Baseline depressive symptoms predict poor substance use outcome following adolescent residential treatment

The longitudinal relationship of alcohol problems and depressive symptoms and the impact of externalising symptoms: findings from the Belfast Youth Developmental Study

PURPOSE

The aim of the present study was to contribute to the inconsistent literature on the comorbid relationship of alcohol problems and depressive symptoms from late adolescent to emerging adulthood by accounting for their trajectories and their conjoint relationship while controlling for the influence of externalising symptoms.

METHODS

We utilised data, from a longitudinal school cohort from Northern Ireland (Belfast Youth Developmental Study), over three time points where the participants were 16, 17 and 21 years of age. A total of 3118 participants were included, 1713 females and 1405 males. Second-order latent growth models were applied to examine growth trajectories. Parallel process growth models were used to assess whether growth trajectories of the symptoms were associated. Externalising symptoms were subsequently added as a covariate.

RESULTS

Alcohol problems among males significantly increased over time but decreased in females. Depressive symptoms initially increased then decreased in both genders. Results indicated associations of the alcohol problems and depression, both initially and with time. Accounting for externalising symptoms only somewhat diminished this effect in males but not in females. An increase of initial levels of depression was associated with a decrease in alcohol problems over time. This association was only true among females. After controlling for externalising symptoms, the relationship was no longer observed.

CONCLUSIONS

The present study provides further evidence of a significant relationship of alcohol problems and depression in adolescents and further supports a small literature indicating that depression may have protective effects of alcohol problems. Finally, the study shows the importance of accounting for externalising symptoms.

A treatment development study of a cognitive and mindfulness-based therapy for adolescents with co-occurring post-traumatic stress and substance use disorder

OBJECTIVE

Substance use is common among adolescents with post-traumatic stress disorder (PTSD). We aimed to develop and study an integrated treatment for adolescents with co-occurring disorders.

DESIGN

This is a therapy development and open pilot trial study of a manualized therapy for adolescents with post-traumatic stress, depression, and substance use that uses a combination of cognitive therapy (CT) and mindfulness.

METHODS

Descriptive statistics and paired sample t-tests were calculated to assess for changes in PTSD symptoms, depression, and substance use frequency from baseline to end of treatment using standardized measures and validated by urine drug screens. We also examined for safety, predictors of clinical outcomes, and treatment retention.

RESULTS

Thirty-seven adolescents participated in the study; 62% were study completers as defined by retention for at least 6 weeks of treatment. There were significant improvements in PTSD and depression symptoms from baseline to end of treatment, reflecting medium effect sizes, and which was associated with changes in trauma-associated cognitions. There was a reduction in cannabis use, which was the most commonly used substance.

CONCLUSIONS

Preliminary results suggest feasibility, safety, and potential clinical effectiveness of an integrated therapy for adolescents with PTSD, depression, and substance use. Retention was comparable to other therapy clinical trial studies of adolescents despite the high risk for poor treatment retention and poor clinical outcomes among adolescents with PTSD and co-occurring disorders. We discuss the rationale for continued research of this mindfulness-based CT for adolescents with co-occurring disorders.

PRACTITIONER POINTS

Adolescents with co-occurring PTSD and substance use achieved meaningful improvement in PTSD and depression symptom severity after receiving a CT and mindfulness dual diagnosis approach. An integrated manualized therapy for dual diagnosis shows promise for reducing cannabis use in adolescents with PTSD. Changes in trauma-related cognitions have the potential to improve PTSD and depression symptoms in adolescents with substance use problems.

Gender and Direction of Effect of Alcohol Problems and Internalizing Symptoms in a Longitudinal Sample of College Students

BACKGROUND

Alcohol problems and internalizing symptoms are consistently found to be associated but how they relate to each other is unclear.

OBJECTIVE

The present study aimed to address limitations in the literature of comorbidity of alcohol problems and internalizing symptoms by investigating the direction of effect between the phenotypes and possible gender differences in college students.

