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<p class="ltrs-br-ltr-br-title"><span class="bold">Abuse of Prescription Medication, Alcohol, and Drugs Among Internal Medicine Outpatients</span></p>
<p class="ltrs-br-ltr-br-body-text"><span class="semibold">To the Editor:</span> Investigators have confirmed relationships between prescription medication abuse and alcohol/drug misuse in various populations (eg, adolescents, community samples, individuals in treatment), but we are unaware of any analogous studies among internal medicine outpatients.</p>
<p class="ltrs-br-ltr-br-body-text"> </p>
<p class="ltrs-br-ltr-br-body-text"><span class="semibold-ital">Method.</span> Adult patients were recruited during 4 research projects from the same clinical setting (an internal medicine outpatient clinic staffed predominantly by resident providers) over a 2-year period (2009–2011).<span class="htm-cite"><a href="#ref1">1–4</a></span> The final sample consisted of 1,102 patients (353 men, 748 women, and 1 patient for whom data were missing), aged 18 to 97 years (mean<span class="thinspace"> </span>=<span class="thinspace"> </span>49.74 years, SD<span class="thinspace"> </span>=<span class="thinspace"> </span>15.35 years), who were mostly white/Caucasian (87.1%).</p>
<p class="ltrs-br-ltr-br-body-text">Patients entering the reception area were approached by a research assistant, who excluded individuals unable to successfully complete a survey (eg, those with severe illness and/or language difficulties). The recruiter reviewed the project with potential participants and invited each to complete a survey that included a demographic query and 2 self-report measures—the borderline personality disorder scale of the Personality Diagnostic Questionnaire-4 (PDQ-4)<span class="htm-cite"><a href="#ref5">5</a></span> and the Self-Harm Inventory (SHI).<span class="htm-cite"><a href="#ref6">6</a></span> SHI item 13 asks, “Have you ever intentionally, or on purpose, abused prescription medication?” The PDQ-4 queries, “I have done things on impulse (such as those listed below) that can get me into trouble,” with 6 options, including “drinking too much” and “taking drugs.”</p>
<p class="ltrs-br-ltr-br-body-text">These 4 projects were reviewed and exempted by the institutional review boards of the community hospital and the university. Survey completion was assumed to be implied consent (explicitly clarified on the cover page of the survey).</p>
<p class="ltrs-br-ltr-br-body-text"><span class="semibold-ital">Results.</span> Of the 1,102 respondents, 100 (9.1%) reported abuse of prescription medication, 230 (20.9%) drinking too much, and 106 (9.6%) taking drugs. Although similar percentages of men (9.3%) and women (9.0%) endorsed abuse of prescription medication (χ<span class="superscript">2</span><span class="thinspace"> </span>=<span class="thinspace"> </span>0.04, <span class="italic">P</span><span class="thinspace"> </span><span class="italic"><</span><span class="thinspace"> </span>.85), statistically significantly more men than women indicated drinking too much (26.1% vs 18.4%, χ<span class="superscript">2</span><span class="thinspace"> </span>=<span class="thinspace"> </span>8.41, <span class="italic">P</span><span class="thinspace"> </span><span class="italic"><</span><span class="thinspace"> </span>.01) and taking drugs (12.2% vs 8.4%, χ<span class="superscript">2</span><span class="thinspace"> </span>=<span class="thinspace"> </span>3.89, <span class="italic">P</span><span class="thinspace"> </span><<span class="thinspace"> </span>.05). Point-biserial correlation coefficients revealed that older respondents were less likely to report having abused prescription medication (<span class="italic">r</span><span class="thinspace"> </span>=<span class="thinspace"> </span>–0.21, <span class="italic">P</span><span class="thinspace"> </span><<span class="thinspace"> </span>.001), drinking too much (<span class="italic">r</span><span class="thinspace"> </span>=<span class="thinspace"> </span>–0.18, <span class="italic">P</span><span class="thinspace"> </span><<span class="thinspace"> </span>.001), or taking drugs (<span class="italic">r</span><span class="thinspace"> </span>=<span class="thinspace"> </span>–0.23, <span class="italic">P</span><span class="thinspace"> </span><<span class="thinspace"> </span>.001). Overall, abuse of prescription medication was predictive of both drinking too much (<span class="italic">r</span><span class="thinspace"> </span>=<span class="thinspace"> </span>0.41, <span class="italic">P</span><span class="thinspace"> </span><<span class="thinspace"> </span>.001) and taking drugs (<span class="italic">r</span><span class="thinspace"> </span>=<span class="thinspace"> </span>0.53, <span class="italic">P</span><span class="thinspace"> </span><<span class="thinspace"> </span>.001).</p>
