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Hinckley JD, Mikulich-Gilbertson SK, He JP, Bhatia D, Ellingson JM, Nguyenkhoa Vu B, Ries Merikangas K, Sakai JT. Cannabis Use Is Associated With Depression Severity and Suicidality in the National Comorbidity Survey-Adolescent Supplement. JAACAP OPEN 2023; 1:24-35. [PMID: 37538853 PMCID: PMC10400070 DOI: 10.1016/j.jaacop.2023.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Objective To investigate the association of cannabis use with major depression and suicidal behavior in adolescence. Method Data are from the National Comorbidity Survey-Adolescent Supplement N = 10 , 123 , a nationally representative survey of adolescents aged 13 to 18 years. Weighted logistic regression and ordinal regression analyses of major depression and suicidal behavior outcomes were conducted on cannabis variables, incorporating sociodemographic characteristics. Results Adolescents with lifetime cannabis use have 2.07 times higher odds of mild/moderate (adjusted odds ratio [aOR]; 95% CI = 1.69 , 2.53 ) and 3.32 times higher odds of severe major depressive disorder (MDD; aOR; 95% CI = 2.31 , 4.75 ). Cannabis use (aOR 6.90, 95% CI = 4.67 , 10.19 ), mild/moderate MDD (aOR 4.10, 95% CI = 2.82 , 5.98 ), and severe MDD (aOR 13.97, 95% CI = 7.59, 25.70) were associated with higher odds of suicide attempt. Past 12-month cannabis use (aOR 3.70, 95% CI = 2.16, 6.32), mild/moderate major depressive episodes (MDE) (aOR 7.85, 95% CI = 3.59 , 17.17 ), and severe MDE (aOR 36.36, 95% CI = 13.68 , 96.64 ) were associated with higher odds of suicide attempt. The frequency of past 12-month cannabis use was associated with higher odds of suicide attempt and with MDE severity, with higher odds among individuals who use cannabis 3 or more days than among individuals who use cannabis less frequently, suggesting a dose effect. Among cannabis users, older age of onset of cannabis use was associated with lower odds of suicidal behaviors. Conclusion Cannabis use is associated with higher odds of depression and depression severity in adolescence. Furthermore, depression and cannabis use are independently associated with higher odds of suicide attempt. Diversity & Inclusion Statement We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group.
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Affiliation(s)
| | - Susan K Mikulich-Gilbertson
- University of Colorado School of Medicine, Aurora, Colorado; University of Colorado School of Public Health, Aurora, Colorado
| | - Jian-Ping He
- Genetic Epidemiology Research Branch, Intramural Research Program at the National Institute of Mental Health, Bethesda, Maryland
| | - Devika Bhatia
- University of Colorado School of Medicine, Aurora, Colorado
| | | | | | - Kathleen Ries Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program at the National Institute of Mental Health, Bethesda, Maryland
| | - Joseph T Sakai
- University of Colorado School of Medicine, Aurora, Colorado
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Willis BM, Kersh PP, Buchanan CM, Cole VT. Internalizing and externalizing pathways to high-risk substance use and geographic location in Australian adolescents. Front Psychol 2022; 13:933488. [PMID: 35992437 PMCID: PMC9387922 DOI: 10.3389/fpsyg.2022.933488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/18/2022] [Indexed: 11/21/2022] Open
Abstract
One specific instantiation of the storm-and-stress view of adolescence is the idea that “normal” adolescence involves high-risk substance use behaviors. However, although uptake of some substance use behaviors is more common during adolescence than other life stages, it is clear that not all adolescents engage in risky substance use—and among those who do, there is much variation in emotional, behavioral, and contextual precursors of this behavior. One such set of predictors forms the internalizing pathway to substance use disorder, whereby internalizing symptoms in childhood such as negative affect and anxiety set off a chain of consequences culminating in high-risk substance use in late adolescence. However, findings linking internalizing symptoms to substance use are mixed, and it is clear that this link varies across adolescents and contexts. One heretofore unanswered question is whether and how geographic location, specifically whether the adolescent lives in an urban or rural location, moderates this link. The current report is a secondary analysis of data from the Longitudinal Study of Australian Children (LSAC; N = 2,285), in which we examined the link between internalizing symptoms in childhood and initiation of substance use through age 19. Using a multiple event process survival mixture model (MEPSUM), we identified three trajectories of substance use initiation in adolescence: one (65.7% of the sample) characterized by near-complete abstinence until late adolescence, another (27.2%) by earlier initiation of alcohol, nicotine, and cannabis, and another (7.2%) by early initiation of these substances and later initiation of more hazardous drugs such as cocaine and methamphetamine. Although childhood externalizing symptoms increased the risk of being in the second or third class, internalizing symptoms decreased risk when rural and non-rural adolescents were considered together. Few effects of rurality were found, but the negative relationship between internalizing at age 10 and high-risk substance use was only observed among non-rural adolescents. This finding, which was inconsistent with our initial predictions that rurality might confer higher risk for substance use, instead suggests a potentially protective effect of internalizing symptoms for engagement in risky substance use which may differ based on an adolescent’s geographical context.
