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Longitudinal investigation of the impact of anxiety and mood disorders in adolescence on subsequent substance use disorder onset and vice versa
... A study assessing the data of 1,036 participants aged 13-18 receiving mental health services found a 40.8% prevalence of substance use disorders [9]. A more recent U.S. study looking into the data of adolescents and young adults (aged [12][13][14][15][16][17][18][19][20] admitted to a psychiatric hospital primarily for mental health conditions found a 48% prevalence of dual diagnoses [10]. A British review [11] examining papers on dual diagnoses among patients with autism spectrum disorders focused on four areas, specifically epidemiology, patient characteristics, the function of drug use, and the effectiveness of treatment interventions. ...
... A four-year follow-up study of 627 lower secondary school students showed mental health disorders as predictors of the development of substance use disorders. Such mental health conditions included anxiety and depressive disorders [15]. In their study of dual diagnoses among adolescents, Wise et al. [5] reported depressive disorders being diagnosed in 24%, conduct disorders in 24%, Children 2023, 10, 293 3 of 10 ADHD in 11%, adjustment disorder in 7.7%, and bipolar affective disorder in 3.3% of the cases. ...
... In addition to substance disorders, affective disorders and conduct disorders were the most common psychiatric conditions diagnosed. The high rates of affective disorders and conduct disorders correspond with the conclusions of Wise et al. [5] and Wolitzky-Taylor et al. [15]. As our review affirms the high levels of comorbid substance use disorders and conduct disorders in dual diagnoses, we support the conclusions drawn by Kim-Cohen et al. [16] to the effect that the relationship between substance use disorders and conduct disorders should be investigated further. ...
Background:
The World Health Organisation defines dual diagnosis as the co-occurrence in the same individual of a psychoactive substance use disorder and another psychiatric disorder. Children and adolescents with dual diagnoses represent a significant public health burden in social and financial terms.
Aims:
The objective of the present paper is to provide a review of studies dealing with dual diagnoses and their prevalence among children and adolescents whose primary treatment involves psychiatric conditions.
Methods:
The PRISMA was used to conduct a systematic search. Articles published between January 2010 and May 2022 were searched for analysis.
Results:
Eight articles were eventually found eligible for the final content analysis. The analysis of the articles identified the prevalence of dual diagnoses among children and adolescents treated primarily for psychiatric conditions, the gender-specific occurrence of dual diagnoses, methods used to diagnose psychiatric and substance use disorders, types of psychiatric diagnoses involved in dual diagnoses, and prevalence differences contingent on the type of service provision as the main thematic areas. The prevalence of dual diagnoses among the target population ranged from 18.3% to 54% (mean 32.7%). Boys were more likely to experience dual diagnoses and affective disorders were the most frequent psychiatric diagnoses.
Conclusion:
The importance of the issue and the high prevalence of dual diagnoses make it imperative that this type of research is pursued.
... Substance use disorders did not predict any subsequent development of either anxiety or depressive disorders. Alcohol use disorders, on the other hand, were associated with a higher probability of obsessive-compulsive disorder [5]. To a greater degree than the adult population, adolescents tend to engage in polydrug use patterns. ...
... The same substance use disorder also appeared in groups with comorbid conduct disorders, neurotic, stress-related, and somatoform disorders, and behavioural syndromes associated with physiological disturbances and physical factors. While not corresponding with the results of the study by Wolitzky-Taylor et al. [5], these conclusions were in line with the findings reported by Cheung and Halladay [6]. Our conclusions highlight a high risk of multiple drug use for people with hyperkinetic disorders and conduct disorders. ...
Introduction: Dual diagnosis is used in addiction medicine to refer to the co-occurrence of an addiction-related disorder and another psychiatric disorder in the same individual. Adolescence is a key period for the development of both mental disorders and addictions. Objective: The aim of this study is to describe the relationships between psychiatric and addiction-related disorders in patients of the Outpatient Addiction Treatment Clinic for Children and Adolescents at the 1st Faculty of Medicine, Charles University in Prague in 2015–2022. Methods: Data were retrospectively analyzed from the hospital’s medical system, which collects basic diagnostic data on patients. Descriptive statistics and cluster analysis were performed to identify relationships between psychiatric and addiction-related disorders. Results: Of the 450 patients, 153 patients (34%) met the criteria for dual diagnosis. The most common addiction-related disorders were mental and behavioural disorders due to the use of cannabinoids (35%) and internet gaming disorder (35%). The most common psychiatric diagnoses were behavioural and emotional disorders with usual onset in childhood and adolescence (64%), with a lower prevalence in girls than in boys. Conclusions: These findings may be important for the diagnosis and treatment of risky behaviours and addictions in children and adolescents.
