Early family adversity as a precursor to narcotic addiction

Critical examination of resilience and resistance in African American families: Adaptive capacities to navigate toxic oppressive upstream waters

African American families navigate not only everyday stressors and adversities but also unique sociocultural stressors (e.g., "toxic upstream waters" like oppression). These adverse conditions are consequences of the historical vestiges of slavery and Jim Crow laws, often manifested as inequities in wealth, housing, wages, employment, access to healthcare, and quality education. Despite these challenges, African American families have developed resilience using strength-based adaptive coping strategies, to some extent, to filter these waters. To advance the field of resilience research, we focused on the following questions: (1) what constitutes positive responses to adversity?; (2) how is resilience defined conceptually and measured operationally?; (3) how has the field of resilience evolved?; (4) who defines what, when, and how responses are manifestations of resilience, instead of, for example, resistance? How can resistance, which at times leads to positive adaptations, be incorporated into the study of resilience?; and (5) are there case examples that demonstrate ways to address structural oppression and the pernicious effects of racism through system-level interventions, thereby changing environmental situations that sustain toxic waters requiring acts of resilience to survive and thrive? We end by exploring how a re-conceptualization of resilience requires a paradigm shift and new methodological approaches to understand ways in which preventive interventions move beyond focusing on families' capacity to navigate oppression and target systems and structures that maintain these toxic waters.

Enduring disruption of reward and stress circuit activities by early-life adversity in male rats

In humans, early-life adversity (ELA) such as trauma, poverty, and chaotic environment is linked to increased risk of later-life emotional disorders including depression and substance abuse. These disorders involve underlying disruption of reward circuits and likely vary by sex. Accordingly, we previously found that ELA leads to anhedonia for natural rewards and cocaine in male rodents, whereas in females ELA instead increases vulnerability to addiction-like use of opioid drugs and palatable food. While these findings suggest that ELA-induced disruption of reward circuitry may differ between the sexes, the specific circuit nodes that are influenced by ELA in either sex remain poorly understood. Here, in adult male Sprague-Dawley rats, we ask how ELA impacts opioid addiction-relevant behaviors that we previously tested after ELA in females. We probe potential circuit mechanisms in males by assessing opioid-associated neuronal activation in stress and reward circuit nodes including nucleus accumbens (NAc), amygdala, medial prefrontal cortex (mPFC), and paraventricular thalamus. We find that ELA diminishes opioid-seeking behaviors in males, and alters heroin-induced activation of NAc, PFC, and amygdala, suggesting a potential circuit-based mechanism. These studies demonstrate that ELA leads to behavioral and neurobiological disruptions consistent with anhedonia in male rodents, unlike the increased opioid seeking we previously saw in females. Our findings, taken together with our prior work, suggest that men and women could face qualitatively different mental health consequences of ELA, which may be essential for individually tailoring future intervention strategies.

Neurodevelopmental origins of substance use disorders: Evidence from animal models of early-life adversity and addiction

Addiction is a chronic relapsing disorder with devastating personal, societal, and economic consequences. In humans, early-life adversity (ELA) such as trauma, neglect, and resource scarcity are linked with increased risk of later-life addiction, but the brain mechanisms underlying this link are still poorly understood. Here, we focus on data from rodent models of ELA and addiction, in which causal effects of ELA on later-life responses to drugs and the neurodevelopmental mechanisms by which ELA increases vulnerability to addiction can be determined. We first summarize evidence for a link between ELA and addiction in humans, then describe how ELA is commonly modeled in rodents. Since addiction is a heterogeneous disease with many individually varying behavioral aspects that may be impacted by ELA, we next discuss common rodent assays of addiction-like behaviors. We then summarize the specific addiction-relevant behavioral phenotypes caused by ELA in male and female rodents and discuss some of the underlying changes in brain reward and stress circuits that are likely responsible. By better understanding the behavioral and neural mechanisms by which ELA promotes addiction vulnerability, we hope to facilitate development of new approaches for preventing or treating addiction in those with a history of ELA.

