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Cheng J, Liang X, Zhang J, Yu H, Chen Y, Ge J. Post-traumatic Reactions and Social-Emotional Competence Among Chinese High School Students Experiencing COVID-19 Lockdown: A Network Analysis. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01760-9. [PMID: 39302499 DOI: 10.1007/s10578-024-01760-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2024] [Indexed: 09/22/2024]
Abstract
In the post-pandemic era, psychological traumas have emerged as major mental health issues. However, the post-traumatic reactions and their connections with social-emotional competence among high school students experiencing COVID-19 lockdown have not been adequately explored. This study aimed to reveal the characteristics of their positive and negative post-traumatic reactions, and their connections with social-emotional competence. Network analysis was used on data from 1096 Chinese high school students who experienced COVID-19 lockdown. Measures included the DSECS-S, the PTGI and the PC-PTSD-5. The results revealed that "Valuing life" and "Recalling unwillingly" were identified as core factors of post-traumatic reactions, while "Having close friendships", "Getting along well with others" and "Respecting others' emotions" played a bridging role in connecting the communities of social-emotional competence and post-traumatic reactions. This study enriches research on post-traumatic reactions, emphasizing the importance of implementing social-emotional competence programs to tackle mental health crises.
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Affiliation(s)
- Jiaqi Cheng
- College of Geography and Environmental Sciences, Zhejiang Normal University, Jinhua, China
| | - Xiaoyu Liang
- College of Education and Human Development, Zhejiang Normal University, Yingbin Avenue, Jinhua, China
| | - Jianzhen Zhang
- College of Geography and Environmental Sciences, Zhejiang Normal University, Jinhua, China
| | - Hongmei Yu
- College of Geography and Environmental Sciences, Zhejiang Normal University, Jinhua, China
| | - Yifei Chen
- College of Geography and Environmental Sciences, Zhejiang Normal University, Jinhua, China
| | - Jiahao Ge
- College of Education and Human Development, Zhejiang Normal University, Yingbin Avenue, Jinhua, China.
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Jouriles EN, Johnson E, Rancher C, Johnson JLC, Cook K, McDonald R. Adolescents Who Have Been Sexually Abused: Trauma Symptoms and Self-Blame while Waiting for Treatment. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:680-689. [PMID: 35486470 DOI: 10.1080/15374416.2022.2051527] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Adolescents who have been sexually abused commonly experience trauma symptoms, and many are referred for trauma-based treatment. However, they sometimes spend considerable time on waitlists before beginning treatment. This study examines the course of trauma symptoms among adolescents who have been sexually abused and are waiting for treatment, and the extent to which self-blame for the abuse predicts trauma symptoms at the beginning of treatment. METHOD Participants were 127 adolescents (89.0% female, Mage = 13.61 years; 53.2% identified as Hispanic) at a Children's Advocacy Center in the southern United States. All had reported being sexually abused. Participants reported on their trauma symptoms and self-blame appraisals at a screening assessment (T1), and trauma symptoms were re-assessed at the beginning of treatment (T2). RESULTS The mean level of trauma symptoms declined over time for the total sample. Regression analyses indicated that greater self-blame for the abuse at T1 was associated with higher levels of trauma symptoms at T2, even when controlling for T1 trauma symptoms and other correlates of T2 trauma symptoms. Higher levels of trauma symptoms at T1 and adolescent sex (female) were also associated with higher levels of trauma symptoms at T2. CONCLUSIONS Findings suggest that assessing for self-blame for sexual abuse may be important in triage and treatment planning for youth with trauma symptoms after experiencing sexual abuse.
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Affiliation(s)
| | - Emily Johnson
- Department of Psychology, Southern Methodist University, Texas, USA
| | - Caitlin Rancher
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, South Carolina, USA
| | | | | | - Renee McDonald
- Department of Psychology, Southern Methodist University, Texas, USA
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3
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Gkintoni E, Kourkoutas E, Yotsidi V, Stavrou PD, Prinianaki D. Clinical Efficacy of Psychotherapeutic Interventions for Post-Traumatic Stress Disorder in Children and Adolescents: A Systematic Review and Analysis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:579. [PMID: 38790574 PMCID: PMC11119036 DOI: 10.3390/children11050579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 04/30/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
Background: This systematic review aggregates research on psychotherapeutic interventions for Post-Traumatic Stress Disorder (PTSD) in children and adolescents. PTSD in this demographic presents differently from adults, necessitating tailored therapeutic approaches. In children and adolescents, PTSD arises from exposure to severe danger, interpersonal violence, or abuse, leading to significant behavioral and emotional disturbances that jeopardize long-term development. The review focuses on describing PTSD within two age groups, children (6 to 12 years) and adolescents (12 to 18 years), while evaluating the effectiveness of various clinical interventions aimed at this condition. Methods: Utilizing the PRISMA guidelines, this review systematically examines studies that assess clinical interventions for PTSD in the younger population. Results: Key symptoms of PTSD in children and adolescents include avoidance, overstimulation, flashbacks, depression, and anxiety. The review identifies several effective treatments, including Cognitive Behavioral Therapy (CBT), Trauma-Focused CBT (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR), Systemic Therapy, Play Therapy, Exposure Therapy, Relaxation Techniques, and Psychodynamic Psychotherapy. Particularly, TF-CBT is highlighted as the most effective and commonly used method in treating childhood and adolescent PTSD, as supported by most of the studies reviewed. Conclusions: A significant outcome of this study is the short-term effectiveness of CBT in reducing PTSD symptoms in children and adolescents. The findings underline the importance of psychotherapeutic interventions and mark a substantial advancement in understanding PTSD in young populations. It is crucial for practitioners to integrate various psychotherapeutic strategies into their practice to improve patient outcomes and treatment efficacy.
