Polysubstance use, mental health and high-risk behaviours: Results from the 2012 Global Drug Survey

Disentangling heterogeneity in substance use disorder: Insights from genome-wide polygenic scores

Substance use disorder (SUD) is a global health problem with a significant impact on individuals and society. The presentation of SUD is diverse, involving various substances, ages at onset, comorbid conditions, and disease trajectories. Current treatments for SUD struggle to address this heterogeneity, resulting in high relapse rates. SUD often co-occurs with other psychiatric and mental health-related conditions that contribute to the heterogeneity of the disorder and predispose to adverse disease trajectories. Family and genetic studies highlight the role of genetic and environmental factors in the course of SUD, and point to a shared genetic liability between SUDs and comorbid psychopathology. In this study, we aimed to disentangle SUD heterogeneity using a deeply phenotyped SUD cohort and polygenic scores (PGSs) for psychiatric disorders and related traits. We explored associations between PGSs and various SUD-related phenotypes, as well as PGS-environment interactions using information on lifetime emotional, physical, and/or sexual abuse. Our results identify clusters of individuals who exhibit differences in their phenotypic profile and reveal different patterns of associations between SUD-related phenotypes and the genetic liability for mental health-related traits, which may help explain part of the heterogeneity observed in SUD. In our SUD sample, we found associations linking the genetic liability for attention-deficit hyperactivity disorder (ADHD) with lower educational attainment, the genetic liability for post-traumatic stress disorder (PTSD) with higher rates of unemployment, the genetic liability for educational attainment with lower rates of criminal records and unemployment, and the genetic liability for well-being with lower rates of outpatient treatments and fewer problems related to family and social relationships. We also found evidence of PGS-environment interactions showing that genetic liability for suicide attempts worsened the psychiatric status in SUD individuals with a history of emotional physical and/or sexual abuse. Collectively, these data contribute to a better understanding of the role of genetic liability for mental health-related conditions and adverse life experiences in SUD heterogeneity.

Simultaneous Substance Use With Alcohol in a Community-Based Sample of Young Adults

Objective: Simultaneous substance use is associated with worse outcomes than concurrent use. Further investigations into simultaneous use are warranted because there is limited knowledge about the co-use of substances other than alcohol and cannabis. Study aims were to examine: (1) the prevalence of simultaneous use of substances with alcohol, (2) the extent to which use patterns are related to key correlates (i.e., psychological functioning, sensation seeking), and (3) differences by college status. Methods: Participants were 623 young adult drinkers who were recruited online to complete a one-time survey. Results: Cannabis (54.3%), tobacco (53.7%), and stimulants (46.5%) were most frequently used with alcohol. Moderation analyses showed the positive association between simultaneous use and psychological distress was stronger for students whereas the positive association with sensation seeking was stronger for nonstudents. Conclusions: Results highlight the need for future research and intervention efforts that consider the link between simultaneous use and psychological wellbeing while acknowledging that educational attainment may differentially influence these factors.

Daily diary study of associations between alcohol, cannabis, co-use and sleep quality in individuals with intentions to use cannabis to cope with anxiety

INTRODUCTION

Sleep problems and anxiety conditions are common comorbidities and may be influenced by cannabis and alcohol use. This study examined daily within-person variation in subjective sleep quality among individuals with anxiety symptoms after cannabis or alcohol were used alone, and after co-use.

METHODS

A total of 347 individuals with intentions to use cannabis to cope with anxiety reported their cannabis and alcohol use in the previous 24 h and their previous nights' sleep quality for 30 consecutive days. Mixed-effects models examined whether the within-person daily variation in use of cannabis and alcohol (alone and co-use) was associated with subjective sleep quality. Models also examined whether daily cannabis and alcohol use associations with sleep were moderated by frequency of cannabis, alcohol and co-use during the study period.

RESULTS

Compared to non-use, participants reported better sleep after cannabis-use-only and after co-use, but not after alcohol-use-only. People who more frequently use alcohol and cannabis reported sleeping better after cannabis-use-only days compared to those who use cannabis and alcohol less frequently.

DISCUSSION AND CONCLUSIONS

The study's utilisation of naturalistic data among individuals with anxiety symptoms replicated previously reported experimental findings among individuals without sleep and anxiety problems that overall, cannabis is associated with higher subjective sleep quality. The results expand upon other research to suggest that more frequent use of alcohol and cannabis may moderate daily associations of cannabis use and sleep, potentially through pharmacokinetics and cross-sensitisation.

Correlates of Stimulant Use among People Who Use Heroin Undergoing Treatment in Out-Patient Facilities in France, 2010-2020

Background: Polydrug use has been implicated in driving a "fourth wave" of the overdose crisis in North America, specifically through concurrent use of stimulants and opioids, especially fentanyl. In France, however, heroin has historically been and remains the easiest-to-access opioid, accounting for most drug treatment demand. Whether similar polydrug use is increasing in Western Europe remains understudied, despite severe health implications and potential inadequate public health responses.Methods: We take advantage of a nation-wide dataset containing information on all patients serviced in treatment centers in France from 2010 to 2020. We conduct Poisson regression to determine the main predictors of stimulant use among people who use heroin (PWUH) and opioids (PWUO) generally.Results: Heroin remains the primary opioid within drug treatment in France. A decreasing number of out-patients seeking treatment for heroin use has been accompanied by an increasing trend of stimulant use over time, most commonly with powder cocaine. Our results suggest a significant increase of crack cocaine use among the most vulnerable PWUH. Concurrent use of stimulants among PWUH was positively associated with use of alcohol, cannabis, unprescribed psychotropics and hallucinogens, and negatively with tobacco. Similar results were found for all in-treatment PWUO.Conclusions: Our results uncover heterogeneity in the profiles of PWUH that should be fully acknowledged to ensure better efficiency in substance use clinical practices and policy, while simultaneously drawing attention to trends in concurrent opioid-stimulant use outside North America. We advocate for an extension of the generalized risk framework and its implementation in prevention programs.

Impaired driving and other risky drug use and sex behaviors: a cross-sectional examination of high-risk rural women incarcerated in jail

Background: Despite women accounting for an increasing proportion of impaired drivers and higher rates of impaired driving and road fatalities in rural areas, little is known about rural women who drive impaired and their other risky behavior.Objective: The present study assessed the association between impaired driving history, risky substance use, and other drug- and sex-related risk behaviors in a sample of high-risk rural women incarcerated in jail.Methods: Four hundred women from three rural jails provided information about their impaired driving, drug use, injection drug use practices, and sex risk behaviors. Groups were stratified on whether they self-reported impaired driving in the year prior to incarceration. Impaired drivers (n = 260, M = 31.90 years old) were compared to women who did not drive impaired (n = 131, M = 34.42 years old) using MANCOVA and logistic regression analyses.Results: Impaired drivers had significantly (p < .05) higher substance use severity scores for cannabis, sedatives, and prescription opioids. Furthermore, impaired drivers were significantly (p < .05) more likely to have been the passenger of an impaired driver (78.08% vs. 53.44%), been an injection drug user (69.62% vs. 41.98%), had a casual sex partner (47.31% vs. 25.95%), and traded sex for drugs or money (31.15% vs. 15.27%) in the year prior to incarceration.Conclusions: This study found a consistent association between past year impaired driving and a range of drug- and sex-related risk behaviors in a sample of high-risk rural women incarcerated in jail. These findings highlight an opportunity to intervene in criminal justice settings to reduce multiple health risk behaviors.

First drug-checking study at an electronic festival and fentanyl detection in the central region of Mexico

BACKGROUND

Perception of drug adulteration has increased in Mexico, but there is little research on adulterants and toxicity. The aim of this study was to identify drug composition in an electronic music outdoor festival nearby Mexico City.

METHODS

The participants completed a questionnaire with demographic data, harm reduction strategies, drug-use patterns, history, and the drug they expected to find. We took a small sample of each substance and prepared it for drug checking. A two-section drug testing station was placed within the grounds of the festival. Interaction with participants occurred at the front part. Drug checking was conducted at the rear part. The service was free of charge, voluntary and confidential. Forty persons aged 22 to 48 years participated (mode = 28), of which 92.5% were male, most (82.5%) were single. Through the Substance Analysis Program of "ReverdeSer Collective," we conducted the testing with the attendants that provided 51 drug samples, following ethical and biosafety protocols. We used colorimetry, Fourier Transform Infrared Spectroscopy, and fentanyl immunoassay strips for sample analysis.

RESULTS

Substances of choice among attendants were psychostimulants (MDMA and other amphetamine-like drugs) and hallucinogens. Most samples contained what the users expected plus adulterants. Main adulterants were methylene-dioxy-ethyl-amphetamine, methylene-dioxy-propyl-amphetamine, hydroxyamphetamine, and the selective serotonin reuptake inhibitor venlafaxine. Fentanyl was present in 2 out of 4 cocaine samples and in 14 of the 22 confirmed MDMA samples.

