Initiation Of Substance Use Research Articles

Sociodemographic and Drug Use Characteristics of Treatment-seeking Cannabis Users at a Tertiary Care Center in India

Background: Cannabis is a common drug of abuse that has got some religious and social sanction in India. It is often perceived as relatively harmless compared with other substances. The rate of treatment seeking is low among its users. Objective: To describe the sociodemographic and drug use profile of treatment-seeking cannabis users visiting a tertiary care center in northern India. Methods: A retrospective chart review was conducted over a period of 1 year for cannabis-dependent subjects who sought treatment and underwent laboratory investigations. Results: A total of 51 subjects fulfilled the DSM-IV-TR criteria for cannabis dependence. All subjects were male with mean age of 28±10.2 years. Among them, 37.3% subjects started substance use before 15 years of age. Although 94% subjects were literate, only 33.3% were employed and 82% were socioeconomically poor. Majority of the subjects initiated substance use with smokable tobacco (66.7%). Cannabis was the initial substance among 15% subjects. Among all 64.7% subjects were comorbid opioid dependent and 58.9% subjects were seeking treatment for the same. Ganja was the most common form of cannabis used (66.7%). Health risk due to cannabis was known to 35.3% subjects, 47% never made any abstinent attempt. Cannabis-related complication was present in 84.37% subjects. Conclusions: Treatment-seeking cannabis users are mostly codependent on other substances that become the main reason for their treatment-seeking. Despite high rate of cannabis-related complications, awareness about its health-risk, treatment seeking, and attempt to abstain remains low.

Neuropsychosocial profiles of current and future adolescent alcohol misusers.

A comprehensive account of the causes of alcohol misuse must accommodate individual differences in biology, psychology and environment, and must disentangle cause and effect. Animal models can demonstrate the effects of neurotoxic substances; however, they provide limited insight into the psycho-social and higher cognitive factors involved in the initiation of substance use and progression to misuse. One can search for pre-existing risk factors by testing for endophenotypic biomarkers in non-using relatives; however, these relatives may have personality or neural resilience factors that protect them from developing dependence. A longitudinal study has potential to identify predictors of adolescent substance misuse, particularly if it can incorporate a wide range of potential causal factors, both proximal and distal, and their influence on numerous social, psychological and biological mechanisms. Here we apply machine learning to a wide range of data from a large sample of adolescents (n = 692) to generate models of current and future adolescent alcohol misuse that incorporate brain structure and function, individual personality and cognitive differences, environmental factors (including gestational cigarette and alcohol exposure), life experiences, and candidate genes. These models were accurate and generalized to novel data, and point to life experiences, neurobiological differences and personality as important antecedents of binge drinking. By identifying the vulnerability factors underlying individual differences in alcohol misuse, these models shed light on the aetiology of alcohol misuse and suggest targets for prevention.

Comparative effectiveness and cost-effectiveness of a computer-delivered psychosocial treatment program for prisoners with substance use disorders

Comparative effectiveness and cost-effectiveness of a computer-delivered psychosocial treatment program for prisoners with substance use disorders

Adapting a blended motivational interviewing and problem-solving intervention to address risky substance use amongst South Africans

The purpose of this study was to examine the acceptability and initial substance use outcomes of a blended motivational interviewing (MI) and problem-solving therapy (PST) intervention, delivered by peer counsellors. Twenty people who scored at risk for substance use according to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) received a five session blended MI-PST intervention and were assessed at baseline and at three months. An open-ended semi-structured interview, designed to identify possible factors that may hinder or promote the acceptability of the intervention was also conducted. Fifteen participants completed the intervention and the three-month follow-up. According to ASSIST scores, participants significantly reduced their substance use (p > 0.001) at the three-month follow-up. Randomized controlled trials are needed to evaluate the effect of this intervention more rigorously.

