Adolescent Alcohol Use Disorders Research Articles

Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs

Background Alcohol consumption and related harm increase steeply from the ages of 12–20 years. Adolescents in the UK are among the heaviest drinkers in Europe. Excessive drinking in adolescents is associated with increased risk of accidents, injuries, self-harm, unprotected or regretted sex, violence and disorder, poisoning and accidental death. However, there is lack of clear evidence for the most clinically effective and cost-effective screening and brief interventions for reducing or preventing alcohol consumption in adolescents attending emergency departments (EDs). Objectives To estimate the distribution of alcohol consumption, alcohol-related problems and alcohol use disorders in adolescents attending EDs; to develop age-appropriate alcohol screening and brief intervention tools; and to evaluate the clinical effectiveness and cost-effectiveness of these interventions. Design The research has been conducted in three linked stages: (1) a prevalence study, (2) intervention development and (3) two linked randomised controlled trials (RCTs). Setting Twelve EDs in England (London, North East, and Yorkshire and The Humber). Participants A total of 5376 participants in the prevalence study [mean age 13.0 years, standard deviation (SD) 2.0 years; 46.2% female] and 1640 participants in the two linked RCTs (mean age 15.6 years, SD 1.0 years; 50.7% female). Interventions Personalised feedback and brief advice (PFBA) and personalised feedback plus electronic brief intervention (eBI), compared with alcohol screening alone. These age-appropriate alcohol interventions were developed in collaboration with the target audience through a series of focus groups and evaluations during stage 2 of the research programme and following two literature reviews. Main outcome measures Total alcohol consumed in standard UK units (1 unit = 8 g of ethanol) over the previous 3 months at 12-month follow-up, assessed using the Alcohol Use Disorders Identification Test, Consumption (3 items) (AUDIT-C). Results In the prevalence study, 2112 participants (39.5%) reported having had a drink of alcohol that was more than a sip in their lifetime, with prevalence increasing steadily with age and reaching 89.5% at the age of 17 years. The prevalence of at-risk alcohol consumption was 15% [95% confidence interval (CI) 14% to 16%] and the optimum cut-off point of the AUDIT-C in identifying at-risk drinking was ≥ 3. Associations of alcohol consumption and early onset of drinking with poorer health and social functioning were also found. In the RCT, the analysis of the primary outcome (average weekly alcohol consumption at month 12) identified no significant differences in effect between the three groups in both trials. In the high-risk drinking trial, the mean difference compared with control was 0.57 (95% CI –0.36 to 1.70) for PFBA and 0.19 (95% CI –0.71 to 1.30) for eBI. In the low-risk drinking trial, the mean difference compared with control was 0.03 (95% CI –0.07 to 0.13) for PFBA and 0.01 (95% CI –0.10 to 0.11) for eBI. The health economic analysis showed that eBI and PFBA were not more cost-effective than screening alone. Conclusions The ED can offer an opportunity for the identification of at-risk alcohol use in adolescents. A simple, short, self-completed screening instrument, the AUDIT-C, is an effective tool for identifying adolescents who are at risk of alcohol-related problems. Associations of alcohol consumption and earlier onset of drinking with poorer health and social functioning were observed in the prevalence study. The trials were feasible to implement and exceeded the recruitment target and minimum follow-up rates. However, PFBA and eBI were not found to be more effective than screening alone in reducing or preventing alcohol consumption in 14- to 17-year-olds attending EDs. Limitations and future work Only one-third of participants engaged with the application program; this is likely to have limited the effect of the intervention. We recommend that future research should focus on methods to maximise engagement with digital interventions and evaluate the effect of such engagement on clinical outcomes. Trial registration Current Controlled Trials ISRCTN45300218. Funding This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 2. See the NIHR Journals Library website for further project information.

Recovery and Youth: An Integrative Review.