CONCLUSIONS

Some of the adulterants found pose serious health risks, especially fentanyl, amphetamine-like substances, and venlafaxine. Therefore, it is urgent to monitor these adulterants at electronic music festivals and to implement prevention, treatment, and harm reduction public policies. Naloxone distribution and drug-assisted therapies should be part of government programs in Mexico.

Combined use of cocaine and alcohol: A violent cocktail? A systematic review

It is generally believed that the use of alcohol and cocaine alone and especially in combination elicits aggression and violent behaviour. Though there is overwhelming proof that heavy alcohol use is associated with violence, this is not the case for cocaine. Still, in the popular press and by spokesmen of the police, cocaine use is seen as a cause of violent incidents. In the current systematic review, available data from human studies on the relation between cocaine and violent behaviour is presented. In particular, we present scientific data on the acute induction of violence by cocaine alone, as well as, that by the combination of cocaine and alcohol known to be frequently used simultaneously. RESULTS: show that there is only weak scientific evidence for the acute induction of violent behaviour by cocaine, either when used alone or in combination with alcohol. Based on these data we were also able to refute misconceptions about the relation between cocaine and violence published in the popular press and governmental reports, because it appeared that there was hardly any empirical support for this widely shared opinion. Probably, contextual factors, including cocaine use disorder and personality disorder, may better explain the assumed association between cocaine and violence.

Development and validation of the Substance Use Protective Strategies Scale (SUPSS) among Polish young adults using various psychoactive substances

Research supports protective behavioral strategies (PBS) as effective in reducing substance use, intoxication, and/or related risks/harms. However, despite the predominance of polysubstance use and common co-occurrence of different substance use disorders (SUDs), previous PBS research has been limited in terms of substance-specific measurement. This study sought to develop and validate a measure of PBS that is not substance-specific. Building from initial pilot work, we tested the psychometric properties of the Substance Use Protective Strategies Scale (SUPSS) in a large sample of young adults (N = 7325, aged 18-30), who reported using multiple psychoactive substances (other than alcohol and nicotine), recruited via social media in Poland. By splitting the sample, we conducted exploratory (n = 3709) and confirmatory factor analysis (n = 3614), which supported a 4-factor structure with 19 items (7 items dropped): Preparation for use (α = 0.66), Manner of use (α = 0.85), Additional concerns (α = 0.74), and Setting (α = 0.62). Configural, metric and scalar invariance were supported across sex, age, and user status for most substance types (cannabis, dissociatives, etc.). Further, the SUPSS factors were strongly associated with substance-related harms (R-squared = 0.495) and SUD symptoms (DUDIT, R-squared = 0.570). Our model fit was adequate (but not excellent), and two subscales had low internal consistency, highlighting the need for further improvement of the SUPSS. Despite its limitations, we found the SUPSS to have strong psychometric properties and it holds promise to enhance PBS research and harm reduction-oriented interventions.

Influence of mental health on information seeking, risk perception and mask wearing self-efficacy during the early months of the COVID-19 pandemic: a longitudinal panel study across 6 U.S. States

BACKGROUND

Understanding factors that influence information seeking, assessment of risk and mitigation behaviors is critical during a public health crises. This longitudinal study examined the influence of self-reported mental health during the early months of the COVID-19 pandemic on information seeking, risk perception and perceived mask wearing ability. Mental health screener items included fear, anger, and hopelessness in addition to avoidance, diminished functional ability and global distress. Theoretical models inform hypotheses linking mental health items and outcomes.

METHODS

The research employed a longitudinal 6-state 3-wave online panel survey, with an initial sample of 3,059 participants (2,232 included in longitudinal analyses). Participants roughly represented the states' age, race, ethnicity, and income demographics.

RESULTS

Women, those who identified as Hispanic/Latinx, Black Americans and lower income participants reported higher overall rates of distress than others. Information seeking was more common among older persons, Democrats, retirees, those with higher education, and those who knew people who had died of COVID-19. Controlling for such demographic variables, in multivariable longitudinal models that included baseline mental health measures, distress and fear were associated with increased information seeking. Distress and fear were also associated with increased risk perception, and feelings of hopelessness were associated with lower reported mask-wearing ability.

CONCLUSIONS

Results advance understanding of the role mental health can play in information seeking, risk perception and mask wearing with implications for clinicians, public health practitioners and policy makers.

Using Social Media to Examine Themes Surrounding Fentanyl Misuse and Risk Indicators

Background: Opioid misuse is a crisis in the United States, and synthetic opioids such as fentanyl pose risks for overdose and mortality. Individuals who misuse substances commonly seek information and support online due to stigma and legal concerns, and this online networking may provide insight for substance misuse prevention and treatment. We aimed to characterize topics in substance-misuse related discourse among members of an online fentanyl community. Method: We investigated posts on a fentanyl-specific forum on the platform Reddit to identify emergent substance misuse-related themes potentially indicative of heightened risk for overdose and other adverse health outcomes. We analyzed 27 posts and 338 comments with a qualitative codebook established using a subset of user posts via inductive and deductive methods. Posts and comments were independently reviewed by two coders with a third coder resolving discrepancies. The top 200 subreddits with the most activity by r/fentanyl members were also inductively analyzed to understand interests of r/fentanyl users. Results: Functional/quality of life impairments due to substance misuse (29%) was the most commonly occurring theme, followed by polysubstance use (27%) and tolerance/dependence/withdrawal (20%). Additional themes included drug identification with photos, substances cut with other drugs, injection drugs, and past overdoses. Media-focused subreddits and other drug focused communities were among the communities most often followed by r/fentanyl users. Conclusion: Themes closely align with DSM-V substance use disorder symptoms for fentanyl and other substances. High involvement in media-focused subreddits and other substance-misuse-related communities suggests digital platforms as acceptable for overdose prevention and recovery support interventions.

Within-person associations of escalated electronic nicotine delivery systems use with cigarette, alcohol, marijuana and drug use behaviors among US young adults

AIMS

Most extant evidence has addressed between-person differences, short-term or cross-sectional associations of electronic nicotine delivery systems (ENDS) use with other substance use, the majority focusing on current rather than escalated use. The present study aimed to examine within-person changes in escalated ENDS use and their associations with individual and combined substance use over a 6-year period.

DESIGN, SETTING AND PARTICIPANTS

This study used a longitudinal cohort design with US young adults. A generalized linear mixed-model approach was employed to fit a series of weighted logistic regression models. Data were drawn from waves 1-5 of the Population Assessment of Tobacco and Health (PATH) study in the United States. Of the 9110 young adults at baseline, aged 18-24 years, a total of 5042 individuals had matched data across all five waves of assessments.

MEASUREMENTS

Escalated ENDS use was computed by subtracting the number of days of ENDS use within the past 30 days at wave w - 1 from that at wave w and coded as 1 = escalated, if the value was greater than zero (otherwise, coded as 0 = not escalated).

FINDINGS

Escalated ENDS use gradually decreased over time, with the lowest prevalence at wave 4 (4.0%) but sharply increasing at wave 5 (8.4%). Escalated ENDS use was associated with increased odds of using each substance (binge drinking, marijuana use, marijuana vaping, prescription and illicit drugs) and different combinations of polysubstance use between cigarette smoking, binge drinking and marijuana use (Ps < 0.05). In addition, sweet/fruit flavor use (versus menthol/mint) was associated with increased likelihood of reporting co-use of cigarettes and marijuana.

CONCLUSIONS

In the United States, the prevalence of young adults using electronic nicotine delivery systems appears to have increased steadily between 2013 and 2019, although the rate of increase may have started to accelerate in recent years. Escalated electronic nicotine delivery systems use and time-lagged established electronic nicotine delivery systems use appear to be prospectively associated with individual and combined substance use, particularly between cigarettes, alcohol and marijuana. Among established electronic nicotine delivery systems users, sweet/fruit flavor appears to be associated with increased risk of co-using cigarettes and marijuana.

Prevalence of Substance Abuse Among Trauma Patients in Rural West Virginia

BACKGROUND

 Substance abuse poses considerable clinical, economic, and social challenges. West Virginia is hailed as the epicenter of the substance abuse in the United States, the prevalence and pattern of different trauma mechanisms in a rural context or in patients with different forms of substance abuse remain unclear.

OBJECTIVE

 We performed the following analysis to understand the prevalence of substance abuse in patients with different trauma mechanisms in the rural setting with high substance abuse in the West Virginia.

METHODS

 We performed a cross-sectional retrospective analysis of adult trauma patients (motor vehicle, fall, assault, firearm suicide, brawl/rape and machinery) hospitalized in two tertiary care hospitals in West Virginia between 2006 and 2016. We identified all patients who had a urine drug screen (UDS) test and extracted the data related to the substance and trauma.

