Gender differences and similarities in the personality correlates of adolescent alcohol problems

Binge-like Alcohol Exposure in Adolescence: Behavioural, Neuroendocrine and Molecular Evidence of Abnormal Neuroplasticity… and Return

Binge alcohol consumption among adolescents affects the developing neural networks underpinning reward and stress processing in the nucleus accumbens (NAc). This study explores in rats the long-lasting effects of early intermittent exposure to intoxicating alcohol levels at adolescence, on: (1) the response to natural positive stimuli and inescapable stress; (2) stress-axis functionality; and (3) dopaminergic and glutamatergic neuroadaptation in the NAc. We also assess the potential effects of the non-intoxicating phytocannabinoid cannabidiol, to counteract (or reverse) the development of detrimental consequences of binge-like alcohol exposure. Our results show that adolescent binge-like alcohol exposure alters the sensitivity to positive stimuli, exerts social and novelty-triggered anxiety-like behaviour, and passive stress-coping during early and prolonged withdrawal. In addition, serum corticosterone and hypothalamic and NAc corticotropin-releasing hormone levels progressively increase during withdrawal. Besides, NAc tyrosine hydroxylase levels increase at late withdrawal, while the expression of dopamine transporter, D1 and D2 receptors is dynamically altered during binge and withdrawal. Furthermore, the expression of markers of excitatory postsynaptic signaling—PSD95; Homer-1 and -2 and the activity-regulated spine-morphing proteins Arc, LIM Kinase 1 and FOXP1—increase at late withdrawal. Notably, subchronic cannabidiol, during withdrawal, attenuates social- and novelty-induced aversion and passive stress-coping and rectifies the hyper-responsive stress axis and NAc dopamine and glutamate-related neuroplasticity. Overall, the exposure to binge-like alcohol levels in adolescent rats makes the NAc, during withdrawal, a locus minoris resistentiae as a result of perturbations in neuroplasticity and in stress-axis homeostasis. Cannabidiol holds a promising potential for increasing behavioural, neuroendocrine and molecular resilience against binge-like alcohol harmful effects.

Efficacy of the Unified Protocol for the treatment of comorbid alcohol use and anxiety disorders: Study protocol and methods

Alcohol Use Disorder (AUD) and anxiety disorders (ANX) are each highly prevalent and frequently co-occur, resulting in a complex clinical presentation. The existing literature to date has not yet identified how to best treat comorbid AUD/ANX, partially due to limitations in understanding what factors and mechanisms are implicated in their co-occurrence. This manuscript describes the rationale and methods for an ongoing randomized-controlled trial designed to evaluate the efficacy of a cognitive behavioral intervention, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), compared to Take Control (TC), a psychosocial and motivational treatment serving as a control condition in this study, for comorbid AUD/ANX. Sixty individuals with comorbid AUD/ANX will be randomized to UP or TC, and complete assessments at pre- and post-treatment, as well as one- and six-month follow-up points. We hypothesize that the UP, compared to TC, will result in significantly greater reductions in drinking-related outcomes, as well as anxiety and depressive-related outcomes. Additionally, the current study is designed to evaluate exploratory aims to contribute to our theoretical understanding of why AUD and ANX frequently co-occur. Specifically, we will examine the relationship between changes in AUD and ANX symptoms in relation to changes in emotional disorder mechanisms, such as emotion regulation. Because the UP is a transdiagnostic treatment that specifically targets underlying components of emotional disorders generally, it may be well suited to effectively target comorbid AUD/ANX.

ADHD and Emotion Dysregulation Among Children and Adolescents

Individuals with attention-deficit/hyperactivity disorder (ADHD) experience impairments in a number of functional domains. Although current evidence-based treatments for ADHD reduce symptoms and improve academic and behavioral functioning, they have minimal impact on social functioning or on risky behaviors (see Evans et al. in J Clin Child Adolesc Psychol, 43:527-551, 2014 for review). Preliminary evidence indicates that emotion dysregulation (ED) is associated with impairments across the developmental spectrum, such as social impairment and risky behaviors, and that its relative absence/presence is differentially associated with treatment response. It thus stands to reason that by incorporating a focus on ED in interventions targeting social impairment and risky behaviors, we may be able to increase the number of youth who respond to such interventions and decrease the prevalence or degree of these impairments and behaviors among youth and adults with ADHD. However, a number of questions remain unaddressed about the association between ADHD and ED, such as the portion of individuals with ADHD who experience ED, the extent to which ED is associated with the above impairments and behaviors, and whether or not ED is malleable. To begin addressing these questions, we summarize and critically evaluate the literature on the association between ADHD and ED and make recommendations for future basic, translational, and treatment outcome research.

