Adolescent Substance Misuse Research Articles

Wilderness as Healing Environment: Treating Adolescent Substance Misuse in Wilderness Therapy

ABSTRACT This paper reviews three psychoanalytic conceptualizations of substance misuse, discussing the implications for substance treatment deriving from these conceptualizations. The paper also presents wilderness therapy as an evidence-based approach, reviewing the outcomes and primary components of such programs. Finally, the paper concludes with two case studies of adolescents with substance use disorders treated in wilderness therapy.

Does Participation in Sports Influence the Prevalence of and Initiation into Multiple Substance Misuse in Adolescence? A Two-Year Prospective Analysis.

Concurrent smoking and harmful drinking (CSHD) in adolescence is an important public health and social problem, while participation in sports is considered as being protective against CSHD. This study aimed to prospectively evaluate the influence of various facets of sports participation on the prevalence of and initiation into CSHD of adolescents. Participants were adolescents from southern Croatia (n = 711, 43.6% females, 16 years of age at study baseline), who were tested at baseline and at follow-up (two years later). Variables included gender, age, sports factors (participation in individual and team sports, sport experience, competitive success, intensity of involvement in sports), and CSHD. The CSHD prevalence did not increase significantly over the course of the study (from 5.6% to 7.5%, p > 0.05). Binomial logistic regression with age and gender as covariates suggested that team sports participation correlated to CSHD prevalence at baseline, and follow-up, with higher risk for CSHD among those adolescents who quit team sports (OR = 9.18 and 2.68, 95%CI = 2.04–22.26 and 1.05–6.83 for baseline and follow-up, respectively), and those never involved in team sports (OR = 9.00 and 3.70, 95%CI = 2.07–39.16 and 1.57–8.72 for baseline and follow-up, respectively). A higher risk of CSHD at baseline was seen among those adolescents who were involved in sports for longer (OR = 1.66, 95%CI = 1.16–2.38). The results are discussed in the context of the fact that the study included adolescents at the age of rigid sports selection (the transition from youth to professional-level sports). Since the majority of participants began CSHD at an earlier age, further studies in subjects of a younger age range are warranted.

International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder

Background: Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. Objective: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. Method: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. Results: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. Conclusion: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.

Implementing Trauma-Informed Research-Supported Treatment: Fidelity, Feasibility, and Acceptability

Evidence indicates the importance of integrating treatment of co-occurring traumatic stress and substance use disorders in adolescent populations. However, the effectiveness of trauma-informed research-supported treatments (TI-RSTs) depends on program fidelity, feasibility, and acceptability. This study assessed perceived fidelity, feasibility, and acceptability of two TI-RSTs, The Sanctuary Model and Seeking Safety, at one residential adolescent substance misuse treatment agency. Perceived fidelity was examined two years into implementation while feasibility and acceptability were examined over time from early in the implementation process (n = 25), to 1 year later (n = 31), and to 2 years later (n = 23) through a series of staff interviews. Findings suggest that implementation of The Sanctuary Model and Seeking Safety at adolescent residential substance misuse treatment agencies can be conducted with fidelity and is feasible and acceptable. However, findings indicate that not all TI-RSTs are responded to in the same way. Furthermore, findings suggest that additional efforts might be necessary to ensure improved and long-term feasibility and acceptability, and consequently, the success of the implementation of TI-RSTs.

Identifying Risk Factors Associated with Fatal Drowning Accidents in the Paediatric Population: A Review of International Evidence.

Introduction: Evidence from Ireland’s Childhood Mortality Register demonstrates that drowning is the second leading cause of death in children. It occurs more commonly in adolescent males engaged in summer water-based activities and in children aged 1-4 years with access to swimming pools/unprotected water sources. Despite being an island nation, a significant lack of guidelines exists to reduce drowning accidents in these at-risk populations.Aim: Review international evidence surrounding risk factors associated with drowning accidents in the paediatric population and existing risk-reduction guidelines. Methods: Structured review of Cochrane, Cinahl, Pubmed Web of Science databases performed using search terms: (“risk factors” AND “drowning”), (“risk reduction” OR “prevention” OR “swim ability” AND “drowning”). Studies were included if satisfied age criteria (0-18 years).Results: Evidence suggests that boys are at highest risk of drowning (1-4 yrs in swimming pools; adolescents in freshwater) with inadequate surveillance, inadequate availability of first responders, certain clinical diagnoses (developmental delay and seizure disorders), lack of swimming ability, and substance misuse in adolescents all posing an increased risk. Formal swimming education in those aged 4+ years, training of supervising adults in safe rescue, installation of isolation barriers, enforcing water safety guidelines, and regulations are all recommended by International Advisory Groups for prevention of drowning.Conclusion: In Ireland, drowning is the second leading cause of accidental paediatric death in the post-neonatal period, and an important cause of childhood fatalities globally. Risk factors increasing the likelihood of fatal paediatric drownings include gender and distinct age peaks. Certain modifiable risk factors relate to peri-event factors such as lack of supervision, to post-event responses, in particular including lack of trained personnel at the scene. There is a poverty of guidelines specifically targeting the paediatric populations; guidelines generally tend to be included into adult drowning reduction strategies. Specific targeting is required to protect those most at risk.

