The developmental psychopathology of alcohol use and alcohol disorders: research achievements and future directions

How Scoring Approaches Impact Estimates of Growth in the Presence of Survey Item Ceiling Effects

Survey scores are often the basis for understanding how individuals grow psychologically and socio-emotionally. A known problem with many surveys is that the items are all "easy"-that is, individuals tend to use only the top one or two response categories on the Likert scale. Such an issue could be especially problematic, and lead to ceiling effects, when the same survey is administered repeatedly over time. In this study, we conduct simulation and empirical studies to (a) quantify the impact of these ceiling effects on growth estimates when using typical scoring approaches like sum scores and unidimensional item response theory (IRT) models and (b) examine whether approaches to survey design and scoring, including employing various longitudinal multidimensional IRT (MIRT) models, can mitigate any bias in growth estimates. We show that bias is substantial when using typical scoring approaches and that, while lengthening the survey helps somewhat, using a longitudinal MIRT model with plausible values scoring all but alleviates the issue. Results have implications for scoring surveys in growth studies going forward, as well as understanding how Likert item ceiling effects may be contributing to replication failures.

Understanding alcohol use and alcohol use disorders from a developmental psychopathology perspective: Research advances, challenges, and future directions

As part of the special issue of Development and Psychopathology honoring the remarkable contributions of Dr Dante Cicchetti, the current paper attempts to describe the recent contributions that a developmental psychopathology perspective has made in understanding the development of alcohol use and alcohol-related problems over the lifespan. The paper also identifies some of the future challenges and research directions. Because the scope of this task far exceeds the confines of a journal length article this paper does not attempt a comprehensive review. Rather, it builds on an earlier review and commentary that was published in Development and Psychopathology in 2013, with a similar goal.)Building on that work and updating its conclusions and suggestions for future directions, the current paper emphasizes findings from the research areas that were identified for further study in 2013 and the findings that have been published since that time.

Heritable Composite Phenotypes Defined by Combinations of Conduct Problem, Depression, and Temperament Features: Contributions to risk for Alcohol Problems

The genetic architectures underlying symptoms of conduct problems and depression have largely been examined separately and without incorporating temperament, despite evidence for their genetic overlap. We examined how symptoms and temperament dimensions were transmitted together in families to identify highly heritable composite phenotypes, and how these composite phenotypes predicted alcohol outcomes in young adulthood. Participants (N = 486) were drawn from the third generation of families oversampled for alcohol use disorder in the first generation. Conduct problems, depression, and temperament were reported at 11-19 years old and alcohol outcomes at 18-26 years old. Using principal components of heritability analysis, we found seven highly heritable composite phenotypes, five of which predicted alcohol outcomes: three characterized by co-occurring conduct problems and depression and two by conduct problems. Novel composite phenotypes that were characterized by both conduct problems and depression showed different types of symptoms, temperament features, and genetic underpinnings. Children manifesting differing composite phenotypes might benefit from distinct treatments based on their unique etiologies.

Prospective associations between adolescent risky substance use and school dropout and the role of externalising and internalising problems

Background: The aim of the present study was to assess to what extent risky substance use (RSU) acts as an important risk factor for school dropout from upper secondary school in a prospective study of Norwegian adolescents, and how externalising and internalising mental health problems influenced this association. Methods: We used data from a large population-based survey (the youth@hordaland-survey), which included adolescents aged 16-19 years. The predictor variables were self-reported RSU. The survey was linked with prospective data from the Norwegian Education Database, following the adolescents to 21-23 years of age. The outcome variable was registry-based school dropout within five years after starting upper secondary school. The analyses were adjusted for sex, age, socioeconomic status, and externalising and internalising problems. Results: After adjustment for sociodemographic variables, all indicators of RSU were prospectively associated with school dropout (adjusted odds ratios 1.26-2.25; all p values <.01). While internalising problems only slightly changed these estimates, the associations were substantially attenuated by externalising problems. Still, all measures of RSU, except frequent alcohol intoxication, remained positively associated with school dropout in the fully adjusted models. For the youngest students, all associations between RSU and school dropout were significant. Conclusions: Adolescent RSU is a strong predictor for school dropout, and externalising problems explained a considerable proportion of this effect. Prevention efforts to reduce student substance could improve academic outcomes among upper secondary school students, and such efforts may benefit from also targeting co-occurring externalising problems.

A life span developmental investigation of marriage and problem-drinking reduction

While prior literature has largely focused on marriage effects during young adulthood, it is less clear whether these effects are as strong in middle adulthood. Thus, we investigated age differences in marriage effects on problem-drinking reduction. We employed parallel analyses with two independent samples (analytic-sample Ns of 577 and 441, respectively). Both are high-risk samples by design, with about 50% of participants having a parent with lifetime alcohol use disorder. Both samples have been assessed longitudinally from early young adulthood to the mid-to-late 30s. Separate parallel analyses with these two samples allowed evaluation of the reproducibility of results. Growth models of problem drinking tested marriage as a time-varying predictor and thereby assessed age differences in marriage effects. For both samples, results consistently showed marriage effects to be strongest in early young adulthood and to decrease somewhat monotonically thereafter with age, reaching very small (and nonsignificant) magnitudes by the 30s. Results may reflect that role transitions like marriage have more impact on problem drinking in earlier versus later adulthood, thereby highlighting the importance of life span developmental research for understanding problem-drinking desistance. Our findings can inform intervention strategies aimed at reducing problem drinking by jumpstarting or amplifying natural processes of adult role adaptation.

Bridging the Gap: A Holistic View of Personality Factors in Individuals With and Without Alcohol Use

This comprehensive review examines the intricate interplay between personality factors and alcohol use, shedding light on the dynamic relationship that shapes the initiation, progression, and outcomes of alcohol-related behaviors. The exploration encompasses vital personality traits such as sensation seeking, impulsivity, neuroticism, extroversion, agreeableness, conscientiousness, and openness to experience. The bidirectional nature of this association is underscored, emphasizing how personality influences and is influenced by alcohol consumption patterns. Protective personality factors, including resilience, emotional regulation, and social support, are identified as crucial elements in mitigating the risk of alcohol use disorders (AUDs). The implications for clinical practice advocate for tailored interventions that address individual personality profiles, while policy considerations highlight the need for targeted prevention efforts that acknowledge the diverse ways individuals respond to alcohol use. Furthermore, a call for future research emphasizes emerging perspectives, improved methodologies, and ongoing exploration of intervention strategies to advance our understanding of this complex relationship and refine approaches for prevention and treatment. As we navigate this evolving field, the insights gleaned hold promise for shaping more compelling and nuanced interventions to address the diverse needs of individuals affected by AUDs.

Prevalence of substance use disorders and associations with mindfulness, impulsive personality traits and psychopathological symptoms in a representative sample of adolescents in Germany

Adolescence is a critical phase for the development of substance use disorders (SUDs). For Europe and Germany, there are limited data on problematic substance use from representative youth samples. Trait mindfulness is relevant in buffering against substance use-related problems and associated deficits in self-regulatory control. The objective of this study is to estimate 12-month prevalence rates for SUDs in a representative sample of adolescents in Germany and to examine associations with mindfulness and related factors such as stress, impulsivity, sensation seeking and symptoms of psychopathology. A sample of 4001 adolescents aged 12-18 years from Germany was surveyed based on DSM-IV diagnostic criteria for SUDs. Logistic regression analyses were used to examine associations with mindfulness-related variables. Criteria of at least one of the assessed SUDs were endorsed by 11.2% of the adolescents. Alcohol use disorders had the highest prevalence rate (10.1%) followed by cannabis use disorders (2.6%). For both substances, the criteria for abuse were met about twice as often as those for dependence. The prevalence of cigarette dependence was 1.7%, while the prevalence for e-cigarette dependence was only 0.1%. Prevalence rates were higher for male youth and increasing with age. SUD prevalence was also related to mindfulness, impulsivity and sensation seeking and externalizing symptoms of psychopathology. The statistically significant associations varied across different SUDs. SUDs appear highly prevalent among German adolescents. The results have public health implications with regard to treatment needs and prevention measures in the youth population in Germany.