Although rates of alcohol and other substance use disorders in adolescents have been estimated for decades, little is known about the prevalence, pathways, and predictors of remission and long-term recovery among adolescents. This article provides an integrative review of the literature on youth recovery. A final selection of 39 relevant articles was grouped into five sections: treatment outcomes, special emphasis populations, recovery-oriented systems of care, families, and non–abstinence-based approaches. The review recommends more adolescent research in three basic areas: more research about medication-assisted treatment and recovery as well as harm reduction approaches for adolescents; expansion of research on recovery practices for youth who do not receive treatment due to personal choice or societal disparities; and more life course research, which may begin with adolescent participants and extend across the life span. Additionally, the authors suggest the recovery capital model for adolescents and the neuroscience of addiction may provide additional precision and direction for the study of youth recovery.

Alcohol use disorder and cannabis use disorder symptomatology in adolescents are differentially related to dysfunction in brain regions supporting face processing

Despite extensive behavioral evidence of impairments in face processing and expression recognition in adults with alcohol or cannabis use disorders (AUD/CUD), neuroimaging findings have been inconsistent. Moreover, relatively little work has examined the relationship of AUD or CUD symptoms with face or expression processing within adolescents. Given the high prevalence of alcohol and cannabis use during adolescence, understanding how these usage behaviors interact with neural mechanisms supporting face and expression processing could have important implications for youth social and emotional functioning. In this study, adolescents (N = 104) responded to morphed fearful and happy expressions during fMRI and their level of AUD and/or CUD symptoms were related to the BOLD response data. We found that AUD and CUD symptom severity were both negatively related to responses to faces generally. However, whereas this relationship was shown for AUD within ventromedial prefrontal cortex and lingual gyrus, it was shown for CUD within rostromedial prefrontal cortex including anterior cingulate cortex. Additionally, AUD symptom levels were associated with differential responses within medial temporal pole and inferior parietal lobule as a function of expression. These results have potential implications for understanding the social and emotional functioning of adolescents with AUD and CUD symptoms.

Neonatal temperament and neuromotor differences are predictive of adolescent alcohol intake in rhesus monkeys (Macaca mulatta).

Identifying predictors of teenage alcohol use disorder (AUDs) is a major health initiative, with studies suggesting that there are distinct personality-related traits that underlie patterns of alcohol intake. As temperament is biologically based, identifiable early in life, and stable across time, it is considered the foundation of personality. As such, we hypothesized that neonatal temperament traits would predict anxiety-mediated adolescent alcohol consumption. To test this, N = 145 rhesus macaque (Macaca mulatta) infants (14 days of age), reared in a neonatal nursery (n = 82) or in a control condition with their mothers (n = 63) were assessed with a widely used standardized nonhuman primate testing battery, the Infant Behavioral Assessment Scale (IBAS), modeled after the Brazelton Neonatal Assessment Scale, evaluating visual orienting, temperament, motor maturity and, more recently, sensory sensitivity. As adolescents (3-4 years of age), these same subjects were allowed unfettered access to a sweetened-alcohol solution for 1 hr/day, 4 days/week, over 5-7 weeks. Subjects were allowed to self-administer alcohol while housed alone (n = 70) or socially in their home cage (n = 55). Linear regressions showed that alcohol intake was predicted by neonatal orienting ability (β = -.35; p = .01), state control (β = -.19; p = .04), and motor maturity (β = -.24; p = .01). Poor neonatal orienting, state control (ease of consolability), and motor maturity were associated with higher adolescent alcohol intake in rhesus monkeys. These findings suggest that neonatal temperament is predictive of patterns of adolescent alcohol intake. To the extent that these results generalize to humans, they provide evidence that early-life temperament and neurodevelopment may be important risk factors for adolescent AUDs and that the IBAS may be used as an assessment tool for identifying such risk.

Rising Prevalence of Comorbid Alcohol and Opioid Use Disorders in Adolescents and Young Adults in the United States.

Rising Prevalence of Comorbid Alcohol and Opioid Use Disorders in Adolescents and Young Adults in the United States.

