Teenline: a CMHC-based adolescent suicide prevention and intervention program.

The need for adolescent suicide prevention ad intervention programs has been demonstrated by national statistics and in frightening newspaper headlines. Can any of us ignore the fact that 5,000 young people between the ages of 15 and 24 commit suicide each year? The two groups in most frequent contact with these adolescents outside of the family are educators and mental health professionals. This article reports how these two professional groups on one occasion merged into a single unit to combat a serious problem. Their cooperative efforts prevented a more devastating incident and demonstrated how a difficult task can be accomplished when various resources are brought together in a single organized effort.     

Longitudinal relationships of sleep and inhibitory control deficits to early adolescent cigarette and alcohol use

Research in older adolescents suggests insufficient sleep may increase substance use initiation risk. This study tested whether sleep duration and dysregulation of sleep-wake patterns in late-elementary school youth were prospectively associated with cigarette and alcohol use initiation and how sleep-related changes in inhibitory control mediate these relationships. Average sleep duration at 4th grade predicted 6th grade cigarette but not alcohol use, however indirect effects were identified through 5th grade inhibitory control to both cigarette and alcohol use. Indirect effects were also identified through inhibitory control for relationships between 4th grade weekend bed-time delay and 6th grade cigarette or alcohol use, and for relationships between 4th grade weekend wake-time delay and 6th grade cigarette or alcohol use. Reductions in nightly sleep increased risk of cigarette use. Findings suggest a pathway linking both reduced sleep duration and greater weekend shifting of sleep patterns to future substance use through sleep-related inhibitory control deficits.     

Anxiety sensitivity and marijuana use: an analysis from ecological momentary assessment

Background: The cognitive factor of Anxiety Sensitivity (AS; the fear of anxiety and related bodily sensations) is theorized to play a role in cannabis use and its disorders. Lower‐order facets of AS (physical concerns, mental incapacitation concerns, and social concerns) may be differentially related to cannabis use behavior. However, little is known about the impact of AS facets on the immediate antecedents of cannabis use. Methods: This study used ecological momentary assessment (EMA) to prospectively examine the relations between specific facets of AS, cannabis craving, state anxiety, and cannabis use in the natural environment using real‐world data about ad lib cannabis use episodes. Participants were 49 current cannabis users (38.8% female). Results: AS‐mental incapacitation fears were related to significantly greater severity of cannabis‐related problems at baseline. During the EMA period, AS‐mental incapacitation and AS‐social concerns significantly interacted with cannabis craving to prospectively predict subsequent cannabis use. Specifically, individuals with higher craving and either higher AS‐mental incapacitation or AS‐social concerns were the most likely to subsequently use cannabis. In contrast to prediction, no AS facet significantly moderated the relationship between state anxiety and cannabis use. Conclusions: These findings suggest facets of AS (mental incapacitation and social fears) interact with cannabis craving to predict cannabis use. Findings also suggest differential relations between facets of AS and cannabis‐related behaviors. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

Social anxiety and cannabis use: an analysis from ecological momentary assessment

Individuals with elevated social anxiety appear especially vulnerable to cannabis-related problems, yet little is known about the antecedents of cannabis-related behaviors among this high-risk population. The present study used ecological momentary assessment (EMA) to examine the relations among social anxiety, cannabis craving, state anxiety, situational variables, and cannabis use in the natural environment during ad-lib cannabis use episodes. Participants were 49 current cannabis users. During the two-week EMA period, social anxiety significantly interacted with cannabis craving to predict cannabis use both cross-sectionally and prospectively. Specifically, individuals with higher social anxiety and craving were most likely to use cannabis. There was a significant social anxiety x state anxiety x others' use interaction such that when others were using cannabis, those with elevations in both trait social anxiety and state anxiety were the most likely to use cannabis.     

