Frequent intoxication and alcohol tolerance in adolescence: associations with psychiatric disorders in young adulthood

Covariates in studies examining longitudinal relationships between substance use and mental health problems among youth: A meta-epidemiologic review

INTRODUCTION

This meta-epidemiological review examines covariate selection and reporting practices in observational studies analyzing longitudinal relationships between youth substance use and mental health problems (internalizing and externalizing).

METHODS

Sixty-nine studies published in high-impact journals from 2018 to 2023 were included. Studies were included if they explored prospective relationships between substance use and mental health among youth (12-25 years) and used repeated measures designs. Data extraction focused on study characteristics, covariates and their selection methods, and reporting practices.

RESULTS

There were 574 covariates included across studies; 33 were included as moderators and 18 were included as mediators. At the study level, the most common covariate domains included demographics (90 % of included studies had at least one demographic, mostly sex), substance-related variables (67 %; mostly alcohol or smoking), internalizing symptoms (39 %; mostly depression), family-related variables (29 %; mostly parental substance use or mental illness), and externalizing symptoms (19 %; mostly conduct). 93 % of studies had unique sets of lower-order covariates. Across all studies (n = 69), only 35 % provided details for how, and why, all covariates were selected with only 12 % reporting selecting covariates a priori, and none being pre-registered. Only 60 % mentioned confounding and only 13 % mentioned risk of confounding in their conclusions.

CONCLUSIONS

The findings highlight the need for improved covariate selection and reporting practices. Establishing a core set of covariates and adhering to standardized reporting guidelines would enhance the comparability and reliability of research findings in this field. Researchers can use this review to identify and justify the inclusion and exclusion of commonly reported covariates when analyzing relationships between youth substance use and mental health problems.

Adolescent alcohol and cannabis use and early adulthood educational attainment in the 1986 Northern Finland birth cohort study

BACKGROUND

Heavy alcohol and cannabis use during adolescence have been previously described as risk factors not only for morbidity in adulthood, but also social problems including adversities in educational attainment. Attempts to consider overlapping risk factors and confounders for these associations are needed.

METHODS

Using weighted multivariable models, we examined prospective associations between age at first drink (AFD), age at first intoxication (AFI), frequency of alcohol intoxication, as well as self-reported alcohol tolerance (i.e., number of drinks needed for the subjective experience of intoxication), and lifetime cannabis use at age 15/16 years with subsequent educational attainment obtained from comprehensive registers until age 33 in the Northern Finland Birth Cohort 1986 (6,564 individuals, 49.1% male). Confounding variables including sex, family structure (intact vs. non-intact), maternal and paternal education level, behavioural/emotional problems in school at age 7/8 years, having a history of illicit substance use in adolescence, having any psychiatric diagnosis before age 16, and parental psychiatric diagnoses, were adjusted for.

RESULTS

In this large birth cohort study with a 17-year follow-up, younger age at first intoxication, higher frequency of alcohol intoxication, and high self-reported alcohol tolerance at age 15/16 years were associated with poorer educational outcomes by the age of 33 years. These associations were evident regardless of potential confounders, including parental education and childhood behavioural/emotional problems. The association between adolescent cannabis use and educational attainment in adulthood was no longer statistically significant after adjusting for confounders including frequency of alcohol intoxication at age 15/16.

CONCLUSIONS

Assessments of age of first alcohol intoxication, high self-reported alcohol tolerance and frequency of intoxication during adolescence should be included when implementing screening strategies aimed at identifying adolescents at risk for subsequent social problems.

Adolescent alcohol and cannabis use as risk factors for head trauma in the Northern Finland Birth Cohort study 1986

BACKGROUND

The aim of this study was to assess the associations between cannabis use and frequency of alcohol intoxication in adolescence with the risk of traumatic brain injury and craniofacial fractures in early adulthood. Hypothesis was that using alcohol and cannabis in adolescence could increase the risk for head traumas.

METHODS

Data from the Northern Finland Birth Cohort 1986 (n = 9432 individuals) were used to investigate the prospective association between the self-reported frequency of alcohol intoxication (n = 6472) and cannabis use (n = 6586) in mid-adolescence and register-based, head trauma diagnoses by ages 32-33 years. To test the robustness of these associations, the statistical models were adjusted for a range of other confounders such as illicit drug use, previous head trauma and self-reported mental health problems.

