Patterns Of Substance Use Research Articles

SAMHSA: Substance use by teens across sexual identities

A new report from the Substance Abuse and Mental Health Services Administration (SAMHSA) has found that LGB+ youth are more likely than straight youth to have major depression and serious thoughts of suicide. But patterns of substance use by sexual identity were nuanced.

Trauma, Resilience, and Substance Use in Adolescents: A Review Article

Background: Adolescence is a sensitive phase of human life featuring changes in physical, emotional, and social characteristics. Many teens experience stressful events and trauma, which can affect their mental health and increase their risk of initiating and continuing substance use. Genetic vulnerabilities impact this relationship. In the face of trauma, while some adolescents are vulnerable, others navigate similar experiences differently, show resilience, and generally fare better without developing substance use problems. Understanding the multiple contributory factors that impact this relationship is critical in informing clinical approaches and program development. Objective: To describe the intricate dynamics between trauma, resilience, and substance abuse among adolescents. This review attempts to offer a synopsis that clarifies existing perspectives on trauma and substance use in adolescents while indicating areas for future research, clinical, and intervention programs in this critical area of adolescent well-being. Methods: A literature review was conducted to reveal available studies related to trauma, adolescent substance use, and resilience. Synthesis of findings from empirical studies, a detailed discussion on trauma and developmental factors while also addressing resilience elements alongside patterns of substance use is presented. Conclusion: Trauma, resilience, and substance use are linked in a tri-directional relationship, which is complex and dynamic. Adolescents with trauma are at higher risk of initiating and continuing substance. Resilience impacts treatment-seeking and engagement and may reduce relapse risk. Future research recommendations include improving the cultural sensitivity of interventions, studying the effects of marginalized identities, and ensuring rigorous evaluation of and progressive development of intervention programs. Results: The review highlights the bidirectional connections between trauma and substance use in adolescents. We include the consideration of resilience in adolescent responses to trauma. Resilience may reduce the risk of substance use, improve treatment-seeking and engagement in the treatment of SUD in adolescents, and reduce the risk of relapse, thereby suggesting it is a third dimension in the relationship between trauma and substance use. This review also provides evidence-based interventions and policies that are tailored to the specific needs of a diverse population of adolescents. We uncover the gaps in research, especially regarding cultural specifics and intersectionality among marginalized identities.

Substance Use Disorder and Severe Maternal Morbidity: Is there a Differential Impact?

BackgroundSubstance use disorder (SUD) is a disease characterized by behavior patterns of substance use leading to dysfunction in cognition, mood, and quality of life. The prevalence of perinatal substance use disorders in the United States continues to rise and have adverse effects on the maternal-infant dyad. Mirroring the rise in SUD is an increasing prevalence of severe maternal morbidity (SMM). However, this relationship needs further examination. Objective(s)The primary objective of this study was to evaluate the association between perinatal SUD and SMM. We hypothesized that SUD would predict a significantly increased risk for SMM events, both as a composite and individually, in adjusted multivariable regression analyses. Study DesignWe conducted a cross-sectional analysis of inpatient pregnancy hospitalizations from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) from 2016 to 2020. ICD-10 codes were used to identify patients with a SUD and/or a SMM event. SUD was defined as a composite. Our primary outcome was rate of SMM as defined by the CDC. Multivariable logistic regression analyses were performed to predict the likelihood of SMM among pregnancy hospitalizations with and without SUD as well as to predict the likelihood of SMM for each individual type of SUD in a subgroup of hospitalizations with SUD and SMM. ResultsOf the 3,672,932 inpatient pregnancy hospitalizations included in the analyses, 6.27% (230,110/ 3,672,932) had SUD diagnosis and 2.10% (77021/ 3,672,932) had an SMM diagnosis. The prevalence of SMM was significantly higher among patients with SUD (7,357/ 230,110 – 3.20%) vs. without SUD (69,664/3,442,822– 2.02%, p <.0001). Patients with SUD were 1.5 times more likely to have a SMM event as compared to those without SUD (aOR 1.52; 95% CI 1.48-1.56). In subgroup analyses based on SUD type - the likelihood of SMM was strongest for stimulants (aOR 3.86; 95% CI 3.61-4.13) and sedatives (aOR 3.82; 95% CI 3.08-4.75). In subgroup analyses based on SMM event, SUD was a strong positive predictor for acute MI (aOR 3.63; 95% CI 2.78-4.74) and aneurysm (aOR 6.28; 95% CI 2.77-14.21). Conclusion(s)Pregnant patients with SUD carry significantly increased risk of experiencing an SMM event. These events occur more readily in patients with certain patterns of SUD use – most notably sedatives and stimulants. Patients with SUD were most likely to experience a cardiovascular-related SMM event, thus informing care.

