Subjective aggression during alcohol and cannabis intoxication before and after aggression exposure

Patterns of substance-involved intimate partner violence perpetration: Findings from a daily diary study

BACKGROUND

Previous work has linked substance use to intimate partner violence (IPV) perpetration, but the extent to which patterns of substance use influence patterns of IPV perpetration is unclear.

METHODS

Women (N = 216, Mage = 40.7 years [SD = 13.1], 34.7 % Black, 26.9 % White) experiencing physical or repeated psychological IPV were recruited from the community and completed daily app-based surveys for 90 days, in which they reported their partner's use of alcohol, cannabis, and other drugs, and their partner's psychological, physical, and sexual IPV perpetration.

RESULTS

Partner's IPV perpetration was significantly more likely on days when partners used (versus did not use) any substances (OR = 2.25, 95 %CI [1.89, 2.67]). Substance use patterns (i.e., alcohol or cannabis use alone, alcohol-cannabis co-use, other drug use) varied with respect to whether they differentiated days with (versus without) IPV, psychological IPV alone, physical IPV without sexual IPV (with or without psychological IPV), and sexual IPV (with or without physical and psychological IPV). In large part, substance use patterns that included alcohol tended to increase the odds of same-day IPV perpetration. Specifically, alcohol use alone increased the odds of same-day psychological and physical IPV perpetration, and alcohol-cannabis co-use increased the odds of same-day physical and sexual IPV perpetration. Use of other drugs increased the odds of same-day sexual IPV perpetration.

CONCLUSIONS

Findings suggest particular patterns of substance use increased the risk of IPV perpetration. These patterns may represent higher-risk events that could be targeted by just-in-time interventions to reduce IPV, and support efforts targeting alcohol use in batterer invention programming.

Revisiting the alcohol-aggression link: The impact of alcohol consumption patterns

Laboratory studies have repeatedly reported a link between alcohol and aggression, yet many rely on single-dose administration methods and overlook variations in alcohol consumption patterns. The present study investigates the effects of alcohol on aggressive behavior using a double-blind, placebo-controlled cumulative drinking administration approach that mirrors the natural drinking behaviors often observed in pubs within a laboratory setting. This study also pioneers the examination of how alcohol consumption patterns (light or heavy) moderate the relationship between precise Breath Alcohol Concentration (BrAC) levels and extreme aggressive behavior. Seventy-five individuals who drink alcohol lightly (N=38) and heavily (N=37) were randomly assigned to alcohol (N=33) or placebo (N=42) conditions. Participants drank four drinks successively. Taylor's aggression paradigm was completed twenty minutes after each drink. Multilevel modeling was applied to analyze the effects of precise BrAC and account for within-person variability. Alcohol showed a dose-dependent effect on aggression; as alcohol levels rose, so did aggression (p<.001). Alcohol consumption pattern moderated the effect of cumulative BrAC on aggression, such that the effect was more substantial for as compared with individuals who drink lightly (p=.03). The current study highlights the moderating role of alcohol consumption pattern in the association between precise BrAC levels and extreme aggression, offering insights into individual differences in susceptibility to alcohol-induced aggression, and supporting the I3 meta-theory (Finkel, 2014). The Findings underscore the importance of investigating the interplay between acute and chronic alcohol use on behavior, challenging conventional thresholds for hazardous drinking classification. Implications for future studies, legislators, and policymakers are discussed.

Using data fusion with multiple imputation to correct for misclassification in self-reported exposure: a case-control study of cannabis use and homicide victimization

BACKGROUND

Cannabis use has been causally linked to violent behaviors in experimental and case studies, but its association with homicide victimization has not been rigorously assessed through epidemiologic research.

METHODS

We performed a case-control analysis using two national data systems. Cases were homicide victims from the National Violent Death Reporting System (NVDRS), and controls were participants from the National Survey on Drug Use and Health (NSDUH). While the NVDRS contained toxicological testing data on cannabis use, the NSDUH only collected self-reported data, and thus the potential misclassification in the self-reported data needed to be corrected. We took a data fusion approach by concatenating the NSDUH with a third data system, the National Roadside Survey of Alcohol and Drug Use by Drivers (NRS), which collected toxicological testing and self-reported data on cannabis use for drivers. The data fusion approach provided multiple imputations (MIs) of toxicological testing results on cannabis use for the participants in the NSDUH, which were then used in the case-control analysis. Bootstrap was used to obtain valid statistical inference.

RESULTS

The analyses revealed that cannabis use was associated with 3.55-fold (95% CI: 2.75-4.35) increased odds of homicide victimization. Alcohol use, being Black, male, aged 21-34 years, and having less than a high school education were also significantly associated with increased odds of homicide victimization.

