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Marino EN, Jha MK, Minhajuddin A, Ayvaci ER, Levinson S, Pipes R, Emslie GJ, Trivedi MH. Problematic substance use in depressed adolescents: Prevalence and clinical correlates. Addict Behav Rep 2024; 19:100539. [PMID: 38510109 PMCID: PMC10951442 DOI: 10.1016/j.abrep.2024.100539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024] Open
Abstract
Background Substance use among adolescents is common and associated with significant consequences, including depression. Adolescents can experience myriad problems related to early onset substance use and depression, making further understanding of this comorbidity necessary. Method Participants were a subset from a large-scale performance improvement project and consisted of adolescents aged 12-18 who screened positive for depression during their routine medical or psychiatric appointment and who then completed the substance use assessment Car, Relax, Alone, Forget, Friends, Trouble Version 2.1 (CRAFFT). Participants with problematic substance use had a CRAFFT score ≥2. Results A total of 621 participants were included in this study, and 105 (16.9%) reported problematic substance use. Compared with participants without problematic substance use, those with problematic use were more likely to have moderate to severe depression and anxiety, as well as significantly higher irritability, impulsivity, suicidal propensity, and suicidal thoughts scores. Controlling for age at screening, sex, race, and ethnicity, problematic substance use remained a significant predictor of depression severity, impulsivity, suicidal propensity, and suicidal thoughts. Limitations Participants were from a large, metropolitan area of the Southwest United States who must have screened positive for depression, so results may not generalize. Because all participants were underage, they may have been wary in responding to the substance use assessment accurately. Conclusions By using a large, diverse sample in a real-world clinical setting, findings strengthen the association between problematic substance use and depression and depression-associated symptoms among adolescents, highlighting the need for early detection and universal depression screening.
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Affiliation(s)
- Elise N. Marino
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Manish K. Jha
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Abu Minhajuddin
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Emine Rabia Ayvaci
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Sara Levinson
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Ronny Pipes
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Graham J. Emslie
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Madhukar H. Trivedi
- Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
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Shimu SJ, Patil SM, Dadzie E, Tesfaye T, Alag P, Więckiewicz G. Exploring Health Informatics in the Battle against Drug Addiction: Digital Solutions for the Rising Concern. J Pers Med 2024; 14:556. [PMID: 38929777 PMCID: PMC11204661 DOI: 10.3390/jpm14060556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/14/2024] [Accepted: 05/19/2024] [Indexed: 06/28/2024] Open
Abstract
Drug addiction is a rising concern globally that has deeply attracted the attention of the healthcare sector. The United States is not an exception, and the drug addiction crisis there is even more serious, with 10% of adults having faced substance use disorder, while around 75% of this number has been reported as not having received any treatment. Surprisingly, there are annually over 70,000 deaths reported as being due to drug overdose. Researchers are continually searching for solutions, as the current strategies have been ineffective. Health informatics platforms like electronic health records, telemedicine, and the clinical decision support system have great potential in tracking the healthcare data of patients on an individual basis and provide precise medical support in a private space. Such technologies have been found to be useful in identifying the risk factors of drug addiction among people and mitigating them. Moreover, the platforms can be used to check prescriptions of addictive drugs such as opioids and caution healthcare providers. Programs such as the Prescription Drug Monitoring Program (PDMP) and the Drug and Alcohol Services Information Systems (DASIS) are already in action in the US, but the situation demands more in-depth studies in order to mitigate substance use disorders. Artificial intelligence (AI), when combined with health informatics, can aid in the analysis of large amounts of patient data and aid in classifying nature of addiction to assist in the provision of personalized care.
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Affiliation(s)
- Shakila Jahan Shimu
- Department of Health Informatics, Harrisburg University of Science and Technology, Harrisburg, PA 17101, USA;
| | | | - Ebenezer Dadzie
- School of Clinical Medicine, Inner Mongolia University for the Nationalities, Tongliao 028000, China;
| | - Tadele Tesfaye
- CareHealth Medical Practice, Addis Ababa 9023, Ethiopia;
| | - Poorvanshi Alag
- Psychiatry Department, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA;
| | - Gniewko Więckiewicz
- Department of Psychiatry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
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Ruberu TLM, Rajapaksha RMDS, Heitzeg MM, Klaus R, Boden JM, Biswas S, Choudhary P. Validation of a Bayesian learning model to predict the risk for cannabis use disorder. Addict Behav 2023; 146:107799. [PMID: 37451153 DOI: 10.1016/j.addbeh.2023.107799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 06/20/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Cannabis use disorder (CUD) is a growing public health problem. Early identification of adolescents and young adults at risk of developing CUD in the future may help stem this trend. A logistic regression model fitted using a Bayesian learning approach was developed recently to predict the risk of future CUD based on seven risk factors in adolescence and youth. A nationally representative longitudinal dataset, Add Health was used to train the model (henceforth referred as Add Health model). METHODS We validated the Add Health model on two cohorts, namely, Michigan Longitudinal Study (MLS) and Christchurch Health and Development Study (CHDS) using longitudinal data from participants until they were approximately 30 years old (to be consistent with the training data from Add Health). If a participant was diagnosed with CUD at any age during this period, they were considered a case. We calculated the area under the curve (AUC) and the ratio of expected and observed number of cases (E/O). We also explored recalibrating the model to account for differences in population prevalence. RESULTS The cohort sizes used for validation were 424 (53 cases) for MLS and 637 (105 cases) for CHDS. AUCs for the two cohorts were 0.66 (MLS) and 0.73 (CHDS) and the corresponding E/O ratios (after recalibration) were 0.995 and 0.999. CONCLUSION The external validation of the Add Health model on two different cohorts lends confidence to the model's ability to identify adolescent or young adult cannabis users at high risk of developing CUD in later life.
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Affiliation(s)
| | | | - Mary M Heitzeg
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Ryan Klaus
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Joseph M Boden
- Department of Psychological Medicine, University of Otago, Christchurch 8011, New Zealand
| | - Swati Biswas
- Department of Mathematical Sciences, University of Texas at Dallas, Richardson, TX 75080, United States
| | - Pankaj Choudhary
- Department of Mathematical Sciences, University of Texas at Dallas, Richardson, TX 75080, United States
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4
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Bharat C, Glantz MD, Aguilar-Gaxiola S, Alonso J, Bruffaerts R, Bunting B, Caldas-de-Almeida JM, Cardoso G, Chardoul S, de Jonge P, Gureje O, Haro JM, Harris MG, Karam EG, Kawakami N, Kiejna A, Kovess-Masfety V, Lee S, McGrath JJ, Moskalewicz J, Navarro-Mateu F, Rapsey C, Sampson NA, Scott KM, Tachimori H, Ten Have M, Vilagut G, Wojtyniak B, Xavier M, Kessler RC, Degenhardt L. Development and evaluation of a risk algorithm predicting alcohol dependence after early onset of regular alcohol use. Addiction 2023; 118:954-966. [PMID: 36609992 PMCID: PMC10073308 DOI: 10.1111/add.16122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 12/10/2022] [Indexed: 01/09/2023]
Abstract
AIMS Likelihood of alcohol dependence (AD) is increased among people who transition to greater levels of alcohol involvement at a younger age. Indicated interventions delivered early may be effective in reducing risk, but could be costly. One way to increase cost-effectiveness would be to develop a prediction model that targeted interventions to the subset of youth with early alcohol use who are at highest risk of subsequent AD. DESIGN A prediction model was developed for DSM-IV AD onset by age 25 years using an ensemble machine-learning algorithm known as 'Super Learner'. Shapley additive explanations (SHAP) assessed variable importance. SETTING AND PARTICIPANTS Respondents reporting early onset of regular alcohol use (i.e. by 17 years of age) who were aged 25 years or older at interview from 14 representative community surveys conducted in 13 countries as part of WHO's World Mental Health Surveys. MEASUREMENTS The primary outcome to be predicted was onset of life-time DSM-IV AD by age 25 as measured using the Composite International Diagnostic Interview, a fully structured diagnostic interview. FINDINGS AD prevalence by age 25 was 5.1% among the 10 687 individuals who reported drinking alcohol regularly by age 17. The prediction model achieved an external area under the curve [0.78; 95% confidence interval (CI) = 0.74-0.81] higher than any individual candidate risk model (0.73-0.77) and an area under the precision-recall curve of 0.22. Overall calibration was good [integrated calibration index (ICI) = 1.05%]; however, miscalibration was observed at the extreme ends of the distribution of predicted probabilities. Interventions provided to the 20% of people with highest risk would identify 49% of AD cases and require treating four people without AD to reach one with AD. Important predictors of increased risk included younger onset of alcohol use, males, higher cohort alcohol use and more mental disorders. CONCLUSIONS A risk algorithm can be created using data collected at the onset of regular alcohol use to target youth at highest risk of alcohol dependence by early adulthood. Important considerations remain for advancing the development and practical implementation of such models.
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Affiliation(s)
- Chrianna Bharat
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales Australia, Sydney, NSW, Australia
| | - Meyer D Glantz
- Department of Epidemiology, Services, and Prevention Research (DESPR), National Institute on Drug Abuse (NIDA), National Institute of Health (NIH), Bethesda, MA, USA
| | | | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Life and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | | | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School|Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School|Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Stephanie Chardoul
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Peter de Jonge
- Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Research, Teaching and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Centre for Biomedical Research on Mental Health (CIBERSAM), Madrid, Spain
| | - Meredith G Harris
- School of Public Health, The University of Queensland, Herston, QLD, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Elie G Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Institute for Development, Research, Advocacy and Applied Care (IDRAAC), St George Hospital University Medical Center, Balamand University, Beirut, Lebanon
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Andrzej Kiejna
- Institute of Psychology, University of Lower Silesia, Wroclaw, Poland
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), Paris Descartes University, Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - John J McGrath
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
- Queensland Brain Institute, The University of Queensland, National Centre for Register-based Research, Aarhus University, Aarhus V, Denmark
| | | | - Fernando Navarro-Mateu
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Basic Psychology and Methodology, University of Murcia, Murcia Biomedical Research Institute (IMIB-Arrixaca), Unidad de Docencia, Investigación y Formación en Salud Mental, Servicio Murciano de Salud, Murcia, Spain
| | - Charlene Rapsey
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Kate M Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Hisateru Tachimori
- Department of Clinical Data Science, Clinical Research and Education Promotion Division, National Center of Neurology and Psychiatry, Endowed Course for Health System Innovation, Keio University School of Medicine, Tokyo, Japan
| | - Margreet Ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Gemma Vilagut
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Bogdan Wojtyniak
- Centre of Monitoring and Analyses of Population Health, National Institute of Public Health-National Research Institute, Warsaw, Poland
| | - Miguel Xavier
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School|Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales Australia, Sydney, NSW, Australia
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5
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Gancz NN, Forster SE. Threats to external validity in the neuroprediction of substance use treatment outcomes. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:5-20. [PMID: 36099534 PMCID: PMC9974755 DOI: 10.1080/00952990.2022.2116712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 08/09/2022] [Accepted: 08/21/2022] [Indexed: 10/14/2022]
Abstract
Background: Tools predicting individual relapse risk would invaluably inform clinical decision-making (e.g. level-of-care) in substance use treatment. Studies of neuroprediction - use of neuromarkers to predict individual outcomes - have the dual potential to create such tools and inform etiological models leading to new treatments. However, financial limitations, statistical power demands, and related factors encourage restrictive selection criteria, yielding samples that do not fully represent the target population. This problem may be further compounded by a lack of statistical optimism correction in neuroprediction research, resulting in predictive models that are overfit to already-restricted samples.Objectives: This systematic review aims to identify potential threats to external validity related to restrictive selection criteria and underutilization of optimism correction in the existing neuroprediction literature targeting substance use treatment outcomes.Methods: Sixty-seven studies of neuroprediction in substance use treatment were identified and details of sample selection criteria and statistical optimism correction were extracted.Results: Most publications were found to report restrictive selection criteria (e.g. excluding psychiatric (94% of publications) and substance use comorbidities (69% of publications)) that would rule-out a considerable portion of the treatment population. Furthermore, only 21% of publications reported optimism correction.Conclusion: Restrictive selection criteria and underutilization of optimism correction are common in the existing literature and may limit the generalizability of identified neural predictors to the target population whose treatment they would ultimately inform. Greater attention to the inclusivity and generalizability of addiction neuroprediction research, as well as new opportunities provided through open science initiatives, have the potential to address this issue.
