The relationship between depressive symptom levels and subsequent increases in substance use among youth with severe emotional disturbance

Identifying Under- And Overutilization Patterns For Idaho Youth With Serious Emotional Disturbance

Children and adolescents with serious emotional disturbance represent 7-12 percent of all youth in the United States. In 2017, the State of Idaho implemented the Youth Empowerment Service program, which allows youth with serious emotional disturbance who are younger than age eighteen living in households with income up to 300 percent of the federal poverty level to qualify for Medicaid and receive intensive, community-based treatment. A uniquely detailed method was used to assess the need for services: the Child and Adolescent Needs and Strengths tool, a ninety-seven-indicator instrument administered by a clinician. We used these indicators and Idaho's 2018-22 administrative Medicaid claims data to study the association between children and adolescents' clinical needs complexity and their actual Medicaid behavioral and mental health service use. Our findings show that there was a substantial proportion of youth who were underusing Medicaid behavioral and mental health care services, and there were virtually no overusers. Our findings have implications for the appropriateness of Medicaid utilization management in behavioral health care and program efforts to maintain families with youth having serious emotional disturbance in the Youth Empowerment Service program.

Adolescent Substance Use at the Intersection of Sexual Orientation and Gender Identity

BACKGROUND

Substance use in adolescence is associated with multiple negative outcomes. Lesbian, gay, or bisexual or transgender or nonbinary (TNB) youth, and those who question their sexual orientation or gender, are more likely to engage in substance use than straight or cisgender youth. However, the extant literature largely considers sexual orientation and gender identity independently. Accordingly, this study examines the associations between the intersectional identities of sexual orientation and gender and substance use to identify those with the greatest need for prevention interventions.

METHODS

Data were from 36 504 high school students aged 14 to 18 years (mean = 15.7, SD = 1.18) enrolled in the 2019 Healthy Kids Colorado Survey using a statewide stratified random sampling design. Logistic regression models examined the associations between intersectional sexual orientation and gender on marijuana use, prescription drug misuse, and polysubstance use, as well as depression and violence victimization (eg, forced sex, partner violence).

RESULTS

Adjusted odds of substance use for sexual and gender minority youth varied by intersectional identity and substance. The largest effect sizes were seen for prescription drug misuse, especially among those questioning their gender and sexual orientation and heterosexuals either questioning their gender or who identified as TNB. Effect sizes for marijuana use and polysubstance use were highest for TNB and heterosexual participants. Depression and violence victimization were significantly associated with each substance use outcome.

CONCLUSIONS

Interventions to reduce substance use in these populations may benefit from targeted interventions for youth with different intersectional identities, and a focus on violence prevention and depression screening and treatment.

Somatic and Depressive Symptoms Among Children From Latin America and the English-Speaking Caribbean

BACKGROUND

The extent to which depression is associated with somatic complaints in children from the English-speaking Caribbean and Latin America is not well established.

OBJECTIVE

We sought to explore the association between depressive and somatic symptoms among children from the English-speaking Caribbean and Latin America, while accounting for age, sex, socioeconomic status, cultural background, and anxiety score.

METHOD

1541 elementary school children, ages 9-12 years, from the English-speaking Caribbean and Latin America completed the Adolescent Depression Rating Scale (ARDS), the Numeric 0-10 Anxiety Self-Report Scale and the Children's Somatic Symptom Inventory-24 (CSSI-24). T-tests and ANOVA's were used to compare CSSI-24 and ARDS scores among countries, and the CSSI-24 scores of children with (ARDS ≥ 4) and without likely clinically significant depression. Regression analyses assessed possible predictors of CSSI-24 score.

RESULTS

Depressive and somatic symptom scores were highest among the Jamaican children and lowest among the Colombian children (p < .001). Children with likely clinically significant depression exhibited higher mean somatic symptom scores (p < .001). Depressive symptom scores predicted somatic symptom scores (p < .001).

CONCLUSIONS

Depressive symptoms were a strong predictor of reporting somatic symptoms. Knowledge of this association may facilitate better recognition of depression among youth.

