Epidemiology of substance use in adolescence: prevalence, trends and policy implications

An epidemiological study of ADHD symptoms among young persons and the relationship with cigarette smoking, alcohol consumption and illicit drug use

BACKGROUND

This study investigates the relationship between attention deficit hyperactivity disorder (ADHD) symptoms and cigarette smoking, alcohol use and illicit drug use.

METHOD

The participants were 10,987 pupils in the final three years of their compulsory education in Iceland (ages 14-16 years). The participants completed questionnaires in class relating to anxiety, depression and antiestablishment attitudes, ADHD symptoms, smoking, alcohol consumption and illicit drug use.

RESULTS

Of the total sample, 5.4% met screening criteria for ADHD. Smoking, alcohol and illicit drug use were significantly related to ADHD symptoms. In addition, the number of different illicit drugs consumed was significantly higher among the ADHD symptomatic than the nonsymptomatic participants, including the illicit use of sedatives. The main distinguishing illicit drug substances were lysergic acid diethylamide (odds ratio or OR = 8.0), cocaine (OR = 7.5), mushrooms (OR = 7.1) and amphetamines (OR = 6.5). Logistic multiple regressions showed that after controlling for gender and school grade, ADHD symptoms predicted smoking, alcohol use and illicit drug use independent of anxiety, depression and antiestablishment attitudes. In addition, poly-substance use was linearly and incrementally related to ADHD symptoms with a large effect size.

CONCLUSIONS

The findings underscore the vulnerability of young persons with ADHD symptoms to smoking, alcohol and illicit drug use, possibly as a means of self-medication, and emphasize a need for early identification and treatment to reduce the risk of escalation.

School performance and alcohol use problems in early adulthood: a longitudinal study

There is inconsistent evidence about the association between school performance and subsequent use of alcohol and alcohol problems in adolescents and young adults. This study examines whether school performance at 14 years is associated with drinking problems in early adulthood; and whether this association is explained by family and individual factors in childhood and adolescence. Data were from a 21-year follow-up of 3,478 Australian young adults from birth to the age of 21 years when data on use of alcohol were collected. Child school performance (CSP) was assessed at 14 years via self- and maternal report. Alcohol consumption at 21 years was measured via self-report, and alcohol abuse and dependence were assessed by the computerized version of Composite International Diagnostic Interview (CIDI-Auto). Potential confounding factors were prospectively measured between the child's birth and age of 14 years. School performance at 14 years predicted young adults' alcohol consumption and alcohol use disorders (AUDs). After controlling for confounding, children who had lower school performance had increased risk of drinking more than two glasses of alcohol per day in early adulthood (odds ratio=1.7; 95% confidence interval: 1.1-2.6). There was a similar pattern of association between CSP and young adults' alcohol abuse and dependence (AUD) measured by CIDI-Auto. Level of academic performance in high school children predicts their drinking problems as young adults, independently of a selected group of individual and family confounders. Exploration of the pathway linking school performance and alcohol problems in young people may help identify opportunities for preventive interventions.

A systematic and methodological review of interventions for young people experiencing alcohol-related harm

AIMS

This review identified published studies evaluating interventions delivered outside educational settings, designed for young people with existing alcohol use problems, or who participate in behaviour that places them at high risk of alcohol-related harm, critiqued their methodology and identified opportunities for new interventions.

METHODS

A systematic search of the peer-reviewed literature interrogated 10 electronic databases using specific search strings, limited to 2005-09. No additional studies were found by a librarian searching other collections and clearing-houses, or by hand-searching review paper reference lists. The 1697 articles identified were reviewed against criteria from the Dictionary for the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies.

RESULTS

The methodological quality of existing studies is variable, and needs to be both more rigorous and more consistent. Particular problems include the lack of blinding outcome assessors, a reliance solely on self-report measures, highly variable consent and follow-up rates, infrequent use of intention-to-treat analyses and the absence of any economic or cost analyses. The range of interventions evaluated is currently limited to individually focused approaches, almost exclusively implemented in the United States.

CONCLUSIONS

There is a great need for more intervention trials for young people at high risk of experiencing alcohol-related harm that are both methodologically rigorous and have a broader community focus, to complement the psychological interventions that currently dominate the relevant literature. Such trials would improve outcomes for high-risk young people themselves and would improve the evidence base, both in their own right and by facilitating future meta-analyses.

Interpersonal Goals and Susceptibility to Peer Influence: Risk Factors for Intentions to Initiate Substance Use during Early Adolescence

Though peer socialization theories are prominent in the adolescent substance use literature, variability in the degree to which adolescents are vulnerable to peer influence is likely, and few studies have examined this issue. This study examines the association between perceived peer substance use/approval of substance use and adolescent intentions to initiate alcohol and cigarette use, and how social goals moderate this relationship. Results support the moderating role of social goals, and suggest important differences across alcohol and cigarette use. Peer use and approval of cigarette use was associated with future intentions to smoke for adolescents with strong agentic goals, and peer use and approval of alcohol use was associated with intentions to drink for adolescents with strong communal goals. These findings suggest that adolescent substance use theories and prevention programs focusing on peer socialization should consider individual differences in social goals and potential differences in peer influence across drugs.

Different forms of bullying and their association to smoking and drinking behavior in Italian adolescents

BACKGROUND

Using data from the 2006 Health Behavior in School-aged Children (HBSC) survey, the prevalence of 6 forms of bullying (physical, verbal, relational, sexual, cyber, and racist), and the role of smoking and drinking in bullying was examined among Italian adolescents for this study.

METHODS

The sample was composed of 2667 Italian middle and secondary school students (49.9% girls) randomly selected. The revised Olweus Bully/Victim Questionnaire was used to measure physical, verbal, relational, sexual, cyber, and racist forms of bullying. For each form, 3 categories were created and compared with students "not involved in bullying": bully, victim, and bully-victim. Logistic regressions were applied to test the connections among the 3 forms of involvement in different types of bullying and smoking and drinking.

RESULTS

Prevalence of having been bullied or having bullied others at school at least once in the last 2 months was 11.6% for physical, 52% for verbal, 47.9% for relational, 18.5% for sexual, 19.4% for cyber, and 9.4% for racist bullying. Compared to girls, boys were more likely to be involved in physical bullying; moreover, boys were more involved as bullies in verbal, sexual, cyber, and racist bullying. In contrast, girls were more likely to be victims of verbal, relational, sexual, and cyber bullying than were boys. Logistic regressions showed the connection between the different forms of involvement in bullying and smoking and drinking.