... This confirms the positive association we found between AD and AUD. The finding that AUD predicts the presence and first-onset of AD is in line with the theory that anxiety symptoms could be a consequence of AUD, for example, caused by neurochemical effects after alcohol withdrawal (Breese et al., 2005;Kushner et al., 2000;Wolitzky-Taylor et al., 2012). ...
... Our finding that AD predicts both the presence and first-onset of AUD after adjusting for sociodemographic variables is in line with the self-medication hypothesis in which people decrease their anxiety symptoms by using alcohol, which can lead to the pathological use of alcohol (Kushner et al., 2000). The positive effects of alcohol are attributed to neurochemical mechanisms, for example acute alcohol intoxication affects GABA receptors in a way similar to the effect of benzodiazepines (Kushner et al., 2000;Wolitzky-Taylor et al., 2012). The attenuation of the association between AD and AUD in fully adjusted models has shown that especially psychotropic medication use and smoking contributed to this Table 4 Multilevel logistic autoregressive models for the prediction of the first-onset of anxiety disorder (upper part of the table) and the first-onset of alcohol use disorder (lower part of the table) from previous-wave alcohol use disorder and anxiety disorder (3-years intervals). ...
Background:
Anxiety disorders (AD) and alcohol use disorder (AUD) frequently co-occur, but the temporal order of the association is unclear. We have determined the association between AD and the presence and first-onset of AUD, and vice versa.
Methods:
Data were used from n = 6.646 participants and four measurement waves (baseline, 3-, 6- and 9-years) of the Netherlands Mental Health Survey and Incidence Study 2 (NEMESIS-2), a cohort study of the Dutch general population aged 18-64 years. AD and AUD were assessed with the Composite International Diagnostic Interview 3.0. Multilevel logistic autoregressive models were controlled for previous-wave AD or AUD, sociodemographics (Model 1), smoking and clinical factors (Model 2).
Results:
People with AUD had a higher risk of present (OR = 1.65, 95 % CI 1.11-2.43; Model 2) and first-onset (OR = 2.03, 95 % CI 1.17-3.51; Model 2) AD in 3-years follow-up intervals than people without AUD. Vice versa, people with AD also had a higher sociodemographics-adjusted risk of present and first-onset AUD over 3-years follow-up intervals, but these associations attenuated into insignificance after adjustment for smoking and clinical variables. Limitations For statistical power reasons we were not able to analyze 9-year follow-up data or distinguish between AD and AUD types.
Conclusions:
Our results indicate a bidirectional relationship between AD and AUD; especially those with severe AD (medication use, comorbid depression) are at risk of developing AUD. Health care professionals should focus on prevention of AD in AUD patients and prevention of AUD in patients with (more severe) AD. Further research should investigate the mechanisms underlying the observed associations.
... Conversely, SUD at age 20/21 and 29/30 predicted DD at age 22/23 and 34/35, respectively. These results expand knowledge from previous studies with short- (Haynes et al., 2005;Li et al., 2020;Wolitzky-Taylor et al., 2012;Worley et al., 2012) and long-term (Brook et al., 2016;McKenzie et al., 2011) follow up. Therefore, the results support our second and third hypotheses (except for the relationship between AD and SUD). ...
... Previous studies (Brook et al., 2016;Degenhardt et al., 2013;Dyer et al., 2019;Haynes et al., 2005;Kushner, 1999; PPp: posterior predictive p-value. McKenzie et al., 2011;Schleider et al., 2019;Wolitzky-Taylor et al., 2012) that mainly focused on the relationships between AD and alcohol use disorder reported mixed findings. Accordingly, we found no evidence of a clear and consistent pattern of association between AD and SUD over a long time period using both AMOS and MPLUS. ...
