Abstract
Purpose of Review
This paper provides a narrative review of the co-use of alcohol and opioids, and its impact on biological, neurocognitive, and behavioral systems. In addition, data addressing co-use among patients receiving opioid replacement therapy and those who have chronic pain are discussed.
Recent Findings
Alcohol and opioids are among the most commonly used substances, and co-use has contributed to a growing number of accidental poisonings, emergency room visits, and overdose deaths. Prevalence of co-use is high among multiple populations and severely impacts treatment outcomes.
Summary
Treatment for those that co-use alcohol and opioids is inadequate. Future research should further investigate salient influences on co-use and identify potential targets for intervention to address this treatment need.
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References
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Hughes A, Williams MR, Lipari RN, Bose J, Copello E, Krout LA. Prescription Drug Use and Misuse in the United States: Results from the 2015 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. http://www.samhsa.gov/data/sites/default/files/NSDUH-FFR2–2015/NSDUH-FFR2–2015.htm. Published 2015. Accessed January 1, 2016.
Daubresse M, Chang H, Yu Y, et al. Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000–2010. Med Care. 2013;51:870–8.
Kreek MJ. Opioid interactions with alcohol. Adv Alcohol Subst Abus. 1984;3(4):35–46.
White JM, Irvine RJ, White JM, Irvine RJ. Mechanisms of fatal opioid overdose. Addiction. 1999;94(7):961–72.
Jones CM, Paulozzi LJ, Mack KA. Alcohol involvement in opioid pain reliever and benzodiazepine drug abuse—Related Emergency Department Visits and Drug-Related Deaths—United States, 2010. Morb Mortal Wkly Rep. 2014;63(40):881-11.
Calcaterra S, Glanz J, Binswanger IA. National trends in pharmaceutical opioid related overdose deaths compared to other substance related overdose deaths: 1999–2009. Drug Alcohol Depend. 2013;131(3):263–70. doi:10.1016/j.drugalcdep.2012.11.018.
Earleywine M, Newcomb MD. Concurrent versus simultaneous polydrug use: prevalence, correlates, discriminant validity, and prospective effects on health outcomes. Exp Clin Psychopharmacol. 1997;5(4):353–64.
•• McCabe SE, Cranford JA, Morales M, Young A. Simultaneous and concurrent polydrug use of alcohol and prescription drugs: prevalence, correlates, and consequences. J Stud Alcohol. 2006;67:529–37. Alcohol and opioid concurrent use is associated with more drug and alcohol related problems than singular substance users, even after statistically controlling for frequency of substance use.
Weathermon R, Crabb DW. Alcohol and medication interactions. Alcohol Res Heal. 1999;23(1):40–54. doi:10.1086/250095.
Jobski K, Schmid U, Behr S, Andersohn F, Garbe E. 3-year prevalence of alcohol-related disorders in German patients treated with high-potency opioids. Pharmacoepidemiol Drug Saf. 2012;21(April):1125–9. doi:10.1002/pds.
Peacock A, Bruno R, Larance B, et al. Same-day use of opioids and other central nervous system depressants amongst people who tamper with pharmaceutical opioids: a retrospective 7-day diary study. Drug Alcohol Depend. 2016;166:125–33. doi:10.1016/j.drugalcdep.2016.07.003.
Larance B, Campbell G, Peacock A, et al. Pain, alcohol use disorders and risky patterns of drinking among people with chronic non-cancer pain receiving long-term opioid therapy. Drug Alcohol Depend. 2016;162:79–87. doi:10.1016/j.drugalcdep.2016.02.048.
Saunders KW, Von Korff M, Campbell CI, et al. Concurrent use of alcohol and sedatives among persons prescribed chronic opioid therapy: prevalence and risk factors. J Pain. 2012;13(3):266–75. doi:10.1016/j.jpain.2011.11.004.
McCabe SE, West BT, Teter CJ, Boyd CJ. Co-ingestion of prescription opioids and other drugs among high school seniors : results from a national study. Drug Alcohol Depend. 2012;126:65–70. doi:10.1016/j.drugalcdep.2012.04.017.
McCabe SE, Cranford JA, West BT. Trends in prescription drug abuse and dependence, co-occurrence with other substance use disorders, and treatment utilization: results from two national surveys. Addict Behav. 2008;33:1297–305. doi:10.1016/j.addbeh.2008.06.005.
Cushman P. Alcohol and opioids: possible interactions of clinical importance. Adv Alcohol Subst Abus. 1987;6(3):33–46.
Arias F, Arnsten JH, Cunningham CO, et al. Neurocognitive, psychiatric, and substance use characteristics in opioid dependent adults. Addict Behav. 2016;60:137–43. doi:10.1016/j.addbeh.2016.03.018.
• Baldacchino A, Balfour DJK, Passetti F, Humphris G, Matthews K. Neuropsychological consequences of chronic opioid use: a quantitative review and meta-analysis. Neurosci Biobehav Rev. 2012;36(9):2056–68. doi:10.1016/j.neubiorev.2012.06.006. Meta-analysis that shows a robust impairment in verbal working memory, cognitive impulsivity (risk taking) and cognitive flexibility (verbal fluency) among those who have had chronic opioid exposure.
