Substance Use and Violence Among Youth: A Daily Calendar Analysis

Background: While researchers have identified factors that contribute to youth violence, less is known about the details of violent incidents. In addition, substance use has been linked to youth violence; however, little is known about actual substance use on days in which violence occurs. Objective: This study examined reasons for peer violence and the association between substance use and violence using daily calendar-based analyses among at-risk urban youth. Methods: Data were collected from Emergency Department (ED) patients (ages 14–24; n = 599; 59% male, 65% African American) who screened positive for substance use in the past 6 months. Daily data regarding past 30-day substance use and violence and reasons for violent incidents were obtained via semi-structured interviews. Multi-level multinomial regression models were conducted to test the associations between substance use and peer violence incidents (i.e., none, moderate and severe). Results: Conflict over ‘personal belongings’ was a common reason for violence among males; ‘jealousy’/‘rumors’ were common reasons among females. Moderate victimization was more likely to be reported on days in which participants reported alcohol and cocaine use. Severe victimization was more likely to be reported on days in which participants reported alcohol use. Moderate or severe aggression was more likely to be reported on days in which participants reported alcohol and non-medical sedative use. Conclusions: Results suggest that youth violence prevention that addresses differential reasons for violence among males and females as well as substance use would be beneficial.     

Associations between substance use,post-traumatic stress disorder and the perpetration of violence: A longitudinal investigation

Aim

Substance use disorder (SUD) and post-traumatic stress disorder (PTSD) commonly co-occur. This is of significant concern, given the increased risk for violence perpetration among individuals with this comorbidity. Limited research, however, has examined relationships between SUD, PTSD and violence among individuals longitudinally. Such an investigation is warranted given that substance use and PTSD symptoms can fluctuate over time. This study therefore aims to examine how changes in substance use and PTSD symptom severity are associated with the perpetration of violent crime over time among individuals with comorbid SUD and PTSD.

Method

One-hundred and two men and women who met criteria for SUD and PTSD were interviewed four times over a 9-month period. These interviews included measures of past-month violent crime perpetration, substance use and dependence, PTSD symptom severity, and depression and state anxiety symptoms. Generalised estimating equations (GEE) modelled associations between substance use, PTSD and violence.

Results

Increased substance use, more severe substance dependence and more severe PTSD symptomology were consistently associated with violent crime over time. Multivariate GEE analyses, however, revealed that the PTSD hyperarousal symptoms, specifically, were independently associated with violence over time.

Conclusions

This longitudinal study found that PTSD hyperarousal symptoms were consistently associated with the perpetration of violent crime, further highlighting the potentiating role of PTSD hyperarousal in relation to violence among individuals with SUD. These findings indicate that interventions addressing hyperarousal symptoms have the potential to reduce the susceptibility for violence among individuals with this common comorbidity.     

Violence perpetration and childhood abuse among men and women in substance abuse treatment

Despite an association between violence perpetration and substance use, the characteristics associated with violence among patients in treatment for substance use disorders (SUDs) are not well documented. Data were gathered from a national sample of men (n = 4,459) and women (n = 1,774) entering SUD treatment on history of violence perpetration, exposure to childhood physical abuse (CPA) and childhood sexual abuse (CSA), and reasons for entering treatment. Rates of violence perpetration were high (72% of men, 50% of women), and violence was associated with being referred by family members, prior SUD treatment, CPA, and CSA. In multivariate analyses, CPA was a significant correlate of violence perpetration across gender; however, CSA was only significant among women. Findings highlight the need for increased screening and treatment of violence perpetration among patients with SUD and suggest that CSA may be an important correlate of violence perpetration among women.     

