Self-reported health problems and physical symptomatology in adolescent alcohol abusers

Pharmacotherapy interventions for adolescent co-occurring substance use and mental health disorders: a systematic review

BACKGROUND

Co-occurring mental health and substance use (SU) disorders among adolescents are common, with two-thirds of adolescents who seek SU treatment also requiring support for mental health. Primary care physicians play a key role in the pharmacological treatment of mental health disorders among adolescents, however, little is known about the impact of these treatments on SU outcomes.

OBJECTIVES

This systematic review summarizes the evidence regarding commonly used pharmacotherapy interventions for mental health and their impact on adolescent SU.

METHODS

Literature searches were conducted across five databases as part of a larger systematic review of adolescent SU interventions. Studies were screened for eligibility by two researchers, and study data were extracted regarding study design, patient and treatment characteristics and results. Risk of bias analyses and qualitative syntheses were completed to evaluate the strength of the evidence and the impact of pharmacotherapy on SU outcomes.

RESULTS

Ten randomized controlled trials exploring seven pharmacotherapies met criteria for inclusion. All studies had low to moderate risk of bias. Four studies evaluated pharmacotherapy for co-occurring depression and SU, three evaluated attention deficit hyperactivity disorder and SU, and three evaluated bipolar disorder and SU. Five of the 10 studies also included a behavioural intervention. We found no evidence that pharmacotherapy for co-occurring mental health diagnoses impacted SU.

CONCLUSION

Family medicine clinicians prescribing pharmacotherapy for mental health should be aware that additional interventions will likely be needed to address co-occurring SU.

Alcohol Use by Youth

Alcohol use continues to be a major concern from preadolescence through young adulthood in the United States. Results of recent neuroscience research have helped to elucidate neurobiological models of addiction, substantiated the deleterious effects of alcohol on adolescent brain development, and added additional evidence to support the call to prevent and reduce underage drinking. This technical report reviews the relevant literature and supports the accompanying policy statement in this issue of Pediatrics.

Reciprocal variations in sleep and drinking over time among heavy-drinking young adults

Prior studies have established an association between sleep problems during early adolescence and heavy alcohol use/alcohol use disorder (AUD) risk in late adolescence. Less research has explored the association between sleep problems and heavy alcohol use during young adulthood, the period when AUD onset peaks. Moreover, research to date has primarily utilized cross-sectional, between-subjects' methods to examine this relationship, with limited focus on the potential intraindividual variation in these behaviors. Multilevel modeling techniques are well-suited to examine the variability in sleep problems and risky alcohol use over time and the dynamic bidirectional relations among these behaviors. This article reports on 42 heavy-drinking college students at-risk for an AUD based on their responses to a validated alcohol screener who completed daily diaries of sleep and alcohol use and wore a sleep-wake activity monitor (i.e., Philips Respironics Actiwatch 2™) daily for 7 days yielding a total of 294 reports. Hierarchical linear models demonstrated that days of heavy drinking predicted delayed bed and wake times within individuals and those individuals who tended to drink more heavily on average had shorter sleep durations. Conversely, days of shorter sleep duration, earlier wake times, and greater perceived sleep quality upon waking predicted greater alcohol use within individuals, and those who tended to feel more alert upon waking drank more on average. These results highlight important within- and between-person variability in the associations among objective and subjective sleep-related problems and at-risk drinking among young adults. Further, the results have implications for alcohol prevention/intervention strategies for young adults at risk for AUDs. (PsycINFO Database Record

Chronic alcohol consumption from adolescence to adulthood in mice--hypothalamic gene expression changes in insulin-signaling pathway

Adolescence is a developmental stage vulnerable to alcohol drinking-related problems, and alcohol exposure during adolescence may lead to long-lasting consequences. The hypothalamus is a key brain region for food and water intake regulation as well as weight control, and is one of the alcohol-sensitive brain regions. However, it is not known what the alcohol effect is on the hypothalamus following adolescent alcohol intake, chronically over adolescent development, at moderate levels. We employed a model of chronic moderate alcohol intake from adolescence to adulthood in mice, and analyzed the effect of alcohol on growth and weight gain, as well as hypothalamic gene expression patterns. The results indicated that chronic alcohol consumption during adolescence, even at moderate levels, led to both a reduction in weight gain in mice, and considerable gene expression changes in the hypothalamus. Pathway analysis and real-time PCR identified the type II diabetes mellitus and the insulin-signaling pathways as being the hypothalamic pathways affected by chronic alcohol. Our findings from the mouse alcohol consumption study therefore serve as a potential warning against alcohol consumption during adolescence, such as in teens and college students.