RESULTS

 Among 8734 patients screened using UDS, 5940 (68.1%) patients were tested positive for the substance. Opiates, alcohol, benzodiazepines, and cannabis were the four most common substances identified in trauma victims. In all instances, the prescribed drug was less than 20%. Fatal outcome was observed in 366 patients in the sample, with 44% (n=162) testing positive for UDS, 12% (n=45) testing positive for only alcohol, and 15% (n=56) testing positive for both alcohol and UDS. Regarding the trauma mechanism, the motor vehicle accident (MVA) was the most prominent with a clear association of substance abuse with fatal outcome.

CONCLUSION

 The most prevalent trauma mechanism was a MVA, with a strong link between drug usage and mortality. Due to the high incidence of positive substance abuse screens, UDS tests may need to be more widely implemented in trauma in the West Virginia region. The findings of this study might help in establishing regional or national policies to reduce acute substance abuse.

Feasibility of using breath sampling of non-volatiles to estimate the prevalence of illicit drug use among nightlife attendees

The prevalence of drug use among nightlife attendees needs to be accurately estimated to, for example, evaluate preventive interventions. This study tested the feasibility of using a breath-sampling device to estimate the prevalence of drug use among nightlife attendees. The study was conducted at five nightclubs and a large music festival in Stockholm, Sweden. Participants were invited to participate and microparticles in exhaled breath were sampled and analyzed for 47 compounds using a state-of-the-art analytic method that follows forensic standards. In addition, participants' breath alcohol concentration was measured and they were interviewed about demographics, drinking habits, and drug use. Of the people invited, 73.7% (n = 1223) agreed to participate, and breath samples were collected from 1204 participants. Breath sampling was fast and well-accepted by participants. 13 percent of participants tested positive for an illicit drug, but only 4.3% self-reported drug use during the last 48 h. The most common substances detected were cocaine, amphetamine, and MDMA. There was no agreement between self-reported and measured use of any drug. Breath sampling is a convenient method to test illicit drug use among a large number of participants at events, and can be used as an estimate of drug use prevalence.

Development of anxiety-like behaviors during adolescence: Persistent effects of adolescent morphine exposure in male rats

Epidemiological studies show the prevalence of opioid use, misuse and abuse in adolescents, which imposes social and economic accountability worldwide. Chronic opioid exposure, especially in adolescents, may have lasting effects on emotional behaviors that persist into adulthood. The current experiments were therefore designed to study the effects of sustained opioid exposure during adolescence on anxiety-like behaviors. Adolescent male Wistar rats underwent increasing doses of morphine for 10 days (PNDs 31-40). After that the open field test (OFT) and elevated plus maze (EPM) test were performed over a 4-week postmorphine treatment from adolescence to adulthood. Moreover, the weight of the animals was measured at these time points. We found that chronic adolescent morphine exposure reduces the weight gain during the period of morphine treatment and 4 weeks after that. It had no significant effect on the locomotor activity in the animals. Moreover, anxiolytic-like behavior was observed in the rats exposed to morphine during adolescence evaluated by OFT and EPM test. Thus, long-term exposure to morphine during adolescence has the profound potential of altering the anxiety-like behavior profile in the period from adolescence to adulthood. The maturation of the nervous system can be affected by drug abuse during the developmental window of adolescence and these effects may lead to behaviorally stable alterations.

A network approach to substance use, internalizing, and externalizing comorbidity in U.S. adults

INTRODUCTION

Use of conventional cigarettes (CIG), alcohol, marijuana, and sedatives [i.e., benzodiazepines and barbiturates]) commonly co-occur with internalizing and externalizing disorders. It is unclear how these relationships extend to electronic cigarettes (ECIGs) and prescription drugs not prescribed (i.e., sedatives, tranquilizers, and painkillers [PDNP]), and whether they differ by gender.

METHODS

Adult data (N = 30,211) from Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health Study were used to estimate a network of current or past-month use for six substances, experiencing four internalizing symptoms in the past month, and experiencing seven externalizing symptoms in the past month. Visual comparisons, global strength invariance, network structure invariance, and edge strength invariance were tested to detail substance use and internalizing/externalizing symptom networks.

RESULTS

Overall, networks were consistent between men and women. The strongest substance use/mental health symptom connections estimated as edge-weights (EW) were between marijuana with lying (EW = 0.60, 95% CI = 0.49; 0.70), marijuana with engaging in fights (EW = 0.54, 95% CI = 0.27; 0.81), PDNP with having trouble sleeping (EW = 0.53, 95% CI = 0.40; 0.66), and alcohol and impulsivity (EW = 0.48, 95% CI = 0.42; 0.53).

DISCUSSION

There were many weak connections throughout the substance use and internalizing/externalizing network. A few important connections were identified and encourage future study. In particular, PDNP was most strongly associated with internalizing symptoms. Marijuana, alcohol and PDNP use were most strongly associated with externalizing symptoms.

Patterns and Correlates of Polysubstance Use Among Individuals With Severe Alcohol Use Disorder

AIM

The present study examined patterns and correlates of polysubstance use among individuals with severe alcohol use disorder (AUD).

METHODS

Participants were 2785 individuals (63% female; mean age = 43 years, range = 18-78 years) from the Genes, Addiction and Personality Study. All participants met lifetime criteria for severe AUD (6+ symptoms). We used latent class analysis to identify patterns of frequency of lifetime use for cigarettes, marijuana, cocaine, stimulants, sedatives, opioids and hallucinogens. A variety of demographic and behavioral correlates of latent class membership were tested in univariable and multivariable models.

RESULTS

A five-class solution was selected: extended range polysubstance use (24.5%); cigarette and marijuana use (18.8%); 'testers,' characterized by high probabilities of smoking 100 or more cigarettes, using marijuana 6+ times, and trying the remaining substances 1-5 times (12.3%); moderate range polysubstance use (17.1%) and minimal use (reference class; 27.3%). In univariable analyses, all potential correlates were related to latent class membership. In the multivariable model, associations with gender, race/ethnicity, age of onset for alcohol problems, dimensions of impulsivity, depressive symptoms, antisocial behavior and family history density of alcohol problems remained significant, though the pattern and strength of associations differed across classes. For instance, sensation-seeking, lack of premeditation and family history were uniquely associated with membership in the extended range polysubstance use class.

CONCLUSION

Patterns of polysubstance use are differentially related to demographic and behavioral factors among individuals with severe AUD. Assessing use across multiple substances may inform the selection of targets for treatment and prevention.

Rates and correlates of cannabis-associated psychotic symptoms in over 230,000 people who use cannabis

Cannabis, a widely used psychoactive substance, can trigger acute cannabis-associated psychotic symptoms (CAPS) in people who use cannabis (PWUC). To assess rates and correlates of CAPS requiring emergency medical treatment, we analyzed data from an international sample of PWUC (n = 233,475). We found that 0.47% (95%CI 0.42; 0.52) PWUC reported lifetime occurrence of CAPS, defined as the occurrence of hallucinations and/or paranoia requiring emergency medical treatment following the use of cannabis. A range of factors correlated with risk of CAPS in the last year: higher rates were observed in young individuals [risk ratio (RR) 2.66, compared to older PWUC] and those residing in Denmark (RR 3.01, compared to PWUC from other countries). Furthermore, risk was elevated in those using predominantly high-potency resin (RR 2.11, compared to PWUC using herbal cannabis), those mixing cannabis with tobacco (RR 2.15, compared to PWUC not mixing with tobacco) and those with a diagnosis of psychosis (RR 14.01), bipolar (RR 4.30), anxiety (RR 2.92) and depression (RR 2.68), compared to individuals without a mental health diagnosis. Taken together, acute self-limiting psychotic symptoms in the context of cannabis use may occur in about 1 in 200 PWUC's lifetime. Some individuals could be particularly sensitive to the adverse psychological effects of cannabis, such as young individuals or those with pre-existing mental health vulnerabilities. In light of the movements towards legalization of recreational cannabis, more research should focus on the potential harms related to cannabis use, to educate PWUC and the public about risks related to its use.