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Affiliation(s)
- Evgenia Gkintoni
- Department of Psychiatry, University General Hospital of Patras, 26504 Patras, Greece
| | - Elias Kourkoutas
- Department of Primary Education, Research Center for the Humanities, Social and Education Sciences, University of Crete, 74100 Rethymno, Greece;
| | - Vasiliki Yotsidi
- Department of Psychology, Panteion University, 17671 Athens, Greece;
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Vidal C, Simon KM, Brooks C, White J, Hinckley JD. A systematic review of evidence on integrated management of psychiatric disorders in youth who use cannabis. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 10:100216. [PMID: 38288007 PMCID: PMC10823056 DOI: 10.1016/j.dadr.2023.100216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 01/31/2024]
Abstract
Given the risks to mental health associated with cannabis use in youth and the increase in cannabis legalization worldwide and in the U.S., there is a need to understand existing evidence-based approaches to integrated management of psychiatric disorders in youth who use cannabis. This systematic review aimed to appraise the current evidence on integrated treatment for adolescents and young adults with common psychiatric disorders who engage in regular cannabis use. A total of 989 studies were screened for inclusion. Study's titles and abstracts were screened and advanced to full text review for further screening by two independent reviewers. Thirty-five full-text articles were reviewed, with five articles ultimately meeting all criteria for inclusion. Five randomized controlled trials examined the effects of therapeutic interventions in youth with common psychiatric disorders who used cannabis, including two studies on depression, one on bipolar disorder, one on anxiety and one on PTSD were reviewed. No studies were considered high in risk of bias. Overall, there is a paucity of research on the treatment of comorbid adolescent mental health disorders and cannabis use, which limits the ability to draw evidence-based treatment recommendations.
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Affiliation(s)
- Carol Vidal
- Johns Hopkins School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
| | - Kevin M Simon
- Harvard Medical School, Department of Psychiatry, USA
| | - Caroline Brooks
- Johns Hopkins School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
| | - Jacob White
- SOM Admin Welch Informationist Services, USA
| | - Jesse D Hinckley
- University of Colorado School of Medicine, Department of Psychiatry, USA
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5
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Pasqualoni S, Bai Y, Curl A, Rettew J, Kimball L, Devadanam V, Yousef H, Hudziak J, Copeland WE. The substance use behaviors change of first-year college students before and during COVID-19 pandemic. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-8. [PMID: 38227917 DOI: 10.1080/07448481.2023.2299419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 12/10/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE This article tests the substance use behaviors of college students before and during COVID-19 pandemic. METHODS In-depth assessment and nightly survey data was used from a longitudinal study (n = 675) which examined student substance use during the 2019-2020 academic year, both before and during the onset of the COVID-19 pandemic. Changes in beer/wine, tobacco, liquor, and marijuana use before versus during the pandemic, in addition to the interaction of COVID-19, were tested with gender and subjective social status. RESULTS Marijuana use significantly decreased from a weekly prevalence of 9.9% before COVID-19 to 6.4% during COVID-19 (p = 0.002). A similar decrease was seen in liquor use (10.6% before COVID to 6.4% during COVID, p = 0.01). There was no significant change observed for beer/wine use or for tobacco use. CONCLUSION In the wake of the COVID-19 pandemic, liquor, and marijuana use decreased for college students, while other substance use stayed the same.
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Affiliation(s)
| | - Yang Bai
- University of Utah, Salt Lake City, Utah, USA
| | - Azilee Curl
- University of Vermont, Burlington, Vermont, USA
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Adams ZW, Marriott BR, Hulvershorn LA, Hinckley JD. Treatment of Adolescent Cannabis Use Disorders. Psychiatr Clin North Am 2023; 46:775-788. [PMID: 37879838 DOI: 10.1016/j.psc.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
This review summarizes treatments for cannabis use disorder (CUD) in adolescents. The best supported CUD treatments are cognitive behavioral psychotherapies, including family-based models that facilitate environmental changes and youth-focused models that incorporate skills training, motivational interviewing, and contingency management to promote reductions in cannabis use. Some medications show promise in reducing cannabis craving and withdrawal symptoms. Further research is needed on the efficacy and implementation of existing treatments given the changes in cannabis use trends over time and on emerging technologies that may expand access to evidence-based CUD treatments.
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Affiliation(s)
- Zachary W Adams
- Department of Psychiatry, Indiana University School of Medicine, 410 West 10th Street, Suite 2000, Indianapolis, IN 46202, USA.
