Neighborhood Structural Factors and Proximal Risk for Youth Substance Use

Legal Cynicism and Drug Use at the Microgeographic Level: Evidence from a Study of Crime Hot Spots

BACKGROUND

A growing body of literature demonstrates that drug activities are concentrated in specific microgeographic areas, exhibiting strong street-to-street variability within neighborhoods. However, little is known about what affects the likelihood of illegal drug use at the microgeographic level. By applying a legal cynicism framework, we aim to explain the likelihood of illegal drug use at the microgeographic level.

METHODS

We leverage survey and crime data at 449 street segments, primarily comprised of crime or drug hot spots in Baltimore, Maryland. Mixed-effects OLS regression models are used to examine the association between legal cynicism, defined by shared perceptions of police ineffectiveness, and drug use at the street level, while accounting for key potential covariates.

RESULTS

We find that shared legal cynicism among residents is key to understanding the likelihood of drug use, specifically marijuana and hard drugs, at the street level. However, legal cynicism is not significantly associated with alcohol consumption at the street level.

CONCLUSION

Our findings suggest that efforts to reduce drug use should focus on addressing legal cynicism regarding police ineffectiveness at the microgeographic level. The police should better communicate with residents to convey their dedication to reducing crime and ensuring public safety. Such communication may help reduce legal cynicism, and in turn, lower drug use at the microgeographic level.

Functional Brain Connectivity Predictors of Prospective Substance Use Initiation and Their Environmental Correlates

BACKGROUND

Early substance use initiation (SUI) places youth at substantially higher risk for later substance use disorders. Furthermore, adolescence is a critical period for the maturation of brain networks, the pace and magnitude of which are susceptible to environmental influences and may shape risk for SUI.

METHODS

We examined whether patterns of functional brain connectivity during rest (rsFC), measured longitudinally during pre- and early adolescence, can predict future SUI. Next, in an independent subsample, we tested whether these patterns were associated with earlier environmental exposures, specifically neighborhood pollution and socioeconomic dimensions. We utilized data from the ABCD (Adolescent Brain Cognitive Development) Study. SUI was defined as first-time use of at least 1 full dose of alcohol, nicotine, cannabis, or other drugs. We created a control group (n = 228) of participants without SUI who were matched to the SUI group (n = 233) on age, sex, race/ethnicity, household income, and parental education.

RESULTS

Multivariate analysis showed that whole-brain rsFC from 9-10 to 11-12 years of age (prior to SUI) prospectively differentiated the SUI and control groups. The SUI-related rsFC pattern was also related to aging in both groups, suggesting a pattern of accelerated maturation in the years prior to SUI. This same pattern of rsFC was predicted by higher pollution but not neighborhood disadvantage (adjusted for family socioeconomic factors) in an independent subsample (n = 2854).

CONCLUSIONS

Brain functional connectivity patterns in early adolescence that are linked to accelerated maturation can predict SUI in youth and are associated with exposure to pollution.

Neighborhood Violence Exposure and Alcohol and Tobacco Use Initiation Among Ethnic Minority Adolescents

