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Meisel SN, Pielech M, Magill M, Sawyer K, Miranda R. Mechanisms of Behavior Change in Adolescent Substance Use Treatment: A Systematic Review of Treatment Mediators and Recommendations for Advancing Future Research. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2024; 31:154-173. [PMID: 38883554 PMCID: PMC11178260 DOI: 10.1037/cps0000089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Substance use disorders commonly onset during adolescence, yet the best available treatments yield only modest and transient effects. Elucidating treatment mediators is essential for improving treatment options. This review summarizes over 20 years of research on mediators of adolescent substance use treatment; k = 17 studies assessing both treatment or treatment ingredient to mediator (a path) and mediator to treatment outcome (b path) paths were included. Mediators were categorized using the Science of Behavior Change target class framework. Overall, mediation tests supported four of eight self-regulation, two of 10 stress resilience and reactivity, six of 19 interpersonal and social process, and two of four treatment engagement and adherence mediators. To enhance the capacity of this work to inform clinical practice, we recommend future research examine theoretically informed mechanisms using temporally sequenced data among other methodological guidelines.
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Affiliation(s)
- Samuel N. Meisel
- Center for Alcohol and Addiction Studies, Brown University
- E. P. Bradley Hospital, Riverside, Rhode Island, United States
| | | | - Molly Magill
- Center for Alcohol and Addiction Studies, Brown University
| | - Kelsey Sawyer
- Center for Alcohol and Addiction Studies, Brown University
| | - Robert Miranda
- Center for Alcohol and Addiction Studies, Brown University
- E. P. Bradley Hospital, Riverside, Rhode Island, United States
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2
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Farnia V, Ahmadi Jouybari T, Salemi S, Moradinazar M, Khosravi Shadmani F, Rahami B, Alikhani M, Bahadorinia S, Mohammadi Majd T. The prevalence of alcohol consumption and its related factors in adolescents: Findings from Global School-based Student Health Survey. PLoS One 2024; 19:e0297225. [PMID: 38558070 PMCID: PMC10984532 DOI: 10.1371/journal.pone.0297225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 12/29/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Alcohol consumption has become very common among adolescents in recent years and its prevalence varies in different countries. This study aimed to investigate the prevalence of alcohol consumption and related factors in adolescents aged 11 to 16 years. METHODS This descriptive cross-sectional study was performed on 288385 adolescents (girls, 53.9% of total) aged 11 to 16 years. In the present study, the GSHS data (2003-2018) available to public on the websites of the US Centers for Disease Control and Prevention (CDC) and WHO was used. To investigate the factors affecting alcohol consumption, univariate and multivariate logistics models with 95% confidence limits were used. RESULTS The overall prevalence of alcohol consumption in adolescents was 25.2%, which was 28.3% and 22.4% in boys and girls, respectively. Among the surveyed countries, the highest prevalence was in Seychelles (57.9%) and the lowest in Tajikistan (0.7). Multivariate analysis showed that the Age for 16 and more than 16 years old (OR = 3.08,95%CI: 2.54-3.74), truancy for more than 10 days (OR = 1.24, 95%CI: 1.08-1.43), loneliness at sometimes of the times (OR = 1.04, 95%CI: 1.01-1.07), insomnia at most of the times (OR = 1.85, 95%CI: 1.70-2.01), daily activity (OR = 1.03, 95%CI: 1.00-1.07), bullied for 1-9 Days in a month (OR = 1.24, 95%CI: 1.09-1.40), cigarette (OR = 4.01, 95%CI: 3.86-4.17), used marijuana for more than 10 days in a month (OR = 5.58, 95%CI: 4.59-7.78), had sex (OR = 2.76, 95%CI: 2.68-2.84), and suicide plan (OR = 1.48, 95%CI: 1.42-1.54) were important factors affecting drinking alcohol. (Table 4). In this study, the sensitivity, specificity, positive predictive value, and negative predictive value were 42.79%, 93.96%, 70.80%, and 82.75. CONCLUSIONS According to the results of the present study, the prevalence of alcohol consumption among teenagers was high. Therefore, it is suggested that demographic, family, and psychological factors should be taken into consideration in health programs for the prevention and treatment of alcohol consumption in adolescents.
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Affiliation(s)
- Vahid Farnia
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Touraj Ahmadi Jouybari
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Safora Salemi
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehdi Moradinazar
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fatemeh Khosravi Shadmani
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Bahareh Rahami
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mostafa Alikhani
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahab Bahadorinia
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Tahereh Mohammadi Majd
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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3
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Vallentin-Holbech L, Karsberg SH, Nielsen AS, Feldstein Ewing SW, Rømer Thomsen K. Preliminary evaluation of a novel group-based motivational interviewing intervention with adolescents: a feasibility study. Front Public Health 2024; 12:1344286. [PMID: 38510360 PMCID: PMC10951374 DOI: 10.3389/fpubh.2024.1344286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024] Open
Abstract
Drinking is closely intertwined with social life among many adolescents, particularly in Europe. Group-based interventions, such as group-based motivational interviewing (group MI), have shown the capacity to prevent and reduce hazardous drinking and related problems among adolescents, but few examinations have been conducted in a European high school setting. This study examines the preliminary outcomes of a pilot group MI intervention among Danish adolescents. High school students (ages 15-18 years) were randomly allocated to two 1-h group MI sessions delivered in a school setting (N = 65) or an assessment only control condition (N = 67). Data were collected in August and November 2020 using online self-administrated questionnaires regarding the acceptability of the intervention and past month alcohol use. The pilot group MI intervention showed high feasibility and acceptability in this setting and with this age group. Group MI adolescents significantly reduced peak drinks per drinking day compared to assessment only adolescents (-2.7 drinks, p < 0.05). Results are discussed in relation to the metrics being evaluated during COVID-19 lockdown, including increased social restrictions at follow-up compared to baseline. Group MI shows promise for reducing hazardous alcohol use among Danish adolescents. In addition, the findings indicate the importance of building on and extending this work in future larger, better-powered randomized controlled trials.
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Affiliation(s)
| | | | - Anette Søgaard Nielsen
- Unit for Clinical Alcohol Research, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Sarah W. Feldstein Ewing
- Centre for Alcohol and Drug Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
- Department of Psychology, University of Rhode Island, Kingston, RI, United States
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4
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Arnaud N, Wartberg L, Simon-Kutscher K, Thomasius R. Prevalence of substance use disorders and associations with mindfulness, impulsive personality traits and psychopathological symptoms in a representative sample of adolescents in Germany. Eur Child Adolesc Psychiatry 2024; 33:451-465. [PMID: 36853515 PMCID: PMC9972301 DOI: 10.1007/s00787-023-02173-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/16/2023] [Indexed: 03/01/2023]
Abstract
Adolescence is a critical phase for the development of substance use disorders (SUDs). For Europe and Germany, there are limited data on problematic substance use from representative youth samples. Trait mindfulness is relevant in buffering against substance use-related problems and associated deficits in self-regulatory control. The objective of this study is to estimate 12-month prevalence rates for SUDs in a representative sample of adolescents in Germany and to examine associations with mindfulness and related factors such as stress, impulsivity, sensation seeking and symptoms of psychopathology. A sample of 4001 adolescents aged 12-18 years from Germany was surveyed based on DSM-IV diagnostic criteria for SUDs. Logistic regression analyses were used to examine associations with mindfulness-related variables. Criteria of at least one of the assessed SUDs were endorsed by 11.2% of the adolescents. Alcohol use disorders had the highest prevalence rate (10.1%) followed by cannabis use disorders (2.6%). For both substances, the criteria for abuse were met about twice as often as those for dependence. The prevalence of cigarette dependence was 1.7%, while the prevalence for e-cigarette dependence was only 0.1%. Prevalence rates were higher for male youth and increasing with age. SUD prevalence was also related to mindfulness, impulsivity and sensation seeking and externalizing symptoms of psychopathology. The statistically significant associations varied across different SUDs. SUDs appear highly prevalent among German adolescents. The results have public health implications with regard to treatment needs and prevention measures in the youth population in Germany.
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Affiliation(s)
- Nicolas Arnaud
- German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Lutz Wartberg
- Medical School Hamburg (MSH), Faculty of Human Sciences, Department of Psychology, University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany
| | - Kathrin Simon-Kutscher
- German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Rainer Thomasius
- German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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5
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Arguello AA, Valade CT, Voutour LS, Reeves CA. Cocaine reward and reinstatement in adolescent versus adult rodents. Front Behav Neurosci 2024; 17:1278263. [PMID: 38249124 PMCID: PMC10796467 DOI: 10.3389/fnbeh.2023.1278263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/27/2023] [Indexed: 01/23/2024] Open
Abstract
Adolescence is a critical juncture when initiation of drug use intersects with profound developmental changes in the brain. Adolescent drug use increases the risk to develop substance use disorders (SUDs) later in life, but the mechanisms that confer this vulnerability are not understood. SUDs are defined by cycles of use, abstinence, and relapse. Intense craving during drug-free periods is often triggered by cues and environmental contexts associated with previous use. In contrast to our understanding of stimuli that elicit craving and relapse in adults, the behavioral processes that occur during periods of abstinence and relapse in adolescents are poorly understood. The current mini-review will summarize findings from preclinical rodent studies that used cocaine conditioned place preference and operant cocaine self-administration to examine subsequent effects on reward, relapse and incubation of craving.
