Transitions to polysubstance use: Prospective cohort study of adolescents in Australia

BACKGROUND AND AIMS

Adolescent polysubstance use has been associated with adverse social and health outcomes. Our aim was to measure rates and transitions to polysubstance use during adolescence and identify factors associated with initiation and discontinuation of polysubstance use.

DESIGN

Prospective cohort study. Multistate Markov modelling was used to estimate rates and identify correlates of transitions between substance use states.

SETTING AND PARTICIPANTS

Adolescent-parent dyads (n = 1927; adolescents in grade 7, age ≈13 years) were recruited from Australian schools during 2010/11 (Wave 1). Adolescents were surveyed annually until 2016/17 (n = 1503; age ≈19 years; Wave 7) and parents were surveyed annually until 2014/15 (Wave 5).

MEASUREMENTS

Alcohol, tobacco, cannabis and 3,4-methylenedioxymethamphetamine (MDMA) use outcomes were collected at Waves 3-7. Potential confounders were collected at Waves 1-6 and consisted of sex, anxiety and depression symptoms and externalizing problems, parental monitoring, family conflict and cohesion, parental substance use and peer substance use. Covariates were age and family socioeconomic status.

FINDINGS

Few adolescents engaged in polysubstance use at earlier waves (Wave 3: 5%; Wave 4: 8%), but proportions increased sharply across adolescence (Waves 5-7: 17%, 24%, 36%). Rates of transitioning to polysubstance use increased with age, with few (<9%) adolescents transitioning out. More externalizing problems (odds ratio [OR] = 1.10; 99.6% confidence interval [CI] = 1.07-1.14), parental heavy episodic drinking (OR = 1.22; 99.6% CI = 1.07-1.40), parental illicit substance use (OR = 3.56; 99.6% CI = 1.43-8.86), peer alcohol use (OR = 5.68; 99.6% CI = 1.59-20.50) and peer smoking (OR = 4.18; 99.6% CI = 1.95-8.81) were associated with transitioning to polysubstance use.

CONCLUSIONS

Polysubstance use in Australia appears to be rare during early adolescence but more common in later adolescence with low rates of transitioning out. Externalizing problems and greater parental and peer substance use are risk factors for adolescent polysubstance use that may be suitable intervention targets.

Alcohol use among in-school adolescents in Sierra Leone

OBJECTIVE

To examine the prevalence of alcohol use and its associated factors among in-school adolescents in Sierra Leone.

DESIGN

Data for the study was sourced from the 2017 Sierra Leone Global School-Based Student Health Survey, a nationally representative survey conducted among in-school adolescents aged 10-19 years using a multistage sampling methodology. Percentages were used to present the prevalence of alcohol use among in-school adolescents. Multivariable binary logistic regression analysis was performed to examine the factors associated with alcohol use among in-school adolescents. The results were presented using adjusted odds ratios (aOR) with their respective 95% confidence interval (CI).

SETTING

Sierra Leone.

PARTICIPANTS

A weighted sample of 1730 in-school adolescents in Sierra Leone.

OUTCOME MEASURE

Current alcohol use.

RESULTS

The prevalence of alcohol use among in-school adolescents was 10.7% (7.3, 15.3). In-school adolescents in senior secondary schools were more likely to use alcohol compared with those in junior secondary school (aOR=2.13; 95% CI 1.37, 3.30). The odds of alcohol use was higher among in-school adolescents who were truant at school relative to those who were not (aOR=2.24; 95% CI 1.54, 3.26). Also, in-school adolescents who were bullied (aOR=1.85; 95% CI 1.24, 2.76), ever engaged in sexual intercourse (aOR=2.06; 95% CI 1.39, 3.06), and used marijuana (aOR=3.36; 95% CI 1.72, 6.53) were more likely to use alcohol compared with those who were not. However, in-school adolescents who reported that their parents understood their problems (aOR=0.52; 95% CI 0.33, 0.82) had a lower likelihood of consuming alcohol.

CONCLUSION

Our study has shown that alcohol use is prevalent among in-school adolescents in Sierra Leone. Grade level, experiences of being bullied, history of sexual intercourse, truancy at school, and previous use of marijuana were the factors influencing alcohol use among in-school adolescents. The findings emphasise the necessity of creating school-based health interventions in Sierra Leone that can effectively identify in-school adolescents potentially vulnerable to alcohol-related issues. Also, existing policies and programmes aimed at reducing alcohol use among in-school adolescents need to be strengthened.

Simultaneous Substance Use With Alcohol in a Community-Based Sample of Young Adults

Objective: Simultaneous substance use is associated with worse outcomes than concurrent use. Further investigations into simultaneous use are warranted because there is limited knowledge about the co-use of substances other than alcohol and cannabis. Study aims were to examine: (1) the prevalence of simultaneous use of substances with alcohol, (2) the extent to which use patterns are related to key correlates (i.e., psychological functioning, sensation seeking), and (3) differences by college status. Methods: Participants were 623 young adult drinkers who were recruited online to complete a one-time survey. Results: Cannabis (54.3%), tobacco (53.7%), and stimulants (46.5%) were most frequently used with alcohol. Moderation analyses showed the positive association between simultaneous use and psychological distress was stronger for students whereas the positive association with sensation seeking was stronger for nonstudents. Conclusions: Results highlight the need for future research and intervention efforts that consider the link between simultaneous use and psychological wellbeing while acknowledging that educational attainment may differentially influence these factors.

Prevalence and factors associated with polydrug use among clients seeking treatment for alcohol misuse

INTRODUCTION

The aim of this paper was to examine the client and psychosocial characteristics associated with polydrug use in patients with alcohol misuse as their primary drug of concern (PDC) seeking treatment from substance use treatment centres.

METHODS

Self-report surveys were undertaken with clients attending 1 of 34 community-based substance use treatment centres across Australia with alcohol as their PDC. Survey items included client's socio-demographic characteristics, level of alcohol dependence, use of other drugs including tobacco, health and wellbeing factors including health-related quality of life. The factors associated with polydrug use (alcohol use concurrent with at least one other drug) were examined.

RESULTS

In a sample of 1130 clients seeking treatment primarily for alcohol problems, 71% reported also using another drug. The most frequently used drug was tobacco (50%) followed by cannabis (21%) and benzodiazepines (15%). Excluding tobacco use, 35% of participants reported polydrug use. Factors associated with any polydrug use were younger age, lower education levels, lower levels of mental health related quality of life and housing risk (i.e., risk of eviction or experienced homelessness in past 4 weeks). When tobacco was excluded, factors associated with polydrug use were age, lower physical and mental health-related quality of life, and housing risk.

DISCUSSION AND CONCLUSIONS

Most adults seeking treatment for alcohol misuse as their PDC reported using another drug in addition to alcohol. Treatment services should be designed accordingly to maximise the likelihood of treatment engagement and success.

The interdependence of substance use, satisfaction with life, and psychological distress: a dynamic structural equation model analysis

Introduction

Longitudinal studies with annual follow-up including psychological and social variables in substance use disorder recovery are scarce. We investigated whether levels of substance use, satisfaction with life, and psychological distress fluctuate across five years in relation to having drug-free friends.

Methods

A prospective naturalistic cohort study of change trajectories in a cohort of people diagnosed with substance use disorder and using multiple substances with quarterly and annual follow-up over five years. Two-hundred-and-eight patients were recruited from substance use disorder treatment in Rogaland, Norway. Out of these, 164 participants fulfilled the inclusion criteria. We used Bayesian two-level dynamic structural equation modelling. The variable 'drug-free friends' was assessed by a self-reporting questionnaire, while psychological distress was assessed using the Symptoms Checklist 90 Revised. Satisfaction with life was assessed using the Satisfaction With Life Scale while drug use was assessed using the Drug Use Disorders Identification Test.

Results

The main findings are that higher-than-average psychological distress at a three-month lag credibly predicts higher-than-normal substance use at the concurrent time point t. Substance use and satisfaction with life seem to have synchronous trajectories over time, i.e. as the first decreases the latter increases and vice versa. During the five years after treatment, the participants mainly experienced a decrease in substance use and increase in satisfaction with life.

Conclusion

Since the participants experienced positive and negative fluctuations for several years after treatment, it seems crucial to establish a dialogue with treatment professionals in order to create functional solutions for maintaining motivation and aiding recovery.

Developmental trajectories of alcohol and cannabis concurrent use in a nationally representative sample of United States youths

BACKGROUND

Previous studies have identified common trajectories of single type substance use over the course of adolescence; however, no study to date has examined joint trajectories of cannabis and alcohol concurrent use. Given that expansion of legal cannabis has increased availability, it is important to understand patterns of concurrent use in adolescents and factors that place male and female youth at risk for harmful trajectories of concurrent use. The current study sought to identify joint trajectories of cannabis and alcohol use - and predictors of harmful use trajectories - among male and female adolescents.