A latent class analysis of the co-occurrence of sexual violence,substance use,and mental health in youth

Purpose: The purpose of this study was to understand co-occurrence of sexual violence, substance use, and mental health in youth and see if there are differences in experiences among sexual identities, races, and genders. Methods: The 2017 Youth Risk Behavior Survey sampled 14,638 high school students. Latent class analysis was used to understand the relationship between incidence of sexual violence, substance use, and depression and suicidality in a nationally representative sample. The model controlled for demographic and bullying covariates. Results: A four-class solution provided optimal fit. Classes were low risk (51.8%); low violence, frequent substance use, and high depression and suicidal ideation (29.7%); experienced violence and moderate mental health issues(5.1%); and some violence, high substance use, and high depression and suicidal ideation (13.4%). Youth who identified as sexual minority youth were almost 2.5–5 times more likely to be in the three higher risk classes than their heterosexual peers. Those who identified as “I don’t know” were almost 3 times more likely to be in the three higher risk classes than heterosexual youth. Multiracial youth had higher likelihood of being in the three riskier classes compared to Caucasian youth. Females were 2.5 and 3 times more likely to be in the low violence and some violence classes compared to males. Conclusion: The study’s finding distinct classes of co-occurring behavioral and mental health outcomes fill gaps in the current literature and informs practitioners that LGB youth and bi/multiracial youth were at an elevated risk of co-occurring victimization, substance use, and mental health problems.     

Treatment Needs of Men and Women with Violence Problems In Substance Use Disorder Treatment

This study examined treatment needs of men and women in substance use disorder (SUD) treatment. The sample (n = 489) was recruited between 2006 and 2007 from a Midwestern state in the United States, and participants were grouped based on injury occurring in partner and nonpartner relationships in the past year. Rates of injury across relationship types were alarming with over 54.8% reporting injuring another person and 55.4% reporting being injured. Overall, those injuring nonpartners or both partners/nonpartners had more severe problems. Implications of the findings for SUD treatment settings and a model for integrated violence prevention are discussed.     

The Complex Nature of Parental Substance Use: Examining Past Year and Prior Use Behaviors as Correlates of Child Maltreatment Frequency

Background: Child maltreatment studies predominantly have operationalized parental substance use as dichotomous variables for any use, any harmful/risky use, or any substance use disorder (SUD). This limits our understanding about how a range of use behaviors may contribute to child maltreatment. Objective: Build upon prior studies by incorporating a multi-faceted approach to operationalizing parental substance use. Methods: Cross-sectional, secondary data analyses were conducted using the National Survey of Child and Adolescent Well-being (NSCAW I). The study used weighted negative binomial regression to examine relationships between annual child maltreatment frequency and different ways of operationalizing substance use among 2,100 parents. Results: Several, inter-related behaviors (i.e., heavy drinking, illicit drug use, polysubstance use, SUD, and prior SUD < 4 years) appeared to be relevant for understanding differences in child maltreatment frequencies. A gradient effect was detected across five substance use behavior patterns: (1) lowest estimated counts were observed for nonusers, light-to-moderate drinkers, and parents with a prior (but not past year) SUD (? < 7.0), (2) slightly higher estimated count was observed for heavy drinkers and/or illicit drug users (? = 9.3), and (3) highest estimated count was observed for parents with past year SUD (? = 17.6). Conclusions/Importance: SUD is a critical screening criteria for potential child harm. Parents reporting risky substance use behaviors may benefit from prevention or brief intervention services related to both their substance use and parenting behaviors. Administrative systems also could benefit from detailed tracking of substance use behaviors for future program evaluation and development.     

A violent mix? The association between concurrent alcohol and cocaine use and violence amongst young people in England and Wales

Aim: This study explored the association between concurrent alcohol and cocaine use and its predictive probability of self-reported violent behaviour. Methods: A series of logistic regression models were run on a sample of 3098 young people (aged 16–25) from a national self-report study. Findings: Current cocaine use was identified as predictive of violent offending (Exp B?=?2.363, p?≤?0.01). Cocaine use was also more likely in those reporting heavy episodic drinking. Whilst findings suggested an additive risk for both heavy episodic drinking and cocaine consumption, there was no evidence of a multiplicative risk associated with concurrent use on the probability of assault outcomes. Results also suggest that heavy episodic alcohol drinking was mediated by experience of violent victimization and having been involved in anti-social behaviour. Conclusions: Findings suggest that whilst interventions aimed at reducing drinking or cocaine consumption are likely to have some effect in reducing offending behaviour, attention should also be given to other individual level factors such as prior violent victimization and wider involvement in anti-social behaviour as these may be confounded as part of a wider substance misusing lifestyle or associated with violence as part as a wider repertoire of anti-social behaviour.     

Does a History of Violence Influence Treatment,Self-Help,and 1-Year Outcomes in Substance Use Disorder Patients?

