Co-occurring addictive behaviors: an analysis of risk profiles among university students

Objectives: The first goal of this study was to empirically identify, among university students, groups with varying levels of risk based on indicators of gambling and substance use. The second goal was to compare the identified groups on various demographic characteristics.

Methods: The study comprised of 2139 full-time undergraduate students, representative of university students in Montreal, Canada. A 3-step latent class logistic regression analysis was performed to identify groups and compare them on demographic characteristics.

Results: The statistical fit indices of the latent class analysis revealed a four-class solution. Class 1 (30.1% of the sample) included non-gamblers with low probabilities of substance use. Class 2 (11.2% of the sample) grouped non-gamblers with high-risk patterns of consumption. Class 3 (36.42% of the sample) included gamblers who are low-risk substance users, and individuals in Class 4 (22.25% of the sample) reported risky patterns of gambling and substance-using behaviors. Results of the logistic regression suggested that gender, being born in Canada, and working full- or part-time are significant predictors of class membership. Participants in both groups labeled at-risk (with and without gambling) were also more likely to report psychological distress and to live outside the family environment.

Conclusions: This study raises important questions regarding the choice of preventive models and feeds into the long-standing debate around universal versus high-risk approaches.     

Mixed messages: Contributions to adolescent drinking and driving

This qualitative study focused on the discrepancies in messages concerning alcohol use presented by adults to young people. The purpose was to investigate how these discrepancies might impact adolescents’ drinking, and drinking and driving behavior. The data consisted of semi-structured interviews with 44 adolescents who in a previous survey had admitted having been involved in drinking and driving, riding with a drunk driver, or both. The analysis of the interviews focused on the discrepancies between messages presented by adult authorities and the respondents’ experience of actual behavior from these authorities. The findings indicate that there are serious problems in the communication between adult authorities and adolescents. Parents, schools, and police are not consistent and persistent in their communication with adolescents concerning alcohol and drinking and driving. This inconsistency seems to prevent teenagers from understanding the extent of the problem of drinking and driving. Implications for research and prevention are discussed.     

Cannabis effects on driving longitudinal control with and without alcohol

Although evidence suggests cannabis impairs driving, its driving‐performance effects are not fully characterized. We aimed to establish cannabis’ effects on driving longitudinal control (with and without alcohol, drivers’ most common drug combination) relative to psychoactive ?⁹‐tetrahydrocannabinol (THC) blood concentrations. Current occasional (≥1×/last 3 months, ≤3 days per week) cannabis smokers drank placebo or low‐dose alcohol, and inhaled 500 mg placebo, low (2.9%), or high (6.7%) THC vaporized cannabis over 10 min ad libitum in separate sessions (within‐subject, six conditions). Participants drove (National Advanced Driving Simulator, University of Iowa) simulated drives 0.5–1.3 h post‐inhalation. Blood and breath alcohol samples were collected before (0.17 and 0.42 h) and after (1.4 and 2.3 h) driving. We evaluated the mean speed (relative to limit), standard deviation (SD) of speed, percent time spent >10% above/below the speed limit (percent speed high/percent speed low), longitudinal acceleration, and ability to maintain headway relative to a lead vehicle (headway maintenance) against blood THC and breath alcohol concentrations (BrAC). In N=18 completing drivers, THC was associated with a decreased mean speed, increased percent speed low and increased mean following distance during headway maintenance. BrAC was associated with increased SD speed and increased percent speed high, whereas THC was not. Neither was associated with altered longitudinal acceleration. A less‐than‐additive THC*BrAC interaction was detected in percent speed high (considering only non‐zero data and excluding an outlying drive event), suggesting cannabis mitigated drivers’ tendency to drive faster with alcohol. Cannabis was associated with slower driving and greater headway, suggesting a possible awareness of impairment and attempt to compensate. Copyright © 2016 John Wiley & Sons, Ltd.     

Brief motivational interviewing for teens at risk of substance use consequences: a randomized pilot study in a primary care clinic

The current study examined the impact of a brief motivational interviewing (MI) intervention (Project CHAT) on alcohol consumption and drug use for high-risk teens in a primary care clinic that provides health care for underserved populations. Youth (N=42, 48% male) were screened, and those eligible completed a baseline survey. Baseline survey completers were randomly assigned to usual care or to an MI intervention and completed a 3-month follow-up survey. The sample (age 12 to 18 years) was 85.7% Hispanic or Latino, 9.5% African American, and 4.8% White. At the 3-month follow-up, Project CHAT teens reported less marijuana use, lower perceived prevalence of marijuana use, fewer friends who used marijuana, and lower intentions to use marijuana in the next 6 months, as compared to teens assigned to usual care. Providing this type of brief intervention is a viable approach to working with high-risk teens to decrease substance use.     

