High Risk For Substance Use Disorders Research Articles

HealthCare educational differences in pain management, adverse childhood experiences and their relationship to substance use disorder education

BackgroundIn order to assist the State of Ohio in the United States in addressing the opioid epidemic, the Ohio Attorney General appointed experts in a variety of academic disciplines to the Scientific Committee on Opioid Prevention and Education (SCOPE). The focus of SCOPE is the application of scientific principles in the development of prevention and educational strategies for reducing substance use disorder (SUD). One area of focus for SCOPE was SUD education of healthcare professionals. The objective of the present was to identify the content and extent to which future healthcare professionals are trained in pain management, SUD, and adverse childhood experiences (ACEs).MethodsIn December of 2019, a survey was distributed to 49 healthcare professional schools in Ohio that included the following disciplines: medicine, pharmacy, advanced practice registered nurse (APRN), physician assistant, dentistry, and optometry. The survey included four domains: initial screening of patients, training in SUD, training in care for patients at high risk for SUD, and education in evaluating patients for ACEs. Descriptive statistics were calculated.ResultsThirty one of the forty-nine schools completed the survey. Most disciplines indicated that some form of basic training in the principles of SUD were taught in their core curriculum. The training on ethical issues surrounding SUD were not as widely covered (range 0-62.5%). Medicine, APRN, physician assistant, and pharmacy schools had a “moderate” to “great” extent of pharmacologic therapy curriculum integration. Other pain management strategies were “somewhat” to “moderately” integrated. There were variations seen in training on risk of medication misuse based on various contributors to health. At least 67.7% of medicine, APRN, physician assistant, and pharmacy programs included motivational interviewing training. The extent to which schools integrated education regarding ACEs into their curriculum varied from 0 to 66.7%.ConclusionsThe study finding suggests a need for a unified, consistent, and expanded training requirement in the foundations of pain management, SUD, and ACEs in professional healthcare education.

Co-ingestion of prescription drugs and alcohol in US adults aged 50 years or older.

To examine prevalence of past-month prescription drug misuse (PDM) and alcohol co-ingestion and its correlates in adults age 50 or older. Data were from the 2015-2018 US National Survey on Drug Use and Health (n=35,190). PDM-alcohol co-ingestion was defined as prescription opioid, tranquilizer/sedative, or stimulant misuse while "drinking alcohol or within a couple of hours of drinking." Co-ingestion prevalence was estimated, and logistic and negative binomial regressions examined the sociodemographic, physical health, mental health, substance use, and substance use disorder (SUD) correlates of co-ingestion. Over 344,000 adults aged 50 years or older (0.3%) engaged in past-month PDM-alcohol co-ingestion, or 27.4% of those with past-month PDM. Past-month co-ingestion was linked to greater past-month alcohol use frequency and elevated adjusted odds ratios (aORs) for all examined substance use outcomes (e.g., non-PDM SUD aOR=21.8; 49.7% prevalence rate). The aOR for suicidal ideation was 506% higher in those with co-ingestion than those without past-year PDM. US adults aged 50 years or older with past-month PDM-alcohol co-ingestion are at high risk for SUD and concerning mental health symptoms. Screening for mental health and substance use treatment is warranted among aging adults with signs of PDM, especially involving co-ingestion.

Risks versus consequences of adolescent and young adult substance use: A focus on executive control.

This review examines the role of executive control processes in the liability for substance misuse and whether substance use, once initiated, leads to subsequent decrements as proposed by neurotoxicity models of substance use disorder (SUD). As indicated by a number of recent meta-analyses, executive control processes, which include working memory, cognitive flexibility and numerous aspects of attentional, behavioral and emotional control, are impaired in the context of active SUD. Longitudinal studies of behaviorally disinhibited children, individuals with familial risks for SUD, and twins within whom genetic versus environmental influences on behavior can be modeled robustly indicate that relatively poor control is a vulnerability factor for early substance use initiation, binge patterns of use, and subsequent SUD. Evidence of further declines in executive control, once substance use is initiated, is mixed, although a growing number of neuroimaging studies indicate that frontostriatal, frontolimbic, and frontocerebellar systems are altered as a consequence of use. Together these patterns suggest strategies for identifying children and adolescents at high risk for SUD, avenues through which substance-related neurotoxicities can be more reliably detected, and the need to structure prevention efforts in a manner that is developmentally appropriate and perhaps personalized to individual vulnerabilities.

