Revisiting the concepts of risk and protective factors for understanding the etiology and development of substance use and substance use disorders: implications for prevention

Large-scale longitudinal analysis of the progression of alcohol use among members of a social media platform: an observational study

Background: The large-scale identification of people at risk of transitioning from relatively lower-risk to higher-risk alcohol use (e.g. problem drinking) remains a public health challenge despite advances in the identification of risk and protective factors.Objective: This observational study used machine learning to identify Reddit (social media platform) posting activity associated with transitioning from lower- to higher-risk forms of alcohol use.Methods: We employed bottom-up and top-down approaches to identify lower- and higher-risk alcohol-related subreddits. Using a non-parametric negative control procedure, we estimated each of 10,006 Reddit communities' risk of progression from lower- to higher-risk alcohol-related communities and applied a random forest model to predict progression among individual Reddit members. Eligible Reddit members had posted on Reddit for two or more years before their first post in a lower-risk alcohol-related community and for three or more years after that (N = 4,160).Results: Our methodology identified 42 alcohol-related communities, four of which were suggestive of problem drinking. Five communities were significantly associated with progression. Random forests model's risk scores for individual members correlated with their progression to higher-risk communities at 0.30; the model predicted progression of individual Reddit members with a 0.92 area under the curve.Conclusions: Posting in communities dedicated to other substance use, depression, and occupation in the food service industry was associated with posting activity suggestive of problem drinking 3 years later. Posting activity on Reddit may be used for early detection of people at higher risk of transitioning from lower- to higher-risk forms of alcohol use.

Protective Factors Associated With Lower Likelihood of Injection Drug Use and Experiencing Overdose Among Incarcerated Women

PURPOSE

Prior studies evaluated protective factors individually as they relate to fewer drug use risk behaviors and related consequences. This is the first study to examine protective factors as part of a multilevel framework along a risk continuum among women involved in the criminal legal system who use drugs. This study describes factors within the socio-ecological framework that are protective against engaging in injection drug use and experiencing nonfatal overdose.

METHOD

Data were collected from 900 women with a history of opioid use disorder who were incarcerated and enrolled in the National Institutes of Health/National Institute on Drug Abuse-funded Justice Community Opioid Innovation Network cooperative. Analysis focused on the relationship among individual, interpersonal, and community- or institutional-level protective factors associated with not injecting drugs and not experiencing an overdose in the 90 days before incarceration using multinomial logistic regression.

FINDINGS

Findings from this study suggest that, even among a sample of women who use drugs, there are a number of factors associated with being less likely to report higher-risk injection behavior and/or overdose experiences at the individual level (age, religiosity, and less polysubstance use), interpersonal level (not having a partner who injects drugs), and community or institutional level (fewer months incarcerated, less treatment utilization, and less enacted stigma by health care workers).

CONCLUSIONS

Findings from this study underscore the importance of being able to target prevention interventions to women at different stages of substance use severity and to capitalize on protective factors for those at lower-risk levels to reduce the trajectory of risk of injection practices and overdose experiences.

Vulnerable Populations and Substance Use Prevention Service Delivery for the Mental Health Professional

The authors discuss the multidimensionality of risk factors for substance use and substance use disorder across the lifespan and the interplay between biological and environmental factors that may lead to substance use. When these underlying factors are not addressed, and usage continues, altered networks in the brain may lead to substance use disorders. Progress in prevention science, and in approaches to delay or prevent substance use initiation and progression to substance use disorder, is reviewed. Four barriers to delivering prevention approaches-unstable funding with a lack of coordination across systems, insufficient workforce capacity, states not knowing where to find evidence-based programs, and a lack of knowledge in how to adapt programs for specific settings-are identified, highlighting the need for a national prevention infrastructure. The authors conclude by providing examples and resources for mental health professionals in promoting prevention of substance use initiation and disorders.

Risk and Promotive Factors Related to Cannabis Use Among American Indian Adolescents

Reservation-dwelling American Indian adolescents are at exceedingly high risk for cannabis use. Prevention initiatives to delay the onset and escalation of use are needed. The risk and promotive factors approach to substance use prevention is a well-established framework for identifying the timing and targets for prevention initiatives. This study aimed to develop predictive models for the usage of cannabis using 22 salient risk and promotive factors. Models were developed using data from a cross-sectional study and further validated using data from a separate longitudinal study with three measurement occasions (baseline, 6-month follow-up, 1-year follow-up). Application of the model to longitudinal data showed an acceptable performance contemporaneously but waning prospective predictive utility over time. Despite the model's high specificity, the sensitivity was low, indicating an effective prediction of non-users but poor performance in correctly identifying users, particularly at the 1-year follow-up. This divergence can have significant implications. For example, a model that misclassifies future adolescent cannabis use could fail to provide necessary intervention for those at risk, leading to negative health and social consequences. Moreover, supplementary analysis points to the importance of considering change in risk and promotive factors over time.

Latent Class Groups of Concurrent Substance Use Among Adolescents in an Urban Community: Correlates With Mental Health, Access to Drugs and Alcohol, and Risk Perception

BACKGROUND

Concurrent substance use among adolescents has been associated with an increase in physical and mental health problems. These outcomes tend to be exacerbated among adolescents of color in underserved urban settings. The purpose of this study was to understand alcohol and concurrent drug use patterns among adolescents in an underserved urban community to provide targeted prevention and treatment recommendations.

METHOD

This study examined data among adolescents in an underserved urban community (N = 1789; 56.90% female; 70.86% Hispanic/Latino/a; meanage = 15.96 ± 1.56). Using latent class analysis (LCA) and multinomial logistic regression modeling, analyses identified independent correlates of latent class membership.

RESULTS

Five latent classes (LC) were identified including LC group 1: Predominant alcohol use and limited to no concurrent-drug use (n = 213; 11.9%); LC group 2: Concurrent drug and alcohol use including methamphetamine, marijuana and synthetic marijuana use, and alcohol use (n = 74; 4.2%); LC group 3: Concurrent drug and alcohol use, with no marijuana use (n = 204; 11.39%); LC group 4: High Concurrent drug use and alcohol use (n = 204; 11.40%); and LC group 5: Concurrent drug use without alcohol use (n = 1101; 61.52%). Significant between group differences were noted between latent class groups and sociodemographic characteristics. Multinomial logistic regression models identified the associations between sociodemographic characteristics and corollary clinical features of substance use on latent class groupings of alcohol and concurrent drug use.

CONCLUSION

Understanding concurrent substance use LC groups among adolescents is essential to providing targeted interventions and treatment programs, as well as early intervention programs that may help reduce substance use during adolescence.

Impact of Adolescent Cannabis Use on Neurocognitive and Brain Development

Research examining associations between frequent cannabis use in adolescence and brain-behavior outcomes has increased substantially over the past 2 decades. This review attempts to synthesize the state of evidence in this area of research while acknowledging challenges in interpretation. Although there is converging evidence that ongoing, frequent cannabis use in adolescence is associated with small reductions in cognitive functioning, there is still significant debate regarding the persistence of reductions after a period of abstinence. Similarly, there is controversy regarding the replicability of structural and functional neuroimaging findings related to frequent cannabis use in adolescence. Larger studies with informative designs are needed.

