Influences of victimization and comorbid conditions on substance use disorder outcomes in justice-involved youth: A discrete time survival mixture analysis

Operational Definitions of Poly-Victimization: A Scoping Review

Throughout the last two decades, research on poly-victimization (PV) has evolved from examinations of a core set of past-year victimization types in youth samples to investigations of a broad range of victimization types experienced during variable time intervals in diverse samples of varying ages. As the concept of PV expands, greater clarity regarding the definition and measurement of PV is needed to advance understanding of its risk and protective factors as well as its associated outcomes. This scoping review aimed to (a) identify approaches used to operationally define and measure PV across studies and (b) synthesize empirical findings concerning risk factors and outcomes associated with PV. A systematic search of peer-reviewed research published before 2022 across 12 databases yielded 98 studies that met inclusion criteria. Study characteristics including the research design, sample type, victimization timeframe, operational definition(s) of PV, measurement of PV, analytic methods, and key findings were synthesized across studies. Findings indicated that the majority of reviewed studies were cross-sectional investigations that utilized categorical measures of lifetime PV in samples of youth. Results also demonstrated that PV is robustly associated with a broad range of predictors, including mental health symptoms and diagnoses as well as family- and community-level factors. PV is also associated with numerous adverse outcomes including depression, anxiety, suicidality, substance use, and delinquency across diverse study types and populations. Future research that examines the conditional effects of PV is needed to identify subgroups of individuals at higher risk of adverse outcomes following PV and modifiable targets for interventions.

Co-occurring trauma- and stressor-related and substance-related disorders in youth: A narrative review

Adolescence is characterized by ongoing neurodevelopment and psychosocial development, resulting in a unique window to the adverse effects of traumatic events and substance use. In addition, trauma- and stressor-related disorders and substance use disorders (SUDs) commonly co-occur in adolescents. Youth with interpersonal violence and who have experienced multiple past traumas, or poly-victimization, are at the highest risk of developing these co-occurring disorders. There is a strong bidirectional relationship between traumatic events and substance use that predisposes youth to developing post-traumatic stress symptoms (PTSS) and SUDs. PTSD and states of substance intoxication and withdrawal also exhibit overlap in symptomatology. High rates of comorbidity may be explained in part by the self-medication hypothesis, that posits that individuals use substances to temporarily alleviate trauma-related symptoms. However, this results in negative reinforcement, often with increasing patterns of substance use and worsening symptoms of hyperarousal, dysphoria, and anxiety. In addition, PTSS and substance use problems share common risk factors and neurobiologic etiology, conceptualized as the susceptibility hypothesis. Youth who experience traumatic events and/or have substance use problems access the healthcare system at multiple levels, including through acute care and crisis services. Notably, substance use in adolescence increases the likelihood of experiencing a traumatic event, and youth presenting to the emergency department for substance-related problems are at higher risk of having a PTSD. Youth presenting for mental health, behavioral, or substance-related problems should be screened for PTSS and substance use problems. Given the strong clinical overlap and bidirectional relationship, evidence-based treatment integrates management of both disorders. An interdisciplinary approach with psychotherapy, psychopharmacologic therapy, and case management is often vital to engaging and maintaining youth in treatment.

Addressing cortex dysregulation in youth through brain health check coaching and prophylactic brain development

The Carter Center has estimated that the addiction crisis in the United States (US), if continues to worsen at the same rate, may cost the country approximately 16 trillion dollars by 2030. In recent years, the well-being of youth has been compromised by not only the coronavirus disease 2019 pandemic but also the alarming global opioid crisis, particularly in the US. Each year, deadly opioid drugs claim hundreds of thousands of lives, contributing to an ever-rising death toll. In addition, maternal usage of opioids and other drugs during pregnancy could compromise the neurodevelopment of children. A high rate of DNA polymorphic antecedents compounds the occurrence of epigenetic insults involving methylation of specific essential genes related to normal brain function. These genetic antecedent insults affect healthy DNA and mRNA transcription, leading to a loss of proteins required for normal brain development and function in youth. Myelination in the frontal cortex, a process known to extend until the late 20s, delays the development of proficient executive function and decision-making abilities. Understanding this delay in brain development, along with the presence of potential high-risk antecedent polymorphic variants or alleles and generational epigenetics, provides a clear rationale for embracing the Brain Research Commission's suggestion to mimic fitness programs with an adaptable brain health check (BHC). Implementing the BHC within the educational systems in the US and other countries could serve as an effective initiative for proactive therapies aimed at reducing juvenile mental health problems and eventually criminal activities, addiction, and other behaviors associated with reward deficiency syndrome.

