The role of mental illness in alcohol abuse and prescription drug misuse: gender-specific analysis of college students

Real-time momentary mood as a predictor of college students' prescription drug misuse in daily life: Direct links and the moderating role of background mental health

The present study addressed calls for research to identify real-time predictors of prescription drug misuse (Schepis et al., 2020) by testing young adults' momentary reports of their negative mood and positive mood as predictors of event-level misuse in daily life. We implemented a 28-day ecological momentary assessment (EMA) procedure that collected individuals' mood and other contextual experiences in moments preceding prescription drug misuse. Consistent with models of problematic substance use as a means to reduce negativity (Khantzian, 1997), results from hierarchical generalized linear modeling (HGLM) indicated within-person links between higher than usual negative mood and greater likelihood of prescription misuse in daily life. Contrary to the hypothesis, misuse was also more likely when preceded by elevated positive mood. We found consistent support for the hypothesized between-person effects, with prescription misuse in daily life associated with higher average levels of negative mood, and lower average levels of positive mood, across the reporting period. We further predicted that individuals reporting greater levels of social anxiety, depression, and externalizing symptoms would evidence stronger links between their momentary negative mood and prescription misuse. Partial support for this moderation hypothesis was found, with the positive within-person link between negative mood and prescription misuse significantly stronger among individuals higher (vs. lower) on social anxiety and depression. Results provide support for intricate connections between young adults' momentary mood, mental health symptoms, and prescription drug misuse. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Alcohol binge drinking in adolescence and psychological profile: Can the preclinical model crack the chicken-or-egg question?

During adolescence, internal and external factors contribute to engaging with alcohol binge drinking (ABD), putting at risk the neurodevelopment of brain regions crucial for emotional control and stress coping. This research assessed the prevalence of ABD in late adolescent students of Southern Italy and characterized their psychological profile and drinking motives. Translational effects of alcohol binge drinking in the animal model were also studied. Seven hundred and fifty-nine high school students of both sexes (aged 18-20) were recruited. Alcohol Use Disorder Identification Test-Consumption (AUDIT-C), Drinking Motives Questionnaire-Revised Short Form, Millon Clinical Multiaxial Inventory-Third Ed., State-Trait Anxiety Inventory, Connor-Davidson Resilience Scale, and Basic Self-Esteem Scale identified alcohol habits, drinking motives, and psychopathological profile. Eighty-five percentage of the students drank alcohol and 28% of them engaged in ABD; AUDIT-C correlated with enhancement, coping, and conformity motives. ABD was related to a greater likelihood of presenting clinical syndromes and personality disorders, as well as low resilience and self-esteem. Thereafter, in the pre-clinical model, adolescent male rats were exposed to alcohol (3.5 g/kg) in an intermittent binge-like paradigm and tested during prolonged abstinence. Rats were evaluated for anxiety-like behavior, motivated behaviors, resilience, and stress response following a psychosocial challenge. Binge-like alcohol-exposed adolescent rats displayed high integrated z-score for social- and novelty-induced anxiety, altered motivation-driven output, decreased resilience, and a blunted HPA axis response to psychosocial stress, with respect to respective controls. Our data confirm that ABD is the chosen pattern of drinking in a significant percentage of high school students in Southern Italy, and highlights AUDIT-C score as a relevant parameter able to predict the occurrence of affective disturbances. The evidence from the preclinical model shows that ABD produces detrimental consequences in the adolescent rat brain, resulting in negative affect, emotional dysregulation, and aberrant stress response, pointing to decreasing excessive alcohol drinking as a primary goal for the global act for brain health.

