Heavy Substance Use Research Articles

The clashing nature of rebelliousness: Nontraditional attitudes and counter-normative behaviors show divergent associations with intelligence.

Prior literature indicates that nontraditional attitudes are linked to higher intelligence. However, such attitudes in adolescence often accompany counter-normative, delinquent-type behaviors, which are themselves negatively linked with intelligence. This points to the possibility of suppression in the relationship between intelligence and nontraditional attitudes. We analyzed a large community sample of 17year olds (N=3330) with data on intelligence, nontraditional attitudes, and a diverse collection of self- and teacher-reported counter-normative behaviors. Developmental questions for these relationships were examined through cross-sectional comparisons between the adolescents and their parents as well as longitudinal analysis of the adolescent sample across emerging adulthood. Youth who endorsed nontraditional attitudes had lower school grades, earlier age at first sex, heavier substance use, and were perceived as more oppositional by their teachers. Each of these problem behaviors was inversely related to intelligence. Accordingly, the positive correlation between nontraditional attitudes and intelligence was much weaker in adolescents as compared to their middle-aged parents. Longitudinal analyses revealed that the association between nontraditional attitudes and intelligence strengthens in early adulthood. Associations between intelligence and sociopolitical attitudes can be obscured even by seemingly distal psychological characteristics.

Prevalence of post-traumatic stress disorder in the United States: a systematic literature review

Objective This study synthesized evidence regarding the prevalence of post-traumatic stress disorder (PTSD) in the United States (US). Methods A systematic literature review (SLR) identified recently published (2015–2019) observational studies of PTSD prevalence in the US via the MEDLINE, EMBASE, and PsycINFO databases. Eligible studies’ most recent data were collected no earlier than 2013. Data elements extracted included study design, sample size, location, data source/year(s), study population(s), traumatic event type, prevalance estimates with corresponding look-back periods, and clinical metrics. Results Data from 38 identified articles were categorized by population, diagnostic criteria, and lookback period. Among civilians, point prevalence ranged from 8.0% to 56.7%, 1-year prevalence from 2.3% to 9.1%, and lifetime prevalence from 3.4% to 26.9%. In military populations, point prevalence ranged from 1.2% to 87.5%, 1-year prevalence from 6.7% to 50.2%, and lifetime prevalence from 7.7% to 17.0%. Within these ranges, several estimates were derived from relatively high quality data; these articles are highlighted in the review. Prevalence was elevated in subpopulations including emergency responders, refugees, American Indian/Alaska Natives, individuals with heavy substance use, individuals with a past suicide attempt, trans-masculine individuals, and women with prior military sexual trauma. Female sex, lower income, younger age, and behavioral health conditions were identified as risk factors for PTSD. Conclusions PTSD prevalence estimates varied widely, partly due to different study designs, populations, and methodologies, and recent nationally representative estimates were lacking. Efforts to increase PTSD screening and improve disease awareness may allow for a better detection and management of PTSD.

SUBSTANCE USE AND ADDICTION AFFECT MORE THAN THE BRAIN: THE PROMISE OF NEUROCARDIAC INTERVENTIONS.

Addiction and excessive substance use contribute to poor mental and physical health. Much research focuses tightly on neural underpinnings and centrally-acting interventions. To broaden this perspective, this review focuses on bidirectional pathways between the brain and cardiovascular system that are well-documented and provide innovative, malleable targets to bolster recovery and alter substance use behaviors. Cardiovascular signals are integrated via afferent pathways in networks of distributed brain regions that contribute to cognition, as well as emotion and behavior regulation, and are key antecedents and drivers of substance use behaviors. Heart rate variability (HRV), a biomarker of efficient neurocardiac regulatory control, is diminished by heavy substance use and substance use disorders. Promising evidence-based adjunctive interventions that enhance neurocardiac regulation include HRV biofeedback, resonance paced breathing, and some addiction medications. Cardiovascular communication with the brain through bidirectional pathways contributes to cognitive and emotional processing but is rarely discussed in addiction treatment. New evidence supports cardiovascular-focused adjunctive interventions for problematic substance use and addiction.

