Advertisement

Association of Substance Use Patterns with Psychiatric Disorders in Homeless Persons with Psychiatric Disorders in Vancouver

  • Marc VogelEmail author
  • Mohammadali Nikoo
  • Nooshin Nikoo
  • Christian G. Schütz
  • Marc Walter
  • Julian Somers
  • Michael Krausz
Original Article
  • 111 Downloads

Abstract

Substance use and psychiatric disorders are highly prevalent in persons experiencing homelessness. We aimed to investigate the associations between the patterns of substance use and risk behaviors with specific psychiatric disorders in homeless persons with psychiatric disorders using baseline data of the Vancouver sample (N = 494) of the At Home/Chez Soi study. Psychiatric disorders were diagnosed with the MINI Neuropsychiatric Interview 6.0, and substance use was assessed with the Maudsley Addiction Profile. In a multivariate analysis, major depressive disorder was associated with the use of stimulants and benzodiazepines, respectively. Posttraumatic stress disorder (PTSD) was associated with stimulant use. Panic disorder was associated with alcohol and benzodiazepine use, respectively. Opioid use was less common in participants with a psychotic disorder. Injection use of drugs occurred more often among participants with major depressive disorder, PTSD, and mood disorder with psychotic features. Awareness of these associations will be useful for clinicians for targeted prevention, diagnosis, and treatment of this population.

