Employment Trajectories: Exploring Gender Differences and Impacts of Drug Use

Long-term trajectories of employment status, workhours and disability support pension status, after a first episode of CNS demyelination

BACKGROUND

People with multiple sclerosis face significant employment-related challenges, with little known of the drivers of these outcomes.

OBJECTIVE

We examined prospective trajectories of employment-related outcomes up to 11 years following a first episode of central nervous system (CNS) demyelination (FCD).

METHODS

Participants were aged 18-59 years, at FCD, with at least two observations and were employed at study entry or anytime during follow-up (n = 207). Outcomes were employment status (full-time, part-time and unemployed), average workhours per week and disability support pension (DSP; receiving/not receiving). We used group-based trajectory modelling to identify groups with common trajectories. Factors associated with trajectory membership were explored using log-multinomial regression.

RESULTS

Distinct trajectories were identified for employment (4), workhours (4) and DSP (2). Compared with stable full-time, female sex was strongly associated with being in the stable part-time trajectory (risk ratio (RR): 5.35; 95% confidence interval (CI) = 2.56-11.20; p < 0.001). A greater level of disability at 5-year review (RR: 1.35; 95% CI = 1.19-1.53) and having more than two comorbidities at baseline (RR: 2.77; 95% CI = 1.37-5.64) were associated with being in early and late deteriorated employment trajectories, respectively. Compared with the increased part-time trajectory, every additional relapse during the 5 years post-FCD was associated with a 10% increased risk of being in the reduced part-time trajectory (RR = 1.10; 95%CI = 1.00-1.22). For every additional EDSS point at 5-year review, the risk of being in the DSP trajectory increased (RR = 1.21; 95% CI = 1.05-1.41).

CONCLUSION

These trajectories indicate substantial heterogeneity and the complex impact of MS on employment from its earliest timepoints. Understanding these trends could enable better targeting of interventions to facilitate workforce retention, particularly for females, those with a higher number of comorbidities, more frequent relapses and greater rate of disability accrual.

Preschool blood lead levels, language competency, and substance use in adolescence

BACKGROUND

Elevated lead levels in children are a persistent public health problem, particularly in urban areas in the United States, yet few prospective studies have examined the association of childhood lead levels with substance use in adolescence.

OBJECTIVES

To determine the association of early lead levels with adolescent substance use and whether childhood IQ, language skills, and externalizing (aggressive and disruptive) behavior mediate the association, controlling for confounding biological and environmental factors.

METHODS

The participants (N = 265) were a subsample of a prospective birth cohort study on the developmental effects of prenatal cocaine exposure in the Midwest United States. Blood lead levels (BLL) were assessed at age 4, IQ at age 11, language skills and externalizing behavior at age 12, and substance (alcohol, tobacco, marijuana) use and substance use-related problems at age 15. Biologic assays (hair, urine, bloodspots), along with self-report, were utilized to determine adolescent substance use. Path analyses were conducted to examine the direct and indirect associations of BLL with adolescent substance use.

RESULTS

The children's mean BLL at 4 years of age was 7.07 (SD = 4.12) μg/dL. Approximately 31% of adolescents used tobacco or marijuana, 40% used alcohol, and 23% reported experiencing substance use-related problems at age 15.7 (SD = 0.28). Elevated BLL was related to a higher likelihood of substance use. Childhood language skills fully mediated the relationship of BLL with substance use-related problems. IQ was related to neither substance use nor substance use-related problems.

DISCUSSION

Elevated BLL in preschool years is a risk factor for adolescent substance use and related problems. Early screening and intervention for language impairment may reduce substance use-related problems.

Being at work improves stress, craving, and mood for people with opioid use disorder: Ecological momentary assessment during a randomized trial of experimental employment in a contingency-management-based therapeutic workplace

Employment problems are common among people with substance use disorders (SUDs), and improving vocational functioning is an important aspect of SUD treatment. More detailed understanding of the psychosocial benefits of employment may help refine vocational interventions for people with SUDs. Here, we used ecological momentary assessment to measure possible affective improvements associated with work. Participants (n = 161) with opioid use disorder were randomized to work (job-skills training) in a contingency-management-based Therapeutic Workplace either immediately or after a waitlist delay. Throughout, participants responded via smartphone to randomly scheduled questionnaires. In linear mixed models comparing responses made at work vs. all other locations, being at work was associated with: less stress, less craving for opioids and cocaine, less negative mood, more positive mood, and more flow-like states. Some of these differences were also observed on workdays vs. non-workdays outside of work hours. These results indicate that benefits associated with work may not be restricted to being actually in the workplace; however, randomization did not reveal clear changes coinciding with the onset of work access. Overall, in contrast to work-associated negative moods measured by experience-sampling in the general population, Therapeutic Workplace participants experienced several types of affective improvements associated with work.

How marijuana use status affects responses to anti-marijuana messages

Background

The current study examined how cannabis use status impacts cognitive and emotional reactions to public health campaigns about cannabis, and the degree to which these reactions influence message likeability and attitudes about cannabis-related harms.

Methods

In a between-subjects design, 252 subjects recruited via Amazon Mechanical Turk viewed six real-world cannabis education messages: three message themes (cognitive ability, driving, and health harms) from each of two real-world public campaigns. Subjects answered questions measuring their cognitive and emotional reactions to each message as well as message likeability and harm perceptions of cannabis. Analyses examined the mediating effects of message responsiveness on the association between baseline cannabis use (user vs non-user) with indices of liking and harm.