METHOD

We utilized data from a large longitudinal study of college students from the United States (N = 2607). Three waves of questionnaire-based data were collected over the first two years of college (in 2011-2013). Cross-lagged models were applied to examine the possible direction of effect of internalizing symptoms and alcohol problems. Possible effects of gender were investigated using multigroup modeling.

RESULTS

There were significant correlations between alcohol problems and internalizing symptoms. A direction of effect was found between alcohol problems and internalizing symptoms but differed between genders. A unidirectional relationship varying with age was identified for males where alcohol problems initially predicted internalizing symptoms followed by internalizing symptoms predicting alcohol problems. For females, a unidirectional relationship existed wherein alcohol problems predicted internalizing symptoms. Conclusions/Importance: We conclude that the relationship between alcohol problems and internalizing symptoms is complex and differ between genders. In males, both phenotypes are predictive of each other, while in females the relationship is driven by alcohol problems. Importantly, our study examines a population-based sample, revealing that the observed relationships between alcohol problems and internalizing symptoms are not limited to individuals with clinically diagnosed mental health or substance use problems.

The Impact of Motivational Interviewing on Delinquent Behaviors in Incarcerated Adolescents

The impact of Motivational Interviewing (MI) on risky behaviors of incarcerated adolescents and adults has been investigated with promising results. Findings suggest that MI reduces substance use, improves motivation and confidence to reduce use, and decreases risky behaviors. The current study investigated the impact of MI on general, alcohol-related, and marijuana-related delinquent behaviors in incarcerated adolescents. Participants in the study were incarcerated adolescents in a state correctional facility in the Northeast region and were assessed as part of a larger randomized clinical trial. Adolescents were randomly assigned to receive MI or relaxation therapy (RT) (N=189) treatment. Delinquent behaviors and depressive symptomatology were measured using the Delinquent Activities Scale (DAS; Reavy, Stein, Paiva, Quina, & Rossi, 2012) and the Center for Epidemiological Studies-Depression scale (CES-D; Radloff, 1991) respectively. Findings indicate that depression moderated treatment effects. Compared to RT, MI was better at reducing predatory aggression and alcohol-related predatory aggression 3 months post-release when depressive symptoms were low. Identifying an efficacious treatment for these adolescents may benefit society in that it may decrease crimes against persons (i.e., predatory aggression) post release.

Motivational Interviewing to Reduce Substance Use in Adolescents with Psychiatric Comorbidity

Substance use among adolescents with one or more psychiatric disorders is a significant public health concern. In this study, 151 psychiatrically hospitalized adolescents, ages 13-17 with comorbid psychiatric and substance use disorders, were randomized to a two-session Motivational Interviewing intervention to reduce substance use plus treatment as usual (MI) vs. treatment as usual only (TAU). Results indicated that the MI group had a longer latency to first use of any substance following hospital discharge relative to TAU (36 days versus 11 days). Adolescents who received MI also reported less total use of substances and less use of marijuana during the first 6 months post-discharge, although this effect was not significant across 12 months. Finally, MI was associated with a significant reduction in rule-breaking behaviors at 6-month follow-up. Future directions are discussed, including means of extending effects beyond 6 months and dissemination of the intervention to community-based settings.

Adolescent substance use treatment: the moderating effects of psychopathology on treatment outcomes

The present study tested the influence of co-occurring mental health diagnoses on the relationship between length of stay and treatment outcome among adolescents residing in an inpatient substance abuse treatment facility. Data were collected via record review. Follow-up information was obtained at 7 days and 3 months post-discharge. Treatment outcome was defined as abstinence and engagement in recovery activities. Hierarchical linear regression demonstrated that comorbidities differentially moderated the relationship between length of stay and treatment outcome. Results suggest that these adolescents attempt to engage in recovery activities independent of abstinence and may need supplemental aftercare assistance to maintain their efforts.

Homeless but connected: the role of heterogeneous social network ties and social networking technology in the mental health outcomes of street-living adolescents

Although social integration tends to have positive effects on the mental health of housed adolescents, the role of homeless adolescents' social networks is more ambiguous. Social network data were collected from 136 homeless adolescents in Hollywood, California to examine how network ties are associated with symptoms of anxiety and depression. Face-to-face relationships with street-based peers were a risk factor for both anxiety and depression, while contacting home-based friends through social networking technology was found to be protective for depression. Community-based and public agencies serving homeless adolescents should consider facilitating the maintenance of these protective relationships by providing internet access.

