Future Substance Use Research Articles

Developing a data-driven predictive model for substance abuse prevention among youth using behavioral analytics

Substance abuse among youth presents a critical public health challenge, necessitating innovative approaches for early intervention and prevention. This study proposes the development of a data-driven predictive model that leverages behavioral analytics to identify youth at risk of substance abuse. The model utilizes data from multiple sources, including social media activity, school performance records, and mental health screenings, to analyze behavioral patterns that may indicate a predisposition toward substance misuse. The core methodology integrates machine learning algorithms to process and analyze large datasets, uncovering correlations between specific behaviors and the likelihood of substance abuse. Predictive features such as changes in social engagement, academic performance fluctuations, and indicators of emotional distress are identified and incorporated into the model to enhance its accuracy. By applying supervised learning techniques, the model is trained to recognize patterns in historical data, allowing it to make predictions about future substance use risks. Furthermore, the model's design emphasizes real-time monitoring and adaptability, enabling health professionals and educators to receive timely alerts and intervene early when behavioral warning signs are detected. The application of behavioral analytics in this context offers a more proactive, personalized approach to prevention, targeting at-risk individuals before they develop harmful substance use habits. In addition to its predictive capabilities, the model also provides actionable insights into effective intervention strategies. By identifying the most influential behavioral factors, it informs tailored prevention programs that address specific risk behaviors among youth. These findings can support policymakers and healthcare providers in developing data-driven, evidence-based prevention initiatives that better allocate resources to high-risk populations.

Associations and mediating factors between adverse childhood experiences and substance use behaviours in early adulthood: A population-based longitudinal study

BackgroundResearch has demonstrated positive associations between adverse childhood experiences (ACEs) and substance use behaviours in young adults. However, many of these are based on cross-sectional data. The pathway between ACEs and substance misuse among emerging adults is also not fully understood and few studies have investigated potential mediating factors. MethodsWe analysed data from the Child Cohort of the Growing Up in Ireland study, a nationally representative longitudinal sample of children recruited at 9 years of age (n = 4,729). Logistic regression was used to examine individual and cumulative ACE exposure relationships with substance use at age 20 years. Mediation analyses were used to assess whether parental and peer relationships and school engagement mediate ACE history associations with substance use behaviours. ResultsACE exposure relationships with current cannabis use, other illicit drug use and problematic drug use were observed. In particular, young adults who had experienced 2 ACEs or 3 + ACEs had an approximate two-fold (OR=1.80, 95 % CI: 1.29, 2.51) and approximate three-fold (OR=2.94, 95 % CI: 2.06, 4.19) increased odds of problematic drug use, respectively, when compared to participants who had experienced no ACEs during the study period. Mediation analyses suggested that parent and peer attachment and liking school partially mediate relationships between ACEs and substance use behaviours. ConclusionsChildren who have experienced ACEs are at higher risk of future substance use and problematic drug use. In supporting these children, identified mediators such as interpersonal relationships and school engagement may help guide selection of prevention interventions.

A scoping review of substance use brief interventions in Africa

Background The burden of substance use in Africa is substantial. Brief interventions (BIs) are a recommended public health strategy for the prevention and early intervention for substance use problems. The objective of this scoping review was to map the literature on substance use BIs in Africa, identify gaps, and provide directions for future research. Methods The scoping review was guided by the Arksey O’Malley Framework and the PRISMA-Scoping review (PRISMA-ScR) guidelines. A search of five bibliographic databases (PubMed, PsychINFO, Web of Science, Cumulative Index of Nursing and Allied Professionals (CINAHL) and Cochrane Library) was conducted from inception until 1st November 2023. BIs were defined as those targeting substance use and delivered over 1–4 sessions, or interventions delivered over more than four sessions if the authors referred to them as ‘brief’. Results of the review have been summarized descriptively and organized by three broad outcomes: BI effect and feasibility; feasibility and effectiveness of training providers to deliver BIs; Other outcomes i.e. cost-effectiveness, BI adaptation and development, and knowledge attitude and practice of BIs by providers. Results Of the 80 studies that were eligible for inclusion, 68 investigated the effect and feasibility of BIs, six studies investigated the feasibility and effectiveness of training providers to deliver BIs, and six explored other outcomes. Most of the available studies had been conducted in Eastern and Southern Africa. BIs were largely based on motivational interviewing and psychoeducational principles. Overall, the BIs were reported as feasible to implement from the perspective of policy makers, providers, and the intervention recipients. Findings on the effect of BIs on substance use were mixed. Key evidence gaps emerged. There was paucity of BI research focusing on substances other than alcohol, and there was limited literature on feasibility and efficacy of BIs among youth and adolescents. Conclusion The results of this scoping review provide important directions for future substance use BI research in Africa.