RESULTS

In multivariate analyses, cannabis use was statistically significantly associated with a greater risk of traumatic brain injury among females [hazard ratio (HR) 1.9, 95% confidence interval (CI) 1.1-3.2, P = 0.024). Frequent alcohol intoxication was a statistically significant independent risk factor for both traumatic brain injury (HR 2.6, 95% CI 1.7-3.9, P < 0.001) and craniofacial fractures (HR 2.7, 95% CI 1.6-4.8, P < 0.001) among males.

CONCLUSIONS

Cannabis use in adolescence appears to associate independently with elevated risk for traumatic brain injury among females, and frequent alcohol intoxication in adolescence seems to associate with elevated risk of both traumatic brain injury and craniofacial fractures among males.

The relationships between use of alcohol, tobacco and coffee in adolescence and mood disorders in adulthood

INTRODUCTION

Alcohol, tobacco and coffee are commonly used substances and use in adolescence has previously been linked to mood disorders. However, few large prospective studies have investigated adolescent use in relation to mental health outcomes in adulthood. The main aim of this study was to examine the prospective associations between alcohol use, cigarette smoking and coffee consumption at age 16 and subsequent mood disorders up to 33 years of age.

METHODS

Data from The Northern Finland Birth Cohort 1986 Study were used and a total of 7660 participants (49.9% male) were included. Associations between alcohol use, cigarette smoking and coffee consumption at age 16 and later diagnoses of major depression and bipolar disorder were examined using multinomial logistic regression analyses.

RESULTS

Mean number of cigarettes/day (OR, 1.23 [95% CI 1.01-1.50]) and mean volume of alcohol consumption (OR, 1.22 [95% CI 1.01-1.47]), but not frequency of excessive drinking, in adolescence were associated with increased risk for subsequent bipolar disorder after adjustment for sex, parental psychiatric disorders, family structure, illicit substance use, and emotional and behavioral problems at age 16. An association between cigarette smoking and major depression attenuated to statistically non-significant when adjusted for emotional and behavioral problems. No associations were observed between adolescent coffee consumption and subsequent mood disorders.

CONCLUSIONS

This is the first study to report an association of adolescent cigarette smoking and subsequent bipolar disorder diagnosis providing grounds for further research and pointing to a place for preventive measures among adolescents.

Alcohol use in adolescence as a risk factor for overdose in the 1986 Northern Finland Birth Cohort Study

Background

Overdoses and poisonings are among the most common causes of death in young adults. Adolescent problem drinking has been associated with psychiatric morbidity in young adulthood as well as with elevated risk for suicide attempts. There is limited knowledge on adolescent alcohol use as a risk factor for alcohol and/or drug overdoses in later life.

Methods

Here, data from The Northern Finland Birth Cohort 1986 study with a follow-up from adolescence to early adulthood were used to assess the associations between adolescent alcohol use and subsequent alcohol or drug overdose. Three predictors were used: age of first intoxication, self-reported alcohol tolerance and frequency of alcohol intoxication in adolescence. ICD-10-coded overdose diagnoses were obtained from nationwide registers. Use of illicit drugs or misuse of medication, Youth Self Report total score, family structure and mother’s education in adolescence were used as covariates.

Results

In multivariate analyses, early age of first alcohol intoxication [hazard ratios (HR) 4.5, 95% confidence intervals (CI) 2.2–9.2, P < 0.001], high alcohol tolerance (HR 3.1, 95% CI 1.6–6.0, P = 0.001) and frequent alcohol intoxication (HR 1.9, 95% CI 1.0–3.4, P = 0.035) all associated with the risk of overdoses. Early age of first intoxication (HR 5.2, 95% CI 1.9–14.7, P = 0.002) and high alcohol tolerance (HR 4.4, 95% CI 1.7–11.5, P = 0.002) also associated with intentional overdoses.

