Impulsivity, age of first alcohol use and substance use disorders among male adolescents: a population based case–control study

Aims   To evaluate the association between impulsivity, age of first alcohol consumption (AFD) and substance use disorders (SUD) in a non-clinical sample of adolescents.
Design and setting   Population-based case–control study of male adolescents between 15 and 20 years of age nested in a community survey in southern Brazil.
Participants   Cases were drug or alcohol abusers/dependents defined according to DSM-IV abuse/dependence criteria ( n  = 63). Individuals who had experienced alcohol use but where non-abusers served as controls ( n  = 355). Cases and controls completed a structured face-to-face interview.
Measurements   The Mini International Neuropsychiatric Interview (MINI) was completed during the original survey and used to identify cases and controls. Impulsivity was measured by means of the Barratt Impulsivity Scale (BIS 11). Self-reported AFD and socio-demographic data were collected and analyzed through logistic regression according to a hierarchical model.
Findings   Impulsivity and AFD were significantly associated with SUD. Both higher impulsivity [odds ratio (OR) 3.3, 95% confidence interval (CI) 1.4–7.8] and earlier AFD (OR 1.2, 95% CI 1.0–1.3) remained associated with SUD after model adjustments.
Conclusions   The findings from this population-based case–control study suggest that impulsivity and age of first alcoholic drink are associated strongly with alcohol and drug problems. Additionally, impulsivity seems to contribute to a premature exposure to alcohol by hastening the AFD. If the temporal effect of these associations is confirmed in longitudinal designs including broader population groups, our findings may contribute to the development of clinical and policy interventions aiming at reducing the incidence and morbidity associated with substance-related problems among adolescents.     

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.     

Risk and speed of transitions to first alcohol dependence symptoms in adolescents: a 10-year longitudinal community study in Germany

Background Although in many western countries alcohol use (AU) and symptoms of alcohol dependence (AD) are frequent in adolescence, temporal patterns and trajectories remain understudied. It is unclear whether early onset of AU is associated with the speed of transition to first AD symptoms and whether specific first AD symptoms and their timing are associated with AD. Aims To examine (i) the incidence patterns of self‐reported first AD symptoms; (ii) whether early AU is associated with the risk and speed of transition to first AD symptoms; and (iii) whether first AD symptoms and their timing are associated with AD. Design A total of 3021 community subjects from Germany aged 14–24 years at baseline followed prospectively over 10 years. AU, AD symptoms and AD were assessed using the Munich–Composite International Diagnostic Interview (DIA‐X/M‐CIDI). Findings Among first AD symptoms, tolerance (13.1%) and much time spent (5.0%) were most prevalent. Five to 30% of all first AD symptoms occurred during the first year after first AU. Early AU was not related to the risk of first AD symptoms. The speed of transition to first AD symptoms was greater among those with AU onset in later adolescence. Tolerance and loss of control were associated with AD development (risk difference 3.9% and 15.4%), as was early onset of tolerance, much time spent and loss of control. Conclusion Early AU and early AD symptoms are frequent among adolescents. Early self‐reported tolerance, much time spent and loss of control are particularly predictive for AD and important targets for early preventive interventions.     

Teenage drinking and the onset of alcohol dependence: a cohort study over seven years

AIM: To determine whether adolescent alcohol use and/or other adolescent health risk behaviour predisposes to alcohol dependence in young adulthood. DESIGN: Seven-wave cohort study over 6 years. PARTICIPANT: A community sample of almost two thousand individuals followed from ages 14-15 to 20-21 years. OUTCOME MEASURE: Diagnostic and Statistical Manual volume IV (DSM-IV) alcohol dependence in participants aged 20-21 years and drinking three or more times a week. FINDINGS: Approximately 90% of participants consumed alcohol by age 20 years, 4.7% fulfilling DSM-IV alcohol dependence criteria. Alcohol dependence in young adults was preceded by higher persisting teenage rates of frequent drinking [odds ratio (OR) 8.1, 95% confidence interval (CI) 4.2, 16], binge drinking (OR 6.7, 95% CI 3.6, 12), alcohol-related injuries (OR 4.5 95% CI 1.9, 11), intense drinking (OR 4.8, 95% CI 2.6, 8.7), high dose tobacco use (OR 5.5, 95% CI 2.3, 13) and antisocial behaviour (OR 5.9, 95% CI 3.3, 11). After adjustment for other teenage predictors frequent drinking (OR 3.1, 95% CI 1.2, 7.7) and antisocial behaviour (OR 2.4, 95% CI 1.2, 5.1) held persisting independent associations with later alcohol dependence. There were no prospective associations found with emotional disturbance in adolescence. CONCLUSION: Teenage drinking patterns and other health risk behaviours in adolescence predicted alcohol dependence in adulthood. Prevention and early intervention initiatives to reduce longer-term alcohol-related harm therefore need to address the factors, including alcohol supply, that influence teenage consumption and in particular high-risk drinking patterns.     

