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Profiles of lifetime substance use are differentiated by substance of choice, affective motivations for use, and childhood maltreatment.

ABSTRACT: To develop personalized interventions and improve outcomes in substance-using populations, research is needed on the heterogeneity in substance use patterns and motivations that exists among adult substance users. This study took a person-centered approach to identify profiles of lifetime substance use and discern the psychosocial differences among them. To survey a spectrum of drug use severity, 1106 adults (43.4% women) were recruited from forensic and community samples. Participants reported on the frequency of lifetime substance use across multiple drug categories (sedatives, stimulants, marijuana, heroin, hallucinogens, misuse of prescription drugs) and alcohol use. Latent profile analysis was used to identify distinct profiles of substance use that were then compared on potential risk and maintenance factors for substance use. Four profiles of lifetime substance use emerged that diverged on severity of use and degree of mono vs. polysubstance use (Recreational Marijuana Use, Heavy Multidrug Intoxication, Heavy Marijuana Use, and Heavy Opioid and Polysubstance Use). The profiles differed on affective motivations for substance use (e.g., using to cope vs. using to seek a thrill), age of use onset, drug-related functional impairment, and experiences of childhood maltreatment. Cognitive functioning did not differentiate the heavy substance use profiles. Results provide compelling initial evidence that lifetime patterns of use can be used to identify groups of substance users with distinct risk and maintenance factors. Results highlight affective motivations for substance use and maltreatment history as potential treatment targets and underscore the importance of studying polysubstance use in the context of the opioid epidemic.

SUBMITTER: Sadeh N

PROVIDER: S-EPMC8312989 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Substance use disorders (SUDs) are among the most common sequelae of childhood maltreatment, yet the independent contributions of SUDs and childhood maltreatment to neurobiological changes and the effect of the latter on relapse risk (a critical variable in addiction treatment) are relatively unknown.To identify structural neural characteristics independently associated with childhood maltreatment (CM; a common type of childhood adversity), comparing a sample with SUD with a demographically comparable control sample, and to examine the relationship between CM-related structural brain changes and subsequent relapse.Structural magnetic resonance imaging study comparing 79 treatment-engaged participants with SUD in acute remission in inpatient treatment at a community mental health center vs 98 healthy control participants at an outpatient research center at an academic medical center. Both groups included individuals with a range of CM experiences. Participants with SUD were followed up prospectively for 90 days to assess relapse and relapse severity.Standard 12-step, recovery-based, inpatient addiction treatment for all participants with SUD.Gray matter volume (GMV), subsequent substance use relapse, days to relapse, and severity of relapse.Controlling for SUD and psychiatric comorbidity, CM (dichotomously classified) was uniquely associated with lower GMV across all participants in the left hippocampus (cornu ammonis 1-3, dentate gyrus), parahippocampus (presubiculum, parasubiculum, prosubiculum, subiculum, and entorhinal cortex), and anterior fusiform gyrus (corrected P?<?.05; uncorrected P?=?.001). Among the sample with SUD, CM prospectively predicted a shorter relapse to use of any drug (P?=?.048), while CM-related GMV reductions predicted severity of substance use relapse (P?=?.04).Findings indicate that CM was related to decreased GMV in limbic regions, which in turn predicted increased risk of relapse in SUD. These results suggest that CM may significantly affect the course of SUD treatment outcomes and that SUD treatment planning may benefit from identifying and addressing CM.

Project description:Childhood maltreatment is associated with adverse effects on the brain, and an increased risk for psychopathology, including mood and substance use disorders. Individuals vary on the degree to which they exhibit neurobiological and clinical differences following maltreatment. Individuals with bipolar disorder exhibit greater magnitude of maltreatment-related prefrontal-paralimbic gray matter volume (GMV) deficits compared to typically developing individuals. It is unclear if greater structural differences stem from greater neural vulnerability to maltreatment in bipolar disorder, or if they relate to presence of other clinical features associated with childhood maltreatment, e.g., elevated prevalence of comorbid substance use disorders. To investigate this, we compared young adults with a family history of bipolar disorder (n = 21), but who did not fulfill diagnostic criteria for bipolar disorder, with typically developing young adults without a family history of bipolar disorder (n = 26). Participants completed structural neuroimaging, clinical and family history interviews, and assessment of childhood maltreatment and recent alcohol and cannabis use patterns. We examined relations between childhood maltreatment and prefrontal-paralimbic GMV by modeling main effects of maltreatment and family history group by maltreatment interactions on prefrontal-paralimbic GMV. We also examined relations between maltreatment and associated GMV changes with recent alcohol and cannabis use. Childhood maltreatment correlated with lower ventral, rostral and dorsolateral prefrontal and insular cortical GMV across all participants regardless of the presence or absence of familial history of bipolar disorder. However, exploratory analyses did reveal greater maltreatment-related GMV differences in individuals with prodromal symptoms of depression. Lower insula GMV was associated with greater frequency of cannabis use across all participants and greater quantity of alcohol use only in those with familial risk for bipolar disorder. Results suggest familial risk for bipolar disorder, and presumably genetic risk, may relate to outcomes following childhood maltreatment and should be considered in prevention/early intervention strategies.

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Profiles of lifetime substance use are differentiated by substance of choice, affective motivations for use, and childhood maltreatment.

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