Conclusions

Alcohol use in adolescence associated prospectively with increased risk of overdose in later life. Early age of first intoxication, high alcohol tolerance and frequent alcohol intoxication are all predictors of overdoses.

Substance use confounds associations between peer victimization and aggression in adolescence with mental disorders in adulthood: A prospective birth cohort study

INTRODUCTION

Peer victimization and aggression in adolescence are associated with later mental health morbidity. However, studies examining this association have not controlled for adolescent substance use. We aimed to study the associations between peer victimization, peer aggression, and mental disorders in adulthood, adjusting for substance use in adolescence.

METHODS

Participants were from the prospective Northern Finland Birth Cohort 1986. Data were available for 6682 individuals (70.8% of the original sample). Peer victimization and peer aggression were assessed with items from the Achenbach Youth Self Report at ages 15-16 years. Outcomes were nonorganic psychosis, anxiety disorder, mood disorder, substance use disorder, and any mental disorder (a none-vs-any indicator) at age 33 years collected from nationwide health care, insurance, and pension registers. Family structure, alcohol intoxication frequency, daily smoking, illicit drug use, and baseline psychopathology using Youth Self-Report total score, and parental mental disorders were considered as confounding factors.

RESULTS

In multivariable analyses, the association between peer victimization and psychosis (Hazard ratio [HR]: 2.9, 95% confidence interval [CI]: 1.2-6.9, p = .020) and mood disorder (HR: 1.7, 95% CI: 1.2-2.4, p = .012) in females remained significant after adjusting for confounders. Other associations between female and male peer victimization or aggression and the studied outcomes attenuated after adjustments.

CONCLUSIONS

Some associations between peer victimization and aggression and later mental health morbidity are explained by adolescent substance use. For females, substance use does not account for the increased risk of psychosis and mood disorder in those who experience peer victimization.

Long-term consequences of alcohol use in early adolescent mice: Focus on neuroadaptations in GR, CRF and BDNF

Our aim was to assess the cognitive and emotional state, as well as related-changes in the glucocorticoid receptor (GR), the corticotropin-releasing factor (CRF) and the brain-derived neurotrophic factor (BDNF) expression of adolescent C57BL/6J male mice after a 5-week two-bottle choice protocol (postnatal day [pd]21 to pd52). Additionally, we wanted to analyse whether the behavioural and neurobiological effects observed in late adolescence (pd62) lasted until adulthood (pd84). Behavioural testing revealed that alcohol during early adolescence increased anxiety-like and compulsive-related behaviours, which was maintained in adulthood. Concerning cognition, working memory was only altered in late adolescent mice, whereas object location test performance was impaired in both ages. In contrast, novel object recognition remained unaltered. Immunohistochemical analysis showed that alcohol during adolescence diminished BDNF+ cells in the cingulate cortex, the hippocampal CA1 layer and the central amygdala. Regarding hypothalamic-pituitary-adrenal axis (HPA) functioning, alcohol abuse increased the GR and CRF expression in the hypothalamic paraventricular nucleus and the central amygdala. Besides this, GR density was also higher in the prelimbic cortex and the basolateral amygdala, regardless of the animals' age. Our findings suggest that adolescent alcohol exposure led to long-term behavioural alterations, along with changes in BDNF, GR and CRF expression in limbic brain areas involved in stress response, emotional regulation and cognition.

Hospitalisation following therapeutic community drug and alcohol treatment for young people with and without a history of criminal conviction

INTRODUCTION

This study examines the association between treatment in a therapeutic community for adolescents with drug and alcohol problems on hospitalisation outcomes up to 15 years later for all clients, and separately for those with and without a history of criminal conviction.

METHOD

A quasi-experimental design was used to examine the linked administrative health and criminal justice records for all adolescents admitted to the Program for Adolescent Life Management (PALM) from January 2001 to December 2016 (n = 3059) in Sydney, Australia. ICD-10AM codes were used to designate hospitalisation outcomes as either physical injury, mental health problems, substance use disorders, or organic illness. The treatment and comparison groups were matched on factors associated with program retention, resulting in a final sample of 1266 clients. We examined the rate of hospitalisation up to 15 years posttreatment for all clients and stratified by prior conviction status using Cox regression analyses.

