A systematic review of the unique prospective association of negative affect symptoms and adolescent substance use controlling for externalizing symptoms

Negative Affect, Sensation Seeking, and Adolescent Substance Use Development: The Moderating Role of Executive Function

It is unknown how the Addictions Neuroclinical Assessment markers-negative affect, sensation seeking, and executive function-contribute to substance use development. This study examined whether associations of negative affect and sensation seeking with substance use vary by executive function. Participants were 167 adolescents (47% female) who participated annually for four years (Mage = 14.07, SDage = 0.54 at Time 1). There were within-person bidirectional associations between higher negative affect and higher substance use for adolescents with lower executive function. Adolescents with higher sensation seeking at age 14 exhibited increasing substance use trajectories from age 14 to 17, regardless of executive function level. Negative affect and substance use influence each other within individuals, whereas sensation seeking predicts substance use between individuals.

Age of onset and alcohol and cannabis use disorders among Mexican American young adults: Robust substance-specific effects of early use as a risk factor

We investigated the substance-specific and cross-substance risk associated with early onset (before age 15) of drunkenness and cannabis use in the subsequent development of alcohol (AUD) and cannabis use disorder (CUD) in Mexican American young adults. Survival analyses employed Cox proportional hazards models for AUD and CUD, separately. In cross-risk analyses, we modeled estimates for those participants reporting lifetime use of both substances. Early onset of drunkenness and early onset of cannabis use were associated with shorter time to AUD and CUD, respectively, even after accounting for psychiatric disorders. While there were no cross-risk associations, adjusting for psychiatric disorders and early onset cannabis use attenuated the association of early drunkenness with AUD.

The role of parental maladaptive emotion socialization in the risk process for negative urgency and drinking behavior in adolescence

INTRODUCTION

Negative urgency (the tendency to act rashly when experiencing negative emotions) is a robust risk factor for a number of problem behaviors, including early adolescent drinking. Little is known about the factors that precede the development of negative urgency, and hence the full etiology of this component of risk. The current study aimed to investigate the possibility that facets of childhood maladaptive emotion socialization (the tendency for children's expressions of emotions to be met with punishment, minimized, or invoke a reaction of distress from their parents/caretakers) increases risk for the development of negative urgency and drinking behavior.

METHOD

Self-report measures of negative urgency, subfacets of maladaptive emotion socialization, and drinking behavior were collected during the 2021-2022 academic year from a sample of 428 high school students (mean age = 14.7, SD = 0.09, 44% female), assessed twice over the course of a semester, reflecting a 4-month longitudinal window.

RESULTS

Distress emotion socialization predicted increases in negative urgency, minimizing predicted decreases in negative urgency, and punitive did not provide significant prediction. Additionally, results found that higher levels of both negative urgency and distress emotion socialization increased adolescents' likelihood of having tried alcohol. These processes were invariant across race and gender.

CONCLUSIONS

The present study may inform the future creation of prevention and intervention efforts aimed at reducing maladaptive emotion socialization and increasing adaptive emotion socialization. Successful reductions in negative urgency as a consequence of increased adaptive emotion socialization may then lead to decreases in adolescent drinking and other impulsigenic behaviors.

Developmental trajectories of child and adolescent emotional problems: associations with early adult alcohol use behaviors

BACKGROUND

Whether emotional problems during childhood and adolescence are longitudinally associated with adult alcohol use behaviors is unclear. This study examined associations between developmental trajectories of emotional problems and early adult alcohol use behaviors, while considering co-occurring conduct problems, developmental change/timing, sex differences, and potential confounds.

METHODS

Participants were from the Twins Early Development Study (analytic N = 19,908 individuals). Emotional and conduct problems were measured by parent reports at child ages 4, 7, and 9 years and via self-reports at ages 9, 11, and 16 years on the Strengths and Difficulties Questionnaire. Alcohol use behaviors (alcohol consumption and alcohol-related problems) were self-reported by the twins on the Alcohol Use Disorders Identification Test at age 22 years. Piecewise latent growth curve models described nonlinear developmental trajectories of emotional and conduct problems from ages 4 to 16. At age 22, alcohol use was regressed on emotional and conduct problems' intercepts and slopes from piecewise latent growth curve model and sex differences in regression coefficients were tested. Using twin modeling, Cholesky decompositions and direct path models were compared to test whether significant phenotypic associations were best explained by direct phenotypic influences or correlated genetic and environmental influences.

RESULTS

Emotional problems had different associations with alcohol-related problems versus alcohol consumption. After accounting for direct influences from conduct problems, emotional problems were not associated with alcohol-related problems, while emotional problems at age 9 were negatively associated with alcohol consumption in males.

CONCLUSIONS

Overall, findings did not support emotional problems as prospective risk factors for severe alcohol use above and beyond risks associated with conduct problems. Sex- and age-specific links between emotional problems and alcohol consumption in early adulthood may be worthy of further exploration, particularly as twin analyses improved our confidence that such links may be underpinned by causal mechanisms.

Patterns of Health-Risk Behaviours and Their Associations With Anxiety and Depression Among Chinese Young Adults by Gender: A Latent Class Analysis

This study investigated gender differences in health-risk behaviour patterns among young adults and assessed the associations of anxiety and depression with these patterns. A cross-sectional survey was conducted with 1740 young Chinese adults aged 18-24 years. Latent class analysis (LCA) and multinomial logistic regression were conducted to identify the clusters of health-risk behaviours and their associations with anxiety and depression. Three common patterns were found for both genders: physical inactivity, substance use, and insufficient fruit intake (5.7% for males [M] and 11.6% for females [F]); a sedentary lifestyle only (48.4% for M and 48.9% for F); and a sedentary lifestyle, substance use, and an unhealthy diet (7.6% for M and 20.0% for F). Additionally, two additional unique patterns were found: physical inactivity and unhealthy diet in males (38.3%) and physical inactivity and insufficient fruit intake in females (19.6%). Sociodemographic variables exert different effects on health-risk behaviour patterns as a function of gender. Lower anxiety levels (odds ratio [OR]: 0.892; 95% confidence interval [CI]: 0.823-0.966) and greater depression levels (OR: 1.074; 95% CI: 1.008-1.143) were associated with a sedentary lifestyle, substance use, and unhealthy diet class only in female young adults compared with a sedentary-only class. These findings underscore the need for the implementation of targeted interventions based on gender differences.

Alcohol milestones and internalizing, externalizing, and executive function: longitudinal and polygenic score associations

BACKGROUND

Although the link between alcohol involvement and behavioral phenotypes (e.g. impulsivity, negative affect, executive function [EF]) is well-established, the directionality of these associations, specificity to stages of alcohol involvement, and extent of shared genetic liability remain unclear. We estimate longitudinal associations between transitions among alcohol milestones, behavioral phenotypes, and indices of genetic risk.

METHODS

Data came from the Collaborative Study on the Genetics of Alcoholism (n = 3681; ages 11-36). Alcohol transitions (first: drink, intoxication, alcohol use disorder [AUD] symptom, AUD diagnosis), internalizing, and externalizing phenotypes came from the Semi-Structured Assessment for the Genetics of Alcoholism. EF was measured with the Tower of London and Visual Span Tasks. Polygenic scores (PGS) were computed for alcohol-related and behavioral phenotypes. Cox models estimated associations among PGS, behavior, and alcohol milestones.

RESULTS

Externalizing phenotypes (e.g. conduct disorder symptoms) were associated with future initiation and drinking problems (hazard ratio (HR)⩾1.16). Internalizing (e.g. social anxiety) was associated with hazards for progression from first drink to severe AUD (HR⩾1.55). Initiation and AUD were associated with increased hazards for later depressive symptoms and suicidal ideation (HR⩾1.38), and initiation was associated with increased hazards for future conduct symptoms (HR = 1.60). EF was not associated with alcohol transitions. Drinks per week PGS was linked with increased hazards for alcohol transitions (HR⩾1.06). Problematic alcohol use PGS increased hazards for suicidal ideation (HR = 1.20).