Brief Report on PROSPER Academic Outcomes: Extended Model of Crossover Effects on Young Adult College Success.

This study examines crossover effects of adolescent substance misuse preventive interventions on academic success in college. It evaluates pathways of influence on college grades, via effects on school engagement, problem-solving skills, and substance misuse in high school. Data were collected as part of an Randomized Controlled Trial (RCT) evaluating a multicomponent intervention conducted in 28 school districts with middle school students. At age 19, study participants (N=1,488) enrolled in college reported on college grades. The model fit the data, supporting hypothesized pathways of intervention impacts. Inclusion of a significant direct effect on college grades further improved model fit. Results support the potential for universal substance misuse preventive interventions delivered by community partnerships during middle school to yield effects on long-term academic success.

Transitional Stress Influences Problem Alcohol Use and Emotion Regulation in Late Adolescence: A Mixed-Methods Study

Rates of alcohol use peak during the transition from adolescence to young adulthood, a developmental phase that encompasses heightened stress and emotion regulation demands. This mixed methods study examines the influence of a critical developmental transition, high school graduation, on the relationship between problem alcohol use and emotion regulation. High school seniors (N = 117) were surveyed within three months of graduation. Quantitative analyses show that transition stress, but not emotion regulation, predicts alcohol-related problems. Qualitative analyses reveal that adolescent high-risk drinkers engage in a variety of strategies to regulate distress. Implications for adolescent substance misuse prevention programs are discussed.

Non Violent Resistance parent training and adolescent substance misuse

Adolescent substance misuse is increasingly being viewed as a systemic problem and several studies have shown the benefit of increased parental involvement. This article describes the evaluation of a ten‐week Non‐Violent Resistance (NVR) group parent training programme delivered within a Young People’s Specialist Substance Misuse Treatment Service. Eighteen participants completed questionnaires before and after the programme, and at follow‐up. Eight participants also took part in semi‐structured interviews. Parents reported experiencing the programme as unique and helpful, and highlighted some challenges. Measures of parental self‐efficacy and goal‐based outcomes showed significant improvement at the end of the programme, and improvement in parental self‐efficacy remained significant at follow‐up. This evaluation provides preliminary evidence that NVR parent training may be a useful intervention in this context. However, the generalisability of the data is limited and further research is needed.Practitioner points Non‐Violent Resistance parent training helps parents resist their child’s behaviour, manage their own emotional reactions, and recruit supporters from their wider network Qualitative data suggests that parents who have attended this programme experience additional benefits to those found in qualitative evaluations of other parenting interventions A group training programme delivered within a Young People’s Specialist Substance Misuse Treatment Service improves parents’ self‐efficacy and helps them achieve their goals for their children

A Review of Personality-Targeted Interventions for Prevention of Substance Misuse and Related Harm in Community Samples of Adolescents.

Several school-based prevention programmes have been developed and used to prevent, delay, or reduce substance misuse, and related problems among community samples of adolescents. However, findings indicate that many of these interventions are associated with null, small, or mixed effects in reducing adolescent substance misuse, in particular for those mostly at risk of transitioning to substance use disorders. These findings highlight the need to shift the focus of substance use prevention efforts toward intervention strategies which directly target high-risk adolescents. The Preventure programme was designed to target four personality risk factors for substance misuse: hopelessness, anxiety sensitivity, impulsivity, and sensation seeking. This article reviews findings from the previous trials of personality-targeted interventions (i.e., Preventure programme) with adolescents and discuss the promises and benefits of these interventions for targeting community samples of high-risk adolescents at school level for reducing substance misuse and related mental health problems. Findings indicated that this programme has been successful in reducing the rates of alcohol and illicit drug use and substance-related harms by ~50% in high-risk adolescents with the effects last for up to 3 years. These interventions were also associated with a 25% reduction in likelihood of transitioning to mental health problems, such as anxiety, depression, suicidal ideation, and conduct problems. The programme is particularly beneficial for youth with more significant risk profiles, such as youth reporting clinically significant levels of externalizing problems, and victimized adolescents. A key strength of the Preventure programme is that it is embedded in the community and provides substance use intervention at school level to the general samples of high-risk adolescents who might not otherwise have access to those programmes.