Drug interaction on psychomotor skills related to driving: Diazepam and alcohol

Summary The effects of combinations of diazepam (5 and 10 mg) and alcohol (0.5 and 0.8 g/kg) on skills related to driving were studied in 200 volunteer students. A choice reaction test and two co-ordination tests were employed, one of which was carried out at a fixed speed, and in the other the speed was chosen by the subject himself. — On their own these drugs either did not affect or even slightly improved the skills measured, but their various combinations definitely impaired the subjects' performances. This effect was greatest before the peak levels of blood alcohol were reached. — The combination of these drugs is considered dangerous for driving. The practical effect of taking one of these drugs on its own is more difficult to assess.     

Learning to become an alcohol user: Adolescents taking risks and parents living with uncertainty

This article investigates how adolescents learn to become alcohol users in a country like Denmark, characterised by extensive drunkenness among young people and a low number of abstainers among adults. Inspired by Howard Becker's study (1953) on marijuana use, the article reveals that just as a road to ‘becoming a marijuana user’ exists, so does a road to becoming an alcohol user. Integrating Becker's three learning steps with modern socio-cultural theories of risk and the notion of ‘controlled loss of control’ leads to findings that crucial for becoming an alcohol user is the demystification of the risk experience associated with alcohol intoxication and the learning to find pleasure in losing control. Both the adolescents and the parents of adolescents share this perception although for different reasons. The analyses are based on quantitative and qualitative material: A survey of 2000 adolescents aged 15–16 years, 28 focus group interviews with adolescents, and 8 focus group interviews with parents.     

Parental prompts as risk factors for adolescent trial smoking: results of a prospective cohort study

Our earlier cross-sectional research suggested that smoking parents, particularly Latino parents, engage in behaviors that may prompt their children to smoke (e.g., request their child to start the parent's cigarette in his/her own mouth). This prospective study of 478 adolescent never-smokers, mostly Latino, suggests that parental prompts to smoke were not significantly related to smoking initiation among adolescents over a 1-year period.     

A review of drug use and driving: epidemiology, impairment, risk factors and risk perceptions

The existing literature on the prevalence of drug driving, the effects of drugs on driving performance, risk factors and risk perceptions associated with drug driving was reviewed. The 12-month prevalence of drug driving among the general population is approximately 4%. Drugs are detected commonly among those involved in motor vehicle accidents, with studies reporting up to 25% of accident-involved drivers positive for drugs. Cannabis is generally the most common drug detected in accident-involved drivers, followed by benzodiazepines, cocaine, amphetamines and opioids. Polydrug use is common among accident-involved drivers. Studies of impairment indicate an undeniable association between alcohol and driving impairment. There is also evidence that cannabis and benzodiazepines increase accident risk. The most equivocal evidence surrounds opioids and stimulants. It is apparent that drugs in combination with alcohol, and multiple drugs, present an even greater risk. Demographically, young males are over-represented among drug drivers. Although there is an association between alcohol use problems and drink driving, it is unclear whether such an association exists between drug use problems and drug driving. Evidence surrounding psychosocial factors and driving behaviour is also equivocal at this stage. While most drivers perceive drug driving to be dangerous and unacceptable, there is less concern about impaired driving among drug drivers and drink drivers than from those who have not engaged in impaired driving. Risk perceptions differ according to drug type, with certain drugs (e.g. cannabis) seen as producing less impairment than others (e.g. alcohol). It is concluded that drug driving is a significant problem, both in terms of a general public health issue and as a specific concern for drug users. [Kelly E, Darke S, Ross J. A review of drug use and driving: epidemiology, impairment, risk factors and risk perceptions. Drug Alcohol Rev 2004;23:319-344]     

Effects of viloxazine with and without alcohol on performance tests related to driving in normal volunteers

The effects of single doses of 50 mg of viloxazine, 100 mg of viloxazine, 50 mg of imipramine, and placebo given alone and in combination with alcohol on perceptual-motor performance potentially related to driving were studied in eight normal subjects. The study design permitted testing of visual reaction time, pursuit rotor performance, and depth perception when blood levels of the active drugs and alcohol were at or near peak. Analyses revealed that the effects of alcohol increased visual reaction time and decreased pursuit rotor performance. None of the drugs produced statistically significant changes on any of the measures. None of the effects of the combined drug and alcohol conditions differed significantly from the effects of alcohol alone.     

Forgiveness and gratitude trajectories among persons undergoing alcohol addiction therapy

Background: The first studies concerning changes in moral virtues during alcohol addiction therapy were published during the last decade. However, as all of these studies applied a variable-oriented approach, it is impossible to capture differences between starting points and changes in variables of interest. 