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Bachrach RL, Chung T. Moderators of Substance Use Disorder Treatment for Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 50:498-509. [PMID: 32716211 DOI: 10.1080/15374416.2020.1790379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This brief review covers the current state of the literature on moderators of adolescent substance use disorder (SUD) treatment. These moderators provide information on "for whom" a specific treatment may work best. METHOD We used Google Scholar, PubMed, PsycInfo, and manual search of relevant reference lists to identify eligible peer-reviewed publications from January 2005 to December 2019. RESULTS We summarize 21 published studies (including meta-analyses, randomized clinical trials, and correlational work) testing moderators and/or predictors of adolescent SUD treatment outcomes. Conclusions are, thus, limited by the relatively small number of studies. Results suggest that, for adolescents with co-occurring externalizing pathology or those higher in SUD severity, more intensive treatment appears to be more effective. Other findings were often inconsistent (e.g., examining sex or race/ethnicity as a moderator) between studies, making it challenging to provide clear recommendations for personalizing SUD treatment choice. CONCLUSIONS Future research may need to shift focus from exploring often unchangeable moderators (e.g., race/ethnicity) to factors that are potentially modifiable with treatment. Additionally, testing models that include mediators of treatment effects-that is, factors that help to explain "how" treatment works-along with moderators (moderated-mediation) may provide the most benefit in understanding both "for whom" and "how" to tailor SUD treatment to optimally meet an adolescent's personal needs.
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Affiliation(s)
- Rachel L Bachrach
- Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System
| | - Tammy Chung
- Rutgers, Institute for Health, Health Care Policy and Aging Research, The State University of New Jersey
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Hinckley JD, Riggs P. Integrated Treatment of Adolescents with Co-occurring Depression and Substance Use Disorder. Child Adolesc Psychiatr Clin N Am 2019; 28:461-472. [PMID: 31076120 DOI: 10.1016/j.chc.2019.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Substance use disorders (SUDs) are commonly co-occurring among adolescents with depression. Integrated treatment is important given treatment implications and increased rates of suicidality. All adolescents should be screened for SUD using Screening, Brief Intervention, and Referral to Treatment. Review of randomized controlled trials in adolescents reveals motivational enhancement therapy/cognitive behavioral therapy is an evidence-based intervention and should be considered first-line treatment. If depression does not improve, fluoxetine should be considered, as it is well-tolerated in substance-involved adolescents with depression. Adolescents who do not show improvement in SUD or who have severe SUD should be referred to evidence-based SUD treatment.
