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Gao CX, Filia KM, Bedi G, Menssink JM, Brown E, Rickwood DJ, Parker AG, Hetrick SE, Herrman H, Hickie I, Telford N, McGorry PD, Cotton SM. Understanding the complexity, patterns, and correlates of alcohol and other substance use among young people seeking help for mental ill-health. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1457-1467. [PMID: 36914881 PMCID: PMC10460308 DOI: 10.1007/s00127-023-02444-w] [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] [Received: 10/19/2022] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE Use of alcohol and other substances is a multifaceted issue impacting young people across multiple life domains. This paper aims to elucidate patterns of substance use and associated demographic and clinical factors among young people seeking treatment for their mental health. METHODS Young people (12-25 years old) were recruited from five youth-specific primary mental health ("headspace") services in Australia. Self-reported substance use and harms in the past 3 months were measured using WHO-ASSIST. Network analyses were conducted to evaluate interrelationships between use and harms associated with different substances. Subgroups were then identified based on whether participants reported using high centrality substances, and associated demographic and clinical factors were assessed with multinomial logistic regression. RESULTS 1107 youth participated. 70% reported use of at least one substance in the past 3 months, with around 30% of those reporting related health, social, legal or financial problems. Network analysis highlighted substantial interconnections between use and harm indicators for all substances, with amphetamine-type stimulants (ATS) and cannabis being high central substances. Higher levels of substance use and harms were reported in subgroups with ATS or cannabis use and different risk factors were associated with these subgroups. CONCLUSIONS Findings highlight the importance of screening for substance use in youth primary mental healthcare settings, offering a key opportunity for early intervention. Clinicians should be aware of the inner connections of use and harms of different drugs and the role of cannabis and amphetamine use as a marker for more substance use profiles.
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Affiliation(s)
- Caroline X Gao
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
- Orygen, 35 Poplar Road, Parkville, VIC, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Kate M Filia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - Gillinder Bedi
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - Jana M Menssink
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - Ellie Brown
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - Debra J Rickwood
- Headspace, National Youth Mental Health Foundation, Melbourne, VIC, Australia
- Faculty of Health, University of Canberra, ACT, Canberra, Australia
| | - Alexandra G Parker
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Helen Herrman
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - Ian Hickie
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Nic Telford
- Headspace, National Youth Mental Health Foundation, Melbourne, VIC, Australia
| | - Patrick D McGorry
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - Sue M Cotton
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
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de Jonge MC, Bukman AJ, van Leeuwen L, Onrust SA, Kleinjan M. Latent Classes of Substance Use in Young Adults - A Systematic Review. Subst Use Misuse 2022; 57:769-785. [PMID: 35188870 DOI: 10.1080/10826084.2022.2040029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: This systematic review provides an overview of studies on latent classes related to the substance use among young adults (18-25 years). Identifying these classes helps to detect high-risk groups, setting a base for selective prevention.Methods: This systematic literature review included peer-reviewed studies (published up to February, 2021) that identified latent classes and investigated predictors of latent classes relating to the use of marijuana, alcohol and/or other substances within samples of young adults.Results: Twenty studies (sample sizes N = 171 to N = 21945) met the inclusion criteria. 14 studies identified 'low-level engagers', 'light alcohol and tobacco use', 'heavy alcohol and tobacco use' and 'heavy use/polysubstance use' classes. Four studies differentiated within the 'heavy/polysubstance' class and found 'traditional clubdrugs', 'hallucinogens' and 'wide-range illicit drugs' classes. Male gender and white race predicted membership of the 'heavy use/polysubstance use' class consistently across studies. Other predictors of polysubstance use that were consistent across studies were peer substance use, depressive symptoms, parental drinking and participating in an honor society.Conclusions: The investigated predictors of class membership provide insight into social settings and characteristics that predict heavy use or polysubstance use. They can contribute to the development of effective prevention interventions by allowing for a more targeted approach.