Pattern of Psychoactive Substance Use in Sierra Leone: A Descriptive Retrospective Study

Background Substance use, and pattern of consumption varies across population and may, within a particular population, show temporal variations in accordance with changing fads. Understanding the pattern of substance use in a population is key to any programme of demand reduction. Thus, we studied a consecutive series of patients with substance use disorders in our facility, aiming to determine the patient profile and pattern of substance use. Methods Hospital’s digital register was consulted and data of patients who were seen over a 16-months period, and who had diagnosis of ‘alcohol and substance use disorder’ were retrieved and analyzed. Results Seven hundred and nineteen patients were treated for substance use disorder over a 16-months period. Age of patients ranged from 16 to 69 years with mean age (SD) of 28.7(9.2) years. Majority were males (91%), single (87%) and had been to secondary or tertiary school with or without graduation. Fifty nine percent (421/719) of the patients admitted being on ‘Kush’, 49% on alcohol, 47% on cannabis, 11% on tramadol and 5.6% on cocaine. About 71% of the patients were poly-substance users while 29 percent were on one agent. Alcohol, ‘Kush’ and cannabis were the most common preferences of those who use more than one agent. Conclusions Substance use disorder in Freetown was most prevalent in young, adult, secondary school educated males. ‘Kush’ was the most common agent of abuse and frequency of polysubstance use is high. Understanding the factors responsible for low substance use among females in the population might point to some preventive control measures.

Substance Use and Adverse Mental Health Disparities Between Heterosexual and Sexual Minority Service Members in the U.S. Military.

Nationally representative studies have shown that lesbian, gay, and bisexual adults have higher levels of substance use than heterosexual adults. In the military, substance use is often associated with adverse mental health outcomes and is often comorbid with other mental health conditions and adverse or harmful behaviors. Few military studies to date have comprehensively examined the relationship between sexual orientation, mental health, and substance use. Data from the 2018 Health-Related Behaviors Survey (n = 17,166) were used. Univariate and multivariable logistic regression models were used to examine the association between sexual orientation and substance use. Regression models were also used to examine whether measures of mental health moderate the relationship between sexual orientation and substance use. Compared to heterosexual individuals, lesbian and gay individuals were more likely to engage in illicit drug use (adjusted odds ratio = 3.27; 95% CI, 1.45 to 7.36). Bisexual individuals were more likely to binge drink (adjusted odds ratio = 1.37; 95% CI, 1.08 to 1.74). Individuals with moderate or serious psychological distress were more likely to report binge drinking or smoking tobacco. Individuals with serious psychological distress were more likely to use illicit drugs. None of the interactions tested in this study were statistically significant. Substance use in the military was more likely among sexual minority individuals compared to heterosexual individuals. These findings reflect the patterns of substance use seen in the general population. Increased levels of psychological distress were associated with both the lesbian, gay, and bisexual population in this study and self-reported substance use behaviors. Further investigation of health disparities by sexual orientation may inform more efficacious treatment and prevention programs.

Personality in Alcohol and Opioid Use Disorder: A Multiphasic Personality Questionnaire Study.

This study explored the relationship between personality attributes and substance use disorder (SUD). Research has identified specific personality dimensions, such as neuroticism, psychoticism, antisocial personality traits, paranoia, and anxiety, as contributing factors on the way to the initiation, continuation, and relapse of SUD. To explore this connection, we examined the personality profiles of subjects with alcohol use disorder (AUD) and opioid use disorder (OUD). A total of 928 subjects, 320 with AUD, 490 with OUD and 118 healthy controls (HC), in the age range of 16-65 years were recruited in the study. The Clinical Profile Sheet and the Multiphasic Personality Questionnaire (MPQ) were administered to HC and patients who fulfil the diagnostic criteria for substance dependence as defined by ICD-10 (WHO-1992). We found significant differences in personality profiles between individuals with OUD and AUD. Patients with AUD scored higher than OUD on the MPQ subscales for depression, mania, paranoia, and antisocial personality traits. All subscales of the MPQ showed elevated scores in subjects with SUD compared to HC. Elevated scores on the MPQ subscales suggest that personality factors may contribute to the pattern of substance use and misuse in this cohort.

