Teenage drinking and the onset of alcohol dependence: a cohort study over seven years

Influence of binge drinking on the resting state functional connectivity of university Students: A follow-up study

Binge Drinking (BD) is characterized by consuming large amounts of alcohol on one occasion, posing risks to brain function. Nonetheless, it remains the most prevalent consumption pattern among students. Cross-sectional studies have explored the relationship between BD and anomalies in resting-state functional connectivity (RS-FC), but the medium/long-term consequences of BD on RS-FC during developmental periods remain relatively unexplored. In this two-year follow-up study, the impact of sustained BD on RS-FC was investigated in 44 college students (16 binge-drinkers) via two fMRI sessions at ages 18-19 and 20-21. Using a seed-to-voxel approach, RS-FC differences were examined in nodes of the main brain functional networks vulnerable to alcohol misuse, according to previous studies. Group differences in RS-FC were observed in four of the explored brain regions. Binge drinkers, compared to the control group, exhibited, at the second assessment, decreased connectivity between the right SFG (executive control network) and right precentral gyrus, the ACC (salience network) and right postcentral gyrus, and the left amygdala (emotional network) and medial frontal gyrus/dorsal ACC. Conversely, binge drinkers showed increased connectivity between the right Nacc (reward network) and four clusters comprising bilateral middle frontal gyrus (MFG), right middle cingulate cortex, and right MFG extending to SFG. Maintaining a BD pattern during critical neurodevelopmental years impacts RS-FC, indicating mid-to-long-term alterations in functional brain organization. This study provides new insights into the neurotoxic effects of adolescent alcohol misuse, emphasizing the need for longitudinal studies addressing the lasting consequences on brain functional connectivity.

Predictors of alcohol use disorder risk in young adults: Direct and indirect psychological paths through binge drinking

Alcohol-use disorders (AUD) risk is highly prevalent in university students, and is associated with both intraindividual (e.g., metacognitions, personality traits) and interindividual (e.g., social motives, drinking identity, drinking norms) psychological factors. Binge drinking (BD) also constitutes a widespread drinking pattern in youth, distinct from AUD risk and mainly predicted by interindividual factors. As BD is itself a risk factor for AUD, we tested a dual psychological path model to AUD risk, combining a direct path (including intra/interindividual factors independent from BD) with an indirect path (where interindividual factors increase AUD risk through BD). We assessed a large range of psychological factors predicting BD and AUD risk in an online survey among 2026 university students (Mage = 20.46; SD = 2.82; 67.42% of women). We tested the direct and indirect (via BD) effects of these psychological factors on three subdimensions of AUDIT (alcohol intake, dependence symptoms, and alcohol-related problems) through a multivariate mediation model using percentile bootstrapped estimates. Support for the dual-path model to risk of AUD emerged from the results, comprising a direct path mainly influenced by intra-individual factors unrelated to BD (e.g., coping motives, depression symptoms, and uncontrollability beliefs), and an indirect BD-mediated path mainly influenced by inter-individual factors (e.g., social motives, enhancement motives, drinking norms) through BD. This new dual-path conceptualization combining direct/intra-individual and indirect/inter-individual risk factors identifies key psychological determinants of AUD risk in youth and offers new prevention avenues for AUD risk.

Acute alcohol intoxication among adolescents in Italy, the Netherlands and Belgium: a cross-national hospital chart comparison study

BACKGROUND

Excessive drinking among adolescents in Western Europe is prevalent, posing significant health risks and societal costs. Comprehensive data on adolescent drinking patterns is crucial for developing effective prevention strategies. Data on alcohol intoxication among adolescents provide valuable insights in this context.

METHODS

To gain insight into the demographic and clinical characteristics of acute alcohol intoxication (AAI) across European countries, we analysed emergency department data on AAI among adolescents (aged 14-17) from 2015 to 2023 in three urban regions: Genoa (Italy), Delft (the Netherlands) and Antwerp (Belgium).

RESULTS

Out of 1826 admissions, Belgium had the highest median annual admission rate (51 per 10 000 adolescents), followed by the Netherlands (49 per 10 000) and Italy (37 per 10 000). The median age of patients was 16 years across all countries. Sex was equally distributed among Dutch patients; however, in Italy (not statistically significant, 55.6%) and Belgium (statistically significant, 56.8%), more males were admitted. The median blood alcohol concentration (BAC) was higher in the Netherlands (2.00 g/L) compared with Italy and Belgium (1.84 g/L and 1.97 g/L, respectively). This difference remained statistically significant after adjusting for confounders in a multiple linear regression model on BAC. Finally, the proportion of patients with combined drug use (10.4% of the total population) was similar across the three countries.

CONCLUSIONS

This is the first international study to consolidate data on AAI in minors from multiple countries, emphasising the need for a unified European database on AAI in adolescents to enhance prevention efforts.

Nationwide Incidence of Acute Alcohol Intoxication in Adolescents in Belgium: A Validation Study of Belgian Health Insurance Data Through Comparison with Retrospective Hospital Chart Data in Antwerp, Belgium

Background/Objectives: This study investigates the incidence of acute alcohol intoxication (AAI) in adolescents in Belgium, by comparing nationwide estimations based on health insurance data with a recently published hospital chart study in Antwerp. In this way, the scope of AAI among adolescents in Belgium can be estimated more precisely. Methods: Health insurance data collected by the Intermutualistic Agency (IMA) regarding 12- to 17-year-olds admitted at emergency departments in Antwerp in 2019-2021 and receiving a blood test to screen for blood alcohol concentration were validated by data derived from a recently conducted retrospective hospital chart study regarding AAI among adolescents in Antwerp. To compare the incidence of adolescents with AAI between these two datasets, a Poisson regression analysis was performed. Results: The findings reveal that the approximations based on administrative health insurance data present a significant underestimation of the incidence of AAI (p < 0.001): the number of admissions in Antwerp determined by the hospital chart study was 21% higher over 2019-2021. Correcting for this underestimation reveals an estimation for the nationwide average yearly incidence of AAI admissions among adolescents of 33.5 per 10,000 instead of 27.7 per 10,000 in Belgium over 2019-2021. Conclusions: These results imply that the occurrence of AAI among Belgian youth is larger than previously estimated. Therefore, a higher fraction of Belgian adolescents are at risk of serious health consequences due to AAI. This underlines the importance of the development of effective intervention strategies regarding indicated prevention and follow-up.

Reciprocal relationships between adolescent mental health difficulties and alcohol consumption

The directionality of the relationship between adolescent alcohol consumption and mental health difficulties remains poorly understood. This study investigates the longitudinal relationship between alcohol use frequency, internalizing and externalizing symptoms from the ages of 11 to 17. We conducted a random-intercept cross-lagged panel model across three timepoints (ages: 11yrs, 14yrs, 17yrs; 50.4% female) in the Millennium Cohort Study (N = 10,647). Survey weights were used to account for attrition. At each timepoint, past month alcohol use frequency was self-reported, parents and cohort members reported internalizing/externalizing symptoms using the Strengths and Difficulties Questionnaire. We controlled for alcohol expectancies, sex, and four cumulative risk indices (perinatal risk, early childhood adverse parenting, longitudinal parent-level risk occurrence, and persistent household socioeconomic deprivation). More frequent past month alcohol use at age 11 predicted increased internalizing symptoms at age 14 (β = 0.06; p =.01). More frequent past month alcohol use at age 14 predicted increased externalizing symptoms at age 17 (β = 0.11; p <.001). Increased internalizing symptoms consistently predicted reduced alcohol use at the next timepoint throughout the study period (11 years: β= -0.04; p =.03; 14 years: β= -0.09; p <.001). Increased externalizing symptoms at age 11 predicted increased alcohol consumption at age 14 (β = 0.06; p =.004). Frequent adolescent alcohol consumption represents a significant risk for subsequent mental health difficulties. Externalizing symptoms and alcohol use frequency appear to exacerbate one another. Internalizing symptoms may reduce the risk of frequent alcohol consumption. Incorporating routine alcohol screening into adolescent mental health treatment settings could reduce the risk of comorbid externalizing and alcohol use disorders.

Alcohol use disorder, cannabis use disorder, and eating disorder symptoms among male and female college students

BACKGROUND AND OBJECTIVES

Eating disorders (EDs) and substance use disorders are prevalent among college students in the United States, with underlying common mechanisms suggesting co-occurrence of these in the student population. As treatment prognosis of EDs improves when they are identified and treated with early intervention, it is essential to understand which substance use behaviors associate with EDs in students.

