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Introduction: Suicide attempts have been associated with both cocaine use disorder (CocUD) and childhood trauma. We investigated how childhood trauma is an independent risk factor for serious and recurrent suicide attempts in CocUD. Method : 298 outpatients (23% women) with CocUD underwent standardized assessments of substance dependence (Diagnostic and Statistical Manual-mental disorders, fourth edition, text revised), impulsiveness, resilience, and childhood trauma, using validated tools. Suicide attempts history was categorized as single vs. recurrent or non-serious vs. serious depending on the lifetime number of suicide attempts and the potential or actual lethality of the worst attempt reported, respectively. Bivariate and multinomial regression analyses were used to characterize which childhood trauma patterns were associated with the suicide attempts groups. Results : 58% of CocUD patients reported childhood trauma. Recurrent and serious suicide attempts clustered together and were thus combined into "severe SA." Severe suicide attempt risk increased proportionally to the number of childhood traumas (test for trend, p  = 9 × 10 -7 ). Non-severe suicide attempt risk increased with impulsiveness and decreased with resilience. In multinomial regression models, a higher number of traumas and emotional abuse were independently and only associated with severe vs. non-severe suicide attempts (effect size = 0.82, AUC = 0.7). The study was limited by its cross-sectional design. Conclusion : These preferential associations between childhood trauma and severe suicide attempts warrant specific monitoring of suicide attempts risk in CocUD, regardless of the severity of addiction profiles. more...

Suicide attempts (SA), especially recurrent SA or serious SA, are common in substance use disorders (SUD). However, the genetic component of SA in SUD samples remains unclear. Brain-derived neurotrophic factor (BDNF) alleles and levels have been repeatedly involved in stress-related psychopathology. This investigation uses a within-cases study of BDNF and associated factors in three suicidal phenotypes ('any', 'recurrent', and 'serious') of outpatients seeking treatment for opiate and/or cocaine use disorder. Phenotypic characterization was ascertained using a semi-structured interview. After thorough quality control, 98 SNPs of BDNF and associated factors (the BDNF pathway) were extracted from whole-genome data, leaving 411 patients of Caucasian ancestry, who had reliable data regarding their SA history. Binary and multinomial regression with the three suicidal phenotypes were further performed to adjust for possible confounders, along with hierarchical clustering and compared to controls (N = 2504). Bayesian analyses were conducted to detect pleiotropy across the suicidal phenotypes. Among 154 (37%) ever suicide attempters, 104 (68%) reported at least one serious SA and 96 (57%) two SA or more. The median number of non-tobacco SUDs was three. The BDNF gene remained associated with lifetime SA in SNP-based (rs7934165, rs10835210) and gene-based tests within the clinical sample. rs10835210 clustered with serious SA. Bayesian analysis identified genetic correlation between 'any' and 'serious' SA regarding rs7934165. Despite limitations, 'serious' SA was shown to share both clinical and genetic risk factors of SA-not otherwise specified, suggesting a shared BDNF-related pathophysiology of SA in this population with multiple SUDs. more...

Aims: To examine cross-national patterns of 12-month substance use disorder (SUD) treatment and minimally adequate treatment (MAT), and associations with mental disorder comorbidity., Design: Cross-sectional, representative household surveys., Setting: Twenty-seven surveys from 25 countries of the WHO World Mental Health Survey Initiative., Participants: A total of 2446 people with past-year DSM-IV SUD diagnoses (alcohol or illicit drug abuse and dependence)., Measurements: Outcomes were SUD treatment, defined as having either received professional treatment or attended a self-help group for substance-related problems in the past 12 months, and MAT, defined as having either four or more SUD treatment visits to a health-care professional, six or more visits to a non-health-care professional or being in ongoing treatment at the time of interview. Covariates were mental disorder comorbidity and several socio-economic characteristics. Pooled estimates reflect country sample sizes rather than population sizes., Findings: Of respondents with past-year SUD, 11.0% [standard error (SE) = 0.8] received past 12-month SUD treatment. SUD treatment was more common among people with comorbid mental disorders than with pure SUDs (18.1%, SE = 1.6 versus 6.8%, SE = 0.7), as was MAT (84.0%, SE = 2.5 versus 68.3%, SE = 3.8) and treatment by health-care professionals (88.9%, SE = 1.9 versus 78.8%, SE = 3.0) among treated SUD cases. Adjusting for socio-economic characteristics, mental disorder comorbidity doubled the odds of SUD treatment [odds ratio (OR) = 2.34; 95% confidence interval (CI) = 1.71-3.20], MAT among SUD cases (OR = 2.75; 95% CI = 1.90-3.97) and MAT among treated cases (OR = 2.48; 95% CI = 1.23-5.02). Patterns were similar within country income groups, although the proportions receiving SUD treatment and MAT were higher in high- than low-/middle-income countries., Conclusions: Few people with past-year substance use disorders receive adequate 12-month substance use disorder treatment, even when comorbid with a mental disorder. This is largely due to the low proportion of people receiving any substance use disorder treatment, as the proportion of patients whose treatment is at least minimally adequate is high., (© 2019 Society for the Study of Addiction.) more...

