Family History Of Substance Use Disorder Research Articles

Improving Nurses' Attitudes Toward Substance Use Disorder: Screening, Brief Intervention, and Referral to Treatment.

Patients with substance use disorder (SUD) encounter many barriers to healthcare, including negative attitudes of healthcare personnel. Compared with other healthcare professions, nurses have been reported as having less tolerant attitudes toward patients with SUD. Knowledge acquisition combined with role support has been shown to improve therapeutic attitudes of nurses toward patients with SUD. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based educational intervention aimed to improve the outcomes of patients at risk and with SUD. SBIRT education has been shown as an effective educational tool with licensed nurses. Therefore, the aim of this study was to evaluate whether a 2-hour educational session on SBIRT (Mitchell et al., 2013) improved the therapeutic attitudes of nurses toward patients with SUD. Peplau's theory of interpersonal relations guided this study with an emphasis on the nurse-patient relationship. A quasi-experimental pretest/posttest design was used to evaluate nurses' attitudes pre and post a 2-hour educational session. Participants included 65 registered nurses employed in a 247-bed teaching hospital in New England. Attitudes were measured before and after the educational session using the 20-item, five-subscale Drug and Drug Problems Perceptions Questionnaire. A paired t test was performed, showing statistically significant improvements in attitudes postintervention. Prior education on SUD significantly correlated with baseline attitudes. A standard regression model, with practice setting, family history of SUD, and prior education as dependent variables, was not predictive of baseline attitudes. The results suggest conducting SBIRT should be considered a mandatory nursing competency, both in undergraduate curriculum and among licensed nurses.

Do the Transmissible Liability Index (TLI) and Adolescent Cannabis Use Predict Paranoid and Schizotypal Symptoms at Young Adulthood?

Background : Adolescent cannabis use is an established risk factor for the development of psychosis, but the premorbid vulnerability factors and specificity versus generality of the psychotic symptom domains affected in cannabis-psychosis relationships remain incompletely understood. To improve our understanding of these relationships, we used longitudinal data to examine the individual and interactive effects of preadolescent transmissible liability to substance use disorders (SUD), measured via the transmissible liability index (TLI), and adolescent cannabis use on the development of two distinct psychotic symptom domains, paranoid and schizotypal personality traits in young adulthood. Methods: We performed secondary analysis of data from the Center for Education and Drug Abuse (CEDAR) study, which longitudinally assessed offspring of men with (N = 211) and without (N = 237) lifetime history of SUD at ages 10-12, and across adolescence as they transitioned to young adulthood. TLI scores were calculated at age 10-12, self-reported cannabis use was assessed at age 16, and paranoid and schizotypal symptoms were assessed at age 19. Results: Cannabis use at age 16 and family history of SUD were significantly associated with paranoid and schizotypal symptoms at age 19, but TLI scores were not. The interactive effect of TLI x cannabis use was also not significant. Paranoid and schizotypal symptoms showed different dose-dependent sensitivities to cannabis exposure at age 16. Conclusions: These findings indicate that adolescent cannabis use and family history of SUD differentially contribute to the development of paranoid and schizotypal personality traits through mechanisms that do not include behavioral disinhibition.

Brain responses during delay discounting in youth at high-risk for substance use disorders

Offspring of parents with substance use disorders (SUD) discount future rewards at a steeper rate on the monetary delay discounting task (DD) than typically developing youth. However, brain activation during DD has yet to be studied in drug naïve youth with a family history (FH) of SUD. Here, we investigate brain activation differences in high-risk youth during DD. We recruited substance naïve youth, aged 11–12, into three groups to compare brain activation during DD: (1) High-risk youth (n = 35) with a FH of SUD and externalizing psychiatric disorders, (2) psychiatric controls (n = 25) who had no FH of SUD, but with equivalent externalizing psychiatric disorders as high-risk youth, and (3) a healthy control group (n = 24) with no FH of SUD and minimal psychopathology. A whole-brain voxel wise analysis of the [Delay > Baseline], [Immediate > Baseline], and [Control > Baseline] contrasts identified functional regions of interest, from which extracted parameter estimates were tested for significant group differences. Relative to control youth, high-risk youth showed stronger activation in the left posterior insula and thalamus when making delayed choices, and stronger activation of the parahippocampal gyrus when making both delayed and control choices (ps < 0.05). Activation in the left posterior insula negatively correlated with both subscales of the Emotion Regulation Checklist, and positively correlated with the Stroop interference effect (ps < 0.05). Our findings suggest possible heritable SUD risk neural markers that distinguish drug naïve high-risk youth from psychiatric and healthy controls.