Effects of reward sensitivity and regional brain volumes on substance use initiation in adolescence

This longitudinal study examines associations between baseline individual differences and developmental changes in reward [i.e. behavioral approach system (BAS)] sensitivity and relevant brain structures' volumes to prospective substance use initiation during adolescence. A community sample of adolescents ages 15-18 with no prior substance use was assessed for substance use initiation (i.e. initiation of regular alcohol use and/or any use of other substances) during a 2-year follow-up period and for alcohol use frequency in the last year of the follow-up. Longitudinal 'increases' in BAS sensitivity were associated with substance use initiation and increased alcohol use frequency during the follow-up. Moreover, adolescents with smaller left nucleus accumbens at baseline were more likely to initiate substance use during the follow-up period. This study provides support for the link between developmental increases in reward sensitivity and substance use initiation in adolescence. The study also emphasizes the potential importance of individual differences in volumes of subcortical regions and their structural development for substance use initiation during adolescence.

The CLIMATE schools combined study: a cluster randomised controlled trial of a universal Internet-based prevention program for youth substance misuse, depression and anxiety.

BackgroundAnxiety, depressive and substance use disorders account for three quarters of the disability attributed to mental disorders and frequently co-occur. While programs for the prevention and reduction of symptoms associated with (i) substance use and (ii) mental health disorders exist, research is yet to determine if a combined approach is more effective. This paper describes the study protocol of a cluster randomised controlled trial to evaluate the effectiveness of the CLIMATE Schools Combined intervention, a universal approach to preventing substance use and mental health problems among adolescents.Methods/designParticipants will consist of approximately 8400 students aged 13 to 14-years-old from 84 secondary schools in New South Wales, Western Australia and Queensland, Australia. The schools will be cluster randomised to one of four groups; (i) CLIMATE Schools Combined intervention; (ii) CLIMATE Schools - Substance Use; (iii) CLIMATE Schools - Mental Health, or (iv) Control (Health and Physical Education as usual).The primary outcomes of the trial will be the uptake and harmful use of alcohol and other drugs, mental health symptomatology and anxiety, depression and substance use knowledge. Secondary outcomes include substance use related harms, self-efficacy to resist peer pressure, general disability, and truancy. The link between personality and substance use will also be examined.DiscussionCompared to students who receive the universal CLIMATE Schools - Substance Use, or CLIMATE Schools - Mental Health or the Control condition (who received usual Health and Physical Education), we expect students who receive the CLIMATE Schools Combined intervention to show greater delays to the initiation of substance use, reductions in substance use and mental health symptoms, and increased substance use and mental health knowledge.Trial registrationThis trial is registered with the Australian and New Zealand Clinical Trials registry, ACTRN12613000723785.

The adolescent origins of substance use disorders: a behavioral genetic perspective.

Over the past 20 years, there has been an increasing recognition within the substance abuse research field that substance use disorders (SUDs) are usefully conceptualized within a developmental framework. That is, initiation of substance use in adolescence and escalation to substance abuse in early adulthood are strongly age-graded, with the relevant behavioral risk and protective factors manifesting early in development, often prior to substance use onset. In this chapter, we review a program of research that seeks to provide a behavioral genetic perspective on the development of SUDs. The Minnesota Center for Twin and Family Research (MCTFR) undertakes longitudinal research on families including twins, adopted siblings, and non-adopted siblings spanning early adolescence through early adulthood. A total of nearly 10,000 individuals in 2,500 families have participated in MCTFR research. We review findings from the MCTFR to establish four general features of the development of SUDs informed by behavioral genetic research: (1) Both general and specific processes contribute to the aggregation of SUDs in families; (2) genetic contributions to SUD risk appear to be primarily at the general factor level, although the contribution of the general factor appears to decrease with age; (3) SUD risk is manifested before initiation of substance use in terms of elevated levels of externalizing psychopathology and personality characteristics indicative of low self-control; and (4) the genetic factors that contribute to SUD risk appear to be numerous with very small phenotypic effects, making them difficult to identify.

