Adolescent Substance Use Disorders Research Articles

Substanzkonsum, Störungen durch Substanzkonsum und begleitende psychische Störungen bei Jugendlichen

Substance Use, Resulting Disorders, and Collateral Mental Disorders Among Adolescents in a Special Outpatient Institutions for Addictions Abstract. Objective: Only few clinics offer the outpatient treatment of substance use disorders (SUDs) among adolescents. Therefore, only limited data describe substance use patterns, SUDs, and co-occurring psychiatric disorders characteristic of adolescents who present in such outpatient clinics specialized in the treatment of SUDs. Method: Via interview we collected data from n = 201 patients between 12 and 19 years concerning their substance use, SUDs, and current co-occurring psychiatric disorders. We created descriptive presentation of data regarding use patterns, SUDs, and co-occurring disorders divided by sex and current age. Results: Tobacco (88 %) and cannabis (86 %) were the most frequently used substances. 67 % of all patients presented with more than one SUD, cannabis use disorder being the most prevalent one (84 %). 72 % presented with at least one co-occurring disorder, with conduct disorders (40 %), attention deficit (hyperactivity) disorders (21 %), and depressive disorders (18 %) being the most frequent ones. Conclusions: Adolescent SUD patients often present with co-occurring psychiatric disorders. Institutions for adolescent SUD treatment should also focus on treating co-occurring conduct disorders, depression, and attention deficit disorders.

Psychotropics for Treatment of Substance Use Disorders in Adolescents: A Brief Review

Substance use disorders (SUD) remain a long-standing problem for adolescents. Medication assisted treatment (MAT) is now standard treatment for adult SUD but less common in adolescents. This article provides a brief summary of the available psychotropics used to treat SUD in adolescent patients; psychotropics should be considered as one part of a multi-disciplinary approach to treatment of SUD. Due to the growing impact of the opioid public health crisis in the adolescent population, pediatricians have an expanding role in identifying and treatment of opioid use disorders, in addition to other substance use disorders. Pediatricians and adolescent medicine physicians are critically important in the solution to the addiction problem. There is expanding evidence that treatment of SUDs must be integrated into multiple parts of the delivery care system, including primary care settings. Medications Used to Treat Opioid Use Disorders (OUD): Methadone and buprenorphine are the two primary methods of MAT available to treat OUD. Methadone is highly regulated and only available to patients over age 18 in the United States. Buprenorphine/naloxone is FDA-approved for patients age ≥16, with the American Academy of Pediatrics Committee on Substance Use and Prevention (2016) recommending improved pediatrician access to buprenorphine training and MAT consideration for adolescents. Buprenorphine/Naloxone (Suboxone) and Buprenorphine (Subutex): Buprenorphine is a schedule III drug, requiring additional prescriber trainings and requirements. Buprenorphine is a mu-opioid partial agonist with greater safety margins than full agonists and less withdrawal. It is often combined 4:1 with naloxone, an antagonist; Alho, et al. found that this combination reduced “street value”, likely decreasing abuse potential.

Coping motives mediate the relationship between PTSD and MDMA use in adolescents with substance use disorders

BackgroundPost-traumatic stress disorder (PTSD) and substance use disorders (SUDs) often co-occur in adolescent patients. Previous research has shown that these patients differ from SUD patients without PTSD in terms of their substance use patterns. In this study, we aimed to test whether substance use in this population is related to an attempt to self-medicate PTSD-related symptoms.MethodsGerman adolescent patients (aged 13–18 years) at an outpatient clinic for SUD treatment, n = 111 (43% female), completed a self-designed questionnaire on use motives, a measure of PTSD-related experiences, and underwent a standardized psychiatric interview including structured substance use questions. Participants were subsequently classified as ‘no traumatic experiences (‘noTEs’ but SUD), ‘traumatic experiences but no current PTSD diagnosis’ (‘TEs’ with SUD), and ‘PTSD’ with SUD. After establishing a self-designed motive measurement through exploratory and confirmatory factor analyses, we calculated non-parametric group differences and a mediation analysis in a linear regression framework.ResultsThe past-year frequency of MDMA use was highest in the PTSD group and lowest in the noTE group (H (2) = 7.2, p = .027, η2 = .058), but no differences were found for frequencies of tobacco, alcohol, cannabis, or stimulant use (all H ≤ 4.9, p ≥ .085, η2 ≤ .033). While controlling for sex, the three groups showed a similar pattern (highest in the PTSD group and lowest in the noTE group) for coping scores (F (103) = 5.77, p = .004, η2 = .101). Finally, mediation analyses revealed an indirect effect of coping score (b = 0.61, 95% CI [0.29, 1.58], p = .145) on the association between group membership and MDMA use frequency.ConclusionsIn adolescent SUD patients, we found an association of current PTSD and lifetime traumatic experiences with higher MDMA use that could be partially explained by substance use being motivated by an attempt to cope with mental health symptoms. This indicates a coping process involved specifically in MDMA use compared to the use of other psychoactive substances, possibly due to unique psychoactive effects of MDMA.