| | - Brigid R Marriott
- Department of Psychiatry, Indiana University School of Medicine, 410 West 10th Street, Suite 2000, Indianapolis, IN 46202, USA
| | - Leslie A Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, 1002 Wishard Boulevard, Suite 4110, Indianapolis, IN 46202, USA
| | - Jesse D Hinckley
- Department of Psychiatry, University of Colorado School of Medicine, 13001 East 17th Place, MS-F546, Aurora, CO 80045, USA. https://twitter.com/JHinckleyMDPhD
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Becker TD, Castañeda Ramirez S, Bruges Boude A, Leong A, Ivanov I, Rice TR. Interventions for prevention and treatment of substance use in youth with traumatic childhood experiences: a systematic review and synthesis of the literature. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02265-x. [PMID: 37480386 DOI: 10.1007/s00787-023-02265-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 07/18/2023] [Indexed: 07/24/2023]
Abstract
Most substance use begins in adolescence. Both childhood trauma and associated post-traumatic stress disorder (PTSD) increase risk for early substance use, which is associated with greater eventual severity of substance use disorders (SUDs). When co-occurring, PTSD and SUD can reinforce and exacerbate each other, necessitating integrated treatment approaches. To systematically review existing literature on interventions for prevention or treatment of SUDs among adolescents (aged 10-24) with a history of trauma, with or without PTSD, we searched databases (PubMed, PsycInfo, CINAHL, Cochrane CENTRAL) using search terms related to substance use, trauma, adolescents, and interventions. Searches identified 8134 unique articles, 68 of which prompted full-text screening. Authors extracted data, applied the Effective Public Health Practice Project Quality Assessment Tool to evaluate the evidence, and synthesized findings. Thirty three articles met eligibility criteria, including 13 RCTs. Twenty studies (10 RCTs) evaluated interventions for substance use and co-occurring problems among youth with a history of trauma, predominantly via individual therapy based on cognitive-behavioral principles, although group therapy, case management, and other approaches have also been studied. Interventions with exposure-based components were infrequent but had robust results and minimal adverse outcomes. Thirteen studies examined differential response of youth with a history of trauma to standard SUD treatments, compared to youth without a history of trauma, with mixed findings. Youth with a history of trauma face elevated risk of SUDs and may respond differently to SUD treatments. Several promising interventions have been recently developed.
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Affiliation(s)
- Timothy D Becker
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Psychiatry, NewYork-Presbyterian Hospital/Weill Cornell, 525 E. 68th Street, Box 140, New York, NY, 10065, USA.
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians & Surgeons, New York, USA.
| | | | - Adriana Bruges Boude
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alicia Leong
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Iliyan Ivanov
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Timothy R Rice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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8
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Andrews AR, Walker J, Bernard DL, Adams Z, de Arellano M, Danielson CK. Clinical diversity in a randomized trial that explicitly sought racial/ethnic diversity in its sample: Baseline comparisons in a treatment of youth substance use and posttraumatic stress. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2023; 15:S183-S191. [PMID: 36862478 PMCID: PMC10259880 DOI: 10.1037/tra0001444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE For more than two decades, federal agencies have sought to address a persistent lack of inclusion of Black, Latinx, Asian, and indigenous peoples in randomized controlled trials (RCTs), often with an underlying hypothesis that such efforts will increase diversity across clinically-relevant dimensions. We examined racial/ethnic and clinical diversity, including racial/ethnic differences in prior service access and symptom dimensions, in an RCT focusing on trauma-related mental health and substance use among adolescents. METHOD Participants were 140 adolescents in an RCT of Reducing Risk through Family Therapy. Recruitment followed several recommendations for enhancing diversity. Structured interviews examined trauma exposure, posttraumatic stress disorder (PTSD) and depression symptoms, substance use, service utilization, and demographics. RESULTS Non-Latinx (NL) Black youth were more likely to receive mental health services for the first time and have greater trauma exposure, but less likely to report symptoms of depression (ps < .05) relative to NL White youth. Relevant caregiver differences included that NL Black caregivers were more likely to be unemployed and looking for work (p < .05) despite having similar levels of education relative to NL White caregivers (p > .05). CONCLUSION Results suggest that efforts to expand racial/ethnic diversity in an RCT of combined substance use and trauma-focused mental health may also expand other clinical dimensions. Many of these differences reflect multiple dimensions of racism experienced by NL Black families that clinicians must attend to. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Arthur R Andrews
- Department of Psychology, Institute for Ethnic Studies, University of Nebraska-Lincoln
| | | | - Donte L Bernard
- Department of Psychological Sciences, University of Missouri
| | - Zachary Adams
- Department of Psychiatry, Indiana University School of Medicine
| | - Michael de Arellano
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
| | - Carla Kmett Danielson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
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9
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Verma S. Substance Use Disorders and Role of Complementary and Integrative Medicine/Functional Medicine. Child Adolesc Psychiatr Clin N Am 2023; 32:217-241. [PMID: 37147038 DOI: 10.1016/j.chc.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Substance use disorders are a growing concern for all ages, including adolescents. Even though there is an increase in recreational substance use and a wider variety of drugs is available to this young population, treatment options remain scarce. Most medications have limited evidence in this population. Few specialists treat individuals struggling with addiction along with mental health disorders. As the evidence grows, these treatments are usually included in complementary and integrative medicine. This article discusses available evidence for many complementary and integrative treatment approaches while briefly describing existing psychotherapeutic and psychotropic medications.
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Affiliation(s)
- Shikha Verma
- Evolve-PC Residential Treatment Centers, CA; Department of Psychiatry and Behavioral Health, Rosalind Franklin University of Medicine and Science, IL.
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10
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Coffman DL, Ayer L, Schuler MS, Godley MD, Griffin BA. The Role of Pre-Treatment Traumatic Stress Symptoms in Adolescent Substance Use Treatment Outcomes. Subst Use Misuse 2023; 58:551-559. [PMID: 36762441 PMCID: PMC11311142 DOI: 10.1080/10826084.2023.2177960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Background: Prominent theories suggest that individuals with co-occurring traumatic stress symptoms (TSS) and substance use (SU) may be less responsive to SU treatment compared to those with SU only. However, empirical findings in adult samples are mixed, and there has been limited work among adolescents. This study assesses the association between TSS and SU treatment outcomes among trauma-exposed adolescents, using statistical methods to reduce potential confounding from important factors such as baseline SU severity. Method: 2,963 adolescents with lifetime history of victimization received evidence-based SU treatment in outpatient community settings. At baseline, 3- and 6-months, youth were assessed using the Global Appraisal of Individual Needs Traumatic Stress Scale and the Substance Frequency Scale. Propensity score weighting was used to mitigate potential confounding due to baseline differences in sociodemographic characteristics and SU across youth with varying levels of TSS. Results: Propensity score weighting successfully balanced baseline differences in sociodemographic factors and baseline SU across youth. Among all youth, mean SU was lower at both 3- and 6- month follow-up relative to baseline, indicating declining use. After adjusting for potential confounders, we observed no statistically significant relationship between TSS and SU at either 3- or 6-month follow-up. Conclusions: Based on this investigation, conducted among a large sample of trauma-exposed youth receiving evidence-based outpatient SU treatment, baseline TSS do not appear to be negatively associated with SU treatment outcomes. However, future research should examine whether youth with TSS achieve better outcomes through integrative treatment for both SU and TSS.
