Higher Substance Use Research Articles

Improvement in delivery of type 2 diabetes services differs by mode of care: a retrospective longitudinal analysis in the Aboriginal and Torres Strait Islander Primary Health Care setting.

BackgroundAddressing evidence-practice gaps in primary care remains a significant public health challenge and is likely to require action at different levels of the health system. Whilst Continuous Quality Improvement (CQI) is associated with improvements in overall delivery, little is known about delivery of different types of care processes, and their relative improvement during CQI.MethodsWe used data from over 15,000 clinical audit records of clients with Type 2 diabetes collected as part of a wide-scale CQI program implemented between 2005 and 2014 in 162 Aboriginal and Torres Strait Islander health centres. We abstracted data from clinical records on 15 service items recommended in clinical guidelines and categorised these items into five modes of care on the basis of the mechanism through which care is delivered: laboratory tests; generalist-delivered physical checks; specialist-delivered checks; education/counselling for nutrition and physical activity and education/counselling for high risk substance use. We calculated delivery for each patient for each of mode of care by determining the proportion of recommended services delivered for that mode. We used multilevel regression models to quantify variation attributable to health centre or client level factors and to identify factors associated with greater adherence to clinical guidelines for each mode of care.ResultsClients on average received 43 to 60 % of recommended care in 2005/6. Different modes of care showed different patterns of improvement. Generalist-delivered physical checks (delivered by a non-specialist) showed a steady year on year increase, delivery of laboratory tests showed improvement only in the later years of the study, and delivery of counselling/education interventions showed early improvement which then plateaued. Health centres participating in CQI had increased odds of top quartile service delivery for all modes compared to baseline, but effects differed by mode. Health centre factors explained 20–52 % of the variation across jurisdictions and health centres for different modes of care.ConclusionsLevels of adherence to clinical guidelines and patterns of improvement during participation in a CQI program differed for different modes of care. Policy and funding decisions may have had important effects on the level and nature of improvements achieved.

Heritability of high sugar consumption through drinks and the genetic correlation with substance use

High sugar consumption contributes to the rising prevalence of obesity. Sugar can have rewarding effects that are similar to, but less strong than, the effects of addictive substances. People who consume large amounts of sugar also tend to use more addictive substances, but it is unclear whether this is due to shared genetic or environmental risk factors. We examined whether there are genetic influences on the consumption of sugar-containing drinks and whether genetic factors can explain the association with substance use. The frequency of consumption of sugar-containing drinks (e.g., cola, soft drinks, and energy drinks) and addictive substances (nicotine, caffeine, alcohol, cannabis, and illicit drugs) was obtained for 8586 twins who were registered at the Netherlands Twin Register (women: 68.7%; mean ± SD age: 33.5 ± 15.3 y). Participants were categorized as high or low sugar consumers (>1 compared with ≤1 SD above daily consumption in grams) and as high or low substance users (≥2 compared with <2 substances). Through bivariate genetic modeling, genetic and environmental influences on sugar consumption, substance use, and their association were estimated. Genetic factors explained 48% of the variation in high sugar consumption, whereas unique environmental factors explained 52%. For high substance use, these values were 62% and 38%, respectively. There was a moderate phenotypic association between high sugar consumption and high substance use (r = 0.2), which was explained by genetic factors (59%) and unique environmental factors (41%). The positive association between high sugar consumption and high substance use was partly due to unique environmental factors (e.g., social situations). Genetic factors were also of influence, suggesting that neuronal circuits underlying the development of addiction and obesity are related. Further research is needed to identify genes that influence sugar consumption and those that overlap with substance use.