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Affiliation(s)
- Naomi N. Gancz
- VA Pittsburgh Healthcare System, VISN 4 Mental Illness Research, Education, & Clinical Center (MIRECC)
- University of California, Los Angeles, Department of Psychology
| | - Sarah E. Forster
- VA Pittsburgh Healthcare System, VISN 4 Mental Illness Research, Education, & Clinical Center (MIRECC)
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6
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Knodt AR, Meier MH, Ambler A, Gehred MZ, Harrington H, Ireland D, Poulton R, Ramrakha S, Caspi A, Moffitt TE, Hariri AR. Diminished Structural Brain Integrity in Long-term Cannabis Users Reflects a History of Polysubstance Use. Biol Psychiatry 2022; 92:861-870. [PMID: 36008158 PMCID: PMC9637748 DOI: 10.1016/j.biopsych.2022.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/26/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cannabis legalization and use are outpacing our understanding of its long-term effects on brain and behavior, which is fundamental for effective policy and health practices. Existing studies are limited by small samples, cross-sectional measures, failure to separate long-term from recreational use, and inadequate control for other substance use. Here, we address these limitations by determining the structural brain integrity of long-term cannabis users in the Dunedin Study, a longitudinal investigation of a population-representative birth cohort followed to midlife. METHODS We leveraged prospective measures of cannabis, alcohol, tobacco, and other illicit drug use in addition to structural neuroimaging in 875 study members at age 45 to test for differences in both global and regional gray and white matter integrity between long-term cannabis users and lifelong nonusers. We additionally tested for dose-response associations between continuous measures of cannabis use and brain structure, including careful adjustments for use of other substances. RESULTS Long-term cannabis users had a thinner cortex, smaller subcortical gray matter volumes, and higher machine learning-predicted brain age than nonusers. However, these differences in structural brain integrity were explained by the propensity of long-term cannabis users to engage in polysubstance use, especially with alcohol and tobacco. CONCLUSIONS These findings suggest that diminished midlife structural brain integrity in long-term cannabis users reflects a broader pattern of polysubstance use, underlining the importance of understanding comorbid substance use in efforts to curb the negative effects of cannabis on brain and behavior as well as establish more effective policy and health practices.
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Affiliation(s)
- Annchen R Knodt
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Madeline H Meier
- Department of Psychology, Arizona State University, Tempe, Arizona
| | - Antony Ambler
- Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, United Kingdom; Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Maria Z Gehred
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - HonaLee Harrington
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - David Ireland
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Richie Poulton
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Sandhya Ramrakha
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Avshalom Caspi
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina; Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, United Kingdom
| | - Terrie E Moffitt
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina; Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, United Kingdom
| | - Ahmad R Hariri
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina.
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7
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Barr PB, Driver MN, Kuo SIC, Stephenson M, Aliev F, Linnér RK, Marks J, Anokhin AP, Bucholz K, Chan G, Edenberg HJ, Edwards AC, Francis MW, Hancock DB, Harden KP, Kamarajan C, Kaprio J, Kinreich S, Kramer JR, Kuperman S, Latvala A, Meyers JL, Palmer AA, Plawecki MH, Porjesz B, Rose RJ, Schuckit MA, Salvatore JE, Dick DM. Clinical, environmental, and genetic risk factors for substance use disorders: characterizing combined effects across multiple cohorts. Mol Psychiatry 2022; 27:4633-4641. [PMID: 36195638 PMCID: PMC9938102 DOI: 10.1038/s41380-022-01801-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Substance use disorders (SUDs) incur serious social and personal costs. The risk for SUDs is complex, with risk factors ranging from social conditions to individual genetic variation. We examined whether models that include a clinical/environmental risk index (CERI) and polygenic scores (PGS) are able to identify individuals at increased risk of SUD in young adulthood across four longitudinal cohorts for a combined sample of N = 15,134. Our analyses included participants of European (NEUR = 12,659) and African (NAFR = 2475) ancestries. SUD outcomes included: (1) alcohol dependence, (2) nicotine dependence; (3) drug dependence, and (4) any substance dependence. In the models containing the PGS and CERI, the CERI was associated with all three outcomes (ORs = 01.37-1.67). PGS for problematic alcohol use, externalizing, and smoking quantity were associated with alcohol dependence, drug dependence, and nicotine dependence, respectively (OR = 1.11-1.33). PGS for problematic alcohol use and externalizing were also associated with any substance dependence (ORs = 1.09-1.18). The full model explained 6-13% of the variance in SUDs. Those in the top 10% of CERI and PGS had relative risk ratios of 3.86-8.04 for each SUD relative to the bottom 90%. Overall, the combined measures of clinical, environmental, and genetic risk demonstrated modest ability to distinguish between affected and unaffected individuals in young adulthood. PGS were significant but added little in addition to the clinical/environmental risk index. Results from our analysis demonstrate there is still considerable work to be done before tools such as these are ready for clinical applications.
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Affiliation(s)
- Peter B Barr
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
- VA New York Harbor Healthcare System, Brooklyn, NY, USA.
| | - Morgan N Driver
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Sally I-Chun Kuo
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA
| | - Mallory Stephenson
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Fazil Aliev
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA
- Rutgers Addiction Research Center, Rutgers University, Piscataway, NJ, USA
| | | | - Jesse Marks
- Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, Durham, NC, USA
| | - Andrey P Anokhin
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St Louis, MO, USA
| | - Kathleen Bucholz
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St Louis, MO, USA
| | - Grace Chan
- Department of Psychiatry, School of Medicine, University of Connecticut, Farmington, CT, USA
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Howard J Edenberg
- Department of Medical and Molecular Genetics, School of Medicine, Indiana University, Indianapolis, IN, USA
- Department of Biochemistry and Molecular Biology, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Alexis C Edwards
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Meredith W Francis
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St Louis, MO, USA
| | - Dana B Hancock
- Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, Durham, NC, USA
| | - K Paige Harden
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
- Population Research Center, University of Texas at Austin, Austin, TX, USA
| | - Chella Kamarajan
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jaakko Kaprio
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Sivan Kinreich
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - John R Kramer
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Samuel Kuperman
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Antti Latvala
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland
| | - Jacquelyn L Meyers
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- VA New York Harbor Healthcare System, Brooklyn, NY, USA
| | - Abraham A Palmer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Institute for Genomic Medicine, University of California San Diego, La Jolla, CA, USA
| | - Martin H Plawecki
- Department of Psychiatry, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Bernice Porjesz
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Richard J Rose
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Marc A Schuckit
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Jessica E Salvatore
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA
| | - Danielle M Dick
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA
- Rutgers Addiction Research Center, Rutgers University, Piscataway, NJ, USA
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8
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Wojciechowski T. Borderline Personality Disorder as a Predictor of Drug Use Variety: Cognitive Vs. Affective Mechanisms. J Psychoactive Drugs 2022; 54:452-461. [PMID: 34856887 DOI: 10.1080/02791072.2021.2009067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Borderline personality disorder has been identified as a risk factor for polydrug use. Despite this, there remains a lack of understanding of which characteristics of the disorder provide the mechanisms for this relationship. This study examined a set of constructs as mechanisms explaining the borderline personality disorder-polydrug use relationship that are divided into affective and cognitive categories. The Pathways to Desistance data were used in analyses. Generalized structural equation modeling was used to examine the direct relationship between borderline personality disorder and test for attenuation of this direct effect. A bootstrap resampling process was used to estimate standard errors utilized to specify specific and total indirect effects of mechanism variables and their significance level. Results indicated that greater symptom severity of borderline personality disorder predicted increased drug use variety. This relationship was attenuated by 70% when hypothesized mechanisms were included and became nonsignificant. It appeared that this attenuation was mainly due to sensation-seeking. Findings indicate that interventions for individuals suffering from borderline personality disorder with polydrug use issues may find utility in structuring programming around mitigating sensation-seeking.
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Niklason GR, Rawls E, Ma S, Kummerfeld E, Maxwell AM, Brucar LR, Drossel G, Zilverstand A. Explainable machine learning analysis reveals sex and gender differences in the phenotypic and neurobiological markers of Cannabis Use Disorder. Sci Rep 2022; 12:15624. [PMID: 36115920 PMCID: PMC9482622 DOI: 10.1038/s41598-022-19804-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Cannabis Use Disorder (CUD) has been linked to a complex set of neuro-behavioral risk factors. While many studies have revealed sex and gender differences, the relative importance of these risk factors by sex and gender has not been described. We used an “explainable” machine learning approach that combined decision trees [gradient tree boosting, XGBoost] with factor ranking tools [SHapley’s Additive exPlanations (SHAP)] to investigate sex and gender differences in CUD. We confirmed that previously identified environmental, personality, mental health, neurocognitive, and brain factors highly contributed to the classification of cannabis use levels and diagnostic status. Risk factors with larger effect sizes in men included personality (high openness), mental health (high externalizing, high childhood conduct disorder, high fear somaticism), neurocognitive (impulsive delay discounting, slow working memory performance) and brain (low hippocampal volume) factors. Conversely, risk factors with larger effect sizes in women included environmental (low education level, low instrumental support) factors. In summary, environmental factors contributed more strongly to CUD in women, whereas individual factors had a larger importance in men.
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10
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A Bayesian learning model to predict the risk for cannabis use disorder. Drug Alcohol Depend 2022; 236:109476. [PMID: 35588608 DOI: 10.1016/j.drugalcdep.2022.109476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/19/2022] [Accepted: 04/23/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The prevalence of cannabis use disorder (CUD) has been increasing recently and is expected to increase further due to the rising trend of cannabis legalization. To help stem this public health concern, a model is needed that predicts for an adolescent or young adult cannabis user their personalized risk of developing CUD in adulthood. However, there exists no such model that is built using nationally representative longitudinal data. METHODS We use a novel Bayesian learning approach and data from Add Health (n = 8712), a nationally representative longitudinal study, to build logistic regression models using four different regularization priors: lasso, ridge, horseshoe, and t. The models are compared by their prediction performance on unseen data via 5-fold-cross-validation (CV). We assess model discrimination using the area under the curve (AUC) and calibration by comparing the expected (E) and observed (O) number of CUD cases. We also externally validate the final model on independent test data from Add Health (n = 570). RESULTS Our final model is based on lasso prior and has seven predictors: biological sex; scores on personality traits of neuroticism, openness, and conscientiousness; and measures of adverse childhood experiences, delinquency, and peer cannabis use. It has good discrimination and calibration performance as reflected by its respective AUC and E/O of 0.69 and 0.95 based on 5-fold CV and 0.71 and 1.10 on validation data. CONCLUSION This externally validated model may help in identifying adolescent or young adult cannabis users at high risk of developing CUD in adulthood.
