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Farmer RF, Seeley JR, Kosty DB, Gau JM. Deconstructing the heterogeneity of alcohol use disorder: lifetime comorbid non-alcohol substance use disorder as a distinct behavioral phenotype? Psychol Med 2023; 53:4962-4976. [PMID: 35781344 DOI: 10.1017/s0033291722001921] [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: 11/05/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) is an etiologically and clinically heterogeneous condition. Accumulating evidence suggests that persons with lifetime histories of comorbid AUD and non-alcohol substance use disorder (DRUG) constitute an important subgroup of AUD. This study evaluated the distinctiveness of the comorbid AUD/DRUG behavioral phenotype in a community sample with respect to risk factors, AUD course features, and outcome variables assessed at age 30. Contrast groups included persons with histories of AUD only, DRUG only, and neither AUD nor DRUG. METHODS This research utilized a prospective study design with an age-based cohort (n = 732). Participants completed four comprehensive diagnostic evaluations during the high-risk periods of adolescence, emerging adulthood, and young adulthood. RESULTS The comorbid AUD/DRUG group was distinguished from the AUD only group by risk factors, AUD course features, and outcomes. Group differences in outcomes were also explained by overall substance use disorder (SUD) severity. Persons with AUD/DRUG comorbidity were indistinguishable from those with DRUG only histories with respect to risk factors and outcomes but demonstrated greater overall SUD severity. Persons with AUD only were indistinguishable from those with neither AUD nor DRUG histories in risk factor endorsements and were mostly similar in outcomes. CONCLUSIONS Findings collectively suggest that young adults with histories of AUD only and those with comorbid AUD/DRUG are drawn from dissimilar populations. Similarities between the AUD only group with those absent AUD or DRUG histories are likely related to the former group's developmentally limited AUD course accompanied by relatively few or short-lived alcohol-related problems.
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Affiliation(s)
- Richard F Farmer
- Oregon Research Institute, 1776 Millrace Drive, Eugene, OR 97403, USA
| | - John R Seeley
- Oregon Research Institute, 1776 Millrace Drive, Eugene, OR 97403, USA
- College of Education, University of Oregon, 901 East 18th Ave., Eugene, OR 97403, USA
| | - Derek B Kosty
- Oregon Research Institute, 1776 Millrace Drive, Eugene, OR 97403, USA
- College of Education, University of Oregon, 901 East 18th Ave., Eugene, OR 97403, USA
| | - Jeff M Gau
- Oregon Research Institute, 1776 Millrace Drive, Eugene, OR 97403, USA
- College of Education, University of Oregon, 901 East 18th Ave., Eugene, OR 97403, USA
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Escelsior A, Belvederi Murri M, Corsini GP, Serafini G, Aguglia A, Zampogna D, Cattedra S, Nebbia J, Trabucco A, Prestia D, Olcese M, Barletta E, Pereira da Silva B, Amore M. Cannabinoid use and self-injurious behaviours: A systematic review and meta-analysis. J Affect Disord 2021; 278:85-98. [PMID: 32956965 DOI: 10.1016/j.jad.2020.09.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/31/2020] [Accepted: 09/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The increasing availability of high-potency cannabis-derived compounds and the use of synthetic cannabinoids may be responsible for severe side effects like cognitive impairment, psychosis or self-injurious behaviours (SIB). In particular, SIB like non-suicidal self-injury (NSSI) and deliberate self-harm (DSH) raise growing concern as a possible consequence of cannabis use. However, the research to date has not addressed the relationship between cannabinoid use and SIB systematically. METHODS We conducted a systematic review on PubMed up to March 2020, using search terms related to cannabinoids and SIB. RESULTS The search yielded a total of 440 abstracts. Of those, 37 studies published between 1995 and 2020 were eligible for inclusion. Cannabinoid use was significantly associated with SIB at the cross-sectional (OR=1.569, 95%CI [1.167-2.108]) and longitudinal (OR=2.569, 95%CI [2.207-3.256]) level. Chronic use, presence of mental disorders, depressive symptoms, emotional dysregulation and impulsive traits might further increase the likelihood of self-harm in cannabis users. Synthetic cannabinoids may trigger highly destructive SIB mainly through the psychotomimetic properties of these compounds. CONCLUSION Cannabinoid use was associated with an increased prevalence of self-injury and may act as a causative factor with a duration-dependent manner. Emotional regulation and behavioural impulsivity functions might crucially moderate this association. Future studies should further investigate the mechanisms underlying this association, while exploring potential therapeutic applications of substances modulating the endocannabinoid system.
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Affiliation(s)
- Andrea Escelsior
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Giovanni Pietro Corsini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Domenico Zampogna
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simone Cattedra
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Jacopo Nebbia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alice Trabucco
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Davide Prestia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Martina Olcese
- Department of Educational Science - Psychology Unit, University of Genoa, Genoa, Italy
| | | | - Beatriz Pereira da Silva
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Crowley TJ, Dalwani MS, Sakai JT, Raymond KM, McWilliams SK, Banich MT, Mikulich-Gilbertson SK. Children's brain activation during risky decision-making: A contributor to substance problems? Drug Alcohol Depend 2017; 178. [PMID: 28641131 PMCID: PMC5548624 DOI: 10.1016/j.drugalcdep.2017.02.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Among young children excessive externalizing behaviors often predict adolescent conduct and substance use disorders. Adolescents with those disorders show aberrant brain function when choosing between risky or cautious options. We therefore asked whether similarly aberrant brain function during risky decision-making accompanies excessive externalizing behaviors among children, hypothesizing an association between externalizing severity and regional intensity of brain activation during risky decision-making. METHOD Fifty-eight (58) 9-11 year-old children (both sexes), half community-recruited, half with substance-treated relatives, had parent-rated Child Behavior Checklist Externalizing scores. During fMRI, children repeatedly chose between doing a cautious behavior earning 1 point or a risky behavior that won 5 or lost 10 points. Conservative permutation-based whole-brain regression analyses sought brain regions where, during decision-making, activation significantly associated with externalizing score, with sex, and with their interaction. RESULTS Before risky responses higher externalizing scores were significantly, negatively associated with neural activation (t's: 2.91-4.76) in regions including medial prefrontal cortex (monitors environmental reward-punishment schedules), insula (monitors internal motivating states, e.g., hunger, anxiety), dopaminergic striatal and midbrain structures (anticipate and mediate reward), and cerebellum (where injuries actually induce externalizing behaviors). Before cautious responses there were no significant externalizing:activation associations (except in post hoc exploratory analyses), no significant sex differences in activation, and no significant sex-by-externalizing interactions. CONCLUSIONS Among children displaying more externalizing behaviors extensive decision-critical brain regions were hypoactive before risky behaviors. Such neural hypoactivity may contribute to the excessive real-life risky decisions that often produce externalizing behaviors. Substance exposure, minimal here, was a very unlikely cause.
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Affiliation(s)
- Thomas J. Crowley
- Division of Substance Dependence, Psychiatry Department, University of Colorado Denver, Mail Stop F478, 12469 East 17th Place, Denver, Colorado 80045, United States of America
| | - Manish S. Dalwani
- Division of Substance Dependence, Psychiatry Department, University of Colorado Denver, Mail Stop F478, 12469 East 17th Place, Denver, Colorado 80045, United States of America
| | - Joseph T. Sakai
- Division of Substance Dependence, Psychiatry Department, University of Colorado Denver, Mail Stop F478, 12469 East 17th Place, Denver, Colorado 80045, United States of America
| | - Kristen M. Raymond
- Division of Substance Dependence, Psychiatry Department, University of Colorado Denver, Mail Stop F478, 12469 East 17th Place, Denver, Colorado 80045, United States of America
| | - Shannon K. McWilliams
- Division of Substance Dependence, Psychiatry Department, University of Colorado Denver, Mail Stop F478, 12469 East 17th Place, Denver, Colorado 80045, United States of America
| | - Marie T. Banich
- Institute of Cognitive Science, Departments of Psychology and Neuroscience, Campus Box 344, D420 Muenzinger Hall, University of Colorado Boulder, Boulder, Colorado 80309-0345, United States of America
| | - Susan K. Mikulich-Gilbertson
- Division of Substance Dependence, Psychiatry Department, University of Colorado Denver, Mail Stop F478, 12469 East 17th Place, Denver, Colorado 80045, United States of America
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Olivares EL, Kendler KS, Neale MC, Gillespie NA. The Genetic and Environmental Association Between Parental Monitoring and Risk of Cannabis, Stimulants, and Cocaine Initiation in a Sample of Male Twins: Does Parenting Matter? Twin Res Hum Genet 2016; 19:297-305. [PMID: 27436053 PMCID: PMC4972338 DOI: 10.1017/thg.2016.52] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Our aim was to test the direction of causation between self-report parental monitoring (PM) and the liability to illicit drug initiation (DI) as indicated by cannabis, cocaine, and stimulants. We fitted a multiple indicator model to test causal and non-causal models based on a large, genetically informative cross-sectional sample of male twins. The sample comprised 1,778 males aged 24-62 years from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. Data came from self-report measures of lifetime cannabis, stimulants, and cocaine initiation, and retrospective assessment of PM between ages 8-17 years. Multivariate modeling showed that familial aggregation in PM and DI were both explained by a combination of additive genetic and shared environmental effects. Moreover, the significant association between PM and DI was best explained by a correlated liability model versus causal models. PM has typically been assumed to be an environmental, causal risk factor for drug use and has been shown to be among the more salient environmental risk factors for illicit DI. Our data were not consistent with this causal hypothesis. Instead, a correlated liability model in which PM and risk of DI share common genetic and environmental risks provided a better fit to the data.
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Affiliation(s)
| | - Kenneth S Kendler
- Department of Psychiatry, Virginia Commonwealth University
- Department of Human Genetics, Virginia Commonwealth University
| | | | - Nathan A Gillespie
- Department of Psychiatry, Virginia Commonwealth University
- Queensland Institute of Medical Research, Brisbane, Australia
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Boulos PK, Dalwani MS, Tanabe J, Mikulich-Gilbertson SK, Banich MT, Crowley TJ, Sakai JT. Brain Cortical Thickness Differences in Adolescent Females with Substance Use Disorders. PLoS One 2016; 11:e0152983. [PMID: 27049765 PMCID: PMC4822952 DOI: 10.1371/journal.pone.0152983] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 03/22/2016] [Indexed: 01/17/2023] Open
Abstract
Some youths develop multiple substance use disorders early in adolescence and have severe, persistent courses. Such youths often exhibit impulsivity, risk-taking, and problems of inhibition. However, relatively little is known about the possible brain bases of these behavioral traits, especially among females.
