Suspected Causal Association Between Cocaine Use and Occurrence of Panic

Abstract

Aim: To estimate a suspected causal association between cocaine use and the occurrence of panic. Methods: Data are from an epidemiologic sample of school-attending youths enrolled in primary school who were traced, rerecruited, and assessed via standardized interviews in young adulthood during 2000–2002. A total of 1,692 young adults comprised the analysis sample. Occurrences of panic and cocaine use were assessed in young adulthood, via standardized item sets from the Diagnostic Interview Schedule. A brief assessment of panic experiences had also been made when the youths were in early adolescence. Results: With statistical adjustment for important covariates, we found a modestly excess occurrence of panic attack-like experiences among those who had used cocaine at least once, relative to occurrence among young people who never had used cocaine (estimated odds ratio, OR = 1.9; p = .014 before exclusion of 288 with early onset panic attack-like experiences; p = .005 after this exclusion). Discussion: The main finding of this study was an association linking cocaine use and panic attack-like experiences, which was more modest than was observed in study samples that included older adults.

RÉSUMÉ

But: Estimer une association causale suspectée entre l’utilisation de cocaïne et l’occurrence de la panique. Méthodes: Les données proviennent d’un échantillon épidémiologique des jeunes antérieurement inscrits à l’école primaire, qui à l’age adulte ont été après re-tracés, recrutés, et évalués par le moyen des interviews standardisées entre 2000 et . L’échantillon d’analyse porte un total de 1692 jeunes adultes. Des occurrences de la panique et de l’utilisation de la cocaïne ont été évaluées à l’âge adulte, grâce a un questionnaire standardisé (Diagnostic Interview Schedule). Cet outil avait également été utilisé pour l’évaluation des retracés à l’adolescence. Résultats: Apres l’ajustement statistique des variables explicatives importantes, nous avons trouvé une occurrence modestement excessive des expériences d’attaque de la panique parmi ceux qui avaient consommé la cocaïne au moins une fois, comparé a celle des jeunes qui n’avaient jamais été exposés a la cocaïne (Odds Ratio estimé, OR = 1.9; p = 0.014 pour toute l’échantillon. Lorsque les 288 sujets qui ont eu une expérience de la panique a la basse sont exclus, la probabilité devient plus significative, p = 0.005). Discussion: La conclusion principale de cette étude révèle une association liant l’utilisation de la cocaïne aux expériences des attaques de la panique. Cette association est plus modeste que celle qu’a été observée dans d’autres échantillons d’étude comportant des sujets plus âgés. SOUTIEN: Projets D43TW05819 et R01DA009897 de NIH FIC et de NIDA, aussi bien que K05DA015799 à l’auteur senior.

RESUMEN

Objetivo: Estimar una probable asociación causal entre el uso de la cocaína y la ocurrencia de pánico. Métodos: Los datos provienen de una muestra epidemiológica de jóvenes adultos que en el pasado estuvieron inscritos en escuela primaria y que fueron encontrados de nuevo, re-reclutados, y evaluados vía entrevistas estandardizadas en edad adulta joven durante 2000–2002. La muestra para el análisis comprendió un total de 1692 adultos jóvenes. Las ocurrencias del pánico y del uso de la cocaína fueron determinadas en edad adulta joven, por medio de ítems estandardizados provenientes del “Diagnostic Interview Schedule”. Una breve medición de experiencias de pánico también había sido realizada cuando los jóvenes estuvieron en adolescencia temprana. Resultados: Luego de ajuste estadístico por variables importantes, encontramos un modesto exceso de ocurrencia de experiencias similares a ataques de pánico entre los que habían utilizado la cocaína por lo menos una vez, comparados con la ocurrencia entre la gente joven que nunca había utilizado cocaína (Odds Ratio estimado, OR = 1.9; p = 0.014 antes de la exclusión de 288 sujetos que habían tenido experiencias similares a ataque de pánico de temprana aparición en la vida; p = 0.005 después de esta exclusión). Discusión: El principal hallazgo de este estudio es una asociación entre uso de cocaína y experiencias similares a ataque de pánico más modesta que aquella que se había observado en muestras de estudio que incluyeron a adultos de mayor edad. FUENTES DE FINANCIAMIENTO: Proyectos D43TW05819 y R01DA009897 de NIH FIC y de NIDA, así como K05DA015799 para el autor senior.

RIASSUNTO

Obiettivo: valutare la probabile associazione causale tra il consumo di cocainae il panico. Metodi: i dati provengono da un campione epidemiologico di giovaniscritti precedentemente alla scuola elementare, che sono stati rintracciati, arruolati e valutati tramite interviste standarizate nel loro periodoadulto-giovane tra il 2000–2002. Il campione è stato costituito da 1692 giovani-adulti.L’avvenimento del panico e il consumo di cocaina furono determinati nell’età adulta-giovane, secondo gli standards provenienti Catologo d’Interviste Diagnostiche (Diagnostic Interview Schedule, DIS). È stata fatta anche una breve valutazione dell’esperienze di panico durante i primi anni dell’adolescenza. Risultati: Dopo la correzione statistica secondo le variabili più importanti, abbiamo trovato che esperienze similari alle crisi di panico accadono, con uno scarso incremento, tra i giovani che avevano usato cocaina almeno una volta in relazione a quelli che non l’avevano mai usata (Odds Ratio stimato, OR = 1.9; p = 0.014,prima dell?esclusione di 288 soggetti che avevano avuto esperienze similaria crisi di panico che iniziarono presto nella vita; p = 0.005 dopo l’esclusione).Discussione: questo studio ha trovato principalmente una associazione tra L’uso di cocaina ed esperienze similari a crisi di panico, più modesta chequella osservata nel campione di adulti di età pià avanzata. FONTI FINANZIARIE:Proietto D43TW05819 e R01DA009897 dal NIH FIC e dal NIDA, nonché K05DA015799 per l’autore senior.

Keywords :

• cocaine
• epidemiology
• panic
• case-control

THE AUTHORS

Germán F. Alvarado, MD, MPH, PhD (abd), a public health scientist, is a professor in the Public Health and Administration School at Cayetano Heredia Peruvian University; he was formerly the director of the Master in Public Health Program. He is interested in epidemiological surveillance of adolescents and young adults, with longitudinal follow-up studies to learn more about the causal determinants of youthful drug involvement and hazards, such as drug dependence. He is particularly interested in cocaine epidemiology, hazards of drug taking, and the efficacy and effectiveness of public health actions to prevent and control these problems.

Carla L. Storr, ScD, is adjunct faculty in the Department of Mental Health at Johns Hopkins Bloomberg School of Public health but more recently joined the faculty at the University of Maryland School of Nursing in Baltimore as a professor. Among Dr Storr's research interests is the exploration of early childhood markers or signs that might discriminate between differing levels or degrees of involvement with drugs or other psychiatric disorders.

James C. Anthony, PhD, a psychiatric epidemiologist, is a Professor and Chairman of Epidemiology at Michigan State University. He was formerly affiliated with the Johns Hopkins University Bloomberg School of Public Health and School of Medicine, where he was a professor in the departments of Mental Heath, Epidemiology, and Behavioral Sciences. Much of his work involves epidemiological research on the suspected hazards of psychoactive drug use, including the clinical syndromes of drug dependence.

Notes

1 The reader is referred to Hills's criteria for causation, which were developed in order to help assist researchers and clinicians evaluate whether corelates might be were causes of a particular disease or outcomes, or merely associated.