Keywords

Alcohol Opioid Stimulant Cannabis Route of administration Risk behavior 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. Afful, S. E., Strickland, J. R., Cottler, L., & Bierut, L. J. (2010). Exposure to trauma: a comparison of cocaine-dependent cases and a community-matched sample. Drug and Alcohol Dependence, 112(1–2), 46–53.  https://doi.org/10.1016/j.drugalcdep.2010.05.012.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Ashton, H. (2005). The diagnosis and management of benzodiazepine dependence. Current Opinion in Psychiatry, 18(3), 249–255.  https://doi.org/10.1097/01.yco.0000165594.60434.84.CrossRefPubMedGoogle Scholar
  3. Boden, J. M., & Fergusson, D. M. (2011). Alcohol and depression. Addiction, 106(5), 906–914.  https://doi.org/10.1111/j.1360-0443.2010.03351.x.CrossRefPubMedGoogle Scholar
  4. Bolton, J. M., Robinson, J., & Sareen, J. (2009). Self-medication of mood disorders with alcohol and drugs in the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Affective Disorders, 115(3), 367–375.  https://doi.org/10.1016/j.jad.2008.10.003.CrossRefPubMedGoogle Scholar
  5. Conway, K. P., Compton, W., Stinson, F. S., & Grant, B. F. (2006). Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of Clinical Psychiatry, 67(2), 247–257.CrossRefGoogle Scholar
  6. D’Souza, D. C., Perry, E., MacDougall, L., Ammerman, Y., Cooper, T., Wu, Y., et al. (2004). The psychotomimetic effects of Intravenous delta-9-tetrahydrocannabinol in healthy individuals: implications for psychosis. Neuropsychopharmacology, 29(8), 1558–1572.  https://doi.org/10.1038/sj.npp.1300496.CrossRefPubMedGoogle Scholar
  7. Degenhardt, L., Coffey, C., Moran, P., Carlin, J. B., & Patton, G. C. (2007). The predictors and consequences of adolescent amphetamine use: findings from the Victoria Adolescent Health Cohort Study. Addiction, 102(7), 1076–1084.  https://doi.org/10.1111/j.1360-0443.2007.01839.x.CrossRefPubMedGoogle Scholar
  8. Esposito, E., Barbui, C., & Patten, S. B. (2009). Patterns of benzodiazepine use in a Canadian population sample. Epidemiologia e Psichiatria Sociale, 18(3), 248–254 Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20034203.CrossRefGoogle Scholar
  9. Fazel, S., Geddes, J. R., & Kushel, M. (2014). The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. The Lancet, 384(9953), 1529–1540.  https://doi.org/10.1016/S0140-6736(14)61132-6.CrossRefGoogle Scholar
  10. Fazel, S., Khosla, V., Doll, H., & Geddes, J. (2008). The prevalence of mental disorders among the homeless in Western countries: ystematic review and meta-regression analysis. PLoS Medicine, 5(12), e225.  https://doi.org/10.1371/journal.pmed.0050225.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Gaetz, S., Gulliver, T., & Richter, T. (2014). The state of homelessness in Canada: 2014. Toronto. Retrieved from http://www.homelesshub.ca/sites/default/files/SOHC2014.pdf
  12. Goering, P. N., Streiner, D. L., Adair, C., Aubry, T., Barker, J., Distasio, J., Hwang, S. W., Komaroff, J., Latimer, E., Somers, J., & Zabkiewicz, D. M. (2011). The at home/chez Soi trial protocol: a pragmatic, multi-site, randomised controlled trial of a housing first intervention for homeless individuals with mental illness in five Canadian cities. BMJ Open, 1(2), e000323–e000323.  https://doi.org/10.1136/bmjopen-2011-000323.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Grinman, M. N., Chiu, S., Redelmeier, D. A., Levinson, W., Kiss, A., Tolomiczenko, G., Cowan, L., & Hwang, S. W. (2010). Drug problems among homeless individuals in Toronto, Canada: prevalence, drugs of choice, and relation to health status. BMC Public Health, 10(94).  https://doi.org/10.1186/1471-2458-10-94.
  14. Houlihan, D. J. (2011). Psychostimulant treatment of combat-related posttraumatic stress disorder. Journal of Psychopharmacology, 25(11), 1568–1572.  https://doi.org/10.1177/0269881110385600.CrossRefPubMedGoogle Scholar
  15. Hwang, S. W., & Burns, T. (2014). Health interventions for people who are homeless. The Lancet, 384(9953), 1541–1547.  https://doi.org/10.1016/S0140-6736(14)61133-8.CrossRefGoogle Scholar
