Diagnosis, course, and assessment of alcohol abuse and dependence in adolescents

Risk Factors Associated with Alcohol Use in Early Adolescence among American Inner-City Youth: A Longitudinal Study

Background: Early alcohol use is associated with an increased risk for later alcohol dependence, as well as social and mental health problems. In this study, we investigate the risk factors (internalizing and externalizing behaviors) associated with early alcohol consumption over a period of 1 year, and examine whether the association is sex-specific. Methods: U.S. inner-city adolescents (N = 1785, Mean age = 12.11) were assessed and reassessed in the sixth and seventh grades (Mean age = 13.10). Self-reported information was obtained on the lifetime level of alcohol consumption, internalizing (depression, anxiety and posttraumatic stress [PTS]), and externalizing behaviors (sensation seeking, conduct problems and affiliation with delinquent peers). Associations between the variables were examined using structural equation modeling (SEM). Results: In an adjusted SEM analysis drinking by the sixth grade was primarily associated with externalizing behaviors, whereas PTS was linked to lower levels of alcohol consumption. In addition, alcohol consumption and greater externalizing behaviors by the sixth grade predicted higher alcohol consumption by the seventh grade, whereas anxiety and African American ethnicity were associated with less alcohol consumption. No sex differences were found in the association between internalizing and externalizing behaviors and drinking. However, in the adjusted SEM analysis female sex predicted higher lifetime consumption by the seventh grade. Conclusion: Sensation seeking behavior, conduct problems and affiliation with delinquent peers should be regarded as risk factors and taken into consideration when planning prevention efforts in order to decrease alcohol use in early adolescence.

Comparing Alcohol Use Disorders Identification Test (AUDIT) with Timeline Follow Back (TLFB), DSM-5 and Phosphatidylethanol (PEth) for the assessment of alcohol misuse among young people in Ugandan fishing communities

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Validated tools are needed to evaluate alcohol-reduction interventions in low income countries.

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Among young Ugandans ACASI-administered 30-day and 12-month-AUDIT have good diagnostic properties.

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Self-reported AUDIT provides an efficient means of assessing alcohol misuse.

Background

Validated tools for assessing alcohol use among young people in low-income countries are needed to estimate prevalence and evaluate alcohol-reduction interventions. We validated Alcohol Use Disorders Identification Test (AUDIT) against Timeline Follow Back (TLFB), Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and phosphatidylethanol (PEth); and the 30-day-AUDIT against the 12-months-AUDIT among young Ugandans.

Methods

In 2018, we collected retrospective data on 30-day and 12-month AUDIT, TLFB and DSM-5 in a cross-sectional study of 15–24 year old residents of Ugandan fishing communities. AUDIT was administered by Audio Computer Assisted Self-Interviewing (ACASI) and DSM-5 and TLFB by psychiatric nurses. We determined PEth16:0/18:1 levels from dried blood spots using liquid chromatography tandem-mass spectrometry (heavy usage, ≥210 ng/mL) and calculated sensitivity and specificity of AUDIT against the other measures.

Results

Among 1281 participants (52.7% male, mean age 20 years), half (n = 659; 51.4%) reported ever drinking alcohol, 19.4% had 12-month-AUDIT ≥ 8 (21.5% men; 17.0% women), and 24.2% had 30-day-AUDIT ≥ 8 (29.0% men; 18.9% women). Twenty percent of participants had detectable PEth with 55 (4.3%) classified as heavy drinkers; 50.7% reported ≥ 2 symptoms on DSM-5 and 6.3% reported binge drinking in the previous month based on TLFB (8.9% men, 3.5% women). The 30-day-AUDIT ≥ 8 had sensitivity 86.7%, 95%CI: 81.8%–90.7% and specificity 90.9%, 95%CI:89.0%–92.6% versus 12-month-AUDIT ≥ 8. Both 30-day and 12-month-AUDIT ≥ 8 were sensitive and specific markers of heavy drinking by PEth (12-month-AUDIT sensitivity = 80.0%; 95%CI:67.0%–89.6%; specificity = 83.3%; 95%CI:81.1%–85.3%). The 30-day-AUDIT was a sensitive and specific marker of binge drinking based on TLFB (sensitivity = 82.7%; 95%CI:72.7%–90.2%, specificity = 79.8%; 95%CI:77.4%–82.1%); 12-month-AUDIT had lower sensitivity. Both 30-day and 12-month AUDIT ≥ 8 were highly specific but insensitive markers of having DSM-5 ≥ 2 symptoms.