Tribal Identity, Pain Interference, and Substance Use Among American Indian and Alaska Native Adolescents

Substance use is high among American Indian/Alaska Native adolescents. Pain interference is a risk factor for substance use, and identifying potential protective factors, such as Tribal identity, is important to help inform culturally grounded substance use prevention strategies. To examine the protective potential of Tribal identity as a moderator in the association between pain interference and substance use in American Indian/Alaska Native adolescents. This cross-sectional study of 10th-grade students self-identifying as American Indian/Alaska Native was conducted among students enrolled at 20 high schools on or near the Cherokee Nation Reservation. Data for this study were collected from the baseline assessments of a cluster randomized trial to prevent substance use among adolescents living on or near the Cherokee Nation Reservation. Inclusion criteria for high schools' participation included being located within counties that partially or fully fall within the Cherokee Nation reservation, a town population of 3000 individuals or fewer, and class sizes between 30 and 100 students. Exclusion criteria included high schools within metropolitan and micropolitan cores (per the US Census Bureau's Rural-Urban Commuting Area codes) and the existence of an established community drug prevention coalition. Student surveys were conducted from September 2021 to May 2024. Pain interference in the 7 days prior to baseline assessment. The primary outcomes were past 30-day alcohol use, marijuana use, and prescription opioid misuse. Generalized estimating equations Poisson models were used, with an exchangeable correlation structure clustered on the school level using baseline data from a cluster randomized trial to prevent alcohol and substance use among adolescents. For each substance, a separate multivariable model was fit, which included pain interference, Tribal identity, an interaction term between pain interference and Tribal identity, age, gender, food insecurity, anxiety symptoms, and depressive symptoms. Among 514 self-identified American Indian/Alaska Native students at 20 high schools on or near the Cherokee Nation Reservation, mean (SD) participant age was 15.59 (0.62) years, and 252 participants (49.0%) self-identified as female. Pain interference was associated with alcohol use and prescription opioid misuse in American Indian/Alaska Native adolescents, controlling for age, gender, food insecurity, anxiety symptoms, and depressive symptoms. Tribal identity significantly moderated the association between pain interference and alcohol use (coefficient, -0.13; 95% CI, -0.23 to -0.02). When Tribal identity was high, the adverse association of pain interference with alcohol use was significantly attenuated. This demonstrates a protective role of Tribal identity on alcohol use, which can inform future substance use prevention efforts among American Indian/Alaska Native adolescents. ClinicalTrials.gov Identifier: NCT04839978.

Associations between behavioral and self-reported impulsivity, brain structure, and genetic influences in middle childhood

Impulsivity undergoes a normative developmental trajectory from childhood to adulthood and is thought to be driven by maturation of brain structure. However, few large-scale studies have assessed associations between impulsivity, brain structure, and genetic susceptibility in children. In 9112 children ages 9–10 from the ABCD study, we explored relationships among impulsivity (UPPS-P impulsive behavior scale; delay discounting), brain structure (cortical thickness (CT), cortical volume (CV), and cortical area (CA)), and polygenic scores for externalizing behavior (PGSEXT). Both higher UPPS-P total scores and more severe delay-discounting had widespread, low-magnitude associations with smaller CA in frontal and temporal regions. No associations were seen between impulsivity and CV or CT. Additionally, higher PGSEXT was associated with both higher UPPS-P scores and with smaller CA and CV in frontal and temporal regions, but in non-overlapping cortical regions, underscoring the complex interplay between genetics and brain structure in influencing impulsivity. These findings indicate that, within large-scale population data, CA is significantly yet weakly associated with each of these impulsivity measures and with polygenic risk for externalizing behaviors, but in distinct brain regions. Future work should longitudinally assess these associations through adolescence, and examine associated functional outcomes, such as future substance use and psychopathology.

