Adult Substance Misuse Research Articles

Prevalence of substance use among adolescents residing in urban slums of Vellore: A cross-sectional study

ABSTRACT Background: Adolescent substance abuse is a growing public health concern. Adolescence is the starting point for adult substance misuse. The likelihood of acquiring dependence in adulthood is significantly decreased when substance use is not initiated during adolescence. The purpose of this study was to estimate the prevalence of substance use among teenagers, as well as to determine the age of initiation and identify the factors that are linked to substance use. Methods: A community-based cross-sectional study was conducted in an urban community in Vellore by a tertiary care teaching hospital. A structured questionnaire was administered by the principal investigator to all adolescent boys aged between 10 and 19 years residing in that area for the past year who gave informed consent/assent to assess the prevalence of substance use among teenagers. Results: The total number of adolescent boys enrolled in the study was 266. The mean (standard deviation [SD]) age of the participants was 16.14 (2.2) years, with a median age of 16 years. Out of the 266 adolescent boys, 33.8% are currently using substances and 15% were past users. The common substance used was smoking tobacco (30%), followed by alcohol consumption (29%). The minimum age of initiation of smoking tobacco and ganja use was 9 and 7 years, respectively. Significant predictors of substance usage included the participant’s educational background and the substance use of their parents. Conclusion: According to this community-based study’s findings, smoking tobacco was the most frequently used substance by teenagers, with a higher prevalence of current substance use. Substance misuse in the family was substantially associated with increased drug usage among teenagers. Notwithstanding having an adequate comprehension of the negative results of substance utilisation, teenagers develop this habit, which they might carry into adulthood. It is therefore necessary to establish comprehensive prevention and control programs in schools and the community that target teenagers and their parents.

Substance misuse in adults with primary tic disorders (P12-11.012)

<h3>Objective:</h3> To estimate prevalence of substance use disorder (SUD) in adults with tics and characterize relationship with sex, age, psychiatric comorbidities and tic severity. <h3>Background:</h3> There are few data regarding SUD in adults with tics. One Swedish population-based study reported a high SUD-prevalence (15.9%) in people with Tourette syndrome (Virtanen et al, 2020). <h3>Design/Methods:</h3> From our Calgary and Paris Adult Tic Registry, we included adults with primary tic disorders who answered to the Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) Tool for substance use screening. For alcohol, tobacco, and cannabis, SUD was possible if the TAPS score was 2+. For illicit and prescription drugs, we used a cut-off of 1+ to identify problem use. We compared the prevalence of possible SUD in our cohort with the Swedish study’s results (Z-test). We looked for associations between possible SUD and age, sex, psychiatric comorbidities and tic severity using logistic/linear regression. <h3>Results:</h3> We included 139 participants (122 with Tourette syndrome; mean age: 32.5 years; 64.0% males; 53.2% Canadian, 46.8% French). A total of 28/139 (20.2%) had possible SUD for alcohol, 16/139 (11.5%) for tobacco and 15/139 (10.8%) for cannabis. For other substances: 7/139 (5.0%) were likely to have a problem use with cocaine/crack/methamphetamine, 1/139 (0.7%) with heroine, 1/139 (0.7%) with opioids, 11/139 (7.9%) with sedative drugs and 1/139 (0.7%) with stimulants for attention deficit/hyperactivity disorder (ADHD). Prevalences of possible overall-SUD (37%) and alcohol-SUD were higher than in the Swedish cohort (p=0.0142 and p&lt;0.00001). Total tic severity score was higher in people with possible SUD (p=0.017). Depression and anxiety were significantly associated with possible cannabis-related SUD (OR=3.5 and OR=7.2 respectively). Age, sex, comorbid ADHD and obsessive-compulsive disorder were not significantly associated with possible SUD. <h3>Conclusions:</h3> Thirty-seven % of adults with tic disorders have possible SUD related to alcohol, tobacco or cannabis, and require further diagnostic assessment. <b>Disclosure:</b> Ms. Nilles has received research support from French Gilles de la Tourette Association. Ms. Nilles has received research support from Owerko Centre of Alberta Children’s Hospital Research Institute. Ms. Nilles has received research support from Assistance Publique - Hôpitaux de Paris. Dr. Roze has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for merz. Dr. Roze has received personal compensation in the range of $500-$4,999 for serving as a Consultant for orkyn. Dr. Roze has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for elivie. Dr. Roze has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for allergan. Dr. Roze has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Orkyn. Dr. Roze has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for elivie. Dr. Roze has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Aguettant. The institution of Dr. Roze has received research support from merz. The institution of Dr. Roze has received research support from Orkyn. Dr. Roze has received research support from elivie. The institution of Dr. Roze has received research support from allergan. The institution of Dr. Roze has received research support from fondation desmarest. The institution of Dr. Roze has received research support from everpharma. Dr. Roze has received research support from AMADYS. The institution of Dr. Roze has received research support from ADCY5.org. The institution of Dr. Roze has received research support from agence nationale de la recherche. The institution of Dr. Roze has received research support from société française de médecine esthétique. The institution of Dr. Roze has received research support from dystonia medical research foundation. Andreas Hartmann has nothing to disclose. Dr. Worbe has nothing to disclose. The institution of Mr. Bendetowicz has received research support from Fondation Recherche Médicale. Dr. Szejko has nothing to disclose. Mrs. SERARI has nothing to disclose. Julian Fletcher has nothing to disclose. Dr. Martino has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Martino has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Merz Pharma Canada Ltd.. The institution of Dr. Pringsheim has received research support from Maternal Newborn Child and Youth Strategic Clinical Network. The institution of Dr. Pringsheim has received research support from Owerko Center of Alberta Children’s Hospital Research Institute. The institution of Dr. Pringsheim has received research support from Canadian Institutes of Health Research. The institution of Dr. Pringsheim has received research support from Public Health Agency of Canada.