CONCLUSIONS

Cannabis use is a major risk factor for homicide victimization. The data fusion with MI method is useful in integrative data analysis for harmonizing measures between different data sources.

"Weeding out" violence? Translational perspectives on the neuropsychobiological links between cannabis and aggression

Recent shifts in societal attitudes towards cannabis have led to a dramatic increase in consumption rates in many Western countries, particularly among young people. This trend has shed light on a significant link between cannabis use disorder (CUD) and pathological reactive aggression, a condition involving disproportionate aggressive and violent reactions to minor provocations. The discourse on the connection between cannabis use and aggression is frequently enmeshed in political and legal discussions, leading to a polarized understanding of the causative relationship between cannabis use and aggression. However, integrative analyses from both human and animal research indicate a complex, bidirectional interplay between cannabis misuse and pathological aggression. On the one hand, emerging research reveals a shared genetic and environmental predisposition for both cannabis use and aggression, suggesting a common underlying biological mechanism. On the other hand, there is evidence that cannabis consumption can lead to violent behaviors while also being used as a self-medication strategy to mitigate the negative emotions associated with pathological reactive aggression. This suggests that the coexistence of pathological aggression and CUD may result from overlapping vulnerabilities, potentially creating a self-perpetuating cycle where each condition exacerbates the other, escalating into externalizing and violent behaviors. This article aims to synthesize existing research on the intricate connections between these issues and propose a theoretical model to explain the neurobiological mechanisms underpinning this complex relationship.

The chronic alcohol consumption influences the gonadal axis in men: Results from a meta-analysis

BACKGROUND

Low testosterone concentrations affect 2-13% of adult males, with a direct association between reduction in testosterone (T) concentrations and cardiovascular events. Lifestyle habits have been linked to visceral fat accumulation and endocrine disorders like secondary hypogonadism. Alcohol intake has also been a topic of debate, with studies showing a detrimental effect on sperm production and underlying mechanisms. This meta-analysis aims to comprehensively evaluate the effect of alcohol consumption on T serum concentrations in adult men.

METHODS

The literature search included only controlled clinical trials comparing men who drink alcohol to men who do not, or who assumed placebo or nonalcoholic beverages. The primary outcome was the comparison of total testosterone serum concentrations between the study and control groups. The publications were examined for publication bias using Egger's test.

RESULTS

Twenty-one studies were included in the analysis for a total of 30 trials that examined the effects of alcohol consumption on testosterone level in 10,199 subjects. The meta-analysis showed that alcohol consumption overall is related to significant reduction in circulating concentrations of total testosterone (mean difference [MD] = -4.02; 95% CI -6.30, -1.73), free T (MD = -0.17; 95% CI -0.23, -0.12), sex hormone binding globulin (SHBG) (MD = -1.94; 95% CI -3.37, -0.48), an increase in estradiol (E2) (MD = 7.65; 95% CI 1.06, 14.23) and neutral effect on luteinizing hormone (LH) (MD = -0.15; 95% CI -0.36, 0.06), independently by age, body mass index (BMI), E2, and LH serum concentrations and alcohol intake. However, these results are evident only in healthy men exposed to chronic alcohol consumption and not in those with a recognized diagnosis of alcohol use disorder or after acute alcohol intake.

CONCLUSION

This study suggests how chronic alcohol consumption may inhibit the gonadal axis in healthy men, although the exact pathophysiological mechanisms connecting alcohol exposure and steroidogenesis are still not completely clarified.

Dental injuries in Swiss soccer supporters: A comparative study of regular fans, ultras, and hooligans for public health strategies

OBJECTIVES

Violence among soccer supporters continues to pose a significant public health concern in many parts of the world. In Switzerland, hooliganism is largely uninvestigated. This study aimed to examine incidents of violence and associated dental injuries among different groups of soccer supporters, as well as assess the impact of intoxicants on their behavior, using survey data from regular fans, ultras, and hooligans in the Swiss Football League.

MATERIAL AND METHODS

A cross-sectional survey using a standardized questionnaire was conducted among distinct factions of soccer supporters in the Swiss Football League in 2022. A total of 165 participants self-identified as belonging to one of three subgroups: "regular fan," "ultra," or "hooligan." Data were gathered on physical altercations, dental injuries, possession of mouthguards, intoxicant use, and medical assistance. Descriptive statistics, logistic regression models, and significance tests were used for data analysis (α = .05).