Background and objective.
Studies exploring longitudinal reciprocal associations between depressive, anxiety, and substance use disorders (DD, AD and SUD, respectively) over long periods of time are mainly lacking. Therefore, the aim of the present study is to test longitudinal associations (i.e. temporal dynamics) between DD, AD and SUD from young adulthood to middle adulthood.
Methods.
A stratified community sample of 591 participants from the canton of Zurich, Switzerland, was interviewed with the Structured Psychopathological Interview and Rating of the Social Consequences of Psychological Disturbances for Epidemiology over seven interview waves from ages 20/21 to 49/50. Diagnostic and Statistical Manual of Mental Disorders criteria were used to evaluate the presence of DD, AD and SUD. We fitted an auto-regressive cross-lagged path analysis within a Bayesian structural equation model to test longitudinal associations.
Results.
Regarding autoregressive effects, AD (except during young adulthood) and SUD predicted themselves over the entire time period, while DD recurrently predicted itself not consistently over time. Regarding cross-lagged effects, DD predicted SUD at different time points, and vice versa. DD predicted subsequent AD in adulthood, whereas the reverse did not happen. Female gender was associated with DD and AD at all ages while male gender was associated with SUD only in young adulthood.
Conclusions.
Reciprocal longitudinal associations were found between DD and SUD and DD usually preceded AD. Our results further confirm an increased risk of DD and AD in women and a higher risk of SUD in young men. Early treatment and broad psychosocial interventions should be provided in order to prevent chronicity and further maladjustment as well as interrupting the cycle of mutual reinforcement between DD and SUD.
... Cross-sectional research, while being the bulk of study design in this area, cannot differentiate between these two pathways, and further complicating our understanding, these need not be mutually exclusive (Berenz et al., 2017;Bountress et al., 2019;Chilcoat and Breslau, 1998b;Kilpatrick et al., 1997;Wolitzky-Taylor et al., 2012). Nevertheless, for this differentiation among pathways to be made, longitudinal research is needed. ...
... Conversely, another report found alcohol consumption to precede interpersonal trauma (IPT) exposure, but IPT was not prospectively associated with alcohol consumption (Bountress et al., 2019). Again, a comparison between our results and prior bidirectional research is difficult as some studies focused only on adult women with intimate partner violence and only alcohol or "hard drug" use, but not substance disorder (Bacchus et al., 2018), violent assault among women and alcohol abuse and drug use (Kilpatrick et al., 1997) or looked at AUD, DUD and PTSD, but did not include traumatic events (Berenz et al., 2017;Wolitzky-Taylor et al., 2012). Others have examined measures of combined traumatic events/any event but not specific traumatic events (Breslau et al., 1998;Chilcoat and Breslau, 1998a) or measures of interpersonal trauma that includes both physical and sexual related traumas and only use of alcohol (Bountress et al., 2019) (for a summary of differences in measurement issues of alcohol and drug use on intimate partner violence in bidirectional analyses see (Bacchus et al., 2018)). ...
Background:
Most research linking type of traumatic events to the incidence of alcohol and drug use disorders among adolescents are cross-sectional and no longitudinal research exists in low/middle income countries where violence is common. Studies on bidirectional associations are infrequent.
Methods:
We estimated prospective associations of 7 types of events and new occurrence of DSM-IV alcohol use disorders (AUD) and drug use disorders (DUD), as well as prospective associations between DSM-IV AUD, DUD and the new onset of 7 types of traumatic events, from a follow-up conducted in 2013 (n = 1071; ages 19-26) of the original Mexican Adolescent Mental Health Survey conducted in 2005 (ages 12-17), by using Relative Ratios (RR) and Hazard Ratios (HR) estimates.
Results:
After adjustments for mental disorders and demographics, "any traumatic event" increased the RR and HR of a new AUD and any substance use disorder (SUD). In HR estimates, bidirectional associations were found between "Ever committed or witnessed violence" and "Ever beaten up by spouse…" and AUD, DUD and SUD. DUD disorder increased HR for several events.
Limitations:
Our sample is representative of the largest metropolitan area in Mexico but does not include other cities and other age groups that may differ in risk factors. Corrections for multiple tests suggests caution.