Conclusion

Among young people in Uganda, ACASI-administered 30-day and 12-month-AUDIT have good diagnostic properties compared to PEth, DSM-5 and TLFB. Self-reported AUDIT provides a quick and valid means of assessing alcohol misuse in these communities.

Alcohol use in early adolescence: findings from a survey among middle school students in Italy

BackgroundThe aims of this study were to measure the extent of alcohol use among a sample of early adolescents and to provide information on the factors influencing the consumption.MethodsData were collected via self-administered anonymous questionnaires from 1,520 middle school students (mean age of 13.1 years (range 12-15 years)), who were recruited from a random sample of public schools in Calabria Region, Italy.ResultsA total of 1,032 participants completed the survey for a response rate of 68%. Nearly 70% of the respondents had drunk at least once during their lifetime, and 16.7% reported consuming alcohol during 30 days before the survey. Multivariate analysis showed that the factors associated with the consumption of alcohol were being male (odds ratio (OR) 0.58, 95% confidence interval (CI) 0.41-0.80), being older (OR 1.88, 95% CI 1.37-2.56), living in an urban area (OR 0.29, 95% CI 0.21-0.40), reporting a sad self-perceived mood (OR 2.76, 95% CI 1.87-4.48), reporting parental drinking habits (OR 7.11, 95% CI 5.02-10.08), and not considering alcohol use as an unhealthy behavior (OR 2.43, 95% CI 1.11-5.31).ConclusionAlcohol use among early adolescents is widespread. Multicomponent interventions are required in order to reduce the average levels of alcohol drinking among early adolescents.

Why young people's substance use matters for global health

During puberty, when young people are completing their education, transitioning into employment, and forming longer-term intimate relationships, a shift in emotional regulation and an increase in risky behaviour, including substance use, is seen. This Series paper considers the potential effects of alcohol, tobacco, and illicit drug use during this period on: social, psychological, and health outcomes in adolescence and young adulthood; role transitions, and later health and social outcomes of regular substance use initiated in adolescence; and the offspring of young people who use substances. We sourced consistent support for causal relations between substance use and outcomes and evidence of biological plausibility from different but complementary research designs. Many adverse health and social outcomes have been associated with different types of substance use. The major challenge lies in deciding which are causal. Furthermore, qualitatively different harms are associated with different substances, differences in life stage when these harms occur, and the quality of evidence for different substances and health outcomes varies substantially. The preponderance of evidence comes from a few high-income countries, thus whether the same social and health outcomes would occur in other countries and cultures is unclear. Nonetheless, the number of harms that are causally related to substance use in young people warrant high-quality research design interventions to prevent or ameliorate these harms.

Validation of the MINI (DSM IV) Tool for the Assessment of Alcohol Dependence among Young People in Northern Tanzania Using the Alcohol Biomarker Phosphatidylethanol (PEth)

The alcohol dependence section of the Mini International Neuropsychiatric Interview questionnaire (MINI) has not been evaluated in young Africans. We applied the MINI in a cross-sectional study of 202 alcohol users from northern-Tanzania, aged 18-24 years (103 male casual workers and 99 students), and validated it against phophatidylethanol (PEth) at a cut-off suggesting heavy chronic alcohol use (≥0.30 µmol/L). Blood was assayed for PEth (16:0/18:1-subform) by liquid chromatography-tandem mass spectrometry. The MINI dependence criteria (≥3 positive responses) were met by 39% participants although their PEth levels were low. Contrary, many young people with high PEth levels were not classified as dependent. The sensitivity of the MINI ranged from 0% to 69% (female students and male workers, respectively) and specificity from 52% to 85% (workers and female students, respectively). The highest AUROC (0.68) occurred with a cut-off of ≥4 positive responses. A modified MINI with three affirmative responses to five questions increased specificity to 92%-97%; however, sensitivity remained low. The performance of the MINI in detecting dependence among young people from northern-Tanzania is unsatisfactory. Specificity was improved using a modified version but sensitivity remained low. An accurate tool for the diagnosis of alcohol dependence is needed for epidemiological and clinical purposes.