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Affiliation(s)
- Peter K. Boulos
- University of Colorado Denver School of Medicine, Aurora, Colorado, United States of America
| | - Manish S. Dalwani
- Division of Substance Dependence, Department of Psychiatry, University of Colorado Denver School of Medicine, Aurora, Colorado, United States of America
| | - Jody Tanabe
- Department of Radiology, University of Colorado Denver School of Medicine, Aurora, Colorado, United States of America
| | - Susan K. Mikulich-Gilbertson
- Division of Substance Dependence, Department of Psychiatry, University of Colorado Denver School of Medicine, Aurora, Colorado, United States of America
| | - Marie T. Banich
- Institute of Cognitive Science, Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, United States of America
| | - Thomas J. Crowley
- Division of Substance Dependence, Department of Psychiatry, University of Colorado Denver School of Medicine, Aurora, Colorado, United States of America
| | - Joseph T. Sakai
- Division of Substance Dependence, Department of Psychiatry, University of Colorado Denver School of Medicine, Aurora, Colorado, United States of America
- * E-mail:
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6
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Dalwani MS, McMahon MA, Mikulich-Gilbertson SK, Young SE, Regner MF, Raymond KM, McWilliams SK, Banich MT, Tanabe JL, Crowley TJ, Sakai JT. Female adolescents with severe substance and conduct problems have substantially less brain gray matter volume. PLoS One 2015; 10:e0126368. [PMID: 26000879 PMCID: PMC4441424 DOI: 10.1371/journal.pone.0126368] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 04/01/2015] [Indexed: 01/22/2023] Open
Abstract
Objective Structural neuroimaging studies have demonstrated lower regional gray matter volume in adolescents with severe substance and conduct problems. These research studies, including ours, have generally focused on male-only or mixed-sex samples of adolescents with conduct and/or substance problems. Here we compare gray matter volume between female adolescents with severe substance and conduct problems and female healthy controls of similar ages. Hypotheses: Female adolescents with severe substance and conduct problems will show significantly less gray matter volume in frontal regions critical to inhibition (i.e. dorsolateral prefrontal cortex and ventrolateral prefrontal cortex), conflict processing (i.e., anterior cingulate), valuation of expected outcomes (i.e., medial orbitofrontal cortex) and the dopamine reward system (i.e. striatum). Methods We conducted whole-brain voxel-based morphometric comparison of structural MR images of 22 patients (14-18 years) with severe substance and conduct problems and 21 controls of similar age using statistical parametric mapping (SPM) and voxel-based morphometric (VBM8) toolbox. We tested group differences in regional gray matter volume with analyses of covariance, adjusting for age and IQ at p<0.05, corrected for multiple comparisons at whole-brain cluster-level threshold. Results Female adolescents with severe substance and conduct problems compared to controls showed significantly less gray matter volume in right dorsolateral prefrontal cortex, left ventrolateral prefrontal cortex, medial orbitofrontal cortex, anterior cingulate, bilateral somatosensory cortex, left supramarginal gyrus, and bilateral angular gyrus. Considering the entire brain, patients had 9.5% less overall gray matter volume compared to controls. Conclusions Female adolescents with severe substance and conduct problems in comparison to similarly aged female healthy controls showed substantially lower gray matter volume in brain regions involved in inhibition, conflict processing, valuation of outcomes, decision-making, reward, risk-taking, and rule-breaking antisocial behavior.
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Affiliation(s)
- Manish S. Dalwani
- Departments of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States of America
- * E-mail:
| | - Mary Agnes McMahon
- Departments of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States of America
| | | | - Susan E. Young
- Departments of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States of America
| | - Michael F. Regner
- Departments of Radiology, University of Colorado School of Medicine, Denver, CO, United States of America
| | - Kristen M. Raymond
- Departments of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States of America
| | - Shannon K. McWilliams
- Departments of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States of America
| | - Marie T. Banich
- Departments of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States of America
- Institute of Cognitive Science and Department of Psychology & Neuroscience, University of Colorado, Boulder, CO, United States of America
| | - Jody L. Tanabe
- Departments of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States of America
- Departments of Radiology, University of Colorado School of Medicine, Denver, CO, United States of America
| | - Thomas J Crowley
- Departments of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States of America
| | - Joseph T. Sakai
- Departments of Psychiatry, University of Colorado School of Medicine, Denver, CO, United States of America
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Thompson EA, Connelly CD, Thomas-Jones D, Eggert LL. School difficulties and co-occurring health risk factors: substance use, aggression, depression, and suicidal behaviors. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2014; 26:74-84. [PMID: 23351110 DOI: 10.1111/jcap.12026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PROBLEM Effective prevention requires understanding vulnerable populations, early signs of health risks, and the impact of social contexts. We tested a model of co-occurring mental health risks among at-risk youth experiencing school difficulties. METHODS We analyzed data from a random sample of 336 at-risk youth, grades 9-12, who completed a comprehensive risk/protective factors assessment. FINDINGS Simultaneously controlling for correlations among health risks, we observed systematic associations among risk factors, with generally consistent patterns for males and females. CONCLUSIONS The findings underscore the importance of developing interventions that incorporate contextual influences and of identifying common adaptable strategies for attenuating co-occurring health risks for at-risk youth.
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Affiliation(s)
- Elaine Adams Thompson
- Reconnecting Youth Prevention Research Program, Psychosocial and Community Health, University of Washington, Seattle, WA, USA.
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Trezza V, Baarendse PJJ, Vanderschuren LJMJ. On the interaction between drugs of abuse and adolescent social behavior. Psychopharmacology (Berl) 2014; 231:1715-29. [PMID: 24553578 DOI: 10.1007/s00213-014-3471-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 01/26/2014] [Indexed: 01/20/2023]
Abstract
RATIONALE Social factors influence drug abuse. Conversely, drugs of abuse alter social behavior. This is especially pertinent during post-weaning development, when there are profound changes in the social repertoire, and the sensitivity to the positive and negative effects of drugs of abuse is altered. OBJECTIVES This study aimed to provide an overview of our current understanding of the interaction between drugs of abuse and juvenile/adolescent social behavior. METHODS We first provide evidence that a characteristic form of juvenile and adolescent social behavior, i.e., social play behavior, has reinforcing properties and is affected by drugs of abuse. Next, social risk factors for drug use and addiction are described, including antisocial personality traits and early social insults. Last, we discuss research that investigates social influences on drug use, as well as the consequences of perinatal drug exposure on later social interactions. RESULTS Social play behavior is highly rewarding in laboratory animals, and it is affected by low doses of opioids, cannabinoids, ethanol, nicotine, and psychostimulants. In humans, antisocial personality traits, most prominently in the form of conduct disorder, are a prominent risk factor for drug addiction. Preclinical studies have consistently shown altered sensitivity to drugs as a result of social isolation during post-weaning development. The social environment of an individual has a profound, but complex, influence on drug use, and perinatal drug exposure markedly alters later social interactions. CONCLUSIONS The studies reviewed here provide a framework to understand the interaction between drugs of abuse and adolescent social interaction, at the preclinical and the clinical level.
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Affiliation(s)
- Viviana Trezza
- Department of Science, Section of Biomedical Science and Technologies, University "Roma Tre", Rome, Italy
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Difficulties in emotional regulation and substance use disorders: a controlled family study of bipolar adolescents. Drug Alcohol Depend 2013; 132:114-21. [PMID: 23422834 PMCID: PMC3683118 DOI: 10.1016/j.drugalcdep.2013.01.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 01/17/2013] [Accepted: 01/19/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Self-regulatory mechanisms appear etiologically operant in the context of both substance use disorders (SUD) and bipolar disorder (BD), however, little is known about the role of deficits in emotional self-regulation (DESR) as it relates to SUD in context to mood dysregulation. To this end, we examined to what extent DESR was associated with SUD in a high-risk sample of adolescents with and without BD. METHODS 203 families were assessed with a structured psychiatric interview. Using the Child Behavior Checklist (CBCL), a subject was considered to have DESR when he or she had an average elevation of 1 standard deviation (SD) above the norm on 3 clinical scale T scores (attention, aggression, and anxiety/depression; scores: 60 × 3 ≥ 180). RESULTS Among probands and siblings with CBCL data (N=303), subjects with DESR were more likely to have any SUD, alcohol use disorder, drug use disorder, and cigarette smoking compared to subjects with scores <180 (all p values <0.001), even when correcting for BD. We found no significant differences in the risk of any SUD and cigarette smoking between those with 1SD and 2SD above the mean (all p values >0.05). Subjects with cigarette smoking and SUD had more DESR compared to those without these disorders. CONCLUSIONS Adolescents with DESR are more likely to smoke cigarettes and have SUD. More work is needed to explore DESR in longitudinal samples.
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Kirisci L, Tarter R, Ridenour T, Zhai ZW, Fishbein D, Reynolds M, Vanyukov M. Age of alcohol and cannabis use onset mediates the association of transmissible risk in childhood and development of alcohol and cannabis disorders: evidence for common liability. Exp Clin Psychopharmacol 2013. [PMID: 23205723 PMCID: PMC3565072 DOI: 10.1037/a0030742] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Age at the time of first alcohol and cannabis use was investigated in relation to a measure of transmissible (intergenerational) risk for addiction in childhood and development of alcohol use disorder (AUD) and cannabis use disorder (CUD). It was hypothesized that age at the time of first experience with either substance mediates the association between transmissible risk and subsequent diagnosis of both disorders. The Transmissible Liability Index (TLI; (Vanyukov et al., 2009) was administered to 339 10- to 12-year-old boys (n = 254) and girls (n = 85). Age at the time of first alcohol and cannabis use, and diagnosis of AUD and CUD, were prospectively tracked to age 22. Each standard deviation unit increase in TLI severity corresponded to a reduction in age of alcohol and cannabis use onset by 3.2 months and 4.6 months, respectively. Age at the time of first alcohol use mediated the association of TLI with both AUD and CUD. Parallel results were obtained for cannabis. Whereas transmissible risk is congenerous to both AUD and CUD, its magnitude was 7 times greater in youths who initiated substance use with cannabis. TLI predicts age of first use of alcohol and cannabis that is common to developing both AUD and CUD. The ramifications of these findings for prevention are discussed.