Motivational interviewing to reduce substance-related consequences: effects for incarcerated adolescents with depressed mood

BACKGROUND

The impact of depressed mood on Motivational Interviewing (MI) to reduce risky behaviors and consequences in incarcerated adolescents was examined in this brief report.

METHODS

Adolescents (N=189) were randomly assigned to receive MI or Relaxation Training (RT).

RESULTS

At 3-month follow-up assessment, MI significantly reduced risks associated with marijuana use, with a trend towards reducing risks associated with alcohol use. There was also a trend for depressive symptoms to be associated with reduced risks after release. Interaction effects were non-significant, indicating no moderating effects for depressed mood on treatment outcome.

CONCLUSIONS

MI may be a useful treatment for incarcerated adolescents in order to reduce risks and consequences associated with substance use after release.

Motivational interviewing for incarcerated adolescents: effects of depressive symptoms on reducing alcohol and marijuana use after release

OBJECTIVE

Motivational interviewing to reduce alcohol and marijuana use among incarcerated adolescents was evaluated.

METHOD

Adolescents (N = 162, 84% male; M = 17.10 years old) were randomly assigned to receive motivational interviewing or relaxation training, with follow-up assessment 3 months after release.

RESULTS

Compared with those who received relaxation training, adolescents who received motivational interviewing had lower rates of alcohol and marijuana use at follow-up, with some evidence for moderating effects of depression. At low levels of depression, adolescents who received motivational interviewing had lower rates of use. Adolescents who received relaxation training and who had high levels of depressive symptoms early in incarceration showed less use at follow-up than those low in depressive symptoms who received relaxation training.

CONCLUSIONS

This brief motivational interviewing intervention during incarceration reduces alcohol and marijuana use after release. In addition, depressive symptoms early in incarceration should be considered in treating these adolescents, but more work is needed to extend follow-up period and account for the impact of depression on outcomes.

Long-term effect of community-based treatment: evidence from the Adolescent Outcomes Project

A growing literature on adolescent drug treatment interventions demonstrates the efficacy of "research therapies," but few rigorous studies examine the effectiveness of community-based treatments that are more commonly available to and utilized by youths and their families, the criminal justice system and other referring agencies. Even less is known about the long-term effects of these community-based treatments. This study evaluates the effects 72-102 months after intake to a widely disseminated community-based treatment model, residential therapeutic community treatment, using data from RAND's Adolescent Outcomes Project. Weighting is used to control for pre-existing differences between adolescent probationers disposed to Phoenix Academy and those assigned to one of six alternative group homes serving as the comparison conditions. Although Phoenix Academy therapeutic community treatment had positive effects on substance use and psychological functioning during the first 12 months following intake, we find no evidence of positive long-term effects on 16 outcomes measuring substance use and problems, criminal activity, institutionalization, psychological functioning and general functioning. We discuss the implications of these findings and the failure to maintain the effects observed during the first year follow-up.

Substance use and the treatment of resistant depression in adolescents

OBJECTIVE

Despite the known association between substance use disorders and major depressive disorder (MDD) among adolescents, little is known regarding substance use among adolescents with MDD.

METHOD

Youths with MDD who had not improved after an adequate selective serotonin reuptake inhibitor trial (N = 334) were enrolled in the Treatment of SSRI-Resistant Depression in Adolescents trial. Analyses examined substance use (via the Drug Use Severity Index) and changes therein in relation to treatment and depressive symptoms. Adolescents meeting substance use disorder criteria via the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version at baseline were excluded.