Conclusions:
We found partial support for the self-medication hypothesis and weaker support for the risky behavior hypothesis, and only two traumatic events ("Ever beaten up by spouse, partner…" and "Ever committed or witnessed violence") showed evidence of a bidirectional association.
... These trends are not coincidental; previous research has found that adolescent-onset of emotional disorder symptoms (i.e. anxiety or depressive syndrome) predicts young adult substance use and this association generalizes across several different types of emotional disorders (Wilkinson et al., 2016;Wolitzky-Taylor et al., 2012). Contemporary research relevant to the current milieu that identifies why emotional disturbance in adolescence increases risk of young adult substance use is needed. ...
... This study's findings have clinical and public health implications. Historically, people with a history of emotional disturbance experience disproportionate levels of substance use in adulthood (Wilkinson et al., 2016;Wolitzky-Taylor et al., 2012), contributing to disparities in addiction facing people with mental health problems. The current study raises concern whether the COVID-19 pandemic could contribute to a possible widening of addiction disparities for people with a history of adolescent emotional disturbance due to their potential maladaptive coping mechanism during the pandemic. ...
The COVID-19 pandemic presents unique stressors (e.g. social isolation) that may increase substance use risk among young adults with a history of emotional disturbance. This study examined whether emotional disorder symptoms and transdiagnostic vulnerabilities during adolescence predicted young adult substance use during COVID-19, and whether using substances to cope with the pandemic’s social conditions mediated these associations. Adolescents (N = 2,120) completed baseline surveys assessing transdiagnostic emotional vulnerabilities (anhedonia, distress intolerance, anxiety sensitivity, negative urgency) and symptoms (major depression[MD], generalized anxiety[GAD], panic disorder[PD], social phobia[SP], obsessive-compulsive disorder[OCD]) in adolescence (September–December 2016; M[SD] age = 17.45[0.38]). At follow-up (May–August 2020; M[SD] age = 21.16[0.39]), past 30-day substance use and using substances to cope with social isolation during the pandemic were reported. Adjusted models showed that baseline distress intolerance, anxiety sensitivity, negative urgency, and MD symptoms each significantly predicted higher number of past-month single-substance using days and number of substances used at follow-up (βs = 0.04–0.06). In each case, associations were mediated by tendency to use substances to cope with the pandemic (βindirect range: 0.028–0.061). To mitigate disproportionate escalation of substance use in young adults with a history of certain types of emotional disturbance, interventions promoting healthy coping strategies to deal with the pandemic’s social conditions warrant consideration.
... Depressive disorders commonly co-occur with alcohol, smoking, and cannabis use [24]. Consistent with the self-medication hypothesis, individuals with depression may use substances to cope with mental health symptoms [28]. Prior, smaller-scale research indicated that a lack of substantial mental health services led Ukrainian college students to similarly use substances as a coping mechanism for their psychological distress [29,30]. ...
Depression is a pervasive issue among college students worldwide, yet there is a significant gap in the literature regarding its prevalence and coping strategies in the Ukrainian context. The present study aims to fill this gap by investigating how substance use and health-promoting behaviors relate to depressive symptoms among Ukrainian college students. Health-promoting behaviors are an important strategy to prevent depression, whereas substance use can contribute to depression or make it harder to manage. Given the substantial psychosocial problems and stressors related to the ongoing war in Ukraine and the limited availability of mental health services for college students, it is important to understand how we can encourage college students to keep themselves mentally healthy. A cross-sectional study was conducted among college students on 10 campuses in 2018. Almost 16% of participants met a cut-off for depression. Female students and those who were older reported significantly higher depressive symptoms. Participants were more likely to report depressive symptoms if they were more often involved with alcohol and cannabis use, were older, and engaged in fewer health-promoting behaviors. Tobacco use was not significantly associated with depressive symptoms. Our findings suggest a moderate prevalence of depressive symptoms in our study population. We recommend implementing balanced public health interventions that address risk factors (such as substance use) while also promoting protective behaviors and can be tailored to the specific cultural and environmental context of the region.
