risk factors in patients with alcohol use disorder alone or poly-substance use disorders: a 19-year prospective cohort study.

Hvilken nytte, for hvem og til hvilken kostnad? En prospektiv studie av stoffmisbrukere i behandling

Gjennom 10 år. En oppfølgingsstudie av narkotikabrukere i behandling

Background: Injecting drug users have a mortality risk between 10 and 20 times higher than the general population, and the persistent high mortality rate in most Western countries, and especially in Norway, is a major public health concern. Naturalistic, prospective studies following drug abusers over many years are needed in order to investigate the most important predictors of mortality and for planning strategic preventive measures.
Methods: Four hundred and eighty-one drug abusers were followed prospectively for 10 years after admission to treatment during the period 1998-2009. Following instruments were used: the European Addiction Severity Index, Symptom Checklist-25 and Millon Clinical Multiaxial Inventory-II. Information on deaths and causes of death were obtained from the National Death Register. Cox regression analysis was used to analyze factors hypothesized to be associated with the risk of death.
Results: A total of 74 deaths were registered during the observation period, which represents a mortality rate of 1.5 per 100 person-years. The main cause of death was overdose, and the relative risk of mortality among males was twice that of females.
Conclusions: Fifteen percent of the drug users in the study died during the 10 years after admission to index treatment. This represents an annual mortality rate of 1.5; which is in line with most similar studies from Europe, showing a mortality rates in the range of 1-2% per year. The main cause of death was overdose (68%). Preventive strategies aiming to reduce mortality among drug users have to be manifold and gender specific, taking into account drug abusers’ life conditions, their modes of thought and how they go about living their lives.

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Grete Ostling Lauritzen

Papers

Hvilken nytte, for hvem og til hvilken kostnad? En prospektiv studie av stoffmisbrukere i behandling

Gjennom 10 år. En oppfølgingsstudie av narkotikabrukere i behandling

A 10-year prospective study of mortality among Norwegian drug abusers after seeking treatment

Gjennom 10 år. En oppfølgingsundersøkelse av narkotikabrukere i behandling