Prevalence of cannabis use in Brazil: Data from the I Brazilian National Alcohol Survey (BNAS)

Aims

To estimate the prevalence of cannabis use in the last 12 months in the Brazilian population and to examine its association with individual and geographic characteristics.

Design

Cross-sectional survey with a national probabilistic sample.

Participants

3006 individuals aged 14 to 65 years.

Measurements

Questionnaire based on well established instruments, adapted to the Brazilian population.

Findings

The 12-month prevalence of cannabis use was 2.1% (95%CI 1.3–2.9). Male gender, better educational level, unemployment and living in the regions South and Southeast were independently associated with higher 12-month prevalence of cannabis use.

Conclusion

While the prevalence of cannabis use in Brazil is lower than in many countries, the profile of those who are more likely to have used it is similar. Educational and prevention policies should be focused on specific population groups.     

The impact of comorbid cannabis and methamphetamine use on mental health among regular ecstasy users

Objective

Residual effects of ecstasy use induce neurotransmitter changes that make it biologically plausible that extended use of the drug may induce psychological distress. However, there has been only mixed support for this in the literature. The presence of polysubstance use is a confounding factor. The aim of this study was to investigate whether regular cannabis and/or regular methamphetamine use confers additional risk of poor mental health and high levels of psychological distress, beyond regular ecstasy use alone.

Method

Three years of data from a yearly, cross-sectional, quantitative survey of Australian regular ecstasy users was examined. Participants were divided into four groups according to whether they regularly (at least monthly) used ecstasy only (n = 936), ecstasy and weekly cannabis (n = 697), ecstasy and weekly methamphetamine (n = 108) or ecstasy, weekly cannabis and weekly methamphetamine (n = 180). Self-reported mental health problems and Kessler Psychological Distress Scale (K10) were examined.

Results

Approximately one-fifth of participants self-reported at least one mental health problem, most commonly depression and anxiety. The addition of regular cannabis and/or methamphetamine use substantially increases the likelihood of self-reported mental health problems, particularly with regard to paranoia, over regular ecstasy use alone. Regular cannabis use remained significantly associated with self reported mental health problems even when other differences between groups were accounted for. Regular cannabis and methamphetamine use was also associated with earlier initiation to ecstasy use.

Conclusions

These findings suggest that patterns of drug use can help identify at risk groups that could benefit from targeted approaches in education and interventions. Given that early initiation to substance use was more common in those with regular cannabis and methamphetamine use and given that this group had a higher likelihood of mental health problems, work around delaying onset of initiation should continue to be a priority.     

Is there any evidence of changes in patterns of concurrent drug use among young Australians 18–29 years between 2007 and 2010?

Background

A significant minority of Australians engage in concurrent drug use (using more than one drug in a given period). We examined clusters and correlates of concurrent drug use using the latest available nationally representative survey data on Australian young adults.

Sample

3836 participants aged 18–29 years (mean age 24 years) from the 2010 National Drug Strategy Household Survey (NDSHS).

Method

Clusters were distilled using latent class analysis of past year use of alcohol, tobacco, cannabis, cocaine, hallucinogens, ecstasy, ketamine, GHB, inhalants, steroids, barbiturates, meth/amphetamines, heroin, methadone/buprenorphine, other opiates, painkillers and tranquillisers/sleeping pills.

Results

Concurrent drug use in this sample was best described using a 4-class solution. The majority (87.5%) of young adults predominantly used alcohol only (50.9%) or alcohol and tobacco (36.6%). 10.2% reported using alcohol, tobacco, marijuana, and ecstasy, and 2.3% reported using an extensive range of drugs.

Conclusion

Most drug use clusters were robust in their profile and stable in their prevalence, indicating little meaningful change at the population level from 2007. The targeting of alcohol and tobacco use remains a priority, but openness to experiencing diverse drug-related effects remains a significant concern for 12.5% of young people in this age group.     