Prevalence of alcohol use disorders and associated factors: a population-based study using AUDIT in southern Brazil

Aims   To assess the prevalence of potential alcohol use disorders and associated factors using the Alcohol Use Disorders Identification Test (AUDIT).
Design   Cross-sectional study.
Setting   A town in southern Brazil.
Participants   A representative sample of 1260 people aged 15 and over.
Measurements   Demographic, socioeconomic, smoking habit and mental health data were collected. Logistic regression was used in the multivariate analysis, and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.
Findings   Overall prevalence of alcohol use disorder was 7.9%, with 14.5% prevalence among men and 2.4% among women. The risk of alcohol misuse increased across social class ( P linear trend = 0.03) and compared with the highest classes (A and B), groups C through E had ORs of 1.48, 1.51 and 2.36, respectively. Males had an OR of 6.89 (CI 3.61–13.16) compared with women. A linear trend was found ( P  = 0.001) between smoking categories, and smokers (OR 3.27; CI 1.91–5.58) and ex-smokers (OR 1.30; CI 0.56–2.98) were at higher risk than non-smokers. Those with minor psychiatric disorders had a 2.48 OR (CI 1.35–4.56) of presenting a positive test.
Conclusions   The AUDIT detected a high prevalence of potential alcohol use disorders in the population sampled. Those identified are potential targets for preventive measures implemented through health policies.     

Clinical predictors for delirium tremens in alcohol dependence

BACKGROUND AND AIMS: This study was aimed to find clinical predictors for developing delirium tremens (DT) in alcohol dependence. METHODS: This cohort study was retrospectively carried out among patients who were diagnosed as having alcohol dependence between January 2001 and July 2004. Fifteen parameters were compared between patients who developed DT and ones who did not. We identified clinical predictors for DT by using multivariate analysis. RESULTS: A total of one hundred and seventy-eight consecutive admission cases from 147 patients were analyzed. The mean age was 47.8 years, and 95.5% were male. Delirium tremens developed in 59 cases (33%) during hospitalization. On multiple logistic regression analysis, a previous history of DT (odds ratio (OR) 3.990; 95% CI 1.631, 9.759) and high pulse rate above 100 b.p.m. (OR 4.158; 95% CI 2.032, 8.511) were significant predictors for developing DT. When combined, DT developed in just 20.4% of cases without any predictors; however, if one predictor was present, DT developed in 45.6%, and if two predictors were present, DT developed in all cases (100%). CONCLUSIONS: A simple assessment using the past history of DT and the pulse rate, which may be easily evaluated in clinical settings, can allow physicians to readily identify the patients who are at a high risk of developing DT during an alcohol dependence period and reserve more intensive therapies for the selected cases.     

Age differences in diagnostic criteria of DSM-IV alcohol dependence among adults with similar drinking behaviour

Aims To test age differences in the prevalence of DSM‐IV alcohol dependence (AD) diagnostic criteria in the adult general population while controlling for drinking behaviour. Design and setting Cross‐sectional data from the 2006 German Epidemiological Survey of Substance Abuse (ESA) were used, applying a two‐stage probability sampling design. The survey used self‐administered questionnaires and telephone interviews (mixed‐mode design; 45% response rate). Participants The analytical sample consisted of n = 6984 individuals aged 18–64 years reporting alcohol consumption within the previous year. Measurements Age effects on individual AD criteria were estimated using logistic regression models, adjusting for eight mutually exclusive drinking groups (defined in terms of average daily alcohol intake and episodic heavy drinking) and socio‐economic variables. Findings When controlling for drinking behaviour, 18–24‐year‐olds were more likely to meet the criteria ‘tolerance’, ‘larger/longer’ and ‘time spent’ relative to older age groups. In contrast, the likelihood of experiencing ‘withdrawal’ symptoms increased with age. There was no significant age effect on the diagnosis of AD. Conclusions Age differences in the prevalence of specific alcohol dependence diagnostic criteria such as ‘tolerance’, ‘drinking larger amount or for longer than intended’ and ‘time spent recovering’ cannot be fully explained by differences in drinking behaviour.     

