Affective dysregulation predicts incident nonmedical prescription analgesic use among college students

Covariates in studies examining longitudinal relationships between substance use and mental health problems among youth: A meta-epidemiologic review

INTRODUCTION

This meta-epidemiological review examines covariate selection and reporting practices in observational studies analyzing longitudinal relationships between youth substance use and mental health problems (internalizing and externalizing).

METHODS

Sixty-nine studies published in high-impact journals from 2018 to 2023 were included. Studies were included if they explored prospective relationships between substance use and mental health among youth (12-25 years) and used repeated measures designs. Data extraction focused on study characteristics, covariates and their selection methods, and reporting practices.

RESULTS

There were 574 covariates included across studies; 33 were included as moderators and 18 were included as mediators. At the study level, the most common covariate domains included demographics (90 % of included studies had at least one demographic, mostly sex), substance-related variables (67 %; mostly alcohol or smoking), internalizing symptoms (39 %; mostly depression), family-related variables (29 %; mostly parental substance use or mental illness), and externalizing symptoms (19 %; mostly conduct). 93 % of studies had unique sets of lower-order covariates. Across all studies (n = 69), only 35 % provided details for how, and why, all covariates were selected with only 12 % reporting selecting covariates a priori, and none being pre-registered. Only 60 % mentioned confounding and only 13 % mentioned risk of confounding in their conclusions.

CONCLUSIONS

The findings highlight the need for improved covariate selection and reporting practices. Establishing a core set of covariates and adhering to standardized reporting guidelines would enhance the comparability and reliability of research findings in this field. Researchers can use this review to identify and justify the inclusion and exclusion of commonly reported covariates when analyzing relationships between youth substance use and mental health problems.

Impact of a multidisciplinary educational training program (OverdosED) on knowledge and perceptions of depressant substance use on a college campus

Objective: Pilot study to assess the efficacy of a multidisciplinary educational training program (OverdosED) designed to increase college students' knowledge of and confidence in their ability to appropriately recognize and respond to suspected overdose on depressant substances. Participants: Undergraduate students (n = 92) with Greek life affiliations at a moderately-sized private liberal arts college in the southeastern USA. Methods: Electronic surveys were administered before and after delivery of the training program. Questions assessing knowledge of depressant substance overdose were compared to determine the impact of the educational intervention. Questions assessing participants' confidence in their ability to recognize and respond to overdose and their perceptions of campus culture were also compared. Results: Mean composite scores on knowledge-based questions were significantly higher for the post-intervention survey compared to the pre-intervention survey. Confidence in knowledge also significantly increased after the intervention. Mean scores for survey responses related to campus culture were high at baseline but significantly increased after the intervention. Conclusions: OverdosED successfully increased college students' knowledge of and confidence in their ability to appropriately recognize and respond to suspected overdose on depressant substances, and positively influenced perceptions on campus culture.

Personality to Prescription Drug Misuse in Adolescents: Testing Affect Regulation, Psychological Dysregulation, and Deviance Proneness Pathways

Background: Fifteen to 25-year-olds are the age group most likely to misuse prescription drugs. Few studies have tested theory-driven models of adolescent risk for prescription drug misuse. Moreover, rarely are distinct pathways to different forms of prescription drug misuse considered. Methods: We tested mediational paths from personality to mental health symptoms to prescription drug misuse, informed by etiological models of addiction. We specified pathways from particular personality traits to unique forms of prescription drug misuse via specific mental health symptoms. We used semi-longitudinal data collected across two waves of the Co-Venture Trial. Our sample included students from 31 Canadian high schools tested in Grade 9 (n = 3,024) and again in Grade 10 (n = 2,869; 95% retention). Personality (hopelessness, anxiety sensitivity, impulsivity, sensation seeking) was assessed in Grade 9. Mental health symptoms (depression, anxiety, ADHD, conduct disorder) and prescription drug misuse (opioids, sedatives/tranquilizers, stimulants) were assessed at both time points. Results: Consistent with the negative affect regulation model, hopelessness was specifically associated with opioid misuse via depressive symptoms, and anxiety sensitivity was specifically associated with sedative/tranquilizer misuse via anxiety symptoms. Consistent with positive affect regulation, sensation seeking was directly associated with stimulant misuse. Consistent with the psychological dysregulation model, impulsivity was associated with stimulant misuse via ADHD symptoms. And consistent with the deviance proneness model, impulsivity was also associated with unconstrained (i.e., all three forms of) prescription drug misuse via conduct disorder symptoms. Conclusions: Screening for adolescents high in hopelessness, anxiety sensitivity, sensation seeking, or impulsivity and providing them with personality-matched cognitive-behavioral interventions may be helpful in preventing or mitigating prescription drug misuse. Our results point to the specific mental health symptoms that are important to target in each of these personality-matched interventions.

