Substance use and mental health factors associated with self-reported higher risk cannabis use among people with HIV screened in primary care.

Background: While cannabis use is prevalent among people with HIV (PWH), factors associated with higher-risk use require further study. We examined factors associated with indicators risk for cannabis use disorder (CUD) among PWH who used cannabis. Methods: Participants included adult (≥18 years old) PWH from 3 HIV primary care clinics in Kaiser Permanente Northern California who reported past three-month cannabis use through the computerized Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) screening. Primary outcome was TAPS cannabis score (range 1-3), categorized as any use (1) and higher risk for CUD (≥2). Measures included sociodemographics (age, sex, race, neighborhood deprivation index [NDI]), Charlson Comorbidity Index (CCI), HIV RNA, CD4 cell counts, higher risk tobacco use (TAPS tobacco score≥2), depression, and anxiety symptoms. Unadjusted and multivariable logistic regression examined factors associated with higher risk for CUD. Results: Of the complete sample (N=978; 94.1% Male; 58.3% White; Age Mode=51-60), 35.8% reported higher risk for CUD. Unadjusted models indicated younger age, Black race, higher CCI, depression, anxiety, and higher risk tobacco use were associated with higher risk, while only Black race (OR=1.84, 95% CI[1.29, 2.63]), anxiety (OR=1.91, 95% CI[1.22, 2.98]), and higher risk tobacco use (OR=2.27, 95% CI[1.47, 3.51]) remained significant in the multivariable model. Conclusions: Black race, anxiety and tobacco use, but not HIV clinical markers, were associated with higher risk for CUD among PWH. Clinical efforts to screen and provide interventions for preventing CUD alongside anxiety and tobacco use among PWH should be evaluated.

Substance abuse treatment initiation among older adults in the GET SMART program: effects of depression and cognitive status.

This study examines how individual patient characteristics predict substance abuse treatment initiation among older adults, in an investigation based on the behavioral health service use model. Analyses tested the impact of demographic factors, substance abuse symptoms, depression and cognitive status on subsequent treatment initiation. The sample included 250 older male veterans screened for substance abuse problems during inpatient medical treatment, who also participated in a clinical evaluation for substance abuse treatment. Measures included demographics and CAGE alcohol screening score. A subset of patients also completed the Michigan Alcohol Screening Test-Geriatric Version (MAST-G), Hamilton Depression Scale (HAM-D), and Folstein Mini Mental State Exam (MMSE). Patients who initiated treatment following evaluation had more years of education, better cognitive status, and more symptoms of substance abuse and depression, compared with patients who did not initiate treatment. In logistic regression analysis, CAGE and MMSE scores independently predicted treatment initiation. Findings contribute to the understanding of how clinical characteristics of older adults affect substance abuse treatment initiation.

Alcohol expectancies and their relationship to alcohol use: age and sex differences.

Previous studies have demonstrated a correlation between expectancies that adolescents and young adults hold about the effects of alcohol and the amount of alcohol they consume. This study examined age and sex differences in expectancies and alcohol consumption in a sample of 92 older and 83 younger adults. The two groups were administered self-report questionnaires for quantity and frequency of alcohol consumption, and for positive and negative expectancies regarding the effects of alcohol. Results found lower quantities of alcohol consumption per occasion in older adults, but higher frequency of drinking occasions. Older adults reported significantly lower levels of both positive and negative expectancies when compared with the younger sample. Among older women, regression analyses found a significant relationship between negative expectancies and lower alcohol consumption. For older men, positive expectancies showed a positive relationship to consumption, while negative expectancies showed a negative relationship to consumption. For younger women, positive expectancies were related to increased consumption. These findings suggest different strategies based on age and sex in treatment models, which identify expectancies as important components of drinking behavior.