Violent Behaviours among Adolescents and Young Adults: Association with Psychoactive Substance Use and Parenting Styles

This study extends existing research on the relationship between psychoactive substance use among young people and violent behaviour, by evaluating the possible effect of the modification of parenting in a nationally representative sample of 14,685 Italian students drawn from the 2019 wave of the ESPAD Italia survey (51% male; mean age about 17 years). Parental dimensions considered in the study were rule-setting, monitoring, and emotional support, as well as the possible absence of a parent. Relative risk ratios and binary logistic regressions were used to estimate the associations separately for adolescents (15–17) and young adults (18–19). Overall, parental rule-setting, perceived parental monitoring, and emotional support were protective factors for substance use, and the strength of this relationship increased with the frequency of use. Among adolescents, the absence of a parent represented a risk factor. In both age groups, the odds of engaging in violent behaviour was increased among those reporting alcohol intoxication and substance use and the greater the frequency of use, the greater the increase in the odds. As parental monitoring and emotional support decreased, the odds of engaging in violent behaviour increased (except in the case of lower parental support among young adults), while the opposite applies to parental rule-setting. The odds of engaging in violent behaviour were increased among those reporting the absence of a parent only in the adolescent age group. Parental rule-setting was found to have an effect only among adolescents, increasing the odds of violent behaviour among frequent drinkers. Our results might be helpful to signal adolescents who would be more prone to adopt violent behaviour in order to target prevention policies.

A Scoping Review of Gender, Sex and Sexuality Differences in Polysubstance Use in Adolescents and Adults

BACKGROUND

Polysubstance use is a common, problematic behavior that increases risk of harm to self and others. Research suggests that rates may vary based on gender, sex and sexuality. Understanding the current state of this literature may inform prevention and treatment of polysubstance use, leading to reduced public health burden.

OBJECTIVES

This review aimed to synthesize research on gender, sex and sexuality differences in polysubstance use in adults and adolescents.

METHODS

A scoping review was conducted using all EBSCO databases, PubMed and Google Scholar to identify articles examining the effects of gender, sex and sexuality on polysubstance use. Polysubstance use was defined broadly as the use of any combination of substances over any time period and included licit (alcohol, tobacco) and illicit substances, concurrent and simultaneous use, from lifetime to daily use and use at any frequency. Studies were considered if they were published in peer-reviewed journals between January 1990 and October 2020 and were written in English. Publicly available data sources were also utilized to fully capture prevalence data that has not been published elsewhere.

RESULTS

Findings were mostly inconsistent and often conflicting. Only two findings were generally consistent: adult men were overall more likely to report polysubstance use than adult women, and sexual and gender minorities report more frequent polysubstance use than non-minorities.

CONCLUSIONS

Research has been unable to clearly elucidate differences in polysubstance use prevalence and patterns according to gender, sex and sexuality. Several recommendations are offered to advance future research and address limitations of current research.

Profiles of individuals with cannabis-related disorders

Background: Profiles of individuals with cannabis-related disorders (CRD) in specialized addiction treatment centers serving high-need patients have not been identified. This longitudinal study developed a typology for 9,836 individuals with CRD attending Quebec (Canada) addiction treatment centers in 2012-2013. Methods: Data on sociodemographic, clinical and service use variables were extracted from several databases for the years 1996-1997 to 2014-2015. Individual profiles were produced using Latent Class Analysis and compared predicting health outcomes on emergency department (ED) use, hospitalizations and suicidal behaviors for 2015-2016. Results: Six profiles were identified: 1-Older individuals, many living in couples and working, with moderate health problems, receiving intensive general practitioner (GP) care and high continuity of physician care; 2-Older individuals with chronic CRD, multiple social and health problems, and low health service use (chronic CRD referred to experiencing CRD for several years; social problems related to homelessness, unemployment, having criminal records or living alone); 3-Students with few social and health problems, and low health service use; 4-Young adults, many working, with few health problems, least health service use and continuity of physician care; 5-Youth, many working but some criminal offenders, with 1 or 2 years of CRD, few health problems and high addiction treatment center use; and 6-Older individuals with chronic CRD and multiple social and health problems, high health service use and continuity of physician care. Profiles 6 and 2 had the worst health outcomes. Conclusions: For Profiles 2 to 5, outreach and motivational services should be prioritized, integrated health and criminal justice services for profile 5 and, for Profiles 2 and 6, assertive community treatments. Screening, brief intervention and referrals to addiction treatment centers may also be encouraged for individuals with CRD, particularly those in Profile 2. This cohort had high social and health needs relative to services received, suggesting continued need for care.

Prevalence and Associated Factors of Common Mental Disorders Among Pregnant Mothers in Rural Eastern Ethiopia

BACKGROUND

Antenatal common mental disorder is a significant public health issue, especially in low- and middle-income countries with an extensive treatment gap. Common mental disorders have multifaceted implications on maternal and fetal health outcomes during pregnancy with long-running economic and social sequels. This study aimed to determine the prevalence of common mental disorder and associated factors among pregnant mothers in eastern Ethiopia, Kersa and Haramaya Health, and Demographic surveillance sites.

METHODS

A community-based cross-sectional study was conducted in Kersa and Haramaya health and demographic surveillance sites from January 30 to April 30, 2021. World Health Organization Self-Reporting Questionnaire (SRQ-20) was used to measure common mental disorder among 1,015 randomly selected pregnant women. Data were collected face-to-face using open data kit software. Logistic regression was fitted to identify factors associated with common mental disorders.

RESULTS

The overall prevalence of common mental disorders (SRQ > 6) among pregnant women was 37.5% (95% CI: 34.5, 40.5). Current substance use (AOR = 1.99, 95% CI 1.37, 2.88), intimate partner violence (AOR = 2.67, 95% CI 2.02, 3.53), null parity (AOR = 3.10, 95% CI 1.65, 5.84), gestational age [first trimester (AOR = 2.22, 95% CI 1.01, 4.93) and third trimester (AOR = 1.74, 95% CI 1.31, 2.31)], history of abortion (AOR = 2.03, 95% CI 1.27, 3.24), and absence of antenatal care follow-up (AOR = 1.43, 95% CI 1.08, 1.89) were significantly associated with common mental disorder during pregnancy.

CONCLUSION

Common mental disorders are prevalent among pregnant women in the study area with significant correlates. Administration of regular screening programs for maternal mental health conditions in rural, low-income communities, integrating into primary health care settings is imperative to reduce the risk.

Associations between simultaneous alcohol and cannabis use and next-day negative affect among young adults: The role of sex and trait anxiety

BACKGROUND AND AIMS

The simultaneous use of alcohol and cannabis ("simultaneous alcohol and marijuana [SAM] use") is common among young adults and associated with negative substance-related consequences. SAM use may be tied to fluctuating mood states such as negative affect and individual characteristics including trait level of anxiety and sex. However, little is understood about their collective role. In this study, we sought to understand the daily link between SAM use and negative affect and whether this link might differ by both trait anxiety and sex.

METHOD

Participants were 154 young adults (57.8% female, 72.7% White, M age = 20.2) who completed baseline surveys on trait anxiety symptoms and up to 14 consecutive daily surveys on their substance use and affective states.

RESULTS

Multilevel models tested for associations of type of substance use day (i.e., alcohol-only days, cannabis-only days, and no use days relative to SAM use days) with next-day negative affect. Three-way and lower order interactions were tested for substance use day type, anxiety, and sex. Two three-way interactions between cannabis-only days, anxiety, and sex and between alcohol-only days, anxiety, and sex emerged such that SAM use was associated with greater next-day negative affect relative to single substance use days particularly among female participants with elevated anxiety.

CONCLUSIONS

Anxiety and sex are salient factors in the link between SAM use relative to single-substance use and daily negative affect. Study findings reinforce the need to account for all of these factors in order to develop maximally efficacious substance use interventions.

Stress and Affect as Daily Risk Factors for Substance Use Patterns: an Application of Latent Class Analysis for Daily Diary Data

At the population level, use of multiple substances (or "co-use") is prevalent in young adulthood and linked with increased risk for experiencing substance-related harms. Less understood is the heterogeneity of substance use behaviors within individuals and across days, as well as the proximal predictors of these daily use patterns. The present study applied latent class analysis to daily diary data to identify daily substance use patterns and compare day-level class membership based on day-level stress and positive and negative affect among a higher-risk sample of young adult substance users. Participants (n = 152) completed up to 13 daily assessments of stress, affect, and substance use behavior. Among substance use days, five classes of days were identified: cannabis (some alcohol; 43% of days), alcohol-only (26%), vaping (some alcohol, cannabis; 24%), stimulant + alcohol (some cannabis, vaping; 4%), and cigarette-only (3%) days. Days with lower levels of perceived stress were significantly more likely to be alcohol-only Days relative to being days characterized by cigarette use, cannabis use, or multiple drug combinations. Days with higher levels of stress and negative affect were more likely to be cigarette-only days relative to cannabis and vaping days. Study findings document the wide range of substance use and co-use behaviors exhibited among young adults in daily life and highlight the importance of considering risk factors that correspond to days of problematic use patterns.

Opioid analgesic use and its sequelae: Opioid and other substance use disorders

OBJECTIVES

While use of opioids is a well-established risk factor for opioid use disorder (OUD), its association with lifetime use of other addictive substances and the emergence of other lifetime substance use disorders (SUDs) has not been studied.