Exploring Over the Counter and Prescription Only Medication misuse amongst adults accessing specialist treatment services: A survey during COVID-19

IntroductionAn improved understanding of Over the Counter (OTC) and Prescription Only Medication (POM) misuse by people who access substance misuse services (SMS) is essential so that appropriate treatment interventions can be provided. There is growing awareness and concerns about this issue, especially during COVID-19; however, there is a paucity of published data (1, 2).AimTo use a questionnaire to explore the misuse of OTC/POM by adults accessing SMS, including the types of medication involved, demographic characteristics, the use of other substances and changes during COVID-19.MethodsFollowing successful piloting, an anonymous (online/paper) self-administered survey was completed by English-speaking adults (18 years or over) currently accessing SMS with a purposive sampling approach. This was undertaken in community SMS across England, provided by one of the UK’s largest third sector organisations. Quantitative analysis was undertaken using SPSS and thematic analysis for qualitative data.ResultsIn 2021, 80 questionnaires were completed, and the 56 that met the inclusion criteria were analysed. All were caucasian (94.6% British), aged between 18 and 61 years and the majority identified as male (58.9%). Forty respondents (71.4%) were in receipt of prescribed interventions for their use of substances, with an adherence rate of 92.5% despite increased liberalisation of dispensing arrangements and additional challenges during COVID-19. In the preceding month 44.6% used alcohol (52% daily), 73.2% used tobacco/vaped and 58.9% used illicit substances concomitantly. Twenty-one (37.5%) reported misusing more than one OTC/POM, route of administration was predominantly oral and ease of their availability was conveyed. Relationships between categories were tested using chi-square/Fisher’s exact test and statistically significant relationships (p <0.05) were identified between the misuse of codeine and the prescribing of oral opioid substitute treatment, and changes during COVID-19 to OTC/POM and illicit misuse. Generally respondents were very complimentary about SMS, outlining the positive impact of accessing pharmacological and psychosocial interventions. However, the need for more training/education and psychologically informed approaches by GPs and pharmacies was highlighted: there was a theme of primary care restrictions on access to medicines leading to escalating OTC/POM misuse and increased use of unregulated illicit sources.ConclusionConducting research during a pandemic is exceptionally challenging. OTC/POM misuse is occurring amongst people accessing SMS and polypharmacy is concerning. A renewed approach to liberalisation, withdrawal management and training for primary care professionals must be considered. Improvements at a systems-level and changes to commissioning/national pathways may assist this and further research is required to explore the themes identified.References(1) Gittins R, Missen L, Maidment I. Misuse of medication in adult substance misuse services: a systematic review protocol. BMJ Open 2021;11:e047283. doi: 10.1136/bmjopen-2020-047283(2) Gittins R, Cole S. Buprenorphine for the management of kratom dependency during covid-19: A case report. Drug Science, Policy and Law. January 2021. doi:10.1177/20503245211021193