Substance use by homeless clinic attenders in Sydney.

Describe patterns of substance use and comorbid conditions among clinic attenders in homeless shelters in Sydney. Retrospective cohort study of 2498 people who attended a psychiatric clinic at one of three homeless hostels between February 2008 and May 2020. Multivariable logistic regression was used to identify factors associated with self-reported substance use, psychiatric diagnosis and measures of social function. A total of 2041 of the 2498 (81.7%) reported the harmful use of at least one substance, with alcohol (61.8%), cannabis (50.9%) and stimulant drugs (34.9%) the three most common. Those reporting the regular use of two or more substances (1466, 58.7%) were more likely to have a history of early life and adult trauma, a diagnosis of personality disorder, a criminal conviction, receive the Disability Support Pension, be chronically homeless and sleep in the open. The study found a high rate of polysubstance use among homeless clinic attenders in Sydney, and an increase in the prevalence of substance use compared to previous studies. Substance use is both a cause and a consequence of homelessness, and services to address substance use have to be part of any program to reduce homelessness and sleeping in the open.

Clinical course and demographic insights into suicide by self-poisoning: patterns of substance use and socio-economic factors.

To analyze whether sociodemographic characteristics influence the substance choice and preclinical and clinical course of suicidal poisoning. This was a retrospective single-center study in patients hospitalized due to suicidal poisoning and who received at least one psychiatric exploration during their inpatient stay. Patients' sociodemographic, anamnestic, preclinical, and clinical parameters were analyzed with respect to sex and age. 1090 patients were included, 727 (67%) were females, median age was 39 years (min-max: 13-91) with 603 (55%) aged 18-44 years. 595 patients (54.8%) ingested a single substance for self-poisoning, 609 (59.5%) used their own long-term medication. Comparing to males, females preferred antidepressants (n = 223, 30.7%, vsn = 85, 23.4%; p = 0.013) and benzodiazepines (n = 202, 27.8%, vsn = 65, 17.9%; p < 0.001); males more often used cardiovascular drugs (n = 33, 9.1%, vsn = 34, 4.7%; p = 0.005) and carbon monoxide (n = 18, 5.0%, vsn = 2, 0.3%; p < 0.001). Use of Z-drugs (n = 1, 1.7%, to n = 37, 33.3%; p < 0.001) and benzodiazepines (n = 4, 6.9%, to n = 33, 29.7%; p = 0.003) increased with age (< 18 to > 64 years), while use of non-opioid analgesics (n = 23, 39.7%, to n = 20, 18.0%; p < 0.001) decreased. Average dose of substance in patients > 64 years was 12.9 ± 18.4 times higher than recommended maximum daily dose (compared to 8.7 ± 15.2 higher in those aged < 18 years; p < 0.001). Males more often required intensive care (n = 150, 41.3%, vsn = 205 females, 28.2%; p < 0.001). These results underline the complexity of (para-)suicidal poisonings and identify potential measures for their prevention, such as restricting access and better oversight over the use of certain substances.

Racial/Ethnic Differences in Adverse Childhood Experiences and Health-Related Outcomes: A Scoping Review.

Racial and ethnic differences have been observed across patterns of substance use and exposure to adverse childhood experiences (ACEs). The goal of this review was to summarize the current evidence on ACE and health outcomes across racial and ethnic groups in the United States. A scoping review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta- Analysis for Scoping Review (PRISMA-ScR) guideline was performed. Using predetermined search terms and parameters, an electronic database search of peer-reviewed literature between 1997 and 2022 was performed. Forty-five articles met the inclusion and exclusion criteria. Thirteen articles focused on health behavior and education outcomes, fifteen reported on physical health outcomes, and eighteen reported on mental health outcomes. Relatively to mental health outcomes, race/ethnicity appeared to play a less significant role in the relationship between ACE and behavioral outcomes or physical health outcomes. There was stronger evidence that race/ethnicity may moderate relationships between ACE exposure and mental health outcomes. Across health behavior, physical health, and mental health domains, the evidence suggests that the relationship between ACE exposure and health outcomes is not uniform across different racial and ethnic groups. These findings highlight the need for future research to uncover how cultural, societal, and developmental factors interact to shape health in the context following exposure to childhood adversity.

