Substance Dependence In Adulthood Research Articles

Differences between users' and addiction medicine experts' harm and benefit assessments of licit and illicit psychoactive drugs: Input for psychoeducation and legalization/restriction debates.

There is a lack of benefit/harm assessments of illicit and licit psychoactive substances performed by substance-dependent users in comparison to addiction medicine experts. We extended the analyses of substance harm/benefit assessments of German addiction medicine experts (N = 101), in parts reported recently in this journal [doi.org/10.3389/fpsyt.2020.59219], by the perspectives of substance-addicted persons. The same questionnaire as used for the abovementioned "experts-study" was handed out to inpatient detoxification or rehab treatment seeking German substance-dependent adults (N = 117) for a subsequent structured interview about harms and benefits of 33 new and traditional psychoactive substances comprising also prescription drugs. Both, users and experts, ranked the traditional illicit psychoactive substances heroin, cocaine and amphetamines within the top overall harm level group. Synthetic cannabinoids, alcohol and benzodiazepine were in a subordinate top-harm level position. Both cohorts also ranked methadone, nicotine and cannabis within the midrange and buprenorphine as well as psychotropic mushrooms within the lowest harm level positions. Experiences with prescription drugs (including opioidergic analgesics and gabapentinoids), cathinones, GHB, methamphetamine and methylphenidate was not prevalent in our user population. The same applied to barbiturates, propofol, kratom, ayahuasca with nearly zero assessments for each substance. The most user-experiences (>50% per assessed substance) were reported with nicotine, cannabis, alcohol, cocaine, heroin, amphetamine and methadone (core group). The user's overall harm ratings in terms of these psychoactive substances were similar to those of the experts with the exception of the methadone assessment which was rated by the experts to be significantly less harmful if compared with the users' estimation (supposed "treatment bias" of experts). The users' benefit ratings for the traditional illicit psychoactive substances, cannabis as well as for nicotine were significantly more positive in comparison to those of the experts (supposed "attraction bias" of users). Both, experts and users, ranked the harms arising from the use of alcohol or benzodiazepines (usually unregulated substances) higher than the harms caused by the use of methadone, cannabis or psychotropic mushrooms (regulated by most Western narcotic acts). Users attributed the most benefits to buprenorphine, methadone and cannabis. This might reflect a main limitation of the study as the data are from an user population comprising over 50% patients who sought detoxification-treatment of opiates where methadone and buprenorphine are usual transient medications (supposed "selection bias"). This study addressed current trends of psychoactive substance abuse (e.g., synthetic cannabinoids, prescription drugs) and provides from both perspectives (that of the user and that of the addiction medicine experts) robust harm/benefit evaluations at least of a core group of psychoactive substances (traditional illicit psychoactive substances, cannabis, methadone, alcohol and nicotine). The results of this study can be valuable to the psychoeducation of substance-addicted individuals and to current restriction/legalization debates, especially in the Western-EU.

Early Life Poly-Victimization and Differential Development of Anxiety as Risk Factors for the Continuity of Substance Dependence in Adulthood

Background: Abuse of psychoactive substances may lead to physical and/or physiological dependence on said substances. While a great deal of research has focused on risk factors predicting onset, there has been little research focused on risk factors influencing continued dependence on substances in adulthood following onset early in life. Purpose/Objectives: The present study examined poly-victimization and developmental patterns of anxiety as predictors of continued substance dependence problems. Methods: The Pathways to Desistance data were used in the present study. A subset of this sample was used in analyses comprising 261 juvenile offenders who reported lifetime drug and/or alcohol dependence at baseline. Firth logistic regression was used to estimate the impact that covariates had on the odds that individuals in this subsample had continued substance dependence in adulthood. Results: Results indicated that increased poly-victimization score pertaining to direct victimization at baseline was associated with increased odds of continued substance dependence problems in adulthood. Further, presentation of high and chronic anxiety symptomatology during adolescence was associated with increased risk for continued dependence. Conclusions/Importance: Drug dependent adolescents who demonstrate chronic anxiety and/or have experienced polyvictimization are at-risk for continuity of dependent in adulthood. Youth should be screened for these issues and targeted with treatment.