METHOD

We used 4 waves of data from 6997 early adolescent participants (age 12-14 years at Wave 1) in the Population Assessment of Tobacco and Health, a nationally representative longitudinal study in the United States. Participants reported their cannabis and alcohol use reassessed yearly for 5 years (2013-2018). We used joint trajectory growth mixture modeling to identify trajectory groups as defined by changes in alcohol and cannabis use over time.

RESULTS

Five classes of alcohol and cannabis concurrent use trajectories were identified. Both internalizing and externalizing symptoms at Wave 1 increased the odds of membership in trajectory groups characterized by more harmful use trajectories. Internalizing symptomatology was a stronger predictor of membership in escalating use trajectories among girls, whereas externalizing symptomatology stronger predictor among boys.

CONCLUSIONS

These findings underscore the utility of jointly considering alcohol and cannabis use when describing common developmental trajectories of use and identifying risk factors for trajectories characterized by harmful use.

Associations between alcohol and cannabis use order, frequency, quantity, and consequences in a college sample of individuals who co-use alcohol and cannabis

BACKGROUND AND OBJECTIVES

Using both alcohol and cannabis (either at the same time or at different times) is common among college students, and is called "co-use." Using these substances simultaneously, such that their effects overlap, is thought to be an especially risky co-use pattern. Gaining a better understanding of how co-use patterns relate to substance use and consequences could aid prevention and intervention efforts.

METHODS

We examined college students (N = 401) who reported using both alcohol and cannabis at least once in the past 30 days. Path analysis was used to explore relations among co-use patterns (number of days in a typical week that participants used both alcohol and cannabis; the number of days using alcohol first, cannabis first, alcohol last, and cannabis last; the number of days of simultaneous use), past-30-day alcohol and cannabis consequences, use frequency, and typical quantities used.

RESULTS

Each additional day of using alcohol first was associated with fewer past-30-day cannabis consequences. Each additional day of using cannabis first was associated with fewer alcohol-related consequences. Each additional day of using alcohol and cannabis on the same day and each additional day of simultaneous use were both associated with less cannabis used and alcohol consumed in a typical week.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

This study is among the first to identify associations between alcohol and cannabis order and outcomes (i.e., consequences and consumption). Results suggest that modifying which substance is used first on a given day could be a practical intervention strategy for individuals who co-use alcohol and cannabis.

Genetic associations among internalizing and externalizing traits with polysubstance use among young adults

Though most genetic studies of substance use focus on specific substances in isolation or generalized vulnerability across multiple substances, few studies to date focus on the concurrent use of two or more substances within a specified time frame (i.e., polysubstance use; PSU). We evaluated whether distinct genetic factors underlying internalizing and externalizing traits were associated with past 30-day PSU above variance shared across general psychopathology and substance use (SU). Using Genomic Structural Equation Modeling, we constructed theory-driven, multivariate genetic factors of 16 internalizing, externalizing, and SU traits using genome-wide association studies (GWAS) summary statistics. Next, we fit a model with a higher order SU-related psychopathology factor as well as genetic variance specific to externalizing and internalizing (i.e., residual genetic variance not explained by SU or general psychopathology). GWAS-by-subtraction was used to obtain single nucleotide polymorphism effects on each of these factors. Polygenic scores (PGS) were then created in an independent target sample with data on PSU, the National Longitudinal Study of Adolescent to Adult Health. To evaluate the effect of genetic variance due to internalizing and externalizing traits independent of variance related to SU, we regressed PSU on the PGSs, controlling for sex, age, and genetic principal components. PGSs for SU-related psychopathology and non-SU externalizing traits were associated with higher PSU factor scores, while the non-SU internalizing PGS was not significantly associated with PSU. In total, the three PGSs accounted for an additional 4% of the variance in PSU above and beyond a null model with only age, sex, and genetic principal components as predictors. These findings suggest that there may be unique genetic variance in externalizing traits contributing to liability for PSU that is independent of the genetic variance shared with SU.

Educational Attainment and Differences in Patterns of Alcohol, Cannabis, and Tobacco Use Among Young Adults

Multigroup latent profile analysis examined whether patterns of alcohol, cannabis, and tobacco use varied between college student and nonstudent young adults ( N = 745), and profiles were characterized by alcohol- and drug-related problems, psychological distress, and perceived stress. Findings supported three profiles (high use across substances, primarily high tobacco use, and low use across substances) among students. Students in the high use group, relative to other groups, experienced the highest number of problems and psychological distress. Among nonstudents, two profiles emerged (high use across substances and primarily high tobacco use), and noncollege participants in the high use group experienced the highest problems, psychological distress, and perceived stress. Students, compared to nonstudents, reported more variability in their substance use profiles, as a low substance use group was not observed among nonstudents. Prevention and intervention efforts should target nonstudents, which could aid in reducing negative health outcomes based on disparities in education.

Patterns of polysubstance use among adults in Malaysia-A latent class analysis

INTRODUCTION

Polysubstance use is the use of more than one non-prescribed licit or illicit substance at one time. This is a common phenomenon, but little is known about the severity and the various substances used by adults in Malaysia.

OBJECTIVE

To determine the pattern of polysubstance use and its associated factors among general adults in Malaysia.

METHODOLOGY

This was a secondary data analysis from the National Health and Morbidity Survey (NHMS) 2019), a cross-sectional population survey with a two-stage stratified random sampling design. A total of 10,472 Malaysians aged 18 years and above participated in this survey. Polysubstance use was defined as concurrent use of more than one substance, either alcohol, tobacco, or drugs (opioids, marijuana, amphetamine/ methamphetamine or kratom). A latent class analysis (LCA) was used to identify the membership of polysubstance groups. The association of class membership with demographic profiles was examined using Multinomial Logistic Regression analysis.

RESULTS

Fit indices (AIC = 16458.9, BIC = 16443.6) from LCA supported 3 classes solution: Class 1; "moderate-drug" group primarily combination used of tobacco and alcohol (2.4%), Class 2; "high-drug" group using multiple substance including kratom (0.3%) and Class 3; "low-drug" group reporting minimal alcohol and tobacco use or non-user (97.3%). The multinomial model showed young adults (18-40 years) had a higher likelihood of being polysubstance users both for moderate-drug class (OR = 4.1) and high-drug class (OR = 3.9) compared to older age (≥60 years). Chinese (OR = 18.9), Indian (OR = 23.3), Indigenous Sabah & Sarawak (OR = 34.6) and others ethnicity (OR = 8.9) showed higher odds of being moderate-drug users than Malays. The greater odds of moderate-drug use for males (OR = 35.5), working groups (OR = 1.5) and low education level group (OR = 3.2).

CONCLUSION

Our study highlights patterns and demographics related to the use of polysubstances among adults in Malaysia. These results would help formulate specific prevention programmes for these high-risk groups.

Psychiatric symptoms, current use of tobacco, alcohol, illicit drug, and poly-substance among medical students in Eastern Turkey

The study aims to investigate the prevalence and patterns of substance use among medical students and to examine associated psychiatric symptoms. It has been observed that depression and psychoticism scores have a significant effect on smoking, and interpersonal sensitivity-hostility-paranoid ideation scores have a significant effect on drinking. It has been shown that interpersonal sensitivity and depression scores are more predictive of mono-and poly-substance use. Revealing the relationship between tobacco, alcohol, poly-substance use, and psychiatric symptoms in the medical school sample shows the importance of practices aimed at increasing students' awareness of their psychiatric symptoms and providing access to psychiatric services.

Cultural Protection from Polysubstance Use Among Native American Adolescents and Young Adults

Reservation-based Native American youth are at disproportionate risk for high-risk substance use. The culture-as-treatment hypothesis suggests aspects of tribal culture can support prevention and healing in this context; however, the protective role of communal mastery and tribal identity have yet to be fully explored. The objectives of this study were to investigate (1) the relationship between cultural factors and high-risk substance use, which includes polysubstance use, early initiation of alcohol and illicit drugs, and binge drinking, and (2) substance use frequency and prevalence of various substances via cross-sectional design. Multiple logistic regression modeling was used to analyze data from 288 tribal members (15–24 years of age) residing on/near the Fort Peck Reservation in the Northern Plains. When controlling for childhood trauma and school attendance, having at least a high school education (OR = 0.434, p = 0.028), increased communal mastery (OR = 0.931, p = 0.007), and higher levels of tribal identity (OR = 0.579, p = 0.009) were significantly associated with lower odds of polysubstance use. Overall prevalence of polysubstance use was 50%, and binge drinking had the highest single substance prevalence (66%). Prevalence of early initiation of substances (≤ 14 years) was inhalants (70%), alcohol (61%), marijuana (74%), methamphetamine (23%), and prescription drug misuse (23%). Hydrocodone, an opioid, was the most frequently misused prescription drug. Findings indicate programs focused on promoting education engagement, communal mastery, and tribal identity may mitigate substance use for Native American adolescents living in high-risk, reservation-based settings.