ABSTRACT

Rates of violence perpetration are high among patients with substance use disorder, but the impact of violence on substance use disorder treatment outcomes has received little attention. Patients with (n = 155) or without (n = 190) a history of difficulty controlling violent behavior were interviewed at entry to substance use disorder treatment and 1 year later. Substance use disorder severity, amount of treatment, and extent of participation in 12-step self-help groups were assessed to examine potential differences in treatment outcomes between violent and non-violent patients. After adjusting for baseline differences, no differences in substance use disorder severity were found at 1 year. However, over the year, violent patients received more treatment and participated more in 12-step groups compared to non-violent patients. In addition, violent patients benefited more from 12-step group participation than non-violent patients did. Referral to 12-step self-help groups may enhance the likelihood of recovery from a substance use disorder for patients with a history of violence.     

Perceived Self-Control is Related to Mental Distress in Patients Entering Substance Use Disorder Treatment

Background: Levels of mental distress are high in patients with substance use disorders (SUD) and investigation of correlates may broaden our understanding of this comorbidity. Objectives: We investigated self-reported symptoms of mental distress among individuals entering either outpatient opioid maintenance treatment (OMT) or other inpatient SUD treatment and related factors, with a particular focus on perceived self-control. Methods: A cross-sectional study including substance users (n = 548; mean age 34 years; 27% women) entering treatment at 21 different treatment-centers across Norway, interviewed between December 2012 and April 2015. Symptoms of mental distress were assessed with Global Symptom Index (GSI) score. Adjusted relative risk ratios (RRR) with 95% confidence intervals (CI) were estimated through multinomial logistic regression. Results: More than half of the participants in both treatment groups reported mental distress (GSI) above clinical cut-off. The use of alcohol and exposure to violence were associated with increased likelihood of high GSI for both patient groups. Also, lower perceived self-control was related to high GSI in both treatment groups. Conclusion: Symptoms of mental distress were equally common among patients entering OMT and those entering other inpatient SUD treatment, even if the patients differed on a number of clinical characteristics. Use of alcohol and exposure to violence were associated with more mental distress in both groups. Perceived self-control also appeared to be important when explaining symptoms of mental distress among these SUD patients.     

Distal and proximal factors associated with aggression towards partners and non-partners among patients in substance abuse treatment

Studies of violence in substance use disorder (SUD) treatment settings typically focus on partner aggression (PA) although non-partner aggression (NPA) is also a common problem. This study examines potentially distinct paths of distal and proximal risk factors related to aggression towards non-partners (NPA) and partners (PA) among a SUD treatment sample. The sample included 176 adults reporting past-year violence. Bivariate analyses indicated several distal and proximal factors were associated with NPA and PA. According to multivariate, multiple mediation analyses youth aggression history was a factor for both NPA and PA. Alcohol and cocaine use and psychological distress were associated with NPA; marijuana use was associated with PA. There also was evidence of indirect effects of distal factors on NPA and PA. The results suggest that there may be substantially different dynamics associated with NPA and PA, and have implications for developing screening, assessment and treatment protocols targeting violence among individuals in SUD treatment.     

Social inequality in youth violence: The role of heavy episodic drinking

Introduction and Aims. Alcohol use is an important risk factor for violence, and violent behaviour is more prevalent in lower socioeconomic status (SES) groups. The aim of this study was to examine whether the SES difference in youth violence can be explained by differential exposure to—and/or differential vulnerability to—heavy episodic drinking (HED). In the latter case, effect modification by impulsivity could be assumed. Design and Methods. We analysed cross‐sectional data from a school survey of 15‐ to 17‐year‐olds in Norway (n = 9853). We employed two measures of low‐SES group. Associations between SES, HED and violence were estimated by Poisson regressions, applying a residual centring procedure to test effect modification. Results. Violent behaviour frequency, HED frequency and impulsivity scores were all elevated in the low‐SES group. The SES difference in violent behaviour was significantly reduced when adjusting for HED. The stronger association between HED and violence in the low, compared with the medium‐SES/high‐SES group, was modified when accounting for impulsivity. Sensitivity analyses suggested robust findings. Discussion and Conclusions. The findings lend support to both the differential exposure hypothesis and to the differential vulnerability hypothesis as well as the hypothesis of an enhancing effect of impulsivity on the HED—violence association. The SES difference in youth violence can be accounted for by: (i) an elevated prevalence of HED in low‐SES groups; and (ii) a stronger than average link between HED and violence in low‐SES groups due to their higher than average impulsivity score. [Norström T, Rossow I, Pape H. Social inequality in youth violence: The role of heavy episodic drinking. Drug Alcohol Rev 2017;00:000‐000]     

