Early age of alcohol initiation is not the cause of alcohol use disorders in adulthood, but is a major indicator of genetic risk. A population-based twin study

Alcohol consumption and lower risk of cardiovascular and all-cause mortality: the impact of accounting for familial factors in twins

BACKGROUND

A moderate to high alcohol consumption is associated with a lower risk of cardiovascular disease (CVD) mortality in comparison with low consumption. The mechanisms underlying this association are not clear and have been suggested to be caused by residual confounding. The main objective of this study was to separate the familial and individual risk for CVD mortality and all-cause mortality related to alcohol consumption. This will be done by estimating the risk for CVD mortality and all-cause mortality in twin pairs discordant for alcohol consumption.

METHODS

Alcohol consumption was assessed at two time points using self-report questionnaires in the Norwegian Twin Registry. Data on CVD mortality was obtained from the Norwegian Cause of Death Registry. Exposure-outcome associations for all-cause mortality and mortality due to other causes than CVD were estimated for comparison.

RESULTS

Coming from a family with moderate to high alcohol consumption was protective against cardiovascular death (HR = 0.54, 95% CI 0.65-0.83). Moderate and high alcohol consumption levels were associated with a slightly increased risk of CVD mortality at the individual level (HR = 1.33, 95% CI 1.02-1.73). There was no association between alcohol consumption and all-cause mortality both at the familial nor at the individual level.

CONCLUSIONS

The protective association of moderate to high alcohol consumption with a lower risk of CVD mortality was accounted for by familial factors in this study of twins. Early life genetic and environmental familial factors may mask an absence of health effect of moderate to high alcohol consumption on cardiovascular mortality.

Prevalence and Factors Associated with Alcohol Consumption Among Secondary School Students in Nekemte, Ethiopia: A Cross-Sectional Study

Background

Alcohol consumption is a major public health concern among adolescents and young adults. Adolescence is an important period of human growth. Alcohol consumption during this age will lead to a variety of problems: health, social, economic, etc. Further, research studies have shown that alcohol consumption, both at normal and above normal levels, will lead to a wide range of health problems. The purpose of this study is to evaluate the prevalence and associated factors for alcohol consumption among secondary school students in Nekemte town, East Wollega Zone, Ethiopia, in 2022.

Methods

A school-based cross-sectional research design approach is used. The data is collected using a structured and self-administered questionnaire. Through systematic random sampling, 291 out of 15,798 students ranging from 9 through 12 grades are chosen. The students selected from each school are proportional to their total strength.

Results

The study is conducted on 291 participants with a mean age of 17.5 ± 1.5 years. Of them, 49.8% are males, and the remaining 50.2% are females. It revealed that 27.84% of participants consume alcohol: 30.3% males and 25.3% females. Age (AOR: 2.755, 95% CI: 1.307-5.809), Urban location (AOR: 1.674, 95% CI: 0.962-2.914), Smoking (AOR: 0.426, 95% CI: 0.104-1.740), Chewing Khat (AOR: 2.185, 95% CI: 0.539-8.855), Having friends who drink (AOR: 1.740, 95% CI: 0.918-3.300), and having a family member who drinks alcohol. All these categories are significantly (p<0.05) associated with alcohol use.

Conclusion

The effects of alcohol consumption and its risks of mental illness, chronic illness, and social problems in adulthood are not completely understood by school students. Alcoholism can be eradicated using educational, preventive, and motivating measures. Special attention should be given to young people and their coping mechanisms against alcohol use.

Interstrain differences in adolescent fear conditioning after acute alcohol exposure

Adolescent sensitivity to alcohol is a predictor of continued alcohol use and misuse later in life. Thus, it is important to understand the many factors that can impact alcohol sensitivity. Data from our laboratory suggested that susceptibility to alcohol-associated contextual fear learning deficits varied among adolescent and adult mice from two mouse strains. To investigate the extent of genetic background's influences on adolescent learning after alcohol exposure, we examined how 9 inbred mouse strains differed in vulnerability to alcohol-induced contextual and cued fear conditioning deficits. We demonstrated significant strain- and sex-dependent effects of acute alcohol exposure on adolescent fear learning, with alcohol having most pronounced effects on contextual fear learning. Female adolescents were more susceptible than males to alcohol-induced impairments in contextual, but not cued, fear learning, independent of genetic background. Heritability for contextual and cued fear learning after alcohol exposure was estimated to be 31 % and 18 %, respectively. Learning data were compared to Blood Ethanol Concentrations (BEC) to assess whether strain differences in alcohol metabolism contributed to strain differences in learning after alcohol exposure. There were no clear relationships between BEC and learning outcomes, suggesting that strains differed in learning outcomes for reasons other than strain differences in alcohol metabolism. Genetic analyses revealed polymorphisms across strains in notable genes, such as Chrna7, a promising genetic candidate for susceptibility to alcohol-induced fear conditioning deficits. These results are the first to demonstrate the impact of genetic background on alcohol-associated fear learning deficits during adolescence and suggest that the mechanisms underlying this sensitivity are distinct from alcohol metabolism.

Alcohol Use among High School Learners in the Peri-Urban Areas, South Africa: A Descriptive Study on Accessibility, Motivations and Effects

Learners are vulnerable to alcohol use and its negative effects, largely due to accessibility of alcohol products, especially in the localities with poor socioeconomic status and infrastructure. This study aimed to determine the accessibility, motivations and effects of alcohol use among high school learners (n = 403) in Tshwane North and West, South Africa, using a descriptive, cross-sectional design. Data were collected using a validated questionnaire and analysed using STATA 17. Learners (16 ± 2 years) had poor demographic status and lifestyle behaviors. Availability of alcohol outlets (54%) near schools was reported, and learners indicated easy access (65%) to taverns and bottle stores (30%), and purchasing alcohol without a proof of identity document (70%). Motivations for alcohol use were self-pleasure (36%), coping with stress (24%) and increasing self-esteem (19%). Almost half of the learners (49%) introduced themselves to alcohol use, while others were influenced by friends (36%) and family (14%). Reported alcohol related effects were a negative impact on health (56%), brain function (25%) and school work (12%), in addition to social harms, including problems with friends (25%) and parents (17%), physical fights (19%) and engaging in risky sexual behaviour (11%). Effective strategies are necessary to address underage alcohol use and should include regulating the proximity of alcohol outlets to schools, life skills training to address learners’ drinking motives and constantly alerting parents about the relevance of modeling behaviour.

Accessibility and availability of alcohol outlets around schools: An ecological study in the city of Madrid, Spain, according to socioeconomic area-level

Neighborhood accessibility and availability of alcohol products has been associated with increased alcohol consumption and harms among adolescents. This availability has been shown to be higher in neighborhoods with lower socio-economic status (SES). The aim of this study was to examine inequalities in alcohol outlet density and proximity around schools by area-level SES in Madrid, Spain. Data on schools, SES, alcohol outlets and population density at census tract level were obtained through public databases from the local government of Madrid. We examined (1) density as the number of alcohol outlets around schools within 3 buffers (i.e. 200 m, 400 m and 800 m) and (2) proximity as the distance from schools to their nearest alcohol outlet. We performed multilevel analyses to examine the associations between alcohol outlet density and proximity and SES, adjusted by population density. Secondary schools (n = 576) located in less deprived areas had lower densities of alcohol outlets at walking distances of 200 and 400 m (50% and 37% lower, respectively p < 0.05). No significant differences were found for the proximity measures. The socioeconomic level of the area in which adolescents go to school is a determinant of their exposure to alcohol, where those who study in high SES areas have lower exposure to alcohol outlets. This study highlights the need to prioritize equity in the design and implementation of policies to limit alcohol accessibility among adolescents, including establishing minimum distances between schools and alcohol outlets or limiting the number of outlets per inhabitant in neighborhoods.

High Prevalence and Early Onsets: Legal and Illegal Substance Use in an Urban Cohort of Young Adults in Switzerland

INTRODUCTION

Debates about the legalization of illegal substances (e.g., cannabis) continue around the globe. A key consideration in these debates is the adequate protection of young people, which could be informed by current prevalence and age-of-onset patterns. For Switzerland, such information is limited, which is particularly true for women, despite advanced political efforts to legalize cannabis. The objective of the current study was to investigate substance use prevalence rates and ages of onset in a community-representative sample of female and male young adults in Switzerland.

