NEW YORK—What are the patterns over time of depression, smoking, unhealthy alcohol use and other substance use among individuals receiving medical care, and when are integrated screening and treatment strategies warranted?

That was the question addressed recently in the journal AIDS and Behavior.1

New York University School of Medicine-led researchers employed the Veterans Aging Cohort Study (VACS) to measure depression, smoking, unhealthy alcohol use and other substance use, including stimulants, marijuana, heroin and opioids. The study team evaluated which conditions tended to co-occur within individuals, and how co-occurrence was temporally structured (i.e. concurrently, sequentially or discordantly).

Results indicate that current depression was associated with current use of every substance examined, with the exception of unhealthy alcohol use. Current unhealthy alcohol use and marijuana use also were consistently associated.

The study reports that current status was strongly predicted by prior status, with an odds ratio of 2.99, but that there were few other sequential relationships.

Associations in the HIV infected and uninfected subgroups were largely the same with some exceptions: Smoking preceded unhealthy alcohol use, and current smoking was associated with current depression in the HIV-infected subgroup only, with an OR 1.33-1.41 and OR 1.25-1.43, respectively.

Opioid use and current unhealthy alcohol use were negatively associated only in the HIV negative subgroup, OR 0.75.

“Patterns of depression, smoking, unhealthy alcohol use, and other substance use were temporally concordant, particularly with regard to depression and substance use,” the study authors concluded. “These patterns may inform future development of more integrated screening and treatment strategies.”

1 Ruggles KV, Fang Y, Tate J, Mentor SM, et. al. What are the Patterns Between Depression, Smoking, Unhealthy Alcohol Use, and Other Substance Use Among Individuals Receiving Medical Care? A Longitudinal Study of 5479 Participants. AIDS Behav. 2016 Jul 30. [Epub ahead of print] PubMed PMID: 27475945.