Mental health, pain, and risk of drug misuse: A nationwide cohort study

Evidence suggests that rising drug misuse, particularly of prescription painkillers, is more closely linked with period increases in reported pain among Americans of the same age range than with deterioration in mental health, but it is unclear whether those cross-sectional associations reflect causal effects of pain and mental health on drug misuse. Using data from the 1995-96, 2004-05, and 2013-14 waves of a nationwide cohort study, we evaluate the effects of pain and mental health on subsequent misuse of prescription painkillers and sedatives. Logistic regression is applied to model drug misuse (separately for painkillers and sedatives) as a function of predictors measured at the previous wave; respondents who reported misuse of that drug type at the prior wave are excluded from the analysis. Mental health is an important predictor of both painkiller and sedative misuse, whereas pain plays a much bigger role in painkiller misuse. Frequency of joint aches and stiffness has the strongest effect on subsequent painkiller misuse, although mental health yields substantial incremental predictive ability above and beyond pain. Negative affect, positive affect, and psychological well-being have notable effects on sedative misuse, while pain (particularly backache) makes only a small incremental contribution to sedative misuse. We suspect that increases over time in pain levels may have played a bigger role than mental health in explaining the rise in prescription painkiller misuse and may have contributed to growing misuse of sedatives. In contrast, deteriorating mental health was probably more important in explaining the rise of sedative misuse.

Conduct disorder and attention-deficit/hyperactivity disorder as risk factors for prescription opioid use

BACKGROUND

Existing studies of attention deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and substance use or substance use disorders have produced mixed results, with some identifying a direct link between ADHD and general or disordered substance use and others suggesting that comorbid CD may explain this relationship. Insufficient research has addressed the issue, which is particularly relevant in the context of the opioid crisis. This study examined the association of probable ADHD and childhood CD with self-reported opioid use in a general-population sample.

METHOD

The 2011-2013 cycles of the CAMH Monitor, a cross-sectional survey of adults (18+ years) from Ontario, Canada provided data from 6074 respondents. Binary logistic regressions were conducted of self-reported medical, non-medical, and any prescription opioid use in the previous 12 months, assessing demographic characteristics, perceived physical and mental health, and probable ADHD, childhood (before age 15 years) symptoms of CD, or their combination.

RESULTS

Adjusting for potential covariates, probable ADHD alone was not associated with prescription opioid use. Childhood symptoms of CD significantly predicted non-medical use (OR = 2.10, 95% CI = 1.10, 4.03). ADHD and CD symptoms combined significantly predicted medical (OR = 3.27, 95% CI = 1.20, 8.91), non-medical (OR = 4.73, 95% CI = 1.05, 21.30), and any (OR = 3.02, 95% CI = 1.13, 8.11) prescription opioid use, although a low base rate of non-medical use may have negatively affected model fit.

CONCLUSIONS

Previous findings relating ADHD to opioid use could be explained, in part, by the high rate of comorbidity between ADHD and CD. These data support prevention and treatment programs targeting individuals with comorbid ADHD and CD symptoms.

Cumulative Risk of Substance Use in Community College Students

BACKGROUND AND OBJECTIVES

Substance use in community college students has been explored in only a handful of studies. Differences in population characteristics and substance use between 2- and 4-year students suggest that different factors may promote and thwart this behavior. Cumulative risk is a parsimonious methodology that provides better model stability and more statistical power, yet it has only been recently used in substance use research. The aim of this study is to investigate multiple aspects of substance use risk in a population in need of substance use prevention and intervention services.

METHODS

We conducted a cross-sectional study of community college students (N = 288; 75% female) examining the relative contributions of different domains of cumulative risk (eg, life stressors, academic stressors, and mental health diagnoses) to develop different profiles of risk across substance use classes (ie, alcohol, cigarette, marijuana, and hard drug use).

RESULTS

Cumulative risk analyses indicated that alcohol and tobacco use were associated with the domains of life stressors and peer/family substance use, marijuana use with peer/family substance use and stressful childhood experiences, and hard drug use with peer/family substance use, lack of social support, low access to care, and stressful childhood experiences.

DISCUSSION AND CONCLUSIONS

Different strategies for prevention and intervention may be necessary to effectively address different forms of substance use in this population.