DSM-IV and DSM-5 alcohol use disorder among young Swiss men

BACKGROUND AND AIMS

Previous studies suggest that the new DSM-5 criteria for alcohol use disorder (AUD) will increase the apparent prevalence of AUD. This study estimates the 12-month prevalence of AUD using both DSM-IV and DSM-5 criteria and compares the characteristics of men in a high risk sample who meet both, only one and neither sets of diagnostic criteria.

DESIGN, SETTING AND PARTICIPANTS

5943 Swiss men aged 18-25 years who participated in the Cohort Study on Substance Use Risk Factors (C-SURF), a population-based cohort study recruited from three of the six military recruitment centres in Switzerland (response rate = 79.2%).

MEASUREMENTS

DSM-IV and DSM-5 criteria, alcohol use patterns, and other substance use were assessed.

FINDINGS

Approximately 31.7% (30.5-32.8) of individuals met DSM-5 AUD criteria [21.2% mild (20.1-22.2); 10.5% moderate/severe (9.7-11.3)], which was less than the total rate when DSM-IV criteria for alcohol abuse (AA) and alcohol dependence (AD) were combined [36.8% overall (35.5-37.9); 26.6% AA (25.4-27.7); 10.2% AD (9.4-10.9)]. Of 2479 respondents meeting criteria for either diagnoses, 1585 (63.9%) met criteria for both. For those meeting DSM-IV criteria only (n = 598, 24.1%), hazardous use was most prevalent, whereas the criteria larger/longer use than intended and tolerance to alcohol were most prevalent for respondents meeting DSM-5 criteria only (n = 296, 11.9%). Two in five DSM-IV alcohol abuse cases and one-third of DSM-5 mild AUD individuals fulfilled the diagnostic criteria due to the hazardous use criterion. The addition of the craving and excluding of legal criterion, respectively, did not affect estimated AUD prevalence.

CONCLUSIONS

In a high-risk sample of young Swiss males, prevalence of alcohol use disorder as diagnosed by DSM-5 was slightly lower than prevalence of DSM-IV diagnosis of dependence plus abuse; 63.9% of those who met either criterion met criteria for both.

Family history density predicts long term substance use outcomes in an adolescent treatment sample

AIMS

This study explored whether the density of family history (FH) of substance use disorders relates to post-treatment substance use outcomes in adolescents, with the primary aim of determining whether FH exerts a relatively stronger influence on longer-term outcomes.

METHOD

The present investigation examined adolescents (ages 12-18, n=366) from two independent samples who were treated for alcohol/substance use disorder (ASUD) and re-assessed during the eight years following treatment with identical methodology. Primary substance use outcomes were assessed at 1, 2, 4, 6, and 8 years post-treatment and included total drinks, days using marijuana, and days using other drugs.

RESULTS

In hierarchical linear models there were significant FH density×linear time interactions for total drinks (z=12.75, p<0.001) and marijuana use days (z=4.39, p<0.001); greater FH density predicted more total drinks and more marijuana use days, with both associations becoming stronger over time. The increasing linkage between FH and other drug use was not significant over time.

CONCLUSIONS

Findings are consistent with previous research indicating that the risk associated with FH increases over time, especially in relation to quantity/frequency measures of alcohol and marijuana use. By extending these findings to an adolescent clinical sample, the current study highlights that FH density of alcohol and drug dependence is a risk factor for poorer long-term outcomes for adolescent-onset ASUD youth as they transition into adulthood. Future work should explore the mechanisms underlying greater post-treatment substance use for adolescents/young adults with greater FH density.

