A systematic review of diffusion weighted MRI studies of white matter microstructure in adolescent substance users

Recent studies using diffusion weighted magnetic resonance imaging (DW-MRI) have provided evidence of abnormal white matter microstructure in adults with substance use disorders (SUDs). While there is a growing body of research using DW-MRI to examine the impact of heavy substance use during adolescence, this literature has not been systematically reviewed. Online databases were searched for DW-MRI studies of adolescent substance users, and 10 studies fulfilled the inclusion and exclusion criteria. We identified consistent evidence for abnormal white matter microstructure in neocortical association pathways as well as in projection and thalamic pathways. Dose-dependent relationships between DW-MRI measures and patterns of substance use were also observed. The consistency of these findings with DW-MRI research in adults suggests that white matter microstructure is impacted in the early stages of heavy substance use. However, given the largely cross-sectional nature of the available data, important questions remain regarding the extent to which white matter abnormalities are a consequence of adolescent exposure to alcohol and other drugs of abuse or reflect pre-existing differences that increase risk for SUDs.     

Romantic relationships and sexuality in diverse adolescent populations: Introduction to the special issue

Although scientific research on adolescent romantic and sexual development has proliferated in recent years, currently, too little is known about how development in these areas can be understood across diverse populations (e.g., different socio-cultural groups within countries) and contexts (e.g., countries or different proximal social environments). The goal of the current virtual special issue in the Journal of Adolescence was to highlight relevant and timely empirical findings from studies utilizing innovative and diverse research methods in the areas of adolescent romantic and sexual development from around the globe, with an emphasis on data collected outside of the Western world. It combines an interesting set of nine empirical papers, which describe datasets from 5 countries (Canada, India, Indonesia, Mexico, and the United States). In this editorial, we provide an introduction to this special issue, and illustrate how these studies expand our understanding of adolescent romantic and sexual development by examining: 1) romantic and sexual relationship constructs that are relevant for understudied and diverse populations; 2) how culture-specific factors may shape adolescents’ romantic and sexual relationships; 3) how romantic and sexual relationship constructs are linked to psychosocial adjustment outcomes in understudied cultural contexts; 4) the role of different proximal social environments (e.g., parents, siblings, peers) in romantic and sexual development in diverse populations.     

Early adolescent temperament,parental monitoring,and substance use in Mexican-origin adolescents

Previous studies suggest that temperamental dispositions are associated with substance use. However, most research supporting this association has relied on European American samples (Stautz & Cooper, 2013). We addressed this gap by evaluating the prospective relations between 5th grade temperament and 9th grade substance use in a longitudinal sample of Mexican-origin youth (N = 674). Effortful control and trait aggressiveness predicted 9th grade substance use, intentions, and expectations, even after controlling for 5th grade substance use. Additionally, we found an interaction between temperament and parental monitoring such that monitoring is a protective factor for early substance use primarily for youth with temperamental tendencies associated with risk for substance use (e.g., low effortful control and aggression). Results add to the growing literature demonstrating that early manifestations of self-control are related to consequential life outcomes.     

Childhood and adolescent onset psychiatric disorders, substance use, and failure to graduate high school on time

We examined the joint predictive effects of childhood and adolescent onset psychiatric and substance use disorders on failure to graduate high school (HS) on time. Structured diagnostic interviews were conducted with a US national sample of adults (18 and over). The analysis sample included respondents with at least 8 years of education who were born in the US or arrived in the US prior to age 13 (N = 29,662). Psychiatric disorders, substance use and substance use disorders were examined as predictors of termination or interruption of educational progress prior to HS graduation, with statistical adjustment for demographic characteristics and childhood adversities. Failure to graduate HS on time was more common among respondents with any of the psychiatric and substance use disorders examined, ranging from 18.1% (specific phobia) to 33.2% (ADHD-combined type), compared with respondents with no disorder (15.2%). After adjustment for co-occurring disorders, significant associations with failure to graduate on time remained only for conduct disorder (OR = 1.89, 95% CI 1.57-2.26) and the three ADHD subtypes (Inattentive OR = 1.78, 95% CI 1.44-2.20, Hyperactive-Impulsive OR = 1.38, 95% CI 1.14-1.67, and Combined OR = 2.06, 95% CI 1.66-2.56). Adjusting for prior disorders, tobacco use was associated with failure to graduate on time (OR = 1.97, 95% CI 1.80-2.16). Among substance users, substance use disorders were not associated with on-time graduation. The findings suggest that the adverse impact of childhood and adolescent onset psychiatric disorders on HS graduation is largely accounted for by problems of conduct and inattention. Adjusting for these disorders, smoking remains strongly associated with failure to graduate HS on time.     

