The relationship between methamphetamine and alcohol use in a community sample of methamphetamine users
Introduction
Methamphetamine (MA) use remains a significant public health concern in the United States and worldwide. Estimates from 2012 suggest over 12 million people in the United States have used MA in their lifetimes and 1.2 million people (0.4%) reported using MA in the past year (Substance Abuse and Mental Health Services Administration, 2013). Amphetamine-type simulants, of which MA is the most frequently used, were found to be the second most commonly used class of illicit drugs worldwide (UNODC, 2012). Furthermore, chronic MA use is associated with increased risk for a number of serious health problems, including psychiatric disorders (e.g., depression, psychosis, etc.), abnormal brain morphology and function, and cardiovascular disease (Darke et al., 2008, Panenka et al., 2012). Given that chronic, heavy alcohol use is also associated with a host of negative health consequences (Harwood, 2000), the consistent co-use of alcohol and MA may exacerbate the health risks of each substance alone. Therefore, understanding patterns of alcohol and MA co-use may have important implications for intervention and public health.
While a paucity of studies to date have examined the co-use of MA and alcohol, the few that have done so indicated a positive association between these substances in cross-sectional epidemiological designs and laboratory-based experimental studies. For example, individuals reporting frequent alcohol intoxication are five times more likely to report using MA as compared to non-drinkers (Furr et al., 2000) and MA use is more frequent among individuals with higher severity of alcoholism (Caetano and Weisner, 1995). Among college students, heavier alcohol consumption is associated with the co-use of alcohol and a psychostimulant (i.e., cocaine or methylphenidate; Barrett et al., 2006). Additionally, frequent alcohol use (≥16 days in the past month) is associated with greater odds of psychotic symptoms among chronic MA users (McKetin et al., 2013). And while the biological mechanisms mediating the acute response to alcohol and MA co-use remain unclear, the concurrent administration of MA and alcohol produces greater changes in cardiovascular function and subjective ratings of drug effects compared to either drug taken alone (Mendelson et al., 1995, Kirkpatrick et al., 2012).
In summary, the available epidemiologic data suggest a significant association between MA use and alcohol co-use, primarily that heavy and frequent drinkers are more likely to use MA. Additionally, the experimental findings, while limited, indicate that the co-administration of MA and alcohol may produce synergistic cardiovascular and subjective effects, thereby simultaneously and problematically potentiating the reinforcing and hazardous effects of each drug. However, most studies to date examining the prevalence of MA and alcohol co-use have been cross-sectional. Thus, the pattern and predictive relationship of MA and alcohol co-use within a given day or across multiple days remains unknown. Finally, as the majority of clinical trials for MA dependence have excluded alcohol dependent participants or did not report data on alcohol use (e.g., Anderson et al., 2012, Galloway et al., 2011, Rawson et al., 2004) and most studies reporting the co-use rates of these substances have been in community samples, there is limited information available on the relationship between alcohol and MA use among regular MA users. Therefore, the goal of this study is to examine the relationship between MA use and alcohol use in non-treatment seeking regular MA users who report regular alcohol consumption. Designs which analyze data at the level of individual days for each participant can determine whether days in which co-use of MA and alcohol occur more frequently than would be expected by chance and also reduce confounds that typically affect cross-sectional epidemiological studies, such as socio-demographic and environmental factors. Logistic multilevel models were conducted to test whether (a) alcohol use and MA use were correlated on a given day, and (b) previous day alcohol use or binge drinking was predictive of following day MA use. A secondary aim of this study was to account for severity of MA and alcohol use problems as plausible moderators of the relationship between alcohol and MA co-use.
Section snippets
Participants and procedures
Non-treatment seeking MA users (N = 126; 33 females) were recruited from the Los Angeles community via print and online advertisements as part of a larger study investigating the effects of naltrexone and response to MA in the laboratory. The study protocol and all related procedures were approved by the University of California, Los Angeles Institutional Review Board. Initial study eligibility was determined via telephone interview. Inclusion criteria included: (1) self-reported use of MA; and
Sample characteristics
Demographic and other descriptive data for the final study sample (N = 60) are presented in Table 1. On average, participants endorsed 5.68 (SD = 2.55, range: 0–11) DSM-IV symptoms of MA abuse and dependence and used MA on 17.00 (SD = 8.87) of the previous 30 days. Data on preferred route of MA administration was available for 52 subjects, the vast majority of whom identified smoking as their preferred route (71%) with 19% preferring snorting, and the remaining 10% preferring intravenous injection.
