Adult Substance Use Research Articles

The Opioid Crisis: A Problem That Defies Solution?

Mortality resulting from drug abuse (or overdose) has tremendously increased over the past decades. Drug abuse (or overdose) has become a critical public health concerns or issue in the United States of America due to its related alarming rate of death. Death rates from opioid overdose have surged in the past years and the opioid crisis is worsening at an alarming rate. There seems to be no quick fix to the opioid problem therefore it is essential to approach the problem in a comprehensive manner that includes overdose prevention. Accordingly, early intervention in childhood experiences can mean the difference between a healthy adult life and substance use. This article reviews current literature to investigate the relationship between Adverse Childhood Experiences (ACEs) and drug overdose. ACEs have a dose-dependent effect on health outcomes hence, direct impacts on childhood intervention can pay large dividends to the society and health in the future. Therefore, the study recommends that developing new partnerships and working across sectors including public health, government, healthcare services, social services, education, housing, non-governmental organizations, media can help prevent early adversity and in turn, addiction in later life. Keywords : Opioid crisis, Drug abuse, Drug overdose, Adverse childhood experiences DOI : 10.7176/PPAR/9-8-08 Publication date : August 31 st 2019

Parent\u2013youth conflict as a predictor of depression in adulthood: a 15-year follow-up of a community-based cohort

Experiencing conflictual relations with one’s parents while growing up has been linked to onset, recurrence, and worse treatment outcome of adolescent depression. While this suggests that significant problems in the parent–youth relationship make depressive disorders more relentless, it is not clear whether this effect lasts into adulthood. Our aim was to examine if major and minor conflict with parents while growing up predicts depression in adulthood in youth with and without a history of depression. We utilized data from the Uppsala Longitudinal Adolescent Depression Study. This community-based cohort was assessed with structured diagnostic interviews both at age 16–17 and at follow-up 15 years later. The analyses included 382 individuals (227 with a history of child or adolescent depression; 155 peers without such a history). Binary logistic regression was used, adjusting for sex, disruptive behavior disorders, and additional family-related adversities. Among individuals with adolescent depression, major conflict with parents was strongly associated with adult depression (adjusted OR 2.28, 95% CI 1.07–4.87). While major conflict with parents was rare among non-depressed controls, a non-significant association of similar magnitude was still observed. Minor conflict, on the other hand, was not significantly associated with adult depression. Overall, conflict with parents did not predict adult anxiety disorders, substance use, suicidal behavior, somatoform disorders, or psychotic disorders. In conclusion, major parent–youth conflict during upbringing seems to be linked with an increased risk of depression in adulthood. These findings underscore the need to consider contextual/familial factors in the prevention and clinical management of early-life depression.

Depression and ADHD-Related Risk for Substance Use in Adolescence and Early Adulthood: Concurrent and Prospective Associations in the MTA.

Childhood attention-deficit/hyperactivity disorder (ADHD) is prospectively linked to substance use and disorder. Depression emerging in adolescence is an understudied risk factor that may explain some of this risk. In the present study, we considered mediating and moderating roles of adolescent depression in explaining this association by using longitudinal data from the prospective 16-year follow-up of the Multimodal Treatment Study of ADHD (MTA). Participants were 547 children diagnosed with DSM-IV ADHD Combined Type, and 258 age- and sex-matched comparison children. In adolescence, depressive symptoms did not exacerbate effects of childhood ADHD on any substance use. For both groups, time-varying and average depressive symptoms were associated with more frequent use of all substances. Prospectively, we found no evidence of depression mediation to adult substance use. However, adolescent depression moderated the association between childhood ADHD and adult marijuana use. Although adults without ADHD histories used marijuana more frequently if they had elevated depressive symptoms in adolescence, marijuana use by adults with ADHD histories was independent of their adolescent depression. In adulthood, depression diagnoses and ADHD persistence continued to operate as independent, additive correlates of substance use risk. Our findings suggest a circumscribed role for depression in substance use risk that adds to, but does not alter or explain, ADHD-related risk.