Background/Objectives: Although the extant literature has recognized the importance of neighborhood contexts for adolescent alcohol and tobacco use, less is known about the effects of exposure to neighborhood violence on the prevalence and timing of initiation across gender and race/ethnic groups. Methods: This secondary analysis of administrative and survey data from a natural experiment in Denver examines the influence of neighborhood contexts on the health and well-being of 1100 Latino/a and African American adolescents. Cox Proportional Hazard models were used to (1) estimate the effects of exposure to neighborhood violence on the prevalence and timing of adolescent alcohol and tobacco use initiation; (2) examine gender and race/ethnic variations in alcohol and tobacco use initiation after controlling for adolescent, caregiver, household, and other neighborhood characteristics; and (3) test for threshold effects. Results: Prevalence rates among all adolescents were 12.9% for alcohol use initiation and 13.7% for tobacco use initiation but were 14.6% and 17.3%, respectively, among adolescents exposed to higher levels of neighborhood violence. The average age of initiation was 16.1 and 15.6 years for alcohol and tobacco use, respectively, but 2-8 months earlier for adolescents exposed to higher levels of neighborhood violence. Heightened exposure to neighborhood violence increased the hazards of alcohol use initiation by 32% for all adolescents and 38% for adolescent males. The hazards of tobacco use initiation were 1.3 to 1.5 times higher for male, Latino/a, and African American adolescents. Exposure to neighborhood violence suggests threshold effects of diminishing returns on adolescent tobacco use initiation. Conclusions: Findings underscore the need to examine gender and race/ethnic group differences in adolescent alcohol and tobacco initiation, the multiple pathways to such use, and interventions aimed at reducing neighborhood violence.

The effects of neighborhood perceptions on response to a technology-assisted parenting intervention for adolescent substance use: protocol of a diversity supplement to parent SMART (Substance Misuse in Adolescents in Residential Treatment)

BACKGROUND

It is well established that an adolescent's neighborhood is associated with their likelihood of developing a substance use disorder. The availability of drugs, lack of access to resources, and exposure to violence are all associated with greater substance use among young people, leading to more pronounced health inequities. Technology assisted interventions (TAIs) have been touted to enhance the reach of substance use treatment and improve outcomes for high-need families living in underserved neighborhoods. A key question is whether neighborhood characteristics impact the effectiveness of TAIs, given these interventions are embedded within an adolescent's natural environment. This National Institute on Drug Abuse-funded Diversity Supplement will examine the role of perceived neighborhood characteristics on response to Parent SMART, a TAI for parents of adolescents in residential substance use treatment (R37DA052918; PI: Becker). Aim 1 will use both adolescent and parent self-report of multiple neighborhood dimensions (e.g., physical environment, social disorder, satisfaction with community resources) to identify indicators predictive of treatment response. Aim 2 will then explore the indirect relationship between neighborhood context and response to Parent SMART, via engagement.

METHODS

Participants include adolescent and parent dyads enrolled in an effectiveness trial evaluating Parent SMART, a TAI for parents of adolescents in residential substance youth treatment. Participants will complete self-report measures of neighborhood physical environment, social disorder, and satisfaction with community resources at baseline to predict parenting and youth substance outcomes at 6-, 12-, and 24-weeks post discharge.

DISCUSSION

To date, few studies have explicitly tested how neighborhood affects response to TAIs for adolescent substance use. Assessing adolescent and parent perceptions of neighborhood characteristics holds potential to pinpoint key contextual factors that affect TAI response and to promote consideration of multi-level health equity determinants in substance use research. Understanding neighborhood influences can advance public health by helping tailor TAIs to address the unique needs of adolescents living in underserved communities.

TRIAL REGISTRATION

This study extends the measurement and analysis plan of a pragmatic effectiveness trial. The pragmatic effectiveness trial is registered at ClinicalTrials.gov NCT05169385; https://clinicaltrials.gov/ct2/show/NCT05169385.

Childhood Aggressive Behavior and Adolescent Substance Use Initiation

BACKGROUND

Drug and alcohol use before the age of 14 is associated with adverse outcomes over the life course. While previous studies have identified numerous sociodemographic characteristics associated with youth substance use initiation, few have examined the relationship between behavioral characteristics, such as childhood aggression, and substance use initiation in adolescence.

METHODS

This longitudinal study consisted of 2985 children from the Future of Families and Child Wellbeing Study. Aggression was measured using primary caregiver report when the children were about the age of 9 and cigarette, alcohol, and marijuana use was measured using the child report when the children were age 9 and age 15. Separate multivariable Poisson regression models were fitted for each substance use initiation outcome.