METHODS

Data came from the Zurich Project on the Social Development from Childhood to Adulthood (z-proso). In 2018, participants (N = 1,180, 50.8% females) were ∼20 years old. Lifetime and past-year use of alcohol, tobacco, cannabinoids, stimulants, hallucinogens, opioids, and benzodiazepines were assessed with an extensive substance use questionnaire. Additionally, ages of onsets of the respective substances were estimated by averaging participants' self-reported ages of onsets from ages 13 to 20 (max. 4 assessments).

RESULTS

57% of 20-year-olds had used cannabinoids, 16% stimulants, 15% opioids (mostly codeine), and 8% hallucinogens in the past year. Males had higher prevalence than females for most drugs; nevertheless, females' prevalence rates were notably high. Legal substance use was typically initiated 1.3-2.7 years before legal selling age. Thus, almost half of the sample had consumed alcohol and tobacco by age 14. More than 40% of the total sample had smoked cannabis by age 16. Males initiated use of legal substances and cannabis earlier than females.

DISCUSSION

Our recent community-representative data suggested unexpectedly high levels and early onsets of substance use compared to a previous Swiss surveys and also the European average. Drug policy debates should consider urban substance use patterns when considering legalization efforts.

Externalizing Risk Pathways for Adolescent Substance Use and Its Developmental Onset: A Canadian Birth Cohort Study: Trajectoires de comportements extériorisés et le risque pour l'initiation et l'usage de substances des adolescents : Une étude de cohorte de naissance canadienne

OBJECTIVE

Only a minority of drug and alcohol users develops a substance use disorder. Previous studies suggest that this differential vulnerability commonly reflects a developmental trajectory characterized by diverse externalizing behaviors. In this study, we examined the relation between child and adolescent externalizing behaviors and adolescent substance use in a prospectively followed Canadian birth cohort, accounting for the temporal sequence of a wide variety of contributing factors.

METHODS

Two hundred and forty-two adolescents followed since birth (date range: 1996 to 2012) were assessed on externalizing behavior (age 17 months to 16 years), alcohol and cannabis use at age 16, age of alcohol use onset, family history of substance use problems, family functioning (age 11 to 15), sensation seeking (age 16), prenatal substance exposure, socioeconomic status (age 1 to 9), and sex.

RESULTS

Age of alcohol use onset was predicted by a family history of substance use problems, externalizing traits from ages 6 to 10 and 11 to 16, sensation seeking at age 16, prenatal alcohol and tobacco exposure and family functioning at ages 11 to 15. High frequencies of alcohol and cannabis use at age 16 were both predicted by externalizing traits from ages 11 to 16, a family history of substance use problems and sensation seeking after controlling for other individual, environmental and familial variables. The association between familial substance use problems and substance use during adolescence was partially mediated by externalizing traits from age 11 to 16.

CONCLUSIONS

The present findings provide prospective evidence for a developmental risk pathway for adolescent substance use, potentially identifying those who could benefit from early interventions.

Correlates of transitions from alcohol use to disorder diagnosed by DSM-5 in China

BACKGROUND

This study aimed to describe the prevalence and lifetime criteria profiles of DSM-5 alcohol use disorder (AUD) and the transitions from alcohol use to disorder in Chifeng, China.

METHODS

Face-to-face interviews were conducted using Composite International Diagnostic Interview-3.0 (CIDI-3.0) among 4528 respondents in Chifeng.

RESULTS

The weighted lifetime and 12-month prevalence of DSM-5 AUD were 3.03 and 1.05%, respectively. Mild lifetime AUD was the most prevalent severity level (69.53%). The two most common criteria were "failure to quit/cutdown" and "drinking more or for longer than intended." Lifetime prevalence was 65.59% for alcohol use, and 22.97% for regular drinking. Male and domestic violence were risk factors for the transition from alcohol use to regular drinking or AUD and from regular drinking to AUD. Younger age was risk factor for the transition to AUD from alcohol use or regular drinking. Poverty (OR = 2.49) was risk factor for the transition from alcohol use to regular drinking. The earlier drinkers were more likely to develop to regular drinking (OR = 2.11).

CONCLUSION

AUD prevalence in Chifeng was not as high as that in Western countries. The study revealed that multiple risk factors might contribute to the transition across different stages of alcohol use. Further research should explore the underlying mechanisms.

Adult and adolescent C57BL/6J and DBA/2J mice are differentially susceptible to fear learning deficits after acute ethanol or MK-801 treatment

Ethanol and other drugs of abuse disrupt learning and memory processes, creating problems associated with drug use and addiction. Understanding individual factors that determine susceptibility to drug-induced cognitive deficits, such as genetic background, age, and sex, is important for prevention and treatment. Comparison of adolescent and adult mice of both sexes across inbred mouse strains can reveal age, sex, and genetic contributions to phenotypes. We treated adolescent and adult, male and female, C57BL/6J and DBA/2J inbred mice with ethanol (1 g/kg or 1.5 g/kg) or MK-801 (0.05 mg/kg or 0.1 mg/kg), an NMDA receptor antagonist, prior to fear conditioning training. Contextual and cued fear retention were tested one day and eight or nine days after training. After ethanol exposure, adult C57BL/6J mice experienced greater deficits in contextual learning than adult DBA/2J mice. C57BL/6 J adolescents were less susceptible to ethanol-induced contextual learning disruptions than C57BL/6J adults, and adolescent males of both strains exhibited greater ethanol-induced contextual learning deficits than adolescent females. After MK-801 exposure, adolescent C57BL/6J mice experienced more severe contextual learning deficits than adolescent DBA/2J mice. Both ethanol and MK-801 had greater effects on contextual learning than cued learning. Collectively, we demonstrate that genetic background contributes to contextual and cued learning outcomes after ethanol or MK-801 exposure. Further, we report age-dependent drug sensitivities that are strain-, sex-, and drug-specific, suggesting that age, sex, and genetic background interact to determine contextual and cued learning impairments after ethanol or MK-801 exposure.

Alcohol-related mortality following the loss of a child: a register-based follow-up study from Norway

OBJECTIVES

The death of one's child is one of the most stressful events a person can experience. Research has shown that bereaved parents have a higher mortality than non-bereaved parents. This increased mortality might partly be caused directly by long-term stress. However, changes in health behaviour such as an increase in alcohol consumption might also play a role. This study examines the association between losing a child and alcohol-related mortality. In addition to Cox regression models using data covering the entire Norwegian adult population, we employ sibling fixed-effect models in order to partly control for genes and childhood experiences that might be associated with both losing a child and alcohol-related mortality.

DESIGN

A follow-up study between 1986 and 2014 based on Norwegian register data.

SETTING

Norway.

PARTICIPANTS

The entire Norwegian adult population.

PRIMARY OUTCOME MEASURE

Alcohol-related mortality.

RESULTS

An increased alcohol-related mortality was found among parents who had experienced the death of a child. The HR of alcohol-related mortality among those bereaved of a child was 1.59 (95% CI 1.48 to 1.71) compared with non-bereaved parents, for women 2.03 (95% CI 1.78 to 2.32) and for men 1.46 (95% CI 1.34 to 1.59). After including sibling fixed effects, the HR of alcohol-related mortality among parents who had lost a child was 1.30 (95% CI 1.03 to 1.64).

CONCLUSIONS

This study provides evidence of an elevated alcohol-related mortality among parents who have lost a child compared with non-bereaved parents. Although strongly attenuated, there is still an association when adjusting for genetic predisposition for alcohol problems as well as childhood environment using sibling fixed-effect models.

[Substance-related disorders in adolescence and young adulthood]

Substance-related disorders in adolescence and young adulthood Abstract. Adolescence is a critical period for the onset of addiction and comorbid psychological disorders. Although substance use disorders (SUD) are among the most prevalent psychiatric conditions and a leading cause for hospitalization in the young population, young people with SUD can be considered an underserved population. Existing capacities for the provision of specific health services including withdrawal treatment for young SUD patients are inadequate, and medical rehabilitation facilities are lacking almost completely. Because SUD often becomes a chronic condition with high degree of relapse, from a life-course perspective this demands a highly connected healthcare structure at the intersection of child and adolescent and adult psychiatry as well as other health services. These interconnected services must be sensitive to the developmental needs and aspects of adolescent SUD, such as motivational, social, and educational factors. Moreover, there is a need for ongoing and often multidisciplinary support during the transition from child and adolescent to adult psychiatry with a transparent medical documentation and clear allocation of costs. The establishment and formative evaluation of (specific) medical rehabilitation facilities for children, adolescents, and young adults is highly recommended to improve the current healthcare situation for young SUD patients.

