Marker or mediator? The effects of adolescent substance use on young adult educational attainment

AIMS: We tested the effects of adolescent substance use on college attendance and completion by young adulthood in the context of the behavioral and familial risk factors that influence substance use. DESIGN, SETTING AND PARTICIPANTS: Longitudinal data were collected from a community sample of children of alcoholics (248) and matched controls (206) at three adolescent assessments (micro(age) = 13-15) and a long-term follow-up in young adulthood (micro(age) = 25). MEASUREMENTS: College attendance and degree completion by age 25 were self-reported in young adulthood. During adolescence, self-reports of alcohol and drug use were assessed with log-transformed quantity/frequency measures; substance use risk factors [e.g. parental monitoring, externalizing and internalizing symptoms and Diagnostic and Statistical Manual version III (DSM-III) diagnosis of parental alcoholism] were assessed by both self- and parent-report, and adolescent reading achievement was assessed using a standardized assessment of reading achievement (Wide Range Achievement Test). FINDINGS: Using growth curve modeling, we found that mean levels and growth in adolescent substance use mark, or identify, those adolescents who are at risk for reduced odds of attending and completing college. Moreover, adolescent substance use was not merely a marker of risk, in that growth in drug use (but not alcohol use) significantly mediated the effects of parental alcoholism and early externalizing behavior on later college completion, partially explaining the effects of these risk factors on college completion. CONCLUSIONS: The current study provides evidence for both the marker and the mediator hypotheses, and identifies multiple pathways to higher educational attainment. The findings point to the importance of studying the effects of adolescent substance use in a broader developmental context of its correlated risk factors to specify more effectively the key pathways to later developmental outcomes.     

Trends and age-related characteristics of substance use in the hospitalized homeless population

We aimed to examine trends and characteristics of substance use (opioid, cocaine, marijuana, and heroin) among hospitalized homeless patients in comparison with other hospitalized patients in 3 states.This was a cross-sectional study, based on the 2007 to 2015 State Inpatient Data of Arizona, Florida, and Washington (n = 32,162,939). Use of opioid, cocaine, marijuana, heroin, respectively, was identified by the International Classification of Diseases, 9th Revision. Multi-level multivariable regressions were performed to estimate relative risk (RR) and 95% confidence intervals (CI). Dependent variables were the use of substances (opioid, cocaine, marijuana, and heroin), respectively. The main independent variable was homeless status. The subgroup analysis by age group was also conducted.Homeless patients were associated with more use of opioid (RR [CI]), 1.23 [1.20–1.26], cocaine 2.55 [2.50–2.60], marijuana 1.43 [1.40–1.46], and heroin 1.57 [1.29–1.91] compared to other hospitalized patients. All hospitalized patients including those who were homeless increased substance use except the use of cocaine (RR [CI]), 0.57 [0.55–0.58] for other patients and 0.60 [0.50–0.74] for homeless patients. In all age subgroups, homeless patients 60 years old or older were more likely to be hospitalized with all 4 types of substance use, especially, cocaine (RR [CI]), 6.33 [5.81–6.90] and heroin 5.86 [2.08–16.52] in comparison with other hospitalized patients.Homeless status is associated with high risks of substance use among hospitalized patients. Homeless elderly are particularly vulnerable to use of hard drugs including cocaine and heroin during the opioid epidemics.     

National gambling experiences in the United States: will history repeat itself?

Aims The aim of this paper is to offer an account of the history and current status of gambling research in the United States. Methods A review of the literature. Results Gambling has been a part of society in the United States since its early history. However, it was not until 1980 that the medical profession in the United States first recognized pathological gambling as a psychiatric disorder. Today, it is still rarely diagnosed or treated, and relatively little federal funding is available to support research in this area. With the upcoming fifth revision of the Diagnostic and Statistical Manual of Mental Disorders, pathological gambling is likely to be included alongside substance use disorders as the first non‐substance‐related addictive disorder. This change may represent an opportunity to expand research on gambling and treatment of pathological gambling. Conclusions We provide 10 suggestions for reducing societal and personal harm associated with this disorder.     

