The relationship between childhood depressive symptoms and problem alcohol use in early adolescence: findings from a large longitudinal population-based study

Aims Depressive symptomatology can increase risk of development of alcohol problems in young people. Tension reduction and family interactional theories may explain the relationship between depression and problematic alcohol use in youth. This study addresses the nature of the longitudinal relationship between these two behaviours. The available literature is currently inconclusive about whether there are gender differences in these relationships; this is also examined. Design The association between childhood depressive behaviours and adolescence problematic alcohol use was examined using ordered logistic regression models. Evidence of gender differences and the impact of relevant covariates on these relations were examined. Missing data were imputed using a Multiple Imputation by Chained Equation (MICE) approach. Settings The Avon Longitudinal Study of Parents and Children (ALSPAC), a large UK population‐based birth cohort. Participants A total of 4220 British boys and girls. Measurements Depressive symptomatology was assessed in childhood (mean age = 10.6, SD = 0.2) using the Short Mood and Feelings Questionnaire (SMFQ). Problematic alcohol use was assessed from several questions queried in adolescence (mean age = 13.8, SD = 0.2). Findings Childhood depressive symptoms were associated with increased risk of problematic alcohol use in early adolescence for girls [odds ratio (OR) = 1.14, P = 0.016] but not boys. This association for girls weakened (OR = 1.12, P = 0.058) when a priori selected covariates were taken into account, particularly the family and greater social environment. Conclusions Problematic alcohol use in girls (but not boys) is associated with prior depressive symptoms. This association may be attributable to several family and social environment factors, suggesting that a family interactional theoretical model may explain these findings.     

Genetic and environmental influences on the relationship between peer alcohol use and own alcohol use in adolescents

AIMS: Genetically influenced aspects of adolescent behaviour can play a role in alcohol use and peer affiliation. We explored the correlations between friends' alcohol use and adolescent own use with a genetically sensitive design. DESIGN: Genetic and environmental factors were estimated on adolescent reports of their friends' alcohol use and their own use and problem use of alcohol. The correlations between the genetic and environmental factors that influence friends' alcohol use and adolescent own alcohol use and problem use were also estimated. PARTICIPANTS: A total of 862 twin pairs aged 11-17 years sampled from the UK population-based Cardiff Study of All Wales and North-west of England Twins (CaStANET). MEASUREMENTS: Data on adolescent own alcohol use and problem use and the alcohol use of their three best friends were obtained using self-report questionnaires. FINDINGS: A significant genetic influence was found on adolescent friends' alcohol use (about 30%). Significant correlations of 0.60 and 0.70 were found between the genetic influences on friends' alcohol use and adolescents' own use and problem use of alcohol. Common environmental influences were almost completely correlated for friends' alcohol use and adolescents' own alcohol use and problem use (0.91 and 0.94). CONCLUSIONS: There is considerable overlap in the common environmental and genetic factors that contribute to the relationship between adolescents' own alcohol use and that of their friends. These findings contribute to understanding of the mechanisms by which friends' alcohol use influences adolescent drinking behaviour.     

The added risk of opioid problem use among treatment‐seeking youth with marijuana and/or alcohol problem use

Objectives To determine the added risk of opioid problem use (OPU) in youth with marijuana/alcohol problem use (MAPU). Methods A total of 475 youth (ages 14–21 years) with OPU + MAPU were compared to a weighted sample of 475 youth with MAPU only (i.e. no OPU) before and after propensity score matching on gender, age, race, level of care and weekly use of marijuana/alcohol. Youth were recruited from 88 drug treatment sites participating in eight Center for Substance Abuse Treatment‐funded grants. At treatment intake, participants were administered the Global Appraisal of Individual Need to elicit information on demographic, social, substance, mental health, human immunodeficiency virus (HIV), physical and legal characteristics. Odds ratios with confidence intervals were calculated. Results The added risk of OPU among MAPU youth was associated with greater comorbidity; higher rates of psychiatric symptoms and trauma/victimization; greater needle use and sex‐related HIV risk behaviours; and greater physical distress. The OPU + MAPU group was less likely to be African American or other race and more likely to be aged 15–17 years, Caucasian; report weekly drug use at home and among peers; engage in illegal behaviors and be confined longer; have greater substance abuse severity and polydrug use; and use mental health and substance abuse treatment services. Conclusions These findings expand upon the existing literature and highlight the substantial incremental risk of OPU on multiple comorbid areas among treatment‐seeking youth. Further evaluation is needed to assess their outcomes following standard drug treatment and to evaluate specialized interventions for this subgroup of severely impaired youth.     