The epidemiology of alcohol use disorders cross-nationally: Findings from the World Mental Health Surveys

BACKGROUND

Prevalences of Alcohol Use Disorders (AUDs) and Mental Health Disorders (MHDs) in many individual countries have been reported but there are few cross-national studies. The WHO World Mental Health (WMH) Survey Initiative standardizes methodological factors facilitating comparison of the prevalences and associated factors of AUDs in a large number of countries to identify differences and commonalities.

METHODS

Lifetime and 12-month prevalence estimates of DSM-IV AUDs, MHDs, and associations were assessed in the 29 WMH surveys using the WHO CIDI 3.0.

RESULTS

Prevalence estimates of alcohol use and AUD across countries and WHO regions varied widely. Mean lifetime prevalence of alcohol use in all countries combined was 80%, ranging from 3.8% to 97.1%. Combined average population lifetime and 12-month prevalence of AUDs were 8.6% and 2.2% respectively and 10.7% and 4.4% among non-abstainers. Of individuals with a lifetime AUD, 43.9% had at least one lifetime MHD and 17.9% of respondents with a lifetime MHD had a lifetime AUD. For most comorbidity combinations, the MHD preceded the onset of the AUD. AUD prevalence was much higher for men than women. 15% of all lifetime AUD cases developed before age 18. Higher household income and being older at time of interview, married, and more educated, were associated with a lower risk for lifetime AUD and AUD persistence.

CONCLUSIONS

Prevalence of alcohol use and AUD is high overall, with large variation worldwide. The WMH surveys corroborate the wide geographic consistency of a number of well-documented clinical and epidemiological findings and patterns.

Consequences of alcohol use, and its association with psychological distress, sensitivity to emotional contagion and age of onset of alcohol use, in Uruguayan youth with or without college degree

Psychological distress can promote alcohol consumption during emerging adulthood. Still unknown is, however, how predisposition to emotional contagion alters psychological distress, and how these phenomena are affected by level of education. The present study analyzed the effect of psychological distress, age of first contact with alcohol (early, late), and predisposition to emotional contagion on alcohol-induced negative consequences and on the volume of alcohol consumed during the last year. We also described alcohol-use behaviors as a function of sex, maximum level of education and age of first contact with alcohol, in 1505 youth from Uruguay (18-30 years). A survey measured alcohol use (Alcohol Use Disorders Identification Test and ad-hoc questionnaire), negative consequences of alcohol use [young adult alcohol consequences questionnaire (YAACQ)], psychological distress (Kessler scale) and proclivity to emotional contagion (Doherty Emotional contagion scale). The patterns of alcohol use were greater in men vs. women and in those featuring an early age of first alcohol use, yet similar in college and non-college graduates. Early drinkers had greater levels of psychological distress than late-onset drinkers. There was a significant bivariate and multiple correlation between psychological distress and the number of negative consequences of alcohol experienced during the last year, which remained significant even after controlling for total volume of alcohol consumed. Significant associations emerged between YAACQ scores and frequency of heavy episodic or binge drinking, and between psychological distress and emotional contagion, but not between emotional contagion and any of the remaining variables. Psychological distress was not significantly correlated with heavy episodic or binge drinking. The study indicates that, during adolescence and youth, psychological distress is associated with experiencing negative consequences of alcohol consumption. The study also suggested that greater levels of psychological distress may underlie the facilitating effect of an early age of drinking onset upon alcohol drinking patterns.

Does a mindfulness-augmented version of the German Strengthening Families Program reduce substance use in adolescents? Study protocol for a randomized controlled trial

BACKGROUND

Mindfulness training (MT) for parents of adolescents has been shown to improve mental health and stress-related outcomes in individuals and their families. Studies of MT among young people are mainly delivered in educational or clinical settings, and there is a need for controlled studies on both parent-directed and adolescent-directed approaches. It is unclear whether MT has preventive effects for substance use outcomes. The primary objective of this trial is to evaluate the effectiveness of family-based MT targeting both adolescents and their parents to prevent adolescent substance use and enhance neurobehavioral self-regulation skills that play a major role in addiction development and mental health.

METHODS/DESIGN

The trial design is a superiority, two-arm, randomized controlled trial in which families will participate either in the full curriculum of the evidence-based Strengthening Families Program 10-14 (SFP 10-14, German adaptation) or in a mindfulness-enhanced version of this program (SFP-Mind). Both seven-session interventions are highly structured and will each be delivered over a period of approximately 7 weeks. The experimental intervention SFP-Mind is a modified version of the SFP 10-14 in which some elements were eliminated or changed to enable the inclusion of additional parent-directed and adolescent-directed mindfulness components. The primary outcome is adolescent self-reported alcohol use based on an alcohol initiation index at 18-month follow-up. Dispositional mindfulness, impulsivity, and emotion regulation will be included as secondary outcomes and potential mechanisms of action. The study will recruit and randomize 216 adolescents, aged 10-14 years, and their parents who will be followed up for 18 months.

DISCUSSION

This trial aims to evaluate the effectiveness of SFP-Mind for family-based prevention of substance use and promoting mental health in adolescence.

TRIAL REGISTRATION

German Register of Clinical Studies, DRKS00015678. Registered on 25 February 2019.

Predictors of Alcohol Use Disorders Among Young Adults: A Systematic Review of Longitudinal Studies

AIMS

Alcohol use disorders (AUDs) are highly disabling neuropsychiatric conditions. Although evidence suggests a high burden of AUDs in young adults, few studies have investigated their life course predictors. It is crucial to assess factors that may influence these disorders from early life through adolescence to deter AUDs in early adulthood by tailoring prevention and intervention strategies. This review aims to assess temporal links between childhood and adolescent predictors of clinically diagnosed AUDs in young adults.

METHODS

We systematically searched PubMed, Scopus, PsycINFO and Embase databases for longitudinally assessed predictors of AUDs in young adults. Data were extracted and assessed for quality using the Newcastle-Ottawa quality assessment tool for cohort studies. We performed our analysis by grouping predictors under six main domains.

RESULTS AND CONCLUSION

Twenty two studies met the eligibility criteria. The outcome in all studies was measured according to the Diagnostic Statistical Manual of Mental Disorders. Our review suggests strong links between externalizing symptoms in adolescence and AUDs in young adulthood, as well as when externalizing symptoms co-occur with illicit drug use. Findings on the role of internalizing symptoms and early drinking onset were inconclusive. Environmental factors were influential but changed over time. In earlier years, maternal drinking predicted early adult AUD while parental monitoring and school engagement were protective. Both peer and parental influences waned in adulthood. Further high-quality large longitudinal studies that identify distinctive developmental pathways on the aetiology of AUDs and assess the role of early internalizing symptoms and early drinking onset are warranted.

Comparing the potential causal influence of two indicators of early alcohol use on later alcohol use disorder symptoms

Age of first drink (AFD) has repeatedly been found to be associated with alcohol use disorder (AUD); however, some studies suggest this is a noncausal effect that may be due to childhood risk factors or familial influences. In contrast to indicators of any early alcohol use, such as AFD, indicators of a pattern of repeated drinking may be more likely to be causally associated with later problematic alcohol use. The current study examined AFD and age of onset of regular drinking (ARD; defined as drinking at least once a month for 6 or more months) as quasicausal predictors of lifetime AUD symptoms. Participants were 3,005 adult Australian twins who reported having been regular drinkers in their lifetime. Semistructured interviews were conducted to assess AFD, ARD, AUD, externalizing symptomatology, and other substance use. Personality traits were assessed via questionnaire. Unadjusted and adjusted multilevel discordant twin models were conducted using data from 1,041 complete twin pairs; adjusted models included socioeconomic status, personality, conduct disorder, and early initiation of regular smoking and marijuana use as covariates. Results from fully adjusted models controlling for familial confounds provided evidence for a causal influence of ARD on AUD symptoms, whereby twins with an earlier age of regular drinking than their cotwin had more lifetime AUD symptoms. However, AFD did not significantly predict AUD symptoms after adjusting for confounds. These results suggest that early regular drinking may serve as a causal risk factor for future problems, while early initiation of any alcohol use may indicate genetic liability. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Childhood Trauma and Two Stages of Alcohol Use in African American and European American Women: Findings from a Female Twin Sample