METHODS

Using a sample of 471 college students recruited for a study on high risk drinking (i.e., students needed to pregame regularly to be included), we explored the associations between ED symptomatology and two common substances used in this population: alcohol and cannabis. As most research on EDs focuses on female students only or does not separate out males and females, we examined whether sex assigned at birth moderated the association between ED symptomatology and substance use outcomes.

RESULTS

About one-third (32.4%) of the sample screened positive for an ED, with females significantly more likely to screen positive. Males were significantly more likely to screen positive for an alcohol or cannabis use disorder. Screening positive for an ED associated with cannabis use frequency and cannabis use disorder symptoms, but not with alcohol outcomes. Sex moderated the association between ED and cannabis use disorder symptoms, with positive ED screen male students experiencing the highest cannabis use disorder symptoms.

DISCUSSION AND CONCLUSIONS

It is necessary to further assess how sex differences in substance use and ED symptomatology inform each other.

SCIENTIFIC SIGNIFICANCE

Findings underscore the need to assess and screen for cannabis use disorder among students who screen positive for an ED, and, more specifically, with focused attention on male students with ED symptoms.

Sexual Minority Identity and Risky Alcohol Use: the Moderating Role of Aggressive Behavior

Adolescent alcohol use has significant consequences for concurrent and longitudinal health and wellbeing, with sexual minority youth consistently reporting higher levels of alcohol use than their heterosexual peers. Understanding how individual-difference variables like aggressive behavior are associated with variability in sexual minority adolescents' higher levels of alcohol use offers novel theoretical insight into this vulnerability. The 81,509 participants were drawn from the Profiles of Student life: Attitudes and Behavior Study. They were ages 14-17 years (M = 15.38, SD = 1.09) and 50.1% were cisgender girls. For sexual identity, 88% were heterosexual, 5% were mostly heterosexual, were 4% bisexual, were 1% mostly gay or lesbian, and were 1% being gay or lesbian. Participants reported on alcohol use, aggressive behavior, and sexual identity. Gay/lesbian and mostly gay/lesbian adolescents who reported higher aggressive behavior had higher levels of alcohol use than their heterosexual peers who also reported higher aggressive behavior. The way in which aggressive behavior amplified the link between mostly gay/lesbian and gay/lesbian identities and alcohol use suggests the need for more research examining how this trait may heighten both exposure and reaction to minority stressors among some subgroups of sexual minority youth.

Neurostructural features predict binge drinking in emerging adulthood: Evidence from a 5-year follow-up study

BACKGROUND

Binge drinking (BD) involves consuming large amounts of alcohol within a short timeframe, leading to a blood alcohol concentration of 0.08g/dL or above. This pattern of alcohol consumption is prevalent among young adults and has significant implications for brain structure and subsequent drinking behaviors.

METHODS

In this prospective longitudinal study, we employed zero-inflated negative binomial regression models to examine whether various neurostructural features (i.e., volume, surface area, cortical thickness) of brain regions involved in executive and emotional/motivational processes at the age of 18-19 could predict number of BD episodes five years later, at ages 23-24, once participants were expected to complete their university degree. Specifically, we recorded magnetic resonance imaging (MRI) data from 68 students who completed both the baseline MRI and follow-up alcohol use assessment, with the aim of analyzing the predictive value of these neurostructural characteristics five years later.

RESULTS

The analysis revealed that a larger surface area in the caudal division of the right middle frontal gyrus was significantly associated with a higher incidence rate of BD episodes (IRR = 2.24, 95 % CI = 1.28-3.91, p = 0.005). Conversely, a smaller surface area in the right caudal anterior cingulate cortex was associated with a higher incidence rate of BD episodes (IRR = 0.61, 95 % CI = 0.44-0.85, p = 0.004).

CONCLUSIONS

These findings suggest that specific neurostructural characteristics during adolescence can predict BD behaviors in young adulthood. This highlights the potential of neuroimaging to identify individuals at risk for developing problematic alcohol use.

Associative memory in alcohol-related contexts: An fMRI study with young binge drinkers

BACKGROUND

Alcohol-related cues are known to influence craving levels, a hallmark of alcohol misuse. Binge drinking (BD), a pattern of heavy alcohol use, has been associated with cognitive and neurofunctional alterations, including alcohol attentional bias, memory impairments, as well as disrupted activity in prefrontal- and reward-related regions. However, literature is yet to explore how memories associated with alcohol-related cues are processed by BDs, and how the recall of this information may influence their reward processing.

AIMS

The present functional magnetic resonance imaging (fMRI) study aimed to investigate the neurofunctional signatures of BD during an associative memory task.

METHOD

In all, 36 university students, 20 BDs and 16 alcohol abstainers, were asked to memorize neutral objects paired with either alcohol or non-alcohol-related contexts. Subsequently, neutral stimuli were presented, and participants were asked to classify them as being previously paired with alcohol- or non-alcohol-related contexts.

RESULTS

While behavioral performance was similar in both groups, during the recall of alcohol-related cues, BDs showed increased brain activation in two clusters including the thalamus, globus pallidus and dorsal striatum, and cerebellum and occipital fusiform gyrus, respectively.

CONCLUSION

These findings suggest that BDs display augmented brain activity in areas responsible for mental imagery and reward processing when trying to recall alcohol-related cues, which might ultimately contribute to alcohol craving, even without being directly exposed to an alcohol-related context. These results highlight the importance of considering how alcohol-related contexts may influence alcohol-seeking behavior and, consequently, the maintenance or increase in alcohol use.

Binge drinking trajectories across adolescence and early adulthood: Associations with genetic influences for dual-systems impulsive personality traits, alcohol consumption, and alcohol use disorder

Binge drinking is a relatively common pattern of alcohol use among youth with normative frequency trajectories peaking in emerging and early adulthood. Frequent binge drinking is a critical risk factor for not only the development of alcohol use disorders (AUDs) but also increased odds of alcohol-related injury and death, and thus constitutes a significant public health concern. Changes in binge drinking across development are strongly associated with changes in impulsive personality traits (IPTs) which have been hypothesized as intermediate phenotypes associated with genetic risk for heavy alcohol use and AUD. The current study sought to examine the extent to which longitudinal changes in binge drinking and intoxication frequency across adolescence and early adulthood are associated with genetic influences underlying dual-systems IPTs (i.e., top-down [lack of self-control] and bottom-up [sensation seeking and urgency] constructs) alongside genetic risk for alcohol consumption and AUD. Associations were tested using conditional latent growth curve polygenic score (PGS) models in three independent longitudinal samples (N=10,554). Results suggested consistent significant and independent associations across all samples between sensation seeking PGSs and model intercepts (i.e., higher frequency of binge drinking at first measurement occasion) and alcohol consumption PGSs and model slopes (i.e., steeper increases toward peak binge drinking frequency). Urgency PGSs were not significantly associated with changes in binge drinking or intoxication frequency. Collectively, these findings highlight the role of unique but correlated IPT and alcohol-specific genetic factors in the emergence and escalation of binge drinking during adolescence and early adulthood.

Editorial: Sounding the alarm-The rising global burden of adolescent and young adult alcohol-related liver disease

This article is linked to Danpanichkul et al papers. To view these articles, visit https://doi.org/10.1111/apt.18101 and https://doi.org/10.1111/apt.18157

Global epidemiology of alcohol-associated liver disease in adolescents and young adults

BACKGROUND AND AIMS

The objective of the study was to analyse the prevalence, incidence, and death of alcohol-associated liver disease (ALD) among adolescents and young adults globally, continentally, and nationally, focusing on trends over time.

METHODS

The study analysed data from the Global Burden of Disease (GBD) study between 2000 and 2019. It examined ALD's prevalence, incidence, and death in adolescents and young adults aged 15-29, segmented by region, nation, and sociodemographic index. The analysis utilised Joinpoint regression modelling to calculate the annual per cent change (APC) in the rate of these parameters over time.

RESULTS

In 2019, there were 281,450 ALD prevalences, 18,930 incidences, and 3190 deaths among adolescents and young adults globally. From 2000 to 2019, the age-adjusted prevalence rate per 100,000 increased in the 25-29 age group (APC: +0.6%, p = 0.003), remained stable among ages 20-24 (p = 0.302) and ages 15-19 (p = 0.160). Prevalence increased significantly from age 15-19 to 20-24 (19-fold increase) and from age 20-24 to 25-29 (2.5-fold increase). ALD prevalence rates increased in all age groups in adolescents and young adults in Africa and the Eastern Mediterranean region. Around three-quarters of countries and territories experienced an increase in ALD incidence rates in young adults.