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Affiliation(s)
- Amy A. Arguello
- Department of Psychology, Interdisciplinary Science and Technology Building, Michigan State University, East Lansing, MI, United States
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King CA, Beetham T, Smith N, Englander H, Button D, Brown PCM, Hadland SE, Bagley SM, Wright OR, Korthuis PT, Cook R. Adolescent Residential Addiction Treatment In The US: Uneven Access, Waitlists, And High Costs. Health Aff (Millwood) 2024; 43:64-71. [PMID: 38190597 PMCID: PMC11082498 DOI: 10.1377/hlthaff.2023.00777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Drug overdose deaths among adolescents are increasing in the United States. Residential treatment facilities are one treatment option for adolescents with substance use disorders, yet little is known about their accessibility or cost. Using the Substance Abuse and Mental Health Services Administration's treatment locator and search engine advertising data, we identified 160 residential addiction treatment facilities that treated adolescents with opioid use disorder as of December 2022. We called facilities while role-playing as the aunt or uncle of a sixteen-year-old child with a recent nonfatal overdose, to inquire about policies and costs. Eighty-seven facilities (54.4 percent) had a bed immediately available. Among sites with a waitlist, the mean wait time for a bed was 28.4 days. Of facilities providing cost information, the mean cost of treatment per day was $878. Daily costs among for-profit facilities were triple those of nonprofit facilities. Half of facilities required up-front payment by self-pay patients. The mean up-front cost was $28,731. We were unable to identify any facilities for adolescents in ten states or Washington, D.C. Access to adolescent residential addiction treatment centers in the United States is limited and costly.
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Affiliation(s)
- Caroline A King
- Caroline A. King , Oregon Health & Science University, Portland, Oregon
| | | | | | | | - Dana Button
- Dana Button, Oregon Health & Science University
| | | | - Scott E Hadland
- Scott E. Hadland, Boston University and Massachusetts General Hospital, Boston, Massachusetts
| | - Sarah M Bagley
- Sarah M. Bagley, Boston University and Boston Medical Center, Boston, Massachusetts
| | | | | | - Ryan Cook
- Ryan Cook, Oregon Health & Science University
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7
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Hareskov Jensen N, Vallentin-Holbech L, Dash GF, Feldstein Ewing SW, Rømer Thomsen K. Validity of an online, self-administered Timeline Followback for alcohol use with adolescents. Front Psychiatry 2023; 14:1221487. [PMID: 38098631 PMCID: PMC10720705 DOI: 10.3389/fpsyt.2023.1221487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
Objective The Timeline Followback (TLFB) is a widely used and well-validated interview-based tool for assessing patterns of recent health risk behavior. There is some evidence of the validity of the TLFB as a self-administered online tool for assessing alcohol use, but further research is needed to establish its validity in younger populations and populations outside the United States. Further, it is unknown how self-administered online TLFB formats compare to more timesaving and commonly used single-item alcohol questions. The primary aim of the current study was to validate a new online, self-administered TLFB for alcohol use against the TLFB interview in a sample of European (Danish) adolescents aged 16-18 years (N = 30). Methods Participants completed a TLFB telephone interview, a self-administered online version of the TLFB, and single-item alcohol questions. Assessments were administered using a within-subject, counter-balanced design. Estimates of number of drinking days, binge-drinking days, maximum drinks consumed on one occasion, total drinks, and drinks per drinking day were compared across metrics. Results All correlations between the drinking outcomes assessed via the TLFB interview and the TLFB online were positive, and statistically significant (rss = 0.86-0.94, p < 0.01). Wilcoxon signed-rank tests showed no significant differences between the TLFB interview and the TLFB online on drinking days, binge drinking days, max drinks, and total drinks. Participants reported drinking significantly more drinks per drinking day on the TLFB online (M = 4.66) compared to on the TLFB interview (M = 4.12; p = 0.009). Conclusion Overall, the results support the validity of the online, self-administered TLFB in a sample of European (Danish) adolescents.
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Affiliation(s)
- Natascha Hareskov Jensen
- Center for Alcohol and Drug Research, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Lotte Vallentin-Holbech
- Center for Alcohol and Drug Research, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Genevieve F. Dash
- Department of Psychological Sciences, University of Missouri, Columbia, MO, United States
| | - Sarah W. Feldstein Ewing
- Center for Alcohol and Drug Research, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
- Department of Psychology, University of Rhode Island, Kingston, RI, United States
| | - Kristine Rømer Thomsen
- Center for Alcohol and Drug Research, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
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Dash GF, Bryan AD, Montanaro E, Feldstein Ewing SW. Long-Term RCT outcomes for adolescent alcohol and cannabis use within a predominantly Hispanic sample. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2023; 33:1038-1047. [PMID: 37127932 PMCID: PMC10530050 DOI: 10.1111/jora.12856] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 09/08/2022] [Accepted: 04/12/2023] [Indexed: 05/03/2023]
Abstract
Because adolescents are unlikely to seek, receive, or complete treatment for alcohol and/or cannabis misuse, it is important to enhance the lasting impact of clinical contacts when they do occur. Adolescents (N = 506; 72.5% Hispanic) were randomized to motivational interviewing (MI) versus alcohol and cannabis education (ACE). Latent growth models estimated change over time. Significant reductions in alcohol use were observed, with slightly greater reductions by 12-month follow-up for MI. Both interventions significantly reduced cannabis use, with no treatment group differences. When outcomes were examined comparing Hispanic to non-Hispanic participants, there were no significant differences in intervention efficacy by group. MI's inherently client-centered and culturally adaptive approach may contribute to its equitable degree of behavior change for youth across race/ethnic backgrounds.
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Affiliation(s)
- Genevieve F. Dash
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Angela D. Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Erika Montanaro
- Department of Psychological Sciences, University of North Carolina Charlotte, Charlotte, North Carolina, USA
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9
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Dash GF, Bryan AD, Yang M, Chung T, Hudson KA, Feldstein Ewing SW. Adolescent: provider connectedness and STI risk reduction following a brief alcohol intervention: findings from a randomized controlled trial. Front Psychol 2023; 14:1171264. [PMID: 37546489 PMCID: PMC10399588 DOI: 10.3389/fpsyg.2023.1171264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Objective Given the frequent co-occurrence between alcohol use and sexual behavior among adolescents, alcohol interventions may play a role in helping prevent sexually transmitted infections (STIs) in this age group. Psychotherapy "common factors" are one potential active ingredient in intervention efficacy. Thus, the purpose of this study was to evaluate the influence of a critical common factor, adolescent: provider connectedness, on STI risk reduction at 3 months post-intervention. Methods Community-based youth (N = 168) were randomized to two 60-min individual sessions of either motivational interviewing (MI) or brief adolescent mindfulness (BAM). Logistic regressions predicted post-intervention positive STI from adolescent: provider connectedness, intervention condition, and their interaction. Path analytic models tested post-intervention hazardous drinking as a mediator of the association between adolescent: provider connectedness and reduction in STI risk at 3-month follow-up. Results Stronger adolescent: provider connectedness reduced risk of STI at 3 months post-intervention, with no differences by treatment condition. A mediational relationship between adolescent: provider connectedness and STI risk via hazardous drinking was not observed. Conclusion Psychotherapeutic common factors, including adolescent: provider connectedness, may be important in mitigating adolescent health risk in behavioral interventions, above and beyond intervention condition and beyond the target behavior of the intervention.