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11
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Adams ZW, Marriott BR, Hulvershorn LA, Hinckley J. Treatment of Adolescent Cannabis Use Disorders. Child Adolesc Psychiatr Clin N Am 2023; 32:141-155. [PMID: 36410901 PMCID: PMC10097012 DOI: 10.1016/j.chc.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This review summarizes treatments for cannabis use disorder (CUD) in adolescents. The best supported CUD treatments are cognitive behavioral psychotherapies, including family-based models that facilitate environmental changes and youth-focused models that incorporate skills training, motivational interviewing, and contingency management to promote reductions in cannabis use. Some medications show promise in reducing cannabis craving and withdrawal symptoms. Further research is needed on the efficacy and implementation of existing treatments given the changes in cannabis use trends over time and on emerging technologies that may expand access to evidence-based CUD treatments.
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Affiliation(s)
- Zachary W Adams
- Department of Psychiatry, Indiana University School of Medicine, 410 West 10th Street, Suite 2000, Indianapolis, IN 46202, USA.
| | - Brigid R Marriott
- Department of Psychiatry, Indiana University School of Medicine, 410 West 10th Street, Suite 2000, Indianapolis, IN 46202, USA
| | - Leslie A Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, 1002 Wishard Boulevard, Suite 4110, Indianapolis, IN 46202, USA
| | - Jesse Hinckley
- Department of Psychiatry, University of Colorado School of Medicine, 13001 East 17th Place, MS-F546, Aurora, CO 80045, USA. https://twitter.com/JHinckleyMDPhD
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12
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Calhoun CD, Stone KJ, Cobb AR, Patterson MW, Danielson CK, Bendezú JJ. The Role of Social Support in Coping with Psychological Trauma: An Integrated Biopsychosocial Model for Posttraumatic Stress Recovery. Psychiatr Q 2022; 93:949-970. [PMID: 36199000 PMCID: PMC9534006 DOI: 10.1007/s11126-022-10003-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 11/29/2022]
Abstract
This theoretical review proposes an integrated biopsychosocial model for stress recovery, highlighting the interconnectedness of intra- and interpersonal coping processes. The proposed model is conceptually derived from prior research examining interpersonal dynamics in the context of stressor-related disorders, and it highlights interconnections between relational partner dynamics, perceived self-efficacy, self-discovery, and biological stress responsivity during posttraumatic recovery. Intra- and interpersonal processes are discussed in the context of pre-, peri-, and post-trauma stress vulnerability as ongoing transactions occurring within the individual and between the individual and their environment. The importance of adopting an integrated model for future traumatic stress research is discussed. Potential applications of the model to behavioral interventions are also reviewed, noting the need for more detailed assessments of relational dynamics and therapeutic change mechanisms to determine how relational partners can most effectively contribute to stress recovery.
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Affiliation(s)
- Casey D Calhoun
- Department of Psychology and Neuroscience, University of North Carolina, 235 E. Cameron Avenue, CB 3270, Chapel Hill, NC, 27599, USA.
| | - Katie J Stone
- Division of Clinical Behavioral Neuroscience, University of Minnesota, Masonic Institute for the Developing Brain, Minneapolis, MN, USA
| | - Adam R Cobb
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Megan W Patterson
- Anschutz Medical Campus, Department of Psychiatry, University of Colorado, Aurora, CO, USA
| | - Carla Kmett Danielson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jason José Bendezú
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
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13
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Jouriles EN, Sitton MJ, Adams A, Jackson M, McDonald R. Non-supportive responses to adolescents who have experienced sexual abuse: Relations with self-blame and trauma symptoms. CHILD ABUSE & NEGLECT 2022; 134:105885. [PMID: 36179384 DOI: 10.1016/j.chiabu.2022.105885] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Youth who have experienced sexual abuse sometimes also experience non-supportive responses, such as accusations of lying, from people in their family and social environment. Little is known about how such responses from different sources (caregivers, friends, other adults) correlate with one another and operate together in the prediction of youth problematic thinking, such as self-blame, and trauma symptoms. OBJECTIVE To better understand how non-supportive responses from different sources relate to one another and contribute to youth problems following sexual abuse. PARTICIPANTS AND SETTING Participants were 475 youths (Mage = 13.57, SD = 1.77) brought to a children's advocacy center in the southern United States. METHODS Participants completed measures of non-supportive responses from caregivers, friends, and other adults. They also completed measures of abuse-specific self-blame and trauma symptoms. RESULTS Non-supportive responses from caregivers, friends, and other adults correlated with each other and with abuse-specific self-blame and trauma symptoms (correlations ranged from 0.12 to 0.18; all p values <.001). Results of regression analyses indicated that only non-supportive responses from caregivers contributed independently to abuse-specific self-blame, whereas non-supportive responses from caregivers and friends contributed to trauma symptoms. CONCLUSIONS In the aftermath of sexual abuse, non-supportive responses from caregivers and friends relate to youth trauma symptoms. Assessing non-supportive responses broadly across the social network can be useful in understanding youth adjustment following sexual abuse.
