• Charles R Jonassaint, Julia O'Brien, Emily Nardo, Robert Feldman, Michael Stanton, Laura DeCastro, and Kaleab Z Abebe.
• Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA. cjonassaint@pitt.edu.
• J Gen Intern Med. 2023 Apr 1; 38 (5): 121412231214-1223.

BackgroundSickle cell disease (SCD) is a heritable chronic health condition characterized by pain symptoms throughout the life course that are routinely treated with opioids.ObjectiveThis study examined differences in substance use disorders in Black American adults with SCD compared to those with other chronic conditions or with no chronic conditions.DesignData from a population-representative sample of Black Americans with SCD, other chronic conditions, and no chronic conditions were obtained from the National Survey of American Life (NSAL) database. Diagnosis of substance use disorder was determined by structured clinical interview. Hierarchical models controlling for covariates (demographics, socioeconomic status, self-rated health, and mood disorders) compared odds of diagnosis between the three groups.ParticipantsThe sample included 4238 African-American and Black Caribbean participants from the NSAL study who were 18 years of age or older.Main MeasuresMeasures included age, sex, income, education, marital status, employment, possession of health insurance, health conditions, and substance use disorders diagnosed by structured clinical interview.Key ResultsControlling for age, sex, and socioeconomic status, there were no differences in odds of a drug use disorder when comparing individuals with SCD to Black adults with other chronic conditions (OR = 1.12; p = 0.804) or no chronic condition (OR = 2.09; p = 0.102). SCD was, however, associated with greater odds of alcohol use disorders when compared to the groups with other chronic conditions (OR = 2.15; p = 0.01) and no chronic conditions (OR = 5.11; p < 0.001). This effect was not better accounted for by socioeconomic status, marital status, self-rated physical health, or the presence of a mood disorder.ConclusionsSCD was not a risk factor for drug use disorders. Further data will be needed to understand the factors contributing to increased risk of alcohol use disorders in SCD and the role uncontrolled pain symptoms may have in driving substance use.© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.

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