Gender differences in the structure of risk for alcohol use disorder in adolescence and young adulthood

Examining time-varying dynamics of co-occurring depressed mood and anxiety

BACKGROUND

Dimensional frameworks of psychopathology call for multivariate approaches to map co-occurring disorders to index what symptoms emerge when and for whom. Ecological momentary assessment (EMA) offers a method for assessing and differentiating the dynamics of co-occurring symptoms with greater temporal granularity and naturalistic context. The present study used multivariate mixed effects location-scale modeling to characterize the time-varying dynamics of depressed mood and anxiety for women diagnosed with social anxiety disorder (SAD) and major depression (MDD).

METHODS

Women completed five daily EMA surveys over 30 days (150 EMA surveys/woman, T ≈ 5250 total observations) and two clinical diagnostic and retrospective self-report measures administered approximately two months apart.

RESULTS

There was evidence of same-symptom lagged effects (bs = 0.08-0.09), but not cross-symptom lagged effects (bs < 0.01) during EMA. Symptoms co-varied such that momentary spikes from one's typical level of anxiety were associated with increases in momentary depressed mood (b = 0.19) and greater variability of depressed mood (b = 0.06). Similarly, spikes from one's typical levels of depressed mood were associated with increases in momentary anxiety (b = 0.19). Furthermore, the presence and magnitude of effects demonstrated person-specific heterogeneity.

LIMITATIONS

Our findings are constrained to the dynamics of depressed and anxious mood among cisgender women with primary SAD and current or past MDD.

CONCLUSIONS

Findings from this work help to characterize how daily experiences of co-occurring mood and anxiety fluctuate and offer insight to aid the development of momentary, person-specific interventions designed to regulate symptom fluctuations.

Distress symptoms and alcohol consumption: anxiety differentially mediates drinking across gender

Introduction

The consumption of alcohol remains a significant health concern and represents a prevalent form of substance use worldwide. Previous research has identified sex differences in the consumption of alcohol. This study explores the relationship between drinking and the presence of distress symptoms across gender. Based on previous research, it was hypothesized that presence of distress symptoms, defined as increases in anxiety and depression, would be prominent features associated with alcohol consumption among women compared to men.

Methods

A sample of undergraduate students (N = 448) participated in an online-based questionnaire (71% female; M age = 22.1; 42.9% Hispanic/Latino). The questionnaire contained assessments related to demographic information and alcohol consumption over the past 30 days. Anxiety and depression symptoms were assessed using the Hospital Anxiety and Depression Scale.

Results

Gender differences were observed with men consuming more alcoholic drinks than women. However, women who consumed alcohol reported having more distress symptoms relative to their male counterparts. A logistic regression revealed that this gender difference was moderated by anxiety, such that greater anxiety scores associates with whether women consumed alcohol. However, an ordinary least squares regression revealed that for men, anxiety scores significantly related to the amount of drinks consumed. Gender differences were not detected in relation to alcohol consumption and depression.

Conclusion

Our findings contribute to the literature by indicating that the mere presence of distress symptoms reveals distinctive gender-specific differences in relation to alcohol consumption in a non-clinical population. Identifying the distinct associations linked with alcohol use for men and women can aid in reducing drinking disparities among young adults.

Age-varying Associations of Depressive Symptoms and Heavy Episodic Drinking Throughout Adulthood Among People with HIV and Receiving care in Cameroon Within a National "treat all" Policy

Comorbid depression and heavy episodic drinking (HED) may threaten the success of "treat all" policies in sub-Saharan Africa as the population of people with HIV (PWH) ages. We investigated associations between depressive symptoms and heavy episodic drinking (HED) and the extent the relationship differed across ages among PWH receiving HIV care in Cameroon. We conducted a retrospective analysis of 18-60-year-old PWH on antiretroviral therapy in Cameroon from January 2016 to March 2020. Age-varying effect modelling was conducted to assess associations between depressive symptoms and HED across ages and by gender. Prevalence of depression and HED was highest at ages 20 and 25, respectively. After age 25, the magnitude of the association between depressive symptoms and HED was significant and increased until age 30 (aOR: 1.88, 95% CI: 1.48, 2.39), with associations remaining significant until age 55 (aOR: 1.64, 95% CI: 1.17, 2.29). Women had more variability and higher magnitudes of associations between depressive symptoms and HED than men. The interrelationship between depressive symptoms and HED was significant throughout most of adulthood for PWH receiving HIV care in Cameroon. Understanding age and gender trends in these associations can guide integration efforts in HIV care settings.

Mechanical and Heat Hyperalgesia upon Withdrawal From Chronic Intermittent Ethanol Vapor Depends on Sex, Exposure Duration, and Blood Alcohol Concentration in Mice

Approximately half of patients with alcohol use disorder report pain and this can be severe during withdrawal. Many questions remain regarding the importance of biological sex, alcohol exposure paradigm, and stimulus modality to the severity of alcohol withdrawal-induced hyperalgesia. To examine the impact of sex and blood alcohol concentration on the time course of the development of mechanical and heat hyperalgesia, we characterized a mouse model of chronic alcohol withdrawal-induced pain in the presence or absence the alcohol dehydrogenase inhibitor, pyrazole. Male and female C57BL/6J mice underwent chronic intermittent ethanol vapor ± pyrazole exposure for 4 weeks, 4 d/wk to induce ethanol dependence. Hind paw sensitivity to the plantar application of mechanical (von Frey filaments) and radiant heat stimuli were measured during weekly observations at 1, 3, 5, 7, 24, and 48 hours after cessation of ethanol exposure. In the presence of pyrazole, males developed mechanical hyperalgesia after the first week of chronic intermittent ethanol vapor exposure, peaking at 48 hours after cessation of ethanol. By contrast, females did not develop mechanical hyperalgesia until the fourth week; this also required pyrazole and did not peak until 48 hours. Heat hyperalgesia was consistently observed only in females exposed to ethanol and pyrazole; this developed after the first weekly session and peaked at 1 hour. We conclude that Chronic alcohol withdrawal-induced pain develops in a sex-, time-, and blood alcohol concentration-dependent manner in C57BL/6J mice. PERSPECTIVE: Alcohol withdrawal-induced pain is a debilitating condition in individuals with AUD. Our study found mice experience alcohol withdrawal-induced pain in a sex and time course specific manor. These findings will aid in elucidating mechanisms of chronic pain and AUD and will help individuals remain abstinent from alcohol.

Sex differences in externalizing and internalizing traits and ventral striatal responses to monetary loss

Ventral striatum (VS) processes rewarding and punishing stimuli. Women and men vary in externalizing and internalizing traits, which may influence neural responses to reward and punishment. To investigate sex differences in how individual traits influence VS responses to reward and punishment, we curated the data of the Human Connectome Project and identified 981 (473 men) subjects evaluated by the Achenbach Adult Self-Report Syndrome Scales. We processed the imaging data with published routines and extracted VS response (β) to win and to loss vs. baseline in a gambling task for correlation with externalizing and internalizing symptom severity. Men vs. women showed more severe externalizing symptoms and higher VS response to monetary losses (VS-loss β) but not to wins. Men but not women showed a significant, positive correlation between VS-loss β and externalizing traits, and the sex difference was confirmed by a slope test. The correlations of VS-loss vs. externalizing and of VS-win vs. externalizing and those of VS-loss vs. externalizing and of VS-loss vs. internalizing traits both differed significantly in slope, confirming its specificity, in men. Further, the sex-specific relationship between VS-loss β and externalizing trait did not extend to activities during exposure to negative emotion in the face matching task. To conclude, VS responses to loss but not to win and their correlation with externalizing rather than internalizing symptom severity showed sex differences in young adults. The findings highlight the relationship of externalizing traits and VS response to monetary loss and may have implications for psychological models of externalizing behaviors in men.

Depressive symptoms, alcohol use, and alcohol-related consequences: the moderating role of gender among American Indian adolescents

OBJECTIVES

Depression, alcohol use, and alcohol-related consequences are experienced disproportionately by American Indian (AI) adolescents. The co-occurrence of depression and alcohol use is clinically relevant, as it is associated with increased risk for suicide, among other negative consequences. Understanding how the association between depressive symptoms and alcohol use and related consequences is influenced by gender is important to understand for whom intervention efforts might be particularly relevant. Thus, the present study seeks to evaluate gender differences in these associations among AI adolescents.

METHODS

Participants were a representative sample of AI adolescents (N = 3,498, Mage=14.76, 47.8% female) residing on or near reservations who completed self-report questionnaires in school classrooms. Study activities were approved by IRB, school boards, and tribal authorities.