CONCLUSIONS

Our results indicate that all forms of bullying behavior are associated with legal substance use. Implication for prevention program was discussed.

Illegal substance use among Italian high school students: trends over 11 years (1999-2009)

Purpose

To monitor changes in habits in drug use among Italian high school students.

Methods

Cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD) carried out in Italy annually for 11 years (1999–2009) with representative samples of youth attending high school. The sample size considered ranges from 15,752 to 41,365 students and response rate ranged from 85.5% to 98.6%. Data were analyzed to obtain measures of life-time prevalence (LT), use in the last year (LY), use in the last 30 days (LM), frequent use. Comparisons utilized difference in proportion tests. Tests for linear trends in proportion were performed using the Royston p trend test.

Results

When the time-averaged value was considered, cannabis (30% LT) was the most, and heroin the least (2%) frequently used, with cocaine (5%), hallucinogens (2%) and stimulants (2%) in between. A clear gender gap is evident for all drugs, more obvious for hallucinogens (average M/F LY prevalence ratio 2, range 1.7–2.4, p<0.05), less for cannabis (average M/F LY prevalence ratio 1.3, range 1.2–1.5, p<0.05). Data shows a change in trend between 2005 and 2008; in 2006 the trend for cannabis use and availability dropped and the price rose, while from 2005 cocaine and stimulant use prevalence showed a substantial increase and the price went down. After 2008 use of all substances seems to have decreased.

Conclusions

Drug use is widespread among students in Italy, with cannabis being the most and heroin the least prevalent. Girls are less vulnerable than boys to illegal drug use. In recent years, a decrease in heroin use is overbalanced by a marked rise in hallucinogen and stimulant use.

Alcohol consumption among adolescents in Kraljevo, Serbia

The aim of this study was to investigate the prevalence and predictors of alcohol consumption among adolescents in one town in Central Serbia. A questionnaire was used to obtain data from 191 Serbian students aged 18 years regarding personal experience with alcohol consumption and cigarette smoking, along with sociodemographics data. Alcohol consumption was reported by 97.4% subjects, with 34.9% having the first experience with alcohol at the age of 14 years or less. Binge drinking (the intake of five or more drinks at one sitting) was reported by 37.8% subjects. Significantly higher consumption of beer (p<0.0001) and spirits (p=0.03) was observed in boys. The most common reason for both initiation and continuation of drinking, regardless of gender, were celebrations (p≥0.12). Smokers were more likely than nonsmokers to consume all alcoholic beverages more frequently (p≤0.04) and in larger quantities (p≤0.004). More frequent or more extensive alcohol consumption, or both, was associated in boys with frequent going out and socializing (p≤0.01), close peer relationship (p=0.04), alcohol abuse within the immediate environment (p≤0.04), better financial status of family (p=0.04), and parental criticism (p≤0.02); in girls, it was associated with parental disapproval (p≤0.02), alcohol abuse within the immediate environment (p≤0.04), and general discontentedness (p=0.049). Regardless of gender, positive alcohol outcome expectancies increased alcohol consumption (p≤0.048), and negative expectancies decreased intake (p≤0.047).

Trends in alcohol and drug use among Canadian adolescents, 1990-2006

OBJECTIVE

To report trends in rates of drunkenness, alcohol use, and drug use among Canadian adolescents.

METHOD

Five national school-based surveys were carried out between 1990 and 2006 as part of the Canadian Health Behaviour in School-aged Children study (n = 4504 to 7010). Students in Grades 6, 8, and 10 were surveyed about the frequency of their drunken episodes and consumption of beer, liquor, and wine. Grade 10 students were also surveyed about their use of drugs.

RESULTS

Rates of drunkenness and alcohol use declined slightly from 1990 to 2006, but about one-half of Grade 10 students in 2006 had used cannabis at least once in their lifetime (up from one-third in 1990). Lifetime prevalence rates of using other drug substances were below 10%.

CONCLUSIONS

Timely information on alcohol and drug use among adolescents is important to health policy. Declining trends in alcohol misuse is encouraging; however, the proliferation of cannabis use indicates a need for continued surveillance and education about the risks associated with frequent cannabis use.

Comparative epidemiology of betel nut use versus ecstasy use among Taiwanese adolescents: findings from a national survey

AIMS

To investigate whether variation may exist in betel nut- and ecstasy-involved adolescents in terms of sociobehavioral characteristics, the experience of psychoactive substance use, and behavioral/emotional problems.

METHODS

Students (n = 53,528) aged 12-18 sampled via stratified, multistage, random cluster sampling in 2004, 2005, and 2006 throughout Taiwan were categorized into four groups: betel nut- and ecstasy-naïve (n = 51,009), betel nut use only (n = 1965), ecstasy use only (n = 196), and use of both (n = 152). Participants completed a questionnaire with information on sociodemographic features, substance-use experiences, and the Chinese adaptation of the Youth Self Report.

RESULTS

Having a job, a larger weekly allowance, truancy, sexual experience, and externalizing behaviors were all in strong association with the involvement of either betel nut or ecstasy use. Compared with ecstasy-only users, betel nut-only users were more likely to be male, from the Eastern region of Taiwan, with initiation motivated by family members or friends, and having excess risks for Anxiety/Depression, Thought Problems, and Attention Problems. In contrast, ecstasy-only users were more likely to be female and involved in using other illegal drugs, with their initiation motivated by entertainment and with the drug use taking place in such settings.

CONCLUSIONS

The variation in the experience of psychoactive substance use and behavioral problems for betel nut and ecstasy users suggests the existence of subgroups of drug-using adolescents in Taiwan. The identification of such heterogeneity may guide the efforts to reduce substance use and develop subgroup-tailored preventive programs.