RESULTS

Childhood aggression was positively associated with the initiation of cigarette and marijuana use in adolescence (aRR = 2.3 [95% CI = 1.5,3.4] and aRR = 1.3 [95% CI = 1.1,1.6], respectively). Childhood aggression was not associated with adolescent alcohol use initiation (aRR = 1.2 [95% CI = 0.9,1.5]).

CONCLUSIONS

The presence of aggressive behavior in childhood was associated with the initiation of cigarette and marijuana use in adolescence. These results may be used to identify children at higher risk of cigarette and marijuana use, who may benefit from additional monitoring for substance use initiation.

Functional brain connectivity predictors of prospective substance use initiation and their environmental correlates

Background

Early substance use initiation (SUI) places youth at substantially higher risk for later substance use disorders. Furthermore, adolescence is a critical period for the maturation of brain networks, the pace and magnitude of which are susceptible to environmental influences and may shape risk for SUI.

Methods

We examined whether patterns of functional brain connectivity during rest (rsFC), measured longitudinally in pre-and-early adolescence, can predict future SUI. In an independent sub-sample, we also tested whether these patterns are associated with key environmental factors, specifically neighborhood pollution and socioeconomic dimensions. We utilized data from the Adolescent Brain Cognitive Development (ABCD) Study®. SUI was defined as first-time use of at least one full dose of alcohol, nicotine, cannabis, or other drugs. We created a control group (N = 228) of participants without SUI who were matched with the SUI group (N = 233) on age, sex, race/ethnicity, and parental income and education.

Results

Multivariate analysis showed that whole-brain rsFC prior to SUI during 9-10 and 11-12 years of age successfully differentiated the prospective SUI and control groups. This rsFC signature was expressed more at older ages in both groups, suggesting a pattern of accelerated maturation in the SUI group in the years prior to SUI. In an independent sub-sample (N = 2,854) and adjusted for family socioeconomic factors, expression of this rsFC pattern was associated with higher pollution, but not neighborhood disadvantage.

Conclusion

Brain functional connectivity patterns in early adolescence that are linked to accelerated maturation and environmental exposures can predict future SUI in youth.

Racial Differences in Biopsychosocial Pathways to Tobacco and Marijuana Use Among Youth

BACKGROUND

The influence of socioeconomic disparities and multidimensional stressors on youth tobacco and marijuana use is recognized; however, the extent of these effects varies among different racial groups. Understanding the racial differences in the factors influencing substance use is crucial for developing tailored interventions aimed at reducing disparities in tobacco and marijuana use among adolescents.

AIMS

This study aims to explore the differential effects of socioeconomic disparities and multidimensional stressors on tobacco and marijuana use between Black and White adolescents.

METHODS

Utilizing longitudinal data from the Adolescent Brain Cognitive Development (ABCD) study, this research includes a cohort of pre-youth, monitored from the age of 9-10 years for a period of up to 36 months. We examined the impact of various socioeconomic status (SES) indicators and multidimensional stressors, including trauma, financial stress, racial discrimination, and family stress, alongside baseline average cortical thickness and the subsequent initiation of tobacco and marijuana use over the 36-month follow-up.

RESULTS

Overall, 10,777 participants entered our analysis. This included 8263 White and 2514 Black youth. Our findings indicate significant differences in the pathways from SES indicators through stress types to cortical thickness between Black and White youths. Notably, cortical thickness's impact on the future initiation of tobacco and marijuana use was present in both groups.

CONCLUSION

The study suggests that compared to White adolescents, Black adolescents' substance use and associated cortical thickness are less influenced by stress and SES indicators. This discrepancy may be attributed to the compounded effects of racism, where psychosocial mechanisms might be more diminished for Black youth than White youth. These findings support the theory of Minorities' Diminished Returns rather than the cumulative disadvantage or double jeopardy hypothesis, highlighting the need for interventions that address the unique challenges faced by Black adolescents.