Shapes of Subcortical Structures in Adolescents With and Without Familial History of Substance Use Disorder

Background: To explore if intergenerational transmission of risk for substance use disorder (SUD) manifests in brain anatomy of substance naive adolescents. Differences in anatomical shapes of subcortical structures (SSS) have been detected in neuroimaging studies, even in the absence of volume differences and SSS have been shown to be heritable. Therefore, we examined if the SSS of adolescents with a family history (FH+) of SUD differed from the SSS of adolescents without a family history of SUD (FH-). Because risk for SUD is associated with anxiety and impulsivity, we also examined correlations between these psychological characteristics and SSS. Methods: Using structural MRI, we obtained indices of SSS from 64 FH+ and 58 FH- adolescents and examined group differences and correlations between shape indices, trait anxiety and impulsivity. Findings: FH+ adolescents had a significant inward deformation in the shape of the right anterior hippocampus compared to FH- adolescents, while the volume of the right anterior hippocampus did not differ. Compared to FH- adolescents, the shape deformation of the brainstem, amygdala, hippocampus, putamen, pallidum and nucleus accumbens of FH+ adolescents exhibited an inverted correlational pattern with trait anxiety and impulsivity. Interpretation: SSS appears to capture anatomical features that traditional volumetric analysis does not. The inward shape deformation in the right anterior hippocampus in the FH+ adolescents may be related to the known increased risk for behavioral dysregulation leading to SUD in FH+ offspring. This novel approach may reveal neural correlates of familial transmission of increased vulnerability to problematic substance use. Funding Statement: This study was supported in part by NIDA (5R01 DA038154, PI: Christina W. Hoven) Declaration of Interests: No authors report any financial relationships with commercial interests. Ethics Approval Statement: The New York State Psychiatric Institute’s Institutional Review Board approved this study, and informed consent/assent was obtained from every participant.

Effects of Substance Misuse and Family History of Substance Use Disorder on Delay Discounting in Adolescents and Young Adults with Attention-Deficit/Hyperactivity Disorder

Background: Attention-deficit/hyperactivity disorder (ADHD) and substance use disorder (SUD) often co-occur. Both disorders are characterized by impulsive choice. However, little is known about the effects of substance misuse (SM) and family history of SUD (FH) on impulsive choice in ADHD-SUD comorbidity. Impulsive choice is also linked to callous-unemotional (CU) traits, which are suggested to play a role in ADHD-SUD comorbidity. Our aim was to examine the effects of (1) FH and (2) SM on impulsive choice, while exploring the role of CU traits. Methods: Impulsive choice was assessed with the delay discounting (DD) task. We compared task performance across (1) ADHD patients and controls with or without FH of SUD (ADHD FH+: n = 86; ADHD FH−: n = 63; control FH+: n = 49; control FH−: n = 72; mean age of the whole sample [n = 270]: 16.39, SD: 3.43) and (2) family history-matched ADHD groups with and without SM and controls (ADHD + SM: n = 62; ADHD-only: n = 62; controls: n = 62; mean age of the whole sample [n = 186]: 18.01, SD: 2.71). Effects of CU traits were explored by adding this as a covariate in all analyses. Results: (1) There was no main effect of FH on DD. (2) We found increased DD in ADHD + SM compared to ADHD-only and no difference between ADHD-only and controls. Finally, increased DD was associated with increased callous traits only in ADHD FH+ and control FH+. Conclusions: In adolescents and young adults with ADHD, high impulsive choice might only be present in those with comorbid SM and in an FH+ subgroup with high callous traits. This suggests that impulsive choice in ADHD might result from (1) effects of SM and (2) a combined effect of SUD vulnerability and high callousness. Future studies should investigate efficacy of early interventions, targeting CU traits.

