Cannabis dependence in young adults: an Australian population study

Objectives The symptomatology of cannabis dependence remains ill‐defined and its importance controversial. Compared with alcohol dependence, the symptom profile of cannabis dependence has received little attention. We aimed to (a) report cannabis use in a representative population of young adults, (b) examine cannabis dependence symptoms according to frequency in the dependence syndrome and (c) contrast the symptomatology of cannabis and alcohol syndromes. Methods 1601 young adults (mean age 20.7 years) from an Australian longitudinal cohort study (N = 2032) were surveyed in 1998. Regular substance users were assessed for DSM‐IV cannabis and alcohol dependence. Prevalence estimates allowed for sampling variation and attrition. Results Fifty‐nine per cent reported life‐time use of cannabis, 17% used at least weekly and 7% (11% males, 4% females) met criteria for cannabis dependence. Symptom prevalence in dependent cannabis users was: persistent desire 91%; unintentional use 84%; withdrawal 74%; excessive time obtaining/using 74%; continued use despite health problems 63%; tolerance 21%; and social consequences 18%. The combination of withdrawal, persistent desire and unintentional use was reported by 57%. Dependent cannabis users reported compulsive and out‐of‐control use more frequently than dependent alcohol users, withdrawal similarly and tolerance considerably less often. Conclusions Cannabis use appears to be normative behaviour in young Australians. Progression beyond weekly use of cannabis carries a significant risk of dependence that should be considered in the public health response. The differing profiles of cannabis and alcohol dependence, particularly with regard to craving, draws attention to the need for further study of cannabis dependence as an important and distinct disorder in young adults.     

Eating disorders and substance abuse in Canadian women: a national study

AIMS: This study aimed to examine the comorbidity between eating disorders and substance use in a large nationally representative sample of Canadian adult women. Recent as well as life-time measures of substance use were used. DESIGN: The research was based on secondary analyses of data collected, using multi-stage stratified probability sampling, by Statistics Canada in the Mental Health and Well-being cycle 1.2 of the Canadian Community Health Survey (CCHS). MEASUREMENTS: The Eating Attitude Test (EAT-26) was used to measure risk of eating disorders. Alcohol use, dependence and interference, and illicit drug use, dependence and interference were measured using relevant modules from the short form of the Composite International Diagnostic Interview (CIDI-SF). PARTICIPANTS: Data on a nationally representative sample of Canadian adult women, grouped into three age groups, were used for this research. FINDINGS: Alcohol dependence and alcohol interference were associated significantly with the risk for an eating disorder in the three adult age groups. Significant associations were also found in the three age groups between risk for an eating disorder and the life-time abuse of and dependence on illicit drugs. Significant associations were found in the 15-24 and 25-44-year age groups when the 12-month time-frame was used. CONCLUSIONS: The study findings support the call for the development of short screening instruments for adult women with eating disorders and substance abuse, as well as for the development of treatment strategies that address the co-occurrence of eating disorders and substance use     

Gun access,ownership, gun-related experiences,and substance use in young adults: a latent class analysis

ABSTRACT

Background

Substance use is found to associate with gun violence. However, mixed findings have been reported for gun access/ownership. To date, studies have examined gun access/ownership and gun-related experiences (e.g., carrying) separately despite the fact that gun-related experiences often occur among gun owners.     

