Journal
JAMA PSYCHIATRY
Volume 76, Issue 7, Pages 708-720Publisher
AMER MEDICAL ASSOC
DOI: 10.1001/jamapsychiatry.2019.0163
Keywords
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Categories
Funding
- United States National Institute of Mental Health [R01 MH070884]
- John D. and Catherine T. MacArthur Foundation
- Pfizer Foundation
- US Public Health Service [R13-MH066849, R01-MH069864, R01 DA016558]
- Fogarty International Center [FIRCA R03-TW006481]
- Pan American Health Organization
- Eli Lilly and Company
- Ortho-McNeil Pharmaceutical Inc
- Bristol-Myers Squibb
- Australian National Health and Medical Research Council [1081984]
- National Health and Medical Research Council Senior Principal Research Fellowship [1135991]
- National Institute on Drug Abuse [R01 DA044170-02]
- Australian Government Department of Health and Ageing
- Argentinian Ministry of Health (Ministerio de Salud de la Nacion)
- State of Sao Paulo Research Foundation [03/00204-3]
- Ministry of Health
- National Center for Public Health Protection
- Ministry of Social Protection
- Center for Excellence on Research in Mental Health (at CES University)
- European Commission [QLG5-1999-01042, SANCO 2004123, EAHC 20081308]
- Ministerio de Ciencia y Tecnologia, Spain [SAF 2000-158-CE]
- Generalitat de Catalunya [2017 SGR 452, 2014 SGR 748]
- Fondo de Investigacion Sanitaria, Instituto de Salud Carlos III, Spain [FIS 00/0028]
- GlaxoSmithKline
- Japanese and European Funds through United Nations Development Group Iraq Trust Fund
- Israel National Institute for Health Policy and Health Services Research
- National Insurance Institute of Israel
- Japan Ministry of Health, Labour andWelfare [H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013, H25-SEISHIN-IPPAN-006]
- Lebanese Ministry of Public Health
- National Institutes of Health/Fogarty International Center [R03 TW006481-01]
- Algorithm
- AstraZeneca
- Benta
- Bella Pharma
- Eli Lilly
- Glaxo Smith Kline
- Lundbeck
- Novartis
- OmniPharma
- Pfizer
- Phenicia
- Servier
- UPO
- National Institute of Psychiatry Ramon de la Fuente [INPRFMDIES 4280]
- National Council on Science and Technology [CONACyT-G30544-H]
- New Zealand Ministry of Health
- Health Research Council
- World Health Organization Geneva
- World Health Organization Nigeria
- Federal Ministry of Health in Abuja, Nigeria
- Health AMP
- Social Care Research AMP
- Development Division of the Public Health Agency
- National Institute of Health of the Ministry of Health of Peru
- European Economic Area Financial Mechanism [PL 0256]
- Norwegian Financial Mechanism
- Polish Ministry of Health
- US National Institute of Mental Health [R01-MH059575, RO1-MH61905]
- National Institute of Drug Abuse
- South African Department of Health
- Regional Health Authority of Murcia (Servicio Murciano de Salud)
- Fundacion para la Formacion e Investigacion Sanitarias of Murcia
- National Institute of Mental Health [U01-MH60220]
- RobertWood Johnson Foundation [044708]
- Brazilian Council for Scientific and Technological Development (CNPq) [307784/2016-9]
- Medical Research Council of South Africa
- World Health Organization Lebanon
- Alcohol Advisory Council
- University of Michigan
- Regional Health Authority of Murcia (Consejeria de Sanidad y Politica Social)
- Piedmont Region (Italy)
- Instituto de Salud Carlos III (CIBER) [CB06/02/0046, RETICS RD06/0011 REM-TAP]
- Substance Abuse and Mental Health Services Administration
- JohnWAlden Trust
- National Health and Medical Research Council of Australia [1081984] Funding Source: NHMRC
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ImportanceLimited empirical research has examined the extent to which cohort-level prevalence of substance use is associated with the onset of drug use and transitioning into greater involvement with drug use. ObjectiveTo use cross-national data to examine time-space variation in cohort-level drug use to assess its associations with onset and transitions across stages of drug use, abuse, dependence, and remission. Design, Setting, and ParticipantsThe World Health Organization World Mental Health Surveys carried out cross-sectional general population surveys in 25 countries using a consistent research protocol and assessment instrument. Adults from representative household samples were interviewed face-to-face in the community in relation to drug use disorders. The surveys were conducted between 2001 and 2015. Data analysis was performed from July 2017 to July 2018. Main Outcomes and MeasuresData on timing of onset of lifetime drug use, DSM-IV drug use disorders, and remission from these disorders was assessed using the Composite International Diagnostic Interview. Associations of cohort-level alcohol prevalence and drug use prevalence were examined as factors associated with these transitions. ResultsAmong the 90027 respondents (48.1% [SE, 0.2%] men; mean [SE] age, 42.1 [0.1] years), 1 in 4 (24.8% [SE, 0.2%]) reported either illicit drug use or extramedical use of prescription drugs at some point in their lifetime, but with substantial time-space variation in this prevalence. Among users, 9.1% (SE, 0.2%) met lifetime criteria for abuse, and 5.0% (SE, 0.2%) met criteria for dependence. Individuals who used 2 or more drugs had an increased risk of both abuse (odds ratio, 5.17 [95% CI, 4.66-5.73]; P<.001) and dependence (odds ratio, 5.99 [95% CI, 5.02-7.16]; P<.001) and reduced probability of remission from abuse (odds ratio, 0.86 [95% CI, 0.76-0.98]; P=.02). Birth cohort prevalence of drug use was also significantly associated with both initiation and illicit drug use transitions; for example, after controlling for individuals' experience of substance use and demographics, for each additional 10% of an individual's cohort using alcohol, a person's odds of initiating drug use increased by 28% (odds ratio, 1.28 [95% CI, 1.26-1.31]). Each 10% increase in a cohort's use of drug increased individual risk by 12% (1.12 [95% CI, 1.11-1.14]). Conclusions and RelevanceBirth cohort substance use is associated with drug use involvement beyond the outcomes of individual histories of alcohol and other drug use. This has important implications for understanding pathways into and out of problematic drug use.
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