Limitations of lifetime alcohol use disorder assessments: A criterion-validation study

The goal of the present study was to compare etiologically and clinically relevant correlates of lifetime AUD (e.g., alcohol consumption, personality traits, psychiatric disorders) based on a single assessment compared to a cumulative, prospective assessment of lifetime AUD. Data were drawn from the Alcohol, Health and Behavior (AHB; baseline N=489) study, which consisted of a prospective cohort of college students assessed seven times over a 16-year period ([M(SD) age at baseline=18.56 (.97)] and [M(SD) age at final assessment=34.33 (.82)]). The participants were assessed using the Diagnostic Interview Schedule (DIS) for DSM-III at Waves 1-7 and for DSM-IV at Waves 6-7. A single assessment and cumulative assessments of DSM-III lifetime AUD at Wave 6 (M[SD] age=28.98 [1.03]) were used to predict past-year alcohol related variables (e.g., alcohol consumption, drinking motives, drinking expectancies), personality variables, general functioning, lifetime substance use, and lifetime psychiatric disorders at Wave 7. Significantly larger correlations were found between the cumulative assessment and eight of the 25 etiologically relevant correlates of AUD compared to the single assessment. Further, significant incremental validity of cumulative assessment over single, retrospective assessment was observed for 16 of the 25 covariates. Overall, this study provides further support for the value of using prospective data with multiple assessments when determining lifetime history of disorder.

Acute prenatal exposure to ethanol on gestational day 12 elicits opposing deficits in social behaviors and anxiety-like behaviors in Sprague Dawley rats

Our previous research has shown that in Long Evans rats acute prenatal exposure to a high dose of ethanol on gestational day (G) 12 produces social deficits in male offspring and elicits substantial decreases in social preference relative to controls, in late adolescents and adults regardless of sex. In order to generalize the observed detrimental effects of ethanol exposure on G12, pregnant female Sprague Dawley rats were exposed to ethanol or saline and their offspring were assessed in a modified social interaction (SI) test as early adolescents, late adolescents, or young adults. Anxiety-like behavior was also assessed in adults using the elevated plus maze (EPM) or the light/dark box (LDB) test. Age- and sex-dependent social alterations were evident in ethanol-exposed animals. Ethanol-exposed males showed deficits in social investigation at all ages and age-dependent alterations in social preference. Play fighting was not affected in males. In contrast, ethanol-exposed early adolescent females showed no changes in social interactions, whereas older females demonstrated social deficits and social indifference. In adulthood, anxiety-like behavior was decreased in males and females prenatally exposed to ethanol in the EPM, but not the LDB. These findings suggest that social alterations associated with acute exposure to ethanol on G12 are not strain-specific, although they are more pronounced in Long Evans males and Sprague Dawley females. Furthermore, given that anxiety-like behaviors were attenuated in a test-specific manner, this study indicates that early ethanol exposure can have differential effects on different forms of anxiety.

Chronic intermittent ethanol exposure during adolescence: Effects on stress-induced social alterations and social drinking in adulthood

We previously observed lasting and sex-specific detrimental consequences of early adolescent intermittent ethanol exposure (AIE), with male, but not female, rats showing social anxiety-like alterations when tested as adults. The present study used Sprague Dawley rats to assess whether social alterations induced by AIE (3.5g/kg, intragastrically, every other day, between postnatal days [P] 25-45) are further exacerbated by stressors later in life. Another aim was to determine whether AIE alone or in combination with stress influenced intake of a sweetened ethanol solution (Experiment 1) or a sweetened solution ("supersac") alone (Experiment 2) under social circumstances. Animals were exposed to restraint on P66-P70 (90min/day) or left nonstressed, with corticosterone (CORT) levels assessed on day 1 and day 5 in Experiment 2. Social anxiety-like behavior emerged after AIE in non-stressed males, but not females, whereas stress-induced social anxiety was evident only in water-exposed males and females. Adult-typical habituation of the CORT response to repeated restraint was not evident in adult animals after AIE, a lack of habituation reminiscent of that normally evident in adolescents. Neither AIE nor stress affected ethanol intake under social circumstances, although AIE and restraint independently increased adolescent-typical play fighting in males during social drinking. Among males, the combination of AIE and restraint suppressed "supersac" intake; this index of depression-like behavior was not seen in females. The results provide experimental evidence associating adolescent alcohol exposure, later stress, anxiety, and depression, with young adolescent males being particularly vulnerable to long-lasting adverse effects of repeated ethanol. This article is part of a Special Issue entitled SI: Adolescent plasticity.