Minnesota Center for Twin and Family Research.

The Minnesota Center for Twin and Family Research (MCTFR) comprises multiple longitudinal, community-representative investigations of twin and adoptive families that focus on psychological adjustment, personality, cognitive ability and brain function, with a special emphasis on substance use and related psychopathology. The MCTFR includes the Minnesota Twin Registry (MTR), a cohort of twins who have completed assessments in middle and older adulthood; the Minnesota Twin Family Study (MTFS) of twins assessed from childhood and adolescence into middle adulthood; the Enrichment Study (ES) of twins oversampled for high risk for substance-use disorders assessed from childhood into young adulthood; the Adolescent Brain (AdBrain) study, a neuroimaging study of adolescent twins; and the Siblings Interaction and Behavior Study (SIBS), a study of adoptive and nonadoptive families assessed from adolescence into young adulthood. Here we provide a brief overview of key features of these established studies and describe new MCTFR investigations that follow up and expand upon existing studies or recruit and assess new samples, including the MTR Study of Relationships, Personality, and Health (MTR-RPH); the Colorado-Minnesota (COMN) Marijuana Study; the Adolescent Brain Cognitive Development (ABCD) study; the Colorado Online Twins (CoTwins) study and the Children of Twins (CoT) study.

ADGRL3 (LPHN3) variants predict substance use disorder

Genetic factors are strongly implicated in the susceptibility to develop externalizing syndromes such as attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, and substance use disorder (SUD). Variants in the ADGRL3 (LPHN3) gene predispose to ADHD and predict ADHD severity, disruptive behaviors comorbidity, long-term outcome, and response to treatment. In this study, we investigated whether variants within ADGRL3 are associated with SUD, a disorder that is frequently co-morbid with ADHD. Using family-based, case-control, and longitudinal samples from disparate regions of the world (n = 2698), recruited either for clinical, genetic epidemiological or pharmacogenomic studies of ADHD, we assembled recursive-partitioning frameworks (classification tree analyses) with clinical, demographic, and ADGRL3 genetic information to predict SUD susceptibility. Our results indicate that SUD can be efficiently and robustly predicted in ADHD participants. The genetic models used remained highly efficient in predicting SUD in a large sample of individuals with severe SUD from a psychiatric institution that were not ascertained on the basis of ADHD diagnosis, thus identifying ADGRL3 as a risk gene for SUD. Recursive-partitioning analyses revealed that rs4860437 was the predominant predictive variant. This new methodological approach offers novel insights into higher order predictive interactions and offers a unique opportunity for translational application in the clinical assessment of patients at high risk for SUD.

Cannabis use disorder and male sex predict medical cannabis card status in a sample of high risk adolescents

ObjectiveTo examine if a substance use disorder (SUD), especially cannabis use disorder in adolescence, predicts future medical cannabis card status among high-risk youth. MethodsData collection occurred in Denver and San Diego. We recruited adolescents, with or at high risk for SUD and conduct problems (hereafter probands) and their siblings (n=654). Baseline (Wave 1) assessments took place between 1999 and 2008, and follow-up (Wave 2) took place between 2010 and 2013. In initial bivariate analyses, we examined whether baseline DSM-IV cannabis abuse/dependence (along with other potential predictors) was associated with possessing a medical cannabis card in young adulthood (Wave 2). Significant predictors were then included in a multiple binomial regression. Self-reported general physical health was also evaluated at both time points. Finally, within Wave 2, we tested whether card status was associated with concurrent substance dependence. ResultsAbout 16% of the sample self-reported having a medical cannabis card at follow-up. Though bivariate analyses demonstrated that multiple predictors were significantly associated with Wave 2 card status, in our multiple binomial regression only cannabis abuse/dependence and male sex remained significant. At Wave 2, those with a medical cannabis card were significantly more likely to endorse criteria for concurrent cannabis dependence. There was no significant difference in self-reported general physical health. ConclusionsCannabis abuse/dependence and male sex positively predicted future medical cannabis card holder status among a sample of high risk adolescents. Physicians conducting evaluations for medical cannabis cards should carefully evaluate and consider past and concurrent cannabis addiction.