Substance Use and HIV-Risk Behaviors Among Young Men Involved in the Criminal Justice System

Objectives: We examined the relationship between substance use and sexual HIV-risk behaviors among young men who have been incarcerated, in order to understand how HIV risks develop for this vulnerable population. Methods: A sample of 552 young men in a New York City jail was interviewed at the time of incarceration. Bivariate analyses were performed to examine demographic and sexual HIV-risk behavior differences between men with and without recent alcohol and marijuana use. Logistic regression was used to examine associations between alcohol and marijuana use and sexual HIV-risk behaviors in the 90 days prior to incarceration. Results: Respondents were predominantly Black (57%) or Latino (37%), with a mean age of 17.4 years. The most common substances used were marijuana (82%) and alcohol (65%). Alcohol use prior to incarceration was significantly associated with having three or more sexual partners in the same time period (OR = 2.40, p < .001), as well as with having unprotected sex with a long-term partner (OR = 1.72, p < .01). Marijuana use was significantly associated with having multiple sex partners (OR = 1.55, p < .01). Heavy alcohol and marijuana use did not result in an increased likelihood of sexual HIV-risk behaviors. Conclusions: High rates of substance use and unprotected sex may have unintended health consequences for incarcerated young men. Severity of substance use is not a significant predictor of risk behaviors, suggesting the importance of contextual and social factors. Results highlight the need for HIV prevention efforts for this population that take into account contextual and social factors.     

European adolescent substance use: the roles of family structure, function and gender

Objectives The aim of this study was, first, to explore family structure and measures of family functioning in relation to adolescent substance use and secondly, to establish if these relationships differed according to gender or according to the city of origin of the sample. Design, setting, participants The study surveyed pupils aged 14–15 years in representative samples drawn from five European cities: Newcastle upon Tyne, Dublin, Rome, Bremen and Groningen. Data were obtained on 3984 participants in relation to their substance use, living with both biological parents, confiding in parents and grandparents, and supervision, as well as other variables representing delinquency, social class and drug availability. Results Living with both parents was associated with reduced levels of drug use in four cities but not in Dublin, due perhaps to the high availability from peers in that city. It was not associated with reduced levels of regular drinking. The effect of confiding in mother was evident in all cities and in relation to substance use in general. However, when a delinquency variable was added to the logistic regressions, its significance in relation to polydrug use disappeared. Supervision was somewhat more important in relation to male than female drug use. Conclusion Living with both parents is a less robust barrier to substance use than qualitative aspects of family life, particularly attachment to mothers. The latter is a robust inhibitor of substance use irrespective of regional differences in drug availability, weakening only in the face of more generally problematic behaviour. Perhaps because of their greater tendency to risk‐taking or rule breaking, supervision appears more important for male than female drug use. These findings underscore the role of families, but especially that of mothers, in regulating the substance‐related behaviour of young people.     

Does stress mediate the development of substance use disorders among youth transitioning to young adulthood?

Background: Stress is a well-documented factor in the development of addiction. However, no longitudinal studies to date have assessed the role of stress in mediating the development of substance use disorders (SUD). Our previous results have demonstrated that a measure called Transmissible Liability Index (TLI) assessed during pre-adolescent years serves as a significant predictor of risk for substance use disorder among young adults. However, it remains unclear whether life stress mediates the relationship between TLI and SUD, or whether stress predicts SUD. Methods: We conducted a longitudinal study involving 191 male subjects to assess whether life stress mediates the relationship between TLI as assessed at age 10–12 and subsequent development of SUD at age 22, after controlling for other relevant factors. Results: Logistic regression demonstrated that the development of SUD at age 22 was associated with stress at age 19. A path analysis demonstrated that stress at age 19 significantly predicted SUD at age 22. However, stress did not mediate the relationship between the TLI assessed at age 10–12 and SUD in young adulthood. Conclusions and scientific significance: These findings confirm that stress plays a role in the development of SUD, but also shows that stress does not mediate the development of SUD. Further studies are warranted to clarify the role of stress in the etiology of SUD.     

