Adolescent alcohol and drug abuse and health

A Review of the Effects of Adolescent Cannabis Use on Physical Health

The current review highlights the available research related to cannabis and indicators of physical health in a variety of domains. Various studies have found associations between cannabis use with pulmonary, cardiovascular, gastrointestinal, and endocrine function as well as body mass index and sleep. At this time, more research is needed to understand the influence of cannabis use on physical health, particularly among adolescent samples.

A Review of the Effects of Adolescent Cannabis Use on Physical Health

The current review highlights the available research related to cannabis and indicators of physical health in a variety of domains. Various studies have found associations between cannabis use with pulmonary, cardiovascular, gastrointestinal, and endocrine function as well as body mass index and sleep. At this time, more research is needed to understand the influence of cannabis use on physical health, particularly among adolescent samples.

Risk factors for alcohol use among adolescents: The context of township high schools in Tshwane, South Africa

Background

Risk factors for alcohol use originate from many interconnected factors to an interplay of social and physical environments. However, there is a scarcity of data on the contextual risk factors of alcohol use among the adolescents regarding high schools located in townships in South Africa. This study aimed to determine the risk factors for alcohol use among adolescents attending selected township high schools in Tshwane, South Africa.

Method

A validated researcher-administered questionnaire was used to collect data on the demographics, as well as current alcohol use, types, quantity, and frequency among adolescents (n = 403) in the three high schools. Data were analyzed using STATA 17.

Results

The response rate was 97%, with the mean age of 16 ± 2 years for the adolescents. Forty-eight % (48%) of the adolescents reported current alcohol use, which was associated with sex, age, number of children, school grade, repeated grade, spare time job and types, having a pocket money to school, child social grant, transport mode to school, and smoking. The odds of current alcohol use were higher for adolescents in grade 10 [AOR = 6.71; 95% CI: 3.16-14.24], grade 11 [AOR = 4.45; 95% CI: 2.21], grade 12 [AOR = 3.05; 95% CI: 1.47-6.31], repeating a grade [AOR =2 .20; 95% CI: 1.32-3.67), and working during a spare time [AOR = 2.91; 95% CI: 1.33-6.37]. Both sexes had higher odds of alcohol use in the ages of 15-17 and 18-21 years, than adolescents aged 13-14 years.

Conclusion

Key risk factors for alcohol use among learners were sex, age, school grade, repeated grade, and working during a spare time. More evidence-based interventions that would have a greater impact in addressing alcohol use among adolescents, such as focusing on availability, marketing, and taxation of alcoholic beverages, are necessary.

Exploring the relationships between adolescent alcohol misuse and later life health outcomes

BACKGROUND

We sought to clarify the impact of adolescent alcohol misuse on adult physical health and subjective well-being. To do so, we investigated both the direct associations between adolescent alcohol misuse and early midlife physical health and life satisfaction and the indirect effects on these outcomes attributable to subsequent alcohol problems.

METHOD

The sample included 2733 twin pairs (32% monozygotic; 52% female) from the FinnTwin16 study. Adolescent alcohol misuse was a composite of frequency of drunkenness, frequency of alcohol use, and alcohol problems at ages 16, 17, and 18.5. The early midlife outcomes included somatic symptoms, self-rated health, and life satisfaction at age 34. The mediators examined as part of the indirect effect analyses included alcohol problems from the Rutgers Alcohol Problem Index at ages 24 and 34. Serial mediation and co-twin comparison models were applied and included covariates from adolescence and early midlife.

RESULTS

There were weak direct associations between adolescent alcohol misuse and early midlife physical health and life satisfaction. However, there was stronger evidence for indirect effects, whereby young adult and early midlife alcohol problems serially mediated the relationship between adolescent alcohol misuse and early midlife somatic symptoms (β = 0.03, 95% CI [0.03, 0.04]), self-rated health (β = -0.02, 95% CI [-0.03, -0.01]), and life satisfaction (β = -0.03, CI [-0.04, -0.02]). These serial mediation effects were robust in co-twin comparison analyses.

CONCLUSIONS

These results provide evidence that alcohol problems are a primary driver linking adolescent alcohol misuse and poor health outcomes across the lifespan.

Racial Discrimination and Trajectories of Problematic Alcohol Use Among African American Emerging Adults: The Role of Organizational Religious Involvement

Racial discrimination jeopardizes a wide range of health behaviors for African Americans. Numerous studies demonstrate significant negative associations between racial discrimination and problematic alcohol use among African Americans. Culturally specific contexts (e.g., organized religious involvement) often function protectively against racial discrimination's adverse effects for many African Americans. Yet organized religious involvement may affect the degree to which racial discrimination increases problematic alcohol use resulting in various alcohol use trajectories. These links remain understudied in emerging adulthood marked by when individuals transition from adolescence to early adult roles and responsibilities. We use data from 496 African American emerging adults from the Flint Adolescent Study (FAS) to (a) identify multiple and distinct alcohol use trajectories and (b) examine organizational religious involvement's protective role. Three trajectory classes were identified: the high/stable, (20.76% of sample; n = 103); moderate/stable, (39.52% of sample; n = 196); and low/rising, (39.72% of the sample; n = 197). After controlling for sex, educational attainment, and general stress, the interaction between racial discrimination and organized religious involvement did not influence the likelihood of classifying into the moderate/stable class or the low/rising class, compared with the high/stable class. These results suggest organized religious involvement counteracts, but does not buffer racial discrimination's effects on problematic alcohol use. Findings emphasize the critical need for culturally sensitive prevention efforts incorporating organized religious involvement for African American emerging adults exposed to racial discrimination. These prevention efforts may lessen the role of racial discrimination on health disparities related to alcohol use.

The Relationship between Early Alcohol Use Behaviors and Adolescent Pubertal and Psychosocial Development: A Latent Growth Analysis

OBJECTIVE

The present longitudinal study examines how age of alcohol initiation and regular use (weekly drinking for ≥6 months) relates to adolescent physiological development, social behaviors, psychological functioning, and substance use patterns. Method: Data are drawn from a prospective sample of 295 youth (42% female) who completed a 15-year longitudinal study. The current investigation uses data collected at 4 timepoints from ages 12-19. Results: Latent growth modeling revealed earlier age of alcohol initiation is associated with (1) a more advanced stage of pubertal development, more self-reported dating experience, and greater externalizing behaviors at ages 12-13 (study entry); (2) a slower rate of change in pubertal development; and (3) greater rate of increase in externalizing and internalizing symptoms from ages 12 to 19. These relationships were not moderated by gender. Conclusion: Early alcohol initiation appears to be associated with early onset pubertal development and dating behaviors. Over time, early alcohol use behaviors may delay pubertal development while exacerbating psychological risk behaviors (i.e. externalizing and internalizing behaviors). These findings suggest the importance of delaying alcohol initiation and may be beneficial for improving existing adolescent substance use prevention efforts.