The Developmental Origins of Opioid Use Disorder and Its Comorbidities

Opioid use disorder (OUD) rarely presents as a unitary psychiatric condition, and the comorbid symptoms likely depend upon the diverse risk factors and mechanisms by which OUD can arise. These factors are heterogeneous and include genetic predisposition, exposure to prescription opioids, and environmental risks. Crucially, one key environmental risk factor for OUD is early life adversity (ELA). OUD and other substance use disorders are widely considered to derive in part from abnormal reward circuit function, which is likely also implicated in comorbid mental illnesses such as depression, bipolar disorder, and schizophrenia. ELA may disrupt reward circuit development and function in a manner predisposing to these disorders. Here, we describe new findings addressing the effects of ELA on reward circuitry that lead to OUD and comorbid disorders, potentially via shared neural mechanisms. We discuss some of these OUD-related problems in both humans and animals. We also highlight the increasingly apparent, crucial contribution of biological sex in mediating the range of ELA-induced disruptions of reward circuitry which may confer risk for the development of OUD and comorbid neuropsychiatric disorders.

The missing 'P' in pain management: how the current opioid epidemic highlights the need for psychiatric services in chronic pain care

OBJECTIVE

The prevalence of opioid therapy for chronic noncancer pain has increased dramatically in recent years, with a parallel increase in opioid abuse, misuse and deaths from accidental overdose. We review epidemiological and clinical data that point to the important roles psychiatric disorders have in the use and abuse of opioids in patients with chronic pain.

METHOD

We conducted literature searches on the PubMed with the key phrases "chronic pain" and "opioid therapy" and selected those articles on the epidemiology of comorbidity between chronic pain and psychiatric disorders, the trends in long-term opioid therapy and the clinical trials that involved using opioid therapy for chronic pain or for mental health disorders. We then thoroughly reviewed the bibliography of all relevant articles to identify additional papers to be included in the present review.

RESULTS

Chronic pain is highly comorbid with common psychiatric disorders. Patients with mental health and substance abuse disorders are more likely to receive long-term opioid therapy for chronic pain and more likely to have adverse outcomes from this therapy. Although opioids may exert brief antidepressant and anxiolytic effects in some patients with depression or anxiety, there is scant evidence for long-term benefit from opioid treatment of psychiatric disorders.

CONCLUSIONS

Opioids may be used in current clinical practice as the de facto and only psychiatric treatment for patients with chronic pain, despite little evidence for sustained benefit. The opioid epidemic thus reflects a serious unmet need for better recognition and treatment of common mental health problems in patients with chronic pain. Psychiatry is the missing P in chronic pain care.

Neuroadaptive changes associated with smoking: structural and functional neural changes in nicotine dependence

Tobacco smoking is the most frequent form of substance abuse. We provide a review of the neuroadaptive changes evidenced in human smokers with regard to the current neurobiological models of addiction. Addiction is thought to result from an interplay between positive and negative reinforcement. Positive reinforcing effects of the drugs are mediated by striatal dopamine release, while negative reinforcement involves the relief of withdrawal symptoms and neurobiological stress systems. In addition, drug-related stimuli are attributed with excessive motivational value and are thought to exert a control on the behavior. This mechanism plays a central role in drug maintenance and relapse. Further neuroadaptive changes associated with chronic use of the drug consist of reduced responses to natural rewards and in the activation of an antireward system, related to neurobiological stress systems. Reduced inhibitory cognitive control is believed to support the development and the maintenance of addiction. The findings observed in human nicotine dependence are generally in line with these models. The current state of the research indicates specific neuroadaptive changes associated with nicotine addiction that need to be further elucidated with regard to their role in the treatment of nicotine dependence.

The relationship of social support to treatment entry and engagement: the Community Assessment Inventory

This study was conducted to determine the psychometric properties of a measure of social support, the Community Assessment Inventory (CAI), and to examine the role of social support in recovery. The CAI and the Addiction Severity Index (ASI) were administered to 196 opioid-dependent adults in (n = 135) or out of (n = 61) methadone treatment in Baltimore, Maryland, between 2004 and 2006. Baseline CAI scale scores indicated a generally high level of internal consistency (alpha scores). Pearson correlations showed that the scales were stable and had good discriminant validity with the ASI composite scores. One-way analysis of variance indicated that in-treatment participants reported significantly more support at baseline than out-of-treatment participants. This study's findings indicate the CAI may be a useful measure of social support and that such support is an important factor in treatment entry.