Misuse of over the counter and prescription only medication by people accessing specialist treatment services: a systematic review

Abstract Introduction Over the Counter (OTC) and Prescription Only Medication (POM) are misused by people who access substance misuse services (SMS). Harms include impact upon physical/mental wellbeing and potentially fatal overdoses, with concerns growing amongst healthcare professionals, commissioners and the general public (1). SMS must respond to increasing demand and no known systematic review has explored this (2). Aim To examine the literature on the pattern of OTC/POM misuse among adults accessing SMS, including the types of medication, prevalence and associated characteristics. Methods The protocol for this systematic review has been published (2), registered on PROSPERO (CRD42020135216) and undertaken in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive search was conducted, incorporating Cochrane, OVID Medline, Pubmed, Scopus and Web of Science databases and grey literature. Two independent reviewers conducted the title and abstract screenings, followed by full-text reviews, using predetermined selection criteria. Only publications in English, outlining OTC/POM misuse by adults (18 years or over) in receipt of psychological/pharmacological interventions for substance misuse were included. A third reviewer resolved disagreements if consensus could not be reached. Data was extracted using a pilot-tested form, from full-texts of included studies to ensure a consistent approach. Heterogeneity was assessed and the Mixed Methods Appraisal Tool (MMAT) considered the risk of bias for all studies. Results In 2021, the database search provided 3684 results, reducing to 2047 after reviewing grey literature, hand-checking reference lists and removing duplicates. Ineligible publications were excluded, resulting in 143 potentially relevant papers. Restricting to UK-based publications reduced this to thirteen with notable heterogeneity. The third reviewer was consulted on one occasion. Meta-/subgroup analyses were not feasible due an absence of randomised controlled trials/systematic reviews, the limited consistent information available and insufficient detail across all publications; therefore, a narrative synthesis was conducted. To reduce bias risk and add robustness, all publications were included. Based on the MMAT assessment, GRADE-CERQual indicated ‘high confidence’ for all review findings, despite moderate methodological limitations. Benzodiazepines, opioids and antihistamines were most frequently cited, and predominantly sourced online, from (various) GPs/pharmacies, street dealers and friends/family. Some older publications mentioned medicines that are no longer used in clinical practice. Adverse consequences included complications from injecting, criminal activity and withdrawal symptoms which perpetuated use. Misuse also occurred for other reasons, including desired psychoactive effect, to manage psychiatric/pain conditions and street drug shortages. There was significant variance in use, often alongside other substances, especially amphetamine, cannabis and opioids. Conclusion Restricting to UK-only due to the resource available notably limited the number of publications; however, this enabled a more detailed assessment and increased the relevance of findings, because there are differences in drug markets and medicine availability between countries. OTC/POM misuse is common amongst people accessing SMS and polypharmacy is concerning. A different approach to the management of OTC/POM misuse may be required: SMS improvements including withdrawal management must be considered and the need for further UK-based research was highlighted. References (1) Advisory Council on the Misuse of Drugs. Diversion and Illicit Supply of Medicines. London: Home Office; 2016. (2) Gittins R, Missen L, Maidment I. Misuse of medication in adult substance misuse services: a systematic review protocol. BMJ Open 2021;11:e047283.

