Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2019

Open Access 01-12-2019 | Research article

Mortality, cause of death and risk factors in patients with alcohol use disorder alone or poly-substance use disorders: a 19-year prospective cohort study

Authors: Arne Jan Hjemsæter, Jørgen G. Bramness, Robert Drake, Ivar Skeie, Bent Monsbakken, Jūratė Šaltytė Benth, Anne S. Landheim

Published in: BMC Psychiatry | Issue 1/2019

Login to get access

Abstract

Background

This study investigated cause of death, mortality rates and explored if baseline characteristics were associated with risk of death in patients with alcohol use disorder alone or poly-substance use disorders.

Methods

This was a prospective, longitudinal study of patients followed for 19 years after entering specialized treatment for substance use disorders. At baseline 291 patients (mean age 38.3 years, standard deviation 11.4 years, 72% male) with high psychiatric co-morbidity were recruited; 130 (45%) had lifetime alcohol use disorder alone, while 161 (55%) had poly-substance use disorders. Time and causes of death were gathered from the Norwegian Cause of Death Registry. Lifetime psychiatric symptom disorders and substance use disorders at baseline were measured with The Composite International Diagnostic Interview and personality disorders at baseline were measured with The Millon Clinical Multiaxial Inventory II.

Results

Patients with alcohol use disorder alone more often died from somatic diseases (58% versus 28%, p = 0.004) and more seldom from overdoses (9% versus 33%, p = 0.002) compared with patients with poly-substance use disorders. The crude mortality rate per 100 person year was 2.2 (95% confidence interval: 1.8–2.7), and the standardized mortality rate was 3.8 (95% confidence interval: 3.2–4.6) in the entire cohort during 19 years after entering treatment. Having lifetime affective disorder at baseline was associated with lower risk of death (Hazard Ratio 0.58, 95% confidence interval: 0.37–0.91). Older age was associated to increased risk of death among men (p < 0.001) and non-significantly among patients with poly-substance use (p = 0.057). The difference in association between age and risk of death was significantly different between men and women (p = 0.011) and patients with alcohol use disorder alone and poly-substance use disorders (p = 0.041).