Racialized influence of parental education on adolescents’ tobacco and marijuana initiation: Mediating effects of average cortical thickness

Various regions of the cerebral cortex, such as the prefrontal cortex, parahippocampal gyrus, insular cortex, temporal cortex, and anterior cingulate cortex, play critical roles in emotion regulation and executive/cognitive control. Given these regions' involvement, it is hypothesized that average cortical thickness might play a role in mediating the socioeconomic gradient observed in substance use behaviors. However, the mechanisms through which average cortical thickness influences the differential impact of socioeconomic factors, such as parental education, on the initiation of tobacco and marijuana use among youths from diverse backgrounds remain unclear. Recent studies indicate that the effects of socioeconomic factors on substance use and brain development are racialized, often showing weaker associations in racialized populations due to social stratification and racism. Our aim was to examine whether average cortical thickness mediates the racialized effects of parental education as a major socioeconomic determinant on the initiation of tobacco and marijuana use among youth. This longitudinal study, spanning 36 months, utilizes data from the Adolescent Brain Cognitive Development (ABCD) study, which included 10,777 pre-adolescents aged 9–10 years. From this, 8263 (76.67%) were White youth and 2514 (23.33%) were Black. Structural equation modeling was employed to assess the mediating role of average cortical thickness in the relationship between parental education (social determinant), race, and the initiation of tobacco and marijuana use, while considering covariates such as sex and age. Socioeconomic factors were predictive of future substance use. However, the association between these socioeconomic factors and substance use was found to be weaker among Black youths compared to White youths. Average cortical thickness partially mediated the influence of the racialized socioeconomic gradient on substance use, indicating both direct and indirect effects. Average cortical thickness acts as a partial mediator in the racialized impact of socioeconomic determinants on the initiation of adolescent substance use, underscoring the intricate relationship between neurodevelopmental and social factors in influencing substance use behaviors. This observation supports a biopsychosocial model that incorporates the effects of racism, aligning with the theory of minorities’ diminished returns.

Post-traumatic stress and future substance use outcomes: leveraging antecedent factors to stratify risk.

Post-traumatic stress disorder (PTSD) and substance use (tobacco, alcohol, and cannabis) are highly comorbid. Many factors affect this relationship, including sociodemographic and psychosocial characteristics, other prior traumas, and physical health. However, few prior studies have investigated this prospectively, examining new substance use and the extent to which a wide range of factors may modify the relationship to PTSD. The Advancing Understanding of RecOvery afteR traumA (AURORA) study is a prospective cohort of adults presenting at emergency departments (N = 2,943). Participants self-reported PTSD symptoms and the frequency and quantity of tobacco, alcohol, and cannabis use at six total timepoints. We assessed the associations of PTSD and future substance use, lagged by one timepoint, using the Poisson generalized estimating equations. We also stratified by incident and prevalent substance use and generated causal forests to identify the most important effect modifiers of this relationship out of 128 potential variables. At baseline, 37.3% (N = 1,099) of participants reported likely PTSD. PTSD was associated with tobacco frequency (incidence rate ratio (IRR): 1.003, 95% CI: 1.00, 1.01, p = 0.02) and quantity (IRR: 1.01, 95% CI: 1.001, 1.01, p = 0.01), and alcohol frequency (IRR: 1.002, 95% CI: 1.00, 1.004, p = 0.03) and quantity (IRR: 1.003, 95% CI: 1.001, 1.01, p = 0.001), but not with cannabis use. There were slight differences in incident compared to prevalent tobacco frequency and quantity of use; prevalent tobacco frequency and quantity were associated with PTSD symptoms, while incident tobacco frequency and quantity were not. Using causal forests, lifetime worst use of cigarettes, overall self-rated physical health, and prior childhood trauma were major moderators of the relationship between PTSD symptoms and the three substances investigated. PTSD symptoms were highly associated with tobacco and alcohol use, while the association with prospective cannabis use is not clear. Findings suggest that understanding the different risk stratification that occurs can aid in tailoring interventions to populations at greatest risk to best mitigate the comorbidity between PTSD symptoms and future substance use outcomes. We demonstrate that this is particularly salient for tobacco use and, to some extent, alcohol use, while cannabis is less likely to be impacted by PTSD symptoms across the strata.

