Hypothalamic-pituitary-adrenal axis and smoking and drinking onset among adolescents: the longitudinal cohort TRacking Adolescents' Individual Lives Survey (TRAILS)

Early Life Stress and Substance Use Disorders: Underlying Neurobiology and Pathways to Adverse Outcomes

Early life stress (ELS) has been established as a major risk factor for a multitude of psychiatric and medical disorders. ELS is highly prevalent in the general population and constitutes a major public health concern. The current review will focus on the clinical literature that suggests a link between adverse early life experiences and vulnerability for adolescent and adult substance use disorders. It will investigate the characteristics of ELS that appear to increase risk for disorder onset and a more severe disease course, characterized by earlier onset, greater risk of relapse, and treatment resistance. The authors explore how ELS may increase risk for adverse substance use outcomes through long-lasting changes in the HPA axis and development of stress, reward, and executive control brain systems. The review will also discuss potential pathways to substance use disorder following ELS, with a focus on the role of comorbid mood and anxiety disorders and other modifiable traits. Finally, the authors will discuss how the current body of work presents the potential for prevention and intervention strategies to reduce the psychosocial consequences following early life stress and minimize adverse substance use outcomes. Reprinted from Advers Resil Sci 2020; 1:29-47, with permission from Springer. Copyright © 2020.

Stress and substance use disorders: risk, relapse, and treatment outcomes

Stress has long been associated with substance misuse and substance use disorders (SUDs). The past two decades have seen a surge in research aimed at understanding the underlying mechanisms driving this association. This Review introduces a multilevel "adaptive stress response" framework, encompassing a stress baseline, acute reaction, and recovery with return-to-homeostasis phase that occurs at varying response times and across domains of analysis. It also discusses evidence showing the disruption of this adaptive stress response in the context of chronic and repeated stressors, trauma, adverse social and drug-related environments, as well as with acute and chronic drug misuse and with drug withdrawal and abstinence sequelae. Subjective, cognitive, peripheral, and neurobiological disruptions in the adaptive stress response phases and their link to inflexible, maladaptive coping; increased craving; relapse risk; and maintenance of drug intake are also presented. Finally, the prevention and treatment implications of targeting this "stress pathophysiology of addiction" are discussed, along with specific aspects that may be targeted in intervention development to rescue stress-related alterations in drug motivation and to improve SUD treatment outcomes.

Shared genetic basis connects smoking behaviors and bone health: insights from a genome-wide cross-trait analysis

Although the negative association of tobacco smoking with osteoporosis is well-documented, little is known regarding the shared genetic basis underlying these conditions. In this study, we aim to investigate a shared genetic architecture between smoking and heel estimated bone mineral density (eBMD), a reliable proxy for osteoporosis. We conducted a comprehensive genome-wide cross-trait analysis to identify genetic correlation, pleiotropic loci and causal relationship of smoking with eBMD, leveraging summary statistics of the hitherto largest genome-wide association studies conducted in European ancestry for smoking initiation (Nsmoker = 1 175 108, Nnonsmoker = 1 493 921), heaviness (cigarettes per day, N = 618 489), cessation (Ncurrent smoker = 304 244, Nformer smoker = 843 028), and eBMD (N = 426 824). A significant negative global genetic correlation was found for smoking cessation and eBMD (${r}_g$ = -0.051, P = 0.01), while we failed to identify a significant global genetic correlation of smoking initiation or heaviness with eBMD. Partitioning the whole genome into independent blocks, we observed 6 significant shared local signals for smoking and eBMD, with 22q13.1 showing the strongest regional genetic correlation. Such a genetic overlap was further supported by 71 pleiotropic loci identified in the cross-trait meta-analysis. Mendelian randomization identified no causal effect of smoking initiation (beta = -0.003 g/cm2, 95% CI = -0.033 to 0.027) or heaviness (beta = -0.017 g/cm2, 95% CI = -0.072 to 0.038) on eBMD, but a putative causal effect of genetic predisposition to being a current smoker was associated with a lower eBMD compared to former smokers (beta = -0.100 g/cm2, 95% CI = -0.181 to -0.018). Our study demonstrates a pronounced biological pleiotropy as well as a putative causal link between current smoking status and eBMD, providing novel insights into the primary prevention and modifiable intervention of osteoporosis by advocating individuals to avoid, reduce or quit smoking as early as possible.