Results

For all three message themes, informativeness ratings mediated the effect of cannabis user status on the outcomes of perceived harmfulness and message likeability. Specifically, cannabis users perceived cannabis as less harmful and reported all messages as less likeable compared to non-users, partly because they perceived the messages to be less informative than non-users. Surprisingly, users found some of the messages to be more pleasant, which was associated with increased perceptions of harm and message liking compared to non-users.

Conclusions

Cannabis education campaigns that take into account differences in emotional and cognitive reactions by use experience, rather than use a "one size fits all" approach, could possibly maximally impact likeability and harm perceptions of these messages.

Conditional median-based Bayesian growth mixture modeling for nonnormal data

Growth mixture modeling is a common tool for longitudinal data analysis. One of the key assumptions of traditional growth mixture modeling is that repeated measures within each class are normally distributed. When this normality assumption is violated, traditional growth mixture modeling may provide misleading model estimation results and suffer from nonconvergence. In this article, we propose a robust approach to growth mixture modeling based on conditional medians and use Bayesian methods for model estimation and inferences. A simulation study is conducted to evaluate the performance of this approach. It is found that the new approach has a higher convergence rate and less biased parameter estimation than the traditional growth mixture modeling approach when data are skewed or have outliers. An empirical data analysis is also provided to illustrate how the proposed method can be applied in practice.

Income generation and the patterning of substance use: A gender-based analysis

BACKGROUND

Previous research has demonstrated how income-generating activities among marginalized people who use drugs (PWUD)-including employment, income assistance, street-based activities, sex work, and illegal activities-can provide both benefit (e.g., additional income) and harm (e.g., violence, criminalization). However, little is known about gender differences in factors such as drug use patterns that are associated with income-generating activities among PWUD.

METHODS

Using data from prospective cohorts of HIV-positive and HIV-negative PWUD in Vancouver, Canada, we conducted exploratory gender-stratified analyses of associations between substance use patterns and income-generating activities, using generalized linear mixed-models.

RESULTS

Participants reported income sources as employment (23.4 %), income assistance (88.1 %), street-based activities (24.9 %), sex work (15.2 %), drug dealing (31.5 %), or other illegal activities (13.9 %). GLMM results showed gendered patterns of engagement in specific income-generating activities and some diverging patterns of substance use. For instance, men receiving income assistance were less likely to use opioids (Adjusted odds ratio(AOR) = 0.64; 95 % confidence interval(CI) = 0.50-0.82) and women engaged in sex work were more likely to use crack-cocaine (AOR = 2.74, 95 % CI = 2.22-3.37). However, results reflected primarily converging patterns of substance use between women and men across income-generating activities, particularly for drug dealing and other illegal activities.

CONCLUSIONS

Our results suggest that substance use patterns may be more closely associated with income generation context than gender. Given potential harms associated with some income generation activities, results highlight the need for further investigation of the social and structural context of income generation, its intersections with gender and substance use, and the expansion of low-threshold work opportunities.

Addiction, recovery, and work: Surviving the daily grind

BACKGROUND

Employment is a predictor of sobriety for women in recovery from addiction, however, finding and maintaining employment is often a challenge. A number of interventions and a large body of research exist related to improving employment outcomes of women in recovery, but most fail to account for employment as an on-going, uneven process.

OBJECTIVE

This study applied a longitudinal, qualitative design to explore employment experiences of women in recovery, as well as how those experiences interact with participants' sobriety, health, and well-being.

METHODS

Nineteen women from two residential recovery programs were interviewed four times over the course of nine months. Data were analyzed using longitudinal coding.

RESULTS

Women encounter on-going struggle to find and keep employment, and multiple forces exacerbate this struggle. At the same time, positive work experiences described by some participants illustrate opportunities for the creation of new workplace structures that address employment needs of women in recovery while supporting sobriety and overall well-being.

CONCLUSION

Understanding employment as an on-going process that interacts with addiction and sobriety in complex and multiple ways could contribute to improved employment and health outcomes for women in recovery.

Prison sentencing increases the risk of unemployment among illegal heroin users in Taiwan

BACKGROUND

Previous studies have rarely explored the effect of type of sentencing on employment status among illegal heroin users, therefore, we aims to examine the association of the sentencing types and employment outcomes among illegal heroin users in Taiwan.

METHODS

Participants with illegal heroin use were identified through the national prison register system and deferred prosecution system: 2406 with deferred prosecutions, 4741 with observation and rehabilitation, 15 compulsory rehabilitation and 1958 sentenced to prison in calendar 2011. Logistic regression models were built to estimate the effect of sentencing type on unemployment status at 2 years after release. Stratification analysis was conducted to determine the effect of sentencing type based on the offender's employment status before sentencing.

RESULTS

Illegal heroin users receiving a prison sentence were more than twice as likely to be unemployed 2 years later than those receiving deferred prosecution. The unemployment rate was also higher for those with observation and rehabilitation and compulsory rehabilitation than deferred prosecution in the 2 years following sentencing. Males, older users, without a job before sentencing, divorced or widowed and higher prior drug use criminal records were also higher risk of unemployment. Subgroup analysis by prior employment status revealed that being sentenced to prison, observation and rehabilitation and compulsory rehabilitation affected the subsequent employment status only for those heroin users with a job before sentencing. The strength of associations showed dose-dependent relationship between different sentencing types (sentenced to prison> compulsory rehabilitation> observation and rehabilitation) and employment outcomes.

