# Presentation: 700302

## Ronald C. Kessler, Ph.D.
Department of Health Care Policy
Harvard Medical School

May 21, 2007

- Department of Health Care Policy
- Harvard Medical School
- May 21, 2007

- Evidence of Directionality in Epidemiological Studies of Adults

## NCS-2 Study Design 

- 	Nationally representative face-to-face household survey
-   English-speakers, ages 15-54
-   September 1990 to February 1992
-   n = 8098 respondents (82.4% response rate)
-   n = 5877 Part II respondents over-sampled the  young and people with disorders
-   WHO CIDI for DSM-III-R disorders

- 		Baseline NCS

## NCS-2 Study Design 

- 	Face-to-face follow-up survey of Part II NCS respondents
-   A decade after the NCS
-   N = 5001 respondents (87.6% of living NCS respondents; 72.2% of baseline)
-  WHO CIDI for DSM-IV disorders

-  			NCS-2

## Substances assessed in the NCS and NCS-2 

- Tobacco
- Alcohol
- Sedatives-tranquilizers
- Stimulants
- Analgesics
- Marijuana-hashish
- Cocaine
- Heroin-opiates
- Inhalants
- Hallucinogens
- Ecstasy and related club drugs (NCS-2 only)

##  Dimensions of substances assessed 

- 	Age-of-onset (AOO) of use
-   Lifetime and 12-month quantity-frequency of use
-   Recency of use
-   Lifetime prevalence of AOO of abuse (not for nicotine)
-   Recency of abuse (not for nicotine)
-   Lifetime prevalence and AOO of dependence
-   Recency of dependence

##  Transitions studied 

- I.  Among baseline lifetime nonusers
- Onset of use, abuse, and dependence
- II. Among baseline lifetime non-abusing users
- Persistence of use
- Onset of abuse and dependence
- III. Among baseline lifetime non-dependent abusers
- Persistence of use and abuse
- Onset of dependence
- IV. Among baseline lifetime dependent users
- Persistence of use, abuse, and dependence

##   Controls included in the models 

- I. Socio-demographics
- Age
- Gender
- Race-ethnicity
- II. Baseline substance history
- AOO of use
- Quantity-frequency of use
- History of abuse and dependence
- Speed of transition to abuse and to dependence
- Multivariate substance use profile

## Baseline mental disorders included in the models 

- I. Mood Disorders
- Major depressive disorder
- Dysthymic disorder
- Bipolar disorder
- II. Anxiety disorders
- Generalized anxiety disorder
- Panic disorder
- Phobia
- Post-traumatic stress disorder
- III. Impulse-control disorder
- Conduct disorder
- Antisocial personality disorder
- ADHD*
- IED*

- * Only assessed in the NCS-2

##  Nicotine transitions studied 

- Among baseline lifetime nonusers
-    Onset of use and dependence		    9.7             6.1         (2662)
- Among baseline lifetime non-dependent users
-    Persistence of use 			                46.4              --           (1368)
-    Onset of dependence                                             --              37.7         (1368)
- Among baseline lifetime dependent users
-    Persistence of use and dependence                     29.7           42.7         (971)

-       Use     Dependence     (n)

-      %               %

##  Alcohol transitions studied 

- Among baseline lifetime non-users
-    Onset of use, abuse and dependence              47.6      9.8           1.8     (1249)
- Among baseline lifetime non-abusing users
-    Persistence of use 			            53.1       --              --      (2066)
-    Onset of abuse and dependence	            	--        19.1         2.8     (2066)
- Among baseline lifetime abusers
-    Persistence of use and abuse	            60.2       6.6           --       (669)
-    Onset of dependence	                             --           --           3.7     (669)
- Among baseline lifetime dependent users
-    Persistence of use, abuse and dependence     57.7       9.4          4.6    (1018)

-       Use  Abuse   Dependence   (n)

-     %        %              %

##  Drug transitions studied 

- Among baseline lifetime non-users
-    Onset of use, abuse and dependence              14.8      2.6           0.9    (2013)
- Among baseline lifetime non-abusing users
-    Persistence of use 			            14.5       --              --     (2127)
-    Onset of abuse and dependence                        --         6.5           2.0   (2127)
- Among baseline lifetime abusers
-    Persistence of use and abuse	            30.9      3.9             --     (333)
-    Onset of dependence                                          --          --            5.1    (333)
- Among baseline lifetime dependent users
-    Persistence of use, abuse and dependence     33.6      7.9          11.5   (529)