Early childhood maltreatment experience and later sexual behavior in Brazilian adults undergoing treatment for substance dependence.

Objective:To investigate the prevalence of early childhood maltreatment and associations with later sexual behavior among adult substance users.Methods:A cross-sectional study enrolled 134 substance dependents who sought outpatient care in São Paulo, Brazil. Childhood trauma prevalence was assessed using the Childhood Trauma Questionnaire (CTQ). The Sexual Addiction Screening Test (SAST), drug of choice (DOC), and sexual behavior were also investigated.Results:The sample was composed predominantly of single adult males (76.1%), with alcohol as the DOC (73.9%). Experiences of emotional neglect (88.1%), emotional abuse (80.6%), physical neglect (78.4%), physical abuse (64.2%), and sexual abuse (31.3%) were prevalent. Women were more likely to have been sexually abused (OR 2.9, 95%CI 1.15-7.61) and physically abused (OR 3.7, 95%CI 1.31-10.6) in childhood. Those who were sexually abused in adulthood were more likely to have suffered physical abuse in childhood (OR 6.9, 95%CI 1.45-11.8). The odds of having been sexually abused in childhood were higher among subjects who reported to have exchanged sexual favors for drugs (OR 5.7, 95%CI 1.35-9.64) and to have been sexually abused in adulthood (OR 6.1, 95%CI 5.2-12.36).Conclusion:Physical and sexual abuse in childhood are highly prevalent in substance-dependent adults, and are associated with sexual revictimization and high-risk sexual behavior in adulthood.

Comparison of clinical features, comorbidity and functioning in substance dependents with and without adult ADHD

Objective: Because of the interrelation between attention deficit hyperactivity disorder (ADHD) and substance use disorders (SUD), clinicians should consider ADHD comorbidity in assessment and treatment phase when evaluating adult substance dependence. It was aimed to compare the adult substance dependent patients with comorbid ADHD (ADHD+) and without comorbid ADHD (ADHD-) in terms of clinical features, psychiatric comorbidity and de-gree of functioning. Methods: 226 patients with substance dependence were included in the study (ADHD-=140, ADHD+=86). Diagnostic interview with SCID-I was performed. Adult ADD/ADHD DSM IV-Based Diagnostic Screening and Rating Scale, Wender Utah Rating Scale, Barratt Impulsivity Scale-11, Personal and Social Perfor-mance Scale were applied. ADHD+ and ADHD- groups were compared in terms of clinical features of substance dependence, psychiatric comorbidity and scale outcomes. Results: The group of ADHD+ was starting using sub-stance at an earlier age. Polysubstance use, number of days of substance use, and legal issues related to the substance were higher than the ADHD- group. ADHD+ group had more stimulant, opiate dependency. Rates of suicidal ideation and attempts, psychiatric comorbidity were higher in ADHD+ group. Personal and social functioning of ADHD+ group was worse. Discussion: ADHD+ group differs from the ADHD- group in terms of the clinical char-acteristics associated with the substance. In adults, there is a need for randomized, longitudinal follow-up studies involving both genders, investigating the effect of ADHD on SUD.

Psychometric properties of the Turkish version of Drug Use Disorders Identification Test–Extended (Turkish DUDIT-E) in substance-dependent adults under probation

ABSTRACTObjective: Motivation is a widely used concept in substance use treatment, which is related to the change during treatment. The Drug Use Disorders Identification Test–Extended (DUDIT-E) is one of the instruments to measure motivation. Among clients who have been screened already for drug-related problems, DUDIT-E maps the frequency of illicit drug use (D), the positive (P) and negative (N) aspects of drug use, and treatment readiness (T). The aim of the present study was to evaluate the psychometric properties of the Turkish DUDIT-E in adult male patients with substance use disorder (SUD) in Turkey.Methods: We examined the psychometric characteristics of this instrument in a population of outpatients with SUD and who are under probation (n = 196). The participants were administered the Drug Use Disorders Identification Test (DUDIT), the DUDIT-E, and the Addiction Profile Index (API).Results: Cronbach’s alpha coefficient was 0.96 for P score, 0.95 for N score, and 0.85 for T score. Principal compon...

