Does exposure to parental substance use disorders increase substance use disorder risk in offspring? A 5-year follow-up study

Social and health factors associated with unfavourable treatment outcomes in children and adolescents with drug-sensitive tuberculosis in Brazil: a national retrospective cohort study

Background

Although tuberculosis (TB) poses a significant global health threat to children and adolescents, there is limited information on the factors associated with TB treatment outcomes in this group. This study investigated the social and health factors associated with unfavourable treatment outcomes in children and adolescents with TB in Brazil, a high TB burden country.

Methods

We conducted a population-based national retrospective cohort study of children (0-9 years) and adolescents (10-17 years) with TB in Brazil notified to the national Sistema de Informação de Agravos de Notificação (Sinan) from Jan 1, 2001, to Dec 31, 2022. Unfavourable treatment outcomes were defined as loss to follow-up, treatment failure, and death. Logistic regression and multinomial models examined the association between social and health factors, unfavourable treatment outcomes overall, and loss to follow-up and death, respectively.

Findings

A total of 88,270 children and adolescents with TB were included of whom 25,600 (30.6%) had healthcare worker-supervised directly observed therapy (DOT). Of these, 9303 (10.5%) individuals experienced unfavourable TB treatment outcomes. For children, HIV infection (adjusted Odds Ratio 2.4, 95% confidence interval 1.9-3.1) and did not receive DOT (2.3, 1.9-2.7) were associated with unfavourable treatment outcomes. For adolescents, alcohol use (1.6, 1.2-2.0), illicit drug use (4.2, 3.4-5.1), tobacco use (1.6, 1.3-2.1), HIV infection (2.7, 2.2-3.4), and not receiving DOT (2.6, 2.3-2.9) were associated with unfavourable TB treatment outcome. Receiving social protection through government cash transfers protected against death (0.5, 0.3-0.9).

Interpretation

In Brazil, TB treatment success rates were comparable to WHO End TB Strategy targets (90%). Substance use, HIV infection, and the absence of supervised treatment were the main factors associated with unfavourable treatment outcomes. Strategies to improve equity of TB treatment outcomes in this vulnerable group, including integrated HIV-TB services, DOT in healthcare facilities or communities, and holistic, person-centred healthcare and social protection, should be evaluated.

Funding

Department of Health and Social Care (DHSC), the Foreign, Commonwealth & Development Office (FCDO), the Medical Research Council (MRC) and Wellcome, UK.

Effect of selective and family-based prevention on addiction susceptibility, affiliation with deviant peers, risk-taking, and risk and protective factors of substance use in high-risk adolescents: A randomized clinical trial

BACKGROUND

Adolescents with a background in families affected by substance use exhibit an increased susceptibility to developing individual substance-related or other mental disorders. Consequently, they represent a crucial demographic for targeted preventive interventions. The current study examined the impact of selective prevention (SP) and family-based prevention (F-BP) measures on addiction susceptibility, affiliation with deviant peers (ADP), risk-taking, and risk and protective factors (RPFs) related to substance use among high-risk adolescents.

MATERIALS AND METHODS

The study employed an experimental design incorporating pretest, posttest, and 6-month follow-up. A sample of 60 adolescents, meeting the study criteria, was selected and assigned to two intervention groups and one control group using a simple randomization method (with 20 individuals in each group). Measures encompassed the Risk and Protective Factors Inventory (RAPI), Addiction Susceptibility Questionnaire-Adolescents Version (ASQ-AV), Adolescent Affiliation with Deviant Peers Scale (AADPS), and Iranian Adolescents Risk-taking Scale (IARS). The data were analyzed with repeated measures analysis of variance (ANOVA) using Statistical Package for the Social Sciences (SPSS) version 24 software.

RESULTS

The results revealed significant differences only between the SP and F-BP groups in the variables of adolescent risk-taking and addiction susceptibility. However, for the other study variables, no significant differences were observed between the SP and F-BP groups. Furthermore, notable differences were identified between the control group and F-BP, as well as between the control group and SP, across all study variables (P value < 0.05).

CONCLUSIONS

The outcomes of our investigation reinforce the importance of adopting multifaceted approaches in substance abuse prevention, emphasizing the need to target various aspects of individuals' lives. Regarding data generalization, it is noteworthy that the sample comprised adolescents predominantly from middle- or low-income groups, suggesting caution in extending findings to the entire adolescent population. Finally, we recommend that future studies assess interventions that involve both adolescents and parents in sessions.

Maternal Substance Use and Early-Life Adversity: Inducing Drug Dependence in Offspring, Interactions, Mechanisms, and Treatments

The likelihood of substance dependency in offspring is increased in cases when there is a family history of drug or alcohol use. Mothering is limited by maternal addiction because of the separation. Maternal separation (MS) leads to the development of behavioural and neuropsychiatric issues in the future. Despite the importance of this issue, empirical investigations of the influences of maternal substance use and separation on substance use problems in offspring are limited, and studies that consider both effects are rare. This study aims to review a few studies on the mechanisms, treatments, genetics, epigenetics, molecular and psychological alterations, and neuroanatomical regions involved in the dependence of offspring who underwent maternal addiction and separation. The PubMed database was used. A total of 95 articles were found, including the most related ones in the review. The brain's lateral paragigantocellularis (LPGi), nucleus accumbens (NAc), caudate-putamen (CPu), prefrontal cortex (PFC), and hippocampus, can be affected by MS. Dopamine receptor subtype genes, alcohol biomarker minor allele, and preproenkephalin mRNA may be affected by alcohol or substance use disorders. After early-life adversity, histone acetylation in the hippocampus may be linked to brain-derived neurotrophic factor (BDNF) gene epigenetics and glucocorticoid receptors (GRs). The adverse early-life experiences differ in offspring›s genders and rewire the brain›s dopamine and endocannabinoid circuits, making offspring more susceptible to dependence. Related psychological factors rooted in early-life stress (ELS) and parental substance use disorder (SUD). Treatments include antidepressants, histone deacetylase inhibitors, lamotrigine, ketamine, choline, modafinil, methadone, dopamine, cannabinoid 1 receptor agonists/antagonists, vitamins, oxytocin, tetrahydrocannabinol, SR141716A, and dronabinol. Finally, the study emphasizes the need for multifaceted strategies to prevent these outcomes.

The Role of Environment, Early Use, Genetic Influences, and Neurobiology in Substance Use Disorder

Substance use disorders (SUDs) have dire consequences for the individual, family, and community. Although SUDs were once viewed as a moral issue, they are now understood to be complex, chronic brain illnesses associated with both genetic and non-genetic influences. The American Psychiatric Association recognizes SUDs associated with the use of 10 different substances, for example, alcohol, nicotine, opioids, cannabis, caffeine, hallucinogens, inhalants, sedatives, hypnotics, and stimulants. Environmental exposure to substances, early use, genetic influences, and neurobiology have all been correlated with an increased likelihood of the development of SUDs. Having a broader understanding of these complex disorders is key for prevention.

The association between maternal and paternal substance use and child substance use, internalizing and externalizing problems: a systematic review and meta-analysis

AIMS

There is substantial evidence showing an association between parental substance use and child substance use and/or mental health problems. Most research focuses upon maternal substance use, with the influence of paternal substance use often being overlooked. We aimed to investigate the differential effects of maternal and paternal substance use upon children aged 0-18 years.

METHODS

We used systematic review methods to identify observational studies examining the association between either maternal or paternal substance use and child substance use and/or mental health problems. The odds ratio (OR) effect measure was used, for ease of computation. We used a random-effects model with the inverse variance method to meta-analyse the findings from eligible studies.