Methamphetamine and other substance use trends among street-recruited men who have sex with men,from 2008 to 2011

Background

It is particularly important to survey substance use trends in populations most impacted by the consequences of substance use. Men who have sex with men (MSM) exhibit rates of methamphetamine and other substance use that exceeds those observed among other populations in the United States. Such substance use has been associated with numerous negative health sequelae.

Methods

An outreach program performed street encounters with 5599 unique substance-using MSM from January 1, 2008 through December 31, 2011 to collect data on self-reported sociodemographics and recent substance use. Data were aggregated into six-month cohorts for comparisons of recent substance use patterns across time

Results

Participants averaged 33 years of age (SD = 8), most were Caucasian/white (47%) or Hispanic/Latino (32%), and the self-reported HIV seroprevalence rate was 13.4%. Across cohorts, reported use of alcohol (range = 91–93%), marijuana (range = 36–46%), and/or methamphetamine (range = 23–27%) was common; prevalence of amyl nitrite (max = 14%), ecstasy (max = 12%), powder cocaine (max = 8%) and/or crack cocaine (max = 4%) use, although less common, were still elevated relative to the United States general population.

Conclusions

Methamphetamine and other substance use remained common among substance-using MSM, demonstrating the need for continued substance use interventions geared toward this high-risk population.     

C-reactive protein and substance use disorders in adolescence and early adulthood: A prospective analysis

Background

Dysregulated immune function and elevated inflammation markers are seen in adults with chronic diseases, including some psychiatric disorders, but evidence on inflammation in the case of drug abuse is conflicting.

Objective

To test the concurrent and predictive relations between C-reactive protein (CRP) and use and abuse of alcohol, nicotine and cannabis in a longitudinal, population sample of adolescents and young adults, at the period of highest increase in drug use.

Methods

Data from the prospective population-based Great Smoky Mountains Study (N = 1420) were used, covering children in the community assessed at ages 9–16, 19, and 21. Structured interviews were used to assess substance abuse symptoms and DSM-IV substance use disorders. Bloodspots were collected at each assessment and assayed for CRP.

Results

CRP levels were higher in the presence of nicotine, alcohol, and cannabis use and nicotine dependence. In prospective analyses, higher CRP levels predicted cannabis use and nicotine dependence, and nicotine use predicted higher CRP levels, once covariates were included in the models. Significant covariates were age, race (American Indian), and obesity.

Conclusions

The inter-relationship of CRP and substance abuse has implications for the later health risks associated with early drug and alcohol use and abuse.     

Attention-deficit/hyperactivity disorder subtypes and substance use and use disorders in NESARC

Background

Attention-deficit/hyperactivity disorder (ADHD) is associated with substance use and substance use disorders (SUD). However, relatively little is known about the relationship between DSM-IV ADHD subtypes and substance use or DSM-IV abuse/dependence in epidemiological samples.

Methods

Data were obtained from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC, N = 33,588). Respondents reported on ADHD symptoms (DSM-IV) for the period of time when they were 17 years or younger. Lifetime use and DSM-IV abuse/dependence of alcohol, nicotine, cannabis, cocaine, sedatives, stimulants and heroin/opiates were compared across those with ADHD symptoms but no diagnosis (ADHDsx; N = 17,009), the Combined (ADHD-C; N = 361), Predominantly Inattentive (ADHD-I; N = 325), and the Predominantly Hyperactive-Impulsive (ADHD-HI; N = 279) ADHD subtypes. Taking a more dimensional approach, inattentive and hyperactive-impulsive symptom counts and their associations with substance use and misuse were also examined.

Results

After adjustments for conduct disorder, major depressive disorder, any anxiety disorder and other socio-demographic covariates, substance use and SUD were associated with ADHDsx, ADHD-C, ADHD-I and ADHD-HI. Overall, substance use and SUD were more weakly associated with the ADHDsx group compared to the three ADHD diagnostic groups.Statistically significant differences were not evident across the three diagnostic groups. Hyperactive–impulsive symptoms were more consistently associated with substance use and SUD compared to inattentive symptoms.

