Polysubstance addiction patterns among 7,989 individuals with cocaine use disorder

Stiltner, Brendan; Pietrzak, Robert H.; Tylee, Daniel S.; Nuñez, Yaira Z.; Adhikari, Keyrun; Kranzler, Henry R.; Polimanti, Renato

doi:10.1016/j.isci.2023.107336

Cited by 5 publications

(2 citation statements)

References 78 publications

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“…The inconsistency in the findings with regard to the cardiac risk of cocaine–alcohol may also be driven by heterogeneity in the patient characteristics (e.g., age), risk behavior (e.g., chronic smoking, chronic alcohol, or polydrug use), and traditional cardiovascular risk factors (e.g., morbidities) [ 6 ]. Polydrug use is known to be highly prevalent among cocaine users [ 2 , 86 ] and it is well-known that the simultaneous use of cocaine and other substances may exacerbate cocaine-associated cardiovascular complications [ 87 ]. In addition, prolonged cocaine use may predispose to cardiovascular disease, like coronary and myocardium abnormalities [ 87 , 88 , 89 ].…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Risks of Simultaneous Use of Alcohol and Cocaine—A Systematic Review

van Amsterdam,

Gresnigt,

van den Brink

2024

JCM

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Background: The simultaneous use of cocaine and alcohol is highly prevalent and is associated with high numbers of emergency department admissions, primarily due to cardiovascular complications. Aims: To answer the question of whether the co-use of cocaine and alcohol increases the cardiovascular risk compared to the use of cocaine alone. Method: A systematic review of human studies comparing the cardiovascular risk of co-used cocaine and alcohol with the use of cocaine alone. Results: Despite a higher myocardial workload induced by the co-use of cocaine and alcohol and the potentiation of cocaine’s cardiovascular effects by alcohol, the findings on the risk and severity of cardiovascular symptoms due to combined use are inconsistent. However, the co-use of cocaine and alcohol clearly leads to higher mortality. Interestingly, the presence of cocaethylene, a unique metabolite generated only via a pharmacokinetic interaction between alcohol and cocaine, carries an 18- to 25-fold increase over the absence of cocaethylene (cocaine-alone users) in the risk of sudden death and is associated with myocardial injury and cardiac arrest, probably due to the inhibition of cardiac ion channels by cocaethylene. Conclusion: Despite the inconsistency in some of the results, it is concluded that the co-use of cocaine and alcohol poses an additional risk of cardiovascular fatalities compared to the use of cocaine alone.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular Risks of Simultaneous Use of Alcohol and Cocaine—A Systematic Review

van Amsterdam,

Gresnigt,

van den Brink

2024

JCM

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“…In addition, a prior SUD diagnosis significantly accelerates progression from use to disorder for subsequently used substances ( 11 ). Lifetime co-occurrence of SUDs is associated with a higher rate of physical and psychological comorbidity, greater severity of each individual SUD, increased psychiatric debilitation, and overall higher morbidity ( 12 , 13 ). Given the high prevalence of polysubstance use among individuals with SUDs, increased likelihood of comorbid SUDs, and greater health burdens associated with multiple SUD diagnoses, it is of paramount importance that we capture the etiology of this prevailing clinical presentation.…”

Section: Introductionmentioning

confidence: 99%

Generalized genetic liability to substance use disorders

Miller,

Bogdan,

Agrawal

et al. 2024

Journal of Clinical Investigation

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Lifetime and temporal co-occurrence of substance use disorders (SUDs) is common and compared with individual SUDs is characterized by greater severity, additional psychiatric comorbidities, and worse outcomes. Here, we review evidence for the role of generalized genetic liability to various SUDs. Coaggregation of SUDs has familial contributions, with twin studies suggesting a strong contribution of additive genetic influences undergirding use disorders for a variety of substances (including alcohol, nicotine, cannabis, and others). GWAS have documented similarly large genetic correlations between alcohol, cannabis, and opioid use disorders. Extending these findings, recent studies have identified multiple genomic loci that contribute to common risk for these SUDs and problematic tobacco use, implicating dopaminergic regulatory and neuronal development mechanisms in the pathophysiology of generalized SUD genetic liability, with certain signals demonstrating cross-species and translational validity. Overlap with genetic signals for other externalizing behaviors, while substantial, does not explain the entirety of the generalized genetic signal for SUD. Polygenic scores (PGS) derived from the generalized genetic liability to SUDs outperform PGS for individual SUDs in prediction of serious mental health and medical comorbidities. Going forward, it will be important to further elucidate the etiology of generalized SUD genetic liability by incorporating additional SUDs, evaluating clinical presentation across the lifespan, and increasing the granularity of investigation (e.g., specific transdiagnostic criteria) to ultimately improve the nosology, prevention, and treatment of SUDs.

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Association patterns of antisocial personality disorder across substance use disorders

Low,

Stiltner,

Nunez

et al. 2024

Transl Psychiatry

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Polysubstance addiction patterns among 7,989 individuals with cocaine use disorder

Cited by 5 publications

References 78 publications

Cardiovascular Risks of Simultaneous Use of Alcohol and Cocaine—A Systematic Review

Cardiovascular Risks of Simultaneous Use of Alcohol and Cocaine—A Systematic Review

Generalized genetic liability to substance use disorders

Association patterns of antisocial personality disorder across substance use disorders

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