Investigating the associations of age of initiation and other psychosocial factors of singular alcohol, tobacco and marijuana usage on polysubstance use: analysis of a population-based survey in Jamaica

OBJECTIVES

This study aimed to examine concurrent polysubstance use of alcohol, tobacco and marijuana and determine correlations with access to marijuana, friend and familial drug use habits, risk perception and the age of initiation associated with the singular use of these substances.

DESIGN

A secondary data analysis.

SETTING

Used the Jamaica National Drug Prevalence Survey 2016 dataset.

PARTICIPANTS

Involved the entire dataset comprising 4623 randomly selected respondents between 12 and 65 years old.

OUTCOME MEASURES

Primary outcome: concurrent polysubstance use recorded as using two or more of alcohol, tobacco and marijuana. Predictor variables include risk perception and age of initiation of singular alcohol, tobacco and marijuana use, ease of marijuana access and family and friend alcohol and illegal drug use.

RESULTS

Approximately 58%-66% of respondents commenced singular alcohol, tobacco or marijuana use under 17. Participants commencing marijuana use at 11 years and under and between 12 and 17 were 3.346 and 4.560 times more likely to report past month concurrent polysubstance use (p=0.030 and p<0.001). Respondents who did not believe that smoking tobacco sometimes (p=0.049), and smoking marijuana sometimes and often was harmful, had increased odds of concurrent polysubstance use (p=0.047 and p<0.001, respectively). Respondents who indicated access to marijuana as easy were significantly more likely to report past month concurrent polysubstance use compared with those who reported access as difficult (p=0.002). Participants who indicated that friends or family members get drunk and take illegal drugs were associated with 1.722 and 1.864 increased odds of reporting past month concurrent polysubstance use (p=0.004 and p=0.017, respectively).

CONCLUSIONS

Decreased perceived risk, childhood and adolescent age of initiation and easy access to marijuana were significantly associated with polysubstance use among Jamaicans. The influence of friends and family members' drug and alcohol use behaviours on individuals developing polysubstance use habits further endorses the need for interventions.

The relationship between social media addiction, fear of missing out and family functioning: a structural equation mediation model

BACKGROUND

The use of social media became a daily activity for many individuals, with recreational, informational, and social purposes, to name a few. However, for some subjects, the use of these platforms may become problematic and generate functioning impairments in many life areas. Given this, the present research aimed at investigating the factor that may contribute to Social Media Addiction, by focusing on Fear of Missing Out and Family Functioning Patterns.

METHODS

A sample of 303 social media users (Mage = 35.29; SD = 14.87; 65% females, 35% males) completed a survey including the Bergen Social Media Addiction Scale, Family Adaptability and Cohesion Evaluation Scales-IV, and Fear of Missing Out Scale. Data were analysed by implementing Pearson correlation and testing a mediation with the Structural Equation Model approach.

RESULTS

Cohesion, flexibility, and disengagement family functioning patterns were significantly associated with the levels of social media addiction. These dimensions were inserted in the structural equation model, where the full mediation of fear of missing out in their relationship with social media addiction was shown.

CONCLUSIONS

The data showed the protective effect of flexible and cohesive family functioning patterns, as well as the role of disengagement and, sequentially, fear of missing out as risk factors. These findings may provide useful indications to elaborate tailored and effective therapeutic and preventive activity.

Youth focused life skills training and counselling services program-An inter-sectoral initiative in India: Program development and preliminary analysis of factors affecting life skills

OBJECTIVES

This paper describes the methodology of developing and implementation of a youth focused life skills training and counselling services programme (LSTCP) and assessment of factors associated with life skills of participants pre-training.

DESIGN

Development of all aspects of LSTCP (modules, methods and evaluation) was through a consultative process. Experiential learning based facilitation was decided as the approach for training participants. A quasi-experimental design with pre, post and follow-up assessment post-training was finalised. Data collection was done using specifically developed semi-structured self-administered questionnaire.

RESULTS

Multivariable logistic regression with life skills as outcome and various exposure variables was performed. About 2/3rd of participants had high level of life skills (68%). Increased score of extraversion (AOR = 1.57,95% CI = 1.32-1.85), agreeableness (AOR = 1.42,95% CI = 1.16-1.73), conscientiousness (AOR = 1.9,95% CI = 1.55-2.33), physical (AOR = 1.03,95% CI = 1.01-1.04), environmental (AOR = 1.02,95% CI = 1.004-1.03) and social quality of life (AOR = 1.01,95% CI = 1.006-1.02) were associated with high life skills score. Higher score of neuroticism (AOR = 0.66,95% CI = 0.53-0.79) was associated with low life skills score.

CONCLUSION

The results presented provide an opportunity to understand the evolution of factors affecting life skills during the follow-up of this study. This study throws light on development of LSTCP for apparently healthy population in a setting like India and its states.

Normalization of Prevention Principles and Practices to Reduce Substance Use Disorders Through an Integrated Dissemination and Implementation Framework

Major research breakthroughs over the past 30 years in the field of substance use prevention have served to: (1) enhance understanding of pharmacological effects on the central and peripheral nervous systems and the health and social consequences of use of psychoactive substances, particularly for children and adolescents; (2) delineate the processes that increase vulnerability to or protect from initiation of substance use and progression to substance use disorders (SUDs) and, based on this understanding, (3) develop effective strategies and practices to prevent the initiation and escalation of substance use. The challenge we now face as a field is to "normalize" what we have learned from this research so that it is incorporated into the work of those involved in supporting, planning, and delivering prevention programming to populations around the world, is integrated into health and social service systems, and helps to shape public policies. But we wish to go further, to incorporate these effective prevention practices into everyday life and the mind-sets of the public, particularly parents and educators. This paper reviews the advances that have been made in the field of prevention and presents a framework and recommendations to achieve these objectives generated during several meetings of prevention and implementation science researchers sponsored by the International Consortium of Universities for Drug Demand Reduction (ICUDDR) that guides a roadmap to achieve "normalization."

The Role of Environment, Early Use, Genetic Influences, and Neurobiology in Substance Use Disorder

Substance use disorders (SUDs) have dire consequences for the individual, family, and community. Although SUDs were once viewed as a moral issue, they are now understood to be complex, chronic brain illnesses associated with both genetic and non-genetic influences. The American Psychiatric Association recognizes SUDs associated with the use of 10 different substances, for example, alcohol, nicotine, opioids, cannabis, caffeine, hallucinogens, inhalants, sedatives, hypnotics, and stimulants. Environmental exposure to substances, early use, genetic influences, and neurobiology have all been correlated with an increased likelihood of the development of SUDs. Having a broader understanding of these complex disorders is key for prevention.