Trauma Exposure and Externalizing Disorders in Adolescents: Results From the National Comorbidity Survey Adolescent Supplement

Exposure to violence and other forms of potentially traumatic events (PTEs) are common among youths with externalizing psychopathology. These associations likely reflect both heightened risk for the onset of externalizing problems in youth exposed to PTEs and elevated risk for experiencing PTEs among youth with externalizing disorders. In this study, we disaggregate the associations between exposure to PTEs and externalizing disorder onset in a population-representative sample of adolescents. We analyzed data from 13- to 18-year-old participants in the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A) (N= 6,379). Weighted survival models estimated hazard ratios (HRs) for onset of oppositional defiant disorder (ODD), conduct disorder (CD), and substance use disorders (SUDs) associated with PTEs, and for exposure to PTEs associated with prior-onset externalizing disorders. Multiplicative interaction terms tested for effect modification by sex, race/ethnicity, and household income. All types of PTEs were associated with higher risk for SUD (HRs= 1.29-2.21), whereas only interpersonal violence (HR= 2.49) was associated with onset of CD and only among females. No associations were observed for ODD. Conversely, ODD and CD were associated with elevated risk for later exposure to interpersonal violence and other/nondisclosed events (HRs= 1.45-1.75). Externalizing disorders that typically begin in adolescence, including SUDs and CD, are more likely to emerge in adolescents with prior trauma. ODD onset, in contrast, is unrelated to trauma exposure but is associated with elevated risk of experiencing trauma later in development. CD and interpersonal violence exposure exhibit reciprocal associations. These findings have implications for interventions targeting externalizing and trauma-related psychopathology.

Applying SBIRT to new settings: Preliminary findings of substance use disorder risk in community mental health settings

Drug and Alcohol Dependence 156 (2015) e183–e245 e209 the amount spent on cocaine as a predictor of smoking (p=0.01). Specifically, patients receiving MAS-XR spent $43 more on cocaine to increase their smoking by 1 cigarette, while patients receiving placebo spent $56 more on cocaine for the same result. Conclusions: Cocaine use correlates with smoking habits in bothMAS-XR and placebo treated patients. For thosewho continue to use cocaine, MAS-XR with concurrent cocaine use may trigger greater smoking among ADHD/cocaine dependent smokers when compared to the placebo group. Financial Support: NIDA:1R25DA03516101 RFMH:1RO1DA23652/RO1DA23651. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.562 Modulation of reinstated polydrug (cocaine/heroin) seeking by noradrenergic 2 agonists Roger D. Spealman1,∗, Jack Bergman2 1 New England Primate Research Center, Harvard Medical School, Southborough, MA, United States 2 McLean Hospital, Harvard Medical School, Belmont, MA, United States Aims: Noradrenergic 2 agonists can alleviate opioid withdrawal and have been proposed for prevention of relapse to stimulant abuse. We investigated the potential of these drugs for attenuating relapse to polydrug (cocaine/heroin) abuse using a nonhuman primate model of reinstated drug seeking. Methods: Squirrelmonkeyswere trained to respondunder concurrent second-order FR10 (FR5:S) schedules of i.v. cocaine/heroin (10:1) self-administration and milk delivery. Responding on the drug-associated lever subsequently was reduced to <10% of baseline by discontinuing drug injections and presentations of the drug-paired stimulus, while keeping the concurrent schedule of milk delivery intact.We next determined the