RESULTS

Hooligans had a higher frequency of dental injuries resulting from fights than ultras and regular fans. Hooligans with 11-20 fights per soccer season had a 9.6 times higher probability of dental trauma than those with 0-5 fights (p = .048). Possession of a mouthguard was associated with a lower risk of dental injuries for hooligans but an increased risk for ultras. Additionally, hooligans were found to differ significantly from other groups in their consumption of amphetamines and cocaine (p < .001).

CONCLUSIONS

The study found a strong link between physical altercations and dental injuries among soccer supporters. To promote better prevention, there is a necessity for enhanced educational initiatives facilitated by dentists to amplify the dissemination of mouthguards. Furthermore, it is crucial to raise awareness regarding their proper fitting to minimize the occurrence of combat-related dental injuries. Health authorities and other stakeholders should take a comprehensive approach to addressing some of the root causes of violent behavior, which include alcohol abuse and illicit substance consumption.

Endocannabinoid system and aggression across animal species

This narrative review article summarizes the current state of knowledge regarding the relationship between the endocannabinoid system (ECS) and aggression across multiple vertebrate species. Experimental evidence indicates that acute administration of phytocannabinoids, synthetic cannabinoids, and the pharmacological enhancement of endocannabinoid signaling decreases aggressive behavior in several animal models. However, research on the chronic effects of cannabinoids on animal aggression has yielded inconsistent findings, indicating a need for further investigation. Cannabinoid receptors, particularly cannabinoid receptor type 1, appear to be an important part of the endogenous mechanism involved in the dampening of aggressive behavior. Overall, this review underscores the importance of the ECS in regulating aggressive behavior and provides a foundation for future research in this area.

Does cannabis use predict aggressive or violent behavior in psychiatric populations? A systematic review

Background: Despite an increase in information evaluating the therapeutic and adverse effects of cannabinoids, many potentially important clinical correlates, including violence or aggression, have not been adequately investigated.Objectives: In this systematic review, we examine the published evidence for the relationship between cannabis and aggression or violence in individuals with psychiatric disorders.Methods: Following PRISMA guidelines, articles in English were searched on PubMed, Google Scholar, MEDLINE, and PsycINFO from database inception to January 2022. Data for aggression and violence in people with psychiatric diagnoses were identified during the searches.Results: Of 391 papers identified within the initial search, 15 studies met inclusion criteria. Cross-sectional associations between cannabis use and aggression or violence in samples with post-traumatic stress disorder (PTSD) were found. Moreover, a longitudinal association between cannabis use and violence and aggression was observed in psychotic-spectrum disorders. However, the presence of uncontrolled confounding factors in the majority of included studies precludes any causal conclusions.Conclusion: Although cannabis use is associated with aggression or violence in individuals with PTSD or psychotic-spectrum disorders, causal conclusions cannot be drawn due to methodological limitations observed in the current literature. Well-controlled, longitudinal studies are needed to ascertain whether cannabis plays a causal role on subsequent violence or aggression in mental health disorders.

Relation between testosterone, cortisol and aggressive behavior in humans

Aggression is an evolutionary behavior as it has a role in survival, increasing one’s access to food, shelter, status and reproduction. Testosterone and Cortisol are hormones often linked to aggressive behavior. We gathered and organized data from the last five years on the relation among Testosterone, Cortisol and aggression, while assessing the methods used by those scientific papers. A systematic review was made according to PRISMA guidelines. The search for indexed articles was performed in January 2019 using the keywords aggress* AND Testosterone AND Cortisol in three databases: Web of Science, SCOPUS and PsycInfo. The specific role of Testosterone and Cortisol in aggressive behavior is not unanimous. However, most articles found either an increase in Testosterone or a decrease in Cortisol associated with this behavior. There is the need for standardizing methods of triggering and assessing aggressive behavior, taking into account the assessment of social desirability and its impacts.

Glucocorticoids and Aggression: A Tripartite Interaction

The effects of glucocorticoids on aggression can be conceptualized based on its mechanisms of action. These hormones can affect cell function non-genomically within minutes, primarily by affecting the cell membrane. Overall, such effects are activating and promote both metabolic preparations for the fight and aggressive behavior per se. Chronic increases in glucocorticoids activate genomic mechanisms and are depressing overall, including the inhibition of aggressive behavior. Finally, excessive stressors trigger epigenetic phenomena that have a large impact on brain programming and may also induce the reprogramming of neural functions. These induce qualitative changes in aggression that are deemed abnormal in animals, and psychopathological and criminal in humans. This review aims at deciphering the roles of glucocorticoids in aggression control by taking in view the three mechanisms of action often categorized as acute, chronic, and toxic stress based on the duration and the consequences of the stress response. It is argued that the tripartite way of influencing aggression can be recognized in all three animal, psychopathological, and criminal aggression and constitute a framework of mechanisms by which aggressive behavior adapts to short-term and log-term changes in the environment.