A longitudinal study of insomnia and other sleep complaints in adolescents with and without alcohol use disorders

BACKGROUND

Sleep disturbances are both common and well-characterized in adults with alcohol use disorders (AUDs), but have received little study in adolescents with AUDs. Furthermore, a handful of studies suggest that sleep complaints are a risk factor for AUDs. However, no published studies have yet examined the longitudinal course of sleep complaints in adolescents with AUDs; in particular, it remains unclear how persistent AUD-associated sleep complaints are in this age group, and what types of sleep complaints are most relevant to alcohol-use symptoms. We investigated these questions in a 5-year longitudinal study of adolescents with and without AUDs at baseline.

METHODS

Participants were 696 adolescents (age 12 to 19) from a longitudinal study at the Pittsburgh Adolescent Alcohol Research Center. At baseline, 347 participants had a current AUD (AUD+), while 349 had no current or past AUD (AUD-). We examined sleep and alcohol involvement at baseline as well as 1-, 3-, and 5-year follow-up visits. Sleep variables included self-reported insomnia and hypersomnia, as well as variability in weekday-weekend sleep duration, all at baseline. Covariates included sex, age, current alcohol symptoms, and depression severity.

RESULTS

The AUD+ group reported more overall sleep disturbance at baseline, including greater insomnia and hypersomnia complaints, and greater variability in weekday-weekend sleep duration. Group differences in insomnia and hypersomnia complaints persisted to the 5- and 3-year follow-ups, respectively. In the AUD- group, greater insomnia complaints at baseline predicted an increase in alcohol symptoms at the 1-year follow-up, while greater variability in sleep duration at baseline predicted an increase in alcohol symptoms at the 3- and 5-year follow-ups.

CONCLUSIONS

These results complement previous findings in other samples, indicating that insomnia and other sleep problems are a chronic predicament for adolescents with AUDs. The findings also suggest that sleep disturbances may place adolescents without AUDs at an elevated risk of developing alcohol problems.

Perceived norms moderate the association between mental health symptoms and drinking outcomes among at-risk adolescents

OBJECTIVE

There has been limited research examining the association between mental health symptoms, perceived peer alcohol norms, and alcohol use and consequences among samples of adolescents. The current study used a sample of 193 at-risk youths with a first-time alcohol and/or other drug offense in the California Teen Court system to explore the moderating role of perceived peer alcohol norms on the association between mental health symptoms and drinking outcomes.

METHOD

Measures of drinking, consequences, mental health symptoms, and perceived peer alcohol norms were taken at baseline, with measures of drinking and consequences assessed again 6 months later. Regression analyses examined the association of perceived norms and mental health symptoms with concurrent and future drinking and consequences.

RESULTS

We found that higher perceived drinking peer norms were associated with heavy drinking behavior at baseline and with negative alcohol consequences both at baseline and 6 months later. Also, perceived drinking norms moderated the association between mental health symptoms and alcohol-related consequences such that better mental health was related to increased risk for alcohol-related consequences both concurrently and 6 months later among those with higher baseline perceptions of peer drinking norms.

CONCLUSIONS

Findings demonstrate the value of norms-based interventions, especially among adolescents with few mental health problems who are at risk for heavy drinking.

Do ADHD symptoms moderate the relation between positive alcohol expectancies and alcohol-related outcomes?

