A bibliographic essay: the relationship between stress and substance use

Partner incarceration, maternal substance use, and the mediating role of social support: A longitudinal analysis using the future of families and child wellbeing study

INTRODUCTION

The United States is responsible for the highest incarceration rate globally. This study aimed to explore the impact of partner incarceration on maternal substance use and whether social support mediates the relationship between partner incarceration and maternal substance use.

METHODS

Using data from the Future of Families and Child Wellbeing Study, a longitudinal cohort following new parents and children, this analysis quantifies the relationship between paternal incarceration and maternal substance use (N = 2823). We analyzed maternal responses in years 3 (2001-2003), 5 (2003-2006), 9 (2007-2010), and 15 (2014-2017). We explored the role of financial support and emergency social support as potential mediators. Confirmatory factor analysis (CFA) was employed to construct support-related mediators. We modeled the impact of partner incarceration and maternal substance use using generalized estimating equations (GEE) to account for repeated measures, adjusting for appropriate confounders (age of mother at child's birth, race, education, employment, and history of intimate partner violence).

RESULTS

Nearly half (44.2%, N = 1247) of participants reported partner incarceration. Among mothers who experienced partner incarceration, the odds of reporting substance use were 110% greater than those who reported no partner incarceration (adjusted Odds Ratio [aOR]: 2.10; 95% Confidence Interval (CI):1.67-2.63). Financial support at year 5 accounted for 19.5% (95% CI: 6.03-33.06%) of the association between partner incarceration at year 3 and substance use at year 9; emergency social support at year 5 accounted for 6.4% (95% CI: 0.51-12.25%) of the association between partner incarceration and substance use at year 9. Neither financial nor emergency social support at year 9 were significant mediators between partner incarceration at year 3 and substance use at year 15.

CONCLUSIONS

These findings demonstrate that partner incarceration impacts maternal substance use. Financial and emergency support may partially mediate this relationship in the short term, which has important implications for families disrupted by mass incarceration.

Individual Differences in Substance Use Motives, Trauma, and Stress Among College-Based Polysubstance Users

Background: Co-use of alcohol and other drugs within a certain time frame (i.e., polysubstance use) has become increasingly prevalent, particularly among college-aged individuals, but understanding motives for co-use remains limited. Polysubstance use has been associated with a higher likelihood of negative health consequences as compared to single substance use. Objectives: The current study examined associations between motivations for using alcohol, tobacco, and cannabis among college students who use multiple substances versus students using only one substance or no substances. Additionally, we examined the effect of trauma and daily stress on polysubstance use in self-report data from individuals (N=134) participating in the MAPme Study. Results: First, the observed prevalence of polysubstance use was greater than expected by chance, with most individuals co-using alcohol and cannabis. "Alcohol and Other Drug Users" were more frequently motivated to drink for social (β=0.27, CI=[0.07, 0.44]), enhancement (β=0.26, CI=[0.01, 0.42]) and coping (β=0.21, CI=[0.06, 0.47]) reasons compared to individuals who consumed alcohol alone. Conclusions: Individual differences in motivations for use were partly explained by frequency of alcohol use and alcohol problem severity, but not by history of trauma or stress. Finally, while patterns of correlations among motivations for use across substances suggested a general tendency to be motivated to use substances for similar reasons, this was not supported by confirmatory factor models. Overall, shared motives may inform potential behavioral patterns for co-use of substances during college and might advise future treatment efforts.