METHODS

We used data from 36 309 US adults in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III to identify those with lifetime opioid use (n = 4090; 11.3%). Of these individuals, we quantified use of other addictive substances; development of OUD and other SUDs; and whether use of opioids and development of OUD came before or after use of other substances and the emergence of other SUDs.

RESULTS

Of the 11.3% of adults who reported any opioid use, 98.2% of such users reported use of other addictive substances. Of these opioid users, 18.1% met criteria for lifetime OUD but only 3.5% had OUD alone; 47.6% had SUDs other than OUD and 14.6% had OUD plus another SUD. In most instances, opioid use followed use of other substances and OUD followed development of other SUDs.

CONCLUSION

Opioid use is typically linked to use of multiple substances and while less than 20% developed OUD, more than half developed either OUD or another SUD. Opioid use and OUD most often followed other substance use and the emergence of other SUDs. Early intervention in OUD should consider potential complications of other present or past SUDs, and both prevention and treatment development efforts should focus on the multi-morbid dimensions of the current opioid epidemic.

Alcohol dependence and heavy episodic drinking are associated with different levels of risk of death or repeat emergency service attendance after a suicide attempt

BACKGROUND

Alcohol use is a multidimensional risk factor for suicidal behaviour. However, suicide prevention strategies often take 'one-size-fits-all' approaches to alcohol use, reflecting an evidence base built on unidimensional measures. Latent Class Analysis can use a range of measures to differentiate distinct patterns of alcohol using behaviour and their associated risks.

METHODS

We analysed Electronic Health Record data from 650 suicidal adults detained for up to 36 h using police powers (Section 136 of the Mental Health Act 1983, amended 2007) to facilitate psychiatric assessment at a Health-Based Place of Safety, a dedicated emergency psychiatric care centre in London, UK. We conducted a Latent Class Analysis of alcohol using behaviours at first detention, and used multivariable logistic regression to estimate the association of each identified latent class with subsequent death or recontact with emergency psychiatric care over a median follow-up of 490 days, adjusting for sex, age and past-year psychiatric diagnosis.

RESULTS

Three classes of alcohol use were identified: low risk drinkers, heavy episodic drinkers and dependent drinkers. The dependent drinking class had twice the odds of death or recontact with emergency psychiatric care as the low risk drinking class (OR 2.32, 95 %CI 1.62-3.32, p < 0.001). Conversely, the heavy episodic drinking class was associated with lower odds of death or recontact than the low risk drinking class (OR 0.66, 95 %CI 0.53-0.81, p < 0.001).

CONCLUSIONS

The risk of adverse outcomes after a suicide attempt are not uniform for different alcohol use classes. Clinical assessment and suicide prevention efforts should be tailored accordingly.

Craving for Ketamine and Its Relationship With Clinical Outcome Indicators in Males With Ketamine Use Disorder

Background: Craving is considered a hallmark of substance use disorder and is one of the criteria of substance use disorder. The Desires for Drug Questionnaire (DDQ) is a widely used questionnaire to assess craving for heroin. This study aimed to examine the psychometric properties of the ketamine version of the DDQ (DDQ-K) and the associations between craving for ketamine as measured using the DDQ-K and clinical outcome indicators in individuals with ketamine use disorder. Methods: In total, 651 individuals with ketamine use disorder completed the DDQ-K and the Visual Analog Craving Scale (VACS). Demographic data, severity of ketamine use, money spent on ketamine, positive/negative aspects of ketamine use, and readiness to change ketamine use were also recorded. We examined the reliability (internal consistency), construct validity (factor structure), and concurrent validity of the DDQ-K. Multiple regression analysis was used to examine the relationships of craving measured using the DDQ-K with clinical outcome indicators, including money spent on ketamine, severity of ketamine use, positive/negative aspects of ketamine use, and readiness to change ketamine use. Results: The original three-factor model of the DDQ-K was acceptable for use in individuals with ketamine use disorder according to confirmatory factor analysis. The subscales of Desire and Intention and Negative Reinforcement of the DDQ-K, but not the subscale of Control, were of acceptable concurrent validity. The score on the Desire and Intention subscale was positively associated with the level of ketamine dependence, money spent on ketamine use, and positive/negative aspects of ketamine use and negatively associated with readiness to change ketamine use. Conclusion: This study supported the use of the Desire and Intention and Negative Reinforcement subscales of the DDQ-K to assess craving in patients with ketamine use.

Identifying risk factors involved in the common versus specific liabilities to substance use: A genetically informed approach

Individuals most often use several rather than one substance among alcohol, cigarettes or cannabis. This widespread co-occurring use of multiple substances is thought to stem from a common liability that is partly genetic in origin. Genetic risk may indirectly contribute to a common liability to substance use through genetically influenced mental health vulnerabilities and individual traits. To test this possibility, we used polygenic scores indexing mental health and individual traits and examined their association with the common versus specific liabilities to substance use. We used data from the Avon Longitudinal Study of Parents and Children (N = 4218) and applied trait-state-occasion models to delineate the common and substance-specific factors based on four classes of substances (alcohol, cigarettes, cannabis and other illicit substances) assessed over time (ages 17, 20 and 22). We generated 18 polygenic scores indexing genetically influenced mental health vulnerabilities and individual traits. In multivariable regression, we then tested the independent contribution of selected polygenic scores to the common and substance-specific factors. Our results implicated several genetically influenced traits and vulnerabilities in the common liability to substance use, most notably risk taking (bstandardised = 0.14; 95% confidence interval [CI] [0.10, 0.17]), followed by extraversion (bstandardised = -0.10; 95% CI [-0.13, -0.06]), and schizophrenia risk (bstandardised = 0.06; 95% CI [0.02, 0.09]). Educational attainment (EA) and body mass index (BMI) had opposite effects on substance-specific liabilities such as cigarette use (bstandardised-EA = -0.15; 95% CI [-0.19, -0.12]; bstandardised-BMI = 0.05; 95% CI [0.02, 0.09]) and alcohol use (bstandardised-EA = 0.07; 95% CI [0.03, 0.11]; bstandardised-BMI = -0.06; 95% CI [-0.10, -0.02]). These findings point towards largely distinct sets of genetic influences on the common versus specific liabilities.

Illicit Drug Use and Associated Problems in the Nightlife Scene: A Potential Setting for Prevention

Illicit drug use is prevalent in the nightlife scene, especially at electronic dance music (EDM) events. The aim of the present study was to investigate illicit drug use patterns and consequences of drug use among frequent visitors of EDM events. Young adults (18-34 years old) who had visited at least six EDM events in Sweden during the past year participated in a web-based survey on drug use patterns and its consequences. Fifty-nine percent of participants had used illicit drugs during the past year, most often cannabis followed by ecstasy, cocaine, and amphetamine. Nightlife venues were identified as the main setting for the use of central stimulants, while cannabis was mostly used at home. Frequent alcohol and tobacco use was associated with illicit drug use. The most prevalent negative consequences of drug use were related to mental health, such as impairments in mood, sleep, and memory problems, but physical manifestations were also reported, such as palpitations and collapsing. These findings confirm that drug use is prevalent and associated with negative health effects among EDM nightlife attendees. The nightlife scene is a setting with promising potential to reach a high-risk target group with illicit drug use prevention interventions.

Hazy memories in the courtroom: A review of alcohol and other drug effects on false memory and suggestibility

Alcohol and other psychoactive drugs are oftentimes implicated in legal cases. A pertinent question herein is whether such substances might adversely affect testimonies of victims, eyewitnesses, or suspects by propelling the formation of false memory and increasing susceptibility to suggestion. In the current review, we amassed all available evidence on the effects of intoxication on false memory formation and suggestibility, including the substances alcohol, benzodiazepines, cannabis, stimulants, hallucinogens, and antipsychotics. Our review indicated that alcohol and cannabis under certain conditions increased the susceptibility to false memories and/or suggestion with effect sizes ranging from medium to large. When intoxicated during an event, alcohol is most likely to increase this susceptibility at high intoxication levels or after a delay, whereas cannabis exerts detrimental effects during acute intoxication but not necessarily once sober. For other substances, ecologically valid research separating different memory phases is needed. Overall, differences between substances regarding false memory effects exist, suggesting that a nuanced approach is needed when dealing with intoxicated individuals in a legal context.

Alcohol- and drug-related consequences across latent classes of substance use among American Indian adolescents

INTRODUCTION

Substance use among American Indian (AI) adolescents is a significant public health concern, as they report greater health disparities related to substance use compared to other racial/ethnic groups. The present study examines differences across classes of substance use behaviors regarding alcohol- and drug-related consequences.