The Prevalence of Comorbidities and Substance Use Disorder

Substance use disorders (SUDs) are complex illnesses and may occur in individuals with other physical and mental illnesses. Common comorbidities for SUDs include mental health illness and/or chronic pain. Nurses face additional risk factors for the development of SUD and comorbid illnesses. The relationships among these comorbidities and SUD are multifaceted, requiring understanding of the individual disease processes and how they may impact the manifestations of one another, as well as response to treatment considerations. Understanding the prevalence of these comorbidities and potential relationships is crucial to prevention, management, and treatment outcomes.

Impact of Adolescent Cannabis Use on Neurocognitive and Brain Development

Research examining associations between frequent cannabis use in adolescence and brain-behavior outcomes has increased substantially over the past 2 decades. This review attempts to synthesize the state of evidence in this area of research while acknowledging challenges in interpretation. Although there is converging evidence that ongoing, frequent cannabis use in adolescence is associated with small reductions in cognitive functioning, there is still significant debate regarding the persistence of reductions after a period of abstinence. Similarly, there is controversy regarding the replicability of structural and functional neuroimaging findings related to frequent cannabis use in adolescence. Larger studies with informative designs are needed.

Carbohydrate Metabolism, Pancreas Functional Activity And Diet In Young Residents Of Two Ethnic Groups In The North

The objective of this study was to analyze the type and balance of the diet, examine the hormonal regulation of carbohydrate metabolism in order to identify the etiology of hyperglycemic manifestations in young people of two ethnic groups residing in the territory of Magadan Oblast. Methods — Blood serum carbohydrate parameters were measured using the ion-exchange chromatography, enzymatically enhanced chemiluminescence, and the hexokinase method. Results — We established that the homeostatic model assessment of insulin resistance (HOMA-IR) index did not exceed the reference limits, which implied that the examined young men of two ethnic groups had no insulin resistance. The indigenous subjects demonstrated statistically significantly higher values of glycosylated hemoglobin, closely approaching the upper limit of the reference range. The blood insulin level in examined young men was lowered towards the lower limit of the reference range. Against the background of detected hyperglycemic manifestations in young men of two studied groups in Magadan Oblast, their dietary intake was characterized by insufficiency and imbalance in both micronutrient and macronutrient compositions. It was established that the observed diet contained an excessive amount of mono- and disaccharides in 49% of Caucasians and 72% of natives, which was 52% and 108% higher, respectively, compared with the reference range against the pronounced deficiency of chromium, copper, and vitamin D. Conclusion — The results indicated an unbalanced diet with excessive intake of mono- and disaccharides, along with reduced insulin secretion and increased glycosylated hemoglobin, which was more pronounced in the indigenous group, probably causing hyperglycemic manifestations in the carbohydrate metabolism observed in young residents of Magadan Oblast.

Examining protective factors for substance use problems and self-harm behavior during adolescence: A longitudinal co-twin control study

Sports participation, physical activity, and friendship quality are theorized to have protective effects on the developmental emergence of substance use and self-harm behavior in adolescence, but existing research has been mixed. This ambiguity could reflect, in part, the potential for confounding of observed associations by genetic and environmental factors, which previous research has been unable to rigorously rule out. We used data from the prospective, population-based Child and Adolescent Twin Study in Sweden (n = 18,234 born 1994-2001) and applied a co-twin control design to account for potential genetic and environmental confounding of sports participation, physical activity, and friendship quality (assessed at age 15) as presumed protective factors for adolescent substance use and self-harm behavior (assessed at age 18). While confidence intervals widened to include the null in numerous co-twin control analyses adjusting for childhood psychopathology, parent-reported sports participation and twin-reported positive friendship quality were associated with increased odds of alcohol problems and nicotine use. However, parent-reported sports participation, twin-reported physical activity, and twin-reported friendship quality were associated with decreased odds of self-harm behavior. The findings provide a more nuanced understanding of the risks and benefits of putative protective factors for risky behaviors that emerge during adolescence.

The relationship between trait emotional intelligence and problematic alcohol use among college students

Background: Problematic alcohol use among college students is a significant public health concern. Emotional intelligence (EI), or the ability to detect one's own and others' emotions and to use this information to direct behavior, is suggested to mitigate problematic alcohol use. The purpose of this study was to examine the relationship between EI and problematic alcohol use among college students while controlling for drug use covariates. Methods: This cross-sectional study utilized an online survey comprised of previously validated measures to determine EI, problematic alcohol use, and drug use among college students from a large, public university in the south-central United States. Regression modeling and independent samples t-test were used to determine the relationship between EI and problematic alcohol use. Results: Problematic alcohol consumption was reported among 27.3% of participants (n=587). In regression modeling, EI demonstrated a significant, protective effect on problematic alcohol use (b =-0.050, P <0.001, 95% CI: -0.076 - -0.023), when adjusting for important covariates. Independent samples t-test showed that students who screened positive for harmful alcohol use reported significantly lower EI values than those who did not (Mean difference=4.53, t =2.98, P =0.003, 95% CI: 1.54-7.51). Conclusion: The findings from this study show that problematic alcohol use is prevalent among college students and EI may provide a protective effect against this deleterious behavior. Given the findings observed in this study, university officials should incorporate EI training into the university curriculum, such as in onboarding courses for freshman and transfer students, to target prevention of potentially harmful alcohol consumption and associated negative health impacts.

Alcohol Use Disorder: Neurobiology and Therapeutics

Alcohol use disorder (AUD) encompasses the dysregulation of multiple brain circuits involved in executive function leading to excessive consumption of alcohol, despite negative health and social consequences and feelings of withdrawal when access to alcohol is prevented. Ethanol exerts its toxicity through changes to multiple neurotransmitter systems, including serotonin, dopamine, gamma-aminobutyric acid, glutamate, acetylcholine, and opioid systems. These neurotransmitter imbalances result in dysregulation of brain circuits responsible for reward, motivation, decision making, affect, and the stress response. Despite serious health and psychosocial consequences, this disorder still remains one of the leading causes of death globally. Treatment options include both psychological and pharmacological interventions, which are aimed at reducing alcohol consumption and/or promoting abstinence while also addressing dysfunctional behaviours and impaired functioning. However, stigma and social barriers to accessing care continue to impact many individuals. AUD treatment should focus not only on restoring the physiological and neurological impairment directly caused by alcohol toxicity but also on addressing psychosocial factors associated with AUD that often prevent access to treatment. This review summarizes the impact of alcohol toxicity on brain neurocircuitry in the context of AUD and discusses pharmacological and non-pharmacological therapies currently available to treat this addiction disorder.

Towards quantifying the reciprocal associations between frequency of cannabis use and alcohol consumption: a cross-lagged analysis from the CONSTANCES cohort

OBJECTIVE

Disentangle the temporal relationships between frequency of cannabis use and alcohol consumption.