Alcoholic hepatitis: current challenges and future directions

Alcoholic hepatitis is a distinct clinical syndrome among people with chronic and active alcohol abuse, with a potential for 30%-40% mortality at 1 month among those with severe disease. Corticosteroids or pentoxifylline are the current pharmacologic treatment options, but they provide only about 50% survival benefit. These agents are recommended for patients with modified discriminant function (mDF) ≥ 32 or Model for End-Stage Liver Disease score ≥ 18. The Lille score is used to determine response to steroids. Currently, a minimum of 6 months of abstinence from alcohol use is required for patients to receive a liver transplant, a requirement that cannot be met by patients with severe alcoholic hepatitis nonresponsive to steroids (Lille score ≥ 0.45). Data are emerging on the benefit of liver transplantation in select patients with first episode of severe alcoholic hepatitis. This review also focuses on recent treatment trials in alcoholic hepatitis including liver transplantation and its associated controversies, as well as possible future targets and pharmacologic treatment options for patients with alcoholic hepatitis that are being pursued through upcoming consortium studies.

DSM-IV alcohol abuse and dependence criteria characteristics for recent onset adolescent drinkers

BACKGROUND

Little is known about the psychometric properties of alcohol abuse and dependence criteria among recent-onset adolescent drinkers, particularly for those who consume alcohol infrequently. This study evaluated how well DSM-IV alcohol dependence criteria measure an alcohol use disorder (AUD) construct for recent onset adolescent drinkers at different levels of drinking frequency.

METHOD

Data were drawn from the National Survey on Drug Use and Health, a nationally representative sample of 9356 recent-onset adolescent drinkers, aged 12-21, who began drinking within the past year. Multiple group item response theory analysis was conducted to assess the 11 DSM-IV alcohol abuse and dependence criteria.

RESULTS

Criteria most likely to be endorsed at lower AUD severity included "withdrawal," "problems at home, school or work" and "tolerance." The criteria "drinking larger amounts/longer period of time," "unsuccessful efforts to cut down" and "continuing to drink despite related health problems" were more likely to be endorsed at higher AUD severity. Two criteria, "tolerance" and "time spent getting, using or recovering from alcohol" showed differential item functioning between drinking frequency groups (<7 vs. ≥ 7 days in past month), with lower discrimination and severity for more frequent drinkers. DSM-IV criteria were most precise for intermediate levels of AUD severity.

CONCLUSIONS

All but two DSM-IV criteria had consistent psychometric properties across drinking frequency groups. Symptoms were most precise for a narrow, intermediate range of AUD severity. Those assessing AUD in recent onset adolescent drinkers might consider additional symptoms to capture the full AUD continuum.

Alcoholic hepatitis: prognostic models and treatment

Alcoholic hepatitis is a distinct subset of alcoholic liver disease. Inflammation and oxidative stress are the two main pathogenetic mechanisms involved in its pathogenesis. Patients with mild disease usually improve with conservative management. However, about 30-50% of those with severe disease succumb to their illness within about 1 month. Therefore, assessment of disease severity is important and practical issue. Currently, hepatologists do not have an ideal scoring system available. With survival benefit of only about 50% with corticosteroids and pentoxifylline, there is need to develop newer and better treatment options to manage these patients. This article also deals with controversies surrounding the role and use of liver transplantation in patients with alcoholic hepatitis.

General aspects of the treatment of alcoholic hepatitis

General measures for treating patients with alcoholic hepatitis (AH) are similar irrespective of the disease severity. Alcohol abstinence is the cornerstone of treatment and can be achieved with appropriate social support, Alcoholics Anonymous and sometimes pharmacological therapy. Alcohol withdrawal should be anticipated and treatment initiated to prevent this complication. Treatment for complications of cirrhosis should be as for any other patient with cirrhosis. AH patients are particularly prone to infections and malnutrition. These should be identified and treated appropriately using broad spectrum antibiotics and nutritional support respectively.