Prevalence and Correlates of Self-Reported ADHD Symptoms in Children Attending School in India

Objective: To study the prevalence and correlates of self-reported ADHD symptoms among school-going adolescents from Kerala, India. Method: Seven thousand five hundred sixty students from Classes 8, 10, and 12, aged 12 to 19 years, across 73 schools selected by cluster random sampling, were invited to participate, but only 7,150 successfully completed the questionnaire incorporating standardized instruments. Results: Three hundred five (4.3%) self-reported symptoms for ADHD combined type, 131 (1.8%) for ADHD hyperactive–impulsive type, and 102 (1.4%) for ADHD inattentive type with a male predominance. Binary logistic regression analysis showed that those with symptoms of ADHD (combined type) compared with the non-ADHD group had poorer academic performance, significantly higher substance use, psychological distress, suicidality, and sexual abuse. Conclusion: The high prevalence of self-reported ADHD symptoms and its association with negative correlates previously reported in literature in those with a diagnosis of ADHD suggests that clinically significant self-reported ADHD symptoms could be as disabling as ADHD.

Parenting and Adolescent Self-Regulation Mediate between Family Socioeconomic Status and Adolescent Adjustment.

Using two waves of longitudinal data, we utilized the family stress model of economic hardship (Conger & Conger, 2002) to test whether family socioeconomic status is related to adolescent adjustment (substance use and academic achievement) through parental knowledge and adolescent self-regulation (behavioral self-control and delay discounting). Participants included 220 adolescent (55% male, mean age = 13 years at Wave 1, mean age = 15 years at Wave 2) and primary caregiver dyads. Results of Structural Equation Modeling revealed significant three-path mediation effects such that low family socioeconomic status at Wave 1 is associated with low parental knowledge at Wave 1, which in turn was related to low academic performance and high substance use at Wave 2 mediated through low adolescent behavioral self-control at Wave 2. The results illustrate how parental knowledge, influenced by family economic status, may play an important role in the development of adolescent behavioral self-control and adjustment.

Reliability of the GAIN-SS, CRAFTT and PESQ screening instruments for substance use among South African adolescents.

IntroductionScreening for adolescent substance use can assist with the early identification of substance-related problems and guide the provision of appropriate services. As such, psychometrically sound screening tools are needed. The aim of this study was to compare the reliability of the CRAFFT, Global Appraisal of Individual Needs-Short Screener (GAIN-SS) substance use subscale and Personal Experience Screening Questionnaire (PESQ) among adolescents from disadvantaged communities in Cape Town, South Africa.MethodsAdolescents aged 12–19 years (n = 231) completed the three screeners at two points in time.ResultsFindings show that all three of the screeners had adequate internal consistency (Cronbach α ≥ 0.8). Test-retest reliability was similar for all three screeners, with intraclass correlation coefficient values slightly higher for the PESQ (0.82, 95% CI: 0.77–0.86) than for the GAIN-SS substance use subscale (0.79, 95% CI: 0.73–0.84) and CRAFFT (0.76; 95% CI: 0.66–0.83). Kappa values indicated that the GAIN-SS substance use subscale and CRAFFT had moderate levels of agreement, while the PESQ had substantial levels of agreement for identifying those who had moderate or higher substance use risks at Time 1 and Time 2.ConclusionThe findings indicate that all of these short screeners seem to have acceptable reliability when used in this population. All of the three screeners are appropriately reliable when used with adolescents from disadvantaged communities in Cape Town, but the PESQ performed slightly better. Future studies should also include the assessment of validity of these screeners in this context.

Is attention deficit/hyperactivity disorder among men associated with initiation or escalation of substance use at 15-month follow-up? A longitudinal study involving young Swiss men.