Discussion
To address the gap in knowledge on patterns of MA and alcohol co-use, the present study examined the relationship between MA use and alcohol use in a community sample of non-treatment seeking regular MA users. Using the timeline follow-back as an interview-based retrospective indicator of alcohol and MA use over the past 30 days, this study found that among regular MA users, odds of MA use were 3.0 times greater on days when alcohol was consumed as compared to non-drinking days, and binge
Role of funding source
This research was supported by a grant from the National Institute on Drug Abuse (DA029831) to LAR. Support for this study was also provided by a grant from the UCLA Clinical and Translational Science Institute (CTSI), grants UL1RR033176 and UL1TR000124. NRM, KEC, and DR were supported by the UCLA Training Program in Translational Neuroscience of Drug Abuse (T32 DA024635). KEC is currently supported by a predoctoral fellowship from the National Institute on Drug Abuse (DA035604). EH is
Contributors
All authors have made substantial contributions warranting authorship on the current manuscript, and all authors have given their approval for the current version to be submitted for peer-review and publication. Lara A. Ray is the PI for the UCLA Addictions Lab, in which SB, NRM, KEC, VA, and EH, are graduate students, DR, is a post-doctoral fellow, and KL and TR are lab managers. LAR was also the PI for the study from which data was culled. AL is a collaborator and Co-I for the NIDA grant
Conflict of interest statement
LAR is a paid consultant for GSK. None of the authors have any other conflicts of interest to disclose.
Acknowledgements
The authors would like to thank Anna Sheng, Brooke Rowland, Nadine Jacquez, Noelle Cunningham, and Suzanna Osuna for their help with participant recruitment and data collection. The authors would also like to thank the UCLA Clinical and Translational Research Center (T32 DA024635) for their support.
References (30)
- et al.
Modafinil for the treatment of methamphetamine dependence
Drug Alcohol Depend.
(2012) - et al.
The suspected association between methamphetamine (ice) smoking and frequent episodes of alcohol intoxication: data from the 1993 National Household Survey on Drug Abuse
Drug Alcohol Depend.
(2000) A cluster-analytic classification of smoking relapse episodes
Addict. Behav.
(1986)- et al.
A review of research on the alcohol use disorders identification test (AUDIT)
Alcohol Clin. Exp. Res.
(1997) - et al.
Epidemiologic analysis of alcohol and tobacco use
Alcohol Res. Health
(2000) - et al.
Patterns of simultaneous polysubstance use in drug using university students
Hum. Psychopharmacol. Clin. Exp.
(2006) - et al.
Manual for the Beck Anxiety Inventory
(1990) - et al.(1996)
- et al.
The association between DSM-III-R alcohol dependence, psychological distress and drug use
Addiction
(1995) - et al.
Relevance of pharmacokinetic parameters in animal models of methamphetamine abuse
Synapse
(2001)
Major physical and psychological harms of methamphetamine use
Drug Alcohol Rev.
Bupropion for the treatment of methamphetamine dependence
Neuropsychopharmacology
Neural systems of reinforcement for drug addiction: from actions to habits to compulsion
Nat. Neurosci.
Structured Clinical Interview For DSM-IV-TR Axis I Disorders: Patient Edition
A Randomized, placebo-controlled trial of sustained-release dextroamphetamine for treatment of methamphetamine addiction
Clin. Pharmacol. Ther.
Cited by (30)
The effects of alcohol drinking on subsequent methamphetamine self-administration and relapse in adolescent female rats
2022, Behavioural Brain ResearchCitation Excerpt :Alcohol and Meth are commonly co-abused such that 77% of patients diagnosed with amphetamine dependence have comorbid alcohol use disorder (AUD) [1]. Not only is co-abuse of alcohol and Meth common, but the abuse of alcohol also significantly increases the likelihood of subsequent Meth use within the Meth-dependent population and increases the frequency and intensity of Meth use [2–4]. While prior alcohol use does not directly cause subsequent Meth experimentation, it is well established that alcohol is highly associated with Meth and other drug use [5].
