Addressing the critical health problem of adolescent substance use through health care, research, and public policy

Punishment and Reward Sensitivity in Risk-Taking as Potential Mechanisms Explaining the Relationships Between Childhood Callous-Unemotional Traits and Adolescent Substance Use in a Longitudinal Cohort Study Sample

Childhood callous-unemotional (CU) traits are associated with a neurocognitive response style of high reward and low punishment sensitivity, which may make these children particularly vulnerable to substance misuse. However, the mechanisms explaining the link between CU traits and substance use are poorly understood. This study investigated the mediating influences of reward and punishment sensitivity on the association between childhood CU traits and adolescent substance use. Using data from the UK Millennium Cohort Study, mediation analyses were conducted to investigate the potential indirect effects of age 14 reward and punishment sensitivity in risk-taking on the relationships between age 11 CU traits and alcohol, cannabis, and other illicit drug use at age 17. No direct effects of CU traits on substance use were found when accounting for gender, baseline alcohol use, poverty, emotional symptoms, conduct problems, hyperactivity, and verbal ability at age 11. Indirect effects of increased reward sensitivity on the relationship between CU traits and increased use were seen for alcohol, cannabis, and other drugs. There was a significant indirect effect of reduced punishment sensitivity on the relationship between CU traits and increased alcohol use, but not cannabis or other substance use. Findings suggest that reward and punishment sensitivity may have independent effects on decision-making processes contributing to adolescent substance use. Prevention and early intervention for substance use should consider modifying intervention strategies to fit the needs of adolescents with a callous interpersonal style and a neurocognitive profile characterized by a high drive for rewards and low risk aversion.

People who use drugs engagement in substance use disorder services and harm reduction: evaluation, challenges and future direction of a community-based intervention

BACKGROUND

Since 1996, an urban community-based organization whose primary mission is to serve diverse94 and emerging community health needs has provided screening, testing, overdose prevention and training, referrals, and access to treatment for substance use disorders (SUD) and communicable diseases such as HIV through its Life Points harm reduction program.

METHODS

As a partner in a State survey in 2021, the community organization recruited a convenience sample of people who use drugs to participate in a survey focused on their substance use, healthcare, and barriers to SUD services. Community health workers conducted outreach and used an encrypted identifier to collect data from a convenience sample of harm reduction participants regarding demographics, legal justice, engagement in harm reduction and access to healthcare. Evaluators entered paper surveys into Qualtrics for reporting and summative analysis.

RESULTS

A convenience sample of fifty-five people who use drugs were recruited and surveyed. The majority (86%, n = 47) were active participants in the agency Life Points (LP) harm reduction service. Participants' average age was 42.9 years (SD = 11.5). About half (51%, n = 28) were male, 48% (n = 26) were female, and 2% (n = 1) was transgender. About two-thirds (67%, n = 37) of participants were White/Caucasian, 13% (n = 7) were Black/African-American, 11% (n = 6) were Hispanic and 7% (n = 4) were Multi-Racial. Regarding current substance use, 98% (n = 54) reported use of heroin, 51% (n = 28) reported crack, 47% (n = 26) cocaine, 25% (n = 14) alcohol, 24% (n = 13) opioids, and 15% (n = 8) marijuana. The majority, 87% (n = 48) said they had health care insurance and over two-thirds (69%, n = 37) said they had been arrested for a felony. Almost three quarters (71%, n = 39) reported receiving services from the Department of Health & Human Services. A higher percentage of females compared to males (65% and 29% respectively) reported engagement in community mental health services and 69% of females (n = 18) compared to 15% (n = 4) of males reported needing to participate in sex to meet basic social needs. Participants described social determinants of health as barriers to services, including access to food, legal justice and transportation. About 44% (n = 24) said they would consider enrolling in a drug treatment program in the next 30 days.

CONCLUSION

This sample was reflective of increased participation by White participants that began to appear about a decade ago. The majority of participants reported having healthcare insurance, which may be reflective of engagement with community health workers to access appropriate services. Community organizations and healthcare professionals should continue to explore social determinants of health that can impact the health of people who use drugs, including overcoming barriers to health care access such as investing in mobile unit outreach.

Fine-Regional Role of the Claustrum in Anxiety and Higher Sensitivity to Cocaine in Adolescent Cocaine-Exposed Male Mice during Adulthood

Adolescent cocaine exposure (ACE) induces anxiety and higher sensitivity to substances abuse during adulthood. Here, we show that the claustrum is crucial for controlling these psychiatric problems in male mice. In anxiety-like behavioral tests, the CaMKII-positive neurons in the median portion of the claustrum (MClaustrum) were triggered, and local suppression of these neurons reduced the anxiety-like behavior in ACE mice during adulthood. In contrast, the CaMKII-positive neurons in the anterior portion of the claustrum (AClaustrum) were more activated in response to subthreshold dose of cocaine induced conditioned place preference (CPP), and local suppression of these neurons blocked the acquisition of cocaine CPP in ACE mice during adulthood. Our findings for the first time identified the fine-regional role of the claustrum in regulating the anxiety and susceptibility to cocaine in ACE mice during adulthood, extending our understanding of the claustrum in substance use disorder.

Neural correlates of negative life events and their relationships with alcohol and cannabis use initiation

OBJECTIVE

Negative life events (NLEs), e.g., poor academic performance (controllable) or being the victim of a crime (uncontrollable), can profoundly affect the trajectory of one's life. Yet, their impact on how the brain develops is still not well understood. This investigation examined the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) dataset for the impact of NLEs on the initiation of alcohol and cannabis use, as well as underlying neural mechanisms.

METHODS

This study evaluated the impact of controllable and uncontrollable NLEs on substance use initiation in 207 youth who initiated alcohol use, 168 who initiated cannabis use, and compared it to 128 youth who remained substance-naïve, using generalised linear regression models. Mediation analyses were conducted to determine neural pathways of NLE impacting substance use trajectories.

RESULTS

Dose-response relationships between controllable NLEs and substance use initiation were observed. Having one controllable NLE increased the odds of alcohol initiation by 50% (95%CI [1.18, 1.93]) and cannabis initiation by 73% (95%CI [1.36, 2.24]), respectively. Greater cortical thickness in left banks of the superior temporal sulcus mediated effects of controllable NLEs on alcohol and cannabis initiations. Greater left caudate gray-matter volumes mediated effects of controllable NLEs on cannabis initiation.

CONCLUSIONS

Controllable but not uncontrollable NLEs increased the odds of alcohol and cannabis initiation. Moreover, those individuals with less mature brain structures at the time of the NLEs experienced a greater impact of NLEs on subsequent initiation of alcohol or cannabis use. Targeting youth experiencing controllable NLEs may help mitigate alcohol and cannabis initiation.

Stress and strain: a qualitative study into the impact of having relatives with addiction problems on students' health and daily lives

PURPOSE

To explore the impact of having relatives with addiction problems on students' health, substance use, social life, and cognitive functioning, and to establish possible contributions of the participants' gender, type of relationship, and type of addiction of the relative(s).

METHODS

A qualitative, cross-sectional study of semi-structured interviews with thirty students from a University of Applied Sciences in the Netherlands who had relatives with addiction problems.

RESULTS

Nine major themes were identified: (1) violence; (2) death, illness, and accidents of relatives; (3) informal care; (4) perception of addiction; (5) ill health, use of alcohol and illegal drugs; (6) financial problems; (7) pressured social life; (8) affected cognitive functioning, and(9) disclosure.

CONCLUSIONS

Having relatives with addiction problems severely affected the life and health of participants. Women were more likely to be informal carers, to experience physical violence, and to choose a partner with addiction problems than men. Conversely, men more often struggled with their own substance use. Participants who did not share their experiences reported more severe health complaints. It was impossible to make comparisons based on the type of relationship or type of addiction because participants had more than one relative or addiction in the family.