Daily Motives for Alcohol and Marijuana Use as Predictors of Simultaneous Use Among Young Adults

Research on substance use motives typically examines each substance separately. However, simultaneous alcohol and marijuana (SAM) use-that is, using alcohol and marijuana at the same time so that their effects overlap-is common among young adults. This study examines day-to-day fluctuations in motives for using alcohol and/ or marijuana among young adult substance users as predictors of alcohol, marijuana, and SAM use across days. Data were from a community sample of young adults who reported SAM use in the past month (analytic sample: N = 399, mean [SD] age = 21.63 [2.17]; 50.9% women). Participants reported alcohol, marijuana, and SAM use, and also motives "for alcohol and/or marijuana use" for 14 consecutive days. Multilevel models showed that elevated enhancement motives were associated with heavy episodic drinking, drinking more, and more hours high from marijuana. Elevated social motives were associated with heavy episodic drinking and drinking more, and also with fewer hours high. Elevated conformity motives were associated with drinking more. SAM use was more likely: on alcohol days and on marijuana days with elevated enhancement and conformity motives, on alcohol days with elevated coping motives, and on marijuana days with elevated social motives. SAM use on a given day was primarily associated with enhancement and conformity motives. Social motives were more strongly linked to alcohol use, and to some extent coping motives were linked to marijuana use in this young adult sample. Further examination of situation-specific motives and contexts of use is needed to inform development of real-time interventions for SAM use and consequences.

The Effects of Trait Emotional Intelligence on Adolescent Substance Use: Findings From a Hungarian Representative Survey

Previous research has emphasized the importance of emotions in the development of adult and adolescent substance use. There is substantial evidence for deficits in emotional processing among teenagers with substance use, but few studies have investigated the association between emotional intelligence and adolescent substance use. The aim of the present study was to examine the relationship between the use of tobacco, alcohol, and illicit drugs and level of emotional intelligence among adolescents. A representative sample of high school students participated in the study (N = 2,380). Substance use patterns were assessed using data from the European School Survey Project on Alcohol and Other Drugs (ESPAD) Survey, and emotional intelligence was assessed with the Bar-On Emotional Quotient Inventory Youth Version. Self-esteem and depressive symptomatology were also assessed to compare their effects on the frequency of substance use with the effect of emotional intelligence. Results demonstrated that greater difficulty in stress management and empathy predicted a higher frequency of tobacco, alcohol, and cannabis use. However, the level of emotional intelligence showed only a weak relationship to substance use habits. Latent profile analyses supported the hypothesis that different emotional patterns and problems underlie different types of psychoactive substances. Using a multiple linear regression model, the present study found that although emotional intelligence is not a key factor underlying substance use habits, it has an individual effect on substance use beyond depressive tendencies and self-esteem. These results can be applied to both drug prevention programs and interventions in substance abuse treatment.

Food Insecurity and Substance Use in HIV-Infected Adults in the Miami Adult Studies on HIV (MASH) Cohort (P04-066-19)

ObjectivesIt has been estimated that about half of people living with HIV (PLWH) in inner-cities may experience food insecurity. Substance use is common among PLWH and a risk factor for food insecurity. The objective of this study was to evaluate the relationship between substance use and food security in HIV + adults in the MASH cohort in Miami, Florida. MethodsA cross-sectional analysis of data from an observational longitudinal study was conducted in 324 HIV + adults on antiretroviral therapy. After obtaining informed consent, validated questionnaires on demographics, socioeconomic status and illicit drug use and the Alcohol Use Disorders Identification Test (AUDIT) were collected. Polysubstance use was defined as >1 substance, including drugs and alcohol. Food insecurity was determined using the US Household Food Security Survey. HIV disease progression parameters, CD4 cell count and HIV viral load, were obtained from medical records with the participants’ permission. Wilcoxon, chi-square and regression analyses were completed, adjusted for age, gender, race/ethnicity, income, education, household size and quality of life. ResultsThe median age was 53.61 (IQR = 49.4–58.3) years, 59.6% were male, 66.4% were African American, and 70% had an annual income of $15,000 a year or less. Most, 84% used at least one illicit drug, 55.9% were polysubstance users and 25.6% were food insecure. Food insecurity was higher in those who used marijuana (P = 0.007) and polysubstance use (P < 0.001) compared with non-users. Cocaine users had higher food insecurity compared with non-users which trended towards significance (P = 0.076). In a regression model, opiate users were at significantly higher risk for food insecurity than non-users (OR = 1.99, 95% CI: 1.037, 3.80, P = 0.039). Polysubstance users had 3 times greater risk of experiencing food insecurity compared with non-users (OR = 3.22, 95% CI: 1.70, 6.13, P < 0.001). Food insecurity was also associated with having a detectable HIV viral load (P = 0.034). ConclusionsThe current study shows that food insecurity is associated with substance use, alone or in combination, and with uncontrolled HIV viral load among PLWH living in poverty. In resource poor settings, substance use treatment and nutritional services are greatly needed in order to advance HIV treatment and care. Funding SourcesNational Institute on Drug Abuse 5U01DA040381–03.