Which adolescents develop persistent substance dependence in adulthood? Using population-representative longitudinal data to inform universal risk assessment.

To our knowledge, there are no universal screening tools for substance dependence that (1) were developed using a population-based sample, (2) estimate total risk briefly and inexpensively by incorporating a relatively small number of well-established risk factors, and (3) aggregate risk factors using a simple algorithm. We created a universal screening tool that incorporates these features to identify adolescents at risk for persistent substance dependence in adulthood. Participants were members of a representative cohort of 1037 individuals born in Dunedin, New Zealand in 1972-1973 and followed prospectively to age 38 years, with 95% retention. We assessed a small set of childhood and adolescent risk factors: family history of substance dependence, childhood psychopathology (conduct disorder, depression), early exposure to substances, frequent substance use in adolescence, sex, and childhood socioeconomic status. We defined the outcome (persistent substance dependence in adulthood) as dependence on one or more of alcohol, tobacco, cannabis, or hard drugs at ⩾3 assessment ages: 21, 26, 32, and 38 years. A cumulative risk index, a simple sum of nine childhood and adolescent risk factors, predicted persistent substance dependence in adulthood with considerable accuracy (AUC = 0.80). A cumulative risk score can accurately predict which adolescents in the general population will develop persistent substance dependence in adulthood.

Is Adult ADHD a Childhood-Onset Neurodevelopmental Disorder? Evidence From a Four-Decade Longitudinal Cohort Study.

Despite a prevailing assumption that adult ADHD is a childhood-onset neurodevelopmental disorder, no prospective longitudinal study has described the childhoods of the adult ADHD population. The authors report follow-back analyses of ADHD cases diagnosed in adulthood, alongside follow-forward analyses of ADHD cases diagnosed in childhood, in one cohort. Participants belonged to a representative birth cohort of 1,037 individuals born in Dunedin, New Zealand, in 1972 and 1973 and followed to age 38, with 95% retention. Symptoms of ADHD, associated clinical features, comorbid disorders, neuropsychological deficits, genome-wide association study-derived polygenic risk, and life impairment indicators were assessed. Data sources were participants, parents, teachers, informants, neuropsychological test results, and administrative records. Adult ADHD diagnoses used DSM-5 criteria, apart from onset age and cross-setting corroboration, which were study outcome measures. As expected, childhood ADHD had a prevalence of 6% (predominantly male) and was associated with childhood comorbid disorders, neurocognitive deficits, polygenic risk, and residual adult life impairment. Also as expected, adult ADHD had a prevalence of 3% (gender balanced) and was associated with adult substance dependence, adult life impairment, and treatment contact. Unexpectedly, the childhood ADHD and adult ADHD groups comprised virtually nonoverlapping sets; 90% of adult ADHD cases lacked a history of childhood ADHD. Also unexpectedly, the adult ADHD group did not show tested neuropsychological deficits in childhood or adulthood, nor did they show polygenic risk for childhood ADHD. The findings raise the possibility that adults presenting with the ADHD symptom picture may not have a childhood-onset neurodevelopmental disorder. If this finding is replicated, then the disorder's place in the classification system must be reconsidered, and research must investigate the etiology of adult ADHD.

Craving is associated with amygdala volumes in adolescent marijuana users during abstinence

Background: Amygdala volume abnormalities have been reported in relation to craving in substance-dependent adults, but it remains unclear if these effects are seen in adolescent marijuana (MJ) users, particularly following abstinence. Objectives: The aim of this study was to examine the relationship between amygdala volume and craving during 28 days of abstinence in adolescent MJ users. Methods: MJ-using adolescents (n = 22) aged 16–19 were recruited as part of a larger study on brain function in teen drug users. Craving measures were collected twice per week throughout a 28-day abstinence period. High-resolution anatomical magnetic resonance imaging data were collected at the end of the 28 days of confirmed abstinence. Left and right amygdala volumes were traced by hand (ICC > 0.86). Composite scores for self-reported craving and withdrawal symptoms throughout the 28-day abstinence period were calculated to provide four composite measures of total craving, mood, sleep, and somatic complaints. Results: Results revealed that greater craving during abstinence was significantly associated with smaller left and right amygdala volumes, after controlling for age and gender. Other measures of withdrawal, including mood, somatic complaints and sleep problems, were not related to amygdala morphometry. Conclusion: These results are consistent with previous findings in adult alcohol- and cocaine-dependent individuals, who demonstrated a relationship between reduced amygdala volumes and increased craving. Future studies are needed to determine if these brain-behavior relationships are attributable to MJ use or predate the onset of substance use.