High prevalence of alcohol use disorder & psychiatric comorbidity among coal mine workers: Observations from a cross-sectional study in West Bengal.

Background & objectives Tobacco (30%), alcohol (21.4%) and cannabis (3%) are the three most commonly abused substances in India. Tobacco and alcohol abuse have higher prevalence rates among different occupational groups as compared to that in general population in the country. Both tobacco and alcohol lead to significant occupational harm in terms of absenteeism, injuries, sickness and lost productivity. This study estimated the patterns of substance use and associated common psychiatric comorbidity in a sample of coal mine workers. Methods Coal mine workers at the age of 18 yr or above engaged in mining activities (skilled/semi-skilled/unskilled) were recruited from the Raniganj - Asansol coal mining areas of Eastern Coalfields Limited (ECL). Participants were screened to identify patterns of substance use and other common mental health problems. All participants were administered ASSIST (The Alcohol, Smoking and Substance Involvement Screening Test); GENACIS (Gender, Alcohol and Culture: An International Study) modified questionnaire; and Hospital Anxiety and Depression Scale (HADS) for primary screening for anxiety and depression. Results Out of 202 participants 69 per cent (n=140) were found with either 'hazardous and harmful' (moderate risk); or 'dependent' (high risk) patterns of use of either tobacco or alcohol or cannabis or of more than one substance. Only 31 per cent (n=62) were 'low-risk' for all substances. Almost 65 per cent (n=132) and 49 per cent (n=99) participants out of the whole sample (n=202) belonged to 'hazardous and harmful' (moderate risk) and 'dependent' (high risk) pattern of tobacco and alcohol consumption, respectively. About 28.8 per cent (n=38) and 23.7 per cent (n=31) of all participants had anxiety and depression, respectively. Combined moderate to high use of both alcohol and tobacco use was significantly associated with the risk of having anxiety [adjusted odds ratio (AOR)=4.896, P<0.015] and depression (AOR=5.335, P<0.012). Interpretation & conclusions Alcohol and tobacco are major substance abuse problems among coal mine workers. This population requires early community and primary care based brief intervention as well as additional community-based pharmacotherapy for substance dependence problems as well as intervention for common mental health issues.

High-Risk Cannabis Use: A Proposal of an Operational Definition through Delphi Methodology for Scientific Consensus

Introduction: Cannabis ranks as one of the most widely used psychoactive substances worldwide. Its usage has been reported as a risk factor for developing a variety of physical and mental health issues, alongside social and economic problems. According to the World Health Organization (WHO), hazardous (or high-risk) substance use is defined as “a pattern of substance use that increases the risk of harmful consequences for the user.” The primary objective of this study was to achieve a consensus on an operational definition of high-risk cannabis use suitable for a European jurisdiction (Spain). Methods: A three round Delphi study was conducted. The Delphi technique entails group decision-making and iterative forecasting by consulting a panel of experts and conducting systematic feedback rounds. An online survey was distributed among a diverse expert panel comprising professionals from Spain working on fields related to cannabis use (research, policy planning, and clinical professionals). One-hundred ninety-nine invitations were sent to experts, of which forty-five (22.6%) accepted to participate. All participants were provided the option to revise a background document with the latest compiled scientific evidence and guidelines related to health and social conditions associated to cannabis usage. This background document also proposed the quantification of dose using a standardized unit established for the population of Spain (the Standard Joint Unit or SJU) based on quantity of cannabis main psychoactive constituent, 9-tetrahydrocannabinol (9-THC) (1 SJU = 1 joint = 0.25 g of cannabis = 7 mg of 9-THC). Three rounds of Likert scale and open-ended questions were administered until consensus, defined as ≥75% agreement, was attained. Results: Consensus was reached on defining high-risk cannabis use as the usage of more than 4 SJU (>28 mg THC) per week or any use of cannabis with potency >10% THC. Concurrent use of cannabis with other drugs was also considered high risk, while the smoked route was considered the riskiest administration route. It was also agreed that vulnerable groups for high-risk cannabis use (for whom any pattern of cannabis use represents high risk of harm) include individuals under the age of 21, pregnant or breastfeeding women, individuals with psychiatric history, those with medical health issues related to cannabis use, professional drivers and heavy machine operators. Conclusion: This operational definition of high-risk cannabis use for Spain elucidates usage patterns and individual vulnerability factors predictive of heightened harm. Its adoption holds potential to inform decision-making among individuals, professionals, and policy-makers, facilitating evidence-based interventions aimed at prevention and risk reduction.