A bibliometric analysis of the cannabis and cannabinoid research literature

Background

Cannabis refers to a plant in the family Cannabaceae, which has been used medically, recreationally, and industrially. The last two decades, in particular, have seen a large increase in the volume of literature on this topic. The present bibliometric analysis aims to capture the characteristics of scholarly journal publications on the topic of cannabis and cannabinoid research.

Methods

Searches were run on the Scopus database on April 02, 2021, as follows “(TITLE (cannabi* OR hashish OR marijuana OR marihuana)) AND ( LIMIT-TO ( DOCTYPE,"ar" ) OR LIMIT-TO ( DOCTYPE,"re" ) )”. Results were exported on the same day to prevent discrepancies between daily database updates. Only “article” and “review” publication types were included; no further search limits were applied. The “article” publication type includes publications featuring original research, whereas “review” includes reviews and conference papers. The following data were collected: number of publications (in total and per year), authors, and journals; open access status; publications per journal; journals publishing the highest volume of literature and their impact factors, language of publication; document type; publication country; author affiliations; funding sponsors; most highly cited publications; and most highly published authors. Trends in this subset of publications were identified and presented. Bibliometric networks were constructed using the software tool VOSviewer.

Results

A total of 29 802 publications (10 214 open access), published by 65 109 authors, were published in 5474 journals from 1829 to 2021. The greatest number of publications was published over the last 20 years. The journal that published the largest number of publications was Drug and Alcohol Dependence (n = 705). The most productive countries included the USA (n = 12 420), the UK (n = 2236), and Canada (n = 2062); many of the most common institutional affiliations and funding sponsors originated from these countries.

Conclusions

The number of publications published on the topic of cannabis follows an upward trend. Over the past 20 years, the volume of cannabis research has grown steeply, which can be attributed to a large amount of funding dedicated to researching this topic. Future research should continue to investigate changes in the publication characteristics of emerging research, as the volume of publications on this topic is expected to rapidly grow.

Supplementary Information

The online version contains supplementary material available at 10.1186/s42238-022-00133-0.

Sex moderates effects of alcohol and cannabis co-use on alcohol and stress reactivity

BACKGROUND

Simultaneous or concurrent use (co-use) of alcohol and cannabis is associated with greater use of both substances over time, academic difficulties, more severe substance use consequences, and adverse impacts on cognitive functioning than the use of a single substance or no substance use. This study examined potential neural mechanisms underlying co-use behaviors in comparison to single substance use. Specifically, we compared alcohol cue reactivity and stress-cue reactivity among individuals who reported frequent same-day co-use of alcohol and cannabis and individuals who reported only alcohol use.

METHODS

The sample included 88 individuals (41 women) who reported only alcohol use and 24 individuals (8 women) who reported co-use of alcohol and cannabis on at least 50% of drinking occasions. All participants completed fMRI stress and alcohol cue reactivity tasks. Because of known sex effects on stress reactivity and alcohol cue reactivity, we tested sex by co-use interactions.

RESULTS

During alcohol cue presentation, co-users had less activation in the thalamus and dorsomedial prefrontal cortex than alcohol-only users, effects that were driven by differences in responses to neutral cues. Examination of stress cue reactivity revealed sex by co-use interactions in the lingual gyrus, with women co-users showing a greater difference between negative and neutral cue reactivity than all other groups. In addition, women co-users had greater connectivity between the nucleus accumbens and both the medial orbitofrontal cortex and the rostral anterior cingulate cortex during negative cue presentation than the other groups.

CONCLUSIONS

These results provide preliminary evidence of enhanced stress cue reactivity in individuals reporting co-use of alcohol and cannabis, particularly women co-users.

The Effects of Alcohol and Cannabis Co-Use on Neurocognitive Function, Brain Structure, and Brain Function

Purpose of review

Given increases in the rates of alcohol and cannabis co-use among adolescents and young adults, this review aims to summarize literature on the effects of alcohol and cannabis co-use on neurocognitive functioning, brain structure, and brain function.

Recent findings

The limited existing studies examining concurrent, recent, and lifetime alcohol and cannabis co-use suggest effects on the brain are likely multifaceted. The majority of studies report that co-use is associated with negative outcomes such as impaired cognitive function and significant alterations in key structural and functional regions of the brain, while others report null effects of co-use compared to non-substance using control and single-substance use groups.

Summary

Current studies lack a general consensus on methodology, definitions of concurrent and simultaneous use, and neuroimaging approaches, which makes it challenging to draw strong conclusions about the effects of co-use. More studies are needed to explore the effects of co-use in the context of simultaneous alcohol and cannabis use.

Associations between Longitudinal Patterns of Substance Use and Anxiety and Depression Symptoms among a Sample of Canadian Secondary School Students

The objective of this study is to examine the longitudinal associations between latent classes of substance use and anxiety and depression scores among youth who use substances. This study uses data from three waves (Wave 1: 2017/18, Wave 2: 2018/19, and Wave 3: 2019/20) of the COMPASS study. Students in grades 9 and 10 who reported substance use at baseline (n = 738) report their substance use (alcohol, cannabis, cigarettes, and e-cigarettes) and anxiety and depression symptoms at each wave. A Repeated Measures Latent Class Analysis (RMLCA) is used to determine substance use classes, and mixed models are used to examine the associations between substance use classes and anxiety and depression. We identify three classes of substance use: (1) occasional alcohol and e-cigarette use, (2) escalating poly-substance use, and (3) consistent poly-substance use. After controlling for relevant covariates, consistent poly-substance use is associated with depression (Female OR: 1.24 [95%CI: 0.46, 2.02]; Male OR 1.13 [95%CI: 0.38, 1.87]) but not anxiety. Escalating poly-substance use is associated with depression among males (OR 0.72 [95%CI: 0.10, 1.33]). These findings should be taken into consideration when creating prevention programming and treatment strategies for adolescents. Substance use programming should be comprehensive, consider multiple substances, and be cognizant of symptoms of mental illness, particularly depression.

Increases in Serious Psychological Distress among Ontario Students between 2013 and 2017: Assessing the Impact of Time Spent on Social Media

OBJECTIVE

The objective of the current research was to examine the association between time spent on social media and serious psychological distress between 2013 and 2017, a period when the rates of both were trending upward.

METHODS

The current study analyzed population-based data from 3 waves of the Ontario Student Drug Use and Health Survey (N = 15,398). Multivariate logistic regression models were used to examine the association between time spent on social media and serious psychological distress controlling for theoretically relevant covariates. Interactions were tested to assess whether the association changed over time.

RESULTS

The prevalence of serious psychological distress increased from 10.9% in 2013 to 16.8% in 2017 concomitantly with substantial increases in social media usage, especially at the highest levels. In the multivariate context, we found a significant interaction between social media use and the survey year which indicates that the association between time spent on social media and psychological distress has decreased from 2013 to 2017.

CONCLUSION

Although both social media use and psychological distress increased between 2013 and 2017, the interaction between these variables indicates that the strength of this association has decreased over time. This finding suggests that the higher rate of heavy social media use in 2017 compared to 2013 is not actually associated with the higher rate of serious psychological distress during the same time period. From a diffusion of innovation perspective, it is possible that more recent adopters of social media may be less prone to psychological distress. More research is needed to understand the complex and evolving association between social media use and psychological distress. Researchers attempting to isolate the factors associated with the recent increases in psychological distress could benefit from broadening their investigation to factors beyond time spent on social media.

Alcohol-related cognitions: Implications for concurrent alcohol and marijuana use and concurrent alcohol and prescription stimulant misuse among young adults

INTRODUCTION

This study examined the associations between alcohol-related cognitions within the social reaction pathway of the Prototype Willingness Model and concurrent (use of two or more substances within a specified time period) use of 1) alcohol and marijuana and 2) alcohol and prescription stimulant misuse.

METHODS

A convenience sample of 1,062 emerging adults in the U.S. (18-20 years old; 54.5% female) who reported past 3-month alcohol use completed a baseline survey as part of a larger randomized controlled trial.

RESULTS

Results indicate that controlling for age, biological sex, race, ethnicity, and college enrollment, perceived descriptive norms and willingness to drink were associated with past 3-month concurrent alcohol and marijuana use and concurrent alcohol and prescription stimulant misuse. However, alcohol prototype similarity and alcohol-related perceived vulnerability were not associated with either concurrent use outcome examined.