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11
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Pelham WE, Corbin WR, Meier MH. Validating a brief screening measure for early-onset substance use during adolescence in a diverse, nationwide birth cohort. Addict Behav 2022; 129:107277. [PMID: 35219034 PMCID: PMC9850803 DOI: 10.1016/j.addbeh.2022.107277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 01/21/2023]
Abstract
The Loeber Risk Score (LRS) was developed to predict early-onset cannabis use in adolescence from late childhood, facilitating early identification. However, the LRS was developed in non-representative historical samples, leaving uncertain its generalizability to children/adolescents across the U.S. today. We externally validated the LRS in a diverse, nationwide cohort (N = 4,898) weighted to the composition of the U.S. Census. Participants in 20 cities completed assessments when youth were approximately 5, 9, and 15 years old. Parents completed the LRS at the age ∼5 and ∼9 interviews. At the age ∼15 interview, youth reported on the onset of alcohol/drug use before age 15, monthly drinking/binge drinking at ages 14-16, and use of cannabis multiple times per month at ages 14-16. First, we validated the LRS measured at age ∼9. Area under the receiver operating curve was 0.62 for onset of cannabis use before age 15, 0.68 for onset of cigarette use before age 15, and 0.62 for use of cannabis multiple times per month at ages 14-16. For drinking outcomes, LRS performance could not be distinguished from chance prediction. The recommended screening cutoff of LRS ≥ 2 identified 24% of children, among whom early-onset cannabis/cigarette use outcomes occurred 1.4-2.2 times more frequently than the general population. The LRS' performance did not vary significantly by sex, race, or ethnicity. When the LRS was measured at age ∼5, AUROC was significantly lower for some outcomes. Together, findings support the LRS measure as a potential tool for identifying children in early or late childhood at risk of early-onset drug use in adolescence.
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Affiliation(s)
- William E. Pelham
- Center for Human Development, University of California, San Diego, United States,Corresponding author at: Center for Human Development, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093, United States. (W.E. Pelham)
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12
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Vines L, Sotelo D, Johnson A, Dennis E, Manza P, Volkow ND, Wang GJ. Ketamine use disorder: preclinical, clinical, and neuroimaging evidence to support proposed mechanisms of actions. INTELLIGENT MEDICINE 2022; 2:61-68. [PMID: 35783539 PMCID: PMC9249268 DOI: 10.1016/j.imed.2022.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Ketamine, a noncompetitive NMDA receptor antagonist, has been exclusively used as an anesthetic in medicine and has led to new insights into the pathophysiology of neuropsychiatric disorders. Clinical studies have shown that low subanesthetic doses of ketamine produce antidepressant effects for individuals with depression. However, its use as a treatment for psychiatric disorders has been limited due to its reinforcing effects and high potential for diversion and misuse. Preclinical studies have focused on understanding the molecular mechanisms underlying ketamine's antidepressant effects, but a precise mechanism had yet to be elucidated. Here we review different hypotheses for ketamine's mechanism of action including the direct inhibition and disinhibition of NMDA receptors, AMPAR activation, and heightened activation of monoaminergic systems. The proposed mechanisms are not mutually exclusive, and their combined influence may exert the observed structural and functional neural impairments. Long term use of ketamine induces brain structural, functional impairments, and neurodevelopmental effects in both rodents and humans. Its misuse has increased rapidly in the past 20 years and is one of the most common addictive drugs used in Asia. The proposed mechanisms of action and supporting neuroimaging data allow for the development of tools to identify 'biotypes' of ketamine use disorder (KUD) using machine learning approaches, which could inform intervention and treatment.
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Affiliation(s)
| | | | | | | | | | | | - Gene-Jack Wang
- Corresponding author: Gene-Jack Wang, Laboratory of Neuroimaging, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 10 Center Dr, Rm B2L124, Bethesda, Maryland, United States ()
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13
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Ruberu TLM, Kenyon EA, Hudson KA, Filbey F, Ewing SWF, Biswas S, Choudhary PK. Joint risk prediction for hazardous use of alcohol, cannabis, and tobacco among adolescents: A preliminary study using statistical and machine learning. Prev Med Rep 2022; 25:101674. [PMID: 35127353 PMCID: PMC8800066 DOI: 10.1016/j.pmedr.2021.101674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/23/2021] [Accepted: 12/12/2021] [Indexed: 11/17/2022] Open
Abstract
A risk prediction model for hazardous substance use among adolescents is proposed. The model predicts risk of hazardous use of alcohol, cannabis, and tobacco jointly. It uses statistical and machine learning methods for modeling of multiple outcomes. It may help identify adolescent users at elevated risk of hazardous substance use.
For some, substance use during adolescence may be a stepping stone on the way to substance use disorders in adulthood. Risk prediction models may help identify adolescent users at elevated risk for hazardous substance use. This preliminary analysis used cross-sectional data (n = 270, ages 13–18) from the baseline dataset of a randomized controlled trial intervening with adolescent alcohol and/or cannabis use. Models were developed for jointly predicting quantitative scores on three measures of hazardous substance use (Rutgers Alcohol Problems Index, Adolescent Cannabis Problem Questionnaire, and Hooked on Nicotine Checklist) based on personal risk factors using two statistical and machine learning methods: multivariate covariance generalized linear models (MCGLM) and penalized multivariate regression with a lasso penalty. The predictive accuracy of a model was evaluated using root mean squared error computed via leave-one-out cross-validation. The final proposed model was an MCGLM model. It has eleven risk factors: age, early life stress, age of first tobacco use, age of first cannabis use, lifetime use of other substances, age of first use of other substances, maternal education, parental attachment, family cigarette use, family history of hazardous alcohol use, and family history of hazardous cannabis use. Different subsets of these risk factors feature in the three outcome-specific components of this joint model. The quantitative risk estimate provided by the proposed model may help identify adolescent substance users of cannabis, alcohol, and tobacco who may be at an elevated risk of developing hazardous substance use.
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Drugs age-of-onset as a signal of later post-traumatic stress disorder: Bayesian analysis of a census protocol. Addict Behav 2022; 125:107131. [PMID: 34763301 DOI: 10.1016/j.addbeh.2021.107131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 08/24/2021] [Accepted: 10/04/2021] [Indexed: 12/26/2022]
Abstract
Individuals with PTSD have an increased risk of drug use disorders. Conversely, we aim to evaluate how early onset of alcohol, tobacco and psychoactive drugs use are associated with PTSD later in life. 2,193 brazilian young adults completed modularized assessments: The Trauma History Questionnaire, Post-Traumatic Stress Disorder Checklist-Civilian Version (PCL-C, transformed to PCL-5 through a crosswalk procedure), the Barratt Impulsivity Scale; and a survey on drug use with self-report questions about first use, current use, frequency, quantity, and interpersonal consequences. Bayesian inference and multivariate regression models were used to examine the effects on the risk of PTSD, considering different assumptions of information flow. Raw and unbiased (multivariate) estimates consistently revealed that earlier age of onset of alcohol and tobacco use increased risk for PTSD (Odds-ratios between 2.39 and 3.19 (Alcohol) and 1.82 to 2.05 (Tobacco). Among those who had PTSD (310), 10.3% (32) were very precocious at the onset age (12 to 18 years) of alcohol consumption (No-PTSD: 89 out 1883, 4.7%). Data supports a model in which age of onset effects are partially mediated by the number of trauma exposures. Early intoxication might suggest vulnerability for qualifying trauma events, or it may increase chances of exposure. Also, PTSD may be more likely to occur among trauma-exposed individuals with early intoxicating experiences due to alcohol or drug self-administration. The last possibility resonates with the idea that early intoxication might disrupt adolescent brain development, with a subsequent reduction in resilience when qualifying trauma events occur.
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Moska C, Goudriaan AE, Blanken P, van de Mheen D, Spijkerman R, Schellekens A, de Jonge J, Bary F, Vollebergh W, Hendriks V. Youth in transition: Study protocol of a prospective cohort study into the long-term course of addiction, mental health problems and social functioning in youth entering addiction treatment. BMC Psychiatry 2021; 21:605. [PMID: 34863131 PMCID: PMC8642918 DOI: 10.1186/s12888-021-03520-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/04/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Substance use disorders (SUDs) are prevalent in the general population, tend to follow a chronic course, are associated with many individual and social problems, and often have their onset in adolescence. However, the knowledge base from prospective population surveys and treatment-outcome studies on the course of SUD in adolescents is limited at best. The present study aims to fill this gap and focuses on a subgroup that is particularly at risk for chronicity: adolescents in addiction treatment. We will investigate the rate of persistent SUD and its predictors longitudinally from adolescence to young adulthood among youth with DSM-5 SUD from the start of their addiction treatment to 2 and 4 years following treatment-entry. In addition to SUD, we will investigate the course of comorbid mental disorders, social functioning, and quality of life and their association with SUD over time. METHODS/DESIGN In a naturalistic, multi-center prospective cohort design, we will include youths (n = 420), who consecutively enter addiction treatment at ten participating organizations in the Netherlands. Inclusion is prestratified by treatment organization, to ensure a nationally representative sample. Eligible youths are 16 to 22 years old and seek help for a primary DSM-5 cannabis, alcohol, cocaine or amphetamine use disorder. Assessments focus on lifetime and current substance use and SUD, non-SUD mental disorders, family history, life events, social functioning, treatment history, quality of life, chronic stress indicators (hair cortisol) and neuropsychological tests (computerized executive function tasks) and are conducted at baseline, end of treatment, and 2 and 4 years post-baseline. Baseline data and treatment data (type, intensity, duration) will be used to predict outcome - persistence of or desistance from SUD. DISCUSSION There are remarkably few prospective studies worldwide that investigated the course of SUD in adolescents in addiction treatment for longer than 1 year. We are confident that the Youth in Transition study will further our understanding of determinants and consequences of persistent SUD among high-risk adolescents during the critical transition from adolescence to young adulthood. TRIAL REGISTRATION The Netherlands National Trial Register Trial NL7928 . Date of registration January 17, 2019.
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Affiliation(s)
- Christina Moska
- grid.491465.bParnassia Addiction Research Centre (PARC, Brijder Addiction Treatment), Zoutkeetsingel 40, 2512 HN The Hague, the Netherlands ,grid.10419.3d0000000089452978Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Center, Leiden, the Netherlands
| | - Anna E. Goudriaan
- grid.7177.60000000084992262Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands ,grid.491159.10000 0004 0493 7618Amsterdam Institute for Addiction Research, Arkin Mental Health Care, Amsterdam, the Netherlands
| | - Peter Blanken
- grid.491465.bParnassia Addiction Research Centre (PARC, Brijder Addiction Treatment), Zoutkeetsingel 40, 2512 HN The Hague, the Netherlands
| | - Dike van de Mheen
- grid.12295.3d0000 0001 0943 3265Department of Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, the Netherlands
| | - Renske Spijkerman
- grid.491465.bParnassia Addiction Research Centre (PARC, Brijder Addiction Treatment), Zoutkeetsingel 40, 2512 HN The Hague, the Netherlands
| | - Arnt Schellekens
- grid.10417.330000 0004 0444 9382Department of Psychiatry, Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behavior, Nijmegen, the Netherlands ,grid.491352.8Nijmegen Institute for Science Practitioners in Addiction (NISPA), Nijmegen, the Netherlands
| | - Jannet de Jonge
- grid.431204.00000 0001 0685 7679Research Group Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands
| | - Floris Bary
- Netherlands Network of Client Councils in Addiction Care ‘Het Zwarte Gat’, Hollands Kroon, The Netherlands
| | - Wilma Vollebergh
- grid.5477.10000000120346234Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | - Vincent Hendriks
- grid.491465.bParnassia Addiction Research Centre (PARC, Brijder Addiction Treatment), Zoutkeetsingel 40, 2512 HN The Hague, the Netherlands ,grid.10419.3d0000000089452978Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Center, Leiden, the Netherlands
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Coleman LG, Crews FT, Vetreno RP. The persistent impact of adolescent binge alcohol on adult brain structural, cellular, and behavioral pathology: A role for the neuroimmune system and epigenetics. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2021; 160:1-44. [PMID: 34696871 DOI: 10.1016/bs.irn.2021.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Adolescence is a critical neurodevelopmental window for maturation of brain structure, neurocircuitry, and glia. This development is sculpted by an individual's unique experiences and genetic background to establish adult level cognitive function and behavioral makeup. Alcohol abuse during adolescence is associated with an increased lifetime risk for developing an alcohol use disorder (AUD). Adolescents participate in heavy, episodic binge drinking that causes persistent changes in neurocircuitry and behavior. These changes may underlie the increased risk for AUD and might also promote cognitive deficits later in life. In this chapter, we have examined research on the persistent effects of adolescent binge-drinking both in humans and in rodent models. These studies implicate roles for neuroimmune signaling as well as epigenetic reprogramming of neurons and glia, which create a vulnerable neuroenvironment. Some of these changes are reversible, giving hope for future treatments to prevent many of the long-term consequences of adolescent alcohol abuse.