Early life temperamental anxiety is associated with excessive alcohol intake in adolescence: A rhesus monkey (Macaca mulatta) model

Teenage alcohol abuse is a major health concern, particularly because the majority of alcohol consumed by teenagers is via binge drinking, a known risk factor for increasing the likelihood for the development of future alcohol use disorders (AUDs). Identifying individuals at risk for excessive alcohol intake in adolescence is a step toward developing effective preventative measures and intervention programs. As adults with AUDs tend to self-medicate their anxiety with alcohol, this longitudinal study assesses the role of infant anxiety-like temperament in the development of adolescent alcohol abuse using a nonhuman primate model. From birth until they were 5 months of age, behaviors of 64 rhesus monkeys (Macaca mulatta) were coded twice a week using an objective mother-infant scoring system that included behaviors traditionally used to assess anxiety and fearfulness in rhesus monkeys. When subjects were four months old, plasma cortisol was obtained. When subjects were adolescents (M_age = 44.88 months), another plasma cortisol sample was obtained about one month prior to allowing them unfettered access to an 8.4% (v/v) aspartame-sweetened alcohol solution for one hour a day over five-to-seven weeks. Results showed that behavioral indications of anxiety-like temperament in infancy, including high levels of mother-infant mutual ventral contact, low levels of environmental exploration, and low levels of interactions with peers were predictive of high adolescent alcohol intake (ie, drinking to intoxication). Plasma cortisol levels in infancy were positively correlated with plasma cortisol in adolescence, and both were positively correlated with high adolescent alcohol intake. Our findings indicate that high levels of traditional anxiety-like behaviors measured in the context of mother-infant interactions, coupled with high infant and adolescent plasma cortisol, are associated with binge-like high alcohol intake in adolescence, suggesting that individuals at risk for developing an AUD later in life may be determined, at least in part, by assessing their physiological and behavioral propensity for anxiety early in life.

Comparison of self-reports and biological measures for alcohol, tobacco, and illicit drugs consumption in psychiatric inpatients

Background

Asking psychiatric in-patients about their drug consumption is unlikely to yield reliable results, particularly where alcohol and illicit drug use is involved. The main aim of this study was to compare spontaneous self-reports of drug use in hospitalized psychiatric patients to biological measures of same. A secondary aim was to determine which personal factors were associated with the use of tobacco, alcohol, and illicit drugs as indicated by these biological measures.

Methods

The consumption of substances was investigated using biological measures (urine cotinine, cannabis, opiates, cocaine, amphetamines and barbiturates; blood carbohydrate-deficient transferrin [CDT] and gamma-glutamyl transferase [GGT]) in 486 consecutively admitted psychiatric patients, one day following their hospitalization. Patients’ self-reports of alcohol, tobacco and illicit drugs consumption were recorded. Socio-professional and familial data were also recorded.

Results

The results show a low correlation between biological measures and self-reported consumption of alcohol and illicit drugs. Fifty-two percent of the patients under-reported their consumption of illicit drugs (kappa = .47). Patients with schizophrenia and personality disorders were more likely to disclose their illicit drug consumption relative to patients suffering from mood disorders and alcohol dependence. Fifty-six percent of patients underreported alcohol use, as evaluated by CDT (kappa = .2), and 37% underreported when using the CDT + GGT measure as an indicator. Smoking appeared to be reported adequately. In the study we observed a strong negative correlation between cannabis use and age, a strong correlation between tobacco and cannabis use, and correlations between tobacco, cannabis and alcohol consumption.

Conclusion

This study is the first to compare self-reports and biological measures of alcohol, tobacco and illicit drug uses in a large sample of inpatients suffering from various categories of psychiatric illnesses, allowing for cross-diagnosis comparisons.

Monitoring young lifestyles (MyLife) - a prospective longitudinal quantitative and qualitative study of youth development and substance use in Norway

PURPOSE

The Monitoring Young Lifestyles (MyLife) project was initiated as an integrated quantitative and qualitative prospective investigation of correlates, causes, and consequences of adolescent substance use and other addictive behaviours in Norway.

PARTICIPANTS

The MyLife cohort was recruited from middle schools in Norway, which were selected from low, medium and high standard of living areas in both rural and urban regions of the country. A total of 3512 eighth, ninth and tenth graders (55% girls) from 33 schools were enrolled in the quantitative project arm (QT), while a total of 120 eighth graders (52% girls) from six schools were enrolled in the qualitative project arm (QL).

FINDINGS TO DATE

QT baseline was conducted in the fall of 2017, when 2975 adolescents completed an online questionnaire at school during a regular class time. A total of 2857 adolescents participated in the first QT follow-up 1 year later. QL baseline was conducted across the fall semesters of 2014 (one class) and 2015 (five classes), when a total of 118 eighth graders completed face-to-face interviews. QL follow-ups were conducted in the spring of 2015 and fall of 2017 (n=98) for group interviews, and in the spring of 2017 and 2018 (n=95) for individual interviews. In terms of additional data sources, a total of 3035 parents consented to own participation, of which 1899 completed a brief online questionnaire at QT baseline in late 2017. School principals completed brief surveys at the same time.

FUTURE PLANS

Both QT and QL arms have planned follow-ups through 2021. Consents were obtained for individual-level linkages of adolescent and parental quantitative surveys to each other, as well as to the information available in multiple national registries and databases. These supplemental data sources will provide key information on additional putative exposures as well as on the long-term health, educational, and social outcomes of the MyLife participants.

Age-Specific Associations Between Violence Exposure and Past 30-Day Marijuana and Alcohol Use

Using data from a cohort study of students at risk for high school dropout, we examined associations between violence exposure and past 30-day alcohol and marijuana use. We used varying-coefficient regression with person-level fixed effects to estimate how those associations changed within-person across ages approximately 14-23. Generally, violence perpetration was most strongly associated with substance use, within-person. Substance use became increasingly associated with both observed violence and violence perpetration during early/middle adolescence; this increase continued longer into development (age 18+) for alcohol use. Across most of the age range studied here, violence victimization was minimally associated with within-person changes in substance use. Results indicate age-specific associations between violence exposure and alcohol and other drug use, which may be useful for informing prevention strategies.

Are non-psychiatric hospitalisations before self-harm associated with an increased risk for suicide among young people?

OBJECTIVE

This study aimed to investigate any increased risk for suicide in young people with admission for self-harm and if the risk is further increased due to somatic inpatient admissions before a first act of self-harm.

METHODS

This register study included 16,235 cases in the ages 16-24, with a first admission for self-harm, and 32,465 matched controls. All admissions and diagnoses were recorded from the year preceding cases first admission for self-harm. Subjects were followed until death or end of study, registering the cause of death for all deceased. Group differences were analysed using survival analysis with death by suicide as primary outcome.

RESULTS

In cases with a previous somatic admission, the risk for death by suicide during the study period was higher than in cases without a somatic admission (457 and 316 suicides per 100,000 people and year, respectively, p = 0.01). For cases with a somatic admission, the hazard ratio was 1.43 (95% confidence interval 1.04-1.98) compared with those without somatic admissions (controlled for age, sex and psychiatric admission). Survival of cases with a previous somatic admission compared with those without was 98.4% versus 99.2% after the first year, 97.8% versus 98.9% after the second year, and 95.5% versus 96.9% after the tenth year.

CONCLUSIONS

This study suggests that admission for physical illness before self-harm is associated with a higher risk for suicide among young people, and that their contact with healthcare due to physical problems could provide an opportunity to detect suicide risk.