Association between nucleus accumbens volume and future tobacco and Marijuana use in early adolescence

IntroductionNucleus accumbens (NAc), a crucial component of the brain's reward network, plays a role in reward-related behaviors like substance use. However, limited knowledge exists about sex differences in the predictive power of NAc volume for the initiation of tobacco and marijuana use among children transitioning into early and middle adolescence. Our aim was to compare the predictive utility of NAc volume for adolescents' initiation of tobacco and marijuana use over a three-year period. MethodsData from the Adolescent Brain Cognitive Development study (ABCD), a longitudinal study of pre-adolescents aged 9–10 years, were utilized. The study included 9–10 pre-adolescents (n = 11,795) who were followed for 36 months. Cox regression was employed to examine whether NAc volume predicts subsequent initiation of tobacco and marijuana during the follow-up period. Covariates included age, race/ethnicity, puberty, parental composition, parental education, and area-level median income. Sex was the moderator. ResultsWhile NAc volume predicted future substance use, this association varied based on substance type (tobacco vs. marijuana), sex (male vs. female), and laterality (brain hemisphere). A larger right NAc volume (mm^3) inversely associated with subsequent tobacco use initiation for female youth (HR = 0.998; 95% CI: 0.996–1.000), while it showed no association for male youth (p = 0.385). Larger left NAc volume (mm^3) did not associate with subsequent tobacco use initiation for female youth (p = 0.108) but showed a positive association for male youth (HR = 1.002; 95% CI: 1.001–1.003). NAc volume did not show an association with subsequent marijuana use initiation for either sex. ConclusionsThe predictive impact of right and left NAc volumes on future tobacco or marijuana use may differ for male and female adolescents, suggesting that the salience of NAcc in regulating the reward system is influenced by sex, substance type, and brain hemisphere.

Associations Between Family History of Alcohol and/or Substance Use Problems and Frontal Cortical Development From 9 to 13 Years of Age: A Longitudinal Analysis of the ABCD Study

BackgroundPrevious investigations that have examined associations between family history (FH) of alcohol/substance use and adolescent brain development have been primarily cross-sectional. Here, leveraging a large population-based sample of youths, we characterized frontal cortical trajectories among 9- to 13-year-olds with (FH+) versus without (FH−) an FH and examined sex as a potential moderator. MethodsWe used data from 9710 participants in the Adolescent Brain Cognitive Development (ABCD) Study (release 4.0). FH+ was defined as having ≥1 biological parents and/or ≥2 biological grandparents with a history of alcohol/substance use problems (n = 2433). Our primary outcome was frontal cortical structural measures obtained at baseline (ages 9–11) and year 2 follow-up (ages 11–13). We used linear mixed-effects models to examine the extent to which FH status qualified frontal cortical development over the age span studied. Finally, we ran additional interactions with sex to test whether observed associations between FH and cortical development differed significantly between sexes. ResultsFor FH+ (vs. FH−) youths, we observed increased cortical thinning from 9 to 13 years across the frontal cortex as a whole. When we probed for sex differences, we observed significant declines in frontal cortical thickness among boys but not girls from ages 9 to 13 years. No associations were observed between FH and frontal cortical surface area or volume. ConclusionsHaving a FH+ is associated with more rapid thinning of the frontal cortex across ages 9 to 13, with this effect driven primarily by male participants. Future studies will need to test whether the observed pattern of accelerated thinning predicts future substance use outcomes.

Positive correlation between measures of habitual responding and motivated responding in mice.