Swedish High School Students' Drug and Alcohol Use Habits throughout 2020

This study describes gender-specific patterns in alcohol and drug use among Swedish high school students throughout 2020 and questions the current cutoffs for identifying addiction in this population. From September 2020 to February 2021, 1590 Swedish upper secondary high school students (mean age 17.15 years, age range 15-19 years, 39.6% male, and 60.4% female) completed the anonymous, electronic survey of the Mental and Somatic Health without borders study. The respondents reported their substance use habits during the previous 12 months using the Drug Use Disorders Identification Test (DUDIT) and Alcohol Use Disorders Identification Test (AUDIT). They also answered questions about changes in their alcohol and illegal drug use habits after the COVID-19 outbreak. No gender differences were detected in the prevalence and degree of alcohol use. Compared to female adolescents, significantly more male adolescents used drugs (and to a significantly higher degree, although with a small effect size). Substance use problems peaked in females at age 17 and in males at age 18. The COVID-19 outbreak affected alcohol consumption and illegal drug use in male and female adolescents similarly. For both genders, of those who used illegal drugs, over 40% reported increased use after the outbreak. Our results reinforce previous suggestions of the narrowing of gender differences in Swedish adolescents' risk behaviors and challenge the previously validated gender-specific cutoffs for the AUDIT and DUDIT. An improved understanding of the impacts of gender diversity and evolving gender roles and norms on behaviors and mental health is warranted.

Changes in Adolescents' Psychosocial Functioning and Well-Being as a Consequence of Long-Term COVID-19 Restrictions

This work studied self-reports from adolescents on how the COVID-19 pandemic has changed their behaviors, relationships, mood, and victimization. Data collection was conducted between September 2020 and February 2021 in five countries (Sweden, the USA, Serbia, Morocco, and Vietnam). In total, 5114 high school students (aged 15 to 19 years, 61.8% females) responded to our electronic survey. A substantial proportion of students reported decreased time being outside (41.7%), meeting friends in real life (59.4%), and school performance (30.7%), while reporting increased time to do things they did not have time for before (49.3%) and using social media to stay connected (44.9%). One third of the adolescents increased exercise and felt that they have more control over their life. Only a small proportion of adolescents reported substance use, norm-breaking behaviors, or victimization. The overall COVID-19 impact on adolescent life was gender-specific: we found a stronger negative impact on female students. The results indicated that the majority of adolescents could adapt to the dramatic changes in their environment. However, healthcare institutions, municipalities, schools, and social services could benefit from the findings of this study in their work to meet the needs of those young people who signaled worsened psychosocial functioning, increased stress, and victimization.

Between- and within-person associations between negative life events and alcohol outcomes in adolescents with ADHD

Escalations in alcohol use during adolescence may be linked with exposure to negative life events, but most of this research has focused on between-person associations. Moreover, adolescents with attention-deficit hyperactivity disorder (ADHD) may be an especially vulnerable population, reporting more life events and alcohol involvement and may even be more sensitive to the effects of life events on alcohol outcomes compared with those without ADHD. We tested the between- and within-person effects of the number and perceptions of negative life events on the development of alcohol use outcomes from age 14 to 17 years in 259 adolescents with and without ADHD using generalized estimating equations. Between-person differences in exposure to negative life events across adolescence, but not the perception of those events, were associated with a higher likelihood of alcohol use and drunkenness at age 17 years. Within-person differences in life events were associated with alcohol use above and beyond that predicted by an adolescents' typical trajectory over time. Parent- and teacher-reported ADHD symptoms were associated with more negative perceptions of life events and with greater alcohol use and drunkenness at age 17 years, but symptoms did not moderate the life event-alcohol association. Interventions should consider the variables that produce vulnerability to life events as well as the immediate impact of life events. That the accumulation of life events, rather than their perceived negativity, was associated with alcohol outcomes indicates that interventions targeting the reduction of negative events, rather than emotional response, may be more protective against alcohol use in adolescence. (PsycINFO Database Record

The role of minority stress in second-generation Black emerging adult college students' high-risk drinking behaviors

OBJECTIVE

This study used a minority stress framework to investigate the relationships between multiple stressors (e.g., general life stress, race related stress, and acculturative stress) and high-risk drinking behaviors in a sample of second-generation Black emerging adult college students across the United States.

METHOD

Participants (n = 148) were recruited from U.S. colleges and universities as part of a large, multiwave cross-sectional study.

RESULTS

Findings from this study mirrored those in the extant literature: the positive relationship between race-related stress and high-risk drinking behaviors found in other marginalized groups. However, when all stressors were entered into the model, acculturative stress accounted for significant variance in high-risk drinking behaviors above and beyond general life and race-related stressors in second generation Black emerging adult college students.