Family and Peer Influences on Substance Attitudes and Use among Juvenile Justice-Involved Youth

Juvenile justice-involved youth experience high rates of substance use, which is concerning given associated negative consequences, including health and functional deficits. Family and peer factors are associated with a high risk of substance use among justice-involved youth. It is hypothesized that this risk process operates through pro-drug attitudes. However, limited research has been conducted on the mechanisms through which family and peer factors increase risk for substance use among juvenile justice involved youth. The current study examined both the direct and indirect effects of family and peer substance use on youth's substance use (alcohol and illicit drug use). We also examined whether this relationship differs by race. 226 detained youth (81.9% male; 74.3% Black) were recruited from an urban county in the Midwest and completed a clinical interview and substance use assessment battery. A direct effect of family/peer risk on illicit drug use was found for all youth, though the effect was stronger among White youth. Results also supported the indirect effect pathway from family/peer risk to both illicit drug use and alcohol use through pro-drug attitudes. This pathway did not vary by race. These findings suggest that interventions should focus on targeting both family/peer risk and pro-drug attitudes to reduce substance use. Given the racial difference in the direct effect of family/peer risk on illicit drug use, there may be other factors that influence risk more strongly for White youth, which warrants further investigation.

Disclosure, Stigma, and Social Support among Young People Receiving Treatment for Substance Use Disorders and their Caregivers: A Qualitative Analysis

Relational processes (i.e., disclosure, stigma, social support) experienced by youth with substance use disorders (SUDs) and their caregivers may act as barriers to, or facilitators of, recovery but are understudied. Single-session qualitative semi-structured interviews were conducted with 19 patients and 15 caregivers recruited by clinicians from a SUD program. There was variability in disclosure experiences, including how many people knew about patients' SUD diagnosis and treatment, whether patients or caregivers primarily disclosed to others, and feelings about others knowing about one's or one's child's SUD treatment. After disclosing, patients and caregivers experienced stigmatizing (e.g., social rejection) and supportive (e.g., understanding, advice) reactions from others. Disclosures may have important implications for relationship and recovery-related outcomes. Moreover, some child-caregiver pairs have significant disagreements regarding disclosure of SUD treatment. Addressing relational processes within treatment by encouraging patients and caregivers to share the disclosure decision-making process may support the recovery of youth with SUDs.

Past 15-year trends in lifetime cocaine use among US high school students

BACKGROUND

Most recent research on adolescent drug use has focused on alcohol, tobacco, and marijuana. Less is known about the recent epidemiology of adolescent cocaine use, which has serious health consequences.

PURPOSE

To describe recent trends in cocaine use by U.S. high school students, and identify differences in lifetime and repeated use across sex and racial/ethnic groups.

METHODS

We used data from the national Youth Risk Behavior Surveys (YRBS) from 1999 to 2015. We estimated the prevalence of lifetime cocaine use (LCU) and repeated lifetime cocaine use (RLCU) across years by race/ethnicity and sex and tested for linear and quadratic trends.

RESULTS

The prevalence of LCU decreased from 1999 to 2015 (9.54%-5.19%). RLCU also decreased (5.13%-2.84%). Despite the overall decline, LCU and RLCU both rose between 2009-2015 (LCU:2.78%-5.19%, RLCU:1.58%-2.84%). Boys had higher rates of LCU and RLCU than girls (LCU:6.42% vs 4.65%; RLCU:3.69% vs 2.18%). American Indian/Alaskan Native, Native Hawaiian/Pacific Islander, and Hispanic adolescents had the highest overall prevalence of LCU. Black adolescents' LCU patterns differed from other racial/ethnic groups. The prevalence of LCU among Black boys increased over time, while the prevalence for Black girls remained consistently low.

CONCLUSIONS

Adolescent cocaine use is less common today than in the 1990s. However, rates of adolescent cocaine use have risen across all racial/ethnic groups in the past few years. Public health efforts should address at risk groups with particularly high or rising rates of cocaine use.

Treatment motivation among caregivers and adolescents with substance use disorders

Substance use disorders (SUDs) in adolescence have negative long-term health effects, which can be mitigated through successful treatment. Caregivers play a central role in adolescent treatment involvement; however, studies have not examined treatment motivation and pressures to enter treatment in caregiver/adolescent dyads. Research suggests that internally motivated treatment (in contrast to coerced treatment) tends to lead to better outcomes. We used Self-determination theory (SDT) to examine intersecting motivational narratives among caregivers and adolescents in SUD treatment. Relationships between motivation, interpretation of caregiver pressures, adolescent autonomy, and relatedness were also explored. Adolescents in SUD treatment and their caregivers (N_Dyads=15) were interviewed about treatment experiences. Interviews were coded for treatment motivation, including extrinsic (e.g., motivated by punishment), introjected (e.g., motivated by guilt), and identified/integrated motivation (e.g., seeing a behavior as integral to the self). Internalization of treatment motivation, autonomy support/competence (e.g., caregiver support for adolescent decisions), and relatedness (e.g., acceptance and support) were also coded. Four dyadic categories were identified: agreement that treatment was motivated by the adolescent (intrinsic); agreement that treatment was motivated by the caregiver (extrinsic); agreement that treatment was motivated by both, or a shift towards adolescent control (mixed/transitional); and disagreement (adolescents and caregivers each claimed they motivated treatment; conflicting). Autonomy support and relatedness were most prominent in intrinsic dyads, and least prominent in extrinsic dyads. The mixed/transitional group was also high in autonomy support and relatedness. The extrinsic group characterized caregiver rules as an unwelcome mechanism for behavioral control; caregivers in the other groups saw rules as a way to build adolescent competence and repair relationships, and adolescents saw rules as indicating care rather than control. Adolescents with intrinsic motivations were the most engaged in treatment. Results suggest the importance of intrinsically motivated treatment, and highlight autonomy support and relatedness as mechanisms that might facilitate treatment engagement.

Non-psychiatric inpatient care preceding admission for self-harm in young people

OBJECTIVE

Many young people contact health services before they harm themselves intentionally. However, they often seek care for non-suicidal or non-psychiatric causes despite having suicidal thoughts. We investigated the non-psychiatric hospital diagnoses received by young people during the year before their first admission to hospital for self-harm.

METHODS

From a national register, we selected people who were hospitalised for an episode of self-harm during the period 1999-2009, at which time they were aged 16 to 24. We compared them with matched controls regarding the probability for having been admitted with different diagnoses during the year preceding the self-harm admission.

RESULTS

The study included 48,705 young people (16,235 cases and 32,470 controls). Those admitted for self-harm were more likely than controls to have been hospitalised for non-psychiatric reasons, which included symptomatic diagnoses such as abdominal pain, syncope/collapse, unspecified convulsions, and chest pain. Certain chronic somatic illnesses were also overrepresented, such as epilepsy, diabetes mellitus type 1, and asthma.

CONCLUSION

Symptomatic diagnoses were more common in those who had been admitted for self-harm. It is possible that psychiatric problems could have been the cause of the symptoms in some of these admissions where no underlying illness could be found, and if this was not uncovered it might lead to a delay in suicide risk assessment. For several chronic illnesses, when admitted to hospital, a psychiatric evaluation might be indicated.

