Recovery schools for improving behavioral and academic outcomes among students in recovery from substance use disorders: a systematic review.

Mindfulness‐based interventions for improving cognition, academic achievement, behavior, and socioemotional functioning of primary and secondary school students

The aim of this study was to estimate the association between insufficient sleep and prescription opioid misuse among US high school students. Participants were 6,884 high school students who self-reported on sleep duration and prescription opioid misuse in the 2019 Youth Risk Behavior Survey. Sleep duration was categorized by the Youth Risk Behavior Survey according to the American Academy of Sleep Medicine guidelines as follows: recommended sleep duration (8-9 hours) vs insufficient sleep (< 8 hours). Participants also reported whether they had any prescription opioid misuse during their lifetime and whether they had prescription opioid misuse within the past 30 days. Most (79.4%) participants reported sleeping less than 8 hours per night. Among all youth, 12.9% reported lifetime prescription opioid misuse and 6.2% reported current prescription opioid misuse. Prevalence of both lifetime and current opioid medication misuse was higher among those also reporting insufficient sleep compared to those reporting recommended sleep duration (14.3% vs 7.7%, P < .0001 for lifetime misuse and 6.6% vs 4.3%, P = .0091 for current misuse). In multivariate models, insufficient sleep was associated with an increased odds of lifetime prescription opioid misuse (adjusted odds ratios = 1.4; 95% confidence interval, 1.1-1.2; P = .006); however, we did not find an association between sleep duration and current prescription opioid misuse in multivariate analysis. Sleep duration is associated with lifetime opioid misuse among US youth. Longitudinal studies are needed to test whether causal relationships exist, and to understand biobehavioral mechanisms that underlie associations between sleep deficiency and opioid misuse in adolescents. Groenewald CB, Rabbitts JA, Tham SW, Law EF, Palermo TM. Associations between insufficient sleep and prescription opioid misuse among high school students in the United States. J Clin Sleep Med. 2021;17(11):2205-2214.

ABSTRACTBackground: Recovery high schools (RHSs) provide post-treatment education and recovery support for young people with substance use disorders (SUDs). This is the first quasi-experimental outcome study to determine RHS effectiveness relative to students in non-RHSs. Objectives: To examine effects of RHS attendance on academic and substance use outcomes among adolescents treated for SUDs 6 months after recruitment to the study. Methods: A quasi-experimental design comparing outcomes for adolescents with treated SUDs who attended RHSs for at least 28 days versus a propensity-score balanced sample of students with treated SUDs who did not attend RHSs. The sample included 194 adolescents (134 in RHSs, 60 in non-RHSs) enrolled in Minnesota, Wisconsin, or Texas schools (M age = 16; 86% White; 49% female). Multilevel linear regression models were used to examine the effect of RHS attendance on students’ outcomes, after adjusting for a range of potential confounders. Results: Adolescents attending RHSs were significantly more likely than non-RHS students to report complete abstinence from alcohol, marijuana, and other drugs at the 6-month follow-up (OR = 4.36, p = .026), significantly lower levels of marijuana use (d = −0.51, p = .034) and less absenteeism from school (d = −0.56, p = .028). Conclusion: These results indicate that RHSs have significantly beneficial effects on substance use and school absenteeism after 6 months for adolescents treated for SUDs.

Adolescence is a critical phase of development and is frequently a period of initiating and engaging in risky behaviors, including alcohol and other substance use. The COVID-19 pandemic and associated stressors might have affected adolescent involvement in these behaviors. To examine substance use patterns and understand how substance use among high school students changed before and during the COVID-19 pandemic, CDC analyzed data from the nationally representative Youth Risk Behavior Survey. This report presents estimated prevalences among high school students of current (i.e., previous 30 days) alcohol use, marijuana use, binge drinking, and prescription opioid misuse and lifetime alcohol, marijuana, synthetic marijuana, inhalants, ecstasy, cocaine, methamphetamine, heroin, and injection drug use and prescription opioid misuse. Trends during 2009–2021 were assessed using logistic regression and joinpoint regression analyses. Changes in substance use from 2019 to 2021 were assessed using prevalence differences and prevalence ratios, stratified by demographic characteristics. Prevalence of substance use measures by sexual identity and current co-occurring substance use were estimated using 2021 data. Substance use prevalence declined during 2009–2021. From 2019 to 2021, the prevalence of current alcohol use, marijuana use, and binge drinking and lifetime use of alcohol, marijuana, and cocaine and prescription opioid misuse decreased; lifetime inhalant use increased. In 2021, substance use varied by sex, race and ethnicity, and sexual identity. Approximately one third of students (29%) reported current use of alcohol or marijuana or prescription opioid misuse; among those reporting current substance use, approximately 34% used two or more substances. Widespread implementation of tailored evidence-based policies, programs, and practices likely to reduce risk factors for adolescent substance use and promote protective factors might further decrease substance use among U.S. high school students and is urgently needed in the context of the changing marketplaces for alcohol beverage products and other drugs (e.g., release of high-alcohol beverage products and increased availability of counterfeit pills containing fentanyl).