Childhood ADHD and risk for substance dependence in adulthood: a longitudinal, population-based study.

BackgroundAdolescents with attention-deficit/hyperactivity disorder (ADHD) are known to be at significantly greater risk for the development of substance use disorders (SUD) compared to peers. Impulsivity, which could lead to higher levels of drug use, is a known symptom of ADHD and likely accounts, in part, for this relationship. Other factors, such as a biologically increased susceptibility to substance dependence (addiction), may also play a role.ObjectiveThis report further examines the relationships between childhood ADHD, adolescent- onset SUD, and substance abuse and substance dependence in adulthood.MethodIndividuals with childhood ADHD and non-ADHD controls from the same population-based birth cohort were invited to participate in a prospective outcome study. Participants completed a structured neuropsychiatric interview with modules for SUD and a psychosocial questionnaire. Information on adolescent SUD was obtained retrospectively, in a previous study, from medical and school records. Associations were summarized using odds ratios (OR) and 95% CIs estimated from logistic regression models adjusted for age and gender.ResultsA total of 232 ADHD cases and 335 non-ADHD controls participated (mean age, 27.0 and 28.6 years, respectively). ADHD cases were more likely than controls to have a SUD diagnosed in adolescence and were more likely to have alcohol (adjusted OR 14.38, 95% CI 1.49–138.88) and drug (adjusted OR 3.48, 95% CI 1.38–8.79) dependence in adulthood. The subgroup of participating ADHD cases who did not have SUD during adolescence were no more likely than controls to develop new onset alcohol dependence as adults, although they were significantly more likely to develop new onset drug dependence.ConclusionsOur study found preliminary evidence that adults with childhood ADHD are more susceptible than peers to developing drug dependence, a disorder associated with neurological changes in the brain. The relationship between ADHD and alcohol dependence appears to be more complex.

Age of Substance Use Onset as a Predictor of Early Adult Substance Dependence and Offending in Male and Female Delinquents

This study was designed first, to test whether sex moderated the effect of substance use onset on early adult substance dependence and offending and second, to identify the factors responsible for this effect. Structured equation modeling with 1,281 adjudicated delinquents (1,104 males, 177 females) from the Pathways to Desistance study revealed that sex moderated the onset–substance dependence and onset–offending relationships. Whereas age of substance use onset predicted early adult substance dependence in both males and females, it only predicted early adult offending in males. Out of six putative mediators, only one, adolescent moral disengagement, satisfied the criteria for mediated moderation. Mediation of the moderated onset–offending relationship was the result of moral disengagement correlating with both age of substance use onset and early adult offending in male but not female delinquents. Moral disengagement displayed similar patterns of correlation in the onset–substance dependency relationship but failed to satisfy all criteria for mediated moderation.

Association of cognitive functioning with treatment outcomes of substance-dependent adults with major depression

Association of cognitive functioning with treatment outcomes of substance-dependent adults with major depression

Functional Magnetic resonance Imaging Clinical Trial of a Dual-Processing Treatment Protocol for Substance-Dependent Adults

Objectives: Empirical evidence suggests substance dependence creates stress system dysregulation which, in turn, may limit the efficacy of verbal-based treatment interventions, as the recovering brain may not be functionally capable of executive level processing. Treatment models that target implicit functioning are necessary. Methods: An RCT was conducted to examine the effects of a dual-processing (DP) intervention compared to a didactic standard care (RP) model on brain function change in substance-dependent adults (N=29). Results: fMRI analyses showed decreased amygdala activation simultaneous with increased frontal lobe (medial frontal gyrus and ACC) activation in the DP group during passive watch condition, while the RP group showed continued amygdala activation simultaneous to frontal lobe activation during drug stressor presentation at post-treatment. Conclusions: Our study offers preliminary evidence that DP acts on neural functioning in ways that increase regulatory response in the presence of drug stressor cues by enhancing top-down functioning and diminishing amygdala reactivity.