CONCLUSION

Findings underscore the need to better understand the influence of acculturative stress on high-risk drinking behaviors among second-generation Black emerging adult college students: an understudied population in both the acculturation and alcohol use literatures. Implications for future research and clinical practice are discussed. (PsycINFO Database Record

Smoking in young adulthood among African Americans: Interconnected effects of supportive parenting in early adolescence, proinflammatory epitype, and young adult stress

We examined two potentially interacting, connected pathways by which parental supportiveness during early adolescence (ages 1-13) may come to be associated with later African American young adult smoking. The first pathway is between parental supportiveness and young adult stress (age 19), with stress, in turn, predicting increased smoking at age 20. The second pathway is between supportive parenting and tumor necrosis factor (TNF) gene methylation (i.e., TNFm), a proinflammatory epitype, with low levels indicating greater inflammatory potential and forecasting increased risk for smoking in response to young adult stress. In a sample of 382 African American youth residing in rural Georgia, followed from early adolescence (age 10-11) to young adulthood (age 20), supportive parenting indirectly predicted smoking via associations with young adult stress, IE = -0.071, 95% confidence interval [-0.132, -0.010]. In addition, supportive parenting was associated with TNFm measured at age 20 (r = .177, p = .001). Further, lower TNFm was associated with a significantly steeper slope (b = 0.583, p = .003) of increased smoking in response to young adult stress compared to those with higher TNFm (b = 0.155, p = .291), indicating an indirect, amplifying role for supportive parenting via TNFm. The results suggest that supportive parenting in early adolescence may play a role in understanding the emergence of smoking in young adulthood.

The Deterrence Hypothesis Reexamined: Sports Participation and Substance Use among Young Adults

The widely held notion that sports participation reduces subsequent risk of substance use is evaluated with longitudinal data of a representative sample of youth when they were in their preteen and young adult years. Unlike previous inquiries into the deterrence hypothesis, the present study controls for other major factors previously found to be predictive of alcohol and drug use. Results of analyses revealed that contrary to the deterrence hypothesis, playing high school sports does not appear to be a protective factor that lowers one's involvement in young adult alcohol or drug use – with one exception. Subgroup analyses revealed that among blacks, the greater the extent of high school sports participation the less the risk of substance use. In direct contradiction to the deterrence hypothesis, playing high school sports was found to be positively associated with alcohol use for whites, even in the context of other major predictors of alcohol use. Further analyses revealed that the positive association between sports participation and alcohol use appeared to exist only for white males. The implications of these results are discussed.

Economic Stressors, Social Integration, and Drug Use among Women in an Inner City Community

This article uses data from a study of 122 adult women drug users residing in the Atlanta, Georgia metropolitan area to identify associations between economic stressors related to occupying disadvantaged statuses, institutional integration, and drug use. The data stem from targeted sampling and ethnographic mapping procedures. The findings suggest that experiencing stressors related to economic circumstance and daily subsistence increased the likelihood of drug use. Results also indicate religious involvement and kinship networks are independently and negatively associated with drug use, but fail to reduce the negative effects of economic stressors on drug use. The author suggests that institutional integration, however limited, may be a formidable deterrent to drug use. Continued identification of multi-level integration sources may inform drug treatment approaches in community programs.

The Relationship Between the Accumulated Number of Role Transitions and Hard Drug Use among Hispanic Emerging Adults

Emerging adults (ages 18 to 25) who experience multiple role transitions in a short period of time may engage in hard drug use as a maladaptive coping strategy to avoid negative emotions from stress. Given the collectivistic values Hispanics encounter growing up, they may experience additional role transitions due to their group-oriented cultural paradigm. This study examined whether those who experience many role transitions are at greater risk for hard drug use compared to those who experience few transitions among Hispanic emerging adults. Participants completed surveys indicating their hard drug use in emerging adulthood, role transitions in the past year of emerging adulthood, age, gender, and hard drug use in high school. Simulation analyses indicated that an increase in the number of role transitions, from 0 to 13, was associated with a 14% (95% CI, 4 to 29) higher probability of hard drug use. Specific role transitions were found to be associated with hard drug use, such as starting to date or experiencing a breakup. Intervention/prevention programs may benefit from acknowledging individual reactions to transitions in emerging adulthood, as these processes may be catalysts for personal growth where identities are consolidated and decisions regarding hard drug use are formed.