Residual performance impairments in adult rats trained on an object discrimination task subsequent to cocaine administration during adolescence

The present study was conducted to determine whether cognitive impairments in adult rats treated with cocaine during adolescence demonstrated in previous investigations extend to tests of object discrimination learning. Accordingly, 30-day-old male Long-Evans rats were injected subcutaneously with either 10 or 20 mg/kg cocaine or received control injections of saline for 7-8 consecutive days. An extended abstinence period was then introduced (mean = 70.7 ± 9.8 days) before subjects, who were now young adults (mean = 106.3 ± 10.2 days old), were assessed for acquisition of a two-choice object discrimination task. Using a correctional learning procedure conducted in a water maze, subjects were trained (eight trials per day for 10 days) to approach one of two multi-dimentional 'junk' objects. Although all animals acquired the discrimination to a reasonable extent, cocaine-treated subjects exhibited lower percentages of correct choices over the course of training (10 mg/kg = 59.6 ± 7.2% and 20 mg/kg = 59.4 ± 4.9%) relative to the saline control group (67.5 ± 4.9%). Further analyses revealed that saline-treated subjects acquired proficient discrimination performance earlier during the course of training, achieving an approximate 72% performance rate after only 3 days of training. This was in contrast to the two cocaine-treated groups needing 7 days of training to achieve comparable levels of performance. In addition, saline-treated subjects required significantly fewer trials (20.8 ± 8.9) than either cocaine-treated group (10 mg/kg = 52.2 ± 11.9 and 20 mg/kg = 63.3 ± 8.7) to reach an 87.5% correct response criterion (i.e. 7-correct-out-of-8-consecutive-trials) and performed at a higher above-chance level (13.5%) than either cocaine-treated group (3.6% and 5.3% for the 10 and 20 mg/kg cocaine groups, respectively). These findings demonstrate the existence of cognitive impairments in adulthood subsequent to cocaine exposure during adolescence despite a prolonged drug-free interval. Speculation regarding the neurobiological basis for this effect, especially with regard to alterations to prefrontal circuitry, is provided.

Axis I comorbidity in adolescent inpatients referred for treatment of substance use disorders

BACKGROUND

To assess comorbid DSM-IV-TR Axis I disorders in adolescent inpatients referred for treatment of substance use disorders.

METHODS

151 patients (mean age 16.95 years, SD = 1.76; range 13 - 22) were consecutively assessed with the Composite International Diagnostic Interview (CIDI) and standardized clinical questionnaires to assess mental disorders, symptom distress, psychosocial variables and detailed aspects of drug use. A consecutively referred subgroup of these 151 patients consisting of 65 underage patients (mean age 16.12, SD = 1.10; range 13 - 17) was additionally assessed with the modules for attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) using The Schedule for Affective Disorders and Schizophrenia for school-aged children (K-SADS-PL).

RESULTS

128 (84.8%) of the 151 patients were dependent on at least one substance, the remaining patients fulfilled diagnostic criteria for abuse only. 40.5% of the participants fulfilled criteria for at least one comorbid present Axis I disorder other than substance use disorders (67.7% in the subgroup additionally interviewed with the K-SADS-PL). High prevalences of present mood disorder (19.2%), somatoform disorders (9.3%), and anxiety disorders (22.5%) were found. The 37 female participants showed a significantly higher risk for lifetime comorbid disorders; the gender difference was significantly pronounced for anxiety and somatoform disorders. Data from the underage subgroup revealed a high prevalence for present CD (41.5%). 33% of the 106 patients (total group) who were within the mandatory school age had not attended school for at least a two-month period prior to admission. In addition, 51.4% had been temporarily expelled from school at least once.

CONCLUSIONS

The present data validates previous findings of high psychiatric comorbidity in adolescent patients with substance use disorders. The high rates of school refusal and conduct disorder indicate the severity of psychosocial impairment.

Associations between substance use and body mass index: moderating effects of sociodemographic characteristics among Taiwanese adolescents

The aim of this study was to analyze the association between substance use and body mass index (BMI) among adolescents in Southern Taiwan. A total of 10,259 adolescent students aged 11-19 years were selected by stratified random sampling for proportional representation of districts, schools and grades in Southern Taiwan, and completed the questionnaires. The body weight, body height, experience of substance use and sociodemographic characteristics including sex, age, residential background and paternal/maternal educational levels were collected. The association between substance use and BMI, and the moderating effects of sociodemographic characteristics were examined. After adjusting for sociodemographic characteristics, BMI was higher for adolescents who smoke cigarettes or drink alcohol than for those who do not regularly smoke or drink. Chewing betel nuts and using illicit drugs were not significantly associated with BMI. Paternal education level had a moderating effect on the association between smoking and BMI. Smoking, alcohol drinking, and low paternal education level were associated with higher BMI among adolescents. Thus, healthcare professionals should pay more attention to the weight-related problems among these adolescents.

Adolescent brain development, risk-taking and vulnerability to addiction

Adolescents (12-18 years old) and young adults (18-25 years old), are more likely than older adults to drive-or agree to be driven-recklessly or while intoxicated, to use illicit or dangerous substances and to engage in both minor and more serious antisocial behaviour. Numerous factors during adolescence may lead to or favour initiation of drug use, such as sensation-seeking, gregariousness and social conformity. These aspects, however, cannot be dissociated from the increased sex drive and quest for an integrated self. In the separation-individuation process, relationships with peers play many different roles: a field for experimentation, emotional support, a place for "projection" and "identification", and the possibility of finding a partner. Unsurprisingly, therefore, drug use generally takes place in a group setting. Despite evidence of heightened real-world risk-taking, laboratory studies have yet to yield consistent evidence that adolescents, when on their own, are more inclined towards risky behaviour than their elders. Moreover, their comprehension and reasoning abilities in risky decision-making situations are roughly equivalent to those of adults. Structural and functional neuroimaging studies have shown that neural circuitry undergoes major reorganization during adolescence, particularly in those regions of the brain relating to executive functions, the self and social cognition, and that the "emotional brain" may play a role in that reorganization. Age-related decreases in gray matter volume mainly reflect a reduction in the number of synapses and the complexity of axonal ramifications. By 18-20 years old, most of the subcortical white matter and association pathways have reached a plateau. Risk-taking behavior and novelty-seeking may provide, with an appropriate feed back, a mechanism to optimize brain development in adolescence.

Cost-effectiveness of a motivational intervention for alcohol-involved youth in a hospital emergency department

OBJECTIVE

Brief interventions in the emergency department targeting risk-taking youth show promise to reduce alcohol-related injury. This study models the cost-effectiveness of a motivational interviewing-based intervention relative to brief advice to stop alcohol-related risk behaviors (standard care). Average cost-effectiveness ratios were compared between conditions. In addition, a cost-utility analysis examined the incremental cost of motivational interviewing per quality-adjusted life year gained.