RESULTS

We included 17 unique studies with a total of 47 374 child participants. Maternal and paternal substance use were both associated with increased odds of child any drug use [OR = 2.09; 95% confidence interval (CI) = 1.53, 2.86; n = 12 349 participants; three studies and OR = 2.86; 95% CI = 1.25, 6.54; n = 5692 participants; three studies, respectively], child alcohol problem use (OR = 2.16; 95% CI = 1.73, 2.71; n = 7339 participants; four studies and OR = 1.70; 95% CI = 1.36, 2.12; n = 14 219 participants; six studies), child externalizing problems (OR = 1.81; 95% CI = 1.01, 3.22; n = 1748 participants; three studies and OR = 1.60; 95% CI = 1.18, 2.17; n = 2508 participants; six studies) and child internalizing problems (OR = 1.60; 95% CI = 1.25, 2.06; n = 1748 participants; three studies and OR = 1.42; 95% CI = 1.12, 1.81; n = 2248 participants; five studies). Child any alcohol use was associated with maternal substance use only (OR = 2.26; 95% CI = 1.08, 4.70; n = 28 691 participants; five studies).

CONCLUSIONS

Both maternal and paternal substance use are associated with child substance use and mental health problems.

The intergenerational transmission of gambling and other addictive behaviors: Implications of the mediating effects of cross-addiction frequency and problems

INTRODUCTION

This study examined the degree to which perceptions of familial and household participation in gambling and other addictive behaviors in youth was associated with frequency and problem severity of gambling, alcohol and/or drug use in participants as adults.

METHOD

The study measured perceived frequency of gambling, alcohol use, drug use and other potentially addictive behaviors in family/household members and the frequency and problem severity of gambling, alcohol, and drugs in an epidemiological sample of adults 18 and older (N = 3,499; m = 48.26 %, f = 51.74 %).

RESULTS

About 23.45 % of participants reported their father gambled when they were a child or adolescent, followed by mother (13.56 %), grandfather (9.73 %), or grandmother (7.83 %). A pathway model demonstrated cross-addiction inter- and intra-generational influences. Gambling by a father, mother or brother; substance use by a sister; and/or engagement in other behaviors by a brother, sister, grandmother or other household member was related to higher frequency of participant gambling (ps < 0.05), and, in turn, to higher levels of gambling, alcohol, and drug use problem severity (ps < 0.05).

DISCUSSION

Findings demonstrate the complex contributions of specific family and household members in the transmission of addictive behaviors. Frequency of gambling, alcohol use, and drug use mediated the relationship of perceived family behavior with and across addictions. In addition, perceptions regarding use of alcohol and/or other drugs, or engagement in other behaviors by family or household members was related not only to participants' alcohol and drug use but also to problem gambling frequency and severity.

Parental substance use disorder and offspring not in education, employment or training: a national cohort study of young adults in Sweden

AIMS

To test the hypothesis that exposure to parental substance use disorder is associated with an increased risk of being not in education, employment or training (NEET) in male and female offspring during young adulthood.

DESIGN, SETTING AND PARTICIPANTS

A register-based, national cohort study of 797 376 individuals born between 1984 and 1990, residing in Sweden at age 17 years. Participants were followed from age 17 years to maximum age 32 years and assessed annually for being NEET.

MEASUREMENTS

The exposure variable was binary, defined as any diagnosis of substance use disorder (alcohol and/or drug use disorder) in one or both parents, measured between offspring's birth and age 17 years. Cox regression analysis was used to obtain hazard ratios (HRs) for being NEET, assessed annually as a binary variable using income and employment data.

FINDINGS

We found that 4.4% of individuals were exposed to parental substance use disorder. When adjusted for birth year, domicile, origin, psychiatric diagnosis, household income and parental psychiatric diagnosis, HRs for being NEET were HR = 1.13 (95% CI 1.09-1.16) for males, and HR = 1.15 (95% CI 1.12-1.19) for females. When stratified by age, adjusted HRs for experiencing the first episode of NEET peaked at age 17-19 years, HR = 1.37 (95% CI 1.25-1.50) for males, and HR = 1.31 (95% CI 1.18-1.44) for females.

CONCLUSIONS

In Sweden, exposure to parental substance use disorder before age 17 years is associated with increased risk of being not in education, employment or training during early adulthood. The risks were highest at age 17-19 years for both males and females, decreasing with greater age.

Discrepant Parent-Adolescent Reports of Parenting Practices: Associations with Adolescent Internalizing and Externalizing Symptoms

Discrepancies in multi-informant reports of parenting practices represent a meaningful clinical construct that can be harnessed to predict adolescent mental health outcomes and shed light on the nature of parent-adolescent relationships. To date, however, no research has sought to examine discrepancies in perceptions of parenting practices among adolescents with histories of substance use disorders, a population for whom supportive parenting is a critical protective factor during the recovery process. This study examined parent-adolescent informant discrepancies of parenting practices and their associations with externalizing and internalizing symptomology among a sample of adolescents with substance use disorder histories. Data were analyzed from 294 adolescents (M adolescent age = 16 years; 45% female, 72% white) and their parents (87% female, 83% white) from a larger longitudinal study. Parenting practices of interest were positive parenting, inconsistent discipline, and poor monitoring. Polynomial regression analyses were used to test the discrepancy hypotheses. The results generally suggested null associations between single informant reports and internalizing and externalizing symptoms. Discrepancies were noted, however, in multi-informant reports of positive parenting, such that higher levels of adolescent-reported positive parenting were associated with higher levels of internalizing symptoms at high (but not low) levels of parent-reported positive parenting. Similarly, discrepancies were noted in multi-informant reports of poor monitoring, such that lower levels of adolescent-poor monitoring were associated with higher externalizing symptoms at low levels of parent-reported poor monitoring. The findings are discussed in terms of research and clinical implications of collecting and utilizing multi-informant data among clinical samples of adolescents with unique risk profiles.

Within- and between-person associations with drug use disorder among adolescents and emerging adults presenting to an urban emergency department

BACKGROUND

The distinction between within- and between-person associations with drug use disorder (DUD) has implications for intervention targets and content. We used longitudinal data from youth entering an urban emergency department (ED) to identify factors related to changes in DUD diagnosis, with particular emphasis on alcohol use.

METHODS

Research staff recruited youth age 14-24 (n = 599) reporting any past six-month drug use from a Level-1 ED; participants were assessed at baseline and four biannual follow-ups. Participants self-reported validated measurements of peer/parental behaviors, violence/crime exposure, drug use self-efficacy, and alcohol use. Research staff performed diagnostic interviews for DUD with nine substances, post-traumatic stress disorder (PTSD), and major depressive disorder (MDD). We used repeated measures logistic regression models with person-level covariate means, and person-mean-centered covariates, as separate variables, to separate within- and between-person covariate effects.

RESULTS

Among 2,630 assessments, 1,128 (42.9 %) were DUD diagnoses; 21.7 % were co-diagnoses with multiple drugs. Positive (aOR = 0.81, 95 %CI:[0.70, 0.94]) and negative (aOR = 1.73, 95 %CI:[1.45, 2.07]) peer behaviors related to DUD, primarily through between-person effects. Parental support (aOR = 0.92, 95 %CI:[0.83, 0.99]), community violence/crime (aOR = 1.28, 95 %CI:[1.14, 1.44]), PTSD/MDD diagnosis (aOR = 1.36, 95 %CI:[1.04, 1.79]), and alcohol use quantity (aOR = 1.06, 95 %CI:[1.02, 1.11]) were associated with DUD, showing primarily within-person effects. Other factors, such as interpersonal violence involvement (aOR = 1.47, 95 %CI:[1.21, 1.78]), showed both within- and between-person effects.

CONCLUSIONS

DUD is prevalent in this population, and within-person changes in DUD are predictable. Within-person effects suggest the importance of addressing escalating alcohol use, enhancing parental support, crime/violence exposure, and other mental health diagnoses as part of DUD intervention.

Maternal Substance Abuse and the Mother-Child Relationship in Late Childhood

This study examines the relationship between maternal substance abuse and various aspects of the mother-child relationship in late childhood while accounting for mental health and comorbid substance abuse and mental health among a predominantly racial minority sample. Using 369 mother-child dyads from the Rochester Intergenerational Study (64% Black, 17% Hispanic, and 8% mixed race/ethnicity), multilevel generalized linear models examined the effects of a maternal substance abuse history, a history of clinical depression, and comorbid substance abuse and depression histories on both maternal and child reports of five aspects of the mother-child relationship (i.e. warmth, consistent discipline, maternal knowledge, involvement, and conflict).