degree to which drug seeking could be reinstated by: (1) restoring the drug-paired stimulus, (2) primingwith a 10:1 cocaine/heroinmixture, or (3) priming + restoration of the drug-paired stimulus. Each conditionwas studied after pretreatmentwith vehicle or doses of 2 agonists that had no significant effects on an inventory of unconditioned behaviors: 0.1mg/kg clonidine, 0.1mg/kg lofexidine, 1.0mg/kg guanfacine, and 0.03mg/kg brimonidine. Results: Pretreatment with each 2 agonist attenuated reinstatement of drug-seeking induced by cocaine/heroin priming and had less effect on reinstatement induced by the drug-paired stimulus. Clonidine, lofexidine, and guanfacine also attenuated the more pronounced reinstatement induced by priming + restoration of the drug-paired stimulus. Additionally, clonidine and lofexidine reduced% responding on the drug-associated leverwhen reinstatement was induced by priming alone and/or priming + restoration of the drug-paired stimulus. Conclusions: The profile of effects seen with clonidine and lofexidine (attenuation of reinstated responding with a reduction in% responding ondrug lever) suggests a selective effect of these 2 agonists on reinstated drug seeking and encourages further evaluation of their potential for polydrug relapse prevention. Financial Support: NIH grants DA031299, RR00168 and OD011103. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.563 Applying SBIRT to new settings: Preliminary findings of substance use disorder risk in community mental health settings Suzanne E. Spear2,∗, Mitch Karno3, Suzette Glasner-Edwards3, R. Rawson3, Richard Saitz1, Blanca Dominguez3 1 Community Health Sciences, Boston University and Boston Medical Center, Boston, MA, United States 2 Health Sciences, California State University, Northridge, Northridge, CA, United States 3 Psychiatry, UCLA Integrated Substance Abuse Programs, Los Angeles, CA, United States Aims: Screening, Brief Intervention, and Referral to Treatment (SBIRT) has not yet been tested in community mental health treatment settings despite the elevated risk of substance use disorders (SUD) among individuals with mental health disorders. This presentation reports on preliminary findings of SUD risk among 334 adult participants treated in community mental health clinics in Southern California. SUD risk was calculated from the AUDIT and DAST-10 screening tools. Methods: All participants are currently enrolled in a randomized controlled trial of SBIRT. Participants were recruited from four outpatient clinics and one inpatient clinic. High risk for SUDs was defined by scores on the AUDIT (≥13 for women and ≥15 for men) and the DAST-10 (≥3 for women and men). Associations between SUD risk and presence of mood disorders, anxiety disorders, and psychotic disorders were examined using chi-square tests. Results: Results showed that 37% of participants were at high risk for alcohol disorders and 66% of participants were at high risk for illicit drug use disorders. Alcohol disorder risk was significantly associated with mood disorders ( 2 =13.25, p< .01) and anxiety disorders ( 2 =8.6, p< .05). Illicit drug use disorder risk was significantly associated with anxiety disorders ( 2 =25.96, p< .001). Presence of psychotic disorders was not associated with SUD risk. Conclusions: High rates of SUD risk in this community mental health sample were found. Participants with mood and/or anxiety disorders were found to be at high risk of SUDs. Subsequent research will test the efficacy of SBIRT for reducing SUD risk and linking participants with possible SUDs to treatment. Financial Support: Supported by NIDA grant R01DA032733. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.564 Prescription monitoring programs: Best practice and Canadian program review