The current investigation assessed for moderating effects of childhood trauma on genetic and environmental contributions to timing of alcohol use initiation and alcohol use disorder in African American (AA) and European American (EA) women. Data were drawn from diagnostic telephone interviews conducted with 3786 participants (14.6% AA) in a longitudinal female twin study. Childhood trauma was defined alternately as child maltreatment and more broadly to include other events (e.g., witnessing violence). Phenotypic associations between childhood trauma and alcohol outcomes were estimated using logistic regression analyses. Twin modeling was conducted to test for moderating effects of childhood trauma on the contributions of genetic and environmental factors to timing of initiation and alcohol use disorder. Under both definitions, childhood trauma was associated with early initiation (relative risk ratios: 1.90, 1.72) and alcohol use disorder (odds ratios: 1.92, 1.76). Yet gene by environment effects were observed only for child maltreatment and timing of initiation in EA women, with heritable influences less prominent in those who had experienced child maltreatment (0.35, 95% CI: 0.05-0.66 vs. 0.52, 95% CI: 0.30-0.73). We found more similarities than differences in the association of childhood trauma with alcohol outcomes across racial/ethnic groups, trauma type, and stages of alcohol use. However, findings suggest that the relative contribution of genetic factors to alcohol outcomes differs by childhood maltreatment history in EA women specifically in the earliest stage of alcohol use.

Changes in Externalizing Behaviors After Children First Have an Alcoholic Drink and First Drink Heavily

OBJECTIVE

Proximal changes in externalizing behaviors before and after children and early adolescents have their first alcoholic drink and first heavy drinking episode are examined using intergenerational, prospective data from the ongoing U.K. national Millennium Cohort Study (10,529 child-parent pairs followed over 35,406 occasions).

METHOD

We examined how within-person changes in externalizing behaviors (based on parental reports on the Strengths and Difficulties scale when children were modal ages 5, 7, 11, and 14 years) follow children's age at first alcoholic drink (AFD) and age at first heavy drinking (AFHD), based on confidential child self-reports at ages 11 and 14 years. Analyses controlled for child age, time-varying parent-level confounders (parental education and alcohol abstention), and time-stable selection factors.

RESULTS

Estimates from fixed-effects Poisson models revealed a 5% increase in the expected count of externalizing behaviors after children have their first alcoholic drink (incidence rate ratio [IRR] = 1.05, 95% CI [1.03, 1.07]), and a 13% increase after first drinking heavily (IRR = 1.13, 95% CI [1.09, 1.18]), independent of key time-varying and all time-stable individual differences.

CONCLUSIONS

Early AFHD and unobserved time-stable selection factors partially explain relationships between early drinking and problem behaviors, but early AFD continues to be a significant predictor of externalizing behavior. Although prevention efforts should continue to discourage heavy drinking in childhood and early adolescence, the results suggest that both AFHD and AFD should be delayed.

Altered brain cortical maturation is found in adolescents with a family history of alcoholism

Substance-naïve offspring from high-density alcohol use disorder (AUD) families exhibit altered subcortical brain volumes structurally and altered executive-functioning and emotion-processing functionally, compared with their peers. However, there is a dearth of literature exploring alterations of cortical thickness (CTh) in this population. T1-weighted structural brain MRI was acquired in 75 substance-naïve male offspring of treatment-seeking early onset (<25 years) AUD patients with high familial loading of AUDs (≥2 affected relatives) (FHP) and 65 age-matched substance-naïve male controls with negative family history from the community. Surface-based CTh reconstruction was done using FreeSurfer. Univariate general linear models were implemented at each vertex using SurfStat, controlling for age (linear and quadratic effects), and head size, to examine the main effect of familial AUD risk on CTh and its relationship with externalizing symptom score (ESS). A Johnson-Neyman procedure revealed that the main effect of familial AUD risk on CTh was seen during adolescence, where the FHP group had thicker cortices involving bilateral precentral gyri, left caudal middle frontal gyrus (MFG), bilateral temporo-parietal junction, left inferior-frontal gyrus and right inferior-temporal gyrus. Thicker cortices in left MFG and inferior-parietal lobule were also associated with greater ESS within both groups. More importantly, these group differences diminished with age by young adulthood. Familial AUD risk is associated with age-related differences in maturation of several higher order association cortices that are critical to ongoing development in executive function, emotion regulation and social cognition during adolescence. Early supportive intervention for a delay in alcohol initiation during this critical phase may be crucial for this at-risk population.

The effect of voluntary wheel running on 129/SvEvTac and C3H/Ibg alcohol consumption

The mesolimbic dopaminergic reward pathway is activated by both alcohol and exercise, suggesting exercise as a possible treatment or preventative method for alcohol-use disorders (AUDs). Prior studies conducted in our lab have demonstrated the hedonic substitution of voluntary alcohol consumption for voluntary wheel running in female C57Bl/6Ibg mice, and a trend in male C57Bl/6Ibg mice. Given the important contribution of genetic background on AUDs, this study aims to assess the effects of voluntary wheel running on voluntary alcohol consumption in two moderate alcohol-consuming strains of mice, C3H/Ibg and 129/SvEvTac. Contrary to our previous studies conducted in C57Bl/6Ibg mice, 129/SvEvTac and male C3H/Ibg mice housed without a wheel consumed significantly more alcohol than mice housed with a free or locked wheel. This suggests that 129/SvEvTac and male C3H/Ibg mice are reducing their alcohol consumption due to an enriched environment and not exercise. Interestingly, the three groups of female C3H/Ibg mice (free wheel, locked wheel, no wheel) did not significantly differ in alcohol consumption, suggesting sex-specific differences in C3H/Ibg mice. In addition, genetic and sex effects were observed for running phenotypes in the presence of alcohol. Female 129/SvEvTac and C57Bl/6Ibg mice ran longer distances than male mice, whereas male and female C3H/Ibg mice did not differ in distance run. C3H/Ibg and female 129/SvEvTav mice with access only to water ran longer distances than mice with access to both alcohol and water. However, this effect was not observed in C57Bl/6Ibg or male 129/SvEvTac mice. The results of this mouse model highlight the importance of genetic background and sex on an animal's response to exercise as an enrichment to reduce voluntary alcohol consumption.

Is the association between maternal alcohol consumption in pregnancy and pre-school child behavioural and emotional problems causal? Multiple approaches for controlling unmeasured confounding

BACKGROUND AND AIMS

Hazardous drinking (i.e. alcohol consumption that places drinkers at risk for adverse health outcomes) during pregnancy is associated with adverse child outcomes. To address whether the associations are causal, we aimed to estimate the effect of maternal hazardous drinking during the first trimester on offspring emotional and behavioural problems throughout the pre-school age. We adjusted for: (1) measured confounding (e.g. smoking), (2) familial risk factors by sibling control design and (3) non-shared environmental risk factors by using hazardous drinking the 3 months before pregnancy as an instrumental variable.

DESIGN

Prospective cohort study. Participants were recruited between 1999 and 2009 at ultrasound examination offered to all pregnant women in Norway. Data were collected during the 17th and the 30th weeks of gestation, and when the children were aged 1.5, 3 and 5 years.

SETTING

Norway, 1999-2015.

PARTICIPANTS

The sample consisted of 14 639 mothers with 25 744 offspring siblings from the Norwegian Mother and Child Cohort Study.

MEASUREMENTS

Respondents self-reported on: alcohol consumption, children's emotional problems (i.e. emotional reactive, anxiety/depression, somatic complaints) and children's behavioural problems (i.e. attention and aggressive behaviour) throughout pre-school age. We used longitudinal latent growth curve models to estimate the effect of maternal drinking during the first trimester on offspring emotional and behavioural problems.

FINDINGS

Most associations were strongly reduced after controlling for both familial and measured environmental risk factors. After adjustment, exposed children were more emotionally reactive [β = 2.33; 95% confidence interval (CI) = 0.13-4.53] and had more somatic complaints (β = 1.93; 95% CI = 0.09-3.77) at age 3, but not at age 5. Exposed children were less aggressive than unexposed siblings at age 5 (β = -2.27; 95% CI = -4.02 to -0.52).

CONCLUSIONS

Children exposed to their mothers' hazardous drinking during the first trimester appear to be more emotionally reactive and have more somatic complaints at age 3, but not at age 5, and are less aggressive at age 5 compared with unexposed siblings.