DISCUSSION

These findings suggest that alcohol-related perceived descriptive norms and willingness to drink are associated with concurrent substance use among young adults. Thus, it is possible that existing efficacious alcohol interventions that target descriptive norms and willingness to drink may have the added benefit of also reducing concurrent substance cognitions and ultimately use.

Alcohol, cannabis, and tobacco polysubstance use: A latent profile analysis of age of onset

BACKGROUND

Despite understanding the long-term risks associated with early substance use, less is known about the specific patterns of the age of onset (AO) across multiple substances and whether these patterns of early exposure are linked to substance use later in young adulthood. Consequently, the present study sought to (1) identify distinct classes regarding AO for alcohol, cannabis, and tobacco and (2) compare these classes on patterns of individual and simultaneous alcohol, cannabis, and tobacco use, other substance use, and mental health symptoms.

METHODS

Participants were 510 emerging adults (Mage = 21.35; 88.6% men) who reported past-year use of alcohol, cannabis, and tobacco.

RESULTS

Latent profile analysis was used to identify classes based on three indicators: AO for alcohol, cannabis, and tobacco. Results revealed that four classes best fit the data: Earliest AO for Alcohol (19.8%); Latest AO for Substances (6.5%); Late AO for Substances (67.8%); Earliest AO for Cannabis and Tobacco (5.9%). Classes varied on current patterns of individual substance use, co-use of substances, other illicit drug use, and mental health symptomology. The Latest AO of Substances class reported the lowest alcohol use, cannabis use, other illicit drug use, and mental health symptomology than the other classes. The Earliest AO for Alcohol and the Late AO of Substances reported a lower frequency of tobacco compared to the other classes. The Late AO of Substance class reported the highest past-year frequency of simultaneous alcohol and cannabis use.

CONCLUSIONS

The current study contributed to the larger polysubstance literature by identifying profiles that may signify risky patterns of use. Findings may help guide prevention and intervention work with adolescents and young adults.

Substance use and symptoms of mental health disorders: a prospective cohort of patients with severe substance use disorders in Norway

BACKGROUND

There is high co-occurrence of substance use disorders (SUD) and mental health disorders. We aimed to assess impact of substance use patterns and sociodemographic factors on mental health distress using the ten-item Hopkins Symptom Checklist (SCL-10) over time.

METHODS

Nested prospective cohort study of 707 participants with severe SUD across nine opioid-agonist-therapy outpatient clinics and low-threshold municipality clinics in Norway, during 2017-2020. Descriptive statistics were derived at baseline and reported by means and standard deviation (SD). A linear mixed model analysis was used to assess the impact of substance use patterns and sociodemographic factors on SCL-10 sum score with beta coefficients with 95% confidence intervals (CI).

RESULTS

Mean (SD) SCL-10 score was 2.2 (0.8) at baseline with large variations across patients. We observed more symptoms of mental health disorders among people with frequent use of benzodiazepines (beta 3.6, CI:2.4;4.8), cannabis (1.3, CI:0.2;2.5), opioids (2.7, CI:1.1;4.2), and less symptoms among people using frequent stimulant use (- 2.7, CI:-4.1;-1.4) compared to no or less frequent use. Females (1.8, CI:0.7;3.0) and participants with debt worries (2.2, CI:1.1;3.3) and unstable living conditions (1.7, CI:0.0;3.3) had also higher burden of mental health symptoms. There were large individual variations in SCL-10 score from baseline to follow-up, but no consistent time trends indicating change over time for the whole group. 65% of the cohort had a mean score > 1.85, the standard reference score.

CONCLUSIONS

People with SUD have a considerable burden of mental health symptoms. We found no association between substance use patterns and change in mental health symptoms over time. This could suggest that the differences observed were indicating flattening of effects or self-medication to a larger degree than medication-related decline in mental health. This call for better individualized mental health assessment and patient care.

Alcohol- and drug-related consequences across latent classes of substance use among American Indian adolescents

INTRODUCTION

Substance use among American Indian (AI) adolescents is a significant public health concern, as they report greater health disparities related to substance use compared to other racial/ethnic groups. The present study examines differences across classes of substance use behaviors regarding alcohol- and drug-related consequences.

METHODS

The current study was a secondary analysis of the dataset used by Stanley and Swaim (2018). AI adolescents (n = 3498, 47.8% female, M_age = 14.8) completed a survey including substance use and related consequences. Protocols were approved by institutional IRB, tribal authority, school boards, and parental consent/child assent were obtained.

RESULTS

In line with Stanley and Swaim (2018), we identified four classes of substance use: no past month substance use; marijuana and cigarette use only; alcohol, marijuana, and cigarette use only; and polysubstance use. Cross-class comparisons revealed that adolescents in classes characterized by the use of a greater number of substances also reported experiencing greater alcohol- and drug-related consequences with one exception: the class characterized by marijuana and cigarette use reported greater drug-related consequences compared to the class characterized by alcohol, marijuana, and cigarette use.

CONCLUSIONS

AI adolescents who engage in the use of multiple substances should be provided with psychoeducation around the increased risk of associated negative consequences. Given the health disparity experienced by AI adolescents, interventions to alleviate the burden of negative consequences are necessary.

Age-varying associations between lifestyle risk factors and major depressive disorder: a nationally representative cross-sectional study of adolescents

PURPOSE

Lifestyle risk factors, such as alcohol use, smoking, high body mass index, poor sleep, and sedentary behavior, represent major public health issues for adolescents. These factors have been associated with increased rates of major depressive disorder (MDD). The purpose of this paper is to investigate critical peaks in the prevalence of MDD at certain ages and to examine how these peaks might be amplified or attenuated by the presence of lifestyle risk factors.

METHODS

A nationally representative sample of adolescents aged 11-17 years old (n = 2967) and time-varying effect models were used to investigate the associations between lifestyle risk factors and the prevalence of MDD by sex.

RESULTS

The estimated prevalence of MDD significantly increased among adolescents from 4% (95% CI 3-6%) at 13 years of age to 19% (95% CI 15-24%) at 16 years of age. From the age of 13, males were significantly less likely to have a diagnosis of MDD than females with the maximum sex difference occurring at the age of 15 (OR 0.24, 95% CI 0.13-0.47). All lifestyle risk factors were at some point significantly associated with MDD, but these associations did not differ by sex, except for body mass index.

DISCUSSION

These findings suggest that interventions designed to prevent the development of depression should be implemented in early adolescence, ideally before or at the age of 13 and particularly among young females given that the prevalence of MDD begins to rise and diverge from young males. Interventions should also simultaneously address lifestyle risk factors and symptoms of major depression.

Examining Sex and Racial/Ethnic Differences in Co-use of Alcohol, Cannabis, and Cigarettes in a Community Sample of Adolescents

INTRODUCTION

Although adolescents often co-use alcohol, cigarettes, and cannabis, little is known about sex and racial/ethnic differences in the co-use of these substances. Therefore, this investigation examined sex and racial/ethnic differences in alcohol, cigarette, and cannabis co-use in a large and ethnically diverse group. Methods: Participants were drawn from a large, multi-site study of adolescents from three regions in the United States (N = 4,129; Mage=16.10 years, SD = 0.59; 51% female, 49% male; 37% Black, 37% Hispanic, 25% White). Participants were categorized into eight mutually exclusive groups based on their self-reported use of alcohol, cannabis, and cigarettes in the last 30 days. Results: Unadjusted multinomial logistic regression revealed that males were more likely than females to use cannabis-only and to co-use all three substances. Additionally, Black and Hispanic adolescents were more likely to use cannabis-only, while White adolescents were more likely than Black and Hispanic adolescents to co-use alcohol and cigarettes. After adjusting for other sociodemographic variables (age, household income, parental education, and parent marital status), males were more likely to use cannabis-only than females; White youth were more likely than Hispanic youth to use cigarettes only and co-use cigarettes and alcohol. White youth were more likely than Black youth to co-use alcohol and cigarettes and co-use all three substances. Discussion: These results indicate sex and racial/ethnic differences in substance co-use that were not explained by socioeconomic factors. Results of this work suggest potential strategies for targeted prevention efforts and underscore the importance of continued efforts to better understand patterns of alcohol and substance co-use.

Patterns of substance use among adolescents: A systematic review

PURPOSE

This review characterizes empirically derived patterns of multiple (multi-) substance use among adolescents. A secondary objective was to examine the extent to which mental health symptomatology was included in the empirical analyses examining substance use patterns.

METHODS

Eligible studies included those that used cluster-based approaches, included the assessment of at least two different substances, and were based on study samples with mean ages between 11 and 18 years. 4665 records were screened including 461 studies for full-text screening.