Tobacco policies and changes in the tendency of smoking cessation in cigarette users in Chile: a longitudinal cross-sectional study

OBJECTIVE

To assess the impact of tobacco control regulations and policy implementation on smoking cessation tendencies in cigarette users born between 1982 and 1991 in Chile.

DESIGN

Longitudinal cross-sectional study.

SETTING

National level.

PARTICIPANTS

Data from the National Survey of Drug Consumption (Service of Prevention and Rehabilitation for Drug and Alcohol Consumption). A pseudo-cohort of smokers born between 1982 and 1991 (N=17 905) was tracked from 2002 to 2016.

PRIMARY AND SECONDARY OUTCOMES MEASURES

Primary outcome was the tendency to cease smoking conceptualised as the report of using cigarettes 1 month or more ago relative to using cigarettes in the last 30 days. The main exposure variable was the Tobacco Policy Index-tracking tobacco policy changes over time. Logistic regression, controlling for various factors, was applied.

RESULTS

Models suggested a 14% increase in the smoking cessation tendency of individuals using cigarettes 1 month or more ago relative to those using cigarettes in the last 30 days (OR 1.14, CI 95% CI 1.10 to 1.19) for each point increment in the Tobacco Policy index.

CONCLUSIONS

Our study contributes to documenting a positive impact of the implementation of interventions considered in the MPOWER strategy in the progression of smoking cessation tendencies in smokers born between 1982 and 1991 in Chile.

Spatial and Environmental Correlates of Prevalence of Treatment for Substance Use Disorders, Retention, and SUD Services Utilization in South Sardinia

This study explored the economic, social, and spatial correlates of treatment prevalence, retention, and service utilization for substance use disorder (SUD) in South Sardinia. Data from 1,667 patients with an ICD-10 diagnosis of SUD were extracted from the medical records of individuals assisted by three public addiction services in 2019. We used a spatial autoregressive model, a parametric proportional hazard model, and Poisson regression to examine the associations of spatial factors and residents' socioeconomic status with the prevalence of treatment at the census block level, treatment retention, and SUD service utilization at the individual level. The prevalence was higher among residents of areas closer to competent treatment centers, with the worst building conservation status, a lower percentage of high school and university graduates, and a higher percentage of unemployed, divorced, separated, or widowed residents. Men who were older at the time of their first treatment access; primary users of cocaine, cannabis, and alcohol; had higher education level; and who lived far from competent treatment centers and closer to drug trafficking centers interrupted their treatment earlier. Primary heroin users experienced more SUD treatment encounters. Living in economically and socially disadvantaged areas and near treatment facilities was associated with a higher prevalence, whereas living near drug-dealing centers and far from competent treatment centers was associated with a decrease in treatment retention.

Mexican-origin parent and child reported neighborhood factors and youth substance use

Background

Structural oppression affects health behaviors through residence in suboptimal neighborhoods and exposure to community violence. Youth and parents report perceptions of neighborhood factors that can affect youth substance use behaviors. Given that Latinx youth report higher levels of perceived community violence than other racial and ethnic groups, it is imperative to examine how youth- and parent-perceived neighborhood-level factors may relate to youth substance use.

Methods

Data were collected using clinical interviews with family triads (fathers, mothers, and youth) and parent-child dyads (father or mother and youth) enrolled in the Seguimos Avanzando study of 344 Mexican-origin families in Indiana. Neighborhood measures, including perceptions of exposure to violence, neighborhood characteristics, and neighborhood collective efficacy, were included in parent and youth surveys. Self-report measures for past year alcohol and drug use were included in the youth survey only. T-tests were conducted to estimate differences in neighborhood reports among the sample triads. A series of linear regression models were used to estimate the associations between youth-, mother-, and father-reported perceptions of neighborhood factors and youth substance use.