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Affiliation(s)
- Ernest N Jouriles
- Department of Psychology, Southern Methodist University, P.O. Box 750442, Dallas, TX 75275-0442, USA.
| | - Melissa J Sitton
- Department of Psychology, Southern Methodist University, P.O. Box 750442, Dallas, TX 75275-0442, USA
| | - Adrianna Adams
- Department of Psychology, Southern Methodist University, P.O. Box 750442, Dallas, TX 75275-0442, USA
| | - Mindy Jackson
- Dallas Children's Advocacy Center, 5351 Samuell Blvd., Dallas, TX 75228, USA
| | - Renee McDonald
- Department of Psychology, Southern Methodist University, P.O. Box 750442, Dallas, TX 75275-0442, USA
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14
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Grummitt L, Barrett E, Kelly E, Newton N. An Umbrella Review of the Links Between Adverse Childhood Experiences and Substance Misuse: What, Why, and Where Do We Go from Here? Subst Abuse Rehabil 2022; 13:83-100. [PMID: 36411791 PMCID: PMC9675346 DOI: 10.2147/sar.s341818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/09/2022] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES A wealth of research has identified adverse childhood experiences (ACEs; abuse, neglect, violence or disorder in the home) as a strong risk factor for substance misuse. Synthesis of the existing evidence is critical to shape policy and inform directions for future research. Existing reviews have focused on specific substances or substance use outcomes (eg, disorder), and do not include discussion of the mechanisms that operate between ACEs and substance misuse. The current umbrella review aims to synthesize reviews on the relationship between ACEs and substance misuse, review the evidence on the mechanisms linking these, identify existing gaps in our knowledge, and discuss critical directions for future research, practice, and public policy. METHODS Two electronic databases (PsycINFO and Medline) were searched for reviews published between 1998 and 2022 on the link between ACEs and substance misuse. Twenty articles met eligibility criteria and were qualitatively synthesized. RESULTS Results overwhelmingly demonstrated an elevated risk of substance misuse or disorder, among adolescents and adults exposed to ACEs. Research on the mechanisms that explain this link highlights a multitude of potential intervention targets, with childhood stress propelling a cascade of effects across neurobiological, endocrine, immune, metabolic, and nervous systems, impacting psychosocial and cognitive functioning. Nonetheless, the literature is subject to limitations surrounding potential unmeasured cofounders and causality, as well as decontextualizing childhood adversity from broader structural issues that influence the link between ACEs and substance misuse. Research, policy, and practice that seek to holistically understand and address the relationship between ACEs and substance misuse within the broader social determinants of health is crucial.
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Affiliation(s)
- Lucinda Grummitt
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown, NSW, Australia
| | - Emma Barrett
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown, NSW, Australia
| | - Erin Kelly
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown, NSW, Australia
| | - Nicola Newton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown, NSW, Australia
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15
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Hinckley JD, Danielson CK. Elucidating the Neurobiologic Etiology of Comorbid PTSD and Substance Use Disorders. Brain Sci 2022; 12:brainsci12091166. [PMID: 36138902 PMCID: PMC9496654 DOI: 10.3390/brainsci12091166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 11/26/2022] Open
Abstract
Early childhood maltreatment and other traumatic event experiences ("trauma") are common among youth, including those with substance use problems including substance use disorders (SUD). Particularly, interpersonal violence is associated with high rates of comorbidity between posttraumatic stress disorder (PTSD) and SUD, and these comorbid disorders exhibit high levels of overlapping symptomatology. Theoretical models proposed to explain the bidirectional relationship between PTSD and SUD include the self-medication hypothesis and susceptibility hypothesis. In this article, we explore neurobiologic changes associated with trauma, PTSD, and SUD that underly dysregulated stress response. Examining lessons learned from recent translational and clinical research, we propose that further elucidating the neurobiologic etiology of comorbid PTSD and SUD will require a collaborative, interdisciplinary approach, including the integration of preclinical and clinical studies, exploration of biologic markers in clinical studies, and accumulation of larger studies and longitudinal studies with the power to study PTSD and SUD. Such research can transform the field and ultimately reduce high rates and costly impairment of co-occurring PTSD and SUD across the lifespan.