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Affiliation(s)
- Genevieve F. Dash
- Department of Psychological Sciences, University of Missouri, Columbia, MO, United States
| | - Angela D. Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, United States
| | - Manshu Yang
- Department of Psychology, University of Rhode Island, Kingston, RI, United States
| | - Tammy Chung
- Department of Psychiatry, Institute for Health, Healthcare Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Karen A. Hudson
- Department of Psychology, University of Rhode Island, Kingston, RI, United States
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Goldway N, Eldar E, Shoval G, Hartley CA. Computational Mechanisms of Addiction and Anxiety: A Developmental Perspective. Biol Psychiatry 2023; 93:739-750. [PMID: 36775050 PMCID: PMC10038924 DOI: 10.1016/j.biopsych.2023.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
A central goal of computational psychiatry is to identify systematic relationships between transdiagnostic dimensions of psychiatric symptomatology and the latent learning and decision-making computations that inform individuals' thoughts, feelings, and choices. Most psychiatric disorders emerge prior to adulthood, yet little work has extended these computational approaches to study the development of psychopathology. Here, we lay out a roadmap for future studies implementing this approach by developing empirically and theoretically informed hypotheses about how developmental changes in model-based control of action and Pavlovian learning processes may modulate vulnerability to anxiety and addiction. We highlight how insights from studies leveraging computational approaches to characterize the normative developmental trajectories of clinically relevant learning and decision-making processes may suggest promising avenues for future developmental computational psychiatry research.
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Affiliation(s)
- Noam Goldway
- Department of Psychology, New York University, New York, New York
| | - Eran Eldar
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel; Department of Cognitive and Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gal Shoval
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey; Child and Adolescent Division, Geha Mental Health Center, Petah Tikva, Israel; Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Catherine A Hartley
- Department of Psychology, New York University, New York, New York; Center for Neural Science, New York University, New York, New York.
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11
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Olekanma DI, Reeves CA, Cho BR, Herrera Charpentier AN, Gerena J, Bal A, Arguello AA. Context-drug-associations and reinstatement of drug-seeking behavior in male rats: Adolescent and adult time-dependent effects. Neurobiol Learn Mem 2023; 199:107722. [PMID: 36639018 DOI: 10.1016/j.nlm.2023.107722] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/27/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023]
Abstract
RATIONALE Drug use during adolescence results in a life-long risk to develop substance-use disorders. Adolescent rats are sensitive to different drug-associated cues, compared to adults; however, the contribution of adolescent-formed context-drug-associations to elicit relapse-like behavior is underexplored. OBJECTIVES The present study compared the effect of adolescent vs adult-formed context-drug associations to elicit time-dependent increases in cocaine-seeking behavior. This objective was accomplished using an abbreviated (ABRV) operant cocaine self-administration (Coc-SA), Extinction (EXT) paradigm, with cocaine-seeking tests occurring 1 day after training (T1, early relapse) or following 15 days of abstinence (T15, late relapse). METHODS Adolescent and adult rats received ABRV Coc-SA in a distinct context (2 hr, 2x/day over 5 days) then EXT in a second context (2 hr, 2x/day over 4 days). Adolescent or adult cocaine-exposed rats were then tested (2 hr, non-rewarded) in either the previous EXT or Coc-paired contexts during early or late relapse. RESULTS & CONCLUSIONS As previously reported, both adolescent and adult cocaine-exposed rats displayed similar magnitudes of cocaine intake and lever presses during Coc-SA, EXT, and early relapse. Independent analysis of adolescent and adult groups revealed differences in lever responding, specifically rats with cocaine exposure during adolescence showed time-dependent increases in lever responding during late relapse. These data suggest that cocaine-context associations formed during adolescence can elicit craving during adulthood and that these age-specific differences in contextual sensitivity may not be immediately observed at early relapse periods.
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Affiliation(s)
- Doris I Olekanma
- Psychology Dept., Michigan State University, Interdisciplinary Science and Technology Building, West Rm. 4010, 766 Service Rd., East Lansing, MI 48824, USA
| | - Christopher A Reeves
- Psychology Dept., Michigan State University, Interdisciplinary Science and Technology Building, West Rm. 4010, 766 Service Rd., East Lansing, MI 48824, USA
| | - Bo Ram Cho
- Psychology Dept., Michigan State University, Interdisciplinary Science and Technology Building, West Rm. 4010, 766 Service Rd., East Lansing, MI 48824, USA
| | - André N Herrera Charpentier
- Psychology Dept., Michigan State University, Interdisciplinary Science and Technology Building, West Rm. 4010, 766 Service Rd., East Lansing, MI 48824, USA
| | - Jennifer Gerena
- Psychology Dept., Michigan State University, Interdisciplinary Science and Technology Building, West Rm. 4010, 766 Service Rd., East Lansing, MI 48824, USA
| | - Aneesh Bal
- Psychology Dept., Michigan State University, Interdisciplinary Science and Technology Building, West Rm. 4010, 766 Service Rd., East Lansing, MI 48824, USA
| | - Amy A Arguello
- Psychology Dept., Michigan State University, Interdisciplinary Science and Technology Building, West Rm. 4010, 766 Service Rd., East Lansing, MI 48824, USA.
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Vallentin-Holbech L, Ewing SWF, Thomsen KR. Hazardous alcohol use among Danish adolescents during the second wave of COVID-19: Link between alcohol use and social life. NORDIC STUDIES ON ALCOHOL AND DRUGS 2023; 40:127-145. [PMID: 37063817 PMCID: PMC10101166 DOI: 10.1177/14550725221149489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 12/19/2022] [Indexed: 01/28/2023] Open
Abstract
Background: Adolescent drinking has historically been closely linked to social events, and across many countries, students typically increase drinking rates when they transition to upper secondary school. COVID-19-related restrictions offered a unique possibility to examine how changes in social life impact adolescent drinking in the transition to upper secondary school. Aim: The current study investigated changes in hazardous alcohol use, social life and well-being among Danish first-year students (mean age = 16.8 years) during the second wave of the COVID-19 pandemic when restrictions gradually became more intensified. Methods: Data were collected at two time points among 352 Danish students in the first months of upper secondary school (August and November 2020). Multilevel regression models tested changes across time on past 30 days hazardous alcohol use (dependent variables). Separate models tested whether changes in alcohol use were related to gender, social interaction, loneliness and mental health. Results: During increased COVID-19-related restrictions in the second wave, students decreased the frequency and quantity of drinking (number of drinking days and binge drinking), which was associated with attending fewer parties. Students also reported less high-intensity drinking and fewer alcohol-related consequences. Students reported better mental health, but more students were affected by loneliness. Changes in mental health or loneliness were not related to reduced hazardous alcohol use. Conclusion: Our results provide evidence that alcohol use decreased among Danish students transitioning to upper secondary school during the COVID-19 pandemic when restrictions increased, thereby providing support for a close link between adolescent alcohol use and social life; this is an important frame that is relevant when designing interventions to promote healthier and less risky choices throughout the next phase(s) of the pandemic and in general.
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Affiliation(s)
| | - Sarah W. Feldstein Ewing
- Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark; Department of Psychology, University of Rhode Island, Kingston, RI, USA
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Dash GF, Chung T, Yang M, Bryan AD, Hudson KA, Feldstein Ewing SW. Examining the influence of adolescent:provider alliance on youth hazardous drinking: Findings from a randomized controlled trial. Addict Behav 2023; 136:107499. [PMID: 36166981 PMCID: PMC9946157 DOI: 10.1016/j.addbeh.2022.107499] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/26/2022] [Accepted: 09/16/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE Behavioral interventions to reduce hazardous drinking are only moderately successful in promoting sustained behavior change and post-intervention effect sizes among adolescents remain modest. This study aimed to explore a relevant therapeutic active ingredient, adolescent:provider alliance, as a moderator of short-term (3 month) adolescent intervention outcomes within the course of a larger parent randomized control trial (RCT). METHODS Participants were community-based youth engaged in hazardous drinking (N = 168) who were randomized to 2 sessions of either motivational interviewing (MI) or mindfulness (brief adolescent mindfulness; BAM). Youth reported pre-intervention hazardous drinking at baseline and rated therapeutic alliance (a metric of adolescent:provider "connectedness" that helps facilitate working relationships during interventions) immediately post-intervention; they reported hazardous drinking again at 3 months post-intervention. Negative binomial regressions predicted post-intervention hazardous drinking score from adolescent:provider alliance, intervention condition, and their interaction. RESULTS Mean hazardous drinking was reduced by 34-40 % across both intervention conditions, with no significant between-condition differences. Stronger adolescent:provider alliance was associated with lower hazardous drinking scores at 3 months, but this effect was attenuated after controlling for baseline hazardous drinking. Contrary to predictions, adolescent:provider alliance did not appear to moderate the effect of intervention condition in this sample of young people engaged in hazardous drinking. CONCLUSIONS Consistent with prior literature, baseline hazardous drinking was a robust predictor of treatment outcomes. At the same time, these results suggest that future work may benefit from continuing to examine and disaggregate the nature of adolescent:provider alliance across the spectrum of empirically supported brief interventions for adolescent hazardous drinking. CLINICAL TRIALS REGISTRATION NUMBER ClinicalTrials.gov identifier: NCT03367858. Data Sharing Statement: Requests for deidentified individual participant data can be made to the first author.
