One in six patients with inflammatory bowel disease (IBD) experience a substance use disorder (SUD), or drug or alcohol addiction, a study suggests.

In particular, people with IBD with a history of smoking, anxiety disorder, pain, and of the male gender are at a higher risk of SUD and should be targeted for drug and alcohol addiction screening in clinical practice, the researchers said.

The study, titled “Prevalence and Risk Factors of Substance Use Disorder in Inflammatory Bowel Disease,” was published in the journal Inflammatory Bowel Diseases.

Psychiatric disorders are strongly associated with IBD. In fact, previous studies have shown that IBD patients are at a significantly higher risk of developing generalized anxiety disorder and depression compared with the general population.

However, very few studies have investigated substance use disorder — including dependence on alcohol and drugs — among those with IBD.

“Substance use disorder may complicate the management of IBD,” the researchers said. “Comorbid SUD and chronic conditions are associated with higher rates of hospitalization than chronic conditions alone, and the presence of an SUD may interfere with adherence to treatment of the chronic condition and self-care behaviors.”

Now, a group of researchers from the University of Manitoba in Canada set out to evaluate the frequency and risk factors of substance use disorder in those with IBD.

Overall, 247 people with IBD were recruited for the study. The participants underwent interviews and testing to identify a history of SUD, anxiety disorder, and major depressive disorder. The sociodemographic and clinical characteristics of the patients also were assessed.

“Substance use disorders were defined by meeting diagnostic criteria for current or lifetime SUD and categorized by DSM-IV [Diagnostic and Statistical Manual of Mental Disorders-IV, from the American Psychiatric Association] diagnoses: alcohol abuse, alcohol dependence, drug abuse, and drug dependence,” the investigators said.

In total, 41 out of the 247 IBD patients (16.6%) met the criteria for a history of SUD.

Alcohol abuse was found to be the most common SUD diagnosis (9.3%), followed by alcohol dependence (7.3%) and drug abuse (7.3%). On the other hand, drug dependence was infrequent (3.6%) in this population.

Interestingly, the prevalence of alcohol abuse and dependence in IBD patients was found to be lower than that reported in the average American population. This likely is due to the fact that alcohol use is associated with worsening of IBD symptoms, the team said.

The researchers noted that alcohol abuse is present in 17.8% of the general U.S. population, with alcohol dependence found among 12.5%.

“Although previous studies have reported the prevalence of alcohol consumption in those with IBD to be similar to the general population, those with active IBD may moderate their alcohol consumption to lessen IBD symptom exacerbation,” the team said.

The prevalence of drug abuse and dependence were similar among IBD patients and the American general population, the findings showed.

Next, the researchers evaluated which risk factors are associated with a higher prevalence of SUD among people with inflammatory bowel diseases.

The results indicated that patients with a history of smoking were at a 2.96-higher-fold risk of SUD. Those of the male gender were 2.44-fold more likely to develop SUD, while patients with a history of anxiety disorder were at a 2.41-higher-fold risk of substance use disorder.

Further, those with a higher pain impact were 1.08-fold more likely to have SUD. That represents an 8% increase in the odds of substance use disorder for each point on the pain scale, the researchers said.

The predictors of SUD in people with IBD were similar to those that have been previously established for the general population. For example, smoking and SUD are strongly associated in the general population.

“In conclusion, 1 in 6 persons with IBD met the criteria for SUD. Individuals with a history of smoking, higher reported impact of pain, comorbid AD [concurrent diagnosis of generalized anxiety disorder], and males were at elevated risk of SUD and could be targeted for screening of SUD in clinical practice,” the researchers said.

The team added that the substantial individual and societal burden of substance use disorder (SUD), as well as the undertreatment of addiction, highlights the value of conducting future studies on SUD in people with IBD.