CONCLUSION

Over two decades, the burden of ALD among adolescents and young adults has increased globally. The study emphasises the importance of public health policies aimed at reducing alcohol consumption and preventing ALD among younger populations.

Adolescent alcohol binge drinking and withdrawal: behavioural, brain GFAP-positive astrocytes and acute methamphetamine effects in adult female rats

RATIONALE

Alcopop beverages are generally the first alcoholic beverage that young females drink which contain high levels of sugar and alcohol. The over-consumption of these drinks may encourage alcohol co-administration with methamphetamine (METH) impacting on drinking behaviour and glial function.

AIMS

The aims of this study were to evaluate the effect of adolescent binge alcohol exposure on consumption level, anxiety-like behaviour, cross-sensitization with METH and on astrocyte expression in reward related brain regions.

METHODS

Adolescent female Sprague-Dawley rats had daily 1-hour oral alcohol consumption of alcopop (ALCP; with sucrose) or ethanol-only (ETOH; without sucrose), transitioned from 5 to 15% (v/v) ethanol content for 34 days. Water and sucrose groups act as controls. During alcohol withdrawal, rats were tested for anxiety on the elevated plus maze (EPM) and locomotor activity following saline or METH (1 mg/kg i.p) treatment. Brains were then collected to assess astrocyte immunofluorescence for glial fibrillary acidic protein (GFAP) in reward-related brain regions.

RESULTS

Rats pretreated with 5% ALCP consumed significantly more volume and ethanol intake when compared to 5% EtOH rats. Both ALCP and EtOH groups had a higher preference ratio for 5% than 15% alcohol solutions and ALCP rats had greater ethanol intake at 15% than EtOH rats. Alcohol withdrawal showed no significant differences between groups on anxiety, METH cross-sensitization effects or GFAP intensity in the regions studied.

CONCLUSIONS

Overall, the addition of sucrose to alcoholic solutions encouraged female rats to consume larger volumes and greater ethanol intake compared to ethanol-only solutions, yet did not have long lasting effects on behaviour and astrocytes.

Neurological Disorders Induced by Drug Use: Effects of Adolescent and Embryonic Drug Exposure on Behavioral Neurodevelopment

Clinical studies demonstrate that the risk of developing neurological disorders is increased by overconsumption of the commonly used drugs, alcohol, nicotine and cannabis. These drug-induced neurological disorders, which include substance use disorder (SUD) and its co-occurring emotional conditions such as anxiety and depression, are observed not only in adults but also with drug use during adolescence and after prenatal exposure to these drugs, and they are accompanied by long-lasting disturbances in brain development. This report provides overviews of clinical and preclinical studies, which confirm these adverse effects in adolescents and the offspring prenatally exposed to the drugs and include a more in-depth description of specific neuronal systems, their neurocircuitry and molecular mechanisms, affected by drug exposure and of specific techniques used to determine if these effects in the brain are causally related to the behavioral disturbances. With analysis of further studies, this review then addresses four specific questions that are important for fully understanding the impact that drug use in young individuals can have on future pregnancies and their offspring. Evidence demonstrates that the adverse effects on their brain and behavior can occur: (1) at low doses with short periods of drug exposure during pregnancy; (2) after pre-conception drug use by both females and males; (3) in subsequent generations following the initial drug exposure; and (4) in a sex-dependent manner, with drug use producing a greater risk in females than males of developing SUDs with emotional conditions and female offspring after prenatal drug exposure responding more adversely than male offspring. With the recent rise in drug use by adolescents and pregnant women that has occurred in association with the legalization of cannabis and increased availability of vaping tools, these conclusions from the clinical and preclinical literature are particularly alarming and underscore the urgent need to educate young women and men about the possible harmful effects of early drug use and to seek novel therapeutic strategies that might help to limit drug use in young individuals.

"You have to drink with a little bit of shame": Alcohol and other drug use among young people from migrant and ethnic minority backgrounds in Melbourne, Australia

Migrant and ethnic minority groups are underrepresented in alcohol and other drug (AOD) research. This qualitative study explored AOD use among young people from migrant and ethnic minority backgrounds in Melbourne, Australia. We conducted one focus group and 16 interviews and thematically analyzed data drawing on the social-ecological model of health. Theme one showed AOD use was considered a "normal" part of youth identity, particularly for participants who had grown up with peer groups in Australia. Theme two highlighted participant's sense of responsibility to meet expectations and make informed decisions about AOD use to protect themselves and their friends. Theme three highlighted participant's risk of experiencing AOD-related stigma through negative stereotypes and fear of consequences within families and communities, particularly among female participants. Participants' perceptions and experiences differed by individual factors, interpersonal relationships, AOD accessibility across settings and broader gender, cultural and religious norms. Interventions developed with young people from migrant and ethnic minority backgrounds are needed to target the social-ecological factors underpinning AOD use, particularly stigma.

Does the decline in Swedish adolescent drinking persist into early adulthood?

BACKGROUND AND AIMS

Sweden has experienced a substantial decrease in adolescent drinking over the past decades. Whether the reduction persists into early adulthood remains unclear. Using survey data, the present study aimed to determine whether reductions in indicators of alcohol use observed among adolescents remain in early adulthood and whether changes in alcohol intake are consistent among light/moderate and heavy drinkers.

DESIGN

Data from the Swedish monthly Alcohol Monitoring Survey (2001-20) were used to construct five 5-year birth cohorts (1978-82, 1983-87, 1988-92, 1993-97 and 1998-2002).

SETTING

Sweden.

PARTICIPANTS

A total of n = 52 847 respondents (48% females) aged 16 and 30 years were included in this study.

MEASUREMENTS

For both males and females, temporal changes in the prevalence of any drinking, the prevalence of heavy episodic drinking (HED) and total alcohol intake in the past 30 days in centilitres were analysed.

FINDINGS

The prevalence of any drinking in more recent cohorts remained low until young people came into their early (females) and mid- (males) 20s. Male cohorts differed in the prevalence of HED across age, with the later cohorts showing lower odds than earlier cohorts (odds ratios between 0.54 and 0.66). Among females, no systematic differences between cohorts across age could be observed. Later male birth cohorts in light/moderate drinkers had lower alcohol intake than earlier cohorts (correlation coefficients between -0.09 and -0.54). No statistically significant cohort effects were found for male heavy drinkers. Although differences in alcohol intake among females diminished as age increased, the cohorts did not differ systematically in their level of alcohol intake.

CONCLUSIONS

In Sweden, the reduced uptake of drinking in adolescents appears to fade as people move into adulthood. Observed reductions in alcohol intake among light and moderate drinkers appear to persist into adulthood. More recent male cohorts show a lower prevalence rate of heavy episodic drinking.

Utility of the Zebrafish Model for Studying Neuronal and Behavioral Disturbances Induced by Embryonic Exposure to Alcohol, Nicotine, and Cannabis

It is estimated that 5% of pregnant women consume drugs of abuse during pregnancy. Clinical research suggests that intake of drugs during pregnancy, such as alcohol, nicotine and cannabis, disturbs the development of neuronal systems in the offspring, in association with behavioral disturbances early in life and an increased risk of developing drug use disorders. After briefly summarizing evidence in rodents, this review focuses on the zebrafish model and its inherent advantages for studying the effects of embryonic exposure to drugs of abuse on behavioral and neuronal development, with an emphasis on neuropeptides known to promote drug-related behaviors. In addition to stimulating the expression and density of peptide neurons, as in rodents, zebrafish studies demonstrate that embryonic drug exposure has marked effects on the migration, morphology, projections, anatomical location, and peptide co-expression of these neurons. We also describe studies using advanced methodologies that can be applied in vivo in zebrafish: first, to demonstrate a causal relationship between the drug-induced neuronal and behavioral disturbances and second, to discover underlying molecular mechanisms that mediate these effects. The zebrafish model has great potential for providing important information regarding the development of novel and efficacious therapies for ameliorating the effects of early drug exposure.