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Affiliation(s)
- Genevieve F Dash
- University of Missouri, Department of Psychological Sciences, Columbia, MO, United States.
| | - Tammy Chung
- Rutgers, The State University of New Jersey, Department of Psychiatry, Institute for Health, Healthcare Policy and Aging Research, New Brunswick, NJ, United States.
| | - Manshu Yang
- University of Rhode Island, Department of Psychology, Kingston, RI, United States.
| | - Angela D Bryan
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, United States.
| | - Karen A Hudson
- University of Rhode Island, Department of Psychology, Kingston, RI, United States.
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14
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Dash GF, Holt L, Kenyon EA, Carter EK, Ho D, Hudson KA, Feldstein Ewing SW. Detection of vaping, cannabis use, and hazardous prescription opioid use among adolescents. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:820-828. [PMID: 36030794 PMCID: PMC9588707 DOI: 10.1016/s2352-4642(22)00212-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 05/19/2023]
Abstract
There has been a global surge in adolescents' use of electronic nicotine delivery systems (vaping), cannabis (vaped and edible), and prescription opioids, collectively termed ECPO. The nature of ECPO use can make it difficult to detect due to few obvious immediate physical and behavioural signs, as well as subtle long-term effects that allow adolescents to transition from initial exploration into hazardous ECPO use without easy detection by care providers. Here, we address the nature of the presentation of ECPO use in adolescents (roughly age 13-18 years), including challenges in detecting use and related complications, which affect screening, prevention, and intervention. We begin by reviewing empirical data on these difficult to detect effects in adolescents, including acute effects at cellular and neural levels and long-term neurocognitive and developmental changes that precede outwardly detectable physical signs. We then provide concrete approaches for providers to screen for ECPO use in adolescents even in the absence of overt physical and behavioural symptoms. Finally, we conclude with direct practice recommendations for prevention and intervention.
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Affiliation(s)
- Genevieve F Dash
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA.
| | - Laura Holt
- Department of Psychology, Trinity College, Hartford, CT, USA
| | - Emily A Kenyon
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Emily K Carter
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Diana Ho
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Karen A Hudson
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
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15
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Beard SJ, Yoon L, Venticinque JS, Shepherd NE, Guyer AE. The brain in social context: A systematic review of substance use and social processing from adolescence to young adulthood. Dev Cogn Neurosci 2022; 57:101147. [PMID: 36030675 PMCID: PMC9434028 DOI: 10.1016/j.dcn.2022.101147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/19/2022] Open
Abstract
Substance use escalates between adolescence and young adulthood, and most experimentation occurs among peers. To understand underlying mechanisms, research has focused on neural response during relevant psychological processes. Functional magnetic resonance imaging (fMRI) research provides a wealth of information about brain activity when processing monetary rewards; however, most studies have used tasks devoid of social stimuli. Given that adolescent neurodevelopment is sculpted by the push-and-pull of peers and emotions, identifying neural substrates is important for intervention. We systematically reviewed 28 fMRI studies examining substance use and neural responses to stimuli including social reward, emotional faces, social influence, and social stressors. We found substance use was positively associated with social-reward activity (e.g., in the ventral striatum), and negatively with social-stress activity (e.g., in the amygdala). For emotion, findings were mixed with more use linked to heightened response (e.g., in amygdala), but also with decreased response (e.g., in insula). For social influence, evidence supported both positive (e.g., cannabis and nucleus accumbens during conformity) and negative (e.g., polydrug and ventromedial PFC during peers' choices) relations between activity and use. Based on the literature, we offer recommendations for future research on the neural processing of social information to better identify risks for substance use.
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Affiliation(s)
- Sarah J Beard
- Center for Mind and Brain, University of California, Davis, 267 Cousteau Pl, Davis, CA 95618, USA; Department of Human Ecology, University of California, Davis, 301 Shields Ave, Davis, CA 95616, USA.
| | - Leehyun Yoon
- Center for Mind and Brain, University of California, Davis, 267 Cousteau Pl, Davis, CA 95618, USA.
| | - Joseph S Venticinque
- Center for Mind and Brain, University of California, Davis, 267 Cousteau Pl, Davis, CA 95618, USA; Department of Human Ecology, University of California, Davis, 301 Shields Ave, Davis, CA 95616, USA.
| | - Nathan E Shepherd
- Center for Mind and Brain, University of California, Davis, 267 Cousteau Pl, Davis, CA 95618, USA.
| | - Amanda E Guyer
- Center for Mind and Brain, University of California, Davis, 267 Cousteau Pl, Davis, CA 95618, USA; Department of Human Ecology, University of California, Davis, 301 Shields Ave, Davis, CA 95616, USA.
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16
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Beneria A, Santesteban-Echarri O, Daigre C, Tremain H, Ramos-Quiroga JA, McGorry PD, Alvarez-Jimenez M. Online interventions for cannabis use among adolescents and young adults: Systematic review and meta-analysis. Early Interv Psychiatry 2022; 16:821-844. [PMID: 34464502 DOI: 10.1111/eip.13226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 07/22/2021] [Accepted: 08/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Young people present high rates of cannabis use, abuse, and dependence. The United Nations estimates that roughly 3.8% of the global population aged 15-64 years used cannabis at least once in 2017. Cannabis use in young people may impair cognitive skills, interfere with learning, impact relationships, and lead to long term behavioural and psychological consequences. Online cannabis interventions (OCI) are increasingly popular, but their dissemination is not often supported by empirical evidence. AIM To systematically compile and analyse the effectiveness of OCI for the reduction of cannabis use among adolescents and young adults (AYA). METHODS Pooled effect sizes of cannabis use between treatment and control groups were estimated. For each comparison, Hedge's g was calculated using a random effects model. RESULTS The search strategy yielded 4531 articles. Of those, a total of 411 articles were retrieved for detailed evaluation resulting in 17 eligible studies (n = 3525). Analyses revealed that online interventions did not significantly reduce cannabis consumption (Hedge's g = -0.061, 95% CI [-0.363] to [-0.242], p = .695) and high heterogeneity was noted (Q = 191.290). More recent studies using structured interventions, daily feedback, AYA centred designs, and peer support, specifically targeting CU seemed to have positive effects to address CU in this population. CONCLUSIONS The lack of positive outcomes suggests that more specific and targeted interventions may be necessary to promote cannabis-related behavioural change among young people. These targeted interventions may include structured CU modules, daily feedback, peer support for increased adherence, user-centred design procedures, and input from key stakeholders such as families and service providers.
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Affiliation(s)
- Anna Beneria
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain
- Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | - Olga Santesteban-Echarri
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- The Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Alberta, Canada
| | - Constanza Daigre
- Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain
| | - Hailey Tremain
- Orygen, Parkville, Australia. Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain
- Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Patrick D McGorry
- Orygen, Parkville, Australia. Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, Australia. Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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Feldstein Ewing SW, Karalunas SL, Kenyon EA, Yang M, Hudson KA, Filbey FM. Intersection between social inequality and emotion regulation on emerging adult cannabis use. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3:100050. [PMID: 35694031 PMCID: PMC9187048 DOI: 10.1016/j.dadr.2022.100050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/07/2022] [Accepted: 03/28/2022] [Indexed: 05/29/2023]
Abstract
Emerging adulthood (EA; ages 18-25) is characterized by socioemotional and neurodevelopmental challenges. Cannabis is a widely used substance among EAs, and hazardous use may increase risk for sustained use patterns and related health consequences. Research shows differential increases in hazardous use by objective as well as subjective measures of social inequality, with more concerning trajectories for youth with greater experiences of social inequality. Learning how to flexibly monitor and modify emotions in proactive ways (i.e., emotion regulation) is a central developmental task navigated during the EA window. Challenges to and with emotion regulation processes can contribute to the emergence of mental health symptoms during EA, including hazardous cannabis use. In this perspective, we highlight emotion dysregulation and social inequality as two critical factors that interact to either buffer against or exacerbate cannabis use during the EA period, noting critical gaps in the literature that merit additional research. We recommend novel methods and longitudinal designs to help clarify how dynamic cognition-emotion interplay predicts trajectories of negative emotional experiences and cannabis use in EA.