RESULTS

The treatment group had significantly lower rates of hospitalisation for a physical injury (HR = 0.77 [95% CI = 0.61-0.98]), mental health problem (HR = 0.62 [95% CI = 0.47-0.81]), substance use disorder (HR = 0.59 [95% CI = 0.47-0.75]), and organic illness (HR = 0.71 [95% CI = 0.55-0.92]). There was a significant interaction between treatment and prior criminal conviction status on rate of hospitalisation for physical injury, suggesting that the effect of treatment on physical injury was significantly greater for clients with a prior criminal conviction.

CONCLUSIONS

Adolescents who engage in a therapeutic community treatment program may have a long-lasting reduction in the risk of subsequent hospitalisation. This also appears to apply to those with a history of criminal conviction.

Parental smoking and young adult offspring psychosis, depression and anxiety disorders and substance use disorder

Background

To study the associations between maternal smoking during pregnancy and paternal smoking before pregnancy and adult offspring psychiatric disorders.

Methods

Prospective general population cohort study in Northern Finland, with people from the Northern Finland Birth Cohort 1986: 7259 subjects (77% of the original sample). Data on parental smoking were collected from parents during pregnancy using questionnaires. Outcomes were offspring’s register-based diagnoses: any psychiatric disorder, any non-organic psychosis, mood disorder, anxiety disorder and substance use disorder (SUD) until the age of 29–30 years. Maternal smoking during pregnancy and paternal smoking before pregnancy were pooled to three-class variables: (i) none; (ii) 1–9 and (iii) ≥10 cigarettes/day. Information regarding both parents’ alcohol use during pregnancy and at offspring age 15–16 years, maternal education level, family structure, parental psychiatric diagnoses and offspring gender, smoking, intoxication frequency and illicit substance use at the age of 15–16 years were investigated as covariates.

Results

In the multivariable analyses, maternal smoking during pregnancy did not associate with the studied outcomes after adjusting for offspring smoking and other substance use at offspring age 15–16 years and parental psychiatric disorders. However, paternal smoking ≥10 cigarettes/day before pregnancy [hazard ratio (HR) = 5.5, 95% confidence interval (CI) 2.7–11.2, P < 0.001] and paternal psychiatric disorders (HR = 1.7, 95% CI 1.1–2.8, P = 0.028) associated with offspring SUD after adjustments.

Conclusions

Information across the offspring life course is essential in exploring the association between parental smoking and offspring psychiatric disorders. Paternal smoking before pregnancy and paternal psychiatric disorders may act as modifiers in elevating the risk of substance-use-related problems among offspring.

Age of first alcohol intoxication and psychiatric disorders in young adulthood - A prospective birth cohort study

OBJECTIVE

Early onset of alcohol use is associated with an increased risk of substance use disorders (SUD), but few studies have examined associations with other psychiatric disorders. Our aim was to study the association between the age of first alcohol intoxication (AFI) and the risk of psychiatric disorders in a Finnish general population sample.

METHODS

We utilized a prospective, general population-based study, the Northern Finland Birth Cohort 1986. In all, 6,290 15-16-year old adolescents answered questions on AFI and were followed up until the age of 33 years for psychiatric disorders (any psychiatric disorder, psychosis, SUD, mood disorders and anxiety disorders) by using nationwide register linkage data. Cox-regression analysis with Hazard Ratios (HR, with 95% confidence intervals (CI)) was used to assess the risk of psychiatric disorders associated with AFI.

RESULTS

Statistically significant associations were observed between AFI and any psychiatric disorder, psychosis, SUDs, and mood disorders. After adjustments for other substance use, family structure, sex and parental psychiatric disorders, AFIs of 13-14 years and ≤12 years were associated with SUD (HR = 5.30; 95%CI 2.38-11.82 and HR = 6.49; 95%CI 2.51-16.80, respectively), while AFI ≤ 12 years was associated with any psychiatric disorder (HR = 1.59; 95%CI 1.26-2.02) and mood disorders (HR = 1.81; 95%CI 1.22-2.68). After further adjustments for Youth Self Report total scores, AFI ≤ 14 was associated with an increased risk of SUD and AFI ≤ 12 with an increased risk of any psychiatric disorder.