Characteristics of Adolescents Admitted with Acute Alcohol Intoxication: A Retrospective Multicentre Study in Antwerp, Belgium, in the Period 2015-2021

Binge drinking among adolescents is common in Belgium, posing a risk of serious health consequences. Until today, only estimations of the prevalence of acute alcohol intoxication (AAI) in adolescents have been made. Research into potential risk factors has not yet been conducted in Belgium. Therefore, this study aims to gain more insight into the prevalence, medical characteristics and potential risk factors of AAI among adolescents. A retrospective multicentre chart study was performed on adolescents aged 10-17 years with AAI in Antwerp, Belgium (2015-2021). Patient's demographics, medical characteristics and information regarding the context of the AAI were collected from medical charts. Over the study period, a total of 1016 patients were admitted with AAI in Antwerp, having a median age of 16.6 years old, a median blood alcohol concentration of 1.95 g/L and combined drug use in 10% of cases. These findings did not significantly change over the study period. Multiple linear regression analysis indicated that after correcting for covariates, higher age, no combined drug use and decreased consciousness at admission were associated with more severe AAI cases (higher blood alcohol concentration). This study shows that AAI is prevalent among Belgian adolescents, and better targeted preventive measures and policies are needed. Our findings could be taken into account when developing preventive measures. However, data addressing the demographics and context of AAI were mostly missing. Therefore, prospective research is required to further investigate potential risk factors associated with AAI.

Exposure to tobacco, alcohol and 'Junk food' content in reality TV programmes broadcast in the UK between August 2019-2020

BACKGROUND

Exposure to alcohol, tobacco and foods high in fat, sugar or salt (HFSS) content in media is a risk factor for smoking, alcohol use and HFSS consumption in young people. We report an analysis of tobacco, alcohol and HFSS content in a sample of reality TV programmes broadcast on TV and video-on-demand services throughout a 1-year period.

METHODS

We used 1-min interval coding to quantify content in all episodes of 20 different reality TV programmes between August 2019 and August 2020 and estimated population exposure to a sample of these programmes using viewing data and UK population estimates.

RESULTS

We coded 13 244 intervals from 264 episodes. Tobacco content appeared in 227 intervals (2%) across 43 episodes (2%), alcohol in 5167 intervals (39%) across 258 episodes (98%) and HFSS in 1752 intervals (13%) across 234 episodes (88%). A sample of 15 series delivered ~157.4 million tobacco, 3.5 billion alcohol and 1.9 billion HFSS gross impressions to the UK population, including 24 000, 12.6 million and 21.4 million, to children, respectively.

CONCLUSION

Tobacco, alcohol and HFSS content are common in reality TV programmes. These programmes deliver exposure to tobacco, alcohol and HFSS imagery, which are a potential driver of tobacco use, alcohol use and HFSS consumption in young people.

Does Sport Participation Protect Adolescents from Alcohol Consumption? A Scoping Review

(1) Background: Participation in youth sports is believed to protect against alcohol consumption. Although this concept has been questioned for over 40 years, the review of methodologically reliable evidence data is scarce. This review summarizes the state of knowledge on the association between practicing sports and alcohol consumption among adolescents (10-19 years old) and its moderators. (2) Methods: The review covers only random-sample-based and population research. A systematic search was conducted on Scopus, PubMed, and WoS, for articles published between 2000 and 2021. From the 1944 identified records, 139 advanced to the full-text review, and 32 to the final data extraction and quality review. (3) Results: About two-thirds of the studies, including all the longitudinal ones, showed a positive association between sport participation and alcohol consumption. The most common mediators were gender (males were at higher risk), discipline (odds for team sports were higher, but professionalization could reduce it), and race, which intersected with gender, putting white males at the highest risk. (4) Conclusions: Further longitudinal research based on random samples using standardized indicators, including psychological and social variables, may provide more consistent outcomes and allow for the identification of mediating mechanisms.

Who are Australia's young heavy drinkers? a cross-sectional population study

OBJECTIVE

In light of the recent declines in youth drinking, the socio-demographic correlates of (1) annual total alcohol consumption (volume) and (2) monthly single occasion risky drinking among underage young people (14-17-year-olds) and young adults (18-24-year-olds) were examined.

METHODS

Cross-sectional data were drawn from the 2019 National Drug Strategy Household Survey (n=1,547). Multivariable negative binomial regression analyses identified the socio-demographic correlates of total annual volume and monthly risky drinking.

RESULTS

Those who spoke English as first language reported higher total volume and rates of monthly risky drinking. Not being in school predicted total volume for 14-17-year-olds, as did having a certificate/diploma for 18-24-year-olds. Living in affluent areas predicted a greater total volume for both age groups, and risky drinking for 18-24-year-olds. Young men in regional areas and working in labour and logistics reported higher total volume than young women in the same groups.

CONCLUSIONS

There are important differences among young heavy drinkers related to gender, cultural background, socio-economic status, education, regionality and work industry.

IMPLICATIONS FOR PUBLIC HEALTH

Prevention strategies that are sensitively tailored towards high risk groups (e.g. young men in regional areas and working in trade and logistics) may be of public health benefit.

The Growing Trend of Young People Abstaining from Drinking Alcohol: A Literature Review

Background: Youth alcohol use and misuse lead to adverse outcomes. However, the literature has not always associated complete abstinence with better health. Since recent literature indicates an increased proportion of young abstainers, the aim of this paper is to review the studies investigating this upward trend and the factors associated with it, such as socio-demographics, school performance, social life, physical and mental health, and parental influence. Methods: Different databases were searched and appropriated terms were used. Given that the trend has only emerged in recent years, the review was limited to papers published since 2000. A total of 970 papers were returned and 10 were retained for the present review. Results: All papers covered by the review acknowledge the existence of a new significant trend resulting in more young people in developed countries who are choosing to abstain completely from drinking alcohol. They are in good physical and mental health and perform better at school than their drinking peers. The quality of their social life, albeit slightly more limited than that of their drinking peers, appeared to be good. Conclusion: Young alcohol abstainers represent a group situated at the beginning of a continuum of alcohol consumption, they do well and are not very different from light drinkers. Alcohol abstinence at young age does not seem to have any downsides and should therefore be generally advised. To further promote such behavior, measures to encourage parental monitoring and more generous public expenditure on health services and family benefits should be encouraged.

Heterogeneity of definitions and measurements of binge drinking in research on adolescents and young adults

INTRODUCTION

Binge drinking is a widespread health compromising behaviour among adolescents and young adults and is one of the leading causes of mortality and injuries among this population. The definitions and measurement methods of binge drinking are heterogeneous but constitute a crucial component in the literature on associated factors related to binge drinking. This study focused on how binge drinking is defined and measured in the literature exploring its associated risk factors among adolescents and young adults.

METHODS

The databases PubMed, Embase, PsycINFO and Social Care were searched for articles published between 1 January 2006 and 30 April 2020 using 3 concepts: binge drinking; risk or protective factors; and adolescents/young adults with respective key words. Data were extracted on the main characteristics of studies and the parameters of binge drinking measurements.

RESULTS

173 studies were included, mostly cross-sectional (61 %) and longitudinal (38 %). Only 23 % of the studies explicitly referred to a standardised definition of binge drinking even though 76 % of the studies used a consensual threshold of 5 drinks or more for men. A lower threshold for women was applied in 26 % of the studies. Recall periods ranged between 2 weeks and 1 year in 85 % of the studies and only 16 % presented binge drinking in terms of frequency and/or quantity of drinks.

CONCLUSION

Our results highlight the heterogeneity in the definitions and measurements of binge drinking, raising concerns for meaningful comparisons between studies focused on factors associated with the behaviour. The scientific community needs to be aware of these variations and address the gap of poor stratification and inconsistencies in binge drinking reporting.

Early-Life Sleep Deprivation Enhanced Alcohol Consumption in Adolescent Rats

Evidence in the literature suggests that sleep deprivation during early-life developmental stages, by impacting important processes such as the reward circuit maturation, may increase the vulnerability for alcohol and substance use. The mechanisms involved are not fully understood. In this study, utilizing our previously established model, we examined the impact of early-life sleep deprivation on alcohol consumption in adolescent rats. Male Sprague Dawley rats served as either the control (CON) or sleep-deprived (SD) group. Sleep deprivation was induced using a Pinnacle automated sleep deprivation apparatus. The SD group of rats was sleep deprived for 6–8 h/day for 14 days from postnatal day (PND)19 to PND32. At PND33, anxiety- and depression-like behaviors were assessed in rats using elevated plus maze and sucrose splash test, respectively. At PND39, alcohol consumption was assessed in rats for five consecutive days using the two-bottle choice paradigm, water versus 5% ethanol. SD rats exhibited significant anxiety- and depression-like behaviors as compared to CON rats. Interestingly, SD rats consumed a larger volume of alcohol when compared to CON rats, which was significantly higher at day 5 (mean of alcohol consumption (ml) ± SD; CON = 6.67 ± 3.42; SD = 19.00 ± 6.05, p = 0.0126). SD rats also showed high preference for alcohol over water, which was significantly higher at day 5 (mean of alcohol preference (%) ± SD; CON = 26.85 ± 14.97; SD = 57.69 ± 5.61, p = 0.014). Our data suggest that early-life sleep deprivation enhanced alcohol consumption in adolescent rats.