Cannabis consumption and prosociality

The existing literature largely focuses on health risks and other pharmacodynamics of using cannabis, with fewer investigations of other normative psychological effects from consumption among otherwise healthy people. We measured several basic constructs of social psychology corresponding to the concept of prosociality among 146 healthy young adults between 18 and 25 years (M = 18.9, SD = 1.4) with varying detectable levels of tetrahydrocannabinol (THC) in their urine, controlling for participant's sex, age, ethnicity, and childhood socio-economic status. Compared to THC-free individuals, cannabis users scored higher than non-users on validated measures of Prosocial Behaviors (d = .34, p = .04), the Empathy Quotient (d = .36, p < .01), Moral Harmlessness (d = .76, p < .01) and Moral Fairness (d = .49, p < .01), but exhibited a lower sense of Ingroup Loyalty (d = .33, p = .04). Relative to THC-free, same-sex individuals, female cannabis users scored significantly higher on measurements of Aggression (ds = .65 and .57, ps < .05) and male users scored higher on the Agreeableness dimension of personality (d = .91, p < .01).. Linear associations were found between the recency of last cannabis usage and the Prosocial Behaviors, Empathy Quotient, Moral Harmlessness, Moral Fairness and Agreeableness personality scores (rs from - .24 to .38, ps < .05). The findings suggest cannabis usage is associated with an increased sense of prosociality and prioritization of humanitarian behaviors that declines with time following cannabis consumption. Further research should focus on heterogeneity in the effects of cannabis consumption across users.

Ethanol enhanced MDPV- and cocaine-induced aggressive behavior in mice: Forensic implications

BACKGROUND

Reports concerning the causal link between aggressive behavior and use and abuse of different substances (i.e., alcohol, MDPV) can be found in the literature. Nonetheless, the topic concerning the effects of acute ethanol administration on MDPV and cocaine induced aggressive behavior has yet to be thoroughly investigated. The aim of this study was to investigate such synergistic effects.

MATERIALS AND METHODS

A total of 360 male mice were employed in the study. Ethanol was diluted with saline solution and administered 10 min before MDPV or cocaine injection via oral gavage needles. Similarly, MDPV and cocaine were dissolved in saline solution and administered by intraperitoneal injection. Different associations of specific drug doses were then tested. To investigate the acute effects of MDPV and cocaine and their interaction with ethanol on aggression in mice, a resident-intruder test was used.

RESULTS

Ethanol alone was ineffective at dosages of 0.05 g/kg and 0.25 g/kg but increased the aggressiveness of the mice at 0.125 g/kg. Similarly, the injection of both cocaine alone and MDPV alone did not significantly increase the aggressiveness of the mice; conversely, the combination of ethanol and cocaine and ethanol and MDPV enhanced aggression at specific ethanol dosages (0.05 g/kg and 0.125 g/kg).

CONCLUSION

This study demonstrated that acute ethanol administration enhances MDPV- and cocaine-induced aggressive behavior in mice. This aggressive response is particularly enhanced when MDVP and cocaine are coupled with specific ethanol dosages, proving that psychostimulant drugs may act synergistically under certain conditions.

A review of the effects of acute and chronic cannabinoid exposure on the stress response

While cannabis has been used for centuries for its stress-alleviating properties, the effects of acute and chronic cannabinoid exposure on responses to stress remain poorly understood. This review provides an overview of studies that measured stress-related endpoints following acute or chronic cannabinoid exposure in humans and animals. Acute cannabinoid exposure increases basal concentrations of stress hormones in rodents and humans and has dose-dependent effects on stress reactivity in humans and anxiety-like behavior in rodents. Chronic cannabis exposure is associated with dampened stress reactivity, a blunted cortisol awakening response (CAR), and flattened diurnal cortisol slope in humans. Sex differences in these effects remain underexamined, with limited evidence for sex differences in effects of cannabinoids on stress reactivity in rodents. Future research is needed to better understand sex differences in the effects of cannabis on the stress response, as well as downstream impacts on mental health and stress-related disorders.

[Association between substance use and coercive measures on psychiatric wards]

OBJECTIVE

The intention to minimize coercive measures requires a comprehensive understanding of the influencing factors. The aim of the present work was to examine the association between substance use and the use of coercive measures.