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Affiliation(s)
- Jesse D Hinckley
- Division of Substance Dependence, Department of Psychiatry, University of Colorado School of Medicine, 13001 East 17th Place, MS F570, Aurora, CO 80045, USA.
| | - Paula Riggs
- Division of Substance Dependence, Department of Psychiatry, University of Colorado School of Medicine, 13001 East 17th Place, MS F570, Aurora, CO 80045, USA
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Hussong AM, Ennett ST, Cox MJ, Haroon M. A systematic review of the unique prospective association of negative affect symptoms and adolescent substance use controlling for externalizing symptoms. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 31:137-147. [PMID: 28134539 DOI: 10.1037/adb0000247] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This systematic review examines whether negative affect symptoms (i.e., anxiety, depression, and internalizing symptoms more broadly) predict subsequent adolescent substance use after controlling for co-occurring externalizing symptoms. Following PRISMA procedures, we identified 61 studies that tested the association of interest. Findings varied depending on the type of negative affect symptom and to some extent on the substance use outcome. The most consistent associations were evident for depressive symptoms, particularly as predictors of substance use composite scores. No clear association between anxiety and substance use or between internalizing symptoms and substance use was evident, and indeed these associations were as often negative as positive. Mixed findings regarding the depression-substance use association, however, also call for greater attention to potential moderating factors that may help define who, when, and in what context depression serves as an important risk factor for later substance use above and beyond risk associated with externalizing symptoms. (PsycINFO Database Record
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Affiliation(s)
- Andrea M Hussong
- Center for Developmental Science, The University of North Carolina at Chapel Hill
| | - Susan T Ennett
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill
| | - Melissa J Cox
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill
| | - Maleeha Haroon
- Center for Developmental Science and Department of Psychology & Neuroscience, The University of North Carolina at Chapel Hill
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Becker SJ, Hernandez L, Spirito A, Conrad S. Technology-assisted intervention for parents of adolescents in residential substance use treatment: protocol of an open trial and pilot randomized trial. Addict Sci Clin Pract 2017; 12:1. [PMID: 28049542 PMCID: PMC5210307 DOI: 10.1186/s13722-016-0067-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 12/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents in residential substance use disorder (SUD) treatment have poor outcomes post-discharge, with follow-up studies suggesting that most adolescents relapse within 90 days. Parenting practices directly influence adolescent SUD outcomes, but parents of adolescents with SUDs are difficult to engage in traditional behavioral treatments. The current study adapts and evaluates a technology-assisted intervention for parents of adolescents in residential SUD treatment. Based on pilot qualitative data with parents, adolescents, and residential staff, we augment an existing computerized intervention (Parenting Wisely; PW) with four in-person coaching sessions, personalized text messages, and an expert-moderated online parent message board. We hypothesize that parents will find enhanced PW (PW+) both feasible and acceptable, and that adolescents whose parents receive PW+ will have better post-discharge outcomes than adolescents who receive standard care (SC) only. METHODS/DESIGN A two phase approach is used to adapt and evaluate PW+. Phase 1 consists of an open trial with 10 parents of adolescents (age 12-17) in residential SUD treatment. Post-discharge qualitative and quantitative data from parents and adolescents will support PW+ refinement. Phase 2 is a randomized pilot trial with 60 parents testing the effectiveness of adding PW+ to SC. Adolescents and parents will complete assessments at baseline, 6-, 12-, and 24-weeks post-discharge. Primary outcomes will be measures of feasibility and acceptability. Secondary outcomes will include adolescent substance use, truancy, high-risk sexual behavior, and criminal involvement. Two parenting processes (monitoring and communication) are examined as potential mediators of change. DISCUSSION This study will adapt and evaluate a technology-assisted parenting intervention as a means of improving adolescent outcomes following residential SUD treatment. Results have the potential to advance the field by: addressing a high-risk population, improving parental engagement; targeting parenting practices (putative mediators of change) that have been linked to adolescent outcomes; and developing a highly disseminable approach.