RESULTS

The interaction of depressive symptoms and gender was significant in predicting past-year alcohol use frequency (b=.02, p=.02) and, among youth reporting lifetime alcohol use, alcohol-related consequences (b=.03, p=.001). Analysis of simple slopes revealed that, for females, depressive symptoms were significantly associated with past-year alcohol use frequency (b=.02, p<.001) and alcohol-related consequences (b=.05, p<.001). For males, depressive symptoms were only significantly associated with alcohol-related consequences (b=.02, p=.04), and this effect was weaker than for females.

CONCLUSIONS

Results of the present study may inform the development of gender-sensitive recommendations for the assessment and treatment of alcohol use and alcohol-related consequences among AI adolescents. For instance, results suggest that treatments focusing on depressive symptoms may subsequently reduce alcohol use and related consequences for female AI adolescents.

Emergence of Sex Differences in U.S. Adolescent Substance Use

Background: Adolescence is a common time for experimentation with substance use and the emergence of sex differences in substance use patterns. Although similar in early adolescence, male and female substance use patterns historically diverge by young adulthood, with males using more substances than females. We aim to add to current literature by utilizing a nationally representative sample, assessing a broad range of substances used, and focusing on a sentinel period during which sex differences emerge. We hypothesized that certain sex-specific substance use patterns emerge in adolescence. Methods: Data are from the 2019 Youth Risk Behavior Survey (n = 13,677), a nationally representative sample of high school students. Weighted logistic analyses of covariance adjusting for race/ethnicity evaluated males' and females' substance use (14 outcomes) by age category. Results: Among all adolescents, more males reported illicit substance use and cigarette smoking than females, whereas more females reported prescription opioid misuse, synthetic cannabis use, recent alcohol use, and binge drinking. Divergence between male and female use usually occurred at 18+ years. Odds of using most illicit substances were significantly greater among males than females at age 18+ years (aORs 1.7-4.47). Among 18+ year-olds, males and females did not differ in electronic vapor product use, alcohol use, binge drinking, cannabis use, synthetic cannabis use, cigarette smoking, or prescription opioid misuse. Conclusions: Sex differences in adolescent use of most but not all substances emerge by age 18+ years. Sex-specific patterns of adolescent substance use may inform specific prevention efforts and identify peak ages for intervention.

Externalizing and internalizing problems as predictors of alcohol-related harm and binge drinking in early adolescence: The role of gender

BACKGROUND

Externalizing problems are commonly associated with alcohol outcomes in adolescence. Nevertheless, findings regarding internalizing problems are mixed, and fewer longitudinal studies have considered the both problems concomitantly and the role of gender. We examined the role of externalizing and internalizing problems in predicting adolescent alcohol-related harm and binge drinking, taking into account the gender differences. We also evaluated if externalizing problems could moderate the association between internalizing problems and alcohol outcomes.

METHOD

We used longitudinal data from 2368 8th grade students across 37 public schools in three Brazilian cities. Linear and logistic regressions were performed to analyze the association between alcohol outcomes and the independent variables (externalization and internalization scores, and sociodemographic variables) according to gender. We also tested the same model with an interaction term between externalizing*internalizing.

RESULTS

Our results suggest that externalizing problems predict adolescents' binge drinking in both genders; it also may predict adolescents' alcohol-related harms, but only in boys. Internalizing problems seem to be a gender-specific risk factor for binge drinking among girls. All findings are independent of comorbid problems and sociodemographic variables.

LIMITATION

The findings should be considered taking into account the short follow-up period from risk factors to the outcomes.

CONCLUSION

Our results highlight the contribution of internalizing and externalizing problems to the development of alcohol-related harm and binge drinking in early adolescence and the need for interventions to prevent early behavioral problems that consider the role played by gender.

The Role of Metacognition in The Emergence of Anger and Aggression in Patients with Alcohol Use Disorder Alkol Kullanım Bozukluğu Olan Hastalarda Öfke ve Agresyonun Ortaya Çıkışında Üstbilişin Rolü

ABSTRACT OBJECTIVE: In this study, weaimed to investigate metacognitive functions, anger and aggression and the relationship in patients with alcohol dependence. It is to have information about which metacognitive beliefs plays a role in the emergence of anger and aggression in people with alcohol dependence. METHOD: The patient group diagnosed with Alcohol Use Disorder (AUD) according to DSM-5 (n = 72) and the control group without any psychiatric diagnosis (n = 71) were included in the study. Sociodemographic data form, Alcohol Use Disorders Identification Test (AUDIT), Metacognition Questionnaire (MCQ-30), Trait Anger and Anger Expression Scale (STAXI) and Buss-Perry’s Aggression Questionnaire (AQ) were used. RESULT: In the AUD group, the MCQ-30, STAXI trait anger, anger out and anger in, and AQ scores were found to be significantly higher than the control group (p

Bad mommies: socio-cognitive judgments of single mothers with alcohol use disorder

Gender disparity persists in the United States; women are still paid less than men and are also subject to discrimination in the workplace based on the fact that they may become mothers. Further, there is evidence to indicate that single mothers are judged more harshly than their married mother counterparts and single fathers. As a form of amelioration, some women self medicate with alcohol and according to the CDC), alcohol use disorder (AUD) is on the rise for women. Although there is research on gender disparity, the motherhood penalty, and AUD, there are no experiments testing socio-cognitive judgments on those combined factors and specifically examining what we term "the single motherhood penalty". Therefore, in two experiments using between-participants designs, participants rated a picture of a person (female or male) paired with a brief description where marital status (single or married) and type of ailment (alcohol or physical) was manipulated. In Experiment 1, a passive AUD manipulation did not show a clear single motherhood penalty. In Experiment 2, the results of an active AUD manipulation supported the predicted single motherhood penalty (Experiment 2a), but did not show an analogous single fatherhood penalty (Experiment 2 b). These findings are the first to offer empirical evidence that socio-cognitive judgments might perpetuate the interplay of the single motherhood penalty and AUD.

The role of adolescent social relationships in promoting alcohol resistance: Interrupting the intergenerational transmission of alcohol misuse

Genetic factors contribute to the intergenerational transmission of alcohol misuse, but not all individuals at high genetic risk develop problems. The present study examined adolescent relationships with parents, peers, and romantic partners as predictors of realized resistance, defined as high biological risk for disorder combined with a healthy outcome, to alcohol initiation, heavy episodic drinking, and alcohol use disorder (AUD). Data were from the Collaborative Study on the Genetics of Alcoholism (N = 1,858; 49.9% female; mean age at baseline = 13.91 years). Genetic risk, indexed using family history density and polygenic risk scores for alcohol problems and AUD, was used to define alcohol resistance. Adolescent predictors included parent-child relationship quality, parental monitoring, peer drinking, romantic partner drinking, and social competence. There was little support for the hypothesis that social relationship factors would promote alcohol resistance, with the exception that higher father-child relationship quality was associated with higher resistance to alcohol initiation (β ^ = - 0.19 , 95% CI = -0.35, -0.03). Unexpectedly, social competence was associated with lower resistance to heavy episodic drinking (β ^ = 0.10 , 95% CI = 0.01, 0.20). This pattern of largely null effects underscores how little is known about resistance processes among those at high genetic risk for AUD.

Violent Video Game Exposure and Problem Behaviors among Children and Adolescents: The Mediating Role of Deviant Peer Affiliation for Gender and Grade Differences

Based on problem behavior theory, a mediation model for gender and grade differences is explored in this study. The study examined gender and grade differences in the effects of violent video games and deviant peer affiliation on problem behaviors among children and adolescents. A total of 2118 children and adolescents from four primary and middle schools in China (M age = 13.08, SD = 2.17) were surveyed using an anonymous questionnaire on basic information, exposure to violent video games, deviant peer affiliation, and problem behaviors. The results showed that exposure to violent video games significantly positively predicted problem behaviors, and deviant peer affiliation played a mediating role. Significant gender and grade differences were found in the mediating effect. This finding helps understand the individual differences in the influencing factors of problem behaviors. Further, it has important implications for interventions to reduce problem behaviors among children and adolescents.

Severity of alcohol use disorder influences sex differences in sleep, mood and brain functional connectivity impairments

Growing evidence suggests greater vulnerability of women than men to the adverse effects of alcohol on mood and sleep. However, the underlying neurobiological mechanisms are still poorly understood.