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18
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Ewing SF, Bryan AD, Dash GF, Lovejoy TI, Borsari B, Schmiege SJ. Randomized controlled trial of motivational interviewing for alcohol and cannabis use within a predominantly Hispanic adolescent sample. Exp Clin Psychopharmacol 2022; 30:287-299. [PMID: 33749294 PMCID: PMC9113520 DOI: 10.1037/pha0000445] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hispanic youth represent one of the fastest-growing minority groups. Yet, we know little about Hispanic adolescents' response to empirically-supported interventions for adolescent addiction, including motivational interviewing (MI). This randomized controlled trial (RCT) compared MI to an active educational treatment for adolescent alcohol and cannabis use (alcohol and cannabis education; ACE). Adolescents who regularly use substances (N = 448; n = 347 Hispanic; n = 101 non-Hispanic white; ages 13-18) were randomized to two 1-hr individual sessions of MI or ACE. We examined 6-month outcomes and mechanisms of change across Hispanic and non-Hispanic white youth. Treatment response was comparable across ethnicities (Hispanic vs. non-Hispanic white youth). Additionally, adolescents in the MI condition showed greater reductions in alcohol use compared to those in ACE, with support for motivation and self-efficacy as mechanisms of treatment response. Direct effects of MI on cannabis use were not observed; however, a significant indirect effect of motivation was observed for reductions in cannabis use. Data support the efficacy of MI in reducing adolescent alcohol use, through the vehicle of enhanced motivation and self-efficacy. While consistent treatment response was observed for adolescent alcohol use across ethnicities (Hispanic vs. non-Hispanic white), further exploration into potential underexplored mechanisms of Hispanic adolescents' treatment response is requisite to strengthening prevention and intervention programming for Hispanic adolescents' cannabis use. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Angela D. Bryan
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO
| | - Genevieve F. Dash
- University of Missouri, Department of Psychological Sciences, Columbia, MO
| | - Travis I. Lovejoy
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR
| | - Brian Borsari
- Mental Health Service, San Francisco VA Health Care System/ Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA
| | - Sarah J. Schmiege
- University of Colorado Anschutz Medical Campus, Department of Biostatistics and Informatics, Aurora, CO
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19
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Mackiewicz Seghete KL, Filbey FM, Hudson KA, Hyun B, Feldstein Ewing SW. Time for a paradigm shift: The adolescent brain in addiction treatment. Neuroimage Clin 2022; 34:102960. [PMID: 35172248 PMCID: PMC8850747 DOI: 10.1016/j.nicl.2022.102960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 12/29/2021] [Accepted: 02/06/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE One route to improve adolescent addiction treatment outcomes is to use translational approaches to help identify developmental neuroscience mechanisms that undergird active treatment ingredients and advance adolescent behavior change. METHODS This sample included 163 adolescents (ages 15-19) randomized to motivational interviewing (MI) vs. brief adolescent mindfulness (BAM). Youth completed an fMRI paradigm assessing adolescent brain response to therapist language (complex reflection vs. mindful; complex reflection vs. confront; mindful vs. confront) at pre- (prior to the completion of the full intervention) and post-treatment (at 3-month follow-up) and behavioral measures at 3, 6 and 12 months. RESULTS Youth in both treatment groups showed significant problem drinking reductions at 3 and 6 months, but MI youth demonstrated significantly better treatment outcomes than BAM youth at 12 months. We observed several significant treatment group differences (MI > BAM) in neural response to therapist language, including at pre-treatment when examining complex reflection vs. mindful, and complex reflection vs. confront (e.g., superior temporal gyrus, lingual gyrus); and at post-treatment when examining mindful vs. confront (e.g., supplementary motor area; middle frontal gyrus). When collapsed across treatment groups (MI + BAM), we observed significant differences by time, with youth showing a pattern of brain change in response to complex reflection vs. mindful, and complex reflection vs. confront (e.g., precuneus; postcentral gyrus). There was no evidence of a significant group × time interaction. However, brain change in response to therapist language (complex reflection vs. confront) in regions such as middle frontal gyrus, was associated with reductions in problem drinking at 12 months. Yet, few treatment group differences were observed. CONCLUSIONS These data underscore the need to better understand therapist language and it's impact on the developing brain, in order to inform and aggregate the most impactful elements of addiction treatment for future treatment development for adolescents.
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Affiliation(s)
- Kristen L Mackiewicz Seghete
- Oregon Health & Science University, Department of Psychiatry, 3181 SW Sam Jackson Park Rd, M/C UHN80R1, Portland, OR 97239, USA.
| | - Francesca M Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, 2200 West Mockingbird Lane, Dallas, TX 75235, USA.
| | - Karen A Hudson
- Departments of Psychology and Interdisciplinary Neuroscience, University of Rhode Island, 130 Flagg Rd, Kingston, RI 02881 USA.
| | - Benedict Hyun
- Departments of Psychology and Interdisciplinary Neuroscience, University of Rhode Island, 130 Flagg Rd, Kingston, RI 02881 USA.
| | - Sarah W Feldstein Ewing
- Departments of Psychology and Interdisciplinary Neuroscience, University of Rhode Island, 130 Flagg Rd, Kingston, RI 02881 USA.
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20
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Evaluating Providers' Prescription Opioid Instructions to Pediatric Patients. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050707. [PMID: 35626884 PMCID: PMC9140090 DOI: 10.3390/children9050707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/30/2022]
Abstract
Receiving an opioid prescription during childhood increases the risk of hazardous prescription opioid (PO) use during emerging adulthood. Instruction on how to safely use POs plays an essential role in pediatric patients’ capacity to utilize as well as to discontinue POs appropriately. This study aimed to evaluate pediatric PO label instructions provided to a large sample of pediatric outpatients. Data were extracted from the electronic healthcare records system identifying pediatric patients who received a PO between 2016 and 2019 from pediatric outpatient medical clinics were affiliated with a northwestern United States medical center and children’s hospital. Pediatric patients (n = 12,613) between 0−17 years old who received a PO during outpatient care were included. Patients with chronic health conditions (e.g., cancer) or who received their PO from an inpatient medical setting were excluded. Patient demographics, medication instructions, associated diagnoses, and other prescription information (e.g., name of medication, dose, and quantity dispensed) were examined using automated text classification. Many label instructions did not include any indication/reason for use (20.8%). Virtually none of the POs (>99%) included instructions for how to reduce/wean off POs, contact information for questions about the POs, and/or instructions around how to dispose of the POs. Efforts are needed to ensure that pediatric PO instructions contain essential elements to improve comprehension of when and how to use POs for pediatric patients.
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21
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[Substance-related disorders and transition psychiatry]. DER NERVENARZT 2022; 93:341-350. [PMID: 35267052 DOI: 10.1007/s00115-022-01266-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Addictive disorders are typically manifested during adolescence and have a high transmission rate into adulthood. When adulthood is reached the responsibility by the child and adolescent psychiatric care system ends and patients transition to adult psychiatry. A lack of supportive concepts and approaches to this transition can have detrimental effects on the long-term health of affected individuals. OBJECTIVE Addiction treatment requirements of young adults transitioning between the systems of care are presented. Developmental psychopathological concepts are presented and treatment recommendations are provided. MATERIAL AND METHODS The scientific literature on development-related approaches to addiction treatment was evaluated. Care conditions relevant to transitional psychiatry are discussed and a description of needs is carried out. RESULTS Adolescents and young adults are very frequently affected by addictive disorders. The need for disorder-specific and age-specific transition-related concepts and services for these patients is high. During the transition from child and adolescent psychiatry to the psychiatric care system for adults, patients with substance-related disorders require treatment-related educational and age-appropriate psychosocial support services that address the high comorbidity and developmental delays. CONCLUSION Age-specific and disorder-specific treatment services should be broadly expanded and the interfaces to youth welfare, addiction counseling and adult psychiatry should be better coordinated.
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22
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Ruberu TLM, Kenyon EA, Hudson KA, Filbey F, Ewing SWF, Biswas S, Choudhary PK. Joint risk prediction for hazardous use of alcohol, cannabis, and tobacco among adolescents: A preliminary study using statistical and machine learning. Prev Med Rep 2022; 25:101674. [PMID: 35127353 PMCID: PMC8800066 DOI: 10.1016/j.pmedr.2021.101674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/23/2021] [Accepted: 12/12/2021] [Indexed: 11/17/2022] Open
Abstract
A risk prediction model for hazardous substance use among adolescents is proposed. The model predicts risk of hazardous use of alcohol, cannabis, and tobacco jointly. It uses statistical and machine learning methods for modeling of multiple outcomes. It may help identify adolescent users at elevated risk of hazardous substance use.
For some, substance use during adolescence may be a stepping stone on the way to substance use disorders in adulthood. Risk prediction models may help identify adolescent users at elevated risk for hazardous substance use. This preliminary analysis used cross-sectional data (n = 270, ages 13–18) from the baseline dataset of a randomized controlled trial intervening with adolescent alcohol and/or cannabis use. Models were developed for jointly predicting quantitative scores on three measures of hazardous substance use (Rutgers Alcohol Problems Index, Adolescent Cannabis Problem Questionnaire, and Hooked on Nicotine Checklist) based on personal risk factors using two statistical and machine learning methods: multivariate covariance generalized linear models (MCGLM) and penalized multivariate regression with a lasso penalty. The predictive accuracy of a model was evaluated using root mean squared error computed via leave-one-out cross-validation. The final proposed model was an MCGLM model. It has eleven risk factors: age, early life stress, age of first tobacco use, age of first cannabis use, lifetime use of other substances, age of first use of other substances, maternal education, parental attachment, family cigarette use, family history of hazardous alcohol use, and family history of hazardous cannabis use. Different subsets of these risk factors feature in the three outcome-specific components of this joint model. The quantitative risk estimate provided by the proposed model may help identify adolescent substance users of cannabis, alcohol, and tobacco who may be at an elevated risk of developing hazardous substance use.