METHODS

The current study was a secondary analysis of the dataset used by Stanley and Swaim (2018). AI adolescents (n = 3498, 47.8% female, M_age = 14.8) completed a survey including substance use and related consequences. Protocols were approved by institutional IRB, tribal authority, school boards, and parental consent/child assent were obtained.

RESULTS

In line with Stanley and Swaim (2018), we identified four classes of substance use: no past month substance use; marijuana and cigarette use only; alcohol, marijuana, and cigarette use only; and polysubstance use. Cross-class comparisons revealed that adolescents in classes characterized by the use of a greater number of substances also reported experiencing greater alcohol- and drug-related consequences with one exception: the class characterized by marijuana and cigarette use reported greater drug-related consequences compared to the class characterized by alcohol, marijuana, and cigarette use.

CONCLUSIONS

AI adolescents who engage in the use of multiple substances should be provided with psychoeducation around the increased risk of associated negative consequences. Given the health disparity experienced by AI adolescents, interventions to alleviate the burden of negative consequences are necessary.

Symptoms of anxiety, depression, and borderline personality in alcohol use disorder with and without comorbid substance use disorder

OBJECTIVE

Alcohol use disorder (AUD) is highly comorbid with other substance use disorders (SUDs) as well as other psychiatric disorders, such as anxiety, depression, and Borderline Personality Disorder (BPD). However, studies of persons with AUD rarely account for its comorbidity with other SUDs. Some research suggests that BPD symptoms reflect an important connection between internalizing disorders and SUDs. The current study investigated: 1) the levels of trait anxiety and symptoms of depression and BPD in persons with an AUD as a function of comorbid SUDs (cannabis use disorder - CUD) and other substance use disorder (oSUD), and 2) the influence of BPD on the association between severity of overall lifetime SUD symptoms (AUD + CUD + oSUD) and both trait anxiety and symptoms of depression.

METHOD

Trait anxiety and symptoms of depression and BPD were assessed in 671 young adults (351 men; 320 women; mean age 21 years) separated into four groups: Controls (n = 185), AUD-only (134), AUD + CUD (n = 210), and AUD + oSUD (n = 142).

RESULTS

Trait anxiety and symptoms of depression and BPD were elevated in all AUD groups compared with controls, and in the AUD + oSUD group compared with all other groups as well. Structural models also indicated that BPD symptoms accounted for all of the variance in lifetime SUD symptoms associated with Trait Anxiety, and a significant portion of the variance in lifetime SUD symptoms associated with depression symptoms.

CONCLUSION

Results indicate that when AUD is comorbid with oSUD, it is associated with more severe AUD symptoms and higher levels of trait anxiety and symptoms of both depression and BPD. The results also indicate that BPD symptoms account for the majority of the variance in SUD symptoms associated with both trait anxiety and depression, suggesting that a considerable amount of the internalizing symptomatology in AUD/SUDs is associated with BPD psychopathology.

Recreational drug use and use of drugs associated with chemsex among HIV-negative and HIV-positive heterosexual men and women attending sexual health and HIV clinics in England

Background

There is little information on the prevalence of recreational drug use among UK heterosexual men and women, in particular on use of drugs associated with ‘chemsex’ within gay communities. The aim of this study was to examine among HIV-negative and HIV-positive heterosexual men and women in England: (i) the prevalence of recreational drug use (including use of drugs associated with chemsex), (ii) socio-economic/lifestyle correlates of drug use, and (iii) the association of drug use with sexual behavior measures and mental health symptoms.

Methods

Data are from the AURAH study of HIV-negative individuals attending sexual health clinics across England (2013–2014) and the ASTRA study of HIV-positive individuals attending HIV outpatient clinics in England (2011–2012). Prevalence of recreational drug use (past three months) and associations are presented separately among the four sample groups: HIV-negative (N = 470) and HIV-positive (N = 373) heterosexual men and HIV-negative (N = 676) and HIV-positive (N = 637) women.

Results

The age standardized prevalence of any drug use was 22.9%, 17.1%, 15.3%, and 7.1% in the four sample groups respectively. In all groups, cannabis was the drug most commonly used (range from 4.7% to 17.9%) followed by cocaine (1.6% to 8.5%). The prevalence of use of drugs associated with chemsex was very low among HIV-negative participants (1.0% heterosexual men, 0.2% women) and zero among HIV-positive men and women. In age-adjusted analysis, factors linked to drug use overall and/or to cannabis and cocaine use specifically in the four sample groups included Black/mixed Caribbean and white (vs. Black/mixed African) ethnicity, lower level of education , cigarette smoking, and higher risk alcohol consumption. Associations of recreational drug use with measures of condomless sex, depression, and anxiety were observed in the four groups, but were particularly strong/apparent among women.

Conclusion

Providers need to be aware of cannabis and cocaine use and its potential link with sexual risk behavior and symptoms of depression and anxiety among heterosexual men and women attending sexual health and HIV clinics.

Patterns of Substance Use and Associations with Mental, Physical, and Social Functioning: A Latent Class Analysis of a National Sample of U.S. Adults Ages 30-80

Trends show increased substance use among adults, yet little research on general population samples has examined differential patterns of licit and illicit substance use that can inform prevention and treatment efforts. This study identifies distinct patterns (classes) of substance use among 30- to 80-year olds, identifies demographic subgroups with the highest probability of class memberships, and compares classes on key indicators of functioning. Method: Participants (n = 1,877) were from the RAND American Life Panel. Online survey measures included current alcohol, tobacco, cannabis, and nonmedical prescription drug use, as well as mental, physical, and social functioning. Results: Latent class analysis identified four classes: "Lighter Drinking" (46.6%), "Abstaining" (33.7%), "Heavy Drinking with Cigarette/Cannabis Use" (17.1%), and "Cigarette Smoking with Prescription Drug/Cannabis Use" (2.6%). Of these classes, "Cigarette Smoking with Prescription Drug/Cannabis Use" reported the worst mental and physical functioning, and greater loneliness than the "Lighter Drinking" class. "Heavy Drinking with Cigarette/Cannabis Use" reported worse mental and physical functioning than the "Lighter Drinking" class and less social support than the "Lighter Drinking" and "Abstaining" classes. The "Abstaining" class reported consistently worse functioning than the "Lighter Drinking" class. Both polysubstance use classes were associated with younger age, less education, and lower income, and heavy drinking polysubstance use was associated with being male and unmarried. Conclusions: Although lighter drinking was the most common pattern, 20% of adults were classified into two polysubstance use classes associated with poorer functioning. Targeted efforts may be needed to reach certain subgroups of adults who are particularly susceptible to polysubstance use.

Harm Reduction Strategies and Drug-Related Negative Consequences in the Dance Music Scene: The Moderating Role of Polysubstance Use

Although simultaneous polysubstance use (SPU) is associated with greater harms than concurrent polysubstance use (CPU), no previous research has examined the effectiveness of harm reduction strategies in reducing drug-related harms in people who use drugs simultaneously and whether these strategies have a differential impact on drug-related negative consequences according to SPU patterns. Objectives: to examine the relationship between SPU patterns, harm reduction strategies and drug-related consequences experienced among people who attend dance music settings, and to examine the moderating role of SPU patterns in the relationship between harm reduction strategies and drug-related negative consequences Methods: a web-based survey was used to gather data from 649 substance-using attendees at dance music settings (mean age = 26.2, 68% male). The survey collected data on: settings of last party attended, drug use, harm reduction strategies used and drug-related negative consequences experienced during last party attended. Results: Latent class analysis identified two SPU profiles: Moderate SPU and Severe SPU. Participants in the severe SPU class experienced more drug-related negative consequences at their last party in comparison with those in the moderate SPU class. Regardless of SPU pattern, avoiding binge drinking was related to fewer drug-related negative consequences, whilst avoiding mixing stimulants was related to fewer drug-related negative consequences only among those participants in the severe simultaneous polysubstance use class. Conclusions: These findings could help to inform the design of messages and tailored interventions aimed at minimizing drug-related negative consequences among people who use multiple substances in the dance music scene.

European Forum for Primary Care: Position Paper for Primary Care Mental Health

There is a need for a paradigm shift across mental health in primary care to improve the lives of millions of Europeans. To contribute to this paradigm shift, the European Forum for Primary Care (EFPC-MH) working group for Mental Health, produced a Position Paper for Primary Care Mental Health outlining 14 themes that needed prioritizing. These themes were developed and discussed interactively during the EFPC conferences between 2012 and 2019. The Position Paper on Mental Health gives direction to the necessary improvements over the next ten years. The themes vary from preferable healthcare model to the social determinants highlighting issues such as inequalities. The Statement of Mental Health in Primary Care will be established in cooperation with fellow organizations.