METHODS

A cross-lagged model providing standardised coefficients (SCs)±their standard errors in 13 255 men and 13 696 women enrolled in 2015 or 2016 in the French population-based 'CONSulTANts des Centres d'Examens de Santé' (CONSTANCES) cohort. Cannabis use was categorised as follows: 'No use during the past 12 months', 'Use during the past 12 months but not in the past month' and 'Use in the past month' for cannabis use at baseline, and No use during the past 12 months, 'Use less than once per month' and 'Use once per month or more' for cannabis use at 1 year of follow-up. Alcohol consumption was measured at baseline and at 1 year of follow-up and three categories were determined: low risk (<28 drinks per week in men; <14 drinks per week in women), moderate risk (≥28 and<42 in men; ≥14 and<28 in women) and high risk (≥42 in men; ≥28 in women). Analyses were adjusted for age, sex, education, income, tobacco consumption, self-rated health status and depressive symptoms.

RESULTS

Both associations from alcohol to cannabis and from cannabis to alcohol were significant (SC=0.02±0.01 with p=0.003 and SC=0.06±0.01 with p<0.001, respectively). However, the SC of the association from cannabis to alcohol was three times higher than the opposite association (p<0.001). After stratification for sex, SCs of the association from cannabis to alcohol were more than two times higher than for the opposite association in men, and more than four times higher in women (both p<0.001).

CONCLUSIONS

The association between frequency of cannabis use and subsequent alcohol consumption was stronger than the opposite association. This finding encourages considering the risk of increased alcohol consumption among cannabis users.

School-related Promotive Factors Related to Cannabis Use Among American Indian Adolescents

Reservation-dwelling American Indian adolescents are at exceedingly high risk for cannabis use. Prevention initiatives to delay onset and escalation of use are needed. School engagement and student's positive experiences at school have been identified as key promotive factors against cannabis use in the general population of adolescents, but little work has examined these factors among American Indian youth. Seven school-related promotive factors were examined as predictors of past 30-day cannabis use (measured 6 months later), controlling for previous onset of cannabis use as well as a set of relevant potential confounders. Models were tested using 280 adolescents in 6th or 7th grade at the start of the study from two reservation-based schools in the US. Students were surveyed three times, with 6 months in between each survey. The average age at the start of the study was 11.99 years (SD = 0.87) and 54% of participants were female. Using a cumulative logit model to predict past 30-day use, American Indian youth who reported greater school bonding, academic aspirations, proclivity to endeavor in their studies, and interest in school at Wave 2 reported less 30-day cannabis use at Wave 3 (controlling for onset of cannabis at Wave 1 and several other control variables). No evidence of an effect of self-reported grades, perceived safety, or participation in school-related extracurricular activities was found. Given substantial deterioration of these school-related promotive factors over time, and the effect of the school-related promotive factors on subsequent cannabis use, efforts to design and test interventions to promote school engagement as a protective measure against cannabis use is warranted.

Cannabis use disorder trajectories and their prospective predictors in a large population-based sample of young Swiss men

BACKGROUND AND AIMS

Cannabis use disorder (CUD) is frequent in adolescence and often goes into remission towards adulthood. This study aimed to estimate trajectories of CUD severity (CUDS) in Swiss men aged from 20 to 25 years and to identify prospective predictors of these trajectories.

DESIGN

Latent class growth analysis of self-reported CUDS in a cohort study with three data collection waves.

SETTING

A general population sample of young Swiss men.

PARTICIPANTS

A total of 5987 Swiss men assessed longitudinally at the mean ages of 20, 21.5 and 25 years.

MEASUREMENTS

Latent CUDS in the last 12 months was measured at each wave with the Cannabis Use Disorders Identification Test-Revised (CUDIT-R). Predictors of CUDS trajectories, measured at age 20, were from six domains: factors related to cannabis use, family, peers, other substance use, mental health and personality.

FINDINGS

We distinguished four CUDS trajectories: stable-low (88.2%), decreasing (5.2%), stable-high (2.6%) and increasing (4.0%). Predictors were generally associated with higher odds of membership in the decreasing and stable-high trajectory (versus the stable-low), and to a lesser degree with higher odds of membership in the increasing trajectory. Bivariate predictors of persistent high CUDS (stable-high versus decreasing trajectory) were major depression severity [odds ratio (OR) = 1.19, 95% confidence interval (CI) = 1.01, 1.40], attention deficit hyperactivity disorder severity (OR = 1.25, 95% CI = 1.04, 1.51), antisocial personality disorder severity (OR = 1.18, 95 % CI = 1.04, 1.34), relationship with parents (OR = 0.74, 95% CI = 0.63, 0.88), number of friends with drug problems (OR = 1.33, 95% CI = 1.11, 1.60) and the personality dimensions neuroticism-anxiety (OR = 1.35, 95% CI = 1.11, 1.65) and sociability (OR = 0.78, 95% CI = 0.62, 0.97).

CONCLUSIONS

Factors associated with persistent cannabis use disorder in young Swiss men include cannabis use, cannabis use disorder severity, mental health problem severity, relationship with parents (before the age of 18), peers with drug problems and the personality dimensions neuroticism-anxiety and sociability at or before age 20. Effect sizes may be small, and predictors are mainly associated with persistence via higher severity at age 20 years.

A longitudinal study of the impact of marijuana on adult memory function: Prenatal, adolescent, and young adult exposures

More Americans are using marijuana than in previous decades but there are concerns over its long-term impact on cognitive functioning, especially memory. The literature on marijuana use and cognitive functioning is mixed, with some studies showing recovery of functioning upon abstinence from the drug and others showing long-term effects that persist. The latter seems especially true for individuals who initiate marijuana at a younger age and engage in more chronic patterns of use. The goal of the current study is to use prospectively collected data on young adults from a prenatal cohort to determine if there is an effect of early and/or current marijuana use on young adult memory, controlling for prenatal exposure to marijuana use, childhood memory deficits, and other significant covariates of memory functioning. At the 22-year follow-up phase of the Maternal Health Practices and Child Development (MHPCD) study, 524 young adults (58% Black, 42% White, 52% female) completed the Wechsler Memory Scale-III. Multiple regression analyses and structural equation modeling were used to determine the effect of marijuana exposure during gestation, early adolescence, and young adulthood on young adult memory function. Results indicated that initiating marijuana use before age 15 placed young adults at greater risk of memory deficits, even after controlling for childhood memory and current marijuana use. First trimester marijuana exposure also indirectly predicted young adult memory function via childhood memory deficits and early initiation of marijuana. These findings highlight the risk of prenatal marijuana exposure and early initiation of marijuana for long-term memory function in adulthood.

An Integrated Model of Nature and Nurture Factors that Contribute to Addiction and Recovery

BACKGROUND

In the context of the opioid epidemic and growing awareness of addiction as a public health concern, there are efforts to inform the public, patients, families, and policy makers about the factors that contribute to addiction and facilitate recovery. Several theoretical models provide useful frameworks for this discussion, but each of them has limitations.

OBJECTIVES

This paper presents an accessible yet comprehensive theoretical model that integrates empirical evidence about addiction etiology and recovery using the nature-nurture paradigm.