Predictors of alcohol-related negative consequences in adolescents: A systematic review of the literature and implications for future research

OBJECTIVE

To conduct a systematic review of the literature examining risk and protective factors of alcohol related negative consequences (ARNCs) among adolescents.

METHODS

We conducted a systematic search of original empirical articles published between January 1, 1990 and June 1, 2015. The qualitative synthesis was performed using the Theory of Triadic Influence as a framework.

RESULTS

Fifty-two studies were reviewed. Intrapersonal (e.g., personality traits, drinking motives and expectancies, depression), interpersonal (e.g., parental and peer alcohol use, violence exposure) and attitudinal factors (e.g., media exposure to alcohol, religiosity) influence ARNCs. Emerging evidence of new trends contributing to ARNCs include ready mixed alcohol drinks and childhood trauma and abuse.

CONCLUSIONS

Risk factors from all domains of influence were observed. More research is needed on protective factors and how alcohol use interacts with preventive factors in predicting ARNCs. The conceptualization of negative consequences varies significantly between studies and may impact the external validity of previous research.

Personality, negative affect coping, and drinking alone: a structural equation modeling approach to examine correlates of adolescent solitary drinking

AIMS

This study examined the personality traits of negative emotionality and constraint and the ability to resist drinking during negative affective states as correlates of solitary drinking in adolescence. We hypothesized that higher levels of negative emotionality and lower levels of constraint would predict solitary drinking and that these relationships would be mediated by the ability to resist drinking in response to negative emotions.

DESIGN

Structural equation modeling was used to fit a path model from the personality traits of negative emotionality and constraint to solitary drinking status through intermediate effects on the ability to resist drinking during negative emotions using cross-sectional data.

SETTING

Clinical and community settings in Pennsylvania, USA.

PARTICIPANTS

The sample included 761 adolescent drinkers (mean age = 17.1).

MEASUREMENTS

Adolescents completed the Lifetime Drinking History, the Multidimensional Personality Questionnaire, the Constructive Thinking Inventory and the Situational Confidence Questionnaire.

FINDINGS

The path model provided a good fit to the data. The association between trait negative emotionality and solitary drinking was fully mediated by adolescents' ability to resist drinking during negative affective states (b = 0.05, P = 0.01). In contrast, constraint had a direct effect on solitary drinking (odds ratio (OR) = 0.79, b = -0.23, P<0.01), as well as an indirect effect through the ability to resist drinking during negative affective states (b = -0.03, P = 0.02).

CONCLUSIONS

The ability to resist drinking while experiencing negative feelings or emotions may be an important underlying mechanism linking trait negative emotionality (a tendency toward depression, anxiety and poor reaction to stress) and constraint (lack of impulsiveness) to adolescent solitary drinking.

Chronic intermittent ethanol exposure during adolescence: effects on social behavior and ethanol sensitivity in adulthood

This study assessed long-lasting consequences of repeated ethanol exposure during two different periods of adolescence on 1) baseline levels of social investigation, play fighting, and social preference and 2) sensitivity to the social consequences of acute ethanol challenge. Adult male and female Sprague-Dawley rats were tested 25 days after repeated exposure to ethanol (3.5 g/kg intragastrically [i.g.], every other day for a total of 11 exposures) in a modified social interaction test. Early-mid adolescent intermittent exposure (e-AIE) occurred between postnatal days (P) 25 and 45, whereas late adolescent intermittent exposure (l-AIE) was conducted between P45 and P65. Significant decreases in social investigation and social preference were evident in adult male rats, but not their female counterparts following e-AIE, whereas neither males nor females demonstrated these alterations following l-AIE. In contrast, both e-AIE and l-AIE produced alterations in sensitivity to acute ethanol challenge in males tested 25 days after adolescent exposure. Ethanol-induced facilitation of social investigation and play fighting, reminiscent of that normally seen during adolescence, was evident in adult males after e-AIE, whereas control males showed an age-typical inhibition of social behavior. Males after l-AIE were found to be insensitive to the socially suppressing effects of acute ethanol challenge, suggesting the development of chronic tolerance in these animals. In contrast, females showed little evidence for alterations in sensitivity to acute ethanol challenge following either early or late AIE. The results of the present study demonstrate a particular vulnerability of young adolescent males to long-lasting detrimental effects of repeated ethanol. Retention of adolescent-typical sensitivity to the socially facilitating effects of ethanol could potentially make ethanol especially appealing to these males, therefore promoting relatively high levels of ethanol intake later in life.