CONCLUSIONS

Behavioral markers of addiction vulnerability precede and follow alcohol transitions, highlighting dynamic, bidirectional relationships between behavior and emerging addiction.

Substitutions of physical activity and sedentary behavior with negative emotions and sex difference among college students

BACKGROUND

A growing number of studies have found that physical activity (PA) benefits mental health, and sedentary behavior (SB) increases the risk of psychological symptoms, but it remains unclear whether substituting the duration of different activities may affect the association, and whether sex difference exists among college students.

METHODS

A longitudinal survey was conducted in three colleges in Anhui province, China. A total of 8049 participants validly answered the questionnaire, which included demographic variables, PA, SB and negative emotions (depressive, anxiety, and stress symptoms).

RESULTS

Substituting 30 min per day of SB with equivalent walking was associated with lower scores of depressive symptoms. Stress symptoms were reduced when SB was substituted by moderate intensity PA (MPA) and walking. Substituting 30 min per day of MPA in place of walking and SB was associated with an amelioration of depressive and stress symptoms in females, and a reallocation of 30 min walking was associated with lower depressive and stress symptom scores when SB was replaced in males.

CONCLUSIONS

Replacing SB with walking and MPA ameliorates the depressive and stress symptoms in young adults. The results suggest a reallocation of time from SB or walking to MPA in females while from SB to walking in males may markedly reduce the depressive and stress symptoms in college population.

Psychopathology as dynamic markers of alcohol initiation across development: A three-year longitudinal examination

Sipping, an early form of alcohol initiation, is associated with aspects of psychopathology and personality that reflect long-term risk for harmful alcohol use. In the Adolescent Brain and Cognitive Development cohort (N = 11,872), sipping by age 9-10 was concurrently associated with impulsivity, other aspects of externalizing, and prodromal schizophrenia symptoms. Still, these associations were cross-sectional in nature, leaving open the possibility that these features of psychopathology and personality might not reflect long-term risk for alcohol consumption and related harm across development. Here, we attempted to replicate baseline concurrent associations across three waves of data to extend concurrent associations to prospective ones. Most cross-sectional associations replicated across waves, such that impulsivity, other aspects of externalizing, reward sensitivity (e.g., surgency, sensation seeking), and prodromal schizophrenia symptoms were associated with increased odds of having sipped alcohol by the age of 12. Nevertheless, not all concurrent associations replicated prospectively; impulsigenic features did not reflect long-term risk for sipping. Thus, some psychopathology features appeared to reflect stable risk factors, whereas others appeared to reflect state-dependent risk factors. All told, sipping might not reflect long-term risk for harmful alcohol use, and the nature of sipping may change across development.

The impact of COVID-19 on the peer relationships of adolescents around the world: A rapid systematic review

The main objective of this rapid systematic review was to examine how the COVID-19 pandemic impacted peer relationships for adolescents (10-25 years of age) around the globe. We focused on four indices of peer relationships: (1) loneliness, (2) social connectedness, (3) social support, and (4) social media use. In addition, we examined gender and age differences. Four databases (APA PsychInfo, PubMed, Scopus, and Web of Science) were searched for articles published from January 2020 to November 2022. A total of 96 studies (cross-sectional: n = 66, longitudinal: n = 30, quantitative: n = 67, qualitative: n = 12, mixed-methods: n = 17) met our inclusion criteria (empirical observational studies with data on at least one of the indices of interest, cross-sectional data on COVID-19-related experiences or longitudinal data collected during the pandemic, age range of 10-25 years, typically developing adolescents). We extracted data and conducted a narrative synthesis. Findings suggest that COVID-19 disruptions negatively impacted peer relationships for youth. Most studies reported either an increase in loneliness over the course of the pandemic or a positive association between loneliness and COVID-19-related experiences. Similar findings were observed for increased social media use as a means of continued communication and connection. Fewer studies focused on social support but those that did reported a decrease or negative association with COVID-19-related experiences. Lastly, findings suggest a mixed impact on social connectedness, which might be due to the strengthening of closer ties and weakening of more distant relationships. Results for gender differences were mixed, and a systematic comparison of differences across ages was not possible. The heterogeneity in measures of COVID-19-related experiences as well as timing of data collection prevented a more nuanced examination of short and more long-term impacts.

Longitudinal Relations Among Parental Substance Use Disorder and Adolescent Drinking Behavior: The Role of Temperament, Negative Urgency, and Maternal Parenting

Research suggests that parental substance use disorder is associated with adolescent drinking indirectly through negative urgency, a form of impulsivity that is particularly associated with high-risk drinking. Moreover, childhood mechanisms of risk may play a role in this developmental chain such that childhood temperament and parenting may be mechanisms through which parental substance use disorder is associated with adolescent negative urgency and drinking behavior. Therefore, the current study tested whether parental substance use disorder was indirectly associated with adolescent drinking frequency through childhood temperament (i.e., "dysregulated irritability") and adolescent negative urgency, and whether relations differed by levels of maternal support and consistency of discipline. Data come from a multigenerational, longitudinal study of familial substance use disorder (N = 276, Mage in childhood = 6.28 (SD = 1.16), Mage in adolescence = 15.86 (SD = 1.56), 45.3% female). Findings indicated that parental substance use disorder indirectly predicted adolescent drinking through both childhood dysregulated irritability and adolescent negative urgency (mediated pathways). This indirect relation was stronger at higher vs. lower levels of maternal support but did not vary by maternal consistency of discipline. Parental substance use disorder also indirectly predicted adolescent drinking separately through childhood dysregulated irritability and negative urgency. Findings thus suggest that childhood dysregulated irritability may be an early marker of risk toward high-risk personality traits and behavior in adolescence that are associated with having a parental history of substance use disorder. Findings also suggest that increased maternal support may only be helpful in buffering risk for those with low levels of dysregulated irritability. Prevention efforts focused on childhood emotion regulation and emotion-based action may be useful in preventing adolescent risk behavior.

Progression of Comorbid Depression and Substance Use among Racially Diverse Adults

Comorbidity of depression and substance abuse is common and a major public health burden. Studies of this form of comorbidity in racial and ethnic minoritized (REM) populations are minimal and have mixed findings. The present study examined the effect of general risk factors (family bonding, supervision, involvement, peer delinquency), depression risk factors (caregiver depression), and substance use risk factors (adult family members, sibling, and peer substance use) in early adolescence (~ ages 13-14) on comorbid depression and substance use in later adolescence (~ ages 15-17) and adulthood (~ ages 29-31) and continuity in comorbidity from adolescence to adulthood. Longitudinal data on 1000 Black (n = 680) Hispanic (n = 170) and White (n = 150) individuals came from the Rochester Youth Development Study. Participants were interviewed 14 times over 17 years beginning in 1988. General risk factors predicted comorbidity across racial/ethnic groups. Substance specific risk predicted comorbidity among Black and Hispanic individuals whereas depression specific risk was predictive among White individuals. Adolescent comorbidity predicted comorbidity in adulthood across race. These findings highlight the importance of substance use intervention for racial and ethnic minoritized individuals and mental health risk factors in Whites. The continuity of comorbidity from adolescence to adulthood highlights the importance of targeting adolescents for intervention to prevent long-term manifestation of this form of comorbidity and its associated consequences.