RESULTS

70 studies were included with common clusters being: low use, single or dual substance use, moderate general multi-use, and high multi-use. The most common patterns of single or multi-substance use were: alcohol only, alcohol with cannabis and/or tobacco, and use of alcohol, tobacco, and cannabis with and without other drugs. Lower socioeconomic status, older age, and male gender were consistent predictors of multi-use clusters. Only 37 % of studies compared differences in levels of mental health across clusters with symptoms consistently associated with a greater likelihood of multi-use. Only 29 % of studies included mental health indicators in cluster-based analyses, with over half identifying distinct mental health and substance use clusters. Fit indices in cluster analyses and measurement properties of substance use were heterogeneous and inconsistently reported across studies.

CONCLUSIONS

Distinct patterns of substance use were derived but methodological differences prevented direct comparison and reduced capacity to generalize across studies. There is a need to establish standardized methodological approaches to identify robust patterns of substance use to enhance etiological, prognostic, and intervention research.

Prevalence and correlates of youth poly-substance use in the COMPASS study

BACKGROUND AND AIMS

Youth poly-substance use, associated with long-term negative health and social outcomes, is of increasing concern following the rise of e-cigarette vaping and cannabis legalization in Canada. This work aimed to investigate current evidence on correlates of this behaviour to inform effective prevention and harm reduction programming.

DESIGN

Cross-sectional sample taking part in a cohort study.

SETTING

Canadian high schools (AB, BC, ON, QC) PARTICIPANTS: 74,501 Canadian high school students who completed the COMPASS student questionnaire in 2018/2019.

MEASUREMENTS

Self-report data on use of five substances (alcohol, cigarettes, e-cigarettes, cannabis, and opioids) alongside demographic factors, social and school support, and mental health-related measures.

RESULTS

Of the 39% of youth who reported current substance use, 53% reported using two or more. E-cigarette vaping was most prevalent (28%) and most often combined with other substances. Feeling supported by friends and having no problem with seeking help at school were associated with higher levels of poly-substance use. Family support, school connectedness, and school support to resist drugs decreased the risk of substance co-use.

CONCLUSIONS

The evidence presented here suggests that interventions for youth poly-substance use should rely on joint efforts between parents, schools, and communities to focus on structural factors rather than problematizing the individual.

Gender, Maltreatment and Psychiatric Symptoms among Adolescents in Outpatient Substance Abuse Treatment

Childhood maltreatment experiences are risk factors for externalizing and internalizing symptoms, as well as substance abuse problems during adolescence. In the present study, we administered structured interviews to 394 adolescents receiving outpatient substance abuse treatment services (280 males; M _years=16.33; SD _years=1.15). K-means cluster analysis was used to examine: (a) the co-patterning of childhood maltreatment experiences and past-year externalizing symptoms (for drug and alcohol abuse and dependence, conduct disorder); (b) between-cluster differences in serious internalizing problems (for past-year anxiety and depression symptoms and current distress); and (c) gender differences in these relations. Both similarities and differences were identified in maltreatment-externalizing behavior patterns and relations with serious internalizing problems across gender groups. Childhood maltreatment and subsequent psychopathology have implications for the adaptation and delivery of substance abuse treatment services to boys and girls to improve their engagement and treatment outcomes.

Differential typologies of current substance use among Black and White high-school adolescents: A latent class analysis

Black and White adolescents demonstrate different prototypical profiles (i.e., typologies) of substance use, with Blacks demonstrating lower risk for concurrent use of two or more substances. Despite knowledge of these differences, typologies of adolescent substance use identified by person-centered methods, such as latent class analysis, have not characterized profiles by racial group. The current study examined typologies of substance use among Black and White youth separately using person-centered methods to identify common patterns of substance use among subjects. Data were drawn from a 5-year parent study examining adolescent health outcomes. The current study examined high-school aged White (n = 7271, 45.4% male) and Black youth (n = 1301, 40.1% male) who reported past-30-day frequency of cigarette, alcohol, marijuana, inhalant, and other drug use. Latent class analysis was used to examine substance use typologies among each group adjusting for grade and sex. Black and White youth demonstrated different typologies such that four typologies emerged among Blacks: Non-Use (87.8%), Alcohol and Marijuana Use (6.3%), Alcohol, Marijuana, and Cigarette Use (3.8%), and Frequent Polysubstance Use (2.0%). Conversely, five typologies emerged among Whites: Non-Use (73.4%), Predominant Alcohol Use (13.9%), Alcohol, Marijuana, and Cigarette Use (9.4%), Moderate Polysubstance Use (1.6%), and Frequent Polysubstance Use (1.7%). Findings suggest that Black and White youth engage in similar rates of concurrent substance use. Given that Black youth face greater risk for adverse consequences from substance use, prevention efforts are needed to prevent related health disparities related to concurrent substance use.

Substance Use among Adolescent High School Students in Nigeria and Its Relationship with Psychosocial Factors

Background: Despite the tremendous negative consequences of substances on the health and well-being of adolescents, studies continue to report the high rates of substance use among adolescents. We aimed to identify the pattern of substance use among high school students and its relationship with psychosocial factors.

Study design: A cross-sectional study.

Methods: The study was conducted in Oct 2019 among students in the senior secondary school in Ado-Ekiti, Ekiti State; southwestern Nigeria. Participants were selected using random sampling, and data were collected using a socio-demographic questionnaire, the Kessler Psychological distress scale and an adapted version of the NIDA-Modified ASSIST. Bivariate analysis and multiple logistic regression were carried out to identify factors associated with psychological distress.

Results: Overall, 682 students participated in the study. The lifetime and current prevalence of any substance were 17.3% (95% CI: 14.7%, 20.5%) and 11.7% (95% CI: 9.0, 14.0), respectively. Although most substance use variables increases the risk of psychological distress, history of lifetime substance use AOR= 3.03 (95% CI: 1.19, 7.72, P =0.020) and absence of direct parental care AOR=2.04 (1.19, 3.48, P=0.009) significantly increases the risk of experiencing psychological distress. Parental substance use AOR=3.48 (95% CI: 1.57, 7.69, P =0.002), male gender AOR=2.97 (95% CI: 1.82, 4.83, P=0.001) significantly increased substance use risk while having married parents AOR=0.50 (95% CI: 0.27, 0.92, P=0.027) and living with parents AOR 0.39 (95% CI: 0.20, 0.75, P =0.005) were significant protective factors.

Conclusion: The prevalence of substance use among these adolescents was substantial. Drug education initiated in primary school and services aimed at promoting the mental wellbeing of adolescents may go a long way in decreasing substance use among this population.

Clinical characteristics distinguishing tramadol-using adolescents from other substance-using adolescents in an out-patient treatment setting

BACKGROUND

Non-medical Prescription Opioid Use (NMPOU) has increased worldwide during the last decades, and specifically, tramadol misuse may represent a novel pattern of substance use among adolescents. The present study aims to analyze characteristics distinguishing tramadol-using adolescents from other substance-using adolescents seeking out-patient treatment.

METHODS

This is a cross-sectional study of treatment-seeking patients between 13 and 24 years of age in an out-patient facility for substance use problems in Malmö, Sweden. A total of 526 treatment-seeking adolescents at an out-patient treatment center were included. Data on substance use, treatment history and socio-demographic variables were extracted through a semi-structured interview method aimed specifically for adolescents with alcohol or drug problems (Ung-DOK). Lifetime tramadol users were compared to non-users, and also, primary tramadol users were compared to remaining subjects.

RESULTS

Thirty-one percent (n = 162) were tramadol users (lifetime prevalence). In logistic regression, the tramadol group showed a significantly increased risk of tobacco use, problematic lifetime cocaine, benzodiazepine and amphetamine use, and were more likely to report contacts with the judicial system, and less likely to report contacts with child or adult psychiatry, and more likely to have parents born outside the Scandinavian countries. In logistic regression, primary tramadol use was negatively associated with frequent cannabis use.

CONCLUSIONS

Tramadol use appears to be a novel pattern among treatment-seeking adolescents. They showed a significantly increased risk of initiation of other illicit drugs and criminal behaviour, despite less contact with psychiatric care. More attention may be needed to this relatively novel pattern of opioid use.