Substance use and periodontal disease among Australian Aboriginal young adults

Aim To investigate the effects of tobacco, marijuana, alcohol and petrol sniffing on periodontal disease among Australian Aboriginal young adults. Design Cross‐sectional nested within a long‐standing prospective longitudinal study. Setting Aboriginal communities in Australia's Northern Territory. Participants Members of the Aboriginal Birth Cohort study who were recruited from birth between January 1987 and March 1990 at the Royal Darwin Hospital, Northern Territory, Australia. Data were from wave III, when the mean age of participants was 18 years. Measurements Clinical dental examination and self‐report questionnaire. Findings Of 425 participants with complete data, 26.6% had moderate/severe periodontal disease. There was elevated risk of periodontal disease associated with tobacco [prevalence ratio (PR) = 1.59, 95% CI = 1.06–2.40], marijuana (PR = 1.44, 95% CI = 1.05–1.97) and petrol sniffing (PR = 1.83, 95% CI = 1.08–3.11), but not alcohol (PR = 0.92, 95% CI = 0.67–1.27). Stratified analysis showed that the effect of marijuana persisted among tobacco users (PR = 1.47, 95% CI 1.03–2.11). It was not possible to isolate an independent effect of petrol sniffing because all petrol sniffers used both marijuana and tobacco, although among smokers of both substances, petrol sniffing was associated with an 11.8% increased prevalence of periodontal disease. Conclusions This is the first time that substance use has been linked with periodontal disease in a young Australian Aboriginal adult population, and the first time that petrol sniffing has been linked with periodontal disease in any population. The role of substance use in periodontal disease among this, and other, marginalized groups warrants further investigation.     

High prevalence of undiagnosed coeliac disease in adults: a Swedish population-based study

OBJECTIVE: To determine the prevalence of coeliac disease in a population-based sample of Swedish adults. DESIGN: Population-based cross-sectional study. SETTING: Northern Sweden. SUBJECTS: A total of 1894 adults (76%) out of 2500 invited, randomly selected from the population register after stratification for age and sex. MAIN OUTCOME MEASURES: Prevalence of biopsy verified coeliac disease, symptoms of undiagnosed cases, and results of antiendomysium and antigliadin serum antibody tests. RESULTS: Coeliac disease was confirmed by intestinal biopsy showing enteropathy in 10 individuals (seven women and three men), corresponding to a prevalence of 5.3 per 1000 (95% CI = 2.5-9.7). The majority of cases (eight out of 10) had not been diagnosed prior to the screening, although many had symptoms compatible with coeliac disease. All individuals with antiendomysium antibody positivity who were subjected to a small intestinal biopsy had enteropathy. Furthermore, all of them also had elevated levels of antigliadin antibodies type IgA and/or IgG. CONCLUSIONS: Coeliac disease is common, albeit mostly undiagnosed, in Swedish adults. It is likely that the situation is no better in other countries. This highlights the importance of keeping coeliac disease in mind, and of promptly investigating individuals with unexplained, even mild, symptoms compatible with the disease. Serological markers, e.g. antigliadin and antiendomysium antibodies, are useful tools within this active case-finding strategy, although the final diagnosis should be based on an intestinal biopsy demonstrating enteropathy.     

Chronic medical conditions and late effects following non-Hodgkin lymphoma in HIV-uninfected and HIV-infected adolescents and young adults: a population-based study

Little is known about the incidence of late effects following non-Hodgkin lymphoma (NHL) among adolescent and young adult (AYA, 15–39 years) survivors. Using data from the California Cancer Registry linked to hospital discharge, we estimated the cumulative incidence of late effects at 10 years among AYAs diagnosed with NHL during 1996–2012, who survived ≥2 years. Cox proportional-hazards models were used to investigate the influence of sociodemographic and clinical factors on the occurrence of late effects. Of 4392 HIV-uninfected patients, the highest incident diseases were: endocrine (18·5%), cardiovascular (11·7%), and respiratory (5·0%), followed by secondary primary malignancy (SPM, 2·6%), renal and neurologic (2·2%), liver/pancreatic (2·0%), and avascular necrosis (1·2%). Among the 425 HIV-infected survivors, incidence was higher for all late effects, especially over threefold increased risk of SPM, compared to HIV-uninfected patients (8·1% vs. 2·6%). In multivariable models for HIV-uninfected patients, public or no health insurance (vs. private), residence in lower socioeconomic neighbourhoods (vs. higher), and receipt of a haematopoietic stem cell transplant were associated with a greater risk of most late effects. Our findings of substantial incidence of late effects among NHL AYA survivors emphasise the need for longterm follow-up and appropriate survivorship care to reduce morbidity and mortality in this vulnerable population.     