ROLE OF PARENTAL, SCHOOL AND PEER GROUPS IN PREVENTION OF SUBSTANCE ABUSE

This research is an attempt to assess the role of parents, schools, and peer groups in substance abuse prevention. Substance misuse is more common in persons, particularly children, who believe they are ignored by others, are excluded from their peer groups, and have no one with whom to discuss their problems. Such children utilise escapism to escape from all of life's worries by immersing themselves in a completely fictional yet lovely world. This world, on the other hand, is a fleeting pleasure that can cost one's life. The direct and indirect effects of alcohol and other drugs on children can result in a variety of negative health and safety consequences for the kid, family, and community. Understanding the dangers and how to avoid them A first step toward alleviating the problem of drug use in the paediatric population is to identify factors that may influence the development of substance dependence. This page analyses the literature on substance abuse prediction, protection, and prevention in children, as well as a list of available preventative programmes for children of various ages. The earlier a youngster begins drinking and using other drugs, the greater the chance of catastrophic health repercussions and adult substance misuse. Accidental and purposeful deaths connected with adolescent drug and alcohol use are one of the main preventable causes of death in the 15- to 24-year-old demographic. Adolescents who use alcohol or other drugs have an increased risk of academic underachievement, delinquency, teenage pregnancy, and depression. Multiple medical consequences have resulted from inadvertent passive drug exposure in infants and toddlers, including respiratory infections, seizures, changed mental status, and death. There are numerous factors that lead to the formation of substance misuse in children. Prevention and intervention programmes that use research-based, comprehensive, culturally relevant social resistance skills training and normative education in an active school-based learning format can address behavioral, emotional, and environmental factors that put children at risk for substance abuse.

Misuse of medication in adult substance misuse services: a systematic review protocol

IntroductionThere is a growing concern about the misuse of over the counter (OTC) and prescription only medication (POM) because of the impact on physical and mental health, drug interactions, overdoses...

Creating Virtual Reality Based Interventions for Older Adults Impacted by Substance Misuse: Safety and Design Considerations

Virtual reality (VR) is an emerging evidence-based intervention approach that has been successfully used to address substance use disorders (SUDs) and manage chronic pain in young and middle age adults. However, the safe and effective use of VR-based interventions with older adults living with SUDs has not been established. This article outlines considerations for researchers wishing to develop and test VR-based intervention approaches for older adults impacted by substance misuse. An overview of older adult substance misuse and treatment needs will be provided, followed by a review of ethics and general safety related considerations for using VR based intervention approaches with an older adult population.

Lofexidine: A Novel Treatment Option for Opioid Withdrawal Symptoms.

Substance misuse in adults 60 years of age and older is one of the fastest-growing health issues in the United States. Alcohol and prescription drugs are among the most commonly misused agents. With growing concern for opioid-overdose deaths and the use of opioids in the treatment of persistent pain in older adults, it is imperative that practitioners are aware of emerging therapies used to manage the symptoms that may result after discontinuation of opioid medications. This review highlights the first nonopioid treatment plan for the management of opioid withdrawal symptoms with a novel pharmacologic mechanism.

Predictors of substance use in youth with borderline personality disorder.

