Dan Blazer | Duke University School of Medicine (original) (raw)

Papers by Dan Blazer

Journal of the American Geriatrics Society, Jul 1, 2009

OBJECTIVES-To estimate the frequency, distribution, and correlates of non-prescription use of pai... more OBJECTIVES-To estimate the frequency, distribution, and correlates of non-prescription use of pain relievers among middle aged and elderly persons in the United States. DESIGN-Cross-sectional data analysis of a national community survey.

Journal of Addiction Medicine, Mar 1, 2011

Objectives-To study substance use and psychiatric disorders among prescription opioid users, hero... more Objectives-To study substance use and psychiatric disorders among prescription opioid users, heroin users, and non-opioid drug users in a national sample of adults. -Analyses of data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N=43,093). Results-Four groups were identified among 9140 illicit or non-prescribed drug users: heroinother opioid users (1.0%; used heroin and other opioids), other opioid-only users (19.8%; used other opioids but never heroin), heroin-only users (0.5%; used heroin but never other opioids), and non-opioid drug users (78.7%; used drugs but never heroin or other opioids). After adjusting for variations in socioeconomic characteristics, history of substance abuse treatment, and familial substance abuse, heroin-other opioid users had greater odds of several substance use disorders (cocaine, hallucinogen, sedative, amphetamine, and tranquilizer) as compared with the other groups; heroin-only users had reduced odds of sedative and tranquilizer use disorders as compared with other opioid-only users. Non-opioid drug users had reduced odds of all substance use disorders and other mental disorders (mood, anxiety, pathological gambling, and personality) as compared with other opioid-only users. Past-year other opioid-only users also reported slightly lower scores on quality of life than past-year non-opioid drug users. Conclusions-All opioid use groups had higher rates of substance use disorders than nonopioid drug users, and these rates were particularly elevated among heroin-other opioid users.

Carolina Digital Repository (University of North Carolina at Chapel Hill), 2012

While item response theory (IRT) research shows a latent severity trait underlying response patte... more While item response theory (IRT) research shows a latent severity trait underlying response patterns of substance abuse and dependence symptoms, little is known about IRT-based severity estimates in relation to clinically relevant measures. In response to increased prevalences of marijuana-related treatment admissions, an elevated level of marijuana potency, and the debate on medical marijuana use, we applied dimensional approaches to understand IRT-based severity estimates for marijuana use disorders (MUDs) and their correlates while simultaneously considering gender-and race/ethnicity-related differential item functioning (DIF). Using adult data from the 2008 National Survey on Drug Use and Health (N = 37,897), Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for MUDs among past-year marijuana users were examined by IRT, logistic regression, and multiple indicators-multiple causes (MIMIC) approaches. Among 6917 marijuana users, 15% met criteria for a MUD; another 24% exhibited subthreshold dependence. Abuse criteria were highly correlated with dependence criteria (correlation = 0.90), indicating unidimensionality; item information curves revealed redundancy in multiple criteria. MIMIC analyses showed that MUD criteria were positively associated with weekly marijuana use, early marijuana use, other substance use disorders, substance abuse treatment, and serious psychological distress. African Americans and Hispanics showed higher levels of MUDs than Whites, even after adjusting for race/ethnicity-related DIF. The redundancy in multiple criteria suggests an opportunity to improve efficiency in measuring symptom-level manifestations by removing low-informative criteria. Elevated rates of MUDs