Method: In this study, we employed a person-oriented approach to identify trajectories of change in two moral virtues—forgiveness and gratitude—during alcohol addiction treatment. The sample consisted of 358 alcohol-dependent individuals who were receiving outpatient therapy. Measurements were taken (1) at the beginning of the basic treatment, (2) after its completion (5–7?weeks from baseline), and (3) about six months later. Three forgiveness scales and the Gratitude Questionnaire (GQ-6) were used to assess the patients’ moral virtues. 

Results: Latent class growth analysis (LCGA) revealed four trajectories for self-forgiveness and gratitude, and three trajectories for forgiveness of others and feeling forgiven by God. For patients with a low baseline level of moral virtues, the changes varied depending on the kind of moral virtue. Patients with a relatively high initial level of moral virtues maintained that level in subsequent measurements. Significant correlates of trajectory class membership were gender, education, age, religiosity, diagnosis of coexisting psychiatric disorders, and frequency of attending Alcoholics Anonymous (AA) meetings. 

Conclusions: This study highlights the clinical importance of considering differences at the baseline level and in changes of forgiveness and gratitude, as well as personal and alcohol-related correlates of trajectory group membership among people who participate in alcohol addiction therapy.     

Single‐ and dual‐task performance during on‐the‐road driving at a low and moderate dose of alcohol: A comparison between young novice and more experienced drivers

Driving experience and alcohol are two factors associated with a higher risk of crash involvement in young novice drivers. Driving a car is a complex task involving multiple tasks leading to dividing attention. The aim of this study was to compare the single and combined effects of a low and moderate dose of alcohol on single‐ and dual‐task performance between young novice and more experienced young drivers during actual driving. Nine healthy novice drivers were compared with 9 more experienced drivers in a three‐way, placebo‐controlled, cross‐over study design. Driving performance was measured in actual traffic, with standard deviation of lateral position as the primary outcome variable. Secondary task performance was measured with an auditory word learning test during driving. Results showed that standard deviation of lateral position increased dose‐dependently at a blood alcohol concentration (BAC) of 0.2 and 0.5 g/L in both novice and experienced drivers. Secondary task performance was impaired in both groups at a BAC of 0.5 g/L. Furthermore, it was found that driving performance in novice drivers was already impaired at a BAC of 0.2 g/L during dual‐task performance. The findings suggest that young inexperienced drivers are especially vulnerable to increased mental load while under the influence of alcohol.     

Effect of treatment with diazepam or lithium and alcohol on psychomotor skills related to driving

Summary The effects of diazepam, 5 mg t. i. d., or lithium administered for two weeks on psychomotor skills was examined in 20 healthy male volunteers. The drugs were administered either with alcohol 0.5 g/kg or a placebo. Psychomotor skills were measured by a choice reaction test, two co-ordination tests and an attention test. Serum drug concentrations and blood alcohol levels were also measured. Alcohol impaired all the psychomotor factors tested. Diazepam improved choice reaction performance and slightly eye-hand co-ordination. Lithium impaired the choice reaction performane. Alcohol and diazepam potentiated each other's harmfull effects, whilst lithium tended to antagonize the effects of alcohol, except on co-ordination. The combination of alcohol 0,5 g/kg and lithium may be dangerous in motor vehicle drivers. Alcohol and diazepam together also had very deleterious effect on psychomotor skills related to driving.     

Drug effects on psychomotor skills related to driving: Interaction of atropine,glycopyrrhonium and alcohol

Summary Atropine 0.5 mg and glycopyrrhonium 1.0 mg in combination with alcohol or a placebo drink were administered double blind to 170 healthy young volunteers, and certain psychomotor skills were measured by a choice reaction test, two coordination tests, and an attention test. The drugs were administered 30 min before the test and the tests were repeated 90 and 150 min after dosing. Both atropine and glycopyrrhonium shortened reaction time and either left co-ordination unaffected or slightly improved. Anticholinergics or alcohol alone impaired attention. The combination of anticholinergics and alcohol further impaired attention whilst leaving reaction times and co-ordination unaffected. The interaction of atropine and alcohol differed only slightly from that of glycopyrrhonium and alcohol.     