Research indicates that attention-deficit/hyperactivity disorder (ADHD) may be a risk factor for heavy alcohol use and related problems. Research also suggests that positive alcohol expectancies (i.e., positive beliefs about the effects of alcohol) are predictive of risky alcohol use and related problems (e.g., driving while intoxicated). However, no research has examined the association between ADHD symptoms and positive expectancies or the role of ADHD symptoms in the relation between positive expectancies and alcohol use and related problems, an unexplored area addressed by the current study. Participants were 889 undergraduates (76% female, 82.3% Caucasian) at a Southeastern University who completed self-report measures. Parent report (59%) of current and childhood ADHD symptoms was also collected. Findings indicated that ADHD symptoms moderated the relation between positive alcohol expectancies and alcohol-related problems, but not the relation between expectancies and alcohol use. Additional analyses revealed that ADHD symptoms moderated the specific relation between positive expectancies and social alcohol problems (e.g., engaging in unplanned sexual behavior), but not between expectancies and internal alcohol problems (e.g., feeling sad). Moderating effects were significant even after controlling for conduct disorder symptoms and stimulant medication use. Findings have implications for the identification of college students who are at particularly high risk for heavy drinking and alcohol-related problems. Results may also aid in the development of interventions aimed at reducing risky drinking among students.

Integrating substance use treatment into adolescent health care

Substance use (SU) problems are common among adolescents, a serious health risk for them and a major public health problem, but are inadequately addressed in most pediatric health care settings. Primary care offers an excellent context for SU assessment and treatment for adolescents and their families, offering better access and a less stigmatized environment for receiving treatment than specialty programs. This paper examines the literature on the integration of substance use treatment with adolescent health care, focusing on 2 areas: Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Emergency Departments and Primary Care, and School- and College-Based Health Centers.

Cigarette and cannabis use trajectories among adolescents in treatment for attention-deficit/hyperactivity disorder and substance use disorders

BACKGROUND

Cigarette smoking is common in adolescents with attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUD). However, little is known about the relationship between cigarette and cannabis use trajectories in the context of treatment for both ADHD and SUD. To address this research gap, we report collateral analyses from a 16-week randomized, controlled trial (n=303) of osmotic-release methylphenidate (OROS-MPH) in adolescents with ADHD concurrently receiving cognitive behavioral therapy (CBT) targeting non-nicotine SUD.

METHODS

Participants completed cigarette and cannabis use self-report at baseline and throughout treatment. Analyses were performed to explore the relationships between cigarette smoking, cannabis use, and other factors, such as medication treatment assignment (OROS-MPH versus placebo).

RESULTS

Baseline (pre-treatment) cigarette smoking was positively correlated with cannabis use. Negligible decline in cigarette smoking during treatment for non-nicotine SUD was observed in both medication groups. Regular cigarette and cannabis users at baseline who reduced their cannabis use by >50% also reduced cigarette smoking (from 10.8±1.1 to 6.2±1.1 cigarettes per day).

CONCLUSIONS

Findings highlight the challenging nature of concurrent cannabis and cigarette use in adolescents with ADHD, but demonstrate that changes in use of these substances during treatment may occur in parallel.

Alcohol use by youth and adolescents: a pediatric concern

Alcohol use continues to be a major problem from preadolescence through young adulthood in the United States. Results of recent neuroscience research have substantiated the deleterious effects of alcohol on adolescent brain development and added even more evidence to support the call to prevent and reduce underaged drinking. Pediatricians should be knowledgeable about substance abuse to be able to recognize risk factors for alcohol and other substance abuse among youth, screen for use, provide appropriate brief interventions, and refer to treatment. The integration of alcohol use prevention programs in the community and our educational system from elementary school through college should be promoted by pediatricians and the health care community. Promotion of media responsibility to connect alcohol consumption with realistic consequences should be supported by pediatricians. Additional research into the prevention, screening and identification, brief intervention, and management and treatment of alcohol and other substance use by adolescents continues to be needed to improve evidence-based practices.

Intentions to quit smoking among youth in substance abuse treatment

INTRODUCTION

Smoking cessation interventions for adolescents in substance abuse treatment have shown promise. However, a better understanding of the correlates of substance use disordered (SUD) youths' intentions toward smoking cessation will help tailor cessation interventions to this population. The current study examined tobacco use, smoking-related self-efficacy, substance use and intentions to quit using alcohol and illicit drugs as correlates of intentions to quit smoking among youth in SUD treatment.

METHODS

Participants were 178 adolescents who were in inpatient (n=90) or outpatient (n=88) SUD treatment and had smoked at least once in the past 30 days. The sample was 44% female, 72% non-Hispanic Caucasian, with a mean age of 16.2 years (SD=1.2). Participants rated the likelihood that they would be nonsmokers in the next year (9-point scale).

