Those under age 25 are particularly vulnerable to dual abuse.
Men and women with alcohol use disorders (AUDs) are 18 times more likely to report nonmedical use of prescription drugs than people who don't drink at all, according to researchers at the University of Michigan. Dr. Sean Esteban McCabe and colleagues documented this link in two NIDA-funded studies; they also discovered that young adults were most at risk for concurrent or simultaneous abuse of both alcohol and prescription drugs.
"The message of these studies is that clinicians should conduct thorough drug use histories, particularly when working with young adults," says Dr. McCabe. "Clinicians should ask patients with alcohol use disorders about nonmedical use of prescription drugs [NMUPD] and in turn ask nonmedical users of prescription medications about their drinking behaviors." The authors also recommend that college staff educate students about the adverse health outcomes associated with using alcohol and prescription medications at the same time.
The authors' first study looked at the prevalence of AUDs and NMUPD in 43,093 individuals 18 and older who participated in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) between 2001 and 2005. Participants lived across the United States in a broad spectrum of household arrangements and represented White, African-American, Asian, Hispanic, and Native American populations. Although people with AUDs constituted only 9 percent of NESARC's total sample, they accounted for more than a third of those who reported NMUPD.
Since the largest group of alcohol/prescription drug abusers were between the ages of 18 and 24, the team's second study focused entirely on this population and involved 4,580 young adults at a large, public, Midwestern university. The participants completed a self-administered Web survey, which revealed that 12 percent of them had used both alcohol and prescription drugs nonmedically within the last year but at different times (concurrent use), and 7 percent had taken them at the same time (simultaneous use).
When alcohol and prescription drugs are used simultaneously, severe medical problems can result, including alcohol poisoning, unconsciousness, respiratory depression, and sometimes death. In addition, college students who drank and took prescription drugs simultaneously were more likely than those who did not to blackout, vomit, and engage in other risky behaviors such as drunk driving and unplanned sex.
Who, What, and When
The prescription drugs that were combined with alcohol in order of prevalence included prescription opiates (e.g., Vicodin, OxyContin, Tylenol 3 with codeine, Percocet), stimulant medication (e.g., Ritalin, Adderall, Concerta), sedative/anxiety medication (e.g., Ativan, Xanax, Valium), and sleeping medication (e.g., Ambien, Halcion, Restoril). The college study asked about the respondent's use of medications prescribed for other people while the NESARC explored both use of someone else's prescription medications as well as the use of one's own prescription medications in a manner not intended by the prescribing clinician (e.g., to get high).
The researchers found that the more alcohol a person drank and the younger he or she started drinking, the more likely he or she was to report NMUPD. Compared with people who did not drink at all, drinkers who did not binge were almost twice as likely to engage in NMUPD; binge drinkers with no AUDs were three times as likely; people who abused alcohol but were not dependent on alcohol were nearly seven times as likely; and people who were dependent on alcohol were 18 times as likely to report NMUPD.
While the majority of the respondents in both studies were White (71 percent in NESARC and 65 percent in the college group), an even higher percentage of the simultaneous polydrug users in the college study were White males who had started drinking in their early teens. The NESARC study also found that Whites in general were two to five times more likely than African-Americans to report NMUPD during the past year. Native Americans were at increased risk for NMUPD, and the authors indicated that this subpopulation should receive greater research attention in the future.
Dr. McCabe emphasizes that many people who simultaneously drink alcohol and use prescription medications have no idea how dangerous the interactions between these substances can be. "Passing out is a protective mechanism that stops people from drinking when they are approaching potentially dangerous blood alcohol concentrations," he explains. "But if you take stimulants when you drink, you can potentially override this mechanism and this could lead to life-threatening consequences."
Dr. James Colliver, formerly of NIDA's Division of Epidemiology, Services and Prevention Research, offers perspective on these studies. "Prescription sedatives, tranquilizers, painkillers, and stimulants are generally safe and effective medications for patients who take them as prescribed by a clinician," Dr. Colliver states. "They are used to treat acute and chronic pain, attention deficit hyperactivity disorder, anxiety disorders, and sleep disorders.
"The problem is that many people think that, because prescription drugs have been tested and approved by the Food and Drug Administration, they are always safe to use; but they are safe only when used under the direction of a physician for the purpose for which they are prescribed."
Nonmedical Use of Prescription Drugs
The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), sponsored by the National Institutes of Health, defines nonmedical use as follows:
Using drugs that were not prescribed to you by a doctor, or using drugs in a manner not intended by the prescribing clinician (e.g., to get high). Nonmedical use does not include taking prescription medications as directed by a health practitioner or the use of over-the-counter medications.
McCabe, S.E., et al. The relationship between pastyear drinking behaviors and nonmedical use of prescription drugs: Prevalence of co-occurrence in a national sample. Drug and Alcohol Dependence 84(3):281-288, 2006. [Abstract]
McCabe, S.E., et al. Simultaneous and concurrent polydrug use of alcohol and prescription drugs: Prevalence, correlates, and consequences. Journal of Studies on Alcohol 67(4):529-537, 2006. [Abstract]