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Affiliation(s)
- Leon G Coleman
- Department of Pharmacology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Bowles Center for Alcohol Studies, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Fulton T Crews
- Department of Pharmacology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Bowles Center for Alcohol Studies, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ryan P Vetreno
- Bowles Center for Alcohol Studies, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Wojciechowski T. Relevance of the dual systems model for predicting drug/alcohol dependence in early adulthood among previously adjudicated young adults. Drug Alcohol Depend 2021; 226:108876. [PMID: 34225226 DOI: 10.1016/j.drugalcdep.2021.108876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/03/2021] [Accepted: 06/16/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND While the dual system model has been found to have utility for predicting drug use, examinations have yet to extend to the clinically relevant issue of drug/alcohol dependence. This study sought to provide better understanding of how the dual systems model constructs (impulse control and sensation-seeking) predicted risk for drug/alcohol dependence in early adulthood among a sample of young adults who were adjudicated for a serious offense as minors. METHODS Data from several waves of the Pathways to Desistance data were used in analyses. Logistic regression was used to model covariate effects on drug/alcohol dependence risk. RESULTS Findings indicated that lower impulse control predicted increased odds of meeting criteria for drug/alcohol dependence in early adulthood. Sensation-seeking was not a significant predictor of drug/alcohol dependence risk at follow-up. CONCLUSIONS Lower impulse control was predictive of drug/alcohol dependence risk. Prevention programming should seek to boost impulse control during adolescence to mitigate this risk and treatment programming should focus on impulse control training in order to treat drug/alcohol dependence in inpatient and outpatient contexts.
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de Goede J, van der Mark-Reeuwijk KG, Braun KP, le Cessie S, Durston S, Engels RCME, Goudriaan AE, Moons KGM, Vollebergh WAM, de Vries TJ, Wiers RW, Oosterlaan J. Alcohol and Brain Development in Adolescents and Young Adults: A Systematic Review of the Literature and Advisory Report of the Health Council of the Netherlands. Adv Nutr 2021; 12:1379-1410. [PMID: 33530096 DOI: 10.1093/advances/nmaa170] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/20/2020] [Accepted: 12/04/2020] [Indexed: 11/14/2022] Open
Abstract
Young people, whose brains are still developing, might entail a greater vulnerability to the effects of alcohol consumption on brain function and development. A committee of experts of the Health Council of the Netherlands evaluated the state of scientific knowledge regarding the question whether alcohol negatively influences brain development in young people. A systematic literature search for prospective studies was performed in PubMed and PsychINFO, for longitudinal studies of adolescents or young adults ranging between 12 and 24 y of age at baseline, investigating the relation between alcohol use and outcome measures of brain structure and activity, cognitive functioning, educational achievement, or alcohol use disorder (AUD), with measures at baseline and follow-up of the outcome of interest. Data were extracted from original articles and study quality was assessed using the Newcastle-Ottawa Scale. A total of 77 studies were included, 31 of which were of sufficient quality in relation to the study objectives. There were indications that the gray matter of the brain develops abnormally in young people who drink alcohol. In addition, the more often young people drink or the younger they start, the higher the risk of developing AUD later in life. The evidence on white matter volume or quality, brain activity, cognitive function, and educational achievement is still limited or unclear. The committee found indications that alcohol consumption can have a negative effect on brain development in adolescents and young adults and entails a risk of later AUD. The committee therefore considers it a wise choice for adolescents and young adults not to drink alcohol.
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Affiliation(s)
| | | | - Kees P Braun
- Department of Child Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands.,Department of Biomedical Datasciences, section Medical Statistics, Leiden University Medical Center, Leiden, Netherlands
| | - Sarah Durston
- NICHE-lab, Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Rutger C M E Engels
- Department of Psychology, Education & Child Studies/Clinical Psychology, Erasmus University, Rotterdam, Netherlands
| | - Anna E Goudriaan
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Arkin, Amsterdam, Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Wilma A M Vollebergh
- Faculty of Social and Behavioral Sciences, University of Utrecht, Utrecht, Netherlands
| | - Taco J de Vries
- Department of Anatomy and Neurosciences, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT)-lab, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Jaap Oosterlaan
- Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Emma Neuroscience Group, Department of Pediatrics, Amsterdam Reproduction & Development, Amsterdam, Netherlands
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Causey ST, Towe SL, Hartsock J, Xu Y, Meade CS. Perceived Healthcare Access among Persons with and without HIV Who Use Illicit Stimulants: The Role of Cumulative Risk. Subst Use Misuse 2021; 56:1387-1396. [PMID: 34034631 PMCID: PMC8370044 DOI: 10.1080/10826084.2021.1928211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Persons who use stimulant drugs have greater morbidity and mortality relative to non-users. HIV infection has the potential to contribute to even great disparity in health outcomes among persons who use stimulants. These health disparities likely result in part due to poorer access to healthcare. Our study used a cumulative risk model to examine the impact of multiple risk factors on healthcare access in a sample of persons with and without HIV who use stimulants. Method: Our sample included 453 persons who reported recent use of illicit stimulants (102 HIV+, 351 HIV-). Participants completed clinical interviews, questionnaires, and a rapid oral HIV test. We constructed an 8-item cumulative risk index that included factors related to socioeconomic status, homelessness, legal history, and substance use. Results: Participants with HIV (PHW) were older than participants without HIV and more likely to have health insurance. Participants with and without HIV reported similar prior treatment utilization, but PWH reported better healthcare access and lower cumulative risk scores. Regression analyses showed cumulative risk was a significant predictor of healthcare access (β = -0.20, p < 0.001) even after controlling for age, HIV status, and health insurance status. We did not observe an interaction of HIV status by cumulative risk. Conclusions: Access to care among persons who use stimulants, both with and without HIV, is negatively impacted by the accumulation of risk factors from a number of different domains. Understanding the cumulative effects of these factors is critical for developing interventions to facilitate access to care, thus reducing health disparities and improving health outcomes.
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Affiliation(s)
- Shakiera T Causey
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sheri L Towe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jeremiah Hartsock
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Yunan Xu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christina S Meade
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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Fischer LC, Kölligan V, Wieland N, Klein M. Development and Evaluation of a Digital Health Intervention for Substance Use Reduction in Young Refugees With Problematic Use of Alcohol and/or Cannabis-Study Protocol for a Single-Armed Feasibility Trial. Front Public Health 2021; 9:557431. [PMID: 33869122 PMCID: PMC8044446 DOI: 10.3389/fpubh.2021.557431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 03/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Refugee populations are at substantial risk of developing substance use disorder (SUD) and other mental health disorders. At the same time, refugee populations face numerous barriers to accessing mental health services. Digital interventions can address some of these issues, as emerging evidence indicates that digital interventions offer an effective, low-cost alternative with high accessibility and similar efficacy as standard SUD prevention programs. As an add-on to traditional services, they further present a viable approach to the lack of personnel available for foreign language communication in preventive and therapeutic settings. In the present study, we thus aim to develop and evaluate a digital health intervention (DHI) for the reduction of substance use for young refugees with problematic use of alcohol and/or cannabis. The intervention will be implemented in a smartphone app, translated into Arabic, English, Farsi, German, and Pashto, and is to be used stand-alone. It is based on methods from cognitive behavioral therapy, contains culturally adapted elements, provides practical information on how to deal safely with alcohol and cannabis, and motivates behavior change through increased self-reflection and behavioral, cognitive, and emotional skills-training in interactive exercises. Methods: We conduct a single-armed feasibility trial among 150 young refugees with problematic use of alcohol and/or cannabis. Participants will receive a digital screening and digital health intervention (DHI) for the reduction of problematic substance use, carried out over a 4-week time frame. The primary outcomes are the intervention's feasibility and the target population's acceptance of the intervention. The secondary outcome is a change in substance use post-intervention from baseline. Measurements are taken pre-intervention (baseline), post-intervention (after 4 weeks), and at 3- and 6-month follow-ups. We expect the intervention to be feasible and accepted by the target group. Discussion: The present study will establish to what degree the digital intervention (the "BePrepared App") is feasible and accepted by the target group. The evaluation of an easily accessible, feasible, and accepted intervention may impact refugees' mental health and health-related consequences. It aims at overcoming barriers to preventive health care in the substance use field for underserved refugee populations as a tool within a larger set of urgently needed interventions. Trial Registration: DRKS00021095 at the "German Clinical Trials Register" (30.03.2020).
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Affiliation(s)
- Laura Charlotte Fischer
- German Institute on Addiction and Prevention Research (DISuP), Catholic University of Applied Sciences of North Rhine–Westphalia, Cologne, Germany
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21
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Bares C, Lopez-Quintero C. Shared Environmental Influences on Electronic Cigarette Use Among Adolescent and Young Adult Females. Nicotine Tob Res 2021; 23:1425-1430. [PMID: 33539519 DOI: 10.1093/ntr/ntab022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 01/28/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Electronic cigarettes are now the most commonly used form of tobacco product among youth in the United States. Current evidence suggests that although e-cigarettes are perceived as less harmful and preferred over combustible cigarettes by adolescents, adolescents who try e-cigarettes are at greater risk of transitioning to combustible cigarettes. The genetic and environmental contributions to liability for e-cigarette use have not yet been examined using a behavioral genetic design. METHODS Behavioral genetic models of lifetime and current e-cigarette use and friends who use e-cigarettes were examined among female monozygotic and dizygotic twins. RESULTS A total of 41 female twin pairs (65.9% monozygotic twins; age = 19.7, SD = 1.6) with complete data on the study variables were included in the present analyses. The majority of the sample (68.1%) had at least some friends who use e-cigarettes. Additive genetic effects on e-cigarette use were not present, but the shared environment explained 98.7% of the variance in lifetime e-cigarette use, 96.6% in current e-cigarette use, and 94.9% in affiliation with friends who use e-cigarettes. CONCLUSION This first study on the behavioral genetics of e-cigarette use among adolescents and young adults suggest that environmental factors shared by twins within a family seem to play a predominant role in the initial stages of e-cigarette use, a finding that is consistent with what has been found for tobacco. The findings emphasize the importance of continuing population-based tobacco control interventions to reduce the burden of e-cigarette use among adolescents. IMPLICATIONS The shared environment significantly influences the initiation and regular use of electronic cigarettes and affiliation with friends who use electronic cigarettes among adolescent and young adult females. These findings underscore the importance of formulating preventive interventions that mitigate the social effects of familial influences on e-cigarette use through social skills training, education on harms of e-cigarettes for young people, or altering social norms regarding initiation of novel tobacco products.