Rejection attitudes, poor parental bonding, and stressful life events in heroin addicts' families

BACKGROUND

The influence of family factors on the development and/or on maintenance of heroin addiction still remains unclear.

OBJECTIVES

The aim of this study was to investigate family factors, which might be associated with heroin addiction in a sample of male individuals.

METHODS

A group of 40 heroin addicts' families was compared with a group of 17 families with a member presenting schizophrenia and a group of 27 families with mentally healthy members in regard to (1) parents' rejection attitudes toward their adult child, (2) quality of parental bond, as perceived by the adult child, and (3) stressful life events in the nuclear family.

RESULTS

The main findings showed that the degree of rejection by the fathers in the heroin addicts' families as well as in the subjects with schizophrenia was significantly higher compared to the fathers' degree of rejection in the control group. Moreover, the degree of rejection by mothers in the heroin addicts' families was significantly higher compared to the mothers' degree of rejection in the control group. Heroin addicts reported that they had perceived less care from their fathers than healthy controls. The total number of stressful life events in the nuclear family was higher in the patients with schizophrenia in comparison to the healthy controls. Also, in the heroin addicts' group, a significantly higher number of fathers presented a current or past psychiatric disorder.

CONCLUSIONS

The findings of this study showed the importance of negative family factors in the course of heroin addiction.

Emerging adulthood themes, role transitions and substance use among Hispanics in Southern California

INTRODUCTION

Hispanic emerging adults appear to be at especially high risk for substance use but little is known about their risk and protective factors. A crucial next step to reducing substance use among this priority population may involve understanding how transition-to-adulthood themes are associated with substance use. Intervention and prevention programs could also benefit from information about which if any specific transitions undergone in emerging adulthood are associated with substance use.

METHODS

Hispanic emerging adults (aged 18 to 24) completed surveys indicating their identification with transition-to-adulthood themes, role transitions in the past year, and use of alcohol and marijuana. Logistic regression models were used to examine the associations between transition-to-adulthood themes and past-month binge drinking and marijuana use, controlling for age and gender. Separate logistic regression models explored the association between each individual role transition and past-month binge drinking and marijuana use, controlling for age and gender and using a Bonferonni correction.

RESULTS

Among the participants (n=1,390), 41% were male, the average age was 21, 24% reported past-month marijuana use and 34% reported past-month binge drinking. Participants who felt emerging adulthood was a time of focusing on others were less likely to report marijuana use and binge drinking. Among the 24 transitions, five were significantly associated with past-month marijuana use and 10 were significantly associated with past-month binge drinking.

CONCLUSION

Findings suggest transition-to-adulthood themes as well as specific changes experienced by emerging adults are meaningful for Hispanics and should be explored in prevention and intervention programs in the future. Future research should determine what specific mechanisms are making these transitional processes risk factors for substance use.

Role transitions in emerging adulthood are associated with smoking among Hispanics in Southern California

INTRODUCTION

Smoking initiation seldom occurs after emerging adulthood, making prevention critical during this phase of the life course. Among emerging adults, Hispanics have an especially high risk for cigarette use. Emerging adulthood scholars suggest role transitions commonly experienced by this age group may lead to substance use including cigarette experimentation and/or progression, contributing to the high smoking rates exhibited by Hispanics.

METHODS

Hispanic emerging adults (aged 18-24) completed surveys indicating which of a comprehensive list of role transitions they had experienced in the past year. Separate logistic regression models explored the association between each individual role transition and smoking in the past 30 days, controlling for age and gender and using a Bonferonni correction.

RESULTS

Among the sample of emerging adults (n = 1,390), 41% were male, the average age was 21, and about 21% reported cigarette use in the past 30 days. Losing a job, becoming a family member's caregiver, starting to date someone new, experiencing a breakup, being arrested, and becoming addicted to illicit drugs and/or alcohol were all associated with smoking.