Adolescent gender norms and adult health outcomes in the USA: a prospective cohort study

SummaryBackgroundPrevious research has documented differences in health behaviours between men and women, with differential risks and health outcomes between the sexes. Although some sex-specific differences in health outcomes are caused by biological factors, many others are socially driven through gender norms. We therefore aimed to assess whether gender expression as an adolescent, determined by the degree to which an individual's behvaiours were typical of their gender, were associated with health behaviours and outcomes in adulthood.MethodsIn this prospective cohort study, we used data from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative sample of US adolescents from whom data were collected during adolescence (ages 11–18 years) and adulthood (ages 24–32 years). We created a measure of gender expression that was based on the degree to which male and female adolescents and adults behave in stereotypically masculine (for men) or feminine (for women) ways relative to their same-gender peers. Adolescents were assessed for baseline sociodemographic characteristics and gender expression, and these participants were later assessed, during adulthood, for their gender expression and health behaviours and outcomes, which included depression, self-rated health, drug and alcohol use, cardiovascular risk factors, experience of sexual violence, diet, and obesity. These data were collected via surveys, except for body-mass index, cholesterol, and blood pressure, which were collected as biomarkers.FindingsBetween April and December, 1995, self-reported data were collected from 10 480 female and 10 263 male adolescents; similar data were subsequently collected in several waves in this cohort, with a final collection between January, 2008, and February, 2009, when participants were aged 24–32 years. We used data from this final wave and from baseline, and our study represents a secondary analysis of these data. Of these participants, complete follow-up data from 6721 (80%) adult women and 5885 (80%) adult men were available. Gender expression was stable for men and women from adolescence to adulthood. High masculinity (vs low masculinity) in adolescent and adult men was positively associated with smoking in the past month, use of marijuana and recreational drugs, prescription drug misuse (adult gender expression only), and consumption of fast food and soda (adolescent gender expression only) in the past week. However, higher masculine gender expression in adult men was negatively associated with diagnosed depression and high cholesterol in adulthood, and masculine gender expression in adolescent and adult men was negatively associated with high blood pressure in adults. High femininity (vs low femininity) in adolescent or adult women was positively associated with high cholesterol and blood pressure (both adult gender expression only), depression, migraines (adult gender expression only), and physical limitations (ie, health problems that limited their daily activities). However, higher femininity in adolescence was negatively associated with self-rated good health in adulthood. Although feminine gender expression in adolescents was predictive of adult recreational and prescription drug and marijuana use and experience of sexual violence, feminine gender expression in adulthood was negatively associated with adult substance use and experience of sexual violence, suggesting that expressions of femininity typical of adolescents impart risks that expression of femininity as an adult does not. Individuals who are highly masculine or feminine seem to be at greatest risk of adverse health outcomes and behaviours.InterpretationWe found compelling evidence that adolescent gender expression is correlated with health in adulthood independently of gender expression as an adult. Although more research is needed to identify causal mechanisms, our results suggest that those designing health behaviour interventions should carefully consider integrating gender transformative components into interventions.FundingEunice Kennedy Shriver National Institute of Child Health and Human Development, Gender Equality, Integrated Delivery, HIV, Nutrition, Family Planning, and Water Sanitation and Hygiene Program Strategy Teams (Bill and Melinda Gates Foundation).