METHODS

All coercive measures carried out on acute psychiatric wards of the Charité Campus Mitte in 2019 were examined, with a particular focus on the association with substance use disorders.

RESULTS

In 106 cases (92 patients) out of a total of 1232 cases (1131 patients), coercive measures were used, mainly admissions according to PsychKG (94) and BGB (21), more rarely isolation (23) or mechanical restraint (18). Acute intoxication was present in approximately one third of cases with coercive measures and a history of substance use disorder in two thirds, most often with alcohol and/or cannabis. In contrast, 9% of 1232 treatment cases presented with acute intoxication and 36% with substance use disorders in general.

CONCLUSION

The present work delivers empirical data confirming the clinically known association between intoxication and the use of coercive measures.

What determines violent behavior in men? Predicting physical, psychological, and sexual violent offending based on classification and regression tree analysis

Despite compelling evidence that victimization and offending co-occur, it remains unclear what types of victimization are linked to specific forms of perpetration. Here we examined the relationship between physical, psychological, and sexual violence with respect to influencing variables including mental health, risk-taking behaviors, and coping strategies. Data from 5385 men were collected as part of an epidemiological study on violence experience. A classification and regression tree analysis identified the main predictors of violence perpetration and classified violent offending into high- and low-risk groups. Results indicate that violence is best predicted by previous exposure to violence and polyvictimization. Physical violence is best predicted by prior exposure to physical violence and this is further influenced by the frequency of and the age at which violence was experienced. Drug use was a strong predictor of physical and psychological violence. The latter is best predicted by a history of polyvictimization, the severity and the originator of violence. Sexual violence is strongly predicted by one's sexual violence experience. Other factors such as demographic characteristics are less predictive. Our results may contribute to the development of early prevention and intervention approaches that account for different risk factors. The significance of violence exposure suggest that intervention measures must focus on victims of early and prolonged experience of violence. On the strength of the link between drug use and violence, exposure to violence should be considered in drug prevention and intervention and vice versa.

Comparable level of aggression between patients with behavioural addiction and healthy subjects

Heightened aggression is identified in several psychiatric disorders, including addiction. In this preliminary study with a relatively small number of samples, aggression in subjects diagnosed with behavioural addiction (BA) was implicitly assessed using the point subtraction aggression paradigm (PSAP) test along with measurements of oxy- and deoxyhaemoglobin dynamics in the prefrontal cortex (PFC) during the test using functional near-infrared spectroscopy. Aggression in BA patients was no higher than that of healthy control (CT) subjects in the PSAP test. Although no apparent increase or decrease in haemoglobin concentrations was observed in the PFC of either BA patients or CT subjects, abnormal correlations within the PFC network were present in BA patients. Consistent with comparable aggression between the groups, blood concentrations of the sex hormone testosterone, which has been shown to be associated with aggressiveness, was even lower in BA patients than in CT subjects. In contrast, when a set of questionnaire surveys for the assessment of aggression were administered, BA patients rated themselves as more aggressive than non-BA subjects. Collectively, these results suggest that aggression may not be heightened in BA, but BA patients may overestimate their aggressiveness, raising concerns about the use of questionnaire surveys for assessments of affective traits such as aggression in behavioural addiction.

Cannabinoids and myocardial ischemia: Novel insights, updated mechanisms, and implications for myocardial infarction

Cannabis is the most widely trafficked and abused illicit drug due to its calming psychoactive properties. It has been increasingly recognized as having potential health benefits and relatively less adverse health effects as compared to other illicit drugs; however, growing evidence clearly indicates that cannabis is associated with considerable adverse cardiovascular events. Recent studies have linked cannabis use to myocardial infarction (MI); yet, very little is known about the underlying mechanisms. A MI is a cardiovascular disease characterized by a mismatch in the oxygen supply and demand of the heart, resulting in ischemia and subsequent necrosis of the myocardium. Since cannabis is increasingly being considered a risk factor for MI, there is a growing need for better appreciating its potential health benefits and consequences. Here, we discuss the cellular mechanisms of cannabis that lead to an increased risk of MI. We provide a thorough and critical analysis of cannabinoids' actions, which include modulation of adipocyte biology, regional fat distribution, and atherosclerosis, as well as precipitation of hemodynamic stressors relevant in the setting of a MI. By critically dissecting the modulation of signaling pathways in multiple cell types, this paper highlights the mechanisms through which cannabis may trigger life-threatening cardiovascular events. This then provides a framework for future pharmacological studies which can identify targets or develop drugs that modulate cannabis' effects on the cardiovascular system as well as other organ systems. Cannabis' impact on the autonomic outflow, vascular smooth muscle cells, myocardium, cortisol levels and other hemodynamic changes are also mechanistically reviewed.