Conclusions

ADHD subtypes are consistently associated with substance use and SUD. The relatively stronger association of hyperactive/impulsive symptoms with substance use and abuse/dependence is consistent with the extant literature noting impulsivity as a precursor of substance use and SUD.     

Adolescent binge drinking and risky health behaviours: Findings from northern Russia

Background

Some evidence suggests that in recent years the prevalence of heavy drinking has increased among Russian adolescents. However, as yet, little is known about either heavy alcohol consumption or its relationship with other adolescent health risk behaviours in Russia. The aim of this study therefore was to investigate the association between binge drinking and health risk behaviours among adolescents in Russia.

Methods

Data were drawn from the Social and Health Assessment (SAHA), a survey carried out in Arkhangelsk, Russia in 2003. Information was obtained from a representative sample of 2868 adolescents aged 13–17 regarding the prevalence and frequency of binge drinking (five or more drinks in a row in a couple of hours) and different forms of substance use, risky sexual behaviour and violent behaviour. Logistic regression analysis was used to examine the association between binge drinking and adolescent involvement in various health risk behaviours.

Results

Adolescent binge drinking was associated with the occurrence of every type of health risk behaviour – with the sole exception of non-condom use during last sex. In addition, there was a strong association between the number of days on which binge drinking occurred and the prevalence of many health risk behaviours.

Conclusions

Binge drinking is associated with a variety of health risk behaviours among adolescents in Russia. Public health interventions such as reducing the affordability and accessibility of alcohol are now needed to reduce binge drinking and its harmful effects on adolescent well-being.     

Predicting the transition from frequent cannabis use to cannabis dependence: A three-year prospective study

Background

Frequent cannabis users are at high risk of dependence, still most (near) daily users are not dependent. It is unknown why some frequent users develop dependence, whereas others do not. This study aims to identify predictors of first-incidence DSM-IV cannabis dependence in frequent cannabis users.

Methods

A prospective cohort of frequent cannabis users (aged 18–30, n = 600) with baseline and two follow-up assessments (18 and 36 months) was used. Only participants without lifetime diagnosis of DSM-IV cannabis dependence at baseline (n = 269) were selected. Incidence of DSM-IV cannabis dependence was established using the Composite International Diagnostic Interview version 3.0. Variables assessed as potential predictors of the development of cannabis dependence included sociodemographic factors, cannabis use variables (e.g., motives, consumption habits, cannabis exposure), vulnerability factors (e.g., childhood adversity, family history of mental disorders or substance use problems, personality, mental disorders), and stress factors (e.g., life events, social support).

Results

Three-year cumulative incidence of cannabis dependence was 37.2% (95% CI = 30.7–43.8%). Independent predictors of the first incidence of cannabis dependence included: living alone, coping motives for cannabis use, number and type of recent negative life events (major financial problems), and number and type of cannabis use disorder symptoms (impaired control over use). Cannabis exposure variables and stable vulnerability factors did not independently predict first incidence of cannabis dependence.

Conclusions

In a high risk population of young adult frequent cannabis users, current problems are more important predictors of first incidence cannabis dependence than the level and type of cannabis exposure and stable vulnerability factors.     

Factors associated with variability and stability of cannabis use in young adulthood

Background

This study investigated the factors associated with initiating cannabis use, reverting to cannabis use and remaining a cannabis user in young adulthood. This is an important area of research as the risk for cannabis initiation is extending beyond adolescence and opportunities to influence cannabis use pathways can emerge throughout the life-course.

Methods

A large, community-based sample was followed prospectively. Data from two successive waves (mean age 23 years and 27 years respectively) of the Path Through Life Study (PATH) were analysed (n = 2045). The longitudinal design enabled change in cannabis use in young adulthood to be predicted based on factors assessed approximately four years prior.