Substance Use Disorder Visits Among Adolescents at Children’s Hospitals During COVID-19

PurposeTo assess changes in adolescent visits with substance use disorders (SUDs) at children’s hospitals during COVID-19. MethodsWe conducted a retrospective cohort study of adolescents (11–18 years) with SUD diagnoses during a hospital visit in the Pediatric Health Information System. Study periods were defined as spring (03/15–05/31), summer (06/01–08/31), and fall (09/01–12/31), pre-COVID-19 (2017–2019), or during COVID-19 (2020). We summarized the change in weekly median visits and interquartile range (IQR) by characteristics and compared between the two periods (e.g., spring pre-COVID-19 [3/15–05/31/2017–2019] versus spring COVID-19 [3/15–05/31/2020]) using median regression. ResultsThere were 42,979 SUD visits (10,697 COVID-19; 32,282 pre-COVID-19) and 256 annual weekly median adolescent SUD visits [IQR 235, 280] pre-COVID-19 and 268 [IQR 245, 278] during COVID-19. The median number of weekly SUD visits increased by 14.3% during summer COVID-19 (median visits, [IQR]: 272 [268, 278]) compared to pre-COVID-19 (median visits: 237, IQR [216, 249]; p < .001) but did not significantly differ in spring (p = .091) or fall (p = .65) COVID-19. DiscussionOur findings suggest increased problematic adolescent substance use during summer COVID-19. Efforts to increase the identification and treatment of adolescent SUDs remain critical.

Acceptability of an mHealth App for Youth With Substance Use and Mental Health Needs: Iterative, Mixed Methods Design.

BackgroundTreating substance use disorders (SUDs) during adolescence can prevent adult addiction and improve youth outcomes. However, it can be challenging to keep adolescents with SUDs engaged in ongoing services, thus limiting potential benefits. Developmentally appropriate tools are needed to improve treatment engagement during and between sessions for youth with SUDs and mental health disorders. Mobile health apps may augment or replace psychotherapy components; however, few have been developed specifically for youth with SUDs following user-guided design principles, which may limit their appropriateness and utility. Formative research on acceptability to intended end users is needed before the efficacy of such tools can be examined.ObjectiveThis study involves user-centered, iterative development and initial user testing of a web-based app for adolescents with SUDs and mental health concerns.MethodsAdolescents aged 14 to 17 years with past-year involvement in outpatient psychotherapy and behavioral health clinicians with adolescent SUD treatment caseloads were recruited. Across 2 assessment phases, 40 participants (alpha: 10 youths and 10 clinicians; beta: 10 youths and 10 clinicians) viewed an app demonstration and completed semistructured interviews and questionnaires about app content and functionality.ResultsParticipants expressed positive impressions of the app and its potential utility in augmenting outpatient therapy for youth with SUDs and mental health concerns. Noted strengths included valuable educational content, useful embedded resources, and a variety of activities. Adolescents and clinicians favored the app over conventional (paper-and-pencil) modalities, citing convenience and familiarity. The app was found to be user-friendly and likely to improve treatment engagement. Adolescents suggested the inclusion of privacy settings, and clinicians recommended more detailed instructions and simplified language.ConclusionsThe novel app developed here appears to be a promising, acceptable, and highly scalable resource to support adolescents with SUDs and mental health concerns. Future studies should test the efficacy of such apps in enhancing adolescent behavioral health treatment engagement and outcomes.

