ADULT ATTENTION DEFICIT HYPERACTIVITY DISORDER AND ITS ASSOCIATION WITH SUBSTANCE USE AND ABUSE

Transcription

1 SWISS PUBLIC HEALTH CONFERENCE 204 CONFÉRENCE SUISSE DE SANTÉ PUBLIQUE 204 ADULT ATTENTION DEFICIT HYPERACTIVITY DISORDER AND ITS ASSOCIATION WITH SUBSTANCE USE AND ABUSE Natalia Estévez, Michelle Dey 2, Dominique Eich-Höchli 3, Simon Foster, Gerhard Gmel 4, Meichun Mohler- Kuo Institute of Social and Preventive Medicine, University of Zurich, 2 University of Melbourne, 3 Psychiatric University Hospital Zurich, 4 Lausanne University Hospital CHUV Background: Attention deficit hyperactivity disorder (ADHD) often persists into adulthood and can significantly affect functioning and mental health over one s life span. In this context, one area of major public health concern is the relationship between ADHD and substance use and abuse, as the impairments that people suffering from ADHD experience may be worsened by such use. However, the impact of ADHD on substance use and abuse remains unclear. Aim: The present project was conducted to examine the association between ADHD and both the use and abuse of licit and illicit substances within a large, representative sample of young Swiss men. The sample included data from 5677 Swiss men (mean age: 20 years) who participated in the Cohort Study on Substance Use Risk Factors (C-SURF). ADHD was assessed with the adult ADHD Self Report Screener (ASRS), developed by the World Health Organization. The association between ADHD and substance use/abuse was assessed for alcohol, nicotine, cannabis and other illicit drugs. Outcomes of interest included variables related to subjects experimentation with these substances (i.e., age at first use, lifetime prevalence), as well as the risky use of alcohol, nicotine and cannabis and the presence of substance use disorders. To assess the unbiased contribution of ADHD to these outcomes, logistic regression analyses were conducted, both unadjusted and adjusted for specific socio-demographic variables (e.g., age, education) and co-morbid disorders (i.e., antisocial-personality disorder, major depression). Men with ADHD were more likely to have previously used nicotine and illicit substances, but not alcohol. Additionally, ADHD was positively associated with an earlier age at first use of alcohol, nicotine and cannabis, with the risky use of these substances, and with the presence of substance use disorders. On logistic regression analysis adjusted for socio-demographic variables and co-morbid disorders, the presence of adult ADHD at least partially predicted the use and abuse of both licit and illicit substances. Our results demonstrate that adult ADHD is significantly associated with problematic use patterns of both licit and illicit substances. Preventative strategies to reduce substance use and abuse in young men affected by ADHD may be crucial to preventing further impairments later in life.

2 SWISS PUBLIC HEALTH CONFERENCE 204 CONFÉRENCE SUISSE DE SANTÉ PUBLIQUE 204 CANNABIS USE OVER BRIEF FOLLOW-UP AMONG SWISS YOUNG MEN Meichun Mohler-Kuo, Gerhard Gmel 2, Jen Wang Institute of Social and Preventive Medicine, University of Zurich, 2 Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland Background: Cannabis use constitutes an issue in numerous fields given its high prevalence in many countries and potentially deleterious health and social effects. Switzerland has one of the highest levels of cannabis use among adolescents and young adults in Europe, with 39% of 5-6 year old male pupils in 2007 and 46% of 3-29 year old males in 200 reporting any cannabis use in their lifetime. The aim of this paper is to present initial findings from a large population-based cohort on ) prevalence of cannabis use over a short follow-up and 2) personality profiles of different cannabis use categories at each wave and over time. Data for the Cohort Study on Substance Use Risk Factors (C-SURF) were collected among young Swiss men recruited while presenting for mandatory military conscription at baseline (T0, N=5990) in 200- and first follow-up (T, N=5223) in Cannabis use was assessed as both waves whereas personality traits (i.e., neuroticism-anxiety, aggression-hostility, sociability, and sensation seeking) and behavioral symptoms (i.e., anti-social and ADHD) were assessed only at T0. out of 2 young Swiss men has used cannabis in his lifetime, and out of 3 in the past 2 months. Despite comparable 2-month point prevalences at T0 and T, the longitudinal data show that despite the brief follow-up, 40-50% of users moved into or out of their respective cannabis use category at T, including those fulfilling criteria for cannabis use disorder. All the personality trait and behavioral symptoms at T0 not only distinguish between lifetime abstainers and users, but also between use categories concurrently and over time, distinguishing clearly between the stable categories of lifetime abstainers, former users, moderate users, and risky/disorder users. Many movers resemble users in the higher use category regardless of directionality. Sensation seeking distinguishes between the highest number of use categories. Personality does not only help profile users, but also distinguishes between various use categories not just concurrently but also prospectively. The finding with movers suggests that personality may be more useful in establishing risk profiles rather than recovery profiles, at least in the short-term. 2