A Role for Epigenetics in Broadening the Scope of Pediatric Care in the Prevention of Adolescent Smoking

Adolescence presents a critical opportunity to support the development of healthy patterns of behavior and prevent future health problems. Unfortunately, there is not yet a well-developed prevention model that allows pediatricians to initiate and monitor prevention efforts for the substantial minority of individuals who engage in risky behavior during adolescence. We suggest that recently developed epigenetic technologies may provide a bridge to a new prevention paradigm in which pediatricians screen for indicated smoking prevention services. Specifically, since currently available tobacco use screening measures are insensitive to low levels of use, newly developed methylation based approaches may enhance the sensitivity of the initial screening for nascent smoking behavior as well monitoring of outcomes. We conclude that the incorporation of Next Gen screening technologies into standard pediatric evaluations may allow for more effective referral to prevention programming for tobacco use. In addition to the potential direct impact on long-term enhancement of health outcomes secondary to smoking prevention, well-established links between smoking and other risk behaviors suggest that expanded referral for nascent smoking may also create opportunities to address other risky adolescent behaviors, and so decrease several interrelated drivers of long-term health care costs.

Screening and Treatment for Alcohol, Tobacco and Opioid Use Disorders: A Survey of Family Physicians across Ontario

INTRODUCTION

As a primary point of contact within the health care system, family physicians are able to play a vital role in identifying individuals with substance use disorders and connecting them to the appropriate treatment. However, there is very little data available on whether family physicians are actively screening for and treating substance use disorders. The objective of the current survey was to assess whether family physicians in Ontario are screening for alcohol, opioid and tobacco use disorders, using validated tools and providing treatment.

METHODS

An online survey consisting of a series of 38 primarily close-ended questions was circulated to family physicians in Ontario. Rates of screening for alcohol, opioid and tobacco dependence, use of validated tools for screening, providing treatment for dependent individuals and the current barriers to the prescription of pharmacotherapies for these drug dependences were assessed.

RESULTS

The use of validated screening tools was limited for all three substances. Screening by family physicians for the substance use disorders among adolescents was much lower than screening among adults. Pharmacotherapy was more commonly used as an intervention for tobacco dependence than for alcohol and opioid dependence. This was explained by the lack of knowledge among family physicians on the pharmacotherapies for alcohol and opioid dependence.

CONCLUSIONS

Findings from the current study suggest there is a need for family physicians to integrate screening for substance use disorders using validated tools into their standard medical practice. Furthermore, there is a need for increased knowledge on pharmacotherapies for alcohol and opioid use disorders. It is important to note that the low response rate is a major limitation to this study. One possible reason for this low response rate may be a lack of interest and awareness among family physicians on the importance of screening and treatment of substance use disorders in Ontario.

Underage drinking among Asian American and Pacific Islander adolescents

This study assessed the prevalence of alcohol abuse and dependence rates among four major ethnic groups of Hawai'i and examined the relationship among risk factors, protective factors, and demographic variables related to underage drinking. A total of 196 students were administered the Diagnostic Interview Schedule for Children, the American Drug and Alcohol Survey, and the Prevention Planning Survey. Drinking rates for Native Hawaiian students were significantly higher than those for Japanese and Caucasian students. Multiple logistic regression models accounted for 49% of the variance for any alcohol use. Ethnic group differences were found when data were disaggregated for Asian and Pacific Islander students.

Early adolescent patterns of alcohol, cigarettes, and marijuana polysubstance use and young adult substance use outcomes in a nationally representative sample

BACKGROUND

Alcohol, tobacco and marijuana are the most commonly used drugs by adolescents in the U.S. However, little is known about the patterning of early adolescent substance use, and its implications for problematic involvement with substances in young adulthood. We examined patterns of substance use prior to age 16, and their associations with young adult substance use behaviors and substance use disorders in a nationally representative sample of U.S. adolescents.

METHOD

Using data from Wave 4 of the Add Health Survey (n=4245), we estimated the prevalence of various patterns of early adolescent use of alcohol, cigarettes, and marijuana use individually and in combination. Then we examined the effects of patterns of early use of these substances on subsequent young adult substance use behaviors and DSM-IV substance use disorders.

RESULTS

While 34.4% of individuals reported no substance use prior to age 16, 34.1% reported either early use of both alcohol and marijuana or alcohol, marijuana and cigarettes, indicating the relatively high prevalence of this type of polysubstance use behavior among U.S. adolescents. Early adolescent use of all three substances was most strongly associated with a spectrum of young adult substance use problems, as well as DSM-IV substance use disorder diagnoses.

CONCLUSIONS

This research confirms the elevated prevalence and importance of polysubstance use behavior among adolescents prior to age 16, and puts early onset of alcohol, marijuana and cigarette use into the context of use patterns rather than single drug exposures.

Screening instruments for substance use and brief interventions targeting adolescents in primary care: a literature review

BACKGROUND

A review of the literature was conducted to examine substance use screening instruments commonly used with adolescents in medical settings, their comparative usefulness, and SBIRT (Screening, Brief Intervention, and Referral to Treatment).

METHODS

We screened two databases (Ovid MEDLINE and PsycINFO) targeting journal articles dealing with screening for alcohol and drug use in adolescence as well as adolescent SBIRT.

RESULTS

Adolescents preferred paper forms and computerized questionnaires over interviews with physicians or nurses. The CRAFFT was the best studied instrument for screening for alcohol/drug use and related problems, and is the only tool with data to support its use in medical settings. Other screening instruments require more testing/evaluation in more representative samples of adolescents in primary care settings. Long term follow-up data to establish the efficacy of SBIRT in adolescence are not available. Innovative computerized approaches to screening for substance use in this population have recently been proposed. Although promising, they require further evaluation.

CONCLUSIONS

The CRAFFT has the most consistent data to support its use in primary care settings. The effects of SBIRT in adolescence have not been adequately evaluated. Adolescents' opinions and preferences for SBIRT should be studied to improve their acceptance.

Pharmacotherapy for adolescent alcohol use disorder

Alcohol use disorder (AUD) occurs in few young adolescents, but is as common as in adults by the late teens. To address problems with the current American Psychiatric Association DSM-IV criteria, the anticipated DSM-V will eliminate the distinction between substance abuse and dependence in favour of a single category. For adolescents, pharmacotherapy for AUD may target alcohol withdrawal symptoms, alcohol consumption reinforcement properties, craving or co-morbid mental disorders. While uncommon among adolescents, severe alcohol withdrawal may require the closely monitored application of benzodiazepines. Disulfiram alters alcohol metabolism and has been shown to increase abstinence in adolescents with AUD, but sufficient motivation to maintain abstinence is needed for this approach to be appropriate. Medications to reduce alcohol craving, including naltrexone and acamprosate, may also assist some adolescents in maintaining abstinence. Adolescents with AUD typically also have co-morbid mental disorders and problems with other substances. Co-morbid mental disorders, such as major depressive disorder and attention-deficit hyperactivity disorder, may be addressed by pharmacotherapy. The potential for interactions between prescribed medications and alcohol or illicit substances necessitates patient education and monitoring. While there is a paucity of empirical information on the applicability of these pharmacotherapy approaches in adolescents, cautious application of these medications in selected cases in the context of systematic psychosocial interventions is warranted to promote abstinence and address associated problems.