Prevalence, sociodemographic variables, mental health condition, and type of drug use associated with suicide behaviors among people with substance use disorders: a systematic review and meta-analysis

We assessed the prevalence, sociodemographic variables, mental health condition, and type of drug use associated with suicide behaviors among patients with substance use disorders (SUD). Studies in English published from January 1, 1995 to December 31, 2020 were searched on PubMed, Scopus, Cochrane and Web of Science to identify studies on variables associated with suicidal behaviors (ideations and attempts) among patients with SUD. After reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria: (i) population: patients with SUD; (ii) intervention: suicide behaviors in the past year; (iii) comparator: SUD who had not suicide behaviors; (iv) outcome: suicide ideations or attempts in the last year; and (v) study type: cross-sectional, cohort, and case–control studies. Out of 10,810 articles, 48 studies met eligibility criteria. Our findings showed a pooled prevalence rate of suicide ideations of 35% (95% CI, 22% 48%) and suicide attempts of 20% (95% CI, 17% 23%) in the last year among patients with SUD. Smoking, previous history of sexual abuse, depression, and alcohol and cannabis use disorders were significantly associated with suicide ideations. Study findings also showed that being female, smoking, history of physical and sexual abuse, depression and alcohol, cannabis, cocaine, amphetamine use disorders, and polysubstance abuse were significantly associated with suicide attempts among patients with SUD. These findings have implications for developing prevention programs. Appropriate initiatives for reducing the risk of suicide behaviors like systematic assessments of changes in drug use pattern at the emergency departments or at other key health providers may be more broadly implemented. Motivational therapy to improve help-seeking, increased information on adverse consequences of heavy substance use, and crisis plan resolutions to face suicide behaviors could also be consolidated.

Variations in Risk and Motivations for Substance Use over the Course of Military Service

Background Epidemiological data identify risk factors related to substance use among military service members to inform prevention and treatment. Less is known about how motivations and risks for substance use vary over a military service career. The study goal was to explore substance use patterns and motivations among a sample of United States undergraduate student veterans in order to identify periods of risk. Methods: Qualitative interviews were conducted (n = 31) between December 2018 and April 2019. Transcripts were coded in ATLAS.ti using thematic content analysis. Results: Interviews revealed complex motivations around substance use and identified key periods of risk. 1) Pre-service: Participants reported using alcohol and marijuana, primarily during social activities. 2) During service: Participants described a culture of heavy alcohol and tobacco use in social contexts, but little use of other substances. Post-deployment was a notable exception, when some reported heavier alcohol use and use of other drugs, including opiates, cocaine, and ecstasy. 3) Post-service: Transitioning out of the military was described as difficult; some participants reported heavier use of substances during this period. Some participants quit smoking after military service, or switched to vaping. Others reported use of alcohol and/or marijuana to calm themselves, relieve stress, and enable sleep. Conclusions: These data indicate that the periods immediately following deployment and transition out of the military may be especially high-risk for heavy substance use and use of a broader range of substances. This highlights the need for tailored interventions and messaging at different points of military service, particularly during periods of greatest risk.

Impact of marital or romantic relationship status on substance use among males aged 15-35 years residing in urban slums: A case-control study

Background: Drug use has been popular these days because of various effects on the body and mind. Drugs may alter the way a person thinks and behaves and act. This, in turn, affects their social relationship resulting in negative outcomes. The literature shows that pattern of consumption of alcohol use, varies by marital status, revealing heavy alcohol use among divorced or single people than among those who are married. Aims and Objectives: Impact of marital or romantic relationship status on substance use among males aged 15–35 years residing in urban slums. Materials and Methods: The proposed study was carried out in urban slums of Amritsar city. In each slum, house to house survey was conducted and the household having a male between age group of 15–35 years was noted as per the definitions of case and control. From each slum 15 cases and 15 controls (matched for age) for each age band were selected. For each case, one control (age matched) was selected keeping in mind to take only either one case or control from one household. As soon as, 60 cases and 60 controls were included, further survey was stopped in that slum. Similar methodology was followed in the remaining three slums selected to get a total sample of 480 (240 controls and 240 cases). Results: Among unmarried majority of substance users (73.1%) were not having friend from opposite sex in comparison to substance non-users (58.6%). Among users and non-user majority 67.5% and 61.8%, respectively, said they will get married according to their parents’ choice. Among married majority of substance users (67.8%) got married at age ≤24 years whereas majority of substance non-users (62.1%) married at an age >24 years. Among substance users, a relatively lower proportion (65.3%) gave consent before marriage in comparison to substance non-users (81%). Conclusion: The present study concludes that single and non-dating relationships were associated with heavy drinking and substance use in comparison to marriage and dating relationships.

