Sex differences and eating disorder risk among psychiatric conditions,compulsive behaviors and substance use in a screened Canadian national sample

Objective

This study examined sex differences and eating disorder risk among psychiatric conditions, compulsive behaviors (i.e., gambling, suicide thoughts and attempts) and substance use in a nationally representative sample.

Method

Data from participants of the Canadian Community Health Survey Cycle 1.2 who completed the Eating Attitudes Test (n= 5116) were analyzed. Sex differences were compared among psychiatric comorbidities according to eating disorder risk, binging, vomiting and dieting behavior. Poisson regression analysis provided prevalence ratios (PRs) of disordered eating adjusting for age, marital status, income, body mass index and recent distress.

Results

Pronounced sex differences were associated with eating disorder risk (PRs 4.89–11.04; all P values < .0001). Findings of particular interest included significantly higher PRs for eating disorder risk in males associated with gambling (PR 5.07, P< .0001) and for females associated with steroid and inhalant use as well as suicide thoughts and attempts (PRs 5.40–5.48, all P values < .0001).

Discussion

The findings from this detailed exploration of sex differences and eating disorder risk among psychiatric conditions, compulsive behaviors and substance use suggest that problem gambling, the use of inhalants and steroids and suicidal ideation in relationship to eating disorder risk warrant further investigation.     

The brain in social context: A systematic review of substance use and social processing from adolescence to young adulthood

Substance use escalates between adolescence and young adulthood, and most experimentation occurs among peers. To understand underlying mechanisms, research has focused on neural response during relevant psychological processes. Functional magnetic resonance imaging (fMRI) research provides a wealth of information about brain activity when processing monetary rewards; however, most studies have used tasks devoid of social stimuli. Given that adolescent neurodevelopment is sculpted by the push-and-pull of peers and emotions, identifying neural substrates is important for intervention. We systematically reviewed 28 fMRI studies examining substance use and neural responses to stimuli including social reward, emotional faces, social influence, and social stressors. We found substance use was positively associated with social-reward activity (e.g., in the ventral striatum), and negatively with social-stress activity (e.g., in the amygdala). For emotion, findings were mixed with more use linked to heightened response (e.g., in amygdala), but also with decreased response (e.g., in insula). For social influence, evidence supported both positive (e.g., cannabis and nucleus accumbens during conformity) and negative (e.g., polydrug and ventromedial PFC during peers’ choices) relations between activity and use. Based on the literature, we offer recommendations for future research on the neural processing of social information to better identify risks for substance use.     

Sexual risk,substance use,mental health,and trauma experiences of gang-involved homeless youth

This study examined the associations of sexual risk behaviors, substance use, mental health, and trauma with varying levels of gang involvement in a sample of Los Angeles-based homeless youths. Data were collected from 505 homeless youths who self-reported various health information and whether they have ever identified as or been closely affiliated with a gang member. Multivariable logistic regression assessed associations of lifetime gang involvement with risk taking behaviors and negative health outcomes. Results revealed seventeen percent of youths have ever identified as a gang member and 46% as gang affiliated. Both gang members and affiliates were at greater risk of many negative behaviors than non-gang involved youths. Gang members and affiliates were more likely to report recent methamphetamine use, cocaine use, chronic marijuana use, having sex while intoxicated, and symptoms of depression, symptoms of posttraumatic stress disorder. They were also more likely to have experienced childhood sexual abuse and witnessing family violence. Gang members were more likely to ever attempt suicide, experience recent partner violence, and report physical abuse during childhood. Results suggest that lifetime gang involvement is related to a trajectory of negative outcomes and amplified risk for youths experiencing homelessness. Additionally, being closely connected to a gang member appears to have just as much as an impact on risk as personally identifying as a gang member. Given the lack of knowledge regarding the intersection between youth homelessness and gang involvement, future research is needed to inform policies and programs that can address the specific needs of this population.     

Neurobiological underpinnings and modulating factors in schizophrenia spectrum disorders with a comorbid substance use disorder: A systematic review

Recently there is a growing interest in the interaction of schizophrenia spectrum disorders (SSD) and substance use disorders (SUD), a condition named dual schizophrenia spectrum disorders (SSD+). While previous research has focused on clinical and cognitive aspects, little is known about the impact of comorbidity in the brain structure and functions. Evidence suggests that dual diagnosis patients, including SSD+, show a better neurocognitive functioning during the first years of illness, followed by a serious long-term decline. The initial search retrieved 94 articles, 12 were excluded for being redundant and 49 for not fulfilling the selection criteria. Thirty-three structural and functional neuroimaging studies that compare SSD and SSD+ patients were included. Both groups exhibited more brain alterations, in comparison to only SUD patients and healthy controls. SSD+ patients are less cognitively and emotionally impaired than non-dual SSD, but worse than healthy controls. The neurobiological alterations are prominent in SSD+ after five years of illness or longer. Moreover, SUD characteristics are important modulating factors, contrary to clinical severity or specific SSD diagnosis.     