Distinct psychological profiles among college students with substance use: A cluster analytic approach

Substance use in youth is a central public health concern, related to deleterious consequences at psychological, social, and cognitive/cerebral levels. Previous research has identified impulsivity and consumption motives as key factors in the emergence of excessive substance use among college students. However, most studies have focused on a specific substance and have considered this population as a unitary group, ignoring the potential heterogeneity in psychological profiles. We used a cluster analytic approach to explore the heterogeneity in a large sample (N = 2741) of substance users (i.e., tobacco, alcohol, cannabis, ecstasy, cocaine, heroin) on impulsivity and consumption motives. We identified four clusters: The first two clusters, associated with good self-esteem, low anxiety, and moderate substance use, were respectively characterized by low impulsivity and consumption motives (Cluster 1) and by high social and enhancement motives without marked impulsivity (Cluster 2). The two other clusters were conversely related to low self-esteem and high anxiety, and characterized by high consumption motives (particularly conformity) together with elevated urgency (Cluster 3) and by globally increased impulsivity and consumption motives (Cluster 4). These two clusters were also associated with higher substance use. These results highlight the existence of distinct psychological profiles of substance users and underline the need to develop targeted prevention and intervention programs (e.g., focusing on the specific impulsivity facets and consumption motives presented by each subgroup). Based on these findings, we also suggest extending the exploration of distinct profiles of substance users by targeting other psychological variables (e.g., self-esteem).

Legal Performance-Enhancing Substances and Substance Use Problems Among Young Adults

BACKGROUND

Legal performance-enhancing substance(s) (PES) (eg, creatine) are widely used among adolescent boys and young men; however, little is known about their temporal associations with substance use behaviors.

METHODS

We analyzed prospective cohort data from the National Longitudinal Study of Adolescent to Adult Health, Waves I to IV (1994-2008). Logistic regressions were used to first assess adolescent substance use (Wave I) and use of legal PES (Wave III) and second to assess use of legal PES (Wave III) and subsequent substance use-associated risk behaviors (Wave IV), adjusting for potential confounders.

RESULTS

Among the sample of 12 133 young adults aged 18 to 26 years, 16.1% of young men and 1.2% of young women reported using legal PES in the past year. Adolescent alcohol use was prospectively associated with legal PES use in young men (odds ratio 1.39; 95% confidence interval [CI] 1.13-1.70). Among young men, legal PES use was prospectively associated with higher odds of problematic alcohol use and drinking-related risk behaviors, including binge drinking (adjusted odds ratio [aOR] 1.35; 95% CI 1.07-1.71), injurious and risky behaviors (aOR 1.78; 95% CI 1.43-2.21), legal problems (aOR 1.52; 95% CI 1.08-2.13), cutting down on activities and socialization (aOR 1.91; 95% CI 1.36-2.78), and emotional or physical health problems (aOR 1.44; 95% CI 1.04-1.99). Among young women, legal PES use was prospectively associated with higher odds of emotional or physical health problems (aOR 3.00; 95% CI 1.20-7.44).

CONCLUSIONS

Use of legal PES should be considered a gateway to future problematic alcohol use and drinking-related risk behaviors, particularly among young men.

Treatment Outcomes in Patients With Opioid Use Disorder Who Were First Introduced to Opioids by Prescription: A Systematic Review and Meta-Analysis

OBJECTIVE

Prescription opioid misuse has led to a new cohort of opioid use disorder (OUD) patients who were introduced to opioids through a legitimate prescription. This change has caused a shift in the demographic profile of OUD patients from predominantly young men to middle age and older people. The management of OUD includes medication-assisted treatment (MAT), which produces varying rates of treatment response. In this study, we will examine whether the source of first opioid use has an effect on treatment outcomes in OUD. Using a systematic review of the literature, we will investigate the association between source of first opioid introduction and treatment outcomes defined as continuing illicit opioid use and poly-substance use while in MAT.

METHODS

Medline, EMBASE, CINHAL, and PsycInfo were searched from inception to December 31st, 2019 inclusive using a comprehensive search strategy. Five pairs of reviewers conducted screening and data extraction independently in duplicate. The review is conducted and reported according to the PRISMA guidelines. A random-effects model was used for meta analyses assuming heterogeneity among the included studies.

RESULTS

The initial search results in 27,345 articles that were screened, and five observational studies were included in the qualitative and quantitative analyses. Our results found that those who were introduced to opioids through a legitimate prescription were significantly less likely to have illicit opioid use (0.70, 95% CI 0.50, 0.99) while on MAT. They were also less likely to use cannabis (0.54, 95% CI 0.32, 0.89), alcohol (0.75, 95% CI 0.59, 0.95), cocaine (0.50, 95% CI 0.29, 0.85), and injection drug use (0.25, 95% CI 0.14, 0.43) than those introduced to opioids through recreational means.

CONCLUSION

This study shows that the first exposure to opioids, whether through a prescription or recreationally, influences prognosis and treatment outcomes of opioid use disorder. Although the increased pattern of prescribing opioids may have led to increased OUD in a new cohort of patients, these patients are less likely to continue to use illicit drugs and have a different prognostic and clinical profile that requires a tailored approach to treatment.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42017058143.

Striatal and white matter volumes in chronic ketamine users with or without recent regular stimulant use

BACKGROUND

Previous studies found enlarged striatum and white matter in those with stimulants use disorders. Whether primarily ketamine users (Primarily-K) and ketamine users who co-used stimulants and other substances (K+PolyS) have abnormal brain volumes is unknown. This study aims to evaluate possible brain structural abnormalities, cognitive function and depressive symptoms, between Primarily-K and K+PolyS users.

METHODS

Striatal and white matter volumes were automatically segmented in 39 Primarily-K users, 41 K+PolyS users and 46 non-drug users (ND). Cognitive performance in 7 neurocognitive domains and depressive symptoms were also evaluated.

RESULTS

Ketamine users had larger caudates than ND-controls (Right: 1-way-ANCOVA-p=0.035; K+PolyS vs. ND, p=0.030; Linear trend for K+PolyS>Primarily-K>ND, p=0.011; Left: 1-way-ANCOVA-p=0.047, Primarily-K vs. ND p=0.051) and larger total white matter (1-way ANCOVA-p=0.009, Poly+K vs. Primarily-K, p=0.05; Poly+K vs. ND p=0.011; Linear trend for K+PolyS>Primarily-K >ND, p=0.004). Across all ketamine users, they performed poorer on Arithmetic, learning and memory tasks, and were more depressed than Non-users (p<0.001 to p=0.001). Greater lifetime ketamine usage correlated with more depressive symptoms (r=0.27, p=0.008). Larger white matter correlated with better learning across all participants (r=0.21, p=0.019), while larger right caudate correlated with lower depression scores in ketamine users (r=-0.28, p=0.013).

CONCLUSION

Ketamine users had larger caudates and total white matter than ND-controls. The even larger white matter in K+PolyS users suggests additive effects from co-use of ketamine and stimulants. However, across the ketamine users, since greater volumes were associated with better learning and less depressive symptom, the enlarged caudates and white matter might represent a compensatory response.

Using behaviour change theory to inform an innovative digital recruitment strategy in a mental health research setting

Recruitment in mental health research is challenging, as some disorders such as depression or schizophrenia may involve vulnerable participants that lack motivation as part of their illness. A mental health diagnosis can be stigmatising, so privacy and access to hospital-based patient cohorts is carefully controlled. Our team describe a pragmatic portal recruitment process for facilitating timely recruitment into multiple research studies focusing on mental health. Three factors were analysed; evaluating the success and impact of this novel recruitment process; identification of patterns in recruitment to better target participants; and provision of metrics of the different media formats engaged. A web-based recruitment portal was developed by the research team in collaboration with the South Australian Health and Medical Research Institute (SAHMRI) Consumer & Carer Research Advisory Group. A comprehensive marketing campaign was then undertaken to direct participants towards the portal. Recruitment insights from the dates and times of registration across a two-year period is provided. In total, 933 potential participants registered with the recruitment portal across a two-year period at a cost of approximately $10,000. The advertisement campaign linked to the portal page enabled 506 participants to register in just one week. The area of research was self-selected by the potential participants, then eligibility was followed up with telephone and face to face interviews. Of the total 933 people who registered 706 (76%) expressed an interest in the target clinical depression study, 119 (13%) opted to be clinical controls, and the remainder chose one of the alternative studies. 240 (26%) of those who registered were excluded through telephone interviews because they fell outside of the strict eligibility criterion. We learnt that 77% (n = 723/933) of participants were recruited within seven days of promotional events, providing an interesting pattern of recruitment that may assist future recruitment design.