Family history of substance use disorders: Significance for mental health in young adults who gamble.

BackgroundAlthough family history of psychiatric disorders has often been considered potentially useful in understanding clinical presentations in patients, it is less clear what a positive family history means for people who gamble in the general community. We sought to understand the clinical and cognitive impact of having a first-degree relative with a substance use disorder (SUD) in a sample of non-treatment seeking young adults.Methods576 participants (aged 18–29 years) who gambled at least five times in the preceding year undertook clinical and neurocognitive evaluations. Those with a first-degree relative with a SUD were compared to those without on a number of demographic, clinical and cognitive measures. We used Partial Least Squares (PLS) regression to identify which variables (if any) were significantly associated with family history of SUDs, controlling for the influence of other variables on each other.Results180 (31.3%) participants had a first-degree family member with a SUD. In terms of clinical variables, family history of SUD was significantly associated with higher rates of substance use (alcohol, nicotine), higher rates of problem gambling, and higher occurrence of mental health disorders. Family history of SUD was also associated with more set-shifting problems (plus higher rates of obsessive-compulsive tendencies), lower quality of decision-making, and more spatial working memory errors.ConclusionsThese results indicate that gamblers with a first-degree family member with a SUD may have a unique clinical and cognition presentation. Understanding these differences may be relevant to developing more individualized treatment approaches for disordered gambling. Compulsivity may be important as a proxy of vulnerability towards addiction.

Sex Differences in Stress Responses in Adolescents With and Without Family History of Substance Use Disorder

Chronic stress due to childhood adversity leads to alterations in the neural circuits that effect emotional regulation. Studies have shown higher rates of impulsivity, substance use disorder (SUD) and conduct disorders among men compared to women. However, it is unknown whether stress reactivity in adolescents with family history of SUD (FH+) also differs by sex. In this study, we examined heart rate (HR) during the Trier social stress test (TSST) performed by male and female adolescents with, and without FH of SUD.

Meta-analysis and review of functional neuroimaging differences underlying adolescent vulnerability to substance use

Adolescence is increasingly viewed as a sensitive period in the development of substance use disorders (SUDs). Neurodevelopmental ‘dual-risk’ theories suggest adolescent vulnerability to problematic substance use is driven by an overactive reward drive mediated by the striatum, and poor cognitive control mediated by the prefrontal cortex. To this end, there has been a growing number of neuroimaging studies examining cognitive and affective neural systems during adolescence for markers of vulnerability to problematic substance use. Here, we perform a coordinate-based meta-analysis on this emerging literature. Twenty-two task-based voxelwise fMRI studies with activation differences associated with substance use vulnerability, representative of approximately 1092 subjects, were identified through a systematic literature search (PubMed, Scopus) and coordinates of activation differences (N ​= ​190) were extracted. Adolescents were defined as ‘at-risk’ for problematic substance use based on a family history of SUD or through prospective prediction of substance use initiation or escalation. Multilevel kernel density analysis was used to identify the most consistent brain regions associated with adolescent substance use vulnerability. Across the included studies, substance use vulnerability was most reliably associated with activation differences in the striatum, where at-risk adolescents had hyper-activation in the dorsal subdivision (putamen). Follow-up analyses suggested striatal differences were driven by tasks sharing a motivational and/or reward component (e.g., monetary incentive) and common across subgroups of substance use risk (family history and prospective prediction studies). Analyses examining the role of psychiatric comorbidity revealed striatal activation differences were significantly more common in samples whose definition of substance use risk included cooccurring externalizing psychopathology. Furthermore, substance use risk meta-analytic results were no longer significant when excluding these studies, although this may reflect limitations in statistical power. No significant activation differences were observed in prefrontal cortex in any analysis. These results suggest striatal dysfunction, rather than prefrontal, may be a more primary neural feature of adolescent vulnerability to problematic substance use, possibly through a dimension of individual variability shared with externalizing psychopathology. However, our systematic literature search confirms this is still an emerging field. More studies, increased data sharing, and further quantitative integration are necessary for a comprehensive understanding of the neuroimaging markers of adolescent substance use risk.