Youth recovery contexts: the incremental effects of 12-step attendance and involvement on adolescent outpatient outcomes

BACKGROUND

A major barrier to youth recovery is finding suitable sobriety-supportive social contexts. National studies reveal most adolescent addiction treatment programs link youths to community 12-step fellowships to help meet this challenge, but little is known empirically regarding the extent to which adolescents attend and benefit from 12-step meetings or whether they derive additional gains from active involvement in prescribed 12-step activities (e.g., contact with a sponsor and other fellowship members). Greater knowledge in this area would enhance the efficiency of clinical continuing care recommendations.

METHODS

Adolescent outpatients (N = 127; M age 16.7; 75% male; 87% white) enrolled in a naturalistic study of treatment effectiveness were assessed at intake and 3, 6, and 12 months later using standardized assessments. Mixed-effects models, controlling for static and time-varying confounds, examined the concurrent and lagged effects of 12-step attendance and active involvement on abstinence over time.

RESULTS

The proportion attending 12-step meetings was relatively low across follow-up (24 to 29%), but more frequent attendance was independently associated with greater abstinence in concurrent and, to a lesser extent, lagged models. An 8-item composite measure of 12-step involvement did not enhance outcomes over and above attendance, but separate components did; specifically, greater contact with a 12-step sponsor outside of meetings and more verbal participation during meetings.

CONCLUSIONS

The benefits of 12-step participation observed among adult samples extend to adolescent outpatients. Community 12-step fellowships appear to provide a useful sobriety-supportive social context for youths seeking recovery, but evidence-based youth-specific 12-step facilitation strategies are needed to enhance outpatient attendance rates.

Selected sociodemographic factors and related differences in patterns of alcohol use among university students in Slovakia

Background

Alcohol use and misuse and their relation to sociodemograhic factors are well studied among university students in Western European countries and the USA, but less is known about students in Eastern Europe. The historical past as communistic countries might have affected the social life among these populations, which is again one of the main factors determining the alcohol consumption among university students. The aim of our study was to assess the association of selected sociodemographic factors with different patterns of alcohol use among university students in Slovakia.

Methods

A sample of 813 young adults (mean age 21.1 years, 63.8% females; response rate of 71%) from four universities in Kosice answered questions about their sociodemographic background and about alcohol use. To obtain a detailed picture of different aspects, alcohol use was measured by four variables: frequency of alcohol use, heavy episodic drinking, frequency of drunkenness and problem drinking. Four separate logistic regression models were used to assess the association between sociodemographic and alcohol-related variables. To assess the potentially different effects in both genders, all two-way interactions with gender were tested.

Results

While 41% of the students drank alcohol once a week or more often, 77% reported heavy episodic drinking and 49% had been drunk more than once in the last month. Problem drinking existed in 23.3% of the sample. Gender was consistently associated with all four alcohol-related variables, with males being at higher risk. A higher study year was associated only with lower levels of heavy episodic drinking, but displayed no association with the other studied variables. Living with parents during the semester was consistently associated with less frequent heavy episodic drinking, drunkenness episodes, and problem drinking while having an intimate relationship was associated with less problem drinking only.

Conclusions

Our findings for the university students from Slovakia are in line with previous studies in Western Europe. Additionally, it appears that frequent alcohol use, excessive alcohol use (heavy episodic drinking and drunkenness) and problem drinking among university students represent a continuum and are influenced by the same sociodemographic factors.

Influence of religiosity on 12-step participation and treatment response among substance-dependent adolescents

OBJECTIVE

Religious practices among adults are associated with more 12-step participation which, in turn, is linked to better treatment outcomes. Despite recommendations for adolescents to participate in mutual-help groups, little is known about how religious practices influence youth 12-step engagement and outcomes. This study examined the relationships among lifetime religiosity, during-treatment 12-step participation, and outcomes among adolescents, and tested whether any observed beneficial relation between higher religiosity and outcome could be explained by increased 12-step participation.

METHOD

Adolescents (n = 195; 52% female, ages 14-18) court-referred to a 2-month residential treatment were assessed at intake and discharge. Lifetime religiosity was assessed with the Religious Background and Behaviors Questionnaire; 12-step assessments measured meeting attendance, step work (General Alcoholics Anonymous Tools of Recovery), and Alcoholics Anonymous (AA)/Narcotics Anonymous (NA)-related helping. Substance-related outcomes and psychosocial outcomes were assessed with toxicology screens, the Adolescent-Obsessive Compulsive Drinking Scale, the Children's Global Assessment Scale, and the Narcissistic Personality Inventory.

RESULTS

Greater lifetime formal religious practices at intake were associated with increased step work and AA/NA-related helping during treatment, which in turn were linked to improved substance outcomes, global functioning, and reduced narcissistic entitlement. Increased step work mediated the effect of religious practices on increased abstinence, whereas AA/NA-related helping mediated the effect of religiosity on reduced craving and entitlement.

CONCLUSIONS

Findings extend the evidence for the protective effects of lifetime religious behaviors to an improved treatment response among adolescents and provide preliminary support for the 12-step proposition that helping others in recovery may lead to better outcomes. Youth with low or no lifetime religious practices may assimilate less well into 12-step-oriented treatment and may need additional 12-step facilitation, or a different approach, to enhance treatment response.

Life Stress, Coping and Comorbid Youth: An Examination of the Stress-Vulnerability Model for Substance Relapse

The stress-vulnerability model of addiction relapse states that the impact of life stress on alcohol and other drug use is influenced by several types of psychosocial risk and protective factors. Coping skills have been shown to be protective against alcohol or other drug use in adolescents and adults. To date, the influence of life stress and coping on addiction relapse has not been investigated among substance use disordered youth with comorbid Axis I psychopathology. In the present study, 80 adolescents, ages 13 to 17, were followed six months after treatment for substance use and Axis I disorders. Participants completed measures of psychopathology, substance use, life stressors and coping during treatment and at three and six months following treatment. Coping ability best predicted youth substance use at six months. Negative life events moderated the relation between coping and frequency of substance use. These results suggest that coping is a protective factor for return to substance involvement post-treatment, particularly for comorbid youth who have experienced high levels of life stress.

The impact of truant and alcohol-related behavior on educational aspirations: a study of US high school seniors

BACKGROUND

Truancy and alcohol use are quality indicators of academic achievement and success. However, there remains a paucity of substantive research articulating the impact these deviant behaviors have on an adolescent's educational aspirations. The purpose of this study is to assess whether recent alcohol use and truancy impact students' educational aspirations among a nationally representative sample of US high school seniors.

METHODS

This study conducted a secondary data analysis of the Monitoring the Future project data, 2006. Logistic regression was conducted to assess how alcohol use and truancy affected educational aspirations. Subsequent interaction effects were assessed in the final multivariable model. Demographic variables such as age, sex, race, and father and mother's educational level were included as covariates in the regression model.

RESULTS

Results indicate that as students engage in increased alcohol use and/or truancy, educational aspirations decrease. Thus, students who indicated a desire to attend a 4-year college/university were less likely to engage in high-risk drinking behavior and/or truancy. Moreover, in testing the interaction between truancy and alcohol use, as it relates to educational aspirations, the logistic regression model found both of these independent variables to be statistically significant predictors of the likelihood students would attend a 4-year college/university.