College students’ patterns of electronic nicotine delivery system use and other substance use

Objective: Electronic nicotine delivery system (ENDS) use on college campuses increased dramatically in recent years. Little is known about how ENDS use among college students relates to other substance use. Participants: Undergraduates (n = 3,917) at a mid-sized Midwestern public university in the United States. Methods: Cross-sectional survey data and latent class analysis of ENDS, cigarettes, alcohol, marijuana, and non-medical use of attention-deficit/hyperactivity disorder (ADHD) medication. Results: Over 95% of ENDS users fit into one of two classes comprising a minority of college students engaged in multiple and often problematic substance use behaviors. Only 4% of ENDS users were grouped into a class comprising 85% of the sample and characterized by either little/no substance use or moderate alcohol consumption. Conclusions: ENDS use in this sample was not indicative of general exploration with substances, nor was it indicative of isolated tobacco use, but rather more heavy and problematic substance use.

Profiles of lifetime substance use are differentiated by substance of choice, affective motivations for use, and childhood maltreatment

To develop personalized interventions and improve outcomes in substance-using populations, research is needed on the heterogeneity in substance use patterns and motivations that exists among adult substance users. This study took a person-centered approach to identify profiles of lifetime substance use and discern the psychosocial differences among them. To survey a spectrum of drug use severity, 1106 adults (43.4% women) were recruited from forensic and community samples. Participants reported on the frequency of lifetime substance use across multiple drug categories (sedatives, stimulants, marijuana, heroin, hallucinogens, misuse of prescription drugs) and alcohol use. Latent profile analysis was used to identify distinct profiles of substance use that were then compared on potential risk and maintenance factors for substance use. Four profiles of lifetime substance use emerged that diverged on severity of use and degree of mono vs. polysubstance use (Recreational Marijuana Use, Heavy Multidrug Intoxication, Heavy Marijuana Use, and Heavy Opioid and Polysubstance Use). The profiles differed on affective motivations for substance use (e.g., using to cope vs. using to seek a thrill), age of use onset, drug-related functional impairment, and experiences of childhood maltreatment. Cognitive functioning did not differentiate the heavy substance use profiles. Results provide compelling initial evidence that lifetime patterns of use can be used to identify groups of substance users with distinct risk and maintenance factors. Results highlight affective motivations for substance use and maltreatment history as potential treatment targets and underscore the importance of studying polysubstance use in the context of the opioid epidemic.

Wearable and Wireless mHealth Technologies for Substance Use Disorder.

The goal of this scoping review is to evaluate the advances in wearable and other wireless mobile health (mHealth) technologies in the treatment of substance use disorders. There are a variety of wireless technologies under investigation for the treatment of substance use disorder. Wearable sensors are the most commonly used technology. They can be used to decrease heavy substance use, mitigate factors related to relapse, and monitor for overdose. New technologies pose distinct advantages over traditional therapies by increasing geographic availability and continuously providing feedback and monitoring while remaining relatively non-invasive. Wearable and novel technologies are important to the evolving landscape of substance use treatment. As technologies continue to develop and show efficacy, they should be incorporated into multifactorial treatment plans.

Effects of homophobic name-calling and verbal sexual harassment on substance use among young adults.