Dual dependence: assessment of dependence upon alcohol and illicit drugs, and the relationship of alcohol dependence among drug misusers to patterns of drinking, illicit drug use and health problems

Aims The study investigates severity of alcohol dependence among drug misusers. Specifically, it investigates the inter‐relationship of alcohol and drug dependence and associations with alcohol consumption, drug consumption and substance‐related problems. Design, setting, participants The sample comprised 735 people seeking treatment for drug misuse problems, who were current (last 90 days) drinkers. Measurements Data were collected by structured face‐to‐face interviews. Dependence upon illicit drugs and upon alcohol was measured by the Severity of Dependence Scale (SDS). Findings Three groups of drinkers were identified: non‐alcohol‐dependent drug misusers (63%); low‐dependence (19%); and high‐dependence (18%). Many drug misusers were drinking excessively and alcohol dependence was related to patterns of alcohol and drug consumption. High‐dependence drinkers were more likely to drink extra‐strength beer; they were less frequent users of heroin and crack cocaine but more frequent users of benzodiazepines, amphetamines and cocaine powder; they reported more psychological and physical health problems. The SDS was found to have good reliability and validity as a measure of alcohol dependence. SDS scores for alcohol and drug dependence were unrelated. Conclusions Alcohol use is an important and under‐rated problem in the treatment of drug misusers. A comprehensive assessment of alcohol use among drug misusers should include separate assessments of alcohol consumption, alcohol‐related problems and severity of alcohol dependence.     

Effects of alcohol use initiation on brain structure in typically developing adolescents

Abstract

Background: Alcohol use in excessive quantities has deleterious effects on brain structure and behavior in adults and during periods of rapid neurodevelopment, such as prenatally. Whether similar outcomes characterize other developmental periods, such as adolescence, and in the context of less extensive use is unknown. Recent cross-sectional studies suggest that binge drinking as well as alcohol use disorders in adolescence are associated with disruptions in white matter microstructure and gray matter volumes. Objectives: The current study followed typically developing adolescents from a baseline assessment, where no experience with alcohol was present, through two years, after which some individuals transitioned into regular use. Methods: Participants (n?=?55) completed MRI scans and behavioral assessments. Results: Alcohol initiators (n?=?30; mean baseline age 16.7?±?1.3 years), compared to non-users (n?=?25; mean baseline age 17.1?±?1.2 years), showed altered patterns of neurodevelopment. They showed greater-than-expected decreases in cortical thickness in the right middle frontal gyrus from baseline to follow-up as well as blunted development of white matter in the right hemisphere precentral gyrus, lingual gyrus, middle temporal gyrus and anterior cingulate. Diffusion tensor imaging revealed a relative decrease over time in fractional anisotropy in the left caudate/thalamic region as well as in the right inferior frontal occipital fasciculus. Alcohol initiators did not differ from non-users at the baseline assessment; the groups were largely similar in other premorbid characteristics. Conclusions: Subclinical alcohol use during mid-to-late adolescence is associated with deviations in neurodevelopment across several brain tissue classes. Implications for continued development and behavior are discussed.     

Associations between fractional anisotropy and problematic alcohol use in juvenile justice-involved adolescents

Abstract

Background: Studies have shown associations between heavy alcohol use and white matter alterations in adolescence. Youth involved with the juvenile justice system engage in high levels of risk behavior generally and alcohol use in particular as compared to their non-justice-involved peers. Objectives: This study explored white matter integrity among justice-involved adolescents. Analyses examined fractional anisotropy (FA) and mean diffusivity (MD) between adolescents with low and high levels of problematic alcohol use as assessed by the Alcohol Use Disorders Identification Test (AUDIT). Methods: Participants (N?=?125; 80% male; 14–18 years) completed measures assessing psychological status and substance use followed by diffusion tensor imaging (DTI). DTI data for low (n?=?51) and high AUDIT (n?=?74) adolescents were subjected to cluster-based group comparisons on skeletonized FA and MD data. Results: Whole-brain analyses revealed significantly lower FA in clusters in the right and left posterior corona radiata (PCR) and right superior longitudinal fasciculus (SLF) in the high AUDIT group, as well as one cluster in the right anterior corona radiata that showed higher FA in the high AUDIT group. No differences in MD were identified. Exploratory analyses correlated cluster FA with measures of additional risk factors. FA in the right SLF and left PCR was negatively associated with impulsivity. Conclusion: Justice-involved adolescents with alcohol use problems generally showed poorer FA than their low problematic alcohol use peers. Future research should aim to better understand the nature of the relationship between white matter development and alcohol use specifically as well as risk behavior more generally.