Exploring pre-surgery and post-surgery substance use disorder and alcohol use disorder in bariatric surgery: a qualitative scoping review.

Bariatric surgery (BS) produces superior weight loss compared to non-surgical interventions. However, studies suggest bariatric patients who have undergone gastric-bypass surgery have an increased risk of developing new onset substance use disorder (SUD) or suffer negative outcomes after surgery. As such, many bariatric programs consider alcohol/ illicit drug misuse a contraindication to BS. The purpose of this systematic review was to investigate weight loss outcomes, post-surgery substance use patterns and other morbidity/mortality in BS patients with a history of substance use/SUD. Studies were identified by searching Ovid Medline(R), Embase, and PsychInfo. We included all study types investigating humans of any age/sex who had undergone any BS procedure with data regarding substance use before and/or after surgery. Outcome measures included metabolic outcomes and psychiatric outcomes after bariatric surgery in patients reporting substance use prior to bariatric surgery and substance use patterns after bariatric surgery. Fifty-eight studies were included in the review. Studies reporting weight loss after BS did not demonstrate an association between substance use and negative weight loss outcomes. Several studies reported a significant portion of participants having new onset or increased substance use after BS. Factors associated with new onset or increased substance use/SUD after BS included the type of surgery, a history of SUD, a family history of SUD, coping skills/life stressors, age, male sex and alcohol sensitization after surgery. Substance use history does not appear to influence weight loss after BS, however it may contribute to increased substance use after BS. Clinicians should ensure valid screening tools when assessing BS candidates for substance use history and ensure long term follow-up care post-operatively.

Early life adversity and increased delay discounting: Findings from the Family Health Patterns project.

Increased discounting (devaluing) of delayed rewards is associated with nearly all types of substance use disorders (SUDs) and is also present in individuals with family histories of SUDs. Early life adversity (ELA) likely contributes to these findings as it is common in both individuals with SUDs and their children and is linked to increased delay discounting and other neurocognitive impairments in human and animal studies. Here we examined data from 1192 healthy young adults (average age 23.6 years old) with (SUDs+) and without (SUDs-) histories of SUDs and with (FH+) and without (FH-) family histories of SUDs. A 2-way ANOVA was conducted to examine the effects of SUDs (SUDs-, SUDs+) and FH (FH-, FH+) on delay discounting followed by an examination of the effects of adding ELA to the model. First, we replicated findings that SUDs+ and FH+ participants had increased rates of delay discounting. After taking ELA into account, the effect of SUDs and FH on delay discounting were both reduced but still significant. The association of ELA and delay discounting was similar in magnitude among both SUDs+ and SUDs- participants and FH+ and FH- participants; those with higher levels of ELA had increased delay discounting. Collectively, these findings indicate that increased ELA is closely associated with the increased delay discounting seen in SUDs+ and FH+ individuals and suggests ELA may be contributing to the increased delay discounting seen in these populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Predictors of initiation of nicotine, alcohol, cannabis, and cocaine use: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

There may be substantial overlap in the risk factors for substance use and substance use disorders (SUD). Identifying risk factors for substance use initiation is essential for understanding the etiology and natural history of SUD and to develop empirically-based preventive interventions to reduce initiation. Analyses were done on Wave 1 participants of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) (n = 43,093). Estimates of the cumulative probability of substance use initiation were obtained separately for nicotine, alcohol, cannabis, and cocaine. Survival analyses with time-varying covariates were implemented to identify risk factors for substance initiation. The lifetime cumulative probabilities of substance initiation were 45.5% for nicotine, 82% for alcohol, 19.6% for cannabis, and 6.4% for cocaine. Among respondents with lifetime nicotine use, 50% had used it by age 15.3, whereas for alcohol, cannabis, and cocaine the respective ages were 17.8, 16.6, and 19.8. Previous use of another substance, being male, having a cluster B personality disorder, family history of SUD, and being separated, divorced, or widowed increased the risk of use of all the substances assessed, whereas social anxiety disorder and some personality disorders were associated with specific substances. Although the age of substance use initiation varies by substance, in more than 50% of cases initiation of use occurs in the first two decades of life. Although most risk factors for substance use initiation are common across substances, some are substance-specific. This information may help in the development of empirically-based preventive interventions. (Am J Addict 2018;27:477-484).