Trends and correlates of driving under the influence of alcohol among different types of adult substance users in the United States: a national survey study

BackgroundDespite a decrease in driving under the influence of alcohol (DUIA) prevalence over the past decades, DUIA prevalence still remains high in the United States. To date, there is limited research examining whether different types of substance users have different trends in DUIA. This study sought to assess trends and variables associated with DUIA by substance use type.MethodsNational Survey on Drug Use and Health (NSDUH) is a cross-sectional, nationally representative population-based survey. By using the NSDUH 2008–2014, we performed the Joinpoint analysis to identify time trends of DUIA in each group of substance users (aged ≥18 years). Logistic regression analysis was used to explore association between substance use type and DUIA and to identify variables associated with DUIA.ResultsAdults who reported alcohol or drug use in the past year were classified into different groups based on past-year substance use status: alcohol use only (n = 141,521) and drug use regardless alcohol use. Drug users included prescription opioids only (n = 5337), marijuana only (n = 32,206), other single drug (n = 3789), prescription opioids-marijuana (n = 3921), multiple prescription drugs (n = 1267), and other multiple drugs (n = 18,432). The Joinpoint analysis showed that DUIA prevalence decreased significantly from 2008 to 2014 among alcohol only users (Average Annual Percent Change [AAPC] = − 2.8), prescription opioids only users (AAPC = -5.4), marijuana only users (AAPC = -5.0), prescription opioids-marijuana users (AAPC = -6.5), multiple prescription drug users (AAPC = -7.4), and other multiple drug users (AAPC = -3.2). Although the estimate was not statistically significant, other single drug users showed a decreasing trend (AAPC = -0.9). Substance use type was significantly associated with DUIA in the adjusted logistic regression. All drug use groups, relative to the alcohol only group, had elevated odds of DUIA, and the odds were especially elevated for the multiple drug use groups (prescription opioids-marijuana, adjusted odds ratio [AOR] = 2.71; multiple prescription drugs, AOR = 2.83; and other multiple drugs, AOR = 3.68). Additionally, younger age, male sex, being white, higher income, and alcohol abuse/dependence were positively associated with DUIA.ConclusionsDUIA prevalence decreased over time and the magnitude of this reduction differed by substance use type. DUIA interventions need to be tailored to substance use type and individual characteristics.

Digit ratio (2D:4D) in relation to substance and computer use: a meta-analysis

Human studies have reported inconsistent associations between the length ratio of the second finger to the fourth finger (2D:4D), which is a proxy for prenatal androgen load, and substance or computer use in adolescents and adults. This meta-analysis quantifies the magnitude of this relationship and investigates the roles of sex, definition of caseness, different forms of addiction, the hand measured (right hand versus left hand), and other cohort characteristics. Univariate random-effects meta-analyses were performed, and moderators were tested with Bonferroni-corrected meta-regression analyses. The study included 18 independent samples with a total of 175,955 participants (96,316 males and 79,639 females). There was a significant difference in 2D:4D between the substance and computer-using subjects and the controls for the combined sample (Hedge’s g = − 0.178 [− 0.291; − 0.064]) and for males (Hedge’s g = − 0.260 [− 0.399; − 0.122]), but not for females. These effects were amplified when only analyzing studies that compared dependent versus non-dependent subjects (combined sample: g = − 0.325 [− 0.492; − 0.157]; males: g = − 0.427 [− 0.564; − 0.291]), but did not reach significance in the subgroup of studies examining other parameters of substance and computer use. When analyzing different forms of substance and computer use separately, alcohol intake and computer use revealed a significant difference in the standardized mean. Again, the effects were amplified when analyzing the subgroup of males and the subgroup of studies comparing dependent versus non-dependent subjects, with effect sizes showing Hedge’s g values as many as − 0.552 [− 0.785; − 0.319] (alcohol-dependent males). Thus, this meta-analysis confirms that lower 2D:4D is associated with substance and computer dependency. Further studies are encouraged to explore the link between intrauterine hormone environment and addiction risk.