Factors Associated with Poly Drug Use in Adolescents

Poly drug use in adolescents represents a significant public health issue, heightening risk for abuse, dependency, and a variety of short- and long-term psychological, psychosocial, and health consequences. However, past studies have typically examined just one or two substances in isolation and there is a lack of research that has comprehensively examined possible predictors of poly drug use in adolescents. To inform the development of comprehensive prevention programs that can simultaneously target multiple substances, the present study sought to identify psychological, environmental, and demographic factors that are most strongly associated with alcohol, tobacco, and cannabis poly drug use. Adolescents aged 15 to 17 years (n = 1661; 50.9% male) completed a survey on their use of alcohol, tobacco, and cannabis over the last 30 days. Various psychological, environmental, and demographic factors were also assessed. Weighted multiple-level logistic regression was conducted to assess the factors associated with poly drug use. In total, 20.3% of respondents had used at least one substance, 6.7% reported using two substances, and 3.3% reported using all three substances. The most common combined pattern of use was alcohol and tobacco, followed by alcohol and cannabis. Several factors emerged as significant, with conduct problems, depression, and the school environment accounting for the most variance. Specific psychological and environmental factors appear to be particularly important domains to target in adolescent substance use prevention programs. Early identification of adolescent depression and conduct problems and the development of programs that address these symptoms in youth may be effective approaches to delaying or preventing poly drug use in this population.

Heavy drinking in adolescents is associated with change in brainstem microstructure and reward sensitivity

Heavy drinker adolescents: altered brainstem microstructure.

Exploring Cannabis and Alcohol Co-Use in Adolescents: A Narrative Review of the Evidence

Objective: Amidst the evolving policy surrounding cannabis legalization in the United States, cannabis use is becoming increasingly prevalent as perceptions of harm decrease, particularly among adolescents. Cannabis and alcohol are commonly used by adolescents and are often used together. However, developmental research has historically taken a "single substance" approach to examine the association of substance use and adolescent brain and behavior rather than examining co-(or poly-substance) use of multiple substances, such as cannabis and alcohol. Thus, the acute effects of cannabis and alcohol, and the impact of co-use of cannabis and alcohol on the adolescent brain, cognitive function and subsequent psychosocial outcomes remains understudied. This narrative review aims to examine the effects of cannabis and alcohol on adolescents across a number of behavioral and neurobiological outcomes. Methods: The PubMed and Google Scholar databases were searched for the last 10 years to identify articles reporting on acute effects of cannabis and alcohol administration, and the effects of cannabis and alcohol on neuropsychological, neurodevelopmental, neural (e.g., structural and functional neuroimaging), and psychosocial outcomes in adolescents. When adolescent data were not available, adult studies were included as support for potential areas of future direction in adolescent work. Results: Current studies of the impact of cannabis and alcohol on adolescent brain and behavior have yielded a complicated pattern. Some suggest that the use of cannabis in addition to alcohol during adolescence may have a "protective" effect, yielding neuropsychological and structural brain outcomes that are better than those for adolescents who use only alcohol. However, other adolescent studies suggest that cannabis and alcohol co-use is associated with negative health and social outcomes such as poorer academic performance and impaired driving. Conclusion: Variation in study methodologies, policy-level limitations and our limited understanding of the developmental neurobiological effects of cannabis preclude the straightforward interpretation of the existing data on adolescent cannabis and alcohol use. Further research on this topic is requisite to inform the development of effective intervention and prevention programs for adolescent substance users, which hinge on a more comprehensive understanding of how cannabis-and its intersection with alcohol-impacts the developing brain and behavior.

The changing patterns and correlates of population-level polysubstance use in Australian youth: a multi-group latent class analysis of nationally representative samples spanning 12 years

AIMS

To (1) identify population-level classes of polysubstance use among young Australians between 2004 and 2016, (2) test if these classes changed over the same period, in terms of class prevalence and probabilities of substance use within each class, and (3) identify demographic and health-related correlates of polysubstance use.

DESIGN

Repeated cross-sectional nationally representative household surveys.

SETTING

All Australian states/territories.

PARTICIPANTS

Young adult samples (aged 18-30 years; 58% females) from the National Drug Strategy Household Surveys (n = 20 350) MEASUREMENTS: Outcomes were the extent of past-year use of 10 licit (e.g. alcohol), and illicit substances (e.g. cannabis) were used to derive polysubstance use classes. The correlates were gender, age, psychological distress, general health, language background, personal income, education level, remoteness of residence and socio-economic index for area of residence.

FINDINGS

Three polysubstance use classes were consistently identified between 2004 and 2016 (SSABIC: 188349): minimal users (MU, ~60%), mainly tobacco, alcohol and cannabis users (TAC, ~30%) and extended range polysubstance users (POLY, ~10%). There were substantial changes in use of different substances within each class over the study period. For example, smoking decreased in all classes (P < 0.05), while harmful alcohol use only decreased in the first two classes (P < 0.05). Factors associated with TAC and POLY were similar over the study period. These included: being male and having an English-speaking background, a high level of psychological distress, suboptimal health and high personal income. Living in an affluent area was associated with reduced likelihood of being TAC, but an increased likelihood of being POLY.

CONCLUSION

At the population-level among young Australians between 2004 and 2016, six in 10 did not engage in polysubstance use; four in 10 used a limited range of substances (mainly alcohol, tobacco and cannabis) and one in 10 used an extended range of substances. Over time, the types of substance within the extended polysubstance use class changed substantially.

Cigarette Smoking, Mental Health, and Other Substance Use among Court-Involved Youth

Background: Justice-involved youth are at risk to become cigarette smokers as they age, leading to a variety of poor health outcomes. However, little is known about cigarette use among justice-involved youth, especially youth supervised in the community where there is ample opportunity to smoke. Objective: This study investigates the prevalence of cigarette smoking and the associations between cigarette smoking, emotional and behavioral functioning, and other substance use among a sample of first-time offending court-involved, non-incarcerated (FTO-CINI) youth. Methods: Youth were recruited from a family court in the Northeast (N = 423). Substance use was self-reported using the Adolescent Risk Behavior Assessment (ARBA). Emotional and behavioral functioning was measured using the Behavior Assessment Schedule for Children-Second Edition (BASC-2), the Affect Dysregulation Scale (ADS), National Stressful Events Survey PTSD Short Scale (NSESSS), and the National Survey of Self-Reported Delinquency (NYS-SRD). Results: About 9.9% of FTO-CINI youth had smoked cigarettes in the past 30 days. Compared with FTO-CINI youth who had not smoked recently, recent smokers endorsed more emotional and behavioral symptoms, such as school problems (p < .001), internalizing problems (p = .012), inattention/hyperactivity (p = .020), affect dysregulation (p = .044), PTSD symptoms (p = .006), and delinquent behavior (p < .001). Recent smokers were also more likely to use alcohol (OR = 5.61, p < .001), marijuana (OR = 11.27, p < .001), and other drugs (OR = 5.00, p < .001). Conclusions: Recent smoking was higher among FTO-CINI youth than youth in the general population. Findings underscore the need to incorporate nicotine into existing substance use prevention interventions for this population, who are at high risk to initiate cigarette use as they age.

Predicting Adolescent Substance Use in a Child Welfare Sample: A Multi-Indicator Algorithm

Given the risk of substance use (SU) among adolescents in the child welfare system, identification of risk for prospective impairing SU behaviors is a significant public health priority. We sought to quantify the incremental validity of routine multi-informant assessments of adolescent psychological distress (i.e., the Child Behavior Checklist and Youth Self-Report) and a commonly used SU screening protocol (i.e., the CRAFFT) to predict SU at 18 and 36 months after baseline in a nationally representative child welfare sample (N = 1,054; M_age = 13.72). We used receiver operator characteristics and reclassification analyses to develop our algorithms. We found that a battery consisting of baseline CRAFFT scores, self-reported delinquent behavior, and parent-reported rule-breaking behavior provided an incrementally valid prediction model for SU behavior among females, while baseline CRAFFT scores and self-reported delinquent behavior incrementally predicted SU for males. Results suggest that leveraging existing assessments within the child welfare system can improve forecasting of SU risk for this population.

Protective Factors Buffer Life Stress and Behavioral Health Outcomes among High-Risk Youth

This study investigated internalizing problems, externalizing problems, and polydrug use among African-American youth residing in high-poverty neighborhoods, and tested the potential protective effects of religiosity, parental monitoring, and neighborhood collective efficacy on life stress and behavioral health outcomes (N = 576; 307 females; Mage = 16 years, SD = 1.44 years). A cumulative risk index reflected the combined effects of past year exposure to stressful life events, racial discrimination, and exposure to violence along with poor neighborhood ecology. Structural equation modeling revealed that cumulative risk significantly predicted internalizing problems, externalizing problems, and polydrug use. Interaction tests showed that the association of cumulative risk with internalizing problems was buffered by adolescent religiosity and neighborhood collective efficacy. The association of cumulative risk with externalizing problems was buffered by parental monitoring and collective efficacy. Adolescent sex further moderated these effects. The findings of the present study collectively highlight potential for protective factors to buffer effects of cumulative risk on behavioral health outcomes among youth residing in high-risk neighborhoods.