From the brain to bad behaviour and back again: Neurocognitive and psychobiological mechanisms of driving while impaired by alcohol

Issues. Driving while impaired by alcohol (DWI) is responsible for substantial mortality and injury. Significant gaps in our understanding of DWI re‐offending, or recidivism, reduce our ability to practically assess recidivism probability and to match interventions to individual risk profiles. These shortcomings reflect the baffling heterogeneity in the DWI population and the limited focus of much existing DWI recidivism research to psychosocial, psychological and substance use correlates. Approach. This narrative review summarises the evidence for the contribution of neurocognitive and psychobiological mechanisms to DWI behaviour and recidivism. Given the nascent nature of this literature, insight into the putative contribution of these mechanisms to DWI is also drawn from other experimental literatures, particularly those on alcohol use disorders and cognitive and behavioural neuroscience. Key Findings. Alcohol‐related neurotoxicity and dysregulation of hypothalamic–pituitary–adrenal axis and serotonergic systems may underlie certain offender characteristics consistently correlated with heightened DWI risk, persistence and intervention resistance. Their markers are less vulnerable to sources of bias than subjective psychosocial indices and are more far‐reaching than alcohol abuse in explaining DWI behaviour and recidivism. Implications. The investigation of neurocognitive and psychobiological mechanisms in DWI research is a promising avenue for discerning clinically meaningful subgroups within the DWI population. This can lead to research and development in alternative assessment and more targeted intervention technologies. Conclusion. Multidimensional research in DWI and recidivism offers novel avenues for increasing road safety.[Brown TG, Ouimet MC, Nadeau L, Gianoulakis C, Lepage M, Tremblay J, Dongier M. From the brain to bad behaviour and back again: Neurocognitive and psychobiological mechanisms of driving while impaired by alcohol. Drug Alcohol Rev 2009;28:406–418]     

Gambling Behavior Subtypes Among Respondents with Gambling-Related Problems in a Population-Based Sample

ABSTRACT

Latent class analysis was used to delineate distinctive subgroups of gamblers and examine whether they differed by demographics and gambling severity. Data from three Canadian provinces focused on respondents who reported at least some risk of problem gambling in the past year (N= 1,071). Three latent classes were distinguished: a low on most items group (class 1), a behaviorally conditioned/substance abusing impulsive/emotionally vulnerable (or all types) group (class 2), and a familial-genetic/behaviorally conditioned group (class 3). Gamblers in classes 2 and 3 were most likely to be moderate-risk and problem gamblers. Community-based prevention efforts may need to address each subgroup differently but also according to their characteristics.     

Understanding the hangover experience in Canadian adults: A latent class analysis of hangover symptom patterns and their alcohol-related correlates

Aim: Given the ubiquitous nature of hangover experience among drinkers, this study aimed to profile hangover experience in terms of the number and patterns of past year symptoms. Methods: Current drinkers in Canada (n?=?565) recruited through zoompanel were asked about 13 past year hangover symptoms. These were explored through correlation with alcohol consumption, problems, treatment and other factors. Findings: Increased number of symptoms were associated with higher Alcohol Use Disorders Identification Test (AUDIT) problem score, perceived harm from drinking, younger age and flushing/blushing when drinking (Mean = 3.3 symptoms). Four patterns were found from latent class analysis; class 4 (43%) no symptoms; class 3 (13%) thirst, tiredness, headache, nausea and vomiting; class 2 (22%) thirst, tiredness and headache; and class 1 (21%) wide range. Class 1 was characterised by blushing when drinking, higher perceived harm and attempts to reduce drinking due to hangovers. Classes 1–3 were associated with heavier consumption; only class 3 compared with class 4 had lower drinking refusal self-efficacy. Conclusions: higher alcohol consumption and lower drinking refusal self-efficacy relate to more symptoms; however, a group with variable alcohol consumption did not experience hangovers. The link between problems, treatment and hangover was not clear from patterns of symptoms; symptom severity may be worth further investigation.     

Heterogeneity in Drinking Practices in England and Wales and Its Association With Violent Behavior: A Latent Class Analysis

Background: Crude single-item consumption metrics, such as “binge drinking” measures, mask the complexity and heterogeneity in young people's drinking; thus limiting our understanding of young people's drinking patterns as well as how alcohol drinking is associated with violent outcomes. Objectives: The current study employed a range of consumption and contextual indicators to explore heterogeneity in young people's (16–29 years) drinking practices, giving due consideration to their social nature. It also assessed to what extent heterogeneity in drinking practices was associated with violent outcomes. Methods: Employing data from the 2006 Offending Crime and Justice Survey, three measures of alcohol consumption and nine drinking context indicators were utilized within latent class analysis to create typologies of drinking practices among current drinkers in England and Wales (n = 2711) and examine their association with violent outcomes. The validity of the typologies was also assessed on age, sex, and socio-economic status. Results: Three discernible drinking profiles were identified: “regular social drinkers” (48%), “regular pub binge drinkers” (32%), and “moderate drinkers” (20%). The “regular pub binge drinkers” were found to be more than twice as likely to commit an assault offence (odds ratio = 2.8 95% CI [1.3, 6.2]) when compared to “moderate drinkers” and “regular social drinkers” (odds ratio = 2.2 95% CI [1.4, 3.4]). Conclusions: Interventions aimed at reducing alcohol-related violence ought to give due consideration to the social context of drinking as well as levels of consumption.