Background and AimsYoung adults with attention deficit/hyperactivity disorder (ADHD) show higher substance use disorder (SUD) prevalence relative to non‐ADHD controls; few longitudinal studies have examined the course of substance use with reference to conduct disorder (CD). We compared initiation and escalation of substance use at 15‐month follow‐up in men screened positive or negative for ADHD (ADHD+ versus ADHD–), controlling for CD presence in early adolescence.DesignParticipants were recruited during August 2010 and November 2011 from the census of all young men who have to pass mandatory army conscription from three of six Swiss Army recruitment centres. A two‐wave data collection was performed via questionnaires at baseline and 15‐month follow‐up as a part of the longitudinal Cohort Study on Substance Use Risk Factors.SettingRecruitment centres in Lausanne, Windisch and Mels, responsible for 21 cantons in German‐ and French‐speaking areas of Switzerland.ParticipantsConsecutive sample of 5103 male Swiss Army conscripts who provided informed consent and responded to questionnaires at baseline and 15‐month follow‐up. Their mean age was 20.0 (standard deviation = 1.21) years at baseline.MeasurementsADHD and CD were assessed using the adult ADHD Self‐Report Scale and the MINI International Neuropsychiatric Interview Plus, respectively, at baseline, and substance use was measured via self‐administered substance use questionnaires at baseline and follow‐up.FindingsCompared with the ADHD– group, the ADHD+ group (n = 215, 4.2%) showed heavier baseline substance use and increased likelihood of alcohol (χ2 = 53.96; P < 0.001), tobacco (χ2 = 21.73; P < 0.001) and cannabis use disorders (χ2 = 48.43; P < 0.001). The extent of alcohol, tobacco and cannabis use in the two groups remained stable from baseline to follow‐up (no escalation). The ADHD+ group was more likely to initiate substance use compared with the ADHD– group (higher initiation rates), particularly with amphetamines [odds ratio (OR) = 3.81; 95% confidence interval (CI) = 2.20–6.60; P < 0.001] and non‐medical use of ADHD medication (OR = 4.45; 95% CI = 2.06–9.60; P < 0.001). CD was associated with initiation of substance use but did not mediate the associations between ADHD and substance use, revealing that the impact of ADHD on substance use was independent of CD.ConclusionsFor men in their early 20s, attention deficit/hyperactivity disorder is a risk factor for continued heavier but not escalating use of alcohol, tobacco and cannabis when already consuming these substances, compared with young men with no ADHD. It is also a risk factor for initiating the use of cannabis, stimulants, hallucinogens and sedatives, independent of conduct disorder in early adolescence.

A cross-sectional study of problem gambling and its correlates among college students in South India.

BackgroundIn the Western world, a significant portion of college students have gambled. College gamblers have one of the highest rates of problem gambling. To date, there have been no studies on gambling participation or the rates of problem gambling in India.AimsThis study evaluated the prevalence of gambling participation and problem gambling in college students in India. It also evaluated demographic and psychosocial correlates of gambling in that population.MethodWe surveyed 5784 college students from 58 colleges in the district of Ernakulam, Kerala, India, using cluster random sampling. Students completed questionnaires that addressed gambling, substance use, psychological distress, suicidality and attention-deficit hyperactivity disorder (ADHD).ResultsA total of 5580 completed questionnaires were returned, and while only 1090 (19.5%) college students reported having ever gambled, 415 (7.4%) reported problem gambling. Lotteries were the most popular form of gambling. Problem gamblers in comparison with non-gamblers were significantly more likely to be male, have a part-time job, greater academic failures, higher substance use, higher psychological distress scores, higher suicidality and higher ADHD symptom scores. In comparison with non-problem gamblers, problem gamblers were significantly more likely to have greater academic failures, higher psychological distress scores, higher suicidality and higher ADHD symptom scores.ConclusionsThis study, the first to look at the prevalence of gambling in India, found relatively low rates of gambling participation in college students but high rates of problem gambling among those who did gamble. Correlates of gambling were generally similar to those noted in other countries. Since 38% of college students who had gambled had a gambling problem, there is a need for immediate public health measures to raise awareness about gambling, and to prevent and treat problem gambling in this population.Declaration of interestS.G. was (until October 2014) a member of the UK Responsible Gambling Strategy Board, and authored the Royal College of Psychiatrists’ Faculty report FR/AP/01 Gambling: The Hidden Addiction – Future Trends in Addictions (2014).Copyright and usage© The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

The Utility of a Syndemic Framework in Understanding Chronic Disease Management Among HIV-Infected and Type 2 Diabetic Men Who Have Sex with Men.

