Rates and Influences of Alcohol Use Disorder Comorbidity among Primary Stimulant Misusing Treatment-Seekers: Meta-analytic Findings Across Eight NIDA CTN Trials

Abstract

Background: There is need to improve treatment effectiveness for stimulant misusers, and one means of doing so is by tailoring services to account for common diagnostic comorbidities and psychosocial challenges they face. Objectives: Using its publicly available datasets, this CTN-approved secondary analysis project examined prevalence of alcohol use disorders (AUDs) among primary stimulant misusing treatment-seekers as well as impact of AUD comorbidity on their pre-treatment psychosocial functioning. Methods: Upon identifying a primary stimulant misuser subsample (N = 1133) from among aggregated treatment-seekers across eight CTN trials, diagnostic data were used to document lifetime AUD rates. Paired comparisons, stratified by stimulant drug type (e.g., amphetamine, cocaine) then tested the influence of AUD comorbidity on psychosocial indices from the Addiction Severity Index – Lite. Results: A high AUD rate (45%) was found in this client population. Among primary cocaine misusers, those with AUD were more likely to: (i) show elevated Addiction Severity Index composite scores, (ii) perceive greater importance of drug treatment, and (iii) endorse psychiatric symptoms and perceived need for their treatment. Among primary amphetamine misusers, those with AUD were more likely to endorse specific psychiatric symptoms. Conclusion: Study findings document AUD comorbidity as a fairly common diagnostic feature of primary stimulant misusers, and suggest it is a pervasive influence on the pre-treatment psychosocial functioning of cocaine misusers. Scientific Significance: This study demonstrates the utility of CTN common assessment battery for secondary analysis projects, though challenges noted during its conduct highlight the value of consistent data collection and documentation within and across CTN trials.

• stimulant misusers
• alcohol use disorders
• comorbidity
• psychosocial functioning

ACKNOWLEDGEMENTS

This work was undertaken with the approval of the National Institute on Drug Abuse (NIDA) Center for Clinical Trials Network, and conducted with support from grants as part of the NIDA Clinical Trials Network U10 DA013714 (Pacific Northwest Node) and N01DA-5-220 (Duke Clinical Research Institute) as well as a career development grant for Dr. Hartzler (K23 DA025678-01A2). The authors thank both Prasad Kothari at NIDA and individual CTN trial investigators who provided assistance during the analytic process, and the CTN Publication Committee for its input in the drafting of this manuscript.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.