Immediate antecedents of marijuana use: an analysis from ecological momentary assessment

Background and objectivesMarijuana remains the most commonly used illicit substance. Marijuana craving, anxiety, and peer marijuana use are thought to play important roles in the etiology and maintenance of marijuana use. The present study aimed to identify patterns between marijuana use and these affective and situational risk factors in the natural environment.MethodsThe sample consisted of 49 current marijuana users (38.8% female), 63.2% of whom evinced a current cannabis use disorder. Ecological momentary assessment was used to collect multiple daily ratings of marijuana craving, state anxiety, and peer marijuana use over two weeks. Mixed effects linear models were used to examine within- and between-day antecedents, correlates, and consequences of marijuana use.ResultsBetween-day analyses indicated that marijuana use days were associated with higher marijuana craving but lower state anxiety. Within-day analyses confirmed that marijuana craving was higher prior to marijuana use and lower following use. Anxiety was related to marijuana craving. Although anxiety was somewhat higher prior to marijuana use, it did not decrease significantly following use. The vast majority of marijuana use occurred when others were also using marijuana.LimitationsThe sample was comprised of college students, a group at particular risk for marijuana use and use-related problems. Future work is necessary to determine whether results generalize to other populations.ConclusionsThese data support the contention that marijuana craving, anxiety, and peer use play important roles in the maintenance of marijuana use.     

Longitudinal outcomes of a consumer-directed program supporting adults with developmental disabilities and their families

Longitudinal impacts of a consumer-directed support program that provides families with an individualized budget were studied at three points in time over a 9-year period: Time 1 (1991), Time 2 (1995), and Time 3 (2000). At Time 3, families in the program were also compared with families on the waiting list. Over time, families in the program experienced decreased unmet service needs, higher service satisfaction, increased community participation of individuals with disabilities, and decreased caregiver burden. At Time 3 families in the program had fewer unmet needs and higher service satisfaction than did families on the waiting list; there were no differences in community participation and caregiver burden.     

The impact of fetal alcohol spectrum disorders on families: evaluation of a family intervention program

The main purpose of the present study was to conduct a preliminary evaluation of the coaching families (CF) program, which aids families and caregivers raising children with fetal alcohol spectrum disorders (FASD). Mentors in the program work with families to educate them about FASD, access resources, and advocate on their behalf. Retrospective data from 186 families were analyzed from pre- to post-program. As expected, among caregivers there was a significant decrease in needs and increase in goal attainment from pre- to post-program. Further, there was a significant decrease in caregiver stress from pre- to post-program. Families reported high overall satisfaction with the CF program. The limitations, directions for future research, and implications for service providers were also discussed.     

Racial differences in alcohol and tobacco use in adolescence and mid-adulthood in a community-based sample

Social Psychiatry and Psychiatric Epidemiology - Smoking and alcohol use have been posited as possible contributors to racial health disparities, despite higher smoking and alcohol use among...     

Neurobiological signatures associated with alcohol and drug use in the human adolescent brain

Magnetic resonance (MR) techniques provide opportunities to non-invasively characterize neurobiological milestones of adolescent brain development. Juxtaposed to the critical finalization of brain development is initiation of alcohol and substance use, and increased frequency and quantity of use, patterns that can lead to abuse and addiction. This review provides a comprehensive overview of existing MR studies of adolescent alcohol and drug users. The most common alterations reported across substance used and MR modalities are in the frontal lobe (63% of published studies). This is not surprising, given that this is the last region to reach neurobiological adulthood. Comparatively, evidence is less consistent regarding alterations in regions that mature earlier (e.g., amygdala, hippocampus), however newer techniques now permit investigations beyond regional approaches that are uncovering network-level vulnerabilities. Regardless of whether neurobiological signatures exist prior to the initiation of use, this body of work provides important direction for ongoing prospective investigations of adolescent brain development, and the significant impact of alcohol and substance use on the brain during the second decade of life.     

Integrated drug and alcohol intervention: development of an opportunistic intervention program to reduce alcohol and other substance use among psychiatric patients.

OBJECTIVE: This paper describes the rationale, aims and processes involved in developing and implementing an opportunistic intervention program to reduce substance misuse detected among psychiatric patients. METHOD: In this randomised, opportunistic intervention program, eligible patients recruited from a large psychiatric hospital and its associated community mental health centres are assigned to receive an integrated drug and alcohol intervention (IDAI) or alternatively allocated to a minimal intervention condition (MI). The IDAI is based on motivational enhancement and cognitive-behavioural principles, and incorporates harm-reduction approaches. This clinical program is based on the research findings and recommendations of the mental health and the drug and alcohol literature. RESULTS: A collaborative partnership between the Mental Health Services and the Drug and Alcohol Services was formed. Following a relatively short training period, mental health staff were trained to opportunistically detect drug and alcohol problems among psychiatric patients and offer appropriate integrated clinical care. CONCLUSION: The process of implementing an integrated opportunistic intervention program is achievable and can be readily incorporated in psychiatric hospitals and community mental health clinics.     

