Substance use disorders linked to poor health outcomes in wide range of physical health conditions
People who have a past history of hospitalisation because of substance use disorders have much worse outcomes following the onset of a wide range of physical health conditions, according to researchers in the UK and Czechia.
In a study published today in The Lancet Psychiatry, researchers looked at the risk of mortality and loss of life-years among people who developed 28 different physical health conditions, comparing those who had previously been hospitalised with substance use disorder against those who had not.
They found that patients with most of the health conditions were more likely than their counterparts to die during the study period if they had been hospitalised with substance use disorder prior to the development of these conditions. For most subsequent health conditions, people with substance use disorders also had shorter life-expectancies than did individuals without substance use disorders.
One in twenty people worldwide aged 15 years or older lives with alcohol use disorder, while around one in 100 people have psychoactive drug use disorders. Although substance use disorders have considerable direct effects on health, they are also linked to a number of physical and mental health conditions. Consequently, the presence of these contributes to higher risk of mortality and shorter lifespan in people with substance use disorders.
To explore this link further, researchers analysed patient records from Czech nationwide registers of all-cause hospitalisations and deaths during the period from 1994-2017. They used a novel design, estimating the risk of death and life-years lost after the onset of multiple specific physical health conditions in individuals with a history of hospitalisation for substance use disorders, when compared with matched counterparts without substance use disorder but with the same physical health condition.
Although the study only looked at people living in Czechia, the researchers believe the results are likely to be similar in other countries, too.
They found that people with pre-existing substance use disorders were more likely than their counterparts to have died during the study following the development of 26 out of 28 physical health conditions. For seven of these conditions – including atrial fibrillation, hypertension, and ischaemic heart disease – the risk was more than doubled. In most cases, people with substance use disorders have shorter life-expectancies than their counterparts.
Lead author Tomáš Formánek, a PhD student at the National Institute of Mental Health, Czechia, and the University of Cambridge, said: “Substance use disorders seem to have a profound negative impact on prognosis following the development of various subsequent physical health conditions, in some cases dramatically affecting the life expectancy of the affected people.”
It is not clear why this should be the case, though the researchers say there are a number of possible reasons. It is already known that substance use has a direct negative impact on physical health and is associated with lifestyle factors that affect our health, such as smoking, lack of exercise, and poor diet. Similarly, people with substance use disorders are less likely to take part in screening and prevention programmes for diseases such as cancer and diabetes and are less likely to use preventive medication, such as drugs to prevent hypertension. There are also some factors not directly related to substance use, such as diagnostic overshadowing, meaning the misattribution of physical symptoms to mental disorders. Such misattribution can subsequently contribute to under-diagnosis, late diagnosis, and delayed treatment in affected individuals.
Senior author Professor Peter Jones from the Department of Psychiatry, University of Cambridge, added: “These results show how important it is not to compartmentalise health conditions into mind, brain or body. All interact leading here to the dramatic increases in mortality from subsequent physical illnesses in people with substance use disorders. There are clear implications for preventive action by clinicians, health services and policy developers that all need to recognise these intersections.”
Co-author Dr Petr Winkler from the National Institute of Mental Health, Czechia, said: “It is also important to consider that the majority of people with substance use disorders go undetected. They often do not seek a professional help and hospitalisations for these conditions usually come only at very advanced stages of illness. Alongside actions focused on physical health of people with substance use disorders, we need to equally focus on early detection and early intervention in substance use disorders.”
The research was funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration East of England at Cambridge and Peterborough NHS Foundation Trust.
Reference
Formánek, T et al. Mortality and life-years lost following subsequent physical comorbidity in people with pre-existing substance use disorders: a national registry-based retrospective cohort study of hospitalised individuals in Czechia. The Lancet Psychiatry; 3 Nov 2022; DOI: 10.1016/S2215-0366(22)00335-2
JOURNAL
The Lancet Psychiatry
METHOD OF RESEARCH
Observational study
SUBJECT OF RESEARCH
People
Parental discord may be an indicator of children’s genetic risk for future alcohol misuse
Genetic risk for alcohol problems may be transmitted across generations through exposure to parental discord or divorce, says Rutgers researcher
Peer-Reviewed PublicationParents can transmit a genetic risk for alcohol problems to their children not only directly, but also indirectly via genetically influenced aspects of the home environment, such as marital discord or divorce, according to a Rutgers researcher.
The study, published in Molecular Psychiatry, found that children’s exposure to parents’ relationship discord or divorce is associated with the potential for alcohol use disorder as adults.
“Previous research has shown that genes that predispose people to alcohol use disorder also predispose them to experience more conflict in their close romantic relationships,” said Jessica Salvatore, coauthor of the study and an associate professor and director of the Genes, Environments and Neurodevelopment in Addictions Program at Rutgers Robert Wood Johnson Medical School. “Based on this, we hypothesized that children who are exposed to divorce or parental relationship discord also inherit a genetic predisposition toward alcohol problems — and that experiencing these family adversities might be one pathway through which genetic risk for alcohol problems is passed from parents to their children.”
The researchers used The Collaborative Study on the Genetics of Alcoholism – a large-scale family study designed to identify genes that affect the risk for alcohol use disorder and alcohol-related behaviors – and analyzed data from 4,846 people of European ancestry and 2,005 people of African ancestry who were interviewed when they were approximately age 30. They assessed whether participants had any symptoms of DSM-5 Alcohol Use Disorder and studied predictors in their parents, including relationship discord, divorce and alcohol use disorder symptoms as well as a measure of their genetic predispositions for alcohol problems.
“The conventional understanding is that genetic risk for alcohol problems is passed in families from parents to children through the sharing of alleles, or variations of genes, from across the genome. What we found is that parents with more alleles for alcohol problems were also more likely to divorce or experience relationship discord, which in turn was associated with greater alcohol use disorder symptoms in their adult children,” Salvatore said. “Genes can shape our environment: Parents’ genes contribute to the types of environment that they create for us. Thus, one of the ways that genetic inheritance works is through our home environment. And these family adversities can turn the dial on our risk of experiencing alcohol use disorder symptoms later on. In other words, it’s not ‘nature’ or ‘nurture,’ but rather nature [genes] contributing to nurture [family experiences].”
In families of European descent, researchers found evidence that parental alleles associated with increased risk of alcohol problems also increased the likelihood that children in those families would experience parental relationship discord and divorce, which were in turn associated with riskier alcohol behaviors from drinking at earlier ages to greater lifetime maximum drinks to a greater likelihood of developing alcohol use disorder symptoms. Importantly, these effects were observed even when parents’ own alcohol use behaviors were statistically controlled for in the model.
The study did not find this evidence in people with African ancestry, and Salvatore said further research is needed to determine why.
Salvatore said the findings can lead to new avenues for treatment beyond medication. “One implication of our study findings is that even if someone’s risk for alcohol problems is, in part, grounded in their genetic makeup, the intervention could be environmental and not necessarily pharmaceutical,” she said.
Salvatore shared first authorship on this study with Nathaniel Thomas, Virginia Commonwealth University. Other Rutgers co-authors included Sally Kuo, Fazil Aliev, Sarah Brislin and Danielle Dick. COGA is a multisite study, and this study included additional co-authors from Washington University School of Medicine, State University of New York Health Sciences University, the University of Connecticut, the University of Iowa, Indiana University, and the University of California San Diego.
JOURNAL
Molecular Psychiatry
METHOD OF RESEARCH
Observational study
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Genetic nurture effects for alcohol use disorder
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