Background: people suffering from substance use disorders (SUD) often die by suicide, so that the prevention of suicide attempts (SA) remains a top priority in this population. SA recurrence is common and is associated with suicide death, but this phenotype has been overlooked in SUD populations. Thus, we aimed at identifying the risk factors of SA recurrence in SUD, controlling for both gender and levels of exposure to addictive substances, including tobacco., Methods: we consecutively recruited 433 treatment-seeking outpatients with either opiate or cocaine use disorder and assessed their lifetime history of addictive and suicidal symptoms by standardized questionnaires. They were reliably classified as never, single or recurrent (≥ 2) suicide attempters, whose characteristics were identified by multinomial regression, stratified by gender; and compared to our previous work on serious SA in order to identify common or different risk profiles., Results: 86/140 (61%) suicide attempters reported recurrence. The mean number of SA was 3.1. Recurrence was independently associated with psychiatric hospitalization in both genders, with nicotine dependence in men and with sedative use disorders in women., Limitations: psychiatric diagnoses were derived from the current medication regimen., Conclusion: specific and possibly avoidable/treatable risk factors for the recurrence of SA in SUD have been identified for the first time, opening new avenues for research and prevention in this high-risk population. Apart from nicotine dependence, these risk factors were very similar to those of serious SA. Although this comparison is indirect for now, it suggests a common liability towards suicidal behavior., (Copyright © 2018. Published by Elsevier B.V.) more...

Background: Suicide is a major public health concern and suicide attempts (SA) are frequent and burdensome in people suffering from substance use disorders (SUDs). In particular, serious SAs are a preoccupying form of attempt, which remain largely overlooked in these populations, especially regarding basic risk factors such as gender, addictive comorbidity and substance use patterns. Thus, we undertook a gender-specific approach to identify the risk factors for serious SAs in outpatients with multiple SUDs., Material and Methods: 433 Treatment-seeking outpatients were consecutively recruited in specialized care centers and reliably classified as serious, non-serious and non-suicide attempters. We also characterized lifetime exposure to SUDs, including tobacco smoking, with standardized instruments. Current medication, including psychotropic treatments were collected, which informed psychiatric diagnoses. Multinomial regression identified independent factors specifically associated with serious SAs in each gender, separately., Results: 32% Participants (N=139, 47% Women and 27% Men) reported lifetime SA. There were 82 serious attempters (59% of attempters), without significant gender difference. Sedative dependence was an independent risk factor for serious SA compared to non-SA in Women and compared to non-serious SA in Men, respectively. Other risk factors included later onset of daily tobacco smoking in Men and history of psychiatric hospitalizations in Women, whose serious SA risk was conversely lower when reporting opiate use disorder or mood disorder, probably because of treatment issues., Conclusions: Despite several study limitations, we identified subgroups for a better-tailored prevention of serious SAs among individuals with SUDs, notably highlighting the need to better prevent and treat sedative dependence., (Copyright © 2017 Elsevier B.V. All rights reserved.) more...

The co-occurrence of substance use disorders (SUDs) and anxiety disorders has been now well established. This association is frequent and can be explained by three models: the shared vulnerability factors model, the self-medication model, and the substance-induced model. General population epidemiological studies provide strong evidence of the frequency of the association for the most used substances: tobacco, alcohol, cannabis, and to a lesser extent sedatives, opiates, and cocaine. For substances that are less commonly used in the general population, the frequency of the co-occurrence can more precisely be studied in clinical samples. We provide the most recent literature results on the association of SUDs and anxiety, and evidence for one explicative model or the other when available. For substances with sedative properties (alcohol, benzodiazepines, cannabis, opioids), both evidence for a self-medication and for a toxic effect exist. For substances with psychostimulant properties (tobacco, cocaine, and amphetamines), the literature favors the toxic hypothesis to explain the association with anxiety disorders. We give practical steps for the recognition of these dual diagnoses and present therapeutic issues, although the strategies are rarely evidence based. more...