A Pilot Study of Neurocognitive Function and Brain Structures in Adolescents With Alcohol Use Disorders: Does Maltreatment History Matter?

Neurocognitive and brain structural differences are associated with adolescent onset alcohol use disorders (AUDs). Maltreatment histories may contribute to current results. To examine these issues, healthy adolescents (n = 31), adolescents without maltreatment and AUD (AUD - MAL, n = 28), and adolescents with AUDs with maltreatment (AUD + MAL, n = 17) underwent comprehensive neurocognitive assessments and MRI structural scans. Controls performed significantly better than the two AUD groups in math and language. The AUD + MAL group performed significantly lower in sustained attention compared to the AUD - MAL and control groups and lower in reading compared to controls. The AUD + MAL group had larger left pars triangularis, a region of the inferior frontal gyrus, compared to the AUD-MAL and control groups, and smaller anterior corpus callosum volumes versus the AUD - MAL group. There were no group differences in other prefrontal cortex, amygdala, hippocampus, and parahippocampal volumes. The AUD + MAL group showed an inverse correlation between hippocampal volumes and age. AUD variables were associated with lower performance in fine-motor and executive function. Cannabis use variables were associated with lower performance in fine-motor, language, visual-spatial, memory, and executive function. Parahippocampal volumes positively correlated with abstinence. The preliminary results suggest adolescent AUD studies should consider examinations of maltreatment history, comorbid substance use disorders, and recovery during abstinence in their analyses.

Binge Drinking among adolescents is related to the development of Alcohol Use Disorders: results from a Cross-Sectional Study

Binge drinking (BD) is a common pattern of alcohol consumption among adolescents. At present few data are available on the possible relationship between BD and alcohol use disorders (AUD) in adolescents. The aim of this study was to assess the prevalence of BD and relationship between BD behavior and AUD among adolescents. A total of 2704 students attending 10 purposively selected high schools from three Italian provinces were surveyed. Questionnaires regarding socio-demographic data, pattern and amount of alcohol intake, smoking habits, use of illicit drugs, and physical activity were administered. AUD and affective disorders were also evaluated. Alcohol intake was reported by 2126 participants; 1278 reported at least one episode BD in the last year and 715 in the last month. A diagnosis of AUD was made in 165 adolescents. The prevalence of AUD was higher in adolescents that reported BD behavior than in those that did not report BD (11.6% vs 0.9%, respectively; p < 0.0001). Logistic regression showed a positive relationship between a diagnosis of AUD and BD behavior (OR 9.6; 95% CI 4.7–22·9; p < 0.0001). In conclusion alcohol consumption with the pattern of BD among adolescents is highly related to development of AUD.

Emergencia sociosanitaria en consumo de riesgo de alcohol y síntomas de dependencia en jóvenes

Introducción. El exceso consumo de alcohol en la población adolescente y joven constituye un problema de gran magnitud y una atención sociosanitaria Objetivo. Evaluar las características psicométricas del Alcohol Use Disorders Identification Test (AUDIT) en población juvenil y estudiar los trastornos por consumo de alcohol en adolescentes y jóvenes españoles y mexicanos, estableciéndose un análisis diferencial. Metodología. Estudio observacional descriptivo con análisis transversal de 1313 adolescentes y jóvenes de España y de México, con edades comprendidas entre los 13 y los 19 años y de ambos sexos. Se ha optado por un diseño de investigación no experimental correlacional, realizado sobre un diseño intrasujeto y seleccionando a los participantes mediante un muestreo probabilístico. Resultados. Se han confirmado las propiedades psicométricas del test AUDIT en muestra juvenil con una adecuada validez de constructo y confiabilidad y su estructura factorial. Asimismo, se confirma la existencia de diferencias significativas entre jóvenes españoles y mexicanos, en todos los indicadores evaluados, obteniéndose un tamaño de efecto elevado. Conclusiones. El consumo intensivo de alcohol en el colectivo juvenil constituye una problemática con múltiples implicaciones, de ahí la importancia de evaluar las conductas de riesgo y los síntomas de dependencia en jóvenes

Prevention of underage drinking and alcohol use disorders in native American adolescents: Influence of stress and dark side symptoms

Prevention of underage drinking and alcohol use disorders in native American adolescents: Influence of stress and dark side symptoms

The BDNF p.Val66Met polymorphism, childhood trauma, and brain volumes in adolescents with alcohol abuse.