... Our emphasis on symptoms rather than clinical diagnoses is in line with a dimensional rather than categorical view of psychopathologies (Hudziak et al., 2007;Kamphaus & Campbell, 2008). Prior work has indicated that subthreshold anxiety symptoms confer significant risk for impairment in socio-emotional functioning (e.g., Biederman et al., 2007;Flanagan et al., 2008;Wolitzky-Taylor et al., 2012), and thus fluctuations in symptoms regardless of diagnostic criteria are an important focal outcome. In addition, when considering the impact of major stressors such as the COVID-19 pandemic, within-person change in anxiety symptoms is a highly relevant outcome to judge the relatively more adaptive and maladaptive approaches to managing responses to stressors. ...
Introduction
Adolescence is a sensitive period during which stressors and social disruptions uniquely contribute to anxiety symptoms. Adolescent's coping strategies (i.e., avoidance and approach) during the coronavirus disease 2019 (COVID‐19) pandemic may be differentially related to anxiety symptom changes. Further, social media use (SMU) is ubiquitous and may serve as an avenue to deploy avoidant and/or approach coping.
Method
Participants included 265 adolescents (ages 12–20 years; 55.8% female, 43.8% male) and one parent per adolescent. At two time points separated by ~6 months, adolescents reported on SMU and coping strategies, and parents and adolescents reported demographic information and adolescents’ anxiety symptoms. Data were collected online in the United States, from summer 2020 through spring 2021.
Results
Increases in avoidant coping predicted increasing anxiety, particularly when approach coping decreased. Decreases in both avoidant coping and SMU coincided with decreasing anxiety. Older adolescents showed decreasing anxiety when avoidant coping declined and SMU increased.
Conclusion
Coping strategies and SMU predicted patterns of adolescent anxiety symptom change across 6 months during the COVID‐19 pandemic. Results highlight that coping and SMU should be contextualized within the time course of stressors.
... Most evidence suggests a PTSD to DUD pathway; for example, PTSD predicted a 3.9-fold increased risk for substance use disorder onset at the 10 year follow-up of the National Comorbidity Study (Swendsen et al., 2010); however, the reverse direction was not tested. Similar findings in support of the selfmedication hypothesis have been demonstrated in an epidemiological study of adolescents, whereby PTSD predicted SUD longitudinally, but the reverse association was not found (Wolitzky-Taylor et al., 2012). In another epidemiological sample, survival analyses suggested PTSD had a substantial association with the risk of onset of DUD (HR = 4.5), far larger than the effect of DUD predicting future onset of PTSD (HR = 1.6); however, the prevalence of baseline DUD was low in this sample, thereby limiting the power of this test (Chilcoat & Breslau, 1998). ...
Background: There are two primary phenotypic models of comorbidity between post-traumatic stress disorder (PTSD) and drug use disorder (DUD), i.e. self-medication (PTSD precedes and causes DUD) and susceptibility (DUD precedes and causes PTSD). We sought to clarify the longitudinal relationship between PTSD and DUD, while examining sex differences.
Method: We used approximately 23 years of longitudinal data from Swedish population registries to conduct two complementary statistical models: Cox proportional hazard models (N ≈ 1.5 million) and a cross-lagged panel model (N ≈ 3.8 million).
Results: Cox proportional hazards models, adjusting for cohort and socioeconomic status, found strong evidence for the self-medication hypothesis, as PTSD predicted increased risk for DUD among both women [hazard ratio (HR) = 5.34, 95% confidence interval (CI) 5.18, 5.51] and men (HR = 3.65, 95% CI 3.54, 3.77), and moreover, that the PTSD to DUD association was significantly higher among women (interaction term 0.68, 95% CI 0.65, 0.71). The results of the susceptibility model were significant, but not as strong as the self-medication model. DUD predicted risk for PTSD among both women (HR = 2.43, 95% CI 2.38, 2.50) and men (HR = 2.55, 95% CI 2.50, 2.60), and HR was significantly higher in men (interaction term 1.05, 95% CI 1.02, 1.08). Investigating the pathways simultaneously in the cross-lagged model yielded support for both pathways of risk. The cross-paths instantiating the susceptibility model (0.10–0.22 in females, 0.12–0.19 in males) were mostly larger than those capturing the self-medication model (0.01–0.16 in females, 0.04–0.22 in males).