Evaluation of underlying mechanisms in the link between childhood ADHD symptoms and risk for early initiation of substance use.

Although there has been support for attention-deficit/hyperactivity disorder (ADHD) as a risk for early substance use, this link is not fully established or understood. Furthermore, the potential mechanisms explaining these associations are unclear. The current study examined peer rejection, school bonding, and internalizing problems as potential mediators of the association between childhood ADHD symptoms and risk for early initiation of substance use. The sample included a control group of 126 students with problematic aggression (79% African American, 66% male) from an intervention study following children from fourth to ninth grade. Results suggested that ADHD symptoms follow a path to early initiation of tobacco use through the combined effects of peer rejection and internalizing problems as well as through internalizing problems alone. ADHD symptoms were also associated with the cubic slope of marijuana use initiation, such that increased ADHD symptoms were associated with a strong cubic trend (e.g., a more rapid acceleration of risk for initiation). ADHD symptoms were not associated with risk for early initiation of alcohol use. Identification of important vulnerability factors in children with ADHD symptoms highlight the need for primary prevention and psychological interventions that target these factors and decrease the likelihood of early tobacco and marijuana use initiation.

Factors associated with treatment seeking behaviour in adolescent substance abuser in a de and #8209;addiction centre in north India

Background: Substance use appears to be increasing among children and adolescents, with an upward trend seen in recent surveys. Any substance abuse at this formative age is likely to interfere with the normal development and may have a lasting impact on the future life, along with affecting family and society. Aims & Objectives: To study the demographic and clinical profile of adolescents seeking de-addiction treatment at a tertiary centre. Materials and Methods: Retrospective structured chart review of adolescent substance abusers seeking treatment at a de-addiction centre between January 2012 and December 2013. Results: The mean age of onset of addiction was 14.9years, with mean age of subjects being 17.8 years, 2.8 years was mean duration of dependence. Majority belonged to joint family (79%), with good social support (61.2%), urban background (50.7 %) and 47.8 % being school dropouts. The commonest substance of abuse was alcohol (41.8%), followed by opioids (40.3 %), tobacco (37.3%), cannabis (34.3 %), multiple substances (14.9 %), inhalants (6 %), benzodiazepines (6 %). The common reasons for initiation of substance use were peer pressure (52 %) and curiosity (48 %). Conclusion: The common substance of abuse was alcohol, opioids, tobacco and cannabis. A small proportion were multiple substance users. Majority of the subjects belonged to joint family with good social support with the influential environmental determinant being peer substance use. Urgent preventive measures in schools seems the need of the hour.

Identifying childhood characteristics that underlie premorbid risk for substance use disorders: Socialization and boldness

We utilized a longitudinal twin study (N = 2,510) to identify the child characteristics present prior to initiation of substance use that best predicted later substance use disorders. Two independent traits accounted for the majority of premorbid risk: socialization (conformity to rules and conventional values) and boldness (sociability and social assurance, stress resilience, and thrill seeking). Low socialization was associated with disruptive behavior disorders, parental externalizing disorders, and environmental adversity and exhibited moderate genetic (0.45) and shared environmental influences (0.30). Boldness was highly heritable (0.71) and associated with less internalizing distress and environmental adversity. In combination, these traits exhibited robust associations with adolescent and young adult substance use disorders (R = .48 and .50, respectively) and incremental prediction over disruptive behavior disorders, parental externalizing disorders, and environmental adversity. The results were replicated in an independent sample. Socialization and boldness offer a novel conceptualization of underlying risk for substance use disorders that has the potential to improve prediction and theory with implications for basic research, prevention, and intervention.