Teen Dating Violence Victimization and Patterns of Substance Use Among High School Students

Background: Fewer than 9% of 12–17 year olds in need (∼146,000 of 1.7 million) receive inpatient or outpatient substance abuse recovery services or other mental health services (SAMHSA, 2012). The literature on adolescent addiction is sparse, however, as most published addiction recovery efforts involve adult populations—often college students. Objectives: The present study examined social influences on escalating substance use (from tobacco, alcohol, and marijuana use to polysubstance use involving opioids) for students enrolled in recovery high schools. Methods: A sample of 31 adolescents enrolled in substance use recovery high schools were surveyed on their patterns of substance use leading to their abuse of opioids. Results: Youth who begin their substance use as young as age 8 are often pressured by peer culture to do so and come from substance-using families. Their escalation in polysubstance use to a pattern including opioids was also most often attributed to peer influence over several years. Conclusions/Importance: This paper is one of scant few that address patterns of use in high school students. Perhaps most salient from this study are the tertiary prevention implications: similar to their adult counterparts, students enrolled in recovery high school programs are likely from substance-using families and have combined complex constellations of substances including opioids by dint of their relationships with substance-using peers.

Exercise and Substance Use Among American Youth, 1991–2009

Amid the opioid epidemic and evolving legal and social changes with marijuana, little is known about substance use among pregnant and postpartum people living with HIV. To evaluate trends in marijuana, alcohol, and opioid use during pregnancy and the first year postpartum among US people living with HIV and the differences in substance use based on marijuana legalization status. Data from the Surveillance Monitoring for Antiretroviral Toxicities (SMARTT) study of the Pediatric HIV/AIDS Cohort Study were analyzed. SMARTT-enrolled, pregnant people living with HIV at 22 US sites from January 1, 2007, to July 1, 2019, with self-reported substance use data available in pregnancy, 1 year postpartum, or both were assessed. Calendar year and state marijuana legalization status. The prevalence of any use of each of the following substances was calculated by calendar year, separately for pregnancy and postpartum: marijuana, alcohol, opioid, and concomitant alcohol and marijuana. Log binomial models were fit using general estimating equations to evaluate the mean annual change, accounting for repeat pregnancies. The study also evaluated differences in substance use by state recreational or medical marijuana legalization status. Substance use data were available for 2926 pregnancies from 2310 people living with HIV (mean [SD] age, 28.8 [6.1] years; 822 [28.1%] Hispanic, 1859 [63.5%] non-Hispanic Black, 185 [6.3%] White, 24 [0.8%] of more than 1 race, 24 [0.8%] of other race or ethnicity [individuals who identified as American Indian, Asian, or Native Hawaiian or other Pacific Islander], and 12 [0.4%] with unknown or unreported race or ethnicity). Between 2007 and 2019, marijuana use during pregnancy increased from 7.1% to 11.7%, whereas alcohol and opioid use in pregnancy were unchanged. Postpartum alcohol (44.4%), marijuana (13.6%), and concomitant alcohol and marijuana (10.0%) use were common; marijuana use increased from 10.2% to 23.7% from 2007 to 2019, whereas postpartum alcohol use was unchanged. The adjusted mean risk of marijuana use increased by 7% (95% CI, 3%-10%) per year during pregnancy and 11% (95% CI, 7%-16%) per year postpartum. Postpartum concomitant alcohol and marijuana use increased by 10% (95% CI, 5%-15%) per year. Differences in substance use were not associated with recreational legalization, but increased marijuana use was associated with medical marijuana legalization. In this cohort study, opioid use among pregnant people living with HIV remained stable, whereas marijuana use during pregnancy and postpartum increased over time and in states with legalized medical marijuana. These patterns of increasing marijuana use among pregnant and postpartum people living with HIV suggest that enhanced clinical attention is warranted, given the potential maternal and child health implications of substance use.