TRAUMA AND STRESSOR-RELATED AND SUBSTANCE USE DISORDERS IN ADOLESCENCE: A PRACTITIONER’S GUIDE TO UNDERSTANDING AND TREATING THESE CO-OCCURRING DISORDERS

We will review clinical impacts and explore overlapping symptoms and neurobiological functional domains. Practical approaches to engaging families and a transdiagnostic approach to understanding and treating co-occurring trauma and substance use disorders (SUDs) in adolescents will be presented. First, Destiny Pegram, MD, will present a case vignette to demonstrate the interaction of early-life trauma and SUD. She will highlight the prevalence, risk factors, and treatment outcome implications of co-occurring trauma and SUD. Iliyan Ivanov, MD, will provide an update on trauma and SUD in the context of the COVID-19 pandemic. Second, Jesse Hinckley, MD, PhD, will discuss the biologic intersections of trauma and SUD. He will present clinical vignettes to illustrate overlapping symptoms and functional domains, review shared neurobiological factors, and explore how these factors may maintain or exacerbate the co-occurring disorders. Third, Abita Raj, MD, will present video clinical vignettes to demonstrate Solution-Focused Brief Therapy as an evidence-based approach to engage families in the treatment of trauma and SUD. Fourth, Liza Suarez, PhD, will present an integrated treatment approach for youth with traumatic stress and co-occurring substance use problems. Steve Berkowitz, MD, director of the Stress, Trauma, Adversity Research, and Treatment (START) Center at the University of Colorado and co-chair of the AACAP Disaster and Trauma Issues Committee will serve as the discussant. At the end of this Clinical Perspectives, participants will identify the importance of co-occurring trauma and SUD and will better understand the clinical and biological factors that maintain or exacerbate co-occurring disorders. Participants will learn best practices and practical approaches for screening in a trauma-informed process and for implementing Solution-Focused Brief Therapy to engage families in treatment. Participants will be introduced to a transdiagnostic approach to understand and treat co-occurring PTSD and SUD in adolescents through an in-depth case presentation. Trauma and SUD commonly co-occur in youth. There is a need for mental health clinicians to implement trauma-informed screening processes and to identify principles of treating these co-occurring disorders.

43.9 Bridging Barriers: Equity in the Treatment of Adolescent Substance Use Disorders

This study reviews the current clinically relevant knowledge on the treatment of substance use disorders (SUD) in adolescents using an equity-informed lens. It identifies populations affected by treatment inequities and evaluates barriers/facilitators to improved treatment access/retention.

1.16 Substance Use and Mental Health in Children in South Bronx: Craft Survey

According to 2020 statistics from NIDA, the lifetime prevalence of illicit substance use disorder (SUD) in eighth graders is 21.3%, which increases up to 46.6% in 12th graders. SUD is the second most common mental health complaint in children to the emergency room (ER). The ER can be used as a screening site for prevalence of this disorder. We conducted a CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) survey to determine the prevalence of SUD in children and adolescents with mental health disorders (CA-MHD). A cross-sectional quality improvement (QI) study was done on children presenting to the Child and Adolescent Psychiatric ER of South Bronx, NY with mental health complaints, between April and June 2021. Participants were screened for concomitant substance use disorder with the CRAFFT questionnaire and a structured survey to observe reasons for using a substance, effects on mood and functionality, and help/treatment received for substance use. Our data comprised 151 patients (61 males and 90 females) with 63 children (42%) and 88 adolescents (58%) presented. With respect to ethnicity, 89 were Hispanics (59%), 57 were African Americans (38%), and 4 were other ethnicities (3%). Forty-two participants (28%) endorsed substance use. Marijuana was the most commonly used substance (29 patients), followed by alcohol (10), and other illicit substances (3). Eight participants denied the use of marijuana, but their urine drug screen was positive for cannabinoids. Patients using drugs were asked about seeking help in the past for substance issues; however, all reported they have not taken any help nor do they want to take any help in the future. Commonly identified reasons for substance use in descending order are frustration due to personal issues, loneliness, and feeling sad. Participants reported that substance use helped them in remaining calm amid work and forgetting about the problems. SUD is prevalent among CA-MHD presenting to the ER, with cannabis being the most used substance in this age group. The majority of substance users identified interpersonal problems to be the trigger for substance use; hence, interpersonal therapy can be useful in ameliorating this pattern. More studies are required to delineate the exact efficacy. Presently, this study is still ongoing, and in the future, we will have more comprehensive and bigger data sets.