Results

Preliminary results indicate that fathers reported higher levels of exposure to violence than mothers [t(163) = 2.33, p = 0.02] and youth [t(173) = 3.61, p < 0.001]. Youth reported lower negative neighborhood characteristics than mothers [t(329) = 6.43, p < 0.001] and fathers [t(169) = 3.73, p < 0.001]. Youth reported significantly better neighborhood collective efficacy than mothers [t(296) = 3.14, p = 0.002], but not statistically different from fathers. Results from the primary analysis showed that youth exposure to violence was positively associated with youth substance use (b = 0.24, SE = 0.06, p < 0.0001), but the youth's neighborhood characteristics and collective efficacy were not significantly associated with youth substance use. None of the parent-reported neighborhood variables were associated with youth substance use.

Conclusion

The discrepant findings between parent and youth reports of perceived neighborhood characteristics and substance use have important implications for researchers and community stakeholders, and for developing targeted interventions and prevention strategies. Our study highlights the need to address youth experience of community violence and to prioritize creating safe and inclusive neighborhood environments. Potential strategies include improving community resources, strengthening social support networks, promoting open communication about neighborhood risks, and fostering collaborative efforts to address substance use behaviors.

Physical inactivity during adolescence heightens risk for cannabis use disorder in adulthood

The association between physical inactivity and substance use throughout adolescence was prospectively investigated in relation to developing cannabis use disorder (CUD). Physical inactivity and substance use in males (N = 462) and females (N = 178) were measured at 12-14, 16, 19, and 22 years of age in a repeated measures design. A structured diagnostic interview was administered to formulate current CUD diagnosis at 22 years of age. Mixture modeling path analysis evaluated the association between physical inactivity, substance use, and CUD. Males: Slope of physical inactivity increase spanning 12-22 years of age mediates the association between number of parents with substance use disorder (SUD) and rate of increase in substance use frequency (prodrome) which mediates the association between physical inactivity (hypothesized vulnerability) and CUD. Females: Number of SUD parents predicts slope of physical inactivity increase in daughters throughout adolescence which covaries with slope of increasing substance use frequency culminating in CUD. The association between parental SUD load (number of SUD affected parents) and CUD was found to not be mediated by physical inactivity. Rate of increase in physical inactivity during adolescence in males and females is a facet of the vulnerability for CUD. These results have ramifications for prevention considering that numerous cognitive, behavior, and emotion features of CUD vulnerability are attenuated by exercise. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining Parental Monitoring, Neighborhood Peer Anti-social Behavior, and Neighborhood Social Cohesion and Control as a Pathway to Adolescent Substance Use

Adolescence is a critical developmental period in which substance use can have long-term adverse effects. Structural ecosystem theory (SET) argues that community contexts may support or undermine the family's ability to protect youth from substance use. Specific parenting attributes (e.g., providing structure, monitoring) have consistently been linked to youth substance use. However, less is known about how community factors may be influencing substance use through family and peer dynamics during adolescence. To address this gap, the current study uses five waves (ages 10-17) of data, collected as part of the Pitt Mother and Child Project (N = 228 low-income boys and their parents). This data are used to test a path model that investigates the relationship between neighborhood disadvantage (at age 10) and adolescent boys substance use (at age 17) through parental perceptions of neighborhood process (age 11), parents' perceptions of monitoring (age 12) and affiliation with anti-social neighborhood peers/best friends (age 15). This study finds support for the relationship between neighborhood disadvantage in late childhood and substance use at age 17 through parental perceptions of neighborhood cohesion, parental monitoring at age 12, and the youths' association with neighborhood best friends and marijuana use, but limited support for the indirect effect. The findings of this study partially support the assertion that neighborhood factors influence adolescent boys marijuana use by affecting other relationships within their ecological systems, suggesting that more research is needed in this area.