Validation of a Brief Measure of Aggression for Ecological Momentary Assessment Research: The Aggression-ES-A

Ecological momentary assessment (EMA) holds significant potential within aggression research. It affords researchers the possibility of collecting data in ecological context, in near real time. However, there is a lack of measures of aggression that have been developed and validated for use in EMA contexts. In this study, we report on the validation of a measure specifically designed to address this need: the Aggression-ES-A. Building on a previous pilot study, we evaluate the within- and between-person reliability, nomological net and associations with a validated trait measure of aggression of the Aggression-ES-A in a sample of N = 255 emerging adults from the Zurich Project on Social Development from Childhood to Adulthood (z-proso). Using multilevel confirmatory factor analysis and structural equation modeling, we found support for the factorial validity, reliability, and concurrent validity of the Aggression-ES-A scores. Results support the use of the Aggression-ES-A in EMA studies utilizing community-ascertained samples.

Association of Cannabis Use With Intimate Partner Violence Among Couples With Substance Misuse

BACKGROUND AND OBJECTIVES

There is a well-established causal link between substance use and intimate partner violence (IPV) perpetration and victimization. However, little is known about the complex emerging relationship between cannabis use and IPV. Because cannabis is the most commonly used drug in the United States and is associated with numerous IPV risk factors such as alcohol use, it is important to examine this relationship in greater detail.

METHOD

The current exploratory study examined the association between (a) self-reported cannabis use during the past 90 days and (b) Δ9-tetrahydrocannabinol (THC) urine drug screens and IPV perpetration and victimization in a sample of 30 alcohol or drug-misusing community couples (N = 60 individual participants).

RESULTS

The majority of participants (n = 50 individuals, 83.3%) had concordant cannabis self-reported and urine drug screen results. After accounting for demographic variables and quantity and frequency of alcohol and stimulant use, greater quantity and frequency of cannabis use as well as positive THC urine drug screen results were associated with greater physical IPV victimization, and greater quantity and frequency of cannabis were associated with greater IPV psychological victimization and perpetration, and physical IPV victimization. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: Findings emphasize the unique and important role that cannabis plays in the occurrence of IPV among intact couples. Findings also underscore the feasibility and utility of integrating confirmatory biological samples into future studies on this topic in order to advance the science in this area. (Am J Addict 2020;00:00-00).

Intoxicated aggression: Do alcohol and stimulants cause dose-related aggression? A review

RATIONALE

Violence and drug use are significant public health challenges that are strongly linked. It is known that alcohol plays a major role in the causation of unnatural deaths and that stimulants like cocaine and amphetamine are often implicated in aggressive acts or violence. However, a clear causal relationship between these substances and aggression, and more specifically a blood concentration threshold at which intoxicated aggression emerges is lacking. In case of a crime and subsequent law enforcement, knowledge about dose-response relationships could be of pivotal importance when evaluating the role of alcohol and drugs in aggressive offences.

AIMS

The present review aimed to determine whether there is a causal relation between intoxication with these psychoactive substances and aggression, and to define blood concentration thresholds above which these substances elicit aggression.

METHODS

Empirical articles published between 2013 and 2017 and review papers containing the predefined search strings were identified through searches in the PubMed and Embase databases and additional reference list searches. The complete search query yielded 1578 publications. Initially all articles were manually screened by title and abstract. Articles with irrelevant titles, given the selected search terms and review aims were discarded. Remaining articles were carefully studied and those that did not comply with the main objectives of this review were discarded. At the end of this process, 167 titles were found eligible for review.

FINDINGS AND CONCLUSION

While placebo-controlled experimental studies clearly showed a causal link between alcohol and aggression, it is evident that such a link has not yet been established for cocaine and amphetamines. In case of alcohol, it is clear that there are various individual and contextual factors that may contribute to the occurrence of an aggressive act during intoxication. A clear threshold blood alcohol concentration has not been defined yet for alcohol, but a statistically significant increase of aggression has been demonstrated at a dose of 0.75 g/kg and higher. Future studies into intoxicated aggression should include multiple doses of alcohol and stimulants and take into account individual and contextual factors.

Cross-sectional survey on occupational needle stick injuries amongst prehospital emergency medical service personnel in Johannesburg

INTRODUCTION

Prehospital personnel are exposed to challenging situations that place them at increased risk of sustaining a needle stick injury (NSI). Blood borne infections such as HIV and Hepatitis B or C may be transmitted from a NSI. Sub-Saharan Africa has the largest number of people living with HIV globally. There is no data pertaining to NSI among Emergency Medical Service (EMS) personnel in South Africa. This study aimed to investigate the cumulative incidence, knowledge, attitudes and practices pertaining to NSIs amongst a select group of prehospital personnel in Johannesburg.

