The relationship between past-year drinking behaviors and nonmedical use of prescription drugs: Prevalence of co-occurrence in a national sample
Introduction
In the United States, the past-year prevalence of alcohol misuse, alcohol use disorders (AUDs), nonmedical use of prescription drugs (NMUPD), and substance use disorders (SUDs) is higher among young adults than any other age group (e.g., Dawson et al., 2004, Grant et al., 2004, Johnston et al., 2004a, Johnston et al., 2004b, Kandel et al., 1997; Substance Abuse and Mental Health Services Administration, 2004a). Adolescents and young adults have particularly high rates of concurrent polydrug use (co-occurrence) which refers to different drugs consumed on separate occasions (Newcomb and Bentler, 1988). While the prevalence of binge drinking and AUDs among young adults in the United States has remained steady for the past decade, NMUPD among young adults has increased significantly during this same time period (e.g., Grant et al., 2004, Johnston et al., 2004a, Mohler-Kuo et al., 2003). Substance abuse researchers are just beginning to identify individual characteristics and vulnerabilities associated with NMUPD (McCabe et al., 2005a, McCabe et al., 2005b, Simoni-Wastila and Strickler, 2004); to date, there has been very little research on the co-occurrence of AUDs and NMUPD.
For purposes of this investigation, NMUPD refers to the use of a scheduled psychotherapeutic drug for which the user has no prescription, or the use of a psychotherapeutic drug for which the user has a prescription, but in a manner not intended by the prescribing clinician. Several anecdotal case reports document the severe consequences that can result from co-ingestion of prescription drugs and other substances, including alcohol (e.g., Barrett and Pihl, 2002, Coetzee et al., 2002, Koski et al., 2002, Reynaud et al., 1998, Sellers et al., 1993, Sheehan et al., 1991). In addition, Toxic Exposure Surveillance System data document fatal exposures from co-ingestion of prescription drugs and alcohol along with the suspected reason for exposure (Watson et al., 2004). Furthermore, according to the Drug Abuse Warning Network (DAWN), a national surveillance system that monitors trends in drug-related emergency department (ED) visits and deaths (including suicide attempts), the drug most frequently used in combination with prescription drugs was alcohol (SAMHSA, 2003a, SAMHSA, 2003b, SAMHSA, 2004b). For example, about one-third of oxycodone and hydrocodone ED visits also involved alcohol. Taken together, these data reinforce the fact that there are possible adverse consequences associated with the co-occurrence of NMUPD and alcohol use.
Despite the harmful consequences associated with the co-occurrence of NMUPD and alcohol use, the relationship between drinking behaviors and NMUPD has received relatively little attention. Although a substance abuse history has been shown to be associated with an increased risk for nonmedical use of prescription benzodiazepines (Griffiths and Weerts, 1997), there are relatively few epidemiological studies examining the increased risk of NMUPD as a function of various drinking behaviors. Accordingly, the main objective of this secondary analysis was to examine data from two groups of adults, 18–24 year olds and adults over 25 years of age, in order to determine the prevalence of nonmedical use of four classes of prescription drugs (i.e., sedatives, tranquilizers, opioids, and stimulants) based on the subjects’ past-year drinking status. A secondary objective was to identify individual characteristics associated with NMUPD.
Section snippets
Methods
The 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) was used as the primary dataset to obtain information regarding alcohol use and NMUPD among the general population in the United States. The NESARC is based on a representative sample of the U.S. population and is an important source of national data on alcohol and other drug use, abuse, and dependence (Grant et al., 2003, Grant et al., 2004). The target population for the NESARC was the civilian
Results
Table 1 presents the prevalence estimates for past-year drinking behaviors and NMUPD overall and within the two subgroups based on age. Most notably, young adults 18–24 years of age had higher rates of binge drinking, AUDs, and NMUPD than adults 25 years or older. For example, the nonmedical use of any prescription drug class was considerably higher among individuals 18–24 years of age than individuals 25 years and older (8% versus 3%, χ2 = 215.9, d.f. = 1, p < 0.01). In addition, the young adult
Discussion
Despite steady increases in nonmedical use of prescription drugs (NMUPD) (e.g., Johnston et al., 2004a, Mohler-Kuo et al., 2003; Substance Abuse and Mental Health Services Administration, 2004a; Zacny et al., 2003), few studies have systematically examined the relationship between past-year drinking behaviors and NMUPD, or identified subgroups at particular risk for either NMUPD or the co-occurrence of alcohol use and NMUPD. Consistent with previous research, the present study found that young
Acknowledgements
The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) was sponsored by the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, U.S. Department of Health and Human Services, with supplemental support from the National Institute on Drug Abuse. The development of this manuscript was supported by research grants DA019492 and DA020899 (PI: Sean Esteban McCabe) and a National Research Service Award DA07267 (PI: Carol J. Boyd) from the National
References (58)
- et al.
Concordance of DSM-IV alcohol and drug use disorder criteria and diagnoses as measured by AUDADIS-ADR, CIDI, and SCAN
Drug Alcohol Depend.
