Nicotine dependence and psychiatric and substance use comorbidities in a sample of American Indian male veterans

Background: American Indians and Alaska Natives have the highest rates of nicotine dependence in the U.S. However, studies analyzing associations between nicotine dependence and psychiatric and substance use disorders in these groups have been limited. Methods: This study analyzes the co-occurrence of current and lifetime DSM-III-R nicotine dependence with psychiatric and substance use disorders in a community sample of 480 American Indian male veterans. Results: Lifetime nicotine dependence (23.3%) was associated with all lifetime disorders studied, including alcohol use and drug use disorders, affective and anxiety disorders, PTSD, pathological gambling and antisocial personality disorder. Current nicotine dependence was present in 19% of the sample and significantly associated with current affective and gambling disorder. Conclusions: Substantial co-morbidity exists between nicotine dependence and other substance abuse and psychiatric disorders among this sample of American Indian male veterans, particularly for lifetime diagnoses. Screening for all psychiatric disorders among American Indian/Alaska Native smokers may be warranted. Although these results are similar to those observed among the general U.S. population, unique risk factors exist among American Indians/Alaska Natives which may require further attention. Specific public health and clinical interventions to reduce the rate of nicotine dependence among American Indians/Alaska Natives are recommended.