Childhood predictors and mid-adolescent correlates of developmental trajectories of alcohol use among male and female youth

The identification of salient risk factors for alcohol consumption among male and female adolescents is an important topic not only for etiology research but also for designing effective gender-specific alcohol prevention programs for young people. This study examined the extent to which problematic alcohol use trajectories from ages 14 to 18 among male and female youth were related to childhood predictors assessed at age 9 (i.e., impulsivity, academic self-confidence, social problems with peers), socio-demographic variables, and mid-adolescent correlates [i.e., parental use, body mass index (BMI), risky peer context, conduct problems at school, parent-child relationship, somatic complaints]. Data analysis was based on a representative German longitudinal study (1986-1995, n = 1,619, 55 % female). Using growth mixture modeling methodology, associations of childhood predictors and mid-adolescent correlates to distinctive trajectories of alcohol use were examined for males and females separately. For males, a problematic consumption trajectory was associated with poor relationships to parents in adolescence and small community size. For females, low impulsivity during childhood, high BMI, and contact with deviant peers during adolescence predicted problematic as compared to normative alcohol use trajectories. Additionally, high parental alcohol use, low parental educational background, and conduct problems at school during adolescence were common predictors of a problematic alcohol use trajectory in both genders. The results provide insights regarding differences in the gender-typical development of adolescent alcohol use as well as stress the need of gender-specific intervention components along with universal prevention strategies against problematic consumption trajectories.

The amphetamine response moderates the relationship between negative emotionality and alcohol use

BACKGROUND

Considerable evidence suggests that sensitivity to the stimulant effects of alcohol and other drugs is a risk marker for heavy or problematic use of those substances. A separate body of research implicates negative emotionality. The goal of the present study was to evaluate the independent and interactive effects of the stimulant response, assessed with an amphetamine challenge, and negative emotionality on alcohol and drug use.

METHODS

Healthy young women and men completed the Multidimensional Personality Questionnaire (MPQ) and an inventory assessing alcohol and other drug use. Subsequently, the effects of 10-mg d-amphetamine were determined in the laboratory using the Stimulant scale of the Biphasic Alcohol Effects Scale. Hierarchical regression analyses evaluated the effects of amphetamine response and the MPQ factor Negative Emotionality on measures of substance use.

RESULTS

The amphetamine response moderated relationships between negative emotionality and alcohol use: in combination with a robust amphetamine response (i.e., enhanced stimulant effects as compared with baseline), negative emotionality predicted greater alcohol consumption, more episodes of binge drinking, and more frequent intoxication in regression models. A strong stimulant response independently predicted having used an illicit drug, and there was a trend for it to predict having used alcohol. Negative emotionality alone was not associated with any measure of alcohol or drug use.

CONCLUSIONS

Consistent with the idea that emotion-based behavioral dysregulation promotes reward seeking, a high level of negative emotionality was associated with maladaptive alcohol use when it co-occurred with sensitivity to drug-based reward. The findings contribute to our understanding of how differences in personality may interact with those in drug response to affect alcohol use.

Psychological dysregulation, white matter disorganization and substance use disorders in adolescence

AIMS

Adolescents with substance use disorders (SUD) have difficulties with cognitive, behavioral and affective regulation. White matter (WM) disorganization has been observed in adolescents with SUD and may be related to psychological dysregulation. This study compared adolescents with SUD and control adolescents to investigate relationships among psychological dysregulation, WM disorganization and SUD symptoms.

DESIGN

Cross-sectional observation.

SETTING

Adolescents with SUD were recruited from SUD treatment programs. Controls were recruited from the community.

PARTICIPANTS

The 55 participants were aged 14-19; 35 with SUD and 20 controls without SUD.

MEASUREMENTS

Psychological dysregulation was characterized by the Behavior Rating Inventory of Executive Function. WM disorganization was measured by diffusion tensor imaging, and fractional anisotropy, radial diffusivity and axial diffusivity were examined within cortical regions of interest.

