Social anxiety and alcohol-related outcomes: the mediating role of drinking context and protective strategies

Purpose: Students with social anxiety are vulnerable to hazardous drinking patterns due to their social evaluative fears and tendency to perceive alcohol use as a socially-approved, normative behavior. These students do not drink as often as their peers, yet they experience more alcohol-related consequences. Thus, it is important to identify specific anxiety-provoking drinking contexts that trigger these students to engage in hazardous episodic drinking. These students are also less likely to seek treatment for mental health or substance use issues, pointing to the importance of examining their use of protective strategies, particularly in those anxiety-provoking contexts. Evidence supports the unique roles of drinking context and protective strategies as influencing the link between social anxiety and alcohol-related outcomes. Therefore, the current study tested the unique and synergistic effects of drinking context and protective strategies on the social anxiety-alcohol outcomes relationship. 

Materials and methods: Data from 678 traditional-aged college students were collected via measures assessing social anxiety symptoms, drinking contexts, and safe and risky drinking behaviors.

Results: Mediation analyses indicated that negative coping drinking contexts and serious harm reduction protective strategies independently mediated the link between interaction social anxiety and hazardous drinking, and between social anxiety and alcohol-related consequences, respectively. Further, negative coping drinking contexts and serious harm reduction strategies sequentially mediated the positive association between interaction social anxiety and alcohol-related consequences. 

Conclusions: There appears to be a complex interplay of cognitive, social, and environmental factors making students with social interaction fears more susceptible to alcohol-related harm and less focused on using safe drinking strategies. Implications and directions for future research are outlined.     

Adolescent Marijuana Use and Perceived Ease of Access Before and After Recreational Marijuana Implementation in Colorado

Background: As of January 1, 2017, eight states have approved laws for recreational marijuana use. While the social impacts of these changes remain under debate, the influence on adolescent marijuana use is a key policy and health issue across the U.S. Objective: To examine changes in adolescent marijuana-use behaviors in the first year after recreational marijuana implementation in Colorado, and to analyze the effect of retail marijuana store proximity on youth use and perceptions. Method: Secondary analysis of Healthy Kids Colorado Survey data from 40 schools surveyed before and after recreational marijuana sales were implemented (2013 student n = 12,240; 2014 student n = 11,931). Self-reported marijuana use, ease of access, and perceived harms were compared between years and by proximity of recreational marijuana stores to surveyed schools. Results: Adolescent marijuana use behaviors, wrongness of use, and perceptions of risk of harm were unchanged from baseline to one-year follow-up. Perceived ease of access to marijuana increased (from 46% to 52%). Proximity of recreational marijuana stores was not significantly associated with perceived ease of access to marijuana.

Conclusions/Importance: In the first study of adolescent marijuana use and perceptions after state retail implementation of recreational marijuana, there was little change in adolescent marijuana use but a significant change in perception of ease of access. Public health workers and policymakers should continue to monitor these changes as essential for evaluating the impact of liberalization of marijuana policies.     

Daily Reports of Positive and Negative Affect and Alcohol and Marijuana Use Among College Student and Nonstudent Young Adults

Background: Daily affect and substance use covary among college students, but little is known about these associations among young adults not in college. Objectives: The current pilot study examines associations between positive and negative affect and alcohol and marijuana use, with a focus on differences between college student and nonstudent young adults. Methods: High school seniors completed a baseline survey during the spring of 2012 and were then randomly selected to participate in an intensive measurement follow-up. Participants in the follow-up (N = 72, 40.3% men, 77.8% White, 66.7% full-time college students) completed up to 14 consecutive web-based daily surveys during the fall after high school completion. Multilevel models in which days (Level 1) were nested in persons (Level 2) were estimated. Results: Weekend days were associated with increased alcohol use among all young adults, increased marijuana use among college students, and decreased marijuana use among nonstudents. For young adults not in college, greater daily positive affect was associated with increased likelihood of binge drinking, consuming a greater number of drinks, and lower odds of marijuana use; greater daily negative affect was associated with lower odds of alcohol use and lower odds of binge drinking for non-students. For college students, greater daily negative affect was associated with lower odds of marijuana use. Conclusions/Importance: Daily affect and alcohol and marijuana use covary among young adults, though these associations differ between students and non-students. Results highlight the need to examine predictors of alcohol and marijuana use among young adults who do not attend college.     

