Personal Income and Substance Use among Emerging Adults in the United States

Background: Taxation and other policy measures have been implemented across the United States to curb the accessibility of substance use, especially among youth. While the inverse relationship between price and youth consumption is well known, available research on youth earned income and substance use is sparser, particularly among emerging adults. Objectives: We examined the association between emerging adult past-year personal income and 30-day substance use. Methods: We analyzed data from Wave 5 (n = 2,202) of the NEXT Generation Health Study, an annual survey study administered to a nationally representative sample of emerging adults in the U.S. Wave 5 (mean age = 20.28 years, SE = 0.02 years) was administered during the 2013–2014 academic year. After grouping participants into five levels of self-reported, pre-tax personal income, we used binomial logistic regression to examine the association between personal income and cigarette smoking, marijuana use, alcohol use, and heavy episodic drinking (HED). Results: In unadjusted models, those at certain levels of higher past-year income were more likely to smoke cigarettes, consume alcohol, or engage in HED at least once in the past 30 days. Several associations remained significant after controlling for covariates. Most associations were no longer significant after including perceived peer norms as additional covariates. Personal income was not associated with 30-day marijuana use in unadjusted or adjusted models. Conclusions/Importance: Higher earned income may provide emerging adults greater economic access to cigarettes and alcohol, but the association might be partly attenuated by social factors, particularly perceived peer norms.     

Substance Abuse Among Asian Indians in the United States: A Consideration of Cultural Factors in Etiology and Treatment

We explore cultural factors that contribute to substance use in the Asian Indian population in the United State and propose culturally sensitive treatment, with an emphasis on family issues. The 2000 U.S. Census figures show that Asian Indians residing in this country have grown to about 1.7 million from the 1990 U.S. Census figure of 815,000. On average, Asian Indians have a higher level of education and proficiency in English compared with many other new immigrant groups. The median family income for Asian Indians in the United State in 1999 was $70,708, compared with $53,356 for Whites. Based on these statistics, Asian Indians are erroneously labeled a “model minority.” However, a closer look shows that Asian Indians are paid lower than their White counterparts with comparable education. Also, many Asian Indians live in areas where the cost of living is higher, and high family income does not automatically translate into a higher standard of living. There is large within-group disparities in income, and Asian Indian families might fall at either end of the Socio-economic status (SES) pole.     

Competitive Sport Involvement and Substance Use among Adolescents: A Nationwide Study

Background: The empirical research examining the impact of sports participation on alcohol and other drug use has produced mixed results. Part of this problem may be the result of how different types of sports participation create different experiences that shape certain types of behaviors that either facilitate or deter substance use. Objectives. We examined the association between different types of competitive sports participation and substance use among a nationally representative sample of adolescents. Methods: Two recent cross-sections from the Monitoring the Future were merged to capture a large subsection of adolescents who participate in either high-contact sports (football, wrestling, hockey, and lacrosse), semicontact sports (baseball, basketball, field hockey, and soccer), and noncontact sports (cross-country, gymnastics, swimming, tennis, track, and volleyball). Results: Multivariate analyses revealed that adolescents who participated in high-contact sports had higher odds of using substances during the past 30 days and initiating substance use at early ages. Further, adolescents who participated in noncontact sports had lower odds to indicate smoking cigarettes and marijuana during the past 30 days. Conclusions: Parents, educators, and policy makers need to consider that some sporting contexts may be a catalyst to engage in risky behaviors like substance use.     

Substance use history in behavioral-variant frontotemporal dementia versus primary progressive aphasia

As older adults are prone to cognitive disorders, the interaction of the fields of substance use and misuse and cognitive neuroscience is an emerging area of research. Substance use has been reported in some subtypes of frontotemporal dementia, such as behavioral variant frontotemporal dementia. However, characterization of substance use in other subtypes of frontotemporal dementia, such as primary progressive aphasia, is unknown. The objective of this baseline analysis was to explore whether any measures of substance use history differed significantly among behavioral variant frontotemporal dementia (n = 842) and primary progressive aphasia (n = 526) in a large national dataset. The National Alzheimer's Coordinating Center's Uniform Data Set study is a national dataset that collects data on patients with various cognitive disorders and includes some questions on substance use. Each substance use variable was used as the outcome and the frontotemporal dementia subtype as the predictor. Total years smoked cigarettes, age when last smoked cigarettes, average number of packs/day smoked when participants smoked, and any recent, remote, or combined recent/remote history of alcohol abuse or drug abuse did not significantly differ between the behavioral variant frontotemporal dementia and primary progressive aphasia subtypes (all p-values > .001). A significantly greater percentage of participants smoked in the last 30 days in the behavioral variant frontotemporal dementia subtype (10.4%, n = 834) compared to the primary progressive aphasia subtype (3.3%, n = 517; p < .001). Clinical providers in both the dementia and substance use fields are encouraged to screen for and monitor substance use in all frontotemporal dementia subtypes.     