Parent-child separation and intergenerational transmission of substance use and disorder: Testing across three generations

There is evidence for intergenerational transmission of substance use and disorder. However, it is unclear whether separation from a parent with substance use disorder (SUD) moderates intergenerational transmission, and no studies have tested this question across three generations. In a three-generation study of families oversampled for familial SUD, we tested whether separation between father (G1; first generation) and child (G2; second generation) moderated the effect of G1 father SUDs on G2 child SUDs. We also tested whether separation between father (G2) and child (G3; third generation) moderated the effect of G2 SUDs on G3 drinking. Finally, we tested whether G1-G2 or G2-G3 separation moderated the mediated effect of G1 SUDs on G3 drinking through G2 SUDs. G1 father-G2 child separation moderated intergenerational transmission. In families with G1-G2 separation, there were no significant effects of father SUD on G2 SUD or G3 drinking. However, in nonseparated families, greater G1 father SUDs predicted heightened G2 SUDs and G3 grandchild drinking. In nonseparated families, G1 father SUDs significantly predicted G2 SUDs, which predicted G3 drinking. However, G2-G3 separation predicted heightened G3 drinking regardless of G2 and G1 SUDs. Parental separation may introduce risk for SUDs and drinking among youth with lower familial risk.

Maternal Adverse Childhood Experiences and Young Adult Latino Children's Mental Health

INTRODUCTION

Maternal adverse childhood experiences have been linked to a variety of negative health outcomes in young children; however, young adults and, specifically, young adult Latinos have been vastly understudied. This study investigates the intergenerational pathway between maternal adverse childhood experiences and behavioral health outcomes of their young adult children, as mediated through young adults' own adverse childhood experiences and maternal depression.

METHODS

Structural equation modeling was used to analyze data (in 2023) from mothers and their young adult children (n=398 dyads) enrolled in the Center for the Health Assessment of Mothers and Children of Salinas cohort, a primarily Latino agricultural sample. Maternal and young adult adverse childhood experiences were self-reported retrospectively during a visit at the age of 18 years (2018-2020). Young adult- and maternal-reported internalizing and maternal-reported externalizing behaviors were assessed at the age of 18 years with the Behavior Assessment for Children, second edition. Maternal depression was assessed during a visit at the age of 9 years (2010-2012) using the Center for Epidemiologic Studies Depression Scale.

RESULTS

Maternal and young adult adverse childhood experiences were weakly but statistically significantly correlated (r=0.22). Maternal adverse childhood experiences were statistically significantly associated with maternal-reported youth internalizing symptoms (β=0.29; 95% CI=0.19, 0.38; p<0.001) and externalizing symptoms (β=0.24; 95% CI=0.14, 0.33; p<0.001) and marginally associated with youth-reported internalizing symptoms (β=0.08; 95% CI= -0.02, 0.18; p=0.13). Youth adverse childhood experiences and maternal depressive symptomatology mediated the associations between maternal adverse childhood experiences and young adult outcomes.

CONCLUSIONS

Findings demonstrate the potential impacts of adversity across generations in Latino immigrant families, an understudied population. Understanding the mechanisms and factors associated with these pathways may lead to strategies that prevent poor mental health outcomes in young adults.

Value-based decision-making predicts alcohol use and related problems in young men

BACKGROUND

Alcohol consumption is a leading cause of morbidity and mortality worldwide, disproportionately affecting young men. Heavy episodic drinking is particularly prevalent among men, with this behavior peaking between the ages of 20 and 24.

AIMS

We sought to identify dimensions of decision-making in men that would predict the development of hazardous alcohol use through emerging adulthood.

METHODS

This prospective observational study profiled value-based decision-making in 198 healthy men at age 18 and assessed their alcohol involvement annually until age 24. Latent growth curve modeling estimated individual variability in trajectories of alcohol involvement and regressed this variability on five choice dimensions.

RESULTS

Low loss aversion predicted sustained heavy episodic drinking from age 18 to 24. Both high delay discounting and risk-seeking for gains independently predicted a considerably higher cumulative alcohol use during these 6 years, with high delay discounting indicating escalating consumption from age 21. Risk-seeking for gains additionally predicted meeting more criteria for Alcohol Use Disorder in these 6 years. Risk-seeking for losses was not significantly related to alcohol outcomes. Choice preferences were largely independent of each other but were correlated with choice consistency, with low consistency predicting heavy episodic drinking from age 18 to 24 beyond these associations.

CONCLUSIONS

The predictive effects collectively suggest that overvaluing immediate and probabilistic incentives, rather than underestimating harm, drives hazardous drinking in young men. The differential relations of choice preferences and consistency to alcohol involvement through emerging adulthood provide distinct cognitive-behavioral patterns that warrant consideration in the development of harm reduction interventions.

The relative effects of parental alcohol use disorder and maltreatment on offspring alcohol use: Unique pathways of risk

Childhood adversity represents a robust risk factor for the development of harmful substance use. Although a range of empirical studies have examined the consequences of multiple forms of adversity (i.e., childhood maltreatment, parental alcohol use disorder [AUD]), there is a dearth of information on the relative effects of each form of adversity when considered simultaneously. The current study utilizes structural equation modeling to investigate three unique and amplifying pathways from parental AUD and maltreatment exposure to offspring alcohol use as emerging adults: (1) childhood externalizing symptomatology, (2) internalizing symptomatology, and (3) affiliation with substance-using peers and siblings. Participants (N = 422) were drawn from a longitudinal follow-up study of emerging adults who participated in a research summer camp program as children. Wave 1 of the study included 674 school-aged children with and without maltreatment histories. Results indicated that chronic maltreatment, over and above the effect of parent AUD, was uniquely associated with greater childhood conduct problems and depressive symptomatology. Mother alcohol dependence was uniquely associated with greater affiliation with substance-using peers and siblings, which in turn predicted greater alcohol use as emerging adults. Results support peer and sibling affiliation as a key mechanism in the intergenerational transmission of substance use between mothers and offspring.

Discrete emotions and global affect: Applying empirically driven approaches to experience sampling data to model state and trait affective structure and affect-alcohol use associations in a heavy drinking young-adult sample

Affective functioning is central to most contemporary models of alcohol use. However, the affective structure at the within- and between-person levels is rarely investigated nor is the differential predictive value of specific affect dimensions assessed across state and trait formats. We examined a) the structure of state and trait affect using experience sampling methodology (ESM) and b) predictive associations between the empirically derived affect facets and alcohol use. Participants were 92 heavy drinking college students aged 18-25 who completed 8 momentary assessments of their affect and drinking a day for 28-days. We found evidence for a single positive affect factor at both the within- (i.e., state) and between-person (i.e., trait) levels. We found a hierarchical factor structure for negative affect, represented by a general, superordinate dimension as well as facet-level sadness, anxiety, and anger dimensions. Associations between affect and alcohol use differed across trait and state levels and across specific types of negative affect. Lagged state positive affect and sadness as well as trait positive affect and sadness were inversely associated with drinking. Lagged state anxiety and trait general negative affect were positively associated with drinking. Thus, our study demonstrates how associations between drinking and affect can be studied in relation to general (e.g., general negative affect) and more specific aspects of affective experiences (e.g., sadness versus anxiety) concurrently within the same study and across trait and state levels of assessment.