Association Between Family Factors and Illicit Polysubstance Use Amongst Methadone Maintenance Patients with Opioid Use Disorder

Background: Opioid use disorder (OUD) is increasingly prevalent in North America. Methadone Maintenance Treatment (MMT) is an opioid substitution therapy used to relieve symptoms of withdrawal, and to manage OUD symptoms. Despite MMT’s overall effectiveness, individual treatment outcomes vary, and little research explores why these differences exist. Objectives: Considering the association between genetic vulnerability, including family factors, and substance use disorders (SUDs), this study investigated the relationship between family factors and treatment outcomes in individuals with OUD receiving MMT. Patients and Methods: This cross-sectional study included a sample of 973 adult patients with OUD in MMT. Family factors were defined as number of relatives with an SUD, and their degree of genetic relatedness to the proband. Patient-related outcomes were determined by measuring illicit opioid and non-opioid use during MMT. Results: A significant association was found between number of family members with an SUD and the proband’s illicit opioid use (OR = 1.08, 95% CI = 1.01, 1.16; P = 0.03). No significant association was found between genetic relatedness and the proband’s illicit opioid and non-opioid use, nor between number of family members with an SUD and the proband’s non-opioid use. Conclusions: These results suggest a role of shared familial environmental factors in OUD treatment outcomes. Specifically, OUD patients with a family history of substance use are at higher risk of relapse during MMT. Based on these findings, healthcare providers should consider stratifying their OUD patients based on family history of SUDs, and providing additional support to those with a positive history to improve their MMT outcomes.

Dopaminergic genetic variation moderates effect of nicotine on cigarette reward self-report

Aims: Youth with a family history of substance use disorders (SUD) oftenhave particular emotional andbehavioral traits that are early predictors of later problem substance use. There is substantial evidence for a gender difference in risk trajectories such that females tend toward negative affectivity and males tend toward impulsivity. Gender differences in substance use are also evident during adolescence, concurrent with the appearance of genderbased developmental differences in the brain, indicating theremay also be gender-specific neural predictors in those at-risk for developing SUD. Methods: Longitudinal fMRI was conducted in males (n=18) and females (n=18) with a family history of SUD starting at ages 8–13 yrs. Participants performed an emotional arousal word task during fMRI at 1to 2-yr intervals (3–4 scans/participant), covering the age range of 8–17.5 yrs. Emotional words were positive, negative, or neutral, and participants were required to press a button indicating they understood the word when it appeared on the screen. A voxel-by-voxel analysis was conducted in SPM8 using a multiple regression model, designed to represent mixed linear effects and identify age-related changes between groups. Results: For performance measures, females demonstrated a significant reduction in reaction time to negative, positive, and neutral words across age, while males showed no change. Significant age-related differences were found between groups in the right premotor cortex (BA6) and right amygdala for the negative vs. neutral contrast, where males showed a significant decrease in activation with age (premotor: p= .006; amygdala: p= .001) and females non-significantly increased in activation (premotor: p= .111; amygdala: p= .351). Conclusions: These results reveal developmental differences in brain functional responses in emotional arousal between males and females at-risk for SUD. These differencesmay underlie gender differences in behavioral risk trajectories for SUD. Financial support:R01DA027261, R01AA12217, R01AA07065, T32 DA007267-19, and T32 DA7268-22.

Prospective progression from high-prevalence disorders to bipolar disorder: Exploring characteristics of pre-illness stages