Conclusions: We demonstrate that the relationship between PTSD and DUD is bidirectional, with evidence that future research should prioritize examining specific pathways of risk that may differ between men and women.
... Mental health problems among adolescents have increased worldwide, with one in seven (14%) young people aged 10-19 years experiencing mental health problems (1), within which anxiety and depression make up about 43% (2) and are considered the leading causes of illness and disability for adolescents (1). Depression and anxiety are also considered risk factors for many adverse health outcomes, such as cardiovascular diseases, behavioral problems, and substance use disorder (7,8). In addition to that, depression and anxiety can affect academic achievement and learning, and reduce quality of life. ...
Background
Despite increasing evidence that social media use is associated with adolescents’ mental well-being, little is known about the role of various factors in modifying the effect of this association during adolescence. This study examined the association between social media use and psychological distress among adolescents and explored whether sex, age, and parental support moderate this association.
Methods
Data came from a representative sample of middle and high school students in Ontario, Canada. Cross-sectional analyses included 6,822 students derived from the 2019 Ontario Student Drug Use and Health Survey.
Results
Our results showed that 48% of adolescents used social media for 3 h or more per day, and 43.7% had moderate to severe psychological distress, with a higher prevalence among females (54%) than males (31%). After adjustment for relevant covariates, heavy social media use (≥3 h/day) was associated with increased odds of severe psychological distress [odds ratio (OR): 2.01; 95% confidence interval (CI):1.59–2.55]. The association of social media use with psychological distress was modified by age (p < 0.05) but not sex or parental support. The association was stronger among younger adolescents.
Conclusion
Heavy social media use is associated with higher levels of psychological distress, with younger adolescents being the most vulnerable. Longitudinal studies are recommended for future research to examine in more depth the role of sex, age, and parental support in the association between social media use and psychological distress to better determine the strength and of the association.
... However, individuals may begin to use substances more frequently and continually, precipitating AUD and NA-SUD onset [60,64,65]. Longitudinal evidence shows that in those with comorbid PTSD and AUD or NA-SUD, PTSD typically precedes the other two [64,[66][67][68]. Specifically, veteran and community sample studies have indicated that SUDs are secondary to PTSD, and PTSD may elevate the likelihood of substance dependence [64,66,67]. ...
Purpose
The self-medication hypothesis suggests people may develop Alcohol Use Disorder (AUD) or Non-Alcohol Substance Use Disorder (NA-SUD) following PTSD as a maladaptive way of coping with PTSD symptoms. Given that an accumulation of trauma experiences and interpersonal trauma increase the likelihood and severity of PTSD, we sought to determine whether the number and type of traumas additionally predict AUD and NA-SUD following PTSD.
Methods
We analysed data from 36,309 adult participants in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) study (M = 45.63 years, SD = 17.53, 56.3% female) who were administered semi-structured diagnostic interviews of trauma exposure and PTSD, AUD and NA-SUD symptoms.
Results
Individuals with PTSD were more likely to have an AUD or NA-SUD than those without PTSD. Endorsement of a greater number of traumas was associated with greater odds of having PTSD, AUD, or NA-SUD. Experience of interpersonal trauma was related to greater odds of having PTSD and subsequent AUD or NA-SUD than not experiencing interpersonal trauma. Multiple experiences of interpersonal trauma compared to one interpersonal trauma exposure also increased the odds of having PTSD followed by AUD or NA-SUD.
Conclusions
Interpersonal trauma and multiple experiences of interpersonal trauma may result in individuals turning to alcohol and substances as a way to alleviate intolerable PTSD symptomology, aligning with the self-medication hypothesis. Our findings highlight the importance of ensuring services and support for interpersonal trauma survivors and for those who have experienced multiple traumas given their increased for unfavourable outcomes.
... Moreover, it should also be noted that the data from this study may support other model configurations. Without multiple timepoints, we are unable to entirely rule out the possibility that alcohol use/problems may have played a predictive role leading to issues regarding behavior and well-being (Wolitzky-Taylor et al., 2012;Fergusson et al., 2009). Longitudinal work is needed to show how the BIS and the BAS shape drinking motivations over time and how these effects relate to changes in drinking behavior in emerging adulthood. ...