Early Lifetime Substance Use and Development of Visual Impairment: Analysis of the National Survey on Drug Use and Health Data

Purpose

To investigate the association between early lifetime substance use on the development of severe visual acuity impairment or blindness on a national level.

Methods

National Survey of Drug Use and Health data was used to identify cases of substance use before 21* years of age, within the past year, and cases of self-reported blindness or visual impairment. Univariable and multivariable binary logistic regression with time-dependency was performed to evaluate odds of visual impairment influenced by 16 substances separated into three classes: prescription, non-prescription, and illicit drugs. Adjusted variables of interest included gender, marital status, race, level of education, total family income, poverty level, population density, and history of chronic disease.

Results

55,824 total responses were analyzed with 2577 (4.6%) cases of self-reported blindness or significant visual impairment. All early-use substance categories, including prescription, non-prescription, and illegal substances, were significantly associated with self-reported VI (OR 2.068, CI 1.451-2.949, p<0.001; OR 1.352, CI 1.227-1.489, p<0.001); OR 1.211, CI 1.086-1.352, p<0.001), respectively). Non-prescription substances displayed parallel significances amongst all constituents (alcohol, cigarettes, inhalants, and marijuana) (OR=1.227, CI 1.12-1.344, p<0.001; OR 1.363, CI 1.243-1.495, p<0.001; OR 1.418, CI 1.134-1.774; OR 1.388, CI 1.27-1.518, p<0.001, respectively). Univariable and multivariable analysis revealed several significant demographical and clinical adjustors.

Conclusion

Early lifetime use of all three classes of substances is associated with enhanced odds of subsequent visual impairment or blindness. Several readily available and commonly used substances have a greater risk. These findings may help clinicians and public health agencies in mitigation ventures including education, prevention, and rehabilitation efforts.

Recent Rates of Substance Use Among Adolescents and Young Adults with Type 1 Diabetes in the USA

PURPOSE OF REVIEW

Substance use is a major public health problem in adolescents and young adults (AYA) and is particularly dangerous for AYA with type 1 diabetes (T1D) due to additional health consequences related to T1D. Rates of substance use among AYA with T1D are difficult to ascertain. Currently, we aim to provide a summary of published rates of substance use, over the last 10 years, among AYA with T1D in the USA.

RECENT FINDINGS

This review included a database search, abstract screening, and synthesizing of articles published in the last 10 years that reported rates of substance use among AYA with T1D. We also compared rates to national survey data from the Center for Disease Control and Substance Abuse and Mental Health Services Administration. Of 138 articles, 123 abstracts were excluded due to non-relevance or because they were conducted outside of the USA; 15 articles were evaluated, and 8 provided original data on AYA with T1D. These 8 studies were summarized and compared to nationwide survey data. Most of the published rates of substance use among AYA with T1D were similar to national survey data for alcohol, tobacco, and marijuana. Rates of illicit drug use were lower among AYA with T1D. Despite additional health consequences, alcohol, tobacco, and marijuana use is about as prevalent among AYA with T1D as in the general US population. These findings emphasize the importance of conducting more research in this area, developing effective interventions, and incorporating prevention into standard clinical practices.

Effective prevention programming for reducing alcohol-related harms experienced by first year college students: Evaluation of the expectancy challenge alcohol literacy curriculum (ECALC)

Prevention programs may have contributed to modest declines in alcohol use among college students in recent years, but negative consequences continue to be pervasive. First year college students (FYCS) are particularly vulnerable, and there is clearly a need for more effective methods to reduce risk. Meta-analyses focused on expectancy challenge (EC) have found this approach to be effective, but "experiential" EC that includes a drinking exercise is not suitable for most FYCS, many of whom are underage. A non-experiential alternative, the Expectancy Challenge Alcohol Literacy Curriculum (ECALC), is practical for widespread implementation. ECALC has been effective with mandated students and members of fraternities, and in the present study, we focused on evaluating effects with FYCS. In a group randomized trial, 48 class sections of a course designed for FYCS received either ECALC or an attention-matched control presentation. ECALC was associated with significant changes on six expectancy subscales of the Comprehensive Effects of Alcohol Scale (CEOA). Structural equation modeling was used to examine the mediated effects of the intervention on alcohol-related harms via alcohol expectancies. There were significant indirect effects from condition to alcohol use (IND = -0.04, p <.001) and alcohol harms (IND = -0.07, p <.001). This model accounted for 54% of the variance in alcohol use and 46% of the variance in alcohol-related harms. These findings suggest ECALC is an effective, single session group-delivered program that can be incorporated into classroom curricula.

Multi-type childhood maltreatment exposure and substance use development from adolescence to early adulthood: A GxE study

BACKGROUND

Childhood maltreatment types can co-occur and are associated with increased substance use during adolescence and early adulthood. There is also a strong genetic basis for substance use which interacts with environmental factors (e.g., childhood maltreatment) to influence substance use phenotype.

OBJECTIVE

This research aimed to identify childhood maltreatment sub-groups based on type and chronicity, and their association with substance use change from adolescence to early adulthood, while accounting for the influence of substance use polygenic risk (i.e., genetic risk based on the combined effects of multiple genes).

PARTICIPANTS

We used a sample of unrelated European-origin Americans with genetic and childhood maltreatment data (n = 2,664) from the National Longitudinal Study of Adolescent to Adult Health.

METHODS

Latent profile analysis was used for sub-group identification and direct and interaction effects were tested for longitudinal trajectories of substance use utilizing generalized estimating equations.

RESULTS

Three sub-groups with co-occurring childhood maltreatment exposures were identified: a high sexual abuse sub-group, a high physical abuse sub-group, and a normative sub-group (with low maltreatment exposure). At high polygenic risk, the high physical abuse sub-group had faster increases in substance use over time. In comparison, the high sexual abuse sub-group had faster progression in substance use only at low and medium polygenic risk.

CONCLUSIONS

Findings provide initial evidence for biological and environmental differences among maltreatment sub-groups on trajectories of substance use.

Applying the PROSPER prevention delivery system with middle schools: Emerging adulthood effects on substance misuse and conduct problem behaviors through 14 years past baseline

This study evaluated emerging adult effects of the PROmoting School‐Community‐University Partnerships to Enhance Resilience (PROSPER) universal prevention delivery system implemented in middle schools. Twenty‐eight rural school districts were randomized to intervention and control conditions, with 1985 nineteen‐year‐old participants (90.6% White, 54.1% female) evaluated through age 25. Intent‐to‐treat, multi‐level, point‐in‐time analyses of covariance and growth analyses were conducted. Outcomes were assessed with self‐report measures of substance misuse (lifetime, current, frequency) and conduct problem behaviors. Analyses showed very limited point‐in‐time effects; there were growth pattern effects on measures of illicit drugs, non‐prescribed drugs, cigarettes, and drug problems. When risk moderation was observed, it favored higher‐risk participants. These emerging adult effects concerning slower growth of lifetime misuse combine with more robust adolescent stage findings to support PROSPER’s public health value.

Police Stops and Adolescent Substance Use: Findings From the United Kingdom Millennium Cohort Study

PURPOSE

The aim of this study is to investigate associations between police stops and adolescent substance use among a large, representative sample of adolescents in the United Kingdom (UK).

METHODS

Data from the three most recent sweeps of the UK Millennium Cohort Study, a nationally representative contemporary birth cohort of children born in the UK between September 2000 and January 2002, were analyzed in 2021 (N = 10,345). Lifetime police stops are assessed at age 14 (Sweep 6, 2015) and a diverse set of adolescent substance use behaviors are assessed at age 17 (Sweep 7, 2018). Weights are used to account for sample design and multiple imputation for missing data.