Assessment of the Relationship of Depression With Tobacco and Caffeine Use Among University Students: A Cross-Sectional Study

Background

University students are at a higher risk of using cognitive enhancers and psychoactive substances. Depression is associated with a noticeable decline in academic performance and can increase the risk of substance use. Due to sociopolitical issues, the use of cognitive enhancers and psychoactive substances among Palestinians has spread in the last decade. However, depression among tobacco and caffeine users remains underrecognized and neglected.

Methodology

A self-administrated questionnaire and the Beck Depression Inventory were used to assess the association of depression and the use of cognitive enhancers and psychoactive substances among university students at An-Najah National University in 2020.

Results

The response rate to the questionnaires was 78.8% (n = 1,051; 38.8% males, 61.2% females). The overall prevalence of depression was high (30.6% males, 34.7% females). The prevalence of cigarette smoking (39.2% males, 3.9% females), waterpipe smoking (43.1% males, 21.6% females), energy drink consumption (59.6% males, 29.7% females), coffee consumption (85.5% for each gender), tea consumption, and chocolate consumption was high, with significant differences in accordance to gender and academic fields. The multinomial logistic regression results revealed that cigarette smokers were more likely to have a higher risk of severe (odds ratio [OR] = 4.5, p = 0.001), moderate (OR = 3.27, p < 0.001), and mild depression (OR = 2.24, p = 0.002) than non-smokers. Severe depression was less prevalent among medical students than health sciences and non-medical students (OR = 0.215, p = 0.015). Moreover, males were less likely to have moderate (OR = 0.5, p = 0.012) and mild (OR = 0.48, p = 0.001) depression than females.

Conclusions

Overall, the results of this study revealed the high prevalence of depression and the detrimental effects of smoking on students. Moreover, the findings suggest the urgent need to address depression and risk factors among Palestinian university students by educating them about mental health, identifying high-risk students, and offering easily accessible psychological help. Further, it is crucial to broaden the focus of studies to include students from various academic fields instead of focusing on medical students.

Delay discounting and neurocognitive correlates among inner city adolescents with and without family history of substance use disorder

Adolescents with a family history (FH+) of substance use disorder (SUD) are at a greater risk for SUD, suggested to be partly due to the transmission of behavioral impulsivity. We used a delay discounting task to compare impulsivity in decision-making and its associated brain functioning among FH+ and FH - minority adolescents. Participants chose between Smaller Sooner (SS) and Larger Later (LL) rewards. The SS was available immediately (Now trials) or in the future (Not-Now trials), allowing for greater differentiation between impulsive decisions. The FH+ group showed greater impatience by responding SS more frequently than the FH - group, only on the Now trials, and even when the relative reward differences (RRD) increased. Surprisingly, there were no differences in brain activity between the groups. Combined, the groups showed greater reward activity during the Now vs. Not-Now trials in medial prefrontal/anterior cingulate, posterior cingulate, precuneus, and inferior frontal gyrus (i.e., an immediacy effect). As the RRD increased activation in the reward network decreased, including the striatum, possibly reflecting easy decision-making. These results indicate that risk for SUD, seen behaviorally among FH+ adolescents, may not yet be associated with discernable brain changes, suggesting that early intervention has the potential to reduce this risk.

State Approaches to Funding Home and Community-Based Mental Health Care for Non-Medicaid Youth: Alternatives to Medicaid Waivers

Home and Community-Based Services (HCBS) Medicaid waivers for children increase the availability of public funding for HCBS by waiving or expanding the means tests for parents' income, basing child eligibility for Medicaid coverage primarily on clinical need. But many states provide mechanisms apart from HCBS waivers to increase coverage for youth with significant mental health needs. Through interviews with public mental health officials from 37 states, this study identifies and explains non-waiver funding strategies for HCBS services for otherwise ineligible youth. Results demonstrate that states expand Medicaid-eligibility through CHIP or use state general revenue funds to pay for medically necessary HCBS for non-Medicaid youth.