Syndemic theory posits that epidemics of multiple physical and psychosocial problems co-occur among disadvantaged groups due to adverse social conditions. Although sexual minority populations are often stigmatized and vulnerable to multiple health problems, the syndemic perspective has been underutilized in understanding chronic disease. To assess the potential utility of this perspective in understanding the management of co-occurring HIV and Type 2 diabetes, we used linear regression to examine glycemic control (A1c) among men who have sex with men (MSM) with both HIV and Type 2 diabetes (n=88). Bivariable linear regression explored potential syndemic correlates of inadequate glycemic control. Compared to those with adequate glycemic control (A1c≤7.5%), more men with inadequate glycemic control (A1c>7.5%) had hypertension (70 vs. 46%, p=0.034), high triglycerides (93 vs. 61%, p=0.002), depression (67 vs. 39%, p=0.018), current substance abuse (15 vs. 2%, p=0.014), and detectable levels of HIV (i.e., viral load ≥75 copies per ml blood; 30 vs. 10%, p=0.019). In multivariable regression controlling for age, the factors that were independently associated with higher A1c were high triglycerides, substance use, and detectable HIV viral load, suggesting that chronic disease management among MSM is complex and challenging for patients and providers. Findings also suggest that syndemic theory can be a clarifying lens for understanding chronic disease management among sexual minority stigmatized populations. Interventions targeting single conditions may be inadequate when multiple conditions co-occur; thus, research using a syndemic framework may be helpful in identifying intervention strategies that target multiple co-occurring conditions.

Nonmonosexual Partnerships: Information, Motivation and Self-Efficacy Among Methamphetamine-Using Men Who Have Sex with Men Who Also Have Sex with Women or Transgender Persons

ABSTRACTSex with more than one gender is associated with higher substance use and sexual HIV risk. The authors examined knowledge, motivation, and self-efficacy to engage in safer substance use and sexual behavior among methamphetamine-using U.S. men who have sex with more than one gender (N = 343). Almost half (46.2%) of the men reported having sex with a man (MSM) and a woman or transgender partner in the last 30 days. Compared to monosexual MSM, nonmonosexual MSM reported greater condom use self-efficacy however, they reported more sexual partners who inject drugs. The authors observed distinct differences between men who do or do not have sex with more than one gender.

Directions of the relationship between substance use and depressive symptoms from adolescence to young adulthood

PurposeBoth substance use and depression are common in adolescence and often comorbid. Past research has produced conflicting results on whether there is a temporal relationship and if so, in which direction it operates and how it may vary by sex. The purpose of this paper is to explore the longitudinal, potentially bidirectional, relationships between high-frequency substance use and depressive symptoms from adolescence into young adulthood for males and females. MethodsUsing data from the National Longitudinal Study of Adolescent to Adult Health we investigated longitudinal associations between high frequency substance use (alcohol, cigarettes, and marijuana) and depressive symptoms. The linear mixed effects models were stratified by sex and used a lagged measure of the dependent variable to test temporal relationships. A random intercept was used for respondent ID. ResultsIncreases in depressive symptoms were significantly associated with a later increase of about a half day in marijuana use frequency for males and nearly a two day increase in smoking frequency for females. Conversely, increases in smoking frequency were significantly associated with approximately a 0.6-point increase for females and 0.4-point increase for males in depressive symptoms at a later wave. ConclusionsResults indicate a bidirectional relationship between smoking and depressive symptoms for females. For males, there was evidence supporting self-medication with marijuana and for smoking being associated with later increases in depressive symptoms. Results inform how substance use and depression screening, prevention and treatment efforts should be paired and targeted for males and females.