RESULTS

SUD youth intention to quit smoking averaged 4.9 out of 10 (SD=3.2), comparable to intention to quit drinking (M=5.3, SD=3.6), but lower than their intention to quit using drugs (M=6.0, SD=3.4). Teens' intentions to quit smoking were associated with nicotine dependence (r=-.30, p<.01) and smoking cessation related self-efficacy (r=.36, p<.01), but not with pretreatment substance use severity (r=-.15). Controlling for nicotine dependence, teens' intentions to quit smoking were positively related to smoking cessation self-efficacy (pr=.26, p<.01) and intention to quit using illicit drugs (pr=.15, p<.05), but unrelated to intention to quit drinking.

DISCUSSION

Findings highlight the appropriateness of addressing adolescent tobacco use during SUD treatment, but emphasize the importance of assessing intention and other cognitions for each substance, as they may differ markedly.

Child abuse and other traumatic experiences, alcohol use disorders, and health problems in adolescence and young adulthood

OBJECTIVE

We prospectively examined the health effects of child abuse and other traumatic events, with objective health indicators and consideration of alcohol use disorders (AUD).

METHODS

Adolescents (n = 668) were recruited from clinical and community sources. At baseline, we examined child abuse and other traumas, AUD, health-related symptoms, physical findings, and blood assays. Subjects were assigned to Trauma Classes (TC), including witnessing violence, physical abuse, and sexual abuse. Health outcomes were again determined at 1-year and young adult follow-up.

RESULTS

In adolescence, higher TC severity was associated with more health-related symptoms, increased age-adjusted body mass index, and stress-response immune system indices. In adolescence and young adulthood, the relationships between TC and health-related symptoms were mediated by anxiety. AUD was associated with liver injury, and cigarette smoking with heart/lung symptoms.

CONCLUSIONS

Child abuse predicted persistently elevated health-related symptoms primarily attributable to anxiety, and early signs of liver disease were attributable to AUD.

Does smoking intervention influence adolescent substance use disorder treatment outcomes?

Although tobacco use is reported by the majority of substance use disordered (SUD) youth, little work has examined tobacco focused interventions with this population. The present study is an initial investigation of the effect of a tobacco use intervention on adolescent SUD treatment outcomes. Participants were adolescents in SUD treatment taking part in a cigarette smoking intervention efficacy study, assessed at baseline and followed up at 3- and 6-months post-intervention. Analyses compared treatment and control groups on days using alcohol and drugs and proportion abstinent from substance use at follow up assessments. Adolescents in the treatment condition reported significantly fewer days of substance use and were somewhat more likely to be abstinent at 3-month follow up. These findings suggest that tobacco focused intervention may enhance SUD treatment outcome. The present study provides further evidence for the value of addressing tobacco use in the context of treatment for adolescent SUD's.

Is cigarette smoking related to alcohol use during the 8 years following treatment for adolescent alcohol and other drug abuse?

AIMS

The present study examined the relationship between cigarette smoking and alcohol use outcomes over an 8-year period following treatment for adolescent alcohol and other drug (AOD) use disorders.

METHODS

The present study was based on a sample of 166 adolescents recruited during inpatient AOD abuse treatment. Included in this study were 123 (74% of the full sample) participants, of whom 41% were female, 81% identified themselves as White and who averaged 15.9 years of age (SD = 1.3) when entering treatment. Data for the present study were drawn from interviews conducted at the time of treatment and 2-, 4-, 6- and 8-years post-treatment.

RESULTS

Twenty six percent of participants had quit smoking for > 1 year at the 8-year assessment, while 44% reported persistent smoking over time. Overall smoking rates decreased significantly over time. Subjects associated with the highest alcohol involvement trajectory reported significantly greater likelihood of persistent smoking as well as higher current smoking and cigarette consumption across time points.

CONCLUSIONS

The significant declines observed in smoking from adolescence into young adulthood were contrary to expectations, indicating that this behaviour may be less stable than previously thought among adolescent AOD abusers. Smoking involvement over time was greater within the highest alcohol use trajectory, consistent with previous evidence for a positive relationship between these behaviours. However, when compared with the general population smoking rates remained very high regardless of alcohol involvement. Thus, individuals treated for AOD abuse as adolescents remained at elevated risk for tobacco related disease regardless of post-treatment AOD use outcomes.