Habit and motivation are thought to be separate processes, with motivated behavior often considered to be goal directed, whereas habits are defined by the absence of goal-directed control over behavior. However, there has been increasing interrogation of the binary nature of habitual versus goal-directed behavior. Furthermore, although drug and alcohol exposure can promote the formation of habits, drug seeking itself can also be highly flexible, pointing toward the need for complex consideration of the parallel processes that drive behavior. The goal of the current study was to determine whether there was a relation between motivation-as measured by progressive ratio-and habit-as measured by contingency degradation-and whether this relation was affected by ethanol exposure history and sex. The results showed that these measures were positively correlated such that greater contingency insensitivity was associated with achieving higher break points on the progressive-ratio task. However, this relation depended on reinforcement schedule history, ethanol exposure history, and sex. These point to potential relations between measures of habit and motivation and stress the importance of carefully parsing behavioral findings and assays. These findings are also expected to inform future substance use research, as drug history may affect these relations.

Peers helping peers: development and evaluation of a peer support worker training series

ABSTRACT Background Peer support workers (PSWs) are essential to the substance use treatment and recovery system, though they often lack access to professional development that accounts for the personal recovery experiences PSWs utilize in their work. Methods This study is an evaluation of a series of five training modules for PSWs designed in collaboration with PSW consultants. Evaluation consisted of pre-/posttest knowledge questions and qualitative feedback from individuals who completed all five modules. Results Knowledge scores increased for all five modules. Qualitative feedback was largely positive, with participants suggesting that integrating PSWs into the module development team made the finished product more relevant to PSWs. Conclusions Findings affirmed the importance of providing training designed by and for PSWs working with people with substance use disorders and suggested that PSW confidence can be improved through targeted training. This training development model demonstrates promise for future substance use training programs for PSWs.

Factors Associated With Indirect Exposure to and Knowledge of Fentanyl Among Youth

PurposeUsing data from an online assessment of youth in the United States, this study examined factors associated with youth's indirect exposure to fentanyl; factors related to youth's level of knowledge of fentanyl; and sources of substance use information obtained by youth. MethodsThis is a secondary analysis of data from a cross-sectional online assessment of youth ages 13 to 18 in the United States in 2022. Participants self-reported on substance use knowledge and concerns, indirect exposure to substance use, access to substance use information and resources, the extent to which youth discussed drug use harms with someone, and COVID-related stress. ResultsAnalyses revealed that most youth did not have knowledge of fentanyl even though they reported indirect likely exposure to fentanyl. Youth concerned about alcohol or drug use in their own life were less likely to have knowledge of fentanyl and more likely to know someone who, if using drugs, would likely be exposed to fentanyl. A significant risk factor of indirect likely exposure to fentanyl was COVID-related stress. Prevalent sources of information included the internet, social media, friends or peers, and school classes. DiscussionWhile youth may have close proximity to fentanyl exposure and a degree of understanding of fentanyl, there is a general lack of knowledge of the substance, a critical gap that future substance use prevention initiatives could fill.

Trauma-informed prevention programmes for depression, anxiety, and substance use among young people: protocol for a mixed-methods systematic review

BackgroundMental ill-health and substance use bear a substantial burden and harm on young people and often arise from co-occurring and compounding risk factors, such as traumatic stress. Trauma-informed prevention of mental ill-health and substance use demonstrates significant promise in reducing this burden. A systematic literature review is required to identify and summarise the effectiveness, feasibility, acceptability, and design principles underpinning existing trauma-informed mental ill-health and/or substance use prevention programmes for young people aged 12–24 years.MethodsMEDLINE, Embase, CINAHL, PsychINFO, and Cochrane Library will be searched from 2012 through September 2022. Reference lists of included articles will be citation-chained. Title and abstracts will be screened and two reviewers will review articles full-text. One reviewer will extract data from eligible articles using a piloted data extraction form, and 20% of the data will be verified by a second reviewer. Risk of bias will be assessed using the Cochrane risk-of-bias tool for randomised trials (RoB 2), Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I), and The Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies and The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research (CASP), depending on the study type. Characteristics of existing trauma-informed mental ill-health and/or substance use prevention programmes for young people will be summarised narratively. Effectiveness, feasibility, and acceptability will be qualitatively described and summarised, with proportions and effect sizes quantitatively synthesised, where possible.DiscussionTrauma-informed approaches to prevention demonstrate significant promise, yet to date, no study has systematically summarised and synthesised the available literature. To fill this gap, the present review will systematically identify and summarise the effectiveness, feasibility, acceptability, and design principles underpinning existing trauma-informed mental health and/or substance use prevention programmes for young people aged 12–24. This review will inform the development, adaptation, evaluation, and implementation of future trauma-informed mental ill-health and substance use prevention programmes for young people. Findings will inform critical efforts to interrupt and prevent already elevated trajectories of mental ill-health, substance use, and related harms among those young people exposed to adversity.Systematic review registrationPROSPERO CRD42022353883.