BackgroundIdentification of risk factors within precursor syndromes, such as depression, anxiety or substance use disorders (SUD), might help to pinpoint high-risk stages where preventive interventions for Bipolar Disorder (BD) could be evaluated. MethodsWe examined baseline demographic, clinical, quality of life, and temperament measures along with risk clusters among 52 young people seeking help for depression, anxiety or SUDs without psychosis or BD. The risk clusters included Bipolar At-Risk (BAR) and the Bipolarity Index as measures of bipolarity and the Ultra-High Risk assessment for psychosis. The participants were followed up for 12 months to identify conversion to BD. Those who converted and did not convert to BD were compared using Chi-Square and Mann Whitney U tests. ResultsThe sample was predominantly female (85%) and a majority had prior treatment (64%). Four participants converted to BD over the 1-year follow up period. Having an alcohol use disorder at baseline (75% vs 8%, χ2=14.1, p<0.001) or a family history of SUD (67% vs 12.5%, χ2=6.0, p=0.01) were associated with development of BD. The sub-threshold mania subgroup of BAR criteria was also associated with 12-month BD outcomes. The severity of depressive symptoms and cannabis use had high effects sizes of association with BD outcomes, without statistical significance. Conclusions and limitationsThe small number of conversions limited the power of the study to identify associations with risk factors that have previously been reported to predict BD. However, subthreshold affective symptoms and SUDs might predict the onset of BD among help-seeking young people with high-prevalence disorders.

Implementation of drug and HIV risk counseling in MMT programs in Taiwan

s / Drug and Alcohol Dependence 146 (2015) e118–e201 e173 Sex-differences in cognition and behaviors in children with family history of substance use disorders Kristin Lee1, Lexi Pritchett1, Gro Lohaugen2,3, Shannon Kogachi1, Erin Fukaya1, Antonette Hernandez1, Caroline Jiang1, Daniel Alicata1, Thomas Ernst1, Linda Chang1 1 Medicine, University of Hawaii, Honolulu, HI, United States 2 Pediatrics and Child Rehabilitation, Norwegian University of Science and Technology, Arendal, Norway 3 Laboratory Medicine, Norwegian University of Science and Technology, Trondheim, Norway Aims: Substance use disorder (SUD) is highly heritable, but it is unclear whether SUD-related cognitive and behavioral deficits are inherited and if they are sexually dimorphic. Polymorphisms in catechol-O-methyltransferase (COMT) genes have been associated with sex-specific deficits associated with SUD. The aim is to determine the association between two COMT genotype variants, sex, and family history of SUD (FSUD) on behavioral measures and cognition in typically developing children. Methods: FSUD, externalizing behavior and total ADHD scores were reported by parents of 226 children ages 3–20 years (85 SUD: 10.1±0.5 years, 48 boys; 141 CON: 10.0±0.4 years, 74 boys). Cognitive performancewas assessed by full scale IQ (FSIQ) and the NIH Toolbox®. Saliva sampleswere genotyped for two functional COMT single nucleotide polymorphisms (SNPs): rs4680 (Val158Met) and rs165599 (near the 3’UTR region). Results: On 3-way (SNP, sex, FSUD) ANOVAs, rs165599 tended to have negative effects on ADHD scores (p=0.08) and externalizing behaviors (p=0.06), with male AA-carriers with FSUD having higher ADHD scores (p=0.10) and externalizing behaviors (p=0.03). COMT rs165599 variant tended to have a negative effect on FSIQ (p=0.08) and IQ processing speed (p=0.07), withmale AAcarriers with FSUD having the lowest scores. Regardless of FSUD, males with the rs4680 variant tended to have lower FSIQ (p=0.06), but significantly lower processing speed scores (p=0.003). Conclusions: The COMT genetic variants appear to have a greater negative influence on boys. FSUD boys with the rs165599 AA-genotype had greater ADHD symptoms and externalizing behaviors as well as lower FSIQ and slower processing speed. Both behaviors and cognitive functionmay be influenced by these genes involved in dopamine metabolism in a sex-specific manner. Financial Support: NIH (RC2-DA029475, 2K24-DA16170, U54NS56883, G12-MD007601). http://dx.doi.org/10.1016/j.drugalcdep.2014.09.386 Implementation of drug and HIV risk counseling in MMT programs in Taiwan Tony Szu-Hsien Lee1, Marek C. Chawarski2, C. Peng1, C. Hung3, D. Metzger4 1 National Taiwan Normal University, Taipei, Taiwan 2 Psychiatry, Yale School of Medicine, New Haven, CT, United States 3 Taichung Veteran General Hospital, Taichung, Taiwan 4 University of Pennsylvania, Philadelphia, PA,

Effects of prenatal alcohol and cigarette exposure on offspring substance use in multiplex, alcohol-dependent families.