Medical conditions of adolescents in alcohol and drug treatment: comparison with matched controls

PURPOSE

Alcohol and drug problems are associated with medical problems among adults. Research on the relationship of adolescent alcohol and drug use disorders to specific medical problems is less developed and focused on acute consequences. This study addresses gaps in the literature regarding medical comorbidities in adolescents with alcohol and drug use disorders.

METHODS

This study compares the prevalence of medical conditions among 417 adolescent alcohol and drug treatment patients with 2082 demographically matched controls from the same managed care health plan and examines whether comparisons vary among substance-type subgroups.

RESULTS

Approximately one-fourth of the comorbid conditions examined were more common among adolescent alcohol and drug patients than among matched controls, and several were highly costly conditions (e.g., asthma, injury). We also found that pain-related diagnoses, including headache and abdominal pain, were more prevalent among alcohol and drug patients.

CONCLUSIONS

Our findings point to the importance of examining comorbid medical and chemical dependency in both adolescent primary care and specialty care. Moreover, optimal treatment of many common medical disorders may require identification, intervention, and treatment of a substance use problem.

Female conduct disorder: health status in young adulthood

PURPOSE

One of the risk factors for poor adult health may be adolescent antisocial behavior, especially in girls. This study was conducted to determine if negative young adult health outcomes in girls who previously had adolescent antisocial behavior could be explained by demographic factors and pre-existing health problems.

METHODS

This 3-year longitudinal study recruited 93 girls, ages 15-17 years (52 with conduct disorder [CD]; 41 with no psychiatric illness [normal controls; NC]) from the community. Baseline interviews of girls and parents collected demographic, psychiatric, and medical history data. Three annual interviews collected data about medical problems, health care service utilization, and reproductive health. In addition, the final follow-up included a standardized self-report questionnaire about young adult health status.

RESULTS

CD and NC groups did not differ in age, racial composition, social class, proportion of smokers, or drug and alcohol experimentation. They were qualitatively different in baseline medical histories. Controlling for age at follow-up and baseline medical problems, the CD group as young adults had worse overall health, more discomfort, higher rates of unhealthy habits, lower rates of healthy behaviors, and more pregnancies at earlier ages. There were no group differences in rates of disorders, injuries, or health care usage.

CONCLUSIONS

Adolescent girls with CD as young adults have poorer overall health, more discomfort, more health risk behaviors, and earlier onset of adult reproductive behaviors, even when controlling for demographic factors and pre-existing health history. Clinical and research implications are discussed.

Alcohol use in families: a 15-year prospective follow-up study

AIMS

To study the prevalence of adolescents' problematic alcohol use and its parental predictors: drinking habits and socio-demographic factors.

DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS

Questionnaires were sent regularly to the same Finnish families (n = 1132) from the onset of pregnancy (in 1986-87) to the child's age of 15 years (in 2001-02) (n = 1028). There was a total of three follow-up points.

FINDINGS

At 15 years of age, 83% of girls and 79% of boys had used alcohol; 18% of boys and 14% of girls had been drunk more than once a month. The child's permanent separation from at least one biological parent was the strongest socio-demographic predictor of adolescents drinking. Fathers' present heavy drinking and parental early drinking were the best predictors of their children's problematic alcohol use at the age of 15.

CONCLUSIONS

Knowledge of fathers' alcohol use and its time of onset may be used to determine children who are at added risk of problematic alcohol use later in life. Special guidance, support and treatment can be targeted to these families.

The epidemiology of alcohol, marijuana, and cocaine use among Mexican American, Puerto Rican, Cuban American, and other Latin American eighth-grade students in the United States: 1991-2002

OBJECTIVES

We compared trends in and correlates of marijuana use, cocaine use, and heavy alcohol use for adolescents of Mexican American, Puerto Rican, Cuban, and other Latin American heritage in the United States.

METHODS

We used/examined data from nationally representative samples of eighth-grade Hispanic students who participated in the Monitoring the Future study during the years 1991-2002 (n=24235).

RESULTS

Drug use was significantly higher among boys and adolescents of almost all Hispanic ethnicities who did not live with both parents. In addition, drug use differed considerably according to ethnic group on language first spoken, parental education, urbanicity, and region.