Typologies of Peer Victimization, Depression, and Alcohol Use among High School Youth in the United States: Measuring Gender Differences

Using the data from 2015 Youth Risk Behavior Surveillance System, our study explored gender differences in the typologies of peer victimization and alcohol use mediated by depression among adolescents. Results showed a significant association between peer victimization types with depression and alcohol use among both male and female students. Results also showed stark gender differences in school victimization, cyber-bullying victimization, sexual-dating violence, and depression on alcohol use. Findings provide implications for policies and programs that examine various forms of peer victimization, mental health, and alcohol use through a gendered lens, critical to acknowledging gendered differences in victimization and behavior of adolescents.

Longitudinal Reciprocal Associations Between Anxiety, Depression, and Alcohol Use in Adolescent Girls

BACKGROUND

Depression, anxiety, and alcohol misuse predict adverse social, academic, and emotional outcomes, and their relations to one another increase during adolescence-particularly in girls. However, evidence on the directions of these relations is mixed. Longitudinal models of internalizing problem-alcohol use links may identify promising prevention targets. Accordingly, we examined reciprocal associations between anxiety severity and alcohol use, as well as between depression severity and alcohol use, in adolescent girls.

METHODS

Data were drawn from a population-based longitudinal study of female adolescents. The current sample comprised 2,100 participants (57.1% Black, 42.9% White) assessed annually between ages 13 and 17. Girls self-reported depression severity, anxiety severity, and frequency of alcohol use (consumption of ≥1 full drink) in the past year. Primary caregivers reported on socioeconomic and neighborhood factors; these were included with race, early puberty, and conduct problems (youth-report) as covariates. Anxiety and depression severity were included within a single cross-lagged panel model, along with alcohol use, to isolate their independent and reciprocal links to drinking behavior.

RESULTS

Higher depression severity modestly predicted increased likelihood of subsequent alcohol use from ages 13 to 17. However, inconsistent relations emerged for the reverse pathway: Alcohol use modestly predicted decreased depression severity at ages 14 and 16; associations were nonsignificant in other lagged associations. Anxiety severity and alcohol use were not consistently associated.

CONCLUSIONS

Results highlight the key role of depression, relative to anxiety, in predicting later alcohol use. Future studies may examine whether depression prevention programs yield secondary reductions in alcohol use in adolescent girls.

The mediating effects of depressive symptoms on the association of childhood maltreatment with non-medical use of prescription drugs

BACKGROUND

Childhood maltreatment might increase the risk of subsequent drug use behavior, and depressive symptoms have been reported to be associated both childhood maltreatment and non-medical use of prescription drugs (NMUPD). This large-scale study aimed to test the mediating effects of depressive symptoms on the association of childhood maltreatment with NMUPD among Chinese adolescents.

METHODS

A secondary analysis of the cross-sectional data collected from 7th to 12th graders who were sampled using a multistage, stratified cluster, random sampling method in the 2015 School-based Chinese Adolescents Health Survey. There were 24,457 students who were invited to participate and 23,039 students' questionnaires were completed and qualified for our survey (response rate: 94.2%).

RESULTS

In the adjusted models without mediation, the results showed that students who reported that they had experienced emotional abuse were at a higher risk of past year use and past month use of opioids (past year: Adjusted OR [AOR] = 1.07, 95% CI = 1.05-1.10; past month: AOR = 1.08, 95% CI = 1.06-1.10) and sedatives (past year: AOR = 1.06, 95% CI = 1.03-1.08; past month: AOR = 1.15, 95% CI = 1.13-1.16). The results of mediation analyses demonstrated that there were significant standardized indirect effects of emotional abuse on opioids use and sedatives use through depressive symptoms, respectively (P < 0.001).

LIMITATIONS

Our study sample only included school students, and causal inference could not be examined due to the cross-sectional design.