CONCLUSIONS

Illegal heroin users who receive a prison sentence have a much higher risk of unemployment than those who receive deferred prosecution after controlling potential confounders, especially those who had a job before sentencing. The implication is the stronger freedom of punishment, the higher risk of unemployment outcomes. Our study support that illegal heroin user is legally regarded as a patient before being regarded as a criminal, so giving priority to quit addition rather than imprisonment.

Economic Effects of Adolescent to Adult Patterns of Cannabis Use: Full-Time Employment and Employment Stability

Research has yet to examine stability in employment as a function of cannabis use once an individual transitions into full-time work. Using data from the Rochester Youth Development Study, trajectories of cannabis use spanning ages 14 to 30 were identified among a sample of predominantly minorities (>80%; 68% African American). After hard-classifying individuals by patterns of cannabis use, probabilities of full-time employment and conditional probabilities of full-time employment were calculated and compared across patterns of use. Abstention or rare cannabis use was associated with a higher likelihood of full-time employment compared with other cannabis use patterns. Full-time employment stability was high for each pattern of cannabis use (>89%) and differences decreased with age and prior periods of employment. The results indicate that patterns of cannabis use spanning adolescence to adulthood have limited impact on the ability to retain full-time employment once employed and are interpreted in light of growing legalization of cannabis use.

The Effectiveness of Interventions Intended to Improve Employment Outcomes for Persons with Substance Use Disorder: An Updated Systematic Review

Employment is one of the strongest predictors of positive outcomes for persons with substance use disorder. Purpose: To conduct a systematic review of interventions intended to improve employment outcomes for persons with substance use disorder (SUD) at any stage of recovery. This is an update of a prior review published in 2004. Methods: Two bibliographic databases, PUBMED and PSYCHINFO, were searched for articles published in the period 2005-2018 that referenced employment, education, or vocational rehabilitation for people with SUD. Results: One hundred thirty-two articles were identified of which 14 met the criteria for inclusion, primarily a minimum of a quasi-experimental evaluation design. Each study was reviewed with the following format: setting (modality); subject characteristics; research procedures; results; limitations/comments. Results: Nine programs or models were represented among the 14 studies, with Individual Placement and Pupport (IPS) and its variant Customized Employment Supports (CES) having the most studies with positive results. But generally, the magnitude of any intervention effects on employment was small for all interventions; one outcome may have shown statistical significance while one or more other outcomes did not, and there was little consistency in how outcomes were measured among the studies. Conclusions/Importance: IPS/CES currently shows the most evidentiary support. But all the studies of interventions with positive outcome data should be replicated with larger samples in diverse settings.

Social inclusion of clients treated for substance abuse in Sweden in the 1980s: A 27-year follow-up

AIM

To investigate social inclusion/exclusion in terms of criminality, substance abuse and participation in the labour market in clients treated for substance abuse in Sweden in the 1980s during a follow-up period of 27 years.

METHOD

SWEDATE data are used for background information on the clients. The data were collected through interviews with clients registered for treatment in 31 in-patient treatment units in 1982 and 1983. Data on labour market status, education and medication related to drugs were collected from public registers. The study population consisted of 1132 individuals, who were followed from the year after exiting from treatment (Year 1) until the end of the follow-up (December 2013).

RESULTS

Among those who survived, the women seem to have succeeded better in terms of social inclusion both at an aggregated level and when the individual pathways were followed during the follow-up period. When comparing pathways between adverse and non-adverse groups during the follow-up period the results show movements from being adverse to non-adverse but also the opposite. In the last follow-up in 2013, the majority of the clients defined as non-adverse for the last nine years were in some way established in the labour market (including studies). In total, about two fifths of the group were in some way established in the labour market.

CONCLUSIONS

The fairly high proportion of clients moving between being adverse and non-adverse during the follow-up might support the perspective suggesting that dependence should not be considered as chronic.

Perceived Effectiveness of Anti-Marijuana Messages in Adult Users and Nonusers: An Examination of Responses to Messages About Marijuana's Effects on Cognitive Performance, Driving, and Health

OBJECTIVE

Marijuana use is associated with negative cognitive and health outcomes and risky driving. Given the rapidly changing policies regarding legal recreational and medicinal marijuana use, it is important to examine what types of marijuana prevention messages may be effective in minimizing such outcomes. This study examined cognitive and affective responses to anti-marijuana public health messages in a sample of adult marijuana users and nonusers to determine the correlates of perceived message effectiveness.

METHOD

Participants (N = 203; mean age = 37.7 years) were adult marijuana users and nonusers recruited via Amazon Mechanical Turk (August 2017). After completing self-report measures of marijuana use, they viewed six anti-marijuana messages presented in a random order, addressing marijuana's effects in each of three topic areas: cognitive performance, driving, and adverse health outcomes (e.g., two messages per topic). Participants completed assessments of cognitive and affective perceptions after viewing each message. For each message topic, a linear regression model was used to determine which cognitive and affective perceptions were most predictive of perceived message effectiveness.