METHOD

Microcosting methods were used to estimate marginal costs of motivational interviewing and standard care as well as two methods of patient screening: standard emergency-department staff questioning and proactive outreach by counseling staff. Average cost-effectiveness ratios were computed for drinking and driving, injuries, vehicular citations, and negative social consequences. Using estimates of the marginal effect of motivational interviewing in reducing drinking and driving, estimates of traffic fatality risk from drinking-and-driving youth, and national life tables, the societal costs per quality-adjusted life year saved by motivational interviewing relative to standard care were also estimated. Alcohol-attributable traffic fatality risks were estimated using national databases.

RESULTS

Intervention costs per participant were $81 for standard care, $170 for motivational interviewing with standard screening, and $173 for motivational interviewing with proactive screening. The cost-effectiveness ratios for motivational interviewing were more favorable than standard care across all study outcomes and better for men than women. The societal cost per quality-adjusted life year of motivational interviewing was $8,795. Sensitivity analyses indicated that results were robust in terms of variability in parameter estimates.

CONCLUSIONS

This brief intervention represents a good societal investment compared with other commonly adopted medical interventions.

Drug consumption among medical students in São Paulo, Brazil: influences of gender and academic year

OBJECTIVE

To analyze alcohol, tobacco and other drug use among medical students.

METHOD

Over a five-year period (1996-2001), we evaluated 457 students at the Universidade de São Paulo School of Medicine, located in São Paulo, Brazil. The students participated by filling out an anonymous questionnaire on drug use (lifetime, previous 12 months and previous 30 days). The influence that gender and academic year have on drug use was also analyzed.

RESULTS

During the study period, there was an increase in the use of illicit drugs, especially inhalants and amphetamines, among the medical students evaluated. Drug use (except that of marijuana and inhalants) was comparable between the genders, and academic year was an important influencing factor.

DISCUSSION

Increased inhalant use was observed among the medical students, especially among males and students in the early undergraduate years. This is suggestive of a specific behavioral pattern among medical students. Our findings corroborate those of previous studies.

CONCLUSION

Inhalant use is on the rise among medical students at the Universidade de São Paulo School of Medicine. Because of the negative health effects of illicit drug use, further studies are needed in order to deepen the understanding of this phenomenon and to facilitate the development of preventive measures.

Is moderate substance use associated with altered executive functioning in a population-based sample of young adults?

BACKGROUND

Substance use (SU) has been linked with impaired cognitive functioning. Evidence comes mainly from clinical studies or studies examining heavy users. Though, the majority of users are not involved in heavy use. This study investigates the association between moderate use and cognition in a population-based sample.

METHODS

A total of 284 young adults with ecstasy, cannabis or alcohol use and a control group were sampled from the EDSP database for participation in the Munich Assessment of Young Adults (MAYA) study. Subjects completed a comprehensive battery of neuropsychological tests (executive functions, working memory and impulsivity). Multiple linear regression models were conducted to examine the relationship between use and cognitive performance.

RESULTS

Increased ecstasy consumption was associated with increased error-proneness (Stroop task, CANTAB ID/ED-shift, spatial working memory). More frequent cannabis use and more extensive alcohol consumption were associated with a higher degree of impulsiveness.

CONCLUSIONS

Based on mild to moderate SU, little indication of differences in executive functioning was found. For ecstasy use, an increased error-proneness was revealed. The subtle differences in relatively young individuals warrant further investigation in prospective long-term studies to identify subjects at risk, and to examine effects of prolonged patterns of use on executive functioning.

A prospective study of familial conflict, psychological stress, and the development of substance use disorders in adolescence

BACKGROUND

Exposure to adverse family environments in childhood can influence the risk trajectory for developing substance use disorders in adolescence. Evidence for this is largely based on cross-sectional studies which have been unable to establish the temporality of this association and investigate underlying pathways.

METHODS

The sample consisted of 1421 adolescents from the Project on Human Development in Chicago Neighborhoods, a three wave longitudinal study conducted between 1994 and 2001 that followed children from ages 10 to 22. Logistic regression analyses with multiple imputation were conducted to examine the relation between familial conflict in childhood and substance use disorders in late adolescence and emerging adulthood. We conducted mediational analyses to determine if internalizing and externalizing problems explain this relationship, and we investigated whether external social support mitigates the adverse effects of familial conflict on the development of substance use disorders.

RESULTS

Familial conflict was significantly associated with the risk of substance use disorders during adolescence (odds ratio: 1.23; 95% CI: 1.02-1.47), and 30% of this effect was due to higher levels of externalizing problems (but not internalizing problems). External social support in childhood did not buffer the effects of familial conflict on substance use disorders during adolescence.

CONCLUSION

Exposure to familial conflict early in life increases the risk of substance use disorders during late adolescence and emerging adulthood, due partly to higher levels of externalizing problems, but not internalizing problems. Future research is needed to identify additional pathways underlying this association, and the extent to which these pathways are modifiable.

Developmental epidemiology of drug use and abuse in adolescence and young adulthood: Evidence of generalized risk

Past studies highlight a narrowing gender gap and the existence of a shared etiology across substances of abuse; however, few have tested developmental models using longitudinal data. We present data on developmental trends of alcohol, tobacco, and marijuana use, abuse and dependence assessed during adolescence and young adulthood in a community-based Colorado twin sample of 1733 respondents through self-report questionnaires and structured psychiatric interviews. Additionally, we report on the rates of multiple substance use and disorders at each developmental stage, and the likelihood of a substance use disorder (SUD; i.e., abuse or dependence) diagnosis in young adulthood based on adolescent drug involvement. Most notably, we evaluate whether the pattern of multiple substance use and disorders and likelihood ratios across substances support a model of generalized risk. Lastly, we evaluate whether the ranked magnitudes of substance-specific risk match the addiction liability ranking. Substance use and SUDs are developmental phenomena, which increase from adolescence to young adulthood with few and inconsistent gender differences. Adolescents and young adults are not specialized users, but rather tend to use or abuse multiple substances increasingly with age. Risk analyses indicated that progression toward a SUD for any substance was increased with prior involvement with any of the three substances during adolescence. Despite the high prevalence of alcohol use, tobacco posed the greatest substance-specific risk for developing subsequent problems. Our data also confirm either a generalized risk or correlated risk factors for early onset substance use and subsequent development of SUDs.