CONCLUSIONS

Depressive symptoms play a significant mediator role on the association of childhood maltreatment with NMUPD. Interventions targeted at adolescents who are involved in NMUPD should pay attention to their histories of childhood maltreatment.

Bullying involvement and adolescent substance use: A multilevel investigation of individual and neighbourhood risk factors

BACKGROUND

Youth involved with school bullying are vulnerable to many negative outcomes, including substance use. Research has yet to examine how this vulnerability operates in the context of other individual and neighbourhood differences. The current study aimed to fill this gap by using multilevel modeling to investigate both the individual and neighbourhood risk factors associated with frequent drunkenness and frequent cannabis use among adolescents.

METHODS

Data from the 2010 Canadian Health Behaviours in School-Aged Children (HBSC) survey were analyzed. Participants consisted of 8971 students from 173 neighbourhoods across Canada. Multilevel modeling was used to examine both individual (age, gender, bullying, victimization, peer deviancy, negative affect) and neighbourhood (socioeconomic status, crime, physical neighbourhood disorder, residential instability) risk factors. We tested whether the links between bullying involvement and frequent substance use were mediated by other risk factors.

RESULTS

Both individual and neighbourhood risk factors were associated with an increased likelihood of frequent substance use. Specifically, bullying served as a unique risk factor for frequent substance use over and above more traditional risk factors. A cross-level interaction was observed between residential instability and peer deviancy, such that the link between peer deviancy and frequent drunkenness was stronger in more residentially-unstable neighbourhoods. Peer deviancy partially mediated the link between bullying and both types of frequent substance use, whereas both peer deviancy and negative affect mediated the link between victimization and both types of frequent substance use.

CONCLUSIONS

Youth who bully others are vulnerable to frequent substance use across peer and neighbourhood contexts.

A systematic review of the unique prospective association of negative affect symptoms and adolescent substance use controlling for externalizing symptoms

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

Associations between depression risk, bullying and current smoking among Chinese adolescents: Modulated by gender

This school-based study aimed to investigate the prevalence of being at risk for depression, bullying behavior, and current smoking among Chinese adolescents in order to explore gender differences in the vulnerability of adolescents with these behaviors to develop a smoking habit. A total of 35,893 high school students sampled from high schools in eighteen cities in China participated in the study from 2011 to 2012. Overall, the prevalence of current smoking was estimated at 6.4%. In total, 1.7% (618) of the participants admitted to bullying others, 5.8% (2071) reported being bullied, 3.5% (1269) were involved in both bullying others and being bullied, and 5.6% (2017) were at high risk for depression. Logistic regression analysis indicated that among girls, with high depression risk, bullying others, being bullied, and both bullying others and being bullied were independently and positively associated with current smoking habits, while the final results among boys showed that bullying others and both bullying others and being bullied were independently associated with an increased risk of current smoking. School-based prevention programs are highly recommended, and we should focus on high-risk students, particularly girls with high risk of depression or involved in school bullying and boys who are involved in school bullying.

Bullying Perpetration and Victimization as Externalizing and Internalizing Pathways: A Retrospective Study Linking Parenting Styles and Self-Esteem to Depression, Alcohol Use, and Alcohol-Related Problems

BACKGROUND

Emerging research suggests significant positive associations between bullying and substance use behaviors. However, these studies typically focused either on the link between substance use and bullying perpetration or victimization, and few have conceptualized bullying perpetration and/or victimization as mediators.

OBJECTIVE

In this study, we simultaneously tested past bullying perpetration and victimization as mediational pathways from retrospective report of parenting styles and global self-esteem to current depressive symptoms, alcohol use, and alcohol-related problems.

METHODS

Data were collected from a college sample of 419 drinkers. Mediation effects were conducted using a bias-corrected bootstrap technique within a structural equation modeling framework.

RESULTS

Two-path mediation analyses indicated that mother and father authoritativeness were protective against bully victimization and depression through higher self-esteem. Conversely, having a permissive or authoritarian mother was positively linked to bullying perpetration, which in turn, was associated with increased alcohol use, and to a lesser degree, more alcohol-related problems. Mother authoritarianism was associated with alcohol-related problems through depressive symptoms. Three-path mediation analyses suggested a trend in which individuals with higher self-esteem were less likely to report alcohol-related problems through lower levels of bullying victimization and depression.