Tracking the decline in Australian adolescent drinking into adulthood

BACKGROUND AND AIMS

Adolescent drinking in Australia (and many other countries) has declined substantially since the early 2000s. This study aimed to test whether these declines have been maintained into adulthood and whether they are consistent across sub-groups defined by sex and socio-economic status.

DESIGN

Quasi-cohorts were constructed from seven repeated waves of cross-sectional household survey data (2001-2019).

SETTING

Australia.

PARTICIPANTS

A total of 20 733 respondents age between 14 and 24 (male: 9492; female: 11 241).

MEASUREMENTS

Participants were grouped into five cohorts based on their birth year (from 1979-1983 to 1999-2003). Three measures of drinking were assessed: any past-year consumption (yes/no), past-year regular risky drinking (12 or more drinking episodes of >40 g of pure alcohol, yes/no) and total volume of alcohol consumed in the past year (in Australian standard drinks, 10 g of alcohol). Socio-economic status was measured based on neighbourhood of residence.

FINDINGS

Drinking declines were consistent across socio-economic groups on all measures and trends were broadly similar for women and men. More recent birth cohorts had significantly lower levels of drinking across all three measures (odds ratios between 0.31 and 0.70 for drinking and risky drinking, coefficients between -0.28 and -0.80 for drinking volume). There were significant interactions between birth cohort and age for past-year drinking and past-year regular risky drinking, with cohort differences diminishing as age increased.

CONCLUSIONS

Lighter drinking adolescent cohorts appear to partly 'catch up' to previous cohorts by early adulthood, but maintain lower levels of drinking and risky drinking up to the age of 24. These ongoing reductions in drinking are spread evenly across socio-economic groups.

Addressing methodological issues in a study of impulsivity and vulnerability for transition to alcohol use disorder

BACKGROUND

Heightened behavioral impulsivity has been advocated as a preexisting risk factor for the development of alcohol use disorder (AUD). Nonetheless, studies investigating impulsivity in adolescent/young adult at-risk drinkers-who are at increased risk of developing AUD-report mixed findings. This may be due to methodological limitations related to definitions of at-risk drinking, the retrospective assessment of alcohol intake, and/or the relatively modest sample size of some studies.

METHODS

Healthy individuals (N = 814, M_age  = 22.50) completed online surveys and a measure of choice impulsivity. Of these, a number of participants also undertook an online measure of response inhibition (n = 627, M_age  = 22.66), and a further subgroup submitted real-time alcohol consumption information for a period of 21 days using an app (n = 543, M_age  = 22.96). Differences in behavioral impulsivity were assessed as a function of various at-risk alcohol intake categories. Hierarchical multiple regression was employed to determine whether impulsivity predicted alcohol use in the form of a continuous index comprising variables related to intake and consequences of use.

RESULTS

Significantly greater impulsivity was not evident in heavy, standard binge, high binge, harmful, or hazardous alcohol drinkers as compared to controls, regardless of the criteria employed to categorize these at-risk drinkers. Neither choice impulsivity nor reduced response inhibition significantly predicted the alcohol use index.

CONCLUSIONS

While results could be attributed to the online nature of this research, it is possible that more sensitive measures of behavioral impulsivity are required when assessing nondependent drinkers.

Do adolescents and young adults accessing the Emergency Room with substance use receive poor therapeutic indications at discharge? An observational retrospective study

PURPOSE

Emergency rooms (ERs) are usually the first point of contact with mental health services for adolescents with Substance Use Disorders (SUDs). However, only a minority of them receives proper treatment and follow-up indications, increasing the risk of relapses and poor prognosis. In this perspective, we sought to characterize and compare socio-demographic and clinical characteristics of adolescents with vs without SUDs accessing the ER, assessing potential differences in terms of discharge instructions.

METHODS

A sample of 557 ER accesses of patients aged 15-25 years old in need of a psychiatric evaluation or with a psychiatric diagnosis at discharge was retrospectively analyzed. Patients were divided in two subgroups according to the presence of SUDs.

RESULTS

About 32.1% of patients had SUDs when accessing the ER. Among these, 62% were unknown to any psychiatric services and 57% were at their psychiatric onset. Nevertheless, considering discharge instructions, patients with current substance use received less therapeutic indication or were less frequently referred to psychiatric facilities, than those without substance use (57.8% vs 42.2%, P = .002).

CONCLUSIONS

Substance abuse is strongly linked to psychopathology and ER accesses in young patients. However, we observed a large rate of SUDs patients unknown by any specialized mental health service, who received poor therapeutic and follow-up instructions at discharge. Improving communication between ER operators and young patients with SUDs could longitudinally reduce the risk of addiction and related disability, morbidity and mortality.

Adolescent neuroimmune function and its interaction with alcohol

Adolescence is an evolutionarily conserved developmental period associated with behavioral change, including increased risk-taking and alcohol use. Experimentation with alcohol typically begins in adolescence and transitions to binge-like patterns of consumption. Alcohol exposure during adolescence can alter normative changes in brain structure and function. Understanding mechanisms by which ethanol impacts neurodevelopmental processes is important for preventing and ameliorating the deleterious consequences of adolescent alcohol abuse. This review focuses on the neuroimmune system as a key contributor to ethanol-induced changes in adolescent brain and behavior. After brief review of neuroimmune system development, acute and chronic effects of ethanol on adolescent neuroimmune functioning are addressed. Comparisons between stress/immunological challenges and ethanol on adolescent neuroimmunity are reviewed, as cross-sensitization is relevant during adolescence. The mechanisms by which ethanol alters neuroimmune functioning are then discussed, as they may portend development of neuropathological consequences and thus increase vulnerability to subsequent challenges and potentiate addictive behaviors.

Trajectories of brain development reveal times of risk and factors promoting resilience to alcohol use during adolescence

Alcohol use disorder (AUD) is recognized as harmful for the developing brain. Numerous studies have sought environmental and genetic risk factors that predict the development of AUD, but recently identified resilience factors have emerged as protective. This chapter reviews normal processes of brain development in adolescence and emerging adulthood, delineates disturbed growth neurotrajectories related to heavy drinking, and identifies potential endogenous, experiential, and time-linked brain markers of resilience. For example, concurrent high dorsolateral prefrontal activation serving inhibitory control and low nucleus accumbens activation serving reward functions engender positive adaptation and low alcohol use. Also discussed is the role that moderating factors have in promoting risk for or resilience to AUD. Longitudinal research on the effects of all levels of alcohol drinking on the developing brain remains crucial and should be pursued in the context of resilience, which is a promising direction for identifying protective biomarkers against developing AUDs.

Tobacco and alcohol content in soap operas broadcast on UK television: a content analysis and population exposure

BACKGROUND

Exposure to tobacco and alcohol content in media is a risk factor for smoking and alcohol use in young people. Our previous research suggested that tobacco and alcohol imagery is common in soap operas. We now report an analysis of tobacco and alcohol content in a sample of soap operas broadcast in the UK.

METHODS

We used 1-minute interval coding to quantify tobacco and alcohol content in all episodes (including advertisement breaks) of six soap operas broadcast on UK television during three separate weeks in November and December 2018 and January 2019.

RESULTS

We coded 2222 intervals from 87 episodes and 360 intervals from 77 advertisement breaks. Tobacco content was rare, occurring in 4% of all intervals across 30% of episodes, the only tobacco appearances in adverts appeared in anti-smoking advertising. Alcohol occurred in 24% of intervals across 95% of episodes and in 13% of advertisement intervals. The programmes delivered ~381.28 million tobacco and 2.1 billion alcohol gross impressions to the UK population, including 18.91 million tobacco and 113 million alcohol gross impressions to children.