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Affiliation(s)
- Jesse D. Hinckley
- Division of Addiction Science, Treatment & Prevention, Department of Psychiatry, University of Colorado School of Medicine, 1890 N Revere Court, MS-F570, Aurora, CO 80045, USA
- Correspondence:
| | - Carla Kmett Danielson
- National Crime Victims Research & Treatment Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC 29425, USA
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16
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Roberts NP, Lotzin A, Schäfer I. A systematic review and meta-analysis of psychological interventions for comorbid post-traumatic stress disorder and substance use disorder. Eur J Psychotraumatol 2022; 13:2041831. [PMID: 35558682 PMCID: PMC9090345 DOI: 10.1080/20008198.2022.2041831] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/13/2022] [Accepted: 01/29/2022] [Indexed: 12/14/2022] Open
Abstract
Background The psychological treatment of comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) is clinically challenging, and outcomes are often poor. Objective This paper describes a systematic review and meta-analysis which sought to establish the current efficacy for a number of established psychological approaches for adults and adolescents, in comparison to interventions for SUD alone, or other active approaches, following a pre-registered protocol. Method This review followed PRISMA and Cochrane Collaboration guidelines. Data extraction and risk of bias judgements using Cochrane criteria were undertaken by all authors. Primary outcomes were PTSD severity and substance use post-treatment. The quality of findings was assessed using GRADE. Following a comprehensive search, conducted to 13 September 2021, 27 studies were included. Results We found a relatively high level of dropout across studies. In our main comparisons, we found no benefits for present-focused treatment approaches aimed at improving coping skills beyond those for SUD-only interventions. We found modest benefits for trauma-focused intervention plus SUD intervention post-treatment for PTSD (standardized mean difference (SMD) = -0.36, 95% confidence interval (CI) -0.64, -0.08), and at 6-13 months for PTSD (SMD = -0.48, 95% CI -0.81, -0.15) and alcohol use (SMD = -0.23, 95% CI -0.44, -0.02). There were no benefits for cognitive restructuring interventions as a group, but we found a modest effect for integrated cognitive behavioural therapy (ICBT) for PTSD post-treatment (SMD = -0.33, 95% CI -0.62, -0.04). There was evidence of some benefit for trauma-focused intervention over present-focused intervention for PTSD from a single study and for reduction in dropout for incentivized attendance for trauma-focused intervention from another single study. Most findings were of very low quality. Conclusion There is evidence that trauma-focused therapy and ICBT can improve PTSD for some individuals, but many patients do not fully engage with treatment and average treatment effects are modest. HIGHLIGHTS For PTSD, evidence was strongest for trauma-focused CBT-based approaches, but effects were modest.There was little evidence of any added benefit on substance use, beyond that of standard addiction treatments, for any included intervention.Dropout from treatment was high.
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Affiliation(s)
- Neil P. Roberts
- Cardiff & Vale University Health Board, Cardiff, UK
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Annett Lotzin
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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17
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Banks DE, Hahn AM, Goodrum NM, Bernard DL, Adams ZW, McCart MR, Chapman J, Sheidow AJ, de Arellano MA, Danielson CK. Sexual Risk Behavior among Adolescents Seeking Treatment for Posttraumatic Stress Disorder: Exploring Psychosocial & Symptom Correlates. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:181-191. [PMID: 35222783 PMCID: PMC8837759 DOI: 10.1007/s40653-021-00378-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 06/14/2023]
Abstract
Adolescents exposed to trauma experience disproportionate rates of HIV/STI. However, integrated treatment for trauma and sexual risk behavior is rare. To inform integrated prevention efforts, the current study describes prevalence and correlates of sexual risk behavior among adolescents seeking treatment for symptoms of posttraumatic stress and substance use disorders. Adolescents aged 13-18 years (N = 135; 88% female) with histories of interpersonal violence exposure completed pre-treatment questionnaires in a randomized controlled trial of an integrated psychotherapy for trauma and substance use symptomology. Adolescents reported high rates of sexual risk behaviors relative to national estimates and general mental health treatment samples. Symptoms of reexperiencing, substance use, and peer deviance were related to sexual risk behavior beyond the influence of other trauma symptoms. Individual and contextual psychosocial factors may be stronger predictors of sexual risk behavior than posttraumatic stress disorder symptoms among adolescents with trauma symptomology. Integrated interventions targeting traumatic stress, substance use, and sexual risk behavior concurrently may prevent revictimization and HIV/STI incidence among trauma-exposed youth.
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Affiliation(s)
- Devin E. Banks
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Columbia, US
- Department of Psychological Sciences, University of Missouri—St. Louis, St. Louis, MO US
| | - Austin M. Hahn
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Columbia, US
| | - Nada M. Goodrum
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Columbia, US
| | - Donte L. Bernard
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Columbia, US
| | - Zachary W. Adams
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN US
| | | | | | | | - Michael A. de Arellano
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Columbia, US
| | - Carla Kmett Danielson
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Columbia, US
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18
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Shenk CE, Keeshin B, Bensman HE, Olson AE, Allen B. Behavioral and pharmacological interventions for the prevention and treatment of psychiatric disorders with children exposed to maltreatment. Pharmacol Biochem Behav 2021; 211:173298. [PMID: 34774585 PMCID: PMC8643336 DOI: 10.1016/j.pbb.2021.173298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/20/2021] [Accepted: 11/08/2021] [Indexed: 01/21/2023]
Abstract
There is a well-established relation between exposure to child maltreatment and the onset and course of multiple, comorbid psychiatric disorders. Given the heterogeneous clinical presentations at the time services are initiated, interventions for children exposed to maltreatment need to be highly effective to curtail the lifelong burden and public health costs attributable to psychiatric disorders. The current review describes the most effective, well-researched, and widely-used behavioral and pharmacological interventions for preventing and treating a range of psychiatric disorders common in children exposed to maltreatment. Detailed descriptions of each intervention, including their target population, indicated age range, hypothesized mechanisms of action, and effectiveness demonstrated through randomized controlled trials research, are presented. Current limitations of these interventions are noted to guide specific directions for future research aiming to optimize both treatment effectiveness and efficiency with children and families exposed to maltreatment. Strategic and programmatic future research can continue the substantial progress that has been made in the prevention and treatment of psychiatric disorders for children exposed to maltreatment.
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Affiliation(s)
- Chad E Shenk
- Department of Human Development and Family Studies, The Pennsylvania State University, 115 Health and Human Development Building, University Park, PA 16802, USA; Department of Pediatrics, The Pennsylvania State University College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, USA.
| | - Brooks Keeshin
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA; Department of Psychiatry, University of Utah, 5021 Chipeta Way, Salt Lake City, UT 84108, USA.
| | - Heather E Bensman
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Anneke E Olson
- Department of Human Development and Family Studies, The Pennsylvania State University, 115 Health and Human Development Building, University Park, PA 16802, USA.
| | - Brian Allen
- Department of Pediatrics, The Pennsylvania State University College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, USA; Department of Psychiatry and Behavioral Health, The Pennsylvania State University College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, USA.