Actions of delta-9-tetrahydrocannabinol in cannabis: relation to use, abuse, dependence

Cannabis use disorders have been recently identified as a relevant clinical issue: a subset of cannabis smokers seeks treatment for their cannabis use, yet few succeed in maintaining long-term abstinence. The rewarding and positive reinforcing effects of the primary psychoactive component of smoked cannabis, delta-9-tetrahydrocannabinol (THC) are mediated by the cannabinoid CB1 receptor. The CB1 receptor has also been shown to mediate cannabinoid dependence and expression of withdrawal upon cessation of drug administration, a phenomenon verified across species. This paper will review findings implicating the CB1 receptor in the behavioural effects of exogenous cannabinoids with a focus on cannabinoid dependence and reinforcement, factors that contribute to the maintenance of chronic cannabis smoking despite negative consequences. Opioidergic modulation of these effects is also discussed.

Use of ecstasy and other psychoactive substances among school-attending adolescents in Taiwan: national surveys 2004-2006

Background

With the backdrop of a global ecstasy epidemic, this study sought to examine the trend, correlates, and onset sequence of ecstasy use among adolescents in Taiwan, where a well-established gateway drug such as marijuana is much less popular.

Methods

A multistage probability survey of school-attending adolescents in grades 7, 9, 10, and 12, aged 11–19 years, was conducted in 2004, 2005, and 2006. A self-administered anonymous questionnaire elicited response rates ranging from 94.3% to 96.6%. The sample sizes were 18232 respondents in 2004, 17986 in 2005, and 17864 in 2006.

Results

In terms of lifetime prevalence and incidence, ecstasy and ketamine by and large appeared as the first and second commonly used illegal drugs, respectively, among middle (grades 7 and 9) and high school students (grades 10 and 12) during the 3-year survey period; however, this order was reversed in the middle school-aged students starting in 2006. Having sexual experience, tobacco use, and betel nut use were factors consistently associated with the onset of ecstasy use across years. The majority of ecstasy users had been involved in polydrug use, such as the use of ketamine (41.4%–53.5%), marijuana (12.7%–18.7%), and methamphetamine (4.2%–9.5%).

Conclusion

From 2004 to 2006, a decline was noted in the prevalence and incidence rate of ecstasy, a leading illegal drug used by school-attending adolescents in Taiwan since the early 2000s. The emerging ketamine use trend may warrant more attention in the future.

Turkish high school students' attitudes toward addictive substances: association with perceived parental attitudes

The aim of this research is twofold: 1) to determine attitudes of high school students toward addictive substances; and 2) to determine students' attitudes toward addictive substances in terms of some variables including gender, grade, and perceived parental attitudes. To this end, Addictive Substances Attitudes Scale and Parental Attitudes Scale were given to a sample of 745 high school students (F = 330, M = 415) chosen by purposive sampling method. Results showed that compared to the males, females had more negative attitudes toward addictive substances. And compared to students from the upper grades, students from lower grades had more negative attitudes toward addictive substances. It is also found that students' attitudes toward addictive substances correlate with perceived parental attitudes. The correlation is low and positive for perceived democratic parental attitudes (r = .29), negative and low for perceived authoritarian parental attitudes (r = -.27).

Two decades of treatment seeking for substance use disorders in Saudi Arabia: trends and patterns in a rehabilitation facility in Dammam

BACKGROUND

Treatment provision and treatment seeking for substance use disorders is a relatively new phenomenon in the Middle East. The present study aims to study these trends among first admissions to the specialized addiction treatment Amal Hospital of Dammam over its first two decades (1986-2006). The main outcome measures were: annual inception number (AIN), relative frequency of substances (RFS), relative frequency of drug combinations (RFDC), mean number of substances (MNS), and sociodemographic changes.

RESULTS

A total of 12,743 patients were admitted between 1986 and 2006. The majority were aged 20-39 years (83%), never married (60%), and with low education (81%). In the second decade, subjects were significantly older and less unemployed than in the first decade (28.9 years versus 30.2 years; 27% versus 19%). The mean AIN rose from 509 in the first decade to 765 in the second decade. In the same periods, the RFS increased for amphetamines and cannabis (from 12.1 and 17.5% to 48.1 and 46.5%, respectively), decreased for heroin, sedatives and volatile substances (from 51.1, 15.1, and 6.1% to 22.5, 7.3, and 2.5%, respectively), and remained stable for alcohol (from 27.1 to 26.7%). The overall RFDC increased from 25.5 to 43.2% with significant pair-wise increases of cannabis/amphetamine, alcohol/cannabis and alcohol/amphetamine, and heroin/alcohol. The mean number of substances per subject increased from 1.32 to 1.56%.

CONCLUSIONS

Significant shifts have occurred in the types and patterns substances use among treatment-seeking subjects. These findings underscore the need for community-based epidemiologic studies and for the establishment of a comprehensive drug information system in Saudi Arabia.

Trends in prevalence of substance use among Icelandic adolescents, 1995-2006

Background

Adolescent substance use continues to be of great global public health concern in many countries with advanced economies. Previous research has shown that substance use among 15–16 year-old-youth has increased in many European countries in recent years. The aim of this study was to examine trends in prevalence of daily smoking, alcohol intoxication, and illicit substance use among Icelandic adolescents.

Methods

Repeated-measures, population-based cross-sectional surveys of between 3,100 and 3,900 10th-grade students who participated in the annual Youth of Iceland studies were analyzed, with response rates of between 80% and 90%.

Results

The prevalence of daily smoking, alcohol intoxication, and illicit substance use was at a peak in 1998, with almost 23% having reported daily smoking, 42% having reported becoming intoxicated at least once during the last 30 days, and over 17% having used hashish once or more often in their lifetime. By 2006, daily smoking had declined to 12%, having become intoxicated once or more often during the last 30 days to 25%, and having ever used hashish declined to 9%.

Conclusion

The prevalence of substance use among Icelandic 10^th graders declined substantially from 1995 to 2006. Proportions of adolescents who smoke cigarettes, had become intoxicated during the last 30 days, as well as those admitting to hashish use all decreased to a great deal during the period under study. The decline in prevalence of adolescent substance use in Iceland is plausibly the result of local community collaboration where researchers, policy makers and practitioners who work with young people have combined their efforts.

Alcohol and drug use among university students: gender differences

OBJECTIVE

This study compared the pattern of alcohol, legal and illegal drugs use among students of the Universidade de São Paulo (Brazil) in 1996 and 2001.

METHOD

Samples of 2.564 (1996) and 2.837 (2001) students answered a questionnaire proposed by the World Health Organization, which characterizes the consumption of alcohol, legal and illegal drugs in lifetime, in the last 12 months and in the last 30 days.