Biomarkers in Medicine, Aug 1, 2008

Aim-To examine environmental sociodemographic risks of high IL-6, a marker of chronic inflammatio... more Aim-To examine environmental sociodemographic risks of high IL-6, a marker of chronic inflammation in older adults. Methods-We spatially linked 1990 USA Census tract demographic and economic measures to a prospective cohort study of representative community residents aged 71 years and older, from over 1700 of whom a cytokine protein and biological marker of chronic inflammation. IL-6, was collected. Using generalized interactive mixed models, we modeled 1989-1990 individual and census level risk factors for the dependent variable high IL-6 between 1992-1993 (high IL-6 = upper quartile: >2.96 pg/ml). Results-After individual health risk adjustment, IL-6 remained elevated in communities with greater densities of poor older adults (odd ratio [OR]: 1.25 per 10% increase in exposure. 95% confidence interval [CI]: 1.05, 1.48) and in racially segregated communities (OR: 1.14 per 10% increase in exposure. 95% CI: 1.04, 1.25). Conclusions-Socially disadvantaged environments may influence IL-6, a biomarker of ageassociated inflammation.

Drug and Alcohol Dependence, Nov 1, 2010

Aims-To identify subtypes of nonmedical opioid users, gender variations in psychiatric disorders,... more Aims-To identify subtypes of nonmedical opioid users, gender variations in psychiatric disorders, and quality of life in a representative sample of adults. -Analyses of data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N=43,093). Latent class analysis (LCA) and multinomial logistic regression procedures examined subtypes of nonmedical opioid users. Results-Approximately 5% (n=1,815) of adults used nonmedical opioids. LCA identified four subtypes: opioid-marijuana users (33%), opioid-other prescription drug users (9%), opioidmarijuana-hallucinogen users (28%), and opioid-polydrug users (30%). Subtypes were distinguished by race/ethnicity, gender, familial substance abuse, personal history of substance abuse treatment, and patterns of psychiatric disorders. Whites and men had increased odds of being in the opioid-polydrug and opioid-marijuana-hallucinogen subtypes. The opioid-other prescription drug use subtype had disproportionately affected women who were characterized by high rates of mood/ anxiety disorders and low quality of life. Across all subtypes, women and men had similarly problematic substance use disorders; however, women had more major depression and disability in the mental health domain. Conclusions-The generally high prevalence of psychiatric disorders among nonmedical opioid users, particularly women, underscores the need for comprehensive assessment and coordinated delivery of services to match needs with treatment, as well as continued monitoring of trends in opioid use and related problems.

Journal of Substance Abuse Treatment, Jun 1, 2010

This study applies a latent variable approach to examine gender and racial/ethnic differences in ... more This study applies a latent variable approach to examine gender and racial/ethnic differences in cocaine dependence, determine the presence of differential item functioning (DIF) or item-response bias to diagnostic questions of cocaine dependence, and explore the effects of DIF on the predictor analysis of cocaine dependence. The analysis sample included 682 cocaine users enrolled in two national multisite studies of the National Drug Abuse Treatment Clinical Trials Network (CTN). Participants were recruited from 14 community-based substance abuse treatment programs associated with the CTN, including 6 methadone and 8 outpatient non-methadone programs. Factor and multiple indicators-multiple causes (MIMIC) procedures evaluated the latent continuum of cocaine dependence and its correlates. MIMIC analysis showed that men exhibited lower odds of cocaine dependence than women (regression coefficient, β=-0.34), controlling for the effects of DIF, years of cocaine use, addiction treatment history, comorbid drug dependence diagnoses, and treatment setting. There were no racial/ethnic differences in cocaine dependence; however, DIF by race/ethnicity was noted. Within the context of multiple community-based addiction treatment settings, women were more likely than men to exhibit cocaine dependence. Addiction treatment research needs to further evaluate gender related differences in drug dependence in treatment entry

Journal of the American Geriatrics Society, Jul 1, 1986

Depression is perhaps the most frequent cause of emotional suffering in later life and significan... more Depression is perhaps the most frequent cause of emotional suffering in later life and significantly decreases quality of life in older adults. In recent years, the literature on late-life depression has exploded. Many gaps in our understanding of the outcome of late-life depression have been filled. Intriguing findings have emerged regarding the etiology of late-onset depression. The number of studies documenting the evidence base for therapy has increased dramatically. Here, I first address case definition, and then I review the current community-and clinicbased epidemiological studies. Next I address the outcome of late-life depression, including morbidity and mortality studies. Then I present the extant evidence regarding the etiology of depression in late life from a biopsychosocial perspective. Finally, I present evidence for the current therapies prescribed for depressed elders, ranging from medications to group therapy.