Smoking,alcohol consumption,and drug use among adolescents with psychiatric disorders compared with a population based sample

This study investigated frequencies of smoking, alcohol use, and illicit drug use by diagnostic category in 566 adolescent psychiatric patients, comparing this sample with 8173 adolescents from the general population in Norway who completed the Young-HUNT 3 survey. Frequencies of current alcohol use were high in both samples but were lower among psychiatric patients. Compared with adolescents in the general population, adolescents in the clinical sample had a higher prevalence of current smoking and over four times higher odds of having tried illicit drugs. In the clinical sample, those with mood disorders reported the highest frequencies of smoking, alcohol use, and illicit drug use, whereas those with autism spectrum disorders reported the lowest frequencies. Our results show an increased prevalence of risky health behaviors among adolescents with psychiatric disorders compared with the general population. The awareness of disorder-specific patterns of smoking and substance use may guide preventive measures.     

Longitudinal relationships of sleep and inhibitory control deficits to early adolescent cigarette and alcohol use

Research in older adolescents suggests insufficient sleep may increase substance use initiation risk. This study tested whether sleep duration and dysregulation of sleep-wake patterns in late-elementary school youth were prospectively associated with cigarette and alcohol use initiation and how sleep-related changes in inhibitory control mediate these relationships. Average sleep duration at 4th grade predicted 6th grade cigarette but not alcohol use, however indirect effects were identified through 5th grade inhibitory control to both cigarette and alcohol use. Indirect effects were also identified through inhibitory control for relationships between 4th grade weekend bed-time delay and 6th grade cigarette or alcohol use, and for relationships between 4th grade weekend wake-time delay and 6th grade cigarette or alcohol use. Reductions in nightly sleep increased risk of cigarette use. Findings suggest a pathway linking both reduced sleep duration and greater weekend shifting of sleep patterns to future substance use through sleep-related inhibitory control deficits.     

Anhedonia,screen time,and substance use in early adolescents: A longitudinal mediation analysis

IntroductionScreen time is associated with substance use risk among adolescents; however, less is known about the underlying factors that explain this association. Methods: This research examined anhedonia, a facet of depression noted by the reduced capacity to experience pleasure, as a mediating factor in the relationship between screen time (hours spent watching television, using internet, and/or playing video games outside of school) and substance use (alcohol and/or cigarettes). We used a longitudinal survey design among a sample of students aged 9–11 years in the 4th to 6th grades in Southern California, United States of America [N = 709 (354 males)]. Results: Structural equation modeling (SEM) findings revealed longitudinal mediation effects of anhedonia on the association between screen time and substance use, while controlling for baseline screen time, baseline individual and peer substance use, race/ethnicity, and gender. Moderation analysis based on a multiple-group approach revealed that gender was not a significant moderator of this mediation pathway. Conclusions: Adolescents may become desensitized and exhibit a blunted response to hedonic effects from increased screen time. This may result in increased anhedonia and greater risk for substance use through the need to compensate for the reduced experience of rewards. These findings have implications for future school-based substance use prevention and intervention programs.     

Gender differences in emotional and behavioral disorders and service use among adolescent smokers: A nationwide Israeli study

Marked gender differences have been identified in cigarette smoking. In this study, we aimed to identify the gender-specific emotional and behavioral disorders among adolescent smokers and their consequent utilization of mental health services. We performed a nationwide survey study of an Israeli representative sample of 906 adolescents and their mothers. Mental disorders were assessed using the Development and Well-Being Assessment (DAWBA) Inventory. Levels of emotional and behavioral difficulties were evaluated using the Strengths and Difficulties Questionnaire (SDQ). Mental health services use and smoking habits were also assessed. Among non-smoker adolescents there were significant gender differences in almost all SDQ scales: emotional problems, pro-social, hyperactivity/inattention and conduct problems, whereas in the smoker group there was a difference only in the SDQ emotional problems scale (both self- and maternal-rated, P < 0.001 and P = 0.002, respectively). Only marginal difference was noted between males and females in help-seeking for emotional or behavioral problems. Over 50% of both male and female smokers in the study had untreated mental disorders (non-significant gender difference). The well-established gender differences in psychiatric symptomatology narrowed markedly in adolescent smokers; the typical gender difference in disruptive behaviors was lost in the adolescent smoking population. The implications of these findings are particularly relevant to developing more effective gender-specific programs to prevent youth smoking, to facilitate quitting and prepare primary care practitioners to identify mental disorders and behavioral problems in adolescents with a smoking history.     