CONCLUSIONS

To ensure that adolescents further their education and maximize their potential life opportunities, school and public health officials should initiate efforts to reduce alcohol consumption and truancy among students. Furthermore, future research should examine the risk and protective factors that may influence one's educational aspirations.

The influence of behavioural and health problems on alcohol and drug use in late adolescence - a follow up study of 2 399 young Norwegians

BACKGROUND

Both early alcohol debut, behavioural and health problems are reported to enhance adolescence substance use. This prospective study investigate the influence of behavioural and health problems on adolescents' alcohol and drug use.

METHOD

Prospective population based cohort study of 2 399 adolescents attending the Young-HUNT study, aged 13-15 at baseline in 1995/97, and 17-19 at follow-up 4 years later. Exposure variables were self reported conduct problems, attention problems, anxiety and depressive symptoms, and muscular pain and tension. Outcome variables at follow-up were frequent alcohol use and initiation of drug use. Associations were estimated by logistic regression models, influence of gender and drinking status at baseline were controlled for by stratification.

RESULTS

At follow-up 19% of the students drank alcohol once a week or more frequently. Baseline conduct problems (OR 2.2, CI 1.7-3.0) and attention problems (OR 1.5, CI 1.2-2.0) increased the risk for frequent alcohol use at follow-up in the total population. Girls who had experienced alcohol-intoxications at baseline showed strong association between baseline problems and frequent alcohol use at follow-up. Conduct problems (OR 2.5, CI 1.3-4.8), attention problems (OR 2.1, CI 1.2-3.4), anxiety/depressive symptoms (OR 1.9, CI 1.1-3.1) and muscular pain and tension (OR 1.7, CI 1.0-2.9) all were associated with frequent alcohol use among early intoxicated girls.14% of the students had tried cannabis or other drugs at follow-up. Conduct problems at baseline increased the odds for drug use (OR 2.6, CI 1.9-3.6). Any alcohol intoxications at baseline, predicted both frequent alcohol use (boys OR 3.6, CI 2.4-5.2; girls OR 2.8, CI 1.9-4.1), and illegal drug use (boys OR 4.7; CI 3.2-7.0, girls OR 7.7, CI 5.2-11.5) within follow-up.

CONCLUSIONS

Conduct problems in high-school more than doubles the risk for both frequent alcohol use and initiation of drug use later in adolescence. The combination of health problems and alcohol intoxication in early adolescence was closely associated with more frequent drinking later in adolescence among girls.Overall, early alcohol intoxication was closely associated with both frequent alcohol use and drug use at follow up in both genders.

Prevalence and perceived health effect of alcohol use among male undergraduate students in Owerri, South-East Nigeria: a descriptive cross-sectional study

BACKGROUND

Alcohol use during adolescence and young adulthood remains a prominent public health problem. Despite growing problems of global alcohol abuse, accurate information on the prevalence and pattern of use in Nigeria remain sparse. This study examines the prevalence and perceived health effects of alcohol use among undergraduate students in Owerri, Nigeria.

METHOD

The prevalence and perceived health effects of alcohol was estimated for 482 male undergraduates of four higher institutions in Owerri, South-East Nigeria between October 2008 and March 2009. Information was obtained using a semi-structured, self-administered questionnaire.

RESULT

The mean age of the students was 24.7 years. Majority of the respondents confirmed they were current users of alcohol given a prevalence of 78.4%, with twenty-seven percent of them being heavy drinkers (≥ 4 drinks per day). Reasons given by respondents for alcohol drinking include: makes them feel high (24.4%); makes them belong to the group of "most happening guys" on campus (6.6%); makes them feel relaxed (52.6%) while (16.4%) drinks it because their best friends do. Perceived health impacts of alcohol use among current users include: it enhances pleasure during moment of sex (51.1%), causes drowsiness and weakness (63.8%), may precipitate defective memory and impaired perception (64.3%) and serves as risk factor for most chronic diseases (68.5%).

CONCLUSION

High prevalence of alcohol use was established among study groups. Evaluation of full-scale community-level intervention, including community mobilisation and media advocacy aimed at supporting changes in policies on drinking, access and sales of alcohol to young people, could be helpful in reducing the trend.

The social contagion effect of marijuana use among adolescents

BACKGROUND

Research on adolescent substance use has consistently identified a strong relationship between adolescent behavior and the behavior of their peers. However, peer effects are difficult to estimate and causal interpretations must be undertaken with caution since individuals in most cases choose with whom to associate. In this paper we seek to empirically quantify the causal role of peer social networks in explaining marijuana usage among adolescents.

METHODS AND FINDINGS

Using data from a nationally representative sample of adolescents we utilize a multivariate structural model with school-level fixed effects to account for the problems of contextual effects, correlated effects and peer selections to purge the potential biases from the estimates of peer influence. Our peer group measures are drawn not only from the nomination of close friends (N = 6,377), but also from classmates (N = 19,335). Marijuana usage among the peer groups were constructed using the peers' own report of their marijuana consumption. Controlling for parent level characteristics, and other demographic parameters, we find that a 10% increase in the proportion of close friends and classmates who use marijuana increases the probability that an individual chooses to use marijuana by 5%.

CONCLUSION

Our findings indicate that peer effects are important determinants of marijuana use even after controlling for potential biases We also found evidence to show that the influence of close friends and the more exogenous classmates are quite similar in magnitude under our preferred specification, supporting theory predicting the importance of peer influence. Effective policy aimed at reducing marijuana usage among adolescents would consider these significant peer effects.

Client characteristics within the Chilean National Youth Addiction Treatment Demonstration System

In the context of an evaluation of a national demonstration program for youth addiction treatment in Chile, a sociodemographic and substance use profile of children and adolescents accessing services through this new program was developed. Information regarding sociodemographic factors, substance use, and problem severity; services used; and unmet needs was retrospectively gathered for all clients (685) admitted between January 1 and June 30, 2006. Thirty-two treatment centers (91.4%) provided data. The client population profile reflected severe psychosocial circumstances (e.g., 61.4% early exit from school). Of the population, 64.9% were classified in the highest substance risk level. The primary drug reported was cocaine-paste-base (52.7%). Comparisons to similar data in other countries illustrate the more severe profile of this Chilean treatment sample. The results suggest the need for increased outreach and comprehensive intersectoral approaches. Monitoring and evaluation should become part of the culture of the national drug treatment system in Chile and other countries.

Factors associated with sexual initiation and condom use among adolescents on Santiago Island, Cape Verde, West Africa

The current study focuses on factors associated with sexual initiation and condom use among teenagers on Santiago Island, Cape Verde, according to gender. This was a representative, probabilistic sample of 13-to-17-year-olds (n = 768) attending public secondary schools on Santiago Island in 2007. Associations were tested by test of proportion, Pearson's chi-square, or Fisher's exact test and logistic regression. Factors related to sexual initiation among boys were: age over 14 years, Catholic religion, and alcohol consumption. For girls, the factors included: > 9 years of schooling and involvement in an affective-sexual relationship. Unlike other Sub-Saharan countries, this study showed a high prevalence of condom use during initial sexual activity. Adolescents are able to safely begin sexually active life if they have access to information, sex education, and other STD prevention and contraceptive methods. This study provides insights on the development of policies to reduce the vulnerability of the young population to STD/AIDS and the limits and challenges related to the promotion of condom use and sex education, focusing on unequal gender relations.