Access to therapy and therapy outcomes in the Swiss Hepatitis C Cohort Study: a person-centred approach.

Socio-demographic and behavioural characteristics are associated with delayed diagnosis and disease progression in HCV-infected persons. However, many analyses focused on single variables rather than groups defined by several variables. We used latent class analysis to study all 4488 persons enrolled in the Swiss Hepatitis C Cohort Study. Groups were identified using predefined variables at enrolment. The number of groups was selected using the Bayesian information criterion. Mortality, loss to follow-up, cirrhosis, treatment status and response to antivirals were analysed using Laplace and logistic regressions. We identified five groups and named them according to their characteristics: persons who inject drugs, male drinkers, Swiss employees, foreign employees and retirees. Two groups did not conform to common assumptions about persons with chronic hepatitis C and were already in an advanced stage of the disease at enrolment: 'male drinkers' and 'retirees' had a high proportion of cirrhosis at enrolment (15% and 16% vs <10.3%), and the shortest time to death (adjusted median time 8.7 years and 8.8 years vs >9.0). 'Male drinkers' also had high substance use, but they were well educated and were likely to be employed. This analysis may help identifying high-risk groups which may benefit from targeted interventions.

Polysubstance use patterns and trajectories in vocational students — A latent transition analysis

BackgroundThe transition from late adolescence to early adulthood (16–20years) represents a time of exploration and self-discovery for many young people. As such, it is often associated with experimentation in substance use. Vocational students in particular report high substance use. Thus, the aim of this study is to examine patterns and trajectories of their substance use behavior. MethodsOn two occasions (interval 18months), we investigated 5214 students (M=19.39years; 54% male) from 49 vocational schools in seven German federal states. We identified classes of substance use and trajectories via latent transition analysis, controlling for gender, age, and socio-economic status. Additionally, we investigated work-related (job demands/stress/satisfaction) and psychopathological (depressive symptoms) predictors of substance use via multinomial regressions. ResultsWe found three latent stages of substance use: low use (baseline: 43%/follow-up: 44%), mainly alcohol use (50%/45%), and polysubstance use (7%/11%). Over time, 10% of alcohol users at baseline transitioned to polysubstance use at follow-up, while there were smaller transition rates (2–9%) between the other stages. Compared to low use, polysubstance use at follow-up was predicted by high job stress (aOR=1.45, 1.07–1.96) at baseline. ConclusionsHigh alcohol use is associated with bidirectional transitions in young adults. Hence, future research needs to identify mechanisms of change to identify protective factors. Regarding vocational practice, early stress management seems to be a viable path to prevent polysubstance use in vocational students.

Alcohol Use Among Active Duty Women: Analysis AUDIT Scores From the 2011 Health-Related Behavior Survey of Active Duty Military Personnel.

Numerous studies document higher substance use among military men after deployment; similar studies focused on military women are limited. This study examines alcohol use of active duty women and deployment factors, social/environmental/attitudinal factors, and psychological/intrapersonal factors. Secondary data analysis of the 2011 Survey of Health-Related Behavior of active duty military personnel was conducted using bivariate statistics and multiple regression analyses with Alcohol Use Disorders Identification Test scores as the dependent variable. Nearly 94% had low risk for alcohol use disorders. Length of combat experience and extent of combat exposure were unrelated to Alcohol Use Disorders Identification Test scores; noncombat deployment was unrelated after controlling for marital status, age of first drink, pay grade, and branch of service. Significant motivators (p < 0.001) for drinking were "like/enjoy drinking," "drink to cheer up," "drink to forget problems," and significant deterrents were "cost of alcohol" and "fear of upsetting family/friends if used alcohol." Anger propensity, risk propensity, lifetime prevalence of suicidal ideation, and depressed mood were significant predictors in the regression model after controlling for covariates. Findings suggest that some active duty women use alcohol to cope with adverse emotional states, whereas others use alcohol consistent with propensity for high-risk behaviors.

