Christelle Nilles1, Emmanuel Roze2, Andreas Hartmann2, Yulia Worbe3, David Bendetowicz2, Natalia Szejko1, Naoual Serari2, Julian Fletcher1, Davide Martino4, Tamara Pringsheim1
1Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, 2Department of Neurology, Hôpital de la Pitié-Salpêtrière, 3National Reference Center for Tourette Syndrome, Hôpital de la Pitié-Salpêtrière, 4Department of Clinical Neurosciences, University of Calgary
Objective:
To estimate prevalence of substance use disorder (SUD) in adults with tics and characterize relationship with sex, age, psychiatric comorbidities and tic severity.
Background:
There are few data regarding SUD in adults with tics. One Swedish population-based study reported a high SUD-prevalence (15.9%) in people with Tourette syndrome (Virtanen et al, 2020).
Design/Methods:
From our Calgary and Paris Adult Tic Registry, we included adults with primary tic disorders who answered to the Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) Tool for substance use screening. For alcohol, tobacco, and cannabis, SUD was possible if the TAPS score was 2+. For illicit and prescription drugs, we used a cut-off of 1+ to identify problem use. We compared the prevalence of possible SUD in our cohort with the Swedish study’s results (Z-test). We looked for associations between possible SUD and age, sex, psychiatric comorbidities and tic severity using logistic/linear regression.
Results:
We included 139 participants (122 with Tourette syndrome; mean age: 32.5 years; 64.0% males; 53.2% Canadian, 46.8% French). A total of 28/139 (20.2%) had possible SUD for alcohol, 16/139 (11.5%) for tobacco and 15/139 (10.8%) for cannabis. For other substances: 7/139 (5.0%) were likely to have a problem use with cocaine/crack/methamphetamine, 1/139 (0.7%) with heroine, 1/139 (0.7%) with opioids, 11/139 (7.9%) with sedative drugs and 1/139 (0.7%) with stimulants for attention deficit/hyperactivity disorder (ADHD). Prevalences of possible overall-SUD (37%) and alcohol-SUD were higher than in the Swedish cohort (p=0.0142 and p<0.00001). Total tic severity score was higher in people with possible SUD (p=0.017). Depression and anxiety were significantly associated with possible cannabis-related SUD (OR=3.5 and OR=7.2 respectively). Age, sex, comorbid ADHD and obsessive-compulsive disorder were not significantly associated with possible SUD.
Conclusions:
Thirty-seven % of adults with tic disorders have possible SUD related to alcohol, tobacco or cannabis, and require further diagnostic assessment.