Alcohol use and marijuana use tend to be social activities among adolescents. Some youth use alcohol or marijuana while alone. This article provides a framework for examining the risk factors for and consequences of solitary alcohol and marijuana use, grounded in a motivational model that emphasizes coping with negative emotions, and provides the first systematic review of research on solitary alcohol and marijuana use among middle school- and high school-aged adolescents in the United States. PubMed, PsycINFO and Web of Science were searched. Articles were included if they mention solitary alcohol or marijuana (or illicit drug) use among adolescents aged 12-18years. Studies on non-human animals, college students, non-English language publications and articles exclusively about solitary tobacco or inhalant use were excluded. Overall, 22 articles were selected. Prevalence of adolescent solitary alcohol and marijuana use was relatively high (e.g. 14% life-time solitary drinking in the general adolescent population), particularly in high-risk subgroups (e.g. 38.8% life-time solitary drinking in a sample of youth recruited from clinical and community settings). Risk factors for solitary alcohol and marijuana use include earlier onset and heavier use, coping motives, negative emotions and positive expectancies about use. Solitary alcohol and marijuana use are prospectively associated with later substance use disorder (SUD) symptoms, diminished academic performance and perceived health. Approximately 1 in 7 adolescents in the US appear to have engaged in solitary alcohol and marijuana use at some point. It is positively associated with extent of drinking and marijuana use, cop;ing motives, negative emotions, and positive expectancies, as well as subsequent SUD symptoms and poor academic and health-related outcomes.

The primary focus of this issue of The Journal of Primary Prevention (JPP)—adolescent substance use—is particularly important to me. As a researcher in adolescent health and the parent of a teenager, I continually monitor the challenges adolescents face in the complex world we live in and examine the most effective ways to prepare them to meet those challenges. Thus, I benefit greatly when research converges to address health and behavioral outcomes that impact me not only professionally (as a researcher) but also personally (as a parent). I trust that JPP readers will feel similarly. Adolescent substance use continues to be a major public health problem in the United States. While tobacco and alcohol use have declined among U.S. teens over the past 20 years, marijuana use has increased. According to the Youth Risk Behavior Surveillance Survey (Centers for Disease Control and Prevention 2012), past-month alcohol use decreased by 24 %, binge drinking by 24 %, and past-month cigarette use by 34 % among U.S. high school students from 1991 to 2011. However, during this same time period, marijuana use increased by 60 %, with 23 % of U.S. high school students reporting having smoked marijuana in the past 30 days. It is important to emphasize that adolescent substance use is not only a national public health problem but also an international one, impacting teens in various communities around the world. Two studies in this issue examined the potential impact of religiosity and spirituality on adolescent substance use. Both of these studies are intriguing given growing evidence suggesting that religiosity and spirituality are protective against substance use, especially among urban adolescents. In a sample of predominantly African American youth, aged 13–20 years and living in Philadelphia, Mason et al. tested whether three dimensions of religiosity (social religiosity, perceived religious support, and private religiosity) as well as proximity to religious institutions were protective against various types of substance use. Contributing to the novelty of this study is the fact that the authors investigated the impact of multiple dimensions of religiosity, which in adolescent substance use research has typically been assessed using a single dimension. Logistic regression analysis revealed that two dimensions of religiosity were protective against at least one type of substance use: Social religiosity was protective against marijuana use, and perceived religious support was protective against tobacco use. However, the third dimension of religiosity, private religiosity, was not protective against any type of substance use. As Mason et al. conclude, in addition to providing initial evidence that proximity to religious institutions is protective against alcohol use, their findings point to the importance of examining religiosity as a multidimensional construct when investigating substance use in urban youth populations. S. R. Tortolero (&) University of Texas School of Public Health, Houston, TX, USA e-mail: Susan.Tortolero@uth.tmc.edu

Introduction. This paper presents methods and findings from an outcome evaluation of an adolescent drug prevention program serving predominantly Hispanic and African American students in an inner-city public middle school and secondary school in Boston. The program, entitled the Urban Youth Connection, consists of individual, pair and group counseling to high risk students identified by school personnel. The study design and statistical analysis techniques are presented as a model approach to estimating the impact of adolescent drug prevention programs to maximize scientific rigor without compromising the service delivery mission of the program. The objectives of the intervention are to prevent and reduce 30-day use of alcohol, tobacco and other drugs, and to reduce risk and improve resiliency factors associated with healthy behaviors: self-esteem, social coping, depression, interpersonal violence, school involvement and aspirations, school attendance, and academic performance. Methods. A pre-test, post-test comparison group design was used to identify changes over time in behavioral, psychosocial, and academic outcomes. Stratified analysis was used to adjust for baseline differences in outcomes of interest between the treatment and comparison groups. A dose-response relationship was measured between amount of services received and self-reported behavioral outcomes, academic performance, and school attendance, by means of correlational and regression analyses. Self-reported behavioral outcomes were measured through surveys administered in both participating schools in the fall and spring of 1993-1994. Academic performance and school attendance was abstracted from student report cards at the end of the 1993-1994 school year. Service records, self-administered questionnaires, and grade and attendance reports were linked in an integrated computerized management information system. Results. Benefits of increased program exposure were indicated for intermediate outcomes of depression, social coping, school performance, especially for high risk students in the secondary school. Reduction of tobacco, beer and marijuana use among treatment students in the secondary school is suggested from this study. The dose-response model which associated amount of program exposure with self-reported outcomes and academic performance and attendance indicated that the intervention had the greatest effect on academic indicators among high school students who were identified as high risk at baseline. Discussion. The Urban Youth Connection shows promise of having an impact on intermediate outcomes of interest for high risk youth in middle school and high school settings. Behavioral indicators related to substance use or abuse are not impacted by the intervention as measured by a smaller subset of paired pre/post self-reported surveys among treatment and comparison group students. Early findings from the pre-test/post-test comparison are limited by small sample sizes. Trends suggest that program success may be demonstrated with increasing sample size as the program continues. Cohort studies in an action setting can lead to insignificant findings due to lower statistical power as a result of small sample sizes. Dose-response modeling can be a useful technique to make causal inferences to estimate program impact and can have more statistical power since this analytic approach can yield larger sample sizes useful for analysis. Dose-response modeling requires linkage of service information to client outcomes. Either approach requires stratification to adjust for variability within both the treatment group and the comparison group that result from application of quasi-experimental study designs for evaluating outcomes of adolescent drug prevention programs.