RESULTS

A maternal substance abuse history alone was unrelated to each aspect of the mother-child relationship as perceived by the mother or child, with the exception of child perceptions of maternal knowledge of behavior. Alternatively, a history of depression or comorbid histories of substance abuse and depression was negatively related to warmth, consistent discipline, involvement, and conflict but only as perceived by the mother.

CONCLUSIONS

This study reinforces the need for integrated treatment programs for women with substance use problems, particularly programs that incorporate mental health and parenting components. Moreover, it highlights specific targets for intervention that can reduce subsequent maternal substance abuse and improve offspring outcomes. The divergence in observed effects across reporter also suggests that future research should use multiple reporters to examine the interpersonal consequences associated maternal substance abuse.

Associations of prenatal alcohol exposure and offspring harmful alcohol use: findings from the Raine Study

BACKGROUND

Epidemiological evidence suggests offspring exposed to prenatal alcohol are at increased risk of alcohol use disorders in adulthood. The evidence on the risk of developing harmful alcohol use in adolescence is less clear.

METHODS

We used data from the Raine Study, a multi-generational birth cohort study, to examine the association between prenatal alcohol exposure and the risk of harmful alcohol use in offspring at the age of 17 years. Log binomial regression was used to estimate the relative risks (RRs) of harmful alcohol use in offspring exposed to maternal alcohol use in the first (early) and third (late) trimesters of pregnancy. Maternal pre-pregnancy alcohol use was used as a negative control for intrauterine exposure for comparison.

RESULTS

Complete data were available for 1200 mother-offspring pairs. After adjustment for potential confounders, we found increased RRs of harmful alcohol use in offspring born to mothers who consumed four or more standard drinks of alcohol per week during the first trimester [RR 1.45(95% CI: 1.08-1.93)], third trimester [RR 1.34 (95% CI: 1.04-1.72)] and during both trimesters of pregnancy [RR 1.86 (95% CI: 1.16-2.96)]. Maternal pre-pregnancy alcohol use was not associated with an increased risk of harmful alcohol use in offspring [RR 1.15 (95% CI: 0.89-1.48)].

CONCLUSION

Observed associations for maternal prenatal alcohol exposure but not maternal pre-pregnancy alcohol use suggests a biological mechanism for intrauterine alcohol exposure on the risk of harmful alcohol use in the offspring.

Prevalence Estimates of ADHD in a Sample of Inpatients With Alcohol Dependence

Objective: ADHD is common in patients with alcohol dependence, but prevalence results are inconsistent. We investigated ADHD prevalence in a complex design to avoid over- or underdiagnosing. Method: Patients with alcohol dependence starting long-term residential treatment were included. A structured interview (Diagnostic Interview for ADHD in Adults [DIVA]) was conducted on all patients. DIVA results indicating childhood or adulthood ADHD were assessed in successive diagnostic interviews by two expert clinicians. Results: 415 of 488 patients had completed the entire diagnostic assessment. ADHD prevalence was 20.5%. DIVA results correlated moderately with experts' diagnoses. In patients with ADHD, a higher comorbid illicit substance use was prevalent and alcohol dependence started earlier and was more severe. Conclusion: This study provides the largest sample on ADHD prevalence in alcohol dependent inpatients. Despite great efforts to avoid overestimation, we found every fifth patient to have ADHD. ADHD diagnosis should not be based solely on a structured interview but should be clinically confirmed.

Parental Optimism and Perceived Control over Children's Initiation of Tobacco, Cannabis, and Opioid Use

Families play an important role in helping teenagers avoid using tobacco, cannabis, and opioids, but some parents may underestimate the risk of their children using those substances. This study aimed to determine parents' perceived likelihood of their child initiating tobacco, cannabis, and opioid use, as well as the control they have in preventing their child from using those substances. We surveyed 427 parents of children aged 0-18 years old using the online Amazon Mechanical Turk platform in the spring of 2019. We measured participants' perceived likelihood of their child initiating tobacco, cannabis, or opioid use before the age of 18 compared to other children, using a five-point Likert scale. This perceived likelihood was dichotomized between optimistic (less likely than average) and non-optimistic (average or more likely than average). Independent variables included parental tobacco use, perceived parental control, and perceived severity of the behavior. Participants with missing data and participants with children who had already initiated substance use were excluded from statistical analyses. Mean age of participants was 38.1 years (Standard Deviation 8.4); 67% were female. Level of parental optimism was 59% for cannabis, 77% for tobacco, and 82% for opioids. Perceived severity was significantly lower for cannabis use (71/100) than tobacco (90/100) and opioid use (92/100) (p < 0.001). Current smokers were less likely than never smokers to be optimistic about their child's risk of initiating using tobacco (Adjusted Odds Ratio (AOR): 0.18 [95% Confidence Interval (CI) 0.10-0.34]) or cannabis (AOR: 0.21 [95% CI 0.12-0.38]). Parental perceived likelihood of a child initiating substance use represents an understudied and potential target for substance use prevention.

"I missed open arms": The Need for Connectedness among Black Youth Affected by Parental Drug Use

Parental drug use has significant impacts on the physical, behavioral and social well-being of adolescents, particularly those from disenfranchised communities. We conducted a qualitative study to understand connectedness among Black adolescents affected by parental drug use in Baltimore, Maryland. In-depth interviews (N=30) were conducted with three groups: parents with a history of drug use, youth (18-24yo) who had a biological parent with a history of drug use and youth providers with experience working with families affected by drug use. Data were analyzed inductively using a content analytic approach. Three salient themes emerged: (1) missing parental connections, (2) the desire for consistent, trusted adults and (3) the consequences of missed connections. All participants emphasized the limited emotional support and guidance provided to youth affected by parental drug use. However, extended family members (e.g., grandmothers, aunts, and older siblings) and community mentors stepped in to fulfill unmet needs, when possible. The consequences of missed connections were increased involvement in risky behaviors, fewer basic necessities and a missed childhood. Findings from the study deepen the understanding of how to support the well-being of youth impacted by parental drug use and highlight the value of including the voices of vulnerable families in research.

The Association Between Adverse Child Health, Psychological, Educational and Social Outcomes, and Nondependent Parental Substance: A Rapid Evidence Assessment

BACKGROUND

Between 5% and 30% of children in high-income countries live with a substance misusing parent, the majority of which is below dependent levels. However, little is understood about the impact of nondependent parental substance misuse upon children.

METHODS

We searched the international literature using rigorous systematic methods to identify studies examining parental substance misuse and adverse outcomes in children. The inclusion criteria were cross-sectional, longitudinal, case-control, and cohort studies; of children aged 0-18 years whose parents are high-risk substance misusers; reporting on their health, psychological, substance use, educational, and social outcomes.

RESULTS

We identified 36 papers (from 33 unique studies), most of which were assessed as being of medium to high methodological quality (N= 28). Parental nondependent substance misuse was found to be associated with adversity in children, with strong evidence of an association with externalizing difficulties (N = 7 papers, all finding an association) and substance use (N = 23 papers, all finding an association) in adolescents and some evidence of adverse health outcomes in early childhood (N = 6/8 papers finding an association). There is less evidence of an association between parental substance misuse and adverse educational and social outcomes. The body of evidence was largest for parental alcohol misuse, with research examining the impact of parental illicit drug use being limited.

CONCLUSION

Methodological limitations restrict our ability to make causal inference. Nonetheless, the prevalence of adverse outcomes in children whose parents are nondependent substance misusers highlights the need for practitioners to intervene with this population before a parent has developed substance dependency.

Adversity profiles among court-involved youth: Translating system data into trauma-responsive programming

BACKGROUND

Court-involved youth have high levels of adverse childhood experiences (ACEs), which can impact functioning in adolescence and throughout adulthood. Yet there is limited research to help clinicians translate these histories into trauma-responsive programming guidelines.

