Substance Use in Adolescents and Young Adults With Inflammatory Bowel Diseases

Abstract

Objectives: Adolescents and young adults (AYAs) with chronic illnesses use substances at similar, if not greater, rates compared to healthy peers. The present study aimed to examine rates and patterns of tobacco use, marijuana use, and binge drinking in AYAs with inflammatory bowel diseases. We expected that substance use would be associated with poorer physical health, psychosocial functioning, and disease management. Methods: One hundred thirty-two AYAs completed a single set of surveys assessing demographics, disease activity, healthcare utilization, health-related quality of life (HRQoL), inflammatory bowel disease–specific self-efficacy, adherence barriers, disease management skills, and substance use in the last 30 days (eg, tobacco use, marijuana use, binge drinking). Exploratory cluster analyses, followed by chi-square tests and analyses of variance examined patterns of substance use and correlates of cluster membership. Results: Four patterns emerged from the sample: Global Users (n = 17), Marijuana Users Engaging in Binge Drinking (n = 18), Exclusive Binge Drinkers (n = 21), and Global Abstainers (n = 76). Groups differed by age, gender, disease activity, healthcare utilization, HRQoL, self-efficacy, and adherence barriers with medium and large effect sizes (P < .05). Conclusions: Older age, male gender, active disease, at least 1 hospitalization in the past year, low self-efficacy, low HRQoL, and high adherence barriers were significantly more likely for those reporting multisubstance use. In addition, all those reporting both marijuana use and binge drinking also reported tobacco use. Future research ought to examine these associations longitudinally and throughout the transition to adult care.

Polysubstance use in inflammatory bowel disease

“…Of note, this association persisted on bivariate and multivariate analyses even when the presence of tobacco use was excluded (data not shown). Although a previous report found an association between PSU and disease activity, 19 we found no such association in this study. Our analysis utilized endoscopically confirmed disease activity, rather than subjective, symptomatic‐based estimates of disease activity, which might have contributed to this variation.…”

“…Several findings from this investigation were similar to those of previous studies. For example, we reported an incidence of PSU similar to that previously described in adolescents and young adults with IBD (20.6% vs 18.2%) 19 . This was also similar to a previous estimate of substance use disorder (16.6%) in adults with IBD 20 .…”

“…Also, as tobacco use was incorporated into the definition of PSU, we could not properly evaluate it separately as a potential predictor of PSU. This is relevant because a previous study has demonstrated that tobacco use is present in 100% of patients exhibiting PSU 19 . We were also unable to collect potentially relevant laboratory values in all the study participants, including hemoglobin, measures of nutrition, and inflammatory markers such as the erythrocyte sedimentation rate and C‐reactive protein.…”

“…Additionally, tobacco smoking is also relatively common in patients with IBD and is strongly associated with poor outcomes in CD in particular 17,18 . There is an increased association in adult and pediatric patients of IBD with substance‐use disorders that are associated with further clinical consequences 19,20 . In summary, use of any one of these agents may have a deleterious effect in IBD.…”

Emerging Comorbidities in Inflammatory Bowel Disease: Eating Disorders, Alcohol and Narcotics Misuse

“…Increased risk for SUDs was demonstrated in studies in paediatric and young adults with IBD [ 95 ]. It is worth noting that in another study in adolescents and young adults with IBD majority of them (76/132) were abstainers; however, those reporting usages of marihuana and binge drinking episodes have been also smoking cigarettes [ 96 ]. Furthermore, two large studies from Sweden on early onset IBD and adult-onset IBD shown a higher prevalence of substance misuse compared to both population and sibling controls [ 41 , 97 ].…”