Objective: School environment is one of the important factors affecting behavior and use of addictive substances in youth. School-related studies on youth behavior are categorized mainly in 3 areas: school structures, sociocultural conditions at schools, and social networks at schools. In this study, the prevalence of youth substance use (cigarette, alcohol, and cannabis) was compared across different types of public high schools (HSs) in Istanbul. Methods: The survey research of 31,272 students was conducted in 154 HSs in 28 districts of Istanbul, Turkey in 2010. The school types consisted of regular, occupational, and Anatolian HSs, which differ on curriculum, resources, and admission requirements. The participating schools were selected randomly through a stratification method. Results: Comparison of school types across lifetime use of cigarette, alcohol, or marijuana showed that vocational HS students had significantly higher rates of cigarette (49.8%) and marijuana (4.1%), whereas Anatolian HS students had higher rates of alcohol (39.7%) use. Cigarette, alcohol, and marijuana were used lifetime 45.5%, 32.5%, and 3.3%, respectively, by all HS students in Istanbul. Vocational HS had greater than average rates of cigarette and marijuana use and Anatolian HS had greater than average rates for alcohol use. Conclusions: Substance use prevalence varied across HS types, but this variance was different according to types of substances. While planning substance use prevention interventions, policy makers should understand the reasons for the differences and prioritize interventions aiming to decrease cigarette and marijuana use in regular and vocational HS and alcohol use in Anatolian HS.

Background Profiles of substance use among less commonly described subgroups of sexual and gender minority (SGM) people (e.g., queer, genderqueer) remain largely unknown. Objective(s): To identify substance use differences among less commonly described SGM identity-based subgroups. Methods: The PRIDE Study is a national, online, longitudinal cohort study of self-identified SGM adults living in the U.S. Between 2015–2017, an iPhone application was used to administer three cross-sectional health questionnaires to participants, one of which included questions about binge alcohol, marijuana, and other drug use (substance use). This study was a secondary data analysis of participant responses to substance use survey items. Logistic regression and generalized linear modeling assessed relationships between sexual orientation or gender and use of or reported problems with substances within the past year. Results: Among the 1790 participants included in this study, 51.0% reported binge alcohol use, 39.8% reported marijuana use, and 19.7% reported other drug use (65.9% endorsed use of one or more of these) within the past year. Over 30% indicated substance use had been a problem in their life. Asexual individuals had lower odds of reporting past year binge alcohol and marijuana use (aOR: 0.27, 95% CI: 0.12–0.61; aOR: 0.38, 95% CI: 0.15–0.96, respectively), and queer participants had higher odds of reporting past year marijuana use (aOR: 2.52, 95% CI: 1.58–4.03) compared to lesbian participants. Gender nonbinary participants had lower odds of reporting past year binge alcohol use (aOR: 0.48, 95% CI: 0.32–0.71) and transmasculine participants had higher odds of reporting past year marijuana use (aOR: 2.18, 95% CI: 1.10–4.31) compared to cisgender women. Conclusions: Substance use heterogeneity exists between SGM groups. Comprehensive assessment of sexual orientation and gender may improve understanding of substance use and increase equity within support and treatment services for SGM populations. Highlights We examined substance use among less represented sexual and gender minority groups. Alcohol and other drug use were examined by both sexual orientation and gender identity. Analyses included identities such as queer, pansexual, genderqueer and nonbinary. Alcohol use differed across asexual, genderqueer and gender nonbinary groups. Marijuana use differed across queer, asexual and transmasculine groups.

Adolescent Gambling: An Update on Research Since 2010

Understanding HIV Sexual Protection and Its Association With Substance Use During Sex Among MSM in an Era of Multiple Primary Prevention Products.