Assessment and Treatment of Adolescent Substance Use Disorders: Alcohol Use Disorders

Psychosocial treatment options for adolescents and young adults with alcohol use disorder: systematic review and meta-analysis

Introduction

Psychosocial intervention is imperative for treating alcohol use disorder (AUD), but there is no comprehensive evidence regarding its effectiveness. Therefore, this study aimed to determine the effectiveness of psychosocial interventions in treating AUD amongadolescents and young adults.

Methods

In this systematic review and meta-analysis, articles were searched from EMBASE, PubMed, Medline, CINAHL, Web of Science, PsycINFO, and Scopus. Also, articles were retrieved from gray literature. The quality of articles has been assessed using the Cochrane risk of bias assessment.

Results

A total of 12 randomized controlled trials were included. Integrated family and CBT, CBT, guided self-change, and ecologically based family therapy had a mild effect in reducing alcohol use frequency. On the other hand, integrated motivational enhancement therapy and CBT (-0.71 [95% CI: -0.97, -0.45]) and common elements treatment approaches (4.5 [95% CI: 6.9, 2.2]) had the highest effect size for reducing alcohol use frequency and amount, respectively. In conclusion, most of the interventions had no significant effect on different drinking outcomes. Nonetheless, the effectiveness of combined interventions surpassed that of the single interventions. The effect of psychosocial interventions on abstinence was inconclusive. Therefore, future studies will explore alternative, newly emerged third-wave therapeutic approaches.

Systematic review registration

PROSPERO, CRD42023435011, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=435011.

"…he's going to be facing the same things that he faced prior to being locked up": perceptions of service needs for substance use disorders

BACKGROUND

High rates of substance use disorders (SUDs) exist among justice-involved populations (i.e., persons incarcerated or recently released). SUD treatment is crucial for justice-involved populations as unmet treatment need increases reincarceration risk and impacts other behavioral health sequalae. A limited understanding of health needs (i.e. health literacy) can be one reason for unmet treatment needs. Social support is critical to seeking SUD treatment and post-incarceration outcomes. However, little is known about how social support partners understand and influence SUD service utilization among formerly incarcerated persons.

METHODS

This mixed method, exploratory study utilized data from a larger study comprised of formerly incarcerated men (n = 57) and their selected social support partners (n = 57) to identify how social support partners understand the service needs of their loved ones recently released from prison who returned to the community with a diagnosis of a SUD. Qualitative data included 87 semi-structured interviews with the social support partners covering post-release experiences with their formerly incarcerated loved one. Univariates were conducted on the quantitative service utilization data and demographics to complement the qualitative data.

RESULTS

Majority of the formerly incarcerated men identified as African American (91%) averaging 29 years of age (SD = 9.58). Most social support partners were a parent (49%). Qualitative analyses revealed that most social support partners avoided using or did not know the language to use regarding the formerly incarcerated person's SUD. Treatment needs were often attributed to focus on peer influences and spending more time at their residence/housing. Analyses did reveal that when treatment needs were recommended in the interviews, social support partners reported employment and education services to be most needed for the formerly incarcerated person. These findings align with the univariate analysis with their loved ones reporting employment (52%) and education (26%) as their most reported service utilized post-release, compared to only 4% using substance abuse treatment.

CONCLUSION

Results provide preliminary evidence suggesting social support partners do influence the types of services accessed by formerly incarcerated persons with SUD. The findings of this study emphasize the need for psychoeducation during and after incarceration for individuals with SUDs and their social support partners.

The brain in social context: A systematic review of substance use and social processing from adolescence to young adulthood

Substance use escalates between adolescence and young adulthood, and most experimentation occurs among peers. To understand underlying mechanisms, research has focused on neural response during relevant psychological processes. Functional magnetic resonance imaging (fMRI) research provides a wealth of information about brain activity when processing monetary rewards; however, most studies have used tasks devoid of social stimuli. Given that adolescent neurodevelopment is sculpted by the push-and-pull of peers and emotions, identifying neural substrates is important for intervention. We systematically reviewed 28 fMRI studies examining substance use and neural responses to stimuli including social reward, emotional faces, social influence, and social stressors. We found substance use was positively associated with social-reward activity (e.g., in the ventral striatum), and negatively with social-stress activity (e.g., in the amygdala). For emotion, findings were mixed with more use linked to heightened response (e.g., in amygdala), but also with decreased response (e.g., in insula). For social influence, evidence supported both positive (e.g., cannabis and nucleus accumbens during conformity) and negative (e.g., polydrug and ventromedial PFC during peers' choices) relations between activity and use. Based on the literature, we offer recommendations for future research on the neural processing of social information to better identify risks for substance use.