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19
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Schollar-Root O, Cassar J, Peach N, Cobham VE, Milne B, Barrett E, Back SE, Bendall S, Perrin S, Brady K, Ross J, Teesson M, Kihas I, Dobinson KA, Mills KL. Integrated Trauma-Focused Psychotherapy for Traumatic Stress and Substance Use: Two Adolescent Case Studies. Clin Case Stud 2021. [DOI: 10.1177/15346501211046054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Post-traumatic stress disorder (PTSD) and substance use disorder (SUD) occur frequently as comorbid diagnoses among adolescents. Historically, these conditions have been treated using a sequential model; however, emerging evidence suggests that an integrated treatment model may be most effective. This article presents two de-identified clinical case studies from an ongoing randomised controlled trial examining the efficacy of an integrated, exposure-based, cognitive-behavioral psychotherapy (CBT) for PTSD and SUD among adolescents (COPE-A), relative to a supportive counselling control condition (person-centred therapy). In both case studies, participants were randomised to receive the COPE-A integrated treatment, which incorporates prolonged exposure (PE) including imaginal and in vivo exposure as a core treatment component alongside CBT for PTSD and SUD. The clinical profile and treatment response of each participant is discussed. Promising results were found in both cases, with substantially reduced traumatic stress symptoms and decreased or stable levels of substance use by the end of treatment. Clinical implications of these early findings are discussed.
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Affiliation(s)
- Olivia Schollar-Root
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Joanne Cassar
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Natalie Peach
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Vanessa E Cobham
- School of Psychology, University of Queensland, St Lucia, QLD, Australia
- Children’s Health Queensland, Child & Youth Mental Health Service, QLD, Australia
| | - Bronwyn Milne
- The Department of Adolescent Medicine, Sydney Children’s Hospital Network, Sydney, NSW, Australia
| | - Emma Barrett
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Sudie E. Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Sarah Bendall
- Orygen, Melbourne, NSW, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
| | - Kathleen Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Joanne Ross
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Ivana Kihas
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Katherine A Dobinson
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Katherine L Mills
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
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20
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Randomized Controlled Trial of an Integrated Family-Based Treatment for Adolescents Presenting to Community Mental Health Centers. Community Ment Health J 2021; 57:1094-1110. [PMID: 33123838 PMCID: PMC8081741 DOI: 10.1007/s10597-020-00735-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
Most adolescents presenting to community mental health centers have one or more comorbidities (internalizing, externalizing, and substance use problems). We evaluated an integrated family-based outpatient treatment for adolescents (OPT-A) that can be delivered in a community mental health center by a single therapist. A sample of 134 youth/families were randomized to receive OPT-A or usual services, delivered at the same public sector mental health center. Repeated, multi-informant assessments occurred through 18-months post-baseline. At baseline, the sample displayed low internalizing symptoms, moderate substance use, and high externalizing problems. Compared to usual services, OPT-A had effects on abstinence rates, retention, motivation, parent involvement, and satisfaction, but not on internalizing or externalizing problems. While OPT-A achieved some key improvements for youth who present to community mental health centers, and families were satisfied with treatment, continued work is necessary to examine treatments for comorbidity while balancing treatment feasibility and complex strategies to boost treatment effectiveness.
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21
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Sheerin CM, Lancaster EE, York TP, Walker J, Danielson CK, Amstadter AB. Epigenome-Wide Study of Posttraumatic Stress Disorder Symptom Severity in a Treatment-Seeking Adolescent Sample. J Trauma Stress 2021; 34:607-615. [PMID: 33529416 PMCID: PMC8217087 DOI: 10.1002/jts.22655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/26/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023]
Abstract
Emerging research has demonstrated that psychosocial trauma exposure may elicit epigenetic changes, with downstream effects on the transcriptional regulation of genes. Epigenome-wide association studies (EWAS) offer an agnostic approach to examine DNA methylation (DNAm) associations and are a valuable tool to aid in the identification of biological pathways involved in posttraumatic stress disorder (PTSD). This study represents the first EWAS of PTSD in an adolescent sample, an important group given the significance of this developmental period regarding both DNAm changes and PTSD risk. The sample (n = 39, M age = 15.41 years, SD = 1.27, 84.6% female) comprised adolescents who experienced interpersonal trauma and were enrolled in a treatment study. Participants were assessed using the UCLA PTSD Reaction Index for DSM-IV-Adolescent Version and provided a blood sample at baseline. Genomic DNA was isolated from whole blood and assayed using the Illumina Infinium MethylationEPIC BeadChip. The primary analysis estimated the associations among individual CpG sites and PTSD symptom scores. Of the 793,575 screened probes tested, two were significant at a false discovery rate (FDR) < 10%. Hypomethylation of both sites was associated with increased PTSD symptom scores. Analysis of differentially methylated regions (DMR) identified a DMR associated with PTSD symptom scores at an FDR < 10%. Results from follow-up models are also discussed. Findings from this preliminary investigation suggest the importance of further research conducted in adolescent samples. The analytic pipeline and results are documented for use in future meta-analytic work as more such samples become available.