Prenatal exposures to alcohol, cigarettes, and other drugs of abuse are associated with numerous adverse consequences for affected offspring, including increased risk for substance use and abuse. However, maternal substance use during pregnancy appears to occur more often in those with a family history of alcohol dependence. Utilizing a sample that is enriched for familial alcohol dependence and includes controls selected for virtual absence of familial alcohol dependence could provide important information on the relative contribution of familial risk and prenatal exposures to offspring substance use. A sample of multigenerational families specifically ascertained to be at either high or low risk for developing alcohol dependence (AD) provided biological offspring for a longitudinal prospective study. High-risk families were selected based on the presence of 2 alcohol-dependent sisters. Low-risk families were selected on the basis of minimal first and second-degree relatives with AD. High-risk (HR=99) and Low-risk offspring (LR=110) were assessed annually during childhood and biennially in young adulthood regarding their alcohol, drug, and cigarette use. At the first childhood visit, mothers were interviewed concerning their prenatal use of substances. High-risk mothers were more likely to use alcohol, cigarettes, and other drugs during pregnancy than low-risk control mothers, and to consume these substances in greater quantities. Across the sample, prenatal exposure to alcohol was associated with increased risk for both offspring cigarette use and substance use disorders (SUD), and prenatal cigarette exposure was associated with increased risk for offspring cigarette use. Controlling for risk status by examining patterns within the HR sample, prenatal cigarette exposure remained a specific predictor of offspring cigarette use, and prenatal alcohol exposure was specifically associated with increased risk for offspring SUD. Women with a family history of SUD are at increased risk for substance use during pregnancy. Both familial loading for alcohol dependence and prenatal exposure to alcohol or cigarettes are important risk factors in the development of offspring substance use. An inadequate assessment of family history may obscure important interactions between familial risk and prenatal exposures on offspring outcomes.

Risk factors for an anxiety disorder comorbidity among Thai patients with bipolar disorder: results from the Thai Bipolar Disorder Registry.

BackgroundThe aim of the study was to determine in a clinical setting the risk factors for current anxiety disorder (AD) comorbidity among Thai patients with bipolar disorder (BD), being treated under the Thai Bipolar Disorder Registry Project (TBDR).MethodsThe TBDR was a multisite naturalistic study conducted at 24 psychiatric units (ie, at university, provincial mental, and government general hospitals) between February 2009 and January 2011. Participants were in- or out-patients over 18 years of age who were diagnosed with BD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Instruments used in this study included the Thai Mini International Neuropsychiatric Interview version 5; Thai Montgomery–Åsberg Depression Rating Scale (MADRS); Thai Young Mania Rating Scale; Clinical Global Impression of Bipolar Disorder-Severity (CGI-BP-S), CGI-BP-S-mania, CGI-BPS-depression, and CGI-BP-S-overall BP illness; and the Thai SF-36 quality of life questionnaire.ResultsAmong the 424 BD patients, 404 (95.3%) had BD type I. The respective mean ± standard deviation of age of onset of mood disturbance, first diagnosis of BD, and first treatment of BD was 32.0±11.9, 36.1±12.2, and 36.2±12.2 years. The duration of illness was 10.7±9.0 years. Fifty-three (12.5%) of the 424 participants had a current AD while 38 (9%) had a substance use disorder (SUD). The univariate analysis revealed 13 significant risks for current AD comorbidity, which the multivariate analysis narrowed to age at first diagnosis of BD (odds ratio =0.95, P<0.01), family history of SUD (odds ratio =2.18, P=0.02), and having a higher current MADRS score (odds ratio =1.11, P<0.01).ConclusionA diagnosis of AD comorbid with BD is suggested by early-age onset of BD together with a higher MADRS score and a family history of SUD. The likelihood of AD comorbidity decreases by 5% with each passing year; early-age onset of BD is a risk while later age onset is protective. Our results underscore how SUD within the family significantly contributes to the risk of an AD comorbidity.