"It just depends on the environment": Patterns and decisions of substance use and co-use by adolescents

This study used rich qualitative data to examine the role that social and physical contexts play in decision-making related to simultaneous use of alcohol and marijuana among adolescents. In-depth, semi-structured interviews were conducted with 13 adolescents who used alcohol and marijuana within several hours of each other. Decisions about whether to use alcohol and marijuana simultaneously as well as use patterns (e.g. the sequence in which substances were used) were informed by the context and the desired effect of the substance(s). Also, simultaneous alcohol and marijuana use was described as occurring in multiple contexts, both destination and transitional. Interventions designed to reduce simultaneous alcohol and marijuana use could benefit from paying attention to substance use contexts.

Gender-specific substance use patterns and associations with individual, family, peer, and school factors in 15-year-old Portuguese adolescents: a latent class regression analysis

BACKGROUND

Adolescence is a critical period of vulnerability to substance use. Recent research has shown that gender differences in adolescence substance use are complex and in constant flux. The present study aims to investigate gender differences in substance use and initiation patterns in male and female adolescents, and to assess individual, family, peer, and school associated factors of these patterns.

METHODS

We applied latent class regression analysis to a Portuguese representative population sample of 1551 15-year-old adolescents, drawn from the 2010 'Health Behavior in School-Aged Children' survey, to characterise different profiles of substance use and initiation for boys and girls, and to identify factors associated with latent class membership, stratifying the associations analysis by gender.

RESULTS

Three common classes were found for both genders, specifically, Non-Users (boys [B] 34.42%, girls [G] 26.79%), Alcohol Experimenters (B 38.79%, G 43.98%) and Alcohol and Tobacco Frequent Users (B 21.31%, G 10.36%), with two additional unique classes: Alcohol Experimenters and Tobacco Users in girls (18.87%), and Early Initiation and Poly-Substance Users in boys (5.48%). Poor school satisfaction, bullying, fighting and higher family affluence scale score formed a common core of associated factors of substance use, although we found gender differences in these associations. In girls, but not in boys, family factors were associated with more problematic substance use. Not living with both parents was associated with girl's Alcohol and Tobacco Frequent Users (gATFU) class (OR 3.78 CI 1.18-12.11) and Alcohol Experimenters and Tobacco Users (AETU) class (OR 3.22 CI 1.4-7.44). Poor communication with mother was also associated with gATFU class membership (OR 3.82 CI 1.26-11.53) and AETU class (OR 3.66 CI 1.99-6.75). Additionally, a higher psychological symptoms score was associated with gATFU class membership (OR 1.16 CI 1.02-1.31).

CONCLUSION

Although we found common patterns and associated factors between boys and girls, we report two unique patterns of substance use in boys and girls and specific associations between family, school and peers, and individual factors with these patterns. These findings underscore the need for substance use prevention and health promotion programmes that address potential differences in substance use patterns and associated factors.

Longitudinal patterns of amphetamine use from adolescence to adulthood: A latent class analysis of a 20-year prospective study of Australians

BACKGROUND

To examine the longitudinal patterns of amphetamine use over twenty years from adolescence to the mid-thirties; and identify adolescent antecedents of future problematic patterns of use.

DESIGN

Ten-wave longitudinal study following participants from age 15 to age 35 in Victoria, Australia. Participants (N = 1755; 47% males) first enrolled in the Victoria Adolescent Health Cohort Study in 1992.

MEASUREMENTS

Outcome: Self-reported frequency of amphetamine use.

PREDICTORS

Gender, depression and anxiety, peer alcohol and tobacco use; self-reported alcohol, tobacco and cannabis use, self-reported adolescent antisocial behavior.

FINDINGS

Three different longitudinal patterns were identified: Non-user (83.7%); Occasional user (14.5%); Regular user (1.8%). Among the two user patterns, amphetamine use was commonly initiated in late teenage years or early 20s, peaked at mid-20s, and declined substantially by mid-30s. Participants who used cannabis and had smoking peers during adolescence were at significantly more likely to become an occasional or regular user (p <  .05).

CONCLUSION

Regular cannabis use and peer tobacco use during adolescence were the two strongest predictors of a longitudinal pattern of regular amphetamine use in the mid-30s. This suggests that prevention programs could be implemented around or before mid-adolescence and interventions to reduce amphetamine harms focus on high-risk individuals in their 20s when amphetamine use was at its peak.

An Examination of Gender Differences in the Association of Adolescent Substance use with Eating and Weight Loss Attitudes

OBJECTIVE

To assess gender differences in the relationship between eating and weight loss attitudes (EWAs), and 30-day tobacco and alcohol use among adolescents, while controlling for potential confounds (age, country of birth, psychological distress, pubertal development, peer alcohol and tobacco use, and sexual activity).

METHODS

School students aged between 11 and 17 years (N = 10,273) from high schools in the State of Victoria (Australia) completed surveys in class under conditions of anonymity and confidentiality.

RESULTS

The interaction between EWAs and gender was significant for tobacco use but not for alcohol use, indicating that the effect of EWAs on tobacco use, but not alcohol use, vary by gender.

CONCLUSIONS

Tobacco use was related to EWAs in adolescent females but not males, and this is consistent with the possibility that females use tobacco in an instrumental fashion to control weight. Implications and Contribution: Female adolescents high in eating and weight loss attitudes were more likely to engage in tobacco use. In contrast, eating and weight loss attitudes were not related to male tobacco use. These results point to the potential importance of developing gender-specific approaches towards addressing problematic behaviors in adolescent populations.

Perceived Discrimination and Substance Use among Adolescents: Examining the Moderating Effect of Distress Tolerance and Negative Urgency

BACKGROUND

Perceived discrimination has been found to increase substance use vulnerability among adolescent populations. However, less is known about individual level factors which may moderate this risk.

OBJECTIVES

The aim of the current study is to examine whether two emotion-based personality traits (i.e., distress tolerance and negative urgency) moderates the effect of perceived discrimination on substance use. We hypothesized that high distress tolerance would decrease risk, while high negative urgency would increase risk for substance use as a consequence of discrimination.

METHODS

108 youth ages 12-18 (68.6% male; 56.2% African-American) provided data on perceived discrimination, distress tolerance, negative urgency, and substance use (i.e., alcohol and marijuana use).

RESULTS

Contrary to our hypothesis, no moderating effect was observed for negative urgency. Distress tolerance was found to moderate the relationship, but in the opposite direction than expected.

CONCLUSIONS

It is speculated that this counterintuitive finding may be due to the racial/ethnic composition of the sample, suggesting that distress tolerance may operate differently among minority youth. Further research examining these relationships among minority youth is warranted.

Cream of the Crop: Clinical Representativeness of Eligible and Ineligible Cannabis Users in Research

BACKGROUND

Experts have recommended criteria (Gonzalez et al., 2002) for recruiting pure chronic cannabis users (i.e., those without polysubstance use or psychiatric illness) when evaluating cannabis' non-acute effects on cognition.

OBJECTIVES

We sought to demonstrate the implications of using such criteria by examining characteristics of respondents who completed an eligibility screening for a parent study evaluating the cognitive effects of chronic cannabis use.

METHODS

Over a 3-year, 8-month period, 612 respondents from the community completed an eligibility screening based on recommendations in the cannabis literature. Using independent samples t-tests and chi-square tests, we examined whether qualified/eligible respondents (n = 219) differed from non-qualified/ineligible respondents (n = 393).

RESULTS

Compared to ineligible cannabis users, eligible cannabis-using respondents were significantly younger, used cannabis more frequently, used alcohol less frequently, and were less likely to have a history of other drug use, a psychiatric diagnosis, or to have used psychiatric medication. Conclusions/Importance: Our findings indicate that eligible/pure cannabis users are not representative of typical cannabis users in the general community (i.e., ineligible users with polysubstance use and/or psychiatric diagnoses) who ultimately comprised the majority of our cannabis-using sample (65.2%). Thus, typical cannabis users may be more accurately characterized as polysubstance users, posing a number of challenges related to the generalizability of findings from studies utilizing pure samples of cannabis users. Recruiting samples of typical cannabis users will improve external validity in research. Furthermore, reporting comprehensive characteristics of such samples will enable consumers to gauge the applicability of study findings to populations of interest.