Drug and Alcohol Dependence, Sep 1, 2009

Aims-To present the prevalence and correlates of hallucinogen use disorders (HUDs: abuse or depen... more Aims-To present the prevalence and correlates of hallucinogen use disorders (HUDs: abuse or dependence) and subthreshold dependence. Methods-The study sample included adolescents aged 12-17 years (N = 55,286) who participated in the National Survey on Drug Use and Health (2004-2006). Data were collected with a combination of computer-assisted personal interviewing and audio computer-assisted self-interviewing. Results-The overall prevalence of HUDs among adolescents was low (<1%). However, more than one in three (38.5%) MDMA users and nearly one in four (24.1%) users of other hallucinogens reported HUD symptoms. MDMA users were more likely than users of other hallucinogens to meet criteria for hallucinogen dependence: 11% (95% confidence interval [CI]: 8.24-14.81) vs. 3.5% (95% CI: 2.22-5.43). Compared with hallucinogen use only, subthreshold dependence was associated with being female (adjusted odds ratio [AOR] = 1.8 [95% CI: 1.08-2.89]), ages 12-13 years (AOR = 3.4 [1.64-7.09]), use of hallucinogens ≥52 days (AOR = 2.4 [1.66-6.92]), and alcohol use disorder ). Compared with subthreshold dependence, abuse was associated with mental health service use (AOR = 1.7 [1.00-3.00]) and opioid use disorder (AOR = 4.9 [1.99-12.12]); dependence was associated with MDMA use (AOR = 2.2 [1.05-4.77]), mental health service use (AOR = 2.9 [1.34-6.06]), and opioid use disorder (AOR = 2.6 [1.01-6.90]). MDMA users had a higher prevalence of most other substance use disorders than users of non-hallucinogen drugs. Conclusions-Adolescent MDMA users appear to be particularly at risk for exhibiting hallucinogen dependence and other substance use disorders.

Drug and Alcohol Dependence, Dec 1, 2013

JAMA, 2020

It is uncertain whether depressive symptoms are independently associated with subsequent risk of ... more It is uncertain whether depressive symptoms are independently associated with subsequent risk of cardiovascular diseases (CVDs). OBJECTIVE To characterize the association between depressive symptoms and CVD incidence across the spectrum of lower mood.

F1000 - Post-publication peer review of the biomedical literature, 2009

Context-Pain and depression are the most common physical and psychological symptoms in primary ca... more Context-Pain and depression are the most common physical and psychological symptoms in primary care, respectively. Moreover, they co-occur 30-50% of the time and have adverse reciprocal effects on quality of life, disability, and health care costs. Objectives-To determine if a combined pharmacological and behavioral intervention improves both depression and pain in primary care patients with musculoskeletal pain and comorbid depression. , Setting, and Patients-Randomized controlled trial conducted at 6 community-based clinics of 1 university primary care system and 5 general medicine clinics of 1 Department of Veterans Affairs Medical Center. Recruitment occurred from January 2005 to June 2007 and follow-up concluded in June 2008. The 250 patients had low back, hip or knee pain for ≥ 3 months and at least moderate depression severity (Patient Health Questionnaire-9 score ≥ 10). Intervention-Patients were randomly assigned to the intervention (n=123) or to usual care (n=127). The intervention consisted of 12 weeks of optimized antidepressant therapy (step 1

