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Saputra F, Uthis P, Sukratul S. Conduct problems among middle adolescents in the community settings: A concept analysis. BELITUNG NURSING JOURNAL 2023; 9:293-301. [PMID: 37645575 PMCID: PMC10461166 DOI: 10.33546/bnj.2670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/07/2023] [Accepted: 07/04/2023] [Indexed: 08/31/2023] Open
Abstract
Background Adolescent problem behavior in research and practice has been traditionally categorized as Oppositional Deviant Disorder and Conduct Disorder. However, a significant number of adolescents remain underdiagnosed. To address this issue, the term "Conduct Problem" has emerged as a commonly used descriptor for those who have not yet received a formal diagnosis, particularly within the community. It is crucial for nurses to comprehend the characteristics of these conduct problems to address them effectively. Objective This concept analysis aimed to clarify the concept of conduct problems among adolescents aged 14 to 16, specifically within community settings. Methods The concept analysis followed Walker and Avant's approach. The usage of the concept was examined in five databases (PsyINFO, ProQuest, PubMed, ScienceDirect, Scopus), which yielded 41 relevant studies for comprehensive analysis. Results The identified attributes of conduct problems in adolescents included oppositional problems, antisocial problems, and criminal-related problems. These conduct problems were found to have antecedents stemming from personal, parental, and environmental factors. Furthermore, the consequences of conduct problems significantly impacted both middle adolescents and their parents. Conclusion The findings of this concept analysis contribute to a better comprehension of the concept of conduct problems among middle adolescents in community settings. The insights gained from this analysis will assist in using this term more effectively in research and nursing practice, ultimately leading to improved care and support for affected adolescents and their families.
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Affiliation(s)
- Fauzan Saputra
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
| | - Penpaktr Uthis
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
| | - Sunisa Sukratul
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
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Coughlin LN, Bonar EE, Wieringa J, Zhang L, Rostker MJ, Augustiniak AN, Goodman GJ, Lin LA. Pilot trial of a telehealth-delivered behavioral economic intervention promoting cannabis-free activities among adults with cannabis use disorder. J Psychiatr Res 2023; 163:202-210. [PMID: 37224772 DOI: 10.1016/j.jpsychires.2023.05.012] [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: 01/16/2023] [Revised: 04/11/2023] [Accepted: 05/01/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Cannabis is increasingly consumed and increasingly perceived as harmless. Among those whose use develops into a cannabis use disorder (CUD), <5% initiate and engage in treatment. Thus, novel options for low-barrier, appealing treatments are needed to foster engagement in care. METHODS We conducted an open trial of a telehealth-delivered multicomponent behavioral economic intervention for non-treatment-engaged adults with CUD. Participants with CUD were recruited from a health system and screened for eligibility. Participants completed behavioral economic indices (cannabis demand, proportionate cannabis-free reinforcement), measures of cannabis use and mental health symptoms, and provided open-ended feedback on the intervention experience. RESULTS Of the 20 participants who enrolled and engaged in the initial intervention session, 70% (14 out of 20) completed all intervention components. All participants were satisfied/very satisfied with the intervention and 85.7% reported the telehealth delivery made it at least slightly easier/more likely for them to receive substance use care. Baseline to immediate post-treatment, behavioral economic cannabis demand decreased (intensity: Hedges' g = 0.14, maximum total expenditure: Hedges' g = 0.53, maximum expenditure for a single hit: Hedges' g = 0.10) and proportionate cannabis-free reinforcement (Hedges' g = 0.12) increased. Past-month total cannabis use decreased by 8.9% from baseline to post-treatment (Hedges' g = 0.39), along with decreases in recent depression (Hedges' g = 0.50) and anxiety symptoms (Hedges' g = 0.29). DISCUSSION These preliminary findings suggest that this behavioral economic intervention was highly acceptable and feasible for adults with untreated CUD. Changes in potential mechanisms of behavior change (cannabis demand, proportionate cannabis-free reinforcement) were consistent with reduced frequency of cannabis use and improved mental health outcomes.
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Affiliation(s)
- Lara N Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Injury Prevention Center, University of Michigan, Ann Arbor, MI, 48109, USA.
| | - Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Injury Prevention Center, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Joshua Wieringa
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Lan Zhang
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Matthew J Rostker
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Alyssa N Augustiniak
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Grant J Goodman
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Lewei Allison Lin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Injury Prevention Center, University of Michigan, Ann Arbor, MI, 48109, USA; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Kim S, Kim D. Behavioral symptoms of child mental disorders and lifetime substance use in adolescence: A within-family comparison of US siblings. Drug Alcohol Depend 2021; 219:108490. [PMID: 33385692 DOI: 10.1016/j.drugalcdep.2020.108490] [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: 08/07/2020] [Revised: 11/18/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Childhood attention deficit hyperactivity disorder (ADHD) is found to be a risk factor for substance use in adolescence, but literature has suggested that the observed influence of ADHD may be driven by the comorbid conduct disorder (CD) or oppositional defiance disorder (ODD). We examine whether childhood ADHD and CD influence lifetime use of substances, independent of other comorbid mental problems and familial risk factors. METHODS A total of 712 sibling pairs from a nationally representative US longitudinal survey were followed from 1997 to 2015. The Behavior Problems Index (BPI) was used to measure mental disorders in children. The hyperactive, antisocial, headstrong, anxious/depressed subscales of the BPI for ADHD, CD, ODD, anxiety/depression of children were assessed by their biological mothers who were the primary caregiver. Lifetime substance use by age 18 was measured by self-reports. A within-family design was used to minimize confounding. RESULTS After controlling for mother fixed effects and comorbid mental disorders, symptoms of ADHD were not associated with lifetime substance use in adolescence except for regular smoking, while those of CD were positively and significantly associated with heightened risk for lifetime use of cannabis, regular smoking, cocaine, barbiturates, tranquilizers, hallucinogens, and inhalants in adolescence. CONCLUSIONS The results suggest that the association observed between childhood ADHD and substance use in adolescence may be driven by comorbid CD whose influences are robust to other mental disorders or unobserved familial factors.
