Rate of progression from first use to dependence on cocaine or opioids: a cross-substance examination of associated demographic, psychiatric, and childhood risk factors.
BACKGROUND
A number of demographic factors, psychiatric disorders, and childhood risk factors have been associated with cocaine dependence (CD) and opioid dependence (OD), but little is known about their relevance to the rate at which dependence develops. Identification of the subpopulations at elevated risk for rapid development of dependence and the risk factors that accelerate the course of dependence is an important public health goal.


METHODS
Data were derived from cocaine dependent (n=6333) and opioid dependent (n=3513) participants in a multi-site study of substance dependence. Mean age was approximately 40 and 40% of participants were women; 51.9% of cocaine dependent participants and 29.5% of opioid dependent participants self-identified as Black/African-American. The time from first use to dependence was calculated for each substance and a range of demographic, psychiatric, and childhood risk factors were entered into ordinal logistic regression models to predict the (categorical) transition time to CD and OD.


RESULTS
In both the cocaine and opioid models, conduct disorder and childhood physical abuse predicted rapid development of dependence and alcohol and nicotine dependence diagnoses were associated with slower progression to CD or OD. Blacks/African Americans were at greater risk than European Americans to progress rapidly to OD.


CONCLUSIONS
Only a subset of factors known to be associated with CD and OD predicted the rate at which dependence developed. Nearly all were common to cocaine and opioids, suggesting that sources of influence on the timing of transitions to dependence are shared across the two substances.
Department of Psychiatry, Yale University School of Medicine, VA Connecticut Healthcare System, 950 Campbell Avenue, 151D, West Haven, CT 06516, USA. Electronic address: carolyn.sartor@yale.edu.
Carolyn E
CE
Sartor
Henry R
HR
Kranzler
Joel
J
Gelernter
D000328:Adult; D017668:Age of Onset; D000368:Aged; D019973:Alcohol-Related Disorders / Q000453:epidemiology*; D016739:Behavior, Addictive / Q000208:ethnology / Q000523:psychology*; D016022:Case-Control Studies; D002648:Child; D002649:Child Abuse / Q000523:psychology / Q000706:statistics & numerical data; D016000:Cluster Analysis; D019970:Cocaine-Related Disorders / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D003237:Connecticut / Q000453:epidemiology; D003430:Cross-Sectional Studies; D017831:Diagnosis, Dual (Psychiatry); D018450:Disease Progression; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D010414:Pennsylvania / Q000453:epidemiology; D012307:Risk Factors; D012931:Social Environment; D012959:Socioeconomic Factors; D013022:South Carolina / Q000453:epidemiology; D013997:Time Factors
Cocaine dependence; Opioid dependence; Transition