BackgroundPrevious studies have indicated that early life adversity, genetic factors and alcohol dependence are associated with reduced brain volume in adolescents. However, data on the interactive effects of early life adversity, genetic factors (e.g. p.Met66 allele of BDNF), and alcohol dependence, on brain structure in adolescents is limited. We examined whether the BDNF p.Val66Met polymorphism interacts with childhood trauma to predict alterations in brain volume in adolescents with alcohol use disorders (AUDs).MethodsWe examined 160 participants (80 adolescents with DSM-IV AUD and 80 age- and gender-matched controls) who were assessed for trauma using the Childhood Trauma Questionnaire (CTQ). Magnetic resonance images were acquired for a subset of the cohort (58 AUD and 58 controls) and volumes of global and regional structures were estimated using voxel-based morphometry (VBM). Samples were genotyped for the p.Val66Met polymorphism using the TaqMan® Assay. Analysis of covariance (ANCOVA) and post-hoc t-tests were conducted using SPM8 VBM.ResultsNo significant associations, corrected for multiple comparisons, were found between the BDNF p.Val66Met polymorphism, brain volumes and AUD in adolescents with childhood trauma.ConclusionsThese preliminary findings suggest that the BDNF p.Met66 allele and childhood trauma may not be associated with reduced structural volumes in AUD. Other genetic contributors should be investigated in future studies.

Childhood adversity is linked to differential brain volumes in adolescents with alcohol use disorder: a voxel-based morphometry study.

Previous neuroimaging studies link both alcohol use disorder (AUD) and early adversity to neurobiological differences in the adult brain. However, the association between AUD and childhood adversity and effects on the developing adolescent brain are less clear, due in part to the confound of psychiatric comorbidity. Here we examine early life adversity and its association with brain volume in a unique sample of 116 South African adolescents (aged 12–16) with AUD but without psychiatric comorbidity. Participants were 58 adolescents with DSM-IV alcohol dependence and with no other psychiatric comorbidities, and 58 age-, gender- and protocol-matched light/non-drinking controls (HC). Assessments included the Childhood Trauma Questionnaire (CTQ). MR images were acquired on a 3T Siemens Magnetom Allegra scanner. Volumes of global and regional structures were estimated using SPM8 Voxel Based Morphometry (VBM), with analysis of covariance (ANCOVA) and regression analyses. In whole brain ANCOVA analyses, a main effect of group when examining the AUD effect after covarying out CTQ was observed on brain volume in bilateral superior temporal gyrus. Subsequent regression analyses to examine how childhood trauma scores are linked to brain volumes in the total cohort revealed a negative correlation in the left hippocampus and right precentral gyrus. Furthermore, bilateral (but most significantly left) hippocampal volume was negatively associated with sub-scores on the CTQ in the total cohort. These findings support our view that some alterations found in brain volumes in studies of adolescent AUD may reflect the impact of confounding factors such as psychiatric comorbidity rather than the effects of alcohol per se. In particular, early life adversity may influence the developing adolescent brain in specific brain regions, such as the hippocampus.