CONCLUSION

Whilst tobacco was rare, alcohol content was common, resulting in billions of viewer impressions. Soap operas represent a potential driver of alcohol consumption in young people.

Alcohol and Brain Development in Adolescents and Young Adults: A Systematic Review of the Literature and Advisory Report of the Health Council of the Netherlands

Young people, whose brains are still developing, might entail a greater vulnerability to the effects of alcohol consumption on brain function and development. A committee of experts of the Health Council of the Netherlands evaluated the state of scientific knowledge regarding the question whether alcohol negatively influences brain development in young people. A systematic literature search for prospective studies was performed in PubMed and PsychINFO, for longitudinal studies of adolescents or young adults ranging between 12 and 24 y of age at baseline, investigating the relation between alcohol use and outcome measures of brain structure and activity, cognitive functioning, educational achievement, or alcohol use disorder (AUD), with measures at baseline and follow-up of the outcome of interest. Data were extracted from original articles and study quality was assessed using the Newcastle-Ottawa Scale. A total of 77 studies were included, 31 of which were of sufficient quality in relation to the study objectives. There were indications that the gray matter of the brain develops abnormally in young people who drink alcohol. In addition, the more often young people drink or the younger they start, the higher the risk of developing AUD later in life. The evidence on white matter volume or quality, brain activity, cognitive function, and educational achievement is still limited or unclear. The committee found indications that alcohol consumption can have a negative effect on brain development in adolescents and young adults and entails a risk of later AUD. The committee therefore considers it a wise choice for adolescents and young adults not to drink alcohol.

A content analysis of tobacco and alcohol audio-visual content in a sample of UK reality TV programmes

Background

Exposure to tobacco and alcohol content in audio-visual media is a risk factor for smoking and alcohol use in young people. We report an analysis of tobacco and alcohol content, and estimates of population exposure to this content, in a sample of reality television programmes broadcast in the UK.

Methods

We used 1-minute interval coding to quantify tobacco and alcohol content in all episodes of five reality TV programmes aired between January and August 2018 (Celebrity Big Brother; Made in Chelsea; The Only Way is Essex; Geordie Shore and Love Island), and estimated population exposure using viewing data and UK population estimates.

Results

We coded 5219 intervals from 112 episodes. Tobacco content appeared in 110 (2%) intervals in 20 (18%) episodes, and alcohol in 2212 (42%) intervals and in all episodes. The programmes delivered approximately 214 million tobacco gross impressions to the UK population, including 47.37 million to children; and for alcohol, 4.9 billion and 580 million respectively.

Conclusion

Tobacco, and especially alcohol, content is common in reality TV. The popularity of these programmes with young people, and consequent exposure to tobacco and alcohol imagery, represents a potentially major driver of smoking and alcohol consumption.

Alcohol Use Behaviors and Reasons to Abstain From or Limit Drinking Among Medically Vulnerable Youth

BACKGROUND

Youth with chronic medical conditions (YCMC) use alcohol at levels similar to their healthy peers but face elevated risk for adverse health consequences. As salient reasons to abstain from or limit drinking (RALD) among YCMC are unknown, we sought to identify clusters of RALD and test associations with use behaviors.

METHODS

Eligible YCMC (ages 9-18) recruited from outpatient clinics reported their use behaviors and importance of potential RALD. Cluster analysis was used to discern RALD patterns, which were examined as predictors of alcohol use using multivariate regression.

RESULTS

Among 398 participants, 30.9% reported past year alcohol use. Concerns about impacts on medications, school, and disease status were the most frequently endorsed RALD; prior negative experiences with alcohol and family history were the least frequently endorsed. Five RALD clusters were identified for all YCMC and 2 for recent drinkers. Compared to the cluster with high endorsement of multiple general and health-related RALD, those predominantly citing concerns about addiction and those not strongly endorsing any RALD consistently reported greater alcohol use. Among recent drinkers, the cluster characterized by low concern across multiple RALD also consistently reported greater alcohol use compared to their counterparts expressing moderate concern.

CONCLUSIONS

For YCMC, RALD are complex but endorsement of multiple general and health-related RALD is associated with less use, and health concerns are especially prevalent. More research is needed to understand how salient RALD can inform tailored interventions that aim to delay and reduce substance use and improve health outcomes for YCMC.

A cluster randomized controlled trial evaluating the effectiveness of the school-based drug prevention program #Tamojunto2.0

AIMS

The study aimed to evaluate the effectiveness of the government school-based program #Tamojunto2.0, the third Brazilian version of the European drug prevention program, Unplugged, in preventing the use of alcohol and other drugs.

DESIGN

A parallel, two-arm cluster randomized controlled trial was conducted in 205 classes in 73 public schools (37 intervention and 36 control) with a baseline assessment and follow-up after 9 months.

SETTING

Schools in the cities of São Paulo, Fortaleza and Eusebio in Brazil.

PARTICIPANTS

A total of 5208 students in the 8th grade with a mean age of 13.2 years (standard deviation = 0.8 years) and an equal gender ratio.

INTERVENTION

In 2019, the intervention group attended 12 classes of the program #Tamojunto2.0, under the supervision of a team from the Ministry of Health. The control group did not receive any intervention to prevent alcohol and drug use.

MEASUREMENTS

The primary outcome measured was prevalence of binge drinking (five or more doses of alcohol in an occasion) within the past month. Secondary outcomes were prevalence of initiation and use of alcohol, tobacco, inhalants, marijuana and cocaine within the past month.

FINDINGS

A statistically significant difference was not found in the prevalence of binge drinking within the past month between intervention and control groups [odds ratio (OR) = 0.934; 95% confidence interval (CI) = 0.761-1.146]. However, students who were exposed to the program were less likely to initiate alcohol use than those in the control group (OR = 0.782; 95% CI = 0.636-0.961). The Bayes factor for reduction in binge drinking was 0.01, providing evidence in favor of the null hypothesis for this variable.

CONCLUSIONS

The drug prevention program #Tamojunto 2.0 reduced alcohol initiation, but appeared not to reduce past-month binge drinking among 8th grade students in Brazil.

The effects of voluntary adolescent alcohol consumption on alcohol taste reactivity in Long Evans rats

RATIONALE

The relationship between age, ethanol intake, and the hedonic value of ethanol is key to understanding the motivation to consume ethanol.

OBJECTIVE

It is uncertain whether ethanol drinking during adolescence changes ethanol's hedonic value into adulthood.

METHODS

The current study compared voluntary intermittent ethanol consumption (IAE; 2-bottle choice; 20%v/v) among adolescent and adult Long-Evans rats to examine the effects of age and IAE on taste reactivity in adulthood. For taste reactivity, orally infused fluids included water, ethanol (5, 20, and 40%v/v), and sucrose (0.01, 0.1, 1M).

RESULTS

IAE results indicate that adolescents drank more ethanol during IAE but had a lower rate of change in ethanol consumption across time than adults due to initially high adolescent drinking. During taste reactivity testing for ethanol, IAE rats had greater hedonic responding, less aversive responding, and a more positive relationship between hedonic responses and ethanol concentration than water-receiving control rats. Hedonic responses had positive, while aversive responses had negative relationships with ethanol concentration and total ethanol consumed during IAE. Adolescent+IAE rats displayed less hedonic and more aversive responses to ethanol than Adult+IAE rats. Sucrose responding was unrelated to ethanol consumption.

CONCLUSIONS

These results suggest that ethanol consumption influences the future hedonic and aversive value of ethanol in a way that makes ethanol more palatable with greater prior consumption. However, it appears that those drinking ethanol as adolescents may be more resistant to this palatability shift than those first drinking as adults, suggesting different mechanisms of vulnerability to consumption escalation for adolescents and adults.

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.

Effects of depression, anxiety and screen use on adolescent substance use

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Comorbid depression, anxiety and risky substance use is common.

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Depression and severe anxiety increase risky substance.

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Excessive screen time is an independent risk factor for substance use.