Increased Neural Activity in Hazardous Drinkers During High Workload in a Visual Working Memory Task: A Preliminary Assessment Through Event-Related Potentials.

Despite equated behavioral performance levels, hazardous drinkers generally exhibited increased neural activity while performing simple cognitive tasks compared to light drinkers. Here, 49 participants (25 hazardous and 24 light drinkers) participated in an event-related potentials (ERPs) study while performing an n-back working memory task. In the control zero-back (N0) condition, the subjects were required to press a button when the number “2” or “6” was displayed. In the two-back and three-back (N2; N3) conditions, the subjects had to press a button when the displayed number was identical to the number shown two/three trials earlier. To assess for the impact of alcohol consumption on the updating of working memory processes under various cognitive loads, difference waveforms of “N2 minus N0” and “N3 minus N0” were computed by subtracting waveforms in the N0 condition from waveforms in the N2 and N3 conditions, for the light and the hazardous drinkers. Three main ERP components were noted for both groups: a P200/N200 complex, a P300 component, and an N400/P600 activity. The results show that, to perform the task at the same level as the light drinkers, the hazardous drinkers exhibited larger amplitude differences, mainly around the P300 and P600 components. These data may be considered, at the preventive level, as vulnerability factors for developing adult substance use disorders, and they stress the importance, at a clinical level, to consider such working memory processes in the management of alcohol dependence.

Foster care, syndemic health disparities and associations with HIV/STI diagnoses among young adult substance users

ObjectivesFoster care history is associated with many health and social problems, including sexual risk behaviours, HIV and other sexually transmitted infections (STIs). This cross-sectional study compares sexual risk behaviours among...

Peripubertal stress of male, but not female rats increases morphine-induced conditioned place preference and locomotion in adulthood.

Animal studies demonstrate that peripubertal social stress markedly increases the risk for subsequent substance use in adulthood. However, whether non-social stress has a similar long-term impact is not clear, and whether male and female animals show different sensitivity to peripubertal non-social stress has not been examined. In the present study, we addressed these issues by introducing two non-social stressors (elevated platform and predator odor 2,5-Dihydro-2,4,5-trimethylthiazoline) to male and female Wistar rats during adolescence (postnatal days 28-30, 34, 36, 40, and 42), then tested reward-related behaviors during adulthood, including morphine-induced conditioned place preference (CPP, 1mg/kg morphine or 5mg/kg morphine) and hyperlocomotor activity (5mg/kg morphine). We found that adult male rats, but not females who were exposed to peripubertal non-social stressors showed enhanced morphine-induced CPP. Moreover, morphine-induced increase in locomotor activity was also significantly increased in adult male rats, but not in females. These results indicate that peripubertal exposure to repeated non-social stress may enhance sensitivity to the rewarding effects of opioids in adulthood in a sex-dependent manner, with males being even more sensitive than females in this regard.

Technological Interventions for Medication Adherence in Adult Mental Health and Substance Use Disorders: A Systematic Review.