Initial Results from a New College Substance Use Prevention Program Targeting Externalizing and Internalizing Traits

Objective: College students engage in high rates of risky substance use. Standard college prevention strategies focus on providing feedback about current substance use behaviors and harm reduction strategies but do not address the underlying genetically-influenced risk factors impacting these behaviors. We created an online Personalized Feedback Program (PFP) for college students that targets genetically-influenced externalizing and internalizing risk pathways and provides personalized recommendations and campus resources. College students received personalized feedback on four risk domains (Sensation Seeking, Impulsivity, Extraversion, and Neuroticism). Methods: An open trial (n = 300) was conducted at a large public university in spring of 2021 to assess initial responses to the PFP and evaluate intentions related to future substance use and campus resource use. Results: 81% of students in the open trial reported they enjoyed the Personalized Feedback Program. Participants reported intending to use significantly more campus resources after completing the PFP. Among participants that drank, 39% reported they intended to decrease their alcohol consumption and 41% reported they intended to decrease the number of times they get drunk after completing the PFP; these intentions to reduce use after completing the PFP are higher than rates found in previous studies. Conclusion: Preliminary data indicate that the Personalized Feedback Program may be a complementary method to enhance current college substance use prevention programs.

Examining differences in opioid deaths by race in North Carolina following the STOP Act, 2010–2019

IntroductionNorth Carolina's 2017 STOP Act implemented several measures to address the increasing opioid overdose death rate. However, due to racial differences prescription opioid use and treatment service access, the STOP Act may exhibit differential impacts by race. This study examined the impact of the STOP Act on opioid overdose deaths by race. MethodsState-level secondary data were compiled for all 50 states. Race-stratified opioid overdose rates were obtained from the Centers for Disease Control and Prevention's WONDER database from 2010 to 2019. The study obtained state-level population characteristics from the Current Population Surveys from 2010 to 2016, the CDC's 2017 Drug Surveillance Report, the National Survey of Substance Abuse Treatment Services from 2011 to 2016, and the National Survey on Drug Use and Health from 2010 to 2016. We obtained outcomes from 2010 to 2019 and state characteristics were obtained for the pre-STOP Act period (2010–2016) as available. Using the synthetic control method, we created two synthetic North Carolinas, one Black/African American and one White, from a weighted average of other states similar to North Carolina in terms of pre-STOP Act race-stratified opioid overdose rates and population characteristics. Change was assessed as the difference in the race-stratified opioid overdose death rate for North Carolina the corresponding synthetic control. ResultsThe opioid overdose death rate among the White population decreased by 7.17 and 8.96 deaths/100 k in 2018 and 2019 following the STOP Act (overall decrease p = .0217); however, the study found no significant change in the opioid overdose death rate among the Black/African American population (overall decrease p = .1053), with decreases 1.68 and 3.2 deaths/100 k in 2018 and 2019, respectively. ConclusionsOur findings suggest that the STOP Act reduced the opioid overdose death rate in North Carolina among the White, but not Black/African American, population. This heterogeneous effect has implications for health equity and can inform the development of future substance use policies.