NEURAL PATHWAYS LINKING CHILDHOOD TRAUMA AND ADOLESCENT SUBSTANCE USE: THE ROLE OF LEARNING AND DECISION-MAKING

Childhood trauma significantly increases the risk for adolescent substance use disorders (SUDs). Dysfunction in neurocircuitry associated with learning and decision making is thought to underlie both trauma- and substance use (SU)-related psychopathologies, and represents a potential pathway by which childhood trauma is associated with later SUD. We will examine neural correlates of learning and decision making across 3 youth samples in the context of trauma exposure and traumatic stress, SU, and their combination. Clinical researchers will present fMRI and EEG findings from tasks examining aspects of learning and decision making, including reinforcement learning, delay discounting, and uncertainty processing. Studies include youth from clinical and community samples. Talk 1: Among children who have been exposed to interpersonal violence, PTSD symptom severity predicted: 1) event-related potentials for unpredictable unpleasant pictures; and 2) brain response to startle probes presented during unpredictable unpleasant pictures. Talk 2: Youth at high SUD risk showed stronger engagement of regions responsible for time encoding, reward valuation, and choice classification during the delayed choice. Talk 3: More severe neglect was associated with reduced responsivity in reward neurocircuitry during reinforcement learning, and alcohol use disorder (AUD) symptom severity compounded these effects. Talk 4: Trauma and AUD symptom severity are associated with reduced reward prediction error representation during reinforcement learning. Across these talks, childhood trauma and SU were associated with overlapping dysfunction in reinforcement learning neurocircuitries, as well as processing unpredictable or high-uncertainty information. Longitudinal work is needed to understand how relationships between childhood trauma and adolescent SUD unfold across time. However, learning and decision-making neurocircuitry dysfunction may represent a brain biomarker for trauma- and SU-related problems. Further, findings suggest that genetic risk and externalizing psychopathology represent important moderators for consideration in future work. The discussant will synthesize findings in both a developmental psychopathology and cognitive neuroscience framework.

Comparing self-report and parental report of psychopathologies in adolescents with substance use disorders

Both internalizing and externalizing psychopathologies interfere with the treatment of substance use disorders (SUD) in adolescents. Self-reports of psychopathologies are likely biased and may be validated with parental reports. We compared N = 70 standardized self-reports of adolescents entering outpatient SUD treatment (13.2–18.6 years old, 43% female) to parental reports on the same psychopathologies, and explored biases due to gender, age, SUD diagnoses and SUD severity. Bivariate bootstrapped Pearson correlation coefficients revealed several small to moderate correlations between both reporting sources (r = 0.29–0.49, all pcorrected ≤ 0.039). A repeated measures MANOVA revealed moderately stronger parental reports of adolescent psychopathologies compared to adolescent self-reports for most externalizing problems (dissocial and aggressive behaviors, p ≤ 0.016, η2part = 0.09–0.12) and social/attention problems (p ≤ 0.012, η2part = 0.10), but no differences for most internalizing problems (p ≥ 0.073, η2part = 0.02–0.05). Differences were not associated with other patient or parental characteristics including age, gender, number of co-occurring diagnoses or presence/absence of a certain SUD (all puncorrected ≥ 0.088). We concluded that treatment-seeking German adolescents with SUD present with a multitude of extensive psychopathologies. The relevant deviation between self- and parental reports indicate that the combination of both reports might help to counteract dissimulation and other reporting biases. The generalizability of results to inpatients, psychiatry patients in general, or adolescents without SUD, as well as the validity of self- and parental reports in comparison to clinical judgements remain unknown.

Treatment of Adolescents with Concurrent Substance Use Disorder and Attention-Deficit/Hyperactivity Disorder: A Systematic Review.

Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for the development of substance abuse and substance use disorders (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment, and is associated with poor treatment outcomes. In this study, we provide a systematic review of controlled studies on the effectiveness of pharmacological, psychosocial, and complementary treatments of ADHD in adolescents with and without comorbid SUD. In addition, we review the longitudinal association between pharmacotherapy for childhood ADHD and the development of SUD in adolescence and early adulthood. We conducted a systematic review of the research literature published since 2000 using Medline, PsycINFO, and the Cochrane Database of Systematic Reviews databases to select randomized clinical trials, observational studies, and meta-analyses. The quality of the evidence from each study was rated using the SIGN grading system. Based on the limited evidence available, strong clinical recommendations are not justified, but provisionally, we conclude that stimulant treatment in children with ADHD may prevent the development of SUD in adolescence or young adulthood, that high-dose stimulant treatment could be an effective treatment for adolescents with ADHD and SUD comorbidity, that cognitive behavior therapy might have a small beneficial effect in these patients, and that alternative treatments are probably not effective. More studies are needed to draw definitive conclusions that will allow for strong clinical recommendations.

International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder

International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder Abstract. Background: Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. Objective: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. Method: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. Results: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. Conclusion: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.

Association between prescribed opioid use for acute pain in adolescents and the subsequent development of opioid misuse and substance use disorders: a systematic review protocol.