A scoping review of school-level risk and protective factors of youth cannabis use: An application of the socio-ecological model

Risk and protective factors for cannabis use exist at various levels of influence, and the school environment can play a key role in preventing cannabis use and initiation as most youth. By using the socio-ecological model to hierarchically characterize school-specific risk and protective factors, a wholistic approach to school-based cannabis use prevention can be demonstrated. This study uses scoping review methodology to describe current research on school-level risk and protective factors of youth cannabis use. The socio-ecological model was used as a guiding framework to characterize the literature. PubMed, Embase, and Scopus were used to retrieve original research articles published between 2010 and 2020 that examined cannabis use as a main outcome of interest. Articles that examined school-related risk and protective factors within participants who were 18 years old or younger were included. Articles that met the pre-established criteria were extracted and categorised by theme based on levels of the socio-ecological framework. Four levels of risk and protective factors related to the school environment were identified (individual, interpersonal, community, and societal). A majority of school-based research examined individual and societal factors that influenced youth cannabis use. Our findings suggest most available research has focused on individual and societal school-level factors of cannabis use. A number of consistent themes were identified, however, findings were mixed and demonstrate the need for a more critical examination of research in order to understand which risk and protective factors are most influential among youth.

Cumulative Stressors and Adolescent Substance Use: A Review of 21st-Century Literature

The aim of this review is to assess empirical studies from the last 2 decades that have examined the association between cumulative stressors and adolescent substance use. Cumulative stressors were measured in these studies with adverse childhood experiences or adolescent stressful life events inventories. The 109 articles meeting the eligibility criteria that emerged from the review demonstrated a consistent, yet modest, association between cumulative stressors and adolescent substance use. Of note, several studies found that the associations were moderated or mediated by genetic factors related to cortisol regulation, intrapersonal factors such as low self-control, or interpersonal factors such as peer substance use. The review's findings thus suggest that efforts to reduce the effects of cumulative stressors on substance use could gainfully identify and target these risk moderators and mediators.

Socioeconomic Differences in Lifetime and Past 30-Day E-Cigarette, Cigarette, and Dual Use: A State-Level Analysis of Utah Youth

Socioeconomic disparities in combustible cigarette use are well established among youth in the United States and lead to substantial health effects. Given the noteworthy rise in electronic cigarette (e-cigarette) use among youth in recent years, health professionals have expressed concern that e-cigarette use will follow similar socioeconomic patterns. The current study examined this question using a 2019 state-representative sample of youth in grades 6, 8, 10, and 12 from Utah (N = 78,740). Logistic regression models estimated associations between neighborhood- and individual-level factors with lifetime and past 30-day e-cigarette, combustible cigarette, and dual use across 267 neighborhoods. After controlling for individual-level sociodemographic factors, results indicated that youth living in higher-poverty neighborhoods were at a significantly increased risk of lifetime e-cigarette, combustible cigarette, and dual use. Additionally, youth living in households with higher levels of education were at a significantly lower risk of lifetime and past 30-day e-cigarette, cigarette, and dual use. Results suggest that e-cigarettes may follow a similar pattern of socioeconomic disparities among youth as combustible cigarettes. Additionally, most youth using combustible cigarettes also used e-cigarettes, suggesting that any potential harms from e-cigarettes may exacerbate existing socioeconomic disparities in health effects from combustible cigarette use. Research should continue to examine individual- and neighborhood-level socioeconomic disparities in youth e-cigarette, combustible cigarette, and dual use.

Changes in cannabis policy and prevalence of recreational cannabis use among adolescents and young adults in Europe-An interrupted time-series analysis

BACKGROUND

Cannabis policy varies greatly across European countries, but evidence of how such policy impacts on recreational cannabis use among young people is conflicting. This study aimed to clarify this association by investigating how changes in cannabis legislation influenced cannabis use.

METHODS

Available data on self-reports of recreational cannabis use among individuals aged 15-34 years was retrieved from EMCDDA. Information on cannabis policy changes was categorized as more lenient (decriminalisation or depenalisation) or stricter (criminalisation, penalisation). Countries that had implemented changes in cannabis legislation or had information on prevalence of use for at least eight calendar years, were eligible for inclusion. We used interrupted time-series linear models to investigate changes in country-specific trajectories of prevalence over calendar time and in relation to policy changes.