Association of socioeconomic status with consumption of cigarettes,illicit drugs,and alcohol

Introduction and Aims: Socioeconomic Status (SES) is considered as one of the important factors associated with use of various drugs. The present study aimed to investigate the effect of SES on cigarette smoking, alcohol use, drug use, and passive exposure to opium and cigarette smoke.

Design and Methods: In this study, which is part of a multicenter case-control study, the research hypothesis was checked among controls who had referred to hospitals. Data were collected through a questionnaire and laboratory tests to determine the actual consumers of opium and other illicit drugs. Then, the data were analyzed using STATA 13.

Result: This study was performed on 364 individuals within the age range of 30 to 75 years. More than 55% of the participants had a history of life-time consumption of cigarettes and hookah as well as alcohol and drugs. The results revealed an inverse relationship between SES and life-time consumption of hookah and alcohol. Furthermore, individuals with higher SES were more likely to deny their drug use.

Discussion and Conclusions: The results revealed little robust evidence supporting the assumption that SES level can have an important effect on illicit drug use. On the other hand, the participants’ characteristics could have a prominent effect on precise evaluation of the relationship between SES and drug use. Further multicenter studies are needed with samples diversified in terms of age and ethnicity to identify these confounding relationships.     

Risk profiles among adolescent nonmedical opioid users in the United States

Although prior research has provided data on nonmedical use of opioids in adolescents, studies examining the heterogeneity of risk are limited. The present study extends prior research by deepening the understanding of adolescent nonmedical opioid use by specifying empirically meaningful profiles of risk. Using data on adolescent non-medical opioid users (N=1783) from the 2008 US National Survey on Drug Use and Health (NSDUH), latent class analysis and multinomial logistic regression were employed to identify latent classes and determine the effects of covariates on class membership. Four latent classes provided the best fit to the data. Classes consisted of a low risk class (33.7%), a high delinquency/low substance use class (17.8%), a high substance use/low delinquency class (34.2%), and finally a high risk class (14.3%) characterized by high levels of both substance use and delinquent behavior. Study findings advance the understanding of adolescent nonmedical opioid use by specifying distinct latent classes. Results suggest that intervention efforts can fruitfully target a number of risk domains especially programs that enhance effective parenting and supervision.     

Further evidence of differences in substance use and dependence between Australia and the United States

The current study compared the prevalence of substance use and DSM-IV dependence in the USA and Australia. Participants aged 18–54 were selected from two cross-sectional nationally representative Australian (National Survey on Mental Health and Well-Being – NSMHWB, 1997, n = 7570) and American (National Epidemiologic Survey on Alcohol and Related Conditions – NESARC, 2001–2002, n = 29,673) household surveys. The NSMHWB utilised the Composite International Diagnostic Interview, whereas the NESARC used the Alcohol Use Disorder and Associated Disabilities Interview Schedule. The 12-month prevalence of alcohol use was lower in the USA (56.5%) than in Australia (77.2%), although the rates of alcohol dependence were similar in both countries. The USA had higher rates of alcohol dependence conditional on use (9.0%) compared to Australia (6.8%). Australians had higher levels of drug use, dependence, and conditional dependence than Americans (except for sedatives and opioids). The absence of significant interactions between country of interview and the common correlates of substance use disorders indicated that the influence of these factors was similar in the USA and Australia. In conclusion, the current investigation revealed striking differences in the rates of conditional drug dependence between Australia and the USA. The cross-national generalizability of the relationships between the common correlates and prevalence of substance use and dependence indicates that a similar process of vulnerability to dependence may be operating in the USA and Australia. In the future, these cross-national differences could be used to help better understand the factors that influence drug use and the development of dependence.     