Psychological Medicine, 2014

BackgroundAsian Americans (AAs) and Native Hawaiians/Pacific Islanders (NHs/PIs) are the fastest ... more BackgroundAsian Americans (AAs) and Native Hawaiians/Pacific Islanders (NHs/PIs) are the fastest growing segments of the US population. However, their population sizes are small, and thus AAs and NHs/PIs are often aggregated into a single racial/ethnic group or omitted from research and health statistics. The groups' substance use disorders (SUDs) and treatment needs have been under-recognized.MethodWe examined recent epidemiological data on the extent of alcohol and drug use disorders and the use of treatment services by AAs and NHs/PIs.ResultsNHs/PIs on average were less educated and had lower levels of household income than AAs. Considered as a single group, AAs and NHs/PIs showed a low prevalence of substance use and disorders. Analyses of survey data that compared AAs and NHs/PIs revealed higher prevalences of substance use (alcohol, drugs), depression and delinquency among NHs than among AAs. Among treatment-seeking patients in mental healthcare settings, NHs/PIs had highe...

F1000 - Post-publication peer review of the biomedical literature, 2010

BACKGROUND-Empirical evidence has only weakly supported antidepressant treatment for patients wit... more BACKGROUND-Empirical evidence has only weakly supported antidepressant treatment for patients with co-occurring depression and alcohol dependence. While some studies have demonstrated that antidepressants reduce these patients' depressive symptoms, most studies have not found antidepressants helpful in reducing excessive drinking in these patients. We provide results from a double blind, placebo-controlled trial that evaluated the efficacy of combining approved medications for depression (sertraline) and alcohol dependence (naltrexone) for treating patients with both disorders. METHODS-170 depressed, alcohol-dependent patients were randomized for 14 weeks to sertraline (200mg/day), naltrexone (100mg/day), the combination, or placebo, while receiving weekly cognitive behavioral therapy. The sertraline + naltrexone combination produced a higher alcohol abstinence rate (53.7%; p = .001; odds ratio = 3.7), and a longer delay before relapse to heavy drinking (98 median days; p = .003; d = .54), than the other treatments: naltrexone (21.3% abstinent, 29 days), sertraline (27.5% abstinent, 23 days), or placebo (23.1% abstinent, 26 days). There also was a trend for more patients in the medication combination group not to be depressed by the end of treatment (83.3%; p = .014; odds ratio = 3.6), compared to the other treatments. The serious adverse event rate was 25.9%, with fewer reported by the medication combination group (11.9%; p < .02) than the other treatments. CONCLUSION-More depressed, alcohol-dependent patients taking the sertraline + naltrexone combination achieved abstinence from alcohol, delayed relapse to heavy drinking, reported fewer serious adverse events, and tended not to be depressed by the end of treatment.

Substance Abuse and Rehabilitation, 2011

In response to the rising rate of treatment admissions related to illicit use of amphetamines (eg... more In response to the rising rate of treatment admissions related to illicit use of amphetamines (eg, methamphetamine), we examined the prevalence of amphetamine use among treatment-seeking, opioid-dependent adults, explored whether amphetamine users were as likely as nonamphetamine users to enroll in opioid-dependence treatment trials, and determined whether amphetamine users manifested greater levels of medical and psychiatric comorbidity than nonusers. Methods: The sample included 1257 opioid-dependent adults screened for participation in threemultisite studies of the National Drug Abuse Treatment Clinical Trials Network (CTN001-003), which studied the effectiveness of buprenorphine for opioid detoxification under varying treatment conditions. Patients were recruited from 23 addiction treatment programs across the US. Medical and psychiatric comorbidity were examined by past-month amphetamine use (current vs former) and route of administration. Five mutually exclusive groups were examined, ie, nonusers, current amphetamine injectors, current amphetamine noninjectors, former amphetamine injectors, and former amphetamine noninjectors. Results: Of the sample (n = 1257), 22.3% had a history of regular amphetamine use. Of the 280 amphetamine users, 30.3% reported injection as their primary route. Amphetamine users were more likely than nonusers to be white and use more substances. Amphetamine users were as likely as nonusers to enroll in treatment trials. Bivariate analyses indicated elevated rates of psychiatric problems (depression, anxiety, hallucinations, cognitive impairment, violence, suicidal thoughts/attempts) and medical illnesses (dermatological, hepatic, cardiovascular, respiratory, neurological, seizure, allergy conditions) among amphetamine users. After adjusting for demographic variables and lifetime use of other substances: current amphetamine users and former injectors showed an increased likelihood of having medical illnesses and hospitalizations; current injectors had elevated odds of suicidal thoughts or attempts; current noninjectors exhibited elevated odds of anxiety, cognitive impairment, and violent behaviors; and former noninjectors had increased odds of depression. Conclusion: Treatment-seeking, amphetamine-using, opioid-dependent adults manifest greater levels of medical and psychiatric morbidity than treatment-seeking, opioid-dependent adults who have not used amphetamines, indicating a greater need for intensive clinical management.