Prevalence and correlates of substance use in Black, White, and biracial Black-White adolescents: Evidence for a biracial intermediate phenomena.

Most substance-use prevention interventions are based on the implicit assumption that risk and protective factors for substance use are the same for biracial and monoracial youth. However, preliminary research suggests this assumption may be untrue. This study compared the prevalence and correlates of substance use among Black, White, and biracial Black-White youth. Data were derived from the National Longitudinal Study of Adolescent and Adult Health, which is a longitudinal investigation using stratified random sampling to study health behaviors. After controlling for sociodemographic factors and using weighted Poisson and logistic regression, the authors found the substance-use prevalence rates of Black-White youth to be intermediate to the higher rates of Whites and lower rates of Blacks. In addition, Black-White youth's scores on most covariates were intermediate to those of the monoracial groups. Family factors were more important in explaining higher substance use than other contextual factors. School factors seem to be important in explaining lower substance use for Black-White youth. Correlates of substance use for Black-White youth were not identical to those of either Black or White youth. More research on the observed intermediate phenomena among biracial youth vis-à-vis prevalence, correlates, and causes of substance use is needed. (PsycINFO Database Record

Pattern of drug abuse along with the criminal and demographic profile of prisoners admitted at the de-addiction facility at a Central Jail in Punjab

Background: To curb the social menace associated with rising illicit drug use among the youth, the law enforcing agencies have filled state prisons with people, who are in urgent need for the management of their drug use problems. This study was planned with a motive to understand the current changing needs of Indian prisons. Objective: To study the pattern of drug abuse and the criminal and demographic profile of the jail inmates who were admitted at the de-addiction facility of jail. Materials and Methods: A cross-sectional study carried out in the Modern Central Jail at Faridkot, Punjab. A total of 66 prisoners who were being treated at the de-addiction facility. The subjects were assessed by the WHO-based ASSIST questionnaire and by the investigator-designed proforma. Result: Among the 66 subjects majority of them were men (98.4%), less than 30 years (35%), married (53%), having rural background (63.6%), and heroin dependent (87.8%), booked for illegal possession of drugs (73%), high-risk behavior (47% intravenous drug abuser). ASSIST scores indicate high Specific Substance Involvement Score and Life-time Substance use Score with tobacco and opioids. Conclusion: High prevalence of intravenous drug abuse in Indian prisons is an alarming situation. The adequate management of such persons in prison, with minimizing associated risk for blood-borne infections has come up as an important issue, in the wake of rising number of arrests under Narcotic Drugs and Psychotropic Substances Act.