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Affiliation(s)
- Cristina Bares
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA
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22
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Buttazzoni A, Tariq U, Thompson-Haile A, Burkhalter R, Cooke M, Minaker L. Adolescent Gender Identity, Sexual Orientation, and Cannabis Use: Potential Mediations by Internalizing Disorder Risk. HEALTH EDUCATION & BEHAVIOR 2021; 48:82-92. [PMID: 33103513 PMCID: PMC7791274 DOI: 10.1177/1090198120965509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/AIMS Adolescents who identify as nonbinary gender or as not heterosexual report higher levels of mental illness than their counterparts. Cannabis use is a commonly employed strategy to cope with mental illness symptoms among adolescents; however, cannabis use can have many deleterious health consequences for youth. Within the frame of minority stress theory, this study investigates the relationships between gender identity and sexual orientation, internalizing disorder symptoms, and cannabis use among adolescents. METHOD A national cross-sectional survey of a generalizable sample of high school students in Canada from the 2017 wave (N = 15,191) of the Cancer Risk Assessment in Youth Survey was analyzed in spring 2019. Mediation analyses were completed to examine risk of internalizing disorder symptoms as a potential mediator of the association between (1) gender identity and (2) sexual orientation, and cannabis use. RESULTS Indirect effects in all models show significantly higher levels of reported internalizing disorder symptoms for female (OR = 3.44, 95% CI [2.84, 4.18]) and nonbinary gender (OR = 3.75, 95% CI [2.16, 6.51]) compared with male students. Sexual minority adolescents had higher odds of internalizing disorder risk relative to non-sexual minority adolescents (OR = 3.13, 95% CI [2.63, 3.74]). Students who reported higher rates of internalizing disorder symptoms were more likely to have ever used cannabis. Patterns of partial mediation are also present among all groups. DISCUSSION/CONCLUSIONS Findings can be used to better inform mental health interventions for adolescents. Future study should explore specific mental health stressors of vulnerable adolescent groups with respect to cannabis use as a coping mechanism.
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Affiliation(s)
| | - Ulaina Tariq
- University of Waterloo, Waterloo,
Ontario, Canada
| | | | | | - Martin Cooke
- University of Waterloo, Waterloo,
Ontario, Canada
| | - Leia Minaker
- University of Waterloo, Waterloo,
Ontario, Canada
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23
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Sehl H, Terrett G, Greenwood LM, Kowalczyk M, Thomson H, Poudel G, Manning V, Lorenzetti V. Patterns of brain function associated with cannabis cue-reactivity in regular cannabis users: a systematic review of fMRI studies. Psychopharmacology (Berl) 2021; 238:2709-2728. [PMID: 34505940 PMCID: PMC8455486 DOI: 10.1007/s00213-021-05973-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 08/17/2021] [Indexed: 12/21/2022]
Abstract
RATIONALE Regular cannabis use (i.e. ≥ monthly) is highly prevalent, with past year use being reported by ~ 200 million people globally.High reactivity to cannabis cues is a key feature of regular cannabis use and has been ascribed to greater cannabis exposure and craving, but the underlying neurobiology is yet to be systematically integrated. OBJECTIVES We aim to systematically summarise the findings from fMRI studies which examined brain function in cannabis users while exposed to cannabis vs neutral stimuli during a cue-reactivity fMRI task. METHODS A systematic search of PsycINFO, PubMed and Scopus databases was pre-registered in PROSPERO (CRD42020171750) and conducted following PRISMA guidelines. Eighteen studies met inclusion/exclusion criteria. Samples comprised 918 participants (340 female) aged 16-38 years. Of these, 603 were regular cannabis users, and 315 were controls. RESULTS The literature consistently reported greater brain activity in cannabis users while exposed to cannabis vs neutral stimuli in three key brain areas: the striatum, the prefrontal (anterior cingulate, middle frontal) and the parietal cortex (posterior cingulate/precuneus) and additional brain regions (hippocampus, amygdala, thalamus, occipital cortex). Preliminary correlations emerged between cannabis craving and the function of partially overlapping regions (amygdala, striatum, orbitofrontal cortex ). CONCLUSIONS Exposure to cannabis-cues may elicit greater brain function and thus trigger cravings in regular cannabis users and thus trigger cannabis craving. Standardised and longitudinal assessments of cannabis use and related problems are required to profile with greater precision the neurobiology of cannabis cue-reactivity, and its role in predicting cravings and relapse.
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Affiliation(s)
- Hannah Sehl
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Daniel Mannix building, 17 Young Street, Fitzroy, VIC 3065 Australia
| | - Gill Terrett
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Daniel Mannix building, 17 Young Street, Fitzroy, VIC 3065 Australia
| | - Lisa-Marie Greenwood
- Research School of Psychology, Australian National University, Canberra, Australia ,The Australian Centre for Cannabinoid Clinical and Research Excellence (ACRE), New Lambton Heights, New South Wales Australia
| | - Magdalena Kowalczyk
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Daniel Mannix building, 17 Young Street, Fitzroy, VIC 3065 Australia
| | - Hannah Thomson
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Daniel Mannix building, 17 Young Street, Fitzroy, VIC 3065 Australia
| | - Govinda Poudel
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Victoria Manning
- Turning Point, Eastern Health, Monash University, Melbourne, Australia
| | - Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Daniel Mannix building, 17 Young Street, Fitzroy, VIC, 3065, Australia.
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Morales AM, Jones SA, Kliamovich D, Harman G, Nagel BJ. Identifying Early Risk Factors for Addiction Later in Life: A Review of Prospective Longitudinal Studies. CURRENT ADDICTION REPORTS 2020; 7:89-98. [PMID: 33344103 DOI: 10.1007/s40429-019-00282-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Purpose of Review To review prospective longitudinal studies that have identified risk factors for the development of substance use disorders in adulthood from individual differences during childhood and adolescence. Recent Findings Risk factors during childhood and adolescence that have been consistently linked to increased risk for addiction include externalizing and internalizing symptoms, early substance use, and environmental influences, such as parental behavior and exposure to traumatic experiences. Summary Since the etiology of substance use disorders is complex and likely is attributable to many causal pathways, systematic examination of the associations between risk factors will be necessary to understand the mixed findings in the existing literature, to determine which individuals should be targeted for prevention efforts, and to design interventions that address risk factors that are most likely to improve outcomes.
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Affiliation(s)
- Angelica M Morales
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Scott A Jones
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Dakota Kliamovich
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA
| | - Gareth Harman
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Bonnie J Nagel
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.,Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA
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Friedrichsdorf SJ, Goubert L. [Pediatric pain treatment and prevention for hospitalized children]. Schmerz 2020; 35:195-210. [PMID: 33337532 DOI: 10.1007/s00482-020-00519-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Prevention and treatment of pain in pediatric patients compared with adults is often not only inadequate but also less often implemented the younger the children are. Children 0 to 17 years are a vulnerable population. OBJECTIVES To address the prevention and treatment of acute and chronic pain in children, including pain caused by needles, with recommended analgesic starting doses. METHODS This Clinical Update elaborates on the 2019 IASP Global Year Against Pain in the Vulnerable "Factsheet Pain in Children: Management" and reviews best evidence and practice. RESULTS Multimodal analgesia may include pharmacology (eg, basic analgesics, opioids, and adjuvant analgesia), regional anesthesia, rehabilitation, psychological approaches, spirituality, and integrative modalities, which act synergistically for more effective acute pediatric pain control with fewer side effects than any single analgesic or modality. For chronic pain, an interdisciplinary rehabilitative approach, including physical therapy, psychological treatment, integrative mind-body techniques, and normalizing life, has been shown most effective. For elective needle procedures, such as blood draws, intravenous access, injections, or vaccination, overwhelming evidence now mandates that a bundle of 4 modalities to eliminate or decrease pain should be offered to every child every time: (1) topical anesthesia, eg, lidocaine 4% cream, (2) comfort positioning, eg, skin-to-skin contact for infants, not restraining children, (3) sucrose or breastfeeding for infants, and (4) age-appropriate distraction. A deferral process (Plan B) may include nitrous gas analgesia and sedation. CONCLUSION Failure to implement evidence-based pain prevention and treatment for children in medical facilities is now considered inadmissible and poor standard of care.
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Affiliation(s)
- Stefan J Friedrichsdorf
- Center of Pain Medicine, Palliative Care and Integrative Medicine, University of California at San Francisco (UCSF), Benioff Children's Hospitals in Oakland and San Francisco, Kalifornien, USA.
- Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA.
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | - Liesbet Goubert
- Department of Experimental-Clinical and Health Psychology, Ghent University, Gent, Belgien
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Luciana M. Risks versus consequences of adolescent and young adult substance use: A focus on executive control. CURRENT ADDICTION REPORTS 2020; 7:453-463. [PMID: 33816055 PMCID: PMC8014909 DOI: 10.1007/s40429-020-00341-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW This review examines the role of executive control processes in the liability for substance misuse and whether substance use, once initiated, leads to subsequent decrements as proposed by neurotoxicity models of substance use disorder (SUD). RECENT FINDINGS As indicated by a number of recent meta-analyses, executive control processes, which include working memory, cognitive flexibility and numerous aspects of attentional, behavioral and emotional control, are impaired in the context of active SUD. Longitudinal studies of behaviorally disinhibited children, individuals with familial risks for SUD, and twins within whom genetic versus environmental influences on behavior can be modeled robustly indicate that relatively poor control is a vulnerability factor for early substance use initiation, binge patterns of use, and subsequent SUD. Evidence of further declines in executive control, once substance use is initiated, is mixed, although a growing number of neuroimaging studies indicate that frontostriatal, frontolimbic, and frontocerebellar systems are altered as a consequence of use. SUMMARY Together these patterns suggest strategies for identifying children and adolescents at high risk for SUD, avenues through which substance-related neurotoxicities can be more reliably detected, and the need to structure prevention efforts in a manner that is developmentally appropriate and perhaps personalized to individual vulnerabilities.
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Affiliation(s)
- Monica Luciana
- Department of Psychology, University of Minnesota, Minneapolis MN, 55455 USA
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Rajapaksha RMDS, Hammonds R, Filbey F, Choudhary PK, Biswas S. A preliminary risk prediction model for cannabis use disorder. Prev Med Rep 2020; 20:101228. [PMID: 33204605 PMCID: PMC7649639 DOI: 10.1016/j.pmedr.2020.101228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/27/2020] [Accepted: 10/13/2020] [Indexed: 12/19/2022] Open
Abstract
Substance use disorders are currently a major public health crisis in the US. The prevalence of cannabis use disorder is rising due to legalization of cannabis. This study built models to predict the risk of cannabis use disorder for a user. Risk factors include personality traits, impulsivity and initial smoking enjoyment.
The ongoing trend toward legalization of cannabis for medicinal/recreational purposes is expected to increase the prevalence of cannabis use disorder (CUD). Thus, it is imperative to be able to predict the quantitative risk of developing CUD for a cannabis user based on their personal risk factors. Yet no such model currently exists. In this study, we perform preliminary analysis toward building such a model. The data come from n = 94 regular cannabis users recruited from Albuquerque, New Mexico during 2007–2010. As the data are cross-sectional, we only consider risk factors that remain relatively stable over time. We apply statistical and machine learning classification techniques that allow n to be small relative to the number of predictors. We use predictive accuracy estimated using leave-one-out-cross-validation to evaluate model performance. The final model is a LASSO logistic regression model consisting of the following seven risk factors: age; level of enjoyment from initial cigarette smoking; total score on Impulsive Sensation-Seeking Scale questionnaire; score on cognitive instability factor of Barratt Impulsivity Scale questionnaire; and scores on neuroticism, openness, and conscientiousness personality traits of Neuroticism, Extraversion, and Openness inventory. This model has an overall accuracy of 0.66 and the area under its receiver operating characteristic curve is 0.65. In summary, a preliminary relative risk model for predicting the quantitative risk of CUD is developed. It can be employed to identify users at high risk of CUD who may be provided with early intervention.
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Affiliation(s)
| | - Ryan Hammonds
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Francesca Filbey
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Pankaj K Choudhary
- Department of Mathematical Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Swati Biswas
- Department of Mathematical Sciences, University of Texas at Dallas, Richardson, TX, USA
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Wojciechowski T. PTSD as a Risk Factor Predicting Polydrug Use: A Dual Systems of Self-Control Mediation Model. JOURNAL OF DRUG ISSUES 2020. [DOI: 10.1177/0022042620958198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Post-traumatic stress disorder (PTSD) is associated with increased risk for polydrug use. Low self-control is a key characteristic of the disorder and is predictive of polydrug use. However, there is a dearth of research focused on the relevance of a dual systems model delineation of self-control into the constructs of risk-seeking and impulsivity as it pertains to polydrug use and PTSD. This study tested dual systems mediation of this relationship. Generalized structural equation modeling was used to test for mediation effects. Results indicated that more PTSD symptoms predicted increased drug use variety (coefficient = 0.024; confidence interval [CI] = [0.001, 0.046]). Inclusion of dual systems constructs fully attenuated this relationship. The total indirect effect achieved marginal significance (coefficient = 0.005; CI = [>−0.001, 0.009]). Sensitivity analyses of the specific indirect effect of impulsivity as the sole mediator indicated significant mediation. These results provide some indication that impulsivity-based programming may help to treat polydrug use among those with severe PTSD.