RESULTS

Men showed a significant increase in lifetime use of tobacco (44.8% to 50.9%), marijuana (33.7% to 39.5%) and hallucinogens (6.6% to 14.1%) between 1996 and 2001. No significant change was observed among women between 1996 and 2001 in tranquilizer use. Concerning the consumption reported in the last 12 months, both genders displayed significant increases in the consumption of marijuana (22.3% to 27.1% for men and 12.9% to 16.9% for women), amphetamines (1.9% to 5.0% for men and 3.4% to 5.6% for women), and inhalants (9.8% to 15.7% for men and 5.4% to 10.6% for women). The greatest gender difference was observed in consumption reported in the last 30 days with significant increases in male use of tobacco (19.6% to 23.5%), marijuana (15.8% to 20.5%), amphetamines (1.1% to 3.2%), and inhalants (4.0% to 7.9%). Substance use reported in the last 30 days remained stable among women between the 2 surveys.

CONCLUSION

Rates of substance use among university students increased. These gender differences in substance consumption should be taken into account in the development of preventive and treatment strategies for undergraduate university students.

Pharmacotherapy and psychotherapy in cannabis withdrawal and dependence

Cannabis has long been perceived as a drug causing questionable dependence. Only recently has a clinically recognized withdrawal syndrome been described, thus laying the foundations for specific treatment evaluations. Six different pharmacotherapies have been studied in cannabis withdrawal. Of these, only oral tetrahydrocannabinol, and perhaps mirtazapine, have shown some promise in the specific treatment of withdrawal symptoms. In cannabis dependence, rimonabant, and perhaps buspiron, have shown promising results. Clinical trials of oral tetrahydrocannabinol were less convincing. Cognitive and behavioral therapies and motivational enhancement therapies have proven their efficacy in several randomized controlled trials. Brief therapies have also been associated with good compliance and efficacy. Combinations with voucher incentives in certain populations have been associated with improved treatment compliance and reduced cannabis use. Only two studies have analyzed the cost-efficacy of psychotherapies. It would seem that brief combined cognitive and behavioral therapies, and motivational enhancement therapies are the most cost effective. For the moment, it is uncertain whether the additional treatment costs associated with voucher incentives are proportional to the accrued abstinence duration.

Anxiogenesis in adult rats treated chronically with cocaine during adolescence: effects of extended abstinence and 8-OH-DPAT treatment

Our laboratory has recently observed the development of an anxiogenic response after a short abstinence period ( approximately 10 days) in young adult rats treated repeatedly with cocaine during adolescence. The present study was conducted to determine if this effect persists into adulthood following extended durations of abstinence and whether it could be modulated with the 5-HT(1A) agonist (+/-)-8-hydroxy-2-(dipropylamino)tetralin hydrobromide (8-OH-DPAT). Accordingly, 30-day-old rats were injected with either 10mg/kg cocaine or saline for 8 consecutive days. Approximately 8 weeks after the final injection, anxiety levels in subjects were assessed with an elevated zero maze with a second assessment performed 4 weeks thereafter. Shortly prior to each test session, half the subjects in each of the two adolescent drug conditions received injections of 300 microg/kg 8-OH-DPAT while the other half received injections of the vehicle. Based on total time spent in the open areas of the maze, the results obtained at the first abstinent duration indicated that adolescent cocaine treatment did not induce an anxiogenic response. Assessment of maze behavior at the second abstinent duration was aided with a digital tracking and computerized scoring system (LimeLight, Actimetrics). Similar to the results obtained at the first abstinent duration, the amount of time spent in the open areas of the maze was unrelated to prior cocaine treatment. However, cocaine-treated rats did show evidence of an anxiogenic response at this abstinent duration based on more frequent entries into and out of the open and enclosed areas of the maze, more frequent and longer durations of exploratory bouts beyond the perimeter of the maze, excessive number of cautious protrusions into the open areas, and faster running velocities through the open areas. These results were not artifacts of generalized motor activation in that comparable total distance traveled scores were noted for all subjects. Treatment with 8-OH-DPAT shortly prior to elevated zero maze testing normalized these behaviors induced by adolescent cocaine. It is concluded that the anxiogenic response produced by cocaine exposure during adolescence persists 12 weeks beyond cessation of drug treatment and that this effect is reversible with 8-OH-DPAT. In addition, the results underscore the importance of taking multiple measures when assessing anxiety in experimental animals. Implications for the neurobiology of drug abuse and the role of serotonin are discussed.

Social correlates of cigarette smoking among Icelandic adolescents: a population-based cross-sectional study

BACKGROUND

Previous research has shown that between 80 and 90 percent of adult smokers report having started smoking before 18 years of age. Several studies have revealed that multiple social factors influence the likelihood of smoking during adolescence, the period during which the onset of smoking usually occurs. To better understand the social mechanisms that influence adolescent smoking, we analyzed the relationship and relative importance of a broad spectrum of social variables in adolescent smoking in Iceland, a Nordic country with high per-capita income.

METHODS

We used cross-sectional data from 7,430 14- to 16 year-old students (approximately 81% of all Icelanders in these age cohorts) in the 2006 Youth in Iceland study. The Youth in Iceland studies are designed to investigate the role of several cognitive, behavioral, and social factors in the lives of adolescents, and the data collected are used to inform the design, implementation, and evaluation of substance use prevention programs that are being developed by Icelandic social scientists, policy makers, and practitioners.

RESULTS

Our analysis revealed that friends' smoking behavior and attitude toward smoking were strongly associated with adolescent smoking and other tobacco use, as well as alcohol consumption during the previous 30 days. Main protective factors were parent's perceived attitude toward smoking, the quantity of time spent with parents, absence of serious verbal conflict between parents and adolescents, and participation in physical activity. Family structure was related to adolescent smoking to a small extent, but other background factors were not.

CONCLUSION

We conclude that multiple social factors are related to adolescent smoking. Parents and other primary preventive agents need to be informed about the complicated nature of the adolescent social world in order to maximize their impact.