Old dog,new tricks: treating co-occurring anxiety and alcohol use disorders

Background: Over 100 million Americans live with chronic pain, and adults with chronic pain may be more likely to experience alcohol-related problems or Alcohol Use Disorder. An evolving conceptual model posits that bidirectional effects between pain and alcohol exacerbate both pain and drinking. Pain has been shown to motivate alcohol urge and consumption, and drinking for pain-coping predicts escalations in alcohol use over time. Pain-related anxiety is a transdiagnostic vulnerability factor that has been implicated in both pain and substance-related (i.e., tobacco, opioids, cannabis) outcomes, but has not yet been studied in relation to alcohol use.

Objective: We sought to conduct the first test of cross-sectional associations between pain-related anxiety, gender, and alcohol use.

Methods: Adults with chronic pain (N = 234; M_age = 29.54, 67% Female) self-reported pain-related anxiety, gender, and alcohol use (i.e., consumption frequency/quantity, alcohol-related consequences, and dependence symptoms measured with the Alcohol Use Disorders Identification Test; AUDIT). Hierarchical regression and conditional effects models were used to test associations between pain-related anxiety, gender, and alcohol use.

Results: Pain-related anxiety was positively associated with alcohol-related consequences and alcohol dependence symptoms measured by the AUDIT among males, but not females. Pain-related anxiety was not associated with the frequency/quantity of alcohol consumption in our sample.

Conclusions: These findings are consistent with prior research, which has demonstrated associations between pain-related anxiety and deleterious substance use outcomes. Results provide initial evidence that pain-related anxiety may be a relevant factor to consider in the context of alcohol research and treatment among male drinkers.     

Early-onset depressive disorders predict the use of addictive substances in adolescence: a prospective study of adolescent Finnish twins

Aims To explore the developmental relationships between early‐onset depressive disorders and later use of addictive substances. Design, setting and participants A sample of 1545 adolescent twins was drawn from a prospective, longitudinal study of Finnish adolescent twins with baseline assessments at age 14 years and follow‐up at age 17.5 years. Measurements At baseline, DSM‐IV diagnoses were assessed with a professionally administered adolescent version of Semi‐Structured Assessment for Genetics of Alcoholism (C‐SSAGA‐A). At follow‐up, substance use outcomes were assessed via self‐reported questionnaire. Findings Early‐onset depressive disorders predicted daily smoking [odds ratio (OR) 2.29, 95% confidence interval (CI) 1.49–3.50, P < 0.001], smokeless tobacco use (OR = 2.00, 95% CI 1.32–3.04, P = 0.001), frequent illicit drug use (OR = 4.71, 95% CI 1.95–11.37, P = 0.001), frequent alcohol use (OR = 2.02, 95% CI 1.04–3.92, P = 0.037) and recurrent intoxication (OR = 1.83, 95% CI 1.18–2.85, P = 0.007) 3 years later. ORs remained significant after adjustment for comorbidity and exclusion of baseline users. In within‐family analysis of depression‐discordant co‐twins (analyses that control for shared genetic and familial background factors), early‐onset depressive disorders at age 14 predicted significantly frequent use of smokeless tobacco and alcohol at age 17.5. Conclusions Our results suggest important predictive associations between early‐onset depressive disorders and addictive substance use, and these associations appear to be independent of shared familial influences.     

Timing of first alcohol use and alcohol dependence: evidence of common genetic influences

Aims   To estimate the magnitude of genetic and environmental influences on timing of first alcohol use and alcohol dependence (AD) and to quantify the overlap in these influences across the two alcohol-related outcomes.
Participants    The sample consisted of 5382 twins (2691 complete pairs), aged 24–36 years, from the Australian Twin Registry.
Measurements   History of alcohol use and DSM-IV alcohol dependence were assessed by structured telephone interview.
Findings   In both sexes, the relationship between age at first alcohol use and risk for AD followed a linear trend, such that the highest rates of AD were observed in individuals who began drinking at an earlier than average age (14 years or younger). Heritability estimates for timing of first alcohol use and AD were 36% and 53%, respectively. Shared environmental factors accounted for 15% of variance in initiation. There was no evidence of shared environmental influences on AD. The genetic correlation between timing of first alcohol use and AD was 0.59.
Conclusions   Findings highlight the substantial role of genetics in the development of AD and the early manifestation of that genetic risk in the timing of alcohol use initiation which, unlike AD, is also influenced to a modest degree by shared environmental factors. The considerable overlap in heritable influences—and the virtual absence of overlap in individual-specific environmental influences—on initiation of alcohol use and AD indicates that the association between age at first drink and AD is attributable in large part to common genetic sources of variance.     

