Adverse childhood experiences (ACEs), genetic polymorphisms and neurochemical correlates in experimentation with psychotropic drugs among adolescents

The missed pandemic: Intimate partner violence in female mental-health-care-users during the COVID-19 pandemic

Adverse childhood experiences (ACEs) and interpersonal violence (IPV) in mentally ill women are often neglected and need to be reviewed in light of the suggested increase in IPV during the COVID-19 pandemic.We investigated the prevalence of ACEs and IPV in women living with severe mental illness (SMI) attending an outpatient psychiatry service at a public hospital in KwaZulu-Natal, South Africa, during the COVID-19 pandemic. We also described the association of ACEs with later IPV.A written survey comprising socio-demographic and clinical questionnaire, WHO Adverse Childhood Experiences International Questionnaire (ACE-IQ) for ACEs and the Women abuse screening tool (WAST) for IPV, was completed by the 154 women with SMI.141 (91.6%) participants scored positive for ACEs and 104 (67.5%) had experienced three or more ACEs. The most prevalent forms of ACEs were emotional neglect 72 (46.8%), one or no parents, parental separation, or divorce 104 (67.5%), contact sexual abuse 67 (43.5%) and witnessing a household member treated violently 67 (43.5%). Sixty-one (46.6%) participants reported IPV with scores  13 (indicative of abuse). On logistic regression, experience of three or more ACEs was significantly associated with IPV in adulthood (aOR 3.3, 95% CI: 1.2-9.6).The high prevalence of IPV and association of IPV with cumulative ACEs reflect firstly the hidden epidemic of domestic violence and secondly the vulnerability of those with ACEs to become victims of abuse later which is often  missed in the care of women with SMI.

Measuring adverse childhood experiences with latent class trajectories

BACKGROUND

Adverse childhood experiences (ACEs) are associated with several negative health and behavioral outcomes during adolescence, but most of the extant research has employed ACEs scores at one or two time points. Studies have not assessed whether latent class ACEs trajectories affect adolescent problem behaviors and conditions.

OBJECTIVES

We used longitudinal data from the Fragile Families and Child Wellbeing Study (FFCWS, n = 3444) to assess ACEs at several time points and empirically developed latent class trajectories. We then examined the sociodemographic characteristics of youth who belonged to each trajectory group. We next evaluated whether the ACEs trajectories during childhood were associated with delinquent behavior, substance use, and symptoms of anxiety or depression. Finally, we explored whether closeness to mother buffered the impact of ACEs on these outcomes.

METHODS

Eight types of ACEs were captured in the FFCWS data. ACE scores were assessed at year one, three, five, and nine, along with the outcomes during year 15. Trajectories were estimated with a semiparametric latent class models.

RESULTS

The analysis revealed three latent trajectories during childhood: a low/none ACEs group, a medium exposure group, and a high exposure group. Adolescents in the high exposure group manifested a heightened risk of involvement in delinquent behaviors and substance use. They also reported more symptoms of anxiety and depression than their peers in the low/none and medium exposure groups.

CONCLUSIONS

Repeated exposure to ACEs during childhood can have serious negative repercussions in the lives of adolescents, but maternal closeness may buffer their effects. Scholars should continue to examine the dynamics of ACEs exposure during childhood by using empirical approaches appropriate for identifying age-graded trajectories.

Cumulative Stressors and Adolescent Substance Use: A Review of 21st-Century Literature

The aim of this review is to assess empirical studies from the last 2 decades that have examined the association between cumulative stressors and adolescent substance use. Cumulative stressors were measured in these studies with adverse childhood experiences or adolescent stressful life events inventories. The 109 articles meeting the eligibility criteria that emerged from the review demonstrated a consistent, yet modest, association between cumulative stressors and adolescent substance use. Of note, several studies found that the associations were moderated or mediated by genetic factors related to cortisol regulation, intrapersonal factors such as low self-control, or interpersonal factors such as peer substance use. The review's findings thus suggest that efforts to reduce the effects of cumulative stressors on substance use could gainfully identify and target these risk moderators and mediators.