Concomitant substance misuse in adults with borderline personality disorder (BPD) is associated with a more severe course of illness and poorer outcomes. Previous research has found an association between the number of borderline personality features and substance misuse in community samples. This study examined the relationship between substance use and severity of BPD in youth presenting for the first time for treatment (first presentation) of BPD. Participants were 117 help-seeking youth aged 15-25 years (93 females; Mage = 19.0 years, SD = 2.8) with BPD. Hierarchical logistic regression was used to investigate whether the severity of BPD predicted substance use. After adjusting for demographic factors and concurrent mental state pathology, BPD independently predicted alcohol dependence, amphetamine use in the previous month, or use of 2 or more illicit substances in the previous month but not daily tobacco use or cannabis use in the previous month. BPD might increase the probability that an individual will engage in higher-risk behaviors, such as amphetamine and polysubstance use, or problematic alcohol use. These findings support the need for assessment of youth with BPD for alcohol, amphetamine, and polysubstance use along with the need for routine screening in drug and alcohol services for BPD features. (PsycINFO Database Record

Predicting Reinforcement and Punishment Behaviors in College Students Coping with Substance Misuse: An Application of Inconsistent Nurturing as Control Theory

Managing a romantic partner’s substance misuse can be challenging, especially in cases where attempts to show support end up worsening the negative behavior. Understanding what might predict one’s actions towards a partner who smokes or drinks can help to alleviate some of the difficulty associated with these interactions. Therefore, this study was designed to examine how issues of undesirable substance use are managed within college students’ romantic relationships. More specifically, the study applied inconsistent nurturing as control theory to assess the extent to which relational uncertainty, perceived network helpfulness, and perceived network hindrance predict the reinforcement and/or punishment of a partner’s smoking or drinking. Results from cross-sectional, self-report survey data (n = 203) revealed that perceived network helpfulness and hindrance were both significant predictors of punishment but not reinforcement. Relational uncertainty was not a significant predictor of reinforcement or punishment. Implications for studying predictors of reinforcement and punishment strategies are discussed, as is the importance of communicating about young adult substance misuse within romantic relationships.

PROSPER delivery of universal preventive interventions with young adolescents: long-term effects on emerging adult substance misuse and associated risk behaviors

Substance misuse and associated health-risking behaviors are prevalent in emerging adulthood. There is a knowledge gap concerning the post-high school effects of community-based delivery systems for universal preventive interventions implemented during young adolescence. This study reports effects of the PROSPER delivery system through age 19, 7.5 years past baseline. A cohort sequential design included 28 public school districts randomly assigned to the PROSPER partnership delivery system or usual-programming conditions. PROSPER community teams implemented a family-focused intervention in 6th grade and a school-based intervention in 7th grade. Outcomes for the age 19, post-high school report included lifetime, current, and frequency of substance misuse, as well as antisocial and health-risking sexual behaviors. Intent-to-treat, multi-level analyses of covariance of point-in-time outcomes were conducted, along with analyses of risk-related moderation of intervention effects. Results showed emerging adults from PROSPER communities reported significantly lower substance misuse across a range of types of substances, with relative reduction rates of up to 41.0%. No significant findings were observed for associated antisocial and health-risking sexual behavior indices; or for lifetime rates of sexually transmitted infections. Risk-related moderation effects were non-significant, suggesting generally comparable outcomes across higher- and lower-risk subgroups of emerging adults. The PROSPER delivery system for brief universal preventive interventions has potential for public health impact by reducing long-term substance misuse, with positive results extending beyond high school.

Replicating and extending a model of effects of universal preventive intervention during early adolescence on young adult substance misuse.