RESULTS

Data from Belgium, Czech Republic, Germany, Italy, Netherlands, Norway, Portugal, Slovakia, Spain, Sweden and United Kingdom, for 1994-2017 was available for analyses. Cannabis use varied considerably over the study period and between countries. On average, use was stable or weakly increasing in countries where legislation was not changed or changed at the extremes of the study period (+0.08 percent per year [95% CI -0.01, 0.17 percent]). In contrast, the pooled average use decreased after changes in legislation, regardless of whether it had become more lenient (-0.22 [-1.21, 0.77]) or stricter (-0.44 [-0.91, 0.03]).

CONCLUSIONS

Our findings do not support any considerable impact of cannabis legislation on the prevalence of recreational cannabis use among youth and young adults in Europe.

Simultaneous use of marijuana and alcohol: Potential prevention targets among young adults who use alcohol

Simultaneous alcohol and marijuana use (SAM) such that their effects overlap has emerged as a behavior that is riskier than using either substance separately. It has been associated with high-risk binge drinking and driving while intoxicated during young adulthood, and it has been demonstrated to cause greater physical and mental impairment than use of alcohol or marijuana separately. To identify intervention and prevention targets specific to SAM, we examined the relationships between alcohol- and marijuana-specific beliefs and attitudes (risk factors) and self-reported SAM compared to non-simultaneous co-use (CAM) and alcohol use only in the past 30 days in a sample of young adults (n = 1,023, mean age = 23.17; SD = 0.43). Of those who reported drinking alcohol in the past 30 days, 20.7% reported SAM, 12.6% reported CAM, and 66.6% reported using only alcohol. Results from multinomial logistic regression analyses indicated that some marijuana-specific risk factors (e.g., belief that it is not at all wrong for someone their age to use marijuana) differentiated SAM or CAM from alcohol use only, but alcohol-specific risk factors generally did not. However, the perceptions that parents approved of their using marijuana or frequently drinking heavily were associated with a greater likelihood of SAM compared to CAM (OR ranged from 2.25 to 3.53). Findings point to the salience of individuals' attitudes and beliefs around marijuana use and their perception of parental approval of heavy drinking and marijuana use as potential targets for prevention programs targeting risk reduction among young adults.

Attention-Deficit/Hyperactivity Disorder and Alcohol and Other Substance Use Disorders in Young Adulthood: Findings from a Canadian Nationally Representative Survey

AIM

(a) To document the prevalence and odds of (i) alcohol use disorders, (ii) cannabis use disorders, (iii) other drug use disorders and (iv) any substance use disorder (SUD), among young adults with and without ADHD, and (b) to investigate the degree to which the association between ADHD and SUDs is attenuated by socio-demographics, early adversities and mental health.

METHOD

Secondary analysis of the nationally representative Canadian Community Health Survey-Mental Health (CCHS-MH). The sample included 6872 respondents aged 20-39, of whom 270 had ADHD. The survey response rate was 68.9%.

MEASUREMENTS

Substance Use Disorder: World Health Organization's Composite International Diagnostic Interview criteria, SUDs, were derived from lifetime algorithms for alcohol, cannabis and other substance abuse or dependence. ADHD was based on self-report of a health professional's diagnosis.

FINDINGS

One in three young adults with ADHD had a lifetime alcohol use disorder (36%) compared to 19% of those without ADHD (P < 0.001). After adjusting for all control variables, those with ADHD had higher odds of developing alcohol use disorders (OR = 1.38, 95% CI: 1.05, 1.81), cannabis use disorders (OR = 1.46, 95% CI: 1.06, 2.00), other drug use disorders (OR = 2.07, 95% CI: 1.46, 2.95) and any SUD (OR = 1.69, 95% CI: 1.28, 2.23). History of depression and anxiety led to the largest attenuation of the ADHD-SUD relationship, followed by childhood adversities and socioeconomic status.