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Affiliation(s)
- Levent Kirisci
- Department of Pharmaceutical Sciences, University of Pittsburgh, PA 15213, USA.
| | - Ralph Tarter
- Department of Pharmaceutical Sciences, University of Pittsburgh
| | - Ty Ridenour
- Department of Pharmaceutical Sciences, University of Pittsburgh
| | - Zu Wei Zhai
- Department of Pharmaceutical Sciences, University of Pittsburgh
| | - Diana Fishbein
- Transdisciplinary Behavioral Science Program in Health, Social, and Economics Research, Research Triangle Institute, Baltimore, Maryland
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Gillespie NA, Lubke GH, Gardner CO, Neale MC, Kendler KS. Two-part random effects growth modeling to identify risks associated with alcohol and cannabis initiation, initial average use and changes in drug consumption in a sample of adult, male twins. Drug Alcohol Depend 2012; 123:220-8. [PMID: 22177896 PMCID: PMC3442360 DOI: 10.1016/j.drugalcdep.2011.11.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 11/18/2011] [Accepted: 11/20/2011] [Indexed: 11/29/2022]
Abstract
AIMS Our aim was to profile alcohol and cannabis initiation and to characterize the effects of developmental and environmental risk factors on changes in average drug use over time. DESIGN We fitted a two-part random effects growth model to identify developmental and environmental risks associated with alcohol and cannabis initiation, initial average use and changes in average use. PARTICIPANTS 1796 males aged 24-63 from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. MEASUREMENTS Data from three interview waves included self-report measures of average alcohol and cannabis use between ages 15 and 24, genetic risk of problem drug use, childhood environmental risks, personality, psychiatric symptoms, as well as personal, family and social risk factors. FINDINGS Average alcohol and cannabis use were correlated at all ages. Genetic risk of drug use based on family history, higher sensation seeking, and peer group deviance predicted both alcohol and cannabis initiation. Higher drug availability predicted cannabis initiation while less parental monitoring and drug availability were the best predictors of how much cannabis individuals consumed over time. CONCLUSION The liability to initiate alcohol and cannabis, average drug use as well as changes in drug use during teenage years and young adulthood is associated with known risk factors.
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Affiliation(s)
- Nathan A. Gillespie
- Department of Psychiatry, Virginia Commonwealth University, United States,Queensland Institute of Medical Research, Brisbane, Australia,Corresponding author at: Virginia Institute for Psychiatric and Behavior Genetics, Department of Psychiatry, Virginia Commonwealth University, 800 East Leigh Street, Biotech 1, Suite 101, Richmond, VA 23219-1534, United States. (N.A. Gillespie)
| | - Gitta H. Lubke
- Department of Psychology, University of Notre Dame, United States
| | - Charles O. Gardner
- Department of Psychiatry, Virginia Commonwealth University, United States
| | - Michael C. Neale
- Department of Psychiatry, Virginia Commonwealth University, United States,Department of Human Genetics, Virginia Commonwealth University, United States
| | - Kenneth S. Kendler
- Department of Psychiatry, Virginia Commonwealth University, United States,Department of Human Genetics, Virginia Commonwealth University, United States
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Does the "gateway" sequence increase prediction of cannabis use disorder development beyond deviant socialization? Implications for prevention practice and policy. Drug Alcohol Depend 2012; 123 Suppl 1:S72-8. [PMID: 22365896 PMCID: PMC3387340 DOI: 10.1016/j.drugalcdep.2012.01.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 01/13/2012] [Accepted: 01/14/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study was conducted to test whether non-normative socialization mediates the association between transmissible risk measured in childhood and cannabis use disorder manifested by young adulthood, and whether the sequence of drug use initiation ("gateway", i.e., consuming legal drugs before cannabis, or the reverse) increases accuracy of prediction of cannabis use disorder. METHODS Sons of fathers with or without substance use disorders (SUDs) related to illicit drugs were tracked from 10-12 to 22 years of age to model the association between transmissible risk for SUD, socialization (peer deviance), order of drug use initiation ("gateway" or reverse sequence), and development of cannabis use disorder. Path analysis was used to evaluate relationships among the variables. RESULTS Non-normative socialization mediates the association between transmissible risk measured during childhood and cannabis use disorder manifest by young adulthood. The sequence of drug use initiation did not contribute additional explanatory information to the model. CONCLUSIONS The order of drug use initiation does not play a substantial role in the etiology of cannabis use disorder.
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Teesson M, Farrugia P, Mills K, Hall W, Baillie A. Alcohol, tobacco, and prescription drugs: the relationship with illicit drugs in the treatment of substance users. Subst Use Misuse 2012; 47:963-71. [PMID: 22676566 DOI: 10.3109/10826084.2012.663283] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Alcohol, tobacco, prescription drug, and illicit drug use frequently co-occur. This paper reviews the extent of this co-occurrence in both general population samples and clinical samples, and its impact on treatment outcome. We argue that the research base for understanding comorbidity among tobacco, alcohol, prescription, and illicit drugs needs to be broadened. We specifically advocate for: (1) more epidemiological studies of relationships among alcohol, tobacco, and other illicit drug use; and (2) increased research on treatment options that address the problematic use of all of these drugs.
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Affiliation(s)
- Maree Teesson
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia.
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14
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Schutter DJLG, van Bokhoven I, Vanderschuren LJMJ, Lochman JE, Matthys W. Risky decision making in substance dependent adolescents with a disruptive behavior disorder. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2011; 39:333-9. [PMID: 21153697 PMCID: PMC3066399 DOI: 10.1007/s10802-010-9475-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Of all psychiatric disorders, the disruptive behavior disorders (DBDs) are the most likely to predispose to substance dependence (SD). One possible underlying mechanism for this increased vulnerability is risky decision making. The aim of this study was to examine decision making in DBD adolescents with and without SD. Twenty-five DBD adolescents (19 males) with SD (DBD+SD), 28 DBD adolescents (23 males) without SD (DBD-SD) and 99 healthy controls (72 males) were included in the study. DBD adolescents with co-morbid attention deficit/ hyperactivity disorder (ADHD) were excluded. Risky decision making was investigated by assessing the number of disadvantageous choices in the Iowa gambling task. DBD+SD made significantly more risky choices than healthy controls and DBD-SD. Healthy controls and DBD-SD did not differ on risky decision making. These results suggest that risky decision making is a vulnerability factor for the development of SD in a subgroup of adolescents with DBD without ADHD.
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Affiliation(s)
- Dennis J. L. G. Schutter
- Department of Experimental Psychology, Utrecht University, Heidelberglaan 2, 3584 CS Utrecht, the Netherlands
| | - Irene van Bokhoven
- Department of Child and Adolescent Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, 3584 CX Utrecht, the Netherlands
| | - Louk J. M. J. Vanderschuren
- Department of Neuroscience and Pharmacology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, 3548 CG Utrecht, the Netherlands
- Department of Animals in Science and Society, Division of Behavioural Neuroscience, Faculty of Veterinary Medicine, Utrecht University, 3584 CM Utrecht, The Netherlands
| | - John E. Lochman
- Department of Psychology, The University of Alabama, Tuscaloosa, AL 35487-0348 USA
| | - Walter Matthys
- Department of Child and Adolescent Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, 3584 CX Utrecht, the Netherlands
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Ward JT, Stogner J, Gibson CL, Akers RL. A New Trick for an Old Dog: Applying Developmental Trajectories to Inform Drug Use Progression. JOURNAL OF DRUG ISSUES 2010. [DOI: 10.1177/002204261004000401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The frequent criticisms of the “gateway hypothesis” have led scholars to note the importance of considering the role of intra-individual change for drug use progression. While studies employing drug use trajectories have added considerably to our understanding of drug use comorbidity, the extent to which trajectories inform drug use progression remains largely unknown despite the fact that there are several theoretical reasons to suspect that intra-individual change is important to the gateway phenomenon. The current study employs latent class growth models using a sample from the Boys Town study of adolescent drug and drinking behavior. The results demonstrate that knowing how gateway drug use changes over time provides important information above and beyond knowing frequency of gateway use for predicting harder drug use trajectories. Implications of the empirical findings and directions for future research are discussed.
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Makanjuola VA, Oladeji BD, Gureje O. The gateway hypothesis of substance abuse: an examination of its applicability in the Nigerian general population. Subst Use Misuse 2010; 45:1558-71. [PMID: 20590375 DOI: 10.3109/10826081003682081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The study aims to estimate the prevalence and predictors of not following the gateway theory. Respondents were selected from a multistage stratified clustered sampling of households in five of Nigeria's six geopolitical regions. Interviews were conducted between February 2002 and May 2003 using the CIDI-version.3 with a total sample size (N) of 2,143. Cumulative incidence proportions of not following a gateway pattern were estimated with SUDAAN. Predictors of this were estimated using multivariate logistic regression models. The deviation from the normative sequence of drug use occurs albeit infrequently. The public health implications of this are discussed as well as the limitations of the findings.
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Boxer P. Covariation of self- and other-directed aggression among inpatient youth: continuity in the transition to treatment and shared risk factors. Aggress Behav 2010; 36:205-17. [PMID: 20309848 DOI: 10.1002/ab.20343] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Although other- and self-directed aggression covary in very high-risk youth, these forms of aggression infrequently are studied simultaneously. Understanding better their covariation is an important task for improving services to high-risk youth. In this study, data from the clinical records of 476 youth admitted to secure inpatient treatment were analyzed to examine relations among self- and other-directed aggression exhibit before and during inpatient treatment. Analyses tested the hypotheses that self- and other-directed aggression would tend to covary and display continuity from pre-treatment to in-treatment. Also tested were the hypotheses that youth with histories of co-occurring self- and other-directed aggression would show the highest levels of aggression during treatment and the greatest degree of personal and contextual risk on entering treatment. These hypotheses were largely supported. Exploratory analyses revealed interesting discontinuities in aggression (aggression emitted only before or during treatment) with critical implications for research and practice with youth receiving clinical care, especially those in institutional placements.