BackgroundMedication adherence is critical to the effectiveness of psychopharmacologic therapy. Psychiatric disorders present special adherence considerations, notably an altered capacity for decision making and the increased street value of controlled substances. A wide range of interventions designed to improve adherence in mental health and substance use disorders have been studied; recently, many have incorporated information technology (eg, mobile phone apps, electronic pill dispensers, and telehealth). Many intervention components have been studied across different disorders. Furthermore, many interventions incorporate multiple components, making it difficult to evaluate the effect of individual components in isolation.ObjectiveThe aim of this study was to conduct a systematic scoping review to develop a literature-driven, transdiagnostic taxonomic framework of technology-based medication adherence intervention and measurement components used in mental health and substance use disorders.MethodsThis review was conducted based on a published protocol (PROSPERO: CRD42018067902) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review guidelines. We searched 7 electronic databases: MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, Web of Science, Engineering Village, and ClinicalTrials.gov from January 2000 to September 2018. Overall, 2 reviewers independently conducted title and abstract screens, full-text screens, and data extraction. We included all studies that evaluate populations or individuals with a mental health or substance use disorder and contain at least 1 technology-delivered component (eg, website, mobile phone app, biosensor, or algorithm) designed to improve medication adherence or the measurement thereof. Given the wide variety of studied interventions, populations, and outcomes, we did not conduct a risk of bias assessment or quantitative meta-analysis. We developed a taxonomic framework for intervention classification and applied it to multicomponent interventions across mental health disorders.ResultsThe initial search identified 21,749 results; after screening, 127 included studies remained (Cohen kappa: 0.8, 95% CI 0.72-0.87). Major intervention component categories include reminders, support messages, social support engagement, care team contact capabilities, data feedback, psychoeducation, adherence-based psychotherapy, remote care delivery, secure medication storage, and contingency management. Adherence measurement components include self-reports, remote direct visualization, fully automated computer vision algorithms, biosensors, smart pill bottles, ingestible sensors, pill counts, and utilization measures. Intervention modalities include short messaging service, mobile phone apps, websites, and interactive voice response. We provide graphical representations of intervention component categories and an element-wise breakdown of multicomponent interventions.ConclusionsMany technology-based medication adherence and monitoring interventions have been studied across psychiatric disease contexts. Interventions that are useful in one psychiatric disorder may be useful in other disorders, and further research is necessary to elucidate the specific effects of individual intervention components. Our framework is directly developed from the substance use disorder and mental health treatment literature and allows for transdiagnostic comparisons and an organized conceptual mapping of interventions.

The accuracy of young adult cannabis users' perceptions of friends' cannabis and alcohol use

ObjectiveUnderstanding the complex influence of peers on young adult substance use is an important component of intervention research and is challenging methodologically. The false consensus theory suggests that individuals falsely attribute their own substance use behaviors onto others, producing biased data. MethodsWe tested this theory with 39 young adults who had a cannabis use disorder and a mean age of 20. Participants (egos) recruited three of their close friends (alters). Egos reported their past 30-day cannabis and alcohol use and their perceptions of alters' use. Alters also reported their actual past 30-day cannabis and alcohol use. ResultsResults demonstrated that egos were very accurate in their perceptions of the frequency of alters' cannabis (ρ = 0.82, p < 0.001) and alcohol (ρ = 0.74, p < 0.001) use. Linear regression models predicted alters' actual cannabis and alcohol use based on egos' perceptions of alters' use, controlling for egos' own substance use. Egos' perceptions of alters' cannabis use strongly predicted alters' actual use (β = 0.80, p < 0.001, adj-R2 = 0.67), and egos' perceptions of alters' alcohol use also predicted alters' actual use (β = 0.66, p < 0.001, adj-R2 = 0.62). Egos' own substance use did not predict alters' use in either model. ConclusionsResults provide evidence that the false consensus theory may be limited when applied to young adults with cannabis use disorder within a close-friend research framework. The results support the hypothesis that young adults are very accurate in their perceptions of the frequency of close friends' substance use and that these perceptions are independent of egos' own use. These findings support the continued use of ego-centric reported close peer substance use for understanding peer effects.

Association between polygenic risk for tobacco or alcohol consumption and liability to licit and illicit substance use in young Australian adults