Substance Use and Social Anxiety in Transsexual Individuals

Objective: This study examined social anxiety and use of cannabis and cocaine among transsexuals.

Methods: A total of 379 transsexuals seeking treatment or consultation participated in this study, providing data on sociodemographics, substance use, and anxiety. Analyses were based on (a) lifetime but not current use versus never used and (b) current use only versus no current use (lifetime only or never used).

Results: Lifetime only cannabis users (n = 72, 19%) and lifetime only cocaine users (n = 36, 9.8%) were older, had more victimization, and received more mental health treatment that those who never used. Current cannabis users (n = 47, 12.4%) had higher scores on fear of negative evaluation and social avoidance than those not currently using (p <.01). Multivariate analysis showed that social avoidance and fear of negative evaluation were associated with current cannabis use (p <.05), but not cocaine. Further, being single was associated with current cannabis use, after controlling for social avoidance and fear of negative evaluation (p <.05).

Conclusions: Transsexuals’ levels of anxiety and cannabis/cocaine use are comparable to those in the general population. Cannabis may be used to control anxiety and can have detrimental clinical implications for transsexuals.     

Testing daily associations between impulsivity,affect, and alcohol outcomes: a pilot study

Background: Considerable research has examined impulsivity between individuals, but less research has focused on whether impulsivity fluctuates within a person. Although previous research supports trait levels of impulsivity as a risk factor for increased alcohol involvement, it is unclear whether daily (i.e., state) fluctuations in impulsivity coincide with same-day drinking behaviors. The present pilot study tested (1) the extent to which impulsivity fluctuates within-person; (2) the influence of daily impulsivity on alcohol use outcomes across all days (i.e., whether drinking occurred, the number of drinks consumed, and intentions to drink) and on drinking days only (i.e., whether heavy episodic drinking occurred and the number of problems experienced); and (3) daily affect as moderators of these relationships.

Method: Participants were 24 young adult drinkers without postsecondary education who completed a baseline plus 14 follow-up daily surveys. Each day, participants reported their impulsivity, affect, and drinking behavior.

Results: Multilevel modeling revealed that 42.5% of the variability in daily impulsivity was due to within-person differences. Impulsivity was related to greater odds of heavy episodic drinking and more alcohol-related problems on drinking days. Positive affect moderated the relationship between impulsivity and alcohol-related problems, and the relationship between impulsivity and drinking intentions.

Conclusions: Findings suggest that changes in positive affect and impulsivity may be a risk factor for alcohol problems in a daily context. Future research examining within-person impulsivity and negative outcomes may benefit from considering positive affect.     

Saying no to weed: Public opinion towards cannabis legalisation in Uruguay

Aims: This research aimed to explore people’s beliefs associated with opposition to cannabis legalisation in Uruguay. In 2014, Uruguay passed a national law regulating the production, sale and consumption of recreational marijuana. However, two-thirds of the Uruguayan public expressed disagreement towards the government’s new policy.

Methods: This study used logistic regressions on data from a national probabilistic sample of 1512 adults in Uruguay. Opinions and beliefs towards cannabis legalisation were collected in face-to-face interviews, using a battery of questions included in Vanderbilt University’s AmericasBarometer national survey in 2014.

Findings: Results showed that opposition to legalisation in Uruguay is independently associated with the beliefs that the new cannabis law will worsen the public security conditions in the country, that it will serve as a gateway to the use of harder drugs, and that the law will ultimately be ineffective to curb illegal trafficking. They also showed the importance of political ideology.

Conclusions: Public views towards cannabis liberalisation are more intertwined with concerns about public security and apprehension that it will open the gate to heavier drugs than with concerns about individual health and demographic factors. The paper underscores the importance of belief systems and political socialisation over personal behaviour of use.     

Social capital and regular alcohol use and binge drinking in adolescence: A cross-sectional study in Greece

Aims: The purpose of this study is to examine the gender-specific associations of different dimensions of individual-level social capital with regular alcohol consumption and binge drinking in 16–17 years old adolescents in Crete, Greece.