People who suffer from substance use disorders (SUDs) frequently report to have undergone childhood adversity that is often associated with father or mother dysfunction, or both. Yet that issue has been barely addressed in opiate dependent patients. Therefore we sought to evaluate parent-specific dysfunctional styles perceived during childhood in a clinical sample from an outpatient addiction treatment program using the Measure Of Parental Styles (MOPS) questionnaire. DSM-IV diagnoses of substance use disorders and history of suicide attempts, family structure and changes of caregiver during childhood were obtained from 159 consecutive outpatients, along with their perception of parental bonding with the MOPS, in which mother and father scores are separate. Mother neglect dimension was significantly correlated with an earlier age at onset of several substances' use, the number of prior hospitalizations and of lifetime suicide attempts. Most of these associations remained significant in multivariate models. This was the first assessment of a representative sample of outpatients with SUDs by the MOPS questionnaire. Given its excellent acceptance and its association with several key correlates of SUDs, it should be used to design specific interventions targeted at attachment and familial management as well as in research models on gene × environment interactions., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.) more...

Background: It is unclear whether the normative sequence of drug use initiation, beginning with tobacco and alcohol, progressing to cannabis and then other illicit drugs, is due to causal effects of specific earlier drug use promoting progression, or to influences of other variables such as drug availability and attitudes. One way to investigate this is to see whether risk of later drug use in the sequence, conditional on use of drugs earlier in the sequence, changes according to time-space variation in use prevalence. We compared patterns and order of initiation of alcohol, tobacco, cannabis, and other illicit drug use across 17 countries with a wide range of drug use prevalence., Method: Analyses used data from World Health Organization (WHO) World Mental Health (WMH) Surveys, a series of parallel community epidemiological surveys using the same instruments and field procedures carried out in 17 countries throughout the world., Results: Initiation of "gateway" substances (i.e. alcohol, tobacco and cannabis) was differentially associated with subsequent onset of other illicit drug use based on background prevalence of gateway substance use. Cross-country differences in substance use prevalence also corresponded to differences in the likelihood of individuals reporting a non-normative sequence of substance initiation., Conclusion: These results suggest the "gateway" pattern at least partially reflects unmeasured common causes rather than causal effects of specific drugs on subsequent use of others. This implies that successful efforts to prevent use of specific "gateway" drugs may not in themselves lead to major reductions in the use of later drugs., (Copyright 2009 Elsevier Ireland Ltd. All rights reserved.) more...

Background: Little is known about the epidemiology of adult attention-deficit hyperactivity disorder (ADHD)., Aims: To estimate the prevalence and correlates of DSM-IV adult ADHD in the World Health Organization World Mental Health Survey Initiative., Method: An ADHD screen was administered to respondents aged 18-44 years in ten countries in the Americas, Europe and the Middle East (n=11422). Masked clinical reappraisal interviews were administered to 154 US respondents to calibrate the screen. Multiple imputation was used to estimate prevalence and correlates based on the assumption of cross-national calibration comparability., Results: Estimates of ADHD prevalence averaged 3.4% (range 1.2-7.3%), with lower prevalence in lower-income countries (1.9%) compared with higher-income countries (4.2%). Adult ADHD often co-occurs with other DSM-IV disorders and is associated with considerable role disability. Few cases are treated for ADHD, but in many cases treatment is given for comorbid disorders., Conclusions: Adult ADHD should be considered more seriously in future epidemiological and clinical studies than is currently the case. more...