First positive reactions to cannabis constitute a priority risk factor for cannabis dependence

Aim   To assess the association between first reactions to cannabis and the risk of cannabis dependence.
Design   A cross-sectional population-based assessment in 2007.
Setting   A campus in a French region (Champagne-Ardennes).
Participants   A total of 1472 participants aged 18–21 years who reported at least one life-time cannabis consumption, of 3056 students who were screened initially [the Susceptibility Addiction Gene Environment (SAGE) study].
Measurements   Positive and negative effects of first cannabis consumptions, present cannabis dependence and related risk factors were assessed through questionnaires.
Findings   The effects of first cannabis consumptions were associated dose-dependently with cannabis dependence at age 18–21 years, both according to the transversal approach of the SAGE study and to the prospective cohort of the Christchurch Health and Development Study (CHDS) assessed at the age of 25 years. Participants of the SAGE study who reported five positive effects of their first cannabis consumption had odds of life-time cannabis dependence that were 28.7 (95% confidence interval: 14.6–56.5) higher than those who reported no positive effects. This association remains significant after controlling for potentially confounding factors, including individual and familial variables.
Conclusions   This study suggests an association between positive reactions to first cannabis uses and risk of life-time cannabis dependence, this variable having a central role among, and through, other risk factors.     

Substance abuse and dependence in prisoners: a systematic review

AIMS: To review studies of the prevalence of substance abuse and dependence in prisoners on reception into custody. DESIGN AND METHOD: A systematic review of studies measuring the prevalence of drug and alcohol abuse and dependence in male and female prisoners on reception into prison was conducted. Only studies using standardized diagnostic criteria were included. Relevant information, such as mean age, gender and type of prisoner, was recorded for eligible studies. The prevalence estimates were compared with those from large cross-sectional studies of prevalence in prison populations. FINDINGS: Thirteen studies with a total of 7563 prisoners met the review criteria. There was substantial heterogeneity among the studies. The estimates of prevalence for alcohol abuse and dependence in male prisoners ranged from 18 to 30% and 10 to 24% in female prisoners. The prevalence estimates of drug abuse and dependence varied from 10 to 48% in male prisoners and 30 to 60% in female prisoners. CONCLUSIONS: The prevalence of substance abuse and dependence, although highly variable, is typically many orders of magnitude higher in prisoners than the general population, particularly for women with drug problems. This highlights the need for screening for substance abuse and dependence at reception into prison, effective treatment while in custody, and follow-up on release. Specialist addiction services for prisoners have the potential to make a considerable impact.     

Treatment patterns and outcomes in adolescents and young adults with nodular lymphocyte-predominant Hodgkin lymphoma: an IMPACT cohort study

We leveraged population-based clinical and healthcare data to identify treatment patterns and long-term outcomes among adolescents and young adults (AYA) with nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). All Ontario, Canada, AYA aged 15–21 years at diagnosis with NLPHL between 1992 and 2012 were identified, and their detailed clinical data were collected. Linkage to healthcare databases identified additional events (subsequent malignant neoplasms [SMN], relapses and deaths). Event-free survival (EFS) and overall survival (OS) were compared by locus of care (adult vs. paediatric) and predictors of outcomes determined. Of 1014 AYA with Hodgkin lymphoma, 54 (5.3%) had NLPHL; 15 (27.8%) were treated at a paediatric centre. No paediatric centre patient received radiation only versus 16 (41.0%) of adult centre patients. Excision only was more common in paediatric centres (p < 0.001). The 20-year EFS and OS rates were 82.9% ± 5.2% and 100% respectively. Advanced stage (hazard ratio: 4.9, 95% CI: 1.3–18.4; p = 0.02) was associated with inferior EFS. Although the 25-year cumulative incidence of SMN was 19.3% ± 9.6% for the entire cohort, there were no SMN among the patients treated with excision only. AYA with NLPHL have outstanding long-term survival. Resection alone was rare outside of paediatric institutions but associated with excellent outcomes. Given substantial SMN risks, chemotherapy-sparing and radiation-sparing strategies for appropriate subsets of patients are warranted.     