Prospective effects of adolescent indicators of behavioral disinhibition on DSM-IV alcohol, tobacco, and illicit drug dependence in young adulthood

ObjectiveTo identify robust predictors of drug dependence. MethodsThis longitudinal study included 2361 male and female twins from an ongoing longitudinal study at the Center for Antisocial Drug Dependence (CADD) at the University of Colorado Boulder and Denver campuses. Twins were recruited for the CADD project while they were between the ages of 12 and 18. Participants in the current study were on average approximately 15years of age during the first wave of assessment and approximately 20years of age at the second wave of assessment. The average time between assessments was five years. A structured interview was administered at each assessment to determine patterns of substance use and Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; Fourth Edition) attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), and drug dependence symptoms. Cloninger's Tridimensional Personality Questionnaire was also used to assess novelty seeking tendencies (NS). At the second wave of assessment, DSM-IV dependence symptoms were reassessed using the same interview. Path analyses were used to examine direct and indirect mechanisms linking psychopathology and drug outcomes. ResultsAdolescent substance use, CD, and NS predicted young adult substance dependence, whereas the predictive effects of ADHD were few and inconsistent. Furthermore, CD and NS effects were partially mediated by adolescent substance use. ConclusionsAdolescent conduct problems, novelty seeking, and drug use are important indices of future drug problems. The strongest predictor was novelty seeking.

Relationship between attention deficit hyperactivity disorder and alcohol dependence: a genetic view.

Dear Editor, Attention deficit hyperactivity disorder (ADHD), is a common, highly heritable childhood-onset psychiatric disorder affecting 2% – 6% of children worldwide. The recent paper examines the effects of child and adult ADHD symptoms in adults among male students on adult addiction acknowledgment and alcoholism potential (1). This article is an original study which provides that adult ADHD and child ADHD predict addiction acknowledgment while child ADHD and impulsivity predict alcohol potential. These findings add new evidence about prediction of adolescent and adult drug abuse and use by early ADHD. However, the biological mechanism of the relationship between ADHD and substance problems is still unclear. One of the important mechanisms is genetic correlation due to shared genetic loci. First, it has been shown that both ADHD and alcohol dependence have strong genetics components. Twin and adoption studies have indicated that ADHD has high heritability in the range of 75% – 91% (2), while family, twin, and adoption studies have revealed that genetic and environmental factors and their interactions contribute to the development of alcohol dependence, with a heritability of more than 50% (3). Second, ADHD has been found to be highly comorbid with nicotine dependence and alcohol dependence. Segregation analysis has provided multigenerational evidence of cosegregation among ADHD, nicotine dependence, and alcohol dependence, while linkage analysis has suggested several regions on human chromosomes with pleiotropic effects on ADHD and alcohol dependence (4). For example, significant linkages at 4q13.1 - 13.2 and 5q31 - 33 for ADHD has been implicated in alcohol dependence and nicotine dependence (4). Third, genetic association studies have suggested several genes which are responsible for both ADHD and alcohol dependence. For example, it has been reported associations between the dopamine transporter (DAT) gene polymorphisms and human disorders including ADHD and alcohol dependence (5). The variants of the dopamine D2 receptor gene (DRD2) has been found to be associated with alcoholism, drug dependency, obesity, smoking, pathological gambling, ADHD, Tourette syndrome, as well as other related compulsive behaviors (6). The tachykinin receptor 1 (TACR1) gene has been reported to be associated with bipolar disorder and alcoholism as well as ADHD (2). However, parts of the associations are not strong and the results are not always consistent due to biologic mechanisms (genetic heterogeneity, gene-gene interactions and gene-environment interactions etc.) and spurious mechanisms (inadequacies of genomic markers, type 1 error, limited sample sizes and power, cohort and age effects, and bias etc.). In addition, some other genes, such as the nicotinic receptor CHRNA5-A3-B4 subunit genes, do not contribute to the common genetic predisposition of ADHD and alcohol dependence (2, 7). In short, the current results not only support previous studies about the relationship between ADHD and alcohol and drug dependence but also provide further evidence on prediction of future substance dependence in adulthood through early ADHD (1). However, the sample size for the current study is relative small; therefore the results need further investigation using large sample and confirmation in other populations. In addition, further genetic and epigenetic study to identify the disease-causing variants including gene-environment interactions in ADHD and alcohol dependence would have promise for understanding the pathogenesis of these comorbity psychiatric disorders, predicting the risks and developing potential treatments for ADHD and alcohol dependence.