Modulation of reinstated polydrug (cocaine/heroin) seeking by noradrenergic α2 agonists

Drug and Alcohol Dependence 156 (2015) e183–e245 e209 the amount spent on cocaine as a predictor of smoking (p=0.01). Specifically, patients receiving MAS-XR spent $43 more on cocaine to increase their smoking by 1 cigarette, while patients receiving placebo spent $56 more on cocaine for the same result. Conclusions: Cocaine use correlates with smoking habits in bothMAS-XR and placebo treated patients. For thosewho continue to use cocaine, MAS-XR with concurrent cocaine use may trigger greater smoking among ADHD/cocaine dependent smokers when compared to the placebo group. Financial Support: NIDA:1R25DA03516101 RFMH:1RO1DA23652/RO1DA23651. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.562 Modulation of reinstated polydrug (cocaine/heroin) seeking by noradrenergic 2 agonists Roger D. Spealman1,∗, Jack Bergman2 1 New England Primate Research Center, Harvard Medical School, Southborough, MA, United States 2 McLean Hospital, Harvard Medical School, Belmont, MA, United States Aims: Noradrenergic 2 agonists can alleviate opioid withdrawal and have been proposed for prevention of relapse to stimulant abuse. We investigated the potential of these drugs for attenuating relapse to polydrug (cocaine/heroin) abuse using a nonhuman primate model of reinstated drug seeking. Methods: Squirrelmonkeyswere trained to respondunder concurrent second-order FR10 (FR5:S) schedules of i.v. cocaine/heroin (10:1) self-administration and milk delivery. Responding on the drug-associated lever subsequently was reduced to <10% of baseline by discontinuing drug injections and presentations of the drug-paired stimulus, while keeping the concurrent schedule of milk delivery intact.We next determined the degree to which drug seeking could be reinstated by: (1) restoring the drug-paired stimulus, (2) primingwith a 10:1 cocaine/heroinmixture, or (3) priming + restoration of the drug-paired stimulus. Each conditionwas studied after pretreatmentwith vehicle or doses of 2 agonists that had no significant effects on an inventory of unconditioned behaviors: 0.1mg/kg clonidine, 0.1mg/kg lofexidine, 1.0mg/kg guanfacine, and 0.03mg/kg brimonidine. Results: Pretreatment with each 2 agonist attenuated reinstatement of drug-seeking induced by cocaine/heroin priming and had less effect on reinstatement induced by the drug-paired stimulus. Clonidine, lofexidine, and guanfacine also attenuated the more pronounced reinstatement induced by priming + restoration of the drug-paired stimulus. Additionally, clonidine and lofexidine reduced% responding on the drug-associated leverwhen reinstatement was induced by priming alone and/or priming + restoration of the drug-paired stimulus. Conclusions: The profile of effects seen with clonidine and lofexidine (attenuation of reinstated responding with a reduction in% responding ondrug lever) suggests a selective effect of these 2 agonists on reinstated drug seeking and encourages further evaluation of their potential for polydrug relapse prevention. Financial Support: NIH grants DA031299, RR00168 and OD011103. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.563 Applying SBIRT to new settings: Preliminary findings of substance use disorder risk in community mental health settings Suzanne E. Spear2,∗, Mitch Karno3, Suzette Glasner-Edwards3, R. Rawson3, Richard Saitz1, Blanca Dominguez3 1 Community Health Sciences, Boston University and Boston Medical Center, Boston, MA, United States 2 Health Sciences, California State University, Northridge, Northridge, CA, United States 3 Psychiatry, UCLA Integrated Substance Abuse Programs, Los Angeles, CA, United States Aims: Screening, Brief Intervention, and Referral to Treatment (SBIRT) has not yet been tested in community mental health treatment settings despite the elevated risk of substance use disorders (SUD) among individuals with mental health disorders. This presentation reports on preliminary findings of SUD risk among 334 adult participants treated in community mental health clinics in Southern California. SUD risk was calculated from the AUDIT and DAST-10 screening tools. Methods: All participants are currently enrolled in a randomized controlled trial of SBIRT. Participants were recruited from four outpatient clinics and one inpatient clinic. High risk for SUDs was defined by scores on the AUDIT (≥13 for women and ≥15 for men) and the DAST-10 (≥3 for women and men). Associations between SUD risk and presence of mood disorders, anxiety disorders, and psychotic disorders were examined using chi-square tests. Results: Results showed that 37% of participants were at high risk for alcohol disorders and 66% of participants were at high risk for illicit drug use disorders. Alcohol disorder risk was significantly associated with mood disorders ( 2 =13.25, p< .01) and anxiety disorders ( 2 =8.6, p< .05). Illicit drug use disorder risk was significantly associated with anxiety disorders ( 2 =25.96, p< .001). Presence of psychotic disorders was not associated with SUD risk. Conclusions: High rates of SUD risk in this community mental health sample were found. Participants with mood and/or anxiety disorders were found to be at high risk of SUDs. Subsequent research will test the efficacy of SBIRT for reducing SUD risk and linking participants with possible SUDs to treatment. Financial Support: Supported by NIDA grant R01DA032733. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.564 Prescription monitoring programs: Best practice and Canadian program review

Amygdala Activation and Emotional Processing in Adolescents at Risk for Substance Use Disorders

Studies are needed that examine neurobiological characteristics in high-risk individuals prior to substance use disorder (SUD) development. In this pilot study, 4 adolescent subjects at high risk for SUD (having at least 1 parent with an SUD) were compared with 4 adolescent reference subjects on a cortico-limbic reactivity paradigm, where they were presented with affect-laden faces or geometric shapes. Functional magnetic resonance imaging was used to measure cortical activation in response to these stimuli. High-risk subjects, compared to low-risk, exhibited greater left amygdala activation (t = 2.76, df = 6, p = 0.03), suggesting they may exhibit hyperresponsivity of the amygdala in response to emotional stimuli.