RESULTS

Youth experiencing police stops by the age of 14 (14.72%) reported significantly higher engagement in substance use behaviors at age 17, including frequent binge drinking (adjusted relative risk ratio [ARRR] = 3.56, confidence interval [CI] = 2.80-4.03), cigarette use (ARRR = 3.97, CI = 3.26-4.84), e-cigarette use (ARRR = 2.22, CI = 1.69-2.93), cannabis use (ARRR = 3.63, CI = 2.88-4.57), and illicit drug use (adjusted incidence rate ratio = 3.06, CI = 2.45-3.81). Ancillary analyses revealed that findings linking police stops to substance use emerge across distinct stop features (e.g., questioned vs. warned), following adjustment for substance use at age 14, and when examining substance use initiation after the age of 14.

CONCLUSIONS

Police officers should be trained to effectively communicate and interact with youth to mitigate adverse sequelae of stops. Youth may also benefit from mental health and substance use screenings as well as counseling care following these events.

Developing a Smartphone-Based Adjunct Intervention to Reduce Cannabis Use Among Juvenile Justice-Involved Adolescents: A Multiphase Study Protocol (Preprint)

Background

Adolescents involved in the juvenile justice system who use cannabis are at an increased risk of future substance use disorders and rearrest. Many court-involved, nonincarcerated (CINI) youth are referred for services in the community and often encounter multiple barriers to care, highlighting the need for minimally burdensome services that can be delivered in justice settings. Digital health interventions are accessible, easy to implement, and can provide ongoing support but have not been developed to address the unique needs of CINI youth who use cannabis.

Objective

This multiphase study will aim to develop, implement, and pilot test a novel smartphone app, Teen Empowerment through Computerized Health (TECH), to reduce cannabis and other substance use among CINI youth. TECH is conceptualized as a digital adjunct to a brief computerized intervention delivered by our family court partner.

Methods

Following the principles of user-centered design, phase I interviews with CINI youth aged 14-18 years (n=14-18), their caregivers (n=6-8), and behavioral health app developers (n=6-8) will guide the TECH design decisions. Next, in phase II, CINI youth (n=10) will beta test the TECH app prototype for 1 month; their feedback regarding feasibility and acceptability will directly inform the app refinement process. Finally, in phase III, CINI youth (n=60) will participate in a pilot randomized controlled trial for 6 months, comparing the preliminary effectiveness of the adjunctive TECH app on cannabis use outcomes.

Results

Phase I data collection began in September 2020 and was completed in December 2021; 14 CINI youth, 8 caregivers, and 11 behavioral health app developers participated in the study. Phases II and III will occur in 2022 and 2023 and 2023 and 2025, respectively.

Conclusions

This body of work will provide insight into the feasibility and acceptability of a smartphone-based adjunctive intervention designed for CINI youth. Phase III results will offer a preliminary indication of the effectiveness of the TECH app in reducing cannabis use among CINI youth.

International Registered Report Identifier (IRRID)

DERR1-10.2196/35402

Implementation of a youth violence prevention programme in primary care

BACKGROUND AND OBJECTIVES

Youth violence is an alarming public health problem, yet, violence screening and interventions are not systematically offered in primary care (PC). This paper describes data from a pilot effectiveness-implementation trial of an efficacious youth violence prevention programme (SafERteens).

METHODS

The study was conducted in two PC clinics: a university-affiliated satellite clinic and a community health centre. In phase 1, we obtained stakeholder feedback to customise the SafERteens package and enrolled a comparison group of adolescents (age 14-18) seeking care in two clinics. In phase 2, clinical staff delivered the SafERteens-PC intervention with adolescents, which is a single, behavioural health therapy session delivered one-on-one from clinic providers to youth patients, followed by text message (TM) reminders. In phase 3, we assessed planned maintenance. All participants reported past-year violent behaviour at intake and completed a 3-month follow-up assessment.

RESULTS

Based on stakeholder interviews (n=13), we created a web-based SafERteens-PC programme package, including a three-item past-year violence screen, 30 min motivational interviewing-based brief intervention delivery tool, training videos and 2 months of TM boosters. We enrolled a comparison group (n=49) first, then an intervention group (n=61). Intervention delivery characteristics varied by clinic, including completion of intervention (75.9%; 62.5%), modality (100% delivered via telehealth; 60% via telehealth/40% in-person) and enrolment in TMs (81.8%; 55.0%); 91.8% completed the follow-up. Using an intention-to-treat approach, the intervention group showed significantly greater reductions in severe peer aggression (p<0.05), anxiety (p<0.05) and substance use consequences (p<0.05) relative to the comparison group. Participant and staff feedback were positive and identified challenges to long-term implementation, such as lack of availability of reimbursement for youth violence prevention.

CONCLUSIONS

If these challenges could be addressed, routine provision of behavioural health services for violence prevention in PC could have high impact on health outcomes for adolescents.

How might the 'Icelandic model' for preventing substance use among young people be developed and adapted for use in Scotland? Utilising the consolidated framework for implementation research in a qualitative exploratory study

Background

Substance use among young people is a significant public health concern, particularly in Scotland. Primary prevention activities are essential in delaying young people’s substance use and reducing the harms associated with use. However, such prevention activities are generally lacking. The Icelandic Model (IM) has received increasing attention and has been associated with improvements in substance use in Iceland since the 1990s. There is interest in implementing the IM in Scotland but concerns regarding transferability. This research study aimed to address a gap in the evidence base by providing insight into stakeholders’ views of the IM in Dundee and more widely in Scotland.

Methods

Qualitative data were collected via semi-structured telephone interviews with 16 stakeholders. Data were analysed using Framework Analysis in NVivo, informed by the Consolidated Framework for Implementation Research.

Results

Participants were keen for more prevention activities to be delivered in Scotland and were generally supportive of the IM, given the high rates of substance use and related harm. A range of positive factors were identified, including the evidence base, the multi-component nature of the IM, and availability of current services that could be embedded into delivery. Several barriers were noted, relating to funding, the franchise model, support and buy-in and cultural differences.

Conclusions

Our findings provide insight into the views of a range of stakeholders regarding the potential implementation of the IM in Scotland, and perceived barriers and facilitators. There is a desire for primary prevention activities in Scotland, driven by concerns about high rates of substance use and related harms, and a general lack of effective and evidence based prevention activities across the country. Several key barriers would need to be addressed in order for implementation to be successful, and participants were clear that initial piloting is required. Future research and evaluation is required to examine its potential and the outcomes of the approach in Scotland.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11828-z.

Risk and benefit of cannabis prescription for chronic non-cancer pain

OBJECTIVES

We investigated whether cannabis usage was associated with reduced opioid usage, and the rates of opioid and cannabis use disorders among chronic pain patients who had been prescribed medical cannabis.

METHODS

A random sample of chronic pain patients who had license for cannabis use were interviewed by telephone about their lifetime opioid and cannabis usage. Cannabis and opioid use disorders were assessed with Portenoy's criteria.

RESULTS

Of the 100 participants aged 18-70 years (compliance 67% (aged >40) and 33% (aged ≤ 40y)), 76 ever used opioids. Of them, 93% decreased or stopped opioids following cannabis initiation. Ten patients (10%), 17.4% of the ≤40 y age group, met the criteria for cannabis use disorder. Compared to those who did not meet the criteria, their lifetime depression was higher (80% vs. 43.2%, respectively, P=.042), and they were less educated (12.2 ± 0.6y vs. 13.5 ± 2.1y, p = 0.05).

CONCLUSIONS

Cannabis usage was associated with reduced opioid usage. The prevalence of cannabis use disorder was high among the younger participants who also had a lower study compliance rate, suggesting the higher actual prevalence of cannabis use disorder. While medical cannabis may help reduce opioid use in chronic non-cancer pain patients, younger age, depression, and other risk factors should be carefully evaluated before cannabis is prescribed.