CONCLUSIONS/IMPORTANCE

Results suggested that bullying perpetration and victimization may, respectively, serve as externalizing and internalizing pathways through which parenting styles and self-esteem are linked to depression and alcohol-related outcomes. The present study identified multiple modifiable precursors of, and mediational pathways to, alcohol-related problems which could guide the development and implementation of prevention programs targeting problematic alcohol use.

Brain activity classifies adolescents with and without a familial history of substance use disorders

We aimed to uncover differences in brain circuits of adolescents with parental positive or negative histories of substance use disorders (SUD), when performing a task that elicits emotional conflict, testing whether the brain circuits could serve as endophenotype markers to distinguish these adolescents. We acquired functional magnetic resonance imaging data from 11 adolescents with a positive familial history of SUD (FH+ group) and seven adolescents with a negative familial history of SUD (FH− group) when performing an emotional stroop task. We extracted brain features from the conflict-related contrast images in group level analyses and granger causality indices (GCIs) that measure the causal interactions among regions. Support vector machine (SVM) was applied to classify the FH+ and FH− adolescents. Adolescents with FH+ showed greater activity and weaker connectivity related to emotional conflict, decision making and reward system including anterior cingulate cortex (ACC), prefrontal cortex (PFC), and ventral tegmental area (VTA). High classification accuracies were achieved with leave-one-out cross validation (89.75% for the maximum conflict, 96.71% when combining maximum conflict and general conflict contrast, 97.28% when combining activity of the two contrasts and GCIs). Individual contributions of the brain features to the classification were further investigated, indicating that activation in PFC, ACC, VTA and effective connectivity from PFC to ACC play the most important roles. We concluded that fundamental differences of neural substrates underlying cognitive behaviors of adolescents with parental positive or negative histories of SUD provide new insight into potential neurobiological mechanisms contributing to the elevated risk of FH+ individuals for developing SUD.

Bidirectional Influence: A Longitudinal Analysis of Size of Drug Network and Depression Among Inner-City Residents in Baltimore, Maryland

BACKGROUND

The prevalence of depression among drug users is high. It has been recognized that drug use behaviors can be influenced and spread through social networks.

OBJECTIVES

We investigated the directional relationship between social network factors and depressive symptoms among a sample of inner-city residents in Baltimore, MD.

METHODS

We performed a longitudinal study of four-wave data collected from a network-based HIV/STI prevention intervention for women and network members, consisting of both men and women. Our primary outcome and exposure were depression using CESD scale and social network characteristics, respectively. Linear-mixed model with clustering adjustment was used to account for both repeated measurement and network design.

RESULTS

Of the 746 participants, those who had high levels of depression tended to be female, less educated, homeless, smokers, and did not have a main partner. In the univariate longitudinal model, larger size of drug network was significantly associated with depression (OR = 1.38, p < .001). This relationship held after controlling for age, gender, homeless in the past 6 months, college education, having a main partner, cigarette smoking, perceived health, and social support network (aOR = 1.19, p = .001). In the univariate mixed model using depression to predict size of drug network, the data suggested that depression was associated with larger size of drug network (coef. = 1.23, p < .001) and the same relation held in multivariate model (adjusted coef. = 1.08, p = .001).

CONCLUSIONS

The results suggest that larger size of drug network is a risk factor for depression, and vice versa. Further intervention strategies to reduce depression should address social networks factors.