Sex differences in psychosocial correlates of concurrent substance use among heterosexual,homosexual and bisexual college students

Abstract

Background: College students identifying as Lesbian, Gay or Bisexual (LGB) are at increased risk for substance use. Few studies have assessed correlates of concurrent substance use, which increases the risk for substance use disorders. Objectives: The current study aimed to (1) examine differences in substance use among male and female sexual minorities and (2) explore the impact of psychosocial factors on the relationship between sexual identity and concurrent substance use. Methods: A web-based survey assessing health behavior, psychosocial characteristics, attitudes and demographics was administered to students from six colleges in the southeastern US. A total of 4840 students responded to the survey; 2.9% reported a homosexual identity (n?=?111) and 3.5% reported a bisexual identity (n?=?135). Multivariable modeling was used to assess the relationship between sexual identity and the number of substances used, adjusting for demographic and psychosocial factors. Results: Bisexual females were significantly more likely than their homosexual or heterosexual counterparts to report tobacco use (p?<?0.0001), binge drinking (p?<?0.05) and marijuana use (p?<?0.0001) in the past 30 days. No differences in substances used existed among males. Adjusted for age and ethnicity, homosexually- and bisexually-identified females were more likely to have concurrent substance use than those who identified as heterosexual (p?<?0.0001 and p?<?0.0001, respectively). Adjusting for psychosocial factors decreased the magnitude and significance of the association (p?<?0.01 and p?<?0.001, respectively). Conclusion: Female sexual minorities are at high risk for substance use. Targeting specific psychosocial factors might be useful in efforts to address use of tobacco, alcohol and marijuana among LGB young adults.     

The daily progress system: A proof of concept pilot study of a recovery support technology tool for outpatient substance abuse treatment

Background: Illicit substance use remains highly prevalent in the US, and epidemiological surveillance surveys estimate that in 2015, over 27 million individuals (10.1% of the US population) 12 years of age or older used illicit drugs in the past 30 days.¹ Outpatient treatment delivered in community-based settings is the dominant modality for addiction treatment, typically involving weekly psychosocial counseling sessions in an individual and/or group format.^2,3 Unfortunately, relapse and premature treatment discontinuation are quite common in outpatient treatment.^3–5 Objectives: This is a pilot proof of concept feasibility study involving clients presenting for outpatient SUD treatment. This study sought to examine the feasibility and acceptability of the Daily Progress System (DPS), a telephone-based software program, using interactive voice response (IVR), designed to enhance quality care and improve client outcomes. Methods: Individuals who presented at the participating treatment clinic, who met study eligibility criteria, and who provided written informed consent to participate were included in the study (N = 15; 53.3% females). Incentives were paid to participants for calls completed. Results: Participants completed 65% of scheduled daily call-ins, representing 273 person-days of data on client cravings, mood, substance use, and involvement in recovery support activities. The average call duration was approximately 2 minutes and 42 seconds. There was a high degree of client and counselor acceptance and satisfaction using the system. Conclusions and Clinical Significance: Findings suggest that the DPS appears to be a feasible means of potentially addressing relapse and treatment engagement issues based on client and counselor engagement and satisfaction with the system.     

Determinants of alcohol use among young males in two Indian states: A population-based study

Objectives

There is insufficient evidence about the determinants of alcohol use amongst young people in India and other low-and middle-income countries, despite alcohol's high contribution to disease burden and increasing consumption in this population. We aimed to identify and estimate the determinants of alcohol use in a representative sample of 2716 young men from Bihar and Uttar Pradesh who participated in the ‘Understanding the Lives of Adolescents and Young Adults’ (UDAYA) study.