Individual Trajectories of Depressive Symptoms Within Racially-Ethnically Diverse Youth: Associations with Polygenic Risk for Depression and Substance Use Intent and Perceived Harm

There are distinct individual trajectories of depressive symptoms across adolescence which are most often differentiated into low, moderate/stable, and high/increasing groups. Research has found genetic predisposition for depression associated with trajectories characterized by greater depressive symptoms. However, the majority of this research has been conducted in White youth. Moreover, a separate literature indicates that trajectories with elevated depressive symptoms can result in substance use. It is critical to identify depressive symptom trajectories, genetic predictors, and substance use outcomes in diverse samples in early adolescence to understand distinct processes and convey equitable benefits from research. Using data from the Adolescent Cognitive Brain Development Study (ABCD), we examined parent-reported depressive symptom trajectories within Black/African American (AA, n = 1783), White/European American (EA, n = 6179), and Hispanic/Latinx (LX, n = 2410) youth across four annual assessments in early adolescence (age 9-10 to 12-13). We examined racially/ethnically aligned polygenic scores (Dep-PGS) as predictors of trajectories as well as substance use intent and perceived substance use harm as outcomes at age 12-13. Differential trajectories were found in AA, EA, and LX youth but low and high trajectories were represented within each group. In EA youth, greater Dep-PGS were broadly associated with membership in trajectories with greater depressive symptoms. Genetic effects were not significant in AA and LX youth. In AA youth, membership in the low trajectory was associated with greater substance use intent. In EA youth, membership in trajectories with higher depressive symptoms was associated with greater substance use intent and less perceived harm. There were no associations between trajectories and substance use intent and perceived harm in LX youth. These findings indicate that there are distinct depressive symptom trajectories in AA, EA, and LX youth, accompanied by unique associations with genetic predisposition for depressive symptoms and substance use outcomes.

Predictors and Correlates of Positive Urine Drug Screening in a Retrospective Cohort Analysis of Child and Adolescent Psychiatry Inpatients Throughout the COVID-19 Pandemic

BACKGROUND AND OBJECTIVES

Youth substance use is associated with significant psychological, neurological, and medical complications. Risk factors for substance use among children and adolescents in the general population include peer and/or parental substance use, certain psychiatric illnesses (eg, Attention-Deficit/Hyperactivity Disorder, depression), and history of maltreatment. Co-occurring substance use and psychiatric illness have been associated with increased suicidality, but few prior studies have characterized substance use among child/adolescent inpatients. As such, it remains unclear how substance use contributing to acute psychiatric presentations has changed since the start of the COVID-19 pandemic.

METHODS

This is a retrospective cohort study of 816 unique child/adolescent psychiatry inpatients with urine drug screening (UDS) results from a diverse urban setting. Charts of patients hospitalized between June 1, 2018 and November 30, 2021 were reviewed for sociodemographic characteristics, indication for admission, psychiatric history, hospital course, treatment plan, and discharge diagnosis. Differences in sociodemographic and clinical characteristics, such as age, race, and diagnoses, between patients with and without positive UDS were explored throughout various periods of the COVID-19 pandemic. Descriptive and comparative statistics were performed, as well as a logistic regression model to identify the predictors of positive UDS.

RESULTS

Of the study sample, 18% had a positive UDS. Older age, diagnosis of impulsive or behavioral disorder, and a history of violence were found to be predictors of positive UDS. Asian/South Asian or Hispanic/LatinX race and history of a developmental or intellectual disability were found to be negative predictors. The frequency of positive UDS in this population did not change based on COVID-19.

DISCUSSION AND CONCLUSIONS

Multiple factors may predispose children and adolescents to substance use. Though no impact of COVID-19 was found in this sample, longer-term studies are needed.

SCIENTIFIC SIGNIFICANCE

This study identifies independent predictors of active substance use in the child and adolescent psychiatric inpatient population.

Trajectory Classes of Externalizing and Internalizing Symptoms to Adolescent Gambling Participation: An Exploratory Study

Engagement in underage gambling remains a public health concern. Risk factors for the development of gambling behaviours in adolescence include the presence of externalizing and/or internalizing problems. This study aims to better understand the role of co-occurrence between externalizing and internalizing symptoms from childhood to adolescence in adolescent gambling. Participants were drawn from an ongoing longitudinal study of children with and without early conduct problems. Externalizing and internalizing problems were measured annually using teacher and parent reports. Gambling behaviours were measured using self-report when participants were approximately 15 years old. Latent class growth trajectory analyses identified five mental health trajectory classes: (1) a co-occurring trajectory characterized by stable clinical levels of both externalizing and internalizing problems, (2) an externalizing trajectory characterized by stable high clinical levels of externalizing problems, (3) an internalizing trajectory characterized by stable at-risk levels of internalizing problems, (4) an at-risk externalizing trajectory characterized by decreasing levels of externalizing problems, and (5) a non-clinical trajectory. Invariance analyses suggested that this model remained valid in both boys and girls. Logistic regression analyses suggested that youth who belonged in the externalizing trajectory reported a greater likelihood of past-year gambling behaviours when compared to youth who belong in the comorbid trajectory. No other mental health trajectory was significantly associated with adolescent gambling. Stable high externalizing behaviours in development appear to increase one's risk of gambling behaviours in adolescence. Efforts to target these throughout development could help decrease one's future risk of engaging in these behaviours.

Child and Adolescent Psychopathology and Subsequent Harmful Behaviors Associated with Premature Mortality: A Selective Review and Future Directions

In the United States (U.S.), premature mortality in adulthood from suicide, alcohol-related disease, and substance overdoses has increased steadily over the past two decades. To better understand these trends, it is necessary to first examine the harmful behaviors that often precede these preventable deaths (i.e., suicidal ideation and attempts, and harmful alcohol and substance use). Representing critical developmental periods in which psychopathology is most likely to emerge, childhood and adolescence provide an informative lens through which to investigate susceptibility to harmful behaviors. This article synthesizes current evidence describing these rising U.S. mortality rates and the prevalence rates of harmful behaviors linked to these types of mortality. A brief selective review of longitudinal research on harmful behaviors in relation to the most relevant categories of child and adolescent psychopathology is then provided. Finally, recommendations for future research and implications for prevention are discussed.

Racial and Ethnic Disparities in Mental Health Problems and Tobacco and Cannabis Use Among US Emerging Adults

INTRODUCTION

Mental health problems in emerging adulthood are linked to tobacco and cannabis use, but whether race and ethnicity modifies these associations is unclear.

METHODS

We used data from wave 4 of the Population Assessment of Tobacco and Health Study (youth n = 6898, young adult n = 10,304) to conduct latent class analysis (LCA) of six past 30-day tobacco and cannabis use indicators (i.e., cigarettes, electronic nicotine delivery systems (ENDS), cigars, blunts, cannabis vaping, other cannabis). We estimated associations between past 30-day internalizing and externalizing (i.e., low (referent), moderate, high) problems and latent classes of tobacco/cannabis use (vs. never/former use) using adjusted multinomial logistic regression. We explored whether associations varied by race and ethnicity through stratification.

RESULTS

We identified four exclusive use latent classes and two dual/poly use latent classes for both youth and young adult samples. Race/ethnicity-stratified models identified associations between internalizing/externalizing problems and most use classes for Hispanic and non-Hispanic White youth/young adults, with mixed results for non-Hispanic Black youth/young adults. For example, Hispanic (OR: 2.50, 95% CI: 1.09-5.74) and non-Hispanic White (OR: 1.90, 95% CI: 1.18-3.06) youth with high internalizing problems had higher odds of ENDS + cannabis vaping. Externalizing problems were not associated with use among non-Hispanic Black youth while internalizing problems were not associated with use among non-Hispanic Black young adults.

CONCLUSION

We observed racial/ethnic variation in mental health problems and tobacco and cannabis use. Understanding mental health problem and tobacco product and cannabis use comorbidity may better inform culturally relevant interventions aimed to prevent and reduce use.

Predictors of problematic adult alcohol, cannabis, and other substance use: A longitudinal study of two samples

This study examined whether a key set of adolescent and early adulthood risk factors predicts problematic alcohol, cannabis, and other substance use in established adulthood. Two independent samples from the Child Development Project (CDP; n = 585; 48% girls; 81% White, 17% Black, 2% other race/ethnicity) and Fast Track (FT; n = 463; 45% girls; 52% White, 43% Black, 5% other race/ethnicity) were recruited in childhood and followed through age 34 (CDP) or 32 (FT). Predictors of substance use were assessed in adolescence based on adolescent and parent reports and in early adulthood based on adult self-reports. Adults reported their own problematic substance use in established adulthood. In both samples, more risk factors from adolescence and early adulthood predicted problematic alcohol use in established adulthood (compared to problematic cannabis use and other substance use). Externalizing behaviors and prior substance use in early adulthood were consistent predictors of problematic alcohol and cannabis misuse in established adulthood across samples; other predictors were specific to the sample and type of substance misuse. Prevention efforts might benefit from tailoring to address risk factors for specific substances, but prioritizing prevention of externalizing behaviors holds promise for preventing both alcohol and cannabis misuse in established adulthood.