Substance Abuse and Rehabilitation, 2011

To examine patterns of onset and abuse/dependence episodes of prescription opioid (PO) and heroin... more To examine patterns of onset and abuse/dependence episodes of prescription opioid (PO) and heroin use disorders in a national sample of adults, and to explore differences by gender and substance abuse treatment status. Methods: Analyses of data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). Results: Of all respondents, 5% (n = 1815) reported a history of nonmedical PO use (NMPOU) and 0.3% (n = 150) a history of heroin use. Abuse was more prevalent than dependence among NMPOUs (PO abuse, 29%; dependence, 7%) and heroin users (heroin abuse, 63%; dependence, 28%). Heroin users reported a short mean interval from first use to onset of abuse (1.5 years) or dependence (2.0 years), and a lengthy mean duration for the longest episode of abuse (66 months) or dependence (59 months); the corresponding mean estimates for PO abuse and dependence among NMPOUs were 2.6 and 2.9 years, respectively, and 31 and 49 months, respectively. The mean number of years from first use to remission from the most recent episode was 6.9 years for PO abuse and 8.1 years for dependence; the mean number of years from first heroin use to remission from the most recent episode was 8.5 years for heroin abuse and 9.7 years for dependence. Most individuals with PO or heroin use disorders were remitted from the most recent episode. Treated individuals, whether their problem was heroin or POs, tended to have a longer mean duration of an episode than untreated individuals. Conclusion: Periodic remissions from opioid or heroin abuse or dependence episodes occur commonly but take a long time. Timely and effective use of treatment services are needed to mitigate the many adverse consequences from opioid/heroin abuse and dependence.

Psychological Medicine, 2010

BackgroundFor the emerging DSM-V, it has been recommended that dimensional and categorical method... more BackgroundFor the emerging DSM-V, it has been recommended that dimensional and categorical methods be used simultaneously in diagnostic classification; however, little is known about this combined approach for abuse and dependence.MethodUsing data (n=37 708) from the 2007 National Survey on Drug Use and Health (NSDUH), DSM-IV criteria for prescription opioid abuse and dependence among non-prescribed opioid users (n=3037) were examined using factor analysis (FA), latent class analysis (LCA, categorical), item response theory (IRT, dimensional), and factor mixture (hybrid) approaches.ResultsA two-class factor mixture model (FMM) combining features of categorical latent classes and dimensional IRT estimates empirically fitted more parsimoniously to abuse and dependence criteria data than models from FA, LCA and IRT procedures respectively. This mixture model included a severely affected group (7%) with a comparatively moderate to high probability (0.32−0.88) of endorsing all abuse and ...