Child and adolescent externalizing behavior and cannabis use disorders in early adulthood: an Australian prospective birth cohort study

This study examined the association between age of onset and persistence of externalizing behavior and young adults' cannabis use disorders (CUDs). Data were from a 21 year follow-up of a birth cohort study in Brisbane, Australia. The present cohort consisted of 2225 young adults who had data available about CUDs at 21 years and externalizing behavior at 5 and 14 years. Young adults' CUDs were assessed using the CIDI-Auto. Child and adolescent externalizing behavior were assessed at the 5- and 14-year phases of the study. After controlling for confounding variables, children who had externalizing behavior at both 5 and 14 years (child-onset-persistent) (COP) had a substantial increase in risk of CUD at age 21 years (Odds ratio (OR)=2.5; 95% CI: 1.5, 4.2). This association was similar for those who had 'adolescent onset' (AO) externalizing behavior. However, there was no association between 'childhood limited' (CL) externalizing behavior and CUD. Externalizing behavior in adolescence is a strong predictor of subsequent CUD. Smoking and drinking at 14 years partially mediated the link between externalizing behavior and CUD.

Psychiatric symptoms in adolescents with Internet addiction: Comparison with substance use

AIMS

The aim of the present study was to compare psychiatric symptoms between adolescents with and without Internet addiction, as well as between analogs with and without substance use.

METHODS

A total of 3662 students (2328 male and 1334 female) were recruited for the study. Self-report scales were utilized to assess psychiatric symptoms, Internet addiction, and substance use.

RESULTS

It was found that Internet addiction or substance use in adolescents was associated with more severe psychiatric symptoms. Hostility and depression were associated with Internet addiction and substance use after controlling for other symptoms.

CONCLUSIONS

This result partially supports the hypothesis that Internet addiction should be included in the organization of problem behavior theory, and it is suggested that prevention and intervention can best be carried out when grouped with other problem behaviors. Moreover, more attention should be devoted to hostile and depressed adolescents in the design of preventive strategies and the related therapeutic interventions for Internet addiction.

Prevalence and correlates of substance use among high school students in South Africa and the United States

OBJECTIVES

We compared prevalence rates and correlates of substance use among high school students in South Africa and the United States.

METHODS

We used weighted data from 2 nationally representative surveys of high school students. We conducted bivariate and multivariate analyses and examined between-country differences in rates and correlates of substance use were examined.

RESULTS

Rates of past-month alcohol and marijuana use were lower among South African students than among US students, but rates of illicit hard drug use were higher. Correlates of use in the 2 countries differed. For example, female gender was protective against tobacco, alcohol, and marijuana use in South Africa, whereas in the United States it was protective only against marijuana use. Black race/ethnicity was associated with lower rates of past-month cigarette and alcohol use in both countries, but the protective effect for alcohol use was stronger in South Africa.

CONCLUSIONS

Crosscultural studies can elucidate common and culturally unique pathways to drug use. Our results can inform future research, policies, and behavioral interventions in South Africa.

Risk/protective factors associated with substance use among runaway/homeless youth utilizing emergency shelter services nationwide

Rates of alcohol, tobacco, and marijuana use among runaway/homeless youth are substantially higher than found among American high school students. To understand the risk and protective factors associated with substance use, this study (1) assessed cigarette, alcohol, and marijuana use among a national sample of runaway/homeless youth, (2) identified risk/protective factors associated with lifetime substance use, and (3) examined risk/protective factors associated with six month frequency of substance use. Unduplicated cases (n = 11,841) from the 1997 Runaway/ Homeless Youth Management Information System (RHY MIS) were analyzed. Results showed that substance use levels are greater than previously reported for this population. Predictors of cigarette, alcohol, and marijuana use and frequency were predominately individual youth risk factors and demographics rather than family risk factors. Providers in emergency youth shelters are in a prime position to assess substance use behaviors, as well as the associated risk factors. Provision of appropriate screening and referral to other services is essential to meet the needs of these youth.

Children's disruptiveness, peer rejection, friends' deviancy, and delinquent behaviors: a process-oriented approach

This study examined whether peer rejection and affiliation with deviant friends throughout childhood could mediate the link between early disruptiveness and two aspects of delinquent behaviors (i.e., violence and substance use) in a sample of 375 children. Furthermore, we tested whether the two putative mediators operated in a sequential manner or in a parallel manner. Participants' disruptiveness, peer rejection, and friends' deviancy were assessed throughout childhood (ages 7 to 13). Delinquency-related outcomes were assessed at ages 14 and 15 years. Results indicate that the sequential mediational model was supported when delinquency-related violence was the outcome, but not when substance use was the outcome. The discussion stresses the differential role of peer rejection and affiliation with deviant friends in regard to the two outcomes considered in this study and in regard to the time frame when they were measured.

Comparison of tobacco, alcohol and illegal drug usage among school students in three Pacific Island societies

BACKGROUND

Many Pacific Island countries are in social and epidemiological transition, but there are little population data about drug and alcohol usage among adolescents in this region.

METHODS

Random samples of school students aged 11-17 years completed surveys in three populations: Pohnpei State in the Federated States of Micronesia (n=1495), Tonga (n=2808) and Vanuatu (n=4474).

RESULTS

Among 15-year-olds, boys in Tonga reported the highest prevalence of weekly smoking (29%), followed by boys in Pohnpei (17%). Kava use at a potentially harmful level (i.e. daily) was low in all countries. Drunkenness on two or more occasions was much more common among 15-year-old boys in Pohnpei (51%) than same-age youth in the other countries. Marijuana use was most often reported by boys (20%) and girls (20%) in Pohnpei, while solvents had been used most often by boys in Pohnpei (15%), and methylated spirits by boys in Tonga (20%). In all countries bullying of other students was independently related to regular smoking, while bullying behaviour and strong relationships with peers and others outside of the family were related to past drunkenness and use of illegal drugs in Tonga and Vanuatu.

CONCLUSIONS

Overall, levels of adolescent substance use were consistently higher in Tonga and Pohnpei than in Vanuatu. These unique data provide a basis for setting priorities and evaluating action to address the health risks posed by substance use in these Pacific Island societies.

Profiles of current disruptive behavior: association with recent drug consumption among adolescents

Instead of using scale thresholds and standard diagnostic criteria, latent class analysis was used to elucidate distinct subgroups of adolescents based on symptom profiles of the 24 Youth Self-Report items assessing attention-deficit hyperactivity, oppositional and conduct problem behaviors. We then investigated the extent to which being classified into different classes of disruptive behavior was associated with drug consumption in the month prior to the survey assessment. Three latent classes of disruptive behavior emerged along a continuum of severity. Youth classified into a class representing multiple and more serious behavior problems were found to have the highest rates of drug use, particularly involving inhalants and marijuana. Contrary to our hypotheses, younger adolescent females in this class reported a higher rate of past month drug use than similarly aged males. Drug use also was found to be common among youth in a class with a greater proportion of subclinical levels of behavior problems. Adolescents evidencing multiple behavior problems, particularly emerging conduct problems, need to be thoroughly assessed for recent drug involvement.