Neurobiology of substance use in adolescents and potential therapeutic effects of exercise for prevention and treatment of substance use disorders

Substance use (e.g., alcohol, marijuana, opioids, cocaine., etc,) use often initiates during adolescence, a critical period of physiological and social development marked by an increase in risk-taking due, in part, to heightened motivation to obtain arousal from rewards. Substance use during adolescence has been associated with a greater risk of substance use disorders (SUD) in adulthood. Although use rates for most substances have remained relatively stable, the frequency of marijuana use and the perception that regular marijuana use is not harmful has increased in adolescents. Furthermore, the nonmedical use of opioids has increased, particularly in the South, Midwest, and rural low-income communities. Substance use in adolescence has been associated with adverse structural and functional brain changes and, may exacerbate the natural "imbalance" between frontal/regulatory and cortical-subcortical circuits, leading to further heightened impulsive and reward-driven behaviors. Exercise increases growth and brain-derived neurotrophic factors that stimulate endogenous dopaminergic systems that, in turn, enhance general plasticity, learning, and memory. Exercise may help to reinforce the "naïve" or underdeveloped connections between neurological reward and regulatory processes in adolescence from the "bottom up" and "offset" reward seeking from substances, while concomitantly improving cardiovascular health, as well as academic and social achievement. In this review, we provide an overview of the current state of substance use in adolescents and rationale for the utilization of exercise, particularly "assisted" exercise, which we have shown increases neural activity in cortical-subcortical regions and may modulate brain dopamine levels during adolescence, a unique window of heightened reward sensitivity and neural plasticity, for the prevention and adjunctive treatment of SUD.

Long-term health outcomes of childhood sexual abuse and peer sexual contact among an urban sample of behaviourally bisexual Latino men

While previous research indicates high rates of childhood sexual abuse among Latino men who have sex with men, few studies have examined the long-term health outcomes of childhood sexual abuse specifically among behaviourally bisexual Latino men. In a sample of 148 behaviourally bisexual Latino men in New York City, we examined associations between childhood sexual abuse and multiple dimensions of adult health: sexual risk behaviours; sexually transmitted infections incidence; polydrug use; depressive symptoms; and perceived stress. We compared outcomes between those with histories of childhood sexual abuse, those reporting peer sexual contact prior to age 13 and those with no sexual contact prior to age 13. Over one-fifth (22.3%) reported a history of childhood sexual abuse, which was significantly associated with engaging in receptive condomless anal intercourse (aOR = 3.59, p < .01, SE = 2.0), high perceived stress (aOR = 2.48, p < .06, SE = 1.13) and clinically significant depressive symptoms (aOR = 2.7, p < .05, SE = 1.25). Across all variables, peer sexual contact did not impact these outcomes, underscoring a key distinction between abusive and non-abusive early sexual experiences. We recommend that sexual abuse prevention policies and programmes better engage Latino youth, and that practitioners serving this population across diverse areas of practice incorporate childhood sexual abuse screening and culturally appropriate treatment and care into practice.

Latent Classes of Substance Use Among American Indian and White Students Living on or Near Reservations, 2009-2013

OBJECTIVES

American Indian adolescents who reside on or near reservations report higher levels of substance use than adolescents in other racial/ethnic groups. Little research has addressed patterns of use, which have important implications for prevention and treatment planning. The objective of our study was to describe substance use among a large, population-based sample of American Indian and white students who lived on or near reservations.

METHODS

We obtained data from 4964 students in grades 7-12 attending 46 schools on or near reservations throughout the United States during 4 academic years (2009-2013). Measures assessed current substance use for alcohol, heavy drinking, marijuana, cigarettes, inhalants, and other drugs. We used latent class analysis to identify patterns of substance use by grade group (grades 7-8 and grades 9-12) and race (American Indian or white).

RESULTS

For American Indians in both grade groups, we found 4 classes of substance use (in order of size): (1) nonusers; (2) marijuana and cigarette users; (3) alcohol, marijuana, and cigarette users; and (4) polysubstance users. For white students, we found 2 classes (nonusers and polysubstance users) among younger students and 4 classes (nonusers; alcohol, marijuana, and cigarette users; alcohol and cigarette users; and polysubstance users) among older students.

CONCLUSION

We found significant differences in substance use patterns, especially at younger ages, between reservation American Indian students and white students attending the same schools. Combinations of substances used by American Indian adolescents were most likely to include marijuana, as compared with alcohol for white adolescents. Identifying subpopulations of users allows the design of interventions that will more efficiently and effectively address prevention and treatment needs of groups of individuals than would a one-size-fits-all approach.

A virtual academy of polydrug use: Masters, novices and the art of combinations

Aims

Information technology has become an essential part of drug culture, providing a platform for lay knowledge concerning drug use. Due to the co-effects of different substances, making substance "combos" requires advanced skills to enhance pleasures and manage risks. In this study, we focussed on Finnish and Swedish online discussions as a context for learning and sharing experiences of combining substances.

Methods

Taking influences from positioning theory, we used qualitative methods to map what kinds of mutual interactive positions related to the expertise in polydrug use online discussants take and how these positions are negotiated and reformulated in the online setting. We reflect these results through Howard S. Becker's theory of social learning, according to which becoming a drug user is a process that occurs in interaction with other users, as the beginners need a model and advice from experienced users in order to claim their place in the users' community.

Results

In online forums, users discuss the risks and pleasures of combining drugs - on the one hand, in relation to different situations and, on the other hand, in relation to different competence positions. This occurs by asking for advice, presenting one's knowledge, challenging others, repositioning oneself, defending one's position or proving one's competence.

Conclusion

Online discussion forums constitute a kind of virtual academy where knowledge of the pleasures and risks of combining substances is produced and circulated, and where experienced masters mediate their expertise to less experienced novices.

School Nurses on the Front Lines of Medicine: Uppers and Downers: The Approach to the Student With Altered Mental Status

Although a student presenting with altered mental status due to substance use may occur infrequently in the school setting, it is of utmost importance to develop a differential diagnosis and to initiate stabilization of the student. This article describes the initial assessment and management of a student presenting with altered mental status, focusing on the differential diagnosis of altered mental status, on the varying presentations associated with common intoxications and ingestions, and on the screening tools available for the detection of depression and substance use.

Trends in typologies of concurrent alcohol, marijuana, and cigarette use among US adolescents: An ecological examination by sex and race/ethnicity

Substance use during adolescence is a public health concern due to associated physical and behavioral health consequences. Such consequences are amplified among concurrent substance users. Although sex and racial/ethnic differences in single-substance use have been observed, the current literature is inconclusive as to whether differences exist in the prevalence of concurrent use. The current study used data from the 2011-2014 National Survey on Drug Use and Health to examine typologies (single and concurrent patterns) of alcohol, marijuana, and cigarette use among current adolescent users age 12-18 by sex and race/ethnicity. Participants were 14,667 White, Hispanic, African American, Asian, and Native American adolescents. The most common typology was alcohol only, followed by concurrent use of alcohol and marijuana. Weighted prevalence estimates indicated that adolescent females were more likely to be current users of alcohol only, whereas male adolescents were more likely to belong to all other typologies. Compared to Whites, racial/ethnic minorities had larger proportions of marijuana only users and were generally less likely than or equally likely to be concurrent users. One exception was for African American adolescents, who were more likely to be alcohol and marijuana users than their White counterparts. Results suggest that concurrent substance use is common among U.S. adolescents, making up over 40% of past-month use, but typologies of use vary by sex and race/ethnicity. Preventive interventions should consider all typologies of use rather than only single substance exposures and address patterns of use that are most pertinent to adolescents based on sex and race/ethnicity.

Polysubstance Use Among Adolescents in a Low Income, Rural Community: Latent Classes for Middle- and High-School Students

PURPOSE

Rural communities are currently being impacted by a nationwide epidemic of prescription opioid misuse. Rural adolescent substance users may be at substantial risk for later addiction to these and other drugs.

METHODS

This study uses Latent Class Analysis to identify subtypes of polysubstance users among a sample of 7,074 rural adolescents. Separate models were estimated for middle- and high-school youth. Predictive validity was estimated using cumulative ordinal logistic regression of the classes on a set of youth and family characteristics.

FINDINGS

We identified a 4-class solution for both middle- and high-school students marked by initiation of an increasing number of substances used at greater frequency. These classes included Substance Nonusers, Primarily Alcohol Users, Initiators-Low Frequency Users, and Initiators-Moderate-to-High Lifetime Frequency Users. About 6%-10% of youth reported using prescription drugs at least once, and in the moderate-to-high frequency class, middle-school youth were more likely to use prescription drugs and inhalants compared to high-school youth in the same class. The 4 classes were associated with race/ethnicity, and in high school with receiving free/reduced price lunch.

CONCLUSION

In general, younger adolescents have lower overall use rates, but within certain classes identified by this analysis, the observed pattern suggests that younger cohorts are turning to prescription drugs and inhalants. These findings support the implementation of universal substance use prevention programs, targeted programs for youth experiencing risk factors associated with substance use, and improved rural substance abuse treatment options.