Results

An environment of licit drug use was strongly associated with initiating cannabis use (tobacco: OR = 4.98, 95%CI: 2.31–10.76) and reverting to cannabis use in young adulthood (alcohol: OR = 2.13, 95%CI: 1.42–3.19). Greater fun seeking was found to orientate people towards initiating cannabis use in young adulthood (OR = 1.17, 95%CI: 1.04–1.30). Higher psychoticism increased the odds of remaining a cannabis user (OR = 1.19, 95%CI: 1.07–1.33). Religious involvement was protective of cannabis initiation (OR = 0.89, 95%CI: 0.83–0.95). Early childhood factors did not influence the pattern of cannabis use in young adulthood.

Conclusions

The findings make an important contribution to the development of prevention and intervention strategies for young adults by drawing attention to specific areas of risk and protection.     

“Youthful epidemic” or diagnostic bias? Differential item functioning of DSM-IV cannabis use criteria in an Australian general population survey

Background

Prevalence rates of cannabis abuse and dependence are higher for younger adults when compared with older adults. It is necessary to examine the performance of criteria across age groups to establish whether these differences in prevalence rates are a result of diagnostic bias. The current study aims to investigate whether there is any age-related differential item functioning in the DSM-IV diagnostic criteria for cannabis use disorders using an item response theory approach.

Method

The sample consisted of 10,641 participants in a population-based survey of Australian adults aged 18 years and older. DSM-IV cannabis use disorders were assessed in all respondents who had used cannabis more than five times in the previous twelve months (n = 722). Age-based differential item functioning was assessed in each of the DSM-IV criteria for cannabis use disorders.

Results

Age-based differential item functioning was only detected in the Hazard criterion of the DSM-IV cannabis use disorders. The Hazard criterion was found to be more discriminating for those aged 18–24 when compared with those aged 25 and over.

Conclusions

The DSM-IV criteria for cannabis use disorders appear to function similarly across age groups. Differential item functioning was only detected in the α parameter for the Hazard criterion. These results are discussed with regard to implications for future editions of the DSM system.     

Coping style and ecstasy use motives as predictors of current mood symptoms in ecstasy users

Background

Elevated depressive and anxiety symptoms during childhood and adolescence have been associated with greater risk of later ecstasy use. Ecstasy users have reported using ecstasy to reduce depression or worry, or to escape. While these findings suggest that some people use ecstasy as a form of self-medication, limited research has been conducted examining the relationship between affective symptoms, coping styles and drug use motives in ecstasy users. This cross-sectional study aimed to determine if coping style and/or ecstasy use motives are associated with current mood symptoms in ecstasy users.

Methods

A community sample (n = 184) of 18–35 year olds who had taken ecstasy at least once in the past 12 months completed self-report measures of depression, anxiety, ecstasy use motives and coping styles. Timeline followback methods were used to collect information on lifetime ecstasy, recent drug use and life stress. Trauma exposure was measured using the Composite International Diagnostic Interview—Trauma List.

Results

Coping motives for ecstasy use and an emotion-focused coping style were significantly associated with current depressive and anxiety symptoms. Emotion-focused coping mediated the relationship between a history of trauma and current anxiety symptoms and moderated the relationship between recent stressful life events and current depressive symptoms.

Conclusions

These findings highlight the importance of interventions targeting motives for ecstasy use, and providing coping skills training for managing stressful life events among people with co-occurring depressive/anxiety symptoms and ecstasy use.     

The reliability and validity of the Alcohol,Smoking and Substance Involvement Screening Test (ASSIST) in first-episode psychosis

Aims

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is a brief, easily administered, valid and reliable screening instrument for all psychoactive substances in drug treatment and primary care settings. This study aims to determine the reliability and validity of the ASSIST for detecting substance use disorders in first-episode psychosis.

Participants

Participants were 214 first-episode psychosis patients attending the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne, Australia.