Empirically supported drug treatment for all: Helping a nation get "Clean"

Reviews the book Clean: Overcoming Addiction and Ending America's Greatest Tragedy by David Sheff. This book provides, in layman's language, an overview of the full range of addiction science including: initiation of substance use, the neuroscience of addiction, prevention, treatment, and drug policy. Sheff has done extensive research for the book, including interviews of both individuals who have been affected by substance use disorders and experts in all aspects of addiction science as well as summaries of up to date empirical literature. The book includes a plan for targeting drug problems in the U.S. at multiple levels including: prevention, treatment, and drug policy. The author describes and encourages the use of empirically supported treatments for substance use disorders. The primary intended audience of the book appears to be individuals who have loved ones with addiction problems. The book is likely less useful for the psychologist who is accustomed to reading primary literature, but it could be a helpful book to which to refer people who may want additional information about substance use disorders and their treatment.

Youths’ Substance Use and Changes in Parental Knowledge-Related Behaviors During Middle School: A Person-Oriented Approach

Parental knowledge is a key protective factor for youths' risky behavior. Little is known about how longitudinal combinations of knowledge-related behaviors are associated with youths' substance use. This longitudinal study uses Latent Transition Analysis to identify latent patterns of parental knowledge-related behaviors occurring in mother-youth dyads during middle school and to investigate how changes in knowledge-related patterns are associated with youths' substance use in Grade 6 and the initiation of substance use from Grade 6 to 8. Using a sample of 536 rural dyads (53 % female, 84 % White), we assessed mother and youths' reports of parental knowledge, active parental monitoring efforts, youth disclosure, and parent-youth communication to identify six latent patterns of knowledge-related behaviors: High Monitors, Low Monitors, Communication-Focused, Supervision-Focused, Maternal Over-Estimators, and Youth Over-Estimators. Fifty percent or more of dyads in the High Monitors, Communication-Focused and Youth Over-Estimators were in the same status in both 6th and 8th grade: 98 % of Low Monitors in Grade 6 were also in this status in Grade 8. The initiation of alcohol, smoking, and marijuana was associated significantly with transitions between patterns of knowledge-related behaviors. The initiation of alcohol and smoking were associated with increased odds of transitions into the Low Monitors from the Communication-Focused, Supervision-Focused, and Maternal Over-Estimators. However, the initiation of substance use was associated with decreased odds of transitions from the High Monitors to the Low Monitors and with increased odds of transitions from High Monitors to Supervision-Focused. The discussion focuses on the value of using a person-oriented dyadic approach with multiple reporters to study changes in knowledge-related behaviors over the middle school period.

A longitudinal examination of alcohol, marijuana, and cigarette perceived norms among middle school adolescents

BackgroundAdolescents tend to overestimate the prevalence of substance use among their peers and these perceived norms are associated with their current and future use. However, little is known about how perceived norms change over time during middle school, a developmental period when adolescents are at-risk for initiating substance use. MethodWe examined changes in perceived norms of alcohol, marijuana, and cigarettes over a two-year period among a large and diverse sample of 6th and 7th grade youth (N=6097; 50.1% female; 54% Hispanic). Participants completed a baseline survey and two subsequent annual surveys. Participants estimated the percentage of their peers they believed used each substance, as well as indicated levels of personal use, offers to use from peers, and exposure to peers who were using each substance. ResultsPerceived norms of all three substances increased over time. Increases were somewhat attenuated when controlling for demographic factors, personal use, and peer factors, but remained significant. Female adolescents and those reporting non-Hispanic White ethnicity experienced the greatest increase in perceived norms over time. ConclusionNormative perceptions of substance use increase greatly during the middle school years, an effect which cannot be fully explained by demographics, personal use, or peer factors. Given that perceived norms are often associated with personal use, early interventions with middle school youth are warranted to prevent the growth of these influential factors during this developmental period.