Prevalence and clinical correlates of alcohol use disorders among bipolar disorder patients: Results from the Brazilian Bipolar Research Network

ObjectivesTo investigate prevalence rates and clinical correlates of alcohol use disorders (AUD) among bipolar disorder (BD) patients in a large sample from the Brazilian Bipolar Research Network. MethodsFour hundred and eighty-three DSM-IV BD patients, divided according to the presence or absence of a lifetime AUD diagnosis (BD-AUD vs. BD-nonAUD), were included. Demographic and clinical characteristics of these two groups were compared. Logistic regression was performed to identify which characteristics were most strongly associated with a lifetime AUD diagnosis. ResultsNearly 23% presented a lifetime AUD diagnosis. BD-AUD patients were more likely to be male, to present rapid cycling, post-traumatic stress disorder (PTSD), anorexia, other substance use disorders (SUD), family history of SUD, any substance misuse during the first mood episode, history of psychosis, suicide attempts, and younger age at onset of illness than BD-nonAUD patients. Logistic regression showed that the variables most strongly associated with a lifetime AUD diagnosis were SUD (non-alcohol), any substance misuse during the first mood episode, PTSD, male gender, suicide attempt, family history of SUD, and younger age at onset of BD. ConclusionsBD-AUD patients begin their mood disorder earlier and present more suicidal behaviors than BD-nonAUD patients. Personal and family history of SUD may be good predictors of comorbid AUD among BD patients. These variables are easily assessed in the clinical setting and may help to identify a particularly severe subgroup of BD patients.

Early-age clinical and developmental features associated to Substance Use Disorders in Attention-Deficit/Hyperactivity Disorder in Adults

ObjectiveThe main objective was to explore early-age conditions associated to Substance Use Disorders (SUD) in adults with Attention Deficit/Hyperactivity Disorder (ADHD); secondly, to determine which of those conditions are specific to ADHD subjects; and finally, to compare ADHD and non-ADHD subjects in terms of SUD lifetime prevalence and professional, social and personal adjustment. MethodComparison between ADHD adults with (n=236) and without lifetime SUD (n=309) regarding clinical characteristics of ADHD, externalization disorders, temperamental traits, environmental factors, academic history and family psychiatric history; secondly, ADHD subjects were compared to a non-ADHD group (n=177) concerning those variables. ResultsThe following variables were found to be positively associated to SUD in ADHD subjects: ADHD severity, CD and ODD comorbidities, temperamental characteristics (“fearful”, “accident prone” and “frequent temper tantrums”), “sexual abuse”, “be suspended from school”, family history of SUD and ADHD, and male gender; ADHD inattentive subtype and “fearful” were inversely associated to SUD. From those variables, “frequent temper tantrums” was also associated to SUD in non-ADHD subjects. ADHD subjects had higher prevalence of lifetime SUD and greater professional, social and personal impairment than non-ADHD subjects. ConclusionFindings suggest a significant association between ADHD, SUD and early-age conditions, such as CD and ODD comorbidity; other variables from childhood, namely, ADHD subtype, temper characteristics (“fearful”, “accident prone”), “sexual abuse”, “be suspended from school” and family history of ADHD are associated to SUD in ADHD subjects, but not in non-ADHD subjects. Moreover, this study confirms both the higher prevalence of lifetime SUD and greater professional, social and personal impairment in ADHD subjects than in non-ADHD subjects.

Reduced Dopamine Response to Amphetamine in Subjects at Ultra-High Risk for Addiction

Not everyone who tries addictive drugs develops a substance use disorder. One of the best predictors of risk is a family history (FH) of substance use problems. In part, this might reflect perturbed mesolimbic dopamine responses. We measured amphetamine-induced changes in [(11)C]raclopride binding in 1) high-risk young adults with a multigenerational FH of substance use disorders (n = 16); 2) stimulant drug-naïve healthy control subjects with no known risk factors for addiction (n = 17); and 3) subjects matched to the high-risk group on personal drug use but without a FH of substance use problems (n = 15). Compared with either control group, the high-risk young adults with a multigenerational FH of substance use disorders exhibited smaller [(11)C]raclopride responses, particularly within the right ventral striatum. Past drug use predicted the dopamine response also, but including it as a covariate increased the group differences. Together, the results suggest that young people at familial high risk for substance use disorders have decreased dopamine responses to an amphetamine challenge, an effect that predates the onset of addiction.