Dampened psychobiological responses to stress and substance use in adolescence

Substance use increases throughout adolescence, and earlier substance use may increase risk for poorer health. However, limited research has examined whether stress responses relate to adolescent substance use, especially among adolescents from ethnic minority and high-adversity backgrounds. The present study assessed whether blunted emotional and cortisol responses to stress at age 14 related to substance use by ages 14 and 16, and whether associations varied by poverty status and sex. A sample of 277 Mexican-origin youth (53.19% female; 68.35% below the poverty line) completed a social-evaluative stress task, which was culturally adapted for this population, and provided saliva samples and rated their anger, sadness, and happiness throughout the task. They also reported whether they had ever used alcohol, marijuana, cigarettes, and vaping of nicotine at age 14 and again at age 16. Multilevel models suggested that blunted cortisol reactivity to stress was associated with alcohol use by age 14 and vaping nicotine by age 16 among youth above the poverty line. Also, blunted sadness and happiness reactivity to stress was associated with use of marijuana and alcohol among female adolescents. Blunted stress responses may be a risk factor for substance use among youth above the poverty line and female adolescents.

Prevalence of E-Cigarette Use and Its Associated Factors Among Youths Aged 12 to 16 Years in 68 Countries and Territories: Global Youth Tobacco Survey, 2012‒2019

Objectives. To describe the recent global prevalence of e-cigarette use and to investigate its associated factors among youths aged 12 to 16 years in 68 countries and territories (hereafter "countries"). Methods. We analyzed 485 746 youths aged 12 to 16 years from the population-based cross-sectional Global Youth Tobacco Survey conducted in 67 countries between 2012 and 2019 and the 2019 National Youth Tobacco Survey in the United States. We defined past-30-day e-cigarette use as using e-cigarettes on 1 or more days during the past 30 days. Results. The global prevalence of past-30-day e-cigarette use among youths was 9.2%, ranging from 1.9% in Kazakhstan to 33.2% in Guam. Maternal smoking (adjusted odds ratio [AOR] = 1.40; 95% confidence interval [CI] = 1.29, 1.52), paternal smoking (AOR = 1.13; 95% CI = 1.07, 1.19), secondhand smoke exposure (AOR = 1.74; 95% CI = 1.64, 1.84), youth cigarette smoking (AOR = 7.18; 95% CI = 6.84, 7.54), and youth other tobacco use (AOR = 3.88; 95% CI = 3.62, 4.15) were positively associated with e-cigarette use. Conclusions. E-cigarette use was moderately frequent among youths aged 12 to 16 years globally. Several important factors were associated with youth e-cigarette use. Public Health Implications. Our findings highlight the need for countries worldwide to develop policies to address e-cigarette use among youths. (Am J Public Health. 2022;112(4):650-661. https://doi.org/10.2105/AJPH.2021.306686).

Early life stress and substance use disorders: The critical role of adolescent substance use

Early life stress (ELS) is a well-established risk factor for many psychiatric and medical disorders, including substance use disorders (SUDs). The relationship between ELS and SUDs is complex and there are likely multiple pathways from ELS to adverse substance use outcomes. The association between ELS and substance use emerges in adolescence. Adolescence is a critical period in development during which substance exposure markedly increases risk for SUDs. Therefore, this review focuses on the literature supporting the hypothesis that ELS increases risk for the development of SUDs through its influence on adolescent substance use. We discuss studies substantiating the role of ELS in adolescent substance use and explore how internalizing and externalizing psychopathology may be antecedents of substance use in adolescence. We examine clinical work suggesting ELS sculpts the Hypothalamic-Pituitary-Adrenal (HPA) Axis and developing brain-particularly subcortical brain regions that underlie stress response, mesocorticolimbic brain systems associated with reward sensitivity, and prefrontal regions that underlie executive control-in a way that increases risk for adolescent substance use and SUDs. We further explore how substance use during adolescence alters structure and function of these same systems, and how brain changes following ELS and adolescent substance use may independently, additively, or interactively contribute to risk for addiction. We conclude by discussing how the current literature can inform interventions aimed at reducing risk for SUDs in individuals with a history of ELS.