Modelle der Substanzabhängigkeit

Neurobiologische Modelle der Substanzabhängigkeit postulieren, dass Abhängigkeit aus einem Zusammenspiel zwischen positiver und negativer Verstärkung entsteht. Die positive Verstärkung wird über die dopaminerge Transmission im Striatum vermittelt, während die negative Verstärkung die neurobiologischen Stresssysteme involviert. Abhängigkeit geht mit lang anhaltenden Änderungen der zerebralen Motivationssysteme einher. Neuropsychologische Forschungsarbeiten weisen auf ein beeinträchtigtes Entscheidungsverhalten hin, welches mit einer Dysfunktion im ventromedialen präfrontalen Kortex zusammenhängen könnte. Sie betonen die Rolle der Insula, welche die neuronale Grundlage für die fehlende Einsicht ins problematische Suchtverhalten als auch für die Vermittlung des bewussten Drangs, die Substanz zu konsumieren, sein könnte. Neurobiologische und neuropsychologische Sichtweisen werden in einem Modell integriert, das impulsive subkortikale und dopamin-bezogene Prozesse mit einer Beeinträchtigung der kortikalen Hemmung und kognitiven Defiziten verbindet.

The Effectiveness of an After-school Program Targeting Urban African American Youth

The present study reports on the effectiveness at one-year follow-up of an after-school prevention program targeting 6(th) grade African American youth residing in high-risk urban areas. The program, conducted on-site over the school-year period, involved a group mentoring approach emphasizing remedial education and an appreciation of African American cultural heritage in promoting school bonding, social skills development, and greater academic achievement. Behavioral and adjustment outcome data were obtained from two participating middle-school sites (intervention and comparison, involving 237 and 241 students, respectively) serving essentially equivalent urban communities. Results of the study revealed significant effects for academic achievement and behavior in terms of grade point average and teacher ratings that favored students at the intervention site. At this site, greater participation of parents in the intervention program was found to be positively related to improvement of the children in grade point average. No differential site-related changes in negative behavior were observed.

Childhood and adolescent antecedents of drug and alcohol problems: A longitudinal study

Despite the serious health and economic consequences of drug and alcohol abuse and dependence, few studies have prospectively examined the etiology of this problem in non-clinical populations. This longitudinal study examines childhood and adolescent antecedents of drug and alcohol problems in adulthood among an African American cohort (n = 1242; 51% female) from Woodlawn, a neighborhood in Chicago. The participants were followed from age 6 to 32 years, and data were collected in first grade, adolescence, and adulthood. Structural equation modeling showed that, for both males and females, educational attainment was directly associated with a reduced risk for substance use problems. For males, first grade shyness was directly associated with a reduced risk of substance use problems, and adolescent substance use was directly associated with an increased risk. First grade aggression, low family socioeconomic status (SES), and low school bonds were indirectly associated with substance use problems for both males and females. For males, first grade underachievement had an indirect effect, and, for females, first grade shyness and strong parental supervision had indirect effects. This study is among the first to identify life course trajectories to substance use problems among an African American, community-based population. These results help to identify the targets and timing of interventions that may help to reduce the risk of drug and alcohol problems in adulthood.

Glucocorticoid negative feedback in methadone-maintained former heroin addicts with ongoing cocaine dependence: dose-response to dexamethasone suppression

Combined cocaine and illicit opiate use is common. This study aimed to test the hypothesis that cocaine dependence in former heroin-addicted patients maintained on methadone treatment is associated with enhanced glucocorticoid negative feedback. Multiple dose dexamethasone suppression tests, using a conventional 2.0 mg dose, and two lower doses, 0.5 mg and 0.125 mg, were performed in 10 methadone-maintained former heroin addicts with ongoing cocaine dependence (C-MM), 10 stabilized methadone-maintained former heroin addicts with no ongoing drug or alcohol use (MM), and 22 normal volunteers (NV). At 9 hours, there was no difference in plasma adrenocorticotropin hormone (ACTH) and/or cortisol levels among groups on the baseline day, as well as after the two lower doses of dexamethasone. At 17 hours, C-MM and MM had significantly lower plasma ACTH and/or cortisol levels than NV. However, C-MM did not significantly differ from MM in their hormonal levels. When the hormonal responses to dexamethasone are expressed as magnitude of lowering from baseline, there was no significant difference at any dose among groups. Therefore, C-MM exhibited a normal glucocorticoid negative feedback in the morning. Using the standard interpretation of dexamethasone suppression testing based on the examination of the actual hormonal levels rather than the difference from baseline condition, C-MM appear to have glucocorticoid effects similar to MM, yet were both greater than NV in the late afternoon. Thus, further studies are needed to know whether altered glucocorticoid negative feedback is related to chronic cocaine exposure, or is the result of former heroin addiction and/or its long-term treatment with methadone.