The current study examined relations between depression risk, anxiety risk, screen time and substance use among adolescents receiving SBIRT services. Between October 2018 and June 2020, 1701 youth ages 12 to 17 received SBIRT services (47% male, 24.2% non-white). SBIRT screening included the completion of the Patient Health Questionnaire for depression risk, Generalized Anxiety Disorder-7 item scale, a question on average amount of screen time daily, and the S2BI for substance use. Analyses included t-tests and chi-squares to examine demographic differences across variables, bivariate correlations among independent variables to assess for use within regression analyses, and stepwise linear regressions to examine relations between depression risk, anxiety risk, screen time and substance use. Analyses were examined using the full sample as well as those who scored positive for mild mental health symptoms. Median screen time was 3 to 4 h daily, 29% met criteria for mental health problems or risky substance use with high comorbidity of depression and anxiety risk. Findings demonstrated a significant risk of increased substance use associated with depression risk, severe anxiety risk, and screen time. Anxiety risk alone was not related to substance use risk when accounting for depression risk. Routine screening for depression, other mental health concerns, screen time and substance use is critical in supporting adolescent health and development, especially given comorbidity and their relative contributions. Interventions aimed at decreasing screen time, and identifying mental health problems may aid in decreasing substance use risk in adolescents.

Repeated binge ethanol drinking enhances electrical activity of central amygdala corticotropin releasing factor neurons in vivo

Binge ethanol drinking is an increasingly problematic component of alcohol use disorder costing the United States approximately over $150 billion every year and causes progressive neuroplasticity alterations in numerous brain regions. However, the precise nature or machinery that underlies binge drinking has not yet been elucidated. Corticotropin releasing factor (CRF) neurons in the central amygdala (CeA) are thought to modulate binge drinking, but the specific circuit mechanisms remain poorly understood. Here, we combined optogenetics with in vivo electrophysiology to identify and record from CeA CRF neurons in mice during a repeated binge ethanol drinking task. First, we found that CeA CRF neurons were more active than CeA non-CRF cells during our binge drinking paradigm. We also observed that CeA CRF neurons displayed a heterogeneous spectrum of responses to a lick of ethanol including, pre-lick activated, lick-excited, lick-inhibited, and no response. Interestingly, pre-lick activated CeA CRF neurons exhibited higher frequency and burst firing during binge drinking sessions. Moreover, their overall tonic and phasic electrical activity enhances over repeated binge drinking sessions. Remarkably, CeA CRF units and pre-lick activated CeA CRF neurons did not show higher firing rate or bursting activity during water and sucrose consumption, suggesting that ethanol may "hijack" or plastically alter their intrinsic excitability. This article is part of the special issue on 'Neurocircuitry Modulating Drug and Alcohol Abuse'.

High Trait Attention Promotes Resilience and Reduces Binge Drinking Among College Students With a Family History of Alcohol Use Disorder

Binge patterns of alcohol use among post-high school emerging adults are associated with both immediate negative consequences and increased risk of long-term drinking problems, particularly among individuals with a family history (FH) of alcohol use disorder (AUD). Therefore, the developmental time period of emerging adulthood, paired with the high-risk environment of college campuses, represents an important target for interventions. Attentional ability has recently emerged as a mediator of resilience to stress-related psychopathology and offers a potential neurocognitive target for interventions. We tested the hypothesis that attentional ability promotes resilience to binge drinking in a sample of 464 college students with (n = 221) or without (n = 243) familial risk for AUD. Two-way analyses of covariance (ANCOVA) tested effects of FH and self-reported binge drinking on attention scores from the Barratt Impulsiveness Scale (BIS). In addition, mediation analyses tested whether BIS attention scores mediated the relationship between Conner-Davidson Resilience Scale scores and binge drinking. ANCOVA results indicated a significant FH-by-binge drinking interaction (p = 0.008) in which FH positive subjects who did not binge drink had the fewest attention problems, consistent with a marker of resilience. Furthermore, BIS attention scores significantly mediated the effect of Conner-Davidson Resilience Scale scores on binge drinking, with stronger effects in FH positive subjects (p < 0.001) than FH negative subjects (p = 0.49). The findings suggest that attention promotes resilience to binge drinking in individuals with familial risk for AUD. Interventions targeting attentional ability in this high-risk population, particularly FH positive individuals with attention deficits, may serve to reduce binge drinking and its consequences.

Performance of self-reported measures of alcohol use and of harmful drinking patterns against ethyl glucuronide hair testing among young Swiss men

Background

There is a need for empirical studies assessing the psychometric properties of self-reported alcohol use as measures of excessive chronic drinking (ECD) compared to those of objective measures, such as ethyl glucuronide (EtG).

Objectives

To test the quality of self-reported measures of alcohol use and of risky single-occasion drinking (RSOD) to detect ECD assessed by EtG.

Methods

A total of 227 samples of hair from young Swiss men were used for the determination of EtG. Self-reported measures of alcohol use (previous twelve-month and previous-week alcohol use) and RSOD were assessed. Using EtG (<30 pg/mg) as the gold standard of ECD assessment, the sensitivity and specificity were computed, and the AUROC were compared for alcohol use measures and RSOD. Logistic regressions were used to test the contribution of RSOD to the understanding of ECD after controlling for alcohol use.

Results

A total of 23.3% of participants presented with ECD. Previous twelve-month alcohol use with a cut-off of >15 drinks per week (sensitivity = 75.5%, specificity = 78.7%) and weekly RSOD (sensitivity = 75.5%, specificity = 70.1%) yielded acceptable psychometric properties. No cut-off for previous-week alcohol use gave acceptable results. In the multivariate logistic regression, after controlling for the previous twelve months of alcohol use, RSOD was still significantly associated with EtG (p = .016).

Conclusion

Self-reported measures of the previous twelve months of alcohol use and RSOD were acceptable measures of ECD for population-based screening. Self-reported RSOD appeared to be an interesting screening measure, in addition to the previous twelve months of alcohol use, to understand ECD among young people.

Electroencephalographic signatures of the binge drinking pattern during adolescence and young adulthood: A PRISMA-driven systematic review

Research on neurophysiological impairments associated with binge drinking (BD), an excessive but episodic alcohol use pattern, has significantly increased over the last decade. This work is the first to systematically review -following PRISMA guidelines- the empirical evidence regarding the effects of BD on neural activity -assessed by electroencephalography- of adolescents and young adults. A systematic review was conducted in 34 studies (N = 1723). Results indicated that binge drinkers (BDs) showed similar behavioral performance as non/low drinkers. The most solid electrophysiological finding was an augmented P3 amplitude during attention, working memory and inhibition tasks. This increased neural activity suggests the recruitment of additional resources to perform the task at adequate/successful levels, which supports the neurocompensation hypothesis. Similar to alcoholics, BDs also displayed increased reactivity to alcohol-related cues, augmented resting-state electrophysiological signal and reduced activity during error detection -which gives support to the continuum hypothesis. Evidence does not seem to support greater vulnerability to BD in females. Replication and longitudinal studies are required to account for mixed results and to elucidate the extent/direction of the neural impairments associated with BD.

Risk factors for the onset of dependence and chronic psychosis due to cannabis use: Survey of patients with cannabis-related psychiatric disorders

AIM

The objective of the current study was to identify risk factors that affect the onset of dependence and chronic psychosis due to cannabis use.

METHODS

We examined clinical genetic factors, psychiatric disorders prior to cannabis use, starting age of cannabis use, duration and frequency of cannabis use, types of cannabis products used, combined use of other psychoactive substances, and the psychiatric diagnosis of 71 patients with cannabis-related psychiatric disorders who underwent treatment at nine mental health hospitals in Japan. Information was collected from cross-sectional interview surveys conducted by each patient's attending psychiatrist.

RESULTS

For the diagnosis of dependence syndrome due to the use of cannabis, we found associations with the number of years of cannabis use and the use of cannabis products with a high Δ9-tetrahydrocannabinol (THC) content. However, we found no association between diagnosis of residual and late-onset psychotic disorders and clinical genetic factors, presence of preceding psychiatric disorders, duration and frequency of cannabis use, starting age of cannabis use, or combined use of other psychoactive substances; an association was found only for the absence of use of cannabis products other than dried cannabis.

CONCLUSION

The onset of cannabis dependence was related to long-term cannabis use and the use of cannabis products with a high THC content. However, chronic psychosis was not associated with total THC intake or psychiatric vulnerability. Thus, unknown factors appear to be involved in the onset of chronic psychosis.

Prevalence and risk factors associated with substance use in children: A questionnaire-based survey in two cities of Uttar Pradesh, India

BACKGROUND

There is a sharp increase of substance use, particularly tobacco and alcohol, among schoolchildren.

AIMS

A study was undertaken to assess the prevalence, age of initiation, and determinants for the uptake of tobacco and alcohol habits among ever-user students.