Exposure to police-related deaths and physiological stress among urban black youth

BACKGROUND

Emerging evidence indicates that exposure to police-related deaths is associated with negative health and wellbeing outcomes among black people. Yet, no study to date has directly examined the biological consequences of exposure to police-related deaths for urban black youth.

METHODS AND FINDINGS

We employ unique data from the 2014-16 Adolescent Health and Development in Context (AHDC) study - a representative sample of youth ages 11 to 17 residing in the Columbus, OH area. A subsample of participants contributed nightly saliva samples for cortisol for up to six days, providing an opportunity to link recent exposures to police-related deaths within the residential county to physiological stress outcomes during the study period (N = 585). We examine the effect of exposure to a recent police-related death in the same county on the physiological stress (nightly cortisol) levels of black youth. We find evidence of elevated average levels of nightly cortisol (by 46%) for black boys exposed to a police-related death of a black victim in the 30 days prior to the subject's cortisol collection. We find no evidence of police-related death effects on the physiological stress levels of black girls or white youth.

CONCLUSIONS

These analyses indicate that police-related deaths influence the biological functioning of black boys, with potential negative consequences for health. We consider the implications of exposure to lethal police violence among black boys for understanding racial disparities in health more broadly.

Feeling bad is not always unhealthy: Culture moderates the link between negative affect and diurnal cortisol profiles

Prior research has demonstrated that the daily experience of negative affect is associated with increased levels of proinflammatory activity as evidenced by higher interleukin-6 among Americans but not among Japanese. This cultural difference may be driven by culturally divergent beliefs about negative affect as a source of threat to self-image versus as natural and integral to life. Here, we examined whether culture may moderate the relationship between negative affect and biological stress responses, with a focus on the hypothalamic-pituitary-adrenal (HPA) axis activity. By using culturally matched surveys of Americans (N = 761) and Japanese (N = 328), we found that negative affect was associated with a flattening of the diurnal cortisol slope among Americans after controlling for demographic variables, personality traits, sleep patterns, and health behaviors. In contrast, the association between negative affect and the HPA axis activity was negligible among Japanese. Moreover, we assessed biological health risk with biomarkers of both inflammation (interleukin-6 and C-reactive protein levels) and cardiovascular function (higher systolic blood pressure and total-to-HDL cholesterol ratio) and found that the relationship between negative affect and increased biological health risk, which was observed only among Americans, was mediated by the flattening of the diurnal cortisol rhythm. These findings suggest that cultural differences in how emotions are construed may make the experience of negative affect more or less stressful and differentially consequential for health. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Anger, anxiety, and depressive affect as predictors of stress-induced cortisol production in khat and tobacco users

INTRODUCTION

Glucocorticoid activity is disrupted in substance users including khat chewers who also use tobacco. Anger, dysphoria, and anxiety can mediate this relationship. The aim of this study was to contrast emotion dysregulation and substance use variables as predictors of post-stress cortisol output.

MATERIALS AND METHODS

Comparable numbers of males (n = 90) and females (n = 85) including controls, khat only, and concurrent khat and tobacco users participated in a stress study. Depressive affect, anxiety, anger, substance use patterns, and saliva samples were collected following a standardized laboratory stress manipulation.

RESULTS

Regression analysis showed that high depression and low anxiety was associated with high post-stress cortisol, but only in co-users of tobacco and khat. Males, but not females, showed a significant association between co-use of khat and tobacco and cortisol, which appears to be mediated by frequency of use. The link between anxiety and post-stress cortisol in the co-users remained significant after controlling for nicotine dependence and substance use frequency.

CONCLUSION

Anxiety predicted the neuroendocrine consequences of concurrent use of tobacco and khat above and beyond sex, nicotine dependence, anger, and substance use frequency. Sex differences, however, are related to differences in nicotine dependence.