BackgroundCo-morbid substance use is very common. Despite a historical focus using genetic epidemiology to investigate comorbid substance use and misuse, few studies have examined substance-substance associations using polygenic risk score (PRS) methods. MethodsUsing summary statistics from the largest substance use GWAS to date (258,797- 632,802 subjects), GWAS and Sequencing Consortium of Alcohol and Nicotine use (GSCAN), we constructed PRSs for smoking initiation (PRS-SI), age of initiation of regular smoking (PRS-AI), cigarettes per day (PRS-CPD), smoking cessation (PRS-SC), and drinks per week (PRS-DPW). We then estimated the fixed effect of individual PRSs on 22 lifetime substance use and substance use disorder phenotypes collected in an independent sample of 2463 young Australian adults using genetic restricted maximal likelihood (GREML) in Genome-wide Complex Trait Analysis (GCTA), separately in females, males and both sexes together. ResultsAfter accounting for multiple testing, PRS-SI significantly explained variation in the risk of cocaine (0.67%), amphetamine (1.54%), hallucinogens (0.72%), ecstasy (1.66%) and cannabis initiation (0.97%), as well as DSM-5 alcohol use disorder (0.72%). PRS-DPW explained 0.75%, 0.59% and 0.90% of the variation of cocaine, amphetamine and ecstasy initiation respectively. None of the 22 phenotypes including emergent classes of substance use were significantly predicted by PRS-AI, PRS-CPD, and PRS-SC. ConclusionsTo our knowledge, this is the first study to report significant genetic overlap between the polygenic risks for smoking initiation and alcohol consumption and the risk of initiating major classes of illicit substances. PRSs constructed from large discovery GWASs allows the detection of novel genetic associations.

Integrated cognitive behavioral therapy for ADHD in adult substance use disorder patients: Results of a randomized clinical trial

BackgroundAttention Deficit Hyperactivity Disorder (ADHD) frequently co-occurs with Substance Use Disorders (SUDs). Standard ADHD pharmacotherapies are not effective in patients with this comorbidity and cognitive behavioral therapy (CBT) has not been tested in this population. This RCT aimed to compare the efficacy of Integrated CBT (CBT/Integrated) directed at adult ADHD and SUD with CBT directed at SUD only (CBT/SUD) in patients with SUD and ADHD (SUD + ADHD). MethodsRandomized clinical trial among 119 SUD + ADHD patients in a SUD treatment center. CBT/Integrated consisted of 15 individual sessions of motivational therapy, coping skills training and relapse prevention for SUD, and training of planning skills, problem-solving skills and dealing with emotions for ADHD. CBT/SUD consisted of 10 individual SUD treatment sessions only. Primary outcome was ADHD symptom severity according to the ADHD rating scale (ARS) at post-treatment. Secondary outcomes included ADHD symptom severity after two-month follow-up, and treatment response (≥30% ADHD symptom reduction), substance use, depressive or anxiety symptoms, and quality of life at post-treatment and follow-up. ResultsCBT/Integrated was more effective than CBT/SUD in the reduction of ADHD symptoms post-treatment: ARS = 28.1 (SD 9.0) vs. 31.5 (SD 11.4) (F = 4.739, df = 1, 282, p = .030; d = 0.34). At follow-up, CBT/Integrated still resulted in lower ARS scores than CBT/SUD, but the difference was not significant at the 0.05 level. For other secondary outcomes, including substance use, no significant between-group differences were present. ConclusionsCompared to regular SUD cognitive behavioral therapy, integrated cognitive behavioral therapy resulted in a significant extra improvement in ADHD symptoms in SUD + ADHD patients.

Outcomes of Early Adolescent Sexual Behavior in Australia: Longitudinal Findings in Young Adulthood

PurposeLimited longitudinal research has examined the adult health and behavioral outcomes associated with early adolescent sexual behavior. This paper examined whether adolescent sexual behavior predicted young adult health and social outcomes within longitudinal cohorts in Victoria, Australia. MethodsAdolescents were recruited in 2002 to be state-representative of school students in Victoria, Australia, and resurveyed in 2003 and 2004. The sample responded to a web-based survey as young adults in 2010/2011. Multivariate negative binomial regression models examined the predictive effect of sex by age 15 on young adult outcomes (average age 21) of sexual risk taking, substance use, antisocial behavior, and psychological distress (N = 2,147). ResultsAfter adjustment for other factors, sex at age 15 or younger (early sex) predicted higher rates of young adult sexual risk taking such as pregnancy, lifetime partners, and sex without using a condom. Early sex also predicted higher rates of young adult substance use (alcohol, tobacco, and/or illicit substance use) and antisocial behavior, but rates of adult psychological distress were not affected. ConclusionsThis study found that early adolescent sex had unique predictive effects on a range of adverse young adulthood outcomes. Public health policies should synthesize longitudinal data on the risks of early sexual behavior, while advocating evidence-based adolescent sexual health promotion interventions.