RESULTS

For all message topics, nonusers perceived the messages as more effective than did users (p < .001). In the majority of analyses, greater message effectiveness was associated with increased perceived harm of marijuana and increased liking of the message. For driving and health messages, greater message effectiveness was also significantly correlated with lower pleasant affect.

CONCLUSIONS

The findings suggest that audience perceptions may be uniquely predictive of message effectiveness, depending on the topic.

The association of employment status with ideal cardiovascular health factors and behaviors among Hispanic/Latino adults: Findings from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Background

The American Heart Association’s 2020 Impact Goals propose to improve cardiovascular health (CVH) and reduce deaths from cardiovascular diseases and stroke in the US. Targeted health promotion efforts in workplaces and communities are needed to achieve these population-level changes. The present study examined the sex-specific cross-sectional associations between employment status and ideal CVH among Hispanics/Latinos, and whether these associations were modified by age (i.e., younger adults [aged 18–44] compared to middle-aged and older adults [aged 45–74]).

Methods

This study included 4,797 males and 7,043 females (aged 18–74) from the Hispanic Community Health Study / Study of Latinos. Employment status was categorized as employed full-time (FT), employed part-time (PT), employed (FT or PT) and homemakers, homemakers only, and unemployed. CVH metrics, operationalized as ‘ideal’ versus ‘less than ideal,’ included health factors (i.e., blood pressure, cholesterol, and fasting glucose) and health behaviors (i.e., body mass index, smoking, physical activity [PA], and diet). A total CVH score was derived based on the seven CVH metrics, and dichotomized as ideal vs. less than ideal (score of 11–14 vs. 0–10). Survey-based generalized linear regression models with Gaussian binomial distribution were used to estimate adjusted prevalence differences (APDs) and their 95% confidence intervals (CIs) for the associations between employment status (with employed FT as referent) and ideal CVH (total score and each metric), adjusting for socio-demographic characteristics. Effect modification by age was examined.

Results

Among males, compared to their employed FT counterparts, those who were employed PT had a higher prevalence of ideal CVH score (APD = 6.8, 95% CI = 1.7, 11.8), ideal BMI (APD = 8.5, 95% CI = 3.0, 14.0), and ideal PA (APD = 4.8, 95% CI = 0.9, 8.7). Age modified the associations of employment type with ideal CVH score and ideal BMI, i.e., younger males who were employed PT had a higher prevalence of ideal CVH score and ideal BMI. Among females, employment status was not associated with ideal CVH score. Compared to females employed FT, females who were homemakers had a lower prevalence of ideal (non-) smoking (APD = -4.7, 95% CI = -8.5, -1.0) and ideal PA (APD = -7.9, 95% CI = -12.7, -3.0), and females who were unemployed had a lower prevalence of ideal PA (APD = -10.4, 95% CI = -16.7, -4.1). Age modified the associations of employment type with ideal fasting glucose and ideal PA, i.e., middle-aged and older females who were homemakers or unemployed had a lower prevalence of ideal fasting glucose and ideal PA.

Conclusions

Hispanic/Latino males who were employed PT had the most favorable CVH profiles but these associations were mostly driven by better CVH (total score and metrics) among younger males. Hispanic/Latino females who were homemakers or unemployed had lower rates of ideal CVH metrics.

Marihuana y drogas ilícitas en jóvenes mexicanos: Factores de riesgo y protección asociados a la edad de inicio del consumo

Objetivo: Determinar factores de riesgo y protección asociados a la edad de inicio del consumo de mariguana y drogas ilícitas en jóvenes mexicanos. Método: Se analizaron datos de 40,366 jóvenes participantes de la Encuesta de Cohesión Social para la Prevención de la Violencia y la Delincuencia (ECOPRED). Las variables asociadas con la edad de inicio del consumo de mariguana y otras drogas ilícitas fueron determinadas mediante dos modelos de riesgos proporcionales. Resultados: La edad mediana de inicio en consumo de drogas ilícitas osciló entre los 15 y 18 años, mientras que en consumo de marihuana fue de 17 años. En ambos modelos, tener un par consumidor de marihuana fue el factor más fuertemente asociado al inicio de consumo. Discusión: La edad de inicio de consumo revelada en el presente estudio resultó similar a aquella propuesta en investigaciones previas. A pesar de las diferencias de factores en cada modelo, tener un par consumidor de marihuana y el consumo previo de tabaco (variable moderadora) resultaron los factores más fuertemente asociados en ambos modelos.

Frequent Drug Use and Negative Employment Outcomes among the Criminally Active

BACKGROUND

Employment is a central component of economic independence and is widely viewed as an essential element of social control. Whether frequent drug use reduces the likelihood of employment or obstructs hours worked, wages, and job commitment is therefore an important question about which there remains uncertainty.

METHODS

We improve on shortcomings of prior research through a monthly within-person analysis of a population at high-risk of both drug use and poor employment outcomes. We present multilevel models of the 18 months spent on the street preceding the arrest that led to incarceration in minimum/medium security facilities in Ohio from a random sample of 250 adult male inmates interviewed during the outset of a prison spell.

RESULTS

The analysis reveals consistently strong, negative effects of frequent drug use on employment, hours worked, and wages in the month following frequent drug use, including marijuana, cocaine, heroin, and prescription opioids. As well, frequent drug use (with the exception of marijuana) undermines job commitment during the months that participants are employed.