OBJECTIVE

This manuscript utilizes data that is routinely collected to inform practitioners about how to utilize trauma histories to inform program and practice decisions.

METHODS

This study used administrative data with a diverse sample of medium- to high-risk youth on probation (N = 5,378) to examine how ACE clusters, identified through Latent Class Analysis, evinced differential treatment needs across multiple domains.

RESULTS

Six identified classes - Low All, Parental Incarceration, Parental Health Problems, High Conflict, High Maltreatment, and High All - were assessed for differences in self-regulation, mental health, substance use, academic functioning, family/social resources, and behavioral problems. Classes varied significantly on all assessed domains, indicating differential needs for effective interventions to interrupt negative trajectories.

CONCLUSIONS

Utilizing existing data in a real-world setting and addressing challenges and barriers in real-time can help bring research evidence to practice. In addition to juvenile justice settings, we conclude with discussion of ways that allied community based services in schools, youth programming, and family services can benefit from awareness of these youth adversity profiles.

Would You Be Surprised If This Patient Died This Year? Advance Care Planning in Substance Use Disorders

Primary care physicians are increasingly incorporating screening tools for substance use disorders (SUDs) and referral to treatment into their practice. Despite efforts to provide access to treatment, patients with SUDs remain at an increased risk of mortality, both from overdose and from general medical conditions. Advance care planning (ACP) is recommended for patients with chronic, progressive medical conditions such as malignancies or heart failure. Though SUDs are widely acknowledged to be chronic diseases associated with an increased risk of mortality, there has been little discussion on ACP in this population. ACP is a discussion regarding future care, often including selection of a surrogate decision-maker and completion of an advanced directive. ACP has been associated with better quality of end-of-life and care more consistent with patient preferences. Studies in other vulnerable populations have shown that marginalized and high-risk individuals may be less likely to receive ACP. Similarly, patients with SUDs may employ different decision-makers than that defined by law (i.e., friend vs. family member), increasing the importance of discussing patient values and social structure. Physicians should routinely conduct ACP conversations with patients with SUDs, especially those with chronic, progressive medical conditions and/or severe, uncontrolled substance use disorders.

Cross-sectional study on influence of the family environment on the lifetime non-medical use of prescription drugs among Chinese adolescents in Guangdong: an analysis of sex differences

OBJECTIVES

This study aimed to assess if adolescents had used any prescription drugs non-medically, to explore the associations between the family environment and non-medical use of prescription drugs (NMUPD) and to investigate whether there are any sex differences in the aforementioned associations.

DESIGN

A population-based cross-sectional study.

SETTING

A secondary analysis of the cross-sectional data collected from high school students in Guangdong who were sampled using a multistage, stratified-cluster, random-sampling method in the 2015 School-based Chinese Adolescents Health Survey.

PARTICIPANTS

A total of 21 774 students aged 12-20 years.

DATA ANALYSIS

Multilevel logistic regression models were used to explore the univariable and multivariable relationship between family environment and NMUPD among adolescents. Adjusted ORs and corresponding 95% CI were calculated.

OUTCOME MEASURES

Questions regarding to adolescent' NMUPD (including sedative, opioid and stimulant) were surveyed in the study.

RESULTS

A total of 6.3% students reported lifetime NMUPD in this study. The most commonly used drugs were opioids (3.9%), followed by sedatives (3.2%) and stimulants (2.5%). Multilevel analyses indicated that living arrangements, family economic status, parental relationships, parental education levels, monthly pocket money, parental drinking and drug problems were significantly correlated to the NMUPD among all students. Among boys, living arrangements, family economic status, maternal education levels, monthly pocket money, parental drinking and drug problems were significantly related to different types of NMUPD. The same factors were related to girls' NMUPD, except for maternal education levels. Parental relationships and paternal education levels were also associated with girls' NMUPD.

CONCLUSION

The family environment exerts an important influence on adolescents' NMUPD. Interventions targeted at families are highly recommended considering the negative effects of NMUPD. In addition, the child's sex might be taken into consideration when developing and implementing preventive strategies.

Mini Review: Socio-Cultural Influences on the Link Between ADHD and SUD

Attention-deficit/hyperactivity disorder (ADHD) is a risk factor for the development and persistence of substance use disorders (SUD). The prevalence of ADHD in patients with SUD varies across countries and cultures. So far, cross-cultural variance in ADHD prevalence rates among SUD patients was mainly ascribed to methodological differences between studies, leaving the role of societal and cultural practices in the ADHD-SUD link hardly acknowledged. The aim of the present mini review is to address this gap in the literature by providing evidence for the effect of socio-cultural practices on the ADHD-SUD link and suggesting directions for future research. To achieve this goal, we map the influence of socio-cultural factors on the ADHD-SUD link along three lines of research. The first line is concerned with the role of socio-cultural factors in the recognition, diagnosis and treatment of childhood ADHD. The second line of research is concerned with socio-cultural influences on substance use (e.g., religion, ethnic identity, acculturation, and socio-economic status). Finally, we describe potential socio-cultural factors which may operate as mechanisms for reducing or increasing access to substance abuse treatment (e.g., ethnic disparities in health care utilization). Identifying socio-cultural influences on the ADHD-SUD link may provide further insight into the bidirectional association between ADHD and SUD in different contexts and encourage future research in the field.

Depressive symptoms, sexual activity, and substance use among adolescents in Kampala, Uganda

BACKGROUND

Adolescents experience high rates of depression, initiation of sexual activity, and substance use.

OBJECTIVES

To better understand the demographics of adolescents presenting to an adolescent clinic in Uganda, and to elucidate which factors are associated with depressive symptoms, sexual initiation, and substance use.

METHODS

A retrospective review was performed on intake forms obtained during interviews with adolescents presenting to the Makerere/Mulago Columbia Adolescent Health Clinic (MMCAH) in Kampala, Uganda.

RESULTS

Depressive symptoms in adolescents were correlated with having a chronic illness (p=.026), and reported poor quality of home life (p<.001). Initiation of sexual activity was also correlated with chronic illness (p=.008) and poor quality of home life (p=.006). Substance use was correlated with maternal death (p=.041), chronic illness (p=.038), and substance use among family members (p<.001) and friends (p<.001).

CONCLUSIONS

Knowing the aforementioned risk factors can help us better understand the needs of adolescents presenting to MMCAH, and allows us to develop targeted interventions aimed at decreasing health risks in Kampala's adolescent population.

Anhedonia as a phenotypic marker of familial transmission of polysubstance use trajectories across midadolescence

Psychopathologic traits that arise in adolescence may increase proneness to substance use uptake as well as channel the familial transmission of substance use. Poly use is a common pattern of substance use in youth. To identify a parsimonious model of familial transmission of substance use, the current study tested whether anhedonia-a psychopathologic endophenotype manifested as the inability to experience pleasure-mediates the association of family history of substance use (FHS) with polysubstance use patterns across midadolescence. High school students (N = 3,392) in Los Angeles, CA, completed 4 semiannual surveys of mental health and substance use from ages 14- to 16-years-old. Use and co-use of cigarettes, alcohol, and marijuana across the 4 waves were reduced to 4 homogenous classes using parallel process growth mixture modeling: (a) abstainers (N = 1,629, 48.0%); (b) experimenters (N = 1,293, 38.1%); (c) polysubstance using marijuana escalators (N = 210, 6.2%); and (d) heavy polysubstance using cigarette escalators (N = 126, 3.7%). FHS was positively associated with membership in each of the three substance using trajectory groups (vs. the abstainers group). After adjusting for depressive symptoms and other covariates, associations of FHS with membership in the polysubstance using marijuana escalators group and with the heavy polysubstance using cigarette escalators group (in comparison with the abstainers or experimenters groups) were each significantly mediated by anhedonia in youth age 14 (the proportion mediated by anhedonia: 0.33-0.42). Etiology research and intervention addressing anhedonia may have value for understanding and preventing the familial transmission of adolescent polysubstance use patterns. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

An upbringing with substance-abusing parents: Experiences of parentification and dysfunctional communication

Aim

To increase understanding of the consequences of growing up with substance-abusing parents, including how this can influence the experience of becoming a parent.