Assessment of health risk behaviours and their interrelationships among young people from two counties of Romania

Aim

The first goal of this study was to assess the prevalence of different health risk behaviours among Romanian young people. Next, the interrelationship between different health risk behaviours as well as age and gender differences with respect to health risk behaviours were examined.

Subjects and methods

Self-administered questionnaires were completed by a sample of 1,598 junior high school students, senior high school students and university students from urban and rural areas of two counties of Romania.

Results

The results showed that 31% of junior high school students, 59.7% of senior high school students and 64.8% of university students reported more than one risk behaviour. Many of the risk behaviours were likely to correlate with each other and the strongest correlation was found between smoking, alcohol-related behaviour and precocious sexual intercourse. Factor analysis revealed that among junior high school students all health risk behaviours loaded on one factor. In senior high school students and university students the risk behaviours split into two factors, based probably on their frequency and severity. Factor 1 comprised smoking, alcohol-related behaviours as well as precocious sexual intercourse, while factor 2 included less common behaviours: violence, delinquency and illicit drug use. No gender differences were observed regarding the relationship between health risk behaviours.

Conclusion

The results stress the importance of developing prevention programmes among Romanian youth for the behaviours discussed. Further research is needed to identify how to best offer these programmes: as stand-alone programmes or as an integrated set of programmes and whether the same approach has to be taken for younger and older adolescents.

Alcohol use and physical health in adolescence: a general population survey of 8,983 young people in North-Trøndelag, Norway (the Young-HUNT study)

AIMS

To investigate the relationship between adolescents' alcohol use and physical health.

DESIGN

A total population, cross-sectional survey of adolescents, aged 13-19 years, attending secondary or high school in Nord-Trøndelag County, Norway. 8,983 youths (91%) answered the Young-Hunt questionnaire in the 1995-1997 HUNT-survey.

METHOD

Self-reported data mainly analyzed by logistic regression models. Findings 80% of the respondents had tried alcohol, and 29% reported more than 10 intoxications. Ill health perception was associated with frequent alcohol intoxications. Tension symptoms had the closest relationship to frequency of intoxications in both genders. Girls that frequently used health services had frequent alcohol intoxications.

FUNDING

Central Norway Regional Health and the County Council of Nord-Trøndelag.

CONCLUSIONS

There is a close association of physical health complaints and alcohol intoxication frequency in Norwegian teenagers. The study's limitations were noted.

Risky alcohol use, peer and family relationships and legal involvement in adolescents with antisocial problems

The aim of the study was to examine risk and vulnerability factors contributing to problems with alcohol use in adolescence. Data relating to seven life areas (medical status, school status, social relationships, family background and relationships, psychological functioning, legal involvement, and alcohol use) was gathered using the ADAD (Adolescent Drug Abuse Diagnosis) interview. A total of 1163 Swedish adolescents (809 boys and 354 girls) between the ages of 12 and 20 years old were interviewed. All had antisocial problems and were detained at special youth homes. It was found that for those aged between 12 and 18 years, the general risk factors for alcohol use were leisure and peer problems, problems associated with family background and relationships, and criminal behavior. These results suggest that drug abuse treatment planning should focus on altering the predisposing factors that exist in these domains. It was also found that the ADAD problem areas seem to be most useful as prognostic indicators of treatment outcome for adolescents with antisocial problems who are under 18 years of age.

Drinking context and drinking problems among black, white, and Hispanic men and women in the 1984, 1995, and 2005 U.S. National Alcohol Surveys

OBJECTIVE

The purpose of this study was to investigate the preferred drinking contexts of different gender and ethnic groups (white, black, and Hispanic men and women), by examining where these groups do most of their drinking and to what extent drinking contexts preferences are associated with certain drinking-related consequences.

METHOD

The study used data from the 1984, 1995, and 2005 U.S. National Alcohol Surveys. Among current drinkers, cluster analyses of volume drunk in six contexts (restaurants, bars, others' parties, or when spending a quiet evening at home, having friends drop over at home, and hanging out in public places) were used to classify individuals by their drinking context preferences in each gender by ethnicity subgroup.

RESULTS

We identified three highly similar drinking context-preference clusters within each of the six subgroups: (1) bar-plus group (did most drinking in bars, plus much in other venues), (2) home group (did most drinking at home, and a fair amount elsewhere), and (3) light group (drank almost nothing quietly at home and also less in other settings than the other two clusters). For a number of ethnic-by-gender groups, context preference group assignment predicted drinking-related problems, over and above general drinking patterns. For example, for all groups, the bar-plus preference group relative to the light group showed higher risk of arguments, fighting, and drunk driving, after taking into account the volume consumed, frequency of heavy drinking, age, and year of survey.

CONCLUSIONS

Examining individuals' preferred drinking contexts may provide important information to augment overall drinking patterns in risk and prevention studies.

Association between mental and physical health problems in high-risk adolescents: a longitudinal study

PURPOSE

This longitudinal study examined the relationship between mental and physical health problems in a sample of high-risk youth served in the public sector.

METHODS

Participants included youth aged 9-18 years at baseline, randomly sampled from one of five public service sectors in San Diego County, California, and youths may have been active to more than one sector. Diagnoses for mood, anxiety, and disruptive disorders based on structured diagnostic interviews were determined at baseline and data regarding health-related problems were collected 2 years post-baseline.

RESULTS

Mood and disruptive behavior disorders were related to cumulative health problem incidence, as well as aggregate measures of health problems and severe health problems. In addition mood disorder diagnosis was associated with higher rates of infectious diseases, respiratory problems, and weight problems. Disruptive disorder diagnosis was related to higher rates of risk behavior-related health problems.

CONCLUSIONS

The present work extends the research on the relationship between mental and physical health problems to adolescents served in the public sector, who are at especially high risk for behavioral and emotional problems. Potential mechanisms by which mental health problems may impact health problems are discussed. We suggest the development of effective interagency cooperation between medical and mental health systems to improve the care of youth with comorbid mental and physical disorders.

Psychosocial functioning of adults who experienced substance use disorders as adolescents

The authors examined whether substance use disorder (SUD) before age 19 was associated with functioning at age 30. Participants (N = 773) were assessed twice during adolescence and at ages 24 and 30. Eight of 14 adult measures were associated with adolescent SUD: education, unemployment, income, risky sexual behavior, suicide attempt, coping, stressful life events, and global adjustment. After adolescent comorbidity and functioning and adult SUD were controlled for, education and unemployment remained associated, and three variables emerged as significant: being a parent (significant only for participants without adult SUD), being currently married, and having decreased life satisfaction (significant only for participants with adult SUD). Adolescent SUD is associated with numerous functioning difficulties at age 30, some of which appear to be related to recurrent SUD, comorbid adolescent disorders, or functioning problems already evident in adolescence.