Understanding Neighborhoods' Impact on Youth Substance Use and Mental Health Outcomes in Paterson, New Jersey: Protocol for a Community-Based Participatory Research Study

BACKGROUND

Substance use among youth is a major public health concern. Of note, substance use among youth is increasing in prevalence, and the incidence of substance use at earlier ages is rising. Given the long-term consequences of early substance use, it is important to identify factors that increase youth vulnerability to drug use, as they may be important targets for future interventions.

OBJECTIVE

This study aims to use innovative methods, such as venue-based sampling, to recruit youth who are disconnected from school and use community-based participatory research to gain a better understanding of the prevalence of substance use and important correlates among youth aged between 13 and 21 years in Paterson, New Jersey, a low-income, urban community. The study will use a convergent, mixed methods design involving multiple data collection components and the analysis of a ministrative data source, designed with the strengths of complex intervention frameworks in mind. The overall aims of the study are to identify the prevalence of substance use among youth who are engaged in school and not engaged in school; to understand important antecedents and correlates of substance use; and to use this information to inform social, environmental, and culturally appropriate interventions to address substance use and its correlates among youths in a lower-resourced urban community.

METHODS

This study will use both qualitative and quantitative methods to address important questions. Specifically, semistructured interviews using focus group and interview methodologies will be used to assess youths' lived experiences and will account for specific details that quantitative methods may not be able to attain. In addition, quantitative methods will be used to examine direct and multilevel associations between neighborhood factors and youth substance use and mental health outcomes.

RESULTS

A previous analysis from a substance use initiative in Paterson, New Jersey found that youth who use substances such as marijuana and alcohol are more likely to have higher rates of depression and anxiety. On the basis of the research questions, this study will examine the association between neighborhood characteristics, substance use, and mental health symptoms among youth in Paterson by using quantitative and qualitative methods and will use these findings to inform the adaptation of a community- and evidence-based substance use prevention intervention for these youths.

CONCLUSIONS

The findings of this study will provide an important contribution to understanding the role of socioecological factors in predicting substance use and mental health outcomes among youth in a lower-resourced, urban community. Furthermore, these findings will serve as evidence for the development of a culturally informed, community-based prevention program to address substance use disparities for youth, including those who are truant in Paterson, New Jersey.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/29427.

Differential Decline in Illicit Drug Use by Sexual Identity Among United States High School Students, 2005-2017

Purpose: Adolescent drug use remains a significant public health concern. Sexual minority youth (SMY) are at elevated risk for illicit drug use compared with their heterosexual peers. We investigated this pattern at the national level, exploring whether trends and disparities in drug use vary over time and by sexual identity. Methods: This study used Youth Risk Behavior Survey (YRBS) data, which were collected at seven time points from 2005 to 2017. Trends and disparities over time in the use of five drugs, as well as any drug use, were analyzed by self-reported sexual identity. Results: The results demonstrated a general decrease in drug use behaviors from 2005 to 2017. The greatest number of significant decreases was among heterosexual and bisexual students; the fewest were among gay and lesbian students. Disparities between heterosexual youth and SMY persisted across years, and were greater for gay and lesbian students in 2017 than for bisexual and not-sure youth. Conclusions: Our results represent the most comprehensive analysis of recent trends in drug use by sexual identity to date. Disparities in drug use remained significant despite overall downward trends within our sample. The significant decreases among bisexual students are not readily explained. We emphasize the need for ongoing research in this area, particularly given the currently volatile social position of sexual minority populations in the United States, and for culturally responsive and trauma-informed responses to SMY drug use.

Influences of victimization and comorbid conditions on substance use disorder outcomes in justice-involved youth: A discrete time survival mixture analysis

To understand how exposure to victimization during adolescence and the presence of comorbid psychological conditions influence substance use treatment entry and substance use disorder diagnosis from 14 to 25 years old among serious juvenile offenders, this study included 1,354 serious juvenile offenders who were prospectively followed over 7 years. Growth mixture modeling was used to assess profiles of early victimization during adolescence (14-17 years). Discrete time survival mixture analysis was used to assess time to treatment entry and substance use disorder diagnosis. Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) were used as predictors of survival time. Mixture models revealed three profiles of victimization: sustained poly-victimization, moderate/decreasing victimization, and low victimization. Youth in the sustained poly-victimization class were more likely to enter treatment earlier and have a substance use diagnosis earlier than other classes. PTSD was a significant predictor of treatment entry for youth in the sustained poly-victimization class, and MDD was a significant predictor of substance use disorder diagnosis for youth in the moderate/decreasing victimization class. Therefore, substance use prevention programming targeted at youth experiencing poly-victimization in early adolescence-especially those who have PTSD or MDD-is needed.

Substance Use among Adolescent High School Students in Nigeria and Its Relationship with Psychosocial Factors

Background: Despite the tremendous negative consequences of substances on the health and well-being of adolescents, studies continue to report the high rates of substance use among adolescents. We aimed to identify the pattern of substance use among high school students and its relationship with psychosocial factors.

Study design: A cross-sectional study.

Methods: The study was conducted in Oct 2019 among students in the senior secondary school in Ado-Ekiti, Ekiti State; southwestern Nigeria. Participants were selected using random sampling, and data were collected using a socio-demographic questionnaire, the Kessler Psychological distress scale and an adapted version of the NIDA-Modified ASSIST. Bivariate analysis and multiple logistic regression were carried out to identify factors associated with psychological distress.

Results: Overall, 682 students participated in the study. The lifetime and current prevalence of any substance were 17.3% (95% CI: 14.7%, 20.5%) and 11.7% (95% CI: 9.0, 14.0), respectively. Although most substance use variables increases the risk of psychological distress, history of lifetime substance use AOR= 3.03 (95% CI: 1.19, 7.72, P =0.020) and absence of direct parental care AOR=2.04 (1.19, 3.48, P=0.009) significantly increases the risk of experiencing psychological distress. Parental substance use AOR=3.48 (95% CI: 1.57, 7.69, P =0.002), male gender AOR=2.97 (95% CI: 1.82, 4.83, P=0.001) significantly increased substance use risk while having married parents AOR=0.50 (95% CI: 0.27, 0.92, P=0.027) and living with parents AOR 0.39 (95% CI: 0.20, 0.75, P =0.005) were significant protective factors.

Conclusion: The prevalence of substance use among these adolescents was substantial. Drug education initiated in primary school and services aimed at promoting the mental wellbeing of adolescents may go a long way in decreasing substance use among this population.

Local Health Department Activities to Reduce Emergency Department Visits for Substance Use Disorders

The Affordable Care Act (ACA) provides financial incentives to prevent substance use disorders (SUDs). Local health departments (LHDs) can receive funds to establish care teams that partner with primary care providers and health systems. This study estimates the potential effect of LHDs on emergency visits for SUDs, using linked data sets from the Healthcare Cost and Utilization Project Emergency Department (ED) sample for the State of Maryland-2012, the National Association of County and City Health Officials Profiles Survey 2013, and Area Health Resource File 2013 to estimate potential effect of LHDs' provision of SUD preventive care and SUD-related policy implementation. Local health department involvement in SUD-related policy during the past 2 years and provision of preventive care for behavioral health in the past year significantly reduced the probability of having a SUD-related ED visit by 11% and 6%, respectively, after controlling for individual characteristics (odds ratio [OR] = 0.89, p < .001; OR = 0.93, p < .001). After adjusting for the individual and contextual factors, LHD involvement in policy was still associated with 14% reduction in SUD-related ED visits (OR = 0.86, p < .001). Results offer insights on the extent to which the LHD activities can possibly affect SUD-related ED visits and provide a foundation for future work to identify effective LHD interventions.