Drug addiction co-morbidity with alcohol: Neurobiological insights
2021, International Review of NeurobiologyCitation Excerpt :Alcohol and cocaine co-exposure increased DA levels in the NAc (Bardo, 1998; Koob & Bloom, 1988; Koob, Sanna, & Bloom, 1998; Wise & Rompre, 1989) significantly more than either drug separately (Lindholm, Rosin, Dahlin, Georgieva, & Franck, 2001). Human studies suggest that the co-use of methamphetamine and alcohol has a synergistic effect on intoxication symptoms like euphoria and elevated heart rate (Brecht, Huang, Evans, & Hser, 2008; Bujarski et al., 2014; Kirkpatrick, Gunderson, Levin, Foltin, & Hart, 2012; Martin, Lampinen, & McGhee, 2006; O'Grady, Arria, Fitzelle, & Wish, 2008). However, a study by Winkler et al. showed that methamphetamine self-administration decreased alcohol consumption (Winkler, Greager, Stafford, & Bachtell, 2018), an effect the authors hypothesize may be due to lingering increases in extracellular DA by methamphetamine that blunted the reinforcing properties of alcohol (Winkler et al., 2018).
Neurotoxicity to dopamine neurons after the serial exposure to alcohol and methamphetamine: Protection by COX-2 antagonism
2019, Brain, Behavior, and ImmunityPrior binge-drinking history promotes the positive affective valence of methamphetamine in mice
2018, Drug and Alcohol DependenceCitation Excerpt :Globally, there exists a high prevalence of methamphetamine (MA) addiction and alcoholism co-morbidity (e.g., UN Office on Drugs and Crime, 2015). In fact, recent excessive alcohol consumption is associated with a 4–5-fold greater incidence of co-abuse (Brecht et al., 2007; Bujarski et al., 2014; Chen et al., 2014; Furr et al., 2000; Herbeck et al., 2013; O’Grady et al., 2008; Sattah et al., 2002). Further, co-abuse is a risk factor for treatment discontinuation and non-compliance in MA-dependent individuals (Brecht et al., 2005).
Polydrug use and its association with drug treatment outcomes among primary heroin, methamphetamine, and cocaine users
2017, International Journal of Drug PolicyCitation Excerpt :Both secondary alcohol and marijuana use were positively associated with primary MA use, and primary cocaine use. These results were consistent with several previous studies (Barrett, Darredeau, & Pihl, 2006; Brecht et al., 2008; Bujarski et al., 2014; Furr, Delva, & Anthony, 2000; McKay, Alterman, Rutherford, Cacciola, & McLellan, 1999) and might indicate users’ desire to counterbalance the effects of stimulant use (Brecht et al., 2008). In contrast, there appeared to be negative associations between secondary alcohol and marijuana use with primary heroin use.
Methamphetamine-alcohol interactions in murine models of sequential and simultaneous oral drug-taking
2017, Drug and Alcohol DependenceCitation Excerpt :Conversely, the percentage of current MA users that report alcohol co-abuse (a.k.a. mixing) ranges from 34 to 99% (e.g., Brecht et al., 2007; Celentano et al., 2008; Furr et al., 2000; O'Grady et al., 2008; Sattah et al., 2002). Prior AUD history is a major predisposing factor for MA abuse, with recent excessive alcohol consumption associated with a 4–5-fold greater incidence of co-abuse (e.g., Brecht et al., 2007; Bujarski et al., 2014; Chen et al., 2014; Furr et al., 2000; Herbeck et al., 2013; O'Grady et al., 2008; Sattah et al., 2002) and co-abuse is a risk factor for treatment discontinuation and non-compliance in MA-dependent individuals (Brecht et al., 2005). This latter fact is particularly serious as primary MA use accounts for ∼30% of all addiction treatment admissions in the U.S. (SAMHSA, 2009, 2012), the world-wide treatment admission rate for MA use is rising annually (UN Office on Drugs and Crime, 2015) and currently, there exists no effective treatment for MA addiction, let alone addiction co-morbidity.