Drinking behaviors of Chinese adolescents over the past three decades: A systematic review and meta-analysis

Adolescent drinking is a major worldwide public health challenge. China is home to the world's second largest youth population, but relatively little is known about adolescent drinking behaviors. This study examined (1) prevalence rates and sex and age differences in drinking behaviors among Chinese adolescents over the past three decades and (2) whether underage drinking declined following the enactment of a strict national underage drinking policy in 2006. Literature search was conducted in one Chinese and five English databases following the PRISMA guidelines. A total of 186 studies were included in the meta-analyses using random-effects models on nine measures (Ns range: 13,489-755,796, number of studies range: 12-110): lifetime, past month, past year, and weekly drinking; lifetime, past year, and past month drunkenness; past month binge drinking, and age at first drinking (≤ 13 years). Males reported higher prevalence on all drinking behaviors except for weekly drinking and past month drunkenness. High school students reported higher prevalence in lifetime drinking, past year drunkenness, and lifetime drunkenness, than middle school students. No measured drinking behavior showed a significant or reliable decline after 2006. The findings suggest that prevalence rates of drinking behaviors remain high among Chinese adolescents but are lower than among European or North American adolescents. The 2006 Chinese national policy to reduce underage drinking did not measurably alter patterns of underage drinking. Implications for prevention, research, and policy are discussed.

Is the association between psychological distress and risky alcohol consumption shifting over time? An age-period-cohort analysis of the Australian population

This study explored age, period, and cohort effects associated with trends in psychological distress and risky alcohol consumption. Data came from 108,536 Australians aged 14-79 years old from birth cohorts between 1925-2005, endorsing past year alcohol use in the 2004-2019 Australian National Drug Strategy Household Surveys. Risky alcohol consumption was split into exceeding weekly national drinking limits (>10 drinks per week) or daily limits (>4 drinks per day). An extended hierarchical age-period-cohort model was used to investigate differential effects on trends in psychological distress. Psychological distress showed an inverse U-shape throughout the lifespan with a peak in distress at age 60. Exceeding weekly alcohol limits was positively related to psychological distress prior to age 40 while exceeding daily alcohol limits remained positively related across the lifespan. There were relatively flat period effects, with no alcohol-related changes in psychological distress across years. Lastly, psychological distress gradually increased across birth cohorts until a notable spike among Australians born from 1980-2005 alongside weakening alcohol-related cohort effects. Overall, the recent increases in psychological distress did not appear to be meaningfully explained by risky alcohol consumption though risky alcohol consumption remained an important factor to consider alongside psychological distress.

Grounding alcohol simulation models in empirical and theoretical alcohol research: a model for a Northern Plains population in the United States

The growing number of systems science simulation models for alcohol use (AU) are often disconnected from AU models within empirical and theoretical alcohol research. As AU prevention/intervention efforts are typically grounded in alcohol research, this disconnect may reduce policy testing results, impact, and implementation. We developed a simulation model guided by AU research (accounting for the multiple AU stages defined by AU behavior and risk for harm and diverse transitions between stages). Simulated projections were compared to historical data to evaluate model accuracy and potential policy leverage points for prevention and intervention at risky drinking (RD) and alcohol use disorder (AUD) stages. Results indicated prevention provided the greatest RD and AUD reduction; however, focusing exclusively on AUD prevention may not be effective for long-term change, given the continued increase in RD. This study makes a case for the strength and importance of aligning subject-based research with systems science simulation models.

Climate Change and Substance-Use Behaviors: A Risk-Pathways Framework

Climate change is undermining the mental and physical health of global populations, but the question of how it is affecting substance-use behaviors has not been systematically examined. In this narrative synthesis, we find that climate change could increase harmful substance use worldwide through at least five pathways: psychosocial stress arising from the destabilization of social, environmental, economic, and geopolitical support systems; increased rates of mental disorders; increased physical-health burden; incremental harmful changes to established behavior patterns; and worry about the dangers of unchecked climate change. These pathways could operate independently, additively, interactively, and cumulatively to increase substance-use vulnerability. Young people face disproportionate risks because of their high vulnerability to mental-health problems and substance-use disorders and greater number of life years ahead in which to be exposed to current and worsening climate change. We suggest that systems thinking and developmental life-course approaches provide practical frameworks for conceptualizing this relationship. Further conceptual, methodological, and empirical work is urgently needed to evaluate the nature and scope of this burden so that effective adaptive and preventive action can be taken.

The nomological network of drinker identity: A scoping review

BACKGROUND

Despite the growing interest in the construct of drinker identity and empirical evidence for its role in drinking behavior, there is a paucity of papers that evaluate and integrate the results of studies on drinker identity, leaving a gap in our knowledge of the importance of the drinker identity construct. The current paper addresses this gap by reviewing and integrating the results of the studies of drinker identity.

METHODS

The scoping review identified, retrieved, and evaluated the existing literature regarding drinker identity. English language studies from EBSCOHost, PubMed, ScienceDirect, and Scopus databases were reviewed. Studies were included in the review if they were data-based studies or theoretical publications with drinker identity as the primary topic published in peer-reviewed journals. Studies were reviewed and coded based on their reported methodology and findings and codes were used to integrate and present findings.

RESULTS

This review advances this line of research in four ways. First, the operationalization of drinker identity is evaluated by examining the theoretical frameworks defining the construct. Second, the conceptualization and measurement of drinker identity is assessed, with suggestions for future measurement research. Third, an integrated framework of predictors, outcomes, moderators, and mediators is presented. Finally, the research gaps, future recommendations, and clinical implications are discussed.

CONCLUSIONS

There is a need for continued research, specifically research which aims to standardize and improve measurement of drinker identity, considers longitudinal and developmental processes, and broadens the research samples and settings.

Peer-elicited alcohol craving in adolescents and emerging adults: Bridging the laboratory and natural environment

BACKGROUND

Although peers figure prominently in developmental models of alcohol use, our understanding of the influence of peer social context in cue reactivity paradigms with adolescents and emerging adults in the human laboratory and the natural environment is limited. This study tested associations between alcohol craving among youth in the human laboratory using alcohol-related images, with and without peers, and in the natural environment using ecological momentary assessment (EMA).

METHODS

Data for this preregistered secondary analysis were collected prior to randomization in two medication trials (N = 115). Participants completed an image cue exposure paradigm at the baseline laboratory session followed by approximately 7 days of EMA.

RESULTS

In the laboratory, model-based mean comparisons from multilevel models (MLMs) showed that all drinking images elicited greater craving than neutral images. No differences were observed across the three image categories containing alcohol. Image category by age interactions demonstrated that, compared to older youth, younger youth displayed lower craving in response to neutral versus social drinking context with peers images and older, compared to younger, youth displayed higher craving in response to nonsocial drinking images versus social drinking contexts with peers images. In the natural environment, craving was greatest when youth were in the presence of alcohol-using peers and alcohol-related cues, regardless of age. Laboratory craving to alcohol images was positively associated with craving in the natural environment.

CONCLUSIONS

For youth, peers are a salient social context associated with increased craving, particularly in the natural environment. Laboratory cue reactivity to alcohol images predicted real-world craving, further supporting the ecological validity of this paradigm in youth.

Socialization processes within adolescents' relationships with parents and peers predicting couples' intimate partner violence in adulthood: A social learning perspective

Previous studies have established that individual characteristics such as violent behavior, substance use, and high-risk sexual behavior, as well as negative relationships with parents and friends, are all risk factors for intimate partner violence (IPV). In this longitudinal prospective study, we investigated whether violent behavior, substance use, and high-risk sexual behavior in early adulthood (ages 22-23 years) mediated the link between family conflict and coercive relationship talk with friends in adolescence (ages 16-17 years) and dyadic IPV in adulthood (ages 28-30 years). A total of 998 individuals participated in multimethod assessments, including observations of interactions with parents and friends. Data from multiple reporters were used for variables of interest including court records, parental and self-reports of violence, self-reports of high-sexual-risk behaviors and substance use, and self- and romantic partner-reports of IPV. Longitudinal mediation analyses showed that violent behavior during early adulthood mediated the link between coercive relationship talk with friends in adolescence and dyadic IPV in adulthood. No other mediation paths were found and there was no evidence of gender differences. Results are discussed with attention to the interpersonal socialization processes by which IPV emerges relative to individual risk factors.