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Affiliation(s)
- Paul Boxer
- Department of Psychology, Rutgers University, Newark, New Jersey, USA.
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18
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Young SE, Friedman NP, Miyake A, Willcutt EG, Corley RP, Haberstick BC, Hewitt JK. Behavioral disinhibition: liability for externalizing spectrum disorders and its genetic and environmental relation to response inhibition across adolescence. JOURNAL OF ABNORMAL PSYCHOLOGY 2009; 118:117-30. [PMID: 19222319 DOI: 10.1037/a0014657] [Citation(s) in RCA: 286] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Behavioral disinhibition has been characterized as a generalized vulnerability to externalizing disorders. Despite increasing evidence for its validity and heritability, the structural stability of behavioral disinhibition across adolescence and the strength and etiology of its relation to executive functions have not been studied. In this multivariate twin study, the authors assessed behavioral disinhibition using measures tapping substance use, conduct disorder, attention-deficit/hyperactivity disorder (ADHD), and novelty seeking at ages 12 and 17. Executive functions were assessed with laboratory-based cognitive tasks at age 17. Results indicated that, at age 12, behavioral disinhibition was dominated by ADHD and conduct problems and was highly heritable. At age 17, the contributions of the 4 components were more balanced, and the proportion of variance attributable to genetic factors was somewhat smaller, with additional variance due to shared environmental influences. At both ages, behavioral disinhibition was more closely related to response inhibition than other executive functions (working memory updating and task-set shifting), and this relationship was primarily genetic in origin. These results highlight the dynamic nature of behavioral disinhibition across adolescence and suggest that response inhibition may be an important mechanism underlying vulnerability to disinhibitory psychopathology.
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Affiliation(s)
- Susan E Young
- Institute for Behavioral Genetics, University of Colorado at Boulder, Boulder, CO 80309, USA.
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Sakai JT, Mikulich-Gilbertson SK, Crowley TJ. Adolescent Inhalant Use among Male Patients in Treatment for Substance and Behavior Problems: Two-Year Outcome. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2009; 32:29-40. [PMID: 16450641 DOI: 10.1080/00952990500328513] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
UNLABELLED Adolescent inhalant users are significantly more likely than other patients to have conduct disorder, to report abuse and neglect, and to have previously attempted suicide. Yet little has been published regarding treatment outcome for inhalant users. METHODS Eighty male adolescents admitted to a residential treatment program underwent baseline assessment during treatment, and follow-up assessment at two-years post admission. Subjects reporting any lifetime inhalant use at baseline (n = 34) were compared to the other patients (n = 46) on 4 outcome variables. RESULTS Adolescents reporting any lifetime inhalant use at baseline assessment reported twice as many past-year conduct disorder symptoms at two-year follow up (p = 0.03). The relationship between inhalant use and conduct disorder symptoms remained significant (p = 0.03) in analyses that controlled for age, time in jail or restricted environments in the 6-months preceding follow-up, as well as baseline-reported lifetime number of conduct disorder symptoms. Inhalant users were not significantly worse on these other outcome measures: crime in the last month (p = 0.60), days of nontobacco substance use in the last 6 months (p = 0.65), or, commission of selected crimes in the last 6 months (p = 0.06). CONCLUSIONS Inhalant use among adolescent males in treatment for substance and behavior problems may predict more severe conduct disorder symptoms after treatment.
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Affiliation(s)
- Joseph T Sakai
- Division of Substance Dependence, University of Colorado School of Medicine, Denver 80262, USA.
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20
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Vitoratou S, Ntzoufras I, Smyrnis N, Stefanis NC. Factorial composition of the Aggression Questionnaire: a multi-sample study in Greek adults. Psychiatry Res 2009; 168:32-9. [PMID: 19443044 DOI: 10.1016/j.psychres.2008.01.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 01/07/2008] [Accepted: 01/28/2008] [Indexed: 11/29/2022]
Abstract
The primary aim of the current article was the evaluation of the factorial composition of the Aggression Questionnaire (AQ(29)) in the Greek population. The translated questionnaire was administered to the following three heterogeneous adult samples: a general population sample from Athens, a sample of young male conscripts and a sample of individuals facing problems related to substance use. Factor analysis highlighted a structure similar to the one proposed by Buss and Perry [Buss, A.F., Perry, M., 1992. The Aggression Questionnaire. Journal of Personality and Social Psychology 63, 452-459]. However, the refined 12-item version of Bryant and Smith [Bryant, F.B., Smith, B.D., 2001. Refining the architecture of aggression: a measurement model for the Buss-Perry Aggression Questionnaire. Journal of Research in Personality 35, 138-167] provided a better fit to our data. Therefore, the refined model was implemented in further analysis. Multiple group confirmatory factor analysis was applied in order to assess the variability of the 12-item AQ across gender and samples. The percentage of factor loading invariance between males and females and across the three samples defined above was high (higher than 75%). The reliability (internal consistency) of the scale was satisfactory in all cases. Content validity of the 12-item AQ was confirmed by comparison with the Symptom Check-List 90 Revised.
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Affiliation(s)
- Silia Vitoratou
- University Mental Health Research Institute, Soranou Efesiou 2, Papagou, 156 01, Athens, Greece; Department of Statistics, University of Economics and Business, Patision 76, 104 34 Athens, Greece
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21
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SPOONER CATHERINE. Causes and correlates of adolescent drug abuse and implications for treatment. Drug Alcohol Rev 2009. [DOI: 10.1080/09595239996329] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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22
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Strong DR, Kahler CW, Colby SM, Griesler PC, Kandel D. Linking measures of adolescent nicotine dependence to a common latent continuum. Drug Alcohol Depend 2009; 99:296-308. [PMID: 18938047 PMCID: PMC2655729 DOI: 10.1016/j.drugalcdep.2008.09.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Revised: 08/29/2008] [Accepted: 09/02/2008] [Indexed: 11/26/2022]
Abstract
Using the theoretical model of nicotine dependence (ND) operationalized within the Diagnostic and Statistical Manual of Mental Disorder, fourth Edition (DSM-IV: American Psychiatric [American Psychiatric Association, 1994. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. American Psychiatric Association, Washington, DC]) as a frame of reference, we used methods based in item response theory to link alternative instruments assessing adolescent nicotine dependence severity to a common latent continuum. A multi-ethnic cohort of 6th-10th graders selected from the Chicago Public Schools (CPS) completed five household interviews over 2 years. Youth who reported at least some cigarette use in the last 30 days prior to the interviews at waves W3-W5 completed measures of DSM-IV ND, the Modified Fagertrom Tolerance Questionnaire (mFTQ: Prokhorov et al., 1998) and the Nicotine Dependence Syndrome Scale (NDSS: Shiffman et al., 2004), yielding samples of 253, 241, and 296 respondents at W3-W5, respectively. Confirmatory factor analysis supported a primary dimension of ND. Each instrument's items had complementary and stable relationships to ND across multiple waves of assessment. By aligning symptoms along a common latent ND continuum, we evaluated the consistency of symptoms from different instruments that target similar content. Further, these methods allowed for the examination of the DSM-IV as a continuous index of ND, evaluation of the degree of heterogeneity in levels of ND within groups above and below diagnostic thresholds, and the utility of using the pattern or particular DSM-IV symptoms that led to each score in further differentiating levels of ND. Finally, we examined concurrent validity of the ND continuum and levels of current of smoking at each wave of assessment.
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23
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Wells JE, McGee MA. Violations of the usual sequence of drug initiation: prevalence and associations with the development of dependence in the New Zealand Mental Health Survey. J Stud Alcohol Drugs 2008; 69:789-95. [PMID: 18925336 PMCID: PMC2583386 DOI: 10.15288/jsad.2008.69.789] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 05/02/2008] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE For 3 decades, studies have reported that the usual sequence of drug initiation is licit drugs, then cannabis, and then other illicit drugs. This article describes the prevalence of violations of this sequence, the predictors of violations, and the relationship between violations and the onset of alcohol or drug dependence. METHOD The New Zealand Mental Health Survey is a nationally representative sample with 12,992 face-to-face interviews carried out in 2003-2004. The response rate was 73.3%. The World Health Organization Composite International Diagnostic Interview (CIDI 3.0) was used in the survey. Reports of the age at first use were obtained for alcohol and drugs but not for smoking. RESULTS Violations of the usual sequence of drug initiation were uncommon in the population (2.6%). Use of other illicit drugs before cannabis was the main violation, found in 2.3% of alcohol users, 3.0% of cannabis users, 8.6% of cocaine users, and 16.7% of those who had used other illicit drugs. Use of other illicit drugs before cannabis was more predominant in younger cohorts and those with more early-onset internalizing disorders. Violations had little association with the development of dependence in users when other important predictors such as age at onset of use and the number of illicit drugs used were taken into account. Internalizing disorders and early-onset bipolar disorder also predicted dependence. CONCLUSIONS In New Zealand, violations of the gateway sequence are not common and they are not markers of progression to dependence.
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Affiliation(s)
- J Elisabeth Wells
- Department of Public Health and General Practice, University of Otago, Christchurch, P.O. Box 4345, Christchurch Mail Centre, Christchurch 8140, New Zealand.
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24
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Lopez B, Schwartz SJ, Prado G, Huang S, Rothe EM, Wang W, Pantin H. Correlates of early alcohol and drug use in Hispanic adolescents: examining the role of ADHD with comorbid conduct disorder, family, school, and peers. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2008; 37:820-32. [PMID: 18991132 PMCID: PMC2916647 DOI: 10.1080/15374410802359676] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examined correlates of early adolescent alcohol and drug use in a community sample of 217 eighth-grade adolescents with behavior problems and from Hispanic/Latino immigrant families. Structural equation modeling was used to examine relationships of multiple contexts (e.g., family, school, and peers) to alcohol and drug use. Results suggest that conduct disorder in youth with high levels of hyperactivity symptoms, poor school functioning, and peer alcohol and drug use was directly related to early adolescent alcohol and drug use. Attention deficit/hyperactivity disorder with comorbid conduct disorder and family functioning was indirectly related to early alcohol and drug use through poor school functioning and through peer alcohol and drug use. Results are discussed in terms of possible targets for interventions to prevent alcohol and drug use in Hispanic adolescents.