The prevalence of unhealthy alcohol and drug use among inpatients in a general hospital

Abstract

Background: Unhealthy substance use is a growing public health issue. Intersections with the health care system offer an opportunity for intervention; however, recent estimates of prevalence for unhealthy substance use among all types of hospital inpatients are unknown. Methods: Universal screening for unhealthy alcohol or drug use was implemented across a 999-bed general hospital between January 1 and December 31, 2015. Nurses completed alcohol screening using the Alcohol Use Disorders Identification Test alcohol consumption questions (AUDIT-C) with a cutoff of ≥5 for moderate risk and ≥8 for high risk and drug screening using the single-item screening question with ≥1 episode of use considered positive. Results: Out of 35,288 unique inpatients, screens were completed on 21,519. There were 3,451 positive screens (16% of all completed screens), including 1,291 (6%) moderate risk and 1,111 (5%) high risk screens for alcohol and 1,657 (8%) positive screens for drug use. Among screens that were positive for moderate- or high-risk alcohol use, 221 (17%) and 297 (27%), respectively, were concurrently positive for drug use. The majority (61%) of patients with unhealthy alcohol use was on the medical services. Men, those who were white or Hispanic, middle-aged, single, unemployed, or screened positive for drug use were more likely to screen positive for high-risk alcohol use. Those who were younger, single, worked less than full time, or screened high risk for alcohol were more likely to screen positive for drug use. Discordance between diagnosis coding and screening results was noted: 29% of high-risk alcohol use screens had no alcohol diagnosis coding associated with that admission, and 51% of patients with a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnosis code of alcohol dependence had AUDIT-C scores of <8. Conclusions: Across a general hospital, 16% of patients screened positive for unhealthy substance use, with the highest volume on medical floors. Nursing-led screening may offer an opportunity to identify and engage patients with unhealthy substance use during hospitalization.     

Substance abuse1 among Asian Indians in the United States: a consideration of cultural factors in etiology and treatment

We explore cultural factors that contribute to substance use in the Asian Indian population in the United State and propose culturally sensitive treatment, with an emphasis on family issues. The 2000 U.S. Census figures show that Asian Indians residing in this country have grown to about 1.7 million from the 1990 U.S. Census figure of 815,000. On average, Asian Indians have a higher level of education and proficiency in English compared with many other new immigrant groups. The median family income for Asian Indians in the United State in 1999 was 70,708 US dollars, compared with 53,356 US dollars for Whites. Based on these statistics, Asian Indians are erroneously labeled a "model minority." However, a closer look shows that Asian Indians are paid lower than their White counterparts with comparable education. Also, many Asian Indians live in areas where the cost of living is higher, and high family income does not automatically translate into a higher standard of living. There is large within-group disparities in income, and Asian Indian families might fall at either end of the Socio-economic status (SES) pole.     

Substance Use and Sexual Orientation among East and Southeast Asian Adolescents in Canada

The purpose of this study was to examine the relationship between substance use and sexual orientation among Asian adolescents in Canada. We analyzed an East- and Southeast-Asian subsample of a province-wide, school-based survey (weighted N = 51,349). Compared to heterosexual adolescents of the same gender, gay, lesbian, bisexual, and mostly heterosexual adolescents were more likely to use alcohol, marijuana, or other illicit drugs. Particularly, sexual minority girls were at increased risk for substance use. The findings suggest the need for substance use prevention interventions that are sensitive to gender, sexual orientation, and culture.     

Problem recognition, intention to stop use, and treatment use among regular heroin injectors

This study investigated frequency of recent use as an explanatory variable in problem recognition and intention to stop use among regular injection heroin users. Data from the NEURO-HIV Epidemiologic Study, an investigation of neuropsychological and social-behavioral risk factors for HIV and hepatitis A, B, and C among injection and noninjection drug users, were used in the analyses. Participants (N = 337) consisted of those who reported injecting heroin daily or nearly daily for a period of 3 months. Multiple linear regression analysis revealed that frequency of recent injection drug use predicted problem recognition (β = .17), but not intention to stop use; although marginal, being female (β = .15), and homeless (β = .14) contributed to intention to stop use. Past 6-month treatment participation was 48%, and current treatment enrollment was 26% among study participants. This study highlights the importance of capitalizing on injection drug users' recent use as a mechanism for treatment interventions.     