Associations of Adolescent Exposure to Severe Violence with Substance Use From Adolescence into Adulthood: Direct Versus Indirect Exposures

Background: While previous research has documented the impact of violence on substance use, none has looked longitudinally across the lifespan to measure independent effects of direct and indirect violence exposure. Objective: To examine independent associations between adolescent experiences of violence and subsequent substance use in adolescence and adulthood in the United States. Method: Using the National Longitudinal Study of Adolescent to Adult Health (N = 12,288), we examined being shot or stabbed (“experienced”), being threatened with a knife or gun (“threatened”), and seeing someone either shot or stabbed (“witnessed”) during adolescence (Wave I) as correlates of substance use in adolescence and adulthood (Wave IV) via logistic regression. Results: Violence exposure was a significant correlate of drug use in adolescence and several associations remained significant in adulthood. Witnessing violence had the highest point estimates in the adjusted models in adolescence for each substance use outcome (e.g., Cocaine-Adjusted Odds Ratios [AOR] = 2.59, 95% confidence interval [CI] = 1.21, 5.54). However, the point estimates for threatened with violence or experienced violence were highest in three out of the four drug outcomes in adulthood (e.g., Threatened with violence: Binge drinking-AOR = 1.41, 95% CI = 1.08, 1.83). Conclusion/Importance: Adolescent exposure to witnessing violence had stronger effects on substance use in adolescence, while experiencing and being threatened with violence in adolescence had stronger effects on substance use in adulthood. Violence prevention efforts targeted toward adolescents may lead to a reduction in substance use throughout the life-course, and clinicians and policy makers should be aware of the downstream effects of violence experienced in adolescence.

An Examination of the Age of Substance Use Onset and Adult Severity of Use Among Offenders Entering Treatment

Early onset of substance use has demonstrated a robust relationship with later severity of use, yet this relationship has been less examined in criminal justice contexts or examined differentially by gender. The present study utilized secondary data from a sample of offenders in one small Midwestern state entering corrections-based substance abuse treatment in prison, jail, or community settings to address these gaps in the literature. Findings indicated that age of regular cigarette use did not uniquely affect severity of illicit drug use in adulthood, defined as the frequency of use or endorsement of substance use disorder criteria. In comparison, ages of onset for alcohol and illicit drug use were significantly associated with multiple severity variables examined. Gender was not found to moderate these relationships. These findings emphasize that age of use onset for alcohol and illicit drugs can be valuable in identifying offenders at risk of severe substance use in adulthood.

Prenatal cocaine exposure: Direct and indirect associations with 21-year-old offspring substance use and behavior problems

BackgroundPrenatal cocaine exposure (PCE) has been linked to child/adolescent behavior problems and substance use in several longitudinal cohort studies. It is unclear whether these effects extend into adulthood and influence young adult behavior problems and substance use and, if so, whether they are mediated by childhood and adolescent experiences. MethodsThese data are from an ongoing longitudinal study of individuals born to women who were recruited early in pregnancy. Trimester-specific data on prenatal drug exposure were obtained. Caregivers and offspring were assessed at delivery and at 1, 3, 7, 10, 15, and 21 years postpartum. This report is from age 21, when 225 offspring (52% females; 54% African American, 46% Caucasian) reported on behavior problems, emotion regulation, and substance use. ResultsThere were significant direct associations between PCE and early initiation of marijuana, 21-year emotion regulation problems, arrest history, and Conduct Disorder. The relation between PCE and young adult internalizing behavior was mediated by adolescent mood symptoms. The association between PCE and 21-year marijuana use was mediated by early initiation of marijuana use. ConclusionsPCE has both direct and indirect long-term associations with young adult development. Using statistical models that considered the complex interrelationships among PCE and adult outcomes, we demonstrated that the direct effects of PCE on young adult emotion regulation problems, arrest history, and Conduct Disorder are not completely explained by earlier adolescent behavior. Moreover, the analyses suggesting mediated pathways from PCE to young adult problems identify crucial variables to target interventions for exposed children and adolescents.