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Affiliation(s)
- Barbara Lopez
- Miller School of Medicine, Division of Cardiology, University of Miami, Jackson Memorial Hospital North Wing, 210 Miami, FL 33136, USA.
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Wilens TE, Biederman J, Adamson JJ, Henin A, Sgambati S, Gignac M, Sawtelle R, Santry A, Monuteaux MC. Further evidence of an association between adolescent bipolar disorder with smoking and substance use disorders: a controlled study. Drug Alcohol Depend 2008; 95:188-98. [PMID: 18343050 PMCID: PMC2365461 DOI: 10.1016/j.drugalcdep.2007.12.016] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Revised: 11/20/2007] [Accepted: 12/26/2007] [Indexed: 02/08/2023]
Abstract
Although previous work suggests that juvenile onset bipolar disorder increases risk for substance use disorders and cigarette smoking, the literature on the subject is limited. We evaluated the association of risk for substance use disorders and cigarette smoking with bipolar disorder in adolescents in a case-control study of adolescents with bipolar disorder (n=105, age 13.6+/-2.5 years [mean]; 70% male) and without bipolar disorder ("controls"; n=98, age 13.7+/-2.1 years; 60% male). Rates of substance use and other disorders were assessed with structured interviews (KSADS-E for subjects younger than 18, SCID for 18-year-old subjects). Bipolar disorder was associated with a significant age-adjusted risk for any substance use disorder (hazard ratio[95% confidence interval]=8.68[3.02 25.0], chi(2)=16.06, p<0.001, df=1), alcohol abuse (7.66 [2.20 26.7], chi(2)=10.2, p=0.001, df=1), drug abuse (18.5 [2.46 139.10], chi(2)=8.03, p=0.005, df=1) and dependence (12.1 [1.54 95.50], chi(2)=5.61, p=0.02, df=1), and cigarette smoking (12.3 [2.83 53.69], chi(2)=11.2, p<0.001, df=1), independently of attention deficit/hyperactivity disorder, multiple anxiety, and conduct disorder (CD). The primary predictor of substance use disorders in bipolar youth was older age (BPD-SUD versus BPD+SUD, logistic regression: chi(2)=89.37, p<0.001). Adolescent bipolar disorder is a significant risk factor for substance use disorders and cigarette smoking, independent of psychiatric comorbidity. Clinicians should carefully screen adolescents with bipolar disorder for substance and cigarette use.
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Affiliation(s)
- Timothy E. Wilens
- Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Boston, MA 02114, USA, Harvard Medical School, Department of Psychiatry, Cambridge, MA 02115, USA
| | - Joseph Biederman
- Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Boston, MA 02114, USA, Harvard Medical School, Department of Psychiatry, Cambridge, MA 02115, USA
| | - Joel J. Adamson
- Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Boston, MA 02114, USA
| | - Aude Henin
- Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Boston, MA 02114, USA
| | - Stephanie Sgambati
- Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Boston, MA 02114, USA
| | - Martin Gignac
- Institute Philippe Pinel, Université de Montréal, Montréal, Qc, H3C 3J7, CANADA
| | - Robert Sawtelle
- Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Boston, MA 02114, USA
| | - Alison Santry
- Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Boston, MA 02114, USA
| | - Michael C. Monuteaux
- Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Boston, MA 02114, USA, Harvard Medical School, Department of Psychiatry, Cambridge, MA 02115, USA
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Pillai A, Patel V, Cardozo P, Goodman R, Weiss HA, Andrew G. Non-traditional lifestyles and prevalence of mental disorders in adolescents in Goa, India. Br J Psychiatry 2008; 192:45-51. [PMID: 18174509 DOI: 10.1192/bjp.bp.106.034223] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Adolescents comprise a fifth of the population of India, but there is little research on their mental health. We conducted an epidemiological study in the state of Goa to describe the current prevalence of mental disorders and its correlates among adolescents aged between 12 and 16 years. AIMS To estimate the prevalence and correlates of mental disorders in adolescents. METHOD Population-based survey of all eligible adolescents from six urban wards and four rural communities which were randomly selected. We used a Konkani translation of the Development and Well-Being Assessment to diagnose current DSM-IV emotional and behavioural disorders. All adolescents were also interviewed on socio-economic factors, education, neighbourhood, parental relations, peer and sexual relationships, violence and substance use. RESULTS Out of 2,684 eligible adolescents, 2,048 completed the study. The current prevalence of any DSM-IV diagnosis was 1.81%; 95% CI 1.27-2.48. The most common diagnoses were anxiety disorders (1.0%), depressive disorder (0.5%), behavioural disorder (0.4%) and attention-deficit hyperactivity disorder (0.2%). Adolescents from urban areas and girls who faced gender discrimination had higher prevalence. The final multivariate model found an independent association of mental disorders with an outgoing 'non-traditional' lifestyle (frequent partying, going to the cinema, shopping for fun and having a boyfriend or girlfriend), difficulties with studies, lack of safety in the neighbourhood, a history of physical or verbal abuse and tobacco use. Having one's family as the primary source of social support was associated with lower prevalence of mental disorders. CONCLUSIONS The current prevalence of mental disorders in adolescents in our study was very low compared with studies in other countries. Strong family support was a critical factor associated with low prevalence of mental disorders, while factors indicative of adoption of a non-traditional lifestyle were associated with an increased prevalence.
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Abstract
This article summarizes the current knowledge base in the prevention of childhood conduct problems. First, childhood conduct problems and comorbid conditions are described, followed by a review of risk factors that have been found to contribute to the development of conduct problems. Risk factors include both internal child characteristics such as temperament and genetic/neurobiological influences, and external factors such as family, peer, and neighborhood influences. Finally, descriptions are provided for several intervention programs that have demonstrated empirical support in the prevention of youth conduct problems.
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Lane SD, Cherek DR, Tcheremissine OV, Steinberg JL, Sharon JL. Response perseveration and adaptation in heavy marijuana-smoking adolescents. Addict Behav 2007; 32:977-90. [PMID: 16930850 DOI: 10.1016/j.addbeh.2006.07.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Revised: 07/06/2006] [Accepted: 07/13/2006] [Indexed: 10/24/2022]
Abstract
The present study examined two behavioral processes - response perseveration and response adaptation - in adolescents who were heavy marijuana smokers and control adolescents. Testing took place in a controlled laboratory setting, using customized software and either a computer keyboard or a custom built response panel for response input. Adolescents age 14-18 were recruited into a heavy smoking (near daily) group (N=22) or a control group (N=31) with <15 lifetime uses of marijuana and no history of substance abuse or dependence. Marijuana use was verified by daily quantification of urinary cannabinoids and self-reports. Participants completed laboratory tasks designed to measure response perseveration (Wisconsin Card Sort Task, WCST) and response adaptation (concurrent variable-ratio reinforcement schedule with changing contingencies). Data were analyzed via ANOVA, controlling for multiple factors including: gender, age, nicotine use, presence of conduct disorder, and subscales of the Youth Self Report. After controlling for these compared to controls marijuana-using participants made significantly more perseverative and total errors on the WCST and showed significantly impaired (e.g., less adaptive) response allocation to the changing reinforcement contingencies on the concurrent-reinforcement task. Within the constraints of the study's limitations in controlling for alternative sources of between-subject variability, the data suggest that individuals who regularly smoke marijuana during adolescence show measurable perturbations in important basic behavioral processes. The data are also consistent with a previous laboratory study demonstrating reduced motivation in marijuana-smoking adolescents versus controls [Lane, S.D., Cherek, D.R., Pietras, C.J., and Steinberg, J.L. (2005). Performance of heavy marijuana-smoking adolescents on a laboratory measure of motivation. Addictive Behaviors, 30, 815-828].
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Affiliation(s)
- Scott D Lane
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, USA.
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29
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Crowley TJ. Adolescents and substance-related disorders: research agenda to guide decisions on Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V). Addiction 2006; 101 Suppl 1:115-24. [PMID: 16930168 DOI: 10.1111/j.1360-0443.2006.01594.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS Since the publication of the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV), many studies have addressed substance use disorders (SUD) in adolescents. Based on that adolescent literature, this paper suggests further research to help guide decisions about revising for DSM-V the SUD criteria in DSM-IV. METHODS The author has reviewed the 'Substance Related Disorders' section of DSM-IV-TR, recalled his experience in helping to draft that section, accessed relevant articles in PubMed and reviewed his own extensive file of literature citations. RESULTS This paper suggests six questions for adolescent research to help guide the framers of DSM-V's 'Substance Related Disorders' section: (a) DSM-IV did not provide a diagnosis of cannabis withdrawal; should DSM-V continue that position? (b) Should SUD be included or referenced among 'Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence'? (c) Can inter-rater reliability of the substance abuse (SA) criteria be improved with altered example situations, text descriptions or phrasing of the current criteria? (d) Between ages 14 and 18 years is earlier onset of SUD a severity marker that could be incorporated into DSM-V as a predictor of worse course? (e) In DSM-V could a phenotypic descriptor of pathological multi-substance involvement document severity and predict course of SUD? (f) Could clinicians and patients benefit from DSM-V-related postpublication procedures for classifying emerging new drugs into DSM-V's categories? CONCLUSIONS Without substantive changes in SA or substance dependence diagnostic criteria, research may improve the usefulness of those criteria for adolescents.
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Affiliation(s)
- Thomas J Crowley
- Division of Substance Dependence, Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, USA.