Methods

In-depth interviews were conducted with 19 parents who had participated in an Infant and Toddler Psychiatry Unit intervention programme and who had experienced substance-abusing parents in their family of origin. Directed qualitative content analysis was used to analyse the data.

Results

Analysis of the interview material revealed both a high incidence of parentification and a conspiracy of silence concerning the substance abuse that helped generate symptoms of cognitive dissonance in the children. As parents they experience a high degree of inadequacy, incompetence and stress.

Conclusion

A majority of the children who had grown up with substance-abusing parents responded by taking a parenting role for themselves, their siblings and their parents. These children, often well-behaved and seemingly competent, need to be identified and offered support as they risk developing significant psychological and emotional difficulties that can extend into adulthood. They form an extra sensitive group who may need special support up to and including the time when they become parents themselves. This finding underlines the importance of further research on parenting among those who have grown up with abusive parents.

Struggling with one's own parenting after an upbringing with substance abusing parents

AIM

To add to our knowledge concerning the key elements involved in the individual's experience of growing up with substance abusing parents and the resulting challenges this involved for their own parenthood.

METHODS

In-depth interviews were conducted with 19 parents who had participated in a mental health intervention programme. All had experienced substance abusing parents in their family of origin. Qualitative content analysis was used to analyse the data. They also completed a self-report questionnaire assessing their attachment style.

RESULT

Participants reported a high incidence of emotional abuse and neglect coupled with inadequate support from the community. Their own parental role was influenced by high parental stress and a majority had an insecure attachment style.

CONCLUSIONS

All participants had experienced a very difficult childhood which was reinforced by the fact that they received little support from society. Their childhood experience and the resulting challenges that this created in their own parenting role could negatively influence their own children's ability to form a secure psychosocial development. It is therefore important to develop instruments that can help to identify children who were raised in misuse families in order to accommodate the transgenerational effects of growing up with substance abusing parents.

Reward-Based Learning as a Function of Severity of Substance Abuse Risk in Drug-Naïve Youth with ADHD

OBJECTIVE

Attention-deficit/hyperactivity disorder (ADHD) is associated with elevated risk for later development of substance use disorders (SUD), specifically because youth with ADHD, similar to individuals with SUD, exhibit deficits in learning abilities and reward processing. Another known risk factor for SUD is familial history of substance dependence. Youth with familial SUD history show reward processing deficits, higher prevalence of externalizing disorders, and higher impulsivity scores. Thus, the main objective of this proof-of-concept study is to investigate whether risk loading (ADHD and parental substance use) for developing SUD in drug-naïve youth impacts reward-related learning.

METHODS

Forty-one drug-naïve youth, stratified into three groups: Healthy Controls (HC, n = 13; neither ADHD nor parental SUD), Low Risk (LR, n = 13; ADHD only), and High Risk (HR, n = 15; ADHD and parental SUD), performed a novel Anticipation, Conflict, and Reward (ACR) task. In addition to conventional reaction time (RT) and accuracy analyses, we analyzed computational variables including learning rates and assessed the influence of learned predictions of reward probability and stimulus congruency on RT.

RESULTS

The multivariate ANOVA on learning rate, congruence, and prediction revealed a significant main Group effect across these variables [F(3, 37) = 3.79, p = 0.018]. There were significant linear effects for learning rate (Contrast Estimate = 0.181, p = 0.038) and the influence of stimulus congruency on RTs (Contrast Estimate = 1.16, p = 0.017). Post hoc comparisons revealed that HR youth showed the most significant deficits in accuracy and learning rates, while stimulus congruency had a lower impact on RTs in this group. LR youth showed scores between those of the HC and HR youth.

CONCLUSION

These preliminary results suggest that deficits in learning and in adjusting to task difficulty are a function of increasing risk loading for SUD in drug-naïve youth. These results also highlight the importance of developing and applying computational models to study intricate details in behavior that typical analytic methodology may not be sensitive to.

Does exposure to parental substance use disorders increase offspring risk for a substance use disorder? A longitudinal follow-up study into young adulthood

OBJECTIVE

The main aim of this study was to examine the risk of exposure to parental substance use disorders (SUD; alcohol or drug abuse or dependence) on the risk for SUD in offspring with and without attention deficit hyperactivity disorder (ADHD) followed into young adult years.

METHODS

Subjects were derived from two longitudinal case-control studies of probands of both sexes, 6-17 years, with and without DSM-III-R ADHD and their parents. Probands were followed for ten years into young adulthood. Probands with a parental history of non-nicotine SUD were included in this analysis. Exposure to SUD was determined by active non-nicotine parental SUD while the parent was living with their child after birth. Cox proportional hazard models were used to calculate the risk of non-nicotine SUD in offspring.

RESULTS

171 of the 404 probands reassessed at ten-year follow up had a family history of parental SUD. 102 probands were exposed to active parental SUD. The average age of our sample was 22.2 ± 3.5 years old. Exposure to maternal but not paternal SUD increased offspring risk for an alcohol use disorder in young adulthood independently of ADHD status (OR: 2.7; 95% CI: 1.1, 6.9; p = 0.04).

CONCLUSION

Exposure to maternal SUD increases the risk for an alcohol use disorder in offspring ten years later in young adult years irrespective of ADHD status.

Gender Difference in Offspring's Alcohol Use Disorder by 21 Years: A Longitudinal Study of Maternal Influences

AIMS

There is little known about the extent to which maternal alcohol consumption influences offspring's alcohol use disorder. This study aims to examine whether different maternal alcohol consumption trajectories predict gender difference in adolescent alcohol use disorder at child age 21 years.

METHODS

Data are from a prospective cohort, the Mater-University of Queensland Study of Pregnancy (MUSP) and its outcomes. The study involves 2531 mother-child pairs for whom data are available at the 21-year follow-up survey. Maternal alcohol consumption trajectories were determined by group-based trajectory modelling. Offspring's lifetime ever alcohol use disorder was assessed using DSM-IV diagnostic criteria.

RESULTS

Over 14 years of follow-up after the birth of a child, three distinct alcohol consumption trajectories were identified (abstainer, low-stable. and moderate-escalating drinker). A maternal trajectory of moderate-escalating alcohol consumption independently predicted offspring's lifetime ever alcohol use disorder at 21 years after adjustment for a range of potential confounders. "Cross-gender influence" is observed in the study.

CONCLUSIONS

A maternal life course pattern of alcohol consumption may have an independent effect on offspring alcohol consumption, with male offspring being more vulnerable to the effects of maternal alcohol use than are female offspring. Programs intended to address alcohol consumption by adolescents and young adults need to focus on the behaviors of both parents but acknowledging that maternal patterns of alcohol consumption may be particularly important for male offspring.

Maternal Problem Drinking and Child Mental Health

BACKGROUND

Offspring of individuals with alcohol use disorders have been shown to have elevated risk for mental health problems.

OBJECTIVES

To examine the association between maternal problem drinking and child mental health as assessed by three informants in three European countries.

METHODS

Data were drawn from the School Child Mental Health in Europe study. Maternal alcohol use was assessed using the alcohol use disorders identification test. Child mental health was assessed using the mother and teacher versions of the strengths and difficulties questionnaire, and the child self-reported Dominic interactive. Analyses were performed on 2,678 individuals, 6-11 year olds.

RESULTS

Adjusting for variables associated with maternal drinking, among children eight years old or younger, excessive drinking was not significantly associated with mental health problems, whether reported by the mother, teacher or by the child. However, among girls eight years old and above, problem drinking was associated with conduct problems as reported by the mother (OR = 4.19), teacher reported total difficulties (OR = 4.69), and peer relationship problems (OR = 8.86). It was also associated with the presence of any child-reported disorder (OR = 3.88), externalizing (OR = 5.55) and internalizing disorders (OR = 4.42). Conclusions/Importance: Adjusting for sociodemographic variables and for psychological distress, maternal problem drinking was not significantly associated with child mental health problems in boys or in girls ages six to eight. The association was only present among girls ages 8-11. Examining relationships between mothers and their daughters in the peripubertal period may be a critical window for the development of effective intervention strategies.