FINDINGS

Compared to controls, SUD adolescents showed significantly greater psychological dysregulation and prefrontal and parietal WM disorganization. WM disorganization was correlated positively with psychological dysregulation and cannabis-related symptoms. In multivariate mediation models, the results were consistent with both the neurodevelopmental immaturity model, in which WM disorganization leads to psychological dysregulation and cannabis-related symptoms, and with the substance effects model, in which cannabis-related symptoms lead to WM disorganization and psychological dysregulation.

CONCLUSIONS

In adolescents, substance use disorder and psychological dysregulation appear to be associated with reduced frontoparietal network white matter maturation.

Early onset alcohol dependence with high density of family history is not "male limited"

OBJECTIVE

Based on classical adoption studies, early onset type II alcoholism was originally described as "male limited." We examined the possible expression of this subtype in present day alcohol-dependent women. Detailed systematic assessment was obtained from 200 treatment-seeking alcohol-dependent women and 189 healthy population controls. Women fulfilling type II alcoholism criteria had higher alcoholism severity as measured by The Alcohol Use Disorders Identification Test and markedly higher use of illicit drugs. Both alcoholism subtypes scored higher than normal on anxiety and impulsivity traits, but type II women scored markedly higher on aggression subscales than either of the other groups. Importantly, density of family history was markedly higher in type II women, suggesting a higher heritability. Despite its original description as male limited, early onset alcoholism with high density of family history is likely to be a valid construct in women. Its recognition has important implications for diagnosis, treatment, and research.

The use of protective behavioral strategies is related to reduced risk in heavy drinking college students with poorer mental and physical health

The present study examined the moderating role of health status (physical, mental, and social health) and the relationships between protective behavioral strategies utilized to reduce high-risk drinking (e.g., avoiding drinking games, setting consumption limits, or having a designated driver) and alcohol use and negative consequences in a sample of heavy drinking college students (N = 1,820). In this high risk sample, multiple regression analyses showed that stronger social health was related to increased drinking, while poorer physical, mental, and social health were related to increased alcohol negative consequences. Further, moderation effects revealed that increasing the use of protective behaviors was associated with significantly less drinking in those with stronger social health, as well as significantly lower numbers of negative consequences among participants with poorer physical and mental health. Implications for college counselors and medical personnel are discussed.

Gender differences in factors influencing alcohol use and drinking progression among adolescents

While prevalence rates for alcohol use and related disorders differ widely between adult men and women, male and female adolescents do not exhibit the same disparity in alcohol consumption. Previous research and reviews do not address the emergence of differences in drinking patterns that occur during late adolescence. Therefore, a developmental perspective is presented for understanding how various risk and protective factors associated with problematic drinking affect diverging alcohol trajectories as youth move into young adulthood. This review examines factors associated with risk for developing an alcohol use disorder in adolescent girls and boys separately. Findings indicate that certain biological (i.e., genetic risk, neurological abnormalities associated with P300 amplitudes) and psychosocial (i.e., impact of positive drinking expectancies, personality characteristics, and deviance proneness) factors appear to impact boys and girls similarly. In contrast, physiological and social changes particular to adolescence appear to differentially affect boys and girls as they transition into adulthood. Specifically, boys begin to manifest a constellation of factors that place them at greater risk for disruptive drinking: low response to alcohol, later maturation in brain structures and executive function, greater estimates of perceived peer alcohol use, and socialization into traditional gender roles. On an individual level, interventions which challenge media-driven stereotypes of gender roles while simultaneously reinforcing personal values are suggested as a way to strengthen adolescent autonomy in terms of healthy drinking decisions. Moreover, parents and schools must improve consistency in rules and consequences regarding teen drinking across gender to avoid mixed messages about acceptable alcohol use for boys and girls.

Alcohol, psychological dysregulation, and adolescent brain development

While adolescent alcohol consumption has been asserted to adversely alter brain development, research in human adolescents has not yet provided us with sufficient evidence to support or refute this position. Brain constituents actively developing during adolescence include the prefrontal cortex, limbic system areas, and white matter myelin. These areas serving cognitive, behavioral, and emotional regulation may be particularly vulnerable to adverse alcohol effects. Alternatively, deficits or developmental delays in these structures and their functions may underlie liability to accelerated alcohol use trajectories in adolescence. This review will describe a conceptual framework for considering these relationships and summarize the available studies on the relationships among risk characteristics, alcohol involvement and brain development during this period. The cross-sectional designs and small samples characterizing available studies hamper definitive conclusions. This article will describe some of the opportunities contemporary neuroimaging techniques offer for advancing understanding of adolescent neurodevelopment and alcohol involvement.