Hope as a Moderator of the Associations between Common Risk Factors and Frequency of Substance Use among Latino Adolescents

Ample research suggests that delinquency, depressive symptoms, and peer substance use are common risk factors associated with adolescent substance use. However, the factors that may help to buffer the deleterious effects of these risk factors on adolescent substance use, such as hope, have yet to be examined. The current study evaluated hope as a moderator of the associations between these common risk factors and frequency of substance use (alcohol, tobacco, and marijuana) in a sample of Latino high school students (Mage = 16.14years, SD = 1.30; 55% female). Findings indicated that the influence of delinquency on frequency of tobacco and marijuana use depended on levels of hope, with delinquency only positively associated with frequency of use when levels of hope were low. Additionally, hope moderated the association between depressive symptoms and alcohol use, such that depressive symptoms were only positively associated with frequency of alcohol use when levels of hope were low. Results and their implications for intervention are reviewed.

Relationships among independent major depressions, alcohol use, and other substance use and related problems over 30 years in 397 families

OBJECTIVE

Although heavy drinking is related to sadness on multiple levels, the link between alcohol use disorders (AUDs) and major depressive episodes (MDEs) is more controversial. One complicating factor is that some MDEs are temporary and only occur in the context of heavy drinking, whereas other MDEs are longer lasting and occur independently of intense alcohol intake (i.e., independent depressive episodes [IDEs]). We hypothesized that a longitudinal study that uses validated interviews with subjects and relatives and distinguishes between IDEs and alcohol-induced depressive episodes would reveal little evidence of a link between IDEs and AUDs.

METHOD

Histories of AUDs, IDEs, and substance-induced depressions were prospectively evaluated over 30 years in 397 male probands from the San Diego Prospective Study and in their 449 offspring using questions extracted from the Semi-Structured Assessment for the Genetics of Alcoholism interview.

RESULTS

The rate of IDEs over 30 years in the 397 probands was 15.3% overall. Among probands who developed AUDs, 31% of their depressive episodes were substance induced, not IDEs. For these men followed over 3 decades, those with IDEs had no increased rate of AUDs and evidenced no higher rate of use or abuse/dependence on illicit substances. Similar conclusions applied to their 449 offspring ages 12 years and older.

CONCLUSIONS

These data support the importance of distinguishing between IDE and substance-induced depressions when evaluating the relationship between AUDs and depression syndromes.

The influence of behavioural and health problems on alcohol and drug use in late adolescence - a follow up study of 2 399 young Norwegians

BACKGROUND

Both early alcohol debut, behavioural and health problems are reported to enhance adolescence substance use. This prospective study investigate the influence of behavioural and health problems on adolescents' alcohol and drug use.

METHOD

Prospective population based cohort study of 2 399 adolescents attending the Young-HUNT study, aged 13-15 at baseline in 1995/97, and 17-19 at follow-up 4 years later. Exposure variables were self reported conduct problems, attention problems, anxiety and depressive symptoms, and muscular pain and tension. Outcome variables at follow-up were frequent alcohol use and initiation of drug use. Associations were estimated by logistic regression models, influence of gender and drinking status at baseline were controlled for by stratification.

RESULTS

At follow-up 19% of the students drank alcohol once a week or more frequently. Baseline conduct problems (OR 2.2, CI 1.7-3.0) and attention problems (OR 1.5, CI 1.2-2.0) increased the risk for frequent alcohol use at follow-up in the total population. Girls who had experienced alcohol-intoxications at baseline showed strong association between baseline problems and frequent alcohol use at follow-up. Conduct problems (OR 2.5, CI 1.3-4.8), attention problems (OR 2.1, CI 1.2-3.4), anxiety/depressive symptoms (OR 1.9, CI 1.1-3.1) and muscular pain and tension (OR 1.7, CI 1.0-2.9) all were associated with frequent alcohol use among early intoxicated girls.14% of the students had tried cannabis or other drugs at follow-up. Conduct problems at baseline increased the odds for drug use (OR 2.6, CI 1.9-3.6). Any alcohol intoxications at baseline, predicted both frequent alcohol use (boys OR 3.6, CI 2.4-5.2; girls OR 2.8, CI 1.9-4.1), and illegal drug use (boys OR 4.7; CI 3.2-7.0, girls OR 7.7, CI 5.2-11.5) within follow-up.