Verbal aggression victimization, such as homophobic name-calling, has been linked to heavier substance use among young people, but little longitudinal research has examined how different types of victimization may affect substance use or whether certain psychosocial factors moderate these risks. In a diverse cohort (N = 2,663),latent transition analysis was used to model heterogeneity in victimization (age 19) and substance use (age 20). Four victimization (high victimization, homophobic name-calling only, verbal sexual harassment only, and low victimization) and three substance use (poly-substance use, alcohol, and cannabis only, low all) classes were identified. The high victimization and homophobic name-calling only classes had the highest probabilities of transitioning into the poly-substance use class, and the high victimization class had the highest probability of transitioning into the alcohol and cannabis only class. The probability of transitioning into the low all substance use class was highest in the low victimization class and lowest in the high victimization class. For the high victimization class, greater depressive symptoms increased the odds, and better peer relationship quality decreased the odds, of transitioning into the poly-substance use and alcohol and cannabis only classes. For the homophobic name-calling only class, greater depressive symptoms increased the odds of transitioning into the poly-substance use class. Homophobic name-calling, alone or in combination with verbal sexual harassment, is a risk factor for escalating substance use in young adulthood, especially among victims with depressive symptoms.

The Association Between Substance Use and Violence: Results from a Nationally Representative Sample of High School Students in the United States.

With over 52% of high school students reporting that they have tried alcohol or illicit drugs, 16% carrying a weapon, and 23% engaging in a physical fight, substance use and youth violence remain critical public health challenges in the United States. Using data from the 2017 Youth Risk Behavior Survey, study results revealed that youth who reported heavy use of either alcohol, marijuana, or illicit drugs were three to ten times more likely to report carrying a weapon or engaging in a physical fight. Similarly, youth with heavy substance use were one and half times to 14 times more likely to be a victim of violence or sexual or dating violence. The SEM analysis indicated that substance use had a significant effect on all aspects of violence. School-based behavioral health specialists and community-based pediatricians may need to develop targeted messages to address the potential for violence among youth who use alcohol and/or illicit drugs.

Negative Consequences of Substance Use in European University Students: Results from Project SNIPE

Background: University students are a risk group for heavy substance use and the experience of various potentially severe negative substance use consequences which may impact on their health, social, and academic functioning. Whilst the experience of negative consequences of substance use is well understood in North American student samples, there is little data on these experiences in European students. In order to develop effective harm prevention and reduction interventions for students’ substance use, there needs to be an understanding of the types of consequences experienced in European student samples. Objectives: The aim of the study was to investigate the prevalence and predictors of the experience of negative substance use-related consequences amongst university students in 7 European countries. Methods: University students (n = 4,482) in Belgium, Denmark, Germany, the Slovak Republic, Spain, Turkey, and the UK completed an online survey of their substance use behaviours and the experience of associated negative consequences. Results: European students reported that experiencing a hangover or illness, missing class, being short of money, and experiencing memory loss were the most commonly experienced negative consequences of substance use. Not living with other students and using alcohol, cannabis, sedatives, and cocaine were also associated with higher odds of experiencing these negative consequences. Conclusions: In contrast to North American data, European university students tended to experience consequences that are associated with lower level health risks rather than more severe consequences (e.g., drink-driving and physical injury). Harm prevention and reduction interventions for students should be targeted towards those consequences that are most salient to the target group to ensure feedback is relevant and potentially more effective in changing students’ substance use behaviours.

A latent class analysis of heavy substance use in Young adulthood and impacts on physical, cognitive, and mental health outcomes in middle age

BackgroundThis study examines whether longitudinal patterns of persistent or experimental heavy substance use across young adulthood were associated with physical and mental health in midlife. MethodsData (N = 21,347) from Monitoring the Future from adolescence (age 18) to midlife (age 40) were used. Repeated measures latent class analysis modeled patterns of patterns of cigarettes, alcohol, marijuana, and other illicit drugs across young adulthood (ages 18–30). Latent classes were then used as predictors of physical health problems, cognitive problems, self-rated health, and psychological problems in midlife (age 40), while controlling for sociodemographic variables (i.e., gender, race/ethnicity, parental education). ResultsIdentified classes were “Extreme Heavy Users” (3.9%), “Early Young Adult Users” (8.9%), “Cigarette Smokers” (9.2%), “All But Cigarette Smokers” (5.0%), “Frequent Alcohol Bingers” (10.4%), and “Not-Heavy Users” (62.6%). Extreme Heavy Users, Early Young Adult Users, and Cigarette Smokers had significantly poorer overall health based on a number of physical conditions and self-rated health. Extreme Heavy Users, Early Young Adult Users, Cigarette Smokers, and All But Cigarette Smokers had more cognitive problems than other classes. Extreme Heavy Users, Early Young Adult Users, Cigarette Smokers, and All But Cigarette Smokers were more likely to see a health professional for a psychological problem. ConclusionsPatterns of heavy substance use were associated with health across decades. Regular cigarette smokers and heavy users across substances and ages had the worst health in midlife, although even those with time-limited use during young adulthood were at risk for later physical and cognitive health problems.