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Affiliation(s)
- Sara J. Becker
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, 121 South Main Street, Box G-121-5, Providence, RI 02912 USA
- Department of Psychiatry and Human Behavior, Brown University Medical School, Box G-BH, Providence, RI 02912 USA
| | - Lynn Hernandez
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, 121 South Main Street, Box G-121-5, Providence, RI 02912 USA
- Department of Psychiatry and Human Behavior, Brown University Medical School, Box G-BH, Providence, RI 02912 USA
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Brown University Medical School, Box G-BH, Providence, RI 02912 USA
| | - Selby Conrad
- Department of Psychiatry and Human Behavior, Brown University Medical School, Box G-BH, Providence, RI 02912 USA
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Hersh J, Curry JF, Kaminer Y. What is the impact of comorbid depression on adolescent substance abuse treatment? Subst Abus 2015; 35:364-75. [PMID: 25157785 DOI: 10.1080/08897077.2014.956164] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Substance use disorders (SUDs) are among the most common psychiatric diagnoses in adolescents. Some research suggests that comorbid depression in adolescents with SUD is associated with increased likelihood of alcohol dependence, poorer social competence, and greater risk for suicide attempts. However, little is known about how depression influences adolescent substance abuse treatment retention and outcomes. METHODS This review aimed to summarize the effects of comorbid depression on treatment retention and outcomes across 13 adolescent SUD treatment studies. RESULTS RESULTS indicated that depression has a mixed relationship with treatment retention and outcomes, exerting a negative, positive, or nonsignificant effect depending on aspects of the study. CONCLUSIONS More research needs to be done, particularly addressing the potential mediators and moderators of the relationship between depression and SUD outcomes. Importantly, recognizing that the studies varied widely in hypotheses and research methods, the field needs to develop more standardized methods to allow for a clearer understanding of the role of comorbid depression.
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Affiliation(s)
- Jacqueline Hersh
- a Department of Psychology & Neuroscience , Duke University , Durham , North Carolina , USA
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Clair-Michaud M, Martin RA, Stein LAR, Bassett S, Lebeau R, Golembeske C. The Impact of Motivational Interviewing on Delinquent Behaviors in Incarcerated Adolescents. J Subst Abuse Treat 2015; 65:13-9. [PMID: 26517954 DOI: 10.1016/j.jsat.2015.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 09/11/2015] [Accepted: 09/21/2015] [Indexed: 11/25/2022]
Abstract
The impact of Motivational Interviewing (MI) on risky behaviors of incarcerated adolescents and adults has been investigated with promising results. Findings suggest that MI reduces substance use, improves motivation and confidence to reduce use, and decreases risky behaviors. The current study investigated the impact of MI on general, alcohol-related, and marijuana-related delinquent behaviors in incarcerated adolescents. Participants in the study were incarcerated adolescents in a state correctional facility in the Northeast region and were assessed as part of a larger randomized clinical trial. Adolescents were randomly assigned to receive MI or relaxation therapy (RT) (N=189) treatment. Delinquent behaviors and depressive symptomatology were measured using the Delinquent Activities Scale (DAS; Reavy, Stein, Paiva, Quina, & Rossi, 2012) and the Center for Epidemiological Studies-Depression scale (CES-D; Radloff, 1991) respectively. Findings indicate that depression moderated treatment effects. Compared to RT, MI was better at reducing predatory aggression and alcohol-related predatory aggression 3 months post-release when depressive symptoms were low. Identifying an efficacious treatment for these adolescents may benefit society in that it may decrease crimes against persons (i.e., predatory aggression) post release.
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Affiliation(s)
- Mary Clair-Michaud
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Rd., Kingston, RI 02881; The Rhode Island Training School, 300 New London Avenue, Cranston, RI 02920.
| | - Rosemarie A Martin
- Center for Alcohol and Addiction Studies, Brown University, 121 South Main Street, Providence, RI 02912
| | - Linda A R Stein
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Rd., Kingston, RI 02881; The Rhode Island Training School, 300 New London Avenue, Cranston, RI 02920; Center for Alcohol and Addiction Studies, Brown University, 121 South Main Street, Providence, RI 02912
| | - Shayna Bassett
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Rd., Kingston, RI 02881
| | - Rebecca Lebeau
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Rd., Kingston, RI 02881
| | - Charles Golembeske
- The Rhode Island Training School, 300 New London Avenue, Cranston, RI 02920
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