Interplay of psychosocial factors and the long-term course of adolescents with a substance use disorder

This paper examines the association of psychosocial factors and long-term drug use behaviors (year-5.5) among adolescents with a substance dependence disorder. One group received treatment with a 12-Step approach (n = 159) and one group was on a waiting list (n = 62). Four psychosocial factors (deviant behavior, peer drug environment, psychological disturbance and family estrangement), as measured by a standardized self-report questionnaire, were examined as predictors across three time points (year-1, year-4 and year-5.5). Improved outcome across time was significantly associated with decreases in deviant behavior, peer drug environment and family estrangement. However, psychological disturbance was not associated with outcome. Also, we did not find an effect on outcome as a function of age, gender and race. Youth that received treatment, as opposed to the waiting list youth, generally revealed a more favorable outcome across time. Treatment implications of the study findings are discussed.

The development of alcohol use disorders

Pathological alcohol use is a complex and costly problem. This chapter focuses on recent developments in the etiology of alcohol use disorders. Literature is reviewed from the fields of epidemiology, genetics, personality, neuropsychology, parenting, and social influences. In addition, theoretical models that describe pathways to the development of alcohol use disorders are presented. Particular emphasis is given to ways in which genetic, environmental, psychopharmacological, and personological literatures can inform one another.

Patterns of alcohol use between genders: a cross-cultural evaluation

INTRODUCTION

Alcohol use by men and women is very much influenced by social habits and customs. Cultural peculiarities and biological differences between the sexes require more focused and standardized studies. The objective was to systematize information on patterns of alcohol use between the sexes.

METHOD

A literary review (1972-2004) identified 96 publications (Lilacs, Scielo, Medline) and some related books.

RESULTS AND CONCLUSIONS

Men drank more and presented more problems (legal, family, social, clinical, traumas and mortality) associated with alcohol use; the consequences of alcohol use in developing countries with low death rates is even higher. Women can face more discrimination by using alcohol as well as worse health problems when they abuse drinking (liver, pancreas, and central and peripheral nervous system problems, psychiatric comorbidity, etc.); sexual abuse is more commonly associated with women than discussing the different responses to treatment. As for social roles/responsibilities exercised by women, there are indications that marriage, employment, and children have a good influence, discouraging alcohol use, while divorce, unemployment, and no children contribute to higher consumption. For both sexes, religion was a protective factor for alcohol use; acculturation was a strong influence in the pattern of alcohol use, and alcohol worsened the evolution of existing psychiatric disorders.

Behavioral and emotional self-control: relations to substance use in samples of middle and high school students

The authors tested how behavioral and emotional self-control are related to adolescent substance (tobacco, alcohol, and marijuana) use. Data were obtained from 489 middle school students and 602 high school students. Multiple indicators were developed for each domain of self-control, and confirmatory analyses were used to test the measurement structure of latent constructs. Results showed that the domains of behavioral self-control and emotional self-control were statistically distinct, and both were related to adolescent substance use. Structural modeling analyses indicated indirect effects for self-control constructs primarily through pathways to competence and recent events. In addition, poor behavioral control had a direct effect to deviant peer affiliations, and poor emotional control had a direct effect to coping motives for substance use. The results indicate that both types of self-regulation are relevant for adolescent substance use. Implications for prevention and treatment research are discussed.

Associations between volume of alcohol consumption and social status, intelligence, and personality in a sample of young adult Danes

Relatively few studies have investigated associations between volume of alcohol consumption and psychological characteristics in normal samples. A sub-sample, comprising 363 men and 331 women between 29 and 34 years of age, was selected from the Copenhagen Perinatal Cohort on the basis of perinatal records. The sample was divided into four consumption categories: abstainers (including occasional drinkers), light, moderate, and risk drinkers. ANOVA and relevant contrasts were used to test the significance of differences among consumption categories. Both abstaining and risk drinking were associated with low social status family background, low education and intelligence. Abstaining was associated with low disinhibition and social recognition scores, while risk drinking was associated with high neuroticism and, in males, high disinhibition, low social recognition, and low achievement scores. Compared with light drinkers, a more "carefree" life orientation characterized male moderate drinkers, while relatively high scores on anxiety, dysthymia, and somatoform symptom scales characterized female moderate drinkers.

