national survey on substance use in the czech republic in 2016 · casino games 0,8 lotteries 19,3...

Mental Health and Substance Use

National Survey on Substance Use in the Czech Republic in 2016

Pavla Chomynová

15–16 May 2018| GPS expert meeting, EMCDDA, Lisbon

Mental Health and Substance Use: Introduction (1)

2

„Many individuals who develop substance use disorders (SUD) are also diagnosed with mental disorders, and vice versa.“ (NIDA, 2018; NIDA, 2011)

Certain illegal drugs can cause people with an addiction to experience one or more symptoms of a mental health problem

substance use = primary cause

Mental health problems can sometimes lead to alcohol or drug use, as some people with a mental health problem may misuse these substances as a form of self-medication

substance use = secondary effect/consequence(e.g. EMCDDA, 2015)

substance use

mental health

More than one in four adults living with serious mental health problems also has a substance use problem. Substance use problems occur more frequently with certain mental health problems, including:

1. depression2. anxiety disorders3. schizophrenia4. personality disorders

(https://www.mentalhealth.gov/)

„Mental and substance use disorders share some underlying causes, including changes in brain composition, genetic vulnerabilities, and early exposure to stress or trauma.“ (https://www.mentalhealth.gov/)

Mental Health and Substance Use: Introduction (2)

3

methamphetamine users35–72% have psychiatric comorbidity, especially anxiety disorders and depressions, psychosis, personality disorders, eating disorders, gambling, other substance use (e.g. Salo et al., 2011)

buprenorphine users 23–42% with diagnosed anxiety disorder and 39–51% mood disorder

alcohol users45–80 % of patients addicted to alcohol have another psychiatric diagnosis

depression (14–34%) bipolar disorder (5–35%)anxiety, social phobia (5–20%)psychosis (2–10%)

(e.g. Orlikova and Csemy, 2016)

According to systematic reviews (CR)½ of the clients treated for substance use suffer from dual diagnosis½ of the psychiatric patients report substance use(Orlikova and Csemy, 2016)

alcohol-dependent patients have 3–4 times higher risk of developing depression compared to the general population

National Survey 2016

4

monitor the situation in substance use in the general population

trends between 2008–2012–2016

estimates of

population at risk (scales)

aim

multi-stage

stratified random sampling

1. municipalities

2. starting points

3. households

4. respondents

15+

face-to-face interviews, PAPI questionnaires, data collection Sept-Nov

3601 completed interviews

response rate =

57.8%

F2F

•1 – cities and municipalities

•strata (region x size)

476 municipalities

•2 – starting points

750 starting points

•3 - households

•random route

•5th house, 5th flat

max. 10 interviews/address

•4 - respondent

•nearest birthday

1 resp/household, 15+

National Survey 2016: Topics

5

1. tobacco smoking,

2. e-cigarettes,

3. alcohol use and regular consumption,

4. psychoactive medicines,

5. illicit drugs,

6. medical use of cannabis,

7. Internet use,

8. gaming and gambling,

9. mental health, life satisfaction scale, risk sexual behaviour

Scales:

HSICAGECASTPGSILie/betMHI-5SWLS

National Survey 2016: Mental Health

6

Mental Health Inventory (MHI-5) (Ware et al., 1993, Rumpfet al., 2001, Berwick et al., 1991, Cuijpers et al., 2009, Kelly et al., 2008):

1. Have you been a very nervous person?

2. Have you felt so down in the dumps that nothing could cheer you up?

3. Have you felt calm and peaceful?

4. Have you felt downhearted and blue?

5. Have you been a happy person?

Responses: 1 = never to 5 = always

Sum 5–2515+ …………... good state of mental health13–14 ……….. mental distress (higher probability of anxiety

and/or depression symptoms)up to 12 ……. mental disorder (high probability of mental

disorders)

5.98.2

7.15.9 5.2 5.9 5.3

9.6 9.6

3.4

4.5

4.0

1.23.8 3.3 4.3

5.3 4.9

9.4

12.7

11.1

7.1

9.0 9.2 9.6

15.0 14.6

Males Females Total 15–24 25–34 35–44 45–54 55–64 65+

MHI-5 Mental disorder

Mental distress

National Survey 2016: Satisfaction with Life Scale

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Satisfaction with Life Scale (SWLS) (Diener et al., 1985, Kobau et al., 2010):

1. In most ways my life is close to my ideal.

2. The conditions of my life are excellent.

3. I am satisfied with my life.

4. So far I have gotten the important things I want in life.

5. If I could live my life over, I would change almost nothing.

Responses (7-item Likert scale): 1 = strongly disagree to 5 = strongly agree

Sum 5–355–9 …………...extremely dissatisfied10–14 ………..dissatisfied15–19 ………..slightly dissatisfied20……………… neutral21–25…………slightly satisfied26–30…………satisfied31–35…………extremely satisfied

CR: Responses (5-item Likert scale): 1 = strongly disagree to 5 = strongly agree

evaluation of the satisfaction with life is based on positive answers on first four questions (Kobau et al., 2010)

?!