This review aims to examine prescribed short-term opioid use in adolescents to treat acute pain. The review will analyze the influence of opioid use on future non-medical opioid use (misuse) or substance use disorders (addiction) in adolescents and young adults. Prescription opioids are medically indicated for acute pain. Descriptive studies of administrative datasets and surveys implicate adolescent opioid exposure as a risk factor for subsequent opioid misuse and addiction. This review will provide a synthesis of the literature on the association between prescribed opioid exposure to treat acute pain in adolescents and the subsequent development of opioid misuse or substance use disorders in adolescents and young adults. This review will consider quantitative studies on opioid misuse or substance use disorders in Canadian and US adolescents and young adults (12 to 25 years of age). Studies must include exposure during adolescence (12 to 17 years of age) to legitimately prescribed short-term opioid use to treat acute pain. Studies on chronic pain or exposure to opioids for longer duration (more than 30 doses or more than 7 days) will be excluded. This review will follow the JBI methodology for systematic reviews of etiology and risk. Published and unpublished studies will be sourced from multiple databases and resources. Two independent reviewers will screen, appraise, and extract data from studies that meet the inclusion criteria. Data synthesis will be conducted and a Summary of Findings will be presented. PROSPERO CRD42020179635.

Sensitivity and specificity of S2BI for identifying alcohol and cannabis use disorders among adolescents presenting for primary care

Background The Screening to Brief Intervention (S2BI) tool was designed to identify substance use disorders in adolescents. We report the S2BI’s sensitivity and specificity for identifying alcohol and cannabis use disorders (AUD and CUD) in adolescents presenting for primary care. Methods: Participants aged 14–18 (N = 517) completed an electronic survey, consisting of the S2BI, the Composite International Diagnostic Interview (CIDI), and anxiety and depression screens. We calculated sensitivity, specificity, and positive and negative predictive value (PPV, NPV) of the S2BI compared to the CIDI criterion standard, using past year “monthly” and “weekly or more” consumption of alcohol or marijuana as a threshold for AUD or CUD. Results: Current AUD and CUD were present in 2.9% and 8.3% of the sample, respectively and severe AUD and CUD were present in 0.8% and 3.9%. The S2BI had 53.3% sensitivity and 94.2% specificity for identifying any AUD (PPV = 21.6%; NPV = 98.5%), and 81.4% sensitivity and 92.0% specificity for identifying any CUD (PPV = 47.9%; NPV = 98.2%). The same threshold had 100% sensitivity and 93.6% specificity for identifying moderate/severe AUD, and 90.0% sensitivity and 89.0% specificity for identifying moderate/severe CUD. Conclusions: S2BI had excellent sensitivity and specificity for identifying moderate and severe AUD and CUD. Sensitivity decreased when mild AUD and CUD were included.

Substance Use Disorders (SUD) and Suicidal Behaviors in Adolescents: Insights From Cross-Sectional Inpatient Study.

ObjectivesTo determine the demographic predictors of suicidal behaviors and measure the association between the spectrum of substance use disorders (SUD) and hospitalization for suicidal behaviors in the adolescent population.MethodsWe conducted a cross-sectional study using the nationwide inpatient sample and included 466,244 adolescent inpatients with psychiatric illnesses. The study sample was sub-grouped into suicidal (N = 182,454) and non-suicidal (N = 283,790) cohorts. The odds ratio (OR) of association for demographic characteristics and comorbid SUD in the suicidal group was evaluated using a logistic regression model witha P-value < 0.01.ResultsOur study population included 466,244 adolescent inpatients. Females had higher odds of suicidal behaviors (OR 1.45; 95% CI 1.431-1.470) compared to males. The most prevalent comorbid SUD among suicidal inpatients was cannabis (15.3%) but had a statistically non-significant association with suicidal behaviors (OR 0.98; 95% CI 0.95-0.99). Inpatients with alcohol use disorders had significantly increased odds of association with suicidal behaviors (OR 1.18; CI: 1.142-1.209) compare to other SUD. Among other substances (cannabis and stimulants), there existed a statistically non-significant association with hospitalization for suicidal behaviors.ConclusionAdolescent inpatients with comorbid alcohol use disorders were at 18% higher odds of hospitalization for suicidal behaviors. Our study provides a basis for more research while also suggesting potential avenues for early identification and intervention efforts for comorbid SUD in adolescents requiring psychiatric care to improve their prognosis and quality of life.

Parents' Personality Disorders as Predictor of Substance Use Disorder in Children and Adolescents.