Anxiety-specific associations with substance use: Evidence of a protective factor in adolescence and a risk factor in adulthood

Externalizing psychopathology is a strong risk factor for substance use, whereas the role of internalizing manifestations of distress, and anxiety in particular, in predicting substance use remains unclear. Studies have suggested that anxiety may be either a protective or risk factor for substance use. The present study aimed to clarify evidence for anxiety-specific associations with substance use, examining sex and developmental period (adolescence vs. adulthood) as potential moderators that may help explain conflicting results in the literature. In a longitudinal twin sample, cross-sectional associations of anxiety with substance use differed in adolescents and adults and in girls/women and boys/men. Controlling for externalizing psychopathology and depression, anxiety was associated with reduced substance use in adolescent girls and increased substance use in adult women. In contrast, anxiety-specific associations with substance use were not significant in boys and men. Possible explanations for these contrasting results across development and sex are discussed.

Developmental trajectories of alcohol and cannabis concurrent use in a nationally representative sample of United States youths

BACKGROUND

Previous studies have identified common trajectories of single type substance use over the course of adolescence; however, no study to date has examined joint trajectories of cannabis and alcohol concurrent use. Given that expansion of legal cannabis has increased availability, it is important to understand patterns of concurrent use in adolescents and factors that place male and female youth at risk for harmful trajectories of concurrent use. The current study sought to identify joint trajectories of cannabis and alcohol use - and predictors of harmful use trajectories - among male and female adolescents.

METHOD

We used 4 waves of data from 6997 early adolescent participants (age 12-14 years at Wave 1) in the Population Assessment of Tobacco and Health, a nationally representative longitudinal study in the United States. Participants reported their cannabis and alcohol use reassessed yearly for 5 years (2013-2018). We used joint trajectory growth mixture modeling to identify trajectory groups as defined by changes in alcohol and cannabis use over time.

RESULTS

Five classes of alcohol and cannabis concurrent use trajectories were identified. Both internalizing and externalizing symptoms at Wave 1 increased the odds of membership in trajectory groups characterized by more harmful use trajectories. Internalizing symptomatology was a stronger predictor of membership in escalating use trajectories among girls, whereas externalizing symptomatology stronger predictor among boys.

CONCLUSIONS

These findings underscore the utility of jointly considering alcohol and cannabis use when describing common developmental trajectories of use and identifying risk factors for trajectories characterized by harmful use.

Drinking alcohol by mid-adolescence is related to reduced reward reactivity: Novel evidence of positive valence system alterations in early initiating female youth

Initiation of alcohol use at younger ages is prognostic of later drinking problems. Reward system dysfunction is theorized to contribute to early initiation and escalation of drinking, but existing evidence supports both hyposensitivity and hypersensitivity as risk-markers; research employing effective indices of reward processing is needed for clarification. The reward positivity (RewP) is a well-established neurophysiological index of hedonic "liking," an important aspect of reward processing. Adult research has yielded conflicting findings, with different studies reporting reduced, enhanced, or null associations of RewP with engagement in or risk for harmful alcohol use. No study has examined relations between RewP and multiple indices of drinking in youth. Here, we examined how RewP measured in a gain/loss feedback task related to self-reported drinking initiation and past-month drinking, when accounting for age along with depression and externalizing symptoms, in 250 mid-adolescent females. Analyses showed that (1) compared to not-yet drinkers, adolescents endorsing drinking initiation responded less strongly to monetary gain (RewP) but not loss feedback (FN), and (2) past-month drinking was unrelated to both RewP and FN magnitude. These findings provide evidence for reduced hedonic "liking" as a concomitant of early drinking initiation in adolescent females and warrant further research with mixed-sex adolescent samples exhibiting greater drinking variability.

Culturally sensitive prevention programs for substance use among adolescents of color: A systematic review and meta-analysis of randomized controlled trials

This systematic review and meta-analysis aims to synthesize the efficacy of culturally sensitive prevention programs for substance use outcomes among U.S. adolescents of color (aged 11 to 18 years old) and explore whether the intervention effects vary by participant and intervention characteristics. Eight electronic databases and grey literature were searched for eligible randomized controlled trials through September 2022. Robust variance estimation in meta-regression was used to synthesize treatment effect size estimates and to conduct moderator analysis. After screening, 30 unique studies were included. The average treatment effect size across all substance use outcomes (including 221 effect sizes) was Hedges's g = -0.20, 95% CI = [-0.24, -0.16]. The synthesized effect sizes were statistically significant across types of substances (alcohol, cigarette, marijuana, illicit and other drugs, and unspecified substance use), racial/ethnic groups (Hispanic, Black, and Native American), and different follow-ups (0-12 months, >12 months). Very few studies reported substance use consequences as outcomes and the synthesized effect size was non-significant. Meta-regression findings suggest that the intervention effects may vary based on the type of substance. This meta-analysis found supportive evidence of culturally sensitive prevention programs' efficacy in preventing or reducing substance use among Black, Hispanic, and Native American adolescents. More substance use prevention efforts and evidence is needed for Asian American, Pacific Islander, and multiracial adolescents.

Psychiatric Symptomatology is Associated with Polydrug Use and School Violence in Early Adolescence

This study investigated the association between psychiatric symptoms and polydrug use, school violence, and sociodemographic factors among Brazilian early adolescents. Using the baseline data collection from the effectiveness evaluation of PROERD, a school-based drug use prevention program, implemented in 30 public schools in São Paulo (n = 2316, M age = 12.3 years, 48.5% girls), multinomial logistic regressions were performed using Strengths and Difficulties Questionnaire (SDQ) subscales as response variables, and polydrug use, school violence, and sociodemographic characteristics as explanatory variables. In most SDQ subscales, girls and older students were more likely to have psychiatric symptoms. A positive association was identified between polydrug use and psychiatric symptoms. It was found that those who suffered and perpetrated physical violence had a greater likelihood of presenting psychiatric symptoms. Preventive interventions should consider the greater vulnerability related to the mental health of girls, older students, and those who suffer and perpetrate physical violence at school.

Assessing cross-lagged associations between depression, anxiety, and binge drinking in the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) study

BACKGROUND

Between 20 % and 30 % of teens suffer from depression or anxiety before reaching adulthood, and up to half also use or misuse alcohol. Although theories suggest bidirectional links between harmful alcohol use (e.g., binge drinking) and internalizing symptoms (i.e., depression and anxiety), empirical evidence to-date has been mixed. Systematic reviews have attributed mixed findings to limitations in study design, such as the utilization of between-person analyses and the focus on unidirectional effects. The goal of this study was to address these limitations by assessing bidirectional within-person associations between internalizing symptoms and binge drinking over the course of 5 years in the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) sample, a large cohort recruited at ages 12-21 and followed annually on substance use and psychiatric functioning.

METHODS

We used latent curve models with structured residuals to examine within-person lagged associations between depression, anxiety, and past month counts of binge drinking using NCANDA data (N = 831). Analyses were supplemented with post-hoc power simulations.

RESULTS

We found marginal evidence linking binge drinking with subsequent depression symptoms one year later among females. We found no evidence that depression or anxiety predicted subsequent binge drinking despite sufficient power.

CONCLUSIONS

Social and cognitive consequences of binge drinking may predict later depression symptoms in adolescence and young adulthood for young women, though there was little evidence favoring self-medication models for binge drinking. We note several moderating variables and common factor mechanisms that may better explain this link.

Multiple lifestyle risk behaviours and hierarchical dimensions of psychopathology in 6640 Australian adolescents

OBJECTIVE

Physical inactivity, sugar sweetened beverage consumption, alcohol use, smoking, poor sleep and excessive recreational screen time (the 'Big 6' lifestyle risk behaviours) often co-occur and are key risk factors for psychopathology. However, the best fitting latent structure of the Big 6 is unknown and links between multiple lifestyle risk behaviours and hierarchical dimensions of psychopathology have not been explored among adolescents. This study aimed to address these gaps in the literature.