Journal of Psychiatric Research, 2011

This study examined the prevalence of substance use disorders (SUDs) among psychiatric patients a... more This study examined the prevalence of substance use disorders (SUDs) among psychiatric patients aged 2-17 years in an electronic health records database (N=11,457) and determined patterns of comorbid diagnoses among patients with a SUD to inform emerging comparative effectiveness research (CER) efforts. DSM-IV diagnoses of all inpatients and outpatients at a large universitybased hospital and its associated psychiatric clinics were systematically captured between 2000 and 2010: SUD, anxiety (AD), mood (MD), conduct (CD), attention deficit/hyperactivity (ADHD), personality (PD), adjustment, eating, impulse-control, psychotic, learning, mental retardation, and relational disorders. The prevalence of SUD in the 2-12-year age group (n=6,210) was 1.6% and increased to 25% in the 13-17-year age group (n=5,247). Cannabis diagnosis was the most prevalent SUD, accounting for more than 80% of all SUD cases. Among patients with a SUD (n=1,423), children aged 2-12 years (95%) and females (75-100%) showed high rates of comorbidities; blacks were more likely than whites to be diagnosed with CD, impulse-control, and psychotic diagnoses, while whites had elevated odds of having AD, ADHD, MD, PD, relational, and eating diagnoses. Patients with a SUD used more inpatient treatment than patients without a SUD (43% vs. 21%); children, females, and blacks had elevated odds of inpatient psychiatric treatment. Collectively, results add clinical evidence on treatment needs and diagnostic patterns for understudied diagnoses.

Journal of Psychiatric Research, 2012

Aim-To address an urgent need for screening of substance use problems in medical settings, we exa... more Aim-To address an urgent need for screening of substance use problems in medical settings, we examined substance-specific dependence criteria as potential brief screeners for the detection of patients with a substance use disorder (SUD). Methods-The sample included 920 opioid-dependent adults who were recruited from outpatient treatment settings at 11 programs in 10 U.S. cities and who completed intake assessments of SUDs for a multisite study of the National Drug Abuse Treatment Clinical Trials Network (CTN003). Data were analyzed by factor analysis, item response theory (IRT), sensitivity, and specificity procedures. Results-Across all substances (alcohol, amphetamines, cannabis, cocaine, sedatives), withdrawal was among the least prevalent symptoms, while taking large amounts and inability to cut down were among the most prevalent symptoms. Items closely related to the latent trait of a SUD showed good-to-high values of area under the receiver operating characteristic curve in identifying cases of a SUD; IRT-defined severe and less discriminative items exhibited low sensitivity in identifying cases of a SUD (withdrawal for all substances; time using for alcohol and sedatives; giving up activities for sedatives).

International Psychogeriatrics, 2009

The frequency of late life depression is estimated to be low relative to the frequency in young a... more The frequency of late life depression is estimated to be low relative to the frequency in young adulthood and middle age, as documented in many community-based epidemiological studies from Western populations. We first reported such a low-frequency in 1980 (though we did not compare the frequency of late life depression with that earlier in life) (Blazer and Williams, 1980). Since that time, many community-based studies have documented this lower frequency (Blazer et al., 1994; Kessler et al., 2003; Hasin et al., 2005). Yet a review of the origins of late life depression at first glance may suggest that older persons are at significant increased risk compared to adults in young adulthood and mid-life (Blazer, 2003; Blazer and Hybels, 2005).

International Journal of Methods in Psychiatric Research, 2012

Journal of the American Geriatrics Society, Jul 1, 2009

Journal of Addiction Medicine, Mar 1, 2011

Carolina Digital Repository (University of North Carolina at Chapel Hill), 2012

Biomarkers in Medicine, Aug 1, 2008

Drug and Alcohol Dependence, Nov 1, 2010

Journal of Substance Abuse Treatment, Jun 1, 2010

Journal of the American Geriatrics Society, Jul 1, 1986

Drug and Alcohol Dependence, Sep 1, 2009

Drug and Alcohol Dependence, Dec 1, 2013

JAMA, 2020

F1000 - Post-publication peer review of the biomedical literature, 2009

Psychological Medicine, 2014

F1000 - Post-publication peer review of the biomedical literature, 2010

Substance Abuse and Rehabilitation, 2011

Psychological Medicine, 2010

Journal of Psychiatric Research, 2011

Journal of Psychiatric Research, 2012

International Psychogeriatrics, 2009

International Journal of Methods in Psychiatric Research, 2012