Commentary on the special issue on the adolescent brain: Adolescence,trajectories, and the importance of prevention

Adolescence as highlighted in this special issue is a period of tremendous growth, synaptic exuberance, and plasticity, but also a period for the emergence of mental illness and addiction. This commentary aims to stimulate research on prevention science to reduce the impact of early life events that often manifest during adolescence. By promoting a better understanding of what creates a normal and abnormal trajectory, the reviews by van Duijvenvoorde et al., Kilford et al., Lichenstein et al., and Tottenham and Galvan in this special issue comprehensively describe how the adolescent brain develops under typical conditions and how this process can go awry in humans. Preclinical reviews also within this issue describe how adolescents have prolonged extinction periods to maximize learning about their environment (Baker et al.), whereas Schulz and Sisk focus on the importance of puberty and how it interacts with stress (Romeo). Caballero and Tseng then set the stage of describing the neural circuitry that is often central to these changes and psychopathology. Factors that affect the mis-wiring of the brain for illness, including prenatal exposure to anti-mitotic agents (Gomes et al.) and early life stress and inflammation (Schwarz and Brenhouse), are included as examples of how exposure to early adversity manifests. These reviews are synthesized and show how information from the maturational stages that precede or occur during adolescence is likely to hold the key towards optimizing development to produce an adolescent and adult that is resilient and well adapted to their environment.     

Predictors and Correlates of Abortion in the Fragile Families and Well-Being Study: Paternal Behavior,Substance Use,and Partner Violence

This study was designed to identify predictors of the choice to abort or deliver a child within 18 months of a previous birth and to compare mothers who chose to abort or deliver relative to substance use and adverse partner behavior. Using a systems perspective, data from the Fragile Families and Well-Being Study were examined. The sample included participants from 16 cities, and within the selected cities, hospitals with high rates of unmarried births were chosen for inclusion in the survey. The data analysis process entailed two steps: 1) predictors of the choice to abort were identified statistically; 2) mothers who chose to abort and deliver were compared relative to heavy drinking, cigarette smoking, and adverse partner behavior after controlling for potentially confounding factors identified in step one. The results indicated that several variables pertaining to the father's commitment to raising a previously born child and to his relationship with the mother predicted the choice to abort. Further, a recent abortion was related to substance use and partner perpetrated physical aggression after the effects of confounding variables were removed.Professionals who work with women from impoverished environments facing an unplanned pregnancy should be encouraged to sensitively explore the woman’s support system. If the father is unavailable, counselors can assist women in identifying other sources of support within and outside the family.     

Brief report: Parsing the heterogeneity of adolescent girls’ sexual behavior: Relationships to individual and interpersonal factors

Clusters of pre-sexual and sexual behaviors were identified in an urban US sample of 546 mid-adolescent girls. No distinct group of girls engaging in sexually risky behavior was revealed. Sexually active girls were older, lived with a single parent, and reported more substance use and depression, but similar levels of conduct problems, impulsivity and deviant peers to girls engaging in pre-sexual behavior.     

Neurobiological signatures associated with alcohol and drug use in the human adolescent brain

Magnetic resonance (MR) techniques provide opportunities to non-invasively characterize neurobiological milestones of adolescent brain development. Juxtaposed to the critical finalization of brain development is initiation of alcohol and substance use, and increased frequency and quantity of use, patterns that can lead to abuse and addiction. This review provides a comprehensive overview of existing MR studies of adolescent alcohol and drug users. The most common alterations reported across substance used and MR modalities are in the frontal lobe (63% of published studies). This is not surprising, given that this is the last region to reach neurobiological adulthood. Comparatively, evidence is less consistent regarding alterations in regions that mature earlier (e.g., amygdala, hippocampus), however newer techniques now permit investigations beyond regional approaches that are uncovering network-level vulnerabilities. Regardless of whether neurobiological signatures exist prior to the initiation of use, this body of work provides important direction for ongoing prospective investigations of adolescent brain development, and the significant impact of alcohol and substance use on the brain during the second decade of life.     

Introduction to the brain imaging and behavior special issue on neuroimaging findings in mild traumatic brain injury

Contemporary neuroimaging methods and research findings in mild traumatic brain injury (mTBI) are reviewed in this special issue. Topics covered include structural and functional neuroimaging techniques with a particular emphasis on the most contemporary research involving magnetic resonance imaging (MRI). Future research directions as well as applied applications of using neuroimaging techniques to define biomarkers of brain injury are covered.     