Gudin JA, Mogali S, Jones JD, Comer SD. Risks, management, and monitoring of combination opioid, benzodiazepines, and/or alcohol use. Postgrad Med. 2013;125(4):115–30. doi:10.3810/pgm.2013.07.2684.Risks.
Khalili-mahani N, Zoethout RMW, Beckmann CF, et al. Effects of morphine and alcohol on functional brain connectivity during “resting state”: a placebo-controlled crossover study in healthy young men. Hum Brain Mapp. 2012;33(December 2010):1003–18. doi:10.1002/hbm.21265.
Garnier LM, Arria AM, Caldeira KM, Vincent KB, Grady KE, Wish ED. Nonmedical prescription analgesic use and concurrent alcohol consumption among college students. Am J Drug Alcohol Abuse. 2009;35(5):334–8. doi:10.1080/00952990903075059.
Fleming MF, Balousek SL, Klessig CL, Mundt MP, Brown DD. Substance use disorders in a primary care sample receiving daily opioid therapy. J Pain. 2007;8(7):573–82. doi:10.1016/j.jpain.2007.02.432.
Gossop M, Marsden J, Stewart D. Dual dependence: assessment of dependence upon alcohol and illicit drugs, and the relationship of alcohol dependence among drug misusers to patterns of drinking, illicit drug use and health problems. Addiction. 2002;97(2):169–78. doi:10.1046/j.1360-0443.2002.00028.x.
Schepis TS, Hakes JK. Dose-related effects for the precipitation of psychopathology by opioid or tranquilizer/sedative nonmedical prescription use. J Addict Med. 2013;7(1):39–44. doi:10.1097/ADM.0b013e318277e9e5.
McCabe SE, Cranford JA, Boyd CJ. The relationship between past-year drinking behaviors and nonmedical use of prescription drugs: prevalence of co-occurrence in a national sample. Drug Alcohol Depend. 2006;84:281–8. doi:10.1016/j.drugalcdep.2006.03.006.
Hedden SL, Martins SS, Malcolm RJ, Floyd L, Cavanaugh CE, Latimer WW. Patterns of illegal drug use among an adult alcohol dependent population: results from the National Survey on Drug Use and Health. Drug Alcohol Depend. 2010;106(2–3):119–25. doi:10.1016/j.drugalcdep.2009.08.002.
Zacny JP, Drum M. Psychopharmacological effects of oxycodone in healthy volunteers: roles of alcohol-drinking status and sex. Drug Alcohol Depend. 2010;107(2–3):209–14. doi:10.1016/j.drugalcdep.2009.10.012.
Herz A. Endogenous opioid systems and alcohol addiction. Psychopharmacology. 1997;129:99–111.
• Witkiewitz K, Vowles KE, McCallion E, Frohe T, Kirouac M, Maisto SA. Pain as a predictor of heavy drinking and any drinking lapses in the COMBINE Study and the United Kingdom Alcohol Treatment Trial. Addiction. 2016;110(8):1262–71. doi:10.1111/add.12964.Pain. Pain is a signficant predictor of heavy drinking relapses during or after treatment, even after controlling for dependence severity, self-efficacy, temptation, psychiatric distress.
Almog YJ, Anglin MD, Fisher DG. Alcohol and heroin use patterns of narcotics addicts: gender and ethnic differences. Am J Drug Alcohol Abuse. 1993;19(2):219–38. doi:10.3109/00952999309002682.
Gossop M, Browne N, Stewart D, Marsden J. Alcohol use outcomes and heavy drinking at 4-5 years among a treatment sample of drug misusers. J Subst Abus Treat. 2003;25(3):135–43. doi:10.1016/S0740-5472(03)00129-6.
Gossop M, Ph D, Marsden J, et al. Patterns of drinking and drinking outcomes among drug misusers 1-year follow-up results. J Subst Abus Treat. 2000;19:45–50.
Staiger PK, Richardson B, Long CM, Carr V, Marlatt GA. Overlooked and underestimated? Problematic alcohol use in clients recovering from drug dependence. Addiction. 2012;108:1188–93. doi:10.1111/j.1360-0443.2012.04075.x.
Whelan PJ, Remski K. Buprenorphine vs methadone treatment : a review of evidence in both developed and developing worlds. J Neurosci Rural Pract. 2012;3(1):45–52. doi:10.4103/0976-3147.91934.
Clark NC, Dietze P, Lenné MG, Redman JR. Effect of opioid substitution therapy on alcohol metabolism. J Subst Abus Treat. 2006;30(3):191–6. doi:10.1016/j.jsat.2005.11.010.