Substance use disorder and associated factors at an opioid de-addiction clinic in Western Kenya

BACKGROUND: Opioid substitution therapy with methadone is at the heart of substance use disorder intervention at the Jaramogi Oginga Odinga Teaching and Referral Hospital's medication-assisted therapy (MAT) clinic (JOOTRH). However, little is known about the factors linked to substance use disorders and the substances used by clinic patients. The purpose of this study was to assess the factors associated with substance use disorders and the substances used by MAT-JOOTRH clinic patients. METHODS: Between November 2018 and May 2019, data from 61 patients were collected using questionnaires and summarised using descriptive statistics. RESULTS: Participants were mostly men (92%), between the ages of 31 and 40 (51%), married (48%), employed (71%), living with their nuclear family (49%), and had at least a primary school education (49%). Their average age was 32, 87% had used drugs for more than ten years, and 52% lived in an informal settlement. Cannabis (89%) and heroin (86.9%) were the most commonly used drugs. The main factors associated with first-time substance use were peer pressure (67%), role models (66%), and the environment (46%). The main reasons for regular substance use were withdrawal symptoms (75%), enjoyment (71%), peer pressure (69%), and role models (66%). CONCLUSIONS: According to these findings, peer pressure and withdrawal symptoms may be the primary triggers of substance use disorders in the study area. Young male members of society, particularly those from informal settlements, appear to be the most vulnerable to substance use disorder. Future substance use disorder interventions in the study area should target young male members of society from informal settlements.

Primary Socialization Theory and American Indian Adolescents’ Intentions to Use Substances

Objective Intentions to use substances are a robust risk factor for future substance use. Primary Socialization Theory (PST), with its focus on relational factors, is well-suited to provide insight into American Indian adolescents’ intentions to use substances given the importance of relationships in American Indian communities. The goal of the present study was to examine the role of PST-related factors (i.e., parental monitoring, peer pressure, attitudes toward school) on likelihood of intending to use substances (i.e., alcohol, cigarettes, cannabis, other drugs) among American Indian adolescents. Methods American Indian participants (N = 8,950, 50.7% females) were recruited as a part of the Our Youth, Our Future survey, an ongoing surveillance of substance use among 7th–12th graders attending school on or near reservations. Results Parental monitoring was found to be associated with decreased likelihood of intending to use alcohol (aOR = 0.97, 95%CI [0.96, 0.99]), cigarettes (aOR = 0.96, 95%CI [0.94, 0.98]), cannabis (aOR = 0.95, 95%CI [0.94, 0.96]), and other drugs (aOR = 0.94, 95%CI [0.92, 0.96]). Peer pressure was associated with increased likelihood of intending to use alcohol (aOR = 1.68, 95%CI [1.59, 1.78]), cigarettes (aOR = 1.73, 95%CI [1.60, 1.86]), cannabis (aOR = 1.81, 95%CI [1.71, 1.92]), and other drugs (aOR = 1.40, 95%CI [1.26, 1.56]). More positive attitudes toward school were associated with decreased likelihood of intending to use alcohol (aOR = 0.93, 95%CI [0.91, 0.94]), cigarettes (aOR = 0.92, 95%CI [0.90, 0.94]), cannabis (aOR = 0.90, 95%CI [0.88, 0.91]), and other drugs (aOR = 0.96, 95%CI [0.93, 0.99]). Conclusions Results support incorporating social relationships into interventions aiming to prevent substance use initiation, including promoting positive parental monitoring, peer interactions, and school attitudes.

Attention deficit hyperactivity and oppositional defiant disorder symptoms in adolescence and risk of substance use disorders-A general population-based birth cohort study.