-       Use  Abuse   Dependence   (n)

-     %        %              %

## Associations of baseline mental disorders with subsequent first onset of smoking and nicotine dependence among baseline lifetime nonsmokers

|  | Onset of 
nicotine use | Onset of 
dependence |  |
| --- | --- | --- | --- |
| Baseline disorders | OR
 | OR
 |  |
| Anxiety | 2.1* |   2.9* |  |
| Mood |                   1.4 |                 1.5 |  |
| Impulse control  |                   1.7* |                 2.4* |  |
| Any disorder |                   1.7* |                 2.6* |  |

- *Significant at the .05 level, two-sided test

## Associations of baseline mental disorders with subsequent continuation of smoking and first onset of nicotine dependence among baseline lifetime nondependent smokers

|  | Continuation of 
nicotine use | Onset of 
dependence |
| --- | --- | --- |
| Baseline disorders | OR
 | OR |
| Anxiety |  1.1 | 1.4* |
| Mood |                        1.1              |                2.1* |
| Impulse control |                        1.1 |                1.7* |
| Any disorder |                        1.0 |                1.6* |

- *Significant at the 0.5 level, two-sided test

## Associations of baseline mental disorders with subsequent continuation of smoking and nicotine dependence among baseline lifetime dependent smokers

|  | Continuation of 
nicotine use | Continuation of 
dependence |
| --- | --- | --- |
| Baseline disorders | OR
 | OR
 |
| Anxiety |   1.5* | 2.0* |
| Mood |                       1.6* |                       1.2 |
| Impulse control |                       2.1*                                         |                       2.1* |
| Any disorder |                       1.7* |                       2.1* |

- *Significant at the .05 level, two-sided test

## Associations of baseline mental disorders with subsequent first onset of drinking, alcohol abuse, and alcohol dependence among baseline lifetime nondrinkers

|  | Onset of 
alcohol use  | Onset of 
abuse | Onset of dependence  |
| --- | --- | --- | --- |
| Baseline disorders | OR | OR | OR |
| Anxiety | 1.2 | 1.2  | 1.5 |
| Mood |               1.4                | 1.3 |              - |
| Impulse control |               1.4 |  2.8* |            6.8* |
| Any disorder |                 1.2 |  2.0* |            4.5* |

- * Significant at the .05 level, two-sided test

## Associations of baseline mental disorders with subsequent continuation of drinking and first onset of alcohol abuse and dependence among baseline lifetime non-abusing drinkers

|  | Continuation of alcohol use  | Onset of 
abuse | Onset of dependence  |
| --- | --- | --- | --- |
| Baseline disorders | OR
 | OR
 | OR
 |
| Anxiety | 0.8 | 1.2 | 1.6 |
| Mood |               0.8 |            1.4 |            1.8 |
| Impulse control |               1.1 |            1.4 |            2.4* |
| Any disorder |               .96 |            1.3 |            1.3 |

- *Significant at the .05 level, two-sided test

## Associations of baseline mental disorders with subsequent continuation of alcohol use and abuse and first onset of dependence among baseline lifetime alcohol abusers

|  | Continuation of alcohol use  | Continuation of abuse | Onset of dependence  |
| --- | --- | --- | --- |
| Baseline disorders | OR
 | OR
 | OR
 |
| Anxiety | 0.8 | 1.5 | 2.7 |
| Mood |               1.0 |            0.6 |            0.6 |
| Impulse control |               0.8 |            0.9 |            3.2* |
| Any disorder |               0.7 |            0.9 |            3.7* |

- *Significant at the .05 level, two-sided test

## Associations of baseline mental disorders with subsequent continuation of alcohol use, abuse, and dependence among baseline lifetime dependent drinkers

|  | Continuation of alcohol use  | Continuation of abuse | Continuation of dependence  |
| --- | --- | --- | --- |
| Baseline disorders | OR
 | OR
 | OR
 |
| Anxiety | 0.7 | 1.2 | 2.2 |
| Mood |               0.8 |            0.9 |            1.2  |
| Impulse control |               1.2 |            1.5 |            2.3* |
| Any disorder |               0.8 |            1.5 |            4.7* |