18.0 18.7 18.4

26.2

22.0 21.418.4

14.211.7


Link between Mental Health and Substance Use?

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• tobacco smoking

• alcohol consumption

• cannabis use

• gambling

substance use

• mental health inventory

• satisfaction with life

mental health

National Survey 2016: Tobacco Smoking

9

Heaviness of Smoking Index (Heatherton, 1989):

1. How many cigarettes do you typically smoke per day?

2. How soon after you wake up do you have your first cigarette?

Heaviness of Smoking Index

15+ 95% CI

At risk of dependence (1+ points) 30,8 29,1–32,6very low (1–2 points) 10,0 8,9–11,2low to moderate (3 points) 8,8 7,8–9,9moderate (4 points) 7,3 6,4–8,3high (5+ points) 4,6 3,8–5,4

34.5

16.5

25.322.5

29.226.5

30.7

24.9

19.0

Males Females Total 15-24 25-34 35-44 45-54 55-64 65+

Daily tobacco smoking

12.38.0 10.0

13.3 14.1 11.0 10.04.9

8.5

23.1

9.7

16.2 12.2

19.1

16.5 19.2

20.6 10.5

7.7

1.7

4.61.7

4.2

6.37.5

3.5

3.3

43.0

19.4

30.8

27.2

37.4

33.736.7

29.0

22.3


Heaviness of Smoking Index

High dependenceModerate dependenceLow dependence

National Survey 2016: Alcohol Consumption

10

CAGE (e.g. Ewing, 1984, Bühler et al. 2004):

1. Have you ever felt you needed to Cut down on your drinking?

2. Have people Annoyed you by criticizing your drinking?

3. Have you ever felt Guilty about drinking?

4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to get rid of a hangover?

CAGE 15+ 95% CI

At risk of dependence (1+ points) 16,8 15,6–18,1risky drinking (1 point) 7,8 6,9–8,7harmful drinking (2 points) 9,0 8,1–10,0

13.1

2.6

7.7

2.7

5.57.6 7.8

10.7 9.8

19.4

5.6

12.3

7.6

16.3

12.8

15.9

12.3

8.9


Alcohol consumption

Daily alcohol use Frequent binge drinking (1+ per week)

11.0

4.77.8 8.6

10.87.2 8.3 7.3 5.7

14.5

3.8

9.0 8.4

11.4

11.4 9.1 9.4

5.2

25.5

8.6

16.8 17.0

22.2

18.617.4 16.8

10.9


CAGE Harmful drinking

Risky drinking

National Survey 2016: Cannabis Use

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CAST (e.g. Beck and Legleye, 2008):

1. Have you smoked cannabis before midday?

2. Have you smoked cannabis when you were alone?

3. Have you had memory problems when you smoked cannabis?

4. Have friends or family members told you that you should reduce or stop your cannabis consumption?

5. Have you tried to reduce or stop your cannabis use without succeeding?

6. Have you had problems because of your cannabis use?

CAST 15+ 95% CI

At risk of problems (3+ points) 4,4 3,7–5,2moderate risk (3–6 points) 2,7 2,1–3,2high risk (7+ points) 1,8 1,3–2,3

14.2

5.0

9.5

19.519.1

5.9

3.51.9

4.31.1

2.7 3.96.2

1.1 1.8 0.9

3.3

0.31.8

3.2

4.3

1.1 0.20.7

Males Females Total 15–24 25–34 35–44 45–54 55–64

Cannabis use + CAST Prevalence of use in last 12 months

High risk (7+ points)

Moderate risk (3-6 points)

National Survey 2016: Gambling (1)

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Lie/bet 15+ 95% CI

At risk of problems (1+ points) 2,4 1,9–2,9moderate risk (1 point) 1,2 0,8–1,6high risk (2 points) 1,2 0,8–1,5

Lie/bet (Johnson et al., 1997):

1. Have you ever had to lie to people important to you about how much you gambled?

2. Have you ever felt the need to bet more and more money?

2.1

0.3

1.21.7

2.11.6

1.2 1.2

0.0

1.9

0.5

1.2

1.2

2.4

1.01.1 1.1

0.5

4.0

0.8

2.4

2.9

4.5

2.62.3 2.3

0.5


Lie/bet High risk

Low risk

Gambling in 12 months 15+

Land-based

EGM, fruit machines 4,2

Betting for sport etc. 4,7

Live betting 2,7

Casino games 0,8

Lotteries 19,3

On-line

EGM, fruit machines 0,9

Poker, roulette (casino games) 1,1

Betting for sport etc. 1,7

Live betting 1,6

Lotteries 1,2

Total

Any G land-based (without lotteries)