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23
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Rømer Thomsen K, Thylstrup B, Kenyon EA, Lees R, Baandrup L, Feldstein Ewing SW, Freeman TP. Cannabinoids for the treatment of cannabis use disorder: New avenues for reaching and helping youth? Neurosci Biobehav Rev 2021; 132:169-180. [PMID: 34822876 DOI: 10.1016/j.neubiorev.2021.11.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 11/16/2022]
Abstract
Cannabis use peaks during adolescence and emerging adulthood, and cannabis use disorder (CUD) is associated with a wide range of adverse outcomes. This is particularly pertinent in youth, because the developing brain may be more vulnerable to adverse effects of frequent cannabis use. Combining evidence-based psychosocial interventions with safe and effective pharmacotherapy is a potential avenue to improve youth outcomes, but we lack approved CUD pharmacotherapies. Here, we review new potential avenues for helping youth with CUD, with a particular focus on cannabinoid-based treatments. Evidence from placebo-controlled RCTs suggests synthetic delta-9-tetrahydrocannabinol (THC) decreases withdrawal symptoms, but not cannabis use, in adults with daily cannabis use/CUD, while findings regarding formulations containing THC combined with cannabidiol (CBD) are mixed. Preliminary evidence from two placebo-controlled RCTs in adults with CUD suggests that both Fatty Acid Amide Hydrolase inhibitors and CBD can reduce cannabis use. However, larger trials are needed to strengthen the evidence. Findings from adults point to cannabinoid-based treatments as a potential strategy that should be examined in youth with CUD.
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Affiliation(s)
- Kristine Rømer Thomsen
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioral Sciences, Aarhus University, Denmark.
| | - Birgitte Thylstrup
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioral Sciences, Aarhus University, Denmark
| | - Emily A Kenyon
- Department of Psychology, University of Rhode Island, USA
| | - Rachel Lees
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK
| | - Lone Baandrup
- Mental Health Centre Copenhagen and Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Sarah W Feldstein Ewing
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioral Sciences, Aarhus University, Denmark; Department of Psychology, University of Rhode Island, USA
| | - Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK
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Abstract
PURPOSE Alcohol and cannabis are the most commonly used substances during adolescence and are typically initiated during this sensitive neurodevelopmental period. The aim of this review is to provide a comprehensive overview of the most recent literature focused on understanding how these substances affect the developing brain. SEARCH METHODS Articles included in this review were identified by entering 30 search terms focused on substance use, adolescence, and neurodevelopment into MEDLINE, Embase, PsycINFO, ProQuest Central, and Web of Science. Studies were eligible for inclusion if they longitudinally examined the effect of adolescent alcohol and/or cannabis use on structural or functional outcomes in 50 or more participants. SEARCH RESULTS More than 700 articles were captured by the search, and 43 longitudinal studies met inclusion criteria, including 18 studies focused on alcohol use, 13 on cannabis use, and 12 on alcohol and cannabis co-use. DISCUSSION AND CONCLUSIONS Existing studies suggest heavy alcohol and cannabis use during adolescence are related to small to moderate disruptions in brain structure and function, as well as neurocognitive impairment. The effects of alcohol use include widespread decreases in gray matter volume and cortical thickness across time; slowed white matter growth and poorer integrity; disrupted network efficiency; and poorer impulse and attentional control, learning, memory, visuospatial processing, and psychomotor speed. The severity of some effects is dependent on dose. Heavy to very heavy cannabis use is associated with decreased subcortical volume and increased frontoparietal cortical thickness, disrupted functional development, and decreased executive functioning and IQ compared to non-using controls. Overall, co-use findings suggest more pronounced effects related to alcohol use than to cannabis use. Several limitations exist in the literature. Sample sizes are relatively small and demographically homogenous, with significant heterogeneity in substance use patterns and methodologies across studies. More research is needed to clarify how substance dosing and interactions between substances, as well as sociodemographic and environmental factors, affect outcomes. Larger longitudinal studies, already underway, will help clarify the relationship between brain development and substance use.
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Affiliation(s)
- Briana Lees
- Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Camperdown, Australia
| | - Jennifer Debenham
- Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Camperdown, Australia
| | - Lindsay M Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
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25
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Meisel SN, Padovano HT, Miranda R. Combined pharmacotherapy and evidence-based psychosocial Cannabis treatment for youth and selection of cannabis-using friends. Drug Alcohol Depend 2021; 225:108747. [PMID: 34052685 PMCID: PMC8282736 DOI: 10.1016/j.drugalcdep.2021.108747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/13/2021] [Accepted: 03/27/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Theoretical models of behavior change argue that youth should decrease their time with cannabis-using friends and increase their time with non-using friends during treatment. Informed by behavior-change models of recovery and socialization and selection peer-influence models, the current study examined whether combining evidence-based psychosocial treatment with adjunctive pharmacotherapy helps youth decrease their affiliations with cannabis-using friends and increase their affiliations with non-using friends during cannabis misuse treatment. METHODS Youth ages 15-24 years (51 % male), participated in a double-blind randomized clinical trial that tested the effects of motivational enhancement and cognitive behavioral therapy (MET-CBT) plus topiramate (N = 39) or placebo (N = 26) on cannabis craving and use. Ecological momentary assessment data, collected via smartphones throughout the six-week intervention, assessed youths' time with cannabis-using and non-using friends, cannabis use, and craving in daily life. Multiple group multilevel structural equation modeling tested study hypotheses. RESULTS Across the topiramate (48 % completion rate) and placebo (77 % completion rate) conditions, greater time spent with cannabis-using friends promoted greater next day cannabis use and craving (socialization effect). In turn, cannabis craving, but not use, promoted continued selection of cannabis-using friends. This indirect effect was only supported in the placebo condition due to the selection piece of this cycle not being significant for youth who received topiramate. Neither cannabis craving nor use were associated with time with non-using friends the next day. CONCLUSIONS MET-CBT and adjunctive topiramate pharmacotherapy interrupted youth selection processes. This finding suggests that changing peer affiliations could be one mechanism by which treatments can work.
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Affiliation(s)
- Samuel N. Meisel
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, 02912, USA.; E. P. Bradley Hospital, Riverside, RI 02915
| | | | - Robert Miranda
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, 02912, USA; E. P. Bradley Hospital, Riverside, RI, 02915, USA.
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Meisel SN, Carpenter RW, Treloar Padovano H, Miranda R. Day-level shifts in social contexts during youth cannabis use treatment. J Consult Clin Psychol 2021; 89:251-263. [PMID: 34014688 DOI: 10.1037/ccp0000647] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Social context plays a critical role in youth cannabis use. Yet few studies have examined if and when social contexts shift during cannabis use treatment. This study examined daily shifts in youths' social contexts with the goal of characterizing how specific social contexts (e.g., time with cannabis-using friends or siblings) relate to cannabis craving and use during cannabis treatment. METHOD Participants were 65 cannabis users (51% male), ages 15-24 years, who participated in a double-blind randomized clinical trial that tested the effects of motivational enhancement and cognitive behavioral therapies plus either adjunctive pharmacotherapy or placebo on cannabis craving and use. Ecological momentary assessment (EMA) data, collected from a pre-randomization period through the completion of the six-week intervention, assessed youths' social contexts, cannabis use, and craving. RESULTS Time-varying effects models identified shifts in social contexts during treatment. Overall, time spent with cannabis-using friends and siblings decreased, where time spent with non-using friends or alone increased across the trial. Time with parents or non-using siblings was unchanged. Comparing the relative associations of social contexts with same-day craving and use, more time with cannabis-using friends and with siblings was uniquely associated with greater craving and use. CONCLUSIONS Social context is an important factor in youth substance-use treatment. While time spent with cannabis-using friends and siblings decreased over treatment for all participants, those who continued to spend time with using individuals reported greater craving and use. This research supports increased attention to shifting youths' social contexts to enhance treatment success. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Lees B, Garcia AM, Debenham J, Kirkland AE, Bryant BE, Mewton L, Squeglia LM. Promising vulnerability markers of substance use and misuse: A review of human neurobehavioral studies. Neuropharmacology 2021; 187:108500. [PMID: 33607147 PMCID: PMC8129990 DOI: 10.1016/j.neuropharm.2021.108500] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 01/11/2023]
Abstract
Substance use often begins, and noticeably escalates, during adolescence. Identifying predictive neurobehavioral vulnerability markers of substance use and related problems may improve targeted prevention and early intervention initiatives. This review synthesizes 44 longitudinal studies and explores the utility of developmental imbalance models and neurobehavioral addiction frameworks in predicting neural and cognitive patterns that are associated with prospective substance use initiation and escalation among young people. A total of 234 effect sizes were calculated and compared. Findings suggest that aberrant neural structure and function of regions implicated in reward processing, cognitive control, and impulsivity can predate substance use initiation, escalation, and disorder. Functional vulnerability markers of substance use include hyperactivation during reward feedback and risk evaluation in prefrontal and ventral striatal regions, fronto-parietal hypoactivation during working memory, distinctive neural patterns during successful (fronto-parietal hyperactivation) and failed response inhibition (frontal hypoactivation), and related cognitive deficits. Structurally, smaller fronto-parietal and amygdala volume and larger ventral striatal volume predicts prospective substance misuse. Taken together, the findings of this review suggest that neurobehavioral data can be useful in predicting future substance use behaviors. Notably, little to no research has empirically tested the underlying assumptions of widely used theoretical frameworks. To improve the reliability and utility of neurobehavioral data in predicting future substance use behaviors, recommendations for future research are provided. This article is part of the special issue on 'Vulnerabilities to Substance Abuse.'