Social Vulnerability for Polysubstance Use: Exploring the Substance Use Initiation and Pattern among Children with Cumulative Trauma

Background: Due to a concerning rise in reported cases of childhood abuse in India, this study was initiated with the aim of uncovering the social determinants contributing to childhood trauma. Moreover, the second objective of the study was to discuss substance use initiation and patterns among children with cumulative trauma. Method: As a result, an in-depth interview served as a primary source of viewpoints to examine the essential objective. The study was conducted on children with a history of abuse. Twenty-eight children in the age group of 13–18 years (Mage = 16) residing in child-care institutes in Assam were taken into consideration. Results: Content analysis indicated child care and education, parental divorce or remarriage, domestic violence, family mental illness, household substance misuse, parental health, parental crime, poverty, and sexual and physical violence as social determinants of health for childhood trauma. Children reported using alcohol, marijuana, tobacco, cough syrup, inhalants such as paint, and glue, chewables such as betel nut and Gutka (chewing tobacco), and pharmaceutical tablets. Initiation and pattern of substance use among early initiators were likely to be encouraged by detrimental peer influence, indicating substance abuse as normal behavior and the family’s role in shaping children’s pattern of substance use. Problematic patterns of substance use were identified, for instance, health consequences, neglect of responsibilities, and increased daily frequency. Conclusion: The results of this study may offer practical insights for healthcare professionals, enhancing their comprehension and addressing the social determinants of health indicating trauma and referring them to appropriate treatments. A holistic approach, which encompasses the collaboration of policymakers and healthcare providers, is vital for fostering health equity, thereby potentially preventing child abuse, childhood trauma and subsequent recidivism of substance use.

Substance use patterns and mental health comorbidities in youth with a history of depression or suicidality: Findings from TX-YDSRN

BackgroundThere is a robust relationship between depression and substance use in youth, with higher levels of substance use associated with greater depressive symptomatology. However, previous research has examined individual substances, without consideration of psychiatric comorbidities. Here, we investigate patterns of substance use among depressed and/or suicidal youth within the context of psychiatric comorbidities. Methods945 youth with depression and/or suicidality from the Texas Youth Depression and Suicide Research Network (TX-YDSRN) were assessed for current use of alcohol, nicotine, cannabis, and other drugs and comorbid psychiatric diagnoses. We used latent class analysis to identify patterns of past-year substance use, then examined if demographics or psychiatric disorders predicted class membership. ResultsWe identified three patterns of substance use: non-use (63.4 %), moderate likelihood of using alcohol, nicotine and cannabis (23.8 %), and high likelihood of using all substances (12.7 %). Compared to non-users, individuals in the moderate and high likelihood classes were more likely to be older. Individuals in the high likelihood class were more likely to have a substance use disorder, ADHD, and higher suicidality scores. LimitationsWe cannot ascertain the causal or temporal ordering of substance use and psychiatric diagnoses due to the cross-sectional nature of the study. ConclusionsUsing a brief, self-report measure of substance use, we identified three classes of substance users differing in probability of past-year use, which were predicted by older age and some psychiatric comorbidities. While research on universal screening of substance use in youth remains limited, we discuss who may benefit from such screening among depressed youth.

Compliance and response consistency in a lengthy intensive longitudinal data protocol.

Research on real-world patterns of substance use increasingly involves intensive longitudinal data (ILD) collection, requiring long assessment windows. The present study extends limited prior research examining event- and person-level influences on compliance and response consistency by investigating how these behaviors are sustained over time in an ILD study of alcohol and cannabis co-use in college students. Participants (n = 316) completed two 28-day bursts of ILD comprising five daily surveys, which included a morning survey of prior-day drinking. We used linear mixed effects models in a multilevel interrupted time series framework to evaluate the associations of time and measurement burst with (a) noncompliance (count of missed surveys) and (b) response consistency (difference between same-day report of drinking and morning report of prior-day drinking). We observed that time was positively associated with noncompliance, with no discontinuity associated with measurement burst. The slope of time was more positive in the second burst. Neither time nor measurement burst were significantly associated with consistent reporting. However, survey nonresponse and consistency of responding appeared to be impacted by the same-day use of substances. Overall, compliance decreased while consistency was stable across the duration of a lengthy ILD protocol. Shorter assessment windows or adaptive prompting strategies may improve overall study compliance. Further work examining daily burden and context is needed to inform future ILD design. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Association of Stigma, School, and Family Factors with Patterns of Substance Use Among LGBTQ Youth.