Individual, Family, and School Correlates across Patterns of High School Poly-substance Use

Background: Recent popularity in e-cigarette use among high school students and the legalization of marijuana across many states resulted in new patterns of poly-substance use (PSU). Objective: The purpose of this study is to understand contemporary patterns of PSU and their associations with individual social-emotional characteristics (sensation seeking, perceived harm, life satisfaction) and social-contextual factors (parental involvement, school norms, academics, and behaviors). Methods: Latent class analysis (LCA) was used to identify patterns of PSU among 12th-grade students (n = 8417) from the 2016 Monitoring the Future project. Multinomial logistic regression was used to understand the relationship among individual characteristics, social-contextual factors, and patterns of PSU. Results: From the LCA, three patterns of PSU were identified: (1) low-use (72.2%); (2) pre-dominantly marijuana use with some co-occurring substance use (23.8%); and (3) high PSU (4.0%). Results indicate that students with pre-dominant marijuana use were differentiated from those with PSU by having higher perceived harm of electronic and regular cigarette, heavy alcohol use, and better academic grades. Furthermore, students with both polysubstance and pre-dominant marijuana use, when compared to those with low-use, had lower life satisfaction, higher sensation seeking, lower perceived harm of substance use, poorer grades, and more disciplinary problems. Conclusion/Importance: Findings draw attention to the importance of understanding levels of life satisfaction, sensation seeking, perceived harm, academic grades, and disciplinary problems as they pertain to contemporary patterns of PSU. Schools should consider a tailored and multi-tiered approach to addressing students' substance use.

Disruption of Transitions in High-Risk Substance Use from Adolescence to Young Adulthood: School, Employment, and Romantic Relationship Factors

Background: Few studies have examined social-contextual moderators of substance use transitions from adolescence to young adulthood. A better understanding of the extent to which school, employment, and romantic relationships can disrupt high-risk use patterns could inform strategies for substance use prevention and treatment.Objective: The current study examines the extent school, employment, and relationship factors can disrupt transition in high-risk substance use patterns from adolescence to young adulthood.Method: Data were collected biennially from 662 youth in six assessments across ten years (2003-2013). Using latent transition analysis (LTA) that examined transition is substance use classes, we examined school, employment, and relationship moderators of use transitions.Results: Few differences were found during adolescence with the most significant findings occurring in the transition from adolescence to young adulthood. Examining the transitions from adolescence to young adulthood (W4 to W6), we found evidence that school, employment, and relationship status disrupted problematic substance use patterns, such that, individuals that indicated entering school, working full-time, or getting married or entering a relationship were more likely to transition to a low-risk substance use class than remain in the high-risk class.Conclusions/Importance: Findings underscore the importance of school completion, obtaining stable career employment, and quality relationship to help reduce high-risk substance use patterns leading into young adulthood. Prevention and intervention efforts should consider the diverse needs of youth and be prepared to provide a wide range of services that include educational opportunities and career development if they want to reduce high-risk substance use patterns.

Adolescent Anabolic-Androgenic Steroid Use in Association with Other Drug Use, Injection Drug Use, and Team Sport Participation

Introduction

The majority of epidemiologic research on adolescent non-medical anabolic-androgenic steroid (AAS) use was conducted in the 1990s and early 2000s, indicating a need to update evidence for the modern era. We aim to understand the prevalence of AAS use among US adolescents and assess associations between AAS use, sports participation, other drug use, and injection drug use (IDU).

Methods

Using data from the 2017 National Youth Risk Behavior Survey, we estimated the prevalence of AAS use and tested for associations between AAS use, sports participation, and drug use, overall and by sex.

Results

The prevalence of AAS use was 2.98%. The prevalence among boys (3.46%) was higher than among girls (2.41%). AAS use was high among youth with lifetime heroin use (64.41%) and IDU (64.42%). There was no association between AAS and team sport participation (p=0.61).

Conclusions

Our results indicate that adolescent AAS use is an aspect of polysubstance use rather than a substance used solely for performance enhancement in sports. Research with adolescents should be mindful of the overlap of heroin and AAS use among youth with IDU.

Frontostriatal Resting State Functional Connectivity in Resilient and Non-Resilient Adolescents with a Family History of Alcohol Use Disorder

Objectives: Youth with parental substance use disorder (family-history positive [FH+]) are at an elevated risk for substance use problems, but not all FH+ youth experience this outcome. Frontostriatal brain networks involved in inhibitory control and reward responsivity underlie risk-taking behaviors, but the role of these networks in substance use heterogeneity among FH+ youth has not been examined. The present study examined resting state functional connectivity (RSFC) in frontostriatal networks in FH+ youth with and without risky substance use. Methods: Participants were 36 FH+ adolescents (mean age 14.96 years at the scan date; 36% female) from a longitudinal, community-based functional magnetic resonance imaging study enriched for parental alcohol use disorder. Groups were based on the absence (resilient) or presence (high-risk) of at least one occasion of any substance use by age 14 and also use of at least two different types of substances by the most recent substance use assessment (mean age 16.89 years). Bilateral masks of the dorsolateral prefrontal cortex (DLPFC) and the nucleus accumbens were used for seed-based RSFC due to the importance of these regions in executive control and salience networks, respectively. Results: Compared with FH+/high-risk youth, FH+/resilient youth displayed greater connectivity between the left DLPFC seed and the left posterior cingulate cortex. No other brain regions showed significantly different RSFC between resilient and high-risk groups. Conclusion: FH+/resilient youth showed stronger synchrony between brain regions associated with cognitive control, particularly those associated with flexible adaptation of thoughts and behaviors. Although preliminary, the results of this study set the stage for a continued focus on risk-group heterogeneity to better identify neural markers of resilience against substance use problems in vulnerable populations.

Alcohol and Marijuana Polysubstance Use: Comparison of PTSD Symptom Endorsement and Severity Patterns

A growing body of work links posttraumatic stress disorder (PTSD) symptoms and substance use. Unfortunately, much of the literature has examined associations in isolation (e.g., alcohol only). Failure to account for simultaneous or concurrent substance use may limit conclusions that can be drawn from existing research, including the extent to which specific substances contribute differentially to PTSD symptom patterns. The current study examined differences in PTSD symptom profiles between individuals using one or both of the most commonly co-administered psychoactive substances – alcohol and marijuana. Trauma-exposed participants (N = 533; M_age = 21.15) comprised two mutually-exclusive groups: past-month alcohol-only use (n = 334) or past-month alcohol and marijuana use (n = 199). Cluster-level and symptom-level profile analyses evaluated mean differences and shape (parallelism) of PTSD symptom severity profiles between the groups. Follow-up analyses examined symptom-specific difference in PTSD symptom endorsement and severity. Overall, individuals using marijuana and alcohol evidenced greater PTSD negative cognition (30.8% greater) and hyperarousal (26.4% greater) symptom severity. Alcohol and marijuana users were more likely to endorse, and report greater severity of, mood-related PTSD negative cognition symptoms (e.g., anhedonia, negative affect) and externalizing hyperarousal symptom (e.g., irritability/aggression, risky behaviors) than alcohol-only users. Findings highlight important PTSD differences between individuals that are often lumped into homogenous categories of isolated substance users. Findings provide preliminary support for an ‘additive’ self-medication model between PTSD and polysubstance use. Lastly, findings indicate that mood-related negative cognition symptoms and externalizing hyperarousal symptoms may be important targets for PTSD-polysubstance use intervention.

Harm reduction strategies related to dosing and their relation to harms among festival attendees who use multiple drugs

INTRODUCTION AND AIMS

Polysubstance users are a high-risk population for negative health-related consequences. Although some studies have described harm reduction strategies adopted by polysubstance users, studies have not examined their effectiveness in minimising health-related consequences. We aimed to identify dosing-related harm reduction strategies in a sample of polysubstance-using dance festival attendees, and explore the relationship between harm reduction strategies and self-reported adverse health consequences.

DESIGN AND METHODS

Data were examined for 1226 past-year dance festival attendees who self-identified as past-year multiple drug users. We conducted bivariable and multivariable analyses to explore relationships between six dosing-related harm reduction strategies and 13 self-reported adverse consequences.

RESULTS

Self-reported use of dosing-related harm reduction strategies was prevalent, mainly avoidance of mixing depressants (69.2%) and setting limits on quantity (62.2%). Frequent users of harm reduction strategies reported experiencing fewer adverse health consequences (P values < 0.05). Those who reportedly set limits on quantity were at decreased odds of experiencing a bad mood after drug use, sexual difficulties while under drug influence, injuries or fractures while under drug influence, and involvement in fights or being attacked while under drug influence (P values < 0.05). Moreover, those who report frequently avoid mixing depressants were at decreased odds of experiencing headache, loss of consciousness, drop in blood pressure, injuries of fractures, and fights or attacks (P values < 0.05).

DISCUSSION AND CONCLUSIONS

Adoption of dosing-related harm reduction strategies appears to be associated with less drug-related harm among polysubstance-using festival attendees. Findings may inform organisations and policymakers in the designing of harm reduction interventions with this population.