(1997) - et al.
Prevalence of youth substance use: the impact of methodological differences between two national surveys
Drug Alcohol Depend.
(1997) - et al.
The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991–1992 and 2001–2002
Drug Alcohol Depend.
(2004) - et al.
The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample
Drug Alcohol Depend.
(2003) - et al.
The Alcohol Use Disorder and Associated Disabilities Schedule (AUDADIS): reliability of alcohol and drug modules in a general population sample
Drug Alcohol Depend.
(1995) - et al.
Practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults
J. Am. Acad. Child Adolesc. Psychiatry
(2002) - et al.
The Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS): reliability of alcohol and drug modules in a clinical sample
Drug Alcohol Depend.
(1997) - et al.
Nosological comparisons of alcohol and drug diagnoses: a multisite, multi-instrument international study
Drug Alcohol Depend.
(1997) - et al.
Prevalence and demographic correlates of symptoms of last year dependence on alcohol, nicotine, marijuana and cocaine in the U.S. population
Drug Alcohol Depend.
(1997) - et al.
Illicit use of pain medication among college students
Drug Alcohol Depend.
(2005)
Concordance between ICD-10 alcohol and drug use disorder criteria and diagnoses as measured by the AUDADIS-ADR, CIDI, and SCAN: results of a cross-national study
Drug Alcohol Depend.
2003 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System
Am. J. Emerg. Med.
College on problems of drug dependence taskforce on prescription opioid non-medical use and abuse: position statement
Drug Alcohol Depend.
Student perceptions of methylphenidate abuse at a public liberal arts college
J. Am. Coll. Health
The Decline of Substance Use in Young Adulthood: Changes in Social Activities, Roles, and Beliefs
Smoking, Drinking and Drug Use in Young Adulthood
Oral methylphenidate-alcohol co-abuse
J. Clin. Psychopharmacol.
The Spanish Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS): reliability and concordance with clinical diagnoses in a Hispanic population
J. Stud. Alcohol
Megadose intranasal methylphenidate (ritalin) abuse in adult attention deficit hyperactivity disorder
Subst. Abus.
Another look at heavy episodic drinking and alcohol use disorders among college and noncollege youth
J. Stud. Alcohol
Concurrent versus simultaneous polydrug use: prevalence, correlates, discriminant validity, and prospective effects on health outcomes
Exp. Clin. Psychopharmacol.
Examining prevalence differences in three national surveys of youth: impact of consent procedures, mode and editing rules
J. Drug Issues
Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Council on Scientific Affairs, American Medical Association
JAMA
DSM-IV, DSM-III-R and ICD-10 alcohol and drug abuse/harmful use and dependence, United States, 1992: a nosological comparison
Alcohol Clin. Exp. Res.
Benzodiazepine self-administration in humans and laboratory animals – implications for problems of long-term use and abuse
Psychopharmacology
Alcohol dependence and abuse diagnoses: validity in a community sample of heavy drinkers
Alcohol Clin. Exp. Res.
Agreement between DSM-III-R, DSM-IV and ICD-10 alcohol diagnoses in a US community-sample of heavy drinkers
Addiction
Interaction Effects in Logistic Regression.
Dependence on legal psychotropic drugs among alcoholics
Alcohol Alcohol.
Cited by (120)
Poly-prescription drug misuse across the life course: Prevalence and correlates across different adult age cohorts in the U.S.
2021, International Journal of Drug PolicyNonmedical prescription drug use of analgesics and sedatives/hypnotics in Taiwan: Results from the 2014 National Survey of Substance Use
2019, Preventive Medicine ReportsCitation Excerpt :However, the scale of NMPDU from the other regions of the world remains rarely available, including Asia. Compared to people without NMPDU, those with NMPDU have been consistently associated with young adulthood (Center for Behavioral Health Statistics and Quality, 2016; McCabe et al., 2017c; Novak et al., 2016) and various ill-health status and risk behavior, including self-rated poor health (Becker et al., 2008; Havens et al., 2011), anxiety or depression (Becker et al., 2008; Chen et al., 2015; Cole and Logan, 2010; Havens et al., 2011; Kripke, 2007), poor sleep (Tang et al., 2016), suicidal behavior (Guo et al., 2016), problematic use of alcohol and tobacco (Abrahamsson and Hakansson, 2015; Becker et al., 2008; Garnier et al., 2009; McCabe, 2005; McCabe et al., 2006), and illicit drug use (Abrahamsson and Hakansson, 2015; Cole and Logan, 2010; Havens et al., 2011; Simoni-Wastila et al., 2004). Besides, there has been increasing research on people who received prescription medications but reported medical use only (MUO).
Binge Drinking and Prescription Opioid Misuse in the U.S., 2012–2014
2019, American Journal of Preventive MedicineThe epidemiology of benzodiazepine misuse: A systematic review
2019, Drug and Alcohol DependenceOpioid and sedative misuse among veterans wounded in combat
2019, Addictive Behaviors