METHODS

Confirmatory factor analysis, latent class analysis and factor mixture models were conducted among 6640 students (M_age = 12.7 years) to identify the latent structure of the Big 6 lifestyle risk behaviours. Structural equation models were then used to examine associations with psychopathology.

RESULTS

A mixture model with three classes, capturing mean differences in a single latent factor indexing overall risk behaviours, emerged as the best fitting model. This included relatively low-risk (Class 1: 30%), moderate-risk (Class 2: 67%) and high-risk (Class 3: 3%) classes. Students high on externalizing demonstrated significantly greater odds of membership to the high-risk class (odds ratio = 8.75, 99% confidence interval = [3.30, 23.26]) and moderate-risk class (odds ratio = 2.93, 99% confidence interval = [1.43, 5.97]) in comparison to the low-risk class. Similarly, students high on internalizing demonstrated significantly higher odds of membership to the high-risk class (odds ratio = 1.89, 99% confidence interval = [1.06, 3.37]) and the moderate-risk class (odds ratio = 1.66, 99% confidence interval = [1.03, 2.67]) in comparison to the low-risk class. Associations between lower order factors of psychopathology and lifestyle risk behaviours were mostly accounted for by the more parsimonious higher order factors.

CONCLUSION

Classes representing differences in probabilities of the Big 6 lifestyle risk behaviours relate to varying levels of hierarchical dimensions of psychopathology, suggesting multiple health behaviour change and transdiagnostic intervention approaches may be valuable for reducing risk of psychopathology.

The daily association between affect and alcohol use: A meta-analysis of individual participant data

Influential psychological theories hypothesize that people consume alcohol in response to the experience of both negative and positive emotions. Despite two decades of daily diary and ecological momentary assessment research, it remains unclear whether people consume more alcohol on days they experience higher negative and positive affect in everyday life. In this preregistered meta-analysis, we synthesized the evidence for these daily associations between affect and alcohol use. We included individual participant data from 69 studies (N = 12,394), which used daily and momentary surveys to assess affect and the number of alcoholic drinks consumed. Results indicate that people are not more likely to drink on days they experience high negative affect, but are more likely to drink and drink heavily on days high in positive affect. People self-reporting a motivational tendency to drink-to-cope and drink-to-enhance consumed more alcohol, but not on days they experienced higher negative and positive affect. Results were robust across different operationalizations of affect, study designs, study populations, and individual characteristics. These findings challenge the long-held belief that people drink more alcohol following increases in negative affect. Integrating these findings under different theoretical models and limitations of this field of research, we collectively propose an agenda for future research to explore open questions surrounding affect and alcohol use.

The intersection of internalizing symptoms and alcohol use during the COVID-19 pandemic: A prospective cohort study

Given the well-established relationship between alcohol and internalizing symptoms, potential increases in depression and anxiety during the COVID-19 pandemic may lead to increases in alcohol consumption and binge drinking. This study examines this association from before to during two phases of the pandemic in a cohort of Canadian youth. We used linked data from a sub-sample of 1901 secondary school students who participated in three consecutive school years of the Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behaviour (COMPASS) study between 2018/19 and 2020/21. Separate multilevel logistic regression models examined the association between depression and anxiety symptoms with odds of escalation and reduction (vs. maintenance) and initiation (vs. abstinence) of alcohol consumption. Results show that depression and anxiety symptoms significantly increased over the three years, and these changes were moderated by changes in alcohol consumption and binge drinking. Students with increased depression symptoms were less likely to reduce their alcohol consumption in the early pandemic (Adjust odds ratio [AOR] 0.94, 95% CI:0.90-0.98), more likely to initiate alcohol consumption in the ongoing pandemic period (AOR 1.03, 95% CI: 1.01-1.05), and more likely to initiate binge drinking in both periods. The depression-alcohol use association was stronger among females than males. This study demonstrates a modest association between internalizing symptoms and alcohol use, particularly for depression symptoms and in females. The identified depression-alcohol use association suggests that preventing or treating depression might be beneficial for adolescent alcohol use and vice versa.

Adolescents with substance use problems in outpatient treatment: a one-year prospective follow-up study focusing on mental health and gender differences

Background

Although several studies have found a high incidence of coexisting mental health problems among adolescents with substance use problems, follow-up studies addressing how these conditions change over time are rare. The study will describe and analyze indications of mental health problems and how various risk factors predict outcomes 1 year after initial treatment contact. In addition, gender-specific risk factors are explored.

Methods

A clinical sample of 455 adolescents (29% girls, median age 17 years) answered a structural interview at baseline and were followed up using official records 1 year after initiated treatment. Bivariate associations and logistic regressions were conducted to analyse the links between risk factors at the individual, social, and structural levels as well as links between various mental illness symptoms at treatment start and indications of mental health problems 1 year later were analysed.

Results

The results show that mental health problems among adolescents largely persisted 1 year after start of outpatient care for substance use problems. Forty-two per cent of the sample displayed indications of mental health problems at follow-up, and registrations for both outpatient treatment and psychiatric medication were more common among the girls. Girls also reported more mental illness symptoms at treatment start than boys did, especially anxiety. Depression and suicidal thoughts had predictive values regarding indications of mental health problems and small cumulative effects were found for 6–10 co-occurring risk factors.

Conclusions

Adolescents with depression and suicidal thoughts at treatment start should yield attention among clinicians as these general risk factors could predict indication of mental health problems at 1 year follow-up effectively. Also, patients with more than six co-occurring risk factors seem more vulnerable for continued mental health problems. Generally, girls displayed a greater mental health and psychosocial burden at treatment initiation and were more likely to show indication of mental health problems at follow-up. These results suggests that girls are more likely to get psychiatric out-treatment parallel to, or after, substance abuse treatment. We recommend further investigation of gender differences and gender-specific needs in substance use treatment.

Maladaptive Emotion Socialization as a Risk Factor for the Development of Negative Urgency and Subsequent Problem Drinking

AIMS

Negative urgency, which refers to the tendency to act rashly when experiencing intense negative emotions, consistently serves as a robust predictor of problem drinking and other maladaptive behaviors. However, very little is known about the factors that influence the development of negative urgency itself. Although urgency theory suggests that environment and temperament interact to increase risk for the development of urgency, few studies, to date, have examined environmental risk for urgency.

METHOD

In a cross-sectional sample of 518 adults recruited from Amazon Mturk, the current study began the investigation of the role of childhood maladaptive emotion socialization (MES) in risk for negative urgency and the possibility that negative urgency mediates the relationship between MES and problem drinking via self-report measures completed online. Data were analyzed using structural equation modeling.

RESULTS

Individual differences in childhood MES, reported retrospectively, did predict increased present-day negative urgency. In addition, results were consistent with the possibility that negative urgency mediates the relationship between MES and problem drinking when considered concurrently with trait negative affect.

CONCLUSIONS

Successful identification of early environmental predictors of negative urgency may provide useful targets for intervention efforts aimed at reducing or preventing the development of negative urgency and, subsequently, problem drinking. Further longitudinal investigations are needed to better examine these processes as they develop.

Behavioral inhibition and approach tendencies are associated with striatal activation to loss: Implications for adolescent substance use

Behavioral inhibition/avoidance and approach systems (BIS/BAS), which facilitate avoidance of aversive stimuli and approach of enticing stimuli, are thought to underlie engagement in substance use (SU). However, little is known about the neural correlates of these systems, particularly in adolescence. The current study examined associations between BIS/BAS tendencies and neural response to reward and loss and then examined whether there was an indirect effect of BIS/BAS on later SU initiation through these neural responses. 79 12-14 year olds underwent fMRI at baseline during a card guessing task. Adolescents reported on their BIS/BAS at baseline and on their SU at baseline and through a 3-year follow-up period. Results showed that higher BIS was associated with lower striatal activation and higher BAS with higher striatal activation to monetary loss. BIS and BAS were not associated with neural activation to monetary reward. There was no support that BIS or BAS predicted SU initiation through striatal activation to monetary loss. Overall, these results may suggest that adolescents with the tendency to avoid aversive stimuli assign less salience and adolescents with the tendency to approach enticing stimuli assign more salience to monetary loss.