An Association of Adverse Childhood Experiences with Binge Drinking in Adulthood: Findings from a Population-Based Study

Background: Adverse childhood experiences (ACEs) are a major public health issue linked to negative health outcomes. Yet, few recent studies drawing on national data have examined the association between ACEs and binge drinking. Objective: The objective of this study was to examine the association between ACEs and binge drinking among adults in the United States and whether this association is dependent on sex. Methods: Data for this study were obtained from the 2019 Behavioral Risk Factor Surveillance System survey. An analytic sample of 41,322 adults aged 18-64 years (50.7% male) from 17 states was analyzed using binary logistic regression. The outcome variable was binge drinking, and the main explanatory variable was ACEs. Results: Of the 41,322 respondents, 21.3% engaged in binge drinking. About 30% of the respondents had no ACEs and 23.9% had four or more ACEs. In the multivariable logistic regression, we observed that sex moderated the association between ACEs and binge drinking. Odds were 1.36 times higher for females who experienced two ACEs (aOR = 1.36 p < .05, 95% CI = 1.04-1.77) and 1.58 times higher for females who experienced three ACEs (aOR = 1.58 p < .01, 95% CI = 1.17-2.12) to engage in binge drinking. Other factors associated with binge drinking include younger age, non-Hispanic White, higher income level, higher education, not being married, being overweight, and history of cigarette smoking. Conclusion: The findings of this study underscore the importance of developing sex-appropriate screening and intervention strategies to support individuals exposed to ACEs and potentially mitigate negative health outcomes later in life.

Alcohol use disorders among adult children of alcoholics (ACOAs): Gene-environment resilience factors

Both genetic and early environmental factors contribute to the pathogenesis of Alcohol Use Disorder (AUD). Gender and psychopathology symptoms might further moderate this association, resulting in an impairment of both the dopaminergic and serotoninergic pathways that sustain the binge, withdrawal and craving cycle. In a sample of of adult children of alcoholic parents (ACOAs) (n = 107) we compared those with and without an AUD, on socio-demographic variables, adverse childhood experiences, psychopathology symptoms and two polymorphisms associated with an impaired serotoninergic and dopaminergic neurotransmission (5HTTLPR and Taq1A/DRD2). A logistic regression revealed that an early caring environment might lower the risk of developing an AUD. When controlling for the actual psychopathology symptoms, being male and having the genotype associated with an impaired dopaminergic neurotransmission were still associated with AUD. Results were confirmed by an unsupervised approach that showed how the clusters characterised by being male and having the high risk genotypes were still associated with AUD compared to being female without the unfavourable dopamine genotype.Our results point to the need for implementing prevention strategies aimed at creating a caring environment especially in those families with an alcoholic parent. We further suggest that psycho-education as a symptom recognition and avoiding self-medication could improve the outcome in those subjects at higher risk, especially males.

Social vulnerabilities for substance use: Stressors, socially toxic environments, and discrimination and racism

Applying a social determinants of health framework, this review brings attention to evidence from social sciences and neuroscience on the role of selected social factors in individual and population-level vulnerability to substance use and substance use disorders (SUDs). The understanding that social vulnerability to substance use and SUDs is multifaceted and occurs across different levels of influence (individual, interpersonal, community, and societal) is underscored. We propose that socially based stressors play a critical role in creating vulnerability to substance use and SUDs, and as such, deserve greater empirical attention to further understand how they "get under the skin." Current knowledge from social sciences and neuroscience on the relationships among vulnerability to substance use resulting from stressors, exposure to socially toxic childhood environments, and racism and discrimination are summarized and discussed, as are implications for future research, practice, and policy. Specifically, we propose using a top-down approach to the examination of known, yet often unexplored, relationships between vulnerability to substance use and SUDs, related inequities, and potential differential effects across demographic groups. Finally, research gaps and promising areas of research, practice, and policy focused on ameliorating social vulnerabilities associated with substance use and SUDs across the lifespan are presented. This article is part of the special issue on 'Vulnerabilities to Substance Abuse'.