ELSA cohort 2014: association of age of first drink and progression from first drink to drunkenness on alcohol outcomes in Argentinean college freshmen

Background: College freshman are at-risk for hazardous alcohol drinking and for experiencing alcohol-related negative consequences. This is exacerbated in those featuring an early age of first alcohol use or of first drunkenness. It remains unclear which of these milestones is more strongly associated with alcohol outcomes. Objective: We examined, in Argentinean college drinkers (n = 4088; 43% men; racially and ethnically homogeneous), the association of age at drinking onset and progression to drunkenness (drunkenness naïve [Drunk-Naïve]; No-Delay [same age of first alcohol use and first alcohol intoxication]; one year of delay between age of first alcohol use and first alcohol intoxication; ≥2years of delay) on several alcohol outcomes. Methods: A survey measured substance use, age at drinking and drunkenness onset and alcohol-related consequences. Results: Alcohol consumption per drinking occasion was significantly greater in men than in women. An early drinking onset (alcohol use before age 13) and lifetime drunkenness independently exacerbated alcohol consumption per drinking occasion and during the last year. In men, Early-Onset was associated with a greater number of alcohol-related consequences when the delay between Early-Onset and the first drunkenness episode was 1 or ≥2 years yet did not significantly alter the number of negative consequences in Drunk-naïve or No-delay drinkers. In women, Early-Onset significantly enhanced the number of negative consequences when the delay was two years, but not when the delay was one-year or in Drunk-naïve or No-delay drinkers. Conclusions: The window between the first contact with alcohol and the first episode of drunkenness is a critical period to reduce alcohol-related problems.

Early Adolescent Substance Use and Mental Health Problems and Service Utilisation in a School-based Sample

OBJECTIVE

This paper reports on substance use, mental health problems, and mental health service utilisation in an early adolescent school-based sample.

METHOD

Participants were 1,360 grade 7 and 8 students from 4 regions of Ontario, Canada. Students completed an in-class survey on mental health and substance use. The sampling strategy and survey items on demographics, substance use, service utilisation, and distress were adapted from the Ontario Student Drug Use and Health Survey. Internalising and externalising mental health problems were assessed using the Global Assessment of Individual Needs - Short Screener. Distress was defined as fair or poor self-rated mental health.

RESULTS

Rates of internalising and/or externalising problems above the threshold exceeded 30%; yet, fewer than half had received mental health services in the past 12 mo. Substance use was associated with increased odds of internalising and externalising problems above the threshold and distress. Youth using cannabis had 10-times the odds of exceeding the threshold for internalising or externalising problems. The use of substances other than alcohol or cannabis was associated with increased odds of fair or poor self-rated mental health among grade 8 students. Of the youth who confirmed at least a substance use problem, most also reported mental health problems; this association was stronger among girls than boys.

CONCLUSIONS

Early adolescent substance use was associated with concurrent self-reported mental health problems in a non-clinical sample. The low levels of service utilisation reported highlight the need for improved access to early identification and intervention to prevent the development of concurrent disorders.

Age of alcohol use initiation and psychiatric symptoms among young adult trauma survivors

Alcohol use disorder (AUD) evidences high rates of comorbidity with a range of psychiatric disorders, particularly within high-risk populations, such as individuals exposed to physical or sexual violence. Increasing efforts are focused on understanding the role of early alcohol use (e.g., during adolescence) on emotional and psychiatric functioning over time, as well as sex differences in these associations. The aim of the current study was to evaluate patterns of association between age of initiation of regular alcohol use and posttraumatic stress disorder (PTSD), anxiety, and depressive symptoms as a function of sex. Participants were 269 college students with a history of interpersonal trauma and alcohol use who completed a battery of questionnaires regarding alcohol use and emotional health. Neither bivariate correlations nor results from structural equation models covarying for key factors showed a relationship between age of alcohol use initiation and current psychiatric symptoms among men (n = 63). Results of a structural equation model supported an association between earlier age of alcohol use initiation and greater levels of current PTSD (β = -0.14), anxiety (β = -0.15), and depression symptoms (β = -0.16) in the female sub-sample (n = 202), after controlling for covariates, as well as intercorrelations among criterion variables. Statistical support for sex as a moderator of these associations was not detected. The current study provides preliminary evidence for potential sex differences in the role of early alcohol use in the development of psychiatric symptoms and highlights the need for systematic longitudinal research.

Associations of Early Age of First Intoxication with Past Year Drinking Contexts and Problems

BACKGROUND

Mechanisms underlying associations between early drinking and problems are largely unknown.

OBJECTIVES

We investigated (a) associations between early age of first intoxication (≤15 years) and past year drinking in different contexts and (b) whether early age of first intoxication is differentially associated with problems in these contexts.

METHODS

We used survey data collected in 2013-2014 from 405 past-year adolescent drinkers in 24 midsized California cities. Data included demographics; drinking behaviors; age of first intoxication; frequency of being at and drinking at restaurants, bars/nightclubs, outdoor places, and home; and problems. We used multilevel logistic and negative binomial models to account for the clustering of adolescents within cities. Probabilities were corrected to maintain family-wise error rates.

RESULTS

Early age of first intoxication was associated with a 120% increase in the odds of drinking at outdoor settings (OR = 2.20, p_c < .05). Early age of first intoxication was associated with increased numbers of problems related to drinking in restaurants (IRR = 5.72, p_c < .001), outdoor settings (IRR = 3.40, p_c < .001), and homes (IRR = 2.84, p_c < .001). Later intoxication (≥16 years) was not significantly associated with increased drinking or problems in any of these contexts.

CONCLUSIONS

Results suggest that underage drinkers who report early intoxication are more likely to drink at outdoor settings, but not other contexts. However, they may differentially experience drinking problems across contexts. To target youths who have experienced intoxication at an early age and to reduce problems, prevention interventions should focus on outdoor settings.

Predicting Alcohol Misuse Among Australian 19-Year-Olds from Adolescent Drinking Trajectories

BACKGROUND

Alcohol use in adolescence predicts future alcohol misuse. However, the extent to which different patterns of adolescent use present risk remains unclear.

OBJECTIVES

This study investigated how adolescent trajectories of alcohol consumption during the school years predict alcohol misuse at age 19 years.

METHODS

Data were drawn from 707 students from Victoria, Australia, longitudinally followed for 7 years. Five alcohol use trajectories were identified based on the frequency of alcohol use from Grade 6 (age 12 years) to Grade 11 (age 17 years). At age 19 years, participants completed measures indicating Heavy Episodic Drinking (HED), dependency - Alcohol Use Disorders Identification Test (AUDIT) and social harms.

RESULTS

At 19 years of age, 64% of participants reported HED, 42% high AUDIT scores (8+), and 23% social harms. Participants belonging to a steep escalator trajectory during adolescence had twice the odds at 19 years of age of high AUDIT scores and social harms, and three times greater odds of HED than participants whose alcohol use slowly increased. Stable moderate consumption was also associated with an increased risk of HED compared to slowly increasing use. Abstinence predicted a reduced likelihood of all forms of misuse at 19 years of age compared to slowly increased alcohol use.

CONCLUSIONS

Trajectories of drinking frequency during adolescence predict alcohol misuse at age 19 years. Although rapid increasing use presents the greatest risk, even slowly increasing drinking predicts increased risk compared to abstinence. The findings indicate that alcohol policies should recommend nonuse and reduced frequency of use during adolescence.

Genetically Informative Mediation Modeling Applied to Stressors and Personality-Disorder Traits in Etiology of Alcohol Use Disorder

A statistical mediation model was developed within a twin design to investigate the etiology of alcohol use disorder (AUD). Unlike conventional statistical mediation models, this biometric mediation model can detect unobserved confounding. Using a sample of 1410 pairs of Norwegian twins, we investigated specific hypotheses that DSM-IV personality-disorder (PD) traits mediate effects of childhood stressful life events (SLEs) on AUD, and that adulthood SLEs mediate effects of PDs on AUD. Models including borderline PD traits indicated unobserved confounding in phenotypic path coefficients, whereas models including antisocial and impulsive traits did not. More than half of the observed effects of childhood SLEs on adulthood AUD were mediated by adulthood antisocial and impulsive traits. Effects of PD traits on AUD 5‒10 years later were direct rather than mediated by adulthood SLEs. The results and the general approach contribute to triangulation of developmental origins for complex behavioral disorders.