Rates, Patterns, and Predictors of Follow-up Care for Adolescents at Risk for Substance Use Disorder in a School-Based Health Center SBIRT Program

PURPOSE

To examine rates, patterns, and predictors of follow-up care for adolescents screened as being at risk for substance use disorder (SUD) in a school-based health center (SBHC) Screening, Brief Intervention and Referral to Treatment (SBIRT) program.

METHODS

Electronic health records were extracted of adolescents who received health care services from one of three high school-based health centers implementing SBIRT. Patterns and predictors of engagement in follow-up care within 8 weeks following the week of a positive SUD risk screen were analyzed using item response theory (IRT) modeling.

RESULTS

Out of 1,327 adolescents receiving SBHC services, 81.2% completed a health screening questionnaire. Of screened adolescents, 17.7% were positive for SUD risk. Across the 8-week follow-up period, 65.4% of adolescents at risk for SUD received at least one follow-up visit. IRT modeling indicated that high levels of engagement in follow-up care were characterized by contact with a behavioral health care (BHC) provider. The percentage of adolescents having follow-up contact with a BHC provider increased significantly after the onset of the COVID-19 pandemic. Engagement in follow-up care was predicted by risk for depression, history of suicidal behavior, being female, and previous sexual activity.

DISCUSSION

SBHCs provide a favorable setting for screening and detecting adolescents at risk for SUD. Adolescents at risk for SUD should receive follow-up contact with a BHC provider. Enhanced follow-up engagement efforts may be warranted for adolescents at risk for SUD without risk for depression or suicidal history, as well as for females and those with previous sexual activity.

Detecting negative valence symptoms in adolescents based on longitudinal self-reports and behavioral assessments

BACKGROUND

Given the high prevalence of depressive symptoms reported by adolescents and associated risk of experiencing psychiatric disorders as adults, differentiating the trajectories of the symptoms related to negative valence at an individual level could be crucial in gaining a better understanding of their effects later in life.

METHODS

A longitudinal deep learning framework is presented, identifying self-reported and behavioral measurements that detect the depressive symptoms associated with the Negative Valence System domain of the NIMH Research Domain Criteria (RDoC).

RESULTS

Applied to the annual records of 621 participants (age range: 12 to 17 years) of the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA), the deep learning framework identifies predictors of negative valence symptoms, which include lower extraversion, poorer sleep quality, impaired executive control function and factors related to substance use.

LIMITATIONS

The results rely mainly on self-reported measures and do not provide information about the underlying neural correlates. Also, a larger sample is required to understand the role of sex and other demographics related to the risk of experiencing symptoms of negative valence.

CONCLUSIONS

These results provide new information about predictors of negative valence symptoms in individuals during adolescence that could be critical in understanding the development of depression and identifying targets for intervention. Importantly, findings can inform preventive and treatment approaches for depression in adolescents, focusing on a unique predictor set of modifiable modulators to include factors such as sleep hygiene training, cognitive-emotional therapy enhancing coping and controllability experience and/or substance use interventions.

Electronic Cigarette Use Intentions Mediate the Association between Low Self-Control and Future Use by Internalizing Symptoms

Background: Adolescent electronic (e-)cigarette use intentions are related to initiation. Low self-control is also a risk factor for early stages of substance use. Yet, the impact of low self-control on use through intentions may vary across individuals; depression and anxiety may affect this association. Methods: A sample of 200 adolescents who completed waves 1 and 2 of an ongoing longitudinal study were assessed. We hypothesized that high internalizing symptoms would moderate the indirect effect of low self-control on actual e-cigarette use through e-cigarette use intentions. Results: The mediation pathway was significant at high levels of internalizing symptoms, but not at low or moderate levels. Conclusion: Specifically, those with low self-control and high internalizing symptomatology endorsed the highest e-cigarette use intentions and were more likely to subsequently use e-cigarettes. Youth low in self-control and high in depression and anxiety might be at increased risk to initiate e-cigarette use compared to youth high in self-control and high in internalizing symptomatology.

Psychological distress and health behaviours among Cambodian Americans at risk for developing diabetes

This paper reports secondary data analysis of associations between psychological distress and health behaviours among Cambodian Americans. Data are from baseline assessments from a diabetes prevention trial. All participants met stucriteria for depression and were free of diabetes. Participants (n = 191) completed surveys, a food frequency assessment, and wore sleep and physical activity actigraphy devices for 7 days. A factor analysis of symptoms of post-traumatic stress, baksbat (a Cambodian culture-bound syndrome), depression, and anxiety yielded a single factor named 'psychological distress'. Multivariate models controlling for psychotropic medications were run for the following outcomes: sleep actigraphy, self-reported sleep, physical activity actigraphy, self-reported physical activity, nutrition, and substance use. For actigraphy, higher distress was associated with lower moderate/vigorous physical activity and higher mean variability of 24 h total sleep time. Higher distress was also associated with worse self-reported sleep quality as indicated by standard, and culturally-specific, sleep indicators. Higher distress was also associated with lower use of food labels, lower carbohydrate consumption, and higher alcohol consumption as a coping mechanism. Interventions to mitigate diabetes risk in high-distress populations may benefit from strategies to decrease psychological distress. The sequelae of complex trauma may transcend discrete psychiatric diagnoses.

Internalizing and externalizing pathways to high-risk substance use and geographic location in Australian adolescents

One specific instantiation of the storm-and-stress view of adolescence is the idea that “normal” adolescence involves high-risk substance use behaviors. However, although uptake of some substance use behaviors is more common during adolescence than other life stages, it is clear that not all adolescents engage in risky substance use—and among those who do, there is much variation in emotional, behavioral, and contextual precursors of this behavior. One such set of predictors forms the internalizing pathway to substance use disorder, whereby internalizing symptoms in childhood such as negative affect and anxiety set off a chain of consequences culminating in high-risk substance use in late adolescence. However, findings linking internalizing symptoms to substance use are mixed, and it is clear that this link varies across adolescents and contexts. One heretofore unanswered question is whether and how geographic location, specifically whether the adolescent lives in an urban or rural location, moderates this link. The current report is a secondary analysis of data from the Longitudinal Study of Australian Children (LSAC; N = 2,285), in which we examined the link between internalizing symptoms in childhood and initiation of substance use through age 19. Using a multiple event process survival mixture model (MEPSUM), we identified three trajectories of substance use initiation in adolescence: one (65.7% of the sample) characterized by near-complete abstinence until late adolescence, another (27.2%) by earlier initiation of alcohol, nicotine, and cannabis, and another (7.2%) by early initiation of these substances and later initiation of more hazardous drugs such as cocaine and methamphetamine. Although childhood externalizing symptoms increased the risk of being in the second or third class, internalizing symptoms decreased risk when rural and non-rural adolescents were considered together. Few effects of rurality were found, but the negative relationship between internalizing at age 10 and high-risk substance use was only observed among non-rural adolescents. This finding, which was inconsistent with our initial predictions that rurality might confer higher risk for substance use, instead suggests a potentially protective effect of internalizing symptoms for engagement in risky substance use which may differ based on an adolescent’s geographical context.

The joint development of externalizing and internalizing behaviors in black and Hispanic youth and the link to late adolescent substance use

There is a need to understand how the joint development of externalizing and internalizing behaviors is related to substance use, particularly among historically understudied and often disadvantaged populations. Latent class models were used to estimate patterns of externalizing behaviors and internalizing behaviors in the form of depressive and anxious symptoms from age 6 to 14 among 390 Black and Hispanic youth. Then, growth curve models of substance use between the ages of 15 and 19 were estimated as a function of joint latent class membership. Only elevated levels of externalizing behaviors were associated with higher levels of substance use through age 18. Internalizing behaviors appeared to serve as a protective factor among those with moderate displays of externalizing behavior only. Additionally, growth in substance use from ages 15 to 19 was slower among those who displayed the highest level of externalizing behaviors, and internalizing behaviors appeared to moderate growth (and serve as protective factor) among those who displayed moderate levels of externalizing behaviors. The findings underscore the importance of pattern profiles based on observations of the joint development of problem behaviors to assess risk for substance use, particularly in understudied populations where risk/protective factors may operate in a unique manner.