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Affiliation(s)
| | | | - Lonneke van Leeuwen
- Julius Center for Health Sciences and Primary Care Utrecht, Utrecht, The Netherlands
| | | | - Marloes Kleinjan
- Trimbos Institute, Utrecht, The Netherlands.,Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
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Hernández-Serrano O, Gras ME, Font-Mayolas S. Concurrent and Simultaneous Use of Cannabis and Tobacco and Its Relationship with Academic Achievement amongst University Students. Behav Sci (Basel) 2018; 8:E31. [PMID: 29494479 PMCID: PMC5867484 DOI: 10.3390/bs8030031] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 01/23/2018] [Indexed: 11/16/2022] Open
Abstract
The combined use of cannabis and tobacco is frequent in Europe. Few studies have nonetheless explored this pattern of consumption and its relationship with academic achievement in Spanish population. The aim of the present study was to analyze (1) the frequency of four patterns of polydrug use the last year (non-dual users of cannabis and tobacco; concurrent users: cannabis and tobacco separately; simultaneous users: tobacco in cannabis "joints"; simultaneous users: tobacco in cannabis joints alongside alcohol) by gender and age; (2) grade point average (GPA) by gender and age; (3) the association between the frequency of the four patterns of use and the GPA amongst a sample of 477 Spanish university students. The use of cannabis and tobacco (concurrent and simultaneous) and GPA were assessed by means of self-reported questionnaires. Statistically significant differences were found for the GPA with respect to gender. The GPA by the non-dual users of cannabis and tobacco was significantly higher than the GPA corresponding to the concurrent and simultaneous users. The combined use of cannabis and tobacco, regardless of the type of use (concurrent or simultaneous), is moderately related to poor academic achievement amongst university students.
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Affiliation(s)
- Olga Hernández-Serrano
- Departament of Physical Therapy, Campus of Salt, EUSES-University of Girona (UdG), Carrer Francesc Macià, 65, 17190 Salt, Girona, Spain.
| | - Maria E Gras
- Department of Psychology, University of Girona (UdG), Plaça Sant Domènec, 9, 17004 Girona, Spain.
| | - Sílvia Font-Mayolas
- Department of Psychology, University of Girona (UdG), Plaça Sant Domènec, 9, 17004 Girona, Spain.
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Lipperman-Kreda S, Paschall MJ, Saltz R, Morrison C. Places and social contexts associated with simultaneous use of alcohol, tobacco and marijuana among young adults. Drug Alcohol Rev 2018; 37:188-195. [PMID: 28422352 PMCID: PMC5648641 DOI: 10.1111/dar.12537] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/20/2016] [Accepted: 12/29/2016] [Indexed: 12/15/2022]
Abstract
INTRODUCTION AND AIMS Little is known about social-ecological correlates of simultaneous use of alcohol with other substances. This study examined places and social contexts associated with simultaneous use of alcohol, tobacco and marijuana among young adults. DESIGN AND METHODS We used survey data obtained from 1538 young adult recent alcohol drinkers (49% male; 18-30 years old) in 24 non-contiguous cities in California. Event-level measures included alcohol, tobacco and marijuana use, drinking places and social characteristics of the event. Individual-level measures included alcohol expectancies, depression and demographics. RESULTS Bars and restaurants had less alcohol and marijuana use (odds ratio = 0.34; 95% confidence interval 0.18, 0.62; P < 0.001) and alcohol, marijuana and tobacco use (odds ratio = 0.27; 95% confidence interval 0.14, 0.54; P < 0.001) compared with alcohol use only. Perceived percent of intoxicated people at an event was associated with greater likelihood of using alcohol with tobacco and marijuana at the event. At the individual level, greater age was generally associated with increased odds of simultaneous use. Participants who were male, less educated, more depressed and had positive alcohol expectancies were more likely to simultaneously co-use alcohol with tobacco and marijuana. Those with negative expectancies were less likely to simultaneously use these substances. DISCUSSION AND CONCLUSIONS Social events in private settings with a high percentage of people who are intoxicated had increased likelihood of simultaneous use of alcohol, tobacco and marijuana. Prevention efforts in these settings may reduce simultaneous use of these substances and related harms. [Lipperman-Kreda S, Paschall MJ, Saltz RF, Morrison CN. Places and social contexts associated with simultaneous use of alcohol, tobacco and marijuana among young adults. Drug Alcohol Rev 2017;00:000-000].