CONCLUSIONS

The consequences of frequent drug use for future employment are consistently negative within this criminal justice sample. Results suggest that lower levels of drug use may improve the success of postrelease employment programs. In a context of increasing concern over rising opioid and heroin, but also cocaine and marijuana abuse, the findings suggest a renewed focus on and perhaps expansion of evidence-based drug treatment among populations embedded within the criminal justice system, particularly if employment constrains criminal behavior.

Applying the Problem Behavior Theory to Adolescent Drug Use Among a Cross-Sectional Sample of Boys Participating in a Community-Based Youth Organization

BACKGROUND

Drug use remains an important public health concern in the United States, and understanding drug use among young adolescents is vital towards improving the health of the population.

OBJECTIVE

This study applied the Problem Behavior Theory (PBT) to lifetime drug use among a cross-sectional sample of Boy Scouts (N = 770). The PBT provides a conceptual framework for identifying risk and protective factors for adolescent problem behaviors, including drug use.

METHODS

Scouts reported their drug use and socio-demographics, and were assessed on several risk and protective factors. For analyses, sociodemographic and risk and protective factors were selected according to the framework provided by PBT, and use of each drug was regressed logistically on these selected factors. Final logistic models were assessed for goodness of fit and discriminatory power.

RESULTS

The PBT demonstrated discriminatory power for all drugs (Tjur's R² values ≥.29), but fell sharply for illicit drug use (Tjur's R² =.20). There were no consistent correlates of drug use. Conclusions/Importance: The PBT had less explanatory power for illicit drug use compared to tobacco, alcohol, and marijuana, which suggests different risk and protective factors were associated with illicit drug use.

Treating PTSD in Pregnant and Postpartum Rural Women with Substance Use Disorders

The co-occurrence of posttraumatic stress disorder and substance use disorder (PTSD-SUD) can pose significant problems for rural pregnant and postpartum women (PPW) and the well-being of their children. Although effective treatments exist, PPW experience limitations in their ability to access and engage in treatment that may be compounded by various aspects of rural settings, so providers must be attentive to these barriers in order to address this pressing public health need. In addition, as part of increasing rural access to care, it is important to consider the costs and benefits to PPW of selecting exposure-based techniques (e.g., prolonged exposure) to disseminate. The current article discusses the treatment of PTSD-SUD in rural PPW in the context of the authors' experiences providing an exposure-based cognitive behavioral treatment for PTSD in this population. Barriers to treatment access and engagement are discussed and recommendations are provided.

Adolescent Illicit Drug Use and Policy Options in Australia: A Multicriteria Decision Analysis

The etiology of illicit substance involvement is a multidimensional problem shaped by factors across individual, social, and environmental domains. In this study, a multicriteria framework is employed to incorporate the input of specialists regarding risk and protective factors and the effectiveness of alternative interventions to mitigate the adverse harms and consequences associated with adolescent drug initiation and subsequent use. Using a seven-stage drug use continuum (nonuse, priming, initial use, experimental use, occasional use, regular use, and dysfunctional use), experts rate social and environmental factors as the most important from nonuse to occasional use. Experts often support preventive and harm-minimizing strategies to interrupt the progression of drug involvement and accumulation of drug-related harms among adolescents. Compared with preferable interventions, less preferable options (e.g., drug testing/monitoring) are considered to have a negative policy impact on key social, environmental, and drug dimension domains, which tend to override their positive impacts on other areas.

Gender and race/ethnic differences in the persistence of alcohol, drug, and poly-substance use disorders

AIMS

To examine gender and racial/ethnic differences in the effect of substance use disorder (SUD) type on SUD persistence.

METHODS

Data were provided by 1025 women and 1835 men from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to examine whether gender and race/ethnicity (Non-Hispanic White, Black, Hispanic) moderate the effects of DSM-IV defined past-12 month SUD type (alcohol, drug, poly-substance) on SUD persistence at 3-year follow-up, controlling for covariates. Using gender-stratified weighted binary logistic regression, we examined predictors of SUD persistence, tested an SUD type by race/ethnicity interaction term, and calculated and conducted Bonferroni corrected pairwise comparisons of predicted probabilities.

RESULTS

SUD persistence rates at 3-year follow-up differed for SUD type by gender by race/ethnicity sub-group, and ranged from 31% to 81%. SUD persistence rates were consistently higher among poly-substance users; patterns were mixed in relation to gender and race/ethnicity. Among women, alcohol disordered Hispanics were less likely to persist than Whites. Among men, drug disordered Hispanics were less likely to persist than Whites. Also, Black men with an alcohol or drug use disorder were less likely to persist than Whites, but Black men with a poly-substance use disorder were more likely to persist than Hispanics.

CONCLUSIONS

The effect of SUD type on SUD persistence varies by race/ethnicity, and the nature of these relationships is different by gender. Such knowledge could inform tailoring of SUD screening and treatment programs, potentially increasing their impact.

Hur gick det för 1960- och 1970-talets svenska narkotikamissbrukare?

What happened to the Swedish problem drug users of the 1960's and 1970's?

AimS & DESIGN

– In this study we follow a Stockholm birth cohort born in 1953 (n= 14 294) from youth to middle age. The cohort members were in their teenage years when drug abuse was established as a considerable threat to Swedish society and some of the cohort members themselves became drug abusers (n=431).