Predictors of five-year relapse rates of youths with substance abuse who underwent a family-oriented therapy program

BACKGROUND

Substance abuse among young people has become a serious public health problem for years. The risk of relapse among illicit drug use is essential for developing adequate substance reuse prevention policies. The purpose of the current study is to investigate the potential predictor in long-term relapse rates among young patients that underwent a family-based treatment program.

METHODS

To perform this study, 103 young patients with substance use (mean age: 16.2 years, 78.6% male) were referred to participate in a 10-week family-based treatment program. At the beginning and at the end of the treatment, the patients were required to fill out the Chinese Craving Beliefs Questionnaire (CCBQ), the Adolescents' Behavior-problem Scale (ABS), and the Family APGAR. Furthermore, the patients' caregivers had to fill out the Family APGAR, the 12-item version of the Chinese Health Questionnaire (CHQ), and the Parenting Stress Index (PSI). All patients were followed up for 5 years in order to observe their long-term outcomes regarding substance use relapse.

RESULTS

During the 10-week family-oriented programs, the CCBQ scores, the CHQ scores and the Child-domain of PSI significantly decreased. Better changes in patients' behavioral problems during the treatment program predicted a lesser likelihood of substance use relapse in the subsequent 5 years. Furthermore, methamphetamine or 3,4-methylenedioxy-methamphetamine use and living in single-parent families were two factors associated with higher relapse rates.

CONCLUSIONS

The changes in patients' behavioral problems during the treatment program may serve as a predictor of substance use relapse over the subsequent 5 years. This study's findings provide insight about substance use prevention and serve as a reference for policy-making.

Interactive Computer Simulation for Adolescent Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Substance Use in an Undergraduate Nursing Program

PURPOSE

Adolescent substance use has been identified as our nation's number one public health problem. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based approach to identify and address adolescent substance use. Despite recommendations for universal implementation, adolescent SBIRT training has been notably absent from undergraduate nursing curricula. This project describes and evaluates the effectiveness of using an interactive computer simulation for adolescent SBIRT in an undergraduate nursing program.

DESIGN AND METHOD

Undergraduate nursing students (n = 144) completed an adolescent SBIRT interactive computer simulation (SBI with Adolescents, Kognito). Self-perceived competence, confidence, and readiness to deliver adolescent SBIRT were measured via pre- and post-survey items. Student attitudes toward substance use and simulation-based learning were also studied. At the end of the simulation, students received an automatic assessment challenge score based on performance. We compared the pre- and post-SBIRT scores using the Wilcoxon signed rank test and the sign test for repeated measures using 2-tailed α = 0.05.

RESULTS

We saw significant (p < .05) improvement in overall student competence, confidence, and readiness to deliver SBIRT. Positive quantitative and qualitative feedback were also received regarding the simulation experience.

CONCLUSIONS

Adolescent SBIRT training was successfully integrated into an undergraduate nursing curriculum. There were significant improvements in self-reported competence, confidence, and readiness to deliver adolescent SBIRT.

PRACTICAL IMPLICATION

This project provided further support for the potential benefits of an interactive computer-based simulation in an undergraduate nursing curriculum.

Long-Term Outcome of a Brief Intervention to Address Adolescent Drug Abuse in a School Setting

The present study used data from a randomized controlled trial on brief interventions with adolescents to identify distinct longitudinal patterns of substance use and identify predictors, as well as outcomes associated with those use patterns. Data were originally collected for the purpose of evaluating two brief intervention conditions with adolescents who had been identified in a school setting as abusing alcohol or other drugs (total sample, N = 315). Adolescents were randomly assigned to a two-session adolescent only brief intervention (BI-A), a two-session adolescent- plus an additional parent session (BI-AP), or an assessment only control session (CON). We located 74 participants to assess them at approximately 3.5 years post-intervention. Three distinct cluster patterns were identified, including a low decreasing, moderate increasing, and high decreasing pattern of use. The low decreasing cluster was associated with the BI-A condition, mono-substance use, and comorbid anxiety symptoms at baseline. The moderate increasing cluster was associated with the BI-AP condition, polysubstance use, and comorbid conduct disorder symptoms at baseline. No variables were found to be predictive of membership within the high decreasing cluster. There were also no differences found between clusters on adjustment outcomes in young adulthood. Overall findings from this study support the long-term efficacy of a brief intervention, without parent involvement, for adolescents experiencing mild to moderate substance abuse problems. Findings also highlight the importance of early intervention and the tailoring of interventions to meet the unique needs of adolescents.

Posting, texting, and related social risk behavior while high

Background: Posting on social media can have lasting consequences in one's social life and career. Research has not yet focused on social media or more modern forms of communication as social risk factors for individuals high on drugs. This study aims to examine prevalence and correlates of engaging in social media posting and related behavior while high. Methods: We examined data from 872 adults (39.8% female) who were surveyed entering electronic dance music (EDM) parties in New York City and reported lifetime illegal drug use. Participants were asked whether they were ever high on a drug while (1) posting on social media, (2) calling or texting someone, and (3) being in a photo. Those answering affirmatively were also asked whether they later regretted the behavior. We examined demographic and drug-related correlates of these behaviors. Results: Of the participants, 34.3% posted on social media while high (with 21.4% regretting it), 55.9% had texted or called someone while high (with 30.5% regretting it), and 47.6% had been in a photo while high (with 32.7% regretting it). Females and young adults (ages 18-24) were at high risk for posting on social media while high and at higher risk for engaging in more of these behaviors. Past-month marijuana users in particular were at increased risk for engaging in each of these behaviors. Conclusion: Engaging in these behaviors while high on drugs appears to be prevalent, and prevention and harm reduction efforts should seek to prevent or reduce likelihood of social harm that can result from such situations.

The prevalence of substance use in child welfare and general population eighth graders in the United States

Background: Early substance use is an established risk factor for substance abuse and dependence. Objective: The current study sought to examine whether child welfare-involved eighth graders have higher rates of early substance use than general population eighth graders. Data from the first National Survey of Child and Adolescent Well-Being (NSCAW) were analyzed to assess the prevalence of self-reported substance use, including alcohol, marijuana, and inhalant use in child welfare-involved eighth graders (N = 896). These figures were compared to general eighth grade student population estimates from the Monitoring the Future Study (N = 16,900) using 95% confidence intervals (CIs). Finally, regression analyses were conducted to examine demographic predictors (i.e., age, gender, race/ethnicity, and out-of-home placement) of substance use among child welfare eighth graders. Results: Results indicated comparable or lower incidence of substances among child welfare eighth graders relative to the general population, but higher past 30-day inhalant use among child welfare youth in out-of-home placement (17.1%, 95% CI: 6.0%, 40.2%) than the general population (4.2%, 95% CI: 3.7%, 4.7%). Out-of-home placement was associated with higher inhalant use (lifetime β = .659, p = .034; 30-day β = .763, p = .040) and alcohol use (lifetime β = .415, p = .028). Conclusions/Importance: These findings imply the need for screening and prevention education about substance use in child welfare populations, particularly in regards to inhalant use.

Adapting substance use brief interventions for adolescents: perspectives of adolescents living with adults in substance use disorder treatment

Background

Brief interventions (BIs) have shown potential to reduce both alcohol and drug use. Although BIs for adults have been studied extensively, little is known about how to adapt them to meet the needs and preferences of adolescents. This article examines adolescents' preferences to consider when adapting BIs for use with adolescents.