The Community Assessment Inventory--client views of supports to drug abuse treatment

A measure assessing client views of the community supports available to them was developed and tested with entrants to outpatient drug free treatment. Items for a Community Assessment Inventory (CAI) fell into four areas of potential social support for treatment entry and engagement: (1) partner and/or family with whom living; (2) family living outside the home; (3) friends; and (4) the community itself. Based on 241 study participants, it was found that internal consistency alphas for the four scales ranged between .79 and .88. Both total CAI score and individual scales assessing support from friends and from partner/spouse were found capable of predicting treatment readiness as assessed using the TCU Motivation Scale. Evidence of construct validity was suggested by differences in CAI total score between participants reporting and not reporting involvement in discussions with others regarding crime and regarding drugs. Findings are also provided regarding leisure time activities and social relations of treatment entrants.

Psychosocial variables associated with adolescent gambling

The authors empirically examined the relations between several psychosocial variables associated with adolescent problem gambling. Participants were 2,336 students in Grades 7-13, and all completed a questionnaire regarding gambling activities, gambling severity, perceived social support, drug and alcohol dependence, and various social, emotional, and behavioral problems. With respect to gambling severity, 4.9% of adolescents met the criteria for pathological gambling, and 8.0% were found to be at risk. Psychosocial difficulties associated with problem gambling include poor perceived familial and peer social support, substance use problems, conduct problems, family problems, and parental involvement in gambling and substance use. A set of predictor variables that may lead to problem gambling includes having family problems, having conduct problems, being addicted to drugs or alcohol, and being male.

Factors associated with heroin addiction among male adults in Lahore, Pakistan

The objective of this matched case control study was to evaluate the factors associated with heroin addiction among male heroin addicts of age 15 to 35 years in Lahore. A total of 233 heroin addicts, matched on neighborhood controls, were enrolled at a case control ratio of 1:2. Multivariate conditional logistic regression analysis was carried out to study the independent relationship of hypothesized factors with heroin addiction. The factors associated with heroin addiction were parental disharmony (i.e. occasional fights versus no fights: adjusted matched odds ratio (adj. mOR) = 4.3, 95% CI: 2.4-7.8; frequent fights versus no fights: adj. mOR = 6.0, 95% CI: 2.8-16.6), drug using peers (adj. mOR = 5.6, 95% CI, 2.6-12.1), alcohol use (adj. mOR = 4.2, 95% CI, 2.3-7.6). use of over the counter available drugs (adj. mOR = 4.1, 95% CI, 1.8-10.6), father's absence (adj. mOR = 2.9, 95% CI, 1.6-5.5), non-formal schooling of the mother (adj. mOR = 2.8, 95% CI, 1.7-4.7), non-formal schooling of the respondent (adj. mOR = 2.4, 95% CI, 1.5-3.8), and the presence of a drug user among similar age group family members (adj. mOR = 2.4, 95% CI, 1.3-4.8). It is recommended that public health strategies be formulated based on various facets of the problem revealed by this and previous research to prevent illicit drug use.

The prevention of gambling problems in youth: a conceptual framework

Despite increased awareness of the need to begin educating young children about the potential dangers of gambling, empirical knowledge of the prevention of adolescent problem gambling and its translation into science-based prevention initiatives is scarce. This paper poses the question of whether or not the common elements of tobacco, alcohol, and illicit drug abuse prevention programs can be applied to gambling prevention. Common risk and protective factors across addictions, including gambling, appear to point to the need to develop a general model of primary, secondary, and tertiary prevention. The authors present the need for science-based prevention initiatives and describe a general adolescent risk-taking model as a basis for science-based prevention of adolescent problem gambling and other risk behaviors.

European adolescent substance use: the roles of family structure, function and gender

OBJECTIVES

The aim of this study was, first, to explore family structure and measures of family functioning in relation to adolescent substance use and secondly, to establish if these relationships differed according to gender or according to the city of origin of the sample.

DESIGN, SETTING, PARTICIPANTS

The study surveyed pupils aged 14-15 years in representative samples drawn from five European cities: Newcastle upon Tyne, Dublin, Rome, Bremen and Groningen. Data were obtained on 3984 participants in relation to their substance use, living with both biological parents, confiding in parents and grandparents. and supervision, as well as other variables representing delinquency, social class and drug availability.