Methods

First, we developed an exploratory conceptual framework of potential alcohol use determinants in the study settings based on available literature. We then estimated the effects of 35 potential alcohol use determinants identified in the conceptual framework (including 14 latent factors identified through exploratory factor analysis) on any alcohol use in the past 3 years and regular alcohol use amongst past three-year drinkers, using mixed-effects logistic models. The determinants explored were operationalised using longitudinal data from the UDAYA study.

Results

Our adjusted models identified 18 determinants for past 3-year alcohol use and 12 determinants for regular use. Distal determinants (e.g., socioeconomic status), intermediate determinants (e.g., parental alcohol use, media use), and proximal determinants (e.g., emotional regulation, early tobacco use) were identified. Geographical variations in both outcomes indicate potential differences in unmeasured community-level determinants (e.g., alcohol availability and acceptability).

Conclusions

Our findings extend the generalizability of several known determinants across settings, yet highlight the importance of addressing alcohol use in young people as a complex and context-dependent issue. Many identified determinants (e.g., education, media use, poor parental support, early tobacco use) are amenable to intervention through multi-sectoral prevention programs/policies. Such determinants should be the focus of ongoing policy/intervention development efforts in the region, and our revised conceptual framework may inform further research in India or similar South Asian settings.     

Smoking, nicotine dependence and mental health among young adults: a 13-year population-based longitudinal study

Aims   To investigate prospectively the associations between daily smoking and nicotine dependence and anxiety, depression and suicide attempts.
Methods   Data were from the Young in Norway Longitudinal Study. A population-based sample ( n  = 1501) was followed for 13 years from ages 13–27 years. Data were gathered on smoking patterns and nicotine dependence; and depression, anxiety and parasuicide. Extensive information on socio-demographic factors, parental and family conditions, parental rearing practices, educational career, conduct problems, alcohol problems and use of illegal substances was also collected.
Results   Young adults who were nicotine-dependent had clearly elevated rates of anxiety, depression and parasuicide. These rates declined after controlling for a previous history of mental health problems and potential confounding factors. After adjustment, nicotine dependence was still associated with anxiety, depression and parasuicide. There was also a significant association with later depression in the group of non-dependent daily smokers. Measures of reduced mental health did not predict later smoking initiation or the development of nicotine dependence.
Conclusions   Mental health was reduced more seriously in nicotine-dependent smokers than in non-dependent smokers. These findings are consistent with the hypothesis that smoking, in particular nicotine dependence, influences mental health.     

Tobacco use after experiencing a major natural disaster: analysis of a longitudinal study of 2063 young adults

AIM: To identify the extent to which tobacco use is affected by experience of a natural disaster and resulting symptoms of post-traumatic stress disorder (PTSD). DESIGN: Longitudinal community survey. SETTING: Canberra, the national capital of Australia. PARTICIPATION: A random selection of 2063 young adults participating in this project lived in a region affected by a major bushfire in 2003. They were first interviewed in 1999-2000 and re-interviewed in 2003-4 after the bushfire had occurred. MEASUREMENTS: Changes in participants' level of consumption of tobacco over a 4-year period were calculated. When interviewed after the disaster, participants answered questions concerning their experience of traumatic events, their immediate emotional response during the disaster and their fire-related PTSD symptoms of re-experiencing and hyperarousal. FINDINGS: Experience of traumatic events experienced during the disaster was associated with an increase in consumption of tobacco (OR: 1.12, 95% CI: 1.03-1.21). PTSD symptoms did not contribute independently to increased tobacco use after controlling for trauma experiences. CONCLUSIONS: These findings indicate that trauma experiences can trigger increased tobacco use in young adults regardless of whether such experiences result in PTSD symptoms. Public health information provided to communities and health-care providers should note that increases in this preventable health risk may occur as a result of individuals experiencing trauma.     