Risk factors for secondary substance use disorders in people with childhood and adolescent-onset bipolar disorder: Opportunities for prevention

BackgroundCompared to other mental illnesses, bipolar disorder is associated with a disproportionately high rate of substance use disorders (SUDs), and the co-occurrence is associated with significant morbidity and mortality. Early diagnosis of primary bipolar disorder may provide opportunities for SUD prevention, but little is known about the risk factors for secondary SUD among individuals with bipolar disorder. The purposes of this study were to describe the population of people with childhood and adolescent-onset primary bipolar disorder, and to identify risk factors for secondary SUD in this population. MethodsUsing data collected from the National Comorbidity Survey Replication study, we identified 158 individuals with childhood-onset (<13years) or adolescent-onset (13–18years) primary bipolar disorder (I, II or subthreshold). Survival analysis was used to identify risk factors for SUD. ResultsCompared to adolescent-onset, people with childhood-onset bipolar disorder had increased likelihoods of attention deficit hyperactivity disorder (ADHD) (adjusted odds ratio=2.81) and suicide attempt (aOR=3.61). Males were more likely than females to develop SUD, and did so at a faster rate. Hazard ratios of risk factors for SUD were: lifetime oppositional defiant disorder (2.048), any lifetime anxiety disorder (3.077), adolescent-onset bipolar disorder (1.653), and suicide attempt (15.424). SUD was not predicted by bipolar disorder type, family history of bipolar disorder, hospitalization for a mood episode, ADHD or conduct disorder. ConclusionsAs clinicians struggle to help individuals with bipolar disorder, this study provides information that might be useful in identifying individuals at higher risk for SUD. Future research can examine whether targeting these risk factors may help prevent secondary SUD.

Inhibitory Control Deficits in Childhood and Risk for Substance Use Disorders: A Review

Identification of neurobiological factors that confer risk for the development of addiction may substantially advance development of new prevention and treatment strategies to combat substance use disorders. This review focuses on the relationship between impulsivity—a behavior that is common to the clinical picture of both substance use disorders (SUD) and childhood disruptive behavior disorders—and neurobiological risk for SUD. It further examines various behaviors within the over-arching domain of impulsivity, ultimately focusing on the more narrowly defined and measurable construct of inhibitory control, and concluding that underlying deficits in inhibitory control may be central to many of the behaviors associated with high risk for SUD. Targeted cross-sectional study of the neural basis of inhibitory dyscontrol in subjects at high risk for SUD, who have not yet begun to abuse drugs, has the potential to generate important hypotheses regarding the neurobiological underpinnings of SUD risk. Hypotheses developed using this approach can be more definitively evaluated in longitudinal studies with these same populations, extending through the period of maximal risk for SUD in adolescence and early adulthood.

Detection of youth at high risk for substance use disorders: A longitudinal study.

This study extends prior research (D. Clark, J. Cornelius, L. Kirisci, & R. Tarter, 2005) by determining whether variation in the developmental trajectories of liability to substance use disorder (SUD) is contributed by neurobehavioral disinhibition, parental substance use involvement, and demographic variables. The sample, participants in a long-term prospective investigation, consisted of 351 boys, evaluated at ages 10-12, 12-14, 16, 19, and 22, whose parents either had SUD or no adult psychiatric disorder. Neurobehavioral disinhibition in childhood, in conjunction with parental lifetime substance use/SUD, place the child at very high risk for SUD by age 22 if psychosocial maladjustment progresses in severity in early adolescence. These results indicate that monitoring social adjustment during the transition from childhood to mid-adolescence is important for identifying youth at very high risk for succumbing to SUD by young adulthood.

The Dysregulation Inventory: A New Scale to Assess the Risk for Substance Use Disorder

SUMMARY Emerging evidence indicates that psychological dysregulation is an integral component of the liability for substance use disorder (SUD). To date, the measurement of dysregulation entails using a variety of disparate unstandardized instruments. This report discusses the rationale underlying the Dysregulation Inventory (DI), the methods employed in item selection and scale construction, and describes preliminary results regarding psychometric properties. Satisfactory to superior reliability and validity were observed for the self-report, teacher-report, and parent-report versions of the DI. The scores on the DI discriminate youth who are at high and low average risk for SUD ascertained on the basis of paternal SUD. Moreover, the score on the DI at age 10–12 was found to account for a significant proportion of the variance on substance use at age 12–14, thereby pointing to its predictive validity. In addition, the DI score covaried with SUD severity in a sample of female adolescents. These results indicate that the DI may be useful for detecting youth who are at high risk for SUD.