This brief report summarizes a replication and extension of a developmental outcome modeling study, by examining whether delayed substance initiation during adolescence, resulting from universal middle school preventive interventions, reduces problematic use in young adults Ages 25 and 27, up to 14.5 years after baseline. Participants were middle school students from 36 Iowa schools randomly assigned to the Strengthening Families Program plus Life Skills Training (SFP 10-14 + LST), LST-only, or a control condition. Self-report questionnaires originally were collected at 11 time points, through Age 22. A subsequent grant allowed for assessments at Ages 25 and 27, including measures of drunkenness, alcohol-related problems, cigarette use, illicit drug use (lifetime and frequency), marijuana use and prescription drug misuse. These outcomes were modeled as variables influenced by growth factors describing substance initiation during adolescence. Models included the effects of baseline risk, intervention condition assignment, and their interaction; risk-related moderation effects were examined and relative reduction rates were calculated for dichotomous variables. Model fits were good. Analyses showed significant or marginally significant indirect intervention effects on all outcomes, through effects on adolescent substance initiation growth factors. Intervention × Risk interaction effects favored the higher risk subsample, replicating earlier findings. Additional direct effects on young adult use were observed only for cigarette frequency. Relative reduction rates were larger for the higher risk subsamples, ranging from 3.9% to 36.2%. Universal preventive interventions implemented during early adolescence have the potential to decrease the rates of substance misuse and associated problems into young adulthood. (PsycINFO Database Record

Supplemental Material for Replicating and Extending a Model of Effects of Universal Preventive Intervention During Early Adolescence on Young Adult Substance Misuse

Supplemental Material for Replicating and Extending a Model of Effects of Universal Preventive Intervention During Early Adolescence on Young Adult Substance Misuse

Replication RCT of early universal prevention effects on young adult substance misuse.

For many substances, more frequent and problematic use occurs in young adulthood; these types of use are predicted by the timing of initiation during adolescence. We replicated and extended an earlier study examining whether delayed substance initiation during adolescence, resulting from universal preventive interventions implemented in middle school, reduces problematic use in young adulthood. Participants were middle school students from 36 Iowa schools randomly assigned to the Strengthening Families Program: For Parents and Youth 10-14 (Molgaard, Spoth, & Redmond, 2000) plus Life Skills Training (LST; Botvin, 1995, 2000), LST-only, or a control condition. Self-report questionnaires were collected at 11 time points, including 4 during young adulthood. The intercept (average level) and rate of change (slope) in young adult frequency measures (drunkenness, alcohol-related problems, cigarettes, and illicit drugs) across ages 19-22 were modeled as outcomes influenced by growth factors describing substance initiation during adolescence. Analyses entailed testing a 2-step hierarchical latent growth curve model; models included the effects of baseline risk, intervention condition assignment, and their interaction. Analyses showed significant indirect intervention effects on the average levels of all young adult outcomes, through effects on adolescent substance initiation growth factors, along with Intervention × Risk interaction effects favoring the higher risk subsample. Additional direct effects on young adult use were observed in some cases. Relative reduction rates were larger for the higher risk subsample at age 22, ranging from 5.8% to 36.4% on outcomes showing significant intervention effects. Universal preventive interventions implemented during early adolescence have the potential to decrease the rates of substance use and associated problems into young adulthood.

Supplemental Material for Replication RCT of Early Universal Prevention Effects on Young Adult Substance Misuse

Supplemental Material for Replication RCT of Early Universal Prevention Effects on Young Adult Substance Misuse

Re‐offending in forensic patients released from secure care: The role of antisocial/borderline personality disorder co‐morbidity, substance dependence and severe childhood conduct disorder

Research suggests that a particular externalising phenotype, manifested in a developmental trajectory from severe childhood conduct disorder through early-onset substance abuse to adult antisocial/borderline personality disorder co-morbidity, may increase risk of antisocial behaviour in general and criminal recidivism in particular. This study aims to test the hypothesis that antisocial/borderline co-morbidity together with the triad of substance dependence, severe conduct disorder and borderline pathology would result in an increased risk of criminal recidivism. Fifty-three men who had been assessed and treated in a secure hospital unit were followed up after they had returned to the community. They were assessed for severity of the following: (i) antisocial personality disorder; (ii) borderline personality disorder; (iii) drug/alcohol dependence; and (iv) high Psychopathy Checklist Revised scores (factors 1 and 2). Patients with antisocial/borderline co-morbidity took significantly less time to re-offend compared with those without such co-morbidity. Both Psychopathy Checklist Revised factor 2 and the tripartite risk measure significantly predicted time to re-offence; the former largely accounted for the predictive accuracy of the latter. Risk of criminal recidivism can be adequately assessed without recourse to the pejorative term 'psychopath'. It is sufficient to assess the presence of the three elements of our risk measure: borderline and antisocial personality disorders in the context of drug/alcohol dependence and severe childhood conduct disorder. Practical implications of the study are as follows. (i) Sound assessment of personality, inclusive of a detailed history of childhood conduct disorder as well as adolescent and adult substance misuse, yields good enough information about risk of recidivism without recourse to the pejorative concept of 'psychopathy'. (ii) Given the high risk of alcohol-related violence in individuals with antisocial/borderline co-morbidity, there is a need for specific alcohol-directed interventions to help such men retain control of their substance use.