Relationships between insomnia and alcohol and cocaine use frequency with aggression among veterans engaged in substance use treatment

BackgroundVeterans with substance use problems have rates of partner and non-partner violence that typically exceed the general population. Sleep problems may exacerbate violence and maintain addictive behaviors in non-veterans, but requires study in veterans. Therefore, we examine the interrelationships between substance use, insomnia, and violence in veterans.MethodsVeterans (N = 762) screened for a randomized controlled trial at veterans affairs mental health and substance use clinics. Participants completed modified Conflict Tactics Scales to quantify past-year violence and the Insomnia Symptom Questionnaire to assess sleep disturbance. We evaluated associations between substance use and sleep in predicting the target of aggression (partner or non-partner) and degree of violence (aggression or injury) using binomial logistic regressions.ResultsHalf of participants endorsed symptoms suggestive of insomnia, 23.2% endorsed physical aggression toward partners (PA-P) and 33.9% non-partners (PA-NP), and 9.7% endorsed physical injury of partners (PI-P) and 17.6% of non-partners (PI-NP). Regressions revealed significant models for PA-P, PA-NP, and PI-NP, whereas the PI-P model was not significant. PA-P was higher among non-Caucasian race and older veterans. PA-NP was more common in those with insomnia and increased with frequency of cocaine use. Insomnia moderated the relationship between cocaine use and PA-NP; there was a weaker relationship between cocaine use and PA-NP in those with insomnia. PI-NP was more common with higher frequency of alcohol and cocaine use, and in those with insomnia.ConclusionsThis study finds sleep disturbances are meaningful predictors of violence among veterans with differential relationships with aggression severity, victims, and substance use concurrence.     

Brief report: Teen sexting and psychosocial health

The current study examines whether adolescents who report sexting exhibit more psychosocial health problems, compared to their non-sexting counterparts. Participants included 937 ethnically diverse male and female adolescents recruited and assessed from multiple high schools in southeast Texas. Measures included self-report of sexting, impulsivity, alcohol and drug use, and depression and anxiety symptoms. Teen sexting was significantly associated with symptoms of depression, impulsivity, and substance use. When adjusted for prior sexual behavior, age, gender, race/ethnicity, and parent education, sexting was only related to impulsivity and substance use. While teen sexting appears to correlate with impulsive and high-risk behaviors (substance use), we did not find sexting to be a marker of mental health.     

The children of homosexual and heterosexual single mothers

Children reared in homes headed by homosexual and heterosexual mothers were compared with respect to the mothers' and children's attitudes towards marriage, procreation and homosexuality. The mothers did not prefer their chldren to be homosexual; they desired them to marry and procreate. This was expressed more unambiguously for their sons. The children mirrored these expectations, boys with greater frequency than the girls. Most of the children expressed reservations about having a homosexual mother.     

Substance use after bariatric surgery: A review

BackgroundPrevalence of obesity has increased dramatically. Obese individuals may undergo bariatric surgery to lose excessive body fat and mitigate obesity-related comorbidities. However, bariatric patients are particularly vulnerable to substance use problems. We conducted a review to examine the prevalence change and factors associated with substance use and determine the association between substance use and health status after weight loss among bariatric patients.MethodsWe searched peer-reviewed articles published between January 1990 and January 2015 in several databases (PubMed, PsycINFO, Cochrane Library, Google Scholar) using different keywords combinations. Studies that focused on pre-surgery substance use only or without reported effect measurements were excluded.ResultsOverall, 40 studies were included in the review. Preoperative history of substance use was a reliable correlate of postoperative substance use. The prevalence of postoperative alcohol use was higher among patients with preoperative history of alcohol use than those without. Postoperative prevalence of alcohol use ranged from 7.6% to 11.8%. No significant prevalence change in cigarette smoking from pre-to postoperative period was observed. Time effect was not observed on smoking or drug use prevalence, while an increase in alcohol consumption was inconsistent across studies. The proportion of new-onset substance users among bariatric patients after surgery ranged from 34.3% to 89.5%.ConclusionSubstance use is associated with poor health among bariatric patients. Preoperative assessment and postoperative follow-up should include interventions to reduce relapse among users and prevent substance use initiation.     

