Tobacco and alcohol use disorders: Evaluating multimorbidity

Area of Science:

• Mental Health Research
• Addiction Medicine
• Public Health

Background:

• The multimorbidity model examines interactive effects of co-occurring mental health diagnoses.
• Alcohol use disorder (AUD) and tobacco use disorder (TUD) frequently co-occur.
• Distinctive correlates of AUD and TUD co-occurrence require further study.

Purpose of the Study:

• To investigate the unique correlates of co-occurring AUD and TUD in veterans.
• To compare veterans with concurrent AUD and TUD to those with AUD alone or TUD alone.
• To identify specific socio-environmental, medical, psychiatric, and service use differences.

Main Methods:

• Retrospective analysis of Veterans Health Administration (VHA) data from FY 2012.
• Comparison of veterans diagnosed with AUD and TUD concurrently (N=153,397) versus AUD only (N=191,900) or TUD only (N=643,377).
• Analysis of socio-environmental factors, medical and psychiatric diagnoses, and healthcare service utilization.

Main Results:

• Veterans with concurrent AUD and TUD showed significantly higher rates of homelessness (ORs=1.24, 1.68), hepatic disease (ORs=1.11, 2.18), and other substance use disorders (ORs=1.42, 3.14).
• Higher likelihoods of receiving a VA disability pension (ORs=1.26, 1.30) and utilizing substance and mental health outpatient services (ORs=1.04, 1.12) were observed in the dual-diagnosis group.
• Concurrent AUD and TUD were associated with more severe problems in specific socio-environmental, medical, and psychiatric domains compared to single diagnoses.

Conclusions:

• The co-occurrence of AUD and TUD in veterans is linked to generally more adverse effects across diverse areas.
• These combined disorders represent an emergent phenomenon with potentially greater severity than individual diagnoses.
• A distinctive treatment approach may be necessary for veterans with concurrent alcohol and tobacco use disorders.