Childhood adversity and developmental trajectories of alcohol and cannabis co-use

OBJECTIVE

A large body of literature has noted detrimental effects of childhood adversity on young adult behavioral health, yet few studies have assessed how early childhood adversity influences the development of alcohol and cannabis co-use.

METHOD

In the present study we use data from an ongoing longitudinal cohort (N = 2507) to understand how early childhood adversity influences transitions into alcohol and cannabis co-use trajectories. We also explore how sex, depression, and anxiety are associated with transition probabilities. We used latent transition analysis to examine transitions from emergent childhood adversity classes to classes of parallel alcohol and cannabis co-use from ages 17 to 24 years.

RESULTS

Those who reported high levels of childhood adversity were more likely to transition into classes with relatively chronic and rapidly increasing alcohol and cannabis co-use during young adulthood. Young adults who both experienced high levels of childhood adversity and transitioned into increasing alcohol and cannabis co- use trajectories were more likely to be male and meet clinical cutoff for depression.

CONCLUSION

Our results indicate an incrementally more nuanced set of risk profiles, with differential risk of alcohol and cannabis co-use trajectories, dependent on one's experience of childhood adversity.

PUBLIC HEALTH SIGNIFICANCE

Results of the present study note important heterogeneity in alcohol and cannabis co-use throughout young adulthood, with general trends showing increases in co-use. The present study also shows differential risk of alcohol and cannabis co-use dependent on prior experience of childhood adversity.

Poly-victimization and opioid use during late adolescence and young adulthood: Health behavior disparities and protective factors

OBJECTIVE

Recent work has attempted to uncover heterogeneity in experiences of victimization. However, few studies have included important trauma-related characteristics such as known perpetrator, fear of life or injury, and negative reactions to disclosure. Little focus on potentially important subgroup differences including sexual/gender identity, race/ethnicity, and socioeconomic status as well as protective factors have been assessed.

METHOD

Participants (N = 2,880) completed four annual surveys during late adolescence and the transition to young adulthood as part of an ongoing longitudinal study. Latent class analysis was used to extract classes of victimization and trauma-related characteristics. Latent class regression was used to understand how demographic covariates were related to class membership. Finally, discrete-time survival mixture analysis was used to assess latency to opioid use from ages 17 to 24 years, and how demographic and protective factors influenced opioid use across emergent classes.

RESULTS

The four-class solution fit the data best: sexual abuse and indirect violence + high trauma characteristics (n = 79, 3.6%); high all + high trauma characteristics (n = 177; 8.1%); chronic emotional abuse + trusted perpetrator (n = 263; 12.1%); and low all (n = 1,656; 76.1%). Latent class regression results indicated differential risk of class membership by sexual/gender minority status, sex assigned at birth, race/ethnicity, and socioeconomic status. Survival analysis noted shorter latency to opioid use across all classes compared to the low all class. Self-efficacy and neighborhood cohesion emerged as important protective factors.

CONCLUSION

Furthermore, results highlight key individual- and community-level protective factors that decrease the risk of opioid use. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Applying polyvictimization theory to veterans: Associations with substance use and mental health

OBJECTIVE

Prior work has linked exposure to multiple types of trauma (i.e., polyictimization) to increased risk of negative behavioral health outcomes compared with exposure to any single event. However, few studies have attempted to understand how polyvictimization theory relates specifically to veterans' experiences and behavioral health outcomes. The present study assessed heterogeneity in reports of childhood trauma, combat trauma, and military sexual trauma.

METHOD

We recruited 1,230 veterans outside of traditional Veterans Health Administration settings to participate in a study assessing behavioral health. On average, participants were 34.5 years old with the majority identifying as White (79.3%) and male (88.7%). We used latent class analysis to extract classes of traumatic experience exposure including childhood trauma, combat trauma, and military sexual trauma.

RESULTS

Five classes emerged: (a) high all; (b) moderate combat trauma, high military sexual trauma; (c) high combat trauma, moderate military sexual harassment; (d) moderate childhood trauma and combat trauma; and (e) combat trauma only. Overall, veterans in profiles that endorsed multiple trauma types (i.e., polyvictimization) evidenced greater symptoms of depression, posttraumatic stress disorder, and hazardous alcohol or cannabis use. Further, women were overly represented in profiles that included multiple victimization typologies, especially when profiles included elevated endorsement of military sexual trauma.

