Interpersonal Trauma Exposure, Trauma Symptoms, and Severity of Substance Use Disorder among Youth Entering Outpatient Substance Abuse Treatment

Patterns of substance use and associations with mental health and interpersonal violence among adolescents

Objective

To identify patterns of adolescent substance use and associated behavioral health characteristics among adolescents.

Methods

We conducted a cross-sectional study of 167,504 adolescents aged 13-17 who were screened for substance use, mental health symptoms, and interpersonal violence during well-check visits in a large healthcare system in California from 2021 to 2022. We conducted latent class analysis to identify patterns of substance use from four substance use behaviors (past-year alcohol, cannabis, other substance, and close friends' use). We calculated the prevalence of depressive symptoms, suicidal ideation, bullying, physical abuse by an adult, sexual violence, and intimate partner violence for each substance use class compared to those with no reported substance use behaviors and estimated adjusted prevalence ratios using modified Poisson regression.

Results

In total, 29,288 (17 %) adolescents reported ≥ 1 substance use characteristic. From those, we identified five latent classes with different patterns of substance use: substance use among close friends (37 %), alcohol use (21 %), polysubstance use (20 %), cannabis use and some polysubstance use (18 %), and other substance use (5 %). All classes had higher adjusted prevalence of mental health and interpersonal violence outcomes compared to those with no substance use characteristics, with the greatest differences being among the polysubstance use class.

Conclusions

The high prevalence of mental health and interpersonal violence outcomes among adolescents with substance use, even among those who only report close friends' substance use, highlights the need for routine screening during well-check visits. Comprehensive routine social and behavioral health screening among adolescents is vital for early identification and intervention.

A longitudinal examination into childhood abuse and substance use to PTSD symptoms and deviant peer association: Impact of developmental timing of abuse

BACKGROUND

Following child abuse, adolescents often endorse PTSD symptoms and use substances. However, few studies have addressed the longitudinal underlying effects of deviant peer association and revictimization and the developmental impact of PTSD symptoms and substance use.

OBJECTIVE

To address these limitations, the current study utilized the susceptibility and self-medication hypothesis to examine abuse in childhood ages 0-12 and adolescence ages 12-16 as predictors of substance use in mid-adolescence at age 16 and symptoms of (PTSD) in late adolescence at age 18 mediated by associating with deviant peers and revictimization using a sample of 596 (73.8 % racial minority; 50.7 % male) adolescents from Longitudinal Study of Child Abuse and Neglect.

METHODS

This study utilized structural equation modeling (SEM) to examine the direct and indirect effects of child abuse, substance use, deviant peer affiliation, and PTSD symptoms across different developmental periods using bootstrapping procedures.

RESULTS

Results indicated that substance use in mid-adolescence mediated the relationship between abuse in adolescence and PTSD symptoms in middle adolescence, while the abuse in childhood was not indirectly related. Furthermore, the indirect effect between abuse in childhood and PTSD symptoms at age 16 was mediated by PTSD at age 12 and deviant peer affiliation at age 14. Substance use in adolescence, PTSD symptoms, and adolescent peer social networks may be a point of intervention to reduce future adverse outcomes.

CONCLUSION

The findings of this study provided evidence of the long-term consequences of experiencing child abuse and subsequent adverse outcomes, including PTSD symptoms, substance use, and adolescent deviant peer affiliation. This study also highlighted preventive and intervention mechanisms to attenuate these adverse outcomes.

Trauma Exposure and the Mental Health Needs of Latinx Youth: A Systematic Review of the Literature

Although trauma exposure is common among youth in the United States, it is not evenly distributed. In fact, Latinx youth have higher rates of trauma exposure than their non-Latinx White counterparts with approximately 78% of Latinx youth experiencing one traumatic event by the time they are 18 years old. Despite this, the impact of trauma exposure on Latinx youth's mental health needs is not well-established. This is largely because Latinx youth are vastly underrepresented in many of the large-scale, epidemiological studies on childhood trauma exposure. To address this gap in the literature, this study applied PRISMA protocol guidelines to systematically review the methodologies, participant characteristics, and findings from 22 studies examining the relation between Latinx youths' trauma exposure and their mental health needs. Results revealed that while trauma exposure is common among Latinx youth, its association to Latinx youth's mental health needs is not well understood. Indeed, while some studies found a positive association between Latinx youth's trauma exposure and their mental health risk, other studies found no such relation. An examination of the included studies' methodologies and participant characteristics revealed several limitations in the existing research that are likely contributing to these inconsistencies. Concrete recommendations for how future research can address these limitations are put forth. Taken together, the results of this study underscore the urgent need to understand the role that trauma exposure plays in contributing to and/or maintaining mental health disparities among Latinx youth.

Interpersonal trauma, shame, and substance use: A systematic review

BACKGROUND

Interpersonal trauma is a risk factor for a wide array of adverse mental health outcomes, including substance use. Research has begun investigating the role of shame in the intersection between substance use and interpersonal trauma. The current systematic review summarizes the existing literature documenting the relation among shame, substance use, and interpersonal trauma.

METHOD

Articles were collected using a Boolean search strategy of terms related to interpersonal trauma, substance use, and shame across six databases. Independent search and screening by three researchers led to a final review of 27 articles, 15 of which were qualitative studies.

RESULTS

Findings highlight robust associations among shame, interpersonal violence, and substance use across varied samples. Findings emphasize that increased shame is associated with greater substance use among survivors of interpersonal violence and elevated shame and greater interpersonal violence are present among individuals who use substances given the high prevalence rates. Burgeoning research suggests that shame mediates the relationship between interpersonal violence and substance use.