RESULTS

Substance use was common: 28.1% reported repeated experimentation at baseline. Substance-related impairment was associated with baseline depression severity, older age, physical/sexual abuse, family conflict, hopelessness, and comorbid oppositional defiant disorder/conduct disorder. There was significant improvement in substance-related impairment among adolescents who responded to MDD treatment. Baseline suicidal ideation was higher among the subjects who progressed to high substance-related impairment (≥ 75th percentile) versus those whose substance-related impairment remained low (< 75th percentile), and parental depressive symptoms predicted persistence of high substance-related impairment during the study. The MDD response was best among the adolescents with low 12 week substance-related impairment scores regardless of whether they had high or low baseline substance-related impairment. There were no significant differential effects of specific treatments, pharmacological or cognitive-behavioral therapy, on substance use.

CONCLUSIONS

Substance use is common among adolescents with treatment-resistant MDD. The subjects who had persistently low substance-related impairment or who demonstrated reduced substance-related impairment had better MDD treatment response, although the direction of this association is uncertain.

Clinical characteristics of treatment-seeking adolescents with opioid versus cannabis/alcohol use disorders

OBJECTIVES

To assess the clinical characteristics of adolescents with DSM-IV opioid use disorder (OUD) and compare them to adolescents with cannabis/alcohol use disorders.

METHOD

94 adolescents (ages 14-18 years) with a current OUD and 74 adolescents with a current non-OUD cannabis/alcohol use disorders were recruited from admissions, predominantly residential, to a substance abuse treatment program in Baltimore, ML. Participants were assessed cross-sectionally using standardized interviews and self-reports. Chi-square, t-tests and ANCOVA (adjusting for age, gender and treatment setting, race and residence) were performed to determine group differences on demographic, substance use, psychiatric and HIV-risk behaviors; logistic regression analyses, both unadjusted and adjusted for the above five factors were conducted to assess the strength of associations.

RESULTS

The OUD group was more likely to be Caucasian, to have dropped out of school and to live in the suburbs (trend). They also had greater substance use severity with higher proportion of current sedative and multiple substance use disorders (SUD). There were generally no differences in rates of criminal behaviors. Both groups had high rates of current psychiatric disorders (83% vs. 78%, n.s.) but the OUD adolescents reported higher depressive symptoms, mostly in the moderate range. Injection drug use (IDU) and needle sharing was almost exclusive to the OUD group, while both groups reported similar high rates of risky sexual behaviors.

CONCLUSIONS

While there were similarities between the two groups, OUD adolescents evidenced greater impairment in academic, substance use, depressive symptom and IDU-related HIV-risk areas. Findings suggest poorer long-term prognosis and highlight the need for specialized interventions for treatment-seeking OUD adolescents.

Early-onset depressive disorders predict the use of addictive substances in adolescence: a prospective study of adolescent Finnish twins

AIMS

To explore the developmental relationships between early-onset depressive disorders and later use of addictive substances.

DESIGN, SETTING AND PARTICIPANTS

A sample of 1545 adolescent twins was drawn from a prospective, longitudinal study of Finnish adolescent twins with baseline assessments at age 14 years and follow-up at age 17.5 years.

MEASUREMENTS

At baseline, DSM-IV diagnoses were assessed with a professionally administered adolescent version of Semi-Structured Assessment for Genetics of Alcoholism (C-SSAGA-A). At follow-up, substance use outcomes were assessed via self-reported questionnaire.

FINDINGS

Early-onset depressive disorders predicted daily smoking [odds ratio (OR) 2.29, 95% confidence interval (CI) 1.49-3.50, P < 0.001], smokeless tobacco use (OR = 2.00, 95% CI 1.32-3.04, P = 0.001), frequent illicit drug use (OR = 4.71, 95% CI 1.95-11.37, P = 0.001), frequent alcohol use (OR = 2.02, 95% CI 1.04-3.92, P = 0.037) and recurrent intoxication (OR = 1.83, 95% CI 1.18-2.85, P = 0.007) 3 years later. ORs remained significant after adjustment for comorbidity and exclusion of baseline users. In within-family analysis of depression-discordant co-twins (analyses that control for shared genetic and familial background factors), early-onset depressive disorders at age 14 predicted significantly frequent use of smokeless tobacco and alcohol at age 17.5.

CONCLUSIONS

Our results suggest important predictive associations between early-onset depressive disorders and addictive substance use, and these associations appear to be independent of shared familial influences.