SETTINGS AND DESIGN

This was a cross-sectional study conducted among school students.

MATERIALS AND METHODS

Information on alcohol and tobacco use, age at initiation, peer influence, reason of initiation, etc., was collected from students of class 7^th-12^th(ages: 11-19 years) studying in schools of Noida and Ghaziabad cities, through a pretested self-administered questionnaire through multistage sampling design. Univariate analysis was done to assess the significance of various determinants.

RESULTS

"Ever use of substance" (alcohol or tobacco) was found in 14.3% students and was 1.2 times more among boys in comparison to girls (P < 0.05). About 29.5% of these students initiated the habit before 11 years of age and its prevalence was significantly more among boys from government schools as compared to private schools. The habits were 2.2, 3.8, and 4.6 fold higher among students if the father, mother, siblings, or friends also used substances. Substance use was less frequent among children of white-collared father and more educated parents. One-third of students up took the habit to make friends.

CONCLUSION

The rising prevalence of substance use among students is a threat to the society. Introducing a "substance use prevention policy" in schools to educate students about various adverse effects and refusal skills may help curb this menace.

Drinking beyond the binge threshold in a clinical sample of adolescents

BACKGROUND AND AIMS

Nearly all the research conducted on high-intensity drinking has focused on college and school-based samples, with recent calls for research to understand this risky drinking pattern in non-school-based samples and across time. This study aimed to characterize predictors and consequences of non-binge drinking, age- and gender-adjusted binge drinking (level I) and drinking at levels representing two or more times (level II) and three or more times the level I binge threshold (level III) in a clinical sample of adolescents followed into young adulthood.

DESIGN

Cross-sectional associations between non-binge drinking, binge levels, and negative alcohol-related consequences were examined during adolescence; prospective analyses tested whether adolescent non-binge drinking and binge levels predicted alcohol use disorder (AUD) symptoms in young adulthood and whether changes in drinking motives over time were associated with binge levels in young adulthood.

SETTING

US clinical settings.

PARTICIPANTS

A total of 432 adolescents (aged 12-18 years) with alcohol-related problems followed into young adulthood (aged 19-25 years).

MEASUREMENTS

Life-time drinking history, Structured Clinical Interview for DSM AUDs, and Inventory of Drinking Situations.

FINDINGS

Results were generally consistent with a distinction between binge level I versus levels II-III on various negative alcohol-related consequences in adolescence (Ps < 0.05) that were maintained in young adulthood (Ps < 0.01). The maintenance of relatively high endorsement of enhancement and social motives over time was associated with binge levels II-III in young adulthood (Ps < 0.001); decreases in coping motives were associated with less risky drinking in adulthood (P = 0.003).

CONCLUSIONS

Among US adolescents with alcohol-related problems who were followed-up in young adulthood (aged 19-25 years), standard threshold binge drinking (five or more drinks per occasion; level I) was generally associated with fewer alcohol-related consequences and problem behaviors than binge drinking at two or more times (level II) or three or more times (level III) the standard binge threshold.

Preclinical methodological approaches investigating of the effects of alcohol on perinatal and adolescent neurodevelopment

Despite much evidence of its economic and social costs, alcohol use continues to increase. Much remains to be known as to the effects of alcohol on neurodevelopment across the lifespan and in both sexes. We provide a comprehensive overview of the methodological approaches to ethanol administration when using animal models (primarily rodent models) and their translational relevance, as well as some of the advantages and disadvantages of each approach. Special consideration is given to early developmental periods (prenatal through adolescence), as well as to the types of research questions that are best addressed by specific methodologies. The zebrafish is used increasingly in alcohol research, and how to use this model effectively as a preclinical model is reviewed as well.

A content analysis of alcohol content in UK television

Background

Exposure to audio-visual alcohol content in media is associated with subsequent alcohol use in young people, but the extent of exposure contained in UK free-to-air prime-time television has not been explored since 2010. We report an analysis of alcohol content in a sample of UK free-to-air prime-time television broadcasts in 2015 and compare this with a similar analysis from 2010.

Methods

Content analysis of all programmes and advertisement/trailer breaks broadcast on the five national UK free-to-air channels in the UK between 6 and 10 pm during three separate weeks in September, October and November 2015.

Results

Alcohol content occurred in over 50% of all programmes broadcast and almost 50% of all advert/trailer periods between programmes. The majority of alcohol content occurred before the 9 pm watershed. Branding occurred in 3% of coded intervals and involved 122 brands, though three brands (Heineken, Corona and Fosters) accounted for almost half of all brand appearances.

Conclusion

Audio-visual alcohol content, including branding, is prevalent in UK television, and is therefore a potential driver of alcohol use in young people. These findings are virtually unchanged from our earlier analysis of programme content from 2010.

Characteristics and Predictors of Heavy Episodic Drinking (HED) among Young People Aged 16-25: The International Alcohol Control Study (IAC), Tshwane, South Africa

In South Africa, little is known about alcohol consumption patterns, such as drinks consumed, container size, salience of alcohol price, affordability and availability, and perceptions of alcohol policies as potential predictors of heavy episodic alcohol (HED) use among young people. This paper examines predictors of HED among young people with specific consideration given to these alcohol consumption patterns. This study conducted in the Tshwane Metropole in 2014 employed multi-stage stratified cluster random sampling. Participants were between the ages 16–25 years. A structured questionnaire was used to collect data. Of the 287 (n = 678) participants who had used alcohol in the past six months and for whom we had complete consumption data, almost half were identified as heavy episodic drinkers (HEDs) and were significantly more likely to consume alcohol on a daily basis (p = 0.001). Having nightclub as the primary drinking location (p = 0.023) and drinking from a container size bigger than one standard drink (p = 0.014) were significant predictors for HED. HEDs were also more likely to have a perception that most people consume alcohol (p = 0.047). The results point to HED of alcohol among young people who drink in South Africa, highlighting the need for multicomponent interventions.

Can we boost attention and inhibition in binge drinking? Electrophysiological impact of neurocognitive stimulation

RATIONALE

Binge drinking (i.e. excessive episodic alcohol consumption) among young adults has been associated with deleterious consequences, notably at the cognitive and brain levels. These behavioural impairments and brain alterations have a direct impact on psychological and interpersonal functioning, but they might also be involved in the transition towards severe alcohol use disorders. Development of effective rehabilitation programs to reduce these negative effects as they emerge thus constitutes a priority in subclinical populations.

OBJECTIVES

The present study tested the behavioural and electrophysiological impact of neurocognitive stimulation (i.e. transcranial direct current stimulation (tDCS) applied during a cognitive task) to improve attention and inhibition abilities in young binge drinkers.

METHODS

Two groups (20 binge drinkers and 20 non-binge drinkers) performed two sessions in a counterbalanced order. Each session consisted of an inhibition task (i.e. Neutral Go/No-Go) while participants received left frontal tDCS or sham stimulation, immediately followed by an Alcohol-related Go/No-Go task, while both behavioural and electrophysiological measures were recorded.

RESULTS

No significant differences were observed between groups or sessions (tDCS versus sham stimulation) at the behavioural level. However, electrophysiological measurements during the alcohol-related inhibition task revealed a specific effect of tDCS on attentional resource mobilization (indexed by the N2 component) in binge drinkers, whereas later inhibition processes (indexed by the P3 component) remained unchanged in this population.

CONCLUSIONS

The present findings indicate that tDCS can modify the electrophysiological correlates of cognitive processes in binge drinking. While the impact of such brain modifications on actual neuropsychological functioning and alcohol consumption behaviours remains to be determined, these results underline the potential interest of developing neurocognitive stimulation approaches in this population.

Identifying Early Risk Factors for Addiction Later in Life: A Review of Prospective Longitudinal Studies

PURPOSE OF REVIEW

To review prospective longitudinal studies that have identified risk factors for the development of substance use disorders in adulthood from individual differences during childhood and adolescence.

RECENT FINDINGS

Risk factors during childhood and adolescence that have been consistently linked to increased risk for addiction include externalizing and internalizing symptoms, early substance use, and environmental influences, such as parental behavior and exposure to traumatic experiences.

SUMMARY

Since the etiology of substance use disorders is complex and likely is attributable to many causal pathways, systematic examination of the associations between risk factors will be necessary to understand the mixed findings in the existing literature, to determine which individuals should be targeted for prevention efforts, and to design interventions that address risk factors that are most likely to improve outcomes.