CONCLUSIONS

A better understanding of the homogeneity and heterogeneity of drug use patterns within and between Hispanic groups should assist in the development of prevention programs.

Pathways to chemical dependency treatment for adolescents in an HMO

This study examines pathways to chemical dependency (CD) treatment for adolescents in a prepaid health plan, including factors influencing treatment referral and access. Data were collected from 419 adolescent CD treatment intakes ages 13 to 18 in a large, private health plan. The study examines predictors of referral from different sources and of mental health treatment prior to CD treatment. Referral patterns, problem severity, and psychiatric comorbidity differed by gender. Being male (p < .05) and higher scores on the Youth Self-Report (YSR) externalizing scale (p < .01) predicted a justice system referral. Using more types of substances predicted referral by medical and mental health providers (p < .05) and self-referral (p < .01). Higher YSR internalizing scores predicted referral from mental health (p < .01) and self-referral (p <.01). Being White versus African American (p < .05) or Latino (p < .01), older (p < .05), and having higher YSR internalizing scores (p < .05), a conduct disorder (p < .01), or a family member with a substance use problem (p < .01) predicted a mental health visit prior to CD intake. The findings raise questions regarding the role of health plans, clinicians, families, schools, and community agencies in referring and treating adolescents with substance use problems. They suggest that improved coordination of care may promote more integrated treatment practices, which could decrease substance use, mental health, and medical problem severity.

The neurocognitive effects of alcohol on adolescents and college students

BACKGROUND

Adolescents and college students are at high risk for initiating alcohol use and high-risk (or binge) drinking. There is a growing body of literature on neurotoxic and harmful cognitive effects of drinking by young people. On average, youths take their first drink at age 12 years.

METHODS

MEDLINE search on neurologic and cognitive effects of underage drinking.

RESULTS

Problematic alcohol consumption is not a benign condition that resolves with age. Individuals who first use alcohol before age 14 years are at increased risk of developing alcohol use disorders. Underage drinkers are susceptible to immediate consequences of alcohol use, including blackouts, hangovers, and alcohol poisoning and are at elevated risk of neurodegeneration (particularly in regions of the brain responsible for learning and memory), impairments in functional brain activity, and the appearance of neurocognitive deficits. Heavy episodic or binge drinking impairs study habits and erodes the development of transitional skills to adulthood.

CONCLUSIONS

Underage alcohol use is associated with brain damage and neurocognitive deficits, with implications for learning and intellectual development. Impaired intellectual development may continue to affect individuals into adulthood. It is imperative for policymakers and organized medicine to address the problem of underage drinking.

The relationship between perceptions of neighborhood characteristics and substance use among urban African American adolescents

Although the neighborhood microsystem is recognized as an important domain for adolescent development, relative to the family and peer contexts, neighborhood factors have been understudied in relation to adolescent substance abuse. In addition, recent research suggests that risk factors for adolescent substance use may differ for African Americans when compared to Caucasian youth. This study investigated the association between perceived neighborhood disorganization and later substance use, as well as possible mediators of that association, among a community sample of urban African American adolescents. Perceptions of neighborhood disorganization (i.e., violence/safety and drug activity) in grade 7 were associated with increased tobacco, alcohol, and marijuana use in grade 9. For females, this association was mediated by attitudes about drug use and perceptions of drug harmfulness. Findings highlight the importance of neighborhood contextual variables for African American substance use. Implications and directions for future research are presented.

The natural history of adolescent alcohol use disorders

AIM

To examine clinically relevant research on the development, course and outcomes of adolescence alcohol use disorders (AUDs).

METHODS

Observational studies with adolescent samples were selected for inclusion based on systematic assessment of AUDs and clinical relevance. The literature was searched using Medline and Psychinfo. Articles on childhood predictors, characteristics, course, complications and adult outcomes of adolescent AUDs were reviewed.