Perceived parental care during childhood, ACTH, cortisol and nicotine dependence in the adult

Studies evidenced the relationship between adverse childhood experiences (ACEs) and tobacco smoking in adulthood. An appropriate parenting style has been found to be associated with children's less frequent tobacco consumption. Hypothalamus-pituitary-adrenal (HPA) axis hyperactivity could represent the potential link between ACEs, mood disorders and smoking susceptibility. We studied a sample of 50 male smokers, affected by nicotine dependence and 50 controls who never smoked. Self-reported retrospective perception of neglect (Child Experience of Care and Abuse: CECA-Q questionnaire), age of smoking onset, number of cigarette/day, psychiatric symptoms (Symptoms Check List 90 scale: SCL 90) and basal level of ACTH and cortisol have been evaluated. Total SCL-90 scores, CECA-Q values and cortisol plasma level were significantly higher among smokers. Cortisol and ACTH values showed a significant direct correlation with CECA-Q and SCL90 total score and an inverse significant correlation with the age of smoking. Cortisol and ACTH did not correlate with the number of cigarette smoked. Once controlled for SCL90 and CECA-Q with multiple regression measures, the association between smoking and hormone levels reversed, suggesting that increased cortisol and ACTH basal levels were attributable to preexisting conditions such as early-life exposure to emotional neglect, psychological problems and a predisposition to addictive behavior.

Annual Research Review: On the developmental neuropsychology of substance use disorders

BACKGROUND

Adolescence represents a period of development during which critical biological, as well as social and cognitive, changes occur that are necessary for the transition into adulthood. A number of researchers have suggested that the pattern of normative brain changes that occurs during this period not only predisposes adolescents to engage in risk behaviours, such as experimentation with drugs, but that they additionally make the adolescent brain more vulnerable to the direct pharmacological impact of substances of abuse. The neural circuits that we examine in this review involve cortico-basal-ganglia/limbic networks implicated in the processing of rewards, emotion regulation, and the control of behaviour, emotion and cognition.

FINDINGS AND CONCLUSIONS

We identify certain neurocognitive and personality/comorbidity-based risk factors for the onset of substance misuse during adolescence, and summarise the evidence suggesting that these risk factors may be further impacted by the direct effect of drugs on the underlying neural circuits implicated in substance misuse vulnerability.

Longitudinal associations between diurnal cortisol slope and alcohol use across adolescence: a seven-year prospective study

A large body of research has linked hypothalamic-pituitary-adrenal (HPA) axis function and alcohol consumption, including work suggesting that flatter diurnal cortisol slopes are associated with greater alcohol use. A lack of longitudinal studies and a focus on adult and alcoholic populations leaves unclear whether such associations are also present in younger, non-clinical populations and whether flatter diurnal slopes are a consequence of or preexisting risk factor for alcohol use; however, theory suggests such associations may be mutually reinforcing. In a longitudinal, community sample of 200 (55% female) adolescents, the current study demonstrates that flatter diurnal cortisol slope at age 11 predicts higher levels of alcohol use from ages 15-18, and that heavier alcohol use in turn predicts further flattening of diurnal cortisol rhythm at age 18.5. This is the first study to demonstrate a longitudinal chain of associations between diurnal cortisol slope and alcohol use. Findings support contemporary theoretical models of the neurobiological processes underlying alcohol use and can inform future research on risk factors for and consequences of underage drinking.

Prenatal cocaine exposure differentially affects stress responses in girls and boys: associations with future substance use

Prenatal cocaine exposure may affect developing stress response systems in youth, potentially creating risk for substance use in adolescence. Further, pathways from prenatal risk to future substance use may differ for girls versus boys. The present longitudinal study examined multiple biobehavioral measures, including heart rate, blood pressure, emotion, and salivary cortisol and salivary alpha amylase (sAA), in response to a stressor in 193 low-income 14- to 17-year-olds, half of whom were prenatally cocaine exposed (PCE). Youth's lifetime substance use was assessed with self-report, interview, and urine toxicology/breathalyzer at Time 1 and at Time 2 (6-12 months later). PCE × Gender interactions were found predicting anxiety, anger, and sadness responses to the stressor, with PCE girls showing heightened responses as compared to PCE boys on these indicators. Stress Response × Gender interactions were found predicting Time 2 substance use in youth (controlling for Time 1 use) for sAA and sadness; for girls, heightened sadness responses predicted substance use, but for boys, dampened sAA responses predicted substance use. Findings suggest distinct biobehavioral stress response risk profiles for boys and girls, with heightened arousal for girls and blunted arousal for boys associated with prenatal risk and future substance use outcomes.