Rats Lacking Dopamine Transporter Display Increased Vulnerability and Aberrant Autonomic Response to Acute Stress

The activity of the hypothalamus–pituitary–adrenal (HPA) axis is pivotal in homeostasis and presides the adaptative response to stress. Dopamine Transporter (DAT) plays a key role in the regulation of the HPA axis. We used young adult female DAT Knockout (KO) rats to assess the effects of DAT ablation (partial, heterozygous DAT+/-, or total, homozygous DAT-/-) on vulnerability to stress. DAT-/- rats show profound dysregulation of pituitary homeostasis, in the presence of elevated peripheral corticosterone, before and after acute restraint stress. During stress, DAT-/- rats show abnormal autonomic response at either respiratory and cardiovascular level, and delayed body temperature increase. DAT+/- rats display minor changes of hypophyseal homeostatic mechanisms. These rats display a similar pituitary activation to that of the control animals, albeit in the presence of higher release of peripheral corticosterone than DAT-/- after stress, and reduced temperature during stress. Our data indicate that DAT regulates the HPA axis at both the central and peripheral level, including autonomic function during stress. In particular, the partial deletion of DAT results in increased vulnerability to stress in female rats, which display central and peripheral alterations that are reminiscent of PTSD, and they might provide new insights in the pathophysiology of this disorder.

Stress, sensitive periods, and substance abuse

Research on the inter-relationship between drug abuse and social stress has primarily focused on the role of stress exposure during adulthood and more recently, adolescence. Adolescence is a time of heightened reward sensitivity, but it is also a time when earlier life experiences are expressed. Exposure to stress early in postnatal life is associated with an accelerated age of onset for drug use. Lifelong addiction is significantly greater if drug use is initiated during early adolescence. Understanding how developmental changes following stress exposure interact with sensitive periods to unfold over the course of maturation is integral to reducing their later impact on substance use. Arousal levels, gender/sex, inflammation, and the timing of stress exposure play a role in the vulnerability of these circuits. The current review focuses on how early postnatal stress impacts brain development during a sensitive period to increase externalizing and internalizing behaviors in adolescence that include social interactions (aggression; sexual activity), working memory impairment, and depression. How stress effects the developmental trajectories of brain circuits that are associated with addiction are discussed for both clinical and preclinical studies.

Adolescent social isolation increases cocaine seeking in male and female mice

Childhood and adolescent adversity are associated with a wide range of psychiatric disorders, including an increased risk for substance abuse. Despite this, the mechanisms underlying the ability of chronic stress during adolescence to alter reward signaling remains largely unexplored. Understanding how adolescent stress increases addiction-like phenotypes could inform the development of targeted interventions both before and after drug use. The current study examined how prolonged isolation stress, beginning during adolescence, affected behavioral and neuronal underpinnings to the response to cocaine in male and female mice. Adolescent-onset social isolation did not alter the ability of mice to learn an operant response for food, nor influence food self-administration or motivation for food on a progressive ratio schedule. However, male and female social isolation mice exhibited an increase in motivation for cocaine and cocaine seeking during a cue-induced reinstatement session. Additionally, we demonstrated that adolescent-onset social isolation increased cocaine-induced neuronal activation, as assessed by c-Fos expression, within the nucleus accumbens core and shell, ventral pallidum, dorsal bed nucleus of the stria terminalis, lateral septum and basolateral amygdala. Taken together, the present studies demonstrate that social isolation stress during adolescence augments the behavioral responses to cocaine during adulthood and alters the responsiveness of reward-related brain circuitry.

Examination of associations between early life victimisation and alcohol's harm from others

INTRODUCTION AND AIMS

Study aims were to examine: (i) how physical and sexual victimisation in early life are associated with alcohol's harm from others; and (ii) whether respondents' current drinking is a mediator of the association between early life victimisation and alcohol's harm from others among men and women.