The burden of somatic diseases among people with alcohol- and drug use disorders are influenced by mental illness and low socioeconomic status. A registry-based cohort study in Norway

OBJECTIVES

Persons with alcohol use disorder (AUD) and drug use disorder (DUD) have a lower life expectancy than the general population. We examined the burden of somatic diseases among persons with AUD or DUD and investigated impact of socioeconomic status (SES) and mental health disorders on the co-occurrence of somatic diseases in these groups.

METHODS

We performed a retrospective, register-based cohort study with a 6-year follow-up of persons (aged ≥18 y) with AUD (13,478) or DUD (16,659). Cox regression analyses were used to estimate hazard ratios (HRs) of somatic diseases.

RESULTS

Patients with DUD were, on average, 10 years younger at the point of diagnosis than patients with AUD. Mental illnesses were prominent in both groups (AUD: 40.5%, and DUD: 46.9% vs 3.5% in controls). Adjusting for mental disorders, the risk of all somatic diseases among the AUD and DUD groups was reduced by 30%. Some of the elevated risk of somatic diseases among persons with AUD and DUD is explained by low SES, though less than that explained by the presence of mental disorders. The diseases with highest risk among AUD patients were metabolic disorders (16.9-fold) and hypertension (14.8-fold), and among AUD patients, viral hepatitis (23.3-fold), after adjusting for low SES and mental disorders.

CONCLUSIONS

Persons with AUD had a higher risk of most somatic diseases, while those with DUD had specific risks for infections and viral hepatitis. Mental health disorders and SES adjusted the associations regarding most somatic diseases. In general, improvement of socio-economic conditions, preferably in combination with professional support to self-manage mental health problems, will reduce the risk of somatic illness in both groups. For DUD patients, available sterile user equipment will reduce the risk of viral hepatis.

The Genetically Informed Neurobiology of Addiction (GINA) model

Addictions are heritable and unfold dynamically across the lifespan. One prominent neurobiological theory proposes that substance-induced changes in neural circuitry promote the progression of addiction. Genome-wide association studies have begun to characterize the polygenic architecture undergirding addiction liability and revealed that genetic loci associated with risk can be divided into those associated with a general broad-spectrum liability to addiction and those associated with drug-specific addiction risk. In this Perspective, we integrate these genomic findings with our current understanding of the neurobiology of addiction to propose a new Genetically Informed Neurobiology of Addiction (GINA) model.

Hazardous drinking and alcohol use disorders

Alcohol is one of the most widely consumed psychoactive drugs globally. Hazardous drinking, defined by quantity and frequency of consumption, is associated with acute and chronic morbidity. Alcohol use disorders (AUDs) are psychiatric syndromes characterized by impaired control over drinking and other symptoms. Contemporary aetiological perspectives on AUDs apply a biopsychosocial framework that emphasizes the interplay of genetics, neurobiology, psychology, and an individual's social and societal context. There is strong evidence that AUDs are genetically influenced, but with a complex polygenic architecture. Likewise, there is robust evidence for environmental influences, such as adverse childhood exposures and maladaptive developmental trajectories. Well-established biological and psychological determinants of AUDs include neuroadaptive changes following persistent use, differences in brain structure and function, and motivational determinants including overvaluation of alcohol reinforcement, acute effects of environmental triggers and stress, elevations in multiple facets of impulsivity, and lack of alternative reinforcers. Social factors include bidirectional roles of social networks and sociocultural influences, such as public health control strategies and social determinants of health. An array of evidence-based approaches for reducing alcohol harms are available, including screening, pharmacotherapies, psychological interventions and policy strategies, but are substantially underused. Priorities for the field include translating advances in basic biobehavioural research into novel clinical applications and, in turn, promoting widespread implementation of evidence-based clinical approaches in practice and health-care systems.

Alcohol, Marijuana and Other Illicit Drugs Use Throughout Adolescence: Co-occurring Courses and Preadolescent Risk-Factors

This study examined developmental patterns of co-occurrent alcohol, marijuana, and other illicit drugs use during adolescence and the associated preadolescent risk factors in a longitudinal sample of 926 boys from low-socioeconomic, urban neighborhoods. Latent growth mixture modeling revealed six developmental patterns: non-/low-alcohol and non-illicit drug users (61% sample) and five polysubstance user-groups varying in severity based on onset, frequency and type of substances used. In comparisons with non-/low-users, several preadolescent risk factors were associated with increasing severity of polysubstance use. Higher sensation-seeking and lower anxiety were associated with all user-groups. Low self-esteem and family-related risk factors differentiated all user-groups from later-onset users. Higher impulsivity and school problems characterized early-onset and frequent polysubstance users. Impulsive sensation-seekers with lower anxiety and self-esteem cumulated a larger number and higher severity of risk factors and were at risk of early-onset frequent polysubstance use, emphasising the importance of indicated prevention for these high-risk boys.

A social contextual review of the effects of alcohol on emotion

Drinking and drinking problems are complex phenomena. Understanding the etiology of alcohol use disorder requires consideration of biological, psychological, and social processes. It is our view that the last of these dimensions is just beginning to receive adequate scrutiny. In this selective review, we discuss the concept of a biopsychosocial analysis of the effects of alcohol. After briefly addressing biological and psychological research on alcohol's emotional effects, we bid to make a case for the vital role that social processes play in understanding why people drink. The bulk of the paper describes research illustrating the contributions that a social psychological perspective can make to advance understanding of the rewarding effects of alcohol. Overall, studies incorporating social contexts have revealed reliable evidence that alcohol enhances emotional experience in many social environments and have identified socio-contextual variables that moderate responses to alcohol. Further, these studies have broadened the scope of constructs thought to be socially rewarding, including social bonding, relationship functioning, and humor enjoyment. Our analysis concludes by identifying research areas we believe would profit from additional research.

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

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

Trajectories of Substance Use and Well-being in Early and Middle Adolescence Shaped by Social Connectedness

Increasing substance use and decreasing well-being are typical in adolescence, yet how social contexts shape disparate development during this time is less well-understood. A latent growth class analysis was conducted that identified groups of early (N = 706; Age_m  = 12.20) and middle (N = 666; Age_m  = 14.38) adolescents distinguished by rates of substance use and well-being over three years. In both cohorts, the largest group reported low substance use and high well-being, with a smaller group exhibiting maladaptive trajectories for both substance use and well-being. Two additional groups were identified during middle adolescence characterized by either low well-being or high substance use. Family connectedness was a protective factor, while high peer connectedness was a risk factor for substance-use groups and low peer connectedness for languishing.