RESULTS

The model presents substance use along a continuum, and identifies risk and protective factors in multiple domains that have been identified by research. The domains on the nature side of the model include genetic and biological factors, comorbid psychiatric and medical disorders, physiological reinforcement of substance use, and changes to neural mechanisms. The domains on the nurture side of the model include sociocultural factors, environmental factors, personality, emotions, cognitions, psychological reinforcement of substance use, and cognitive and behavioral changes. The progression from increased or decreased substance use to addiction or recovery is mediated by changes in neural mechanisms and cognitive and behavioral changes, which have feedback loops with the physiological and psychological reinforcement.Conclusions/Importance: This model is a useful heuristic, consistent with a public health framework, for discussing addiction and recovery with patients, their families, and the public. This integrated model of nature and nurture factors has the potential to inform clinical practice, consultation, research, prevention programs, educational programs, and public policy.

Monitoring young lifestyles (MyLife) - a prospective longitudinal quantitative and qualitative study of youth development and substance use in Norway

PURPOSE

The Monitoring Young Lifestyles (MyLife) project was initiated as an integrated quantitative and qualitative prospective investigation of correlates, causes, and consequences of adolescent substance use and other addictive behaviours in Norway.

PARTICIPANTS

The MyLife cohort was recruited from middle schools in Norway, which were selected from low, medium and high standard of living areas in both rural and urban regions of the country. A total of 3512 eighth, ninth and tenth graders (55% girls) from 33 schools were enrolled in the quantitative project arm (QT), while a total of 120 eighth graders (52% girls) from six schools were enrolled in the qualitative project arm (QL).

FINDINGS TO DATE

QT baseline was conducted in the fall of 2017, when 2975 adolescents completed an online questionnaire at school during a regular class time. A total of 2857 adolescents participated in the first QT follow-up 1 year later. QL baseline was conducted across the fall semesters of 2014 (one class) and 2015 (five classes), when a total of 118 eighth graders completed face-to-face interviews. QL follow-ups were conducted in the spring of 2015 and fall of 2017 (n=98) for group interviews, and in the spring of 2017 and 2018 (n=95) for individual interviews. In terms of additional data sources, a total of 3035 parents consented to own participation, of which 1899 completed a brief online questionnaire at QT baseline in late 2017. School principals completed brief surveys at the same time.

FUTURE PLANS

Both QT and QL arms have planned follow-ups through 2021. Consents were obtained for individual-level linkages of adolescent and parental quantitative surveys to each other, as well as to the information available in multiple national registries and databases. These supplemental data sources will provide key information on additional putative exposures as well as on the long-term health, educational, and social outcomes of the MyLife participants.

Adequações do piloto do programa Unplugged#Tamojunto para promoção à saúde e prevenção de drogas em escolas brasileiras

Resumo A prevenção ao uso de álcool e outras drogas no Brasil é marcada pela descontinuidade e pelo predomínio de um modelo não baseado em evidência. No ano de 2013, a Coordenação Geral de Saúde Mental, álcool e outras drogas, do Ministério da Saúde, implementou o programa escolar europeu Unplugged#Tamojunto, nos municípios de São Paulo/SP, São Bernardo do Campo/SP e Florianópolis/SC, envolvendo 2.161 educandos da rede pública. O objetivo da pesquisa foi a elaboração de recomendações de adequação do programa ao contexto brasileiro. O estudo qualitativo, baseado na Teoria Fundamentada Construtivista, analisou os documentos institucionais: “Diários Cartográficos”, “Matriz lógica de adaptação cultural” e relatório de pesquisa titulado “Resultados da Avaliação da Implantação Piloto do Programa Unplugged em São Paulo e Santa Catarina” (UFSC e UNIFESP). As formulações teóricas, organizadas a partir da Teoria de Difusão de Inovações, revelaram que é necessário: mudança paradigmática da abordagem de drogas pelos profissionais, maior adesão a metodologias interativas, adequação no tempo da hora-aula, compromisso da gestão escolar, fomento da intersetorialidade entre saúde e educação, consolidação de um monitoramento de processo e um alinhamento ético com os princípios da promoção da saúde.

PERCEPTION OF HARM AND BENEFITS OF MARIJUANA AND ITS RELATIONSHIP WITH THE INTENTION OF USE AND CONSUMPTION IN COLOMBIAN ADOLESCENTS

ABSTRACT Objective: analyze the relationship between the perception of harm and benefits associated with the use of marijuana and its relation to real consumption, as well as the intention to use it in a context of regulatory changes, in young students, between 15 and 17 years old, of a public school in Bogota Colombia. Method: a quantitative, cross-sectional survey was carried out. 268 students in grade 9th to 11th from a public school in the city of Bogotá, Colombia participated of the study. Results: results reveled that there is an association between the perception of benefits and the consumption of marijuana. In addition, how a low perception of risk is associated with an intention to use in a context of legalization. Conclusion: this is one of the first studies in Colombia which explores the intention to use (at age 18) in a context of regulatory changes, as well as the attitude of young people towards the legalization of marijuana for medicinal and recreational use.

Developmental pathways of adolescent cannabis use: Risk factors, outcomes and sex-specific differences

BACKGROUND

Characterizing patterns of adolescent cannabis use (CU), as well as risk factors and outcomes uniquely associated with these pathways is essential for informing treatment and prevention efforts. Yet, few studies have examined these issues among youth at-risk of engaging in problematic cannabis use. Further, research accounting for use of other substances or sex differences in patterns of CU remains exceedingly sparse.

METHODS

Trajectory-based modeling was used to identify underlying CU pathways among a predominantly Hispanic (90%) sample of at-risk youth (n = 401; 46% female) across adolescence (ages∼14-18), controlling for baseline substance use and participant demographics. Adolescent psychopathology (i.e., conduct disorder, attention deficit hyperactivity disorder, anxiety, and depression) was examined as a predictor and outcome of CU.

RESULTS

Three trajectories of adolescent CU were identified, with most youth (74%) engaging in relatively "low" levels of use, followed by ∼12% exhibiting an early-initiating "chronic" course, and 14% "escalating" in use. Although boys and girls both experienced increased levels of CU across adolescence, boys were more likely to exhibit escalating and chronic patterns of use. Findings revealed unique associations between adolescent CU pathways and facets of psychopathology; most notably, the relatively robust and bidirectional association between CU trajectories and conduct problem symptoms.

CONCLUSIONS

Specific facets of psychopathology may confer unique associations with CU across development, including the initiation and exacerbation of CU during adolescence.

Economic and sociocultural poverty in drug abuse: from individual to sociopolitical responsibility

Abstract Research on drug abuse has often ignored users’ own opinions and perceptions about their addiction. In this study, we wanted to hear their voice on the reasons and motives why they engaged in drug abuse, and on the consequences this behavior had on their lives. Data were collected in Portugal from interviews with fifteen people under treatment for addictive behavior relative to alcohol and illegal drugs. The interviews were analyzed through Thematic Analysis and revealed the existence of several structural factors impacting on the lives of the participants, namely, gender discrimination, poor schooling, socioeconomic marginalization and exclusion associated to insufficient and inadequate public policies. The action of more symbolic structural factors - for instance, their widespread beliefs on drug addiction as a result of free will - through its internalization by families, friends and by addicts themselves, became visible in interviewees’ narratives, in which the rejection by close ones, as well as their own feelings of guilt, sadness and self-disapproval, are prominent features. As a conclusion, we call attention to the need for an integrated public policy in the educational, health and justice areas, and the implementation of awareness-raising actions aimed at the general public, in order to attenuate the impact of structural factors on the lives of current and potential drug addicts.