Substance use among persons with homeless experience in primary care

ABSTRACT

Background: Community survey data suggest high prevalence of substance use disorders among currently homeless individuals. There are less data regarding illicit drug and alcohol use problems of homeless-experienced persons engaged in primary care. They may have less severe use and require different care responses from primary care teams. Methods: The authors surveyed currently and formerly homeless, i.e., homeless-experienced, persons engaged in primary care at five federally funded programs in the United States, administering the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ASSIST definitions of lower, moderate, and high risk were used to assess a spectrum of lifetime and recent substance use, from any use to likely dependence, and to identify sociodemographic and health status characteristics associated with severity of use. Results: Almost one half of the sample (N = 601) had recently (within the past three months) used alcohol, and one third had recently used an illicit drug. The most commonly used illicit drugs in the past three months were cannabis (19%), cocaine (16%), and opioids (7.5%). Over one half (59%) of respondents had ASSIST-defined moderate- or high-risk substance use. A significant proportion (31%) of those identified as at moderate risk had no recent substance use, but did report past problematic use. Ten percent of the lower-risk group had past problematic use of alcohol. Severity of use was associated with worse health status, but not with housing status or type of homelessness experienced. Conclusions: Less severe (moderate-risk) use and past problematic use, potentially indicative of remitted substance use disorders, were more common than high-risk use in this primary care, homeless-experienced sample. These findings highlight the urgency of identifying effective ways to reduce risky substance use and prevent relapse in homeless-experienced persons.     

Update: comparison of drug use in Australia and the United States as seen in the 2001 National Household Surveys

This paper updates an earlier article by comparing the results of the 1998 and 2001 household surveys. The Australian survey showed a significant decrease in past-year use of 'any illicit drug'. The methodological changes in the US surveys prevented comparison for these years, but there were increases in use of any illicit drug between 2000 and 2001. Patterns of use of marijuana, stimulants, cocaine, ecstasy, heroin and needles are shown by age group and gender. Use by teenage girls in both countries has risen to the point that they are now using alcohol and some drugs at rates similar to boys. Over 20% of teens in both countries reported binge drinking in the past month. While Australians in their 20s had the highest rates of lifetime and past-year use, in the United States, depending on the drug, lifetime use was highest among people in their 30s or 40s, with past-year use highest among teenagers. Drug treatment services are needed not only for young people, but also for aging users. The changes in perceptions of risk from use of various drugs and availability of these drugs are related to changes in prevalence rates. [Maxwell JC. Update: comparison of drug use in Australia and the United States as seen in the 2001 National Household Surveys. Drug Alcohol Rev 2003;22:347 - 357]     

Validity of the Drug Use Screening Inventory for Predicting DSM-III-R Substance Use Disorder

SUMMARY

The Drug Use Screening Inventory (DUSI) has been shown to have sound psychometric properties for quantifying the severity of health, behavior and psychosocial problems concomitant to substance use in adolescents. Its utility for identifying youth who will develop a disorder of abuse/dependence has, however, not been investigated. In this longitudinal study, the DUSI was administered to a sample of boys at ages 12–14, 16 and 19 in a repeated measures design. An overall problems severity score of 24% at ages 12–14 and 16 predicted a DSM-III-R substance use disorder (SUD) outcome at age 19 with 73% and 84% accuracy respectively. Parental history of SUD did not increase prediction of SUD outcome in the youth. These findings indicate that the DUSI, taking only 15–20 minutes to complete, is a useful practical instrument to identify youth who could benefit most from prevention interventions.     