Randomized controlled trial of motivational interviewing for alcohol and cannabis use within a predominantly Hispanic adolescent sample

Hispanic youth represent one of the fastest-growing minority groups. Yet, we know little about Hispanic adolescents' response to empirically-supported interventions for adolescent addiction, including motivational interviewing (MI). This randomized controlled trial (RCT) compared MI to an active educational treatment for adolescent alcohol and cannabis use (alcohol and cannabis education; ACE). Adolescents who regularly use substances (N = 448; n = 347 Hispanic; n = 101 non-Hispanic white; ages 13-18) were randomized to two 1-hr individual sessions of MI or ACE. We examined 6-month outcomes and mechanisms of change across Hispanic and non-Hispanic white youth. Treatment response was comparable across ethnicities (Hispanic vs. non-Hispanic white youth). Additionally, adolescents in the MI condition showed greater reductions in alcohol use compared to those in ACE, with support for motivation and self-efficacy as mechanisms of treatment response. Direct effects of MI on cannabis use were not observed; however, a significant indirect effect of motivation was observed for reductions in cannabis use. Data support the efficacy of MI in reducing adolescent alcohol use, through the vehicle of enhanced motivation and self-efficacy. While consistent treatment response was observed for adolescent alcohol use across ethnicities (Hispanic vs. non-Hispanic white), further exploration into potential underexplored mechanisms of Hispanic adolescents' treatment response is requisite to strengthening prevention and intervention programming for Hispanic adolescents' cannabis use. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Flexibly modeling age trends in the prevalence of co-occurring patterns of substance use and mental health disorders using time-varying effects and latent class analysis

Background: Substance use disorders (SUDs) and mental health disorders may change and co-occur in complex patterns across adult ages, but these processes can be difficult to capture with traditional statistical approaches.Objective: To elucidate disorder prevalence and comorbidities across adult ages by using time-varying effect models (TVEMs), latent class analysis (LCA), and modeling latent class prevalences as complex functions of age.Methods: Data were drawn from participants who are 18-65 years old in the National Epidemiologic Survey on Alcohol and Related Conditions III (n = 30,999; 51% women) and a subsample who reported a past-year post-traumatic stress disorder (PTSD), mood, anxiety, or SUD based on DSM-5 diagnoses (n = 11,279). TVEM and LCA were used to examine age trends and comorbidity patterns across ages.Results: SUD prevalence peaked at age 23 (31%) and decreased thereafter, while mental health disorder prevalence was stable (20%-26% across all ages). The prevalence of five classes of individuals based on specific combinations of mental health and SUDs varied by age: the Alcohol Use Disorder class had the highest prevalence at age 26, whereas the Mood and Anxiety Disorder classes peaked around age 63. Interestingly, the Poly-Disorder class prevalence was greatest at age 18 but decreased sharply across young adulthood; however, the prevalence of the other high comorbidity class, PTSD with Mood or Anxiety Disorder, remained fairly constant across age, peaking at age 44.Conclusions: Multimorbid mental health disorders (excluding SUDs) persist in prevalence across adult ages. LCA, TVEM, and their integration together hold substantial potential to advance addiction research.

Adaptive Treatment for Youth With Substance Use and Depression: Early Depression Response and Short-term Outcomes

OBJECTIVE

To investigate prevalence and predictors of early depression response (EDR) in adolescents with substance use and depression receiving cognitive-behavioral therapy (CBT) for substance use and to test the efficacy of supplemental CBT targeting depression (CBT-D) for non-EDR adolescents in an adaptive treatment approach.

METHOD

At 2 sites, 95 youths (ages 14-21, mean [SD] = 17.4 [1.8]) with alcohol or cannabis use and depressive symptoms received up to 12 sessions of CBT for substance use over 14 weeks. Assessments were at baseline and weeks 4, 9, and 14. The Children's Depression Rating Scale-Revised was the primary depression measure, with a reduction of 50% or more on this scale at week 4 defining EDR. The primary substance use outcomes of alcohol use, heavy alcohol use, and cannabis use frequency were assessed via interview report on the Alcohol Consumption Questionnaire and the Drug Checklist. Urinalysis provided a secondary measure of cannabis use. Non-EDR adolescents were randomly assigned to supplemental CBT-D or enhanced treatment as usual (ETAU).

RESULTS

Thirty-five adolescents (37%; 95% CI, 27%-47%) demonstrated EDR. Fewer days of cannabis use (odds ratio 0.977; 95% CI, 0.961-0.992) and absence of conduct disorder (odds ratio 0.149; 95% CI, 0.031-0.716) predicted EDR. Frequency of drinking (F_1,82 = 11.09, η² = 0.119, p = .001), heavy drinking (F_1,82 = 19.91, η² = 0.195, p < .0001), and cannabis use (F_1,220 = 35.01, η² = 0.137, p < .001) decreased over time for EDR, CBT-D, and ETAU adolescents, with EDR adolescents evidencing earlier lower cannabis use (F_2,220 = 4.16, η² = 0.036, p = .0169). Negative (clean) urine screens increased over time (F_1,219 = 5.10, η² = 0.023, p = .0249). Comparison of CBT-D and ETAU indicated that depression significantly decreased over time in both groups (F_1,48 = 64.20, η² = 0.572, p < .001), with no advantage for CBT-D.

CONCLUSION

Approximately one-third of adolescents with substance use and depression attain EDR during substance use treatment. Less frequent cannabis use facilitates depression response. The relatively small sample may have precluded identification of additional EDR predictors.

CLINICAL TRIAL REGISTRATION INFORMATION

Treatment for Teens With Alcohol Abuse and Depression; https://clinicaltrials.gov/; NCT02227589.

Peer and Community Influences on Adolescent Substance Use in the Context of Adverse Childhood Experiences

Both adverse childhood experiences (ACEs) and peer influences consistently predict early tobacco, alcohol, and illicit drug use. However, less research considers how peer and community influences contribute to or modify the association between ACEs and early substance use. This study addresses these gaps in the literature by analyzing multilevel, longitudinal data from the Project on Human Development in Chicago Neighborhoods (PHDCN; N = 1,912). Unstructured socializing and peer substance use largely explained the association between ACEs and drinking, smoking cigarettes, and illicit drug use in the past month. A history of ACEs magnified the association between peer substance use and the number of cigarettes smoked. Collective efficacy also shaped the associations between peer influences, ACEs, and substance use, but in different ways depending on the substance use outcome analyzed.

Predicting Self-Medication with Cannabis in Young Adults with Hazardous Cannabis Use

Using cannabis to reduce psychological and physical distress, referred to as self-medication, is a significant risk factor for cannabis use disorder. To better understand this high-risk behavior, a sample of 290 young adults (ages 18–25; 45.6% female) were recruited from two U.S. universities in January and February of 2020 to complete a survey about their cannabis use and self-medication. Results: seventy-six percent endorsed using cannabis to reduce problems such as anxiety, sleep, depression, pain, loneliness, social discomfort, and concentration. When predicting reasons for self-medication with cannabis, logistic regression models showed that lower CUDIT-R scores, experiencing withdrawal, living in a state where cannabis was illegal, and being female were all associated with higher rates of self-medication. Withdrawal symptoms were tested to predict self-medication with cannabis, and only insomnia and loss of appetite were significant predictors. To further explore why young adults self-medicate, each of the original predictors were regressed on seven specified reasons for self-medication. Young adults experiencing withdrawal were more likely to self-medicate for pain. Participants living where cannabis is legal were less likely to self-medicate for anxiety and depression. Living where cannabis is illegal also significantly predicted self-medicating for social discomfort—though the overall model predicting social discomfort was statistically non-significant. Finally, female participants were more likely to self-medicate for anxiety. These results suggest widespread self-medication among young adults with likely CUD and underscore the complexity of their cannabis use. The findings have implications for understanding why young adults use cannabis in relation to psychological and physical distress and for accurately treating young adults with cannabis use disorder.