Gender differences in the prevalence of DSM-IV alcohol use disorders in adolescents

Despite the availability of data about drinking frequency and patterns, the surveys on alcohol use among adolescents carried out in Europe tend not to provide information about diagnostic criteria for alcohol use disorders (AUD) or estimation of their prevalence. This study assesses the prevalence of AUD among a sample of Spanish adolescents, to identify the most prevalent symptoms, and explore gender differences in AUD in this population. The final sample consisted of 504 participants aged 15 to 18, obtained by means of random sampling from all the schools in the region of Asturias (Spain). The presence of alcohol abuse (AA) and alcohol dependence (AD) disorders was evaluated according to DSM-IV-TR criteria. The results showed that 12.5% of the sample met the criteria for the diagnosis of AUD (6.7% for alcohol abuse, AA, and 5.8% for alcohol dependence, AD). The most prevalent symptoms were having social problems for AA diagnosis (9% of students who reported alcohol use in the past year) and tolerance for AD diagnosis (45.8% of students who reported alcohol use in the past year). Males showed a significantly higher score than females in AUD, AA and two AA diagnosis criteria (hazardous use and legal problems). The prevalence of AUD among Spanish adolescents is very high, males being more likely than females to endorse criteria for AUD and AA, though not for AD. These findings reveal a serious health issue and highlight the need to develop preventive efforts and provide coordinated alcohol-abuse interventions.

Genetic and neurophysiological correlates of the age of onset of alcohol use disorders in adolescents and young adults.

Discrete time survival analysis was used to assess the age-specific association of event-related oscillations (EROs) and CHRM2 gene variants on the onset of regular alcohol use and alcohol dependence. The subjects were 2,938 adolescents and young adults ages 12-25. Results showed that the CHRM2 gene variants and ERO risk factors had hazards which varied considerably with age. The bulk of the significant age-specific associations occurred in those whose age of onset was under 16. These associations were concentrated in those subjects who at some time took an illicit drug. These results are consistent with studies which associate greater rates of alcohol dependence among those who begin drinking at an early age. The age specificity of the genetic and neurophysiological factors is consistent with recent studies of adolescent brain development, which locate an interval of heightened vulnerability to substance use disorders in the early to mid teens.

Cortical and subcortical volumes in adolescents with alcohol dependence but without substance or psychiatric comorbidities

Most prior studies of the effects of excessive alcohol intake on the adolescent brain examined alcohol-use-dependent samples with comorbid psychiatric and substance use disorders. In the Cape Town region, we identified a sizeable cohort of adolescents with alcohol use disorders (AUD) without externalizing or other psychiatric disorders. We examined brain morphology in 64 such adolescents compared to age- and gender-matched healthy controls. Magnetic resonance imaging data were analyzed using FSL's FIRST software for subcortical volumes, and cortical gray matter (GM) was analyzed using voxel-based morphometry (VBM) and regions of interest (ROI) analysis. AUD boys had smaller thalamic and putamen volumes compared to non-drinking boys, while AUD girls had larger thalamic and putamen volumes compared to non-drinking girls. VBM revealed a large region of decreased GM density in AUDs compared to controls located in the left lateral frontal, temporal, and parietal lobes, extending medially deep into the parietal lobe. Smaller GM volume in this region was also present when examined using ROI analysis. Our lack of findings in other brain regions, particularly the hippocampus, suggests that reports of smaller brain volumes in adolescent AUDs in the literature are a consequence of psychiatric and substance abuse comorbidities.

A role for cognitive rehabilitation in increasing the effectiveness of treatment for alcohol use disorders.

Neurocognitive impairments are prevalent in persons seeking treatment for alcohol use disorders (AUDs). These impairments and their physical, social, psychological and occupational consequences vary in severity across persons, much like those resulting from traumatic brain injury; however, due to their slower course of onset, alcohol-related cognitive impairments are often overlooked both within and outside of the treatment setting. Evidence suggests that cognitive impairments can impede treatment goals through their effects on treatment processes. Although some recovery of alcohol-related cognitive impairments often occurs after cessation of drinking (time-dependent recovery), the rate and extent of recovery is variable across cognitive domains and individuals. Following a long hiatus in scientific interest, a new generation of research aims to facilitate treatment process and improve AUD treatment outcomes by directly promoting cognitive recovery (experience-dependent recovery). This review updates knowledge about the nature and course of cognitive and brain impairments associated with AUD, including cognitive effects of adolescent AUD. We summarize current evidence for indirect and moderating relationships of cognitive impairment to treatment outcome, and discuss how advances in conceptual frameworks of brain-behavior relationships are fueling the development of novel AUD interventions that include techniques for cognitive remediation. Emerging evidence suggests that such interventions can be effective in promoting cognitive recovery in persons with AUD and other substance use disorders, and potentially increasing the efficacy of AUD treatments. Finally, translational approaches based on cognitive science, neurophysiology, and neuroscience research are considered as promising future directions for effective treatment development that includes cognitive rehabilitation.