Methods: Of the 835 randomly selected students, 708 completed the Youth Social Capital Scale and the Health Behaviours in School-aged Children (HBSC) questionnaire from April through June 2008 and 650 (92%) were included in this analysis. The outcome of interest was regular alcohol use and binge drinking. A gender specific backward stepwise logistic multivariate regression was performed adjusted for potential confounders.

Findings: For both boys and girls, higher score on some structural social capital subscales was associated, per unit increase, with increased likelihood of regular drinking. Neighbourhood connections were also associated with increased binge drinking in girls. Cognitive social capital subscales were associated with decreased likelihood of binge drinking in girls. For both genders, total social capital-score was positively associated with the probability of regular, but not of binge drinking.

Conclusions: Cognitive and structural social capital dimensions have different patterns of association with regular and binge alcohol use in adolescent boys and girls. Social capital's dimensions should receive greater emphasis for the design of effective preventive interventions in adolescence, particularly in the light of an increasing prevalence of alcohol consumption in modern societies.     

The Relationship Between the Big Five Personality Traits,Impulsivity, and Anabolic Steroid Use

Background: The increase in the prevalence of anabolic-androgenic steroids (AAS) use has been the subject of study in the last decades. Several studies indicated a strong association between the use of AAS and the performance of risky behaviors mediated by factors such as aggression, impulsivity, depression, and anxiety. Objective: This study aimed to identify differences in personality trait, impulsivity, and the ability to delay gratification between AAS users and non-users that predispose or serve as a buffering mechanism against its usage and whether it is related to an increased likelihood of engaging in infidelity. Methods: Two hundred and twelve male volunteers (88 AAS users), aged between 21 and 36?years (M = 28.22), completed self-report measures of personality, impulsivity, delayed gratification, and attitudes toward infidelity. Multivariate analysis of variance and logistic regression were conducted to establish differences between AAS users and non-users. Results: The results showed that AAS users displayed an inability to delay gratification, a greater impulsivity, and a more benevolent attitude toward infidelity. AAS users obtained higher scores on openness and neuroticism, which was larger “off-cycle,” although they presented lower scores on extraversion compared to the non-users group. Regression analysis revealed that neuroticism, impulsivity, and delaying gratification scores were significant predictors of AAS usage. In addition, impulsivity functioned as a partial mediator in the relationship between neuroticism and AAS use. Conclusion: The results of this research highlight a pivotal implication of impulsivity in AAS use in conjunction with neuroticism, openness, and extraversion traits.     

Post-traumatic stress and marijuana outcomes: The mediating role of marijuana protective behavioral strategies

Abstract

Background: The present study investigated the mediating role of protective behavioral strategies for marijuana (PBSM) on the relationship between posttraumatic stress disorder (PTSD) and marijuana outcomes (i.e. marijuana use frequency, marijuana use quantity, cannabis use disorder (CUD) symptoms, and marijuana-related problems). Methods: Participants were 1,107 traditional age college students (M_age = 20.26, SD?=?3.32; 66.5% White, non-Hispanic; 68.8% female), who reported consuming marijuana at least once in the last 30?days and completed measures of PTSD symptoms, PBSM, and marijuana-related outcomes. Results: PBSM significantly mediated the positive relationships between PTSD symptoms and both CUD symptoms and marijuana-related problems. More specifically, PTSD symptoms were negatively associated with PBSM, which in turn was negatively associated with marijuana use frequency and marijuana use quantity, which were in turn positively associated with CUD symptoms and marijuana-related problems. Conclusion: Taken together, the associations between higher PTSD symptoms and greater experience of CUD symptoms and marijuana-related problems may occur because students use fewer PBSM and thus engage in larger quantity and frequency of marijuana use. These findings lend support to the utility of targeting PBSM as a harm reduction effort for students with PTSD symptoms who use marijuana.     

Beyond Ketamine and Phencyclidine: Analytically Confirmed Use of Multiple Novel Arylcyclohexylamines

Background: Methoxetamine and 3-methoxy-phencyclidine are novel arylcyclohexylamines whose use and clinical toxicity are poorly reported in the medical literature. We report a case of analytically confirmed use of both methoxetamine and 3-methoxy-phencyclidine.