Testing a Model of Universal Prevention Effects on Adolescent Relationships and Marijuana Use as Pathways to Young Adult Outcomes.

There are several interrelated knowledge gaps in the literature on skills-building interventions for middle schoolers designed to prevent initiation of substance use, all of which concern the limited study of the adolescent pathways of those intervention effects on distal young adult outcomes. Among the most important yet understudied pathways of influence on long-term effects are positive youth relationship outcomes of middle-school interventions. Other influential pathways for long-term effects are reductions in adolescent substance misuse, particularly marijuana use, considering the long-term consequences of early marijuana initiation. To address these knowledge gaps, data from a randomized controlled trial were used to test a longitudinal, developmental model positing pathways of intervention effects on age 21 illicit drug use and positive relationship affect, via earlier effects on adolescent relationships and marijuana use. Sixth-graders and their families enrolled in 22 Iowa schools were randomly assigned to the Iowa Strengthening Families Program or a control group (N = 446). The average age of students at baseline was 11.3 years (10-13 year age range); 48% were male and 98% were Caucasian, reflective of the demographics in the participating rural Midwest communities. Measures included middle-school relationships (parents, peers, school), high school marijuana use, plus age 21 illicit drug use and relationship affect (parents, work, school), 10 years past intervention implementation. As expected, intervention effects on young adult variables were indirect, through effects on adolescent outcomes, with higher-risk participants showing greater intervention impact. The findings suggest preventive interventions with young adolescents have potential to demonstrate effects into young adulthood.

Dissociable psychosocial profiles of adolescent substance users.

ObjectiveAlcohol, tobacco and cannabis use in adolescence is associated with adverse outcomes. Characterizing adolescent substance misusers, however, is difficult due to the wide range of risk and protective factors linked to substance use. The aim of the present study was to examine the role of the Individual, Family, School, Peer, and Social Environment on alcohol (lifetime and risky), tobacco (risky only), and cannabis use (lifetime and riskiness).MethodData were analyzed from a national sample of 5,680 adolescents, capturing substance use behavior alongside risk and protective factors across Individual, Family, School, Peer and Social domains. We applied a sophisticated machine learning classifier to develop models of alcohol, tobacco and cannabis initiation and misuse.ResultsWe found highly accurate (area under curve of receiver-operator-characteristic for out-of-sample performance was > .88) and replicable (over multiple iterations and in comparison with permuted outcomes) dissociable psychosocial profiles of alcohol, tobacco and cannabis use. Alongside common predictors (peer relations and externalizing behavior), dissociable risk and resilience factors were observed. Adolescent profiles of alcohol use were distinguished by the contribution of multiple domains. In contrast, tobacco use was characterized by a small number of individual variables, including female gender and poor perceived academic position. Cannabis use was differentiated by the distinct contribution of Individual risk factors, in particular male gender and feelings of anger. Differential associations were also evident, with the strength and direction of association differing substantially across substances.ConclusionThis study indicates that the relationship between the environment and substance use is more complex than previously thought.

Longitudinal, reciprocal relationships between family management and antisocial peer associations

IntroductionPoor family management and antisocial peer associations are related risk factors for negative outcomes such as adolescent substance misuse and conduct disorders. The relationship between family management and antisocial peer associations is complex. The purpose of this study was to test the reciprocal relationships between youth-reports of poor family management and antisocial peer associations over multiple time-points. MethodsWe used four data points (5th-11th grade) from the Australian arm of the longitudinal International Youth Development Study (IYDS) to test a random-intercepts cross-lagged path model (N = 922). ResultsThe model fit the data well with path estimates showing that poor family management predicted greater antisocial peer associations at the next wave but not the reverse. A second model included a third autoregressive path to control for youth's own antisocial behavior; the direction of the relationships between poor family management and antisocial peer associations did not change. ConclusionsThese results indicate that across adolescence poor family management predicts greater antisocial peer association, which provides evidence that family-focused interventions are an important prevention strategy even in adolescence.