3 SWISS PUBLIC HEALTH CONFERENCE 204 CONFÉRENCE SUISSE DE SANTÉ PUBLIQUE 204 DOES DRINKING LOCATION MATTER? PROFILES OF RISKY SINGLE-OCCASION DRINKERS BY DRINKING LOCATION AND ALCOHOL-RELATED HARM Caroline Bähler, Michelle Dey 2, Petra Dermota 2, Simon Foster 2, Gerhard Gmel 3, Meichun Mohler-Kuo 2, 2 Institute of Social and Preventive Medicine, University of Zurich, 3 Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne In adolescents and young adults, acute consequences likeinjuries account for a substantial proportion of alcohol-related harm, especially in risky single-occasion (RSO) drinkers. The primary aim of the study was to characterize different drinking profiles in RSO drinkers according to drinking locations and their relationship to negative, alcohol-related consequences. The sample consisted of 2746 young men from the Cohort Study on Substance Use Risk Factors (C-SURF) who had reported drinking 6 or more drinks on a single occasion at least monthly over the preceding 2 months. Principal component analysis on the frequency and amount of drinking at different locations was conducted, and two distinguishable components emerged: a nonparty-dimension (loading high on theatre/cinema, sport clubs, other clubs/societies, restaurants, and sport events) and a party-dimension (loading high on someone else s home, pubs/bars, discos/nightclubs, outdoor public places, special events, and home). Differential impacts of drinking location profiles were observed on severe negative alcohol-related consequences (SAC). Relative to those classified as low or intermediate in both dimensions, no significant difference experiencing SAC was found among those who were classified as high in the non-party-dimension only. However, those who were classified as high in the party-dimension alone or in both dimensions were more likely to experience SAC. These differential effects remained after adjusting for alcohol consumption (volume and RSOD), personality traits, and peer-influence (adjusted OR=0.83 [ ],.57 [ ] and.72 [ ], respectively), indicating independent effects of drinking location on SAC.The inclusion of sociodemographic factors did not alter this association. The fact that this cluster of party-dimensionlocations seems to predispose young men to experiencing SAC has important implications for alcohol control policies. 3

4 SWISS PUBLIC HEALTH CONFERENCE 204 CONFÉRENCE SUISSE DE SANTÉ PUBLIQUE 204 TEMPORAL PATTERNS OF ALCOHOL CONSUMPTION AND ALCOHOL-RELATED ROAD ACCIDENTS IN YOUNG SWISS MEN SUGGEST TARGETED ENFORCEMENT OF PREVENTION Simon Foster, Gerhard Gmel 2, Natalia Estévez, Caroline Bähler, Meichun Mohler-Kuo Universität Zürich, Institut für Sozial- und Präventivmedizin, 2 Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland Background and objective: Failing to recognize the temporal patterns of alcohol consumption and related harm could impede effective prevention because special high-risk occasions are missed and prevention is limited to overall consumption. The goal of our study was to assess seasonal, weekdays, and festival day effects in alcohol-related road accidents and in drinking diaries of young Swiss men. Federal road accident data (3550 accidents) from Switzerland and drinking diary data from a large cohort of young Swiss men (930 participants) were analysed for temporal effects across calendar weeks, weekdays, and festival days (Christmas, New Year, national holiday). Alcohol-related accidents were analyzed using rate ratios of expected vs. observed numbers of accidents and proportions of alcohol-related accidents in the total number of accidents. Drinking diaries were analysed for the proportion of drinkers, the median number of drinks consumed, and the 90 th percentile of number of drinks consumed. Several parallel peaks were identified in alcohol-related accidents and drinking diaries. These included increases on Fridays and Saturdays with Saturday drinking extending until early Sunday morning, an increase during summer time in workweeks but not weekends, an increase at the end of the year, and increases at festival days and their eves. Our results suggest specific time windows that are associated with increases in drinking and alcohol-related harm. Established prevention measures should be enforced during these time windows in order to cut the associated peaks. 4

5 SWISS PUBLIC HEALTH CONFERENCE 204 CONFÉRENCE SUISSE DE SANTÉ PUBLIQUE 204 SMOKING CESSATION IN WORKPLACE SETTINGS: DETERMINANTS OF QUIT RATES OF A GROUP BEHAVIOUR THERAPY PROGRAMME IN SWITZERLAND ( ) Yann Hausherr, Carlos Quinto, Leticia Grize, Nicole Probst-Hensch Swiss Tropical and Public Health Institute Basel BACKGROUND: Tobacco smoking is the single leading risk factor for burden of disease in Western Europe. To facilitate adherence to smoking ban legislation in Switzerland smoking cessation programme in a workplace setting was developed with the IFT Institut für Therapieforschung in Munich and nationally implemented by the Lungenliga beider Basel. AIM: Our goal is to identify factors restraining participants from quitting that may be overcome during training sessions. We investigated the association of smoking quit rates (QR) with perceived symptoms and weight change within 2 months of completing the intervention. METHODS: This analysis is based on 287 participants aged 6 to 68 years, voluntarily attending a smoking cessation training at their workplace (Unternehmen Rauchfrei) between 2006 and 202. They were based on a cognitive behavioural group therapy combined with individual proactive telephone counselling. The evaluation consisted of three anonymised questionnaires (pre- and post-intervention; 2-months follow-up). We assessed determinants of post-intervention and 2-months QR (according to the Russel-standard) using logistic regression models with QR as outcome and perceived symptoms, BMI, weight change, sociodemographic variables and factors related to smoking behaviour and stage of motivation as covariates (backward-stepwise selection). RESULTS: At the end of the training, the self-reported continuous abstinence rate was between 72.4% (ITT, Intention-totreat) and 83.7%. A low post-intervention quit rate was associated at p<0.05 with female gender, smoking a cigarette right after waking up, and reporting being depressed, more nervous, yet not having sleeping problems. One year after the training it was still between 8.6% (ITT) and 37.4%. Men and participants with a lower intensity of cigarette smoking at baseline were more likely to adhere to non-smoking after 2 months. While participants with higher baseline BMI were less likely to ever quit smoking, participants who reported weight gain during the training or during the 2 months follow-up were more likely to ever be quitters. CONCLUSION: Our results from modern workplace-based smoking cessation trainings suggest women, overweight or obese persons, and heavy smokers to need special attention towards long lasting abstinence rates. In contrast, weight gain seems to be a marker of smoking cessation rather than a motivational factor to quit. 5