CONCLUSIONS

We found significant associations between the early age of first alcohol intoxication, later SUD and any psychiatric disorder in a general population sample. This further supports the need for preventive efforts to postpone the first instances of adolescent alcohol intoxication.

Not all symptoms of alcohol dependence are developmentally equivalent: Implications for the false-positives problem

OBJECTIVE

Recent studies have examined the extent to which alcohol dependence (AD) criteria prospectively predict the course of AD. Critically, these studies have lacked a developmental perspective. However, the differential performance of criteria by age might indicate overendorsement in younger individuals. The current study examined AD criteria in terms of persistence and prediction of AD course and alcohol use by age in order to identify criteria that are likely to be overly endorsed by younger individuals.

METHOD

The current study used longitudinal data from the National Epidemiologic Survey on Alcohol and Related Conditions to depict age differences in rates of new onset, recurrence, and persistence for each AD criterion, thereby showing how these three factors contribute to the overall age-prevalence curve of each criterion. Additionally, we tested age moderation of the predictive association between each criterion at baseline and new onset, recurrence, and persistence of syndromal AD.

RESULTS

Some criteria (particularly, persistent desire or unsuccessful efforts to cut down or control drinking, and drinking despite physical/psychological problems) are both less persistent and less predictive of AD course among younger adults compared to older adults.

CONCLUSIONS

These findings raise the possibility of elevated rates of false-positive AD among younger adults and suggest ways to improve the assessment of AD criteria. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

What is binge drinking? Insights from a network perspective

This study aimed to delineate the specific characteristics of binge drinking habits by capitalizing on data-driven network analysis. Such an approach allowed us to consider binge drinking as a network system of interacting elements, thus identifying the key variables involved in this phenomenon. A total of 1,455 university students with excessive drinking habits were included in this study. We assessed the most critical features of binge drinking (i.e., the consumption of more than six alcohol units per occasion, drunkenness frequency, consumption speed), together with alcohol use and more general alcohol-related components of dysfunction and harm. All variables were considered in the network analysis. Centrality analysis identified drunkenness frequency as the most influential variable in the entire network. Community detection analysis showed three distinct subnetworks related to alcohol use, drunkenness, and dysfunction/harm components. Drunkenness frequency and blackout occurrence emerged as core bridge items in the binge drinking network. Drunkenness is recognized as the hallmark feature of binge drinking.

Frequent Alcohol Intoxication and High Alcohol Tolerance During Adolescence as Predictors of Mortality: A Birth Cohort Study

PURPOSE

Long-term prospective studies evaluating the health burden that is consequent to adolescent drinking are needed. The aim of this study was to examine the predictive associations between self-reported alcohol tolerance and frequent intoxication at age 15-16 years and the risk of death by age 33 years.

METHODS

A sample (n = 6,615; 49.3% males) of the Northern Finland Birth Cohort Study 1986 was studied. Self-reported alcohol tolerance (drinks needed to feel intoxicated) and frequency of alcohol intoxication at age 15-16 years were analyzed along with background variables and data regarding subsequent psychiatric diagnoses. Categories were formed for both predictive variables from self-reported tolerance and frequency of intoxication in mid-adolescence. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence interval (95% CI) for death by age 30 years.

RESULTS

By the age of 33 years, of all 6,615 participants, 53 (.8%) were deceased. The HR for death by age 33 years was 3.08 (95% CI 1.17-8.07) among adolescents with high alcohol tolerance compared with adolescents without alcohol use or intoxication. The frequency of alcohol intoxication was also associated with mortality; HR 2.05 (95% CI 1.01-4.16) for those who had been intoxicated one to two times and HR 3.02 (95% CI 1.21-7.54) for those who had been intoxicated three or more times in the past 30 days compared with adolescents without intoxication.

CONCLUSIONS

High self-reported alcohol tolerance and frequent alcohol intoxication during mid-adolescence significantly predicted death by age 33 years. These behaviors carry long-term repercussions with respect to premature loss of life. Substantial efforts should be made to diminish this mortality risk.