Measurements

Participants were administered the ASSIST, Alcohol Use Disorders Identification Test (AUDIT), the Severity of Dependence Scale (SDS) and the Brief Psychiatric Rating Scale (BPRS). Presence of DSM-IV substance abuse and dependence disorders in the previous 12 months was assessed using the Structured Clinical Interview for DSM-IV (SCID-IV).

Findings

The ASSIST total substance involvement (TSI) score and specific substance involvement (SSI) scores for cannabis, alcohol and amphetamine use demonstrated high levels of internal consistency and acceptable levels of concurrent and discriminative validity. Individuals with cutoff scores of ≥ 2, 4 and 1 on the ASSIST cannabis, alcohol and amphetamine SSI scores were 5 to 6 times more likely to meet the diagnostic criteria for these substance use disorders.

Conclusions

The ASSIST is a psychometrically sound measure of cannabis, alcohol and amphetamine use disorders in first-episode psychosis.     

Do early experiences with cannabis vary in cigarette smokers?

Introduction

We examine whether regular cigarette smokers were more likely to be exposed to and use cannabis at an earlier age, and further, upon initiation, whether their initial experiences with cannabis varied from those reported by never/non-regular cigarette smokers.

Method

A sample of 3797 Australian twins and siblings aged 21–46 years was used. Survival analyses examined whether cigarette smokers were at increased likelihood of early opportunity to use cannabis and early onset of cannabis use. Logistic regression examined whether cigarette smokers reported greater enjoyment of their cannabis experience, inhaling on the first try, differing positive and negative initial subjective reactions, smoked cigarettes with cannabis the first time and were more likely to try cannabis again within a week.

Results

Regular cigarette smokers were more likely to report an earlier opportunity to use cannabis and early onset of cannabis use. Regular cigarette smokers were also considerably more likely to have enjoyed their first experience with cannabis and reported higher rates of positive initial reactions. They were more likely to report inhaling on the first try and smoking cigarettes with cannabis. Potentially negative subjective reactions were also elevated in regular cigarette smokers. Importantly, cigarette smokers were at 1.87 increased odds of smoking cannabis within a week of their initial use.

Conclusion

These findings indicate that the well-known overlap in cannabis and cigarette smoking behaviors may evolve as early as opportunity to use and extend through the course of the substance use trajectory.     

Alcohol misuse and relationship breakdown: Findings from a longitudinal birth cohort

Background

This study examined the associations between measures of alcohol abuse/dependence (AAD) and relationship dissolution from ages 19 to 30 in a New Zealand birth cohort.

Methods

The outcome measure was self-reported breakdown of a marital/cohabiting relationship during each year from age 20–21 to age 29–30. The study also used contemporaneous and one-year lagged measures of AAD symptoms; and time-dynamic covariate factors including life stress, other substance use, mental health status, peer and partner substance use and offending, unemployment, exposure to intimate partner violence, and prior relationship breakdown. Data were analysed using conditional fixed effects regression modelling augmented by time-dynamic covariate factors to control for confounding.

Results

Those with three or more AAD symptoms had unadjusted odds of relationship breakdown that were 2.17–2.23 times higher than those with no symptoms, but these associations did not differ by gender. Adjustment of the associations for both unobserved fixed effects and time-dynamic covariate factors reduced the magnitude of the associations, with those with three or more AAD symptoms having rates of relationship breakdown that were 1.57–1.66 times higher than those with no symptoms.

Conclusions

The results suggest a causal association between alcohol misuse and relationship breakdown, with estimates suggesting that alcohol use disorder accounted for 4.5–4.6% of marital/cohabiting relationship dissolution in the cohort.     

