(326) Prevalence of substance use in adult cystic fibrosis patients

Background: Substance use is an understudied aspect of Cystic Fibrosis (CF) care. Even casual use of drugs and/or alcohol may reduce compliance with complicated treatment plans, worsen existing conditions associated with CF, or cause potential drug interactions. To understand the need for risky substance use mitigation mechanisms in CF population, we first studied the prevalence of substance use in our adult CF clinic population to characterize relationships between substance use and health status.

Methods: In our large academic CF center, we performed a retrospective chart abstraction of 420 patients over a 6-year period (2015-2021). Clinical staff annually administer the DAST-10, AUDIT, PHQ-9, and GAD-7 to assess drug use, alcohol use, depression, and anxiety symptoms, respectively. Demographics, lung function (FEV₁ %predicted) and anxiety/depression symptom screening scores were recorded. Since substance use can change over time, we counted each assessment date as an independent observation (n=1434). A Chi square test (Table 1) was conducted in R/RStudio [1] to assess for associations between self-reported substance use and depression/anxiety symptoms. Due to insufficient data, aggregate data was used to describe the presence (PHQ9≥10/GAD≥10) or absence (PHQ9/GAD< 10) of anxiety/depression symptoms.

Results: Positive scores for risky use were defined as DAST ≥ 1 and AUDIT ≥8. 83 patients (n=326, 25%) met criteria for risky substance use on at least one observation. There was a slight male predominance (54.2%) and wide age distribution (mean age= 30 ± 7yrs; range 20-55); Thirty (36.1%) had an elevated AUDIT, 34 (40.9%) had an elevated DAST, and 19 (22.9%) had elevation on both screeners. We selected 2019 to evaluate single year prevalence of positive screenings to avoid the impact of COVID. In 2019, 29 patients had at least one positive screening result (DAST n=15/203, 7.3%; AUDIT n=24/193, 12%; Both n=10/193, 5.2%). In the 6-year dataset, we did not find a statistically significant association between anxiety/depression symptoms and indication of drug/alcohol use within the self-reported users (355 observations).

Conclusions: According to a 2020 National Survey of healthy Americans, 20.8% have used illicit drugs at least once in the past year and 10.2% meet criteria for alcohol use disorder [2], compared to 7.3% of patients in our 2019 data who have used drugs (n=15) and 12% (n=24) who indicated risky alcohol use. In this review, positive screening scores on the DAST and AUDIT were not associated with degree of anxiety/depression symptoms, suggesting that substance use and depression/anxiety symptoms were not temporally associated with each other. Future work will include analysis of the relationship between substance use and mental health in the larger UNC clinic population and linear regression to evaluate possible explanatory variables for substance use in this patient population.

Acknowledgements:

References: [1] R Core Team. (2020). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/

[2] Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/