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Affiliation(s)
| | - Mallie J. Paschall
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, USA
| | - Robert Saltz
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, USA
| | - Christopher Morrison
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Cance JD, Talley AE, Morgan-Lopez A, Fromme K. Longitudinal Conjoint Patterns of Alcohol and Tobacco Use Throughout Emerging Adulthood. Subst Use Misuse 2017; 52:373-382. [PMID: 27779451 PMCID: PMC5823508 DOI: 10.1080/10826084.2016.1228677] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The concurrent use of alcohol and tobacco has a multiplicative effect on both social and physical consequences. While it is known that alcohol and tobacco use are strongly correlated in emerging adulthood, there is significant individual variability in use. However, little research has examined how patterns of concurrent use are related over time. OBJECTIVES The current study explores these longitudinal conjoint trajectories, as well as the associated sociodemographic factors. METHODS We used sequential latent class growth analysis to explore the co-occurring longitudinal patterns of recent alcohol and tobacco use across emerging adulthood (10 data collection periods, 2004-2009) with a diverse sample of 2,244 college students (60% female; 54% White). RESULTS Twenty distinct patterns of conjoint alcohol and tobacco use were found. There was more variation in tobacco use trajectories among alcohol users than variation in alcohol trajectories among tobacco users. Using multinomial logistic regression models we determined the impact of sociodemographic characteristics on classification into each conjoint pattern versus the normative trajectory (Abstaining tobacco/Low alcohol). Male gender, White race, fraternity/sorority affiliation, and higher family income were significantly associated with riskier conjoint trajectory patterns. Conclusions/Importance: Findings highlight the diversity of alcohol and tobacco use behaviors across emerging adulthood. The low variation in alcohol use among tobacco users indicates that tobacco use is a significant risk factor for heavier drinking. A better understanding of the covarying use of these two ubiquitous substances may provide new avenues for preventing and reducing the use of both.
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Affiliation(s)
- Jessica Duncan Cance
- Department of Kinesiology and Health Education, the University of Texas at Austin
| | - Anna E. Talley
- Department of Kinesiology and Health Education, the University of Texas at Austin
| | | | - Kim Fromme
- Department of Psychology, the University of Texas at Austin
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Karjalainen K, Kuussaari K, Kataja K, Tigerstedt C, Hakkarainen P. Measuring Concurrent Polydrug Use in General Populations: A Critical Assessment. Eur Addict Res 2017. [PMID: 28641293 DOI: 10.1159/000477802] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Polydrug use is a complicated phenomenon that is measured in a wide variety of different ways. Using Finland as an example, we aimed to demonstrate how the prevalence and prevalence trends of concurrent polydrug use (CPU) varied in the general population based on the different measurements used. METHODS Population-based Drug Surveys conducted every 4 years during 1998-2014 were used. CPU was measured with different measurements: strict, medial and loose definition of CPU, which were based on different combinations of alcohol, illicit drugs, pharmaceutical drugs and cigarettes used during the last 12 months/30 days. Logistic regression was used to estimate the p values for assessing trends. RESULTS Depending on the measurements used, the prevalence of CPU in 2014 varied between 2.0 and 18.7%. Different definitions also produced contradictory trends of CPU: there was a modest increase in prevalence if it was measured with a medial (p < 0.001) or strict (p = 0.054) definition, but when measured with the loose definition (only measure that included smoking), there was a decrease in prevalence (p < 0.001). CONCLUSIONS The prevalence of CPU varies greatly depending on the measurement used, as does the course of the prevalence trends. The concept of simultaneous polydrug use may capture the phenomenon better compared to the concept of CPU.
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Haardörfer R, Berg CJ, Lewis M, Payne J, Pillai D, McDonald B, Windle M. Polytobacco, marijuana, and alcohol use patterns in college students: A latent class analysis. Addict Behav 2016; 59:58-64. [PMID: 27074202 DOI: 10.1016/j.addbeh.2016.03.034] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 02/11/2016] [Accepted: 03/29/2016] [Indexed: 11/19/2022]
Abstract
Limited research has examined polysubstance use profiles among young adults focusing on the various tobacco products currently available. We examined use patterns of various tobacco products, marijuana, and alcohol using data from the baseline survey of a multiwave longitudinal study of 3418 students aged 18-25 recruited from seven U.S. college campuses. We assessed sociodemographics, individual-level factors (depression; perceptions of harm and addictiveness,), and sociocontextual factors (parental/friend use). We conducted a latent class analysis and multivariable logistic regression to examine correlates of class membership (Abstainers were referent group). Results indicated five classes: Abstainers (26.1% per past 4-month use), Alcohol only users (38.9%), Heavy polytobacco users (7.3%), Light polytobacco users (17.3%), and little cigar and cigarillo (LCC)/hookah/marijuana co-users (10.4%). The most stable was LCC/hookah/marijuana co-users (77.3% classified as such in past 30-day and 4-month timeframes), followed by Heavy polytobacco users (53.2% classified consistently). Relative to Abstainers, Heavy polytobacco users were less likely to be Black and have no friends using alcohol and perceived harm of tobacco and marijuana use lower. Light polytobacco users were older, more likely to have parents using tobacco, and less likely to have friends using tobacco. LCC/hookah/marijuana co-users were older and more likely to have parents using tobacco. Alcohol only users perceived tobacco and marijuana use to be less socially acceptable, were more likely to have parents using alcohol and friends using marijuana, but less likely to have friends using tobacco. These findings may inform substance use prevention and recovery programs by better characterizing polysubstance use patterns.