The Complex Nature of Parental Substance Use: Examining Past Year and Prior Use Behaviors as Correlates of Child Maltreatment Frequency

Background: Child maltreatment studies predominantly have operationalized parental substance use as dichotomous variables for any use, any harmful/risky use, or any substance use disorder (SUD). This limits our understanding about how a range of use behaviors may contribute to child maltreatment. Objective: Build upon prior studies by incorporating a multi-faceted approach to operationalizing parental substance use. Methods: Cross-sectional, secondary data analyses were conducted using the National Survey of Child and Adolescent Well-being (NSCAW I). The study used weighted negative binomial regression to examine relationships between annual child maltreatment frequency and different ways of operationalizing substance use among 2,100 parents. Results: Several, inter-related behaviors (i.e., heavy drinking, illicit drug use, polysubstance use, SUD, and prior SUD < 4 years) appeared to be relevant for understanding differences in child maltreatment frequencies. A gradient effect was detected across five substance use behavior patterns: (1) lowest estimated counts were observed for nonusers, light-to-moderate drinkers, and parents with a prior (but not past year) SUD (? < 7.0), (2) slightly higher estimated count was observed for heavy drinkers and/or illicit drug users (? = 9.3), and (3) highest estimated count was observed for parents with past year SUD (? = 17.6). Conclusions/Importance: SUD is a critical screening criteria for potential child harm. Parents reporting risky substance use behaviors may benefit from prevention or brief intervention services related to both their substance use and parenting behaviors. Administrative systems also could benefit from detailed tracking of substance use behaviors for future program evaluation and development.     

Availability of Outpatient Substance Use Disorder Treatment Programs in the United States

The purpose of this study was to examine the availability of outpatient substance use disorder (SUD) treatment programs in the United States. A geographic information system (GIS) was used to spatially locate outpatient SUD treatment programs, calculate areas, and determine population density within specific areas. Urban areas were mapped using data from the US Census (2000). Addresses of outpatient SUD treatment programs were obtained from the Facility Locator Web site of the Substance Abuse and Mental Health Services Administration. A 15-mile service catchment around each outpatient SUD treatment program was drawn. The amount of urban area not covered by the service catchment represents the underserved. Total underserved urban area and population without access was computed for each state. Significant variability of underserved urban area and population was observed across the states. Moderate correlations among area and population suggest that some states are more effective in locating SUD treatment programs than other states.     

Health-related material needs and substance use among emergency department patients

Abstract

Background: Emergency department (ED) visits related to substance use are common. ED patients also have high levels of health-related material needs (HRMNs), such as homelessness and food insecurity. However, little research has examined the intersection between ED patient HRMNs and substance use. Methods: We surveyed a random sample of public hospital ED patients. Surveys included validated single-item screeners for unhealthy alcohol and any drug use and questions on self-reported past-year material needs. We compared individual HRMNs and cumulative number of HRMNs by substance use screening status using bivariate and multivariable analyses. Results: A total of 2312 surveys were completed. Nearly one third of patients (32.3%, n?=?747) screened positive for unhealthy alcohol use, and 21.8% (n?=?503) screened positive for drug use. Prevalence of HRMNs for all patients—including food insecurity (50.8%), inability to meet essential expenses (40.8%), cost barriers to medical care (24.6%), employment issues (23.8%), and homelessness (21.4%)—was high and was significantly higher for patients with unhealthy alcohol use or drug use. In multivariable analyses, homelessness was independently associated with unhealthy alcohol use (adjusted odds ratio [aOR]: 1.61, 95% confidence interval [CI]: 1.24–2.09) and drug use (aOR: 2.30, 95% CI: 1.74–3.05). There was a significant stepwise increase in the odds of patient unhealthy alcohol or drug use as number of HRMNs increased. Conclusions: ED patients with unhealthy alcohol or drug use have higher prevalence of HRMNs than those without. Our findings suggest that HRMNs may act additively and that homelessness is particularly salient. Patients’ comorbid HRMNs may affect the success of ED-based substance use interventions.     

Parental Dissatisfaction with Sons in Substance Abusing Families: Relationship to Child and Parent Dysfunction

Considerable attention has focused on the role of family dysfunction in the development of adolescent substance abuse, particularly in families where a parent has a history of alcohol and drug abuse. This study examined parental reports of dissatisfaction with 41 boys (ages 10-12) of fathers with a history of substance abuse (SA⁺) and 68 boys of fathers without such a history (SA^-). Higher dissatisfaction ratings by both mothers and fathers were found in the SASA⁺ group in contrast to the SA^- group. Both child externalizing behavior problems and parental personality characteristics were correlated with dissatisfaction. Stepwise regression analysis revealed that father's negative affectivity, followed by externalizing symptoms in the boys, were most predictive of dissatisfaction in both mothers and fathers. The implications of these results for an understanding of the adverse family context of substance abuse are discussed.