Association of Cannabis With Cognitive Functioning in Adolescents and Young Adults: A Systematic Review and Meta-analysis

IMPORTANCE

Substantial shifts in perception and policy regarding cannabis have recently occurred, with use of cannabis increasing while its perceived harm decreases. One possible risk of increased cannabis use is poorer cognitive functioning, especially in youth.

OBJECTIVE

To provide the first quantitative synthesis of the literature examining cannabis and cognitive functioning in adolescents and young adults (with a mean age of 26 years and younger).

DATA SOURCES

PubMed, PsycInfo, Academic Search Premier, Scopus, and bibliographies of relevant reviews were searched for peer-reviewed, English-language studies from the date the databases began through May 2017.

STUDY SELECTION

Consensus criteria were used to determine study inclusion through abstract and manuscript review.

DATA EXTRACTION AND SYNTHESIS

This study followed Meta-analysis of Observational Studies in Epidemiology guidelines. Effect size estimates were calculated using multivariate mixed-effects models for cognitive functioning outcomes classified into 10 domains.

MAIN OUTCOMES AND MEASURES

Results from neurocognitive tests administered in cross-sectional studies were primary outcomes, and we examined the influence of a priori explanatory variables on variability in effect size.

RESULTS

Sixty-nine studies of 2152 cannabis users (mean [SD] age, 20.6 [2.8] years; 1472 [68.4%] male) and 6575 comparison participants with minimal cannabis exposure were included (mean [SD] age, 20.8 [3.4]; 3669 [55.8%] male). Results indicated a small overall effect size (presented as mean d) for reduced cognitive functioning associated with frequent or heavy cannabis use (d, -0.25; 95% CI, -0.32 to -0.17; P < .001). The magnitude of effect sizes did not vary by sample age or age at cannabis use onset. However, studies requiring an abstinence period longer than 72 hours (15 studies; n = 928) had an overall effect size (d, -0.08; 95% CI, -0.22 to 0.07) that was not significantly different from 0 and smaller than studies with less stringent abstinence criteria (54 studies; n = 7799; d, -0.30; 95% CI, -0.37 to -0.22; P = .01).

CONCLUSIONS AND RELEVANCE

Associations between cannabis use and cognitive functioning in cross-sectional studies of adolescents and young adults are small and may be of questionable clinical importance for most individuals. Furthermore, abstinence of longer than 72 hours diminishes cognitive deficits associated with cannabis use. Although other outcomes (eg, psychosis) were not examined in the included studies, results indicate that previous studies of cannabis in youth may have overstated the magnitude and persistence of cognitive deficits associated with use. Reported deficits may reflect residual effects from acute use or withdrawal. Future studies should examine individual differences in susceptibility to cannabis-associated cognitive dysfunction.

Individual and school-class correlates of youth cannabis use in Sweden: A multilevel study

Background and aims:

The school-class context is a crucial social environment for young people but substance use researchers have largely overlooked potential influences operating at this level. This study explores associations between school-class and individual-level factors and cannabis use in Swedish youth.

Data and methods:

Data comprised four waves (2012–2015) of the Swedish Council for Information on Alcohol and Other Drugs’ (CAN) nationally representative school surveys among individuals in 9th and 11th grade. For the present analyses, we had data on totally 28,729 individuals from 2377 unique school classes. Multilevel logistic regressions predicted lifetime and 10+ times use of cannabis from both individual-level predictors and school-class-level measures derived from the individual-level variables.

Results:

There were individual-level associations between most predictor variables and cannabis use. An early debut of tobacco use and binge drinking as well as low cannabis related risk perceptions had strong associations with cannabis use. Conversely, several school-class-level variables had aggregate relationships with cannabis use, most notably the overall level of risk perceptions in the school class. Some of the school-class factors predicted cannabis use over and above the individual-level covariates, suggesting the presence of contextual effects. Surprisingly, while female gender was negatively related with cannabis use at the individual level, a higher proportion of females in the classroom increased the odds for lifetime cannabis use even after controlling for individual and other contextual-level covariates.

Conclusions:

Youth cannabis use is related to various factors at both the individual and school-class level in Sweden. Truancy and perceived risk related to cannabis use had contextual associations with cannabis use. The positive contextual association between a higher proportion of females in the classroom and lifetime use should be explored further.

Emerging Adults Riding With Marijuana-, Alcohol-, or Illicit Drug-Impaired Peer and Older Drivers

OBJECTIVE

The purpose of this study was to examine the prevalence and covariates among emerging adults of riding with an impaired peer or older adult driver (RWI) because of marijuana (MJ), alcohol (ALC), or illicit drugs (ID).

METHOD

Data were from Waves 4 (W4, N = 2,085) and 5 (W5, N = 2,116) of the NEXT Generation Health Study, collected in 2013-2014, 1 and 2 years after high school. W5 RWI was specified for substance-specific impaired peer and older adult (peer/older adult) drivers. Multinomial logistic regressions estimated W5 association of substance-specific RWI with W4 RWI, and W5 heavy episodic drinking, MJ use, and school/residence/work status.

RESULTS

At W5, 33% of the participants reported RWI in the past year, including riding with ALC- (21%), MJ- (17%), and ID- (5%) impaired peer drivers and ALC- (2%), MJ- (4%), and ID- (0.7%) impaired older adult drivers. W4 RWI was associated with W5 RWI with impaired peer/older adult drivers for ALC- (adjusted odds ratio [AOR] = 4.28, 2.69) and MJ-RWI (AOR = 2.34, 3.56). W5 heavy episodic drinking was positively associated with W5 peer ALC-related RWI (AOR = 2.16) and peer/older adult MJ-related RWI (AOR = 2.38, 5.45). W5 MJ use was positively associated with W5 peer ALC-related RWI (AOR = 2.23), peer/older adult MJ-related (AOR = 10.89, 2.98), and peer/older adult ID-related (AOR = 9.34, 4.26) RWI. ID-related RWI was higher among those not attending 4-year college (AOR = 3.38), attending technology school (AOR = 16.23), living on their own (AOR = 6.85), or living on campus (AOR = 11.50).

CONCLUSIONS

The high prevalence of RWI among emerging adults occurred mostly with ALC- or MJ-impaired peer drivers. The findings support the need for precisely tailored programs to prevent impaired driving according to substance use and age.

Exposure to tobacco websites: Associations with cigarette and e-cigarette use and susceptibility among adolescents

INTRODUCTION

Exposure to tobacco advertising is a risk factor for tobacco use and susceptibility among adolescents. Although tobacco company websites are ostensibly targeted to adults, some youth access these websites and are exposed to tobacco-related content.

METHODS

This study analyzed data from the Population Assessment of Tobacco and Health (PATH) survey to estimate the prevalence of exposure to tobacco websites and the associations between website exposure and tobacco product use and susceptibility among adolescents in the United States.