The relation between hypothalamic-pituitary-adrenal (HPA) axis activity and age of onset of alcohol use

AIMS

Hypothalamic-pituitary-adrenal (HPA) axis activity may prove a viable biomarker for identifying those susceptible to alcohol use disorders. The purpose of this study was to examine the relation of the age at which adolescents begin drinking with diurnal and stress cortisol.

DESIGN

Adolescents' diurnal cortisol levels on a normal day and cortisol levels during a stress procedure were examined in relation to the age of onset of alcohol use.

SETTING AND PARTICIPANTS

All adolescents (aged 14-20 years) were part of a general population study in the Netherlands (n = 2286).

MEASUREMENTS

Ten assessments of salivary cortisol taken on a normal day (diurnal cortisol), as well as during a social stress procedure (stress cortisol) were used as indicators of HPA axis activity.

FINDINGS

The age at which the first alcoholic drink was consumed varied as a function of cortisol levels at the onset of as well as during the stress procedure. Those who began drinking at an earlier age showed lower cortisol levels at the onset of the stressful tasks (r(2) = 0.14, P < 0.001) and during the stressful tasks (r(2) = 0.10, P < 0.05), although not after the tasks (cortisol recovery). Effects were strongest for anticipatory pre-task cortisol levels. Differences in diurnal cortisol levels did not explain variance in the age at which adolescents had begun drinking.

CONCLUSIONS

Lessened activity of the hypothalamic-pituitary-adrenal axis at the onset of and during a stress procedure is present in adolescents who begin drinking at an early age.

The role of group dynamics in scientific inconsistencies: a case study of a research consortium

Judith Rosmalen and Albertine Oldehinkel describe their experience in the TRAILS research consortium to discuss why research teams might publish contradictory or inconsistent results despite procedures to avoid this; they emphasize the role of internal group dynamics rather than faulty publication practices.

Hypothalamic-pituitary-adrenal axis reactivity to social stress and adolescent cannabis use: the TRAILS study

AIMS

To investigate the relationship of life-time and repeated cannabis use with hypothalamic-pituitary-adrenal (HPA) axis reactivity to social stress in a general population sample of adolescents.

DESIGN

Adolescents who reported life-time or repeated cannabis use, life-time or repeated tobacco use and never use of either cannabis or tobacco were compared with respect to their HPA axis reactivity during the Groningen Social Stress Task (GSST), which was based on the Trier Social Stress Task.

SETTING

A large prospective population study of Dutch adolescents [the TRacking Adolescents' Individual Lives Survey (TRAILS) study].

PARTICIPANTS

A total of 591 adolescents (51% male) who participated in the GSST, which was an additional measurement during the third assessment wave.

MEASUREMENTS

HPA axis stress-reactivity was indexed by four cortisol samples collected before, during and after the GSST. Furthermore, all adolescents in our study completed self-reported questionnaires on life-time and repeated cannabis and tobacco use. Models were adjusted for sex, recent alcohol use, experimental session risk status, socio-economic status, mood and time of the experimental session.

FINDINGS

Life-time cannabis users had significantly lower stress-reactivity levels when compared to abstainers [odds ratio (OR) = 0.68, confidence interval (CI) = 0.55-0.85, P < 0.01] and life-time tobacco users (OR = 0.79, CI = 0.64-0.98, P < 0.05). In addition, repeated cannabis users also exhibited lower stress-reactivity levels when compared to life-time ever users of either tobacco or cannabis (OR = 0.74, CI = 0.53-0.98, P < 0.05).

CONCLUSIONS

Lower hypothalamic-pituitary-adrenal-axis stress-reactivity in adolescents is related specifically to life-time and repeated cannabis use.