Racial and Ethnic Disparities, Referral Source and Attrition From Outpatient Substance Use Disorder Treatment Among Adolescents in the United States

The following study examined the association between race, ethnicity, referral source, and reasons for attrition from substance use treatment in a sample of 72,643 discharges of adolescent youth in the United States from 2014 to 2016. Black and Hispanic adolescents were more likely to be discharged due to incarceration and termination by the facility compared to White adolescents. Adolescents referred by probation, diversion, other juvenile justice organizations, health care providers, community agencies, and individual referrals were significantly more likely to be discharged due to incarceration and terminated by the treatment facility compared to youth who were referred by schools. Findings suggest that enhancing linkage to treatment from systems in the social environment may play a role in attenuating racial and ethnic disparities in rates of attrition from substance abuse treatment among adolescent youth in the United States.

Impact of sex, strain, and age on blood ethanol concentration and behavioral signs of intoxication during ethanol vapor exposure

Animal models of alcohol drinking and dependence are a critical resource for understanding the neurobiological mechanisms and development of more effective treatments for alcohol use disorder (AUD). Because most rat strains do not voluntarily consume large enough quantities of alcohol to adequately model heavy drinking, dependence, and withdrawal-related symptoms, researchers frequently turn to experimenter administered methods to investigate how prolonged and repeated exposure to large quantities of alcohol impacts brain and behavior. Vaporized ethanol is a common method used for chronically subjecting rodents to alcohol and has been widely used to model both binge and dependence-inducing heavy drinking patterns observed in humans. Rodent strain, sex, and age during exposure are all well-known to influence outcomes in experiments utilizing intraperitoneal or intragastric methods of repeated ethanol exposure. Yet, despite its frequent use, the impact of these variables on outcomes associated with ethanol vapor exposure has not been widely investigated. The present study analyzed data generated from over 700 rats across an eight-year period to provide a population-level assessment of variables influencing level of intoxication using vapor exposure. Our findings reveal important differences with respect to strain, sex, and age during ethanol exposure in the relationship between blood ethanol concentration and behavioral signs of intoxication. These data provide valuable scientific and practical insight for laboratories utilizing ethanol vapor exposure paradigms to model AUD in rats.

A new generation of mTORC1 inhibitor attenuates alcohol intake and reward in mice

Alcohol use disorder (AUD) is a chronic condition associated with devastating socioeconomic consequences. Yet, pharmacotherapies to treat behavioral phenotypes such as uncontrolled heavy drinking are limited. Studies in rodents suggest that the mammalian target of rapamycin complex 1 (mTORC1) plays an important role in mechanisms underlying alcohol drinking behaviors as well as alcohol seeking and relapse. These preclinical evidence suggest that mTORC1 may be a therapeutic target for the treatment of AUD. Thus, the aim of the present study was to test the potential use of newly developed mTORC1 inhibitors, RapaLink-1 and MLN0128, in preclinical mouse models of AUD. First, we used the intermittent access to 20 percent alcohol in a two-bottle choice paradigm and tested the efficacy of the drugs to reduce alcohol intake in mice with a history of binge drinking and withdrawal. We found that both inhibitors reduce excessive alcohol intake and preference with RapaLink-1 exhibiting higher efficacy. We further observed that RapaLink-1 attenuates alcohol consumption during the first alcohol-drinking session in naïve mice, and interestingly, the effect was still present 14 days after the initial treatment with the drug. We also found that RapaLink-1 did not alter the consumption of water or saccharin, revealing a specific effect of the inhibitor on alcohol intake. Finally, we report that RapaLink-1 blocks the retrieval but not acquisition of alcohol place preference without affecting locomotion. Together, our findings suggest that RapaLink-1 may be developed as a new medication to treat and prevent the development of AUD.

Identification and initial management of intoxication by alcohol and other drugs in the pediatric emergency room

OBJECTIVE

To review the screening, diagnosis, evaluation, and treatment of intoxication by alcohol and other drugs in children and adolescents in the emergency scenario.

DATA SOURCE

This was a narrative literature review.

DATA SUMMARY

The detection of this problem in the emergency room can be a challenge, especially when its assessment is not standardized. The intentional and episodic use of large amounts of psychoactive substances by adolescents is a usual occurrence, and unintentional intoxication is more common in children younger than 12 years. The clinical picture in adolescents and children differs from that in adults and some particularities are important in the emergency scenario. After management of the acute condition, interventions targeting the adolescent at risk may be effective.

CONCLUSION

The diagnosis and treatment of intoxication by alcohol and other drugs in adolescents and children in the emergency scenario requires a systematic evaluation of the use of these drugs. There are few specific treatments for intoxication, and the management comprehends support measures and management of related clinical complications.