History of being in government care associated with younger age at injection initiation among a cohort of street-involved youth

INTRODUCTION AND AIMS

Compared to the general population of youth, health-related disparities experienced by youth exposed to the child welfare system are well documented. Amongst these vulnerabilities are elevated rates of substance use, including injection drug use; however, less is known about when these youth transition to this high-risk behaviour. We sought to assess whether having a history of government care is associated with initiating injection drug use before age 18.

DESIGN AND METHODS

Between September 2005 and May 2014, data were derived from the At-Risk Youth Study, a cohort of street-involved youth who use illicit drugs in Vancouver, Canada. Multivariable logistic regression analysis was employed to examine the relationship between early initiation of injection drug use and having a history of being in government care.

RESULTS

Among the 581 injecting street-involved youth included, 229 (39%) reported initiating injection drug use before 18 years of age. In multivariable analysis, despite controlling for a range of potential confounders, having a history of government care remained significantly associated with initiating injection drug use before age 18 (adjusted odds ratio = 1.69; 95% confidence interval: 1.15-2.48).

DISCUSSION AND CONCLUSIONS

Youth with a history of being in government care were significantly more likely to initiate injection drug use before age 18 than street-involved youth without a history of being in care. These findings imply that youth in the child welfare system are at higher risk and suggest that interventions are needed to prevent transitions into high-risk substance use among this population.

Association of Drug and Alcohol Use With Adolescent Firearm Homicide at Individual, Family, and Neighborhood Levels

Importance

Homicide is the third leading cause of death for adolescents in the United States and the leading cause of death for adolescents who are African American. Large cities have disproportionate homicide rates.

Objective

To determine the relationships between exposures to drugs and alcohol at the individual, family, and neighborhood levels and adolescent firearm homicide and to inform new approaches to preventing firearm violence.

Design, Setting, and Participants

Population-based case-control study from January 2010 to December 2012 of all 13- to 20-year-olds who were homicide victims in Philadelphia during the study period matched to randomly selected 13- to 20-year-old controls from the general population.

Exposures

Individual drug and alcohol use at the time of injury, history of drug and alcohol use, caregiver drug and alcohol use, and neighborhood availability of alcohol and illegal drugs. We also controlled for age, race, school suspensions, arrests, and neighborhood ethnicity.

Main Outcomes and Measures

Adolescent firearm homicide identified from police and medical examiner's reports.

Results

We enrolled 161 adolescent homicide cases, including 157 (97.5%) firearm homicide cases and 172 matched controls, including 166 (96.5%) firearm homicide controls. Adolescents with a history of alcohol use (adjusted odds ratio [AOR], 4.1; 95% CI, 1.2-14.0) or drug use (AOR, 4.4; 95% CI, 1.7-11.6) had increased odds of firearm homicide. Adolescents whose caregiver had a history of drug use had increased odds of firearm homicide (AOR, 11.7; 95% CI, 2.8-48.0). Adolescents in neighborhoods with high densities of alcohol outlets (AOR, 3.2; 95% CI, 1.1-9.1) and moderate or high drug availability had increased odds of firearm homicide (AOR, 3.4; 95% CI, 1.1-10.3 vs AOR, 7.5; 95% CI, 2.2-25.8).

Conclusions and Relevance

Almost all adolescent homicides in Philadelphia between 2010 and 2012 were committed with a firearm. Substance use at the individual, family, and neighborhood levels was associated with increased odds of adolescent firearm homicide; drug use was associated at all 3 levels and alcohol at the individual and neighborhood levels. Expanding violence prevention efforts to target drug and alcohol use at multiple levels may help to reduce the firearm violence that disproportionately affects adolescents in minority populations in large US cities.

Factors associated with different smoking status in European adolescents: results of the SEYLE study

Early onset and long-term smoking are associated with physical and psychological health problems. The aim of the presented analysis was to investigate risk and influencing factors for different smoking status in a big sample of European adolescents. In the context of the "saving and empowering young lives in Europe" (SEYLE) study we surveyed 12,328 adolescents at the age of 13-17 from 11 countries. The survey took place in a school-based context using a questionnaire. Overall 58% reported the onset of ever-smoking under the age of 14 and 30.9% smoke on a daily basis. Multinomial logistic regression model showed significant positive associations between adolescent smoking and internalizing problems (suicidal behavior, direct self-injurious behavior, anxiety), externalizing problems (conduct problems, hyperactivity, substance consumption) and family problems (parental substance consumption, broken home). Our data show that smoking among adolescents is still a major public health problem and adolescents who smoke are at higher risk for mental problems. Further, adolescent smoking is associated with broken home families and parental behaviors. Therefore, early preventive measures are necessary not only for adolescents, but also for their parents.

Vulnerable parenting among mothers with substance abuse in their family of origin: a cross-sectional comparative study of mothers in an infant and toddler program

Objective

To investigate whether women raised in a family with substance abuse constitute a particularly vulnerable group of patients in an infant psychiatry setting and to identify the risk factors of suspected parental malfunctioning in women referred to treatment in an infant and toddler intervention program.

Background

A history of family substance abuse can severely disrupt the caretaking abilities of parents in ways that can have far-reaching consequences, and children growing up with insufficient parental care may incorporate this deficiency into their own parental behavior.

Methods

In total, 126 mothers completed self-report questionnaires assessing their substance abuse and health problems as well as problems in their family of origin. The index group was defined as women who reported substance abuse in their family of origin (n = 35). The comparison group was defined as women who denied substance abuse in their family of origin (n = 91).

Results

Symptoms of depression and anxiety were overrepresented in the total group of mothers compared with the Swedish norm. The index group had experienced parental divorce and traumatic life events more often and reported earlier substance abuse of their own. They had significantly more depression and ADHD symptoms and were more often single parents. All these factors can have a negative influence, separately or in combination, on the ability to practice sensitive parenting.

Conclusions

Female offspring of substance-abusing parents are an especially vulnerable group of patients. To prevent the intergenerational transmission of alcohol and drug abuse, it is important to identify parents with specific needs and to administer targeted treatment and support at primary health care centers and child psychiatric clinics.

Gender differences in the prospective association between maternal alcohol consumption trajectories and young adult offspring's problem gambling at 30 years

Although a large number of studies have examined the association between young adult’s alcohol consumption and their problem gambling behaviours, none of these studies address the prospective association between mother’s alcohol consumption and their young adult offspring’s problem gambling behaviours. Using data from a 30 year prospective pre-birth cohort study in Brisbane, Australia (n = 1691), our study examines whether different maternal alcohol consumption trajectories predict offspring’s risk of problem gambling behaviours and whether these associations differ by the young adults’ gender. Offspring’s level of problem gambling behaviours was assessed by the short version of the Canadian Problem Gambling Index, with about 10.6 % of young adults having some risk of problem gambling behaviours. Trajectories of maternal alcohol consumption were determined by group-based trajectory modelling over five time points. Our study found that mother’s alcohol consumption pattern fits into three drinking trajectory groups, namely abstainers (17.2 %), a low-stable drinkers group (64.6 %) and a moderate-escalating drinkers group (18.2 %). Multivariate logistic regression analyses showed that the moderate-escalating alcohol trajectory group is independently associated with a risk of their male young adult offspring having problem gambling behaviours at 30 years—even after adjustment for a range of potential confounding variables. Mothers who exhibit a persistent life course pattern of moderate-escalating drinking have male children who have a high risk of engaging in problem gambling behaviours. Offspring’s alcohol consumption partially mediated the association between maternal drinking trajectories and young adult’s risk of problem behaviours. High levels of maternal alcohol consumption may lead to male offspring antisocial behaviours. Programs intended to address problem gambling behaviours by young adults may need to focus on male group with a focus which specifically addresses family influences as these contribute to gambling behaviour.

