title: Stimulant dependence and stimulant-associated psychosis: clinical characteristics and age of onset in a native American community sample.
abstract: OBJECTIVE
  Native Americans experience some of the highest rates of Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) stimulant dependence (SD) of all US ethnic groups. The present report examined the clinical characteristics and age of onset of stimulant use, SD, remission from SD, and stimulant-associated psychosis (SAP) in a Native American community sample.
  
  
  METHODS
  Demographic information, stimulant (methamphetamine or cocaine) use, and lifetime Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) psychiatric disorder diagnoses were assessed in 858 Native Americans. Logistic regression was used to assess the associations of demographic, stimulant use, and psychiatric disorder variables with SD, remission from SD, and SAP. Kaplan-Meier survival analyses were used to assess time from first use to the onset of SD.
  
  
  RESULTS
  The overall rate of SD was 33%, of remission from SD 73%, and of SAP 17%. Stimulant dependence was associated with older age, less current annual household income, fewer lifetime years of education, intravenous stimulant use, and earlier age of first stimulant use. Remission from SD was associated with older age, currently being married, and never having used stimulants intravenously. Attention-deficit/hyperactivity disorder (assessed as a lifetime disorder), increased number of years of daily stimulant use, and intravenous use were independently associated with SAP. Younger age at first use was significantly associated with shorter survival to the onset of SD.
  
  
  CONCLUSIONS
  Stimulant dependence is prevalent in this population and is associated with less income and education and an earlier age at first use. Intravenous stimulant use adds additional risk for SD, nonremission, and psychosis.
authors.affiliation: From the Molecular and Cellular Neuroscience Department (DAG, PL, CLE) and Department of Molecular and Experimental Medicine (CLE), The Scripps Research Institute, La Jolla, CA; and Department of Psychological Sciences (IRG), University of Missouri, Columbia.
authors.forename: David A
authors.initials: DA
authors.lastname: Gilder
authors.forename: Ian R
authors.initials: IR
authors.lastname: Gizer
authors.forename: Philip
authors.initials: P
authors.lastname: Lau
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Ehlers
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D019969:Amphetamine-Related Disorders / Q000150:complications / Q000453:epidemiology*; D019970:Cocaine-Related Disorders / Q000150:complications / Q000453:epidemiology*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D007198:Indians, North American / Q000523:psychology*; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology; D008875:Middle Aged; D065840:Protective Factors; D011605:Psychoses, Substance-Induced / Q000150:complications / Q000453:epidemiology*; D012074:Remission Induction; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
references.citation: Psychol Med. 2003 Nov;33(8):1407-14
references.pmid: 14672249
references.citation: Subst Use Misuse. 2003 Jan;38(2):221-48
references.pmid: 12625429
references.citation: Addiction. 2006 Oct;101(10):1473-8
references.pmid: 16968349
references.citation: Addict Biol. 2008 Mar;13(1):130-42
references.pmid: 18201292
references.citation: Compr Psychiatry. 2009 May-Jun;50(3):245-50
references.pmid: 19374969
references.citation: Actas Esp Psiquiatr. 2012 Jul-Aug;40(4):187-97
references.pmid: 22851479
references.citation: BMC Psychiatry. 2012 Dec 05;12:221
references.pmid: 23216941
references.citation: Am J Public Health. 2006 May;96(5):889-96
references.pmid: 16571710
references.citation: Acta Psychiatr Scand. 1994 Jun;89(6):428-32
references.pmid: 8085475
references.citation: Addiction. 2011 Mar;106(3):657-69
references.pmid: 21077975
references.citation: Addict Behav. 2010 Aug;35(8):741-9
references.pmid: 20444552
references.citation: Psychiatry Res. 2008 Jan 15;157(1-3):273-7
references.pmid: 17928066
references.citation: J Clin Psychiatry. 1991 Dec;52(12):509-12
references.pmid: 1752853
references.citation: Am J Addict. 2013 Jan;22(1):7-13
references.pmid: 23398220
references.citation: Public Health Rep. 2001;116 Suppl 1:216-22
references.pmid: 11889287
references.citation: J Clin Psychiatry. 2006 Feb;67(2):247-57
references.pmid: 16566620
references.citation: Addiction. 1999 Sep;94(9):1361-70
references.pmid: 10615721
references.citation: Alcohol Clin Exp Res. 2003 Aug;27(8):1368-73
references.pmid: 12966342
references.citation: J Stud Alcohol. 2000 Jan;61(1):150-6
references.pmid: 10627109
references.citation: J Clin Psychiatry. 2005 Jun;66(6):677-85
references.pmid: 15960559
references.citation: Drug Alcohol Depend. 2011 May 1;115(1-2):120-30
references.pmid: 21145178
references.citation: Am J Addict. 2013 Mar-Apr;22(2):93-8
references.pmid: 23414492
references.citation: Cultur Divers Ethnic Minor Psychol. 2011 Oct;17(4):366-76
references.pmid: 21988577
references.citation: J Addict Dis. 2007;26(4):23-30
references.pmid: 18032229
references.citation: Am J Addict. 2012 Sep-Oct;21(5):445-52
references.pmid: 22882395
references.citation: J Neuroimmune Pharmacol. 2012 Mar;7(1):113-39
references.pmid: 21728034
references.citation: J Stud Alcohol. 1994 Mar;55(2):149-58
references.pmid: 8189735
references.citation: Am J Psychiatry. 2008 Sep;165(9):1172-8
references.pmid: 18519526
references.citation: Am J Psychiatry. 2004 Jul;161(7):1204-10
references.pmid: 15229052
references.citation: Psychiatry Res. 2011 Apr 30;186(2-3):356-61
references.pmid: 21055832