Here we examined sex difference in resting state functional connectivity in alcohol use disorder using a whole-brain data driven approach and tested for relationships with mood and self-reported sleep. To examine whether sex effects vary by severity of alcohol use disorder, we studied two cohorts: non-treatment seeking n = 141 participants with alcohol use disorder (low severity; 58 females) from the Human Connectome project, and recently detoxified n = 102 treatment seeking participants with alcohol use disorder (high severity; 34 females) at the National Institute on Alcohol Abuse and Alcoholism.

For both cohorts, participants with alcohol use disorder had greater sleep and mood problems than HC, whereas sex by alcohol use effect varied by severity. Non-treatment seeking females with alcohol use disorder showed significant greater impairments in sleep but not mood compared to non-treatment seeking males with alcohol use disorder, whereas treatment-seeking females with alcohol use disorder reported greater negative mood but not sleep than treatment-seeking males with alcohol use disorder. Greater sleep problems in non-treatment seeking females with alcohol use disorder were associated with lower cerebello-parahippocampal functional connectivity, while greater mood problems in treatment-seeking females with alcohol use disorder were associated with lower fronto-occipital functional connectivity during rest.

The current study suggests that changes in resting state functional connectivity may account for sleep and mood impairments in females with alcohol use disorder. The effect of severity on sex differences might reflect neuroadaptive processes with progression of alcohol use disorder and needs to be tested with longitudinal data in the future.

No evidence for trait- and state-level urgency moderating the daily association between negative affect and subsequent alcohol use in two college samples

It remains unclear whether the negative reinforcement pathway to problematic drinking exists, and if so, for whom. One idea that has received some support recently is that people who tend to act impulsively in response to negative emotions (i.e. people high in negative urgency) may specifically respond to negative affect with increased alcohol consumption. We tested this idea in a preregistered secondary data analysis of two ecological momentary assessment studies using college samples. Participants (N = 226) reported on their current affective state multiple times per day and also the following morning reported alcohol use of the previous night. We assessed urgency both at baseline and during the momentary affect assessments. Results from our Bayesian model comparison procedure, which penalises increasing model complexity, indicate that no combination of the variables of interest (negative affect, urgency, and the respective interactions) outperformed a baseline model that included two known demographic predictors of alcohol use. A non-preregistered exploratory analysis provided some evidence for the effect of daily positive affect, positive urgency, as well as their interaction on subsequent alcohol use. Taken together, our results suggest that college students' drinking may be better described by a positive rather than negative reinforcement cycle.

Long-Term Outcomes for Young People With Substance Use Problems in Outpatient Treatment: Gender-Specific Patterns

This study presents the results of a longitudinal research project focusing on long-term outcomes among young people after initiation of outpatient treatment for substance use problems (SUP) in Sweden. Young people are defined with the age group 13-25 years. A clinical sample of 451 young people (29% girls, median age 17 years) completed a structured interview at baseline and was followed using official records one, two, and 3 years after initiation of treatment. Gender-specific patterns at intake were described and bivariate associations and logistic regressions were calculated to analyse the links between risk factors at treatment start and indications of substance use problems 3 years later. Significantly more boys than girls displayed indications of continued SUP at 3-year follow-up. More specifically, 49% of the boys vs. 35% of the girls were identified through records as still having problems with substance use. Predictive risk factors also displayed gender-specific patterns. Primary drug use frequency and age at intake predicted indications of SUP among boys but not among girls. Placement in foster care/residential homes, depression, and early drug debut had significant predictive value regarding indications of SUP among females but not among males. Girls also displayed a greater psychosocial burden at treatment start, but a more favorable treatment outcome at follow-up. Youths with a heavy risk load at treatment start (i.e., over six risk factors) did not display a greater risk of SUP at 3-year follow-up, although our results suggest that this subgroup has indications of continued problems with mental health. Consequently, future studies should further explore gender-specific treatment pathways for young people with substance use problems. Since women and girls seem to have different risk factors, co-occurring psychiatric problems and more experiences of trauma compared to men, they might need multidimensional and more comprehensive treatment interventions that run over a longer period of time.

Major depressive symptoms and escalation of drinking among new drinkers in the United States: Variations across sex and age groups

BACKGROUND

Heavy episodic drinking is common in the United States (US) and causes substantial burden to individuals and the society. The transition from first drinking to first heavy drinking episode is a major milestone in the escalation of drinking. There is limited evidence about whether major depressive symptoms predict the progression from drinking to heavy drinking and potential variations across age, sex, and depressive symptoms. In this study, we aim to estimate the association between history of major depressive symptoms and the risk of first heavy drinking episode among new drinkers in the US.

METHODS

Study population was US non-institutionalized civilian new drinkers 12 years of age and older who had their first drink during the past 12 months drawn from the National Survey on Drug Use and Health. History of major depressive symptoms and alcohol drinking behaviors were assessed via audio-computer-assisted self-interviews. Logistic regressions and structural equation modeling were used for analysis.

RESULTS

Depressed mood and/or anhedonia predicted the transition from the first drink to a heavy drinking episode among underage female new drinkers, whereas null associations were found among males and female new drinkers who had their first drink at 21 and later. Among new drinkers with depressed mood and/or anhedonia, low mood or energy positively predicted the progression to a heavy drinking episode among late-adolescent boys, but negatively among late-adolescent girls; neurovegetative symptoms positively predicted the progression to a heavy drinking episode among young adult new drinkers.

CONCLUSIONS

The relationships linking major depressive symptoms and the transition from drinking to first heavy drinking episode vary across age, sex, and depressive symptoms.

The Etiologic, Theory-Based, Ontogenetic Hierarchical Framework of Alcohol Use Disorder: A Translational Systematic Review of Reviews

Modern nosologies (e.g., ICD-11, DSM-5) for alcohol use disorder (AUD) and dependence prioritize reliability and clinical presentation over etiology, resulting in a diagnosis that is not always strongly grounded in basic theory and research. Within these nosologies, DSM-5 AUD is treated as a discrete, largely categorical, but graded, phenomenon, which results in additional challenges (e.g., significant phenotypic heterogeneity). Efforts to increase the compatibility between AUD diagnosis and modern conceptualizations of alcohol dependence, which describe it as dimensional and partially overlapping with other psychopathology (e.g., other substance use disorders) will inspire a stronger scientific framework and strengthen AUD's validity. We conducted a systematic review of 144 reviews to integrate addiction constructs and theories into a comprehensive framework with the aim of identifying fundamental mechanisms implicated in AUD. The product of this effort was the Etiologic, Theory-Based, Ontogenetic Hierarchical Framework (ETOH Framework) of AUD mechanisms, which outlines superdomains of cognitive control, reward, as well as negative valence and emotionality, each of which subsume narrower, hierarchically-organized components. We also outline opponent processes and self-awareness as key moderators of AUD mechanisms. In contrast with other frameworks, we recommend an increased conceptual role for negative valence and compulsion in AUD. The ETOH framework serves as a critical step towards conceptualizations of AUD as dimensional and heterogeneous. It has the potential to improve AUD assessment and aid in the development of evidence-based diagnostic measures that focus on key mechanisms in AUD, consequently facilitating treatment matching.

Mental Health and Substance Use Diagnoses and Treatment Disparities by Sexual Orientation and Gender in a Community Health Center Sample

Purpose: This study assessed disparities in screener- and provider-identified mental health and substance use diagnoses and treatment attendance by sexual orientation and gender in an urban community health center focused on sexual and gender minority individuals. Methods: Using an electronic data query (October 2015 to October 2018), computerized screening results assessing likely depression, anxiety, alcohol use disorder (AUD), and substance use disorder (SUDs); provider diagnoses; and treatment initiation related to mental health and substance use were compared across sexual orientation (heterosexual, gay/lesbian, bisexual, and other) and gender categories (men and women, inclusive of cisgender and transgender individuals; N = 24,325). Results: Bisexual and other-identified individuals were more likely to screen positive for depression and anxiety, followed by gay/lesbian women, compared with heterosexual individuals and gay men (χ² = 463.22, p < 0.001 and χ² = 263.36, p < 0.001, respectively). Of those who screened positive for AUDs, women were less likely to be diagnosed by a professional (χ² = 63.79, p < 0.001) and of those who screened positive for either alcohol or other SUDs, women were less likely to attend one or more substance use-related behavioral health appointments, regardless of sexual orientation (contingency coefficient = 0.14, p < 0.001). Conclusion: This community health center study identified a need for increased mental health services for bisexual and other-identified individuals and increased assessment and initiation of substance use treatment for women, including sexual minority women.