Mapping the Clinical Complexities of Adolescents with Substance Use Disorders: A Typological Study

SUMMARY

Because of the vast improvements in adolescent substance use assessment, it is widely recognized that adolescent substance use disorders (SUD) encompasses diverse drugs, patterns and etiologies and are characterized by extensive heterogeneity in other life domains. The next step in advancing adolescent SUD assessment is to classify adolescents with SUD into treatment-oriented typologies so that the question “What works with whom under what conditions?” can be empirically investigated. This paper: (1) identifies and describes seven subtypes of 205 adolescents with SUD in alcohol and other drug (AOD) treatment aged 12–18 years (via dimensions of delinquency, psychosocial problems, chemical dependency, and sexual risk behavior); and (2) examines whether certain patterns are distinctive among youth court-mandated to AOD treatment. Each profile type is described in terms of relative problem severity, prevalence for youth mandated to treatment through the courts, demographics, and performance on external measures of mental health and substance use disorders. Multiple logistic regression demonstrated that three profile types yielded 75.6% accuracy (sensitivity = 75.8%, specificity = 75.5%) for discrimination between court-mandated and non-court-mandated to treatment youth, even when controlled for the contributions of youth age, sex, and ethnicity. This paper discusses the need for triage to multiple treatments with varying levels of intensity for different subgroups of adolescents. If cost-effective services by setting by youth typology could be empirically identified and replicated, perhaps an empirically-guided cost-containment strategy would be developed and implemented by managed care and state government. In this way, the trend for a decline in the number and types of on-site services provided by AOD treatment programs might reverse, improving adolescent SUD outcomes.     

The Relationship Between Hope and Adolescent Likelihood to Endorse Substance Use Behaviors in a Sample of Marginalized Youth

Background: Hopefulness has been associated with increased treatment retention and reduced substance abuse among adults, and may be a promising modifiable factor to leverage in substance abuse treatment settings. Few studies have assessed the relationship between hopefulness and substance use in adolescents, particularly those with high-risk backgrounds. Objective: We explored whether high hope is associated with less likelihood for engaging in a variety of substance use behaviors in a sample of marginalized adolescents. Methods: Using logistic regression, we assessed results from a cross-sectional anonymous youth behavior survey (n = 256 youth, ages 14 to 19). We recruited from local youth serving agencies (e.g., homeless shelters, group homes, short-term detention). Results: The sample was almost 60% male and two thirds African American. Unadjusted models showed youth with higher hope had a 50-58% (p = <.05) decreased odds of endorsing heavy episodic drinking, daily tobacco use, recent or lifetime marijuana use, and sex after using substances. Adjusted models showed a 52% decreased odds of lifetime marijuana use with higher hope, and a trend towards less sex after substance use (AOR 0.481; p = 0.065). No other substance use behaviors remained significantly associated with higher hope scores in adjusted models. Conclusions/Importance: Hopefulness may contribute to decreased likelihood of substance use in adolescents. Focusing on hope may be one modifiable target in a comprehensive primary or secondary substance use prevention program.     

Personal Income and Substance Use among Emerging Adults in the United States

Background: Taxation and other policy measures have been implemented across the United States to curb the accessibility of substance use, especially among youth. While the inverse relationship between price and youth consumption is well known, available research on youth earned income and substance use is sparser, particularly among emerging adults. Objectives: We examined the association between emerging adult past-year personal income and 30-day substance use. Methods: We analyzed data from Wave 5 (n = 2,202) of the NEXT Generation Health Study, an annual survey study administered to a nationally representative sample of emerging adults in the U.S. Wave 5 (mean age = 20.28 years, SE = 0.02 years) was administered during the 2013–2014 academic year. After grouping participants into five levels of self-reported, pre-tax personal income, we used binomial logistic regression to examine the association between personal income and cigarette smoking, marijuana use, alcohol use, and heavy episodic drinking (HED). Results: In unadjusted models, those at certain levels of higher past-year income were more likely to smoke cigarettes, consume alcohol, or engage in HED at least once in the past 30 days. Several associations remained significant after controlling for covariates. Most associations were no longer significant after including perceived peer norms as additional covariates. Personal income was not associated with 30-day marijuana use in unadjusted or adjusted models. Conclusions/Importance: Higher earned income may provide emerging adults greater economic access to cigarettes and alcohol, but the association might be partly attenuated by social factors, particularly perceived peer norms.     