CONCLUSIONS

The stress associated with navigating through changes in critical periods of the life course may lead some emerging adults to smoke. Future research should be directed toward determining what specific mechanisms make these transitional processes risk factors for smoking. These determinations could prove critical if effective prevention programs are to be designed that lead to a decrease in the smoking prevalence among Hispanic emerging adults.

Relationship between Stress Symptoms and Drug use among Secondary Students

The aim of this study was to evaluate the relationship between drug use and four kinds of stress symptoms in 954 Brazilian students from the 6thto the 11thgrades, in 4 public and 5 private schools in the city of Sao Paulo. Based on their answers to the Drug Use Screening Inventory (DUSI-R) and to the Stress Scale for Adolescents (SSA), we compared regular drug users with non/occasional drug users regarding the frequency of four kinds of stress symptoms (psychological, cognitive, physiological, interpersonal), and the period in which it happened. When compared to non/occasional drug users, regular drug users presented higher levels of psychological, cognitive and physiological symptoms of stress and these symtoms were in the most severe spectrum of severity (near to exhaustion and exhaustion). The association between drug use and stress was even stronger in the youngest age group (11 to 13 years old). Most of the regular drug users were 16 years old and over, from upper-middle class families, had poor family relationships and more academic problems. These results confirm the association between drug use and stress in adolescents and highlight the need for early screening and intervention in both drug use and stressful situations.

Adverse events and substance use among female adolescent offenders: effects of coping and family support

This study examined a stress-coping model for substance use among female adolescents (N = 305, 69% African American) involved in the Mississippi juvenile justice system. Participants were interviewed in 2006 , regarding exposure to adverse and traumatic events, and they completed self-administered measures of social support from relatives, coping strategies, and questions on frequency of alcohol and other drug use. Results from nested regression models revealed that stressors are associated with drug, but not alcohol use. The use of supportive kinship ties and religion to cope were protective factors. The implications and limitations of the study are discussed.

Prospective relations between growth in drinking and familial stressors across adolescence

Although there is much empirical support for the relation between stress and alcohol consumption in adolescence, it is unclear whether exposure to stressors is associated with overall trajectories or temporary elevations in drinking. Moreover, little research has explored whether the stress-alcohol use association in adolescence may be explained by shared risk factors that produce both individual differences in stress exposure and elevated risk for alcohol use. The present study tested these hypotheses within the context of a state-trait model of family stressors in a prospectively studied sample of children at high risk for alcoholism: children of alcoholic parents and matched controls (n = 451). Levels and growth in alcohol use were modeled longitudinally from ages 13 to 17. Results indicated that shared risk factors accounted for 53% of the impact of trait family stressors on growth in adolescent drinking, but time-specific exposure to familial stressors still predicted short-term boosts in alcohol use in adolescence. These findings imply that trait familial stressors mark adolescents at risk for alcohol use and also impact adolescent alcohol use within a short time frame (i.e., over 1 year vs. over many years) when they occur above and beyond the adolescent's "usual load" of stressors.

The Impact of Stressful Life Events on Alcohol Relapse: Findings from the Collaborative Longitudinal Personality Disorders Study

Alcohol relapse is impacted by a variety of environmental, interpersonal, and intrapersonal factors. We examined the interaction between stressful life events, personality disorder subtype, and alcohol relapse among individuals enrolled in the Collaborative Longitudinal Personality Disorders Study (CLPS). Negative life events predicted relapse in all subjects. In individuals with a history of an alcohol use disorder prior to study entry, positive life events also predicted alcohol relapse. Individuals with Antisocial Personality Disorder (ASPD) were found to be twice as likely to relapse in response to life stressors compared to individuals with Obsessive-Compulsive Personality Disorder (OCPD), who were half as likely to relapse in response to life stressors. Further analysis revealed that individuals with OCPD and no history of an alcohol use disorder were almost 10 times more likely to relapse in the face of a stressful romantic problem, while those with ASPD and a history of an alcohol use disorder were six times more likely to relapse in response to a stressful financial event. These findings have implications for both the assessment and the treatment of individuals who present with co-morbid personality and alcohol use disorders.