Background: Gray's original Reinforcement Sensitivity Theory (RST) posits that an oversensitive behavioral inhibition system (BIS) may increase risk for negative-reinforcement-motivated drinking, given its role in anxiety. However, existing data provides mixed support for the BIS-alcohol use association. The inconsistent evidence is not surprising, as the revised RST predicts that the behavioral approach system (BAS) should moderate the effect of the BIS on alcohol use. A strong BAS is thought to bring attention to the negatively reinforcing effects of alcohol, leading to problem drinking among those with a strong BIS. While emerging results support this interaction, we still have much to learn about the mechanisms underlying this effect on alcohol use. Accordingly, we examined motives for alcohol use as mediators of the joint associations of the BIS and the BAS on drinking behaviors. Specifically, our central hypothesis was that individuals with a strong BIS and a strong BAS would endorse increased negative reinforcement motives for drinking (coping and conformity motives), which in turn would predict heavy drinking and alcohol problems. Method: Participants (N=346; 195 women) completed study measures as part of the baseline assessment for a larger study. Results: Overall, results partially supported the hypotheses. Mediated moderation analyses showed that the indirect effect of the BIS on alcohol problems, through coping and conformity motives, was strongest at high levels of the BAS. This effect was not supported for alcohol use. Conclusions: Our findings suggest that clinical interventions should target coping and conformity reasons for drinking among anxious, reward responsive, young adults.
... This one-dimensional perspective limits our understanding of what elements of stress are the most relevant when it comes to anxiety, and it is therefore detrimental to the application of research results to real-world challenges and to the generation of meaningful and efficient public mental health measures. Such measures could help to prevent anxiety (disorders) as well as anxiety-associated health problems, e.g., related to pathological eating behaviors, or substance use and addiction (Hussenoeder et al., 2021;Li et al., 2019;Rosenbaum & White, 2015;Wolitzky-Taylor et al., 2012). Hence, in this study, we will use a multidimensional approach that includes the following nine domains of chronic stress (TICS; Schulz et al., 2004): (1) Work Overload, (2) Social Overload, (3) Pressure to Perform, (4) Work Discontent, (5) Excessive Demands at Work, (6) Lack of Social Recognition, (7) Social Tensions, (8) Social Isolation, and (9) Chronic Worrying. ...
Studies show a connection between anxiety and stress, but with little differentiation between different domains of stress. In this article, we utilize a multi-dimensional approach to better understand the relationship between different chronic stress domains and anxiety. This will allow researchers to identify and address those areas of stress that are most relevant with regard to anxiety. We used data from a sub sample of the LIFE-Adult-Study (n = 1085) to analyze the association between nine different areas of chronic stress (Trier Inventory for Chronic Stress, TICS) and anxiety (General Anxiety Disorder 7, GAD-7), controlling for sociodemographic variables, personality, and social support. There was a significant and positive association between Work Overload, Pressure to Perform, Social Tensions, Social Isolation, Chronic Worrying, and anxiety. After including the control variables, only Work Overload and Chronic Worrying remained significant. By focusing on Work Overload and Chronic Worrying researchers, practitioners, and policy makers can help to mitigate anxiety and related health problems in the population in an efficient way.
... Anxiety: AUD is highly comorbid with anxiety disorders [95], especially in adolescence [96]. While anxiety is not strictly a cognitive outcome, it is related to altered cognitive functioning [97,98]. ...