RESULTS

Although only 2.3% of youth had ever visited a tobacco company website, youth who visited tobacco company websites were 3.2 times more likely to have used cigarettes and 3.0 times more likely to have used e-cigarettes in the past month, relative to those who had not visited a tobacco website. Among never-users, those who had visited tobacco company websites were 2.4 times more likely to be susceptible to cigarettes and 2.9 times more likely to be susceptible to e-cigarettes.

CONCLUSIONS

Results indicate that more effective regulations are needed to prevent youth from accessing tobacco websites. Stricter age verification procedures on websites could minimize exposure to tobacco websites by youth.

Demographic and clinical characteristics of treatment seeking women with full and subthreshold PTSD and concurrent cannabis and cocaine use disorders

While the detrimental effects of concurrent substance use disorders (SUDs) are now being well documented, very few studies have examined this comorbidity among women with posttraumatic stress disorder (PTSD). Data for these analyses were derived from the "Women and Trauma" study conducted within the National Drug Abuse Treatment Clinical Trials Network. Women with full or subthreshold PTSD and co-occurring cannabis use disorder (CUD) and cocaine use disorder (COD; N=99) were compared to their counterparts with co-occurring CUD only (N=26) and co-occurring COD only (N=161) on rates of trauma exposure, psychiatric disorders, psychosocial problems, and other substance use utilizing a set of multivariate logistic regressions. In models adjusted for age and race/ethnicity, women with PTSD and COD only were significantly older than their counterparts with CUD only and concurrent CUD+COD. Relative to those with CUD only, women with concurrent CUD+COD had higher odds of adult sexual assault. Relative to those with COD only, women with concurrent CUD+COD had higher odds of alcohol use disorder in the past 12months. Finally, relative to those with CUD only, women with COD only had higher odds of ever being arrested/convicted and adult sexual assault. The higher rates of adult sexual assault and alcohol use disorder among those with concurrent CUD+COD suggest the need for trauma-informed approaches that can respond to the needs of this dually-diagnosed population. Moreover, the causal link between repeated traumatic stress exposure and polysubstance use requires further examination.

Impact of Cannabis Use on Treatment Outcomes among Adults Receiving Cognitive-Behavioral Treatment for PTSD and Substance Use Disorders

BACKGROUND

Research has demonstrated a strong link between trauma, posttraumatic stress disorder PTSD and substance use disorders (SUDs) in general and cannabis use disorders in particular. Yet, few studies have examined the impact of cannabis use on treatment outcomes for individuals with co-occurring PTSD and SUDs.

METHODS

Participants were 136 individuals who received cognitive-behavioral therapies for co-occurring PTSD and SUD. Multivariate regressions were utilized to examine the associations between baseline cannabis use and end-of-treatment outcomes. Multilevel linear growth models were fit to the data to examine the cross-lagged associations between weekly cannabis use and weekly PTSD symptom severity and primary substance use during treatment.

RESULTS

There were no significant positive nor negative associations between baseline cannabis use and end-of-treatment PTSD symptom severity and days of primary substance use. Cross-lagged models revealed that as cannabis use increased, subsequent primary substance use decreased and vice versa. Moreover, results revealed a crossover lagged effect, whereby higher cannabis use was associated with greater PTSD symptom severity early in treatment, but lower weekly PTSD symptom severity later in treatment.

CONCLUSION

Cannabis use was not associated with adverse outcomes in end-of-treatment PTSD and primary substance use, suggesting independent pathways of change. The theoretical and clinical implications of the reciprocal associations between weekly cannabis use and subsequent PTSD and primary substance use symptoms during treatment are discussed.

Development of Alcohol and Drug Use in Youth With Manic Symptoms

OBJECTIVE

This analysis examined alcohol and drug use over a 6-year follow-up of children in the Longitudinal Assessment of Manic Symptoms (LAMS) study.

METHOD

LAMS screened 6- to 12.9-year-old children visiting 9 child outpatient mental health (MH) clinics, using the Parent General Behavior Inventory 10-item mania scale. All children with scores ≥12 and a matched group with scores ≤12 were invited to enroll. Children were assessed every 6 months. Assessments included demographics, family, MH history, child diagnoses, child stress, and alcohol and drug use. Univariate, bivariate, and interval censored survival analyses were conducted.

RESULTS

Of those >9 years at baseline, 34.9% used alcohol at least once, with 11.9% regular users; 30.1% used drugs at least once, with 16.2% regular users. Predictors of any alcohol use were parental marital status, older age at study entry, a primary diagnosis of disruptive behavior disorders at baseline, and number of impactful child life events. Predictors of regular alcohol use included parental marital status, age, and sustained high mania symptoms over the first 24 months of follow-up. Predictors of any drug use were single parent, parental substance use, and stressful child life events. Predictors of regular drug use were parental marital status, stressful child life events, and a baseline disruptive behavior disorder diagnosis. Baseline medications decreased the risk of regular drug use.

CONCLUSION

Longitudinal data on youth with elevated manic symptoms suggest that comorbid disruptive behavior disorder, manic symptom burden, family environment, and stress are predictors of initiation and regular use of substances.

Self-Perceived Strengths Among Adolescents With and Without Substance Abuse Problems

The importance of examining positive aspects of youth development has been emphasized across disciplines involved in the care of youth with substance abuse problems. However, little is known about the strengths of adolescents with substance abuse problems, especially youth entering residential treatment. Utilizing the Strengths Assessment Inventory, a measure assessing psychological and social strengths, we examined patterns of strengths across groups of age- and gender-matched youth who reported no substance use, frequent substance use, and those entering treatment for severe substance use. Each group consisted of 43 participants ranging in age from 14 to 18 years. Results indicated that, on average, individuals entering treatment scored lower on personal strengths. However, through the use of more sophisticated statistical approaches, it was found that certain strengths were predictive of individuals belonging to the treatment group. Results are discussed in terms of their relevance to the treatment of adolescent substance abuse problems.

Marijuana-, alcohol-, and drug-impaired driving among emerging adults: Changes from high school to one-year post-high school

INTRODUCTION

Driving while impaired (DWI) increases the risk of a motor vehicle crash by impairing performance. Few studies have examined the prevalence and predictors of marijuana, alcohol, and drug-specific DWI among emerging adults.

METHODS

The data from wave 3 (W3, high school seniors, 2012, N=2407) and wave 4 (W4, one year after high school, N=2178) of the NEXT Generation Health Study with a nationally representative cohort. W4 DWI (≥1day of past 30days) was specified for alcohol-specific, marijuana-specific, alcohol/marijuana-combined, illicit drug-related DWI. Multinomial logistic regression models estimated the association of W4 DWI with W3 covariates (perceived peer/parent influence, drinking/binge drinking, marijuana/illicit drug use), and W4 environmental status variables (work/school/residence) adjusting for W3 overall DWI, demographic, and complex survey variables.