Gender Differences in Associations Between Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder

OBJECTIVE

To examine gender differences in the association between attention-deficit/hyperactivity disorder (ADHD) and substance use disorder (SUD), and to explore the impact of comorbid psychiatric conditions.

METHOD

This was a cohort study of all children born in Denmark in 1990 to 2003 (n = 729,560). By record linkage across nationwide registers, we merged data on birth characteristics, socioeconomic status, familial psychiatric history, and diagnoses of ADHD (N = 19,645), comorbidities, and SUD. Hazard ratios (HR) with 95% CIs were estimated by Cox regression and adjusted for a range of variables.

RESULTS

ADHD increased the risk of alcohol abuse (HRfemales = 1.72 [95% CI = 1.42-2.08], HRmales = 1.57 [1.37-1.79]), cannabis abuse (HRfemales = 2.72 [2.12-3.47], HRmales = 2.24 [1.86-2.70]), and other illicit substance abuse (HRfemales = 2.05 [1.54-2.73], HRmales = 2.42 [1.98-2.96]), compared to individuals without ADHD. In the overall estimates, no gender differences were found. Among individuals with ADHD without comorbidities, females had a higher SUD risk than males, as did females with ADHD and conduct disorder (CD). Comorbid CD, depression, bipolar disorder, and schizophrenia further increased the risk of SUD in ADHD, compared to non-ADHD. Autism spectrum disorder in males with ADHD lowered the SUD risk.

CONCLUSION

ADHD increased the risk of all SUD outcomes. Individuals with ADHD without comorbidities were also at increased risk, and some comorbid disorders further increased the risk. Females and males with ADHD had comparable risks of SUD, although females had higher risk of some SUDs than males. Females with ADHD may be perceived as less impaired than males, but they are at equally increased risk of SUD.

Effects of prenatal alcohol and cigarette exposure on offspring substance use in multiplex, alcohol-dependent families

BACKGROUND

Prenatal exposures to alcohol, cigarettes, and other drugs of abuse are associated with numerous adverse consequences for affected offspring, including increased risk for substance use and abuse. However, maternal substance use during pregnancy appears to occur more often in those with a family history of alcohol dependence. Utilizing a sample that is enriched for familial alcohol dependence and includes controls selected for virtual absence of familial alcohol dependence could provide important information on the relative contribution of familial risk and prenatal exposures to offspring substance use.

METHODS

A sample of multigenerational families specifically ascertained to be at either high or low risk for developing alcohol dependence (AD) provided biological offspring for a longitudinal prospective study. High-risk families were selected based on the presence of 2 alcohol-dependent sisters. Low-risk families were selected on the basis of minimal first and second-degree relatives with AD. High-risk (HR = 99) and Low-risk offspring (LR = 110) were assessed annually during childhood and biennially in young adulthood regarding their alcohol, drug, and cigarette use. At the first childhood visit, mothers were interviewed concerning their prenatal use of substances.

RESULTS

High-risk mothers were more likely to use alcohol, cigarettes, and other drugs during pregnancy than low-risk control mothers, and to consume these substances in greater quantities. Across the sample, prenatal exposure to alcohol was associated with increased risk for both offspring cigarette use and substance use disorders (SUD), and prenatal cigarette exposure was associated with increased risk for offspring cigarette use. Controlling for risk status by examining patterns within the HR sample, prenatal cigarette exposure remained a specific predictor of offspring cigarette use, and prenatal alcohol exposure was specifically associated with increased risk for offspring SUD.

CONCLUSIONS

Women with a family history of SUD are at increased risk for substance use during pregnancy. Both familial loading for alcohol dependence and prenatal exposure to alcohol or cigarettes are important risk factors in the development of offspring substance use. An inadequate assessment of family history may obscure important interactions between familial risk and prenatal exposures on offspring outcomes.

Stress moderates the relationship between problematic Internet use by parents and problematic Internet use by adolescents

PURPOSE

Based on the theoretical framework of Problem Behavior and Stress Reduction theories for problematic Internet use (PIU), this study aimed to investigate the relationship between parental PIU and the PIU among adolescents taking into consideration the stress levels of young people.

METHODS

This was a population-based parent and adolescent dyad health survey utilizing a random sampling technique. PIU for both parents and adolescents was measured by the Internet addiction test designed by Young. The stress level of adolescents was assessed using the stress subscale of the Depression Anxiety Stress Scale (DASS). Data were analyzed using logistic regression modeling techniques with adjustment for potential confounding factors with analysis on the modification effect of stress levels on the relationship between parent and adolescent PIU.

RESULTS

Of the total 1,098 parent and adolescent dyads with usable information, 263 adolescents (24.0%) and 62 parents (5.7%) could be classified as moderate and severe problematic users of the Internet. About 14% (n = 157) of adolescents could be classified with moderate-to-severe stress. Regression analysis results suggested a significant interaction between parental PIU and adolescents' stress levels on adolescent PIU. Stratified regression analyses by stress level resulted in a significant parent and adolescent PIU relationship in the low stress group (odds ratio, 3.18; 95% confidence interval 1.65-6.14). However, the association between parent and adolescent PIU in the high stress group became insignificant.

CONCLUSIONS

There was a significant parent and adolescent PIU relationship; however, this relationship is differentially affected by the stress status of the adolescent. The direct implication of the results is that parental Internet use should also be assessed and included as part of the treatment regime for adolescents.

Prevalence and correlates of substance use among trans female youth ages 16-24 years in the San Francisco Bay Area

BACKGROUND

Substance use is highly prevalent among transgender (trans*) females and has been associated with negative health outcomes, including HIV infection. Little is known about psychosocial risk factors that may influence the onset of substance use among trans*female youth, which can contribute to health disparities during adulthood.

METHODS

We conducted a secondary data analysis of a study on HIV risk and resilience among trans*female youth (N=292). Prevalence of substance use was assessed and multivariable logistic regression models were used to examine the relationship between posttraumatic stress disorder (PTSD), psychological distress, gender-related discrimination, parental drug or alcohol problems (PDAP) and multiple substance use outcomes.

RESULTS

Most (69%) of the trans*female youth reported recent drug use. In multivariable analyses, those with PTSD had increased odds of drug use [AOR=1.94 (95% CI=1.09-3.44)]. Those who experienced gender-related discrimination had increased odds of drug use [AOR=2.28 (95% CI=1.17-4.44)], drug use concurrent with sex [AOR=2.35 (95% CI=1.11-4.98)] and use of multiple drugs [AOR=3.24 (95% CI=1.52-6.88)]. Those with psychological distress had increased odds of using multiple heavy drugs [AOR=2.27 (95% CI=1.01-5.12)]. Those with PDAP had increased odds of drugs use [AOR=2.62 (95% CI=1.43-4.82)], drug use concurrent with sex [AOR=2.01 (95% CI, 1.15-3.51)] and use of multiple drugs [AOR=2.10 (95% CI=1.22-3.62)].

CONCLUSIONS

Substance use is highly prevalent among trans*female youth and was significantly associated with psychosocial risk factors. In order to effectively address substance use among trans*female youth, efforts must address coping related to gender-based discrimination and trauma. Furthermore, structural level interventions aiming to reduce stigma and gender-identity discrimination might also be effective.

The association between parental and adolescent substance misuse: findings from the Irish CASE study

Background

Self-report data from 2716 adolescents aged 15–17 years old in Irish schools were analysed to consider the association between psycho-social factors and the presence of adolescent substance and alcohol abuse, with an emphasis on family circumstances.

Methods

Data were collected using the ‘Lifestyle and Coping Questionnaire’ which includes questions about lifestyle, coping, problems, alcohol and drug use, deliberate self-harm, depression, anxiety, impulsivity and self-esteem. Two additional questions were added to the standard questionnaire regarding parental substance misuse.

