Background International consensus statements on depression and
anxiety in adolescents and adults with CF recommend assessment for
comorbid substance misuse. However, at CF centers, the frequency and
impact of substance misuse have not been well characterized, and best
practices for prevention, identification, and evidence-based treatment
have not been routinely implemented. Methods Medical records of
148 adults with CF over 3 years were reviewed to determine the
prevalence of substance misuse (alcohol or opiates) and its relationship
with clinical variables and healthcare utilization. Independent-sample
t-test for continuous outcomes and chi-square test for binary outcomes
were used to compare groups with and without substance misuse.
Results Substance misuse was documented in 28 (19%) adults
with CF, equally distributed between alcohol (n=13) and opiates (n=15).
Adults with substance misuse were more likely to be male. The prevalence
of diagnosed anxiety and depression did not differ significantly between
groups, but those with substance misuse had more severe anxiety (GAD-7:
10.0±6.1 vs. 3.3±4.4; p<0.001) and depressive symptoms (PHQ-9:
10.4±6.5 vs. 4.0±4.8; p<0.001). Adults with substance misuse
had higher annual rates of missed outpatient CF visits and inpatient
hospitalizations, with hospital admissions of longer mean duration.
Conclusions In adults with CF, substance misuse is common and
is associated with adverse indicators of emotional and physical health
and service utilization, suggesting that systematic approaches to
addressing substance misuse in CF clinics should be considered.
Prospective, longitudinal study is warranted to elucidate the complex
relationships between depression, anxiety, substance misuse, and health
outcomes in individuals with CF.