Comorbidity between mood and substance-related disorders: A systematic review and meta-analysis

BACKGROUND AND OBJECTIVES

Evidence indicates that mood disorders often co-occur with substance-related disorders. However, pooling comorbidity estimates can be challenging due to heterogeneity in diagnostic criteria and in the overall study design. The aim of this study was to systematically review and, where appropriate, meta-analyse estimates related to the pairwise comorbidity between mood disorders and substance-related disorders, after sorting these estimates by various study designs.

METHODS

We searched PubMed (MEDLINE), Embase, CINAHL and Web of Science for publications between 1980 and 2017 regardless of geographical location and language. We meta-analysed estimates from original articles in 4 broadly defined mood and 35 substance-related disorders.

RESULTS

After multiple eligibility steps, we included 120 studies for quantitative analysis. In general, regardless of variations in diagnosis type, temporal order or use of adjustments, there was substantial comorbidity between mood and substance-related disorders. We found a sixfold elevated risk between broadly defined mood disorder and drug dependence (odds ratio = 5.7) and fivefold risk between depression and cannabis dependence (odds ratio = 4.9) while the highest pooled estimate, based on period prevalence risk, was found between broadly defined dysthymic disorder and drug dependence (odds ratio = 11.3). Based on 56 separate meta-analyses, all pooled odds ratios were above 1, and 46 were significantly greater than 1 (i.e. the 95% confidence intervals did not include 1).

CONCLUSION

This review found robust and consistent evidence of an increased risk of comorbidity between many combinations of mood and substance-related disorders. We also identified a number of under-researched mood and substance-related disorders, suitable for future scrutiny. This review reinforces the need for clinicians to remain vigilant in order to promptly identify and treat these common types of comorbidity.

Individual factors associated with the consumption of illicit substances: a review of reviews

INTRODUCTION

According to national studies, the use of illicit drugs is growing in Colombia. With this, the prevalence of substance use disorders and the set of health effects related to this practice also increases. Knowledge of the factors associated with the use of illicit drugs is necessary to guide the comprehensive care of the phenomenon.

METHODS

This is a systematic review of reviews on factors associated with the consumption of illicit drugs with seven databases and evaluation of the quality of the manuscripts according to AMSTAR.

RESULTS

Information was extracted from 38 reviews on individual factors associated with the use of illicit drugs. Demographic factors are associated with consumption through other factors. There is evidence of the association between mental and behavioural disorders and personality disorders.

CONCLUSIONS

The likelihood of consumption of illicit substances and disorders due to their use is affected by a set of personal factors including sociodemographic characteristics, mental health conditions, sexual behaviour, legal drug use, age of onset and risk perception.

The Role of Social Position Within Peer Groups in Distress-Motivated Smoking Among Adolescents

OBJECTIVE

The relationship between smoking and adolescents' peer relationships is complex, with studies showing increased risk of smoking for adolescents of both very high and very low social position. A key question is whether the impact of social position on smoking depends on an adolescent's level of coping motives (i.e., their desire to use smoking to mitigate negative affect).

METHOD

We assessed how social position predicts nicotine dependence in a longitudinal sample (N = 3,717; 44.8% male; mean age = 13.41 years) of adolescent lifetime smokers measured between 6th and 12th grades. Using both social network analysis and multilevel modeling, we assessed this question at the between-person and within-person level, hypothesizing that within-person decreases in social position would lead to increased risk of nicotine dependence among those with high levels of coping motives.

RESULTS

In contrast to our hypotheses, only interactions with the between-person measures of social position were found, with a slight negative relationship at low levels of coping motives. In addition, the main effect of coping motives was considerably stronger than that of social position at the between-person level, and social position had no significant within-person main effect on nicotine dependence risk.

CONCLUSIONS

These results suggest that adolescents with higher overall levels of social position among their peers may have slightly decreased risk for nicotine dependence, but only when coping motives are low. Counter to expectations, higher levels of nicotine dependence risk were not linked to fluctuations in social position.

Mental disorder and opioid overdose: a systematic review

PURPOSE

This systematic review summarizes and presents the current state of research quantifying the relationship between mental disorder and overdose for people who use opioids.

METHODS

The protocol was published in Open Science Framework. We used the PECOS framework to frame the review question. Studies published between January 1, 2000, and January 4, 2021, from North America, Europe, the United Kingdom, Australia, and New Zealand were systematically identified and screened through searching electronic databases, citations, and by contacting experts. Risk of bias assessments were performed. Data were synthesized using the lumping technique.

RESULTS

Overall, 6512 records were screened and 38 were selected for inclusion. 37 of the 38 studies included in this review show a connection between at least one aspect of mental disorder and opioid overdose. The largest body of evidence exists for internalizing disorders generally and mood disorders specifically, followed by anxiety disorders, although there is also moderate evidence to support the relationship between thought disorders (e.g., schizophrenia, bipolar disorder) and opioid overdose. Moderate evidence also was found for the association between any disorder and overdose.

CONCLUSION

Nearly all reviewed studies found a connection between mental disorder and overdose, and the evidence suggests that having mental disorder is associated with experiencing fatal and non-fatal opioid overdose, but causal direction remains unclear.

Somatic Symptoms, Anxiety, and Depression Among College Students in the Czech Republic and Slovakia: A Cross-Sectional Study

Studying in college can be a challenging time for many students, which can affect their mental health. In addition to academic pressure and stressful tasks, another aggravating factor in student life is the ongoing coronavirus disease 2019 (COVID-19) pandemic. The aim of the study was to examine the prevalence of anxiety, depression, and somatic symptoms in Czech and Slovak college students during the COVID-19 pandemic and to evaluate possible socio-demographic determinants of mental health problems. A total of 3,099 respondents participated in this cross-sectional study (Czech Republic: 1,422, Slovakia: 1,677). The analyzes included the Patient Health Questionnaire for somatic symptoms (PHQ-15), the Generalized Anxiety Disorder instrument (GAD-7), and the Patient Health Questionnaire for depression (PHQ-9). Socio-demographic factors were gender, age, family structure, marital status, form of study, degree of study, year of study, field of study, distance between home and college, residence, and housing during the semester. Among Czech students, prevalence of somatic complaints, anxiety and depression was 72.2, 40.3, and 52%, respectively. Among Slovak students, prevalence of somatic complaints, anxiety and depression was 69.5, 34.6, and 47%, respectively. During the COVID-19 pandemic, the most severe mental health problems were identified in a non-negligible part of the sample (Czech Republic: PHQ-15 = 10.1%, GAD-7 = 4.9%, PHQ-9 = 3.4%; Slovakia: PHQ-15 = 7.4%, GAD-7 = 3.5%, PHQ-9 = 2.7%). Regarding the differences between the analyzed countries, a significantly higher score in somatic symptoms, anxiety, and depression was identified in the Czech Republic. Significant differences in mental disorders were found in most socio-demographic characteristics. The main results of the logistic regression analysis revealed that risk factors for mental health disorders in Czech and Slovak students were female gender, younger age, third degree of study, and study of Informatics, Mathematics, Information and Communication Technologies (ICT). Especially in the case of these high-risk groups of students, public policies should consider a response to impending problems. The findings are an appeal for a proactive approach to improving the mental health of students and for the implementation of effective prevention programs, which are more than necessary in the Czech and Slovak college environment.

Electronic cigarette use in adolescence is associated with later cannabis use

BACKGROUND

Research is needed to determine whether e-cigarette use during adolescence is associated with higher odds of subsequent cannabis use, net of tobacco cigarette use and childhood confounders.

METHODS

Multivariable logistic regressions predicting using cannabis by age 17 based upon prospective, intergenerational data from 10,251 youth in a nationally representative UK birth cohort followed from infancy who had not used cannabis by age 14. The focal predictor is e-cigarette use by age 14 in the context of the potential confounder tobacco cigarette use. Regressions include sociodemographic background and risk factors assessed at age 11 (e.g., alcohol initiation, problem behaviors, parental and peer smoking) and during early childhood (e.g., maternal smoking during pregnancy, parental substance use).