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Affiliation(s)
- Briana Lees
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Australia.
| | - Alexis M Garcia
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, USA
| | - Jennifer Debenham
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Australia
| | - Anna E Kirkland
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, USA
| | - Brittany E Bryant
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, USA
| | - Louise Mewton
- Centre for Healthy Brain Ageing, University of New South Wales, Australia
| | - Lindsay M Squeglia
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, USA
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Connery HS, McHugh RK, Welsh JW. Commentary on Monico et al.: The urgent need for developmental competency and effective policy to prevent youth opioid overdose. Addiction 2021; 116:874-875. [PMID: 33474775 DOI: 10.1111/add.15322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Hilary S Connery
- McLean Hospital Division of Alcohol, Drugs, and Addiction/Harvard Medical School, Boston, MA, USA
| | - R Kathryn McHugh
- McLean Hospital Division of Alcohol, Drugs, and Addiction/Harvard Medical School, Boston, MA, USA
| | - Justine W Welsh
- Addiction Services, Emory Healthcare/Emory University School of Medicine, Atlanta, GA, USA
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Schmiege SJ, Magnan RE, Yeater EA, Feldstein Ewing SW, Bryan AD. Randomized Trial to Reduce Risky Sexual Behavior Among Justice-Involved Adolescents. Am J Prev Med 2021; 60:47-56. [PMID: 33341180 PMCID: PMC7755031 DOI: 10.1016/j.amepre.2020.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Justice-involved adolescents are at high risk for sexually transmitted infections; one primary reason is co-occurring substance use. This study investigates the additive benefit of including alcohol and cannabis use content in a theory-based sexual risk reduction intervention, delivered using group-based motivational enhancement therapy. STUDY DESIGN This study had a cluster randomized design, with randomization of single-sex clusters to 1 of 3 interventions. SETTING/PARTICIPANTS Participants were male and female justice-involved adolescents (N=460) residing in youth detention facilities. Data were collected from 2010 to 2014; analyses were completed in 2018-2019. INTERVENTION Adolescents were randomized to 1 of 3 motivational enhancement therapy interventions: sexual risk reduction intervention, sexual risk reduction intervention with alcohol content, or sexual risk reduction intervention with alcohol and cannabis content. MAIN OUTCOME MEASURES The primary outcome was risky sexual behavior (aggregation of condom use and frequency of intercourse), measured every 3 months for 1 year. Secondary outcomes were theoretical mechanisms on which the intervention was based (condom use attitudes, self-efficacy, peer norms, and behavioral intentions), collected at baseline and post-test. RESULTS Risky sexual behavior significantly decreased from baseline to 3-month follow-up (t=10.59, p<0.001) and this decrease was maintained 1 year later (t=9.04, p<0.001). Intervention was associated with improved values on all theoretical mechanisms. Although all outcomes improved over time, changes did not differ by intervention condition (p>0.29 for all). Comparisons to a historical, information-only, sexual risk reduction control arm conducted with a similar juvenile justice sample confirm the effectiveness of all 3 motivational enhancement therapy-based interventions. CONCLUSIONS All 3 interventions were associated with decreased sexual risk up to 1 year later, suggesting that the intervention modality (motivational enhancement therapy) may resonate with this population beyond the specific substance use content. This single-session manualized intervention can be readily disseminated to juvenile justice settings. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01170260.
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Affiliation(s)
- Sarah J Schmiege
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Renee E Magnan
- Department of Psychology, Washington State University Vancouver, Vancouver, Washington
| | - Elizabeth A Yeater
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | | | - Angela D Bryan
- Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado
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Postdischarge Outcomes of Adolescents Attending a Long-term Addiction Treatment Program. ADDICTIVE DISORDERS & THEIR TREATMENT 2020. [DOI: 10.1097/adt.0000000000000227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hesse M, Vallentin-Holbech L, Thomsen KR. Which Youth Are at Risk for Cannabis Use Disorders? Boys and Girls Are Not the Same! J Adolesc Health 2020; 67:7-8. [PMID: 32564808 DOI: 10.1016/j.jadohealth.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Morten Hesse
- Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
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Abstract
Purpose of Review This review summarizes (1) recent trends in delta-9-tetrahydrocannabionol [THC] and cannabidiol (CBD) content in cannabis products, (2) neurobiological correlates of cannabis use on the developing adolescent brain, (3) effects of cannabis on psychiatric symptoms and daily functioning in youth (i.e., academic performance, cognition, sleep and driving), (4) cannabis products used to relieve or treat medical issues in youth, and (5) available treatments for cannabis use disorder in adolescence. Recent findings Despite marked increases in THC content and availability of cannabis, there has been a decline in perceived risk and an increase in use of THC extract products among youth in the United States. The primary psychiatric symptoms associated with cannabis use in youth are increased risk for addiction, depressive, and psychotic symptoms. Cannabis alters endocannabinoid system function which plays a central role in modulating the neurodevelopment of reward and stress systems. To date, few studies have examined neurobiological mechanisms underlying the psychiatric sequalae of cannabis exposure in youth. Adolescent cannabis exposure results in impaired cognition, sleep, and driving ability. There are very limited FDA-approved cannabinoid medications, none of them supporting their use for the treatment of psychiatric symptoms. Behavioral therapies are currently the mainstay of treating cannabis misuse, with no pharmacotherapies currently approved by the FDA for cannabis use disorder in youth. Summary Here, we summarize the most up-to-date knowledge on the neurobiological psychiatric, and daily function effects of the most commonly used cannabinoids, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). We then review FDA approved medical use of cannabinoid treatments as well as pharmacological and psychological treatments for cannabis use disorder in youth. Our current understanding of the effects of cannabis on the developing brain and treatments for cannabis misuse in youth remain limited. Future research aimed at examining the neurobiological effects of cannabis, with objective measures of exposure, over the course of pediatric development and in relation to psychiatric symptoms are needed.
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Thayer RE, Hansen NS, Prashad S, Karoly HC, Filbey FM, Bryan AD, Feldstein Ewing SW. Recent tobacco use has widespread associations with adolescent white matter microstructure. Addict Behav 2020; 101:106152. [PMID: 31639638 DOI: 10.1016/j.addbeh.2019.106152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 09/01/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
IMPORTANCE Given the prevalence of alcohol, cannabis, and tobacco use during adolescence, it is important to explore the relative relationship of these three substances with brain structure. OBJECTIVE To determine associations between recent alcohol, cannabis, and tobacco use and white and gray matter in a large sample of adolescents. DESIGN, SETTING, AND PARTICIPANTS MRI data were collected in N = 200 adolescents ages 14-18 (M = 15.82 years; 67% male; 61% Hispanic/Latino). On average, during the past month, participants reported consuming 2.05 drinks per 1.01 drinking day, 0.64 g per 6.98 cannabis use days, and 2.49 cigarettes per 12.32 smoking days. MAIN OUTCOMES AND MEASURES General linear models were utilized to examine past 30-day average quantities of alcohol, cannabis, and tobacco use, age, sex, and sex by substance interactions in skeletonized white matter (fractional anisotropy and axial, radial, and mean diffusivity) and voxel-based morphometry of gray matter (volume/density). RESULTS Tobacco use was negatively associated with white matter integrity (radial and mean diffusivity) with peak effects in inferior and superior longitudinal fasciculi. Cannabis use was negatively associated with white matter integrity (axial diffusivity) in a small cluster in the left superior longitudinal fasciculus. No associations were observed between recent alcohol use and white or gray matter overall, but interactions showed significant negative associations between alcohol use and white matter in females. CONCLUSIONS AND RELEVANCE It is important to note that recent tobacco use, particularly given the popularity of e-tobacco/vaping in this age group, had widespread associations with brain structure in this sample of adolescents.