Results

– As expected, life became dramatically worse for those with documented drug abuse when young, than for the rest of the cohort members. While 72 percent of those without documented drug abuse were socially included at the age of 56, the corresponding share among those with documented drug abuse was 18 per cent. And while 5 percent in the former group were diseased at 56, this was true for 38 percent in the latter group. Supplementary analyses showed that social inclusion was also less stable among those with documented drug abuse than among the rest of the cohort, and that the flow from exclusion to inclusion was virtually nonexistent, which was not the case for those without experience of drug abuse.

Conclusions

– Gender specific analyses showed that the situation, at least in absolute terms, tended to be even worse for male drug abusers than for women. Gender differences in alcohol abuse, criminality, and with respect to parenthood are suggested as possible explanations to be further studied in future research.

Patterns of the co-use of alcohol, marijuana, and emerging tobacco products in a national sample of young adults

BACKGROUND

Emerging tobacco product use is on the rise in young adults and has been linked to alcohol and marijuana use. Little is known about which patterns of alcohol, marijuana, and emerging tobacco product co-use are most popular in this age group.

OBJECTIVES

This study examined the prevalence of a broad spectrum of marijuana, alcohol, and tobacco co-use patterns across a variety of tobacco products in a national sample of young adults.

METHODS

Data were analyzed from a sub-set of 18-24 year olds (unweighted n = 3,940) from five waves of the Truth Initiative Young Adult Cohort, a national sample of 18-34 year olds. A user-generated statistical program in R was used to assess all possible patterns of past 30-day use of alcohol, marijuana, cigarettes, cigars, e-cigarettes, little cigars/cigarillos, hookah, and other tobacco (pipe, chew, dip, snus, dissolvables).

RESULTS

No past 30-day use of any substance emerged as the most popular pattern across all years (42%), followed by exclusive past 30-day alcohol use (31%), and past 30-day alcohol use with cigarettes (5%) or marijuana (4%). The popularity of exclusive marijuana use increased over time, but only 1% reported exclusive marijuana use without the combination of either alcohol or a tobacco product. E-cigarette use only emerged in combination with alcohol and was the least popular pattern of co-use relative to other patterns.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Patterns stress the importance of alcohol among young people. Successful substance use prevention should focus on alcohol's co-use with a variety of substances of abuse, rather than focus on a single behavior. (Am J Addict 2016;25:634-640).

Using Group-Based Trajectory and Growth Mixture Modeling to Identify Classes of Change Trajectories

Many issues of interest to counseling psychologists involve questions regarding how individuals change over time. Although counseling psychologists often examine average levels of change, statistical methods can also identify patterns of change over time by empirically grouping together individuals with similar patterns of change (e.g., group-based trajectory modeling and latent growth mixture modeling). The purpose of this article is to provide an overview of these methods for counseling psychologists. We discuss the conceptual frameworks and assumptions of average-level and person-centered techniques such as group-based trajectory modeling and latent growth mixture modeling. We provide a nontechnical guide for conducting these analyses using data from a study of psychotherapy outcomes in a sample of mental health center clients ( N = 1,050). We discuss caveats associated with these methods, including the potential for overinterpreting nongeneralizable results. Last, we suggest best practices for reporting and interpreting results.

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.

Why young people's substance use matters for global health

During puberty, when young people are completing their education, transitioning into employment, and forming longer-term intimate relationships, a shift in emotional regulation and an increase in risky behaviour, including substance use, is seen. This Series paper considers the potential effects of alcohol, tobacco, and illicit drug use during this period on: social, psychological, and health outcomes in adolescence and young adulthood; role transitions, and later health and social outcomes of regular substance use initiated in adolescence; and the offspring of young people who use substances. We sourced consistent support for causal relations between substance use and outcomes and evidence of biological plausibility from different but complementary research designs. Many adverse health and social outcomes have been associated with different types of substance use. The major challenge lies in deciding which are causal. Furthermore, qualitatively different harms are associated with different substances, differences in life stage when these harms occur, and the quality of evidence for different substances and health outcomes varies substantially. The preponderance of evidence comes from a few high-income countries, thus whether the same social and health outcomes would occur in other countries and cultures is unclear. Nonetheless, the number of harms that are causally related to substance use in young people warrant high-quality research design interventions to prevent or ameliorate these harms.

The influence of adolescent eating disorders or disordered eating behaviors on socioeconomic achievement in early adulthood

OBJECTIVE

Much research documents the etiology and health consequences of adolescent eating disorders (ED), but very little is known about the long-term effects of EDs on the transition to adulthood. This study explores gender differences in the influence of EDs or disordered eating behaviors (DEB) on measures of socioeconomic independence in early adulthood.

METHOD

Using the National Longitudinal Study of Adolescent Health (Add Health), this study compares individuals who self-identified as have been diagnosed with an ED or engaged in DEBs in late adolescence to those without ED or DEB on three measures of socioeconomic independence during early adulthood, including educational attainment, income, and likelihood of owning a home. This study uses multiple regression techniques and attempts to account for early-life conditions and health outcomes associated with EDs and DEBs.

RESULTS

For females, ED or DEB in late adolescence had a statistically significant, negative association with educational attainment (coefficient = -0.20, p = .05), personal income (coefficient = -0.12, p < .05) and odds of owning a home (odds ratio = 0.73, p < .02) in early adulthood. For males, ED or DEB was not associated with socioeconomic attainment.