HIV-related stigma and substance use in a Russian cohort of HIV+ risky drinkers

Drug and Alcohol Dependence 156 (2015) e183–e245 e197 COCduring conditioning, (3) pre-TAUandTAUduring conditioning, and (4) COC during conditioning. Results: Males and females that were not pre-treated with COC showed a significant preference to the COC-paired chamber. Neither male nor female subjects showed a preference to the TAU-paired chamber. Taurine was effective in inhibiting cocaine preference in both male and female subjects after the preTAU; however, females show a significant preference towards the cocaine-paired chamber when TAU and COC are co-administered. Conclusions:Coc-inducedbehaviors oftenpersist for years after abstinence and the best form of treatment is yet to be determined. This study provides evidence that taurine might deserve study as a treatment for cocaine addiction; however, sex may influence its efficacy. Further studies will be performed to assess possible mechanisms by which taurine inhibits cocaine preference, its relationship to gonadal hormones. Financial support: Supported by NIDA R25DA030310 (KSR); NCRR 5G12RR003060-26, NIMHHD 8G12MD7603-27 (EF, KSR); NIH MARC U*STAR 5T34 GM007639-32 (KU); K05DA015799 (J.C. Anthony, sponsor). http://dx.doi.org/10.1016/j.drugalcdep.2015.07.529 HIV-related stigma and substance use in a Russian cohort of HIV+ risky drinkers Jeffrey Samet1,∗, Karsten Lunze1, Debbie M. Cheng1, Dmitry Lioznov3, Emily Quinn1, Carly Bridden1, Christine Chaisson1, Alexander Y. Walley1, E. Krupitsky3, Anita Raj4, E.J. Edelman2 1 Boston University, Boston, MA, United States 2 Yale, New Haven, CT, United States 3 First St. Petersburg Pavlov State Medical U, St. Petersburg, Russian Federation 4 UCSD, San Diego, CA, United States Aims: To determine whether HIV-related stigma contributes to substance use and dependence among HIV+ Russian individuals with risky alcohol use. Methods: We used data from HERMITAGE, a randomized controlled trial of 700 HIV+ individuals with past 6-month risky sex and risky alcohol use in St. Petersburg, Russia (2007–2011). Demographics, clinical and behavioral characteristics were collected by survey at baseline, 6 and 12 months. We measured HIV-related stigma using the abbreviated Berger HIV-related stigma scale. We assessed past 30 day drug use (modified Risk Behavior Scale), risky alcohol use (Timeline Followback), and substance dependence (CIDI short form). Generalized estimating equations were constructed to examine the association between high HIV-related stigma (score >75th percentile) and substance use over time (any prior 30 days heroin or stimulant or risky alcohol use [per NIAAA criteria]). Secondary outcomes were (1) any prior 30 days heroin or stimulant use; (2) prior 30 days risky alcohol use; and (3) past year alcohol or drug dependence. We adjusted for demographics, education, marital status, intervention group, time since HIV diagnosis, depressive symptoms, antiretroviral therapy use, CD4 count, and social support. Results:At baseline, themean agewas 30 (SD 5) years, with 41% women. Twenty-eight percent reported high HIV-related stigma; 87% reported substanceuse in theprior 30days. In adjustedmodels, high HIV-related stigma (AOR=0.86 [95% CI 0.51, 1.45]) was not significantly associated with substance use. These findings were similar for the secondary outcomes. Conclusions: HIV-related stigma does not appear to be associated with substance use among risky drinkers. Future efforts to identify modifiable factors which contribute to substance use among HIV+ individuals with risky alcohol use are needed. Financial support: R01AA016059; K12DA033312; R25DA013582. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.530 Impact of telehealth in-home-messaging devices on alcohol use in dually diagnosed veterans Elizabeth J. Santa Ana1,∗, Steve Martino2, Mulugeta Gebregziabher1 1 Charleston VAMC and Medical University of South Carolina, Charleston, SC, United States 2 Yale University School of Medicine, West Haven, CT,

Using Videogame Apps to Assess Gains in Adolescents' Substance Use Knowledge: New Opportunities for Evaluating Intervention Exposure and Content Mastery.

BackgroundVideogame interventions are becoming increasingly popular as a means to engage people in behavioral interventions; however, strategies for examining data from such interventions have not been developed.ObjectiveThe objective of this study was to describe how a technology-based intervention can yield meaningful, objective evidence of intervention exposure within a behavioral intervention. This study demonstrates the analysis of automatic log files, created by software from a videogame intervention, that catalog game play and, as proof of concept, the association of these data with changes in substance use knowledge as documented with standardized assessments.MethodsWe analyzed 3- and 6-month follow-up data from 166 participants enrolled in a randomized controlled trial evaluating a videogame intervention, PlayForward: Elm City Stories (PlayForward). PlayForward is a videogame developed as a risk reduction and prevention program targeting HIV risk behaviors (substance use and sex) in young minority adolescents. Log files were analyzed to extract the total amount of time spent playing the videogame intervention and the total number of game levels completed and beaten by each player.ResultsCompleting and beating more of the game levels, and not total game play time, was related to higher substance use knowledge scores at the 3- (P=.001) and 6-month (P=.001) follow-ups.ConclusionsOur findings highlight the potential contributions a videogame intervention can make to the study of health behavior change. Specifically, the use of objective data collected during game play can address challenges in traditional human-delivered behavioral interventions.Trial RegistrationClinicaltrials.gov NCT01666496; https://clinicaltrials.gov/ct2/show/NCT01666496 (Archived by WebCite at http://www.webcitation.org/6cV9fxsOg)