Applying General Strain Theory to Youth Commercial Sexual Exploitation

Scholarly research on commercial sexual exploitation (CSE) of youth has been impeded due to difficulties in researching hidden and vulnerable populations. Drawing from Agnew’s general strain theory, this study utilized multigroup structural equation modeling to explore similarities and differences in vulnerability to CSE across gender. The strain reactive pathway, linking caregiver strain to youth susceptibility to CSE, was tested with data from 1,354 serious youthful offenders, 8.4% of whom indicated CSE. Findings revealed that caregiver strain, such as arrests and substance use, similarly impacted nurturing of boys and girls. Across both genders, poor nurturing was linked to higher negative psychosocial emotion, running away, and initiating substance use and sexual relationships at earlier ages. For males, negative psychosocial emotion and earlier initiation of sexual relationships were significantly related to CSE. In contrast, vulnerability of females was more strongly linked to earlier substance use.

Stressful life events and adolescent drug use: Moderating influences of the MAOA gene

PurposeThough stressful life events appear to impact the likelihood and frequency of substance use among adolescents, these effects are often varied and inconsistent. We suggest that the polymorphic MAOA gene may be partially responsible for variable susceptibility to environmental pressures and substance use. More specifically, we hypothesize that adolescents possessing low activity alleles for the MAOA genotype are more likely to respond to stressful life experiences by initiating substance use. MethodsThe genetic subsample of the National Longitudinal Study of Adolescent Health was analyzed (2,574 adolescents) using logistic regression models for each gender. Respondents’ self-reports of eight key stressors were used to create a composite life stress scale which was allowed to interact with a variable that represented the number of low activity MAOA alleles. ResultsFor males, a significant interaction emerged between stressful life experiences and the MAOA gene for alcohol (p=.029) and marijuana (p=.039) initiation. For females, the interaction was not significant in each model. ConclusionsMAOA interacts with life stress to increase the likelihood of substance use initiation for males. Those with a low activity MAOA allele are more likely to initiate substance use than those with a high activity allele when exposed to stressful experiences.

Prenatal Cocaine Exposure and Gray Matter Volume in Adolescent Boys and Girls: Relationship to Substance Use Initiation

Studies of prenatal cocaine exposure have primarily examined childhood populations. Studying adolescents is especially important because adolescence is a time of changing motivations and initiation of substance use. Using magnetic resonance imaging and whole-brain voxel-based morphometry, we assessed gray matter volume (GMV) differences in 42 prenatally cocaine exposed (PCE) and 21 noncocaine-exposed (NCE) adolescents, aged 14 to 17 years. Associations between GMV differences in significant clusters and the probability of substance use initiation were examined. PCE relative to NCE adolescents demonstrated three clusters of lower GMV involving a limbic and paralimbic (p < .001, family-wise error [FWE] corrected), superior frontal gyrus (p = .001, FWE corrected), and precuneus (p = .019, FWE corrected) cluster. GMVs in the superior frontal and precuneus clusters were associated with initiation of substance use. Each 1-mL decrease in GMV increased the probability of initiating substance use by 69.6% (p = .01) in the superior frontal cluster and 83.6% (p = .02) in the precuneus cluster. PCE is associated with structural differences in cortical and limbic regions. Lower GMVs in frontal cortical and posterior regions are associated with substance use initiation and may represent biological risk markers for substance use.

Age of first cigarette, alcohol, and marijuana use among U.S. biracial/ethnic youth: A population-based study

This study examines age of first cigarette, alcohol, and marijuana use among self-identified biracial youth, using data from the National Longitudinal Study of Adolescent Health (Add Health). We found an intermediate biracial phenomenon in which some biracial youth initiate substance use at ages that fall between the initiation ages of their 2 corresponding monoracial groups. When controlling for the covariates, our findings show that White-Asian biracial youth begin smoking marijuana and drinking alcohol at earlier ages than Whites and engaging in all forms of substance use at earlier ages than Asian youth. Results indicate that White-American Indian youth start smoking cigarettes at earlier ages than all biracial and monoracial groups. Our findings underscore the need for future research to examine substance-use initiation and progression among biracial/ethnic youth.

