Elsevier

Drug and Alcohol Dependence

Volume 84, Issue 3, 1 October 2006, Pages 281-288
Drug and Alcohol Dependence

The relationship between past-year drinking behaviors and nonmedical use of prescription drugs: Prevalence of co-occurrence in a national sample

https://doi.org/10.1016/j.drugalcdep.2006.03.006Get rights and content

Abstract

This study examined the relationship between past-year drinking behaviors and nonmedical use of prescription drugs (NMUPD) in a nationally representative sample. Prevalence estimates in the United States were derived based on data collected from face-to-face interviews using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (n = 43,093 individuals aged 18 years and older). Nonmedical use of prescription opioids, stimulants, tranquilizers, and sedatives was more prevalent among individuals with alcohol use disorders (AUDs) than those without AUDs. The odds of reporting NMUPD were 18 times higher among alcohol dependent participants compared to past-year abstainers (OR = 18.2, 95% CI = 13.9–23.8). Although individuals with AUDs constituted less than 9% of the total sample, those with AUDs accounted for more than one in every three nonmedical users of prescription drugs. The past-year co-occurrence of AUDs and NMUPD was more prevalent among young adults 18–24 years of age than individuals 25 years and older. More than one in every four young adults aged 18–24 years who met the criteria for past-year DSM-IV alcohol dependence also reported past-year NMUPD. These findings suggest that the treatment for AUDs should include a thorough assessment of NMUPD, especially among young adults.

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

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