Association of mental health related quality of life and other factors with treatment seeking for substance use disorders: A comparison of SUDs rooted in legal, partially legal, and illegal substances.

The association of subjective mental health-related quality of life (MHRQOL) and treatment use among people experiencing common substance use disorders (SUDs) is not known. Furthermore, the association of a given substance's legal status with treatment use has not been studied. This work aims determine the association of MHRQOL with SUD treatment use, and how substance legal status modulates this relationship. Our analysis used nationally-representative data from the NESARC-III database of those experiencing past-year SUDs (n = 5,808) to compare rates of treatment use and its correlates among three groups: those with illicit substance use disorders (ISUDs); those with partially legal substance use disorders, i.e., cannabis use disorder (CUD); and those with fully legal substance use disorders, i.e., alcohol use disorder (AUD). Survey-weighted multiple regression analysis was used to assess the association of MHRQOL with likelihood of treatment use among these three groups, both unadjusted and adjusted for sociodemographic, behavioral, and diagnostic factors. Adults with past-year ISUDs were significantly more likely to use treatment than those with CUD and AUD. Among those with ISUDs, MHRQOL had no significant association with likelihood of treatment use. Those with past-year CUD saw significant negative association of MHRQOL with treatment use in unadjusted analysis, but not after controlling for diagnostic and other behavioral health factors. Those with past-year AUD had significant negative association of MHRQOL with treatment use in both unadjusted and adjusted analysis. If legalization and decriminalization continue, there may be a greater need for effective public education and harm reduction services to address this changing SUD landscape.

Mid-life leukocyte telomere length and dementia risk: An observational and mendelian randomization study of 435,046 UK Biobank participants.

Telomere attrition is one of biological aging hallmarks and may be intervened to target multiple aging-related diseases, including Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD). The objective of this study was to assess associations of leukocyte telomere length (TL) with AD/ADRD and early markers of AD/ADRD, including cognitive performance and brain magnetic resonance imaging (MRI) phenotypes. Data from European-ancestry participants in the UK Biobank (n = 435,046) were used to evaluate whether mid-life leukocyte TL is associated with incident AD/ADRD over a mean follow-up of 12.2 years. In a subsample without AD/ADRD and with brain imaging data (n = 43,390), we associated TL with brain MRI phenotypes related to AD or vascular dementia pathology. Longer TL was associated with a lower risk of incident AD/ADRD (adjusted Hazard Ratio [aHR] per SD = 0.93, 95% CI 0.90-0.96, p = 3.37 × 10-7 ). Longer TL also was associated with better cognitive performance in specific cognitive domains, larger hippocampus volume, lower total volume of white matter hyperintensities, and higher fractional anisotropy and lower mean diffusivity in the fornix. In conclusion, longer TL is inversely associated with AD/ADRD, cognitive impairment, and brain structural lesions toward the development of AD/ADRD. However, the relationships between genetically determined TL and the outcomes above were not statistically significant based on the results from Mendelian randomization analysis results. Our findings add to the literature of prioritizing risk for AD/ADRD. The causality needs to be ascertained in mechanistic studies.

Gender Differences in Diagnostic Remission of Posttraumatic Stress Disorder (PTSD): Proportions and Correlates of Remission in a Nationally Representative U.S. Sample.

This study examines differences in a nationally representative sample, in proportions of men and women with lifetime diagnoses of Posttraumatic Stress Disorder (PTSD) who achieved diagnostic remission and gender-specific correlates. Data from the 2012-13 National Epidemiologic Survey on Alcohol and Related Conditions-III included 1,997 adults with a lifetime PTSD diagnosis (70.8% female and 29.2% male). Of these 25.3% of women and 24.3% of men experienced remission (ns). Women who remitted were older than other women, more likely to be retired, and less likely to report disability, past homelessness, suicide attempts, criminal history, violent behavior, or parental histories of drug problems or suicide. Men who remitted were less likely than other men to be separated/divorced, disabled, incarcerated after age 15, and reported fewer violent behaviors. Remission was significantly more strongly associated among women than men with greater age, emergency room visits, trauma and less with schizotypal personality. Although women were twice as likely to be diagnosed with PTSD, there were no significant gender differences in the proportions who experienced remission. Remission was associated with diverse sociodemographic and clinical disadvantages among both men and women but only four were statistically significantly different between genders.

Long-term impact of the U.S. Armed forces Zero-Tolerance drug policy on female veterans.

BACKGROUND: In 1980, the U.S. military instituted a zero-tolerance policy for illicit substance use that led to a reduction in such use during military services. Long-term post-military effects have not been studied. METHODS: National survey data from 2012-2013 were used to compared veteran versus non-veteran differences in sociodemographic, behavioral and substance use and psychiatric diagnoses among women by cohort (i.e., those younger than 52 who would have entered the military under the no tolerance policy, and those older than 52 who would have entered before this policy was implemented). Multivariate interaction analyses between cohorts and veteran status were used to identify significant changes in veteran-non-veteran differences between these age cohorts on during the decades following the implementation of the zero-tolerance policy. RESULTS: Significant interactions primarily involved substance use diagnoses which were less frequent among veterans than non-veterans in the younger group of women, in contrast to the older group in which veterans had greater rates of substance use than non-veterans. These patterns were less robust for alcohol than substance use disorders and were not significant for psychiatric disorders. CONCLUSION: The zero-tolerance policy appears to have had a long-term effect resulting in less substance use disorder and, to some extent, less alcohol use disorder among veterans as compared to non-veterans who served in the military after the zero-tolerance policy was implemented.

Complementary and alternative medicine in US adults with diabetes: Reasons for use and perceived benefits.

BACKGROUND: Although complementary and alternative medicine (CAM) is increasingly used, little is known about the reasons for CAM use (treatment, wellness, or both), or the self-reported perceived benefits among US adults with diabetes. In this study we estimated prevalence rates of overall and specific types of CAM, as well as the perceived benefits of CAM, by reason for use among US diabetic adults. METHODS: Cross-sectional data from the 2012 National Health Interview Survey, which represents non-institutionalized adults with diabetes (n = 3386 unweighted), were used to estimate prevalence rates of CAM use by reason. Multivariate logistic regression analyses were used to investigate the odds of perceived benefits of CAM by reason for use after controlling for covariates. RESULTS: Of US diabetic adults, 26.2% reported using some form of CAM in the past year. Of these, 56.7% used CAM for both treatment and wellness, 28.3% used CAM for wellness only, and 15.0% used CAM for treatment only. Regardless of reasons for use, most commonly used CAM were herbal therapies (56.9%), followed by chiropractic (25.3%) and massage (20.2%). Those using CAM for a combination of both treatment and wellness had a higher likelihood of self-reporting a "better sense of control over their health" (P = 0.011) and "improved overall health and feeling better" (P = 0.014) than those using CAM for treatment only. CONCLUSION: Although CAM may be a promising approach to improving health-related quality of life, future research should address efficacy and patient safety.