Methods

Eighteen adolescents (age 9-17 years) living in Los Angeles County with adults receiving substance use disorder treatment were interviewed and asked about their perspectives on how to adapt a BI originally developed for adults for use with adolescents. Questions focused on adolescents' preferences for who should deliver BIs, how BIs should be delivered, and what content they would want to be included in BIs. Interviews were recorded, transcribed, and coded using summative content analysis.

Results

Adolescents did not express any discernable opinions concerning who delivers BIs or what content they would want to be included, but they did share perspectives on how BIs should be delivered. Most adolescents did not endorse incorporating text messaging or social media into BIs. Instead they preferred having BIs delivered face-to-face or over the telephone. They reported that they did not want BIs to incorporate text messaging or social media due to concerns about trust, the quality of information they would receive, and challenges communicating in writing instead of speaking.

Conclusion

Although the study has limitations because of its small sample size, findings indicate that adolescents may not want text messaging or social media to be incorporated into BIs for substance use. These findings warrant further research and consideration, particularly as work to enhance BIs for adolescents continues.

Difference in long-term relapse rates between youths with ketamine use and those with stimulants use

BACKGROUND

Understanding the relapse risk among different illicit drugs is vital for developing an adequate relapse prevention policy. Therefore, the current study aims to explore the potential difference in long-term relapse rates between youths who use ketamine and those who use stimulants (3,4-Methylenedioxymethamphetamine [MDMA] or methamphetamine).

METHODS

The study's participants included 92 youths with ketamine use (ketamine group, mean age: 16.0 years) and 43 youths with MDMA/methamphetamine use (stimulants group, mean age: 16.1 years) that had undergone a family-oriented treatment program in a medical center in Taiwan. All participants were followed up for a maximum of 7 years in order to observe their long-term outcomes with regard to substance use relapse.

RESULTS

During the follow-up period, compared to the 34.8% relapse rate in ketamine users, their counterparts who used MDMA or methamphetamine had a significantly higher relapse rate (60.5%, Adjusted HR = 1.86, 95%CI: 1.06-3.28, p = 0.032). Of the youths in the ketamine group that relapsed, 65.6% continued to use ketamine in their relapse event, while 34.4% switched to MDMA or methamphetamine. Among the relapsing youths in the stimulants group, 84.6% continued to use MDMA or methamphetamine in their relapse event, while 15.4% switched to ketamine (p = 0.042).

CONCLUSIONS

Compared to adolescents who use ketamine, those using MDMA or methamphetamine had higher relapse rates and were more likely to use the same type of drug upon relapsing. These results can serve as a crucial reference for developing relapse prevention policies of illicit drugs for the youth population.

Family stress processes and drug and alcohol use by Mexican American adolescents

The present study examines the influence of economic and family stress processes on change in drug and alcohol use in a cohort of 478 Mexican American youth (50.8% female) followed longitudinally beginning in Grade 5 when the youth averaged 10.4 years of age. Adolescents, their mothers (median age 36 at Grade 5), and their fathers (median age 39 at Grade 5) were assessed on economic hardship (Grades 5 through 7), family stress processes (Grades 5 through 9), and adolescent substance use (Grades 7 through 9). Hypotheses were derived from a culturally informed family stress model (FSM), which proposes that economic hardship initiates a sequential cascade of problems involving parents' emotional distress, interparental conflict, disruptions in parenting and increased risk for adolescent substance use. Structural equation modeling was used to test these hypothesized linkages and the findings were consistent with predictions derived from the FSM. The results also demonstrated that parents' familism moderated the association between parent distress and interparental conflict, acting as a source of resilience in this family stress process. Findings suggest that prevention and intervention efforts focused on reducing caregiver distress and interparental conflict and enhancing parenting practices, as well as policies that reduce the level of economic hardship experienced by families, may aid in the reduction of adolescent substance use. Additionally, interventions focused on facilitating the cultural value of familism may promote more positive interactions between Mexican American parents which, in turn, may promote more effective parenting practices that help to reduce the risk for adolescent substance use. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Prospective Relationships Between Ethnic Discrimination and Substance Use by Mexican-American Adolescents

Guided by the integrative model (García Coll et al., 1996), this study examines prospective associations between perceived ethnic discrimination by peers, parental support, and substance use from 7th to 11th grades (M_age  = 12.3-16.3 years) in a community sample of 674 Mexican-American adolescents. Results from a cross-lagged panel model indicate that discrimination predicts relative increases in adolescent substance use. Results also revealed a transactional relation between substance use and supportive parenting over time. Supportive parenting was associated with reductions in substance use, but adolescent substance use also predicted lower levels of later parental support. The findings suggest reducing discrimination by peers and supportive parenting as potential targets for intervention in the prevention of substance use.

Substance use in adolescents with mental illness in Durban, South Africa

Comorbid substance use in adolescents with mental illness is often an indicator of poor treatment outcome. This study aims to determine the prevalence of, and associated risk factors for, substance use in adolescents with mental illness attending a mental health service. Data was collected from hospital records of 162 adolescents, using a structured data sheet, over a two-year period. Substance use was more significant in older adolescents and those with severe mental illness. Sixty-two (38.3%) adolescents used substances. Thirty-seven (38.1%) male adolescents reported substance use compared to 25 (38.5%) female adolescents. Alcohol was the most commonly used substance (n = 48; 29.6%), followed by cannabis (n = 32; 19.8%). There were significant direct associations between substance use and history of abuse or neglect, forensic history, educational setting, admission status, and the psychiatric diagnoses of schizophrenia, other psychotic disorders, and bipolar mood disorder. Inverse associations were found between substance use and adjustment disorders, attention deficit hyperactivity disorder, and intellectual disability. The results of this study indicate an urgent need for substance misuse programmes for at risk youth, and the introduction of dual diagnosis intervention programmes in this age group.

For Whom Do Parenting Interventions to Prevent Adolescent Substance Use Work?

Adolescent substance use continues to be a significant public health problem. Parent training interventions are effective preventive strategies to reduce youth substance use. However, little is known about differences in effectiveness for youth across demographic characteristics. This review assessed the effectiveness of parent training programs at reducing adolescent substance use by participant gender, age, and race/ethnicity. Pubmed/MEDLINE, ERIC, CINAHL, and PsycINFO were searched from database origin to October 31, 2016. We included randomized controlled trials that evaluated parent training interventions; reported youth initiation or use of tobacco, alcohol, or other illicit substances; and included adolescents aged 10 to 19. Two independent reviewers extracted data. Disagreements were resolved by consensus or a third researcher. Data were synthesized using harvest plots stratified by participant demographics. A total of 1806 publications were identified and reviewed; 38 unique studies were included. Risk of bias of included studies was high. No studies targeted male teens or youth in late adolescence. Few studies targeted Asian-American, Black/African-American, or Hispanic/Latino adolescents. Overall, interventions including male and female youth and youth in early adolescence (age 10 to 14 or in 5th to 8th grade) were more beneficial than interventions including female-only or both young and older adolescents. Programs tailored to specific racial/ethnic groups, as well as programs designed for youth from multiple races/ethnic groups, were effective. Current evidence supports the benefits of offering parenting guidance to all families with adolescent children, regardless of the gender, age, or race/ethnicity of the adolescent.

The Availability of Alcohol, Tobacco, and Other Drug Services for Adolescents in New York State Community Health Centers

Adolescent experimentation with alcohol, tobacco, or other drugs is commonplace, and limited access to screening and treatment services poses a significant public health risk. This study identified alcohol, tobacco, and other drug services available for adolescents at community health center sites in New York. A survey was distributed to medical and behavioral health directors across 54 community health center organizations serving 255 primary care adolescent sites. One third of sites required adolescent screening for substance use disorders (SUDs). Twenty-eight percent of sites said all/nearly all (80%-100%) and 12% said most (60%-79%) adolescents actually were screened. On-site tobacco cessation treatment and substance abuse counseling were offered at 53% and 14% of sites, respectively. Multilevel models suggested that community health center organizations positively influenced sites’ adolescent SUD screening and tobacco treatment. Additional investment in adolescent behavioral health screening and treatment is needed to reduce alcohol, illicit drug, or tobacco use among the underserved.