Experimental test of the affect-regulation theory of bulimic symptoms and substance use: a randomized trial

OBJECTIVE

Conduct a randomized trial to test whether a cognitive behavioral intervention designed to decrease depressive symptoms produces subsequent decreases in bulimic and substance use symptoms.

METHOD

Female participants (N = 145) with elevated depressive symptoms were randomly assigned to a 4-session depression intervention or a measurement-only condition and assessed through 6-month follow-up.

RESULTS

Relative to control participants, intervention participants showed decreases in depressive symptoms. Intervention participants also showed significantly greater reductions in bulimic symptoms, but not substance use, and change in depressive symptoms mediated this effect for bulimic symptoms.

CONCLUSION

The results provide experimental support for the theory that affect disturbances contribute to bulimic pathology, but do not support the affect regulation theory of substance use.

Psychiatric and psychosocial predictors of substance use disorders among adolescents: longitudinal study

BACKGROUND

Few studies have prospectively examined psychosocial and psychiatric predictors of adolescent substance use disorders simultaneously.

AIMS

To identify psychosocial and psychiatric predictors of substance use disorders in adolescence.

METHOD

School children aged 12 years (s.d.=0.3) free from any substance use disorder at grade 7 (n=428) were assessed in three consecutive years, using a standardised psychiatric interview. Their baseline psychosocial information was also collected. The outcome was the onset age of a substance use disorder. The Cox regression model was used for data analysis.

RESULTS

The most significant predictive factors for adolescent substance use disorder included male gender, attention-deficit hyperactivity disorder, conduct disorder and sibling use of tobacco. Three protective factors against such morbidity included living in a household with two parents, a good academic grade at grade 7 and objection to the use of substances.

CONCLUSIONS

Early intervention for disruptive behaviour disorders and specific psychosocial risk factors might prevent substance use disorders in early adolescence.

Tridimensional personality of adolescents with internet addiction and substance use experience

OBJECTIVE

This study aimed to examine the differences in personality characteristics between adolescents with and without Internet addiction and substance use experience as defined by the Tridimensional Personality Questionnaire (TPQ), and to compare personality characteristics among groups of adolescents with both Internet addiction and substance use experience (comorbid group), those with only Internet addition (Internet addiction group), those with only substance use experience (substance experience group), and those without Internet addiction or substance use experience (control group).

METHOD

In the cross-sectional investigation, we recruited 3662 students (2328 boys and 1334 girls) from high schools in southern Taiwan. Our investigation was conducted using the TPQ, the Chen Internet Addiction Scale, and Questionnaires for Experience in Substance Use.

RESULTS

Adolescents with Internet addiction were more likely to have substance use experience. High novelty seeking (NS), high harm avoidance (HA), and low reward dependence (RD) predicted a higher proportion of adolescents with Internet addiction. High NS, low HA, and low RD predicted a higher proportion of adolescents with substance use experience. Of the 4 groups, the Internet addiction group had the highest HA scores and the comorbid group had the lowest HA scores.

CONCLUSION

Adolescents with high NS and low RD should be provided with effective strategies for preventing Internet addiction and substance use. In addition, the Internet addiction group and the comorbid group should be provided with different preventative strategies focused on HA.

Relationship of binge drinking and other health-compromising behaviors among urban adolescents in China

PURPOSE

To describe frequency and patterns of alcohol use and explore the association between binge drinking and other health-compromising behaviors among adolescents in urban China.

METHODS

Data on alcohol use and other behavioral risk factors were obtained from the 2004 China Adolescent Behavioral Risk Factor Survey conducted in 18 provincial capitals. Chi-square test was used to estimate the prevalence of alcohol use and compare differences in drinking frequency by gender, school type, and grade. Logistic regression was used to estimate the association between binge drinking and other health-compromising behaviors.

RESULTS

Data were available on 54,040 students in grades 7 to 12. In all, 51.1% of students reported ever using alcohol (male: 58.6%; female: 44.3%), 29.7% reported drinking before 13 years of age, and 14.1% had gotten drunk at least once during the past year. In the 30 days preceding the interview, 25.2% students reported consuming at least one alcoholic drink (male: 31.4%; female: 19.6%) and 10.3% reported at least one episode of binge drinking (male: 14.4%; female: 6.6%). Male students from vocational senior high schools reported the highest frequency of alcohol use. The prevalence of other risk behaviors, such as smoking, drug use, and fighting were significantly higher among students with a positive history of binge drinking.

CONCLUSIONS

Alcohol use among urban adolescents is a major problem in China. A comprehensive alcohol control policy is needed, incorporating measures to educate the public about the dangers of adolescent alcohol use and regulating access and purchase of alcohol by minors.

Craving and other characteristics of the comorbidity of alcohol and nicotine dependence

PURPOSE

In this cross-sectional study we compared alcohol-dependent smokers and non-alcohol-dependent smokers with respect to intensity of nicotine dependence, craving conditions, sleep disturbances, comorbidity with major depression, reasons for smoking, accompanying somatic diseases and patients' prolonged abstinence from smoking during the 3 years preceding the study.

SUBJECTS AND METHODS

Fifty-one alcohol-dependent smokers and 327 non-alcohol-dependent smokers diagnosed as ICD-10 and DSM-IV-nicotine dependent, were investigated by means of the Fagerström Test for Nicotine Dependence, the Lübeck Craving-Recurrence Risk Questionnaire and the Lesch Alcohol Dependence Typology (both adapted to smoking).

RESULTS

The intensity of nicotine dependence was more enhanced in alcohol-dependent smokers compared to non-alcohol-dependent smokers. Several variables of all factors of craving ("depressive mood", "stimulation", "relaxation", "socially triggered tension") were significantly increased in alcohol-dependent patients (P<0.05). Alcohol-dependent smokers showed depressive symptoms and sleep disturbances, whilst non-alcohol-dependent individuals mainly smoked for stress release and weight control.

DISCUSSION

Our study demonstrates that the intensity of nicotine dependence, several conditions of craving for nicotine, sleep disturbances and symptoms of depression appear to be enhanced in alcohol-dependent smokers compared with non-alcohol-dependent smokers. Conclusions. - It is hoped that the factors of craving and reasons for smoking identified in this study will contribute to a better understanding of smoking temptation in alcohol-dependent smokers and non-alcohol-dependent smokers in future.