8,5

Any G on-line (without lotteries) 3,0

Any G (without lotteries) 9,8


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Problem Gambling Severity Index (Holtgraves, 2009, Currie et al. 2010):

1. Have you bet more than you could afford to lose?

2. Have you needed to gamble with larger amounts of money to get the same feeling of excitement?

3. Have you gone back another day to try to win back the money you lost?

4. Have you borrowed money or sold anything to get money to gamble?

5. Have you felt that you might have a problem with gambling?6. Have you felt people criticized your betting or told you had a gambling problem regardless of whether or not you thought it was true?7. Have you felt guilty about the way you gamble, or what happens when you gamble?

8. Has your gambling caused you any health problems, including a feeling of stress or anxiety?

9. Has your gambling caused any financial problems for you or your household?

PGSI 15+ 95% CI

At risk of problems (1+ points) 5,7 4,9–6,5low risk (1–2 points) 2,2 1,7–2,7moderate risk (3–7 points) 2,1 1,7–2,6 high risk (8+ points) 1,4 1,0–1,8

3.8

0.72.2

4.43.3 2.6 2.1 1.6

0.5

4.0

0.3

2.1

3.44.2

1.3 2.52.3

0.3

2.2

0.6

1.4

1.5 2.3

1.91.2

1.6

0.4

10.0

1.6

5.7

9.39.7

5.7 5.8 5.5

1.1


PGSI High riskModerate rskLow risk


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Problem Gambling Severity Index (Holtgraves, 2009, Currie et al. 2010):

1. Have you bet more than you could afford to lose?

2. Have you needed to gamble with larger amounts of money to get the same feeling of excitement?

3. Have you gone back another day to try to win back the money you lost?

4. Have you borrowed money or sold anything to get money to gamble?

5. Have you felt that you might have a problem with gambling?6. Have you felt people criticized your betting or told you had a gambling problem regardless of whether or not you thought it was true?7. Have you felt guilty about the way you gamble, or what happens when you gamble?

8. Has your gambling caused you any health problems, including a feeling of stress or anxiety?

9. Has your gambling caused any financial problems for you or your household?

PGSI 15+ 95% CI

At risk of problems (1+ points) 5,7 4,9–6,5low risk (1–2 points) 2,2 1,7–2,7moderate risk (3–7 points) 2,1 1,7–2,6 high risk (8+ points) 1,4 1,0–1,8

3.8

0.72.2

4.43.3 2.6 2.1 1.6

0.5

4.0

0.3

2.1

3.44.2

1.3 2.52.3

0.3

2.2

0.6

1.4

1.5 2.3

1.91.2

1.6

0.4

10.0

1.6

5.7

9.39.7

5.7 5.8 5.5

1.1


PGSI High riskModerate rskLow risk

Substance Use and Mental Health

15

6.9 7.6 6.7 7.910.8 6.8 9.2

22.2

3.8 4.43.2

4.6

10.8

3.8

6.6

11.1

7.1

11.1

Non-smokers

Dailysmokers

No risk Riskydrinking (1

point)

Harmfuldrinking (2+

points)

No risk Moderaterisk (3-6points)

High risk (7+points)

Tobacco smoking Alcohol (CAGE) Cannabis use (CAST)

Mental health and substance useMental disorder

Mental distress

6.8

18.2

24.4

6.7 8.9 7.8

32.7

3.9

6.8

9.8

3.8 3.8 3.9

14.3

7.111.1

No risk Low risk (1point)

High risk (2points)

No risk Low risk (1-2points)

Moderate risk(3-7 points)


LieBet PGSI

Mental health and gamblingMental disorder

Mental distress

Substance Use and Satisfaction with Life

16

20.7

11.2

19.417.9

8.7

18.8

9.1

5.7

18.4

Non-smokers Daily smokers No risk Risky drinking(1 point)

Harmfuldrinking (2+

points)

No risk Moderate risk(3-6 points)


Tobacco smoking Alcohol (CAGE) Cannabis use (CAST)

Satisfaction with life and substance use

18.7

7.04.8

18.8

22.8

3.9 4.0

18.4

No risk Low risk (1point)

High risk (2points)

No risk Low risk (1-2points)

Moderate risk(3-7 points)


LieBet PGSI

Satisfaction with life and gambling

Summary

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differences observed

(p<0,05)

Findings:mental distress in the general population = 7,1 %

mental disorder in the general population = 4,0 %

satisfaction with life = 18,4 %

Mental distress and mental disorder:2 times higher among regular alcohol users (high-risk users)3 times higher among regular cannabis users (high-risk users)3–4 times higher among problem gamblers