Brief screens for detecting alcohol use disorder among 18-20 year old young adults in emergency departments: Comparing AUDIT-C, CRAFFT, RAPS4-QF, FAST, RUFT-Cut, and DSM-IV 2-Item Scale

BACKGROUND

This study compared six of the briefest screening instruments for detecting DSM-IV-defined Alcohol Use Disorder (AUD) among older adolescents treated in Emergency Departments (ED).

METHODS

The AUDIT-C, the RAPS4-QF, the FAST, the CRAFFT, the RUFT-Cut, and 2-Items from the Diagnostic and Statistical Manual IV of the American Psychiatric Association [American Psychiatric Association (1994). Diagnostic and Statistical Manual of Psychiatric Disorders, (1994) (DSM-IV). 4th ed. Washington D.C.: American Psychiatric Association] criteria for AUD (heretofore referred to as the DSM-IV 2-Item Scale) were evaluated against the criterion of a current DSM-IV diagnosis of either alcohol abuse or dependence. The instruments were administered to 181 alcohol-using older adolescents (57% males; age range 18-20 years) in an ED and compared using Receiver Operator Characteristic (ROC) analyses against the criterion of a current DSM-IV diagnosis of alcohol abuse or dependence.

RESULTS

Of these instruments, the DSM-IV 2-Item Scale performed best for identifying AUD (88% sensitivity and 90% specificity), followed by the FAST and the AUDIT-C.

CONCLUSIONS

Two items from the DSM-IV criteria for AUD performed best for identifying ED-treated older adolescents with alcohol use disorders. The FAST and AUDIT-C performed well, but are longer and more difficult to score in the hectic environment of the Emergency Department.

The dimensionality of DSM-IV alcohol use disorders among adolescent and adult drinkers and symptom patterns by age, gender, and race/ethnicity

BACKGROUND

There is limited information on the validity of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) alcohol use disorders (AUD) symptom criteria among adolescents in the general population. The purpose of this study is to assess the DSM-IV AUD symptom criteria as reported by adolescent and adult drinkers in a single representative sample of the U.S. population aged 12 years and older. This design avoids potential confounding due to differences in survey methodology when comparing adolescents and adults from different surveys.

METHODS

A total of 133,231 current drinkers (had at least 1 drink in the past year) aged 12 years and older were drawn from respondents to the 2002 to 2005 National Surveys on Drug Use and Health. DSM-IV AUD criteria were assessed by questions related to specific symptoms occurring during the past 12 months. Factor analytic and item response theory models were applied to the 11 AUD symptom criteria to assess the probabilities of symptom item endorsements across different values of the underlying trait.

RESULTS

A 1-factor model provided an adequate and parsimonious interpretation for the 11 AUD criteria for the total sample and for each of the gender-age groups. The MIMIC model exhibited significant indication for item bias among some criteria by gender, age, and race/ethnicity. Symptom criteria for "tolerance,""time spent," and "hazardous use" had lower item thresholds (i.e., lower severity) and low item discrimination, and they were well separated from the other symptoms, especially in the 2 younger age groups (12 to 17 and 18 to 25). "Larger amounts,""cut down,""withdrawal," and "legal problems" had higher item thresholds but generally lower item discrimination, and they tend to exhibit greater dispersion at higher AUD severity, particularly in the youngest age group (12 to 17).

CONCLUSIONS

Findings from the present study do not provide support for the 2 separate DSM-IV diagnoses of alcohol abuse and dependence among either adolescents or adults. Variations in criteria severity for both abuse and dependence offer support for a dimensional approach to diagnosis which should be considered in the ongoing development of DSM-V.

A Rasch model analysis of alcohol consumption and problems across adolescence and young adulthood

BACKGROUND

Recent investigations using item response modeling have begun to conceptualize alcohol consumption, problems, and dependence as representing points along a single continuum of alcohol involvement. Such a conceptualization may be of particular benefit to measurement of alcohol involvement in adolescents, but investigations to date have been limited to adult samples and may not generalize to adolescents due to age-related developmental differences.