  16. Hwang, S. W., Wilkins, E., Chambers, C., Estrabillo, E., Berends, J., & MacDonald, A. (2011). Chronic pain among homeless persons: Characteristics, treatment, and barriers to management. BMC Family Practice, 12(1), 73.  https://doi.org/10.1186/1471-2296-12-73.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617–627.  https://doi.org/10.1001/archpsyc.62.6.617.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Koegel, P., Burnam, M. A., & Farr, R. K. (1988). The prevalence of specific psychiatric disorders among homeless individuals in the Inner City of Los Angeles. Archives of General Psychiatry, 45(12), 1085.  https://doi.org/10.1001/archpsyc.1988.01800360033005.CrossRefPubMedGoogle Scholar
  19. Krausz, R. M., Clarkson, A. F., Strehlau, V., Torchalla, I., Li, K., & Schuetz, C. G. (2013). Mental disorder, service use, and barriers to care among 500 homeless people in 3 different urban settings. Social Psychiatry and Psychiatric Epidemiology, 48(8), 1235–1243.  https://doi.org/10.1007/s00127-012-0649-8.CrossRefPubMedGoogle Scholar
  20. Kushner, M. G., Sher, K. J., & Erickson, D. J. (1999). Prospective analysis of the relation between DSM-III anxiety disorders and alcohol use disorders. The American Journal of Psychiatry, 156(5), 723–732.  https://doi.org/10.1176/ajp.156.5.723.CrossRefPubMedGoogle Scholar
  21. Lago, J. A., & Kosten, T. R. (1994). Stimulant withdrawal. Addiction, 89(11), 1477–1481.  https://doi.org/10.1111/j.1360-0443.1994.tb03746.x.CrossRefPubMedGoogle Scholar
  22. Larney, S., Conroy, E., Mills, K. L., Burns, L., & Teesson, M. (2009). Factors associated with violent victimisation among homeless adults in Sydney, Australia. Australian and New Zealand Journal of Public Health, 33(4), 347–351.  https://doi.org/10.1111/j.1753-6405.2009.00406.x.CrossRefPubMedGoogle Scholar
  23. Mahoney, J. J., Thompson-Lake, D. G., Cooper, K., Verrico, C. D., Newton, T. F., & De La Garza, R. (2015). A comparison of impulsivity, depressive symptoms, lifetime stress and sensation seeking in healthy controls versus participants with cocaine or methamphetamine use disorders. Journal of Psychopharmacology, 29(1), 50–56.  https://doi.org/10.1177/0269881114560182.CrossRefPubMedGoogle Scholar
  24. Marsden, J., Gossop, M., Stewart, D., Best, D., Farrell, M., Lehmann, P., et al. (1998). The Maudsley ddiction profile (MAP): a brief instrument for assessing treatment outcome. Addiction, 93(12), 1857–1867.CrossRefGoogle Scholar
  25. Marsden, J., Nizzoli, U., Corbelli, C., Margaron, H., Torres, M., Prada De Castro, I., et al. (2000). New European instruments for treatment outcome research: reliability of the Maudsley addiction profile and treatment perceptions questionnaire in Italy, Spain and Portugal. European Addiction Research, 6(3), 115–122 https://doi.org/19023.CrossRefGoogle Scholar
  26. Martins, S. S., Keyes, K. M., Storr, C. L., Zhu, H., & Chilcoat, H. D. (2009). Pathways between nonmedical opioid use/dependence and psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug and Alcohol Dependence, 103(1–2), 16–24.  https://doi.org/10.1016/j.drugalcdep.2009.01.019.CrossRefPubMedPubMedCentralGoogle Scholar
  27. McIntyre, R. S., Lee, Y., Zhou, A. J., Rosenblat, J. D., Peters, E. M., Lam, R. W., Kennedy, S. H., Rong, C., & Jerrell, J. M. (2017). The efficacy of psychostimulants in major depressive episodes. Journal of Clinical Psychopharmacology, 37(4), 412–418.  https://doi.org/10.1097/JCP.0000000000000723.CrossRefPubMedGoogle Scholar
  28. Meade, C. S., Graff, F. S., Griffin, M. L., & Weiss, R. D. (2008). HIV risk behavior among patients with co-occurring bipolar and substance use disorders: associations with mania and drug abuse. Drug and Alcohol Dependence, 92(1–3), 296–300.  https://doi.org/10.1016/j.drugalcdep.2007.07.013.CrossRefPubMedGoogle Scholar
  29. Novak, S. P., & Kral, A. H. (2011). Comparing injection and non-injection routes of administration for heroin, methamphetamine, and cocaine users in the United States. Journal of Addictive Diseases, 30(3), 248–257.  https://doi.org/10.1080/10550887.2011.581989.CrossRefPubMedPubMedCentralGoogle Scholar
  30. Palepu, A., Patterson, M., Strehlau, V., Moniruzzamen, A., Bibiana, J. T., Frankish, J., et al. (2012). Daily substance use and mental health symptoms among a cohort of homeless adults in Vancouver, British Columbia. Journal of Urban Health, 90(4), 740–746.  https://doi.org/10.1007/s11524-012-9775-6.CrossRefPubMedCentralGoogle Scholar