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Bares CB, Chartier KG, Karriker-Jaffe KJ, Aliev F, Mustanski B, Dick D. Exploring how Family and Neighborhood Stressors Influence Genetic Risk for Adolescent Conduct Problems and Alcohol Use. J Youth Adolesc 2020; 49:1365-1378. [PMID: 31407187 PMCID: PMC7012717 DOI: 10.1007/s10964-019-01098-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/27/2019] [Indexed: 10/26/2022]
Abstract
Previous research suggests that genetic risk factors may predispose to conduct problems and alcohol use in adolescence. Whether genetic risk factors interact with social contexts has not been well characterized among African American adolescents. Data came from a subsample of the Genes, Environment, and Neighborhood Initiative study comprising 501 African American adolescents, including 151 lifetime drinkers (56% female, mean age = 16.3, SD = 1.4). Genetic risk was assessed with polygenic risk scores for alcohol dependence. Analyses explored interactions between genetic risk and self-reported alcohol use, conduct problems, life stressors, and other covariates. The effects of two gene-environment interactions (G × E) were tested in the sample of alcohol exposed adolescents; one on conduct problems and the other on alcohol use. There were significant associations between polygenic risk for alcohol dependence and conduct problems. A significant G × E interaction showed the impact of genetic risk on conduct problems was stronger under conditions of high exposure to family and neighborhood stressors. Among this sample of African American adolescents, genetic risk for alcohol dependence was not directly associated with alcohol use but was related to more conduct problems. Further, the effect of genetic risk interacted with stressors from the family and neighborhood, so that the effect of genetic risk on conduct problems was stronger for individuals who reported greater stressors.
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Affiliation(s)
- Cristina B Bares
- School of Social Work, University of Michigan, 1080S. University, Ann Arbor, MI, 48109, USA.
| | - Karen G Chartier
- School of Social Work and Department of Psychiatry, Virginia Commonwealth University, 1000 Floyd Avenue, P.O. Box 842027, Richmond, VA, 23284, USA
| | - Katherine J Karriker-Jaffe
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA, 94608, USA
| | - Fazil Aliev
- Department of Psychology, Virginia Commonwealth University, 817W. Franklin, Suite B-16, Richmond, VA, 23284, USA
- Karabuk University, Karabuk, Turkey
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University, 625N. Michigan Avenue, Suite 14-061, Chicago, IL, 60611, USA
| | - Danielle Dick
- Department of Psychology, Virginia Commonwealth University, 800W. Franklin, Room 202, Richmond, VA, 23284, USA
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Agniel D, Almirall D, Burkhart Q, Grant S, Hunter SB, Pedersen ER, Ramchand R, Griffin BA. Identifying optimal level-of-care placement decisions for adolescent substance use treatment. Drug Alcohol Depend 2020; 212:107991. [PMID: 32408135 PMCID: PMC7293956 DOI: 10.1016/j.drugalcdep.2020.107991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Adolescents respond differentially to substance use treatment based on their individual needs and goals. Providers may benefit from guidance (via decision rules) for personalizing aspects of treatment, such as level-of-care (LOC) placements, like choosing between outpatient or inpatient care. The field lacks an empirically-supported foundation to inform the development of an adaptive LOC-placement protocol. This work begins to build the evidence base for adaptive protocols by estimating them from a large observational dataset. METHODS We estimated two-stage LOC-placement protocols adapted to individual adolescent characteristics collected from the Global Appraisal of Individual Needs assessment tool (n = 10,131 adolescents). We used a modified version of Q-learning, a regression-based method for estimating personalized treatment rules over time, to estimate four protocols, each targeting a potentially distinct treatment goal: one primary outcome (a composite of ten positive treatment outcomes) and three secondary (substance frequency, substance problems, and emotional problems). We compared the adaptive protocols to non-adaptive protocols using an independent dataset. RESULTS Intensive outpatient was recommended for all adolescents at intake for the primary outcome, while low-risk adolescents were recommended for no further treatment at followup while higher-risk patients were recommended to inpatient. Our adaptive protocols outperformed static protocols by an average of 0.4 standard deviations (95 % confidence interval 0.2-0.6) of the primary outcome. CONCLUSIONS Adaptive protocols provide a simple one-to-one guide between adolescents' needs and recommended treatment which can be used as decision support for clinicians making LOC-placement decisions.
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Affiliation(s)
- Denis Agniel
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA; Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck St., Boston, MA 02115, USA.
| | - Daniel Almirall
- Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48104-2321, USA
| | - Q Burkhart
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA
| | - Sean Grant
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA; Department of Social & Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, RG 6046, Indianapolis, IN 46202, USA
| | - Sarah B Hunter
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA
| | - Eric R Pedersen
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA
| | - Rajeev Ramchand
- RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202-5050, USA
| | - Beth Ann Griffin
- RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202-5050, USA
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Zapolski TCB, Yu T, Brody GH, Banks DE, Barton AW. Why now? Examining antecedents for substance use initiation among African American adolescents. Dev Psychopathol 2020; 32:719-734. [PMID: 31452473 PMCID: PMC7044022 DOI: 10.1017/s0954579419000713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Current adolescent substance use risk models have inadequately predicted use for African Americans, offering limited knowledge about differential predictability as a function of developmental period. Among a sample of 500 African American youth (ages 11-21), four risk indices (i.e., social risk, attitudinal risk, intrapersonal risk, and racial discrimination risk) were examined in the prediction of alcohol, marijuana, and cigarette initiation during early (ages 11-13), mid (ages 16-18), and late (ages 19-21) adolescence. Results showed that when developmental periods were combined, racial discrimination was the only index that predicted initiation for all three substances. However, when risk models were stratified based on developmental period, variation was found within and across substance types. Results highlight the importance of racial discrimination in understanding substance use initiation among African American youth and the need for tailored interventions based on developmental stage.
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Affiliation(s)
- Tamika C. B. Zapolski
- Department of Psychology, Indiana University-Purdue University Indianapolis, 420 University Blvd., Indianapolis, IN 46202, USA
| | - Tianyi Yu
- Center for Family Research, University of Georgia, 1095 College Station Road, Athens, GA 30602, USA
| | - Gene H. Brody
- Center for Family Research, University of Georgia, 1095 College Station Road, Athens, GA 30602, USA
| | - Devin E. Banks
- Department of Psychology, Indiana University-Purdue University Indianapolis, 420 University Blvd., Indianapolis, IN 46202, USA
| | - Allen W. Barton
- Center for Family Research, University of Georgia, 1095 College Station Road, Athens, GA 30602, USA
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Goulet M, Clément ME, Helie S, Villatte A. Longitudinal Association Between Risk Profiles, School Dropout Risk, and Substance Abuse in Adolescence. CHILD & YOUTH CARE FORUM 2020. [DOI: 10.1007/s10566-020-09550-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Salgado García F, Bursac Z, Derefinko KJ. Cumulative Risk of Substance Use in Community College Students. Am J Addict 2020; 29:97-104. [PMID: 31898858 DOI: 10.1111/ajad.12983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 11/09/2019] [Accepted: 12/15/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Substance use in community college students has been explored in only a handful of studies. Differences in population characteristics and substance use between 2- and 4-year students suggest that different factors may promote and thwart this behavior. Cumulative risk is a parsimonious methodology that provides better model stability and more statistical power, yet it has only been recently used in substance use research. The aim of this study is to investigate multiple aspects of substance use risk in a population in need of substance use prevention and intervention services. METHODS We conducted a cross-sectional study of community college students (N = 288; 75% female) examining the relative contributions of different domains of cumulative risk (eg, life stressors, academic stressors, and mental health diagnoses) to develop different profiles of risk across substance use classes (ie, alcohol, cigarette, marijuana, and hard drug use). RESULTS Cumulative risk analyses indicated that alcohol and tobacco use were associated with the domains of life stressors and peer/family substance use, marijuana use with peer/family substance use and stressful childhood experiences, and hard drug use with peer/family substance use, lack of social support, low access to care, and stressful childhood experiences. DISCUSSION AND CONCLUSIONS Different strategies for prevention and intervention may be necessary to effectively address different forms of substance use in this population. SCIENTIFIC SIGNIFICANCE The risk domain profiles related to specific drugs may lead to targeted interventions to reduce substance use in community college students. (Am J Addict 2020;29:97-104).
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Affiliation(s)
| | - Zoran Bursac
- Biostatistics Consulting Service Center, Florida International University, Miami, Florida
| | - Karen J Derefinko
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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Wojciechowski TW. Early Life Poly-Victimization and Differential Development of Anxiety as Risk Factors for the Continuity of Substance Dependence in Adulthood. Subst Use Misuse 2020; 55:1347-1355. [PMID: 32193969 DOI: 10.1080/10826084.2020.1741637] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: Abuse of psychoactive substances may lead to physical and/or physiological dependence on said substances. While a great deal of research has focused on risk factors predicting onset, there has been little research focused on risk factors influencing continued dependence on substances in adulthood following onset early in life. Purpose/Objectives: The present study examined poly-victimization and developmental patterns of anxiety as predictors of continued substance dependence problems. Methods: The Pathways to Desistance data were used in the present study. A subset of this sample was used in analyses comprising 261 juvenile offenders who reported lifetime drug and/or alcohol dependence at baseline. Firth logistic regression was used to estimate the impact that covariates had on the odds that individuals in this subsample had continued substance dependence in adulthood. Results: Results indicated that increased poly-victimization score pertaining to direct victimization at baseline was associated with increased odds of continued substance dependence problems in adulthood. Further, presentation of high and chronic anxiety symptomatology during adolescence was associated with increased risk for continued dependence. Conclusions/Importance: Drug dependent adolescents who demonstrate chronic anxiety and/or have experienced polyvictimization are at-risk for continuity of dependent in adulthood. Youth should be screened for these issues and targeted with treatment.
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Pediatric pain treatment and prevention for hospitalized children. Pain Rep 2019; 5:e804. [PMID: 32072099 PMCID: PMC7004501 DOI: 10.1097/pr9.0000000000000804] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/23/2019] [Accepted: 11/13/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction: Prevention and treatment of pain in pediatric patients compared with adults is often not only inadequate but also less often implemented the younger the children are. Children 0 to 17 years are a vulnerable population. Objectives: To address the prevention and treatment of acute and chronic pain in children, including pain caused by needles, with recommended analgesic starting doses. Methods: This Clinical Update elaborates on the 2019 IASP Global Year Against Pain in the Vulnerable “Factsheet Pain in Children: Management” and reviews best evidence and practice. Results: Multimodal analgesia may include pharmacology (eg, basic analgesics, opioids, and adjuvant analgesia), regional anesthesia, rehabilitation, psychological approaches, spirituality, and integrative modalities, which act synergistically for more effective acute pediatric pain control with fewer side effects than any single analgesic or modality. For chronic pain, an interdisciplinary rehabilitative approach, including physical therapy, psychological treatment, integrative mind–body techniques, and normalizing life, has been shown most effective. For elective needle procedures, such as blood draws, intravenous access, injections, or vaccination, overwhelming evidence now mandates that a bundle of 4 modalities to eliminate or decrease pain should be offered to every child every time: (1) topical anesthesia, eg, lidocaine 4% cream, (2) comfort positioning, eg, skin-to-skin contact for infants, not restraining children, (3) sucrose or breastfeeding for infants, and (4) age-appropriate distraction. A deferral process (Plan B) may include nitrous gas analgesia and sedation. Conclusion: Failure to implement evidence-based pain prevention and treatment for children in medical facilities is now considered inadmissible and poor standard of care.