CONCLUSION

Results from our review suggest that shame may be an important treatment target for individuals presenting with substance use and a history of interpersonal violence. Future studies, with longitudinal designs, are needed to parse out the temporal relation among shame, substance use, and interpersonal violence.

Adverse Childhood Experiences and Binge Drinking in Adolescence: the Role of Impulsivity and PTSD Symptoms

Background

The present study examines impulsivity and posttraumatic stress disorder (PTSD) symptoms as factors that may help understand the relationship between adverse childhood experiences (ACEs) and adolescent binge drinking.

Methods

Data were drawn from a subset of adolescents (N = 285) ages 12-22 from the National Consortium on Alcohol & Neurodevelopment in Adolescence (NCANDA). Impulsivity and PTSD symptoms were each predicted to moderate the relationship between ACEs and binge drinking.

Results

The positive relationship between PTSD symptoms and binge drinking was stronger when impulsivity was included. The positive relationship between ACEs and binge drinking was also strengthened when accounting for PTSD symptoms.

Conclusion

Our results provide evidence that impulsivity and PTSD symptoms may increase the risk for binge drinking during adolescence, including following ACEs. Interventions targeting PTSD symptoms and impulsivity could be valuable tools in preventing adolescent binge drinking.

Cognitive behavioral treatments for children and adolescents exposed to traumatic events: A meta-analysis examining variables moderating treatment outcomes

Due to the negative impact of trauma exposure, effective treatments are necessary to prevent and improve negative trauma-related outcomes. Cognitive behavioral therapy (CBT) is considered an efficacious treatment for children and adolescents exposed to traumatic events. Despite the various meta-analyses that have examined trauma treatments, there is a paucity of research on the moderating variables that may impact treatment outcomes. This meta-analytic CBT study addressed those limitations by examining the moderating effects of treatment components on outcomes. A search identified 94 CBT studies with 97 relevant effect sizes for children and adolescents exposed to traumatic events. Consistent with prior meta-analytic studies, CBT was shown to be effective for trauma-exposed youth. CBT subtreatments did not produce significantly different results from one another. Moderators shown to significantly impact CBT treatment outcomes for posttraumatic stress symptom were trauma type, Q = 24.09, p = .004, ds = -0.22 to -1.42, and gender, Q = 10.68, p = .005, ds = -0.53 to -1.36, whereas moderators shown to impact treatment outcomes for depression were study design, Q = 10.95, p = .004, ds = -0.26 to -0.50, and treatment setting, Q = 10.98, p = .004, ds = -0.31 to -0.56. The implications of these findings for research and practice are discussed.

Social Learning and Addiction

Social learning theory, as originally proposed by Albert Bandura, followed 2000 years of intellectual inquiry into the determinants of human behavior. Reciprocal determinism is a central component of this theory and proposes that human behavior is determined by functional relationships between (1) personal factors, (2) the external environment, and (3) the behavior itself. Using this model, drug addiction can be viewed as resulting from the functional relationships between an individual's personal characteristics, social environment, and drug-centric behaviors. In other words, addiction can be viewed as a chronically evolving biopsychosocial disorder, encompassing dimensions that are both internal and external to the individual. Effective treatment interventions should thus target all nodes of the model and the functional relationships between them, and they must constantly evolve with the progression of the disorder. An argument is thus constructed that emphasizes the need for an organized structure of metacontingencies, operating within an individual's social environment, that targets the functional relationships between the factors that drive drug use. Optimally, these metacontingencies would operate within socially connected individuals who have the power to control the functional relationships that influence drug use, the vested interest to monitor individual and collective outcomes, the skills to determine what moment-to-moment decisions are needed to influence behavioral change, and the relative permanence necessary to carry through with the implementation of new strategies to produce outcomes that are cumulatively significant.

Individualized approach to primary prevention of substance use disorder: age-related risks

Background

The misuse of legal and illegal substances has led to an increase in substance use disorder (SUD) in the United States. Although primary prevention strategies have been successfully used to target chronic physical diseases, these strategies have been less effective with SUD, given misconceptions of SUD, shortages in behavioral health professionals, and the population-based focus on specific substances. A developmental approach to the identification and primary prevention of SUD that does not fully rely upon behavioral health workers is needed. The purpose of this paper was to examine age related risk factors for developing SUD and present a novel individualized approach to SUD prevention.

Methods

A literature search was conducted to identify risk factors for SUD among children, young adults, adults, and older adults. We searched CINAHL, PsycINFO, and PubMed between the years 1989–2019, and extracted data, analyzing similarities and differences in risk factors across life stages. Broader categories emerged that were used to group the risk factors.

Results

More than 370 articles were found. Across all age groups, risk factors included adverse childhood experiences, trauma, chronic health diseases, environmental factors, family history, social determinants, and grief and loss. Despite the similarities, the contextual factors and life challenges associated with these risks varied according to the various life stages. We proposed an approach to primary prevention of SUD based on risk factors for developing the disease according to different age groups. This approach emphasizes screening, education, and empowerment (SEE), wherein individuals are screened for risk factors according to their age group, and screening results are used to customize interventions in the form of education and empowerment. Given that trained persons, including non-healthcare providers, close to the at-risk individual could conduct the screening and then educate and mentor the individual according to the risk level, the number of people who develop SUD could decrease.

Conclusions

The risk factors for developing SUD vary across the various life stages, which suggests that individualized approaches that do not overtax behavioral healthcare workers are needed. Using SEE may foster early identification and individualized prevention of SUD.