Social Identity Mapping in Addiction Recovery (SIM-AR): extension and application of a visual method

Background: The Social Identity approach offers a unifying framework for understanding recovery from addiction as a process of identity change, associated with change in social network composition. This paper introduces Social Identity Mapping in Addiction Recovery (SIM-AR) — a visual method for capturing social group memberships, extended to integrate the substance use ‘status’ of group members as an indicator of group substance use norms. The aim here is to test theory-derived predictions focused on the relationship between changes in social identity and network composition reflected in groups' substance use norms in early recovery.Method: 155 therapeutic community (TC) residents in Victoria, Australia, completed the SIM-AR plus measures of substance-using and recovery identities and substance use shortly after admission, and 65% (N = 101) again 6 months later.Results: As predicted, substance use severity at follow up was associated with changes in both social identity and network composition. Furthermore, reduced strength of substance-using identity was associated with a decrease in the proportion of groups with heavy substance use norms, while increased strength of ‘recovery’ identity was associated with an increased proportion of non-using groups.Conclusion: SIM-AR proved useful in testing predictions about social identity and network changes in a residential treatment context. It captured key social identity constructs in recovery using a visual technique with value to both research and applied contexts. Findings highlight the clinical importance of assessing a person’s group-based relationships in treatment and early recovery, especially the influence of social group norms in relation to substance use.

50.2 Neurobiologic Overlaps of Heavy Social Media Use and Substance Use Disorder

50.2 Neurobiologic Overlaps of Heavy Social Media Use and Substance Use Disorder

Substance Use, Criminal Recidivism, and Mortality in Criminal Justice Clients: A Comparison between Men and Women.

Background. This study aimed to map differences between male and female offenders with substance abuse, with respect to descriptive characteristics and risk factors for mortality and criminal recidivism. Methods. Criminal justice clients with substance abuse problems (n = 7085) were interviewed with the Addiction Severity Index. Mortality and data on return to criminal justice were retrieved from national registers. Results. Female offenders reported heavier substance use patterns, more psychiatric symptoms, and more often a partner with substance abuse, but had lower mortality (2% versus 4%) and criminal recidivism (62% versus 71%) during follow-up. Having a substance-abusing partner was associated with criminal recidivism among females. Conclusions. Female offenders with substance abuse differ from their male counterparts. Males and females had different risk factors for criminal recidivism.

Late-Onset ADHD Reconsidered With Comprehensive Repeated Assessments Between Ages 10 and 25.

Adolescents and young adults without childhood attention deficit hyperactivity disorder (ADHD) often present to clinics seeking stimulant medication for late-onset ADHD symptoms. Recent birth-cohort studies support the notion of late-onset ADHD, but these investigations are limited by relying on screening instruments to assess ADHD, not considering alternative causes of symptoms, or failing to obtain complete psychiatric histories. The authors address these limitations by examining psychiatric assessments administered longitudinally to the local normative comparison group of the Multimodal Treatment Study of ADHD. Individuals without childhood ADHD (N=239) were administered eight assessments from comparison baseline (mean age=9.89 years) to young adulthood (mean age=24.40 years). Diagnostic procedures utilized parent, teacher, and self-reports of ADHD symptoms, impairment, substance use, and other mental disorders, with consideration of symptom context and timing. Approximately 95% of individuals who initially screened positive on symptom checklists were excluded from late-onset ADHD diagnosis. Among individuals with impairing late-onset ADHD symptoms, the most common reason for diagnostic exclusion was symptoms or impairment occurring exclusively in the context of heavy substance use. Most late-onset cases displayed onset in adolescence and an adolescence-limited presentation. There was no evidence for adult-onset ADHD independent of a complex psychiatric history. Individuals seeking treatment for late-onset ADHD may be valid cases; however, more commonly, symptoms represent nonimpairing cognitive fluctuations, a comorbid disorder, or the cognitive effects of substance use. False positive late-onset ADHD cases are common without careful assessment. Clinicians should carefully assess impairment, psychiatric history, and substance use before treating potential late-onset cases.