Consequences of adolescent use of alcohol and other drugs: Studies using rodent models

Studies using animal models of adolescent exposure to alcohol, nicotine, cannabinoids, and the stimulants cocaine, 3,4-methylenedioxymethampethamine and methamphetamine have revealed a variety of persisting neural and behavioral consequences. Affected brain regions often include mesolimbic and prefrontal regions undergoing notable ontogenetic change during adolescence, although it is unclear whether this represents areas of specific vulnerability or particular scrutiny to date. Persisting alterations in forebrain systems critical for modulating reward, socioemotional processing and cognition have emerged, including apparent induction of a hyper-dopaminergic state with some drugs and/or attenuations in neurons expressing cholinergic markers. Disruptions in cognitive functions such as working memory, alterations in affect including increases in social anxiety, and mixed evidence for increases in later drug self-administration has also been reported. When consequences of adolescent and adult exposure were compared, adolescents were generally found to be more vulnerable to alcohol, nicotine, and cannabinoids, but generally not to stimulants. More work is needed to determine how adolescent drug exposure influences sculpting of the adolescent brain, and provide approaches to prevent/reverse these effects.     

Mental health and the use of alcohol,tobacco, analgesics and vitamins in a secondary school population

A survey of mental health in relation to patterns of alcohol, tobacco, pharmaceutical drug use and reducing diets was carried out in six Hobart high schools and matriculation colleges. A response rate of 89% was achieved, yielding a sample of 2,419 teenagers. Psychiatric disorder was assessed by the 60-item General Health Questionnaire. A statistically significant association was found between the probability of psychiatric disturbance and the use of alcohol, cigarettes, analgesics, vitamin supplements and weight-reducing diets.     

A systems approach to child effeminacy and the prevention of adolescent transsexualism

This paper describes the treatment of a boy with transsexual behaviour by means of family therapy supplemented by group therapy. It argues that a family systems approach can grasp dimensions of the problems of transsexualism that are missed if an exclusively individual treatment approach is adopted, and concludes that a family systems approach should be part of the assessment and treatment of all children and adolescents presenting with effeminacy or transsexual problems.     

An evaluation of a prevention program for disordered eating in adolescent girls: examining responses of high- and low-risk girls

A prevention program for disordered eating was evaluated. Grade 9 girls (N = 173) were assigned to a prevention intervention (n = 114) or a no-treatment control group (n = 59). High-risk, but not low-risk, girls reported significant improvements in body dissatisfaction, drive for thinness, and interoceptive awareness at post-intervention. These changes were not maintained at three-month follow-up, although nonsignificant trends were still apparent for high-risk girls. Individual session analyses indicated that the program was rated positively overall. The importance of assessing effects of programs on different recipient types is discussed.     

Changes in adolescents mental health and use of alcohol and tobacco: a 10-year time-trend study of Finnish adolescents

The present study examines the 10-year time-trend changes of adolescent psychiatric symptoms, smoking and alcohol use. Representative population-based samples with same methods at two time-points, same age range and with 10-year period between the time points were gathered in Finland to investigate secular changes in adolescents?? emotional and behavioral problems. Seventh and ninth grade students filled in the Strengths and Difficulties Questionnaire (SDQ) and questions regarding alcohol use and smoking anonymously during a school lesson in 1998 (n?=?1458) and 2008 (n?=?1569). The self-reports of SDQ showed substantial stability in emotional and behavioral problems from 1998 to 2008. There was no increase between the two timepoints in self-reports of SDQ total, conduct, hyperactivity, emotional or peer problems when using the 90th percentile clinical cut-off points. However, there was a trend showing decreasing prosocial behavior among girls indicating that proportions of adolescent boys and girls having problems in prosocial behavior have converged, The self-reported alcohol use, drunkenness and cigarette smoking decreased within the 10-year time period. Of alcohol use, the number of non-users increased from 44 to 63?% between the years 1998 and 2008. Similarly, the proportion of non-smokers increased from 56 to 68?%. Although rates of substance use declined within the 10-year study period, drunkenness-oriented alcohol use and regular smoking are still prevalent among Finnish adolescents.