Prevalence and Risk Factors of Substance Use Disorder in Inflammatory Bowel Disease

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Abstract

Background

Substance use disorders (SUDs) impose a substantial individual and societal burden; however, the prevalence and associated factors in persons with inflammatory bowel disease (IBD) are largely unknown. We evaluated the prevalence and risk factors of SUD in an IBD cohort.

Methods

Inflammatory bowel disease participants (n = 247) were recruited via hospital- and community-based gastroenterology clinics, a population-based IBD research registry, and primary care providers as part of a larger cohort study of psychiatric comorbidity in immune-mediated inflammatory diseases. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV was administered to participants to identify lifetime SUD, anxiety disorder, and major depressive disorder. Additional questionnaires regarding participants’ sociodemographic and clinical characteristics were also completed. We examined demographic and clinical factors associated with lifetime SUD using unadjusted and adjusted logistic regression modeling.

Results

Forty-one (16.6%) IBD participants met the criteria for a lifetime diagnosis of an SUD. Factors associated with elevated odds of SUD were ever smoking (adjusted odds ratio [aOR], 2.96; 95% confidence interval [CI], 1.17–7.50), male sex (aOR, 2.44; 95% CI, 1.11–5.36), lifetime anxiety disorder (aOR, 2.41; 95% CI, 1.08–5.37), and higher pain impact (aOR, 1.08; 95% CI, 1.01–1.16).

Conclusions

One in six persons with IBD experienced an SUD, suggesting that clinicians should maintain high index of suspicion regarding possible SUD, and inquiries about substance use should be a part of care for IBD patients, particularly for men, smokers, and patients with anxiety disorders and pain.

Abstract

Authors evaluated the prevalence and risk factors of SUD in an IBD cohort (n = 247). Forty-one (16.6%) participants experienced a lifetime SUD. Factors associated with elevated odds of SUD were ever smoking, male sex, lifetime anxiety disorder, and higher pain impact.

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Most cited references 39

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Toward an Integrated Clinical, Molecular and Serological Classification of Inflammatory Bowel Disease: Report of a Working Party of the 2005 Montreal World Congress of Gastroenterology

Renzo Caprilli, Jean-Frédéric Colombel, Tariq Ahmad … (2005)

The discovery of a series of genetic and serological markers associated with disease susceptibility and phenotype in inflammatory bowel disease has led to the prospect of an integrated classification system involving clinical, serological and genetic parameters. The Working Party has reviewed current clinical classification systems in Crohn’s disease, ulcerative colitis and indeterminate colitis, and provided recommendations for clinical classification in practice. Progress with respect to integrating serological and genetic markers has been examined in detail, and the implications are discussed. While an integrated system is not proposed for clinical use at present, the introduction of a widely acceptable clinical subclassification is strongly advocated, which would allow detailed correlations among serotype, genotype and clinical phenotype to be examined and confirmed in independent cohorts of patients and, thereby, provide a vital foundation for future work.

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A simple index of Crohn's-disease activity.

R Harvey, J M Bradshaw (1980)

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Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions.

Wilson Compton, Yonette Thomas, Frederick S Stinson … (2007)

Current and comprehensive information on the epidemiology of DSM-IV 12-month and lifetime drug use disorders in the United States has not been available. To present detailed information on drug abuse and dependence prevalence, correlates, and comorbidity with other Axis I and II disorders. Face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule of the National Institute on Alcohol Abuse and Alcoholism in a large representative sample of US adults (N=43093). Twelve-month and lifetime prevalence of drug abuse and dependence and the associated correlates, treatment rates, disability, and comorbidity with other Axis I and II disorders. Prevalences of 12-month and lifetime drug abuse (1.4% and 7.7%, respectively) exceeded rates of drug dependence (0.6% and 2.6%, respectively). Rates of abuse and dependence were generally greater among men, Native Americans, respondents aged 18 to 44 years, those of lower socioeconomic status, those residing in the West, and those who were never married or widowed, separated, or divorced (all P<.05). Associations of drug use disorders with other substance use disorders and antisocial personality disorder were diminished but remained strong when we controlled for psychiatric disorders. Dependence associations with most mood disorders and generalized anxiety disorder also remained significant. Lifetime treatment- or help-seeking behavior was uncommon (8.1%, abuse; 37.9%, dependence) and was not associated with sociodemographic characteristics but was associated with psychiatric comorbidity. Most individuals with drug use disorders have never been treated, and treatment disparities exist among those at high risk, despite substantial disability and comorbidity. Comorbidity of drug use disorders with other substance use disorders and antisocial personality disorder, as well as dependence with mood disorders and generalized anxiety disorder, appears to be due in part to unique factors underlying each pair of these disorders studied. The persistence of low treatment rates despite the availability of effective treatments indicates the need for vigorous educational efforts for the public and professionals.

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Author and article information

Journal

Journal ID (nlm-ta): Inflamm Bowel Dis

Journal ID (iso-abbrev): Inflamm Bowel Dis

Journal ID (publisher-id): ibd

Title: Inflammatory Bowel Diseases

Publisher: Oxford University Press (US )

ISSN (Print): 1078-0998

ISSN (Electronic): 1536-4844

Publication date Collection: January 2021

Publication date (Electronic): 06 February 2020

Publication date PMC-release: 06 February 2020

Volume: 27

Issue: 1

Pages: 58-64

Affiliations

[1 ] College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba , Manitoba, Canada

[2 ] Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba , Manitoba, Canada

[3 ] Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba , Manitoba, Canada

[4 ] Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba , Manitoba, Canada

[5 ] Department of Community Health Sciences, Cumming School of Medicine, University of Calgary , Alberta, Canada

[6 ] Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba , Manitoba, Canada

[7 ] Department of Medical Epidemiology & Biostatistics, Karolinska Institutet , Solna, Sweden

Author notes

Address correspondence to: Kaarina Kowalec, 750 McDermot Ave, Winnipeg MB R3N 0T5, Canada. E-mail: kaarina.kowalec@ 123456umanitoba.ca .

Author information

Kaarina Kowalec http://orcid.org/0000-0003-3928-9879

Article

Publisher ID: izaa014

DOI: 10.1093/ibd/izaa014

PMC ID: 7737154

PubMed ID: 32025740

SO-VID: 07b1ade1-af5d-4651-8bb5-093020d028ee

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

History

Date received : 23 November 2019

Date: 06 January 2020

Page count

Pages: 7

Funding

Funded by: Canadian Institutes of Health Research, DOI 10.13039/501100000024;

Award ID: THC-135234

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Prevalence and Risk Factors of Substance Use Disorder in Inflammatory Bowel Disease

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Karger: Gastroenterology

Most cited references 39

Toward an Integrated Clinical, Molecular and Serological Classification of Inflammatory Bowel Disease: Report of a Working Party of the 2005 Montreal World Congress of Gastroenterology

A simple index of Crohn's-disease activity.

Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions.

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