  31. Quinn, D. I., Wodak, A., & Day, R. O. (1997). Pharmacokinetic and pharmacodynamic principles of illicit drug use and treatment of illicit drug users. Clinical Pharmacokinetics, 33(5), 344–400.  https://doi.org/10.2165/00003088-199733050-00003.CrossRefPubMedGoogle Scholar
  32. Robinson, J., Sareen, J., Cox, B. J., & Bolton, J. (2009). Self-medication of anxiety disorders with alcohol and drugs: results from a nationally representative sample. Journal of Anxiety Disorders, 23(1), 38–45.  https://doi.org/10.1016/j.janxdis.2008.03.013.CrossRefPubMedGoogle Scholar
  33. Roncero, C., Comín, M., Daigre, C., Grau-López, L., Martínez-Luna, N., Eiroa-Orosa, F. J., Barral, C., Torrens, M., & Casas, M. (2014). Clinical differences between cocaine-induced psychotic disorder and psychotic symptoms in cocaine-dependent patients. Psychiatry Research, 216(3), 398–403.  https://doi.org/10.1016/j.psychres.2014.01.026.CrossRefPubMedGoogle Scholar
  34. Schmauss, C., Yassouridis, A., & Emrich, H. M. (1987). Antipsychotic effect of buprenorphine in schizophrenia. The American Journal of Psychiatry, 144(10), 1340–1342.  https://doi.org/10.1176/ajp.144.10.1340.CrossRefPubMedGoogle Scholar
  35. Sheehan, D. V, Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., … Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of Clinical Psychiatry, 59 Suppl 2(SUPPL. 20), 22–33-57.  https://doi.org/10.1016/S0924-9338(99)80239-9.CrossRefGoogle Scholar
  36. Smith, R. C., Blumenthal, H., Badour, C., & Feldner, M. T. (2010). An investigation of relations between crystal methamphetamine use and posttraumatic stress disorder. Addictive Behaviors, 35(6), 625–627.  https://doi.org/10.1016/j.addbeh.2010.01.010.CrossRefPubMedGoogle Scholar
  37. Swann, A. C. (2009). Impulsivity in mania. Current Psychiatry Reports, 11(6), 481–487 Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19909671.CrossRefGoogle Scholar
  38. Tang, Y., Martin, N. L., & Cotes, R. O. (2014). Cocaine-induced psychotic disorders: presentation, mechanism, and management. Journal of Dual Diagnosis, 10(2), 98–106.  https://doi.org/10.1080/15504263.2014.906133.CrossRefPubMedGoogle Scholar
  39. The U.S. Department of Housing and Urban Development. (2017). The 2017 Annual Homeless Assessment Report (AHAR) to Congress - part 1: point-in-time estimates of homelessness. Retrieved from https://www.hudexchange.info/resources/documents/2017-AHAR-Part-1.pdf
  40. Torchalla, I., Strehlau, V., Li, K., Aube Linden, I., Noel, F., & Krausz, M. (2013). Posttraumatic stress disorder and substance use disorder comorbidity in homeless adults: prevalence, correlates, and sex differences. Psychology of Addictive Behaviors, 28(2), 1–10.  https://doi.org/10.1037/a0033674.CrossRefGoogle Scholar
  41. Torchalla, I., Strehlau, V., Li, K., & Krausz, M. (2011). Substance use and predictors of substance dependence in homeless women. Drug and Alcohol Dependence, 118(2–3), 173–179.  https://doi.org/10.1016/j.drugalcdep.2011.03.016.CrossRefPubMedGoogle Scholar
  42. Tsai, J., Kasprow, W. J., & Rosenheck, R. A. (2014). Alcohol and drug use disorders among homeless veterans: prevalence and association with supported housing outcomes. Addictive Behaviors, 39(2), 455–460.  https://doi.org/10.1016/j.addbeh.2013.02.002.CrossRefPubMedGoogle Scholar
  43. van Marwijk, H., Allick, G., Wegman, F., Bax, A., & Riphagen, I. I. (2012). Alprazolam for depression. The Cochrane Database of Systematic Reviews, 7(7), CD007139.  https://doi.org/10.1002/14651858.CD007139.pub2.CrossRefGoogle Scholar
  44. Volkow, N. D., Swanson, J. M., Evins, A. E., DeLisi, L. E., Meier, M. H., Gonzalez, R., Bloomfield, M. A. P., Curran, H. V., & Baler, R. (2016). Effects of Cannabis use on human behavior, including cognition, motivation, and psychosis: a review. JAMA Psychiatry, 73(3), 292.  https://doi.org/10.1001/jamapsychiatry.2015.3278.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of Basel Psychiatric HospitalDivision of Addictive DisordersBaselSwitzerland
  2. 2.Institute of Psychiatric Health, Department of PsychiatryThe University of British ColumbiaVancouverCanada
  3. 3.Centre for Health Evaluation and Outcome Sciences (CHEOS)The University of British ColumbiaVancouverCanada
  4. 4.Faculty of Health SciencesSimon Fraser UniversityVancouverCanada

Personalised recommendations