Comorbid conduct disorder and substance use disorders

Substance Use Outcomes from Two Formats of a Cognitive-Behavioral Intervention for Aggressive Children: Moderating Roles of Inhibitory Control and Intervention Engagement

Although cognitive-behavioral interventions have reduced the risk of substance use, little is known about moderating factors in children with disruptive behaviors. This study examined whether aggressive preadolescents’ inhibitory control and intervention engagement moderates the effect of group versus individual delivery on their substance use. Following screening for aggression in 4th grade, 360 children were randomly assigned to receive the Coping Power intervention in either group or individual formats. The sample was primarily African American (78%) and male (65%). Assessments were made of children’s self-reported substance use from preintervention through a six-year follow-up after intervention, parent-reported inhibitory control at preintervention, and observed behavioral engagement in the group intervention. Multilevel growth modeling found lower increases in substance use slopes for children with low inhibitory control receiving individual intervention, and for children with higher inhibitory control receiving group intervention. Children with low inhibitory control but who displayed more positive behavioral engagement in the group sessions had slower increases in their substance use than did similar children without positive engagement. Aggressive children’s level of inhibitory control can lead to tailoring of group versus individual delivery of intervention. Children’s positive behavioral engagement in group sessions is a protective factor for children with low inhibitory control.

An Integrated Model of Nature and Nurture Factors that Contribute to Addiction and Recovery

BACKGROUND

In the context of the opioid epidemic and growing awareness of addiction as a public health concern, there are efforts to inform the public, patients, families, and policy makers about the factors that contribute to addiction and facilitate recovery. Several theoretical models provide useful frameworks for this discussion, but each of them has limitations.

OBJECTIVES

This paper presents an accessible yet comprehensive theoretical model that integrates empirical evidence about addiction etiology and recovery using the nature-nurture paradigm.

RESULTS

The model presents substance use along a continuum, and identifies risk and protective factors in multiple domains that have been identified by research. The domains on the nature side of the model include genetic and biological factors, comorbid psychiatric and medical disorders, physiological reinforcement of substance use, and changes to neural mechanisms. The domains on the nurture side of the model include sociocultural factors, environmental factors, personality, emotions, cognitions, psychological reinforcement of substance use, and cognitive and behavioral changes. The progression from increased or decreased substance use to addiction or recovery is mediated by changes in neural mechanisms and cognitive and behavioral changes, which have feedback loops with the physiological and psychological reinforcement.Conclusions/Importance: This model is a useful heuristic, consistent with a public health framework, for discussing addiction and recovery with patients, their families, and the public. This integrated model of nature and nurture factors has the potential to inform clinical practice, consultation, research, prevention programs, educational programs, and public policy.

Associations Between Substance Use in Commission of Sexual Crimes and Offense Characteristics Among Youth: Mitigating Effects of Substance Use Treatment

The small extant research base on substance use and youth sexual offending has very few descriptive details. Furthermore, research has yet to test associations between the use of substances in the commission of sexual crimes and offense-related characteristics and how substance use treatment can mitigate these effects. In a sample of residentially housed youth adjudicated of a sexual crime ( N = 332), prevalence patterns are broken down by type of substance use behavior. Sequential regression models are run to test the associations between substance use prior to a sexual crime and number of victims, sexual deviance, and non-sexual criminality. Substance use treatment is tested as a mitigating factor in these relationships. Results reveal high levels of family substance use, and high rates of alcohol, marijuana, and other substance use. There were associations between substance use prior to sexual criminality and sexual deviance and non-sexual criminality. Substance use treatment reduced the effects of substance use on non-sexual criminality. Research and treatment implications are offered.

Differential susceptibility to environmental influences: Interactions between child temperament and parenting in adolescent alcohol use

Temperament and parental practices (PP) are important predictors of adolescent alcohol use (AU); however, less is known about how they combine to increase or decrease risk of AU. This study examined whether age 6 temperament (i.e., impulsivity and inhibitory control) interacted with age 6 coercive PP and/or age 14 parental monitoring to predict AU at 15 years among 209 adolescents. Results showed that low parental monitoring was associated with more frequent AU and that coercive PP interacted with impulsivity to predict AU. This interaction was examined as a function of two models that were not studied before in the prediction of AU: the diathesis-stress model (i.e., impulsive children are more "vulnerable" to adverse PP than those with an easy temperament); and the differential susceptibility model (i.e., impulsive children are also more likely to benefit from good PP). Results supported the differential susceptibility model by showing that impulsive children were not only at higher risk for AU when combined with high coercive PP but also benefit from the absence of coercive PP. This supports the suggestion that the conception of certain temperament characteristics, or in this case impulsivity, as a "vulnerability" for adolescent AU, may need revision because it misrepresents the malleability it may imply.

Do ADHD symptoms moderate the relation between positive alcohol expectancies and alcohol-related outcomes?

Research indicates that attention-deficit/hyperactivity disorder (ADHD) may be a risk factor for heavy alcohol use and related problems. Research also suggests that positive alcohol expectancies (i.e., positive beliefs about the effects of alcohol) are predictive of risky alcohol use and related problems (e.g., driving while intoxicated). However, no research has examined the association between ADHD symptoms and positive expectancies or the role of ADHD symptoms in the relation between positive expectancies and alcohol use and related problems, an unexplored area addressed by the current study. Participants were 889 undergraduates (76% female, 82.3% Caucasian) at a Southeastern University who completed self-report measures. Parent report (59%) of current and childhood ADHD symptoms was also collected. Findings indicated that ADHD symptoms moderated the relation between positive alcohol expectancies and alcohol-related problems, but not the relation between expectancies and alcohol use. Additional analyses revealed that ADHD symptoms moderated the specific relation between positive expectancies and social alcohol problems (e.g., engaging in unplanned sexual behavior), but not between expectancies and internal alcohol problems (e.g., feeling sad). Moderating effects were significant even after controlling for conduct disorder symptoms and stimulant medication use. Findings have implications for the identification of college students who are at particularly high risk for heavy drinking and alcohol-related problems. Results may also aid in the development of interventions aimed at reducing risky drinking among students.

What do we really know about ADHD in college students?

Research on ADHD in college students began in the 1990s and has been steadily increasing in recent years. Because young adults with ADHD who attend college have experienced greater academic success during high school than many peers with the disorder, which is likely to be associated with better overall functioning, the degree to which they experience similar patterns of adjustment difficulties was not initially known. Accumulating research suggests that college students with ADHD experience less academic success and greater psychological and emotional difficulties than other students and use alcohol and drugs at higher rates. However, conclusions to be drawn from this research are limited by the use of small samples that may not be representative of the wider population of students with ADHD, and a lack of diagnostic rigor in identifying students with ADHD to be included in such research. Studies of the effectiveness of psychosocial treatments, medication treatment, and academic accommodations are extremely limited or nonexistent. Issues particularly germane to college students include feigning ADHD and the misuse and diversion of stimulant medication. Given that at least 25 % of college students with disabilities are diagnosed with ADHD, methodologically sound investigations are clearly needed in order to better understand the impact of ADHD on college students' adjustment and to develop and implement interventions that can enhance students' success.