Adult liver transplant survey: policies towards eligibility criteria in Canada and the United States 2007

Goals: To assess the current practice patterns of liver transplant centres in Canada and the USA regarding transplant eligibility. Background: Liver transplantation is an evolving field and today remains the only life‐sustaining treatment for end‐stage liver disease. Issues of allocation and transplant eligibility are important factors in the ethical practice of medicine. Study: Questionnaires were mailed to liver transplant programme directors in Canada and the USA inquiring about current practices regarding recipient eligibility. Results: This study demonstrates that there is consensus in the use of other eligibility criteria, including non‐compliance, social status, abstinence from alcohol and methadone and cocaine use. Interestingly, literature is lacking to support the use of these parameters as eligibility criteria with the exception of alcohol. There is a lack in consensus regarding marijuana use, human immunodeficiency virus status, ability to accept blood transfusions and prisoner status. The literature suggests that liver transplantation in select patients who refuse blood transfusions results in good outcomes. Conclusions: Important decisions regarding transplant eligibility still have to be made empirically in the absence of scientific literature about various social issues. While consensus among transplant programmes is useful, it is important that we continue to use the evidence in the literature to revise these eligibility criteria, keeping in mind ethical principles applied to the access and allocation of a scarce resource.     

Comparison of Objective Screening and Self-Report for Alcohol and Drug Use in Traumatically Injured Patients

Alcohol and drug use is prevalent in trauma patients. Concerns over the validity of self-reporting drug use could make nonlaboratory screening problematic. This study sought to validate patient self-report of substance use against objective screening to determine the reliability of self-report in trauma patients. Patients admitted to either the Trauma or Burn services who were at least age 18 were screened for alcohol and drug use with validated screening tools. Exclusion criteria were altered mental status, non English speaking, inability to answer questions for other reasons, under police custody, or admission for <24 hours. Results from admission blood alcohol concentration (BAC) and urine drug screen (UDS) were also collected and compared to self-reported use to determine its reliability. Alcohol use was queried in 128 patients, 101 of whom had a BAC drawn. Of those 101, 34 (33.7%) had a BAC ≥ 0 mg%. Alcohol Use Disorder Identification Test creening revealed 13 (12.9%) patients who were self-reported non drinkers, none of which had a BAC > 0 mg%. Drug use was queried in 133 patients, 93 of whom had a UDS. A positive was found in 26 (28.0%) of the patients, only 12 (46.2%) of whom reported drug use in the past year. Although substance use in trauma patients is prevalent, self-report screening techniques for drugs may be inadequate at determining those patients whom could benefit from brief interventions while in the hospital. Further investigation is needed to determine the discrepancy between alcohol and drug use screening in trauma patients and more acceptable means of drug use discussion.     

Risk Factors for Serious Alcohol and Drug Use: The Role of Psychosocial Variables in Predicting the Frequency of Substance Use Among Adolescents

Reviews of the psychosocial risk factors of adolescent alcohol and drug use suggest that the highest risks can be summarized as: 1) psychological functioning, 2) family environment, 3) peer relationships, and 4) stressful life events. The purpose of this study is to describe the relationships among the most common risk factors among a clinical sample (n = 214) and to determine the collective importance of these risk factors on problems with substance use. Collectively, these risk factors were most effective in explaining alcohol use and binge drinking and marijuana use, which were the most frequent types of substance use in this sample. Antisocial peers and delinquent behavior were the strongest predictors of substance use. Implications are that treatment programs target different psychosocial factors depending on the substance being used, and put extra effort on understanding and altering the relationship between an adolescent's choice of peers and their own attitudes toward delinquency and drug use.     

Does “High = High Risk”? An Event-Based Analysis of the Relationship Between Substance Use and Unprotected Anal Sex Among Gay and Bisexual Men

This study examined the relationship between substance use and condom use using a study design that remedied some of the methodological problems noted in prior research. A community sample of 147 gay men completed daily diaries in which they reported their substance use and sexual behaviors for 8 weeks. This method helped ensure the contiguity of substance use and sexual behaviors, established the temporal relationships between them, and controlled for confounding individual differences that could cause both substance use and sexual risktaking. A within-subjects analysis showed no significant relationships between condom use and alcohol and/or drug use consumed within 4 hr of having anal sex. Condoms were more likely to be used with casual than with steady partners and were more likely to be used by HIV– men. These results suggest that the relationships found in prior studies could be due to measurement differences or confounding personality or situational factors.     

Clinical Supervision in the Addictions Field: A Case Example of Effective Gatekeeping

Clinical supervision is essential to the development of competent, ethical, and professional practice among substance abuse counselors. A vital role of supervisors is to act as gatekeepers responsible for protecting clients and the profession. Many supervisors in the addictions field lack formal education and training in supervision and, hence, could benefit from information and guidance in performing challenging supervisory tasks such as gatekeeping. This article focuses on the key elements of effective supervision, particularly with regard to supervisee assessment, remediation, and dismissal, all while considering the common pitfalls experience and encountered by those receiving supervision. These processes are presented and illustrated through a case example as a means of providing practical guidance to those who supervise current and aspiring substance abuse counselors.     