Externalizing symptoms are associated with risk of future substance use disorder (SUD). Few longitudinal studies exist using general population-based samples which assess the spectrum of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms. We aimed to study the associations between adolescent ADHD symptoms and subsequent SUD and additionally examine whether the risk of SUD is influenced by comorbid oppositional defiant disorder (ODD) symptoms. The Northern Finland Birth Cohort 1986 was linked to nationwide health care register data for incident SUD diagnoses until age 33 years (n = 6278, 49.5% male). ADHD/ODD-case status at age 16 years was defined using parent-rated ADHD indicated by Strengths and Weaknesses of ADHD symptoms and Normal Behaviors (SWAN) questionnaire with 95% percentile cut-off. To assess the impact of ODD comorbidity on SUD risk, participants were categorized into four groups based on their ADHD/ODD case status. Cox-regression analysis with hazard ratios (HRs) and 95% confidence intervals (CIs) were used to study associations between adolescent ADHD/ODD case statuses and subsequent SUD. In all, 552 participants (8.8%) presented with ADHD case status at the age of 16 years, and 154/6278 (2.5%) were diagnosed with SUD during the follow-up. ADHD case status was associated with SUD during the follow-up (HR = 3.84, 95% CI 2.69-5.50). After adjustments for sex, family structure, and parental psychiatric disorder and early substance use the association with ADHD case status and SUD remained statistically significant (HR = 2.60, 95% CI 1.70-3.98). The risk of SUD remained elevated in individuals with ADHD case status irrespective of ODD symptoms. ADHD in adolescence was associated with incident SUD in those with and without symptoms of ODD. The association of ADHD and SUD persisted even after adjustment for a wide range of potential confounds. This emphasizes the need to identify preventative strategies for adolescents with ADHD so as to improve health outcomes.

Substance familiarity in middle childhood and adolescent substance use

BackgroundChildhood familiarity with (knowledge of) substances is a potentially important, currently understudied adolescent substance use risk factor. We aimed to describe changes in childhood familiarity with substances and to test whether baseline familiarity predicts early adolescent substance use. MethodsUtilizing the Substance Use Module of the longitudinal cohort study, Adolescent Brain Cognitive Development (ABCD; US youth aged 9–10 years followed for 10 years) through Data Release 4 (n=7896; individuals who completed all six assessments in the first three years), we conducted longitudinal mixed models and survival analyses to describe changes in familiarity and to determine the adjusted odds of substance use by age 13 based on number of familiar substances at baseline. ResultsThe sample consisted of 3754 females and 4142 males, aged 9–10 at baseline, with majority White individuals (68.9%). Unconditional time models indicated age significantly predicted familiarity (B=0.08, p<0.001; R2=0.288) with ~3.59 familiar substances at 9 years increasing to ~7.43 substances at 13 years. Family history, home use, peer use, and neighborhood availability predicted familiarity, accounting for 1% of additional variance (R2=0.299; ∆R2=0.011). For each additional familiar substance at baseline, adjusted odds of future use increased 1.28 times (95% CI 1.22, 1.34). ConclusionsThis is the first study to characterize substance familiarity in this age range as a predictor of future substance use. Familiarity increases with age (age being the most predictive indicator). Familiarity at age 9–10 predicts early adolescent substance use. As such, childhood familiarity may represent an easily implemented screening tool for at-risk youth.

Homelessness and the association with future substance use and STI/HIV risk behaviors among urban gay, bisexual, and other men who have sex with men (MSM): a longitudinal analysis

ABSTRACT Introduction: Homelessness is associated with an increased risk of syphilis, HIV, and other STIs and disproportionately impacts sexual and gender minorities. Method: Data for this analysis came from a longitudinal cohort study of 285 urban gay, bisexual, and other men who have sex with men (MSM). The study aimed to (1) describe the prevalence of homelessness over time (2) identify characteristics associated with homelessness, and (3) measure associations between recent homelessness and substance use and STI/HIV risk behaviors three months later. Participants were recruited from clinical and non-clinical settings and attended a baseline visit and study visits every three months for up to 18-months. Data was collected between July 2018 and September 2020. Descriptive analyses and mixed-effects logistic regression models were utilized. Results: One-third of participants (94) reported experiencing homelessness throughout the study. Homelessness was significantly and independently associated with increased risk for future drug/alcohol use before/during sex (aOR: 3.8, 95% CI: 1.7, 8.6), methamphetamine use (aOR: 6.3 95% CI: 2.6, 15.2), injection drug use (adjusted odds ratio (aOR): 3.7, 95% CI: 1.0, 13.1), and sex exchange (aOR: 12.7; 95% CI: 5.5, 29.4). Conclusion: Interventions to reduce homelessness are necessary to lower risk of substance use and STI/HIV risk behaviors.