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Affiliation(s)
- Seongju Kim
- Department of Psychiatry, Ajou University School of Medicine and Graduate School of Medicine, Suwon, South Korea
| | - Dohyung Kim
- Department of Economics, Myongji University, Seoul, South Korea.
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Hogue A, Bobek M, MacLean A. Core Elements of CBT for Adolescent Conduct and Substance Use Problems: Comorbidity, Clinical Techniques, and Case Examples. COGNITIVE AND BEHAVIORAL PRACTICE 2020; 27:426-441. [PMID: 34103883 PMCID: PMC8184115 DOI: 10.1016/j.cbpra.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adolescent externalizing problems (AEPs), including serious conduct problems, delinquency, and substance misuse, are the most common adolescent behavioral issues in specialty care. High rates of comorbidity between conduct and substance use problems necessitate multidomain treatment strategies that can effectively address the AEP spectrum. One strategy to increase delivery of evidence-based interventions for multiproblem youth in usual care is to focus on core elements of empirically supported treatments that can be judiciously applied to clients presenting with diverse clinical profiles. This article describes six core practice elements of the cognitive-behavioral treatment (CBT) approach for AEPs: (1) Functional Analysis of Behavior Problems; (2) Prosocial Activity Sampling; (3) Cognitive Monitoring and Restructuring; (4) Emotion Regulation Training; (5) Problem-solving Training; (6) Communication Training. Integrated delivery of these core CBT elements is illustrated in two case examples, and implications for treatment planning for youth with AEPs are discussed.
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Affiliation(s)
- Aaron Hogue
- Center on Addiction, Robert Miranda and Jennifer C. Wolff, Brown University, Amanda Jensen-Doss, University of Miami
| | - Molly Bobek
- Center on Addiction, Robert Miranda and Jennifer C. Wolff, Brown University, Amanda Jensen-Doss, University of Miami
| | - Alexandra MacLean
- Center on Addiction, Robert Miranda and Jennifer C. Wolff, Brown University, Amanda Jensen-Doss, University of Miami
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Abstract
Drug consumption is driven by a drug's pharmacological effects, which are experienced as rewarding, and is influenced by genetic, developmental, and psychosocial factors that mediate drug accessibility, norms, and social support systems or lack thereof. The reinforcing effects of drugs mostly depend on dopamine signaling in the nucleus accumbens, and chronic drug exposure triggers glutamatergic-mediated neuroadaptations in dopamine striato-thalamo-cortical (predominantly in prefrontal cortical regions including orbitofrontal cortex and anterior cingulate cortex) and limbic pathways (amygdala and hippocampus) that, in vulnerable individuals, can result in addiction. In parallel, changes in the extended amygdala result in negative emotional states that perpetuate drug taking as an attempt to temporarily alleviate them. Counterintuitively, in the addicted person, the actual drug consumption is associated with an attenuated dopamine increase in brain reward regions, which might contribute to drug-taking behavior to compensate for the difference between the magnitude of the expected reward triggered by the conditioning to drug cues and the actual experience of it. Combined, these effects result in an enhanced motivation to "seek the drug" (energized by dopamine increases triggered by drug cues) and an impaired prefrontal top-down self-regulation that favors compulsive drug-taking against the backdrop of negative emotionality and an enhanced interoceptive awareness of "drug hunger." Treatment interventions intended to reverse these neuroadaptations show promise as therapeutic approaches for addiction.
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Affiliation(s)
- Nora D Volkow
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Michael Michaelides
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Ruben Baler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
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Acuff SF, Dennhardt AA, Correia CJ, Murphy JG. Measurement of substance-free reinforcement in addiction: A systematic review. Clin Psychol Rev 2019; 70:79-90. [PMID: 30991244 DOI: 10.1016/j.cpr.2019.04.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 01/23/2019] [Accepted: 04/04/2019] [Indexed: 12/31/2022]
Abstract
A robust body of theoretical and experimental work highlights the influence of alternative, substance-free rewards on decisions to use alcohol and other drugs. However, translational applications have been limited in part by the lack of consensus on how to measure substance-free reinforcement in applied and clinical settings. The current study summarizes extant research utilizing self-report reinforcement or reward methodologies, and critically reviews the psychometric properties of the available measures. These studies (N = 50) fell into three categories: measures of recent substance-related and substance-free activity participation and enjoyment (n = 32), measures of time or monetary resource allocation (n = 15), and rating scale measures of reward availability and experience (n = 8). The available research suggests that, consistent with experimental laboratory research and with behavioral economic predictions, there is an inverse relation between substance-free reinforcement and substance use. These studies also support the clinical utility of these measures in predicting substance use severity and course. Reinforcement measures could be improved by enhancing content validity, multimethod convergent validity, and generalizability.
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Affiliation(s)
- Samuel F Acuff
- Department of Psychology, University of Memphis, 400 Innovation Dr., Memphis, TN 38152, United States
| | - Ashley A Dennhardt
- Department of Psychology, University of Memphis, 400 Innovation Dr., Memphis, TN 38152, United States
| | - Christopher J Correia
- Department of Psychology, Auburn University, 226 Thach Hall, Auburn, AL 36849, United States
| | - James G Murphy
- Department of Psychology, University of Memphis, 400 Innovation Dr., Memphis, TN 38152, United States.
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