Satisfaction with life:lower among daily smokers2 times lower among regular alcohol users (high-risk users)3 times lower among regular cannabis users (high-risk users)3–5 times lower among problem gamblers

References

18

BECK, F. & LEGLEYE, S. 2008. Measuring cannabis-related problems and dependence at the population level. In: EMCDDA (ed.) A cannabis reader: global issues and local experiences, vol. II. Luxembourg: EMCDDA.BERWICK, D. M., MURPHY, J. M., GOLDMAN, P. A., WARE, J. E. J., BARSKY, A. J. & WEINSTEIN, M. C. 1991. Performance of a five-item mental health screening test. Med Care, 29, 169-176.BÜHLER, A., KRAUS, L., AUGUSTIN, R. & KRAMER, S. 2004. Screening for alcohol-related problems in the general population using CAGE and DSM-IV: characteristics of congruently and incongruently identified participants. Addictive Behaviors, 29, 867-878.CUIJPERS, P., SMITS, N., DONKER, T., TEN HAVE, M. & DE GRAAF, R. 2009. Screening for mood and anxiety disorders with the five-item, the three-item, and the two-item Mental Health Inventory. Psychiatry Res., 168, 250-255.CURRIE, S. R., CASEY, D. M. & HODGINS, D. C. 2010. Improving the Psychometric Properties of the Problem Gambling Severity Index. Canadian Consortium for Gambling Research.DIENER, E., EMMONS, R. A., LARSEN, R. J. & GRIFFIN, S. 1985. The Satisfaction with Life Scale. Journal of Personality Assessment, 49, 71-75.EWING, J. A. 1984. Detecting Alcoholism. The CAGE Questionnaire. JAMA: Journal of the American Medical Association, 1905-1907.EMCDDA. (2015). Comorbidity of substance use and mental disorders in Europe. Luxembourg: Publications Office of the European Union. HEATHERTON, T. F., KOZLOWSKI, L.T., FRECKER, R.C., RICKERT, W., ROBINSON, J. 1989. Measuring the heaviness of smoking: Using self-reported time to the first cigarette of the day and number of cigarettes smoked per day. Addiction, 84, 791-800.HOLTGRAVES, T. 2009. Evaluating the problem gambling severity index. Journal of Gambling Studies, 25, 105-120JOHNSON, E. E., HAMER, R., NORA, R. M., TAN, B., EISENSTEIN, N. & ENGELHART, C. 1997. The Lie/Bet Questionnaire for screening pathological gamblers. Psychol Rep, 80, 83-8.KELLY, M. J., DUNSTAN, F. D., LLOYD, K. & FONE, D. L. 2008. Evaluating cutpoints for the MHI-5 and MCS using the GHQ-12: a comparison of five different methods. BMC Psychiatry, 10.KOBAU, R., SNIEZEK, J., ZACK, M. M., LUCAS, R. E. & BURNS, A. 2010. Well-being assessment: An evaluation of well-being scales for public health and population estimates of well-being among US adults. Applied Psychology: Health and Well-being, 2, 272-297.NIDA (2011). Comorbidity: Addiction and Other Mental Disorders. Retrieved from https://www.drugabuse.gov/publications/drugfacts/comorbidity-addiction-other-mental-disorders on 2018, May 13NIDA (2018). Common Comorbidities with Substance Use Disorders. Retrieved from https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders on 2018, May 13.ORLIKOVA, B. & CSEMY, L. 2016. Psychiatric comorbidity in methamphetamine users. Adiktologie 16 (1), 26-35.RUMPF, H. J., MEYER, C., HAPKE, U. & JOHN, U. 2001. Screening for mental health: validity of the MHI-5 using DSM-IV Axis I psychiatric disorders as gold standard. Psychiatry Res., 105, 243-253.SALO, R., FLOWER, K., KIELSTEIN, A., LEAMON, M.H., NORDAHL, T.E. & GALLOWAY, G.P. 2011. Psychiatric comorbidity in Methamphetamine Dependence. Psychiatry Res., 186 (2-3), 356-361.WARE, J. E., SNOW, K. K., KOSINSKI, M. & GANDEK, B. 1993. SF-36 health survey manual & interpretation guide. . Boston, MA: New England Medical Center.

Thank you

Pavla Chomynová

Czech National Monitoring Centre for Drugs and Addiction

[email protected]

www.drogy-info.czrvkpp.vlada.czwww.vlada.czwww.hazardni-hrani.czwww.alkohol-skodi.cz

National website for support of smoking cessation: www.koureni-zabiji.cz National hotline for smoking cessation: 800 35 00 00

national survey on substance use in the czech republic in 2016 · casino games 0,8 lotteries 19,3...

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