Negative health outcomes are linked to substance abuse disorders, says study

People who have previously been hospitalised for substance abuse disorders may experience much worse consequences after developing a variety of physical health conditions. Let's find out all about this.

In a study published on 4th November 2022, in 'The Lancet Psychiatry', researchers looked at the risk of mortality and loss of life-years among people who developed 28 different physical health conditions, comparing those who had previously been hospitalised with substance use disorder against those who had not. 

It was found that patients with most of the health conditions were more likely than their counterparts to die during the study period if they had been hospitalised with substance use disorder before the development of these conditions. 

For most subsequent health conditions, people with substance abuse disorders also had shorter life expectancies than individuals without substance abuse disorders. 

One in twenty people worldwide aged 15 years or older lives with an alcohol use disorder, while around one in 100 people has psychoactive drug use disorders. 

Although substance use disorders have considerable direct effects on health, they are also linked to a number of physical and mental health conditions. Consequently, the presence of these contributes to a higher risk of mortality and shorter lifespan in people with substance use disorders. 

To explore this link further, researchers analysed patient records from Czech nationwide registers of all-cause hospitalisations and deaths during the period from 1994-2017. 

A novel design, estimating the risk of death and life-years lost after the onset of multiple specific physical health conditions in individuals with a history of hospitalisation for substance use disorders when compared with matched counterparts without substance use disorder but with the same physical health condition. 

Although the study only looked at people living in Czechia, the researchers believe the results are likely to be similar in other countries, too. 

People with pre-existing substance abuse disorders were found to be more likely than their counterparts to have died during the study following the development of 26 out of 28 physical health conditions. For seven of these conditions - including atrial fibrillation, hypertension, and ischaemic heart disease - the risk was more than doubled. 

In most cases, people with substance use disorders have shorter life expectancies than their counterparts. Lead author Tomas Formanek, a PhD student at the National Institute of Mental Health, Czechia, and the University of Cambridge, said, "Substance use disorders seem to have a profound negative impact on prognosis following the development of various subsequent physical health conditions, in some cases dramatically affecting the life expectancy of the affected people."

It is not clear why this should be the case, though the researchers say there are a number of possible reasons. It is already known that substance use has a direct negative impact on physical health and is associated with lifestyle factors that affect our health, such as smoking, lack of exercise, and poor diet. 

Similarly, people with substance abuse disorders are less likely to take part in screening and prevention programmes for diseases such as cancer and diabetes and are less likely to use preventive medication, such as drugs to prevent hypertension. 

There are also some factors not directly related to substance use, such as diagnostic overshadowing, meaning the misattribution of physical symptoms to mental disorders. 

Such misattribution can subsequently contribute to underdiagnosis, late diagnosis, and delayed treatment in affected individuals. Senior author Professor Peter Jones from the Department of Psychiatry, University of Cambridge, added, "These results show how important it is not to compartmentalise health conditions into mind, brain or body. All interact leading here to dramatic increases in mortality from subsequent physical illnesses in people with substance use disorders. There are clear implications for preventive action by clinicians, health services and policy developers that all need to recognise these intersections."

Co-author Dr Petr Winkler from the National Institute of Mental Health, Czechia, said, "It is also important to consider that the majority of people with substance use disorders go undetected. They often do not seek professional help and hospitalisations for these conditions usually come only at very advanced stages of illness."

Actions focused on the physical health of people with substance abuse disorders must be accompanied by early detection and early intervention in substance abuse disorders as well.