Mindfulness impairments in individuals seeking treatment for substance use disorders

Background: Mindfulness training may be an effective treatment for substance use disorders (SUDs). Little research has been done, however, on baseline levels of mindfulness in the substance using population. Objectives/Methods: We investigated mindfulness levels using the Mindful Attention Awareness Scale (MAAS) in individuals presenting for substance use treatment, and compared polydrug vs. monodrug users, as well as investigated for differences between groups based on substance used, predicting that group means would fall below the mean obtained from a large national adult sample, that the different drug groups would have comparable scores, and that the polydrug users would have a significantly lower score than do monodrug users. Results: We found that the means of most drug groups were below the national mean, and that the polydrug users had a lower score on the MAAS than did monodrug users (4 vs. 3.6, p = 0.04). We were also surprised to find that opiate users had a significantly higher score (4.31) than did users of other substances (p = 0.02). Conclusion/Significance: These results suggest that mindfulness deficits may be common in the substance using population, that there may be sub-groups in which these deficits are more pronounced, and that they may be a suitable focus of SUD treatment. These findings lend support to the ongoing development of mindfulness-based treatments for SUDs, and suggest that particular sub-groups may benefit more than others. Future research can aim at clarifying these deficits, and at elucidating their clinical relevance.     

Alcohol and tobacco use in men: the role of alexithymia and externally oriented thinking style

Background: A high prevalence of alexithymia has been consistently reported in alcohol- and drug-dependent populations. However, less is known about the role of alexithymia, and its individual dimensions on substance use in healthier populations. Objectives: To examine how different alexithymia dimensions associate with substance use, while controlling for confounding factors. Methods: In the FinnBrain Birth Cohort Study, we analyzed a sample of 994 men. We assessed alexithymia levels (difficulty identifying feelings, difficulty describing feelings and externally oriented thinking (EOT) style), self-reported quantity and frequency of alcohol use in two different time points during and after their partners’ pregnancy, as well as cigarette smoking status. Age, education level, and anxiety scores were used as control variables. Results: Men scoring high on EOT style drank more alcohol per occasion, compared to low scorers (Cohen’s d = 0.43, p < 0.001 during pregnancy, and Cohen’s d = 0.3, p = 0.012 after pregnancy). Individuals in the high EOT quartile were also more likely to be daily smokers (8.7% vs. 17.3%, p = 0.023), and engage in binge drinking (23.7% vs. 43.6%, p = 0.001). Conclusions: The association of alexithymia and substance use may be specifically explained by EOT, a trait characterized by low levels of introspection and pragmatic thinking. It is important for future studies to distinguish between individual alexithymia dimensions and their specific roles in shaping mental health.     

Pilot feasibility study of Heart2HAART: a smartphone application to assist with adherence among substance users living with HIV

Background: Smartphones with programmable apps may offer innovative interactive interventions for improving adherence among people living with HIV with substance use problems. Methods: This pilot randomized controlled trial sought to primarily determine the usability and feasibility of using a smartphone-based intervention called Heart2HAART as an adjunct to directly observed treatment with adherence counseling compared to directly observed treatment with adherence counseling alone among those with HIV and a history of substance use over a three-month time frame. Participants in the Heart2HAART condition completed an additional survey on usability and acceptability. Adherence was measured using unannounced pill counts assessed via a phone call. Results: Twenty-eight participants were randomized to receive Heart2HAART (n?=?19) or control (n?=?9). All were receiving either weekly (n?=?9) or daily (n?=?19) observed treatment. Among those randomized to Heart2HAART, 63.2% reported no difficulty using the Heart2HAART smartphone application and 94.7% responded that the medication reminders did not interfere negatively with their activities. On average participants used Heart2HAART application 56.8 times over the three-month trial. In analyses adjusting for age, there was no difference in adherence to HAART medication between the Heart2HAART and control group as evaluated by the random pill count assessment (P?=?.29). Conclusions: Heart2HAART was feasible to use during a three-month pilot trial. Future studies may evaluate a more tailored approach, with more robust contingency management.