DESIGN AND METHODS

Data were from national computer-assisted telephone interviews, using the landline sample (3335 men and 3520 women ages ≥18) from the 2010 US National Alcohol Survey. Harms from someone else's drinking included family/marital problems, financial troubles, assault and vandalism in the past 12 months. Victimisation was measured with severe physical abuse or sexual assault before age 18.

RESULTS

Severe physical or sexual victimisation before age 18 was reported by 3.4% of men and 8.1% of women. Significantly more men (5.2%) than women (2.4%) reported assault by other drinkers, and significantly more women reported family/marital (5.3%) and financial problems (2.8%) than did men (2.6 and 1% respectively). Severe early life victimisation was robustly associated with a greater likelihood of experiencing past-year harms from other drinkers for both men and women. Men's drinking partially mediated associations between early life victimisation and recent assaults and vandalism by other drinkers.

DISCUSSION AND CONCLUSIONS

Early life victimisation may increase risk of harms from someone else's drinking. Health services and interventions that screen for histories of victimisation may help decrease risk of later harms from others' drinking. Reductions in drinking among men with histories of victimisation also could help reduce their exposure to such harms. [Kaplan LM, Greenfield TK, Karriker-Jaffe KJ. Examination of associations between early life victimisation and alcohol's harm from others.

Stress in adolescence and drugs of abuse in rodent models: role of dopamine, CRF, and HPA axis

RATIONALE

Research on adolescence and drug abuse increased substantially in the past decade. However, drug-addiction-related behaviors following stressful experiences during adolescence are less studied. We focus on rodent models of adolescent stress cross-sensitization to drugs of abuse.

OBJECTIVES

Review the ontogeny of behavior, dopamine, corticotropin-releasing factor (CRF), and the hypothalamic-pituitary-adrenal (HPA) axis in adolescent rodents. We evaluate evidence that stressful experiences during adolescence engender hypersensitivity to drugs of abuse and offer potential neural mechanisms.

RESULTS AND CONCLUSIONS

Much evidence suggests that final maturation of behavior, dopamine systems, and HPA axis occurs during adolescence. Stress during adolescence increases amphetamine- and ethanol-stimulated locomotion, preference, and self-administration under many conditions. The influence of adolescent stress on subsequent cocaine- and nicotine-stimulated locomotion and preference is less clear. The type of adolescent stress, temporal interval between stress and testing, species, sex, and the drug tested are key methodological determinants for successful cross-sensitization procedures. The sensitization of the mesolimbic dopamine system is proposed to underlie stress cross-sensitization to drugs of abuse in both adolescents and adults through modulation by CRF. Reduced levels of mesocortical dopamine appear to be a unique consequence of social stress during adolescence. Adolescent stress may reduce the final maturation of cortical dopamine through D2 dopamine receptor regulation of dopamine synthesis or glucocorticoid-facilitated pruning of cortical dopamine fibers. Certain rodent models of adolescent adversity are useful for determining neural mechanisms underlying the cross-sensitization to drugs of abuse.

Windows of vulnerability: maternal separation, age, and fluoxetine on adolescent depressive-like behavior in rats