- *Significant at the .05 level, two-sided test

## Associations of baseline mental disorders with subsequent first onset of marijuana use among baseline lifetime nonusers and continuation of marijuana use among baseline lifetime users

|  |  | Marijuana |  |  |  |
| --- | --- | --- | --- | --- | --- |
|  | Onset |  | Continuation |  |  |
| Baseline disorders | OR
 |  | OR
 |  |  |
| Anxiety |  1.3 |  | 1.1 |  |  |
| Mood |                    1.0 |  |                 0.9 |  |  |
| Impulse control  |                    2.9* |  |                 1.4* |  |  |
| Any disorder |                    2.0* |  |                 1.2 |  |  |

- *Significant at the .05 level, two-sided test

## Associations of baseline mental disorders with subsequent first onset of cocaine use among baseline lifetime nonusers and continuation of cocaine use among baseline lifetime users

|  |  | Cocaine |  |  |  |
| --- | --- | --- | --- | --- | --- |
|  | Onset |  | Continuation |  |  |
| Baseline disorders | OR
 |  | OR
 |  |  |
| Anxiety |  1.0 |  |  0.7 |  |  |
| Mood |                    1.3 |  |                 0.5 |  |  |
| Impulse control  |                    2.6* |  |                 2.1 |  |  |
| Any disorder |                    1.9* |  |                 1.1 |  |  |

- *Significant at the .05 level, two-sided test

## Associations of baseline mental disorders with subsequent first onset of sedative or tranquilizer use among baseline lifetime nonusers and continuation of sedative or tranquilizer use among baseline lifetime users

|  |  |  | Sedatives and tranquilizers |  |  |  |
| --- | --- | --- | --- | --- | --- | --- |
|  |  | Onset |  | Continuation |  |  |
| Baseline disorders |  | OR
 |  | OR
 |  |  |
| Anxiety |  | 1.6 |  | 1.9* |  |  |
| Mood |  |                  1.2 |  |                1.1 |  |  |
| Impulse control  |  |                  3.3* |  |                1.5 |  |  |
| Any disorder |                     1.9* |  |  |                2.2 |  |  |

- *Significant at the .05 level, two-sided test

## Associations of baseline mental disorders with subsequent first onset of stimulant use among baseline lifetime nonusers and continuation of stimulant use among baseline lifetime users

|  |  |  | Stimulants |  |  |  |
| --- | --- | --- | --- | --- | --- | --- |
|  |  | Onset |  | Continuation |  |  |
| Baseline disorders 
 |  | OR
 |  | OR
 |  |  |
| Anxiety |  | 1.2 |  | 0.7 |  |  |
| Mood |  |                  1.3 |  |                 1.2 |  |  |
| Impulse control  |  |                  3.0* |  |                 2.5 |  |  |
| Any disorder |                     2.0* |  |  |                 2.7* |  |  |

- *Significant at the .05 level, two-sided test

## Associations of baseline mental disorders with subsequent first onset of analgesic use among baseline lifetime nonusers and continuation of analgesic use among baseline lifetime users

|  |  |  | Analgesics |  |  |  |
| --- | --- | --- | --- | --- | --- | --- |
|  |  | Onset |  | Continuation |  |  |
| Baseline disorders 
 |  | OR
 |  | OR
 |  |  |
| Anxiety |  | 1.5 |  | 1.3 |  |  |
| Mood |  |                  1.6 |  |                 2.1 |  |  |
| Impulse control  |  |                  2.5* |  |                 2.1 |  |  |
| Any disorder |                     2.1* |  |  |                 3.7* |  |  |

- *Significant at the .05 level, two-sided test

## Associations of baseline mental disorders with subsequent first onset of inhalant use among baseline lifetime nonusers and continuation of inhalant use among baseline lifetime users

|  |  |  | Inhalants |  |  |  |
| --- | --- | --- | --- | --- | --- | --- |
|  |  | Onset |  | Continuation1 |  |  |
| Baseline disorders |  | OR
 |  | OR
 |  |  |
| Anxiety |  | 0.4 |  | - |  |  |
| Mood |  |                  1.3 |  |                   - |  |  |
| Impulse control  |  |                  3.9* |  |                   - |  |  |
| Any disorder |                     3.4* |  |  |                   - |  |  |