Psychometric Validation of a Multidimensional Schema of Substance Use Topology: Discrimination of High and Low Risk Youth and Prediction of Substance Use Disorder

SUMMARY The purpose of this study was to design and evaluate a multidimensional schema for the assessment of alcohol, tobacco and other drug use topology. Six first order dimensions and a single second order dimension were confirmed. The first order dimensions are: motive state, beliefs and expectancies, social context, substance use behavior, behavioral pharmacological consequences, and social consequences. At age 16, the second order factor score predicted transition to a DSM-III-R substance use disorder (SUD) at age 19 with 71% accuracy and correlated significantly with the overall problem density score of the Drug Use Screening Inventory (R2 = .27, p < .0001). Offspring of substance-abusing fathers scored higher than boys having normal fathers on the motive state and substance use behavior dimensions. These findings illustrate the value of multidimensional assessment of ATOD topology for identifying youth at high risk for SUD as well as for elucidating the factors contributing to the transition to suprathreshold SUD.

Risk for Substance Use Disorders in Youths With Child- and Adolescent‐Onset Bipolar Disorder

Previous work in adults has suggested that early-onset bipolar disorder (BPD) is associated with an elevated risk for substance use disorders (SUD). To this end, the authors assessed the risk for SUD in child- versus adolescent-onset BPD with attention to comorbid psychopathology. All youths (aged 13-18 years) with available structured psychiatric interviews were studied systematically. From clinic subjects (N = 333), 86 subjects with DSM-III-R BPD were identified. To evaluate the risk for SUD and BPD while attending to developmental issues, the authors stratified the BPD sample into those with child-onset BPD (< or = 12 years of age, n = 50) and those with adolescent-onset BPD (13-18 years of age, n = 36). In mid-adolescence, youths with adolescent-onset BPD were at significantly increased risk for SUD relative to those with child-onset BPD (39% versus 8%; p = .001). Compared with those with child-onset BPD, those with adolescent-onset BPD had 8.8 times the risk for SUD (95% confidence interval = 2.2-34.7; chi 7(2) = 9.7, p = .002). The presence of conduct disorder or other comorbid psychopathology within BPD did not account for the risk for SUD. Adolescent-onset BPD is associated with a much higher risk for SUD than child-onset BPD, which was not accounted for by conduct disorder or other comorbid psychopathology. Youths with adolescent-onset BPD should be monitored and educated about SUD risk. The identification and treatment of manic symptomatology may offer therapeutic opportunities to decrease the risk for SUD in these high-risk youths.

Reactions of dyes with cell substances. IV. Quantitative comparison of tissue nuclei and extracted nucleoproteins : Edward G. Kelley. ( Journal of Biological Chemistry, 127: 55, Jan. 1939.)

Previous work in adults has suggested that early-onset bipolar disorder (BPD) is associated with an elevated risk for substance use disorders (SUD). To this end, the authors assessed the risk for SUD in child- versus adolescent-onset BPD with attention to comorbid psychopathology.All youths (aged 13–18 years) with available structured psychiatric interviews were studied systematically. From clinic subjects (N= 333), 86 subjects with DSM-III-R BPD were identified. To evaluate the risk for SUD and BPD while attending to developmental issues, the authors stratified the BPD sample into those with child-onset BPD (≤12 years of age, n = 50) and those with adolescent-onset BPD (13–18 years of age, n = 36).In mid-adolescence, youths with adolescent-onset BPD were at significantly increased risk for SUD relative to those with child-onset BPD (39% versus 8%; p =.001). Compared with those with child-onset BPD, those with adolescent-onset BPD had 8.8 times the risk for SUD (95% confidence interval = 2.2–34.7; x27 = 9.7, p =.002). The presence of conduct disorder or other comorbid psychopathology within BPD did not account for the risk for SUD.Adolescent-onset BPD is associated with a much higher risk for SUD than child-onset BPD, which was not accounted for by conduct disorder or other comorbid psychopathology. Youths with adolescent-onset BPD should be monitored and educated about SUD risk. The identification and treatment of manic symptomatology may offer therapeutic opportunities to decrease the risk for SUD in these high-risk youths.