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Karoly HC, Ross JM, Ellingson JM, Feldstein Ewing SW. Exploring Cannabis and Alcohol Co-Use in Adolescents: A Narrative Review of the Evidence. J Dual Diagn 2020; 16:58-74. [PMID: 31519143 PMCID: PMC7007306 DOI: 10.1080/15504263.2019.1660020] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Amidst the evolving policy surrounding cannabis legalization in the United States, cannabis use is becoming increasingly prevalent as perceptions of harm decrease, particularly among adolescents. Cannabis and alcohol are commonly used by adolescents and are often used together. However, developmental research has historically taken a "single substance" approach to examine the association of substance use and adolescent brain and behavior rather than examining co-(or poly-substance) use of multiple substances, such as cannabis and alcohol. Thus, the acute effects of cannabis and alcohol, and the impact of co-use of cannabis and alcohol on the adolescent brain, cognitive function and subsequent psychosocial outcomes remains understudied. This narrative review aims to examine the effects of cannabis and alcohol on adolescents across a number of behavioral and neurobiological outcomes. Methods: The PubMed and Google Scholar databases were searched for the last 10 years to identify articles reporting on acute effects of cannabis and alcohol administration, and the effects of cannabis and alcohol on neuropsychological, neurodevelopmental, neural (e.g., structural and functional neuroimaging), and psychosocial outcomes in adolescents. When adolescent data were not available, adult studies were included as support for potential areas of future direction in adolescent work. Results: Current studies of the impact of cannabis and alcohol on adolescent brain and behavior have yielded a complicated pattern. Some suggest that the use of cannabis in addition to alcohol during adolescence may have a "protective" effect, yielding neuropsychological and structural brain outcomes that are better than those for adolescents who use only alcohol. However, other adolescent studies suggest that cannabis and alcohol co-use is associated with negative health and social outcomes such as poorer academic performance and impaired driving. Conclusion: Variation in study methodologies, policy-level limitations and our limited understanding of the developmental neurobiological effects of cannabis preclude the straightforward interpretation of the existing data on adolescent cannabis and alcohol use. Further research on this topic is requisite to inform the development of effective intervention and prevention programs for adolescent substance users, which hinge on a more comprehensive understanding of how cannabis-and its intersection with alcohol-impacts the developing brain and behavior.
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Affiliation(s)
- Hollis C Karoly
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, Colorado, USA
| | - J Megan Ross
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, Colorado, USA
| | - Jarrod M Ellingson
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Sarah W Feldstein Ewing
- Department of Child & Adolescent Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
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Halladay J, Scherer J, MacKillop J, Woock R, Petker T, Linton V, Munn C. Brief interventions for cannabis use in emerging adults: A systematic review, meta-analysis, and evidence map. Drug Alcohol Depend 2019; 204:107565. [PMID: 31751868 DOI: 10.1016/j.drugalcdep.2019.107565] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/11/2019] [Accepted: 07/11/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE This systematic review summarizes and critically appraises the existing literature on brief interventions (BIs) for cannabis use among emerging adults. METHODS Eligible BIs were operationalized as 1-2 sessions focused exclusively on cannabis use for samples with mean ages between 15 and 30. Outcomes related to cannabis use, other substance use, mental health, help-seeking, or functional status were included. Two independent reviewers screened a total of 3638 records, identifying 244 studies for full-text screening. In total, 32 BIs in 26 primary studies with 6318 participants were included. RESULTS Participants were typically not seeking treatment and using cannabis at least once a month. Most interventions were motivational, single sessions, and delivered in person. Few discussed concurrent psychiatric conditions. Pooling results at 1-3 months post-intervention, BIs compared to passive control slightly reduced symptoms of cannabis use disorder (SMD -0.14 [95% CI -0.26 to -0.01]) and increased the odds of abstinence (OR 1.73 [95% CI 1.13-2.66]). Other outcome results often favored BIs but were not significant. Results of studies comparing types of BIs (k = 8) or BIs to longer interventions (k = 1) are discussed narratively. Quality assessment suggested low to very low-quality evidence. CONCLUSIONS This review indicates that BIs targeting non-treatment seeking emerging adults result in significant reductions in symptoms of cannabis use disorder and an increased likelihood of cannabis abstinence, however evidence is of low quality.
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Affiliation(s)
- Jillian Halladay
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada.
| | - Justin Scherer
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5th St, Hamilton, Ontario, L8N 3K7, Canada.
| | - James MacKillop
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5th St, Hamilton, Ontario, L8N 3K7, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4S4, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4S4, Canada.
| | - Rachel Woock
- Department of Health, Aging, and Society, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4S4, Canada.
| | - Tashia Petker
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5th St, Hamilton, Ontario, L8N 3K7, Canada.
| | - Vanessa Linton
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada.
| | - Catharine Munn
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4S4, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4S4, Canada.
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Methodological Advances in Leveraging Neuroimaging Datasets in Adolescent Substance Use Research. CURRENT ADDICTION REPORTS 2019; 6:495-503. [PMID: 32714741 DOI: 10.1007/s40429-019-00275-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose of Review Recent innovations in the statistical analysis of neuroimaging data related to adolescent substance use are highlighted. Going beyond assumptions of homogeneity in small studies of regional localization, the focus is on novel approaches that integrate across regions of the brain and levels of analysis in order to detect individual differences in use along with antecedents and consequences. Recent Findings Three analysis approaches are considered. Multimodal approaches like the construct-network framework combine neural, behavioral (including cognitive), and self-report indicators to create comprehensive representations of risk factors for adolescent substance use. Machine learning approaches link adolescent substance use to complex patterns of brain activity detected using prediction-focused algorithms. Person-specific approaches reflect heterogeneity in functional brain connectivity associated with adolescent substance use. Summary When applied to specialized datasets, multimodal, machine learning, and person-specific approaches have significant potential to provide unique insights into the neural processes underlying adolescent substance use.
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Squeglia LM, Fadus MC, McClure EA, Tomko RL, Gray KM. Pharmacological Treatment of Youth Substance Use Disorders. J Child Adolesc Psychopharmacol 2019; 29:559-572. [PMID: 31009234 PMCID: PMC6727439 DOI: 10.1089/cap.2019.0009] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
While the majority of youth who experiment with alcohol and drugs do not develop problematic levels of use, 5% of adolescents and 15% of young adults meet criteria for a substance use disorder (SUD). Pharmacotherapy, in combination with behavioral interventions, has the potential to increase the likelihood of successful treatment for youth struggling with SUD; however, the literature in this area is limited. To date, there are no Food and Drug Administration (FDA)-approved medications for adolescent SUD, other than buprenorphine, which has been approved down to 16 years of age for opioid use disorder. Despite alcohol and cannabis being the most commonly used substances during adolescence, only three medications have been tested among this demographic, and only two have warranted further study (i.e., naltrexone for alcohol and N-acetylcysteine for cannabis use disorder). Although less common in adolescents and young adults, the most promising pharmacological findings for this age group are for opioid (buprenorphine) and tobacco (bupropion and varenicline) use disorders. In addition, despite the recent marked increases in electronic nicotine delivery systems (i.e., vaping) among youth, treatment strategies are still in their infancy and no recommendation exists for how to promote cessation for youth vaping. Current findings are limited by: small, demographically homogeneous samples; few trials, including a substantial number of youth younger than 18; low retention; medication adherence rates; and minimal information on effective dosing levels and long-term outcomes. Overall, pharmacotherapy may be a potentially effective strategy to increase treatment effects; however, more rigorous research trials are warranted before FDA approval would be granted for any of the potential adjunctive medications in this age group.
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Affiliation(s)
- Lindsay M. Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.,Address correspondence to: Lindsay M. Squeglia, PhD, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC 29425
| | - Matthew C. Fadus
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Erin A. McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Rachel L. Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
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Feldstein Ewing SW, Chung T. Precuneus: A Key on the Road to Translation. Alcohol Res 2019; 43:1063-1065. [PMID: 30892706 DOI: 10.1111/acer.14026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/14/2019] [Indexed: 01/30/2023] Open
Affiliation(s)
- Sarah W Feldstein Ewing
- Department of Child and Adolescent Psychiatry , Oregon Health and Science University, Portland, Oregon
| | - Tammy Chung
- Department of Psychiatry , Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania
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