Striatal dopamine D2-type receptor availability and peripheral 17β-estradiol

Research using rodent models has established a relationship between the steroid hormone estrogen and dopamine function, by revealing changes throughout the estrous cycle and by directly manipulating neuroendocrine signaling through ovariectomy and administration of estrogen. However, a direct link between estrogen levels and dopamine signaling had not been established in humans. The goal of this study, therefore, was to assess the relationship between circulating 17β-estradiol and dopamine signaling in the human brain by testing for a relationship between two proxies for these variables: peripheral 17β-estradiol and striatal dopamine D₂-type receptor availability, measured with [¹⁸F]fallypride and positron emission tomography (PET). Sixteen (23-45 years of age) women were tested on 2 days of the menstrual cycle estimated prospectively to occur during (a) the early follicular phase, when estrogen levels are near their nadir, and (b) the periovulatory phase, when estrogen levels peak. PET scans with [¹⁸F]fallypride were performed on these 2 days, and serum 17β-estradiol was measured using radioimmunoassay. Dopamine D₂-type receptor availability did not differ significantly in the whole striatum or the caudate, putamen, or accumbens subregions during the high-estrogen vs. the low-estrogen phases of the menstrual cycle. We conclude that circulating estrogen levels do not affect dopamine D₂-type receptor availability in the human striatum although other indices of dopaminergic function may be affected.

Drinking Intensity at Age 29/30 as a Predictor of Alcohol Use Disorder Symptoms at Age 35 in a National Sample

OBJECTIVE

The purpose of this longitudinal study was to identify associations of drinking intensity at age 29/30 with symptoms of alcohol use disorder (AUD) at age 35.

METHOD

Analyses used national longitudinal data from 1,253 individuals (53.5% female) participating in the Monitoring the Future study. Age 29/30 data were collected from 2005 to 2013; age 35 data were collected from 2010 to 2018. Multivariable models regressed age 35 past-5-year AUD symptoms (vs. nondisordered drinking/abstinence) on age 29/30 past-2-week drinking intensity (no/low [0-4] drinking, binge [5-9] drinking, high-intensity [10+] drinking), with key covariates being controlled for.

RESULTS

At age 35, 32.6% (SE = 1.50) of respondents reported AUD symptoms. AUD symptoms at age 35 were reported by 77.5% (SE = 4.79) of participants who reported age 29/30 high-intensity drinking and 60.6% (SE = 3.95) of participants who reported age 29/30 binge drinking. Age 35 past-5-year abstinence was reported by almost no respondents reporting age 29/30 binge drinking or high-intensity drinking. AUD symptoms at age 35 were significantly more likely for those who reported binge (adjusted multivariable odds ratio [AOR] = 5.61, 95% CI [3.79, 8.30], p < .001) or high-intensity (AOR = 12.26, 95% CI [6.70, 22.41], p < .001) drinking versus no/low drinking at age 29/30. The likelihood of having AUD symptoms was significantly higher for high-intensity than for binge drinkers (AOR = 2.18, 95% CI [1.14, 4.19], p = .019).

CONCLUSIONS

Nearly 80% of those young adults who reported engaging in high-intensity drinking (10+ drinks in a row) at age 29/30 later reported AUD symptoms at age 35. High-intensity drinking appears to be a strong prospective marker of risk for AUD symptoms among adults in the United States.

Drinking Intensity at Age 29/30 as a Predictor of Alcohol Use Disorder Symptoms at Age 35 in a National Sample

OBJECTIVE

The purpose of this longitudinal study was to identify associations of drinking intensity at age 29/30 with symptoms of alcohol use disorder (AUD) at age 35.

METHOD

Analyses used national longitudinal data from 1,253 individuals (53.5% female) participating in the Monitoring the Future study. Age 29/30 data were collected from 2005 to 2013; age 35 data were collected from 2010 to 2018. Multivariable models regressed age 35 past-5-year AUD symptoms (vs. nondisordered drinking/abstinence) on age 29/30 past-2-week drinking intensity (no/low [0-4] drinking, binge [5-9] drinking, high-intensity [10+] drinking), with key covariates being controlled for.

RESULTS

At age 35, 32.6% (SE = 1.50) of respondents reported AUD symptoms. AUD symptoms at age 35 were reported by 77.5% (SE = 4.79) of participants who reported age 29/30 high-intensity drinking and 60.6% (SE = 3.95) of participants who reported age 29/30 binge drinking. Age 35 past-5-year abstinence was reported by almost no respondents reporting age 29/30 binge drinking or high-intensity drinking. AUD symptoms at age 35 were significantly more likely for those who reported binge (adjusted multivariable odds ratio [AOR] = 5.61, 95% CI [3.79, 8.30], p < .001) or high-intensity (AOR = 12.26, 95% CI [6.70, 22.41], p < .001) drinking versus no/low drinking at age 29/30. The likelihood of having AUD symptoms was significantly higher for high-intensity than for binge drinkers (AOR = 2.18, 95% CI [1.14, 4.19], p = .019).

CONCLUSIONS

Nearly 80% of those young adults who reported engaging in high-intensity drinking (10+ drinks in a row) at age 29/30 later reported AUD symptoms at age 35. High-intensity drinking appears to be a strong prospective marker of risk for AUD symptoms among adults in the United States.

Drinking Behavior, Taste Preferences and Special Beer Perception among Romanian University Students: A Qualitative Assessment Research

The transition from adolescence to adulthood can be a challenging period for many students. This period is associated with an increase in alcohol consumption (AC) which can develop a drinking behavior or shape the preferences for certain alcoholic beverages. The purpose of this study was to analyze the AC pattern among Romanian university students, by investigating the association between taste and consumption, including preferences for special beer. A 30-item omnibus-type questionnaire was distributed to undergraduate students and used to gather sociodemographic data, alcohol expectancies, drinking motives and consequences, and special beer consumption. Results showed a statistically significant relationship between the age of first alcohol use and the existence of an alcoholic family member. The main reasons for AC are taste, sensation, relaxation, and socialization. Both female and male students tend to drink occasionally, with a preference for public places. Female students prefer a sweet taste, choosing special beers over the regular ones. The students' residence may also influence the choice of special beers. Understanding the students' drinking behavior and taste preferences is essential to create useful strategies to discourage excessive AC. Special beer, a growing segment in the beverage industry, could represent a healthier and safety alternative to AC.

The Continuum of Recovery from Alcohol Dependence: From Addiction Remission to Complete Mental Health

BACKGROUND

Few representative studies have examined optimal mental health among those with a history of alcohol dependence (AD).

OBJECTIVES

In a representative sample of Canadians with a history of AD, to determine prevalence of, and factors associated with 1) remission from AD, 2) the absence of Substance Dependence and Psychiatric Disorders (SDPD) in the past year, and 3) complete mental health (CMH).

METHOD

Secondary analysis of a publicly available Statistics Canada database, the 2012 Canadian Community Health Survey-Mental Health (820 adults with AD history; 19,945 without AD). Lifetime AD, past-year remission from AD, and previous 12-month absence of SDPD were determined using World Health Organisation Composite International Diagnostic Interview (WHO-CIDI) measures. Individuals are classified as being in CMH if they possessed social and psychological well-being, happiness or life satisfaction and absence of SDPD.

RESULTS

Over 70% of those with a history of AD were in remission, 52% were without past-year SDPD, and 38% of respondents were in CMH. Positive outcomes were more common among married respondents, older individuals, those with higher level of social support, and those who had never had major depressive disorders or generalised anxiety disorders.

CONCLUSION

The majority of Canadians with a history of AD achieve remission and a significant proportion achieve CMH. However, targeted outreach is warranted for the most vulnerable with a history of alcohol dependence, including younger respondents and those with low levels of social support or a history of mental illness.

Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1922451.