CONCLUSIONS

Conduct problems in high-school more than doubles the risk for both frequent alcohol use and initiation of drug use later in adolescence. The combination of health problems and alcohol intoxication in early adolescence was closely associated with more frequent drinking later in adolescence among girls.Overall, early alcohol intoxication was closely associated with both frequent alcohol use and drug use at follow up in both genders.

Bullying victimization and substance use among U.S. adolescents: mediation by depression

This study examined the link between bullying victimization and substance use and tested the mediating role of depression in male and female adolescents. Cross-sectional data were collected from a national sample of 1,495 tenth graders who participated in the 2005/06 Health Behaviors in School-aged Children U.S. Survey. Victimization, depression and substance use were all measured as latent variables. Substance use was measured by drinking alcohol, being drunk, smoking cigarettes and using marijuana in the past 30 days. Multiple-group structural equation modeling showed that victimization was linked to substance use in both males and females. Among females, depression was positively associated with both victimization and substance use and mediated the association between the two latter variables. Among males, depression was associated with victimization but not with substance use. Results highlight the elevated risk for victimization and substance use problems that depression poses among adolescent females.

Factors associated with initiation of ecstasy use among US adolescents: findings from a national survey

AIMS

To investigate adolescent pathways to ecstasy use by (1) examining how early onsets of smoking, drinking, and marijuana use are related to a child's risk of initiation of ecstasy use and (2) assessing the influence of other individual and parental factors on ecstasy use initiation.

METHODS

Data on 6426 adolescents (12-17 years old at baseline) from the National Survey of Parents and Youth (NSPY), a longitudinal, nationally representative household survey of youth and their parents, were used in the analyses. Information on youth substance use, including ecstasy use, as well as familial and parental characteristics, was available.

RESULTS

Initiation of ecstasy use is predicted by an adolescent's early initiation of smoking, drinking, or marijuana use. In particular, early initiation either of marijuana use, or of both smoking and drinking, increases a child's risk for ecstasy use initiation. Among the familial and parental variables, parent drug use emerged as significantly predictive of child initiation of ecstasy use; living with both parents and close parental monitoring, on the other hand, are negatively associated with ecstasy use initiation, and may be protective against it. At the individual level, sensation seeking tendencies and positive attitudes towards substance use, as well as close associations with deviant peers, are predictive of adolescent initiation of ecstasy use.

CONCLUSION

Our findings on the risk and protective factors for initiation of ecstasy use, especially with regard to factors that are modifiable, will be useful for prevention programs targeting youth use not only of ecstasy, but also of other drugs.

Antidepressant treatment facilitates dopamine release and drug seeking behavior in a genetic animal model of depression

Anhedonia and lack of motivation are core symptoms of depression. In contrast, hyper-motivation and euphoria characterize intoxicated states. In order to explore the relationship between these two behavioral states we examined cocaine self-administration tasks in an animal model of depression [Flinders Sensitive Line (FSL) rats]. We found that FSL rats exhibit sub-sensitivity in their cocaine-seeking behavior, which was normalized following a chronic treatment with the antidepressant desipramine. However, when the cocaine dosage was increased, FSL rats demonstrated a similar cocaine-seeking behavior to that of controls. In light of dopamine's central role in modulating cocaine reinforcement, we examined dopaminergic neurotransmission in the nucleus accumbens, a brain region implicated in the rewarding and hedonic effects of substances of misuse. FSL rats exhibited low but dose-dependent increases in extracellular levels of dopamine in the nucleus accumbens after acute intravenous cocaine injection. Furthermore, by using the dopamine transporter blocker GBR-12909 we were able to demonstrate that the low extracellular dopamine levels, observed in FSL rats, were a consequence of low dopamine release in the nucleus accumbens, as opposed to the possibility of increased uptake. Treatment of FSL rats with the antidepressant desipramine raised cocaine- and GBR-12909-induced dopamine release to the level of controls. This treatment also resulted in increased cocaine-seeking behavior.