Drinking patterns of college students with comorbid depression and anxiety symptoms: The moderating role of gender

Students with anxiety or mood issues tend to engage in more problematic drinking, but less is known about those students with co-occurring anxiety and mood symptoms. This study compares rates of weekly alcohol use, hazardous drinking, and alcohol-related negative consequences in a sample of 699 college students with symptoms of comorbid anxiety and depression (35% of the sample) compared to their non-symptomatic drinking peers, as well as the moderating role of gender. We found main effects of gender and comorbidity status such that participants with comorbid symptoms of anxiety and depression or who were male reported higher rates of weekly alcohol use, more hazardous drinking and more alcohol-related negative consequences than their non-symptomatic and female peers. We also found an interaction effect on alcohol-related negative consequences such that male participants with comorbid anxiety and depression reported more alcohol-related negative consequences than all other groups. These findings imply that while any student drinker with both anxiety and depression may be considered at higher risk for problematic drinking behavior, the risk of negative consequences in particular may be highest in the men of that group.

Satisfaction With Life, Mental Health Problems and Potential Alcohol-Related Problems Among Norwegian University Students

Objective: Recent studies have shown that today's college students more than ever are struggling with mental health and alcohol problems. While poor satisfaction with life and mental health problems have been linked to higher alcohol consumption, there is still a lack of studies examining in detail the shape and nature of the relationship between mental health and alcohol consumption. Aim: To investigate the associations between satisfaction with life, mental health problems and potential alcohol-related problems among Norwegian university students. The shape of the associations was also examined. Methods: Data were drawn from a 2018 national survey of students in higher education in Norway (the SHoT-study). Associations between satisfaction with life, mental health problems and potential alcohol-related problems (AUDIT; risky and harmful alcohol use) were investigated using logistic regression. Both crude models and models adjusted for age, gender and marital status were conducted. To investigate the shape of the associations, logistic regression with quadric and cubic terms was tested. Results: Decreased satisfaction with life and increased mental health problems were associated with potential alcohol-related problems. For satisfaction with life, a curvilinear association with risky alcohol use and a linear association with harmful alcohol use was identified. For mental health problems, curvilinear associations were found for both risky and harmful alcohol use. Conclusion: Many students report potential alcohol-related problems. Students with harmful alcohol use seem to be more at risk of reduced satisfaction with life and increased mental health problems than students with risky alcohol use. Educational institutions may be an ideal setting for raising awareness of mental health issues and responsible alcohol consumption among students. The present study contributes with important information about the shape of the associations between satisfaction with life, mental health problems and potential alcohol-related problems in the student population.

Motivations for the nonmedical use of prescription drugs in a longitudinal national sample of young adults

INTRODUCTION

People's motivations for nonmedical use of prescription drugs (NMUPD) are not well studied, particularly in longitudinal representative samples. However, understanding which motivations are most popular and how these change over time for specific groups is important to inform interventions for NMUPD.

METHODS

The current study examined how young adults' motives for NMUPD changed over young adulthood, using a nationally representative sample of 12,223 young adults in 36 cohorts (1976-2012) as part of the Monitoring the Future study across three biennial waves (waves 1, 2, 3: modal ages 19/20, 21/22, and 23/24 years). We investigated these young adults' motivations for using stimulants, central nervous system depressants, and opioids when controlling for possible cohort effects. We included sex and college attendance as potential moderators.

RESULTS

Participants commonly reported recreational and self-treatment motivations over time and across drug classes, reporting four to five popular motivations in each drug class. Generalized estimating equations repeated measure analyses revealed relatively stable NMUPD motivations across young adulthood. Participants reported some reductions in experimentation and boredom as motivations for NMUPD and increases in certain self-treatment motivations, depending on prescription drug class. Overall, men were more likely to endorse recreational motivations, whereas women were more likely to endorse self-treatment motivations, though this varied somewhat by prescription drug class. Young adults not enrolled in college courses were more likely to endorse using stimulants nonmedically for different reasons than their peers who were enrolled.

CONCLUSIONS

NMUPD prevention and treatment efforts tailored to the young adult population should include methods to reduce both self-treatment and recreational use and need to consider prescription drug class, sex, and college attendance.