Circadian Misalignment, Reward‐Related Brain Function, and Adolescent Alcohol Involvement

Developmental changes in sleep and circadian rhythms that occur during adolescence may contribute to reward-related brain dysfunction, and consequently increase the risk of alcohol use disorders (AUDs). This review (i) describes marked changes in circadian rhythms, reward-related behavior and brain function, and alcohol involvement that occur during adolescence, (ii) offers evidence that these parallel developmental changes are associated, and (iii) posits a conceptual model by which misalignment between sleep-wake timing and endogenous circadian timing may increase the risk of adolescent AUDs by altering reward-related brain function. The timing of sleep shifts later throughout adolescence, in part due to developmental changes in endogenous circadian rhythms, which tend to become more delayed. This tendency for delayed sleep and circadian rhythms is at odds with early school start times during secondary education, leading to misalignment between many adolescents' sleep-wake schedules and their internal circadian timing. Circadian misalignment is associated with increased alcohol use and other risk-taking behaviors, as well as sleep loss and sleep disturbance. Growing evidence indicates that circadian rhythms modulate the reward system, suggesting that circadian misalignment may impact adolescent alcohol involvement by altering reward-related brain function. Neurocognitive function is also subject to sleep and circadian influence, and thus circadian misalignment may also impair inhibitory control and other cognitive processes relevant to alcohol use. Specifically, circadian misalignment may further exacerbate the cortical-subcortical imbalance within the reward circuit, an imbalance thought to explain increased risk-taking and sensation-seeking during adolescence. Adolescent alcohol use is highly contextualized, however, and thus studies testing this model will also need to consider factors that may influence both circadian misalignment and alcohol use. This review highlights growing evidence supporting a path by which circadian misalignment may disrupt reward mechanisms, which may in turn accelerate the transition from alcohol use to AUDs in vulnerable adolescents.

Not lesser but Greater fractional anisotropy in adolescents with alcohol use disorders.

ObjectiveThe objective of this study is to examine white matter microstructure using diffusion tensor imaging (DTI) in a sample of adolescents with alcohol use disorders (AUD) and no psychiatric or substance co-morbidity.MethodsFifty adolescents with AUD and fifty non-alcohol abusing controls matched on gender and age were studied with DTI, neurocognitive testing, and a clinical assessment that included measures of alcohol use and childhood trauma. Maps of fractional anisotropy (FA) and mean diffusivity (MD) were computed, registered to a common template, and voxel-wise statistical analysis used to assess group differences. Associations between regions of altered WM microstructure and clinical or neurocognitive measures were also assessed.ResultsCompared with controls, adolescent drinkers without co-morbid substance abuse or externalizing disorder, showed 1) no regions of significantly lower FA, 2) increased FA in WM tracts of the limbic system; 3) no MD differences; and 4) within the region of higher FA in AUD, there were no associations between FA and alcohol use, cognition, or trauma.DiscussionThe most important observation of this study is our failure to observe significantly smaller FA in this relatively large alcohol abuse/dependent adolescent sample. Greater FA in the limbic regions observed in this study may index a risk for adolescent AUD instead of a consequence of drinking. Drinking behavior may be reinforced in those with higher FA and perhaps greater myelination in these brain regions involved in reward and reinforcement.

Preliminary evidence for a gene-environment interaction in predicting alcohol use disorders in adolescents.

