Journal of Dual Diagnosis: Highlights from the 2020 Issues

The year 2020 will be remembered for, among other events, the coronavirus outbreak. The pandemic has brought with it death and isolation, as well as unemployment and other economic consequences. Research has also been impacted. New enrollment in clinical research, not related to COVID-19, halted for at least a few months at most institutions and many visits were conducted remotely (Kardas-Nelson, 2020; Tuttle, 2020). The consequences may ultimately include a delay in finishing studies and potentially an increase in underpowered studies. Interestingly, however, COVID-19 appears to have been associated with an increase in manuscript submissions to scientific journals (Alkhouri et al., 2020; Lee et al., 2020).

This very challenging year has seen growth and bright spots for the Journal of Dual Diagnosis. The journal’s 5-year impact factor (a measure of number of citations divided by the number of publications over the previous 5-year period) continues to increase and is at its highest level yet. The same is true of the article influence score. The journal is truly international with papers from 20 countries and every continent except Antarctica accepted for publication.

The year began with a special issue on cannabis featuring guest editor, Dr. Francisca Filbey. The issue covered a variety of topics relevant to cannabis use including neuroimaging findings (Chye et al., 2020), use with alcohol in young people (Karoly et al., 2020), and relationships between cannabis use and conduct disorder (Blair, 2020). One paper focused on concerns that cannabis may precipitate psychosis in some individuals; a review by Sideli et al. concluded that there is strong evidence that cannabis with high levels of tetrahydrocannabinol increases psychosis risk (Sideli et al., 2018). The authors suggested that the evidence of cannabis-related mania and suicide is not as strong as the evidence for cannabis-related psychosis, while the evidence for anxiety and depression is weak and/or contradictory. Duperrouzel et al. reviewed meta-analysis examining cognition in people who use cannabis (Duperrouzel et al., 2020). The authors concluded that regular cannabis users on average demonstrate poorer cognitive function in the small to medium effect size across a variety of cognitive domains. The therapeutic potential of cannabinoids is an area of much interest. This issue included reviews on the use of cannabinoids for seizures (Doyle & Harvey, 2020), pain (Milligan et al., 2020) and post-traumatic stress disorder (Hindocha et al., 2020). Hindocha et al. concluded that the evidence is quite limited and generally low in quality for an effect of cannabinoids for post-traumatic stress disorder. Yoo et al. reviewed the important topic of the effects of cannabis use on the aging brain (Yoo et al., 2020). The review noted the paucity of data in this area with some data suggesting hippocampal changes with cannabis use.

Several papers during 2020 focused on military veterans with dual diagnoses. Riblet et al. reported that high adherence to Medication Assisted Therapy (MAT) was associated with a substantial but non-significant decrease in all cause, external cause and suicide or overdose death in veterans with post-traumatic stress disorder (PTSD) and opioid use disorder (Riblet et al., 2020). Roberts & Rosenheck used VA system electronic medical records to examine the health impact of tobacco use and obesity alone and together (Roberts & Rosenheck, 2020). Notably, an additive effect was observed for the two conditions together for medical and psychiatric comorbidity. However, the veterans with both obesity and tobacco use disorder had lower rates of other substance use disorders than those with only tobacco use disorder. Rosenbaum et al. examined smoking motives in veterans with PTSD, MDD and neither illness (Rosenblum et al., 2020). Smokers with PTSD scored higher in a variety of primary (automaticity, craving, tolerance) and secondary (cue exposure/associate processes, affective enhancement, affiliative attachment, cognitive enhancement, weight control) motives while smokers with MDD were primarily influenced by secondary motives. Rosenbaum et al. also studied tobacco use in veterans by examining smoking motives in veterans with PTSD, major depressive disorder (MDD) and neither illness. Using the VA database, Stefanovics et al. examined sex differences in dual diagnosis veterans. They observed no significant differences between men and women in length of stay, treatment satisfaction, or substance and PTSD measures (Stefanovics & Rosenheck, 2020). Szabo et al. reviewed the literature on cortisol levels and alcohol use in combat veterans. The authors suggest that PTSD may play a role and that cortisol levels could be a biomarker of alcohol use disorder development or relapse (Szabo et al., 2020). Lyons et al. reported that negative affect mediated the relationship between PTSD and alcohol craving in veterans (Lyons et al., 2020).

Multimorbidity, in which substance use disorders co-occur not only with other psychiatric illnesses, but with medical illnesses is common (North et al., 2016). Osborne et al. examined medical illnesses of people treated for substance use disorders at a residential treatment facility. The authors observed that a staggering 80% of these patients had a medical condition with musculoskeletal conditions being the most common. Using data from 22,471 participants in the Healthy Life in an Urban Setting (HELIUS), van Binnendijk et al. examined the relationship between alcohol and nicotine use and depression in Dutch natives and persons from five other ethnic groups (van Binnendijk et al., 2020). Both alcohol and nicotine misuse were associated with depression in most of the groups studied.

Disclosure statement

No potential conflict of interest was reported by the author(s).