Untreated depression and non-medical use of prescription pain relievers: findings from the National Survey on Drug Use and Health 2008-2014

OBJECTIVES

Despite growing concerns for non-medical use of prescription pain relievers (NMUPPRs), little is known about the role of comorbid, untreated depressive disorders.

METHODS

We examined past year rates of NMUPPRs and major depressive episode (MDE), using data between 2008 and 2014 from the National Survey on Drug Use and Health for both youths (12-17 years) and adults (18 or older). Prevalence estimates with 95% confidence intervals were computed. Stratified analyses and generalized linear models were run to examine the association between NMUPPRs and MDE, controlling for treatments received for mental health and/or substance misuse. In order to explore whether MDE effect might change by treatment received, a model with an interaction term including MDE and treatment was fit.

RESULTS

Among respondents, about 9% (youths) and 7% (adults) reported past year MDE and about 6% (youths), and 4% (adults) NMUPPRs. About 1.2% (youths) and 0.7% (adults) reported both MDE and NMUPPRs. Those with past year MDE were more likely to report NMUPPRs (RR, 95%CI: 2.60, 2.42-2.80, and 2.64, 2.47-2.82, for youths and adults). Considering the any treatment/MDE interaction on NMUPPRs, MDE risk ratio for subjects who received some treatment (youths: adjusted risk ratio (ARR) = 1.15; adults: ARR = 1.25) was about 70-80% as compared with their untreated counterpart (youths: ARR = 1.57; adults: ARR = 1.54). The likelihood of reporting NMUPPRs amongst respondents who did not receive any treatment was higher for those with past year MDE (main effect: youths ARR = 1.57, p < 0.001; adults ARR = 1.54, p < 0.001).

CONCLUSION

Unrecognized and untreated depressive disorders should be considered for prevention, treatment, and policy implications in order to tackle NMUPPRs epidemic.

Engaging Male Post-Secondary Student Leaders to Apply a Campus Cultural and Gender Lens to Reduce Alcohol Misuse: Lessons Learned

This paper describes a project that took place at three large Canadian universities aimed at engaging male students to address alcohol misuse and associated mental health issues through a gendered and campus culture lens. Although considerable effort has been put into decreasing alcohol misuse on campuses, most of this effort has been aimed at individual factors, rather than targeting the cultural and gendered context through which most post-secondary students consume alcohol. Gender transformative and gender sensitive health promotion approaches were guiding frameworks for the project. In addition to discussing how gender theory was implemented in a post-secondary context, this paper also explores some of the key features that guided these projects including the Summit Model, social marketing, sharing narratives of alcohol misuse and mental health, and planning for sustainability. Key lessons learned in engaging male students to be involved in challenging gendered norms related to alcohol misuse on campus are discussed.

Protective Behavioral Strategies and Hazardous Drinking Among College Students: The Moderating Role of Psychological Distress

There is increasing evidence that mental health problems may attenuate the relationship between protective behavioral strategies (PBS) and alcohol outcomes. However, psychological distress may also affect these relationships. Further, it appears that different types of PBS have differential relationships with alcohol outcomes. The current study examined the degree to which psychological distress moderated the associations PBS subtypes had with hazardous drinking and alcohol-related negative consequences. Participants were 632 traditional-age undergraduate students (M = 20.04, standard deviation = 1.48) who had consumed alcohol within the past 30 days and completed online self-report measures designed to assess PBS use, level of psychological distress, hazardous drinking patterns, and alcohol-related negative consequences. Serious harm reduction PBS were associated with less hazardous drinking and less alcohol-related negative consequences, and these associations were strengthened for those experiencing greater psychological distress. Controlled consumption PBS were associated with less hazardous drinking, but this association was not moderated by psychological distress. These findings highlight the potential benefit of teaching serious harm reduction PBS to college students experiencing elevated levels of psychological distress.