Fractionating the Impulsivity Construct in Adolescence

The teenage years are often associated with ‘impulsive' behavior; that is, behavior with diminished regard to potential negative consequences. Adolescent impulsivity, while often adaptive, can manifest itself in a range of sub-optimal behaviors, including use of nicotine, alcohol, or illicit substances, symptoms associated with attention deficit hyperactivity disorder (ADHD), or poorer performance on laboratory assays of impulse control. Although these maladaptive behaviors are often co-morbid, their correlation is not perfect. It is therefore increasingly recognized that impulsivity is multi-dimensional, with some predicting that ‘what is generally denoted as impulsivity will be fractionated into distinct forms that may, however, often coexist in the same individual' (Dalley et al, 2011, page 691). Fractionating impulsivity is challenging, not least because of the large sample size needed to ensure an adequate number of participants in each phenotypic group, although recently the ‘population neuroscience' (Paus, 2010) approach has provided these large samples. Data from the IMAGEN (Schumann et al, 2010) project permitted the data-driven identification of impulsivity subtypes by Whelan et al (2012). Nearly 1900 14-year-olds completed a test of motor inhibition—the Stop Signal Task (SST)—while undergoing functional magnetic resonance imaging (fMRI). The large sample size allowed functional brain activity to be decomposed into a smaller number of distinct networks using factor analysis (a data-reduction method). Next, these networks were tested for relationships with various phenotypes. Adolescents who had experimented with either alcohol, cigarettes, or illicit substances showed reduced activity in an orbitofrontal cortex network on successful stop trials, even those with only 1–4 total lifetime alcohol uses. For adolescents who had used illicit substances, there was hyperactivity in a right frontal network (inferior frontal gyrus, cingulate, and insula), an effect that remained even after controlling for nicotine and alcohol effects. In contrast, ADHD symptoms were associated with bilateral frontal (inferior frontal gyri, anterior cingulate, and anterior insula) and basal ganglia networks only on unsuccessful stop trials. Individual differences in the speed of the inhibition process on the SST were associated with activity in the right frontal network and in the basal ganglia. Finally, the right frontal network was also associated with allelic variation in a single-nucleotide polymorphism located in the SLC6A2 gene, which codes for the norepinephrine transporter (see Figure 1). Figure 1 The impulsivity networks and associated phenotypes described in Whelan et al (2012), for both trials on which subjects successfully inhibited an already initiated motor response (Stop Success) and trials on which subjects failed to inhibit (Stop Fail). ... Understanding the neural correlates of impulsivity subtypes is important because it yields insights into the etiology of maladaptive impulsive behaviors. Disentangling the biological basis of substance misuse and ADHD symptoms has proven difficult previously because, for example, adult substance misusers are more likely to retrospectively endorse childhood ADHD symptoms (Ivanov et al, 2008). However, the results of Whelan et al (2012) suggest that ADHD symptoms and adolescent substance misuse can be separated, at least in terms of brain activity during a test of inhibitory control. Furthermore, these results support the role of norepinephrine in modulating impulse control, with implications for treatment of ADHD (Chamberlain et al, 2007). A goal of future research will be to shed more light on the structural, functional, neurochemical, and genetic underpinnings of the various impulsivity brain networks.