We report on a tianeptine dependence lasting for eighteen months in a 42 year old patient. The patient had a previous history of addiction to opiates, amineptine, cocaïne and alcohol. He also had a family history of addiction to alcohol and opiates. Tianeptine was prescribed for a major depressive disorder. The patient alleged a "flash sensation" like with heroin since the very first doses with a physical and psychological well-being sensation, better psychomotor performances and transient mood elation. His addiction to tianeptine was immediate and heavy. The positive reinforcement faded away after one month and a total dependance took over, with physical and psychological withdrawal symptoms when doses were not renewed. After two months of treatment, the daily consumption of tianeptine was of 90 tablets. The patient was hospitalised to treat both the addiction to tianeptine and the ongoing major depressive disorder. He was taking 240 tablets daily. In the literature, reports of addictions to antidepressants are scarce and most of them involve agents with amphetamine-like properties, including amineptine and tranylcypromine. Other reports involving other antidepressant agents, including amitriptyline, fluoxetine and tianeptine remain exceptional. Addictions to antidepressants almost exclusively concern patients with a diagnosis of personality disorder and a previous history of drug or alcohol abuse and who are treated for a depressive disorder. Tianeptine, which is devoid of any psychostimulating effect in human, does not seem to have addictive properties apart from the reports of scarce cases. more...

Many hypotheses have been made to explain the high rate of benzodiazepine consumption in France, including a general cultural and/or familial tendency to use certain types of psychotropic drugs. This study explored the association between lifetime medication use by parents and their children. Two hundred and twenty-one young patients (158 boys and 63 girls) consulting at a child and adolescent psychiatry department, six to 16 years of age (mean = 9.7 years), were screened for lifetime use of psychotropic drugs using a structured interview. Parents were asked about their own consumption, as well as their children's. Lifetime consumption rates (at least once) were 22.2% in boys and 20.6% in girls, and 19.6% in children less than 11 years old. Higher rates were found in patients with emotional disorders (anxiety disorders and depression). In parents, 45.1% of mothers and 24.1% of fathers reported using medications at least once. A significant association was found between child and parental medication use: 34.1% of children had positive lifetime consumption when their mothers also used medications at least once versus only 13.6% in other children (odds ratio = 3.31 [1.68-6.50]; P = 0.001). The most significant association was found between medication use by girls and their mothers (odds ratio = 12.1 [2.38-61.5]; P = 0.003). These data point to the existence of a family pattern of psychotropic drug consumption, especially in females. more...

Both epidemiological and clinical studies indicate that social phobia is highly comorbid with anxiety and affective disorders and, to a lesser extent, with substance use disorders. In epidemiological surveys, about one in five subjects with social phobia has been reported as having no other lifetime disorder. Other patterns of comorbidity with eating disorders, personality disorders and medical morbidity have been studied more recently and are reviewed here. Comorbidity has a strong influence on impairment, health-seeking behavior and suicidality. These results have major implications for improving the recognition, assessment and treatment of this disorder by physicians and for the design of new research perspectives. more...

A study was conducted in Paris among primary care physicians as part of a World Health Organization study entitled Psychological Problems in General Health Care. Though social phobia is associated with significant impairment and drug use, the level of problem recognition by general practitioners was low. Social phobia (n = 38) was identified as a psychological case in 53% of the patients in whom social phobia was not comorbid with depression, and in 66% when comorbid with depression. This low level of recognition was comparable to that observed for depression where only 66% of the depressed patients (n = 121) were recognized as psychological cases. Psychotropic drug use was high: 61% of patients with social phobia had taken at least one psychotropic drug in the last month, compared to only 32% of those without social phobia. This difference was explained by a significant difference in the use of anxiolytics (45.4 versus 12.1%). The use of psychotropic drugs was twice as frequent in patients with social phobia who were depressed than in those not depressed. The results of this study emphasize the crucial need for primary care physician training in the recognition and treatment of mental disorders. more...

Drug use was examined in a French general population adult sample from a household survey conducted in 1987-8 in a newly built town near Paris. Psychotropic drug use was measured by the percentage of subjects reporting their use during the past week. It was prominently represented by benzodiazepines (90% of psychotropic users), differed strongly between genders (4.6% in men, 10.2% in women) and age groups (higher after 40 years). A lifetime history of major depressive episode (MDE) or of anxiety disorders was associated with a higher proportion of psychotropic drug use. Psychotropic drug use also went with a current well-being questionnaire score. Using a logistic analysis, the following set of variables held for women: well-being score, history of both MDE and anxiety disorder, age, and marital status. Making allowance for the cross-sectional nature of this retrospective survey, these finding confirmed the relatively high level of benzodiazepine drug use in an urban French community sample and emphasized its association with mental health status. more...