Early substance use in the pathway from childhood attention-deficit/hyperactivity disorder (ADHD) to young adult substance use: Evidence of statistical mediation and substance specificity

This study tested whether early and developmentally atypical substance use mediates risk for adult substance use among children with attention-deficit/hyperactivity disorder (ADHD), and whether that risk is substance-specific. Participants were children with ADHD previously enrolled in a randomized controlled trial (RCT), and a demographically similar non-ADHD group, assessed at 2 through 16 years after the original RCT baseline. Self-reports of heavy drinking, marijuana use, daily smoking, and other illicit drug use were collected at follow-ups to establish atypically early and frequent use. Models estimated statistically mediated effects of childhood ADHD on adult substance use via early substance involvement, with planned comparisons to evaluate substance specificity. Results supported the mediation hypothesis, showing that childhood ADHD was associated with more frequent adult substance use via early substance involvement for marijuana, cigarettes, illicit drugs, and to a lesser extent, alcohol. Mediation was not escalated by comorbid childhood conduct disorder or oppositional defiant disorder except for early use of nonmarijuana illicit drugs. Substance-specificity in the mediational pathway was largely absent except for cigarette use, where ADHD-related early smoking most strongly predicted adult daily smoking. Findings from this study provide new evidence that atypically early substance use associated with childhood ADHD signals important cross-drug vulnerability by early adulthood, but cigarette use at a young age is especially associated with increased risk for habitual (daily) smoking specifically. Efforts to prevent, delay, or reduce substance experimentation should occur early and focus on factors relevant to multiple drugs of abuse in this at-risk population. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Early Substance Use Initiation And Psychological Distress Among Adolescents In Five ASEAN Countries: A Cross-Sectional Study

Aim

The study aimed to assess the associations between substance use early initiation (<12 years) (smoking cigarettes, alcohol and drug use) with psychological distress among adolescents in five ASEAN countries.

Methods

Cross-sectional data were analysed from 33,184 school adolescents, with a median age of 14 years, from Indonesia, Laos, Philippines, Thailand and Timor-Leste that took part in the “Global School-Based Student Health Survey (GSHS)” in 2015.

Results

The overall prevalence of pre-adolescent (<12 years) cigarette use was 10.6%, 8.1% pre-adolescent current alcohol use, and 4.2% pre-adolescent drug use initiation. In adjusted multinomial logistic regression analysis, pre-adolescent initiation of cigarette smoking, pre-adolescent initiation of alcohol use, pre-adolescent initiation of drug use and multi-substance pre-adolescent initiation were highly associated with medium (=1) and high (=2–5) psychological distress (of five psychological distress items: no close friends, loneliness, anxiety, suicidal ideation and suicide attempt). Late initiation of cigarette use and late initiation of drug use were not associated with medium and/or high psychological distress.

Conclusion

Early prevention programmes should target concurrent early substance use initiation in order to prevent possible subsequent psychological distress.

The Impact of Traumatic Experiences on Risky Sexual Behaviors in Black and White Young Adult Women

BACKGROUND

Trauma exposure has been linked to risky sexual behavior (RSB), but few studies have examined the impact of distinct trauma types on RSB in one model or how the association with trauma and RSB may differ across race.

PURPOSE

The objective of the current study was to examine the contribution of trauma exposure types to RSB-substance-related RSB and partner-related RSB identified through factor analysis-in young Black and White adult women.

METHODS

We investigated the associations of multiple trauma types and RSB factor scores in participants from a general population sample of young adult female twins (n = 2,948). We examined the independent relationship between specific traumas and RSB, adjusting for substance use, psychopathology, and familial covariates. All pertinent constructs were coded positive only if they occurred before sexual debut.

RESULTS

In Black women, sexual abuse was significantly associated with substance-related and partner-related RSB, but retained significance only for partner-related RSB in a fully adjusted model. For White women, sexual abuse and physical abuse were associated with both RSB factors in the base and fully adjusted models. Witnessing injury or death was only associated with RSBs in base models. For both groups, initiating alcohol (for Black women), alcohol, or cannabis (for White women) before sexual debut (i.e., early exposure) was associated with the greatest increased odds of RSB.

CONCLUSIONS

Data highlight the contribution of prior sexual abuse to RSBs for both White and Black women, and of prior physical abuse to RSBs for White women. Findings have implications for intervention after physical and sexual abuse exposure to prevent RSB, and thus, potentially reduce sexually transmitted infection/human immunodeficiency virus infection and unintended pregnancy in young women.