Relation between age at first alcohol drink & adult life drinking patterns in alcohol-dependent patients

Background & objectives:

Age at first drink has its influence on later life drinking patterns. The association between age at first drink and adult alcohol consumption has not been studied in clinical population. This study was aimed to determine the age at first drink and its correlation with adult life drinking patterns in alcohol-dependent patients.

Methods:

Adult participants with alcohol dependence were included from the inpatient and outpatient wards of a tertiary care de-addiction facility in India. Questionnaires administered were National Institute on Alcohol Abuse and Alcoholism-Quantity Frequency for alcohol and the Fagerstrom Test for Nicotine Dependence for tobacco.

Results:

Of the 99 participants (92% males) with mean age 37±8.36 yr, mean age at first drink was 21.14±5.33 yr. After controlling for age, satisfaction with life scores and smoking, age at first drink showed a significant negative correlation with drinking days per week (r=-0.259, P=0.012), typical drink per day (r=-0.218, P=0.035) and maximum drinks in the previous month/year (r=-0.233, -0.223 and P=0.024, 0.031, respectively).

Interpretation & conclusions:

Our study suggested that earlier age of first drink correlated with chronic heavy drinking patterns in later adult life in alcohol-dependent patients. This may have implications for alcohol control policies determining the age for legal consumption.

The Speed of Progression to Tobacco and Alcohol Dependence: A Twin Study

We investigated the etiological role of genetic and environmental influences for two milestones of tobacco and alcohol use: age of initiation, and speed of progression to dependence (latency). Study participants included 1352 monozygotic and 1422 dizygotic twins (mean age at assessment = 24.31). Earlier ages of initiation significantly increased the likelihood of developing dependence, but were associated with longer dependence latencies for tobacco and alcohol. Latencies to dependence were heritable traits for tobacco (a2 = 0.63) and alcohol (a2 = 0.64). Genetic influences contributing to early age of initiation were associated with faster latencies to dependence but sometimes were counteracted by environmental factors, the extent to which depended on substance and, sometimes, sex. Our findings may have important implications for public policy and add to the literature by characterizing the genetic and environmental contributions to the speed of progression to tobacco and alcohol dependence.

Free will in addictive behaviors: A matter of definition

Certain people are at risk for using alcohol or other drugs excessively and for developing problems with their use. Their susceptibility might arise from a variety of factors, including their genetic make-up, brain chemistry, family background, personality and other psychological variables, and environmental and sociocultural variables. Moreover, after substance use has become established, there are additional cognitive-motivational variables (e.g., substance-related attentional bias) that contribute to enacting behaviors consistent with the person's motivation to acquire and use the substance. People who are at such risk are likely to choose to use addictive substances even though doing so entails negative consequences. In the sense of complete freedom from being determined by causal factors, we believe that there is no such thing as free will, but defined as ability to make choices from among multiple options, even though the choices are ultimately governed by natural processes, addicted individuals are free to choose. Although they might appear unable to exercise this kind of free will in decisions about their substance use, addictive behaviors are ultimately always goal-directed and voluntary. Such goal pursuits manifest considerable flexibility. Even some severely addicted individuals can cease their use when the value of continuing the use abruptly declines or when the subjective cost of continuing the use is too great with respect to the incentives in other areas of their lives. Formal treatment strategies (e.g., contingency management, Systematic Motivational Counseling, cognitive training) can also be used to facilitate this reversal.

Associations between alcohol dehydrogenase genes and alcohol use across early and middle adolescence: Moderation × Preventive intervention

Data from the in-school sample of the PROSPER preventive intervention dissemination trial were used to investigate associations between alcohol dehydrogenase genes and alcohol use across adolescence, and whether substance misuse interventions in the 6th and 7th grades (targeting parenting, family functioning, social norms, youth decision making, and peer group affiliations) modified associations between these genes and adolescent use. Primary analyses were run on a sample of 1,885 individuals and included three steps. First, we estimated unconditional growth curve models with separate slopes for alcohol use from 6th to 9th grade and from 9th to 12th grade, as well as the intercept at Grade 9. Second, we used intervention condition and three alcohol dehydrogenase genes, 1B (ADH1B), 1C (ADH1C), and 4 (ADH4) to predict variance in slopes and intercept. Third, we examined whether genetic influences on model slopes and intercepts were moderated by intervention condition. The results indicated that the increase in alcohol use was greater in early adolescence than in middle adolescence; two of the genes, ADH1B and ADH1C, significantly predicted early adolescent slope and Grade 9 intercept, and associations between ADH1C and both early adolescent slope and intercept were significantly different across control and intervention conditions.

Prediction of alcohol use disorder using personality disorder traits: a twin study

BACKGROUND AND AIMS

The DSM-IV personality disorders (PDs) are comorbid with alcohol use disorder (AUD) and with each other. It remains unclear which PD criteria are most likely to drive onset and recurrence of AUD and which are merely confounded with those criteria. We determine which individual PD criteria predict AUD and the degree of underlying genetic and/or environmental aetiology.

DESIGN

A prospective observational twin study.

SETTING

Norway 1999-2011.

PARTICIPANTS

A total of 2528 and 2275 Norwegian adult twins in waves 1 and 2 variable-selection analyses, and 2785 in biometric analyses.

MEASUREMENTS

DSM-IV PDs and their 80 criteria were assessed using a structured personal interview, and AUD using the World Health Organization's Composite International Diagnostic Interview.

FINDINGS

In a variable-selection analysis, two PD criteria were associated with AUD even after taking all the other criteria into account: criterion 8 of antisocial PD (childhood conduct disorder) and criterion 4 of borderline PD (self-damaging impulsive behaviours). Adjusting for each other, their respective odds ratios were 3.4 [confidence interval (CI) = 2.1-5.4] and 5.0 (CI = 3.3-7.7). Endorsement strength of the criteria was associated with AUD in a dose-response manner and they explained 5.5% of variation in AUD risk-more than the full diagnoses of antisocial and borderline PDs together (0.5%). The association between borderline criterion 4 and AUD 10 years later derived mainly from their overlapping genetic factors, whereas the association between antisocial criterion 8 and AUD 10 years later was due to both genetic and non-genetic factors.

CONCLUSIONS

Conduct disorder and self-harming impulsivity are the foremost risk traits for alcohol use disorder among the 80 personality disorder criteria of DSM-IV, predicting alcohol use disorder more effectively than personality disorder diagnoses. The twin-study analysis suggested that conduct disorder represents a joint genetic and developmental risk for alcohol use disorder and that impulsivity is a genetic risk.

Predicting early onset of intoxication versus drinking-A population-based prospective study of Norwegian adolescents

AIMS

Recent research suggests that early onset of intoxication (EOI) may be of greater importance for a wide range of subsequent adverse outcomes than early drinking experiences without intoxication. However, research on antecedents of EOI is scarce. The present study identifies predictors of EOI and whether they differ from those of early onset of drinking (EOD).

METHODS

Data was drawn from the prospective Tracking Opportunities and Problems (TOPP) study of Norwegian families (n = 382), which followed up mothers and their children with six data collections from childhood (age 1.5) to adolescence (age 14.5). Self-reports from the adolescents (parenting practices, adolescent's conduct problems and friends' deviant behaviour) and their mothers (adolescent temperament, socio-economic factors and household alcohol problems) were used to identify predictors of EOI and EOD.

FINDINGS

A variety of temperamental, socio-economic, and family factors predicted EOI, whereas EOD was predicted of substantially fewer variables. Particularly, when controlling for relevant covariates, low levels of shyness, own conduct problems and having friends with deviant behaviour prospectively predicted EOI, but not EOD.

CONCLUSIONS

Future research and prevention efforts should take into consideration that EOI and EOD without getting drunk appear to be predicted by different risk factors in childhood and adolescence.

Age of first drunkenness and risks for all-cause mortality: A 27-year follow-up from the epidemiologic catchment area study

BACKGROUND

Early-onset drunkenness is associated with an increased risk of developing an alcohol use disorder (AUD), which predicts excess mortality risk. Here, we estimated mortality risk for drinkers with and without early drunkenness.

METHODS

For 14,848 adult participants interviewed about drinking, drunken episodes, and AUD in 1981-83 for the Epidemiologic Catchment Area in New Haven (Connecticut), Baltimore (Maryland), St. Louis (Missouri), and Durham (North Carolina), we linked National Death Index records through 2007.