Welfare, Temperance and Compulsory Commitment to Care for Persons with Substance Misuse Problems: A Comparative Study of 38 European Countries

Aims: The study explores the existence and types of law on compulsory commitment to care (CCC) of adult substance misusers in Europe and how such laws are related to variations in demographics, alcohol consumption and epidemiology in misuse of opiates, cocaine, amphetamines, temperance culture heritage, health and welfare expenditure, and involvement and role of the state in welfare distribution. Material and Methods: Legal information on laws on CCC of misusers was obtained primarily through a survey of 38 European countries. Predictors of laws on CCC, and types of such, were analyzed from country descriptors in multivariate models. Results: A majority (74%) of the explored countries have a law concerning CCC. The most common type of CCC law is within criminal justice legislation (45%), but civil CCC is almost as frequent (37%). These two models of CCC legislation are related to differences in cultural heritage and welfare distribution models. Conclusions: Temperance cultures, i.e. countries with a history of a strong temperance movement, and countries with a Beveridgean distribution of welfare, i.e. through the state, tend to favor civil CCC, while countries with a Bismarckian distribution of welfare, i.e. through insurance with less state interference, tend to favor CCC within criminal justice legislation.

“They mess with me, I mess with them”: Understanding physical aggression in rural girls and boys from methamphetamine-involved families

This mixed method study examines the mental health and experiences of physical aggression in 41 children aged six to 14 years from rural families involved with methamphetamine misuse and the child welfare system. Each child was seen for a minimum of 3 h total by experienced clinicians on at least three sessions conducted at the child's home. Fifty percent of children scored in the clinical range (98th percentile and above) on externalizing and 26% on aggression scales of the Child Behavior Checklist (CBCL). More girls (75%) scored in the clinical range on CBCL externalizing behaviors than did boys (32%). During individual, semi-structured interviews, 17 children spontaneously produced 58 narratives of past physical aggression. These were primarily set at home and involved adults and the children themselves. Children primarily attributed physical aggression to anger and adult substance misuse, and described negative outcomes of the aggression. In contrast, a subgroup of girls with clinically significant levels of CBCL externalizing behaviors characterized their own physical aggression as appropriate retaliation with emotionally satisfying consequences. Many of these girls also scored in the clinically significant range on CBCL internalizing behaviors and total problems. Clinicians who collected the data expressed concern about these girls, in particular because they were ostracized from non delinquent peer groups, viewed others' continuing physical aggression against them as an inevitable part of their future, and described their own physical aggression as unavoidably driven by that violence. The perspectives of this subgroup of girls are elaborated through a case study of a physically aggressive 12-year-old. Implications for intervention are discussed.

Screening and Brief Intervention for Substance Misuse Among Older Adults: The Florida BRITE Project

We developed and examined the effectiveness of the Florida Brief Intervention and Treatment for Elders (BRITE) project, a 3-year, state-funded pilot program of screening and brief intervention for older adult substance misusers. Agencies in 4 counties conducted screenings among 3497 older adults for alcohol, medications, and illicit substance misuse problems and for depression and suicide risk. Screening occurred in elders' homes, senior centers, or other selected sites. Individuals who screened positive for substance misuse were offered brief intervention with evidence-based practices and rescreened at discharge from the intervention program and at follow-up interviews. Prescription medication misuse was the most prevalent substance use problem, followed by alcohol, over-the-counter medications, and illicit substances. Depression was prevalent among those with alcohol and prescription medication problems. Those who received the brief intervention had improvement in alcohol, medication misuse, and depression measures. The BRITE program effectively shaped state policy by responding to legislative mandates to address the needs of an increasing, but underserved, elder population. The pilot paved the way for obtaining a federally funded grant to expand BRITE to 27 sites in 17 counties in Florida.