A trait-like propensity to experience internalizing symptoms is associated with problem alcohol involvement across adulthood, but not adolescence

There are stable between-person differences in an internalizing "trait," or the propensity to experience symptoms of internalizing disorders, such as social anxiety, generalized anxiety disorder, and depression. Trait internalizing may serve as a marker of heightened risk for problem alcohol outcomes (such as heavier drinking, binge drinking, or alcohol dependence). However, prior research on the association between internalizing symptoms and alcohol outcomes has been largely mixed in adolescence, with more consistent support for an association during adulthood. It may be that trait internalizing is only associated with problem alcohol outcomes in adulthood, after individuals have gained experience with alcohol. Some evidence suggested that these effects may be stronger for women than men. We used data from a community sample (n = 790) interviewed during adolescence (ages 14-16) and again at ages 21, 24, 27, 30, 33, and 39. Using generalized estimating equations, we tested the association between trait internalizing and alcohol outcomes during both adolescence and adulthood, and tested whether adult trait internalizing mediated the association between adolescent trait internalizing and adult alcohol outcomes. Trait internalizing in adulthood (but not adolescence) was associated with more frequent alcohol use, binge drinking and symptoms of alcohol use disorders, and mediated the effects of adolescent trait internalizing on alcohol outcomes. We observed no moderation by gender or change in these associations over time. Understanding the developmental pathways of trait internalizing may provide further insights into preventing the emergence of problem alcohol use behavior during adulthood. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Third Ventricular Injection of CCL2 in Rat Embryo Stimulates CCL2/CCR2 Neuroimmune System in Neuroepithelial Radial Glia Progenitor Cells: Relation to Sexually Dimorphic, Stimulatory Effects on Peptide Neurons in Lateral Hypothalamus

Clinical and animal studies show maternal alcohol consumption during pregnancy causes in offspring persistent alterations in neuroimmune and neurochemical systems known to increase alcohol drinking and related behaviors. Studies in lateral hypothalamus (LH) demonstrate in adolescent offspring that maternal oral administration of ethanol stimulates the neuropeptide, melanin-concentrating hormone (MCH), together with the inflammatory chemokine C-C motif ligand 2 (CCL2) and its receptor CCR2 which are increased in most MCH neurons. These effects, consistently stronger in females than males, are detected in embryos, not only in LH but hypothalamic neuroepithelium (NEP) along the third ventricle where neurons are born and CCL2 is stimulated within radial glia progenitor cells and their laterally projecting processes that facilitate MCH neuronal migration toward LH. With ethanol's effects similarly produced by maternal peripheral CCL2 administration and blocked by CCR2 antagonist, we tested here using in utero intracerebroventricular (ICV) injections whether CCL2 acts locally within the embryonic NEP. After ICV injection of CCL2 (0.1 µg/µl) on embryonic day 14 (E14) when neurogenesis peaks, we observed in embryos just before birth (E19) a significant increase in endogenous CCL2 within radial glia cells and their processes in NEP. These auto-regulatory effects, evident only in female embryos, were accompanied by increased density of CCL2 and MCH neurons in LH, more strongly in females than males. These results support involvement of embryonic CCL2/CCR2 neuroimmune system in radial glia progenitor cells in mediating sexually dimorphic effects of maternal challenges such as ethanol on LH MCH neurons that colocalize CCL2 and CCR2.

Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Girls and Women

Females ages 12 and older are the fastest growing segment of alcohol consumers in the United States, with the past decade showing a 16% increase in alcohol use per 12-month period and a 58% increase in high-risk drinking (i.e., > 3 drinks in a day and/or > 7 drinks in a week) per 12-month period. The increase in alcohol use and risk drinking poses unique and serious consequences for women. Women have a more rapid progression to alcohol-related problems and alcohol use disorders (AUD) than men, and if pregnant, women can potentially expose the fetus to alcohol. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based, integrated public health approach used to identify and address risky alcohol use among women in a variety of health and social service settings. This article presents the current status of SBIRT among girls ages 12 and older, women of childbearing age, and older women. Screening instruments, brief interventions, and implementation issues specific to women of all ages are described. Through this review of the current literature, care providers can determine best practices for the prevention and treatment of risk drinking in women of all ages presenting in health care settings.

CCL2/CCR2 system in neuroepithelial radial glia progenitor cells: involvement in stimulatory, sexually dimorphic effects of maternal ethanol on embryonic development of hypothalamic peptide neurons

BACKGROUND

Clinical and animal studies show that alcohol consumption during pregnancy produces lasting behavioral disturbances in offspring, including increased alcohol drinking, which are linked to inflammation in the brain and disturbances in neurochemical systems that promote these behaviors. These include the neuropeptide, melanin-concentrating hormone (MCH), which is mostly expressed in the lateral hypothalamus (LH). Maternal ethanol administration at low-to-moderate doses, while stimulating MCH neurons without affecting apoptosis or gliogenesis, increases in LH the density of neurons expressing the inflammatory chemokine C-C motif ligand 2 (CCL2) and its receptor CCR2 and their colocalization with MCH. These neural effects associated with behavioral changes are reproduced by maternal CCL2 administration, reversed by a CCR2 antagonist, and consistently stronger in females than males. The present study investigates in the embryo the developmental origins of this CCL2/CCR2-mediated stimulatory effect of maternal ethanol exposure on MCH neurons.

METHODS

Pregnant rats from embryonic day 10 (E10) to E15 during peak neurogenesis were orally administered ethanol at a moderate dose (2 g/kg/day) or peripherally injected with CCL2 or CCR2 antagonist to test this neuroimmune system's role in ethanol's actions. Using real-time quantitative PCR, immunofluorescence histochemistry, in situ hybridization, and confocal microscopy, we examined in embryos at E19 the CCL2/CCR2 system and MCH neurons in relation to radial glia progenitor cells in the hypothalamic neuroepithelium where neurons are born and radial glia processes projecting laterally through the medial hypothalamus that provide scaffolds for neuronal migration into LH.

RESULTS

We demonstrate that maternal ethanol increases radial glia cell density and their processes while stimulating the CCL2/CCR2 system and these effects are mimicked by maternal administration of CCL2 and blocked by a CCR2 antagonist. While stimulating CCL2 colocalization with radial glia and neurons but not microglia, ethanol increases MCH neuronal number near radial glia cells and making contact along their processes projecting into LH. Further tests identify the CCL2/CCR2 system in NEP as a primary source of ethanol's sexually dimorphic actions.

CONCLUSIONS

These findings provide new evidence for how an inflammatory chemokine pathway functions within neuroprogenitor cells to mediate ethanol's long-lasting, stimulatory effects on peptide neurons linked to adolescent drinking behavior.

Trends in Socioeconomic Inequalities in Norwegian Adolescents' Mental Health From 2014 to 2018: A Repeated Cross-Sectional Study

Background

Adolescents’ mental health, and its consistent relationship with their socioeconomic background, is a concern that should drive education, health, and employment policies. However, information about this relationship on a national scale is limited. We explore national overall trends and investigate possible socioeconomic disparities in adolescents’ mental health, including psychological distress and symptoms of depression, anxiety, and loneliness in Norway during the period 2014–2018.

Methods

The present study builds on data retrieved from five waves of the national cross-sectional Ungdata survey (2014–2018). In total 136,525 upper secondary school students (52% girls) completed the questionnaire during the study period. Trends in socioeconomic inequalities were assessed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII).

Results

The prevalence of students with moderate to high symptoms score and mean symptoms scores of psychological distress (in terms of symptoms of depression, anxiety, and loneliness) increased among girls and boys during 2014–2018, with girls showing higher rates. Our results suggest distinct, but stable, inequalities between socioeconomic groups, both in absolute and relative terms, among girls and boys during the study period.

Conclusion

Rising rates of adolescents’ psychological distress, particularly among girls, may have long-term consequences for individuals involved and the society as a whole. Future studies should investigate the causes of these results. We did not find evidence of any change in inequalities in adolescents’ mental health between socioeconomic groups, suggesting current strategies are not sufficiently addressing mental health inequalities in the adolescent population and therefore a significant need for research and public health efforts.

Differential implications of persistent, remitted, and late-onset ADHD symptoms for substance abuse in women and men: A twin study from ages 11 to 24

BACKGROUND

Persistence and emergence of ADHD in adulthood are associated with substance problems. We investigate differential implications of ADHD course for tobacco, alcohol, or marijuana problems by sex, then whether substance misuse results from ADHD or contributes to it, through a twin differences design.

METHODS

A population-based cohort of 998 twins (61 % monozygotic; 52 % female), born in Minnesota from 1988 to 1994, was prospectively assessed from ages 11-24. Childhood ADHD was oversampled. At age 24, 255 had a history of childhood-onset ADHD (160 persistent, 95 remitted); 93 had late-onset ADHD symptoms identified in late-adolescence/adulthood. Persistent, remitted, and late-onset groups were compared to those without ADHD (N = 459) on childhood characteristics and age-24 substance problems.

RESULTS

Persistent and late-onset groups differed in childhood; twin concordances suggested greater genetic etiology for persistent ADHD. As adolescents, however, both groups were high in conduct problems; by adulthood, they were comparably high in substance problems. In particular, women whose ADHD persisted were 5 times more likely to develop tobacco use disorder than women without ADHD. Remitted ADHD was associated with less-increased risk, except for alcohol problems among women. Consistent with possible causality, monozygotic female twins with more age-17 ADHD symptoms than co-twins had more age-24 tobacco symptoms; a similar association was found for alcohol.