Polysubstance use is associated with myriad short- and long-term health outcomes. Although prior research has documented differences in polysubstance use between lesbian, gay, bisexual, transgender, queer/questioning, and other sexual and gender minoritized (LGBTQ +) youth and their heterosexual/cisgender counterparts, as well as between subgroups of LGBTQ + youth, it is unknown how personal, family, and school factors are associated with substance use patterns among LGBTQ + youth. Using a large, national sample of 9646 LGBTQ + youth ages 13-17, we used latent class analysis to examine patterns of alcohol, tobacco, and marijuana use and to determine whether personal, family, and school factors predict class membership. We identified five classes of substance use: polysubstance use, polysubstance experimentation, dual alcohol and cannabis, alcohol, and no use. Greater depression and LGBTQ + victimization, and an ability to be oneself at school, were associated with greater odds of membership in the polysubstance use class, while higher levels of family connection and having a Gender Sexuality Alliance (GSA) at school were associated with lower odds of membership in the polysubstance use class. Our analysis also revealed sociodemographic differences in class membership. These findings highlight potential mechanisms for intervention to reduce polysubstance use among LGBTQ + youth.

Implementation of universal screening for substance use in pregnancy in a public healthcare system

ObjectiveScreening questionnaires are one option for identification of at-risk substance use and substance use disorder (SUD) during pregnancy. We report the experience of a single institution following universal implementation of a brief screening tool for self-reported substance use at the first prenatal encounter. Study DesignThis is a prospective implementation study evaluating screening for substance use in pregnancy in a large safety net healthcare system. Universal screening with the National Institute of Drug Abuse (NIDA) Quick Screen V1.0 was integrated into the electronic medical record (EMR) and administered at the first point of contact with the healthcare system. SUD was identified initially with diagnosis within the EMR by a healthcare provider and was confirmed with toxicology (maternal or neonatal) results corroborating a pattern of substance use and maternal and neonatal ICD-10 codes for SUD. Patients identified with SUD were then classified as moderate or severe SUD based on criteria established by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. We measured rates of NIDA implementation across different healthcare settings, evaluated NIDA concordance with ascertainment of SUD, and compared adverse pregnancy outcomes associated with moderate and severe SUD. ResultsFrom July 28, 2021, through June 25, 2022, 14,634 unique pregnant individuals accessed care at ambulatory and acute care sites. Universal implementation of the NIDA Quick Screen identified at-risk substance use in 2146 (14.7%) of those who accessed our system, or 17.1% of 12,550 screened across the system, with greater screen completion in ambulatory over acute care settings. SUD was identified in 256 (1.7%) of 14,634 individuals and moderate or severe SUD was identified in 184 (1.3%). Among those with moderate or severe SUD, 90 (48.9%) were NIDA positive, 22 (12.0%) NIDA negative, and 72 (39.1%) unscreened. Of 94 individuals with NIDA discordance or who were unscreened 76 (81%) accessed initial care through an acute care setting. Of 96 individuals with opioid use disorder, 68 (70.8%) were treated with medication-assisted therapy, and 56 (58.3%) were screened with the NIDA Quick Screen. Among delivered individuals with available outcomes, those with moderate or severe SUD were less likely to seek prenatal care (71 (76%) vs 9852 (98%), <0.001)) and more likely to deliver before 37 weeks, (18 (20%) vs 909 (9%), RR (95% CI) 2.13 (1.40, 3.24)) compared to individuals without SUD. Neonates exposed to moderate or severe SUD were more likely to have birth weight <10th centile for gestational age (20 (22%) vs 1147 (12%), RR (95% CI) 1.92 (1.29, 2.85)) and require admission to the neonatal intensive care unit (NICU) (19 (21%) vs 964 (10%), RR (95%) 1.95 (1.30, 2.93)). ConclusionUniversal screening was implemented across a large public healthcare system at a high rate, with higher rates of implementation in ambulatory settings. NIDA successfully identified at-risk substance use in 17% of the SUD cohort but failed to identify more than 50% of patients with moderate or severe SUD. Patients with moderate and severe SUD accessed care primarily through the emergency department and experienced higher rates of adverse obstetric and neonatal outcomes. Future efforts to identify, engage, and retain this highest-risk group are needed.