Case Report: A 27-year-old male presented 10 hours after insufflating an Internet-obtained powder. He was hypertensive, tachycardic, and demonstrated dissociated affect, a delayed verbal response to questions, ataxia, and vertical nystagmus. A urine drug screen was positive for phencyclidine and 11-nor-delta9-THC-9-carboxylic acid. He was admitted and his mental status and blood pressure normalized eight hours later. Blood samples (0, 2, and 3 hours from arrival) and the powders were analyzed by liquid chromatography-quadrupole time-of-flight mass spectrometry. Methoxetamine and 3-methoxy-phencyclidine were detected in all samples (279 ng/ml, 205 ng/ml, and 180 ng/ml for methoxetamine; 167 ng/mL, 131 ng/mL, and 90 ng/ml for 3-methoxy-phencyclidine at 0, 2, and 3 hours, respectively). No phencyclidine or tetrahydrocannabinol was detected. Two powders contained methoxetamine while one contained 3-methoxy-phencyclidine.

Conclusion: The literature regarding methoxetamine and 3-methoxy-phencyclidine toxicity is limited. Methoxetamine use is associated with altered mental status, ataxia, and hypertension. Toxicity from 3-methoxy-phencyclidine is poorly described. There is no prior case describing serial qualitative analysis. Health care providers should be aware of the novel arylcyclohexylamines and their toxicity.     

Drug-drug interactions as a result of co-administering Δ9-THC and CBD with other psychotropic agents

Introduction: To determine, via narrative, non-systematic review of pre-clinical and clinical studies, whether the effect of cannabis on hepatic biotransformation pathways would be predicted to result in clinically significant drug-drug interactions (DDIs) with commonly prescribed psychotropic agents.

Areas covered: A non-systematic literature search was conducted using the following databases: PubMed, PsycInfo, and Scopus from inception to January 2017. The search term cannabis was cross-referenced with the terms drug interactions, cytochrome, cannabinoids, cannabidiol, and medical marijuana. Pharmacological, molecular, and physiologic studies evaluating the pharmacokinetics of Δ⁹-tetrahydrocannabinol (Δ⁹-THC) and cannabidiol (CBD), both in vitro and in vivo, were included. Bibliographies were also manually searched for additional citations that were relevant to the overarching aim of this paper.

Expert opinion: Δ⁹-Tetrahydrocannabinol and CBD are substrates and inhibitors of cytochrome P450 enzymatic pathways relevant to the biotransformation of commonly prescribed psychotropic agents. The high frequency and increasing use of cannabis invites the need for healthcare providers to familiarize themselves with potential DDIs in persons receiving select psychotropic agents, and additionally consuming medical marijuana and/or recreational marijuana.     

Use of substances among professionals and students of professional programs: a review of the literature

Background and aims: This literature review investigates the scope of information regarding self-reported substance use by professionals and students in professional programs, with a focus on anticipated and actual effects of substances.

Methods: A review of English, peer-reviewed journals and professional journals was conducted. Articles were included if they reported empirical findings of original research and specifically described an aspect of substance use (e.g. type of substance used, patterns of use, reasons for use) by professionals or students.

Results: Of the 130 articles ultimately included, 105 involved anonymous self-administered survey methodology. Self-reported data about the effects of substance use or reasons for use were reported in 35 articles. Reasons for use included positive impact on performance and experience, such as fun, pleasure, sleep, enhanced work performance, improved attention and concentration, and relaxation. Predictive associations were analysed regarding demographic factors, mental health, type of profession, and area of specialisation.

Conclusions: Little is known about the effects of substance use on the performance or experience of professionals or students in professional programs. Research is required that incorporates qualitative methodologies, elicits anticipated and actual effects of substance use, including controlled and beneficial patterns of use. Minimisation of research bias is key to future study of the effects of substance use by professionals or students in professional programs.     