Relationship Between Predictors of Incident Deliberate Self-Harm and Suicide Attempts Among Adolescents

PURPOSE

Data on the incidence of deliberate self-harm (DSH) and suicide attempts (SAs) are lacking in non-Western adolescents, and no studies have investigated differences in incident DSH and SA worldwide. This study aimed to investigate the incidence rates and relationships between predictors in DSH and SA.

METHODS

The Taiwanese Adolescent Self-Harm Project was a longitudinal study of DSH among adolescents. We recruited 5,879 students from 14 senior high schools in northern Taiwan. Online questionnaires on sociodemographic data, suicidality, depressive symptoms, self-esteem, social support, family discord, impulsivity, and alcohol and tobacco use were assessed at baseline (T1) and at 1 year of follow-up (T2). Logistic regression analyses were performed to evaluate the predictors of incident DSH and SA.

RESULTS

The mean age was 16.02 years, and 56.73% of the cohort was female. At T1, the lifetime prevalence rates of DSH and SA were 25.04% and 3.50%, respectively. At T2, 4,331 (73.67%) students had completed follow-up assessments. The 1-year incidence rates of DSH and SA were 4.04% and 1.53%, respectively. The predictors of incident DSH included perceived family discord and more depressive symptoms at T1. The predictors of incident SA were lifetime suicide ideation, more depressive symptoms, and tobacco use at T1.

CONCLUSIONS

The incidence rates of DSH and SA were similar to those reported in Western countries. The predictors of incident DSH and SA were similar but not identical. Our results highlight the risk factors which should be considered in terms of early identification and intervention among adolescents to prevent suicidality.

Exploring the Link Between Alcohol and Marijuana Use and Teen Dating Violence Victimization Among High School Students: The Influence of School Context

BACKGROUND

Adolescence is a developmental period when dating behavior is first initiated and when the risk of abuse by or against a dating partner begins to emerge. It is also one in which experimentation with alcohol and illicit substances typically begins. The current study examined the association between recent alcohol use and recent marijuana use and the experience of physical and verbal teen dating violence (TDV) victimization while considering the potential influence of school contextual variables.

METHOD

Data came from 27,758 high school students attending 58 Maryland public high schools. Hierarchical linear modeling was used to identify student- and school-level predictors associated with TDV.

RESULTS

Results indicated that approximately 11% of students reported experiencing physical TDV and 11% of students reported experiencing verbal TDV over the past year. In addition, 33% of students reported recent alcohol use and 21% reported recent marijuana use. Hierarchical linear modeling results revealed that students who reported frequent recent alcohol or recent marijuana use were at increased odds of experiencing physical (adjusted odds ratio [AOR]alcohol = 2.80, p < .001; AORmarijuana = 2.03, p < .001) or verbal TDV (AORalcohol = 2.63, p < .001; AORmarijuana = 2.20, p < .001) victimization compared to students who reported little or no alcohol or marijuana use. School support was a protective factor for both physical TDV (AOR = 0.74, p < .001) and verbal TDV (AOR = 0.76, p < .001) victimization.

CONCLUSIONS

Findings suggested that prevention efforts to address alcohol and marijuana use may have an effect on TDV victimization. Results also highlight the potential utility of enhancing student perceptions of school support as an approach for reducing TDV victimization.

The Mediating Influence of Treatment Participation Rate on Post-Treatment Employment

This study explored treatment participation rate as a mediator between individuals’ baseline alcohol use, drug use, and psychiatric issue levels and post-treatment employment status. The study sample included 106 unemployed or underemployed individuals with substance use disorders who were participants in an intensive drug abuse treatment program. Structural equation modeling was applied to examine relationships between study variables. The results showed that (a) the direct effect of individuals’ baseline alcohol use, drug use, and psychiatric issue severities reduced treatment participation rate; (b) the direct effect of treatment participation rate ameliorated post-treatment employment status; and (c) the indirect effect of individuals’ baseline alcohol use, drug use, and psychiatric issue severities on post-treatment employment status was mediated by treatment participation rate, which reduced the negative influence of baseline issue severity on employment. This significant mediating effect has both practical and theoretical importance in that it indicates the need for increased focus on treatment participation in practice and future research.

Assessing the risk of marijuana use disorder among adolescents and adults who use marijuana

BACKGROUND

The changing political and social climate surrounding marijuana use, coupled with the fact that available estimates of marijuana use disorder prevalence are outdated and do not adequately represent adolescents, underscore the need for up-to-date and comprehensive prevalence estimates of marijuana use disorder.

OBJECTIVES

To provide recent national estimates of marijuana use disorder as a function of usage patterns, age, and other sociodemographic, substance use, and mental health variables.

METHODS

Analyses of data from the 2014 National Survey on Drug Use and Health examined the prevalence of marijuana use disorder among respondents (N = 55,271) with various sociodemographic, substance use, and mental health characteristics. Logistic and multinomial regression analyses examined the correlates of marijuana use disorder as a function of these variables, with a special focus on age.

RESULTS

In 2014, 3.49% of lifetime, 11.62% of past-year, and 15.32% of past-30-day marijuana users met DSM-IV criteria for a marijuana use disorder; rates among youth generally were at least double those of adults across reported time frame and intensity of use. Regression analyses indicated that young age, black race/ethnicity, greater intensity of use, current tobacco/nicotine use, and alcohol and other drug use disorders were associated with increased odds of a marijuana use disorder.

CONCLUSIONS

A significant proportion of marijuana users, especially youth, are at risk for having a marijuana use disorder, even at relatively low levels of use.

Familias Unidas for high risk adolescents: Study design of a cultural adaptation and randomized controlled trial of a U.S. drug and sexual risk behavior intervention in Ecuador

BACKGROUND

Developing, testing and implementing evidence-based prevention interventions are important in decreasing substance use and sexual risk behavior among adolescents. This process requires research expertise, infrastructure, resources and decades of research testing, which might not always be feasible for low resource countries. Adapting and testing interventions proven to be efficacious in similar cultures might circumvent the time and costs of implementing evidence-based interventions in new settings. This paper describes the two-phase study, including training and development of the research infrastructure in the Ecuadorian university necessary to implement a randomized controlled trial.

METHODS/DESIGN

Familias Unidas is a multilevel parent-centered intervention designed in the U.S. to prevent drug use and sexual risk behaviors in Hispanic adolescents. The current study consisted of Phase 1 feasibility study (n=38) which adapted the intervention and study procedures within a single-site school setting in an area with a high prevalence of drug use and unprotected sexual behavior among adolescents in Ecuador, and Phase 2 randomized controlled trial of the adapted intervention in two public high schools with a target population of families with adolescents from 12 to 14 years old.

DISCUSSION

The trial is currently in Phase 2. Study recruitment was completed with 239 parent-youth dyads enrolling. The intervention phase and the first follow-up assessment have been completed. The second and third follow-up assessments will be completed in 2016. This project has the potential of benefitting a large population of families in areas of Ecuador that are disproportionally affected by drug trafficking and its consequences.

TRIAL REGISTRATION

MSP-DIS-2015-0055-0, Ministry of Public Health (MSP), Quito, Ecuador.

A family-oriented therapy program for youths with substance abuse: long-term outcomes related to relapse and academic or social status

OBJECTIVE

The abuse of illegal substances by youths in Taiwan has become a major public health issue. This study explores the outcomes (relapse rate and academic or social status) of a family-oriented therapy program conducted for substance-using youths who were referred by a judge to participate in it.