Affective differences in Iowa Gambling Task performance associated with sexual risk taking and substance use among HIV-positive and HIV-negative men who have sex with men

We investigated the relationship between emotional distress and decision making in sexual risk and substance use behavior among 174 (ages 25 to 50 years, 53% black) men who have sex with men (MSM), a population at increased risk for HIV. The sample was stratified by HIV status. Measures of affective decision making, depression, anxiety, sex acts, and substance use during the past 60 days were collected at our research center. Negative binomial regression models were used to examine the relationship between age, HIV status, anxiety, depression, and IGT performance in the prediction of number of risky sex acts and substance use days. Among those without anxiety or depression, both number of risky sex acts and drug use days decreased with better performance during risky trials (i.e., last two blocks) of the IGT. For those with higher rates of anxiety, but not depression, IGT risk trial performance and risky sex acts increased concomitantly. Anxiety also interacted with IGT performance across all trials to predict substance use, such that anxiety was associated with greater substance use among those with better IGT performance. The opposite was true for those with depression, but only during risk trials. HIV-positive participants reported fewer substance use days than HIV-negative participants, but there was no difference in association between behavior and IGT performance by HIV status. Our findings suggest that anxiety may exacerbate risk-taking behavior when affective decision-making ability is intact. The relationship between affective decision making and risk taking may be sensitive to different profiles of emotional distress, as well as behavioral context. Investigations of affective decision making in sexual risk taking and substance use should examine different distress profiles separately, with implications for HIV prevention efforts.     

Activity spaces and urban adolescent substance use and emotional health

This study analyzed routine locations (activity spaces) of urban adolescents enrolled in a substance abuse treatment program to understand the relationship between their spatial lives and health outcomes such as substance use and mental health. Sixty-eight adolescents were interviewed and produced a list of 199 locations identified as most important, safe, and risky. A TwoStep Cluster analysis resulted in two mutually exclusive groups of adolescents (n = 58). Clusterwise importance analyses showed that sex, distress, anxiety, emotional problems, and drug use significantly distinguish clusters from each other. An important finding was that activity spaces vary according to the frequency of substance use and the amount of emotional problems. School was frequently perceived as a risky place – followed by friend's house and nature – for those who used alcohol and marijuana more frequently and had more emotional distress. The intersection between environment, emotion regulation, and health outcomes is discussed.     

Substance use disorders among older adults: A review of randomized controlled pharmacotherapy trials

Substance use disorders (SUDs) are a growing problem among older adults. Acamprosate, disulfiram, and naltrexone are United States Food and Drug Administration (referred to as FDA) approved for the treatment of alcohol use disorder, and buprenorphine is approved for the treatment of opiate use disorder among adults. However, the data on the use of these medications for the treatment of SUDs among older adults are unclear from randomized controlled trials (referred to as RCTs). A review of the literature indicates that there are only two RCTs that evaluated the use of pharmacologic agents for SUDs among older adults (≥ 50 years). One trial evaluated the use of naltrexone when compared to placebo for the treatment of alcohol use disorder among individuals, 50-70 years in age. The other trial evaluated the use of naltrexone or placebo as adjuncts with sertraline in the treatment of alcohol use disorder among individuals older than 55 years in age. Both trials indicated that the use of naltrexone reduced the rates of relapse among older adults with alcohol use disorder. However, we did not identify any RCTs that studied the use of buprenorphine, acamprosate, or disulfiram for SUDs among older adults. Based on available evidence, it would be safe to conclude that limited data indicate some efficacy for naltrexone in the treatment of alcohol use disorder among older adults. However, data from controlled trials on the use of other medications that are FDA approved for the treatment of SUDs among younger adults are nonexistent among older adults with SUDs.     

Social media use and risky behaviors in adolescents: A meta-analysis

IntroductionThis systematic review and meta-analysis examined the associations between social media use and risky behaviors during adolescence, and evaluated study characteristics (e.g., sample age, type of social media platform assessed) that may moderate these relationships.MethodsA comprehensive search strategy identified relevant studies from PsycInfo, PubMed, Google Scholar, and Proquest Dissertations and Theses Global.ResultsThe final sample included 27 independent cross-sectional studies with a total of 67,407 adolescents (M_age = 15.5, range: 12.6–18.0 years; 51.7% girls; 57.2% White). Results from random effects models indicated that there were positive, small-to-medium correlations between social media use and engagement in risky behaviors generally (r = 0.21, 95% CI = 0.16-0.25), substance use (r = 0.19, 95% CI = 0.12-0.26), and risky sexual behaviors (r = 0.21, 95% CI = 0.15-0.28). There were an insufficient number of independent samples available to conduct a random effect models for violence-related behaviors (k = 3). Moderator analyses suggested that studies assessing solely early social media platforms (e.g., Facebook/MySpace only) in relation to substance use had smaller effect sizes than substance use studies assessing a broader range of contemporary social media platforms. In addition, younger samples had larger effect sizes for studies focused on social media use and risky sexual behaviors.ConclusionsThe positive links identified between social media and risky behaviors during adolescence in this meta-analysis suggest that developmental theories of risk taking would benefit from incorporating the social media context. Longitudinal studies are needed to clarify directionality and make more specific practice and policy recommendations so that social media is a safe place in which adolescents can thrive.     