METHODS

This study used Rasch model analyses to examine the properties of indices of alcohol consumption and problems among 6,353 adolescents, aged 12 to 18 years, in Wave 1 of the Add Health survey. A particular focus was on whether the functioning of items changed when these adolescents were re-interviewed in Wave 3 when they were 18 to 24 years of age.

RESULTS

Rasch model analyses supported the unidimensionality and additive properties of the items in the Wave 1 data. Comparisons of Wave 1 and Wave 3 data indicated differential item functioning in most of the items such that items related to alcohol consumption were more severe during adolescence, whereas items related to alcohol problems were more severe in young adulthood.

CONCLUSIONS

A valid index of alcohol involvement in adolescents can be constructed combining indices of alcohol consumption and alcohol problems. Such an index covers a range of severity and functions similarly across sex and race/ethnicity. A similar index can be constructed in young adulthood. However, the interpretation of scores must be attentive to developmental differences. In particular, for adolescents, indices of alcohol consumption are relatively closer in severity to indices of alcohol problems than they are among young adults. Thus, alcohol problems are more likely among adolescents than young adults given a similar level of drinking.

Toward DSM-V: an item response theory analysis of the diagnostic process for DSM-IV alcohol abuse and dependence in adolescents

OBJECTIVE

Item response theory analyses were used to examine alcohol abuse and dependence symptoms and diagnoses in adolescents. Previous research suggests that the DSM-IV alcohol use disorder (AUD) symptoms in adolescents may be characterized by a single dimension. The present study extends prior research with a larger and more comprehensive sample and an examination of an alternative diagnostic algorithm for AUDs.

METHOD

Approximately 5,587 adolescents between the ages of 12 and 18 years from adjudicated, clinical, and community samples were administered structured clinical interviews. Analyses were conducted to examine the severity of alcohol abuse and dependence symptoms and the severity of alcohol use problems (AUDs) within the diagnostic categories created by the DSM-IV.

RESULTS

Although the DSM-IV diagnostic categories differ in severity of AUDs, there is substantial overlap and inconsistency in AUD severity of persons across these categories. Item Response Theory-based AUD severity estimates suggest that many persons diagnosed with abuse have AUD severity greater than persons with dependence. Similarly, many persons who endorse some symptoms but do not qualify for a diagnosis (i.e., diagnostic orphans) have more severe AUDs than persons with an abuse diagnosis. Additionally, two dependence items, "tolerance" and "larger/longer," show differences in severity between samples.

CONCLUSIONS

The distinction between DSM-IV abuse and dependence based on severity can be improved using an alternative diagnostic algorithm that considers all of the alcohol abuse and dependence symptoms conjointly.

Practitioner review: adolescent alcohol use disorders: assessment and treatment issues

BACKGROUND

Alcohol use disorders in adolescents are associated with significant morbidity and mortality. Over the past decade, there has been a burgeoning of research on adolescent alcohol use disorders.

METHODS

A summary of the alcohol assessment tools is provided, and randomized studies reviewed and synthesized to provide an overview of state of the art knowledge of treatment of adolescent alcohol use disorders. Animal models of addiction are also briefly reviewed, and the value of translational research approaches, using findings from basic studies to guide the design of clinical investigations, is also highlighted.

RESULTS

Comorbidity is the rule, not the exception in adolescent alcohol use disorders. Comprehensive assessment of psychiatric and other substance use disorders, trauma experiences, and suicidality is indicated in this population to optimize selection of appropriate clinical interventions. In terms of available investigated treatments for adolescents with alcohol use disorders, Multidimensional Family Therapy and group administered Cognitive Behavioral Therapies have received the most empirical support to date. There is a paucity of research on pharmacological interventions in this patient population, and no firm treatment recommendations can be made in this area.

CONCLUSIONS

Given the high rate of relapse after treatment, evaluation of combined psychosocial and pharmacological interventions, and the development of novel intervention strategies are indicated.