Adolescent stressors, psychopathology, and young adult substance dependence: a prospective study

OBJECTIVE

There is much theory, but sparse empirical evidence, supporting the notion that internalizing symptoms and negative affect are the mechanism by which exposure to stressful life events influence the development of substance-use disorders in adolescence and young adulthood. However, many empirical studies have shown that, in addition to elevations in internalizing symptoms, exposure to stressful life events also produces elevations in externalizing behaviors and conduct problems, which are important risk factors for substance-use disorders. The current study tested adolescent externalizing and internalizing symptoms as competitive mediators of the effects of stressors on young adult drug dependence.

METHOD

Data from an ongoing study of children of alcoholics (n=223) and matched controls (n=204) were collected in two annual interviews in adolescence and two follow-ups in young adulthood.

RESULTS

Experiencing stressful life events during adolescence led to increases in both externalizing and internalizing symptoms, but only externalizing symptoms mediated the later effects of adolescent stressors on young adult drug dependence.

CONCLUSIONS

These findings suggest that understanding how stressors produce elevations in behavioral problems may provide important insights into understanding how broad environmental risk factors lead to substance dependence and suggests that processes other than affect regulation may operate in the pathway from the experiences of stressors to substance use and disorder.

Stress during adolescence alters behavioral sensitization to amphetamine

In humans, chronic intermittent and uncontrollable stress during adolescence is viewed as a key factor for vulnerability to drug abuse and development of psychopathologies later in life. Less is known about the long-term effects of chronic stress in animals during the juvenile period. Although there is evidence of cross sensitization during prenatal period and adulthood between chronic stress and amphetamine-induced behavioral sensitization in the rat, no studies have been conducted on cross sensitization between chronic variable stress in adolescence and behavioral sensitization to amphetamine. To address this question, at the onset of adolescence (28 days) male rats were subjected to 28 days of intermittent non-habituating social stress (isolation, novel environment, crowding, litter-shifting, subordination), or physical stress (restraint, swim, cold, ether, noise), or were handled as controls. Twenty-four hours after the last stressor or handling, all groups were exposed to a novel environment for 1 h, after which they underwent a regimen of behavioral sensitization to amphetamine. Our results showed that socially stressed rats have low locomotor activity in the novel environment, when compared to the control and physical groups who were identical in the same test. Even though socially stressed rats had lower locomotor activity in response to amphetamine injections, there were no significant differences during the training phase between the three groups at this dose of amphetamine. However, when tested for behavioral sensitization to amphetamine control and physically stressed rats showed a robust sensitization, socially stressed rats were significantly inhibited. We conclude that our chronic variable social stress protocol during adolescence inhibits behavioral sensitization to amphetamine during adulthood.

Stress activation of glutamate neurotransmission in the prefrontal cortex: implications for dopamine-associated psychiatric disorders

In most psychiatric disorders, stress is the major nongenomic factor that contributes to the expression or exacerbation of acute symptoms, recurrence or relapse after a period of remission, and treatment outcome. Delineation of mechanisms by which stress contributes to these processes is fundamental to understanding the disease process and for improving outcome. In this article, evidence is reviewed to indicate that many central aspects of stress response, including activation of the hypothalmic-pituitary-adrenal (HPA) axis and dopamine neurotransmission, are modulated, and in some cases mediated, by glutamate neurotransmission in the prefrontal cortex (PFC). It is suggested that activation of glutamatergic neurotransmission in the PFC presents a common mechanism by which stress influences normal and abnormal processes that sustain affect and cognition. Although monoamines, in particular dopamine, have been considered the major culprits in the adverse effects of stress in disorders such as addiction and schizophrenia, it is likely that in a vulnerable brain with an underlying PFC pathophysiology, abnormal stress-activated monoaminergic neurotransmission is secondary to anomalies in cortical glutamate neurotransmission. Thus, understanding the contribution of glutamate-mediated processes to stress response through the use of experimental models that involve disrupted PFC function can provide insights to the fundamental pathophysiology of stress-sensitive psychiatric disorders and lead to novel strategies for treatment and prevention.