Associations of parental alcohol use disorders and parental separation with offspring initiation of alcohol, cigarette and cannabis use and sexual debut in high-risk families

BACKGROUND AND AIMS

Parental alcohol use disorders (AUDs) and parental separation are associated with increased risk for early use of alcohol in offspring, but whether they increase risks for early use of other substances and for early sexual debut is under-studied. We focused on associations of parental AUDs and parental separation with substance initiation and sexual debut to (1) test the strength of the associations of parental AUDs and parental separation with time to initiation (age in years) of alcohol, tobacco and cannabis use and sexual debut and (2) compare the strength of association of parental AUD and parental separation with initiation.

DESIGN

Prospective adolescent and young adult cohort of a high-risk family study, the Collaborative Study on the Genetics of Alcoholism (COGA).

SETTING

Six sites in the United States.

PARTICIPANTS

A total of 3257 offspring (aged 14-33 years) first assessed in 2004 and sought for interview approximately every 2 years thereafter; 1945 (59.7%) offspring had a parent with an AUD.

MEASUREMENTS

Diagnostic interview data on offspring substance use and sexual debut were based on first report of these experiences. Parental life-time AUD was based on their own self-report when parents were interviewed (1991-2005) for most parents, or on offspring and other family member reports for parents who were not interviewed. Parental separation was based on offspring reports of not living with both biological parents most of the time between ages 12 and 17 years.

FINDINGS

Parental AUDs were associated with increased hazards for all outcomes, with cumulative hazards ranging from 1.19 to 2.71. Parental separation was also an independent and consistent predictor of early substance use and sexual debut, with hazards ranging from 1.19 to 2.34. The strength of association of parental separation with substance initiation was equal to that of having two AUD-affected parents, and its association with sexual debut was stronger than the association of parental AUD in one or both parents.

CONCLUSIONS

Parental alcohol use disorders (AUDs) and parental separation are independent and consistent predictors of increased risk for early alcohol, tobacco and cannabis use and sexual debut in offspring from families with a high risk of parental AUDs.

Early Substance Use Initiation and Suicide Ideation and Attempts among School-Aged Adolescents in Four Pacific Island Countries in Oceania

This study aimed to investigate the correlations between early initiation (<12 years) of smoking cigarettes, alcohol use, and drug use (cannabis) with suicidal ideation and suicide attempts in school-aged adolescents in four Pacific Island countries in Oceania. The sample included 6540 adolescents (≤13 to ≥16 years old) from Kiribati, Samoa, Solomon Islands, and Vanuatu. Bivariate and multivariable analyses were conducted to assess the association between pre-adolescent substance use initiation and suicidal ideation and suicide attempts. Results indicate a prevalence of 25.8% suicidal ideation in the past 12 months (ranging from 17.2% in Vanuatu to 34.7% in Kiribati) and 34.9% suicide attempts in the past 12 months (ranging from 23.5% in Vanuatu to 62.0% in Samoa). The prevalence of early cigarette smoking initiation was 15.7%, early alcohol initiation 13.8%, and early drug use initiation was 12.9%. Students who reported pre-adolescent substance use initiation, compared with non-substance users, were more likely reporting suicidal ideation and suicide attempts. The concurrent initiation of cigarette smoking, alcohol, and drug use should be targeted in early prevention programmes in order to prevent possible subsequent suicidal behaviours.

Adolescent deviant peer clustering as an amplifying mechanism underlying the progression from early substance use to late adolescent dependence

BACKGROUND

Early substance use co-occurs with youths' self-organization into deviant peer groups in which substance use is central to social interaction. We hypothesized that the social dynamics of deviant peer groups amplify the risk of progressing from early use to later dependence, and that this influence occurs over and above escalations in use that typically accompany early substance use and membership in deviant groups.

METHODS

Our study used a longitudinal, multimethod dataset consisting of 998 adolescents and their families. Participants were recruited from middle schools in a large metropolitan area in the Pacific Northwest. The sample was 47.3% female and ethnically diverse (42.3% European American, 29.1% African American, and 28.6% other, including biracial). We examined deviant peer clustering as a mediator between early substance use and later dependence, controlling for proximal levels of use, SES, early antisocial behavior, and parental monitoring. Tobacco, alcohol, and marijuana use were assessed at ages 12, 13, and 16-17. Past-year nicotine, alcohol, and marijuana dependence (DSM-IV) was assessed at age 19. Youth and parent reports and observational data were used to assess deviant peer clustering at age 16-17, and youth reported on antisocial behavior and parental monitoring at ages 12 and 13.

RESULTS

Early substance use predicted increased likelihood of dependence on tobacco, alcohol, and marijuana by late adolescence. Deviant peer affiliation mediated these links, even when accounting for proximal levels of substance use.

CONCLUSIONS

Early substance use not only promotes escalations in use across adolescence but also provides entry into a deviant social context that contributes to increased risk of dependence. Our results emphasize the importance of identifying and intervening in early substance use before it becomes an organizing factor in friendship selection and interaction. Deviant peer clusters are clearly an important avenue for intervention when seeking to interrupt the progression to substance dependence.