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Friedrichsdorf SJ, Postier AC. Recent advances in pain treatment for children with serious illness. Pain Manag 2019; 9:583-596. [PMID: 31735116 DOI: 10.2217/pmt-2019-0029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Pain is a common distressing symptom in children receiving pediatric palliative care. Both in children with cancer, but especially in children with progressive neurodegenerative and chromosomal conditions with CNS impairment pain is common, and often under-recognized and undertreated. Multimodal analgesia for children with serious illness acts synergistically for more effective pediatric pain and symptom control with fewer side effects than a single analgesic or modality. Successful pain treatment and prevention usually include integrative 'nonpharmacological' therapies, rehabilitation, psychology and spirituality in addition to pharmacology and regional anesthesia. This review article will address these effective components of multimodal pediatric analgesia and present starting doses of basic analgesia, opioids and adjuvants analgesia in infants, children and adolescents with serious illness.
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Affiliation(s)
- Stefan J Friedrichsdorf
- Center of Pain Medicine, Palliative Care & Integrative Medicine, Benioff Children's Hospitals at University of California - San Francisco (UCSF), CA 94158, USA.,Department of Pain Medicine, Palliative Care & Integrative Medicine, Children's Minnesota, Minneapolis, MN 55404, USA
| | - Andrea C Postier
- Department of Pain Medicine, Palliative Care & Integrative Medicine, Children's Minnesota, Minneapolis, MN 55404, USA
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Menon SV, Thakur H, Shorey RC, Cohen JR. Predicting Adolescent Substance Use in a Child Welfare Sample: A Multi-Indicator Algorithm. Assessment 2019; 28:1207-1218. [PMID: 31602995 DOI: 10.1177/1073191119880966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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; Mage = 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.
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Affiliation(s)
- Suvarna V Menon
- University of Illinois at Urbana Champaign, Champaign, IL, USA
| | - Hena Thakur
- University of Illinois at Urbana Champaign, Champaign, IL, USA
| | - Ryan C Shorey
- University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Joseph R Cohen
- University of Illinois at Urbana Champaign, Champaign, IL, USA
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Skinner SR, Marino J, Rosenthal SL, Cannon J, Doherty DA, Hickey M. Prospective cohort study of childhood behaviour problems and adolescent sexual risk-taking: gender matters. Sex Health 2019; 14:492-501. [PMID: 28610653 DOI: 10.1071/sh16240] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/29/2017] [Indexed: 11/23/2022]
Abstract
Background Externalising (delinquent, aggressive) and internalising (anxious/depressed, withdrawn) behaviour problems are prevalent in childhood. Few studies have prospectively measured relationships between childhood behaviour problems and adolescent health risk behaviour, a major predictor of morbidity and mortality. This study sought to determine relationships, by gender, between childhood behaviour problems and adolescent risky sexual behaviours and substance use. METHODS In a population-based birth cohort [The Western Australian Pregnancy Cohort (Raine) Study], total, externalising and internalising behaviour problems (domain-specific T≥60) were calculated from parent-reported Child Behavior Checklist at ages 2, 5, 8, 10 and 14 years. At age 17 years, 1200 (49% male) participants reported sexual and substance use activity Results: For both genders, those with earlier externalising behaviour problems were more likely to be sexually active (oral sex or sexual intercourse) by age 17 years. Males with childhood externalising behaviour problems were more likely to have multiple sexual partners by age 17 years than those without such problems [adjusted odds ratio (aOR) 2.96, 95% confidence interval (CI) 1.49-5.86]. Females with childhood externalising behaviour problems were more likely to have had unwanted sex (aOR 1.91, 95% CI 1.04-3.53). Externalising behaviour problems were associated with substance use for both genders. No association was found between internalising behaviour problems and risky behaviour. CONCLUSIONS Externalising behaviour problems from as early as 5 years old in boys and 8 years old in girls predict a range of risky sexual behaviour in adolescence, which has important implications for targeting interventions in adolescence.
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Affiliation(s)
- S Rachel Skinner
- Discipline of Child and Adolescent Health, University of Sydney, the Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia
| | - Jennifer Marino
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Vic. 3010, Australia
| | - Susan L Rosenthal
- Columbia University College of Physicians and Surgeons and New York Presbyterian Morgan Stanley Children's Hospital, New York, NY 10032, USA
| | - Jeffrey Cannon
- Telethon Kids Institute, The University of Western Australia, Perth, WA 6008, Australia
| | - Dorota A Doherty
- Biostatistics and Research Design Unit, Women and Infants Research Foundation, Perth, WA 6008, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Vic. 3010, Australia
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Harbaugh CM, Lee JS, Chua KP, Kenney B, Iwashyna TJ, Englesbe MJ, Brummett CM, Bohnert AS, Waljee JF. Association Between Long-term Opioid Use in Family Members and Persistent Opioid Use After Surgery Among Adolescents and Young Adults. JAMA Surg 2019; 154:e185838. [PMID: 30810738 DOI: 10.1001/jamasurg.2018.5838] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Prior studies have found a substantial risk of persistent opioid use among adolescents and young adults undergoing surgical and dental procedures. It is unknown whether family-level factors, such as long-term opioid use in family members, is associated with persistent opioid use. Objective To determine whether long-term opioid use in family members is associated with persistent opioid use among opioid-naive adolescents and young adults undergoing surgical and dental procedures. Design, Setting, and Participants This retrospective cohort study used data from a commercial insurance claims database for January 1, 2010, to June 30, 2016, to study 346 251 opioid-naive patients aged 13 to 21 years who underwent 1 of 11 surgical and dental procedures and who were dependents on a family insurance plan. Exposures Long-term opioid use in family members, defined as having 1 or more family members who (1) filled opioid prescriptions totaling a 120 days' supply or more during the 12 months before the procedure date or (2) filled 3 or more opioid prescriptions in the 90 days before the procedure date. Main Outcomes and Measures The main outcome measure was persistent opioid use, defined as 1 or more postoperative prescription opioid fills between 91 and 180 days among patients with an initial opioid prescription fill. Generalized estimating equations with robust SEs clustered at the family level were used to model persistent opioid use as a function of long-term opioid use among family members, controlling for procedure, total morphine milligram equivalents of the initial fill, and patient and family characteristics. Results A total of 346 251 patients (mean [SD] age, 17.0 [2.3] years; 175 541 [50.7%] female) were studied. Among these patients, 257 085 (74.3%) had an initial opioid fill. Among patients with an initial opioid fill, 11 016 (4.3%) had long-term opioid use in a family member. Persistent opioid use occurred in 453 patients (4.1%) with long-term opioid use in a family member compared with 5940 patients (2.4%) without long-term opioid use in a family member (adjusted odds ratio, 1.54; 95% CI, 1.39-1.71). Conclusion and Relevance The findings suggest that long-term opioid use among family members is associated with persistent opioid use among opioid-naive adolescents and young adults undergoing surgical and dental procedures. Physicians should screen young patients for long-term opioid use in their families and implement heightened efforts to prevent opioid dependence among patients with this important risk factor.
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Affiliation(s)
- Calista M Harbaugh
- National Clinician Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.,Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Jay S Lee
- Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Kao-Ping Chua
- Department of Pediatrics and Communicable Diseases, Child Health Evaluation and Research Center, University of Michigan, Ann Arbor
| | - Brooke Kenney
- Michigan Opioid Prescribing Engagement Network, Ann Arbor
| | - Theodore John Iwashyna
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.,Veterans Affairs (VA) Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan
| | | | - Chad M Brummett
- Division of Pain Medicine, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
| | - Amy S Bohnert
- Veterans Affairs (VA) Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan.,Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Jennifer F Waljee
- Department of Surgery, University of Michigan Medical School, Ann Arbor
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Abstract
OBJECTIVE This study tested longitudinal associations between cannabis use and cardiometabolic risk factors that underlie the development of cardiovascular diseases. METHODS Participants were men from the youngest cohort of the Pittsburgh Youth Study who were followed prospectively from approximately age 7 to 32 years (N = 253). Frequency of cannabis use was assessed yearly from approximately ages 12 to 20 years and again at approximately ages 26, 29, and 32 years. The following cardiometabolic risk factors were assessed during a laboratory visit at approximately age 32 years: body mass index (BMI), waist-hip ratio, high- and low-density lipoprotein cholesterol, triglycerides, fasting glucose, insulin resistance, blood pressure, interleukin 6, and C-reactive protein. RESULTS Greater cannabis exposure was associated with relatively lower BMI (β = -0.31, p < .001), smaller waist-hip ratio (β = -0.23, p = .002), better high- (β = 0.14, p = .036) and low-density lipoprotein cholesterol (β = -0.15, p = .026), lower triglycerides (β = -0.17, p = .009), lower fasting glucose (β = -0.15, p < .001) and insulin resistance (β = -0.21, p = .003), lower systolic (β = -0.22, p < .001) and diastolic blood pressure (β = -0.15, p = .028), and fewer metabolic syndrome criteria (β = -0.27, p < .001). With exception of BMI, cannabis users' mean levels on cardiometabolic risk factors were generally below clinical cutoffs for high risk. Most associations between cannabis use and cardiometabolic risk factors remained after adjusting for tobacco use, childhood socioeconomic status, and childhood health. However, after adjusting for adult BMI, these associations were no longer apparent, and mediation tests suggested that cannabis users' relatively lower BMI might explain their lower levels of risk on other cardiometabolic risk factors. CONCLUSIONS Cannabis use is associated with lower BMI, and lower BMI is related to lower levels of risk on other cardiometabolic risk factors.
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Gray KM, Squeglia LM. Research Review: What have we learned about adolescent substance use? J Child Psychol Psychiatry 2018; 59:618-627. [PMID: 28714184 PMCID: PMC5771977 DOI: 10.1111/jcpp.12783] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Adolescence is a critical biological, psychological, and social developmental stage involving heightened risk for substance use and associated adverse consequences. This review, synthesizing emerging findings on this complex topic, is intended to inform research and clinical care focused on adolescents. METHODS Literature searches were conducted using PubMed, yielding a cross-section of observational and interventional studies focused on adolescent substance use. Findings were organized and categorized to cover key areas of epidemiology, neurobiology, prevention, and treatment. FINDINGS Adolescent substance-related attitudes and use patterns have evolved over time, informed by adult and peer behaviors, public policy, media messaging, substance availability, and other variables. A number of risk and resiliency factors contribute to individual differences in substance use and related consequences. Advances in observational techniques have provided enhanced understanding of adolescent brain development and its implications for substance use. Prevention efforts have yielded mixed results, and while a number of adolescent-targeted evidence-based treatments for substance use disorders have been developed, effect sizes are generally modest, indicating the need for further research to enhance prevention and treatment outcomes. CONCLUSIONS Substance use in adolescence is heterogeneous, ranging from normative to pathological, and can lead to significant acute and long-term morbidity and mortality. Understanding risk and resiliency factors, underlying neurobiology, and optimal developmentally sensitive interventions is critical in addressing substance-associated problems in adolescence.