Neural cognitive control moderates the longitudinal link between hedonia and substance use across adolescence

Hedonic dysregulation is evident in addiction and substance use disorders, but it is not clearly understood how hedonic processes may interact with brain development related to cognitive control to influence risky decision making and substance use during adolescence. The present study used prospective longitudinal data to clarify the role of cognitive control in the link between hedonic experiences and the development of substance use during adolescence. Participants included 167 adolescents (53% male) assessed at four time points, annually. Adolescents participated in a functional magnetic resonance imaging (fMRI) session where blood-oxygen level dependent (BOLD) response was monitored during the Multi-Source- Interference Task to assess cognitive control. Substance use and hedonia were assessed using self-report. A two-group growth curve model of substance use with hedonia as a time-varying covariate indicated that higher levels of hedonia predicted higher substance use, but only in adolescents with higher activation in the frontoparietal regions and in the rostral anterior cingulate cortex during cognitive control. Results elucidate the moderating effects of neural cognitive control on associations between hedonia and adolescent substance use, suggesting that lower cognitive control functioning in the brain may exacerbate risk for substance use promoted by hedonia.     

Anxiety disorders,climate change,and the challenges ahead: Introduction to the special issue

Climate change involves (1) increases in the prevalence of extreme weather events (e.g., wildfires, floods, hurricanes), (2) more gradual climatic changes (e.g., rising sea levels, desertification), and (3) increased risks of pandemics and other widespread disease outbreaks. Anxiety evoked by the threat of climate change can be either adaptive or maladaptive. Adaptive anxiety can motivate climate activism, such as efforts to reduce one’s carbon footprint. Maladaptive anxiety can take the form of anxious passivity, where the person feels anxious but incapable of addressing the problem of climate change, and may take the form of an anxiety disorder triggered or exacerbated by climatic stressors. Such stressors may involve exposure to extreme weather events or may involve exposure to other stressors such as forced migration due to rising sea levels or desertification. Three types of interventions are needed to address the various types of climate-related anxiety: (1) programs that motivate people to overcome anxious passivity and thereby take action to mitigate the effects of climate change, (2) treatment programs that address anxiety associated with exposure to climatic stressors, and (3) programs that build resilience at an individual and community level, to help people better cope with the challenges ahead.     

Trajectories of adolescent substance use development and the influence of healthy leisure: A growth mixture modeling approach

Considerable heterogeneity exists in adolescent substance use development. To most effectively prevent use, distinct trajectories of use must be identified as well as differential associations with predictors of use, such as leisure experience. The current study used a person-centered approach to identify distinct substance use trajectories and how leisure is associated with trajectory classes. Data came from a larger efficacy trial of 2.249 South African high school students who reported substance use at any time across 8 waves. Growth mixture modeling was used to identify developmental trajectories of substance use and the influence of healthy leisure. Results identified three increasing and one stable substance use trajectory and subjective healthy leisure served to protect against use. This study is the first of its kind to focus on a sample of South African adolescents and serves to develop a richer understanding of substance use development and the role of healthy leisure.     

The role of school engagement in preventing adolescent delinquency and substance use: a survival analysis

The present study was designed to examine the effects of school engagement on risky behavior in adolescence. Using data from the 4-H Study of Positive Youth Development (PYD), a longitudinal study of U.S. adolescents, discrete-time survival analyses were conducted to assess the effect of behavioral and emotional school engagement on the initiation of drug use and delinquency. The current analyses used seven years of longitudinal data collected from youth and their parents. Results of discrete-time survival analysis indicated that, controlling for demographic variables, higher degrees of behavioral and emotional school engagement predicted a significantly lower risk of substance use and involvement in delinquency. Substance use prevention programs and other health-risk reduction programs should include components (i.e., adolescents' participation in and emotional attachment to school) to capitalize on the protective role of the school context against youth risk behavior.     

Schizophrenia, Co-occurring Substance use Disorders and Quality of Care: The Differential Effect of a Managed Behavioral Health Care Carve-out

This study explores the differential effect of a managed behavioral health Carve-Out (CO) on outpatient treatment quality for persons with schizophrenia (SCHZ) alone and co-occurring substance use disorders (SUD) (SCHZ+SUD). We used claims data from a state Medicaid program and employed a retrospective, quasi-experimental design with logit and difference in difference formula regression models. The results show the CO was associated with greater changes in treatment quality for the SCHZ population, compared to the SCHZ+SUD population. Most pronounced across both populations were decrements in receiving the psychosocial treatments for enrollees in the CO arrangement.An earlier version of this analysis was presented on June 24, 2004 at the Co-occurring Conditions Conference sponsored by NIMH, NIDA, NIAAA, AHRQ, HRSA AND SAMHSA.