Results

Adolescent substance abuse was more common in boys; parental substance misuse increased the risk of adolescent abuse of alcohol and drugs; the increased risk was marginally higher if the parental substance abuse was maternal rather than paternal; the increased risk was higher if the parental substance abuse affected both rather than one of the parents, especially regarding adolescent drug abuse; the magnitude of the increased risk was similar for boys and girls. Parental substance misuse increased the risk of adolescent substance abuse even after adjusting for other family problems and the adolescent’s psychological characteristics.

Conclusions

This study indicates that parental substance misuse affects the development of both alcohol and drug misuse in adolescent children independent of other family problems and the psychological characteristics of the adolescent. A wider perspective is needed, including societal and family issues, especially parental behaviour, when attempting to reduce risk of adolescent addiction. The impact on children of parental substance misuse also needs consideration in clinical contexts.

Brief interventions for illicit drug use among peripartum women

We review the evidence and identify limitations of the current literature on the effectiveness of brief interventions (≤5 intervention sessions) on illicit drug use, treatment enrollment/retention, and pregnancy outcomes among pregnant and postpartum women; and consider this evidence in the context of the broader brief intervention literature. Among 4 published studies identified via systematic review and meeting a priori quality criteria, we found limited, yet promising evidence of the benefit of brief interventions to reduce illicit drug use among postpartum women. Two of the 4 randomized controlled trials tested similar computer-delivered single-session interventions; both demonstrate effects on postpartum drug use. Neither of the 2 randomized controlled trials that assessed treatment use found differences between intervention and control groups. Studies examining brief interventions for smoking and alcohol use among pregnant women, and for illicit drug use in the general adult population, have shown small but statistically significant results of the effectiveness of such interventions. Larger studies, those that examine the effect of assessment alone on illicit drug use, and those that use technology-delivered brief interventions are needed to assess the effectiveness of brief interventions for drug use in the peripartum period.

Time to relapse following treatment for methamphetamine use: a long-term perspective on patterns and predictors

INTRODUCTION

This paper describes methamphetamine (MA) use patterns, specifically the duration of continuing abstinence ("time to relapse") for periods averaging 5 years post-discharge from treatment for MA use, and the relationship with selected user and treatment characteristics.

METHODS

A sample of 350 treatment admissions from a large county substance use disorder (SUD) treatment system was randomly selected (within gender, race/ethnicity, treatment modality strata). Retrospective self-report data are from natural history interviews (NHI) conducted approximately 3 years after treatment and a follow-up of 2-3 years later. Relapse is defined as any use of MA with time as the number of months of continuous MA abstinence after treatment discharge until relapse. This outcome was constructed from a monthly MA use timeline using NHI data. A Cox model was used to examine time to relapse and predictors.

RESULTS

Sixty-one percent of the sample relapsed to MA use within 1 year after treatment discharge and 14% during years 2-5. Significant protective factors predicting longer time to relapse included having experienced serious MA-related psychiatric/behavioral problems (hazard ratio [HR]=0.75, p=0.027), longer duration of the index treatment episode (HR=0.93, p=0.001), and participating in self-help or other treatment during the post-treatment abstinence period (HR=0.29, p<0.001); risk factors for shorter time to relapse included having a parent with alcohol and/or drug use problems (HR=1.35, p=0.020) and involvement in MA sales (HR=1.48, p=0.002).

CONCLUSIONS

Results contribute a long-term perspective on patterns of MA use following treatment and support a need for early post-treatment and long-term continuing care and relapse-prevention services.

The complicated relationship between attention deficit/hyperactivity disorder and substance use disorders

Adolescents and young adults with substance use disorders (SUD) and attention deficit/hyperactivity disorder (ADHD) are increasingly presenting in clinical practice. The overlap and role of treatment for these co-occurring disorders remains unclear. A review of the literature was conducted to highlight and update recent evidence on the overlap of ADHD and SUD, the role of ADHD medication on later SUD, and the treatment of ADHD and SUD in adolescents and young adults. Recent work continues to highlight the high risk for comorbid ADHD in patients with SUD; and conversely, the high risk for SUD developing in ADHD across the lifespan, particularly in the context of comorbid conduct disorder. Although the data remains discordant, it appears that ADHD pharmacotherapy does not increase the risk for SUD. Medication treatment alone does not appear to be particularly effective in treating SUD in currently active substance abusing individuals with ADHD. Structured therapies may be effective in treating adolescents and young adults with ADHD and SUD. Further controlled trials evaluating the sequence and effect of structured psychotherapies and/or ADHD pharmacotherapy on SUD relapse in these groups are warranted.

Women's experience of abuse in childhood and their children's smoking and overweight

BACKGROUND

Smoking and overweight are principal determinants of poor health for which individual-level interventions are at best modestly effective. This limited effectiveness may be partly because these risk factors are patterned by parents' experiences preceding the individual's birth.

PURPOSE

To determine whether women's experience of abuse in childhood was associated with smoking and overweight in their children.

METHODS

In 2012, data were linked from two large longitudinal cohorts of women (Nurses' Health Study II [NHSII], n=12,666) and their children (Growing Up Today [GUTS] Study, n=16,774), 1989-2010. ORs of children following higher-risk smoking trajectories and risk ratios (RRs) of children's overweight and obesity by their mother's childhood experience of physical, emotional, and sexual abuse were calculated. The extent to which mother's smoking and overweight, socioeconomic indicators, family characteristics, and child's abuse exposure accounted for possible associations was ascertained.

RESULTS

Children of women who experienced severe childhood abuse had greater likelihood of higher-risk smoking trajectories (OR=1.40, 95% CI=1.21, 1.61), overweight (RR=1.21, 95% CI=1.11, 1.33), and obesity (RR=1.45, 95% CI=1.21, 1.74) across adolescence and early adulthood compared with children of women who reported no abuse. Mother's smoking and overweight and children's abuse exposure accounted for more than half of the elevated risk of following the highest-risk smoking trajectory and overweight in children of women abused.

CONCLUSIONS

These findings raise the possibility that childhood abuse may not only adversely affect the health of the direct victim but may also affect health risk factors in her children decades after the original traumatic events.

Risk factors for an anxiety disorder comorbidity among Thai patients with bipolar disorder: results from the Thai Bipolar Disorder Registry

BACKGROUND

The aim of the study was to determine in a clinical setting the risk factors for current anxiety disorder (AD) comorbidity among Thai patients with bipolar disorder (BD), being treated under the Thai Bipolar Disorder Registry Project (TBDR).

METHODS

The TBDR was a multisite naturalistic study conducted at 24 psychiatric units (ie, at university, provincial mental, and government general hospitals) between February 2009 and January 2011. Participants were in- or out-patients over 18 years of age who were diagnosed with BD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Instruments used in this study included the Thai Mini International Neuropsychiatric Interview version 5; Thai Montgomery-Åsberg Depression Rating Scale (MADRS); Thai Young Mania Rating Scale; Clinical Global Impression of Bipolar Disorder-Severity (CGI-BP-S), CGI-BP-S-mania, CGI-BPS-depression, and CGI-BP-S-overall BP illness; and the Thai SF-36 quality of life questionnaire.

RESULTS

Among the 424 BD patients, 404 (95.3%) had BD type I. The respective mean ± standard deviation of age of onset of mood disturbance, first diagnosis of BD, and first treatment of BD was 32.0±11.9, 36.1±12.2, and 36.2±12.2 years. The duration of illness was 10.7±9.0 years. Fifty-three (12.5%) of the 424 participants had a current AD while 38 (9%) had a substance use disorder (SUD). The univariate analysis revealed 13 significant risks for current AD comorbidity, which the multivariate analysis narrowed to age at first diagnosis of BD (odds ratio =0.95, P<0.01), family history of SUD (odds ratio =2.18, P=0.02), and having a higher current MADRS score (odds ratio =1.11, P<0.01).

CONCLUSION

A diagnosis of AD comorbid with BD is suggested by early-age onset of BD together with a higher MADRS score and a family history of SUD. The likelihood of AD comorbidity decreases by 5% with each passing year; early-age onset of BD is a risk while later age onset is protective. Our results underscore how SUD within the family significantly contributes to the risk of an AD comorbidity.