Early life stress and substance use disorders: The critical role of adolescent substance use

Early life stress (ELS) is a well-established risk factor for many psychiatric and medical disorders, including substance use disorders (SUDs). The relationship between ELS and SUDs is complex and there are likely multiple pathways from ELS to adverse substance use outcomes. The association between ELS and substance use emerges in adolescence. Adolescence is a critical period in development during which substance exposure markedly increases risk for SUDs. Therefore, this review focuses on the literature supporting the hypothesis that ELS increases risk for the development of SUDs through its influence on adolescent substance use. We discuss studies substantiating the role of ELS in adolescent substance use and explore how internalizing and externalizing psychopathology may be antecedents of substance use in adolescence. We examine clinical work suggesting ELS sculpts the Hypothalamic-Pituitary-Adrenal (HPA) Axis and developing brain-particularly subcortical brain regions that underlie stress response, mesocorticolimbic brain systems associated with reward sensitivity, and prefrontal regions that underlie executive control-in a way that increases risk for adolescent substance use and SUDs. We further explore how substance use during adolescence alters structure and function of these same systems, and how brain changes following ELS and adolescent substance use may independently, additively, or interactively contribute to risk for addiction. We conclude by discussing how the current literature can inform interventions aimed at reducing risk for SUDs in individuals with a history of ELS.

Age varying polygenic effects on alcohol use in African Americans and European Americans from adolescence to adulthood

Genetic effects on alcohol use can vary over time but are often examined using longitudinal models that predict a distal outcome at a single time point. The vast majority of these studies predominately examine effects using White, European American (EA) samples or examine the etiology of genetic variants identified from EA samples in other racial/ethnic populations, leading to inconclusive findings about genetic effects on alcohol use. The current study examined how genetic influences on alcohol use varied by age across a 15 year period within a diverse ethnic/racial sample of adolescents. Using a multi-ethnic approach, polygenic risk scores were created for African American (AA, n = 192) and EA samples (n = 271) based on racially/ethnically aligned genome wide association studies. Age-varying associations between polygenic scores and alcohol use were examined from age 16 to 30 using time-varying effect models separately for AA and EA samples. Polygenic risk for alcohol use was found to be associated with alcohol use from age 22-27 in the AA sample and from age 24.50 to 29 in the EA sample. Results are discussed relative to the intersection of alcohol use and developmental genetic effects in diverse populations.

Effects of topiramate on the association between affect, cannabis craving, and cannabis use in the daily life of youth during a randomized clinical trial

RATIONALE

Topiramate is an anticonvulsant currently under study for treating substance use disorders. Topiramate is thought to reduce substance use by attenuating craving and the rewarding effects of acute substance use through its concurrent GABAergic agonism and glutamatergic antagonism. Importantly, topiramate also impacts mood states central to many models of substance use. Despite this, little previous research has examined whether topiramate attenuates the respective associations of affect and craving with substance use.

OBJECTIVES

We conducted a secondary analysis of 63 youths that exhibited heavy cannabis use, aged 15-24 years, who were randomized in a double-blinded 6-week clinical trial comparing the effects of topiramate (up to 200 mg/day) and placebo on cannabis use. Ecological momentary assessment data were leveraged to model the role positive affect, negative affect, and craving on use over the 6-week period and whether topiramate attenuated associations between these feeling states and cannabis use.

RESULTS

Findings showed that craving was positively associated with use at the within-person level, while positive affect was negatively associated with use at the between-person level. Topiramate appears to attenuate the negative association of between-person positive affect (i.e., average) and cannabis use. Specifically, those in the placebo condition exhibited this inverse association between average positive affect and use while those in topiramate condition did not. No other significant affect or affect × medication condition interactions were observed.

CONCLUSIONS

These findings implicate craving and low positive affect as important risk factors for cannabis use in youth in treatment. Topiramate may attenuate this association for positive affect.

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

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

Psychosocial predictors of substance use in adolescents and young adults: Longitudinal risk and protective factors

Many psychosocial factors have been implicated in the onset and escalation of substance use in adolescence and young adulthood. Typically, each factor explains a small amount of the variance in substance use outcomes, and effects are typically applied across a broad range of ages or computed from cross-sectional data. The current study evaluated the association of factors including social influence (e.g., peer substance use), cognitive features (e.g., alcohol expectancies), and personality and emotional characteristics (e.g., impulsivity and typical responses to stress) in substance use throughout adolescence and emerging adulthood (ages 13-25; N = 798). Mixed-effects models tailored for the accelerated longitudinal design employed in this study were constructed with psychosocial and developmental factors predicting alcohol and cannabis use. As most participants in the sample exhibited little or no substance use at baseline by design, we excluded baseline assessments and examined data from follow-up years 1, 2, 3, and 4. Interactions between age cohort, change in age, and psychosocial predictors of substance use revealed differing associations over the developmental window for alcohol and cannabis use. For example, positive alcohol expectancies and sensation seeking were most strongly associated with greater drinking after age 18, whereas sensation seeking was associated with increased cannabis use as early as age 15. Higher emotion regulation skills led to less cannabis use in younger ages (i.e., shallower slopes below age 17), but this protective effect diminished after age 17. Results highlight developmentally important factors that differentially contribute to substance use in adolescence and young adulthood. We also demonstrate the importance of developmentally sensitive analyses that maximize the value of data from accelerated longitudinal designs.

Maternal Parenting Behaviors Amplify Environmental Influences on Developmental Trajectories of Alcohol Use During Adolescence

Compared to peer alcohol use, less is known on how parenting practices may modify genetic and environmental contributions to alcohol use longitudinally across adolescence. This study examined whether two maternal parenting behaviors, supervision and harsh parenting, may suppress or amplify genetic and environmental influences on three distinct developmental trajectories of adolescent alcohol use: normative increasing, early-onset, and low trajectories. Participants were drawn from a longitudinal study of a population-based twin sample (N = 842, 84% European descent, 52.7% female). Adolescents self-reported their past year alcohol use at ages 13, 14, 15, and 17 years, and their mothers reported their supervision and harsh parenting when twins were 13, 15, and 17 years old. Maternal supervision amplified non-shared environmental influence on the normative increasing and early-onset trajectories, whereas maternal harsh parenting amplified shared environmental influence on the early-onset trajectory and non-shared environmental influence on the low trajectory, respectively. The findings suggest maternal parenting practices as a potent developmental context that modulates the environmental influences of other proximal processes on adolescent alcohol use, and suggest that family-based parenting-focused intervention could be especially beneficial for adolescents following the early-onset trajectory.

Associations of developmental imbalance between sensation seeking and premeditation in adolescence and heavy episodic drinking in emerging adulthood

BACKGROUND

Dual systems theories suggest that greater imbalance between higher reward sensitivity and lower cognitive control across adolescence conveys risk for behaviors such as heavy episodic drinking (HED). Prior research demonstrated that psychological analogues of these systems, sensation seeking and premeditation, change from childhood through emerging adulthood, and each has been independently linked with HED. However, few studies have assessed whether change over time in these developing analogues is prospectively associated with HED. Moreover, we know of no research that has shown whether within-person differences between higher sensation seeking and relatively lower premeditation across the adolescent period predict HED in emerging adulthood.

METHODS

Prospective data from the National Consortium on Alcohol and NeuroDevelopment in Adolescence study (n = 715) were used to examine the association of sensation seeking and premeditation with HED among adolescents ages 16 to 20 years. We used novel applications of latent difference score modeling and growth curve analysis to test whether increasing sensation seeking, premeditation, and their imbalance over time are associated with HED across the study period, and whether these associations differed by sex.

RESULTS

Whereas premeditation increased linearly from adolescence through emerging adulthood across sexes, males reported growth and females reported decline in sensation seeking. Sensation seeking in adolescence (and not premeditation) was associated with higher levels of HED by emerging adulthood. Importantly, greater imbalance between sensation seeking and premeditation was associated with higher levels of HED by emerging adulthood though we note that variability capturing this imbalance correlated highly (r = 0.86) with baseline levels of sensation seeking.

CONCLUSIONS

Developmental imbalance between higher sensation seeking and lower premeditation in late adolescence may be a risk factor for greater HED in emerging adulthood.