Disparities in safe sex counseling & behavior among individuals with substance dependence: a cross-sectional study

BackgroundDespite the vast literature examining disparities in medical care, little is known about racial/ethnic and mental health disparities in sexual health care. The objective of this study was to assess disparities in safe sex counseling and resultant behavior among a patient population at risk of negative sexual health outcomes.MethodsWe conducted a cross-sectional analysis among a sample of substance dependent men and women in a metropolitan area in the United States. Multiple logistic regression models were used to explore the relationship between race/ethnicity (non-Hispanic black; Hispanic; non-Hispanic white) and three indicators of mental illness (moderately severe to severe depression; any manic episodes; ≥3 psychotic symptoms) with two self-reported outcomes: receipt of safe sex counseling from a primary care physician and having practiced safer sex because of counseling.ResultsAmong 275 substance-dependent adults, approximately 71% (195/275) reported ever being counseled by their regular doctor about safe sex. Among these 195 subjects, 76% (149/195) reported practicing safer sex because of this advice. Blacks (adjusted odds ratio (AOR): 2.71; 95% confidence interval (CI): 1.36,5.42) and those reporting manic episodes (AOR: 2.41; 95% CI: 1.26,4.60) had higher odds of safe sex counseling. Neither race/ethnicity nor any indicator of mental illness was significantly associated with practicing safer sex because of counseling.ConclusionsThose with past manic episodes reported more safe sex counseling, which is appropriate given that hypersexuality is a known symptom of mania. Black patients reported more safe sex counseling than white patients, despite controlling for sexual risk. One potential explanation is that counseling was conducted based on assumptions about sexual risk behaviors and patient race. There were no significant disparities in self-reported safer sex practices because of counseling, suggesting that increased counseling did not differentially affect safe sex behavior for black patients and those with manic episodes. Exploring the basis of how patient characteristics can influence counseling and resultant behavior merits further exploration to help reduce disparities in safe sex counseling and outcomes.Trial registrationNCT00278447

Predictors of Treatment Retention for Substance-Dependent Adults with Co-occurring Depression

Low attendance in addiction treatment, particularly in cases of comorbidity, has been identified as a pervasive challenge. We examine predictors of treatment retention in a sample of veterans (N = 253) participating in a clinical trial comparing two types of psychotherapy for co-occurring depression and substance use disorders. The study protocol included 24 weeks of outpatient group psychotherapy in either a newly developed Integrated Cognitive Behavioral Therapy (ICBT) or Twelve-Step Facilitation Therapy (TSF). Using a model of treatment utilization developed by Aday and Anderson, we analyzed predictors categorized into predisposing factors, enabling resources, need for treatment, and type of treatment received. Outcome included total number of sessions attended (maximum of 36 sessions). Treatment retention did not differ between the two study interventions. Bivariate analyses indicated that predisposing factors were most predictive, with older participants, Caucasians, and those using only alcohol in the month before treatment attending more sessions, and individuals who had recently experienced a health event remained in treatment longer. Importantly, several factors were not related to treatment retention: marital status, education, neuropsychological functioning, financial stress, chronic health problems, treatment motivation, and psychiatric severity. In the combined model of predisposing, enabling and need factors, age and ethnicity were the only significant predictors.