Substance use disorder trajectory classes: diachronic integration of onset age, severity, and course

BACKGROUND

Substance use disorders (SUDs) may be characterized by onset age, severity, substance type, course, and outcomes. SUD phenotypes in the literature typically consider each of these features in isolation. Conceptual frameworks and data collection procedures for assessing SUD phenotypes are increasingly "diachronic" in approach, providing for characterizations "throughout time". The recent availability of statistical procedures for the identification of latent classes offers the possibility of developing SUD phenotypes integrating these developmental features. This article illustrates the utilization of SAS-TRAJ mixture modeling to characterize variations in SUD symptom trajectories to define phenotypes.

METHODS

The subjects were 332 adult males with SUDs. Their course of symptoms from early adolescence through middle adulthood was retrospectively determined. Symptom trajectories were defined by the number of DSM-IV SUD symptoms by year of age. SAS-TRAJ mixture models identified trajectory classes. Model development, evaluation, and selection using this approach are discussed.

RESULTS

Among these men with SUDs, six trajectory classes were identified, including groups characterized by early-onset and severe SUD symptoms persisting into adulthood, an early-onset group similar in adolescence but improving in adulthood, and other groups with symptoms emerging later with varying degrees of severity and persistence. The SUD trajectory classes were significantly different on comorbid psychopathology, particularly childhood disruptive behavior disorders.

CONCLUSION

The results present a new method for the comprehensive depiction of heterogeneity in SUD symptoms. Future studies may determine the extent to which SUDs phenotypes based on the course of symptom development inform etiology, prevention and treatment research.

The drinking situations of adolescents treated for alcohol use disorders: a psychometric and alcohol-related outcomes investigation

Psychometric properties of the Inventory of Drinking Situations (IDS) were examined using a sample of adolescents with Alcohol Use Disorders (AUDs; N = 352; mean age=16.6; 65.6% boys). Relations of drinking situations to alcohol-related outcomes 1 and 3 years following treatment also were investigated. Consistent with the higher-order structure of the IDS reported in adult samples, findings indicated that a 3 factor solution provided the best fit to the data: Negative (alpha = .98), Social (alpha = .95), and Temptation (alpha = .84) Situations. With regard to convergent and discriminate validity, evidence suggested that the Negative Situations subscale was related more strongly to an indicator of negative emotionality than to an indicator behavioral undercontrol. Conversely, the Social Situations subscale was associated more strongly with an indicator of behavioral undercontrol than an indicator of negative emotionality. Social and temptation drinking situations were associated with alcohol-related outcomes 1 year following treatment, but this was generally not the case 3 years following treatment. These results indicate that the IDS is a reliable and valid measure for use with adolescents receiving treatment for alcohol-related problems.

Assessment issues in adolescent drug abuse treatment research

Experimentation with alcohol and other drugs (AOD) is commonplace among American adolescents. Despite reduction efforts, the use of AOD by adolescents has increased over the past decade. A number of youth experience significant negative personal, societal, economic, and health ramifications, but continue to abuse AOD and develop substance use disorders (SUD). Accurate assessment of adolescent AOD use is essential in determining the prevalence of SUDs, the development of effective interventions, and the implementation of beneficial prevention initiatives. Developmental considerations are significant factors in the validity of youth AOD assessment and are detailed in this chapter.

Adolescent alcohol initiation: a review of psychosocial risk factors

Longitudinal research studies focused on alcohol use initiation in adolescence were reviewed to determine which variables function as antecedent predictors or risk factors. Only studies that focused on time-1 abstainers were included. Classes of risk factors examined include sociodemographic, family, peer, personality, and behavioral variables. The most consistent antecedent risk factors for starting to drink in adolescence were parental and peer approval and models for drinking and drug use as well as adolescents' own prior involvement in delinquent behavior. There was little evidence for gender differences in risk factors for alcohol use initiation. Secondary analyses of existing longitudinal data sets are encouraged to examine whether there are ethnic/racial differences in the risk factors for starting to drink and to establish those factors that serve a protective or buffering function, delaying onset of alcohol use in adolescence.

The natural history of adolescent alcohol use disorders

AIM

To examine clinically relevant research on the development, course and outcomes of adolescence alcohol use disorders (AUDs).