Out-of-School Time and Adolescent Substance Use

PurposeHigh levels of adolescent substance use are linked to lower academic achievement, reduced schooling, and delinquency. We assess four types of out-of-school time (OST) contexts—unsupervised time with peers, sports, organized activities, and paid employment—in relation to tobacco, alcohol, and marijuana use at the end of high school. Other research has examined these OST contexts in isolation, limiting efforts to disentangle potentially confounded relations. MethodsLongitudinal data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (N = 766) examined associations between different OST contexts during high school and substance use at the end of high school. ResultsUnsupervised time with peers increased the odds of tobacco, alcohol, and marijuana use, whereas sports increased the odds of alcohol use and decreased the odds of marijuana use. Paid employment increased the odds of tobacco and alcohol use. Unsupervised time with peers predicted increased amounts of tobacco, alcohol, and marijuana use, whereas sports predicted decreased amounts of tobacco and marijuana use and increased amounts of alcohol use at the end of high school. ConclusionsAlthough unsupervised time with peers, sports, and paid employment were differentially linked to the odds of substance use, only unsupervised time with peers and sports were significantly associated with the amounts of tobacco, alcohol, and marijuana use at the end of high school. These findings underscore the value of considering OST contexts in relation to strategies to promote adolescent health. Reducing unsupervised time with peers and increasing sports participation may have positive impacts on reducing substance use.

Brief report: Bifactor modeling of general vs. specific factors of religiousness differentially predicting substance use risk in adolescence

Religiousness is important to adolescents in the U.S., and the significant link between high religiousness and low substance use is well known. There is a debate between multidimensional and unidimensional perspectives of religiousness (Gorsuch, 1984); yet, no empirical study has tested this hierarchical model of religiousness related to adolescent health outcomes. The current study presents the first attempt to test a bifactor model of religiousness related to substance use among adolescents (N = 220, 45% female). Our bifactor model using structural equation modeling suggested the multidimensional nature of religiousness as well as the presence of a superordinate general religiousness factor directly explaining the covariation among the specific factors including organizational and personal religiousness and religious social support. The general religiousness factor was inversely related to substance use. After accounting for the contribution of the general religiousness factor, high organizational religiousness related to low substance use, whereas personal religiousness and religious support were positively related to substance use. The findings present the first evidence that supports hierarchical structures of adolescent religiousness that contribute differentially to adolescent substance use.

Spirituality and Quaker Approaches to Substance Use and Addiction

The Religious Society of Friends (Quakers) has held a consistent testimony of abstinence and moderation regarding alcohol and other substances. This paper outlines the historical background, and describes modern Quaker understandings of moderation. It then outlines hitherto unpublished results regarding spirituality from the only study to date about Quaker behaviour and atttitudes regarding substance use. The association between low substance use and religiosity is established in the literature, but the role of spirituality is less defined. This study methodology allowed an unusually detailed analysis of different aspects of spirituality. Results generally support Miller’s suggestion that idiographic spirituality may have a role in resilience to higher substance use. However, spiritual practice through prayer/meditation emerges as having a more consistent role in the Quaker sample—a finding that is of interest and potential significance in considerations of resilience and recovery. The community dimension of shared spiritual attitudes towards substance use, and the spiritual values that underlie the interpretation of testimony, are also explored. The congruence that some Quakers find with the spiritual approaches of Alcoholics Anonymous is also discussed. It is concluded that spirituality is a significant factor in a Quaker balance that can mitigate immoderate use and support recovery from addiction, without, in general, excluding those who use at higher levels.