Is It Important to Prevent Early Exposure to Drugs and Alcohol Among Adolescents?

Exposure to alcohol and illicit drugs during early adolescence has been associated with poor outcomes in adulthood. However, many adolescents with exposure to these substances also have a history of conduct problems, which raises the question of whether early exposure to alcohol and drugs leads to poor outcomes only for those adolescents who are already at risk. In a 30-year prospective study, we tested whether there was evidence that early substance exposure can be a causal factor for adolescents' future lives. After propensity-score matching, early-exposed adolescents remained at an increased risk for a number of poor outcomes. Approximately 50% of adolescents exposed to alcohol and illicit drugs prior to age 15 had no conduct-problem history, yet were still at an increased risk for adult substance dependence, herpes infection, early pregnancy, and crime. Efforts to reduce or delay early substance exposure may prevent a wide range of adult health problems and should not be restricted to adolescents who are already at risk.

Adolescent stressors, psychopathology, and young adult substance dependence: a prospective study.

There is much theory, but sparse empirical evidence, supporting the notion that internalizing symptoms and negative affect are the mechanism by which exposure to stressful life events influence the development of substance-use disorders in adolescence and young adulthood. However, many empirical studies have shown that, in addition to elevations in internalizing symptoms, exposure to stressful life events also produces elevations in externalizing behaviors and conduct problems, which are important risk factors for substance-use disorders. The current study tested adolescent externalizing and internalizing symptoms as competitive mediators of the effects of stressors on young adult drug dependence. Data from an ongoing study of children of alcoholics (n=223) and matched controls (n=204) were collected in two annual interviews in adolescence and two follow-ups in young adulthood. Experiencing stressful life events during adolescence led to increases in both externalizing and internalizing symptoms, but only externalizing symptoms mediated the later effects of adolescent stressors on young adult drug dependence. These findings suggest that understanding how stressors produce elevations in behavioral problems may provide important insights into understanding how broad environmental risk factors lead to substance dependence and suggests that processes other than affect regulation may operate in the pathway from the experiences of stressors to substance use and disorder.

Does initial treatment focus influence outcomes for depressed substance abusers?

Interventions for alcohol- and substance-dependent adults with comorbid depressive disorders are needed, but few have been empirically tested. In a randomized clinical trial of two psychotherapy interventions for these disorders, we examined whether initial focus of treatment was related to retention, substance use, and depression outcomes. Both interventions, integrated cognitive–behavioral therapy (ICBT; n = 105) and twelve-step facilitation ( n = 92), were delivered in group formats with entry points every 4 weeks at the beginning of three content-distinct modules. Entry module (i.e., initial treatment focus) was not related to percentage days abstinent, proportion of the sample abstinent, or depression symptoms for either intervention. This was true at both 12 and 24 weeks postbaseline. Furthermore, attendance was similar for both treatments, regardless of initial treatment focus, with a single exception in the ICBT condition. Our findings support the use of modular formats with multiple or rotating entry points for psychotherapy group interventions.

A Prospective Study of the Effects of Age of Initiation of Alcohol and Drug Use on Young Adult Substance Dependence*

Previous cross-sectional research has disagreed about whether an adolescent's age of onset of alcohol use is a unique predictor of later alcohol dependence or whether it is merely a correlate of those factors that produce alcohol dependence. The current study tests this question in a longitudinal sample, and extends the literature by testing whether age of onset of alcohol and drug use predicts alcohol and drug dependence. Data from an ongoing study of children of alcoholics and matched controls (n = 395) were collected during three annual interviews during adolescence and two 5-year follow-ups in young adulthood. Taking a first drink of alcohol at or before age 13 was unrelated to the odds of alcohol and drug dependence when the adolescent did not also participate in early drug use or when correlated risk factors were taken into account. On the other hand, early drug use elevated the odds of drug dependence by young adulthood, even while controlling for shared risk factors. The current study provides support for the notion that early-adolescent onset of alcohol use is a marker of risk for later dependence rather than a causal influence. Moreover, it provides evidence for the impact of early drug use on drug-substance dependence. Implications for theory and intervention are discussed.