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Dellu-Hagedorn F. Relationship between impulsivity, hyperactivity and working memory: a differential analysis in the rat. Behav Brain Funct 2006; 2:10. [PMID: 16569223 PMCID: PMC1471794 DOI: 10.1186/1744-9081-2-10] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Accepted: 03/28/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Impulsivity is a behavioural trait that comprises several distinct processes. It is a key feature of many psychopathologies such as mania, addictive disorders or attention deficit-hyperactivity disorders. To date, the aspects of impulsiveness involved in these pathologies have not yet been explicitly defined. In these disorders, sensation or drug seeking and cognitive deficits are closely related, but the nature of these relationships remains largely unknown. A new animal model of impulsiveness based on spontaneous inter-individual differences is proposed here to help clarify the relationship between characteristic aspects of impulsive-related pathologies. METHODS Rats were divided into sub-groups according to their scores in three operant tasks with varying degrees of behavioural inhibition, timing and motor vs. cognitive impulsivity demands. These tasks included a fixed consecutive number schedule (ability to complete an action to receive a reinforcer), a multiple fixed-interval/extinction schedule of reinforcement (high level of responding), and a delayed reward task (delay discounting). In addition, measurements of locomotor responses to novelty and to amphetamine in a circular corridor, and working memory in an 8-arm radial maze were obtained. RESULTS Substantial behavioural inter-individual differences were observed in each task, whereas few inter-task relationships were found. Impulsive rats, as defined in a task requiring inhibition of premature responses, presented a higher increase in amphetamine-induced locomotion. Reduced working memory performance was only observed in hyperactive rats in an extinction schedule. CONCLUSION This novel approach shows that distinct aspects of impulsiveness and hyperactivity can be expressed based on large inter-individual differences that vary from poorly to highly adapted behaviours ones in a normal population of rats. Inhibitory deficit was related to a higher response to psychostimulants a characteristic of rats predisposed to amphetamine self-administration and related to higher limbic dopaminergic activity, whereas working memory capacity was only related to hyperactivity. This approach allows for the identification of particular individuals presenting distinct behavioural characteristics of impulsive-related psychopathologies. These individuals may be of great interest in the modelling of these disorders and the exploration of their neurobiological bases.
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Affiliation(s)
- Françoise Dellu-Hagedorn
- Laboratoire de Neuropsychobiologie des Désadaptations, CNRS UMR 5541, Université Victor Segalen Bordeaux 2--BP, 31, 146 rue Léo Saignat; 33076 Bordeaux cedex, France.
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Turner AP, Larimer ME, Sarason IG, Trupin EW. Identifying a negative mood subtype in incarcerated adolescents: relationship to substance use. Addict Behav 2005; 30:1442-8. [PMID: 16022939 DOI: 10.1016/j.addbeh.2005.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2004] [Revised: 01/03/2005] [Accepted: 01/21/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The following study tested the empirical validity and clinical meaningfulness of a negative mood subtype of incarcerated adolescent males (N=270). Differences in alcohol and marijuana use and consequences were examined. METHOD Participants were subtyped according to reports of depressive and anxious symptoms using the Children's Depression Inventory and the Revised Children's Manifest Anxiety Scale. RESULTS Cluster analysis confirmed the presence of negative mood (34%) and normal mood (66%) subtypes. Incarcerated adolescents in the negative mood subtype reported higher levels of alcohol use, higher levels of use-related consequences for both alcohol and marijuana, greater use of both substances to regulate mood states, and more use of avoidant coping. CONCLUSION Results underscore the need for identification and treatment of mental health and substance use difficulties in the juvenile justice system.
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Affiliation(s)
- Aaron P Turner
- VA Puget Sound Health Care System, and Department of Rehabilitation Medicine, University of Washington, Seattle 98108, United States.
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Gelhorn HL, Stallings MC, Young SE, Corley RP, Rhee SH, Hewitt JK. Genetic and environmental influences on conduct disorder: symptom, domain and full-scale analyses. J Child Psychol Psychiatry 2005; 46:580-91. [PMID: 15877764 DOI: 10.1111/j.1469-7610.2004.00373.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We used variable threshold models which accounted for age and gender differences to investigate the genetic and environmental influences on DSM-IV conduct disorder (CD) at the level of symptoms, aggressive versus non-aggressive domains, and full-scale. METHOD A community sample of 1100 twin pairs (age 11-18) was interviewed using the Diagnostic Interview Schedule for Children. RESULTS Behavior genetic model fitting suggested that genetic and environmental influences on individual symptoms varied by symptom. The best-fitting models for aggressive and non-aggressive domains, and full-scale CD included additive genetic effects and unique environmental effects only (AE models). These effects could be constrained across age cohorts and sex. The results suggest that using models that incorporate age- and gender-appropriate thresholds specific to each subject we can account for prevalence differences between cohorts. Heritability estimates were .49, .55 and .53 for the aggressive domain, non-aggressive domain, and full-scales, respectively. These results are in contrast to previous research on antisocial behavior measured with the CBCL reporting higher heritability for aggressive versus non-aggressive domains. CONCLUSIONS Results suggest that individual symptoms of CD may be differentially heritable. Additionally, CD assessed using DSM-IV criteria may show differing patterns of heritability compared with estimates obtained for other measures of antisocial behavior such as the CBCL.
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Affiliation(s)
- Heather L Gelhorn
- Institute for Behavioral Genetics, University of Colorado, Boulder, CO 80309-0447, USA.
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Abstract
Despite what is often believed, the majority of those who experiment with substances with a dependence potential do not develop dependence. However, there is a subpopulation of users that easily becomes dependent on substances, and these individuals exhibit pre-existing comorbid traits, including novelty seeking and antisocial behavior. There appears to be a genetic basis for the susceptibility to dependence and these comorbid traits. Animal studies have identified specific genes that can alter susceptibility to dependence and response to novelty. The mechanisms underlying the genetic susceptibility to dependence and response to novelty are complex, but genetic susceptibility plays a significant role in the transition from substance use to dependence and from chronic use to addiction. We discuss two models to explain how genetic variations alter dependence susceptibility. Identification of the specific genes involved in these processes would help to identify individuals that are vulnerable to dependence/addiction and to devise novel treatment strategies.
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Affiliation(s)
- N Hiroi
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
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Copur M, Turkcan A, Erdogmus M. Substance abuse, conduct disorder and crime: assessment in a juvenile detention house in Istanbul, Turkey. Psychiatry Clin Neurosci 2005; 59:151-4. [PMID: 15823160 DOI: 10.1111/j.1440-1819.2005.01350.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of the present study was to determine the rate of substance abuse in the juvenile detention house and to determine the relationship between crime and substance abuse and conduct disorder. Two hundred and thirty cases in the biggest juvenile detention house in Istanbul, Turkey were assessed according to Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) criteria. Law files and data of crime were examined. A total of 80 out of 230 juvenile detainees (34.8%) were found to have substance abuse excluding nicotine and alcohol. The substances abused in preferential order were cannabis (72.5%), volatile substances (21.3% bally and 3.7% thinner; 25%) and sedative hypnotic drugs and biperidents (2.5%). The rate of conduct disorder was 46.3% in substance abusers and 25.3% in the others (odds ratio: 2.536). The rate of substance abuse was 48.5% in the juveniles who had committed multiple crimes and 14.1% in the others (odds ratio: 5.735). The study shows that conduct disorder was very high in juvenile detainees. Conduct disorder was higher in substance-abusing than in non-abusing juvenile detainees. Substance-abusing juvenile detainees were found to have a higher detention rate than non-abusing juvenile detainees. There was a close relation between conduct disorder and substance abuse and multiple crimes. In the light of these results, diagnosis and treatment for conduct disorder in juvenile detainees are of great importance.
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Affiliation(s)
- Mazlum Copur
- Bakirkoy Research Hospital for Psychiatric and Neurological Diseases, Osmaniye cad Göksu Apt. No. 7/16, Bakirkoy, Istanbul, Turkey.
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Sood AB, Razdan A, Weller EB, Weller RA. How to differentiate bipolar disorder from attention deficit hyperactivity disorder and other common psychiatric disorders: a guide for clinicians. Curr Psychiatry Rep 2005; 7:98-103. [PMID: 15802085 DOI: 10.1007/s11920-005-0005-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Bipolar disorder in children often is confused with attention deficit disorder, substance-induced mood disorder, oppositional defiant disorder, and conduct disorder. It is not uncommon for some of these disorders to be comorbid with pediatric bipolar disorder. This article provides the reader with a review of the existing literature on differentiating these illnesses and recognizing the phenomenology of each disorder as it pertains to a psychiatric diagnostic work-up of a child. Clinically helpful overlapping and unique characteristics of each disorder are discussed and a practical approach to differentiate these disorders is provided.
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Affiliation(s)
- Aradhana Bela Sood
- Division of Child and Adolescent Psychiatry, Virginia Commonwealth University Health Systems, 515 North 10th Street, Richmond, VA 23298, USA.
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Helstrom A, Bryan A, Hutchison KE, Riggs PD, Blechman EA. Tobacco and alcohol use as an explanation for the association between externalizing behavior and illicit drug use among delinquent adolescents. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2005; 5:267-77. [PMID: 15566052 DOI: 10.1023/b:prev.0000045360.23290.8f] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The prevalence and persistence of adolescent substance use and abuse is a national health issue, and substance use among adolescents is frequently comorbid with other psychiatric disorders. Most studies in this area utilize samples of middle or high school students or from inpatient settings. Less is known about substance use and psychiatric comorbidity among delinquent adolescents. The present study examined data from two cohorts of juvenile offenders collected over a 2-year period (n = 245, n = 299). Participants reported frequency of cigarette, alcohol, marijuana, and other substance use. Participants' parents completed a measure of behavior problems. Path analyses suggested that parental reports of externalizing problems were significantly related to self-reported substance use while parental reports of internalizing problems were not. Results also suggested that smoking and alcohol use act as mediators between externalizing problems and marijuana and other drug use. Although there were some mean differences by gender, the pattern of relationships amongst the variables did not differ by gender. Implications of the findings and future directions are discussed.
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Affiliation(s)
- Amy Helstrom
- Department of Psychology, University of Colorado, Boulder, Colorado 80309-0345, USA
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Wilens TE, Biederman J, Kwon A, Ditterline J, Forkner P, Moore H, Swezey A, Snyder L, Henin A, Wozniak J, Faraone SV. Risk of substance use disorders in adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry 2004; 43:1380-6. [PMID: 15502597 DOI: 10.1097/01.chi.0000140454.89323.99] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Previous work in adults and youths has suggested that juvenile onset bipolar disorder (BPD) is associated with an elevated risk of substance use disorders (SUD). Considering the public health importance of this issue, the authors now report on a controlled study of adolescents with and without BPD to evaluate the risk of SUD. METHOD Probands with DSM-IV BPD (n=57, mean age +/- SD=13.3 +/- 2.4 years) and without DSM-IV BPD (n=46, 13.6 +/- 2.2 years) were studied. Structured psychiatric interviews and multiple measures of SUD were collected. RESULTS Bipolar disorder was associated with a highly significant risk factor for SUD (32% versus 7%, Z=2.9, p=.004) that was not accounted for by conduct disorder (adjusted odds ratio=5.4, p=.018). Adolescent-onset BPD (> or =13 years) was associated with a higher risk of SUD compared with those with child-onset BPD (chi1=9.3, p=.002). CONCLUSIONS These findings strongly indicate that BPD, especially adolescent onset, is a significant risk factor for SUD independently of conduct disorder.