- *Significant at the .05 level, two-sided test

- 1No cases continued to use at time 2

## Associations of baseline mental disorders with subsequent first onset of heroin or opiate use among baseline lifetime nonusers and continuation of heroin or opiate use among baseline lifetime users

|  |  |  | Opiates |  |  |  |
| --- | --- | --- | --- | --- | --- | --- |
|  |  | Onset |  | Continuation |  |  |
| Baseline disorders 
 |  | OR
 |  | OR
 |  |  |
| Anxiety |  | 1.1 |  | 0.1 |  |  |
| Mood |  |                  1.2 |  |                 0.5 |  |  |
| Impulse control  |  |                  5.8* |  |                 5.6 |  |  |
| Any disorder |                     3.4* |  |  |                 0.4 |  |  |

- *Significant at the .05 level, two-sided test

## Associations of baseline mental disorders with subsequent first onset of hallucinogen use among baseline lifetime nonusers and continuation of hallucinogen use among baseline lifetime users

|  |  |  | Hallucinogens |  |  |  |
| --- | --- | --- | --- | --- | --- | --- |
|  |  | Onset |  | Continuation |  |  |
| Baseline disorders |  | OR
 |  | OR
 |  |  |
| Anxiety |  | 1.0 |  | 1.2 |  |  |
| Mood |  |                  1.4 |  |                 0.4 |  |  |
| Impulse control  |  |                  3.0* |  |               26.3 |  |  |
| Any disorder |                     1.8* |  |  |                 5.4 |  |  |

- *Significant at the .05 level, two-sided test

## Associations of baseline mental disorders with subsequent first onset of any illicit drug use, abuse, and dependence among baseline lifetime nonusers of any illicit drug

|  |  | Onset of 
illicit drug use | Onset of 
abuse | Onset of dependence |  |
| --- | --- | --- | --- | --- | --- |
| Baseline disorders |  | OR
 | OR
 | OR
 |  |
| Anxiety |  | 1.6* | 2.1* | 5.2* |  |
| Mood |  |            1.4 |           0.4* |           1.3 |  |
| Impulse control  |  |            3.0* |           3.7* |           5.2* |  |
| Any disorder |               2.2* |  |           2.8* |           4.5* |  |

- *Significant at the .05 level, two-sided test

## Associations of baseline mental disorders with subsequent continuation of illicit drug use and first onset of drug abuse and dependence among baseline lifetime non-abusing drug users

|  |  | Continuation of 
illicit drug use | Onset of 
abuse | Onset of dependence |  |
| --- | --- | --- | --- | --- | --- |
| Baseline disorders |  | OR
 | OR
 | OR
 |  |
| Anxiety |  | 1.1 | 1.8* | 1.2 |  |
| Mood |  |            1.2 |           1.2 |            0.9 |  |
| Impulse control  |  |            1.4* |           4.3* |            3.6* |  |
| Any disorder |               1.2 |  |           2.4* |            1.6 |  |

- *Significant at the .05 level, two-sided test

## Associations of baseline mental disorders with subsequent continuation of drug use and abuse and first onset of dependence among baseline lifetime drug abusers

|  |  | Continuation of 
illicit drug use | Continuation of 
abuse | Onset of dependence |  |
| --- | --- | --- | --- | --- | --- |
| Baseline disorders |  | OR
 | OR
 | OR
 |  |
| Anxiety |  | 0.6 | 0.5 | 0.5 |  |
| Mood |  |            0.9 |            0.1 |            4.6 |  |
| Impulse control  |  |            1.5 |            1.0 |            2.1 |  |
| Any disorder |               1.2 |  |            0.6 |            1.8 |  |

## Associations of baseline mental disorders with subsequent continuation of drug use, abuse, and dependence among respondents with baseline lifetime illicit drug dependence

|  |  | Continuation of 
illicit drug use | Continuation of 
abuse | Continuation of dependence |  |
| --- | --- | --- | --- | --- | --- |
| Baseline disorders |  | OR
 | OR
 | OR
 |  |
| Anxiety |  | 1.3 | 1.1 | 1.6 |  |
| Mood |  |            0.8 |            1.6 |            1.9 |  |
| Impulse control  |  |            1.6* |            3.2* |            2.0 |  |
| Any disorder |               1.4 |  |            1.7 |            4.8* |  |

- *Significant at the .05 level, two-sided test