Publisher's note

Substance use disorders (SUDs) are complex mental health conditions involving a problematic pattern of substance use. Challenges remain in understanding their neural mechanisms, which are likely to lead to improved SUD treatments. Human brain organoids, brain-like 3D in vitro cultures derived from human stem cells, show unique potential in recapitulating the response of a developing human brain to substances. Here, we review the recent progress in understanding SUDs using human brain organoid models focusing on neurodevelopmental perspectives. We first summarize the background of SUDs in humans. Moreover, we introduce the development of various human brain organoid models and then discuss current progress and findings underlying the abuse of substances like nicotine, alcohol, and other addictive drugs using organoid models. Furthermore, we review efforts to develop organ chips and microphysiological systems to engineer better human brain organoids for advancing SUD studies. Lastly, we conclude by elaborating on the current challenges and future directions of SUD studies using human brain organoids.

Distress tolerance is linked with substance use motivations and problems in young adults across four continents.

People low in trait distress tolerance are at higher risk for harmful patterns of substance use. Some evidence suggests that maladaptive motives for substance use account for this correlation. However, the generality of these associations remains in doubt because virtually all available data come from North American samples. Using data from 7 countries (total N = 5858; U.S., Argentina, Uruguay, Spain, South Africa, Canada, and England), we examined distress tolerance's association with alcohol- and cannabis-related problems in young adults. On an exploratory basis, we examined how distress tolerance related to different substance-use motivations. We found that distress tolerance was inversely related to problematic alcohol and cannabis use (rs = -0.14 and - 0.13). There was notable variation across countries in the magnitude of these effects, particularly for cannabis-related problems. Additionally, exploratory analyses revealed statistically significant (cross-sectional) indirect effects of distress tolerance on substance-related problems via substance-use motivations related to neutralizing negative emotions. Distress tolerance's role in substance-use problems appears to generalize beyond North America, although effect sizes were generally small and varied notably across geographical regions. Distress tolerance's connection with negative reinforcement processes (e.g., coping motives) warrants attention as a possible mediator of its association with problematic substance use.

Measurement issues in race ethnicity and substance use

ABSTRACT Objective To investigate substance use patterns by race and ethnicity with more detail about racial and ethnic background. There are many studies of substance use and race-ethnicity, however few studies have examined a more diversified delineation of race and ethnicity. By looking more closely at racial and ethnic groups who are multiracial and multiethnic, we may gain more information about patterns of substance use among diverse groups of people in the United States. Methods We use national data sample from the United States and delineate racial and ethnic groups. Results Findings indicate that there are substantive differences in patterns of substance use among the race, ethnic and multiracial/ethnic populations in the United States. These patterns vary by substance used and strongly suggest that we need a careful assessment of the measurement used to classify individuals as racial and ethnic people in our studies. Conclusions The measurement of racial and ethnic groups should be more fully assessed since the patterns of substance vary considerably within traditionally measured racial and ethnic groups.

Comparative Associations between Substances Used with Depression and Anxiety in a Sample of High School Students in Turkey

Objective: To explore the associations between the type and the amount of substances used with depression and anxiety symptoms by high school students. Methods: The study data was collected by the Istanbul Department of Education on 31,604 high school students which was a survey of 66 questions administered in the school setting. The primary questions and sub-questions on anxiety and depression scores were added to generate a scaled score. Specific substances used by the participants were used to explore the relationship between substance use and depression and anxiety scores by using multinomial logistic regression models. Two regression models were analyzed, one for each dependent variable, keeping the significance level at 0.05. Odds ratios were calculated to explore the association between depression and anxiety scores and specific substance use among the youth. Results: The participants with low levels of anxiety were at an increased odds of using heavy amounts of sleep pills (OR=1.6) and alcohol (OR=1.3) as compared to those without anxiety. In addition to sleep pills and alcohol, illicit substances such as LSD and inhalant use were also seen in the participants with higher levels of anxiety. The participants with low levels of depression were found to be at an increased odds of using sleep pills (OR=1.8) and alcohol (OR=1.3). In addition to this pattern of substance use, participants with higher levels of depression were also found to be heavy cocaine users, low inhalant users, heavy steroid users, and low alcohol users. A decrease in the use of homemade brews was seen in the participants with low and high levels of depression as compared to those who didn’t have any depressive symptoms. Conclusion: A unique pattern of drug and alcohol use was found in the participants experiencing varying levels of anxiety and depression.