Conduct Disorder and Initiation of Substance Use: A Prospective Longitudinal Study

To examine the influence of conduct disorder (CD) on substance use initiation. Community adolescents without CD (n = 1,165, mean baseline age = 14.6 years), with CD (n = 194, mean baseline age = 15.3 years), and youth with CD recruited from treatment (n = 268, mean baseline age = 15.7 years) were prospectively followed and re-interviewed during young adulthood (mean ages at follow-up respectively: 20, 20.8, and 24). Young adult retrospective reports of age of substance initiation for 10 substance classes were analyzed using Cox regression analyses. Hazard ratios of initiation for the CD cohorts (community without CD as the reference) at ages 15, 18, and 21 were calculated, adjusting for baseline age, gender, and race/ethnicity. Among community subjects, CD was associated with elevated adjusted hazards for initiation of all substances, with comparatively greater hazard ratios of initiating illicit substances at age 15 years. By age 18, the adjusted hazard ratios remained significant except for alcohol. At age 21, the adjusted hazard ratios were significant only for cocaine, amphetamines, inhalants, and club drugs. A substantial portion of community subjects without CD never initiated illicit substance use. Clinical youth with CD demonstrated similar patterns, with comparatively larger adjusted hazard ratios. CD confers increased risk for substance use initiation across all substance classes at age 15 years, with greater relative risk for illicit substances compared to licit substances. This effect continues until age 18 years, with the weakest effect for alcohol. It further diminishes for other substances by age 21, However, the likelihood of initiating cocaine, amphetamines, inhalants and club drug use among those who have not initiated yet continues to be highly elevated by age 21.

Profile of Substance Use among Patients Attending De-Addiction Centres in a Coastal City of Southern India

Drug dependence is still to be recognized in developing countries as a significant public health problem and literature on the magnitude of this problem is limited. The present research was planned to study the socio-demographic profile and the reasons for substance use among patients admitted at De-addiction centres in Mangalore, India. In this cross-sectional study, all the patients admitted at the De-addiction centres during the study period were interviewed. The data was analyzed and the results obtained were expressed in proportions. A total of 83 patients were included in the study, all of whom were males. A positive family history of substance use was evident in 63% of the respondents. The mean age of the study participants was 41.9 (SD±11.2) years and the mean age for starting substance use was 20.9 (SD±7.7) years. The most common substance used was alcohol (95.2%). Majority of the subjects (56.6%) cited peer pressure as a reason for initiating substance use. Our findings suggest that the initiation of substance use occurs during late teenage years and mostly due to peer pressure. Our observations point towards the vulnerability of younger age towards substance use and hence, it is proposed that the preventive health policies in this regard should be targeted specifically during teenage years.

Attention deficit hyperactivity disorder (ADHD) among illicit psychostimulant users: a hidden disorder?

To estimate the prevalence, nature and correlates of symptomatology consistent with adult attention deficit hyperactivity disorder (ADHD) among illicit psychostimulant users. Cross-section survey. Sydney, Australia. 269 regular illicit psychostimulant users. Structured interview assessing demographics, drug use and treatment history, psychostimulant dependence and self-reported symptoms consistent with adult ADHD. Almost half (45%) screened positive for adult ADHD (ADHD+). Symptoms of inattention (90%) were more prevalent than symptoms of hyperactivity/impulsivity (57%). Of those who screened positive for adult ADHD, only 17% had received a prior diagnosis of ADHD. The ADHD+ group differed from other participants in several respects: an earlier initiation of substance use and injecting drug use; more extensive polydrug use; a higher frequency of recent stimulant use and injecting drug use; a greater likelihood of stimulant dependence; and a greater likelihood of having received treatment for drug dependence. After controlling for other factors, screening positive for ADHD was associated independently with fewer years of education, earlier initiation of regular tobacco use and more extensive life-time polydrug use. Clinicians should be aware of the potential for patients of drug and alcohol treatment services to have undiagnosed and/or untreated ADHD that may impact on their compliance with, and retention in, treatment.