Emerging research suggests that genetic influences on adolescent drinking are moderated by environmental factors. The present study builds on molecular-genetic findings by conducting the first analysis of gene-environment interactions in the association between a functional single nucleotide polymorphism (SNP) of the μ-opioid receptor (OPRM1) gene (A118G) and risk of developing an alcohol use disorder (AUD) during adolescence. Specifically, we tested whether variation in parenting practices or affiliation with deviant peers moderated the link between the OPRM1 gene and risk of an AUD. Adolescents reporting European ancestry (N=104), ages 12 to 19years (M=15.60, SD=1.77), were interviewed to ascertain AUD diagnoses, provided a DNA sample for genetic analyses, and completed measures of parental monitoring and deviant peer affiliation. Logistic regression was used to test the effects of environmental variables and their interactions with OPRM1 genotype as predictors of AUD diagnosis while controlling for age and sex. Case-control comparisons showed that the proportion of youth with an AUD (n=18) significantly differed by genotype such that 33.3% of G allele carriers met criteria for an AUD compared to 10.8% of youth who were homozygous for the A allele (p=0.006). The OPRM1 × parental monitoring (odds ratio=0.16) and OPRM1 × deviant peer affiliation (odds ratio=7.64) interactions were significant predictors of AUD risk, such that G allele carriers with high levels of deviant peer affiliation or lower levels of parental monitoring had the greatest likelihood of developing an AUD (p-values <0.01). This study provides initial evidence that the association between the A118G SNP of the OPRM1 gene and risk of AUDs is moderated by modifiable factors. These results are limited, however, by the small sample size and require replication.

Absence of P300 reduction in South African treatment-naïve adolescents with alcohol dependence.

Event-related potential studies show reduced P300 amplitudes in alcohol use disorders (AUDs). Alcohol exposure, genetic vulnerability to alcoholism, and comorbid psychopathology may contribute to this reduction. Most previous research has studied treated adult AUD samples, which have more severe alcoholism, a greater family history of AUDs, and more comorbidity than untreated samples. Untreated AUD samples tend to have little or no P300 amplitude reduction. We compared P300 between treatment-naïve alcohol-dependent (TNAD) adolescents with no diagnosable substance abuse or psychiatric comorbidity and nonsubstance-abusing control (NSAC) adolescents. Individuals between the ages of 13 and 18 years were recruited into either TNAD (n = 45) or NSAC (n = 64) groups. Alcohol use variables, family history density of alcohol problems, and psychiatric symptom counts were assessed in a clinician-administered evaluation. EEGs were recorded during performance of a 3-condition visual target detection task. P300 amplitudes were of comparable size in TNAD adolescents and NSAC adolescents. Boys demonstrated larger P3a and P3b amplitudes than girls. Within TNAD, P3b amplitude was reduced in those who drank more frequently, and P3a latency was more prolonged in subjects with higher internalizing symptom counts. The P300 deficit was not present in TNAD adolescents without comorbidities. In comparison to results of reduced P300 in treated adolescent AUD samples, this finding likely reflects moderate alcohol exposure, lower genetic vulnerability to alcoholism, and lack of comorbidity in our sample. Further work is needed to determine the relative contributions of these factors to changes in the P300.

Treatment of Children and Adolescents with Posttraumatic Stress Disorder (PTSD): A Review of Current Evidence

Conclusion and Summary Multiple treatments exist for the treatment of alcohol use disorders in adolescents. Current literature and evidence focuses mainly on adult populations. Clinical trials investigating pharmacologic treatment of alcohol use disorders in children and adolescents are limited. When discussing treatment with an adolescent who suffers from a substance use disorder, it is important to discuss risks and benefits of pharmacotherapy and also explain to the patient and family that these medications have been primarily studied in adult populations. Family therapy may be particularly important when treating adolescents with substance use disorders and addressing comorbid psychiatric conditions also yields better outcomes. Sarah B. Johnson, M.D., M.Sc., University of Louisville Department of Psychiatry, 401 E. Chestnut St., Ste. 610, Louisville, KY 40202. E-mail: sarah. johnson@louisville.edu.