RESULTS

The developmental trajectory toward adolescent AUDs begins with the emergence of childhood mental disorders. These problems are transmitted from parent to child in a developmentally specific fashion, reflect psychological dysregulation dimensions and predict adolescent AUDs. While most DSM-IV AUD diagnostic criterion items are valid for adolescents, tolerance and impaired control items are problematic, and some adolescents with significant alcohol problems are not identified by this diagnostic system. Understanding the psychosocial and biomedical complications that accompany AUDs requires attention to factors other than alcohol involvement itself, including childhood maltreatment and comorbid psychopathology. While some adolescents with AUDs manifest chronic alcohol dependence in adulthood, a substantial proportion overcome alcohol problems and transition to abstinence or normative drinking.

CONCLUSIONS

Developmentally specific phenotypic characteristics define the natural history of adolescent AUDs, inform clinical assessment and provide the developmental context for treatment research. While alcohol consumption may be the primary treatment focus, other important consequences, comorbidities and complications need to be addressed for successful developmental outcomes to result.

Adolescent heavy episodic drinking trajectories and health in young adulthood

OBJECTIVE

This study examined the association of trajectories of heavy episodic drinking (at least five alcoholic drinks on one occasion) during adolescence with health status and practices at age 24.

METHOD

Semiparametric group-based modeling and logistic regressions were used to analyze data from a longitudinal panel of 808 youths interviewed between 10 and 24 years of age.

RESULTS

Four distinct trajectories of adolescent heavy episodic drinking were identified: nonheavy drinkers, late onsetters, escalators and chronic heavy drinkers. Overall, young adults who did not engage in heavy episodic drinking during adolescence had the lowest occurrence of health problems and were most likely to engage in safe health behaviors at age 24. Chronic and late-onset heavy episodic drinking during adolescence had negative effects on health status and practices at age 24. Adolescent chronic heavy drinkers were more likely to be overweight or obese and to have high blood pressure at age 24 than those who did not drink heavily in adolescence. Late-onset heavy drinkers were less likely to engage in safe driving practices at age 24 and were more likely to have been ill in the past year than adolescents who did not drink heavily. These health disparities remained even after current frequency of heavy episodic drinking at age 24, other adolescent drug use, ethnicity, gender and family poverty were controlled.

CONCLUSIONS

Heavy episodic alcohol use during adolescence has long-term, negative health consequences. Distinct patterns of adolescent heavy drinking affect health status and practices in young adulthood differently.

Drug use and neurobehavioral, respiratory, and cognitive problems: precursors and mediators

PURPOSE

To test a model of the early predictors and mediators of drug use and respiratory, neurobehavioral, and cognitive problems in adolescence and young adulthood.

METHODS

We prospectively examined self-reported measures of unconventional behavior, peer- and self-drug use, and self-reported health problems in a sample of 286 males and 327 females. The sample represented the northeastern United States at the time the data were first collected in 1975. The participants were assessed in early, middle, and late adolescence and in young adulthood. Latent variable structural equation models were used to examine the data.

RESULTS

Structural equation modeling conducted on the data provided support for the proposed longitudinal model. The findings indicated that adolescent drug use was associated indirectly with respiratory and directly with neurobehavioral and cognitive symptoms in young adulthood. Adolescent drug use during middle and late adolescence served as a mediator between unconventional behavior in early adolescence and health problems in young adulthood.

CONCLUSIONS

A reduction in adolescent drug use may reduce respiratory and neurobehavioral and cognitive symptoms in young adulthood. This study identifies several points in the biopsychosocial pathways in adolescence leading to later health problems in young adulthood.

Increased prevalence of herpes simplex virus type 2 among adolescent women with alcohol use disorders

PURPOSE

To determine the relationship between alcohol use disorders (AUDs) and herpes simplex virus type 2 (HSV-2), hepatitis B virus (HBV), and human immunodeficiency virus (HIV) infections among a sample of sexually active adolescents.

METHODS

Subjects were 240 sexually active male and female adolescents aged 14 to 21 years (mean 17.5 years) recruited from clinical and community settings in western Pennsylvania between 1991 and 1995; 55% had a lifetime history of AUDs (63 females, 69 males) and 45% did not have a lifetime history of AUDs (57 females, 51 males). Participants provided information about demographic factors and sexual behaviors as well as a serum sample that was assayed for antibodies to HSV-2, HBV, and HIV infections. Multivariate logistic regression was used to determine the independent relationship of AUDs to HSV-2 infections among females.