RESULTS

Living with both parents was associated with reduced levels of drug use in four cities but not in Dublin, due perhaps to the high availability from peers in that city. It was not associated with reduced levels of regular drinking. The effect of confiding in mother was evident in all cities and in relation to substance use in general. However, when a delinquency variable was added to the logistic regressions, its significance in relation to polydrug use disappeared. Supervision was somewhat more important in relation to male than female drug use.

CONCLUSION

Living with both parents is a less robust barrier to substance use than qualitative aspects of family life, particularly attachment to mothers. The latter is a robust inhibitor of substance use irrespective of regional differences in drug availability, weakening only in the face of more generally problematic behaviour. Perhaps because of their greater tendency to risk-taking or rule breaking, supervision appears more important for male than female drug use. These findings underscore the role of families, but especially that of mothers, in regulating the substance-related behaviour of young people.

A complementary perspective to primary socialization theory

Primary socialization theory as formulated by Oetting and his associates emphasizes the transmission of societal norms during childhood and adolescence within society's three major socializing agencies: family, school, and small, intimate peer groups. The norms thus transmitted may be prosocial or deviant, with prosocial norms more likely to be transmitted through strong bonds to healthy families or schools. Personality traits and other personal characteristics influence negative outcomes, such as deviance or drug use, only to the extent that they interfere with socialization to family or school. Our own research does not address primary socialization theory directly in that we have not focused on the transmission of norms per se as central. Nevertheless, we have studied social factors, personality factors, and various psychopathologies as etiological for deviance and substance use. By and large our research has supported the hypotheses of primary socialization theory, even extending them in specific areas, such as the importance of family influences as etiological. Our work has also emphasized the significance of rebelliousness and impulse control in this regard. Like all large-scale theories which necessarily abstract from the totality and diversity of human behavior, primary socialization theory leaves some gaps requiring further elucidation. Among these is its ethnocentric and temporocentric perspective, but even within this perspective it understates the difficulties for adolescents in making a successful transition to adult social roles (Kingley Davis) and in establishing a unique identity independent of parents (Erik H. Erikson). Also, it generally ignores the salience of the youth culture as rebellious against the older generation, a particularly important characteristic of modern society. And finally, it should cover the process of "maturing out" of deviance, which perhaps results in a reaffirmation of the legitimacy of norms transmitted earlier, and it should also cover gender differences in their transmission and legitimization. Nevertheless, despite these caveats and especially because of this theory's insightfulness and path-breaking character, its hypotheses should be tested in carefully designed, large-scale studies. These studies should allow, among other factors, measurement of the effects of genetic factors on the early emergence of deviant personality attributes and of their impact on the transmission of prosocial norms. [Translations are provided in the International Abstracts Section of this issue.]

Differential contributions of family and peer factors to the etiology of narcotic addiction

This retrospective study investigated relationships among early family circumstances, peer associations, and narcotic addiction in a sample of 601 urban males. Results of logistic regression analyses indicated that the extent of deviant behavior among close friends at ages 12-14 and disruption in family structure (parental divorce/separation) prior to age 11 were significantly associated with narcotic addiction. Additional regression analyses indicated that deviant behavior among family members, as well as family disruption, experienced prior to age 11, also increased the probability of association with deviant peers and a negative home atmosphere at ages 12-14. Implications of these findings for preventive interventions and for future research are presented.

The family experiences of narcotic addicts and their subsequent parenting practices

This survey study of male and female narcotic addicts participating in methadone maintenance programs examined self-reported retrospective data on parental behavior experienced by addicts during their adolescent years. These findings were contrasted with the addicts' self-report of their current parenting practices with their own adolescent children. Results showed addicts as perceiving their mothers as significantly more functional in their parenting practices than their fathers on indices of parental involvement, attachment, and responsibility. Significant parenting differences between addicts and their parents were reported for the three indices mentioned, as well as for parent discipline and punitive actions, with the addicts rating their current parenting practices as more effective than those of their parents. Reported parenting practices were further analyzed in the context of how the ratings of parental functioning were related to problems of drug and alcohol abuse exhibited in the home. Findings are discussed in terms of the implications for prevention and treatment approaches for addicts and their children.