The Cannabis Expectancy Questionnaire for Men who have Sex with Men (CEQ-MSM): A measure of substance-related beliefs

Objective

Substance-related expectancies are associated with substance use and post-substance use thoughts, feelings and behaviours. The expectancies held by specific cultural or sub-cultural groups have rarely been investigated. This research maps expectancies specific to gay and other men who have sex with men (MSM) and their relationship with substance patterns and behaviours following use, including sexual practices (e.g., unprotected anal intercourse). This study describes the development of a measure of such beliefs for cannabis, the Cannabis Expectancy Questionnaire for Men who have Sex with Men (CEQ-MSM).

Method

Items selected through a focus group and interviews were piloted on 180 self-identified gay or other MSM via an online questionnaire.

Results

Factor analysis revealed six distinct substance reinforcement domains (“Enhanced sexual experience”, “Sexual negotiation”, “Cognitive impairment”, “Social and emotional facilitation”, “Enhanced sexual desire”, and “Sexual inhibition”). The scale was associated with consumption patterns of cannabis, and in a crucial test of discriminant validity not with the consumption of alcohol or stimulants.

Conclusions

The CEQ-MSM represents a reliable and valid measure of outcome expectancies, related to cannabis among MSM. Future applications of the CEQ-MSM in health promotion, clinical settings and research may contribute to reducing harm associated with substance use among MSM, including HIV transmission.     

Common and unique parenting predictors of adolescent tobacco and alcohol use

Aim

The current study sought to identify unique and common demographic and parental predictors of adolescent tobacco and alcohol initiation behaviors.

Methods

A total of 1023 middle school students (Grades 6–8) and their parents from six Rhode Island schools were enrolled in a larger study on substance use initiation and progression, with the current sample representing those dyads with data at baseline and at a 12-month follow-up (n = 814 dyads). There was a relatively even split with regard to adolescent sex (n_females = 444; 55%). Comparisons were made between covariate and predictor associations with corresponding substance use behaviors (e.g., ever puffed a cigarette vs. ever sipped an alcoholic drink; ever smoked a whole cigarette vs. ever drank a full alcoholic drink).

Results

At the bivariate level, a host of demographic and parent-related variables were associated with each adolescent substance use behavior. Adolescent reports of parental monitoring variables were consistently more related to use than parent reports. In multivariate logistic regression analyses, adolescent reports of parental monitoring variables were more frequently associated with tobacco use behaviors than alcohol use behaviors. Tobacco use behaviors were more strongly predicted by perceived availability of tobacco than alcohol use behaviors were predicted by perceived availability of alcohol.

Conclusions

The distinctive predictors observed for cigarette versus alcohol use make it problematic for new and existing programs to assume that efforts targeting specific individual or parental characteristics will impact both substances with equivalent efficacy.     

Prevalence and correlates of alcohol misuse among returning Afghanistan and Iraq veterans

Objective

Several studies have reported high rates of alcohol misuse and low rates of substance use treatment among OEF/OIF military service members. This study assessed the prevalence and correlates of alcohol misuse and the factors associated with treatment utilization among recently returned National Guard service members.

Methods

The sample included 585 members of the National Guard who volunteered to complete an anonymous survey assessing mental health and substance use problems, functional status, and past treatment experiences. Bivariate and multivariate logistic regression analyses were performed examining the significance of associations between alcohol misuse and mental health service use as outcomes and demographic variables, mental health symptoms, and military service characteristics as predictors. Barriers to treatment and factors facilitating treatment were also examined.

Results

Thirty-six percent of the service members met criteria for alcohol misuse. Of those misusing alcohol, 31% reported receiving any mental health treatment and 2.5% reported receiving specific substance use treatment in the past year. The barrier to treatment most commonly endorsed by those misusing alcohol was concern that the information about treatment would appear in their records. Among those misusing alcohol who had received services, spouses were most commonly endorsed as facilitating the pursuit of care.

Conclusions

Rates of alcohol misuse are high and rates of substance use treatment are low among National Guard service members. Additional research is needed to identify means of overcoming barriers to care and establish more effective approaches to facilitate linkage to care and receipt of appropriate interventions.