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Affiliation(s)
- Timothy E Wilens
- Pediatric Psychopharmacology Unit, Child Psychiatric Service, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114, USA.
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Eftekhari A, Turner AP, Larimer ME. Anger expression, coping, and substance use in adolescent offenders. Addict Behav 2004; 29:1001-8. [PMID: 15219349 DOI: 10.1016/j.addbeh.2004.02.050] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The present study examined anger expression and avoidant coping and their relationship to substance use and use-related consequences in a sample of 270 incarcerated adolescents. Outwardly expressed anger was significantly associated with both alcohol and marijuana use and use-related consequences. Avoidant coping was also significantly associated with all outcome variables. There were no significant interactions between anger expression (outward or inward) and avoidant coping. Collectively, results suggest that expression of anger and avoidant coping are independent risk factors for substance use and use-related consequences across two classes of drugs in adolescent offenders.
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Kendall PC, Safford S, Flannery-Schroeder E, Webb A. Child anxiety treatment: outcomes in adolescence and impact on substance use and depression at 7.4-year follow-up. J Consult Clin Psychol 2004; 72:276-87. [PMID: 15065961 DOI: 10.1037/0022-006x.72.2.276] [Citation(s) in RCA: 347] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Research suggests that the sequelae of childhood anxiety disorders, if left untreated, can include chronic anxiety, depression, and substance abuse. The current study evaluated the maintenance of outcomes of children who received a 16-week cognitive-behavioral treatment for primary anxiety disorders (generalized, separation, and social anxiety disorders) an average of 7.4 years earlier. The 86 participants (ages 15 to 22 years; 91% of the original sample) and their parents completed diagnostic interviews and self- and parent-report measures. According to the diagnostic interviews, a meaningful percentage of participants maintained significant improvements in anxiety at long-term follow-up. With regard to sequelae, positive responders to anxiety treatment, as compared with less positive responders, had a reduced amount of substance use involvement and related problems at long-term follow-up. The findings are discussed with regard to child anxiety and some of its sequelae.
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Affiliation(s)
- Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA 19122, USA.
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40
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Wu NS, Lu Y, Sterling S, Weisner C. Family environment factors and substance abuse severity in an HMO adolescent treatment population. Clin Pediatr (Phila) 2004; 43:323-33. [PMID: 15118775 DOI: 10.1177/000992280404300403] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To examine how parental limit setting, family conflict, and perception of family experience influence severity of alcohol and drug problems, and important gender differences in these relationships, we interviewed consecutive intakes, aged 12 to 18 years, at 4 chemical dependency programs of a large group-model nonprofit health maintenance organization (HMO) (n=419). The Family Conflict, Limit Setting, and Positive Family Experience scales correlated with substance dependence (p<0.01, p<0.01, p<0.05, respectively). Depression also correlated with family conflict (p<0.01), absence of limit setting (p<0.01), poor family experience (p<0.01) and dependence symptoms (p<0.01). Number of substance-using friends correlated with number of dependence symptoms (p<0.01). Gender differences included the following: (1) girls scoring higher in family conflict (p=0.0002), negative perceptions of family experience (p<0.0017), and lower in absence of limit setting (p<0.0001); (2) how family environment predicted problem severity: absence of limit setting was significant for boys and girls but family conflict for boys only; (3) girls had more dependence symptoms (p=<0.0001), psychiatric diagnoses (e.g., depression (p<0.0003), anxiety (p<0.0002), conduct disorder (p=0.07)), and substance-abusing family members (53 % versus 39%; p=0.006). To conclude, family and peers influence severity of alcohol and drug problems in adolescents.
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Affiliation(s)
- Nancy S Wu
- Department of Psychiatry, University of California, San Francisco, California, USA
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Langenbucher JW, Labouvie E, Martin CS, Sanjuan PM, Bavly L, Kirisci L, Chung T. An application of item response theory analysis to alcohol, cannabis, and cocaine criteria in DSM-IV. JOURNAL OF ABNORMAL PSYCHOLOGY 2004; 113:72-80. [PMID: 14992659 DOI: 10.1037/0021-843x.113.1.72] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Item response theory (IRT) is supplanting classical test theory as the basis for measures development. This study demonstrated the utility of IRT for evaluating DSM-IV diagnostic criteria. Data on alcohol, cannabis, and cocaine symptoms from 372 adult clinical participants interviewed with the Composite International Diagnostic Interview--Expanded Substance Abuse Module (CIDI-SAM) were analyzed with Mplus (B. Muthen & L. Muthen, 1998) and MULTILOG (D. Thissen, 1991) software. Tolerance and legal problems criteria were dropped because of poor fit with a unidimensional model. Item response curves, test information curves, and testing of variously constrained models suggested that DSM-IV criteria in the CIDI-SAM discriminate between only impaired and less impaired cases and may not be useful to scale case severity. IRT can be used to study the construct validity of DSM-IV diagnoses and to identify diagnostic criteria with poor performance.
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Gerra G, Zaimovic A, Moi G, Bussandri M, Bubici C, Mossini M, Raggi MA, Brambilla F. Aggressive responding in abstinent heroin addicts: neuroendocrine and personality correlates. Prog Neuropsychopharmacol Biol Psychiatry 2004; 28:129-39. [PMID: 14687867 DOI: 10.1016/j.pnpbp.2003.09.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective measures of experimentally induced aggressiveness were evaluated in 20 abstinent heroin-dependent subjects, in comparison with 20 normal healthy male subjects. All the subjects were preliminarily submitted to DSM-IV interviews, Buss-Durkee Hostility Inventory (BDHI) and Minnesota Multiphasic Personality Inventory (MMPI II). During a laboratory task, the Point Subtraction Aggression Paradigm (PSAP), subjects earned monetary reinforcers with repeated button presses and were provoked by the subtraction of money, which was attributed to a fictitious other participant. Subjects could respond by ostensibly subtracting money from the fictitious subject (the aggressive response). Money-earning responses were not different in drug-free heroin addicts and controls during the first two sessions and significantly lower during the third session in heroin-dependent subjects (t=2.99, P<.01). Aggressive responses were significantly higher (F=4.9, P<.01) in heroin addicted individuals, in comparison with controls. During the experimentally induced aggressiveness, plasma adrenocorticotropic hormone (ACTH) and cortisol (CORT) concentrations increased less significantly, and norepinephrine (NE) and epinephrine (EPI) levels, together with heart rate (HR), increased more significantly in abstinent heroin-dependent subjects than in healthy subjects. PSAP aggressive responses positively correlated with catecholamine changes, BDHI "direct" and "irritability" scores, MMPI "psychopathic deviate" scores in heroin-dependent subjects and controls, and with CORT responses only in healthy subjects. No correlation was found between heroin-exposure extent (substance abuse history duration) and aggressiveness levels. The present findings suggest that heroin-dependent patients have higher outward-directed aggressiveness than healthy subjects, in relation with monoamine hyperreactivity, after long-term opiate discontinuation. Aggressiveness in heroin addicts seems to be related more to the personality traits than to drug effects. The impairment of hypothalamus-pituitary-adrenal (HPA) axis in abstinent addicted individuals could be due to a long-lasting action exerted by opiates on proopiomelanocortin (POMC) or to a premorbid psychobiological condition, in association with increased sympathetic arousal.
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Affiliation(s)
- Gilberto Gerra
- Centro Studi Farmacotossicodipendenze, Ser. T., AUSL, Via Spalato 2, 43100 Parma, Italy.
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Hser YI, Grella CE, Collins C, Teruya C. Drug-use initiation and conduct disorder among adolescents in drug treatment. J Adolesc 2003; 26:331-45. [PMID: 12770530 DOI: 10.1016/s0140-1971(03)00012-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study investigated effects of drug-use initiation and conduct disorder (CD) among 1031 adolescents who participated in the Drug Abuse Treatment Outcomes Studies for Adolescents (DATOS-A) sponsored by the National Institute on Drug Abuse (NIDA). The mean age of first drug use was 12.7 (S.D.=2.2), 57% met DSM-III-R criteria for CD, and earlier initiators were more likely to have CD. About 78% of the adolescents with CD reported that their first CD symptom occurred prior to drug-use initiation. The proportions of adolescents who had prior treatment were similar (about 28%) across all groups, but earlier initiators reported a greater number of treatment episodes and younger ages at their first treatment. Conduct disordered adolescents revealed greater problems prior to DATOS-A treatment, but they appeared to be more motivated and ready for treatment. Although adolescents with CD still showed worse outcomes after treatment, the impact of CD appeared to lessen when pretreatment differences were controlled. To a lesser extent, adolescents who began using drugs at earlier ages had greater alcohol and drug use and other problems at intake, but their treatment outcomes appeared to be similar to later initiators. There were few significant interaction effects of initiation and CD. Findings from this study highlight the importance of better understanding the progression of drug use, treatment utilization, and psychiatric comorbidity among adolescents with substance abuse problems.
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Affiliation(s)
- Yih-Ing Hser
- UCLA Drug Abuse Research Center, Neuropsychiatric Institute, University of California, Suite #200, 1640 S Sepulveda Blvd, Los Angeles, CA 90025, USA.
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Young SE, Corley RP, Stallings MC, Rhee SH, Crowley TJ, Hewitt JK. Substance use, abuse and dependence in adolescence: prevalence, symptom profiles and correlates. Drug Alcohol Depend 2002; 68:309-22. [PMID: 12393225 DOI: 10.1016/s0376-8716(02)00225-9] [Citation(s) in RCA: 206] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We present data on the lifetime prevalence of substance use, abuse and dependence in adolescents obtained through structured psychiatric interviews and self-report questionnaires. Most notably, we evaluate symptom profiles based on DSM-IV abuse and dependence criteria for tobacco, alcohol and marijuana, including a gender comparison. Participants are 3,072 adolescents (12-18 years) drawn from three community-based family samples in Colorado. Age trends suggest that substance use is a developmental phenomenon, which increases almost linearly from early to late adolescence. Substance use disorders are less common than experimentation in adolescence, but approximately 1 in 4 adolescents in the oldest cohorts meets criteria for abuse for at least one substance, and 1 in 5 meets criteria for substance dependence. By age 18 nearly 1 in 3 adolescents report daily smoking and 8.6% meet criteria for tobacco dependence. Although alcohol is the most commonly abused substance (10%), a slightly larger proportion of adolescents meet criteria for dependence on marijuana (4.3%) than alcohol (3.5%). Gender differences in prevalence of use more often show greater use in males than females. Males more frequently meet criteria for dependence on alcohol and marijuana in late adolescence, while females are more often nicotine dependent. A comparison of abuse and dependence symptom profiles shows some interesting variability across substances, and suggests that manifestations of a subset of symptoms are gender specific.