Health care services use by adolescents with intakes into an outpatient alcohol and drug treatment program

We examined utilization and cost in the 1 year pre- and post-intake among a sample of adolescents (N=419) entering chemical dependency (CD) treatment. Multivariate analyses showed that these youth used significantly more medical services than a demographically matched sample of members without substance use (SU) problems. Their utilization and costs were higher than matched members, and they did not show the same reductions in post-treatment costs that adults do. This is of concern since it would appear that the medical and mental health problems of adolescents entering CD treatment may be so severe that there are no short-term reductions in post-treatment cost, including ER and hospitalizations.

The "Six T's": barriers to screening teens for substance abuse in primary care

PURPOSE

To identify barriers to adolescent substance abuse screening in primary care.

METHODS

Focus groups were held at six primary care sites with a total of 38 providers. Providers brainstormed a list of barriers, collectively grouped similar barriers, and voted to produce a final ranked list. Two investigators qualitatively analyzed field notes and transcripts to triangulate findings, ranked the barriers across all sites by the number of groups identifying the barrier, then calculated a mean ranking (MR) for each.

RESULTS

The most commonly identified barrier was insufficient time (MR 1.8). Lack of training in how to manage a positive screen was ranked second (MR 1.7), but was linked to the first. Providers reported they had enough time to administer a short screen, but insufficient time to manage a positive result during the well care visit. The need to triage competing problems (MR 3.0), lack of treatment resources (MR 3.3), tenacious parents who would not leave the room for a confidential discussion (MR 2.5), and unfamiliarity with screening tools (MR 3.0) were also noted by more than one group.

CONCLUSIONS

Insufficient time and lack of training in how to manage positive screens are the greatest barriers to screening adolescents for substance abuse. This suggests that some providers might differentially avoid screening youth who they suspect will screen positive, yet these patients would benefit most from early recognition. More research is needed on effective ways to manage positive substance abuse screens in primary care.

Substance use treatment outcomes for youth: integrating personal and environmental predictors

This investigation examined personal and environmental predictors of substance treatment outcomes in youth. A 424 adolescents (M=15.9 years, S.D.=1.3) completed comprehensive assessments, including substance use, environmental factors (e.g., family history, social supports), and person-centered variables (e.g., Axis I diagnosis, motivation, self-esteem), at study intake and throughout the year following inpatient treatment. Youth treatment outcomes were assessed by relapse status (abstaining, minor relapse, major relapse) and DSM-IV dependence symptoms at 1 year. Relapse status was predicted by demographic (age), environmental (social supports), and person-centered factors (diagnosis) while dependence symptoms were best predicted by substance use variables alone. Consideration of the general and specific nature of risk and protection within the adolescent developmental context were explored.

Medical conditions of adolescents in alcohol and drug treatment: comparison with matched controls

PURPOSE

Alcohol and drug problems are associated with medical problems among adults. Research on the relationship of adolescent alcohol and drug use disorders to specific medical problems is less developed and focused on acute consequences. This study addresses gaps in the literature regarding medical comorbidities in adolescents with alcohol and drug use disorders.

METHODS

This study compares the prevalence of medical conditions among 417 adolescent alcohol and drug treatment patients with 2082 demographically matched controls from the same managed care health plan and examines whether comparisons vary among substance-type subgroups.

RESULTS

Approximately one-fourth of the comorbid conditions examined were more common among adolescent alcohol and drug patients than among matched controls, and several were highly costly conditions (e.g., asthma, injury). We also found that pain-related diagnoses, including headache and abdominal pain, were more prevalent among alcohol and drug patients.

CONCLUSIONS

Our findings point to the importance of examining comorbid medical and chemical dependency in both adolescent primary care and specialty care. Moreover, optimal treatment of many common medical disorders may require identification, intervention, and treatment of a substance use problem.

A prospective test of the negative affect model of substance abuse: moderating effects of social support

The authors tested whether dimensions of negative affect--specifically, trait levels of negative emotionality and state levels of depressive symptoms--increased risk for substance abuse onset and whether perceived social support moderated this relation using data from a 5-year prospective study of 496 school-recruited adolescent girls. Initial negative emotionality, but not depressive symptoms, and deficits in parental, but not peer, support predicted future substance abuse onset in a multivariate hazard model. Tests of the interaction between negative affect dimensions and social support suggested that support did not moderate the relation of negative affect to risk for substance abuse onset. Results provide prospective support for the etiological role in the onset of substance abuse of trait-linked negative affect and of parental support.

The constitutionality of random drug and alcohol testing of students in secondary schools

Adolescent drug and alcohol use is a major public health problem. Multiple studies indicate that substance use is a risk factor for physical and mental disorders in adolescents. Secondary schools and the communities they serve have been facing a long-standing problem of substance abuse. American adolescents have become quite accustomed to drug prevention being a part of their curriculum. However, some policy decisions made by school administrators have been legally challenged. In 1989, Vernonia School District serving a small community in Oregon, instituted a random drug testing policy of its athletes. In 1991, the parents of a seventh grader refused to give their consent for random drug testing. The seventh grader was denied participation in the sport and sued the School District arguing that the school policy violated the Fourth and Fourteenth Amendments to the United States Constitution, and Article I, Section 9 of the Oregon Constitution. In 1995, on appeal to the Supreme Court of the United States, the School District won the case. The Vernonia School District versus Acton case became a landmark case, but random drug and alcohol testing in secondary schools has been a subject of multiple court cases. The authors discuss three of them. Both Federal and State Courts have recognized that a secondary school environment in itself represents "a special need," for which suspicionless searches are sometimes necessary to maintain order, safety, and discipline. Drug and alcohol testing programs in secondary schools may still be challenged on its legality. Therefore, examining court sanctioned programs and their long-term efficacy statistics is recommended.

Alcohol abuse in Russian delinquent adolescents. Associations with comorbid psychopathology, personality and parenting

INTRODUCTION

Adolescent delinquency and alcohol abuse have become a growing concern in Russia. Psychopathology, a dysfunctional family and specific personality factors have all been linked to addictive and antisocial behavior. Since delinquent youth represent a specific risk group, where alcohol misuse tends to be more pronounced than in the general population, the objectives of this study were: 1) to compare differences in personality and parenting factors, and in psychopathology in juvenile delinquents with and without alcohol abuse; and 2) to evaluate the associations between alcohol abuse, personality and parenting factors, after controlling for comorbid psychopathology.

METHODS

Psychopathology, including alcohol abuse, was assessed by means of a psychiatric interview in 229 Russian incarcerated male juvenile delinquents. In addition, alcohol use, personality, and parenting factors were assessed by self-reports.

RESULTS

Alcohol-abusing delinquents (n=138) scored significantly higher on novelty seeking and maternal emotional warmth and reported higher levels of psychopathology, as compared to nonalcohol-abusing delinquents (n=91). Logistic regression analysis demonstrated that personality and parenting factors were significantly related to alcohol abuse, even after controlling for comorbid psychopathology.

CONCLUSION

Alcohol-abusing delinquents are at risk for a wide spectrum of psychiatric disorders. Alcohol abuse is associated with personality and parenting factors independently of comorbid psychopathology. Early interventions with high-risk youths may help to reduce their psychiatric problems and alcohol abuse.