Hurt people who hurt people: violence amongst individuals with comorbid substance use disorder and post traumatic stress disorder

Aims

The association between substance use disorder (SUD) and the perpetration of violence has been well documented. There is some evidence to suggest that the co-occurrence of post traumatic stress disorder (PTSD) may increase the risk for violence. This study aims to determine the prevalence of violence perpetration and examine factors related to violence amongst individuals with comorbid SUD and PTSD.

Design and participants

Data was collected via interview from 102 participants recruited to a randomised controlled trial of an integrated treatment for comorbid SUD and PTSD.

Measurements

The interview addressed demographics, perpetration of violent crime, mental health including aggression, substance use, PTSD, depression, anxiety and borderline personality disorder.

Findings

Over half of participants reported committing violence in their lifetime and 16% had committed violence in the past month. Bivariate associations were found between violence perpetration and trait aggression, higher levels of alcohol and cannabis use, lower levels of other opiate use, and experiencing more severe PTSD symptoms, particularly in relation to hyperarousal. When entered into a backward stepwise logistic regression however, only higher levels of physical aggression and more severe PTSD hyperarousal symptoms remained as independent predictors of violence perpetration.

Conclusions

These findings highlight the importance of assessing for PTSD amongst those with SUD particularly in forensic settings. They also indicate that it is the hyperarousal symptoms of PTSD specifically that need to be targeted by interventions aimed at reducing violence amongst individuals with SUD and PTSD.     

Exposure to Violence and Substance Use Treatment Outcomes Among Female Patients

Background: Many female substance use patients have experienced violence in the past, with most estimates showing the majority of patients reporting violent experiences at some point. Prior experience with violence has been linked to increased severity of substance use, and this may contribute to more challenges in the path to recovery. Objectives: Existing research has confounded the timing at which violence has occurred with the type of violence to which patients have been exposed. The current study was conducted to specify the extent to which the timing of exposure and the type of violence were associated with substance use after discharge from treatment. Methods: Data were collected from 3,439 female patients included in the Comprehensive Assessment and Treatment Outcome Research (CATOR) system. Results: With regard to the type of exposure, findings indicated female patients who were exposed to multiple forms of violence (i.e. physical and sexual) displayed the greatest severity of substance use upon treatment initiation, as well as the greatest likelihood for use following discharge from treatment. In terms of the timing, female patients who experienced violence at various time points (i.e. before and after 18 years of age) displayed the greatest severity of substance use, but patients who experienced violence after 18 years of age had the highest probability of substance use following discharge from treatment. Conclusions/Importance: Clinicians should collect information related to these important details as treatment protocols are developed, and as patients are connected to aftercare services to minimize post-treatment substance use.     

Differences in Adolescent Emotion Regulation and Impulsivity: A Group Comparison Study of School-Based Recovery Students

Background: Recovery high schools (RHS) vary in organization and operating philosophy, but are designed to support the unique needs of students struggling with substance use disorders (SUD). Previous research on youth risk taking behaviors suggests emotion regulation is a key predictor of outcomes. Specifically, the ability to respond in adaptive rather than maladaptive ways is often associated with challenges of impulsivity, poor distress tolerance, and adolescent substance use. Objectives: The current study considers data from RHS students in order to answer research questions concerning impulsivity and emotion regulation of youth working to change their risk trajectories in comparison to group of typically developing youth. Methods: Participants (n = 114) in the study were composed of students enrolled in 3 RHS programs and a comparison group of similar aged youth (15–20 years) without an identified SUD. Data collection occurred through an anonymous online survey set of four measures of reactivity and impulsivity, emotion regulation, and parent and peer influence, as well as an online version of the Stroop Inhibitory Control Task. Results: Participants in the three RHS groups reported decreased emotion regulation abilities, increased impulsivity and increased peer influence when compared to the comparison group; differential effects within RHS are presented. Conclusions/Importance: Results are consistent with the extant literature that difficulty regulating emotions is associated with an increased risk for substance abuse and suggests these difficulties persist in early recovery. Results also suggest the need to better understand how different operating philosophies of programs influence student outcomes and the recovery process.     