METHODS

The present study includes 121 participants categorized into three groups: 36 youths underwent a weekly ten-session outpatient motivational enhancement psychotherapy (MEP) group program; 41 youths participated in a program that combined the aforementioned MEP program with an additional weekly ten-session parenting skill training (PST) program for their guardians (MEP + PST group); and 44 adolescents who received standard supervision by the court served as the control group. All participants were followed-up for a maximum of 2 years.

RESULTS

Of the 121 participants (mean age: 16.1±1.1 years), 33.1% relapsed into substance use during the follow-up period. The probability of relapse did not differ significantly between the MEP group (36.1%) and the control group (40.9%), but the youths in the MEP + PST group (22.0%) were at a lower risk of relapse than the control group participants (adjusted hazard ratio =0.48, 95% confidence interval [CI] =0.21-1.09). By the end of the study follow-up period, participants in both the MEP group and the MEP + PST group were more likely to be attending school (MEP group: adjusted odds ratio [aOR] =6.61, 95% CI =1.60-27.35; MEP + PST group: aOR =8.57, 95% CI =1.94-37.82) or employed (MEP group: aOR =7.75, 95% CI =1.95-30.75; MEP + PST group: aOR =7.27, 95% CI =1.76-29.97), when compared to the control group.

CONCLUSION

This study revealed that a family-oriented treatment approach may be a more effective option for preventing youths' relapsing into substance abuse. In comparison to individuals who received standard supervision by the court, those who received MEP experienced a better school attendance or social outcome over the follow-up period.

Underage drinking: prevalence and correlates of risky drinking measures among youth aged 12-20

BACKGROUND

Underage drinking and its effects have been researched extensively. However, no study to date has examined how the levels of drinking that have been defined as risky for adults might relate to youth who have a heightened physiological vulnerability to alcohol.

OBJECTIVES

To examine a range of drinking measures that go beyond common measures of youth alcohol use to gain a more detailed understanding of the nature of underage drinking and its associated correlates and outcomes.

METHODS

Analyzing data from a 2013 nationally representative US survey, we examined a variety of measures of alcohol use among 24,445 youth (weighted N = 381,155,562), the demographic groups most likely to have reported drinking in these ways, and associations between these measures of drinking and a number of adverse outcomes.

RESULTS

On all measures of potentially risky drinking, including meeting diagnostic criteria for an alcohol use disorder, underage drinkers exceeded the rates found for adults. Independent of sex, race, and age, youth who reported drinking in ways that exceeded guidelines set for adults had increased odds of meeting diagnostic criteria for an alcohol, tobacco, or other drug use disorder, and of reporting a number of health problems.

CONCLUSIONS

The high rates at which youth report engaging in a range of risky drinking behaviors suggest a need for a more nuanced approach to substance use and mental health screening and interventions in clinical practice. The findings also underscore the need to address apparent misconceptions about what constitutes unhealthy or unsafe alcohol use among youth.

Teen Dating Violence Victimization and Patterns of Substance Use Among High School Students

PURPOSE

Substance use in adolescence is a significant concern, particularly the use of multiple drugs. Yet, most studies examine a single substance in isolation, with limited consideration of the use of multiple substances. Furthermore, few studies have examined how teen dating violence (TDV) victimization is associated with patterns of substance use.

METHODS

Using latent class analysis and latent class regression, the present study aimed to (1) identify subtypes of substance use among high school students and (2) examine the association between past-year physical and psychological TDV victimization and pattern of substance use. We focused on 30-day use of alcohol, binge drinking, marijuana, cigarette, cigarillo, and prescription drug use. Analyses were conducted on data from 18,680 adolescents in Grades 9-12, across 58 high schools.

RESULTS

The latent class analysis indicated a five-class model best fit the data; the largest class was composed of nonusers, whereas the other classes were high polysubstance use, alcohol use, alcohol and marijuana use, and moderate polysubstance use. The multinomial regression analyses indicated that adolescents who had experienced physical and psychological TDV were more likely to be in the two polysubstance use classes and the alcohol and marijuana use class, as compared with nonvictimized adolescents.

CONCLUSION

There is heterogeneity in adolescents' self-reported recent substance use, although a large proportion of substance-using youth reported recent alcohol and marijuana use. Preventive interventions should focus their efforts on preventing substance use among victims of TDV, in part because substance use is a risk factor for TDV victimization.

Organizational Predictors and Use of Evidence-Based Practices in Adolescent Substance Abuse Treatment

BACKGROUND

Adolescent substance abuse remains a significant problem in the United States, yet treatment centers do not always admit adolescent clients. In this paper, we first determine the extent to which treatment is available for adolescents in general and whether or not adolescent-specific (segregated) tracks are offered. Second, we examine the organizational characteristics associated with adolescent treatment. Third, we illuminate how the adolescent caseload in a treatment center is related to offering evidence-based practices (EBPs).

METHODS

Drawing upon a nationally representative sample of US treatment programs, we use logistic regression to assess how organizational characteristics are associated with the provision of adolescent treatment. Using ordinal logistic regression, we analyze how the treatment center's adolescent caseload and organizational characteristics affect the extent to which a treatment center offers medication-assisted treatment (MAT) and psychosocial treatment.

RESULTS

Half (49.5%) of treatment programs admitted adolescents, and 41.8% offered an adolescent-specific track. Findings from the logistic regression suggested several organizational characteristics that were significantly associated with treating adolescents and/or having an adolescent-only track. Our findings from the ordinal models indicated a negative relationship between the percent of adolescents in a treatment center and the extent of MAT, and a positive relationship between the percent of adolescent clients and the extent of psychosocial treatment offered.

CONCLUSIONS

This paper highlights organizational barriers to treatment entry for adolescents, who remain a small proportion of clients in treatment centers. When treatment centers serve adolescents, however, those adolescents are likely to receive care in adolescent-only tracks and/or services and in programs that offer several psychosocial EBPs. Finally, adolescents are less likely to receive treatment in centers that offer a variety of MAT.

The influence of assets and environmental factors on gender differences in adolescent drug use

For adolescents, illicit drug use remains a significant public health problem. This study explored prospectively the differential effects of 17 youth assets and 5 environmental factors on drug use in adolescent males and females (Youth Asset Study - a 5-wave longitudinal study of 1117 youth/parent pairs). Baseline analyses included 1093 youth (53% female). Mean age was 14.3 years (SD = 1.6) and the youth were 40% Non-Hispanic White, 28% Hispanic, 24% Non-Hispanic Black, and 9% Non-Hispanic other. Analyses revealed that 16 assets for males and 15 for females as well as the total asset score were prospectively associated with no drug use. No environmental factors were prospectively associated with any drug use for males, and for a subset of females, only Neighborhood Support was significant. This study confirms and extends previous work regarding youth drug use by recognizing the importance of the protective effect of assets for both males and females.

Biological contributions to addictions in adolescents and adults: prevention, treatment, and policy implications

PURPOSE

Despite significant advances in our understanding of the biological bases of addictions, these disorders continue to represent a huge public health burden that is associated with substantial personal suffering. Efforts to target addictions require consideration of how the improved biological understanding of addictions may lead to improved prevention, treatment, and policy initiatives.

METHOD

In this article, we provide a narrative review of current biological models for addictions with a goal of placing existing data and theories within a translational and developmental framework targeting the advancement of prevention, treatment, and policy strategies.

RESULTS

Data regarding individual differences, intermediary phenotypes, and main and interactive influences of genetic and environmental contributions in the setting of developmental trajectories that may be influenced by addictive drugs or behavior indicate complex underpinnings of addictions.

CONCLUSIONS

Consideration and further elucidation of the biological etiologies of addictions hold significant potential for making important gains and reducing the public health impact of addictions.