The role of substance use in young adult divorce

AIM: To test the relationships between various forms of substance use during marriage and subsequent divorce among US young adults. DESIGN: Three waves of survey data collected at approximately ages 18, 23 and 29 years were used. Using multivariate logistic regression and controlling for factors present at the two early waves, we tested for prospective relationships between substance use at the second assessment and divorce by the third. PARTICIPANTS: A longitudinal panel following adolescents on the west coast of the United States into young adulthood. The analytic subsample consisted of the 454 individuals currently married at the age 23 survey. MEASUREMENTS: Predictors were past-year frequency of alcohol intoxication, marijuana use and cigarette use, as well as any hard drug use in the past year. Covariates included substance use prior to marriage, demographic and socio-economic factors, marital discord and religiosity. FINDINGS: Controlling for other factors, more frequent alcohol intoxication during marriage was an independent predictor of later divorce. Frequency of marijuana use had a significant bivariate relationship with divorce that was not significant in the multivariate model. CONCLUSION: These data are consistent with the notion that alcohol intoxication is related causally to divorce among young adults.     

Early pubertal maturation in the prediction of early adult substance use: a prospective study

Aims   To examine whether self-reporting a later stage of pubertal development in early adolescence predicts young adults' use of illicit drugs.
Design   Population-based prospective birth cohort study.
Setting   Follow-up of a cohort of mothers and their children, recruited between 1981 and 1983.
Participants   Cohort of 2710 young adults who completed a self-report questionnaire about their use of cannabis and amphetamines at the 21-year follow-up.
Measurements   Young adults' use of cannabis and amphetamines were measured at the 21-year follow-up. Stage of pubertal development was assessed at the 14-year follow-up. Potential confounding and mediating variables were assessed between birth and when the child was 14 years.
Findings   Of 2710 young adults, 49.9% (47.3 females and 52.7% males) reported that they had used cannabis and 21.0% (18.9% females and 23.3% males) reported that they had used amphetamines and cannabis by 21 years. In multivariate analyses, adolescents with a later stage of puberty were more likely to use cannabis or amphetamines in young adulthood. This association was not confounded by mother's education or child's gender and age. Part of the relationship was explained by the higher frequency of child externalizing behaviour at 14 years.
Conclusions   The findings warrant further attention to puberty as a sensitive period in an individual's development. With regard to prevention, there is a need to understand more about the pathways between pubertal development, child behaviour problems and substance use.     

The natural course of cannabis use, abuse and dependence during the first decades of life

AIMS: There has been little available information on the long-term natural course, persistence and remission of cannabis use, abuse and dependence. The current study estimated rates and risk factors associated with stability and variation in cannabis use patterns, cannabis abuse and cannabis dependence in a community sample over a 10-year period. DESIGN, SETTING AND PARTICIPANTS: Prospective longitudinal, epidemiological study with a 4- and 10-year follow-up of a community sample (n = 3021) aged 14-24 years at baseline in Munich, Germany. MEASUREMENTS: Cannabis use, abuse and dependence and associated risk factors were assessed by face-to-face interviews using the Munich Composite International Diagnostic Interview. Findings At baseline, one-third of the sample (34.2%) had used cannabis at least once. The cumulative incidence of cannabis use 10 years later was 50.7%. Fifty-six per cent of all repeated users (five times or more) at baseline reported cannabis use at 4-year follow-up. Ten years later, this proportion had decreased slightly to only 46.3%. Repeated (five times or more) users were almost three times more likely to report repeated use at 10-year follow up (OR = 2.8, 95% CI = 1.6-4.7), compared with those who had used cannabis fewer times. Peer use of cannabis, life-events and alcohol dependence also predicted use of cannabis at 10-year follow-up. CONCLUSIONS: Among youth who have used cannabis repeatedly (five times or more) cannabis use is fairly stable and rates of remission relatively low until age 34 years. Patterns of progression suggest that early targeted preventive measures should delay first use and reduce the number of experiences using cannabis, as these factors appear critical in progression to persistent cannabis use and cannabis dependence.