RESULTS

Overall DWI prevalence from W3 to W4 changed slightly (14% to 15%). W4 DWI consisted of 4.34% drinking-specific, 5.02% marijuana-specific, 2.41% drinking/marijuana combined, and 3.37% illicit drug-related DWI. W3 DWI was significantly associated with W4 alcohol-related and alcohol/marijuana-combined DWI, but not other DWI. W3 marijuana use, binge drinking, and illicit drug use were positively associated with W4 marijuana-specific, alcohol/marijuana-combined, and illicit drug-related DWI, respectively. W3 friend drunkenness and marijuana use were positively associated with W4 alcohol-specific and marijuana-related DWI, respectively. W3 peer marijuana use was negatively associated with W4 alcohol-specific DWI.

CONCLUSIONS

Driving under the influence of alcohol, marijuana, and illicit drugs is a persistent, threatening public health concern among emerging U.S. adults. High school seniors' binge drinking as well as regular alcohol drinking and marijuana/illicit drug use were independently associated with respective DWI one year after high school. Peer drunkenness and marijuana use in high school may be related to subsequent DWI of emerging adults.

PRACTICAL APPLICATIONS

The results support the use of injunctive peer norms about getting drunk and smoking marijuana in guiding the development of prevention programs to reduce youth DWI.

Neurobiology of addiction: a neurocircuitry analysis

Drug addiction represents a dramatic dysregulation of motivational circuits that is caused by a combination of exaggerated incentive salience and habit formation, reward deficits and stress surfeits, and compromised executive function in three stages. The rewarding effects of drugs of abuse, development of incentive salience, and development of drug-seeking habits in the binge/intoxication stage involve changes in dopamine and opioid peptides in the basal ganglia. The increases in negative emotional states and dysphoric and stress-like responses in the withdrawal/negative affect stage involve decreases in the function of the dopamine component of the reward system and recruitment of brain stress neurotransmitters, such as corticotropin-releasing factor and dynorphin, in the neurocircuitry of the extended amygdala. The craving and deficits in executive function in the so-called preoccupation/anticipation stage involve the dysregulation of key afferent projections from the prefrontal cortex and insula, including glutamate, to the basal ganglia and extended amygdala. Molecular genetic studies have identified transduction and transcription factors that act in neurocircuitry associated with the development and maintenance of addiction that might mediate initial vulnerability, maintenance, and relapse associated with addiction.

A new approach to researching the etiology of cannabis use disorder: integrating transmissible and nontransmissible risk within a developmental framework

Rapidly occurring changes in law enforcement and licensing of retail outlets to sell marijuana raises the prospect that the population of consumers will expand and accordingly the prevalence of cannabis use disorder (CUD) will increase. This report presents a novel approach to researching CUD etiology joining multivariate and ontogenetic perspectives. CUD is conceptualized as a developmental outcome consisting of transmissible (intergenerational) and nontransmissible components. Partitioning the liability for CUD into these 2 dimensions enables implementing interventions targeted at the particular source and severity of risk. In addition, results showing that infant temperament disturbances predict transmissible risk leading to CUD 2 decades later underscore the importance of implementing early prevention.

Young people in drug treatment in Ireland: their views on substance use aetiology, trajectory, parents' role in substance use and coping skills

OBJECTIVES

The aim of the current study was to gain insight into the process of initiation and progression to problematic use among young people who reach clinically significant levels of substance use requiring treatment.

METHOD

Twenty young people, aged between 15 and 19 years from two different drug treatment centres in Ireland were interviewed regarding their views on their pathway into substance use, their progress to more problematic use, their perception of their parents' role, if any, in their trajectory and their typical coping style before treatment. Content analysis was conducted on the resulting narratives.

RESULTS

The use of substances to cope with life stressors emerged as a prominent theme at initial and problematic stages of use. Multiple maladaptive coping approaches were reported. Both direct and indirect influences from parents in their substance use problem were cited. However, some participants reported that parents had no causal role in their substance use trajectory, in particular regarding mothers.

CONCLUSIONS

The current findings suggest that substance misuse is a multi-determined problem and a number of intervention strategies are suggested to delay onset and related harms associated with adolescent substance use.

Assessing Drug Consumption Behavior With the Heidelberger Drogenbogen (Heidelberg Drug Scales): Reliabilities, Validities, and Cut-Off Criteria

BACKGROUND

The Heidelberger Drogenbogen (HDB) is a German language assessment of substance-specific knowledge and consumption patterns of the illicit psychoactive substances cannabis, MDMA (ecstasy), amphetamines, cocaine, and hallucinogens. The behavior modules for each of these five drugs/drug groups allow for a diagnostic evaluation of the extent of harmful consumption behavior. Each of the five modules represents a single standardized test.

OBJECTIVES

This paper outlines several statistical parameters, Cronbach's alpha, retest reliabilities, as well as numerous validity and cut-off-criteria of the behavioral modules.

METHODS

Participants (N = 4,794) were recruited at schools, universities, in subcultural contexts, and in institutions of substance abuse treatment.

RESULTS

Internal consistencies range from = .68 to .79 while test-retest reliabilities between .87 and .94 were found. The behavior modules of the HDB can discriminate between populations with and without clinical levels of substance use. Furthermore, this measure has incremental validity and higher diagnostic accuracy over competing measures.

CONCLUSIONS

The behavior modules of the HDB are reliable and valid measures of substance use and misuse.

Predictors of onset of cannabis and other drug use in male young adults: results from a longitudinal study

Background

The use of cannabis and other illegal drugs is particularly prevalent in male young adults and is associated with severe health problems. This longitudinal study explored variables associated with the onset of cannabis use and the onset of illegal drug use other than cannabis separately in male young adults, including demographics, religion and religiosity, health, social context, substance use, and personality. Furthermore, we explored how far the gateway hypothesis and the common liability to addiction model are in line with the resulting prediction models.

Methods

The data were gathered within the Cohort Study on Substance Use Risk Factors (C-SURF). Young men aged around 20 years provided demographic, social, health, substance use, and personality-related data at baseline. Onset of cannabis and other drug use were assessed at 15-months follow-up. Samples of 2,774 and 4,254 individuals who indicated at baseline that they have not used cannabis and other drugs, respectively, in their life and who provided follow-up data were used for the prediction models. Hierarchical logistic stepwise regressions were conducted, in order to identify predictors of the late onset of cannabis and other drug use separately.

Results

Not providing for oneself, having siblings, depressiveness, parental divorce, lower parental knowledge of peers and the whereabouts, peer pressure, very low nicotine dependence, and sensation seeking were positively associated with the onset of cannabis use. Practising religion was negatively associated with the onset of cannabis use. Onset of drug use other than cannabis showed a positive association with depressiveness, antisocial personality disorder, lower parental knowledge of peers and the whereabouts, psychiatric problems of peers, problematic cannabis use, and sensation seeking.

Conclusions

Consideration of the predictor variables identified within this study may help to identify young male adults for whom preventive measures for cannabis or other drug use are most appropriate. The results provide evidence for both the gateway hypothesis and the common liability to addiction model and point to further variables like depressiveness or practising of religion that might influence the onset of drug use.