Point Prevalence and Patterns of Mental Health Comorbidity Among People Accessing Australia's First Older Adult–Specific Alcohol and Other Drug Treatment Service

Objective: There are good data regarding the prevalence and patterns of dual diagnosis among the general population; however, data regarding the older adult cohort are limited. We aimed to extend the knowledge of the point prevalence and patterns of dual diagnosis among older adults and the impact of dual diagnosis on the utilization of alcohol and other drug treatment services.

Method: A 12-month medical chart audit of clients discharged from an Australian older adult–specific alcohol and other drug treatment service was performed. Measures included the Alcohol Use Disorders Identification Test–Consumption, the Drug Use Disorders Identification Test–Consumption, the Kessler 10, and the Modified MINI Screen. Additional data collected included mental health diagnoses, number of session types, and treatment outcomes.

Results: There were 79 (n = 45, 57% male) medical charts audited, with a mean age of 65.9 years (SD = 5.8). There were 68 (89%) clients having at least one comorbid mental illness. Clients with a dual diagnosis were younger (p = .011) than those without. Some comorbid mental health conditions were associated with additional service utilization (p < .05). Clients with personality disorders required more telephone calls and outreach services (p < .05). The number of mental health diagnoses was associated with additional treatment sessions (p < .05).

Conclusions: Further research with a larger sample size of older adults seeking age-specific alcohol and other drug treatment services is required. Older adult–specific alcohol and other drug treatment services need to allow for longer episodes of care for clients with certain dual diagnoses and a focus on reducing anxiety to increase treatment retention.     

Relationships Between Drinking Motives and Smoking Expectancies Among Daily Smokers Who Are Also Problem Drinkers

Objective: There is a high co-occurrence of problem drinking and regular cigarette smoking, and cognitive processes (e.g., motivation to use, expectations about the consequences of use) related to each are positively associated with one another. We explored drinking motives in relation to cognitive-based smoking processes among smokers with problematic drinking. We expected that drinking coping motives would be associated with smoking consequences related to negative reinforcement and negative personal outcomes and inflexibility of smoking behavior; observed effects for coping motives would be unique from shared variance with other motives and incrementally evident beyond the variance accounted for by tobacco-related health problems, smoking rate, negative affectivity, cannabis use, and gender.

Methods: The sample included 195 individuals recruited into a larger study of smoking cessation treatments (i.e., they were interested in quitting), who were heavy drinkers and smoked daily. Participants were primarily male (n = 122, 63%), fairly young (M_age = 30.3 years; SD = 12.46), and predominantly White/Caucasian (n = 175, 80%). Roughly 57% (n = 111) had at least one comorbid Axis I disorder, the most common being social anxiety (n = 21, 11%) and generalized anxiety disorder (n = 12, 6%).

Results: Coping drinking motives predicted negative smoking consequences, negative reinforcement, and smoking inflexibility. Enhancement drinking motives marginally predicted positive reinforcement. Conformity drinking motives predicted smoking consequences related to appetite/weight control. Social drinking motives predicted negative reinforcement and barriers to cessation and marginally predicted positive reinforcement.

Conclusions: Theoretical models and clinical activities focused on smoking cessation among problem drinkers may benefit from considering the role of drinking motives, particularly coping-oriented motives, to better understanding cognitive-based smoking processes.     

Posttraumatic Stress,Coping Flexibility,and Risky Drinking Among Trauma-Exposed Male and Female College Students: The Mediating Effect of Delay of Gratification

Background: The co-occurence of posttraumatic stress (PTS) and risky drinking has been demonstrated in diverse populations, including college students. However, the mechanisms underlying this co-occurrence, as well as the protective factors that may reduce risky drinking among trauma-exposed college students have yet to be fully understood in the literature. Objectives: The present study builds upon self-regulation theories and previous empirical work to determine whether the effects of PTS and coping flexibility on risky drinking were mediated by delay of gratification among trauma-exposed college students. In addition, the potential moderating effect of gender on these relationships was examined. Methods: Participants included 624 trauma-exposed college students (68.4% female) attending a public university in the southeast region of the United States. Data were collected through an online survey. The hypothesized model was examined using a multigroup structural equation modeling approach. Results: As hypothesized, PTS had a significant, positive indirect effect on risky drinking through delay of gratification; however, the effect of PTS on delay of gratification was stronger for males than for females. Results also indicated that the indirect effect of coping flexibility on risky drinking through delay of gratification was significant and negative for males and females.