Substance abuse among adolescents

Substance use and dependence are among the most prevalent causes of adolescent morbidity and mortality in the United States. This paper provides a review of differences between adolescent and adult substance abuse, prevention and treatment approaches, and future potential directions and needs for more effective programming in the treatment of adolescent substance abuse(1) and dependence on psychoactive substances.

Delinquency as a mediator of the relation between negative affectivity and adolescent alcohol use disorder

This investigation examined mediators of the longitudinal relation between negative affectivity and the development of problematic drinking behavior in adolescent boys and girls. In the present study, 499 early adolescents completed inventories of negative affectivity, attitudes toward delinquency, personal delinquency, and affiliation with delinquent peers. Positive attitudes toward delinquency emerged as the most consistent mediator and strongly predicted drinking frequency in various situations. Compared with personal delinquency, both attitudes toward delinquency and peer delinquency were superior predictors of affect-related drinking. Our results also demonstrated that positive attitudes toward delinquency mediated the relation between negative affectivity and later development of an alcohol use disorder. These findings suggest that a proneness to unpleasant affect impacts adolescent drinking by heightening risk for general rejection of normative behavior, rather than by increasing drinking as a means of managing affect. The importance and implications of testing delinquency variables together in the same model are discussed.

Role of stress in acquisition of alcohol-conditioned place preference in adolescent and adult mice

BACKGROUND

Both clinical evidence and findings from animal models demonstrate that there are differences between adolescents and adults in alcohol dependence. As stress plays a critical role in processes of alcohol addiction, we tested whether stress is involved in alcohol vulnerability differently during adolescence and adulthood in mice.

METHODS

To determine whether age differences exist in the acquisition of alcohol-conditioned place preference (CPP) in mice, adolescent and adult mice were trained for CPP with different doses of alcohol (0, 0.5, 1, and 2 g/kg, i.p.). To explore the effects of stress (footshock) on acquisition of alcohol CPP in mice of different ages, adolescent and adult mice underwent acute (1 day) or chronic (1 week) stress before CPP training. Acquisition of CPP was examined after the CPP training.

RESULTS

Under nonstress conditions, adult mice acquired alcohol CPP when trained with 2 g/kg alcohol, while adolescent mice did not acquire alcohol CPP. After chronic but not acute stress exposure, adolescent mice acquired significant CPP trained with 2 g/kg alcohol that did not produce CPP under nonstress conditions. However, stress did not have significant effect on acquisition of CPP in adult mice trained CPP with 1 g/kg alcohol.

CONCLUSIONS

These results indicate that there is an age difference in acquiring alcohol CPP and adolescent mice are more sensitive than adults to stress.

Hypo-response of the hypothalamic-pituitary-adrenocortical axis after an ethanol challenge in prenatally stressed adolescent male rats

The period of adolescence and environmental factors, such as stress, are important in determining ethanol vulnerability in both humans and rats. Ethanol is a powerful activator of the hypothalamic-pituitary-adrenal (HPA) axis but attenuated responses of the HPA axis to ethanol have been described in populations with a high risk of ethanol abuse. In rats, prenatal stress leads to prolonged stress-induced corticosterone secretion and increases the vulnerability to drugs of abuse, such as amphetamine and nicotine in adulthood and 3,4-methylenedioxymethamphetamine in adolescent rats. The aim of the present study was to assess the impact of a prenatal stress on HPA axis responsiveness to a moderate dose of ethanol (1.5 g/kg i.p.) in adolescent male rats (28 days old). The parameters evaluated were plasma adrenocorticotropic hormone, plasma corticosterone and mRNA expression of HPA axis central markers (mineralocorticoid receptor, glucocorticoid receptor, corticotropin-releasing hormone and pro-opiomelanocortin). Contrary to prior expectations, our results demonstrate that prenatal stress blunts the HPA axis responsiveness to a moderate dose of ethanol in adolescent rats in spite of similar blood ethanol levels. These data suggest that prenatal stress may have the opposite effect on the response to stress depending on the attributes of the stressor stimulus. They thus raise questions about the possible impact of prenatal stress on the further development of ethanol vulnerability.