METHODS

This was a prospective, questionnaire based, cross-sectional survey of personnel employed at three EMS service providers in Johannesburg.

RESULTS

Of the 240 subjects that participated in the study, there was a total of 93 NSIs amongst 63 (26.3%) subjects. Of these, 41 (65.1%) had sustained one previous NSI, 16 (25.4%) had two NSIs, 5 (7.9%) had three NSIs and one (1.6%) had five NSIs. Almost two-thirds (n = 60; 64.5%) of NSIs were sustained during intravenous line insertion. Most of the study subjects were male (n = 145, 60.4%), between the age of 25-29 years (n = 67, 27.9%), had a BLS qualification as the highest level of training (n = 89, 37.1%), had >10 years of EMS experience (n = 69; 28.8%) and were up to date with their Hepatitis B vaccination at the time of the study. HIV post exposure prophylaxis (PEP) was initiated in 82 (88.2%) out of the 93 NSI incidents. However, the recommended 28-day course of therapy was only completed in 68 (82.9%) out of the 82 cases where PEP was initiated.

CONCLUSION

Prehospital personnel are at risk of sustaining a NSI. There is a need to promote awareness with regards to the risks, preventive measures, awareness of PEP protocols and the timely initiation and completion of HIV PEP amongst EMS personnel in Johannesburg.

Internalizing symptoms and cannabis and alcohol use: Between- and within-person risk pathways with coping motives

OBJECTIVE

To test reciprocal associations among internalizing symptoms (depression and social anxiety), using alcohol and cannabis to cope, and use-related problems.

METHOD

The study utilized a community sample (N = 387, 55% female; majority non-Hispanic Caucasian (83.1%) or African American (9.1%) and a longitudinal design that spanned 17 to 20 years of age, and distinguished within- and between-person associations using latent curve models with structured residuals.

RESULTS

Reciprocal prospective within-person associations were supported for alcohol, such that elevated depression symptoms were associated with increased alcohol coping motivates 1 year later, which, in turn, was associated with subsequent increased depression symptoms. Bidirectional associations were not supported for social anxiety, although high levels of social anxiety were associated with elevated levels of coping drinking 1 year later. Cannabis coping motives were associated with exacerbation of depression, but not social anxiety symptoms, 1 year later. Between- and within-person contemporaneous associations suggested that depression and social anxiety were more strongly associated with coping than social/enhancement motives, and that coping motives were associated with use-related problems.

CONCLUSION

Findings suggest that alcohol coping motivates exacerbate rather than ameliorate depression symptoms, which, in turn, leads to greater reliance on alcohol to cope. There was more consistent support for associations with substance use-related problems for depression than for social anxiety. Both between- and within-person associations may be useful for identifying targets and timing of coping-oriented interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Relevance of Sex in the Association of Synthetic Cannabinoid Use With Psychosis and Agitation in an Inpatient Population

BACKGROUND

Current evidence suggests that women are more sensitive to the effects of cannabinoids. The aim of this study was to investigate the relevance of sex in the association of synthetic cannabinoid (SC) use with psychosis and agitation.

METHODS

A retrospective chart review was conducted for patients admitted to a psychiatric unit (2014-2016) to extract information on demographic factors, use of substances, clinical symptoms, and pharmacologic treatments. Study groups were defined as SC users (anyone who reported use of SCs over the past 3 months), cannabis users (positive toxicology screen for Δ⁹-tetrahydrocannabinol [THC]), and controls (those who denied use of SCs over the past 3 months and had negative toxicology for THC).

RESULTS

Digital charts of 983 patients were reviewed. A total of 162 subjects reported use of SCs over the past 3 months (76% male), and 292 subjects had positive toxicology screen for THC (67% male). A total of 38.9% of SC users (n = 63) had positive urine toxicology screen for THC. SC users had higher risks of psychotic presentations (adjusted odds ratio [AOR] = 3.390; 95% CI, 1.390-8.267) and agitation (AOR = 4.643; 95% CI, 1.974-10.918) compared to the controls. While women had lower rates of psychosis than men in the cannabis and control groups, the rates were markedly potentiated with SC use to high levels (79%) approximately equal to that seen in men (80%). There was also a significant interaction between SC use and sex for agitation (AOR = 0.308; 95% CI, 0.117-0.808). Female SC users were significantly more agitated than male SC users (73.7% vs 47.6%, respectively, P = .005).