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Affiliation(s)
- Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences; Medical University of South Carolina; Charleston SC USA
| | - Lindsay M. Squeglia
- Department of Psychiatry and Behavioral Sciences; Medical University of South Carolina; Charleston SC USA
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Kassis W, Artz S, Maurovic I, Simões C. What doesn't kill them doesn't make them stronger: Questioning our current notions of resilience. CHILD ABUSE & NEGLECT 2018; 78:71-84. [PMID: 29254696 DOI: 10.1016/j.chiabu.2017.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 10/30/2017] [Accepted: 12/10/2017] [Indexed: 06/07/2023]
Abstract
This study expands on earlier analyses of the data generated by a cross-sectional study involving a random sample of 5149 middle-school students with a mean age of 14.5 years from four EU-countries (Austria, Germany, Slovenia, and Spain), in which every fourth respondent (23.0%) had been physically abused by his or her parents and almost every sixth respondent (17.3%) had witnessed physical spousal abuse. Contrary to expectations, some of these youths reported no engagement in peer violence and no symptoms of depression, which meant that they could be considered "resilient." Given their precarious conditions, we inquired into how these young people functioned on other protective and risk indicators when compared to non-violence exposed peers. Using Bonferroni post-hoc tests, we conducted an analysis of variance based comparison of levels of risk and protective factors on three groups of violence and depression-resilient youth (low, middle and high family violence experience) with those participants who reported no family violence or abuse, no depression and no use of violence. The violence and depression-resilient participants reported significantly higher levels of aggression supportive beliefs, alcohol consumption, drug use, verbal aggression towards and from teachers and use of indirect aggression, along with lower levels of social and personal protective characteristics such as self-acceptance, emotional self-control, optimism about the future, and positive relations with parents and teachers, than students without family violence experiences. We therefore concluded that while some family violence exposed young people may not engage in violence or experience depression, this does not automatically imply an absence of other challenges and calls into question our current notions of resilience.
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Affiliation(s)
- Wassilis Kassis
- Research Department, Zurich University of Teacher Education, Lagerstrasse 2, 8090 Zurich, Switzerland.
| | - Sibylle Artz
- School of Child and Youth Care, University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2, Canada.
| | - Ivana Maurovic
- Faculty of Education and Rehabilitation Sciences, University of Zagreb, Borongajska 83f, 10000 Zagreb, Croatia.
| | - Celeste Simões
- Departamento de Educação, Ciências Sociais e Humanidades, Faculdade de Motricidade Humana, Universidade de Lisboa, 1499-002 Cruz Quebrada, Portugal.
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Pestka EL, Craner J, Evans M, Nash V, Kimondo N, Pestka D, Loukianova L, Sperry J. Impact of Family History of Substance Abuse on Admission Opioid Dose, Depressive Symptoms, and Pain Catastrophizing in Patients with Chronic Pain. Pain Manag Nurs 2017; 19:115-124. [PMID: 29153294 DOI: 10.1016/j.pmn.2017.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 09/22/2017] [Accepted: 09/30/2017] [Indexed: 10/18/2022]
Abstract
The objectives of this study were to examine association between a family history of substance abuse and admission morphine equivalent dose, depression and pain catastrophizing screening scores, as well as reported personal history of substance use. The retrospective research was completed in an interdisciplinary three-week pain rehabilitation center. The subject cohort included admissions from January through December 2014 with 351 datasets for family history of substance abuse and oral morphine equivalency and 341 for depression, pain catastrophizing and use of substances. Outcome measures included admission self-reported data on family history of substance abuse and past and current substance use, admission morphine equivalency dose, and scores on the Center for Epidemiologic Studies-Depression Scale and the Pain Catastrophizing Scale. One hundred forty-seven patients were using opioid medications on admission and those with a positive family history of substance abuse had an oral morphine equivalency (M = 92.12, SD = 95.32) compared to a negative history (M = 80.34, SD = 64.86); the difference was not statistically significant, t (120.01) =.87, p = .39. Patients with a positive family history reported higher levels of both depression, t (327.40) = 3.15, p = .002 and pain catastrophizing, t (338) = 2.76, p = .01. Those with a positive family history endorsed greater frequency of past alcohol use χ2 (1, N = 326) = 6.67, p = 0.1 and marijuana use χ2 (1, N = 341) = 4.23, p = .04 and past χ2 (1, N = 329) = 9.90, p = .002 and current tobacco use χ2 (1, N = 327) = 8.81, p = .003. Use of family history of substance abuse information may help provide data for multimodal treatments of chronic non-cancer-pain. The findings from this study can be used to guide future research.
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Affiliation(s)
| | - Julia Craner
- Department of Psychiatry and Behavioral Medicine, Spectrum Health System, Grand Rapids, Michigan
| | - Michele Evans
- Department of Psychiatry, Mayo Clinic, Rochester, Minnesota
| | - Virginia Nash
- Department of Psychiatry, Mayo Clinic, Rochester, Minnesota
| | - Njoki Kimondo
- Department of Psychiatry, Mayo Clinic, Rochester, Minnesota
| | - Deborah Pestka
- College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| | | | - Jeannie Sperry
- Department of Psychiatry, Mayo Clinic, Rochester, Minnesota
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Janik P, Kosticova M, Pecenak J, Turcek M. Categorization of psychoactive substances into “hard drugs” and “soft drugs”: a critical review of terminology used in current scientific literature. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017. [DOI: 10.1080/00952990.2017.1335736] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Peter Janik
- Department of Psychiatry, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Michaela Kosticova
- Institute of Social Medicine and Medical Ethics, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Jan Pecenak
- Department of Psychiatry, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Michal Turcek
- Department of Psychiatry, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
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Bröning S, Baldus C, Thomsen M, Sack PM, Arnaud N, Thomasius R. Children with Elevated Psychosocial Risk Load Benefit Most from a Family-Based Preventive Intervention: Exploratory Differential Analyses from the German “Strengthening Families Program 10–14” Adaptation Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2017. [DOI: 10.1007/s11121-017-0797-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Pérez-Milena A, Redondo-Olmedilla MDD, Martínez-Fernández ML, Jiménez-Pulido I, Mesa-Gallardo I, Leal-Helmling FJ. [Changes in hazardous drinking in Spanish adolescent population in the last decade (2004-2013) using a quantitative and qualitative design]. Aten Primaria 2017; 49:525-533. [PMID: 28501394 PMCID: PMC6875921 DOI: 10.1016/j.aprim.2016.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/10/2016] [Accepted: 11/15/2016] [Indexed: 11/26/2022] Open
Abstract
Objetivo Conocer los cambios del consumo alcohólico de riesgo en los adolescentes en la última década, así como sus motivaciones y vivencias. Diseño 1) descriptivo transversal: encuesta autoadministrada; 2) cualitativo explicativo: grupos de discusión videograbados, con análisis de contenido (codificación, triangulación de categorías y verificación de resultados). Emplazamiento y participantes Alumnos de un instituto urbano de educación secundaria, administrando un cuestionario cada 3 años de 2004 a 2013. En el año 2013 se realizan las entrevistas grupales, con muestreo de conveniencia. Criterio de homogeneidad: nivel educativo; criterios de heterogeneidad: edad, sexo y consumo de drogas. Mediciones principales Cuestionario: edad, sexo, consumo de drogas y cuestionario CAGE. Entrevistas: semiestructuradas sobre un guión previo, valorando vivencias y expectativas. Resultados Descriptivo: 1.558 encuestas, edad 14,2 ± 0,3 años, 50% mujeres. Disminuye la prevalencia de consumo de alcohol (13%), aumentando el consumo de riesgo (11%; p < 0,001 χ2). Relacionado con ser mujer (p < 0,01 χ2), mayor consumo alcohólico (> 6 unidades de bebida estándar/semana; p < 0,001 ANOVA) en fin de semana (56%; p < 0,01 χ2) y policonsumo (p < 0,01 χ2). Cuestionario CAGE: 37% ≥ 1 respuesta positiva (relacionado con consumo de riesgo, p < 0,05 χ2), 18% ≥ 2 respuestas. Cualitativo : 48 entrevistados; se establecen 4 categorías: determinantes personales (edad, género), influencias sociales (familia, amigos), normalización del consumo (accesibilidad, ocio nocturno) y adicción (riesgo, policonsumo). Conclusión Es preocupante el aumento del porcentaje del consumo alcohólico de riesgo, pese a disminuir las prevalencias del consumo. Se relaciona con el sexo femenino, el consumo binge-drinking y el policonsumo. El ocio nocturno y la normalización social son las principales motivaciones argumentadas por los adolescentes, sin percepción del riesgo de este tipo de consumo.
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Affiliation(s)
- Alejandro Pérez-Milena
- Centro de Salud El Valle, Distrito Sanitario de Jaén, Servicio Andaluz de Salud, Jaén, España.
| | | | | | - Idoia Jiménez-Pulido
- Centro de Salud de Úbeda, Área de Gestión Clínica Jaén Norte, Servicio Andaluz de Salud, Úbeda, Jaén, España
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Abstract
Cannabis is the most common illicit drug used worldwide and it is used frequently by Canadian teenagers. Cannabis use during adolescence can cause functional and structural changes to the developing brain, leading to damage. Marijuana use in this age group is strongly linked to: cannabis dependence and other substance use disorders; the initiation and maintenance of tobacco smoking; an increased presence of mental illness, including depression, anxiety and psychosis; impaired neurological development and cognitive decline; and diminished school performance and lifetime achievement. Rates of acute medical care and hospitalization for younger children who have ingested cannabis unintentionally are increasing. Ongoing debate concerning cannabis regulation in Canada makes paying close attention to the evidence for its health effects and ensuring that appropriate safeguards are in place, vital public health priorities.
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Affiliation(s)
- Christina N Grant
- Canadian Paediatric Society, Adolescent Health Committee, Ottawa, Ontario
| | - Richard E Bélanger
- Canadian Paediatric Society, Adolescent Health Committee, Ottawa, Ontario
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48
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Grant CN, Bélanger RE. Le cannabis et les enfants et adolescents canadiens. Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Christina N Grant
- Société canadienne de pédiatrie, comité de la santé de l’adolescent, Ottawa, Ontario
| | - Richard E Bélanger
- Société canadienne de pédiatrie, comité de la santé de l’adolescent, Ottawa, Ontario
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Hall W. Alcohol and cannabis: Comparing their adverse health effects and regulatory regimes. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 42:57-62. [PMID: 27908654 DOI: 10.1016/j.drugpo.2016.10.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/04/2016] [Accepted: 10/28/2016] [Indexed: 01/13/2023]
Abstract
The claim that the adverse health effects of cannabis are much less serious than those of alcohol has been central to the case for cannabis legalisation. Regulators in US states that have legalised cannabis have adopted regulatory models based on alcohol. This paper critically examines the claim about adverse health effects and the wisdom of regulating cannabis like alcohol. First, it compares what we know about the adverse health effects of alcohol and cannabis. Second, it discusses the uncertainties about the long term health effects of sustained daily cannabis use. Third, it speculates about how the adverse health effects of cannabis may change after legalisation. Fourth, it questions the assumption that alcohol provides the best regulatory model for a legal cannabis market. Fifth, it outlines the major challenges in regulating cannabis under the liberal alcohol-like regulatory regimes now being introduced.
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Affiliation(s)
- Wayne Hall
- National Addiction Centre, Kings College London and Centre for Youth Substance Abuse Research, University of Queensland, Australia.
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Vaughn MG, Salas-Wright CP, Reingle-Gonzalez JM. Addiction and crime: The importance of asymmetry in offending and the life-course. J Addict Dis 2016; 35:213-217. [PMID: 27192094 DOI: 10.1080/10550887.2016.1189658] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The intersection of addiction and crime is pervasive. Not only is there a high prevalence of substance use and substance use disorders among criminal justice populations that is substantially higher than in the general population, but also offenders with substance use disorders are more likely to be rearrested. The authors believe there are several broad points that addiction researchers and criminologists have come to understand that are important to bring together. In this commentary, the asymmetrical nature of crime (i.e., a small subset account for the lion's share of offending) and the value of a developmentally sensitive life-course approach to inform criminal behavior are elucidated and discussed. These 2 themes are intertwined. High-impact offenders have extensive drug use histories and need intervention (policy or individual-level), but the form and content and ultimately the effectiveness of the intervention may depend on what period in the life-course the intervention is to be implemented.
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Affiliation(s)
- Michael G Vaughn
- a School of Social Work, College for Public Health and Social Justice, Saint Louis University , St. Louis , Missouri , USA
| | | | - Jennifer M Reingle-Gonzalez
- c Department of Epidemiology , Human Genetics, and Environmental Sciences, University of Texas School of Public Health , Dallas , Texas , USA
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