RESULTS

Cox regression modeling estimates showed excess mortality for drinkers with age of first drunkenness earlier than 15 years old (hazard ratio, HR: 1.47, 95% CI: 1.25, 1.72) and when first drunkenness occurred at or after age 15 (HR: 1.20, 95% CI: 1.11, 1.29), as compared with adults who had never been drunk. Consistent results were observed, irrespective of AUD history. That is, early drunkenness signaled excess mortality risk even in absence of AUD.

CONCLUSIONS

In a large community sample from four cities in the US, early age of onset of drunkenness predicts mortality risk. We discuss experiments to investigate the possible causal significance of this predictive association.

Genetic and environmental sources of covariation between early drinking and adult functioning

The vast majority of individuals initiate alcohol consumption for the first time in adolescence. Given the widespread nature of its use and evidence that adolescents may be especially vulnerable to its effects, there is concern about the long-term detrimental impact of adolescent drinking on adult functioning. While some researchers have suggested that genetic processes may confound the relationship, the mechanisms linking drinking and later adjustment remain unclear. The current study utilized a genetically informed sample and biometric modeling to examine the nature of the familial influences on this association and identify the potential for genetic confounding. The sample was drawn from the Minnesota Twin Family Study (MTFS), a longitudinal study consisting of 2,764 twins assessed in 2 cohorts at regular follow-ups from age 17 to age 29 (older cohort) or age 11 to age 29 (younger cohort). A broad range of adult measures was included assessing substance use, antisocial behavior, personality, socioeconomic status, and social functioning. A bivariate Cholesky decomposition was used to examine the common genetic and environmental influences on adolescent drinking and each of the measures of adult adjustment. The results revealed that genetic factors and nonshared environmental influences were generally most important in explaining the relationship between adolescent drinking and later functioning. While the presence of nonshared environmental influences on the association are not inconsistent with a causal impact of adolescent drinking, the findings suggest that many of the adjustment issues associated with adolescent alcohol consumption are best understood as genetically influenced vulnerabilities. (PsycINFO Database Record

Adolescent Ethanol Exposure Leads to Stimulus-Specific Changes in Cytokine Reactivity and Hypothalamic-Pituitary-Adrenal Axis Sensitivity in Adulthood

Adolescent alcohol use comprises a significant public health concern and is often characterized by binge-like consumption patterns. While ethanol exposure in adulthood has been shown to alter the stress response, including the Hypothalamic–Pituitary–Adrenal (HPA) axis, few studies have examined whether binge-like ethanol exposure during adolescence results in enduring changes in HPA axis sensitivity in adulthood. In the present studies, adolescent Sprague-Dawley rats were given intragastric (i.g.) intubations of ethanol (4 g/kg) or vehicle once per day for three consecutive days, beginning on postnatal day (P) 30 (±1). This exposure was followed by a 2-day period of rest/withdrawal. Rats received a total of either two (Experiments 1, 2 and 3) or four (Experiment 4) cycles of ethanol exposure and were subsequently allowed to age normally until adulthood. In Experiment 1, adult, (P71–75), ethanol- or vehicle-exposed rats received a 60 min restraint stress challenge. In Experiment 2, rats received a 50 μg/kg injection of lipopolysaccharide (LPS). In Experiment 3, rats received a challenge of 2.5 g/kg ethanol (intraperitoneally; i.p.). In Experiment 4, male and female ethanol- or vehicle- exposed rats received a 50 μg/kg injection of LPS. In all experiments, blood samples were collected for later assessment of corticosterone (CORT), blood ethanol concentrations (BECs), and the cellular fraction of blood was analyzed for cytokine gene expression. As expected, all three challenges led to a time-dependent surge in CORT. Gene expression analyses of cytokines (Interleukin [IL]-6, IL-1β, and Tumor necrosis factor alpha [TNFα]) from the cellular fraction of blood revealed unique, time-dependent patterns of cytokine expression depending upon the nature of the adult challenge incurred (restraint, LPS, or EtOH). Importantly, adolescent ethanol exposure led to attenuated restraint and LPS-induced cytokine expression in males, whereas female rats displayed an absence of cytokine alterations, and a tendency toward heightened HPA axis reactivity. These findings suggest that adolescent ethanol exposure may cause lasting alterations in cytokine regulation and HPA axis sensitivity that (a) persist into adulthood; (b) may vary depending on the nature of the challenge incurred during adulthood; and that (c) are sex-specific.

Effects on alcohol use of a Swedish school-based prevention program for early adolescents: a longitudinal study

BACKGROUND

The aim of the study was to address the lack of evaluations of school-based substance use prevention programs and to conduct a quasi-experimental evaluation of the alcohol use part of the Triad intervention.

METHODS

Eleven Swedish intervention schools (285 pupils) and three control schools (159 pupils) participated in the evaluation. Baseline measurements were conducted in 2011 before the alcohol part in the prevention program was implemented in the intervention schools (school year 6, ages 12-13). We estimated an Intention-To-Treat (ITT) Difference-in-Difference (DD) model to analyze the effectiveness of the intervention on subsequent alcohol use measured in grades 7, 8 and 9.

RESULTS

The main results show no effect on the likelihood of drinking alcohol or drinking to intoxication.

CONCLUSIONS

The lack of positive effects highlights the need for policy-makers and public health officials need to carefully consider and evaluate prevention programs in order to ensure that they are worthwhile from school, health, and societal perspectives.

Childhood cigarette and alcohol use: Negative links with adjustment

Children who initiate cigarette or alcohol use early-during childhood or early adolescence-experience a heightened risk of nicotine and alcohol dependence in later life as well as school failure, crime, injury, and mortality. Using prospective intergenerational data from the Millennium Cohort Study (MCS), we investigate the association between early substance use initiation (cigarettes or alcohol) and age 11 school engagement, academic achievement, and wellbeing. The ongoing MCS tracks the development of a nationally representative sample of children in the United Kingdom (born 2000-2002) from infancy through adolescence. At age 11, MCS children (n=13,221) indicated whether they had ever used cigarettes or alcohol; at age 7 and 11 they reported on school engagement and wellbeing and completed investigator-assessed tests of academic achievement. Using propensity score methods, children who had initiated cigarette or alcohol use by age 11 were matched to abstaining children with similar risks (or propensities) of early substance use, based on numerous early life risk and protective factors assessed from infancy to age 7. We then examined whether early initiators differed from non-initiators in age 11 adjustment and achievement. Results show that substance use by age 11 was uncommon (3% cigarettes; 13% alcohol). After matching for propensity for early initiation, school engagement and wellbeing were significantly lower among initiators compared to non-initiators. Academic achievement was not consistently related to early initiation. We conclude that initiation of smoking and drinking in childhood is associated with poorer adjustment.

The Impact of the Minimum Legal Drinking Age on Alcohol-Related Chronic Disease Mortality

BACKGROUND

The minimum legal drinking age (MLDA) of 21 has been associated with a number of benefits compared to lower MLDAs, including long-term effects, such as reduced risk for alcoholism in adulthood. However, no studies have examined whether MLDA during young adulthood is associated with mortality later in life. We examined whether individuals exposed to permissive MLDA (<21) had higher risk of death from alcohol-related chronic disease compared to those exposed to the 21 MLDA. Because prior work suggests that MLDA affects college students differently, we also conducted conditional analyses based on ever having attended college.

METHODS

Data from the 1990 through 2010 U.S. Multiple Cause-of-Death files were combined with data on the living population and analyzed. We included individuals who turned 18 during the years 1967 to 1990, the period during which MLDA varied across states. We examined records on death from several alcohol-related chronic diseases, employing a quasi-experimental approach to control for unobserved state characteristics and stable time trends.

RESULTS

Individuals who reported any college attendance did not exhibit significant associations between MLDA and mortality for the causes of death we examined. However, permissive MLDA for those who never attended college was associated with 6% higher odds for death from alcoholic liver disease, 8% higher odds for other liver disease, and 7% higher odds for lip/oral/pharynx cancers (odds ratio [OR] = 1.06, 95% confidence interval [CI] [1.02, 1.10]; OR = 1.08, 95% CI [1.03, 1.13]; OR = 1.07, 95% CI [1.03, 1.12], respectively).

CONCLUSIONS

The 21 MLDA likely protects against risk of death from alcohol-related chronic disease across the lifespan, at least for those who did not attend college. This is consistent with other work that shows that the long-term association between MLDA and alcohol-related outcomes is specific to those who did not attend college.