CONCLUSIONS

Young adults with ADHD have a high prevalence of alcohol and other SUDs. Targeted outreach and interventions for this extremely vulnerable population are warranted.

Youth Cannabis use and Legalization in Canada - Reconsidering the Fears, Myths and Facts Three Years In

Canada legalized and regulated non-medical cannabis in October 2018, and in the lead up to this policy change much debate was generated around the Federal Government's stated objective of "keeping cannabis out of the hands of children and youth". As Canada moved through the process of passing Bill C-45 (the Cannabis Act), a contentious issue was whether the 'public health approach' to legalization with strict regulation guiding Federal policy would protect young people from accessing cannabis and from the potential harms of use. Now that we are several years post-legalization of cannabis, in this brief commentary we reconsider the arguments made about the potential consequences of legalization for youth, centered on three key concerns: that prevalence would significantly increase, that there would be greater incidence of harms to youth brain development, and that there would be increased presentations of severe mental illnesses associated with cannabis use. We also consider how focusing narrowly on clinical outcomes has neglected the association between criminalization and social inequities, where the burdens are disproportionate for marginalized and racialized youth.

The emotional and psychiatric problems of adolescents on parole whose parents are substance users: A Brazilian cross-sectional study

The aim of this study is to evaluate the associations between having parents with substance use problems, and having suffered neglect within the family, and behavioral problems (psychological and drug use) among adolescents. All the participants were enrolled on the socio-educational parole scheme, 'Assisted Freedom'. In this cross-sectional study, 150 adolescents were interviewed using the Drug Abuse Screening Test, Teen Addiction Severity Index, and Childhood Trauma Questionnaire. Ninety-five percent of the participants were male (n = 143), aged 13-17. Thirty percent of adolescents had a parent who used substances and had experienced neglect from their families. Those adolescents who were living with both parents (odds ratio adjusted (ORA) = 2.7, 95% confidence interval (CI) = 1.13-6.37), from a low-income family (ORA = 6.7, 95% CI = 1.85-24.22), experienced hallucinations (ORA = 2.8, 95% CI = 1.25-6.14), had problems controlling violent behavior (ORA = 2.6, 95% CI = 1.12-5.87), and were physically neglected (ORA = 3.0, 95% CI = 1.24-7.49) were more likely to have parents who used substances and to have experienced parental neglect. This article concludes that adolescents, who are on parole, come from families with high level of psychosocial vulnerabilities, including substance use, experience neglect by their families leading to adverse emotional and psychological states.

Social vulnerabilities for substance use: Stressors, socially toxic environments, and discrimination and racism

Applying a social determinants of health framework, this review brings attention to evidence from social sciences and neuroscience on the role of selected social factors in individual and population-level vulnerability to substance use and substance use disorders (SUDs). The understanding that social vulnerability to substance use and SUDs is multifaceted and occurs across different levels of influence (individual, interpersonal, community, and societal) is underscored. We propose that socially based stressors play a critical role in creating vulnerability to substance use and SUDs, and as such, deserve greater empirical attention to further understand how they "get under the skin." Current knowledge from social sciences and neuroscience on the relationships among vulnerability to substance use resulting from stressors, exposure to socially toxic childhood environments, and racism and discrimination are summarized and discussed, as are implications for future research, practice, and policy. Specifically, we propose using a top-down approach to the examination of known, yet often unexplored, relationships between vulnerability to substance use and SUDs, related inequities, and potential differential effects across demographic groups. Finally, research gaps and promising areas of research, practice, and policy focused on ameliorating social vulnerabilities associated with substance use and SUDs across the lifespan are presented. This article is part of the special issue on 'Vulnerabilities to Substance Abuse'.