The Cedar Project: Using Indigenous-Specific Determinants of Health to Predict Substance use among Young Pregnant-Involved Indigenous Women In Canada

BackgroundIndigenous women in Canada have been hyper-visible in research, policy and intervention related to substance use during pregnancy; however, little is known about how the social determinants of health and substance use prior to, during, and after pregnancy intersect. The objectives of this study were to describe the social contexts of pregnant-involved young Indigenous women who use substances and to explore if an Indigenous-Specific Determinants of Health Model can predict substance use among this population.MethodsUsing descriptive statistics and hierarchical logistic regression guided by mediation analysis, the social contexts of pregnant-involved young Indigenous women who use illicit drugs’ lives were explored and the Integrated Life Course and Social Determinants Model of Aboriginal Health’s ability to predict heavy versus light substance use in this group was tested (N = 291).ResultsImportant distal determinants of substance use were identified including residential school histories, as well as protective factors, such as sex abuse reporting and empirical evidence for including Indigenous-specific determinants of health as important considerations in understanding young Indigenous women’s experiences with pregnancy and substance use was provided.ConclusionsThis analysis provided important insight into the social contexts of women who have experiences with pregnancy as well as drug and/or alcohol use and highlighted the need to include Indigenous-specific determinants of health when examining young Indigenous women’s social, political and historical contexts in relation to their experiences with pregnancy and substance use.

Early maturation and substance use across adolescence and young adulthood: A longitudinal study of Finnish twins.

Early maturation, indexed by pubertal development (PD), has been associated with earlier initiation and greater frequency of adolescent substance use, but this relationship may be biased by confounding factors and effects that change across development. Using a population-based Finnish twin sample (N = 3,632 individuals), we conducted twin modeling and multilevel structural equation modeling of the relationship between PD and substance use at ages 12-22. Shared environmental factors contributed to early PD and heavier substance use for females. Biological father absence was associated with early PD for boys but not girls, and did not account for the relationship between PD and substance use. The association between early PD and heavier substance use was partially due to between-family confounds, although early PD appeared to qualitatively alter long-term trajectories for some substances (nicotine), but not others (alcohol). Mediation by peer and parental factors did not explain this relationship within families. However, higher peer substance use and lower parental monitoring were themselves associated with heavier substance use, strengthening the existing evidence for these factors as targets for prevention/intervention efforts. Early maturation was not supported as a robust determinant of alcohol use trajectories in adolescence and young adulthood, but may require longer term follow-up. Subtle effects of early PD on nicotine and illicit drug use trajectories throughout adolescence and adulthood merit further investigation.

Preadolescent sensation seeking and early adolescent stress relate to at-risk adolescents' substance use by age 15

Background and aimsSubstance use during adolescence can lead to the development of substance use disorders and other psychosocial problems. These negative outcomes are especially likely for individuals who use substances at earlier ages and those who engage in heavier use during adolescence, behaviors which are both more common among youth at higher risk for developing a substance use disorder, such as those with a family history of substance use disorders (FH+). Factors such as increased sensation seeking and greater exposure to stressors among FH+ youth may influence these associations. Therefore, the aim of this study was to examine the relative and unique contributions of sensation seeking during preadolescence and exposure to stressors during early to mid-adolescence to cumulative substance use by mid-adolescence among FH+ youth. MethodsA total of 167 mostly Hispanic FH+ youth (ages 12–15) who were participating in an ongoing longitudinal study were included in these analyses. Participants' data from biennial waves covering approximately 2.5years were used. Self-reported sensation seeking, exposure to stressors, and substance use were compared. ResultsHigher sensation seeking during preadolescence and greater exposure to stressors during early to mid-adolescence were both associated with substance use by age 15. These factors differentiated Substance Users from Non-Users, and also related to level of substance use. ConclusionsElevated sensation seeking and exposure to stressors are both associated with substance use by age 15 among high-risk youth. Additionally, these factors can distinguish youth who develop heavier substance use during this important developmental period.