Trajectories of Substance Use among Child Welfare-Involved Youth: Longitudinal Associations with Child Maltreatment History and Emotional/Behavior Problems

Background: Maltreated children experience a variety of adverse outcomes including substance use problems. Although previous research indicated that there may be distinct trajectories of substance use among these youth, studies have examined them as if they were a single homogeneous group. Objectives: The goals of this study were to explore substance use trajectories among child welfare-involved youth and to identify characteristics that distinguish substance use trajectories. Methods: Data from the National Survey of Child and Adolescent Well-Being (NSCAW II) were used. Multilevel latent growth mixture modeling (MLGMM) was performed using a subsample of 625 youth from ages 11–17 years investigated for maltreatment in 2008–2009. Measures included self-reported use of substance use during the previous 30 days, demographic characteristics, maltreatment history, placement in out-of-home care, and behavioral health problems. Results: MLGMM identified two distinct substance use trajectory classes including High Stable Substance Use and Rapid Progression Use. Findings suggest that the experience of physical abuse is the key factor that distinguishes the two groups. When the effects of class-specific covariates were examined, results suggest that involvement in substance use behavior and its escalation vary between groups and are affected by youth’s different previous experiences. Conclusions/Importance: The results have important implications for understanding individual differences in substance use behavior over time and how these differences were shaped by youth’s experiences of family adversity. Study findings may be helpful for developing and enhancing the effectiveness of interventions targeted at decreasing substance use behaviors in child welfare-involved youth.     

Gender Differences in the Relationship Between Discrimination and Substance Use Disorder Among Latinos

Using data from the National Latino and Asian American Study collected in 2002–2003 (N = 2,554), we assessed the adjusted odds of lifetime substance use disorder (SUD) associated with report of both unfair treatment and racial/ethnic discrimination. Among men, SUD was increased for those reporting low, moderate, and high levels of unfair treatment compared to those reporting no unfair treatment and patterns were similar for racial/ethnic discrimination. Among women, only those reporting high levels of unfair treatment were at increased risk of lifetime SUD and no associations were observed between racial/ethnic discrimination and lifetime SUD. Future research should examine the role that discrimination plays in the development of substance misuse among Latinos.     

Prevalence of Substance Use among Lesbian,Gay, Bisexual,and Transgender Youth in Military Families: Findings from the California Healthy Kids Survey

Background: In addition to the challenges associated with military life, lesbian, gay, bisexual, and transgender (LGBT) youth in military families may face stressors associated with having a stigmatized sexual orientation and/or gender identity or expression, placing them at risk of substance use. To the authors' knowledge, this is the first study exploring substance use outcomes among LGBT youth in military families. Objectives: This study assessed the role of military connection, LGB identity, and transgender identity on lifetime and past 30-day substance use. Methods: This study is a secondary data analysis of the 2013–2015 California Healthy Kids Survey (CHKS). The study's participants (n = 634,978) were students attending middle and high schools in nearly all school districts in California. The study outcomes were lifetime and past 30-day cigarette, alcohol, tobacco, and marijuana use. Chi-square tests of associations (including cross-tabulations) and multivariate logistic regressions were conducted to address the study aims. Results: Multivariate logistic regression results indicated that military connection, LGB identity, and transgender identity were significantly associated with an increased odd of lifetime and past 30-day substance use. Compared to military non-transgender youth, military transgender youth had an increased likelihood of past 30-day cigarette use and past 30-day alcohol use. In addition, military LGB youth were 3.62 times as likely as military non-LGB youth to report past 30-day cigarette use. Conclusions/Importance: This study provides researchers with knowledge about the behavioral health of LGBT youth in military families, a vulnerable subgroup within the military-connected youth population, thus informing substance use prevention programs.