RESULTS

The seroprevalence of HSV-2 infections was 15% among females and 0% among males; the overall prevalence of HBV (1.2%) and HIV (0.4%) infections was very low. Among adolescent females, the seroprevalence of HSV-2 infections was significantly higher among those with an AUD (19%), compared with those without an AUD (10.5%) (adjusted odds ratio 8.1, 95% confidence interval 1.5-44.8, p =.017).

CONCLUSIONS

Adolescent women with an AUD appear to be at substantially increased risk of HSV-2 infection. These results highlight the need to address sexually transmitted diseases among adolescents with alcohol problems.

Health problems in adolescents with alcohol use disorders: self-report, liver injury, and physical examination findings and correlates

BACKGROUND

Although adolescent alcohol consumption has been found to be positively correlated with self-reported health problems, few studies have examined other health indicators. This study compared adolescents with alcohol use disorders (AUDs) and a community reference group on self-reported health problems, serum liver enzymes, and physical examination findings. The relevance of negative emotionality to understanding these health problems was also investigated.

METHODS

The subjects were adolescents with AUDs recruited from clinical programs and classified as having DSM-IV alcohol dependence (n = 71) or alcohol abuse (n = 57) and reference adolescents without AUDs recruited from community sources (n = 131). The assessment of health status included self-reported health problems in 15 areas; serum liver enzyme assays, including gamma-glutamyl transpeptidase, alanine aminotransferase, and aspartate aminotransferase; and physical examination findings. Negative emotionality was determined by systematically combining scores from the Hamilton Anxiety Rating Scale, the Beck Depression Inventory, the Child Behavior Checklist, and the Multidimensional Personality Questionnaire.

RESULTS

Adolescent AUDs were associated with more self-reported health problems, higher gamma-glutamyl transpeptidase and alanine aminotransferase levels, and more physical examination abnormalities. Negative emotionality was highly correlated with self-reported health problems, mediated the relationship between AUDs and self-reported health problems, and was not correlated with serum liver enzyme levels or physical examination abnormalities.

CONCLUSIONS

These results indicated that AUDs during adolescence were associated with health problems, including modest but demonstrable liver injury. Self-reported health problems were probably best understood, in this context, as a negative emotionality manifestation.

Adolescent alcohol and drug abuse and health

PURPOSE

To examine the relationship of adolescent alcohol and drug use over a 5-year period to cumulative health problems in late adolescence and young adulthood.

METHODS

We prospectively examined self-reported health problems in a sample of adolescents, some of whom received treatment for substance use disorders and had consistently poor substance use outcomes (n = 38), some of whom received treatment for substance use disorders and had positive substance use outcomes (n = 30), and a low alcohol and drug use community comparison group (n = 48). Data regarding health-related problems of these adolescents (mean, 15.9 years; 83% Caucasian; 56.5% female) were collected at 2, 4, and 6 years following initial assessments.

RESULTS

Alcohol and/or drug involvement severe enough to warrant treatment during adolescence was associated with more cumulative health problems and severe health problems for girls and more cumulative health problems for boys. Protracted and continuous abuse of alcohol and drugs was associated with more cumulative and severe health problems for girls and more severe health problems for boys.

CONCLUSIONS

These results suggest that significant health problems and concerns are related to both brief and protracted alcohol and drug abuse during adolescence. Health problems will likely become even more evident as early-onset, chronic substance abusers continue to age.

Effects of prenatal alcohol exposure on birth weight in rats: is there an inverted U-shaped function?

Decreases in birth weight are among the most commonly reported effects of prenatal alcohol exposure in animals. However, these decreases are typically associated with relatively high doses of alcohol. Two studies were conducted. The first evaluated the effects of low doses of alcohol (0.15 and 0.30 g/kg) on birth weight and other measures. A second study examined the effects of a relatively high dose of alcohol (3.0 g/kg). The two low doses of alcohol produced a slight, but not significant, increase in birth weight relative to vehicle controls whereas the high dose of alcohol produced a significant decrease in birth weight relative to its controls. When the data for the two studies were combined, the relationship between alcohol and birth weight assumed an inverted U-shaped function. There was no effect of prenatal alcohol exposure on weights at weaning, passive avoidance learning, or ambulation. In the context of birth weight, slight increases may be related to increased protein synthesis associated with low doses of alcohol.