Alcohol use and alcohol-related problems among adolescents in China: A large-scale cross-sectional study

Alcohol misuse among adolescents is a common issue worldwide and is an emerging problem in China. This study aimed to investigate the prevalence of alcohol drinking and alcohol-related problems among Chinese adolescents and to explore their risk factors and connections.A cross-sectional study using an anonymous questionnaire was conducted among junior and senior high school students between 2010 and 2012. Data on self-reported alcohol use, alcohol-related problems, school factors, family factors, and psychosocial factors were collected. Descriptive analyses were made of the proportions of sociodemographics, family, school, and psychosocial factors. Multilevel logistic regression models were conducted to analyze the risk factors for alcohol drinking and alcohol-related problems.Of the 105,752 students who ranged in age from 9 to 21 years, the prevalence of current drinking among students was 7.3%, and 13.2% students reported having alcohol-related problems. Male students were 1.78 (95% confidence interval [CI] = 1.69-1.87) times more likely to be involved in current drinking and 1.86 (95% CI = 1.79-1.93) times more likely to have alcohol-related problems. Higher grade level students were at a higher risk of current drinking (adjusted odds ratio [AOR] = 1.09, 95% CI = 1.05-1.13) and having alcohol-related problems (AOR = 1.43, 95% CI = 1.42-1.58). Older students were more likely to report current drinking (AOR = 1.06, 95% CI = 1.04-1.17) and having alcohol-related problems (AOR = 1.83, 95% CI = 1.82-1.85). Having poor classmate relations (AOR = 1.28, 95% CI = 1.03-1.37), having poor relationships with teachers (AOR = 1.08, 95% CI = 1.00-1.16), and below average academic achievement (AOR = 1.50, 95% CI = 1.41-1.59) were positively associated with current drinking. Moreover, students with suicidal ideation were at a higher risk of current drinking (AOR = 1.70, 95% CI = 1.61-1.81) and having alcohol-related problems (AOR = 2.08, 95% CI = 1.98-2.16). Having higher Center for Epidemiology Scale for Depression scores was positively associated with current drinking (AOR = 1.09, 95% CI = 1.05-1.11) and having alcohol-related problems (AOR = 1.08, 95% CI = 1.06-1.18).Alcohol drinking and alcohol-related problems among Chinese adolescents are major public health problems, and effective preventive programs will require full consideration of the individual, social, and environmental factors that facilitate and prevent alcohol use.

A systematic review of the motivations for the non-medical use of prescription drugs in young adults

BACKGROUND

Young adults (18-25) are most at-risk for the non-medical use of prescription drugs (NMUPD). Understanding this population's motivations for use can help inform efforts to reduce NMUPD. Therefore, this systematic review synthesizes the findings from research on young adults' motivations to engage in NMUPD.

METHODS

Based on PRISMA guidelines, relevant databases were systematically searched for articles that assessed the motivations for NMUPD in young adults and college-aged students. Search strings included a range of prescription drug classes and terms to ensure an exhaustive review.

RESULTS

The search resulted in identifying 353 potential articles after duplicates were removed, and 37 articles were included in the final qualitative synthesis. Of the final articles, the majority investigated the non-medical use of prescription stimulants in U.S. student populations cross-sectionally. Seven studies, either exclusively or in combination with other medications, researched prescription opioids, and five investigated central nervous system depressants. Only one study investigated motivations over time.

CONCLUSION

There are many ways in which the current literature can be expanded, including researching other populations and focusing on prescriptions other than stimulants. Using the medications for their prescribed properties and known side effects emerged as a consistent theme. It was also fairly common for young adults to report recreational motives. Issues with measurement and definitions of key terms (e.g., non-medical) would benefit from consistency in future work. Research on motivations should continue and be incorporated into the larger drug use context, as well as existing prevention and intervention strategies.