Incubation of alcohol craving as it naturally occurs in a developmentally diverse sample of dependent and nondependent drinkers

Longer periods of abstinence are shown to enhance response to alcohol cues among alcohol-dependent animals and humans, a phenomenon described as "incubation of craving." The present work examined the effects of days since last drink on general craving and alcohol-cued craving as it occurs in daily life and explored whether effects were influenced by age and dependence. Three samples were combined to include 266 drinkers ranging in age from 14 to 67 years recruited from the community; about half (59.4%) met criteria for alcohol dependence. Drinkers used handheld electronic devices to rate their subjective alcohol craving (assessed as "urge to drink") and situational context (e.g., presence of visible alcohol cues) at nondrinking times in daily life, with days since last alcohol use culled from timeline follow-back interviews and real-world reports. Drinkers at the lower end of the age range in this sample reported greater intensification of craving with more days of continuous abstinence than drinkers at the upper end of the age range. Age was not related to incubation of cue-elicited craving, in specific, however. For drinkers with dependence, craving when in the presence of visible alcohol cues intensified with more days of continuous abstinence, suggesting craving incubation. This study builds from important foundational work to demonstrate that incubation of cue-elicited craving occurs in dependent drinkers and applies regardless of age. Inasmuch as craving is a motivational drive that maintains alcohol use, understanding factors that influence craving in daily life holds promise for improving clinical care.

Young adult predictors of alcohol dependence to age 53: a 44-year prospective cohort study of Danish men

AIMS

To examine if (1) there is a positive association between drinking volume in young men and life-time risk of alcohol dependence (AD) and (2) there are other associations between young adulthood factors and life-time risk of AD.

DESIGN

Prospective cohort study of sons of fathers with alcohol use disorder (AUD) and matched low-risk controls without paternal AUD. Setting and participants A total of 204 men, who were assessed at baseline in 1979 at age 19-20 years, were followed through record linkage with Danish registers and consecutive psychiatric interviews at the ages of 33, 43 and 53 years.

MEASUREMENTS

AD diagnoses were interview-based according to the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, or made by treating clinicians according to the International Classification of Diseases (ICD) revision 8 (ICD-8) until 1993 and revision 10 (ICD-10) from 1994.We estimated odds ratios (ORs) with 95% confidence intervals (CI) for the development of AD after adjustment for confounders including smoking, social status and paternal AUD.

FINDINGS

The following variables from the examination at age 19-20 independently predicted life-time AD: alcohol consumption > 21 beverages/week versus 0-21 [odds ratio (OR) = 2.46, 95% confidence interval (CI) = 1.22-4.97], police contact (OR = 2.60, 95% CI = 1.28-5.28) and institutionalization related to the individual (OR = 2.90, 95% CI = 1.39-6.02). Compared with < 1 beverages/week, the risk for AD did not increase significantly for drinking volume categories: 1-7, 8-14 or 15-21 beverages/week.

CONCLUSION

Independently of other risk factors in young adulthood, young Danish men's risk for life-time alcohol dependence appears to be predicted by a drinking volume at age 19-20 years exceeding 21 beverages per week.

Parental risk constellations and future alcohol use disorder (AUD) in offspring: A combined HUNT survey and health registries study

OBJECTIVE

We examined the risk of developing a future alcohol use disorder (AUD) among offspring of families with different constellations of parental risk factors.

METHOD

We analyzed a sample of 8,774 offspring (50.2% male) from 6,696 two-parent families who participated in the Nord-Trøndelag Health Study in Norway when offspring were 13-19 years old in 1995-1997 or 2006-2008. Based on population registry information and parental Nord-Trøndelag Health Study self-reports, families were classified via Latent Profile Analysis into fiver risk constellations reflecting parents' education, drinking quantities and frequencies, and mental health. Information about AUD-related diagnoses, treatments, and prescriptions for all offspring in the period between 2008 and 2016 was obtained from 3 national health registries and pooled to reflect any AUD. The likelihood of AUD in offspring was examined with a set of nested logistic regression models.

RESULTS

Registry records yielded 186 AUD cases (2.1%). Compared with the lowest-risk constellation, offspring from two constellations were more likely to present with AUD in unadjusted analyses. After adjusting for all covariates, including offspring's alcohol consumption and witnessing parental intoxication during adolescence, AUD risk remained elevated and statistically significant (adjusted odds ratio = 2.34, 95% confidence interval = 1.14, 4.85) for offspring from the constellation characterized by at least weekly binge drinking, low education, and poor mental health in both parents.

CONCLUSION

Weekly binge drinking by both parents was associated with future AUD risk among community offspring in Norway when clustered with additional parental risks such as poor mental health and low educational attainment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Substance use and symptoms of mental health disorders: a prospective cohort of patients with severe substance use disorders in Norway

BACKGROUND

There is high co-occurrence of substance use disorders (SUD) and mental health disorders. We aimed to assess impact of substance use patterns and sociodemographic factors on mental health distress using the ten-item Hopkins Symptom Checklist (SCL-10) over time.

METHODS

Nested prospective cohort study of 707 participants with severe SUD across nine opioid-agonist-therapy outpatient clinics and low-threshold municipality clinics in Norway, during 2017-2020. Descriptive statistics were derived at baseline and reported by means and standard deviation (SD). A linear mixed model analysis was used to assess the impact of substance use patterns and sociodemographic factors on SCL-10 sum score with beta coefficients with 95% confidence intervals (CI).

RESULTS

Mean (SD) SCL-10 score was 2.2 (0.8) at baseline with large variations across patients. We observed more symptoms of mental health disorders among people with frequent use of benzodiazepines (beta 3.6, CI:2.4;4.8), cannabis (1.3, CI:0.2;2.5), opioids (2.7, CI:1.1;4.2), and less symptoms among people using frequent stimulant use (- 2.7, CI:-4.1;-1.4) compared to no or less frequent use. Females (1.8, CI:0.7;3.0) and participants with debt worries (2.2, CI:1.1;3.3) and unstable living conditions (1.7, CI:0.0;3.3) had also higher burden of mental health symptoms. There were large individual variations in SCL-10 score from baseline to follow-up, but no consistent time trends indicating change over time for the whole group. 65% of the cohort had a mean score > 1.85, the standard reference score.

CONCLUSIONS

People with SUD have a considerable burden of mental health symptoms. We found no association between substance use patterns and change in mental health symptoms over time. This could suggest that the differences observed were indicating flattening of effects or self-medication to a larger degree than medication-related decline in mental health. This call for better individualized mental health assessment and patient care.

Longitudinal changes in alcohol use and binge-drinking among young-adult college students: Analyses of predictors across system levels

BACKGROUND

Longitudinal research regarding young-adult college student alcohol use behaviors is needed to identify risk factors and inform interventions, particularly with regard to binge-drinking.

METHODS

Data from 3,418 US college students (aged 18-25) in a two-year, six-wave panel study (64.6% female, 63.4% White) were used to examine alcohol use and binge-drinking trajectories, as well as predictors of differing trajectories across individual (sociodemographics, depressive symptoms, ADHD symptoms, early-onset substance use), interpersonal (adverse childhood events, social support, parental substance use), and community factors (college type, rural/urban).

RESULTS

Baseline alcohol use was associated with being White, higher parental education, early-onset use of alcohol, cigarettes, and marijuana, greater social support, parental alcohol use, attending private institutions, and rurality (p's < 0.01). Greater alcohol use over time was predicted by being White and attending private institutions (p's < 0.01). Multivariable regression indicated that predictors of binge-drinking at any assessment included older age, sexual minority, greater ADHD symptoms, early-onset substance use, parental alcohol use, attending private institutions, and rurality (p's < 0.01). GMM indicated 4 binge-drinking trajectory classes: Dabblers (89.94% of the sample), Slow decelerators (7.35%), Accelerators (1.86%), and Fast decelerators (0.84%). Fast and Slow decelerators were older; Dabblers and Fast decelerators were more likely female; Accelerators reported more depressive symptoms; Dabblers were less likely early-onset substance users; and those from rural settings were more likely Slow decelerators vs. Dabblers (p's < 0.05).