This study investigated how the parents' personality disorders may be related to substance use disorder in children and adolescents. The study was a cross-sectional study in which 28,540 children and adolescents (aged 6 to 18 years) and their parents participated between 2015 and 2016. The diagnosis of substance use was made using the Kiddie Schedule for Affective Disorders and Schizophrenia--Present and Lifetime Version (K-SADS-PL) interview and the personality disorders were assessed using Millon Clinical Multiaxial Inventory - Third Edition (MCMI-III). The parents were also surveyed for their personality assessed with MCMI. The results showed that the paranoid personality disorder in father (odds ratio [OR] = 8.34, 95% CI, P = 0.042) and borderline personality disorder in mother (OR = 4.6, 95% CI, P = 0.049) increase the chance of substance use in children. The findings suggest that in designing preventive programs for substance use, the personality characteristics of the parents need to be taken into account.

Substance use disorders in adolescence - a review

IntroductionSubstance use disorders in adolescents are a growing problem worldwide. These disorders are often unrecognised, unvalued by families, society and clinicians and as a result underdiagnosed, with serious future consequences if improperly addressed.ObjectivesUpdated review of the recent literature on this topic.MethodsUnsystematic review of the most recent and relevant literature.ResultsReview of neurobiology, risk factors, co-morbidity, differential diagnosis, diagnostic criteria, evaluation and treatment of substance use disorders in adolescence.ConclusionsSubstance use disorder in adolescence includes a variety of behaviours related to the use of alcohol and/or drugs, for instance, inability to control substance use, impairment of function at school, home or work, interpersonal problems and hazardous use of substance. Further knowledge in identifying, early diagnosing and adequate intervention in adolescents’ substance use disorder may have paramount prognostic features.DisclosureNo significant relationships.

Adverse childhood experiences (ACEs) and substance use disorder (SUD): A scoping review

BackgroundThe long-term negative effects of adverse childhood experiences (ACEs) and their impact on physical and mental health has been widely studied. However, research about the relationship between ACEs and substance use disorder (SUD) diagnosis in adolescence and adulthood is still scarce. Therefore, this scoping review was conducted to collect the existing research findings to explore the relationship between the experience of ACEs and the diagnosis of SUD later in life. MethodsThe PsycINFO, Medline, Scopus, Web of Science, and Cochrane Library databases were searched. After identifying the records based on eligibility and exclusion criteria, 12 studies were finally selected for inclusion. ResultsMost of the studies were conducted in the USA with adult male and female participants. All studies were cross-sectional in nature and assessed ACEs retrospectively. The main conclusions of the studies were that there is a higher prevalence of ACEs in the population with SUD than in the general population, and a positive association between ACEs and the development and severity of SUD in adolescence and adulthood. ConclusionsIt is difficult to make comparisons between studies and to draw solid conclusions because of the lack of standardized criteria for evaluating ACEs and due to the heterogeneity in the substance types examined. More research is needed to fully elucidate the underlying mechanism of the relationship between ACEs and SUD.

Maternal Attitudes, Irritability, Problem Solving Skills and Decision Making in Adolescents with Substance Use: Case-control Study

Multiple risk factors affect the emergence of substance use disorders among adolescents and their families. To the best of our knowledge, the effects of irritability, problem solving, decision making skills and maternal attitudes on the severity of the substance use have not been evaluated on the same population. We aimed to evaluate the presence and the effects all of these variables on the severity of substance dependence. The study included 40 adolescents, between 14 and 17 years of age, consulting the Child and Adolescent Mental Health and Diseases outpatient clinics with complaints of substance use and 40 age and gender matched healthy controls. The diagnoses were based on the DSM-5 diagnostic criteria. Both groups completed a sociodemographic questionnaire, the Parent Attitude Research Instrument (PARI), the Adolescent Decision Making Questionnaire (ADMQ), the ProblemSolving Inventory (PSI) and the DSM-5 Level 2 Irritability Scale. The patient group were also tested on the Addiction Profile Index for Adolescents (API-AF). Problem solving skills scores of the patients were lower and the scores on the irritability scale completed by the patients and their parents were higher as compared to the control group. Complacency (indifference) in decision-making predicted the severity of the addiction. As the complacency in decision-making increased, the severity of addiction also increased. Our results indicated that problem solving and decisionmaking skills and irritability levels of the adolescents together with the family attitudes, affect substance use disorder in adolescence. These variables should be considered in preventive and therapeutic approaches.

Future directions for part II: Substance use disorders in adolescence-A vision for a better future.

Future directions for part II: Substance use disorders in adolescence-A vision for a better future.