DISCUSSION

Our findings suggest that EDs and DEBs are negatively associated with socioeconomic achievement during early adulthood for females, but not for males. EDs or DEBs during adolescence may set individuals on a different trajectory whereby they do not have the same life chances or opportunities for success in adulthood. These results confirm the public health message that EDs or DEBs have lasting negative consequences for women.

Adolescent exposure to violence and adult illicit drug use

Informed by a strain theory perspective, this study utilizes data on adolescent exposure to violence (AEV) from a prospective, longitudinal, national household probability sample that originally consisted of 1,725 respondents, first interviewed as adolescents in 1977 and last interviewed in middle adulthood in 2003. Findings from bivariate correlations and logistic regression models indicate that AEV is associated with both adolescent and adult illicit drug use, but some of the association between AEV and adult illicit drug use becomes nonsignificant when controlling for adolescent illicit drug use. Specific types of AEV associated with adult illicit drug use differ by gender. Implications, limitations, and future research directions are discussed.

Women’s Employment Outcomes Following Gender-Sensitive Substance Abuse Treatment

Employment problems are common among low-income, substance abusing women. The present study links an empirically developed quantitative measure of gender-sensitive (GS) substance abuse treatment to employment outcomes among substance abusing women ( N = 5,109) treated in 13 mixed-gender intensive inpatient programs (IIPs) in the Washington State. Hierarchical linear models were used to test the relationship between GS treatment and subsequent employment. Propensity scores and receipt of public assistance were used to control for the preexisting differences among women. Men’s employment outcomes were used to control for potential confounding at the program level. The study found that women treated in more (vs. less) GS treatment programs were more likely to be employed 12 months after treatment admission, though not for the hypothesized 24 months. Treatment completion did not affect the relationship between GS treatment and employment. Findings point to recent progress in tailoring generic substance abuse treatment to women’s needs.

Trajectories of injecting behavior in the Amsterdam Cohort Study among drug users

BACKGROUND

Injecting frequency among people who inject drugs (IDU) can change along distinct trajectories, which can reflect on incidence of HIV and HCV infections. We aimed at assessing these patterns of longitudinal changes, their predictors and their association with the incidence of HIV and HCV.

METHODS

We analyzed data from the Amsterdam Cohort Study among Drug Users, selecting participants recruited from 1985 to 2005, injecting drugs before cohort entry and with records in at least three different six months intervals (N=740). We used latent class mixed models to identify distinct trajectories of injecting, multinomial regression to identify socio-demographic variables associated with those patterns and Kaplan-Meier analysis for the estimation of the corresponding cumulative HIV and HCV incidence.

RESULTS

Five distinct patterns for injecting frequency and for injecting since last visit were identified. The majority of participants (three groups, 69% of participants) had stable risk injecting behavior; the remaining displayed a decrease in injecting over time. Those with longer duration of injecting at cohort entry and those who entered the cohort in earlier years tended to have continuing high risk behavior. The HIV risk was highest among those with continuing high risk behavior and its changes over time mirrored the patterns of change in injecting in a group with decrease in injecting.

CONCLUSIONS

Individual longitudinal patterns of changes in injecting behavior are related to socio-demographic and drug use variables and are reflected in the incidence of HIV infections. Understanding these associations might provide valuable information for targeted interventions.

Twelve-month employment intervention outcomes for drug-involved offenders

BACKGROUND

Employment has been identified as an important part of substance abuse treatment and is a predictor of treatment retention, treatment completion, and decreased relapse. Although employment interventions have been designed for substance abusers, few interventions have focused specifically on drug-involved offenders.

OBJECTIVES

The purpose of this study was to examine employment outcomes for drug-involved offenders who received a tailored employment intervention.

METHODS

In a randomized controlled trial, baseline and follow-up data were collected from 500 drug-involved offenders who were enrolled in a drug court program. Participants were randomly assigned to drug court as usual (control group) or to the employment intervention in addition to drug court.

RESULTS

Intent-to-treat analyses found that the tailored intervention was associated only with more days of paid employment at follow-up (210.1 vs. 199.9 days). When focusing on those with greater employment assistance needs, a work trajectory analyses, which took into account participants' pre-baseline employment pattern (negative or positive), revealed that intervention group participants had higher rates of employment (82.1% vs. 64.1%), more days paid for employment (188.9 vs. 157.0 days), and more employment income ($8623 vs. $6888) at follow-up than control group participants.

CONCLUSION

The present study adds to the growing substance abuse and employment literature. It demonstrates the efficacy of an innovative employment intervention tailored for drug-involved offenders by showing positive changes in 12-month employment outcomes, most strongly for those who have not had recent employment success.

Intergenerational continuity of substance use

Guided by rigorous methodology and a life-course perspective, the goal of this research is to address a gap in current knowledge on whether, when, and how strongly intergenerational continuity of substance use exists when examining age-equivalent and developmentally specific stages of the life course. Annual self-reported substance use measures were analyzed from a prospective, longitudinal, and nationally representative sample that originally consisted of 1,725 respondents and their families, who were then interviewed over a 27-year period from 1977 to 2004. Findings from multilevel random-intercept regression models provide support for intergenerational continuity when substance use occurs in emerging adulthood but not when limited to adolescence. Implications, limitations, and future research directions are discussed.