CONCLUSIONS

Presence or emergence of ADHD in early adulthood increases substance problems to a greater degree for women than men. While effects of substances on later ADHD were not statistically significant, detection was limited by the relative rarity of late-adolescent substance symptoms.

Moderate Prenatal Ethanol Exposure Stimulates CXCL12/CXCR4 Chemokine System in Radial Glia Progenitor Cells in Hypothalamic Neuroepithelium and Peptide Neurons in Lateral Hypothalamus of the Embryo and Postnatal Offspring

BACKGROUND

Prenatal exposure to ethanol (EtOH) has lasting effects on neuropeptide and neuroimmune systems in the brain alongside detrimental alcohol-related behaviors. At low-to-moderate doses, prenatal EtOH stimulates neurogenesis in lateral hypothalamus (LH) and increases neurons that express the orexigenic peptides hypocretin/orexin (Hcrt/OX) and melanin-concentrating hormone (MCH), and the proinflammatory chemokine CCL2, which through its receptor CCR2 stimulates cell differentiation and movement. Our recent studies demonstrated that CCL2 and CCR2 colocalize with MCH neurons and are involved in EtOH's stimulatory effect on their development but show no relation to Hcrt/OX. Here, we investigated another chemokine, CXCL12, and its receptor, CXCR4, which promote neurogenesis and neuroprogenitor cell proliferation, to determine if they also exhibit peptide specificity in their response to EtOH exposure.

METHODS

Pregnant rats were intraorally administered a moderate dose of EtOH (2 g/kg/d) from embryonic day 10 (E10) to E15. Their embryos and postnatal offspring were examined using real-time quantitative PCR and immunofluorescence histochemistry, to determine if EtOH affects CXCL12 and CXCR4 and the colocalization of CXCR4 with Hcrt/OX and MCH neurons in the LH and with radial glia neuroprogenitor cells in the hypothalamic neuroepithelium (NEP).

RESULTS

Prenatal EtOH strongly stimulated CXCL12 and CXCR4 in LH neurons of embryos and postnatal offspring. This stimulation was significantly stronger in Hcrt/OX than MCH neurons in LH and also occurred in radial glia neuroprogenitor cells dense in the NEP. These effects were sexually dimorphic, consistently stronger in females than males.

CONCLUSIONS

While showing prenatal EtOH exposure to have a sexually dimorphic, stimulatory effect on CXCL12 and CXCR4 in LH similar to CCL2 and its receptor, these results reveal their distinct relationship to the peptide neurons, with the former closely related to Hcrt/OX and the latter to MCH, and they link EtOH's actions in LH to a stimulatory effect on neuroprogenitor cells in the NEP.

Neural correlates of inhibitory control in youth with symptoms of food addiction

Prior research has found that food addiction is associated with reward-related neural differences, but research has yet to examine whether there are also neural differences in inhibitory control. This may be particularly relevant during adolescence as it is a key developmental period where difficulties in inhibitory control are more prevalent. The Yale Food Addiction Scale is a self-report questionnaire that applies substance use disorder diagnostic criteria to certain foods that has also been adapted for children. Here we investigate the association between addictive-like eating and brain functioning during inhibitory control in youth. Seventy-six right-handed participants 8.2-17.8 years (44 male) were recruited. Participants performed a go/no-go task during functional magnetic resonance imaging and completed the Yale Food Addiction Scale for Children, after which they were categorized into two groups according to their scores (No Symptom Group = 0; YFAS-C Group: score ≥ 1). Inhibitory control was probed with a contrast of correct no-go versus go trials. An independent-samples t-test comparing groups revealed a significant difference in three primary clusters, all exclusively in the left hemisphere (No Symptom Group > YFAS-C Group): middle temporal gyrus/occipital gyrus, precuneus/calcarine sulcus, and inferior frontal gyrus. Specifically, the YFAS-C Group showed deactivation in all three clusters. Adolescents who endorse food addiction appear to show hypo-activation in response to the inhibitory control portion of a go/no-go task, which suggests possible inhibitory control difficulties.

CCL2/CCR2 Chemokine System in Embryonic Hypothalamus: Involvement in Sexually Dimorphic Stimulatory Effects of Prenatal Ethanol Exposure on Peptide-Expressing Neurons

Maternal consumption of ethanol during pregnancy is known to increase the offspring's risk for developing alcohol use disorders and associated behavioral disturbances. Studies in adolescent and adult animals suggest the involvement of neuroimmune and neurochemical systems in the brain that control these behaviors. To understand the origin of these effects during early developmental stages, we examined in the embryo and neonate the effects of maternal intraoral administration of ethanol (2 g/kg/day) from embryonic day 10 (E10) to E15 on the inflammatory chemokine C-C motif ligand 2 (CCL2) and its receptor CCR2 in a specific, dense population of neurons in the lateral hypothalamus (LH), where they are closely related to an orexigenic neuropeptide, melanin-concentrating hormone (MCH), known to promote ethanol consumption and related behaviors. We found that prenatal ethanol exposure increases the expression and density of CCL2 and CCR2 cells along with MCH neurons in the LH and the colocalization of CCL2 with MCH. We also discovered that these effects are sexually dimorphic, consistently stronger in female embryos, and are blocked by maternal administration of a CCL2 antibody (1 and 5 µg/day, i.p., E10-E15) that neutralizes endogenous CCL2 and of a CCR2 antagonist INCB3344 (1 mg/day, i.p., E10-E15) that blocks CCL2's main receptor. These results, which in the embryo anatomically and functionally link the CCL2/CCR2 system to MCH neurons in the LH, suggest an important role for this neuroimmune system in mediating ethanol's sexually dimorphic, stimulatory effect on MCH neurons that may promote higher level of alcohol consumption described in females.

Predicting Adolescent Substance Use in a Child Welfare Sample: A Multi-Indicator Algorithm

Given the risk of substance use (SU) among adolescents in the child welfare system, identification of risk for prospective impairing SU behaviors is a significant public health priority. We sought to quantify the incremental validity of routine multi-informant assessments of adolescent psychological distress (i.e., the Child Behavior Checklist and Youth Self-Report) and a commonly used SU screening protocol (i.e., the CRAFFT) to predict SU at 18 and 36 months after baseline in a nationally representative child welfare sample (N = 1,054; M_age = 13.72). We used receiver operator characteristics and reclassification analyses to develop our algorithms. We found that a battery consisting of baseline CRAFFT scores, self-reported delinquent behavior, and parent-reported rule-breaking behavior provided an incrementally valid prediction model for SU behavior among females, while baseline CRAFFT scores and self-reported delinquent behavior incrementally predicted SU for males. Results suggest that leveraging existing assessments within the child welfare system can improve forecasting of SU risk for this population.

The Social Support Buffering Effect in the Relationship Between Perceived Stress and Alcohol Use Among Brazilian Women

This cross-sectional study interviewed Brazilian women regularly attending primary care to investigate whether the relationship between social support and alcohol use is direct or is mediated by stress, in order to support the development of recommendations related to health prevention and mental health promotion actions. The results suggest that social support affects the outcome alcohol use in the women studied by buffering the effect of stress. Based on these results, recommendations are made for amplifying the social support network that prevents stress-induced alcohol use.

Gender differences among Veterans with alcohol use disorder nationally in the Veterans Health Administration

Alcohol use among women is increasing relative to men but no study has compared rates and characteristics of women with alcohol use disorder (AUD) to men among Veterans Health Administration (VHA) service users. To compare male and female VHA service users on rates of AUD, and among those with AUD, on sociodemographic characteristics, medical and physical comorbidities, and service and medication use national VHA data from fiscal year (FY) 2012 were used to identify Veterans diagnosed with AUD. Bivariate analyses evaluate gender differences in: sociodemographic characteristics; comorbid medical and psychiatric diagnoses; service use and psychotropic prescription fills. Multivariate stepwise logistic regression was used to identify a parsimonious set of differences. About 13,797 of all 349,430 women served by VHA in FY 2012 (3.94%) were diagnosed with AUD as compared to 331,407 of 5,102,877 men (6.50%) for a risk ratio of 0.608 for AUD among women. Women were younger, more likely to have served in recent Middle East conflicts and had more comorbid psychiatric and substance use diagnoses than men. They filled fewer psychotropic prescriptions (after taking greater number of psychiatric diagnoses in to account), but were more likely to fill a prescription for naltrexone than men. Women had fewer comorbid medical diagnoses than men. Women Veterans with an AUD have higher rates of psychiatric comorbidities than men, highlighting the need for better integration of treatment for AUD and comorbid psychiatric conditions, and suggesting different pathways and potential interventions for AUD in women.