CONCLUSIONS

Intervention efforts should be informed by data regarding those most likely to drink, binge-drink, and escalate use (e.g., Whites, men, early-onset users, parental use, private college students, rural).

Association between aggressive and non-fatal suicidal behaviors among U.S. high school students

OBJECTIVE

This study quantified the association between aggressive and non-fatal suicidal behaviors (NFSB) among U.S. high school students and examined whether the association could be explained by substance use, bullying and sexual/dating violence victimization, and other potential risk factors.

METHOD

Data were based on self-reports from 14,765 students who responded to the 2017 National Youth Risk Behavior Survey. Confirmatory latent class analysis (LCA) identified two distinct, dichotomous latent class variables manifested by indicators of past-year NFSB (i.e., ideation, plan, and attempt) and aggressive behavior (i.e., physical fighting in general and on school property). The structural model estimated the odds ratios between NFSB, aggressive behavior, and their potential risk factors.

RESULTS

Without adjusting for covariates, the confirmatory LCA estimated an odds ratio (OR) of 2.55 (95% confidence interval [CI]: 1.93, 3.37) between two latent class variables for violence against self (NFSB) and others (physical fighting). The net association, however, was rendered nonsignificant (OR = 1.08 [95% CI: 0.88, 1.31]) when adjusted for covariates. Significant common risk factors included exposure to physical dating violence, being bullied on school property and/or electronically, being threatened or injured by someone with a weapon on school property, and lifetime illegal drug use and prescription opioid misuse.

LIMITATIONS

Cross-sectional data do not allow assessment of causal relationships.

CONCLUSIONS

Findings elucidated the association between NFSB and aggressive behavior, with serious implications for prevention and intervention. Targeting substance use, bullying, and sexual and dating violence will protect students from engaging in both types of violent behaviors.

Exploring how Family and Neighborhood Stressors Influence Genetic Risk for Adolescent Conduct Problems and Alcohol Use

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.

Mother and Father Prescription Opioid Misuse, Alcohol Use Disorder, and Parent Knowledge in Pathways to Adolescent Alcohol Use

Parenting during early adolescence is key in protecting adolescents against substance use initiation and patterned use. Parental alcohol use disorder is a robust risk factor for maladaptive parenting and adolescent alcohol use. However, it is unclear what effect parent prescription opioid misuse has on parenting and adolescent alcohol use. Associations were examined among parent alcohol use disorder, prescription opioid misuse, and parent knowledge of adolescent activities in early adolescence and their prediction of adolescent alcohol use approximately five years later. The current sample consisted of mothers (N = 457) and fathers (N = 368) drawn from a large longitudinal sample (The Adult and Family Development Project: AFDP). The average age was 11.68 in early adolescence and 16.22 in adolescence and 47% of adolescents were female. Parent knowledge was tested as a mediator of the effects of parent alcohol disorder and parent opioid misuse on adolescence alcohol use. This model was examined separately in mothers and fathers. For mothers, alcohol use disorder and prescription opioid misuse both predicted adolescent alcohol use indirectly via parent knowledge. Mothers' alcohol use disorder also directly predicted adolescent alcohol use. For fathers, no direct or indirect effects of alcohol use disorder or prescription opioid misuse were detected although a covariate effect of illicit drug use on parent knowledge emerged. The results are discussed with regards to the processes that may explain how alcohol disorder or prescription opioid misuse affect mothers' knowledge and increase risk for adolescent alcohol use.

Longitudinal Impact of Life Events on Adolescent Binge Drinking in the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA)

Background: Life events experienced during adolescence are associated with risk and resilience to heavy episodic drinking (HED; i.e. binge drinking). The current study builds on prior research using latent class analysis (LCA) to examine heterogeneity in patterns of adolescent life events at baseline to HED over the course of three years (4 timepoints) as part of the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA). Methods: Life event classes were modeled using LCA that characterized NCANDA participants based upon their responses to the Life Events Questionnaire (N = 467, age: M = 14.98, SD = 1.69, 49.7% female). These baseline latent life event classes were then compared to HED at baseline and years 1, 2 and 3 using multinomial logistic regression. Results: At baseline, the LCA characterized four classes of adolescents based on endorsement of life events: negative-relational conflict (n = 65, 13.9%), negative-financial problems (n = 49, 10.5%), low life events (n = 130, 27.8%), and positive life events (n = 223, 47.8%). Life event trajectories differed for the negative life event classes compared to the other two classes, with greater odds of HED in the negative-financial problems class at year 1. Conclusion: The four latent classes derived from the life events of NCANDA youth yielded a characterization of adolescents that could aid in understanding HED over the subsequent three years, suggesting that everyday life events may inform adolescent binge drinking.

Does Alcohol Initiation in Early-To-Middle Adolescence Predict Changes in Reward Motivation? Evidence of Sex Differences

BACKGROUND

Reward motivation has been cross-sectionally correlated with adolescent alcohol use, but the temporal nature of this relationship remains unclear. This project sought to determine whether adolescent alcohol initiation longitudinally predicted changes in reward motivation and behavioral inhibition from early to middle adolescence, and explored the role of adolescent sex in this prediction.

METHODS

A total of 180 11- to 14-year-olds were recruited and then followed for 3 years to age 14 to 17. Participants self-reported their alcohol use at all time points. We selected participants who were alcohol-naïve at Baseline (early adolescence) and then grouped them based on whether or not they reported alcohol initiation by Year 3 (Y3: middle adolescence). Adolescents completed self-report and experimental (delay discounting) measures of reward motivation and self-report measures of behavioral inhibition at Baseline and Y3.

RESULTS

Adolescents' alcohol initiation significantly predicted higher Y3 self-reported reward motivation on one measure. Additionally, a significant sex × alcohol initiation interaction was found predicting Y3 task-based reward motivation (delay discounting), with boys' alcohol initiation predicting increased bias toward immediate reward at Y3. There was also a sex × alcohol initiation interaction predicting behavioral inhibition, with girls' alcohol initiation predicting higher behavioral inhibition at Y3.

CONCLUSIONS

Results suggest that alcohol initiation among adolescents might precede changes in reward motivation, and the effects of alcohol on reward and behavioral inhibition may differ by adolescent sex.

Parental Alcohol Use and the Alcohol Misuse of their Offspring in a Finnish Birth Cohort: Investigation of Developmental Timing

There is a positive association between parental alcohol use and the alcohol use of their offspring. It is less clear whether this relation exists at different developmental periods. The purpose of the current study was to examine the associations between parental alcohol use at two developmental periods (prenatal and adolescence) and the alcohol misuse of their offspring at two developmental periods (adolescence and young adulthood). Data from the Northern Finland Birth Cohort 1986 (NFBC1986; n = 6963; 51% of offspring were girls) were used. The NFBC1986 is a population-based study of individuals born during a 1-year period in Finland. Multi-informant (parent, teacher, and youth) and multi-method (surveys and population registers) data were collected at four developmental periods (prenatal, childhood, adolescence, and young adulthood). The findings indicated that parents' alcohol use was stable from the prenatal period to adolescence. Mothers' and fathers' (based on mothers' perceptions) alcohol use during the prenatal period and adolescence were directly related to adolescents' heavy drinking. Prenatal alcohol use by mothers and fathers were related to young adults' alcohol use disorder indirectly (but not directly) through mothers' and fathers' alcohol use during adolescence and then through adolescents' heavy drinking. The results suggest that early and ongoing screening for alcohol use by mothers and fathers could help identify individuals at risk for heavy drinking and alcohol-related problems during adolescence and young adulthood.