A Developmental Social Neuroscience Model for Understanding Pathways to Substance Use Disorders During Adolescence

Adolescence is a transitional period of development characterized by critical changes in physical, neural, cognitive, affective, and social functions. Studies investigating the underlying mechanisms of substance use at levels of self-report, brain response, and behavioral data are generally consistent with suggestions from dual-process model that differential growth rates of frontally mediated control and striato-frontal reward processing are related to a heightened risk of substance use during adolescence. However, social theories highlight the important role of social context and environment in which adolescents grow up and suggest that growing up in an unfavorable environment and in particular exposure to adverse childhood experiences play a huge role in how this vulnerability is translated into actual risk. In this review, we provide a summary of recent theories that examine a number of key individual and social and environmental risk factors underlying risk for early initiation and escalation of substance misuse. We also present a model that expands the dual-process model to incorporate the role of negative self-concept and negative affect associated with growing up in an unfavorable environment and their interactions with cognitive control and inhibition to further explain vulnerability to early initiation and development of substance misuse in adolescents.

74. The Role of Poor Response Inhibition in Onset and Growth of Substance Use and Aggressive Behaviours

The ability to inhibit pre-potent and goal inappropriate responses (i.e., response inhibition) is a key executive function for self-regulation of behaviours. It is also identified as a precursor to substance misuse and aggression in adolescents. However, it remains to be explained how the simple process of stopping a behavioural response, is implicated in emergence of substance use disorders and proactive interpersonal aggression.

Testing the Social Interaction Learning Model's Applicability to Adolescent Substance Misuse in an Australian Context

ABSTRACTBackground: Parents and peers both influence the development of adolescent substance misuse, and the Social Interaction Learning (SIL) model provides a theoretical explanation of the paths through which this occurs. Objective: The SIL model has primarily been tested with conduct outcomes and in US samples. This study adds to the literature by testing the SIL model with four substance use outcomes in a sample of Australian youth. Method: We used structural equation modeling to test the fit of the SIL model to a longitudinal sample (n = 907) of students recruited in grade 5 in Victoria, Australia participating in the International Youth Development Study, who were resurveyed in grades 6 and 10. Results: The model fit was good (χ2(95) = 248.52, p < .001; RMSEA = .04 [90% CI: .036 – .049]; CFI = .94; SRMR = .04). Path estimates from parenting to antisocial behavior and from antisocial behavior to antisocial peers were significant. In turn, having antisocial peers was significantly related to alcohol use, binge drinking, tobacco use, and marijuana use. From parenting, only the direct path to marijuana use was significant, but indirect effects were significant. Conclusions: The SIL model illustrates that parenting plays an early role in the formation of adolescent peer relations that influence substance misuse and identifies etiological pathways that can guide the targets of prevention. The SIL pathways appear robust to the Australian social and policy context.

Meat Consumption During Pregnancy and Substance Misuse Among Adolescent Offspring: Stratification of TCN2 Genetic Variants

Reducing meat consumption is often advised; however, inadvertent nutritional deficiencies during pregnancy may result in residual neurodevelopmental harms to offspring. This study assessed possible effects of maternal diets in pregnancy on adverse substance use among adolescent offspring. Pregnant women and their 13-year-old offspring taking part in a prospective birth cohort study, the Avon Longitudinal Study of Parents and Children (ALSPAC), provided Food Frequency Questionnaire data from which dietary patterns were derived using principal components analysis. Multivariable logistic regression models including potential confounders evaluated adverse alcohol, cannabis, and tobacco use of the children at 15years of age. Lower maternal meat consumption was associated with greater problematic substance use among 15-year-old offspring in dose-response patterns. Comparing never to daily meat consumption after adjustment, risks were greater for all categories of problem substance use: alcohol, odds ratio OR=1.75, 95% CI=(1.23, 2.56), p<0.001; tobacco use OR=1.85, 95% CI=(1.28, 2.63), p<0.001; and cannabis OR=2.70, 95% CI=(1.89, 4.00), p<0.001. Given the likelihood of residual confounding, potential causality was evaluated using stratification for maternal allelic variants that impact biological activity of cobalamin (vitamin B12) and iron. Lower meat consumption disproportionally increased the risks of offspring substance misuse among mothers with optimally functional (homozygous) variants (rs1801198) of the gene transcobalamin 2 gene (TCN2) which encodes the vitamin B12 transport protein transcobalamin 2 implicating a causal role for cobalamin deficits. Functional maternal variants in iron metabolism were unrelated to the adverse substance use. Risks potentially attributable to cobalamin deficits during pregnancy include adverse adolescent alcohol, cannabis, and tobacco use (14, 37, and 23, respectively). Lower prenatal meat consumption was associated with increased risks of adolescent substance misuse. Interactions between TCN2 variant status and meat intake implicate cobalamin deficiencies.