CONCLUSION

A polyvictimization framework was partially supported, with differential effects on behavioral health outcomes noted across trauma experiences. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Longitudinal effects of adverse childhood experiences on substance use transition patterns during young adulthood

BACKGROUND

Few studies have investigated how adverse childhood experiences are associated with substance use patterns during young adulthood, a crucial developmental period.

OBJECTIVE

The objective of this study was to extend current knowledge on the association between adverse childhood experiences and patterns of substance use among young adults. We also sought to understand how current mental health status and biological sex influences these patterns.

PARTICIPANTS AND SETTING

The current study utilized wave 8-wave 11 data of a longitudinal cohort study (N = 2880).

METHODS

We used latent transition analysis (LTA) to understand stability and transition patterns of substance use across participants who reported adverse childhood experiences (ACEs+) versus those who did not (ACEs-). Latent class regression was used to assess contemporaneous effects of mental health and sex on classes over time.

RESULTS

Both groups had similar patterns of substance use emerge at each timepoint: High all; Binge, tobacco, cannabis; and Steady/increasing binge drinking. ACEs+ had a higher proportion of youth in the High all class and much higher stability in this class, compared to the ACEs- group. Those in the ACES+ group were less likely to transition out of a riskier class. Mental health and sex showed differential effects across ACEs groups.

CONCLUSION

Results point to increased risk of polysubstance use, including opioids and prescription medications, among those who reported adverse childhood events. Future work may explore protective, malleable, factors that may confer reduced risk of long-term polysubstance use.

Relevance of the dual systems model for predicting drug/alcohol dependence in early adulthood among previously adjudicated young adults

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.

Effects of homophobic name-calling and verbal sexual harassment on substance use among young adults

Verbal aggression victimization, such as homophobic name-calling, has been linked to heavier substance use among young people, but little longitudinal research has examined how different types of victimization may affect substance use or whether certain psychosocial factors moderate these risks. In a diverse cohort (N  = 2,663), latent transition analysis was used to model heterogeneity in victimization (age 19) and substance use (age 20). Four victimization (high victimization, homophobic name-calling only, verbal sexual harassment only, and low victimization) and three substance use (poly-substance use, alcohol, and cannabis only, low all) classes were identified. The high victimization and homophobic name-calling only classes had the highest probabilities of transitioning into the poly-substance use class, and the high victimization class had the highest probability of transitioning into the alcohol and cannabis only class. The probability of transitioning into the low all substance use class was highest in the low victimization class and lowest in the high victimization class. For the high victimization class, greater depressive symptoms increased the odds, and better peer relationship quality decreased the odds, of transitioning into the poly-substance use and alcohol and cannabis only classes. For the homophobic name-calling only class, greater depressive symptoms increased the odds of transitioning into the poly-substance use class. Homophobic name-calling, alone or in combination with verbal sexual harassment, is a risk factor for escalating substance use in young adulthood, especially among victims with depressive symptoms.

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.

Influences of victimization and comorbid conditions on latency to illicit drug use among adolescents and young adults

OBJECTIVE

Exposure to violent victimization is associated with higher rates of mental health and substance use disorders (SUD). Some youth who experience multiple victimizations and associated characteristics (i.e. poly-victims) are at heightened risk for long term problems. Thus, we conducted the first study to examine how heterogeneity in experiences of victimization vary in terms of latency to illicit drug use following treatment completion. We also examined if victimization profiles vary across gender and if comorbid conditions (e.g., posttraumatic stress disorder and major depressive disorder) differentially predict latentcy to illicit drug use across groups.

METHODS

Adolescents and young adults (N = 5956; M_age  = 17.5 years; 64.0% male) with SUDs in treatment for illicit drug use completed a battery of measures at baseline. At 3-, 6- and 12-month follow-ups, they reported on the number of days before they used any illicit drug following their last assessment.

RESULTS

Continuous time survival mixture modeling revealed that, as hypothesized, females who experienced high rates of all victimization and related characteristics had a higher hazard for latency to first illicit drug use as compared to females in the low victimization group. This was not the case for males; rather, those who experienced high rates of sexual abuse were quickest to return to illicit drug use. Finally, comorbid conditions led to a higher hazard rate, but only for certain profiles across females.

DISCUSSION

Findings emphasize the necessity for professionals to more fully integrate poly-victimization research and theory into their clinical practices and research.