Alcohol use, mental well-being, self-esteem and general self-efficacy among final-year university students

PURPOSE

We aimed to quantify associations between drinking and mental well-being, self-esteem and general self-efficacy among New Zealand university students approaching graduation.

METHODS

A web-based survey was conducted across all eight New Zealand universities in 2011. Participants were enrolled in their final year of a bachelor degree or a higher qualification and were aged 25 years and under (n = 5082, response level 65 %). Measures included the Alcohol Use Disorders Identification Test-Consumption, Warwick-Edinburgh Mental Well-being Scale, and items from the Rosenberg Self-esteem Scale and General Self-efficacy Scale. Linear regression models were used to estimate associations between the psychological measures and (1) drinking patterns for all participants (abstention/moderate/hazardous); and (2) consumption indicators for non-abstaining participants (frequency/quantity/heavy drinking frequency), adjusting for a range of individual, social and personality characteristics, separately for men and women.

RESULTS

Lower mental well-being was associated with a moderate or hazardous drinking pattern for men, and a hazardous pattern for women, compared to abstaining participants. Higher self-esteem was associated with any level of heavy drinking frequency for men, while the heaviest drinking women had a pattern of lower self-esteem. There was a general pattern of higher general self-efficacy for men and women who drank alcohol.

CONCLUSIONS

We observed that higher levels of drinking were associated with small, yet statistically significant, differences in psychological outcomes for men and women. Our findings are of uncertain clinical significance; however, they underscore the importance of investigating a fuller range of social and personality factors that may confound the association of drinking and psychological outcomes.

Gender differences in the association between cigarette smoking, alcohol consumption and depressive symptoms: a cross-sectional study among Chinese adolescents

The aim of this study was to examine the association between cigarette smoking, alcohol consumption and depressive symptoms among adolescents, with a particular focus on gender differences. A total of 19,578 middle and high school students in Chongqing Province were surveyed. Self-reported cigarette smoking, alcohol consumption, depressive symptoms, and family- and school-related factors were assessed. A total of 8.8% adolescents reported smoking cigarettes. Tobacco use by boys (16.5%) was significantly higher than by girls (1.9%). Approximately 23.5% of adolescents reported alcohol consumption. Consumption in boys (31.5%) was significantly higher than in girls (16.2%). Depressive symptoms were prevalent in 9.1% of the sample. Girls reported significantly more symptoms (10.4%) than boys (7.7%). Multiple logistic regression analyses showed that the association between alcohol consumption and depressive symptoms was stronger among girls (AOR = 2.1, 95% CI = 1.8-2.5) than boys (AOR = 1.7, 95% CI = 1.4-2.1). A significant association (AOR = 2.3, 95% CI = 1.6-3.4) between cigarette smoking and depressive symptoms was revealed in girls only. The significant gender differences found above may provide a basis for the early identification of individuals at high risk for depression.

Protective Behavioral Strategies and Alcohol Use Outcomes Among College Women Drinkers: Does Disordered Eating and Race Moderate This Association?

The current study examined the degree to which associations that protective behavioral strategy use had with alcohol consumption and alcohol-related negative consequences were moderated by disordered eating and race. Participants were 382 female undergraduates (ages 18-25) who had consumed alcohol at least once within the previous month. Participants completed online self-report measures concerning their use of protective behavioral strategies, disordered eating, weekly alcohol consumption, harmful drinking patterns, and alcohol-related negative consequences. White non-Hispanic women who used the fewest protective behavioral strategies reported the highest levels of alcohol consumption and harmful drinking patterns. Protective behavioral strategy use was associated with lower levels of alcohol-related negative consequences except for African American women with low levels of disordered eating behaviors. For interventions targeting drinking among college women, disordered eating behaviors may increase risky behaviors and qualify relationships between protective behavioral strategies and alcohol-related negative consequences. Thus, assessment of disordered eating behavior as part of drinking interventions may be helpful.