Relating Therapist Characteristics to Client Engagement and the Therapeutic Alliance in an Adolescent Custodial Group Substance Misuse Treatment Program

ABSTRACT Background: Client engagement in substance misuse treatment programs is directly associated with positive treatment outcomes. The nature of these programs means there are often difficulties engaging and retaining clients, but authors have consistently found a strong therapeutic alliance is associated with client engagement. While research has focused on the association between the alliance and engagement, the factors that influence the therapeutic alliance have received less attention. Objective: To examine therapists' characteristics, namely therapists' stress and empathy levels, as potential predictors of client engagement and the therapeutic alliance, within an adolescent substance misuse group treatment program. Method: The sample included 84 adolescent clients and 14 therapists from a Secure Training Centre in England. Client engagement in the treatment program was observed, while self-reporting measures assessed the therapeutic alliance (client and therapist-rated), and therapists' stress and empathy levels. Results: Multiple regression analysis revealed that therapists' stress levels negatively influenced the therapeutic alliance and had a curvilinear relationship with client engagement, indicating that stress is not exclusively negatively related to engagement. Although stress was found to negatively impact both cognitive and affective empathy, neither cognitive nor affective empathy were significantly related to client engagement or the therapeutic alliance. Conclusions: This study demonstrates the importance of therapist characteristics on client engagement and the therapeutic alliance. Within practice stress can have a positive impact on clients' engagement. Nevertheless, therapists may need additional support to deal with stress effectively. Therapists' empathy may too be fundamental to client engagement, but only it if is perceived by clients.

Household Prescription Medication Practices and Adolescent Substance Misuse: An Opportunity for Clinical Intervention

Household Prescription Medication Practices and Adolescent Substance Misuse: An Opportunity for Clinical Intervention

The Effectiveness of Functional Family Therapy for Adolescent Behavioral and Substance Misuse Problems: A Meta-Analysis.

A systematic review of published and unpublished English language articles identified 14 studies containing 18 comparisons between functional family therapy (FFT) and another condition in the treatment of adolescent disruptive behavior and substance use disorders. In 11 of these comparisons, assignment to conditions was random, while nonrandom assignment occurred in seven studies. For both random and nonrandom comparisons, separate meta-analyses were conducted for subgroups of studies depending on the type of comparison group used. Data from studies of untreated control groups (CTL), treatment as usual (TAU), and well-defined alternative treatments (ALTs) were analyzed separately. Effect sizes from these six meta-analyses were as follows: random assignment FFT versus CTL (k=3, d=0.48, p<.01); random assignment FFT versus TAU (k=3, d=.20, ns); random assignment FFT versus ALT (k=5, d=.35, p<.05); nonrandom assignment FFT versus CTL (k=2, d=.90, ns); nonrandom assignment FFT versus TAU (k=2, d=.08, ns); and nonrandom assignment FFT versus ALT (k=3, d=.75, p<.001). These results provide support for the effectiveness of FFT compared with untreated controls and well-defined ALTs, such as cognitive behavior therapy, other models of family therapy, and individual and group therapy for adolescents.

An Examination of the Ethnicity-Specific Prevalence of and Factors Associated with Substance Use and Misuse: Cross-Sectional Analysis of Croatian and Bosniak Adolescents in Bosnia and Herzegovina.

Substance use and misuse (SUM) in adolescence is a significant public health problem and the extent to which adolescents exhibit SUM behaviors differs across ethnicity. This study aimed to explore the ethnicity-specific and gender-specific associations among sports factors, familial factors, and personal satisfaction with physical appearance (i.e., covariates) and SUM in a sample of adolescents from Federation of Bosnia and Herzegovina. In this cross-sectional study the participants were 1742 adolescents (17–18 years of age) from Bosnia and Herzegovina who were in their last year of high school education (high school seniors). The sample comprised 772 Croatian (558 females) and 970 Bosniak (485 females) adolescents. Variables were collected using a previously developed and validated questionnaire that included questions on SUM (alcohol drinking, cigarette smoking, and consumption of other drugs), sport factors, parental education, socioeconomic status, and satisfaction with physical appearance and body weight. The consumption of cigarettes remains high (37% of adolescents smoke cigarettes), with a higher prevalence among Croatians. Harmful drinking is also alarming (evidenced in 28.4% of adolescents). The consumption of illicit drugs remains low with 5.7% of adolescents who consume drugs, with a higher prevalence among Bosniaks. A higher likelihood of engaging in SUM is found among children who quit sports (for smoking and drinking), boys who perceive themselves to be good looking (for smoking), and girls who are not satisfied with their body weight (for smoking). Higher maternal education is systematically found to be associated with greater SUM in Bosniak girls. Information on the associations presented herein could be discretely disseminated as a part of regular school administrative functions. The results warrant future prospective studies that more precisely identify the causality among certain variables.