Conclusions

Patients with alcohol use disorder alone died more often from somatic disease than patients with poly-substance use disorders, and all subgroups of patients had an increased risk of death compared with the general population. Men with long-lasting substance use disorders are a priority group to approach with directed preventive measures for somatic health before they reach 50 years of age.
Literature
1.
2.
3.
Giraudon I, Buster M, Espelt A, Matias J, Vicente J. Mortality among drug users in Europe: new and old challenges for public health: publications Office of the European Union; 2015.
4.
Degenhardt L, Bucello C, Mathers B, Briegleb C, Ali H, Hickman M, et al. Mortality among regular or dependent users of heroin and other opioids: a systematic review and meta-analysis of cohort studies. Addiction. 2011;106(1):32–51.PubMedCrossRef
5.
Rudd RA, Aleshire N, Zibbell JE, Matthew GR. Increases in drug and opioid overdose deaths—United States, 2000–2014. Am J Transplant. 2016;16(4):1323–7.CrossRef
6.
Martins SS, Sampson L, Cerdá M, Galea S. Worldwide prevalence and trends in unintentional drug overdose: a systematic review of the literature. Am J Public Health. 2015;105(11):e29–49.PubMedPubMedCentralCrossRef
7.
Manchikanti L, Fellows B, Janata JW, Pampati V, Grider JS, Boswell M. Opioid epidemic in the United States. Pain physician. 2012;15(3 Suppl):ES9–38.PubMed
8.
Roerecke M, Rehm J. Alcohol use disorders and mortality: a systematic review and meta-analysis. Addiction. 2013;108(9):1562–78.PubMedCrossRef
9.
Timko C, DeBenedetti A, Moos BS, Moos RH. Predictors of 16-year mortality among individuals initiating help-seeking for an alcoholic use disorder. Alcohol Clin Exp Res. 2006;30(10):1711–20.PubMedCrossRef
10.
Haver B, Gjestad R, Lindberg S, Franck J. Mortality risk up to 25 years after initiation of treatment among 420 Swedish women with alcohol addiction. Addiction. 2009;104(3):413–9.PubMedCrossRef
11.
Roerecke M, Rehm J. Cause-specific mortality risk in alcohol use disorder treatment patients: a systematic review and meta-analysis. Int J Epidemiol. 2014;43(3):906–19.PubMedCrossRef
12.
Arendt M, Munk-Jørgensen P, Sher L, Jensen SO. Mortality among individuals with cannabis, cocaine, amphetamine, MDMA, and opioid use disorders: a nationwide follow-up study of Danish substance users in treatment. Drug Alcohol Depend. 2011;114(2–3):134–9.PubMed
13.
Gjersing L, Bretteville-Jensen AL. Gender differences in mortality and risk factors in a 13-year cohort study of street-recruited injecting drug users. BMC Public Health. 2014;14(1):440.PubMedPubMedCentralCrossRef
14.
Kielland KB, Skaug K, Amundsen EJ, Dalgard O. All-cause and liver-related mortality in hepatitis C infected drug users followed for 33 years: a controlled study. J Hepatol. 2013;58(1):31–7.PubMedCrossRef
15.
Nyhlén A, Fridell M, Hesse M, Krantz P. Causes of premature mortality in Swedish drug abusers: a prospective longitudinal study 1970–2006. J Forensic Legal Med. 2011;18(2):66–72.CrossRef
16.
Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, et al. Comorbidity of mental disorders with alcohol and other drug abuse: results from the epidemiologic catchment area (ECA) study. JAMA. 1990;264(19):2511–8.PubMedCrossRef
17.
Morisano D, Babor TF, Robaina KA. Co-occurrence of substance use disorders with other psychiatric disorders: implications for treatment services. Nordic Stud Alcohol Drugs. 2014;31(1):5–25.CrossRef
18.
Hjorthøj C, Østergaard MLD, Benros ME, Toftdahl NG, Erlangsen A, Andersen JT, et al. Association between alcohol and substance use disorders and all-cause and cause-specific mortality in schizophrenia, bipolar disorder, and unipolar depression: a nationwide, prospective, register-based study. Lancet Psychiatry. 2015;2(9):801–8.PubMedCrossRef
19.
Schmidt LM, Hesse M, Lykke J. The impact of substance use disorders on the course of schizophrenia—a 15-year follow-up study: dual diagnosis over 15 years. Schizophr Res. 2011;130(1):228–33.PubMedCrossRef
20.
Gossop M, Stewart D, Treacy S, Marsden J. A prospective study of mortality among drug misusers during a 4-year period after seeking treatment. Addiction. 2002;97(1):39–47.PubMedCrossRef
21.
Nyhlen A, Fridell M, Backstrom M, Hesse M, Krantz P. Substance abuse and psychiatric co-morbidity as predictors of premature mortality in Swedish drug abusers a prospective longitudinal study 1970–2006. BMC Psychiatry. 2011;11:122.PubMedPubMedCentralCrossRef
22.
Landheim A, Bakken K, Vaglum P. Gender differences in the prevalence of symptom disorders and personality disorders among poly-substance abusers and pure alcoholics. Eur Addict Res. 2003;9(1):8–17.PubMedCrossRef
23.
Landheim AS, Bakken K, Vaglum P. Impact of comorbid psychiatric disorders on the outcome of substance abusers: a six year prospective follow-up in two Norwegian counties. BMC Psychiatry. 2006;6:44.PubMedPubMedCentralCrossRef
24.
Organization WH. International statistical classification of diseases and related health problems: World Health Organization; 2004.
25.
26.
27.
Robins LN, Wing J, Wittchen HU, Helzer JE, Babor TF, Burke J, et al. The Composite International Diagnostic Interview. An epidemiologic Instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry. 1988;45(12):1069.PubMedCrossRef
28.
Choca JP, Shanley LA, Van Denburg E. Interpretative guide to the Millon clinical multiaxial inventory: American Psychological Association; 1992.CrossRef
29.
Gerdts S, Iversen E. Implementation of the National Client Assessment Form in Norway. Final Report; 2000.
30.
Bird SM, McAuley A, Perry S, Hunter C. Effectiveness of Scotland’s National Naloxone Programme for reducing opioid-related deaths: a before (2006–10) versus after (2011–13) comparison. Addiction. 2016;111(5):883–91.PubMedPubMedCentralCrossRef
31.
Mueller SR, Walley AY, Calcaterra SL, Glanz JM, Binswanger IA. A review of opioid overdose prevention and naloxone prescribing: implications for translating community programming into clinical practice. Subst Abus. 2015;36(2):240–53.PubMedPubMedCentralCrossRef
32.
Skeie I, Brekke M, Gossop M, Lindbaek M, Reinertsen E, Thoresen M, et al. Changes in somatic disease incidents during opioid maintenance treatment: results from a Norwegian cohort study. BMJ Open. 2011;1(1):e0000130.CrossRef
33.
Clausen T, Waal H, Thoresen M, Gossop M. Mortality among opiate users: opioid maintenance therapy, age and causes of death. Addiction. 2009;104(8):1356–62.PubMedCrossRef
34.
35.
Ødegård E, Amundsen EJ, Kielland KB. Fatal overdoses and deaths by other causes in a cohort of Norwegian drug abusers—a competing risk approach. Drug Alcohol Depend. 2007;89(2):176–82.PubMedCrossRef
36.
Westman J, Wahlbeck K, Laursen TM, Gissler M, Nordentoft M, Hällgren J, et al. Mortality and life expectancy of people with alcohol use disorder in Denmark, Finland and Sweden. Acta Psychiatr Scand. 2015;131(4):297–306.PubMedCrossRef
37.
Liebert RM, Liebert LL. Science and behavior. An Introduction to Methods of Psychological Research. New Jersey: Prentice-Hall, Inc; 1995.
38.
39.
Andrews G, Peters L. The psychometric properties of the composite international diagnostic interview. Soc Psychiatry Psychiatr Epidemiol. 1998;33(2):80–8.PubMedCrossRef
Metadata
Title
Mortality, cause of death and risk factors in patients with alcohol use disorder alone or poly-substance use disorders: a 19-year prospective cohort study
Authors
Arne Jan Hjemsæter
Jørgen G. Bramness
Robert Drake
Ivar Skeie
Bent Monsbakken
Jūratė Šaltytė Benth
Anne S. Landheim
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2019
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-019-2077-8

Other articles of this Issue 1/2019

BMC Psychiatry 1/2019 Go to the issue

Research article

Feasibility of peer support services among people with severe mental illness in China

Research article

Problematic use of the Internet is a unidimensional quasi-trait with impulsive and compulsive subtypes

Research article

Association between pharmacotherapy for ADHD in offspring and depression-related specialty care visits by parents with a history of depression

Research article

Suicide attempts among activated soldiers in the U.S. Army reserve components

Research article

Moral cognition, the missing link between psychotic symptoms and acts of violence: a cross-sectional national forensic cohort study

Research article

Hyperactivity/restlessness is associated with increased functional connectivity in adults with ADHD: a dimensional analysis of resting state fMRI