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Affiliation(s)
- Christina M. Sheerin
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Eva E. Lancaster
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, USA,Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Timothy P. York
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, USA,Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jesse Walker
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA,Department of Psychology, University of Houston, Houston, Texas, USA
| | - Carla Kmett Danielson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ananda B. Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, USA
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22
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Adams ZW, Hahn AM, McCart MR, Chapman JE, Sheidow AJ, Walker J, de Arellano M, Danielson CK. Predictors of substance use in a clinical sample of youth seeking treatment for Trauma-related mental health problems. Addict Behav 2021; 114:106742. [PMID: 33291058 DOI: 10.1016/j.addbeh.2020.106742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 10/22/2022]
Abstract
Child maltreatment and traumatic events are well established risk factors for adolescent substance use problems, but little is known about the unique contributions of etiological factors on trauma-exposed youths' pre-treatment substance use in clinical settings. This study examined associations between substance use and risk and protective factors measured across multiple ecological levels among a unique sample of youth seeking treatment for trauma-related mental health problems in child advocacy centers. Participants were adolescents (N = 135; 85% female; 60% white, 31% black) aged 13-17 years (M = 15.4) with ≥ 1 experience of child maltreatment or other interpersonal violence, current substance use, and ≥5 PTSD symptoms. Youth and caregivers completed validated questionnaires and clinical interviews at a pre-treatment assessment in a randomized controlled trial of a treatment for co-occurring traumatic stress and substance use. Negative binomial regression models identified different patterns of risk and protective factors for alcohol and cannabis. Clinical implications of these results are discussed, including the potential targets for integrated psychotherapies that address co-occurring substance use and traumatic stress in youth.
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23
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Mills KL, Barrett E, Back SE, Cobham VE, Bendall S, Perrin S, Brady KT, Ross J, Peach N, Kihas I, Cassar J, Schollar-Root O, Teesson M. Randomised controlled trial of integrated trauma-focused psychotherapy for traumatic stress and substance use among adolescents: trial protocol. BMJ Open 2020; 10:e043742. [PMID: 33257495 PMCID: PMC7705546 DOI: 10.1136/bmjopen-2020-043742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/30/2020] [Accepted: 11/16/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) and substance use disorder frequently co-occur and tend to have their onset during adolescence. Although research has highlighted the importance of treating these disorders in an integrated fashion, there is a dearth of empirically validated integrated treatment options for adolescents with this comorbidity. This paper describes the study protocol for a randomised controlled trial (RCT) examining the efficacy of an integrated trauma-focused cognitive-behavioural treatment for traumatic stress and substance use among adolescents (Concurrent Treatment of PTSD and Substance Use Using Prolonged Exposure - Adolescent (COPE-A)), relative to a supportive counselling control condition (Person-Centred Therapy (PCT)). METHODS AND ANALYSIS A two-arm, parallel, single-blind RCT with blinded follow-up at 4 and 12 months poststudy entry will be conducted in Sydney, Australia. Participants (n~100 adolescents aged 12-18 years) and their caregivers (caregiver participation is optional) will be allocated to undergo either COPE-A or PCT (allocation ratio 1:1) using minimisation. Both therapies will be delivered individually by project psychologists over a maximum of 16 sessions of 60-90 min duration and will include provision of up to four 30 min optional caregiver sessions. The primary outcome will be between-group differences in change in the severity of PTSD symptoms from baseline to 4-month follow-up, as measured by the Clinician-Administered PTSD Scale for Children and Adolescents for DSM-5. ETHICS AND DISSEMINATION Ethical approval has been obtained from the human research ethics committees of the Sydney Children's Hospital Network (HREC/17/SCHN/306) and the University of Sydney (HREC 2018/863). Findings will be published in peer-reviewed journals and presented at scientific conferences. TRIAL REGISTRATION NUMBER ACTRN12618000785202; Pre-reults. PROTOCOL VERSION Version 1, 31 July 2017.
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Affiliation(s)
- Katherine L Mills
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Emma Barrett
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Sudie E Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Vanessa E Cobham
- School of Psychology, The University of Queensland, Saint Lucia, Queensland, Australia
- Children's Health Queensland, Child and Youth Mental Health Service, Brisbane, Queensland, Australia
| | - Sarah Bendall
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Joanne Ross
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Natalie Peach
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Ivana Kihas
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Joanne Cassar
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Olivia Schollar-Root
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
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24
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Hahn AM, Adams ZW, Chapman J, McCart MR, Sheidow AJ, de Arellano MA, Danielson CK. Risk reduction through family therapy (RRFT): Protocol of a randomized controlled efficacy trial of an integrative treatment for co-occurring substance use problems and posttraumatic stress disorder symptoms in adolescents who have experienced interpersonal violence and other traumatic events. Contemp Clin Trials 2020; 93:106012. [PMID: 32339768 PMCID: PMC7194734 DOI: 10.1016/j.cct.2020.106012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 11/16/2022]
Abstract
Decades of research demonstrate that childhood exposure to traumatic events, particularly interpersonal violence experiences (IPV; sexual abuse, physical abuse, witnessing violence), increases risk for negative behavioral and emotional outcomes, including substance use problems (SUP) and posttraumatic stress disorder (PTSD). Despite this well-established link-including empirical support for shared etiological and functional connections between SUP and PTSD -the field has been void of a gold standard treatment for adolescent populations. To address this gap, our team recently completed a large randomized controlled trial to evaluate the efficacy of Risk Reduction through Family Therapy (RRFT), an integrative and exposure-based risk-reduction and treatment approach for adolescents who have experienced IPV and other traumatic events. The purpose of this paper is to provide a detailed description of the design and methods of this RCT designed to reduce SUP, PTSD symptoms, and related risk behaviors, with outcomes measured from pre-treatment through 18 months post-entry. Specifically, the recruitment and sampling procedures, assessment measures and methods, description of the intervention, and planned statistical approaches to evaluating the full range of outcomes are detailed. Clinical and research implications of this work are also discussed.
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Affiliation(s)
- Austin M Hahn
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Zachary W Adams
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | - Michael A de Arellano
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Carla Kmett Danielson
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
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