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Affiliation(s)
- Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, United States
| | - Carla J Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, United States.
| | - Michael Lewis
- Department of Marketing, Goizueta Business School, Emory University, 1300 Clifton Road, Atlanta, GA 30322, United States
| | - Jackelyn Payne
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, United States
| | - Drishti Pillai
- Deparment of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, United States
| | - Bennett McDonald
- Deparment of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, United States
| | - Michael Windle
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, United States
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Co-occurrence between mental distress and poly-drug use: a ten year prospective study of patients from substance abuse treatment. Addict Behav 2015; 48:71-8. [PMID: 26004857 DOI: 10.1016/j.addbeh.2015.05.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 04/23/2015] [Accepted: 05/03/2015] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Longitudinal research investigating psychiatric trajectories among patients with poly-drug use patterns remains relatively scant, even though this specific population is at elevated risk for multiple negative outcomes. The present study examined temporal associations between poly-drug use (i.e. heroin, cannabis, tranquilizers, and amphetamines) and mental distress over a 10-year period. METHODS A clinical cohort of 481 patients was recruited from substance use treatment facilities in Norway, and prospectively interviewed 1, 2, 7 and 10years after the initial data collection at treatment admission. At each assessment participants completed a questionnaire addressing their substance use and mental distress. Longitudinal growth models were used to examine whether, and if so, how, levels of drug use were associated with the level and rate of change in mental distress over time. RESULTS Results from the longitudinal growth models showed a co-occurrence between active poly-drug use and mental distress, such that there was a dose-response effect where mental distress increased both in magnitude and over time with the number of drugs used. Reduction in mental distress during the 10-year study period was evident only in the no-drug use condition. Use of multiple drugs and mental distress appear strongly co-related over time. CONCLUSIONS Pre-treatment assessment should carefully identify individuals manifesting poly-drug use and mental disorders. Treatment and follow-up services should be tailored to their specific needs.
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Palamar JJ, Griffin-Tomas M, Kamboukos D. Reasons for recent marijuana use in relation to use of other illicit drugs among high school seniors in the United States. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 41:323-31. [PMID: 26115351 DOI: 10.3109/00952990.2015.1045977] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Studies show that illicit cannabis (marijuana) use is related to use of other illicit drugs and that reasons for use are related to frequency of marijuana use. However, research is needed to examine whether specific reasons for marijuana use are associated with use of other illicit drugs. METHODS Data from recent marijuana-using high school seniors were examined from 12 cohorts of Monitoring the Future (Weighted n = 6481) to examine whether reasons for recent marijuana use are associated with use of eight other illicit drugs. RESULTS Using "to experiment" decreased odds of reporting use of each drug and using to decrease effects of other drugs increased odds of reporting use of each drug. In multivariable models, using marijuana "to experiment" decreased the odds for reporting use of hallucinogens other than LSD and narcotics other than heroin. Using marijuana for "insight" increased the odds for use of hallucinogens other than LSD, and use due to "boredom" increased the odds for reporting use of powder cocaine and hallucinogens other than LSD. Using marijuana to increase effects of other drugs increased odds of reporting use of each of the eight drugs, and using it to decrease other drug effects increased odds of reporting use of crack, hallucinogens other than LSD, and amphetamine/stimulants. CONCLUSIONS This study helped identify illicit marijuana users who are more likely to report use of other illicit drugs. Prevention efforts need to focus on students who report certain reasons for marijuana use as they may be at risk for use of other illicit drugs.
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Affiliation(s)
- Joseph J Palamar
- Department of Population Health, New York University Langone Medical Center , New York , NY
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Greydanus DE, Kaplan G, Baxter LE, Patel DR, Feucht CL. Cannabis: The never-ending, nefarious nepenthe of the 21st century: What should the clinician know? Dis Mon 2015; 61:118-75. [DOI: 10.1016/j.disamonth.2015.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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