Coadministration of disulfiram and lorazepam in the treatment of alcohol dependence and co-occurring anxiety disorder: an open-label pilot study

ABSTRACT

Background: Anxiety is common among persons with alcohol use disorder during early abstinence from alcohol. Although benzodiazepines are effective for short-term treatment of anxiety, they are rarely used beyond acute detoxification due to concerns about misuse or interactions with alcohol. Objectives: We conducted an open-label trial to explore the effects of coadministering lorazepam and disulfiram to alcohol-dependent patients with anxiety disorder symptoms. The rationale for this model is to minimize the risks of the benzodiazepine, while also potentially enhancing adherence to disulfiram. Methods: Forty-one participants with DSM-IV alcohol dependence who also met syndromal criteria for anxiety disorder with or without co-occurring major depressive syndrome initiated treatment with lorazepam (starting dose 0.5 mg three times daily) and disulfiram (starting dose 500 mg three times weekly). Participants received 16 weeks of monitored pharmacotherapy with manualized medical management. Results: Adherence to treatment decreased steadily with time (85.4% at 4 weeks, 36.6% at 16 weeks). Participants showed significant increases in percent abstinent days during treatment and at 24 weeks follow-up. Large reductions in anxiety, depression, and craving were observed during treatment, and improvement remained significant at 24 weeks. Duration of adherence with disulfiram strongly predicted abstinence at 16 weeks. There was no evidence of misuse of lorazepam or dose escalation during the study. Conclusion: Lorazepam can be safely used for short-term treatment of anxiety in combination with disulfiram treatment of alcohol use disorder. However, it is not clear that making lorazepam dispensing contingent on adherence to disulfiram enhances retention in disulfiram treatment.     

The association between alcohol use trajectories from adolescence to adulthood and cannabis use disorder in adulthood: a 22-year longitudinal study

Background: Due to the increasing prevalence of cannabis use disorder (CUD), the impact of cannabis use on public health may be significant. Objective: The present study seeks the possible precursors (e.g., alcohol use) of CUD in order to minimize the potential negative consequences of CUD such as impaired coordination and performance. Method: The Harlem Longitudinal Development Study included 674 participants (53% African Americans, 47% Puerto Ricans), with 60% females (n=405) from a six wave survey. We used a growth mixture model to obtain the trajectories of alcohol use from the mean ages of 14 to 36. To examine the associations between alcohol use trajectories and CUD, we used logistic regression analyses with the indicator of CUD as the dependent variable and the indicator of membership in each trajectory group as the independent variables. Results: A three alcohol use trajectory group model was selected. Male gender, higher frequency of cannabis use in adolescence, and a lower educational level were associated with an increased likelihood of having CUD. Membership in the increasing alcohol use group (OR=27.44, p < .01; AOR=15.54, p < .01) and the moderate alcohol use group (OR=10.40, p < .05; AOR=8.63, p < .05) were associated with an increased likelihood of having CUD compared with the membership in the no or low alcohol use group. Conclusions: The findings of our study support the hypothesis that addressing alcohol use at an early age could impact later CUD.     

Age moderates non-genetic influences on the initiation of cannabis use: a twin-sibling study in Dutch adolescents and young adults

Aims To examine the heritability of cannabis initiation, the influence of a possible twin‐specific environment and the influence of age on the effects of genes and environment in Dutch adolescents and young adults. Design Genetic structural equation modelling was used to partition the variance in the liability to cannabis initiation into genetic and environmental components. Setting All participants were registered with the Netherlands Twin Register. Participants A total of 6208 twins (age 13–20) and 1545 siblings (age 11–25) from 3503 families participated in this study. Measurements Self‐reported cannabis use was assessed prospectively with the Dutch Health Behavior Questionnaire. Findings At the median age of the sample (16.5), genetic factors explained 40% of the individual differences in liability to cannabis initiation. Twins resembled each other more than non‐twin siblings, which could not be attributed to the age difference between non‐twin siblings. Environmental influences increased with age. This increase applied to environmental factors shared by twins (47% of the variance), environmental factors shared by twins and siblings (24%) and environmental factors unique to an individual (13%). Conclusion The heritability of the liability for cannabis initiation is higher in adolescents than in young adults due to a larger contribution of environmental factors in young adults. This is due mainly to environmental factors only shared by twins and those shared by all offspring growing up in the same family, but the contribution of environmental factors specific to individuals is also larger in young adults.