•• Nolan S, Klimas J, Wood E. Alcohol use in opioid agonist treatment. Addict Sci Clin Pract. 2016;11(17):1–7. doi:10.1186/s13722-016-0065-6. Review on alcohol use among individuals with opioid addiction. Findings show that indivdiuals with alcohol and opioid co-use have poorere treamtent outcomes, signfiicnatly increased morbidity and mortality, and report exacerbations of psychiatric comorbidities.
Srivastava A, Kahan M, Ross S. The effect of methadone maintenance treatment on alcohol consumption: a systematic review. J Subst Abus Treat. 2008;34:215–23. doi:10.1016/j.jsat.2007.04.001.
Degenhardt L, Hall W. Patterns of co-morbidity between alcohol use and other substance use in the Australian population. Drug Alcohol Rev. 2003;22:7–13. doi:10.1080/0959523021000059776.
Zador D, Sunjic S. Deaths in methadone maintenenace treatment in New South Wales, Australia 1990–1995. Addiction. 2000;95(1):77–84.
Joseph H. Alcoholism and methadone treatment: consequences for the patient and program. Am J Drug Alcohol Abuse. 1985;11(1–2):37–53.
Senbanjo R, Wolff K, Marshall J. Excessive alcohol consumption is associated with reduced quality of life among methadone patients. Addiction. 2006;102:257–63. doi:10.1111/j.1360-0443.2006.01683.x.
Caldeiro RM, Malte CA, Calsyn DA, et al. The association of persistent pain with out-patient addiction treatment outcomes and service utilization. Addiction. 2008;103:1996–2005. doi:10.1111/j.1360-0443.2008.02358.x.
Trafton JA, Oliva EM, Horst DA, Minkel JD, Humphreys K. Treatment needs associated with pain in substance use disorder patients: implications for concurrent treatment. Drug Alcohol Depend. 2004;73(1):23–31. doi:10.1016/j.drugalcdep.2003.08.007.
Larson MJ, Paasche-orlow M, Cheng DM, Lloyd-travaglini C, Saitz R, Samet JH. Persistent pain is associated with substance use after detoxification: a prospective cohort analysis. Addiction. 2007;102:752–60. doi:10.1111/j.1360-0443.2007.01759.x.
Goebel JR, Compton P, Zubkoff L, et al. Prescription sharing, alcohol use, and street drug use to manage pain among veterans. J Pain Symptom Manag. 2016;41(5):848–58. doi:10.1016/j.jpainsymman.2010.07.009.
Savage SR. Addiction in the treatment of pain: significance, recognition, and management. J Pain Symptom Manag. 1993;8(5):265–78.
Morasco BJ, Gritzner S, Lewis L, Oldham R, Turk DC, Dobscha SK. Systematic review of prevalence, correlates, and treatment outcomes for chronic non-cancer pain in patients with comorbid substance use disorder. Pain. 2011;152(3):488–97. doi:10.1016/j.pain.2010.10.009.
Ilgen MA, Conner KR, Valenstein M, Austin K, Blow FC. Violent and nonviolent suicide in veterans with substance-use disorders. J Stud Alcohol Drugs. 2010;71(4):473–9.
Egli M, Koob GF, Edwards S. Neuroscience and biobehavioral reviews alcohol dependence as a chronic pain disorder. Neurosci Biobehav Rev. 2012;36(10):2179–92. doi:10.1016/j.neubiorev.2012.07.010.
Weiss RD, Potter JS, Griffin ML, et al. Reasons for opioid use among patients with dependence on prescription opioids: the role of chronic pain. J Subst Abus Treat. 2014;47:140–5. doi:10.1016/j.jsat.2014.03.004.
•• Dutra L, Stathopoulou G, Basden SL, Leyro TM, Powers MB, Otto MW. A meta-analytic review of psychosocial interventions for substance use disorders. Am J Psychiatry. 2008;165:179–87. Meta-analysis of treatment responses to psychosocial interventions among opioid, marijuana, cocaine, and polysubstance users. Polysubstance users and opioid users had the poorest treatment responses and outcomes.
Bowen S, Witkiewitz K, Clifasefi SL, et al. Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders a randomized clinical trial. JAMA Psychiatry. 2014;71(5):547–56. doi:10.1001/jamapsychiatry.2013.4546.
Bowen S, Collins SE, Witkiewitz K, et al. Mindfulness-based relapse prevention for substance use disorders: a pilot efficacy trial. Subst Abus. 2009;30:295–305. doi:10.1080/08897070903250084.
Witkiewitz K, Warner K, Sully B, et al. Randomized trial comparing mindfulness-based relapse prevention addiction treatment center. Subst Use Misuse. 2014;49:536–46. doi:10.3109/10826084.2013.856922.
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Karlyn A. Edwards, Dr. Kevin E. Vowles, and Dr. Katie Witkiewitz declare that they have no conflicts of interest.
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Edwards, K.A., Vowles, K.E. & Witkiewitz, K. Co-use of Alcohol and Opioids. Curr Addict Rep 4, 194–199 (2017). https://doi.org/10.1007/s40429-017-0147-x
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DOI: https://doi.org/10.1007/s40429-017-0147-x