SCIENTIFIC SIGNIFICANCE

The risk domain profiles related to specific drugs may lead to targeted interventions to reduce substance use in community college students. (Am J Addict 2020;29:97-104).

The impact of opioid use disorder on levels of educational attainment: Perceived benefits and consequences

BACKGROUND/AIMS

Adolescents and young adults have the highest rates of opioid use, and despite shared risk-factors such as mental health and social pressures, there is little information on the relationship between education and opioid use disorder. In this study, we sought to assess differences in educational attainment between opioid users and the general population, and the impact of opioid use on one's education.

METHODS

Patients (N = 14,349) entering opioid treatment programs across the United States were surveyed on educational attainment from 2010 to 2018. Data were compared to estimates from an annual survey administered by the US Census. A follow-up sub-set of opioid users (N = 240) was interviewed to add context and expand on the structured survey.

RESULTS

Nearly one-third (32.2%) of the US population is estimated to have earned a bachelor's/advanced degree, compared to just 7.8% of treatment-seeking opioid users. Over half of follow-up respondents (57.5%) reported initiating regular opioid use while attending an educational institution. The majority (68.0%) also indicated opioids negatively impacted their education, with drug-seeking behavior prioritized over attendance and academic performance. Perceived benefits included cognitive enhancement and therapeutic value for anxiety/depression.

CONCLUSIONS

Our data suggest that opioid users achieve lower levels of education, which may result in both individual and economic costs. Prevention programs need to not only include education-specific risk factors (e.g., social norms), but underlying precipitators such as mental health, stigma, and the myth of risk-free cognitive enhancement. Opioid specific services should be available and disseminated to student populations, including certification of campus physicians to provide buprenorphine maintenance.

Emotion dysregulation as an explanatory factor in the relation between negative affectivity and non-medical use of opioid in a diverse young adult sample

The non-medical use of prescription opioids is an area of increasing public health concern, particularly among young college-age adults (ages 18-25) who demonstrate an increased risk of opioid-related problems. Negative mood states are consistently associated with more severe non-medical use of opioid. Emotion dysregulation defined an impaired ability to understand, evaluate, and differentiate one's emotions, and access strategies to regulate them could play an explanatory role in this association. The present study examined the potential explanatory role of emotion dysregulation in the relationship between negative affectivity and non-medical use of prescription opioid among a racially/ethnically diverse young adult sample (N = 2080, 78.7% female, Mage = 21.9, SD = 4.9) attending a large southwestern state university, and across the two sub-samples of individuals with and without pain. Results indicated that emotion dysregulation explained, in part, the association between negative affectivity and non-medical use of opioid-related variables, including self-reported addiction to opioids, denial of opioid prescription by a healthcare provider, and family concerns about participant's opioid use. These indirect effects were comparable across individuals with and without pain. Findings suggest that targeting emotion dysregulation may be one therapeutic strategy to reduce non-medical use of opioid in the context of negative affectivity among college students.

Feasibility of ecological momentary assessment to study mood and risk behavior among young people who inject drugs

AIMS

To test the acceptability and feasibility of ecological momentary assessment (EMA) of mood and injection risk behavior among young people who inject drugs (PWID), using mobile phones.

METHODS

Participants were 185 PWID age 18-35 recruited from two sites of a large syringe service program in Chicago. After completing a baseline interview, participants used a mobile phone app to respond to momentary surveys on mood, substance use, and injection risk behavior for 15 days. Participants were assigned to receive surveys 4, 5, or 6 times per day.

RESULTS

Participants were 68% male, 61% non-Hispanic white, 24% Hispanic, and 5% non-Hispanic Black. Out of 185 participants, 8% (n = 15) failed to complete any EMA assessments. Among 170 EMA responders, the mean number of days reporting was 10 (SD 4.7), the mean proportion of assessments completed was 0.43 (SD 0.27), and 76% (n = 130) completed the follow-up interview. In analyses adjusted for age and race/ethnicity, women were more responsive than men to the EMA surveys in days reporting (IRR = 1.33, 95% CI 1.13-1.56), and total number of surveys completed (IRR = 1.51, 95% CI 1.18-1.93). Homeless participants responded on fewer days (IRR = 0.76, 95% CI 0.64-0.90) and completed fewer surveys (IRR = 0.70, 95% CI 0.54-0.91), and were less likely to return for follow-up (p = 0.016). EMA responsiveness was not significantly affected by the number of assigned daily assessments.

CONCLUSIONS

This study demonstrated high acceptability and feasibility of EMA among young PWID, with up to 6 survey prompts per day. However, homelessness significantly hampered successful participation.