Early exposure to stressful life events plays a significant role in adolescent depression. Clinical studies have identified a number of factors that increase the risk of depression, including sex of the subject, duration of the stressor, and genetic polymorphisms that elevate serotonin levels. In this study we used the maternal separation (MS) model to investigate to what extent these factors interacted during development to manifest in depressive-like behavior in male and female rats. The triadic model of learned helplessness parses depressive-like behavior into aspects of controllable, uncontrollable, and motivational behaviors. This model was used to investigate how the timing of MS between the ages of postnatal day (P) 2-9 and P9-16 interacted with either simultaneous vehicle (saline; 1ml/kg; i.p.) or fluoxetine (10mg/kg) exposure, which was used to enhance serotonin levels; these experiments also compared the effect of a vehicle injection during these developmental periods to a no injection control. Vehicle injections alone increased helplessness in the controllable condition in male rats when injected between P9-16 only, and did not interact further with MS. MS at both ages decreased controllability in male adolescents; females demonstrated an increase in controllability after MS. Elevated serotonin at P2-9 increased escape latencies in male and female control and MS subjects. Fluoxetine exposure at P9-16 increased helplessness in controls. Fluoxetine decreased helplessness in MS males independent of age, but increases helplessness in MS females. This study highlights the importance of age of MS (MS between P2-9 increases helplessness in males more than females), the duration of the stressor (previous results show females are effected by longer MS [P2-20], but not shorter [this study]), and that elevated serotonin increases escape latencies to a greater extent in females.

Psychobiology of cocaine addiction: Contribution of a multi-symptomatic animal model of loss of control

Transition to addiction is the shift from controlled to uncontrolled drug use that occurs after prolonged drug intake in a limited number of drug users. A major challenge of addiction research in recent years has been to develop models for studying this pathological transition. Toward this goal, a DSM-IV/5-based multi-symptomatic model of cocaine addiction has been developed in the rat. It is based on an operational translation of the main features of the disease. 1. Addiction is not just taking drug; it is a non-adaptive drug use: The procedure models addiction in relation to its clinical definition. 2. All drug users do not face the same individual risk of developing addiction: The model includes an individual-based approach. 3. Addiction develops after protracted periods of controlled drug use: This procedure allows for the study of the long-term shift from controlled drug use to addiction. We describe this model in detail and show how it can contribute to our understanding of the pathophysiology of cocaine addiction. This article is part of a Special Issue entitled 'NIDA 40th Anniversary Issue'.

Engaging young people who misuse substances in treatment

PURPOSE OF REVIEW

The focus of this review is to examine service utilization, treatment effectiveness, and future directions for adolescents who misuse substances.

RECENT FINDINGS

Although the effectiveness of treatments has improved in the last two decades, young people's utilization of services has remained relatively stable. This is disconcerting because early intervention improves outcomes and deterioration is associated with physical, psychological, and social problems. The requirement for coordinated service provision across a wide range of treatment agencies cannot be emphasized enough, because young substance misusers come to services with a variety of symptoms and problems. It is encouraging that, to date, treatment studies indicate that adolescents in almost all types of treatment reduce their use of substances. The greatest reductions are shown for family therapy, followed by cognitive behavior therapy (CBT), motivational enhancement therapy (MET)/CBT, MET behavior therapy, and pharmacological treatment. Despite the developing treatment literature, important methodological limitations restrict comparability between studies.

SUMMARY

The requirement for holistic, systematic assessments should include adolescents' social contexts, trauma, and psychiatric and physical illnesses because they are the cornerstones to understanding engagement and retention. Our review shows the importance of coordinating primary healthcare, mental health, and substance abuse treatment facilities, and highlights networking between other providers as integral to providing an optimal response to this unpredictable, often marginalized, group.

Responses to novelty and vulnerability to cocaine addiction: contribution of a multi-symptomatic animal model

Epidemiological studies have revealed striking associations between several distinct behavioral/personality traits and drug addiction, with a large emphasis on the sensation-seeking trait and the associated impulsive dimension of personality. However, in human studies, it is difficult to identify whether personality/behavioral traits actually contribute to increased vulnerability to drug addiction or reflect psychobiological adaptations to chronic drug exposure. Here we show how animal models, including the first multi-symptomatic model of addiction in the rat, have contributed to a better understanding of the relationships between different subdimensions of the sensation-seeking trait and different stages of the development of cocaine addiction, from vulnerability to initiation of cocaine self-administration to the transition to compulsive drug intake. We argue that sensation seeking predicts vulnerability to use cocaine, whereas novelty seeking, akin to high impulsivity, predicts instead vulnerability to shift from controlled to compulsive cocaine use, that is, addiction.