Key personality traits and alcohol use disorder symptoms in first and second year college students: detangling antecedent from consequence

BACKGROUND

Studies have consistently shown that low constraint and high negative emotionality are associated with higher levels of alcohol use and greater alcohol related problems. Less research has examined associations between these traits and alcohol use disorder (AUD) from the first to second year of college, when alcohol use increases rapidly, or has evaluated gender differences in these associations.

METHODS

The longitudinal College Experiences Study (N = 209, 60% female, 90% white) was used to detangle antecedent vs. consequence between constraint, negative emotionality, and AUD symptoms using multiple methods (cross-lagged panel analysis, latent difference score approach).

RESULTS

Providing evidence for a scar/complication model, greater AUD symptoms in the first year of college was predictive of rank-order and correlated decreases in constraint in the second year, but only for males. Surprisingly, negative emotionality was not associated with AUD symptoms for either gender. Qualitative analyses show that the vast majority of those that met an AUD diagnosis (90%+) did not consider their drinking to be problematic.

CONCLUSION

Given the vast majority of college students with AUD do not perceive their drinking to be problematic, results support the potential of using personality-based risk prevention/intervention programs to target at-risk individuals for problematic drinking, rather than targeting problematic drinking alone.

Positive and negative effects of internalizing on alcohol use problems from childhood to young adulthood: The mediating and suppressing role of externalizing

A longstanding hypothesis is that some alcohol use problems (AUP) develop and are maintained through the "self-medication" of internalizing (INT; depression and anxiety) problems. However, their high rate of co-occurrence with one another and with externalizing (EXT; antisocial behavior and impulse control) problems obscures any causal association because EXT may account for the INT-AUP link. Using a large community sample, we estimated prospective effects of INT and EXT on AUP via latent cross-lagged mediation panel spanning 14 years from childhood (ages 9-11) to young adulthood (ages 21-23). After adjusting for the cross-lagged, concurrent, and stability effects across factors, INT decreased AUP risk through its direct and indirect effects and increased AUP risk through shared variance with EXT. Between childhood and young adulthood, unique aspects of INT reduced risk for AUP while aspects of INT shared with EXT increased risk for AUP. (PsycINFO Database Record

Alcohol Use Disorder and Depressive Disorders

Alcohol use disorder (AUD) and depressive disorders are among the most prevalent psychiatric disorders and co-occur more often than expected by chance. The aim of this review is to characterize the prevalence, course, and treatment of co-occurring AUD and depressive disorders. Studies have indicated that the co-occurrence of AUD and depressive disorders is associated with greater severity and worse prognosis for both disorders. Both pharmacologic and behavioral treatments have demonstrated efficacy for this population. However, treatment response is somewhat modest, particularly for drinking outcomes, highlighting the importance of further research on the etiology and treatment of co-occurring AUD and depressive disorders. Key future directions include studies to understand the heterogeneity of both AUD and depressive disorders, research on novel treatment approaches to enhance outcomes, and better understanding of sex and gender differences.

The gender risk-severity paradox for alcohol use disorder from adolescence through young adulthood

A large proportion of the public health costs of alcohol use disorder (AUD) can be accounted for by a small percentage of severe cases with a chronic course starting in adolescence and persisting into adulthood. However, chronicity may be a less effective marker of AUD severity in women than men due to a gender risk-severity paradox wherein comparable levels of risk exposure yield more co-occurring problems for women than men with AUD. To model this paradox, we compared trajectories of alcohol and drug use problems, depression symptoms, and antisocial behavior from ages 17 to 29 in men and women with a persistent, desistent, or no history of AUD. Problems followed a quadratic trajectory (i.e., increases followed by decreases), with gender and AUD chronicity moderating age-related change. Specifically, persistent and desistent courses differentiated the severity of problems more effectively in men while chronicity had less utility for differentiating AUD severity in women.

Hypothalamic CCL2/CCR2 Chemokine System: Role in Sexually Dimorphic Effects of Maternal Ethanol Exposure on Melanin-Concentrating Hormone and Behavior in Adolescent Offspring

Clinical and animal studies show that ethanol exposure and inflammation during pregnancy cause similar behavioral disturbances in the offspring. While ethanol is shown to stimulate both neuroimmune and neurochemical systems in adults, little is known about their anatomical relationship in response to ethanol in utero and whether neuroimmune factors mediate ethanol's effects on neuronal development and behavior in offspring. Here we examined in female and male adolescent rats a specific population of neurons concentrated in lateral hypothalamus, which coexpress the inflammatory chemokine C-C motif ligand 2 (CCL2) or its receptor CCR2 with the orexigenic neuropeptide, melanin-concentrating hormone (MCH), that promotes ethanol drinking behavior. We demonstrate that maternal administration of ethanol (2 g/kg/d) from embryonic day 10 (E10) to E15, while having little impact on glia, stimulates expression of neuronal CCL2 and CCR2, increases density of both large CCL2 neurons colocalizing MCH and small CCL2 neurons surrounding MCH neurons, and stimulates ethanol drinking and anxiety in adolescent offspring. We show that these neuronal and behavioral changes are similarly produced by maternal administration of CCL2 (4 or 8 μg/kg/d, E10-E15) and blocked by maternal administration of a CCR2 antagonist INCB3344 (1 mg/kg/d, E10-E15), and these effects of ethanol and CCL2 are sexually dimorphic, consistently stronger in females. These results suggest that this neuronal CCL2/CCR2 system closely linked to MCH neurons has a role in mediating the effects of maternal ethanol exposure on adolescent offspring and contributes to the higher levels of adolescent risk factors for alcohol use disorders described in women.SIGNIFICANCE STATEMENT Ethanol consumption and inflammatory agents during pregnancy similarly increase alcohol intake and anxiety in adolescent offspring. To investigate how neurochemical and neuroimmune systems interact to mediate these disturbances, we examined a specific population of hypothalamic neurons coexpressing the inflammatory chemokine CCL2 and its receptor CCR2 with the neuropeptide, melanin-concentrating hormone. We demonstrate in adolescent offspring that maternal administration of CCL2, like ethanol, stimulates these neurons and increases ethanol drinking and anxiety, and these effects of ethanol are blocked by maternal CCR2 antagonist and consistently stronger in females. This suggests that neuronal chemokine signaling linked to neuropeptides mediates effects of maternal ethanol exposure on adolescent offspring and contributes to higher levels of adolescent risk factors for alcohol use disorders in women.

[Internalizing and externalizing behavior problems and substance use in adolescence]

This study investigated the relationship between externalizing behavior problems (EBP), internalizing behavior problems (IBP), and combined externalizing/internalizing behavior problems (EIBP) in early adolescence (11 years) and substance use (alcohol, tobacco, and illegal drugs) at 15 years, using data from the 1993 Pelotas (Brazil) birth cohort. Behavior problems were assessed with the Strengths and Difficulties Questionnaire (SDQ), applied to mothers when their children were 15 years old. Substance use was assessed with a self-applied confidential questionnaire for the adolescent. The association between behavior problems and substance use was analyzed with Poisson regression with robust adjustment of variance. After adjusting for confounding, adolescents with EBP showed higher risk of alcohol abuse (RR = 1.74, 95%CI: 1.21; 2.50) and experimentation (RR = 1.78, 95%CI: 1.42; 2,23) and tobacco use in the previous 30 days (RR = 2.38, 95%CI: 1.64; 3.45). Adolescents with IBP showed greater risk of having tried tobacco (RR = 1.54, 95%CI: 1.22; 1.93) and of having used tobacco products in the previous 30 days (RR = 1.92, 95%CI: 1.31; 2.83). Adolescents with EIBP showed greater risk of trying (RR = 2.24, 95%CI: 1.57; 3.21) and consuming tobacco products in the previous days (RR = 3.01, 95%CI: 1.63; 5.56), and lower risk of having tried alcohol at 15 years of age (RR = 0.72, 95%CI: 0.55; 0.94). Public health measures aimed at reducing behavior problems in early adolescence can help reduce tobacco and alcohol consumption at 15 years.

Advancing statistical analysis of ambulatory assessment data in the study of addictive behavior: A primer on three person-oriented techniques

Ambulatory assessment (AA) methodologies have the potential to increase understanding and treatment of addictive behavior in seemingly unprecedented ways, due in part, to their emphasis on intensive repeated assessments of an individual's addictive behavior in context. But, many analytic techniques traditionally applied to AA data - techniques that average across people and time - do not fully leverage this potential. In an effort to take advantage of the individualized, temporal nature of AA data on addictive behavior, the current paper considers three underutilized person-oriented analytic techniques: multilevel modeling, p-technique, and group iterative multiple model estimation. After reviewing prevailing analytic techniques, each person-oriented technique is presented, AA data specifications are mentioned, an example analysis using generated data is provided, and advantages and limitations are discussed; the paper closes with a brief comparison across techniques. Increasing use of person-oriented techniques will substantially enhance inferences that can be drawn from AA data on addictive behavior and has implications for the development of individualized interventions.