CONCLUSIONS

SC users are more likely than nonusers to be psychotic or agitated in an inpatient setting. The potentiated rates of psychosis and agitation with SC use in women suggest that they may have a greater sensitivity to these synthetic compounds.​.

Approach to Children with Aggressive Behavior for General Pediatricians and Hospitalists: Part 1-Epidemiology and Etiology

Children and adolescents are increasingly presenting to the hospital and emergency department with aggressive behavior and psychiatric emergencies. The rise in pediatric mental health problems, coupled with a lack of much needed resources, necessitates that pediatricians safely diagnose and treat patients presenting with aggressive behavior. In this article, we discuss the broad differential diagnosis that should be considered when initially evaluating a patient presenting with aggression or altered mental status; underlying causes include predisposing factors, comorbid conditions, and acute organic causes involving almost every organ system. Emergency and hospital physicians should tailor their examination and testing individually based on the patient's history and presentation. [Pediatr Ann. 2018;47(10):e402-e407.].

Risky Sex in High-Risk Adolescents: Associations with Alcohol Use, Marijuana Use, and Co-Occurring Use

Risky sexual behavior and substance use appear to be interconnected behaviors among adolescents, but data are scarce regarding the extent to which sexual risk behavior is associated with high levels of marijuana and alcohol use, both separately and in combination. 301 adolescents were recruited from a short-term detention facility, and substance use and risky sexual behavior were assessed. We found that adolescents who frequently used marijuana, but not alcohol, reported significantly less risky sex as well as greater intentions to use condoms than either adolescents who frequently used alcohol, but not marijuana, or adolescents who frequently used both substances. Substance use status as a predictor of future risky sexual behavior followed a similar pattern. When designing interventions to reduce substance use in the context of risky sex, it might be especially effective to target efforts toward reducing harm associated with alcohol use, either alone or in combination with marijuana use.

Marijuana Use and Hypothalamic-Pituitary-Adrenal Axis Functioning in Humans

Preclinical studies suggest cannabinoids affect functioning of the hypothalamic-pituitary-adrenal (HPA) axis, but little is known about the effects of marijuana (MJ) use on HPA axis functioning in humans. Since previous work indicates substances of abuse may dysregulate the HPA axis, it is critical to understand how MJ use affects HPA axis activity. Here, we review studies that (a) examined the effects of acute MJ administration on HPA axis functioning, (b) investigated the impact of stress on HPA axis functioning in MJ users, (c) examined the effect of chronic MJ use on basal cortisol levels, and (d) studied the relationship between MJ use and the cortisol awakening response (CAR). Findings indicate acute MJ administration typically raises cortisol levels, but this increase is blunted in MJ-dependent users relative to controls. Frequent MJ users have blunted adrenocorticotropic hormone and cortisol reactivity in response to acute stress. These findings suggest HPA axis activity may be dysregulated by heavy MJ use. Alternatively, dysregulation of the HPA axis may be a risk marker for heavy MJ use. There is mixed evidence for how MJ use affects basal cortisol levels and the CAR. Future studies should consider MJ use characteristics, method of hormone collection, time when samples are collected, and environmental factors that may influence HPA axis activity in MJ users. By examining existing studies we provide one of the first reviews aimed at synthesizing the literature on HPA axis functioning in MJ users.

Marijuana use and physical dating violence among adolescents and emerging adults: A systematic review and meta-analysis

BACKGROUND

As restrictions on marijuana are loosened, there is concern of a coming increase in marijuana use among adolescents and emerging adults, which could be coupled with commensurate increases in behavioral problems associated with use, such as physical dating violence (PDV). To summarize what is known about the association between marijuana use and PDV victimization and perpetration among 11-21year olds, we conducted a systematic review and meta-analysis of the relevant literature published between 2003 and 2015.

METHODS

Candidate articles were identified with a systematic search, and we used inclusion and exclusion criteria to review titles, abstracts, and the full text of studies for consideration. There were 13 articles examining marijuana in association with PDV; five addressed victimization and 11 addressed perpetration.

RESULTS

Findings suggest that marijuana use is associated with a 54% increase in the odds PDV victimization, and a 45% increase in the odds of perpetration.

CONCLUSIONS

Findings suggest that dating violence is a correlate of marijuana use, and that association is strongest among adolescents (vs. emerging adults) and girls (vs. boys). Therefore, it should be routinely included as a core data item in marijuana surveillance systems, so as to allow for behavioral monitoring.