Is 'age at first drink' a useful concept in alcohol research and prevention? We doubt that

AIM

To address and discuss the weaknesses of age at first drink (AFD) as a concept in alcohol research and prevention.

METHODS

Narrative literature review.

RESULTS

Varying from one sip to the consumption of several full drinks, and sometimes including the specification of particular conditions (e.g. without parental consent), no exact definition and operationalization of AFD was found. Evidence reveals poor test-retest reliability when the same individuals report their AFD two or more times. Theoretical arguments and empirical evidence fail to explain why having one sip or one drink earlier than peers should cause heavier drinking and related problems later in life. Alternative explanations such as self-selection, third variable effects and systematic report bias are not considered in most studies. These shortcomings also make AFD unsuitable as an indicator or marker of underlying problems such as conduct problems and academic failure. Together with unjustified causal inferences, this has led to an over-emphasis on the relevance of postponing AFD as a way to prevent problems later in life.

CONCLUSION

We argue in favour of shifting the focus of alcohol research and prevention away from AFD towards a better understanding of the progression from infrequent, low-quantity drinking to more detrimental drinking patterns and the prevention of associated acute and short-term harm.

Role of overlapping genetic and environmental factors in the relationship between early adolescent conduct problems and substance use in young adulthood

AIMS

To determine (1) the prospective associations of conduct problems during early adolescence with tobacco, alcohol and cannabis use in young adulthood and (2) to what extent these associations are due to overlapping genetic versus environmental influences.

DESIGN

A prospective twin study using biometric twin modelling.

SETTING

Finland.

PARTICIPANTS

A total of 1847 Finnish twins (943 males and 904 females) were interviewed in early adolescence, 73% of whom (n = 1353, 640 males and 713 females) were retained in young adulthood.

MEASUREMENTS

Symptom counts of conduct disorder (CD) criteria were obtained from a semi-structured clinical interview in early adolescence [age 14-15 years, mean = 14.2, standard deviation (SD) = 0.15]. Frequency of alcohol, tobacco and cannabis use was obtained from a semi-structured clinical interview in young adulthood (age 19.9-26.6 years, mean = 22.4, SD = 0.7).

FINDINGS

We found modest to moderate phenotypical correlations (r = 0.16-0.35) between early adolescent CD symptoms and substance use in young adulthood. In males, the phenotypical correlations of CD symptoms with all three substance use variables are explained largely by overlapping genetic influences. In females, overlapping shared environmental influences predominantly explain the phenotypical correlation between CD symptoms and tobacco and cannabis use.

CONCLUSIONS

Conduct disorder symptoms in early adolescence appear to moderately predict substance use in early adulthood. In males, genetic influences seem to be most important in explaining the relationship between conduct disorder symptoms and substance use whereas in females, shared environmental influences seem to be most important.

Did the 18 Drinking Age Promote High School Dropout? Implications for Current Policy

OBJECTIVE

Disagreement exists over whether permissive minimum legal drinking age (MLDA) laws affected underage adolescents (e.g., those age 17 years with the MLDA of 18). We used MLDA changes during the 1970s and 1980s as a natural experiment to investigate how underage exposure to permissive MLDA affected high school dropout.

METHOD

MLDA exposure was added to two data sets: (a) the 5% public use microdata samples of the 1990 and 2000 censuses (n = 3,671,075), and (b) a combined data set based on the 1991-1992 National Longitudinal Alcohol Epidemiological Survey (NLAES) and the 2001-2002 National Epidemiological Survey on Alcohol and Related Conditions (NESARC; n = 16,331). We used logistic regression to model different thresholds of MLDA on high school dropout. We also estimated models conditioned on demographic variables and familial risk of developing alcohol problems.

RESULTS

Only the MLDA of 18 predicted high school dropout. Exposure was associated with 4% and 13% higher odds of high school dropout for the census and NLAES/NESARC samples, respectively. We noted greater impact on women (5%-18%), Blacks (5%-19%), and Hispanics (6%). Self-report of parental alcohol problems was associated with 40% higher odds, which equals a 4.14-point increase in dropout rate for that population.

CONCLUSIONS

The MLDA of 18 likely had a large impact on high school dropout rates, suggesting that the presence of legal-aged peers in a high school setting increased access to alcohol for younger students. Our results also suggest that policy can promote less dangerous drinking behavior even when familial risk of alcohol use disorders is high.

Why young people's substance use matters for global health

During puberty, when young people are completing their education, transitioning into employment, and forming longer-term intimate relationships, a shift in emotional regulation and an increase in risky behaviour, including substance use, is seen. This Series paper considers the potential effects of alcohol, tobacco, and illicit drug use during this period on: social, psychological, and health outcomes in adolescence and young adulthood; role transitions, and later health and social outcomes of regular substance use initiated in adolescence; and the offspring of young people who use substances. We sourced consistent support for causal relations between substance use and outcomes and evidence of biological plausibility from different but complementary research designs. Many adverse health and social outcomes have been associated with different types of substance use. The major challenge lies in deciding which are causal. Furthermore, qualitatively different harms are associated with different substances, differences in life stage when these harms occur, and the quality of evidence for different substances and health outcomes varies substantially. The preponderance of evidence comes from a few high-income countries, thus whether the same social and health outcomes would occur in other countries and cultures is unclear. Nonetheless, the number of harms that are causally related to substance use in young people warrant high-quality research design interventions to prevent or ameliorate these harms.

Concurrent and prospective associations between bullying victimization and substance use among Australian adolescents

BACKGROUND

Adolescence is a vulnerable time for both substance use and bullying involvement; however, there is limited research on substance use among adolescent victims of bullying. This study aimed to examine concurrent and prospective associations between bullying and substance use, differentiating between passive-victims, bully-victims and 'pure' bullies.

METHOD

Associations between bullying involvement and substance use at baseline and 24 months post-baseline were examined in a cohort of adolescents in Australia. Bullying victims were divided into passive-victims (those who get bullied and do not bully others) and bully-victims (those who both get bullied and bully others). Perpetrators of bullying were divided into 'pure' bullies (those who bully others but do not get bullied), and bully-victims (as above). Outcomes examined were past six month use of alcohol (any drinking; risky drinking), tobacco, and cannabis.

RESULTS

While there was no evidence of an association between bullying victimization and/or perpetration and substance use at baseline, there was evidence of an association between bullying and substance use 24 months post-baseline. Specifically, there was evidence of increased odds of risky drinking and cannabis use for the bully-victim group.

CONCLUSIONS

Bully-victim status at age 13 was associated with substance use at age 15, controlling for concurrent bullying involvement at age 15. Bully-victims are a particularly high-risk group that could benefit from targeted substance use preventive interventions. Reducing bullying is of great importance in reducing substance use and other harms among adolescents.

Detecting initiation or risk for initiation of substance use before high school during pediatric well-child check-ups

BACKGROUND

Youth substance use (SU) is prevalent and costly, affecting mental and physical health. American Academy of Pediatrics and Affordable Care Act call for SU screening and prevention. The Youth Risk Index(©) (YRI) was tested as a screening tool for having initiated and propensity to initiate SU before high school (which forecasts SU disorder). YRI was hypothesized to have good to excellent psychometrics, feasibility and stakeholder acceptability for use during well-child check-ups.

DESIGN

A high-risk longitudinal design with two cross-sectional replication samples, ages 9-13 was used. Analyses included receiver operating characteristics and regression analyses.

PARTICIPANTS

A one-year longitudinal sample (N=640) was used for YRI derivation. Replication samples were a cross-sectional sample (N=345) and well-child check-up patients (N=105) for testing feasibility, validity and acceptability as a screening tool.

RESULTS

YRI has excellent test-retest reliability and good sensitivity and specificity for concurrent and one-year-later SU (odds ratios=7.44, CI=4.3-13.0) and conduct problems (odds ratios=7.33, CI=3.9-13.7). Results were replicated in both cross-sectional samples. Well-child patients, parents and pediatric staff rated YRI screening as important, acceptable, and a needed service.

CONCLUSIONS

Identifying at-risk youth prior to age 13 could reap years of opportunity to intervene before onset of SU disorder. Most results pertained to YRI's association with concurrent or recent past risky behaviors; further replication ought to specify its predictive validity, especially adolescent-onset risky behaviors. YRI well identifies youth at risk for SU and conduct problems prior to high school, is feasible and valid for screening during well-child check-ups, and is acceptable to stakeholders.