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Affiliation(s)
- S E Young
- Institute for Behavioral Genetics, University of Colorado, Campus Box 447, Boulder, CO 80309, USA.
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Präventionsforschung im Bereich substanzgebundener Abhängigkeiten bei Jugendlichen: State of the Art. J Public Health (Oxf) 2001. [DOI: 10.1007/bf02956495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
OBJECTIVE Depression, impulsivity, and aggression during adolescence have been associated with both adoption and suicidal behavior. Studies of adopted adults suggest that impulsivity, even more than depression, may be an inherited factor that mediates suicidal behavior. However, the association between adoption and adolescent suicide attempts and the mechanisms that might explain it remain unknown. The objective of this study was to determine the following: 1) whether suicide attempts are more common among adolescents who live with adoptive parents rather than biological parents; 2) whether the association is mediated by impulsivity, and 3) whether family connectedness decreases the risk of suicide attempt regardless of adoptive or biological status. METHODS A secondary analysis of Wave I data from the National Longitudinal Study of Adolescent Health was conducted, which used a school-based, clustered sampling design to identify a nationally representative sample of 7th- to 12th-grade students, with oversampling of underrepresented groups. Of the 90 118 adolescents who completed the National Longitudinal Study of Adolescent Health in-school survey, 17 125 completed the in-home interview and had parents of identified gender who completed separate in-home questionnaire. The subset of adolescents for this study was drawn from the in-home sampling according to the following criteria: 1) adolescent living with adoptive or biological mother at the time of the interview, 2) adolescent had never been separated from mother for more than 6 months, 3) mother was in first marriage at the time of the interview, and 4) the adoptive mother had never been married to the adolescent's biological father. Of the 6577 adolescents in the final study sample, 214 (3.3%) were living with adoptive mothers and 6363 (96.7%) were living with biological mothers. Variables. The primary outcome measured was adolescent report of suicide attempt(s) in the past year. Other variables included in the analyses were sociodemographics characteristics (gender, age, race/ethnicity, family income, parental education), general health (self-rated health, routine examination in the past year, need for medical care in the past year that was not obtained), mental health (depressive symptoms, self-image, trouble relaxing in the past year, bad temper, psychological or emotional counseling in the past year), risk behaviors (cigarettes, alcohol, marijuana, sexual intercourse ever, delinquency, physical fighting in the past year, impulsive decision making), school-related characteristics (grade point average, school connectedness), and family interaction (family connectedness, parental presence, maternal satisfaction with parent-adolescent relationship). Data Analysis. Univariate analyses were used to compare adoptees versus nonadoptees, suicide attempters versus nonsuicide attempters, and adopted suicide attempters versus nonadopted suicide attempters on all variables. Variables that were associated with attempted suicide were entered into a forward stepwise logistic regression procedure, and variables that were associated with the log odds of attempt were retained in the model. The area under the model's receiver operating characteristic curve was calculated as a measure of its overall performance. After the association of adoption with attempted suicide was demonstrated, the potential mediating effect of impulsivity was explored by adding it to the model. The same procedure was followed for any variable that was associated with adoption in the full sample or the subsample of suicide attempters. To determine whether any variable in the model moderated the association between adoption and suicide attempt, the interaction term for that variable x adoption was forced into the model. RESULTS Adoptees differed significantly from nonadoptees on 4 of 26 variables. They were more likely to have attempted suicide (7.6% vs 3.1%) and to have received psychological or emotional counseling in the past year (16.9% vs 8.2%), and their mothers reported higher parental education and family income. Attempters differed significantly from nonattempters on all variables except for age, race/ethnicity, parental education, family income, and routine examination in the past year. On logistic regression, 9 variables were independently associated with attempted suicide: depression (adjusted odds ratio [AOR]: 3.41), counseling (AOR: 2.83), female gender (AOR: 2.31), cigarette use (AOR: 2.31), delinquency (AOR: 2.17), adoption (AOR: 1.98), low self-image (AOR: 1.78), aggression (AOR: 1.48), and high family connectedness (AOR: 0.60). The receiver operating characteristic curve for the model had an area of 0.834, indicating performance significantly better than chance. The AOR for adoption did not change when parental education, family income, and impulsivity were forced into the model. (ABSTRACT TRUNCATED)
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Affiliation(s)
- G Slap
- Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229-3039, USA.
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47
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Grella CE, Hser YI, Joshi V, Rounds-Bryant J. Drug treatment outcomes for adolescents with comorbid mental and substance use disorders. J Nerv Ment Dis 2001; 189:384-92. [PMID: 11434639 DOI: 10.1097/00005053-200106000-00006] [Citation(s) in RCA: 248] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study compared the pretreatment characteristics and posttreatment outcomes of substance-abusing adolescents with and without comorbid mental disorders in the Drug Abuse Treatment Outcome Studies for Adolescents. Subjects (N = 992) were sampled from 23 adolescent drug treatment programs across three modalities (residential, short-term inpatient, outpatient drug-free). Nearly two thirds (64%) of the sample had at least one comorbid mental disorder, most often conduct disorder. Comorbid youth were more likely to be drug or alcohol dependent and had more problems with family, school, and criminal involvement. Although comorbid youth reduced their drug use and other problem behaviors after treatment, they were more likely to use marijuana and hallucinogens, and to engage in illegal acts in the 12 months after treatment, as compared with the noncomorbid adolescents. Integrated treatment protocols need to be implemented within drug treatment programs in order to improve the outcomes of adolescents with comorbid substance use and mental disorders.
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Affiliation(s)
- C E Grella
- UCLA Drug Abuse Research Center, Neuropsychiatric Institute, University of California, Los Angeles 90025, USA
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48
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Goren S. Healing the victim, the young offender, and the community via restorative justice: an international perspective. Issues Ment Health Nurs 2001; 22:137-49. [PMID: 11885218 DOI: 10.1080/01612840121244] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The 1990s saw the enactment of much "get tough with young offenders" legislation in the United States. At the same, problems with our present punishment and treatment model, in which many youngsters cycle repeatedly through the justice and mental health systems, raised interest in restorative justice, a community-based alternative model emphasizing a balanced, negotiated approach to the needs of victims, offenders, and the community. After summarizing the philosophical bases underlying both models, this article describes the practice of restorative justice in New Zealand, where it was pioneered. Restorative justice has special relevance for Maori community in New Zealand and minority communities in the United States, where youth are consistently overrepresented in the courts, detention centers, and jails, and in which the juvenile justice system is seen as hostile and biased. Outcome data from New Zealand and early outcome research from the United States suggest that the restorative model, in which offenses are understood as a breakdown in social bonds, offers a hopeful alternative for offending youngsters, their families, and their communities.
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Affiliation(s)
- S Goren
- Nursing Program, University of Washington, Tacoma, Washington 98402-3100
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49
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Crowley TJ, Mikulich SK, Ehlers KM, Whitmore EA, MacDonald MJ. Validity of structured clinical evaluations in adolescents with conduct and substance problems. J Am Acad Child Adolesc Psychiatry 2001; 40:265-73. [PMID: 11288767 DOI: 10.1097/00004583-200103000-00005] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine discriminative and convergent validity for certain structured diagnostic assessments among adolescents with conduct and substance problems. METHOD Patients were 87 adolescents (both genders) in treatment for conduct and substance problems. Most controls (n = 85; both genders) came from patients' neighborhoods. Assessments included Diagnostic Interview Schedule for Children, Composite International Diagnostic Instrument-Substance Abuse Module, Child Behavior Checklist, and others. Patients' data guided clinical care. RESULTS Youths' self-reports significantly discriminated patients from controls in DSM-IVconduct and substance use disorders (CD, SUD) and in numerous associated measures. CD and SUD symptoms correlated strongly. However, some patients apparently minimized symptoms. Youths' self-reports did not discriminate patients from controls in attention-deficit/hyperactivity disorder (ADHD) or major depression (MDD). Parent information raised prevalence rates of ADHD and MDD, which then discriminated patients from controls. However, patients and parents usually disagreed on MDD and ADHD diagnoses. CONCLUSIONS Despite some dissimulation, patients' self-reports of CD and SUD correlated highly and had superb discriminative validity, making them useful for treatment and research. Self-reports of ADHD and MDD, apparently lacking discriminative validity, are less useful. Parent reports improve these discriminations but present additional problems.
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Affiliation(s)
- T J Crowley
- Psychiatry Department, University of Colorado Medical School, Denver 80262, USA.
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50
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Mikulich SK, Hall SK, Whitmore EA, Crowley TJ. Concordance between DSM-III-R and DSM-IV diagnoses of substance use disorders in adolescents. Drug Alcohol Depend 2001; 61:237-48. [PMID: 11164688 DOI: 10.1016/s0376-8716(00)00143-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Except for cannabis and alcohol, concordance between DSM-III-R and DSM-IV substance use disorder diagnoses has not been reported in adolescents. We assessed a clinical sample of 102 adolescents using CIDI-SAM. Prevalence of either an abuse or dependence diagnosis was lower with DSM-IV than DSM-III-R except for cannabis and alcohol, and concordance rates were better for dependence than for abuse. For most substances, rates of DSM-IV withdrawal were lower than in DSM-III-R, but rates of DSM-IV physiological dependence remained high. Changes in DSM-IV criteria appear to have impacted diagnoses in these adolescents, particularly for the substances they use most--i.e. alcohol, tobacco, and cannabis.
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Affiliation(s)
- S K Mikulich
- Department of Psychiatry, University of Colorado School of Medicine, Box C268-35, 4200 E. 9th Avenue, Denver, CO 80262, USA
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