<p class="ltrs-br-ltr-br-body-text">Last, we performed a logistic regression analysis in which prescription medication abuse was predicted by the drinking and drug-use variables, with age and sex included as covariates. While age and sex were considered simultaneously, age remained independently related to abuse of prescription medication (Wald<span class="thinspace"> </span>=<span class="thinspace"> </span>7.67, <span class="italic">P</span><span class="thinspace"> </span><<span class="thinspace"> </span>.01) as did both drinking too much (Wald<span class="thinspace"> </span>=<span class="thinspace"> </span>33.18, <span class="italic">P</span><span class="thinspace"> </span><<span class="thinspace"> </span>.001) and abusing drugs (Wald<span class="thinspace"> </span>=<span class="thinspace"> </span>61.85, <span class="italic">P</span><span class="thinspace"> </span><<span class="thinspace"> </span>.001), whereas sex did not (Wald<span class="thinspace"> </span>=<span class="thinspace"> </span>1.15, <span class="italic">P</span><span class="thinspace"> </span><<span class="thinspace"> </span>.29).</p>
<p class="ltrs-br-ltr-br-body-text"> </p>
<p class="ltrs-br-ltr-br-body-text">The potential limitations of this study include the self-report nature of the data, potential definitional overlap among the variables, and possible participant overlap in the 4 databases, yet findings indicate clear relationships between prescription medication abuse and drug/alcohol abuse among internal medicine outpatients.</p>
<p class="ltrs-br-ltr-br-references-head"><span class="smallcaps">References</span></p>
<p class="references-references-text-1-9"><a name="ref1"></a>1. Sansone RA, Farukhi S, Wiederman MW. Disruptive behaviors in the medical setting and borderline personality. <span class="italic">Int J Psychiatry Med</span>. 2011;41(4):355–363. <span class="pubmed-crossref"><a href="
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=22238840&dopt=Abstract">PubMed</a> <a href="
http://dx.doi.org/10.2190/PM.41.4.e">doi:10.2190/PM.41.4.e</a></span></p>
<p class="references-references-text-1-9"><a name="ref2"></a>2. Sansone RA, Lam C, Wiederman MW. Borderline personality disorder and reckless driving. <span class="italic">J Clin Psychiatry</span>. 2010;71(4):507. <span class="pubmed-crossref"><a href="
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=20409451&dopt=Abstract">PubMed</a> <a href="
http://dx.doi.org/10.4088/JCP.09l05494gre">doi:10.4088/JCP.09l05494gre</a></span></p>
<p class="references-references-text-1-9"><a name="ref3"></a>3. Sansone RA, Lam C, Wiederman MW. The relationship between illegal behaviors and borderline personality symptoms among internal medicine outpatients. <span class="italic">Compr Psychiatry</span>. 2012;53(2):176–180. <span class="pubmed-crossref"><a href="
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=21550032&dopt=Abstract">PubMed</a> <a href="
http://dx.doi.org/10.1016/j.comppsych.2011.03.006">doi:10.1016/j.comppsych.2011.03.006</a></span></p>
<p class="references-references-text-1-9"><a name="ref4"></a>4. Sansone RA, Leung JS, Wiederman MW. Litigious history and borderline personality symptomatology. <span class="italic">Prim Care Companion CNS Disord</span>. 2012;14(6).</p>
<p class="references-references-text-1-9"><a name="ref5"></a>5. Hyler SE. <span class="italic">Personality Diagnostic Questionnaire-4</span>. New York, NY: New York State Psychiatric Institute; 1994.</p>
<p class="references-references-text-1-9"><a name="ref6"></a>6. Sansone RA, Wiederman MW, Sansone LA. The Self-Harm Inventory (SHI): development of a scale for identifying self-destructive behaviors and borderline personality disorder. <span class="italic">J Clin Psychol</span>. 1998;54(7):973–983. <span class="pubmed-crossref"><a href="
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9811134&dopt=Abstract">PubMed</a> <a href="
http://dx.doi.org/10.1002/(SICI)1097-4679(199811)54:7%3C973::AID-JCLP11%3E3.0.CO;2-H">doi:10.1002/(SICI)1097-4679(199811)54:7<973::AID-JCLP11>3.0.CO;2-H</a></span></p>
<p class="ltrs-br-ltr-br-author"><span class="bold">Randy A. Sansone, MD</span></p>
<p class="ltrs-br-ltr-br-author"><a href="
mailto:Randy.sansone@khnetwork.org">
Randy.sansone@khnetwork.org</a></p>
<p class="ltrs-br-ltr-br-author"><span class="bold">Michael W. Wiederman, PhD</span></p>
<p class="ltrs-br-ltr-br-endmatter-fieldnotes"><span class="semibold-ital">Author affiliations:</span> Departments of Psychiatry and Internal Medicine, Wright State University School of Medicine, Dayton, and Department of Psychiatry Education, Kettering Medical Center, Kettering, Ohio (Dr Sansone); and Department of Psychology, Columbia College, Columbia, South Carolina (Dr Wiederman).</p>
<p class="ltrs-br-ltr-br-endmatter-fieldnotes"><span class="semibold-ital">Potential conflicts of interest:</span> None reported.</p>
<p class="ltrs-br-ltr-br-endmatter-fieldnotes"><span class="semibold-ital">Funding/support:</span> None reported.</p>
<p class="ltrs-br-ltr-br-endmatter-fieldnotes"><span class="semibold-ital">Published online:</span><span class="italic"> </span>September 26, 2013.</p>
<p class="ltrs-br-ltr-br-copyright-doi"><span class="italic">Prim Care Companion CNS Disord 2013;15(5):</span><span class="doi">doi:10.4088/PCC.12l01433</span></p>
<p class="ltrs-br-ltr-br-copyright-doi"><span class="italic">© Copyright 2013 Physicians Postgraduate Press, Inc. </span></p>
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