RCT of a promising vocational/employment program for high-risk juvenile offenders

Juvenile offenders with substance use problems are at high risk for deleterious long-term outcomes. This study evaluated the capacity of a promising vocational and employment training program in the building sector (i.e., Community Restitution Apprenticeship-Focused Training, CRAFT) to mitigate such outcomes through enhanced employment and education. Participants were 97 high-risk juvenile offenders (mean age=15.8 years) randomized to CRAFT versus education as usual (EAU) intervention conditions. Multi-method procedures measured employment, education, substance use, mental health, and criminal outcomes through a 30-month post-baseline follow-up. CRAFT was significantly more effective than EAU at increasing rates of youth employment and GED attendance. Intervention effects were not observed, however, for months employed, hours worked, or hourly wage. Measures of youth substance use, mental health symptoms, and criminal activity showed no favorable or iatrogenic effects. The potential of CRAFT was modestly supported, and suggestions were made for future research.

Concurrent life-course trajectories of employment and marijuana-use: exploring interdependence of longitudinal outcomes

This study analyzes data on 7661 individuals who participated in the 1979 National Longitudinal Survey of Youth (NLSY79) to estimate trajectories of employment and marijuana-use over a 17-year period. Bivariate random intercept and slope modeling is applied to examine concurrently the cross-correlation between the two concurrent longitudinal trajectories from age 23 to 39. Parameter estimates indicate baseline level (at age 23) of employment to be negatively correlated with marijuana, suggesting marijuana-use is associated with lower workforce productivity at age 23. The longitudinal employment slope is positively correlated with employment intercept for both males and females, indicating that survey participants with higher levels of employment at age 23 are more likely to have a positive impact on employment trajectory over time. For males, however, the employment slope is also significantly correlated with marijuana intercept (r=-0.07), indicating marijuana-use in early adulthood may uniquely lower workforce productivity over age.

Drug use patterns in young adulthood and post-college employment

BACKGROUND

The relationship between serious drug involvement and risk for unemployment is well recognized, but few studies have prospectively examined this relationship among college students. This study used longitudinal data to examine the association between drug use patterns during college and the likelihood of employment post-college, holding constant sociodemographic variables and personality characteristics. Second, we estimate the prevalence of alcohol and other drug use disorders among employed individuals.

METHODS

Data were derived from the College Life Study. Participants entered college as traditional students and were assessed annually for six years, regardless of continued college attendance. Analyses were restricted to 620 individuals no longer enrolled in school by Year 6.

RESULTS

Using multinomial regression modeling, persistent drug users (i.e., used illicit drugs (other than marijuana) and/or nonmedical prescription drugs every year they were assessed during the first four years of study) were significantly more likely than non-users to be unemployed vs. employed full-time post-college. Persistent drug users and infrequent marijuana users were also more likely than non-users to be unemployed vs. employed part-time. In Year 6, 13.2% of individuals employed full-time and 23.7% of individuals employed part-time met DSM-IV criteria for drug abuse or dependence during the past year.

CONCLUSIONS

If confirmed, the results of this study suggest that persistent drug use among academically achieving young adults might increase risk for post-college unemployment. More research is needed to understand the processes underlying this association. Further attention should be directed at managing substance use problems among recent college graduates who have secured employment.

The Role of Study and Work in Cannabis Use and Dependence Trajectories among Young Adult Frequent Cannabis Users

Life course theory considers events in study and work as potential turning points in deviance, including illicit drug use. This qualitative study explores the role of occupational life in cannabis use and dependence in young adults. Two and three years after the initial structured interview, 47 at baseline frequent cannabis users were interviewed in-depth about the dynamics underlying changes in their cannabis use and dependence. Overall, cannabis use and dependence declined, including interviewees who quit using cannabis completely, in particular with students, both during their study and after they got employed. Life course theory appeared to be a useful framework to explore how and why occupational life is related to cannabis use and dependence over time. Our study showed that life events in this realm are rather common in young adults and can have a strong impact on cannabis use. While sometimes changes in use are temporary, turning points can evolve from changes in educational and employment situations; an effect that seems to be related to the consequences of these changes in terms of amount of leisure time and agency (i.e., feelings of being in control).

The analysis of multiple ties in longitudinal egocentric network data: A case study on bidirectional relationships between trust and drug use

We extend multi-level models to examine single egocentric network ties to the joint analysis of paired dynamic ties. Two analytic challenges are addressed. First, inference needs to account for multiple layers of nesting: ties are nested within pairs, pairs are nested within time points, and time points are nested within egos. Second, the focus is on the relationship between two dynamic ties; specification of outcome and predictor may be difficult. Instead, we treat both ties as outcomes. Our approach is used to analyze trust and reported drug use between egos and alters over time in a Bayesian framework.

Developmental timing of first drug treatment and 10-year patterns of drug use

To examine the developmental timing of first drug treatment and its associations with 10-year drug use patterns, pooled data (N=1318) from four longitudinal studies conducted in California was used to compare individuals first treated during young adulthood (26%) to those first treated at an older age. Treatment timing was associated with particular participant characteristics and experiences. Matched data showed that most people in both age groups exhibited a low level of drug use after first treatment, albeit fewer who were first treated during young adulthood maintained a low drug use level over time. Receipt of more drug treatment over 10 years was associated with maintenance of low drug use levels among those first treated as young adults, but not among those first treated as older adults. Developmental timing of first drug treatment interacts with subsequent treatment experiences in ways that impact the course of drug use.