RESULTS

Youth use of e-cigarettes by age 14 was associated with 2.8 times higher odds of subsequent cannabis use by age 17 [OR 2.75; 95% CI 1.82,4.15], net of tobacco cigarette smoking and childhood confounders. Similarly, use of e-cigarettes by age 14 was associated with 2.5 times higher odds [OR 2.46; 95% CI 1.48,4.08] of frequent cannabis use at age 17 (>10 times in prior year). If youth used both e-cigarettes and tobacco cigarettes by age 14, the probabilities of cannabis initiation were 75% and of frequent use was 25% by age 17, compared to probabilities of 23% and 6%, respectively, among youth who had used neither product.

CONCLUSIONS

Findings add to accumulating evidence that adolescent e-cigarette use is associated with higher odds of later cannabis initiation and frequent use, independent of tobacco cigarette use.

Cross-substance patterns of alcohol, cigarette, and cannabis use initiation in Black and White adolescent girls

Characterizing variations in the timing of alcohol, cigarette, and cannabis use onset both among and between Black and White youth can inform targeted prevention. The current study aimed to capture cross-substance initiation patterns in Black and White girls and characterize these patterns with respect to substance use related socioeconomic, neighborhood, family, community, and individual level factors. Data were drawn from interviews conducted at ages 8 through 17 in an urban sample of girls (n = 2172; 56.86% Black, 43.14% White). Discrete-time multiple event process survival mixture modeling was used to identify patterns (i.e., classes) representing timing of alcohol, cigarette, and cannabis use initiation, separately by race. Class characteristics were compared using multinomial logistic regression. Among both Black and White girls, four classes, including abstainer and cross-substance early onset classes, emerged. Two classes characterized by mid-adolescence onset (Black girls) and variation in onset by substance (White girls) were also observed. Class differences centered around cannabis for Black girls (e.g., preceding or following cigarette use) and alcohol for White girls (e.g., (in)consistency over time in greater likelihood of initiation relative to cigarette and cannabis use). Several factors distinguishing the classes were common across race (e.g., externalizing behaviors, friends' cannabis use); some were specific to Black girls (e.g., intentions to smoke cigarettes) or White girls (e.g., primary caregiver problem drinking). Findings underscore the need to recognize a more complex picture than a high-risk/low-risk dichotomy for substance use initiation and to attend to nuanced differences in markers of risky onset pathways between Black and White girls.

Weighing the Risk: Developmental Pathways and Processes Underlying Obesity to Substance Use in Adolescence

Research on co-occurring obesity and substance use in adolescence has grown substantially in the past decade, but questions on the pathways and processes underlying co-occurrence remain. This review first synthesizes empirical findings on the relationship between obesity and substance use (e.g., alcohol, cannabis, tobacco use). Multidisciplinary theoretical frameworks referencing behavioral medicine, neuroscience, psychology, and public health are then used to inform an interdisciplinary, conceptual model focused on pathways and processes by which obesity increases risk of substance use. Recommendations for future research underscore the importance of prospective studies that encompass multiple domains of development. Recommendations for practice include family-based interventions that promote adaptive self-regulation, targeted antibullying or victimization interventions, and increased attention by health professionals on risky behavior associated with adolescent obesity.

Depressive Symptoms, Alcohol Beliefs and Heavy Episodic Drinking in Adolescents

Adolescents who engage in heavy episodic drinking (HED—i.e., 5+ drinks on a single occasion) increase risks for psychopathology, alcohol dependence, and similar negative consequences in adulthood. We explored associations among depressive symptoms, positive alcohol beliefs, and progression of heavy episodic drinking (HED) in 3021 German adolescents (M(SD) age at baseline = 12.4 (1.0)) followed for 30 months in 4 waves, using a conditional parallel process linear growth model, with full information maximum likelihood estimation. By wave 4, 40.3% of participants had engaged in HED more than once; 16.4% had done so ≥5 times. Depressive symptoms were indirectly related to baseline values of HED (through positive beliefs and wave 1 drinking frequency and quantity) and to the rate of growth in HED (through positive beliefs and wave 1 quantity). Adolescents with higher levels of depressive symptoms and positive alcohol beliefs drink more frequently and at greater quantities, which is associated with initiating HED at a higher level and escalating HED more rapidly than peers with similar depressive symptoms who lack those beliefs. This suggests that, to the extent that positive alcohol beliefs can be tempered through public health campaigns, education and/or counseling, HED among depressed adolescents might be reduced.

Predicting smoking and nicotine dependence from the DSM-5 alternative model for personality pathology

Individuals with personality disorders (PDs) have higher morbidity and mortality than the general population, which may be due to maladaptive health behaviors such as smoking. Previous studies have examined the links between categorical PD diagnoses/personality traits and smoking/nicotine dependence, but little is known about how the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition alternative model for personality disorders relates to smoking and nicotine dependence. The current study examined this question in a sample of 500 participants using the Levels of Personality Functioning Scale to assess general personality pathology, the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition to measure specific traits, the Fagerström test for Nicotine Dependence to assess nicotine dependence, and questions about current and past smoking to assess smoking status (i.e., current, former, never). Multinomial logistic regression results demonstrated that general personality pathology (Criterion A) was not related to smoking status, and there were no reliable associations between traits (Criterion B) and smoking status. However, correlations showed that higher negative affectivity and disinhibition were related to higher levels of nicotine dependence within smokers. Findings are discussed in regard to previous findings linking personality pathology to smoking/nicotine dependence as well as the general validity of this new personality disorder diagnostic system. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Youth's personal relationships, psychological symptoms, and the use of different substances: A population-based study

Background: Externalising symptoms and peer influence are well-established predictors of youth's substance use in general. However, there is little integrative research that compares the relative contribution of psychological and social relationship characteristics as predictors of the use of specific substances among youth in different developmental stages. Methods: A representative sample of Danish adolescents (n  =  1,168) and emerging adults (EA; n  =  1,878) reported last-month prevalence use of cigarettes, cannabis, and other illicit drugs (OID), and four indices of alcohol use. Predictor variables included internalising and externalising symptoms, and major characteristics of the youth's relationships (e.g., parental drug use, number of close friends). Results: Having a close friend who used illicit drugs, and high externalising symptoms, predicted the risk for using all substances across both age groups. Alcohol use was more consistently related to peer-related variables than to symptoms. Smoking cigarettes, cannabis use, and OIDs use were related to peer and symptom variables. Age group moderated some associations. Parental separation was related more strongly to alcohol use among adolescents than among EA, and higher internalising symptoms were more strongly related to smoking and using OIDs among adolescents than among EA. Male EAs had higher risk for using alcohol than female EAs. Conclusion: Beyond having a close friend who used illicit drugs, and externalising problems, the use of each substance was better explained by a different group of variables. There were few but important moderations by age group. The findings highlight the need for research on risk factors for substance use that is developmentally sensitive, particularly for adolescents, and for specific substances. Thus, interventions and policies should address social, developmental, and psychological factors.

Understanding the Etiology of Adolescent Substance Use through Developmental Perspectives

There are notable risks associated with alcohol, cigarette, and marijuana use during adolescence. Yet, there is no single cause for adolescent substance use. The etiology of substance use is known to develop over time, across multiple levels of influence. Informed by developmental perspectives, this review aims to provide an overview of biological (e.g., genetic, neuroimaging), individual (e.g., temperament, behavior problems), and social (e.g., parents, peers) factors that increase risk for and protection against this multifaceted phenomenon. Additionally, emerging areas of research are highlighted, as well as preliminary work examining the etiology of adolescent substance use across multiple levels of influence. Understanding early factors associated with the emergence of adolescent substance use can help inform prevention programming to reduce subsequent cognitive impairments and psychopathology. Adaptive individualized interventions addressing various domains linked to adolescent substance use in real-time are likely to have significant utility given the numerous pathways to adolescent substance use.