Associations between childhood ADHD, gender, and adolescent alcohol and marijuana involvement: A causally informative design

BACKGROUND

We report whether the etiology underlying associations of childhood ADHD with adolescent alcohol and marijuana involvement is consistent with causal relationships or shared predispositions, and whether it differs by gender.

METHODS

In three population-based twin samples (N = 3762; 64% monozygotic), including one oversampling females with ADHD, regressions were conducted with childhood inattentive or hyperactive-impulsive symptoms predicting alcohol and marijuana outcomes by age 17. To determine whether ADHD effects were consistent with causality, twin difference analyses divided effects into those shared between twins in the pair and those differing within pairs.

RESULTS

Adolescents with more severe childhood ADHD were more likely to initiate alcohol and marijuana use earlier, escalate to frequent or heavy use, and develop symptoms. While risks were similar across genders, females with more hyperactivity-impulsivity had higher alcohol consumption and progressed further toward daily marijuana use than did males. Monozygotic twins with more severe ADHD than their co-twins did not differ significantly on alcohol or marijuana outcomes, however, suggesting a non-causal relationship. When co-occurring use of other substances and conduct/oppositional defiant disorders were considered, hyperactivity-impulsivity remained significantly associated with both substances, as did inattention with marijuana, but not alcohol.

CONCLUSIONS

Childhood ADHD predicts when alcohol and marijuana use are initiated and how quickly use escalates. Shared familial environment and genetics, rather than causal influences, primarily account for these associations. Stronger relationships between hyperactivity-impulsivity and heavy drinking/frequent marijuana use among adolescent females than males, as well as the greater salience of inattention for marijuana, merit further investigation.

Prediction of incidence and stability of alcohol use disorders by latent internalizing psychopathology risk profiles in adolescence and young adulthood

BACKGROUND

Comorbid internalizing mental disorders in alcohol use disorders (AUD) can be understood as putative independent risk factors for AUD or as expressions of underlying shared psychopathology vulnerabilities. However, it remains unclear whether: 1) specific latent internalizing psychopathology risk-profiles predict AUD-incidence and 2) specific latent internalizing comorbidity-profiles in AUD predict AUD-stability.

AIMS

To investigate baseline latent internalizing psychopathology risk profiles as predictors of subsequent AUD-incidence and -stability in adolescents and young adults.

METHODS

Data from the prospective-longitudinal EDSP study (baseline age 14-24 years) were used. The study-design included up to three follow-up assessments in up to ten years. DSM-IV mental disorders were assessed with the DIA-X/M-CIDI. To investigate risk-profiles and their associations with AUD-outcomes, latent class analysis with auxiliary outcome variables was applied.

RESULTS

AUD-incidence: a 4-class model (N=1683) was identified (classes: normative-male [45.9%], normative-female [44.2%], internalizing [5.3%], nicotine dependence [4.5%]). Compared to the normative-female class, all other classes were associated with a higher risk of subsequent incident alcohol dependence (p<0.05). AUD-stability: a 3-class model (N=1940) was identified with only one class (11.6%) with high probabilities for baseline AUD. This class was further characterized by elevated substance use disorder (SUD) probabilities and predicted any subsequent AUD (OR 8.5, 95% CI 5.4-13.3).

CONCLUSIONS

An internalizing vulnerability may constitute a pathway to AUD incidence in adolescence and young adulthood. In contrast, no indication for a role of internalizing comorbidity profiles in AUD-stability was found, which may indicate a limited importance of such profiles - in contrast to SUD-related profiles - in AUD stability.

Activation of extrasynaptic δ-GABAA receptors globally or within the posterior-VTA has estrous-dependent effects on consumption of alcohol and estrous-independent effects on locomotion

Recent reports support higher than expected rates of binge alcohol consumption among women and girls. Unfortunately, few studies have assessed the mechanisms underlying this pattern of intake in females. Studies in males suggest that alcohol concentrations relevant to the beginning stages of binge intoxication may selectively target tonic GABAergic inhibition mediated by GABAA receptor subtypes expressing the δ-subunit protein (δ-GABAARs). Indeed, administration of agonists that interact with these δ-GABAARs prior to alcohol access can abolish binge drinking behavior in male mice. These δ-GABAARs have also been shown to exhibit estrous-dependent plasticity in regions relevant to drug taking behavior, like the hippocampus and periaqueductal gray. The present experiments were designed to determine whether the estrous cycle would alter binge drinking, or our ability to modulate this pattern of alcohol use with THIP, an agonist with high selectivity and efficacy at δ-GABAARs. Using the Drinking-in-the-Dark (DID) binge-drinking model, regularly cycling female mice were given 2h of daily access to alcohol (20%v/v). Vaginal cytology or vaginal impedance was assessed after drinking sessions to track estrous status. There was no fluctuation in binge drinking associated with the estrous cycle. Both Intra-posterior-VTA administration of THIP and systemic administration of the drug was also associated with an estrous cycle dependent reduction in drinking behavior. Pre-treatment with finasteride to inhibit synthesis of 5α-reduced neurosteroids did not disrupt THIP's effects. Analysis of δ-subunit mRNA from posterior-VTA enriched tissue samples revealed that expression of this GABAA receptor subunit is elevated during diestrus in this region. Taken together, these studies demonstrate that δGABAARs in the VTA are an important target for binge drinking in females and confirm that the estrous cycle is an important moderator of the pharmacology of this GABAA receptor subtype.

Sex differences in the development of emotion circuitry in adolescents at risk for substance abuse: a longitudinal fMRI study

There is substantial evidence for behavioral sex differences in risk trajectories for alcohol and substance use, with internalizing factors such as negative affectivity contributing more to female risk. Because the neural development of emotion circuitry varies between males and females across adolescence, it represents a potential mechanism by which underlying neurobiology contributes to risk for substance use. Longitudinal functional magnetic resonance imaging was conducted in males and females (n = 18 each) with a family history of alcohol use disorders starting at ages 8-13 years. Participants performed an affective word task during functional magnetic resonance imaging at 1- to 2-year intervals, covering the age range of 8.5-17.6 years (3-4 scans per participant). Significant age-related sex differences were found in the right amygdala and right precentral gyrus for the negative vs neutral word condition. Males showed a significant decrease in both amygdala and precentral gyrus activation with age, whereas the response in females persisted. The subjective experience of internalizing symptomatology significantly increased with age for females but not for males. Taken together, these results reveal sex differences in negative affect processing in at-risk adolescents, and offer longitudinal neural evidence for female substance use risk through internalizing pathways.

Association of Specific Traumatic Experiences With Alcohol Initiation and Transitions to Problem Use in European American and African American Women

BACKGROUND

The aims of this study were to (i) characterize racial differences in alcohol involvement and (ii) examine the risk conferred by specific trauma exposures and posttraumatic stress disorder (PTSD) for different stages of alcohol involvement in European American (EA) and African American (AA) women.

METHODS

Data are from the Missouri Adolescent Female Twins Study (N = 3,787, 14.6% AA; mean age at most recent interview = 24.5 [SD 2.8]). Trauma exposures (e.g., sexual abuse [SA], physical abuse [PA], witnessing another person being killed or injured, experiencing an accident, and experiencing a disaster) were modeled as time-varying predictors of alcohol initiation, transition to first alcohol use disorder (AUD) symptom, and transition to AUD diagnosis using Cox proportional hazards regression while taking into account other substance involvement, parental characteristics, and commonly co-occurring psychiatric disorders.

RESULTS

In EA women only, SA was associated with alcohol initiation prior to the age of 14, PA predicted transition from initiation to first AUD symptom, and PA, witnessing injury or death, and SA predicted transition to AUD diagnosis. No association was discovered between trauma exposures or PTSD for any stage of alcohol involvement in AA women.

CONCLUSIONS

Results reveal trauma experiences as important contributors to all stages of alcohol involvement in EA women only, with different trauma types conferring risk for each stage of alcohol involvement. PTSD was not revealed as a significant predictor of AUD in EA or AA women, suggesting trauma, independent of PTSD, directly contributes to alcohol involvement. Findings highlight the importance of considering racial differences when developing etiologic models of the association of traumatic experiences with alcohol involvement.