Conclusions/Importance: The findings of this study suggest that delay of gratification might be an important mechanism underlying the co-occurrence of PTS and risky drinking. In addition, our results highlight the potential benefits of coping flexibility for college students coping with PTS.     

From substances to food: an examination of addiction shift in individuals undergoing residential treatment for substance use

Background: Addiction shift (also known as “Cross,” “Transfer,” or “Substitute” addiction) is a common theme that emerges in the literature on recovery from substance use disorders. Some research has suggested that those who recover from one substance use disorder are at increased risk of developing another. Despite existing research in this area, little is known about how individuals may be at risk of developing an addiction to food as they recover from a substance use disorder.

Methods: The current study sought to examine addiction shift, specifically from substances to food in 44 participants undergoing residential treatment for substance use disorders. It was hypothesized that drug and/or alcohol use cravings would go down from pre (at intake to residential treatment) to post (at discharge from residential treatment), while food addiction and/or food craving would increase.

Results: Significant changes were observed from pre to post for mean body mass index, and scores from measures assessing alcohol cravings, impulsive behaviors, distress tolerance, depression, and anxiety. No significant differences from pre to post were observed for scores measuring food addiction or food cravings.

Conclusions: Changes in pre to post measures indicated that drug and/or alcohol use cravings decreased. Contrary to original hypotheses, food addiction and food craving was relatively low at baseline and did not change from pre to post. Exploratory post-hoc analyses of psychological factors suggested that impulsivity, distress tolerance, depression, and anxiety went down from pre to post. Short follow-up timeframe and competition theory are likely important factors in these findings.     

The role of mindfulness skills in terms of anxiety-related cognitive risk factors among college students with problematic alcohol use

Background: The aim of the current study was to examine the associations between the specific mindfulness skills of observing, describing, awareness, nonjudgment, and nonreactivity in terms of anxiety sensitivity (AS), distress tolerance (DT), and intolerance of uncertainty (IU) among college students with problematic alcohol use. Methods: Participants were 202 (69.3% male; M_age = 18.96, SD = 2.24, range = 18–45 years) undergraduate college students with problematic alcohol use who completed self-report measures for course credit. Results: Results indicated that after controlling for the effects of gender, smoking status, marijuana use status, and negative affectivity, greater use of the mindfulness skill of observing was associated with higher AS, greater describing was associated with lower AS and higher DT, greater nonjudgment was associated with lower AS and IU and higher DT, and greater nonreactivity was associated with increased DT. Awareness did not significantly predict any of the examined risk factors. Conclusions: These results suggest that specific mindfulness skills are associated with a greater tolerance of physiological, emotional, and uncertain states. An important next step will be to examine whether mindfulness skills are associated with decreased problematic alcohol use due to improvements in these anxiety-related risk factors.     

Pharmacological interventions for anxiety in Parkinson’s disease sufferers

Introduction: Anxiety disorders are a common non-motor symptom of Parkinson’s disease (PD) with a reported prevalence ranging from 20% to 50%. Although anxiety is associated with Parkinson’s disease, anxiety disorders can begin before the onset of motor symptoms, and have been linked to a possible abnormality of dopaminergic, serotonergic, and adrenergic neurons that precedes motor disturbance.

Area covered: Several studies have reported the pharmacological treatment of depression in PD, but none have been randomized clinical trials with a primary outcome measure of anxiety. Two trials showed that pharmacological intervention with tricyclic antidepressants or selective serotonin reuptake inhibitors proved beneficial in treating anxiety in PD. However, the effect size was modest. Anxiety is associated with off-periods and improved by L-Dopa, especially in patients with high levels of anxiety.

Expert opinion: Decreasing off-periods is important for managing anxiety in patients with motor fluctuations. Minor suggestive data indicate that tricyclic antidepressants and selective serotonin reuptake inhibitors can be helpful with modest effect sizes, but the former can cause additional side effects. Only one study has examined the use of benzodiazepines to treat anxiety in PD, and benzodiazepines cannot be recommended because they increase the risk of falling. Further clinical studies for pharmacological intervention against anxiety are required.