Depression and Substance Use: A Temporal-Ordered Model

BACKGROUND AND OBJECTIVES

This study sought empirical evidence for the self-medication hypothesis. It asked whether diagnosis of depression, together with the use of mental-health care, leads to substance use.

METHODS

Data came from the 5-wave, longitudinal Fragile Families and Child Wellbeing (FFCW) Study, an investigation of a cohort of nearly 5,000 births, which over sampled non-marital births. FFCW examined newborns' biological mothers and fathers, all of whom lived in the United States. The adults were initially interviewed between 1998 and 2000 (the period of the cohort's births); they were then re-interviewed for four times over 10 years. FFCW measured mental health-related variables, level of drug use, and social structural and demographic factors, all of which are also measured by the present study. Respondents in our study's two final subsamples had responded to every FFCW interview item we would use in constructing our final model's variables. Our subsample of mothers totaled 3,477 women, from whom 5,987 person-waves were derived. Our subsample of fathers totaled 2,096 men, yielding 3,543 person-waves.

RESULTS

We used STATA generalized estimating equations for panel data, and found some evidence to support the self-medication hypothesis. In addition, our results indicated that the relationship of substance use to the use of mental-health care was gender-specific. Conclusions/Importance: Empirical evidence from this study only partially supported the self-medication hypothesis; the co-occurrence of depression and substance abuse in our sample was also reflective of social structural and demographic variables and of prior substance use variables.

Prescription drug misuse among homeless youth

BACKGROUND

Prescription drug misuse (PDM) is highly prevalent among youth in the U.S., and can have serious health consequences. Homeless youth are a particularly vulnerable population with high rates of substance use. However, PDM has not been studied in a sample comprised exclusively of homeless youth.

METHODS

A sample of 451 homeless youth recruited from drop-in centers in Los Angeles, CA, provided information on substance use, mental health, service utilization, trauma, and sexual risk behavior. Multivariable logistic regression assessed correlates of past month PDM.

RESULTS

Nearly 50% reported lifetime PDM and 21.6% reported PDM in the past month. The most frequently used prescriptions in the past month were: opioids only (24.5%), sedatives only (23.4%), and stimulants only (10.6%); 14.9% used some combination of these three types of prescription medications. Homeless youth reported that prescriptions were most commonly obtained for free from friends or relatives (24.5%). Foster care involvement was associated with decreased PDM, while hard drug use, suicidal ideation, and unprotected sex were associated with increased PDM.

CONCLUSIONS

Homeless youth report high rates of PDM, and access these medications most frequently from friends and family. PDM among homeless youth clusters with other risk factors, including hard drug use, unprotected sex, and suicidal ideation. Surprisingly, foster care history was associated with decreased PDM. Programs aimed at preventing PDM among homeless youth should recognize the clustering of risk behaviors, assess prescription use/access when providing mental health services, and educate the general public about proper disposal of prescriptions.

Alcohol-related problems and life satisfaction predict motivation to change among mandated college students

The present study investigated the role specific types of alcohol-related problems and life satisfaction play in predicting motivation to change alcohol use. Participants were 548 college students mandated to complete a brief intervention following an alcohol-related policy violation. Using hierarchical multiple regression, we tested for the presence of interaction and quadratic effects on baseline data collected prior to the intervention. A significant interaction indicated that the relationship between a respondent's personal consequences and his/her motivation to change differs depending upon the level of concurrent social consequences. Additionally quadratic effects for abuse/dependence symptoms and life satisfaction were found. The quadratic probes suggest that abuse/dependence symptoms and poor life satisfaction are both positively associated with motivation to change for a majority of the sample; however, the nature of these relationships changes for participants with more extreme scores. Results support the utility of using a multidimensional measure of alcohol related problems and assessing non-linear relationships when assessing predictors of motivation to change. The results also suggest that the best strategies for increasing motivation may vary depending on the types of alcohol-related problems and level of life satisfaction the student is experiencing and highlight potential directions for future research.