A short-term longitudinal analysis of friendship selection on early adolescent substance use

There is a strong empirical connection between individual and peer substance use during adolescence. The determination of whether this level of covariation reflects influence or selection is obscured by both the design and measurement strategies used. This present study utilizes a short-term longitudinal design with bi-monthly assessments to address the following two hypotheses: a) Adolescents select friends on the basis of their substance use, and b) New friend substance use predicts changes in future use. French Canadian adolescents (n = 143) were interviewed on their friendship networks and substance use behaviors (e.g., tobacco, alcohol and marijuana) four times during a school year. Cross-lag panel models revealed that adolescents who use substances tend to select new friends who use. Moreover, once in the network, these new friends also contribute to changes in the adolescents’ substance use. These findings are relevant to understanding the multiple functions of adolescent substance use.     

Associations among sleep problems, learning difficulties and substance use in adolescence

This study investigated the relationships among sleep problems, learning difficulties and substance use in adolescence. Previous research suggests that these variables share an association with executive functioning deficits, and are intertwined. The sample comprised 427 adolescents (M age = 16 years) attending remedial schools and 276 adolescents (M age = 15 years) attending a mainstream school in Cape Town, South Africa. Participants completed anonymous self-report questionnaires. Results indicated that adolescents without learning difficulties were more likely to use tobacco, methamphetamine and cannabis, whereas those with learning difficulties engaged in more inhalant use. Adolescents who had more sleep problems were more likely to use tobacco, alcohol, methamphetamine, cannabis, inhalants, cocaine, ecstasy and any other illegal drug. Adolescents with learning difficulties had more sleep problems than those without learning difficulties. However, sleep problems remained independently associated with tobacco, cannabis and inhalant use when learning difficulties were taken into account.     

A systematic review of diffusion weighted MRI studies of white matter microstructure in adolescent substance users

Recent studies using diffusion weighted magnetic resonance imaging (DW-MRI) have provided evidence of abnormal white matter microstructure in adults with substance use disorders (SUDs). While there is a growing body of research using DW-MRI to examine the impact of heavy substance use during adolescence, this literature has not been systematically reviewed. Online databases were searched for DW-MRI studies of adolescent substance users, and 10 studies fulfilled the inclusion and exclusion criteria. We identified consistent evidence for abnormal white matter microstructure in neocortical association pathways as well as in projection and thalamic pathways. Dose-dependent relationships between DW-MRI measures and patterns of substance use were also observed. The consistency of these findings with DW-MRI research in adults suggests that white matter microstructure is impacted in the early stages of heavy substance use. However, given the largely cross-sectional nature of the available data, important questions remain regarding the extent to which white matter abnormalities are a consequence of adolescent exposure to alcohol and other drugs of abuse or reflect pre-existing differences that increase risk for SUDs.     

Peer-relationship patterns and their association with types of child abuse and adolescent risk behaviors among youth at-risk of maltreatment

IntroductionThis study investigates underlying patterns of peer relationships using diverse concepts (i.e., peer dynamics, peer popularity, and deviant peer affiliation). It also examines whether the patterns of peer relationships differ by type of child abuse, as well as the association between peer relationships and adolescent risk behaviors.MethodsThis study included a sample of 659 youth (328 boys, 331 girls) at-risk of maltreatment, primarily low-income and living in the U.S. Peer dynamics were assessed using five separate components (self-report). Peer popularity was measured using teacher's estimation of child's peer status. Deviant peer affiliation was assessed using a modified version of the Youth Risk Behavior and Monitoring the Future Survey. Each type of abuse was assessed at age 12 using a self-report method. Self-reported adolescent sexual risk behaviors and substance use were assessed at age 16.ResultsLatent class analysis identified 4 distinct patterns: 1) Friendly, with prosocial peer groups (10.2%); 2) Socially ignored, with prosocial peer groups (55.2%); 3) Severely antisocial peer groups (6.8%); and 4) Moderately antisocial peer groups (27.8%). Among all types of child abuse, emotionally abused youth were more likely to be involved in severely antisocial peer groups. Additionally, youth in the severely antisocial peer groups were more likely to exhibit adolescent risk behaviors.ConclusionsThese findings argue clearly for the need to gain a deeper understanding of the role played by peer relationships, and of the effect of emotional abuse on the likelihood of membership in severely antisocial peer groups.