METHODS

Observational studies with adolescent samples were selected for inclusion based on systematic assessment of AUDs and clinical relevance. The literature was searched using Medline and Psychinfo. Articles on childhood predictors, characteristics, course, complications and adult outcomes of adolescent AUDs were reviewed.

RESULTS

The developmental trajectory toward adolescent AUDs begins with the emergence of childhood mental disorders. These problems are transmitted from parent to child in a developmentally specific fashion, reflect psychological dysregulation dimensions and predict adolescent AUDs. While most DSM-IV AUD diagnostic criterion items are valid for adolescents, tolerance and impaired control items are problematic, and some adolescents with significant alcohol problems are not identified by this diagnostic system. Understanding the psychosocial and biomedical complications that accompany AUDs requires attention to factors other than alcohol involvement itself, including childhood maltreatment and comorbid psychopathology. While some adolescents with AUDs manifest chronic alcohol dependence in adulthood, a substantial proportion overcome alcohol problems and transition to abstinence or normative drinking.

CONCLUSIONS

Developmentally specific phenotypic characteristics define the natural history of adolescent AUDs, inform clinical assessment and provide the developmental context for treatment research. While alcohol consumption may be the primary treatment focus, other important consequences, comorbidities and complications need to be addressed for successful developmental outcomes to result.

NEO PI-R predictors of alcohol use and alcohol-related problems

We investigated the relationships between Five-factor model domains and facets and drinking and alcohol-related problems. We also examined the moderating effects of gender. Two hundred students (99 men and 101 women) who had used alcohol in the past year completed self-report and interview assessments. Bivariate analyses demonstrated some significant relationships. In the multivariate analyses that controlled for gender, Neuroticism and Conscientiousness were linked to drinking, but only some of the facets from these domains had significant relationships to drinking. Facets of Extraversion and Agreeableness, but not these domains, were associated with drinking. Neuroticism and Conscientiousness and most of their facets were related to alcohol-related problems in the multivariate analyses. The interactions between gender and traits were not significant.

Measuring risks and outcomes in substance use disorders prevention research

Assessment planning in substance use disorder prevention research entails the identification of measurement domains and the selection of corresponding instruments needed to fulfill specific project goals. The study design, developmental periods examined, feasibility constraints, and anticipated statistical analyses are important considerations in optimally designing the assessment protocol. As a conceptual framework to organize the domains considered here as examples, the multifactorial model of complex disorders with elaborations emphasized by the discipline of developmental psychopathology is applied. Risks reviewed include family history, childhood maltreatment, peer relationships, and psychopathology. The substance involvement dimensions germane as outcomes include substance type, consumption quantity and frequency, and substance-related problems. Comprehensive diachronic evaluation over critical developmental periods provides the technical foundation for etiology and intervention research.

Health problems in adolescents with alcohol use disorders: self-report, liver injury, and physical examination findings and correlates

BACKGROUND

Although adolescent alcohol consumption has been found to be positively correlated with self-reported health problems, few studies have examined other health indicators. This study compared adolescents with alcohol use disorders (AUDs) and a community reference group on self-reported health problems, serum liver enzymes, and physical examination findings. The relevance of negative emotionality to understanding these health problems was also investigated.

METHODS

The subjects were adolescents with AUDs recruited from clinical programs and classified as having DSM-IV alcohol dependence (n = 71) or alcohol abuse (n = 57) and reference adolescents without AUDs recruited from community sources (n = 131). The assessment of health status included self-reported health problems in 15 areas; serum liver enzyme assays, including gamma-glutamyl transpeptidase, alanine aminotransferase, and aspartate aminotransferase; and physical examination findings. Negative emotionality was determined by systematically combining scores from the Hamilton Anxiety Rating Scale, the Beck Depression Inventory, the Child Behavior Checklist, and the Multidimensional Personality Questionnaire.

RESULTS

Adolescent AUDs were associated with more self-reported health problems, higher gamma-glutamyl transpeptidase and alanine aminotransferase levels, and more physical examination abnormalities. Negative emotionality was highly correlated with self-reported health problems, mediated the relationship between AUDs and self-reported health problems, and was not correlated with serum liver enzyme levels or physical examination abnormalities.

CONCLUSIONS

These results indicated that AUDs during adolescence were associated with health problems, including modest but demonstrable liver injury. Self-reported health problems were probably best understood, in this context, as a negative emotionality manifestation.