Adolescence is an important developmental period associated with increased risk for excessive alcohol use, but also high rates of recovery from alcohol use-related problems, suggesting potential resilience to long-term effects compared to adults. The aim of this systematic review is to evaluate the current evidence for a moderating role of age on the impact of chronic alcohol exposure on the brain and cognition. We searched Medline, PsycInfo, and Cochrane Library databases up to February 3, 2021. All human and animal studies that directly tested whether the relationship between chronic alcohol exposure and neurocognitive outcomes differs between adolescents and adults were included. Study characteristics and results of age-related analyses were extracted into reference tables and results were separately narratively synthesized for each cognitive and brain-related outcome. The evidence strength for age-related differences varies across outcomes. Human evidence is largely missing, but animal research provides limited but consistent evidence of heightened adolescent sensitivity to chronic alcohol’s effects on several outcomes, including conditioned aversion, dopaminergic transmission in reward-related regions, neurodegeneration, and neurogenesis. At the same time, there is limited evidence for adolescent resilience to chronic alcohol-induced impairments in the domain of cognitive flexibility, warranting future studies investigating the potential mechanisms underlying adolescent risk and resilience to the effects of alcohol. The available evidence from mostly animal studies indicates adolescents are both more vulnerable and potentially more resilient to chronic alcohol effects on specific brain and cognitive outcomes. More human research directly comparing adolescents and adults is needed despite the methodological constraints. Parallel translational animal models can aid in the causal interpretation of observed effects. To improve their translational value, future animal studies should aim to use voluntary self-administration paradigms and incorporate individual differences and environmental context to better model human drinking behavior.
... A robust literature links trauma and substance use, suggesting a bidirectional relationship: a PTSD diagnosis is associated with subsequent development of SUD (Wolitzky-Taylor et al., 2012) and SUD may increase vulnerability to future trauma (Smith & Randall, 2012). People impacted by both trauma and SUD typically have more severe symptoms, poorer treatment outcomes, and face increased social consequences (McCauley et al., 2012;Mills et al., 2006). ...
Purpose
Intimate partner violence (IPV) and substance use disorder (SUD) frequently co-occur and are rarely addressed together despite evidence indicating benefits of combined interventions. Both are linked to trauma. Scholars have theorized attention to trauma may facilitate engagement with IPV and SUD but have not studied this potential empirically.
Methods
Using service system level quantitative data on organizations focused on IPV or SUD (n = 281) in a midwestern city in the United States and semi-structured interviews with policymakers, funders, and practitioners in both areas (n = 27), this paper uses grounded theory to explore whether attention to trauma facilitates attention to IPV and SUD.
Results
While quantitative data suggest addressing trauma and both IPV and SUD are associated at the service system level, analysis of interview data indicates greater complexity. Despite consensus on trauma-informed care’s potential, competing understandings of temporality (when trauma occurs in relation to IPV or SUD), different liabilities associated with addressing trauma, and different intervention approaches combine to limit engagement by both IPV and SUD organizations. Rather than adopting trauma-informed care, both types of organizations more typically engage trauma selectively, offering discrete services rather than holistic intervention. Findings have implications for addressing co-occurring IPV, SUD, and trauma and for practice, policy, education, and research.
Conclusions
There is need for greater consensus about what it means to address trauma, increased investments in practitioner education and training around intersections of IPV, SUD, and trauma, and additional supports to incentivize movement from a trauma services approach towards meaningful implementation of trauma-informed care.
... 627 ergenin dahil edildiği 4 yıllık bir kohort çalışmasında başlangıçtaki unipolar depresyon ve anksiyetenin takipte madde kulanım bozukluğu için öngörücü olduğu, tersinin ise geçerli olmadığı gösterilmiştir. 19 Deneysel modeller SMH ile ilgili kanıtlar sunsa da, aynı durum her zaman geçerli olmayabilir. Stresli durumlar her zaman madde kullanımı ile so-nuçlanmayabilir. ...
82 COVID-19 pandemisi, 2019 yılının son çeyreğinden bu yana Dünya'nın, özellikle Mart 2020'den bu yana da ülkemizin gündeminde olup etkisini sürdürmektedir. Bir ön-ceki pandeminin yüz yıl önce meydana geldiği düşünüldüğünde günümüz jenerasyonu böyle bir durumla ilk defa karşılaşmıştır. Pandemi, kitlesel bir travma olarak kabul edi-lebilir. Kitlesel travmalar özellikle yatkınlığı olan bireyleri farklı düzeylerde etkileyerek ruhsal bozuklukların ortaya çıkmasında rol oynarlar. Bununla birlikte travmalar var olan ruhsal bozuklukların şiddetini artırırlar. 1-3 ABD'de her yıl yapılan "Ulusal Uyuşturucu Kullanımı ve Sağlık Anketi (NSDUH)'nin 2019 verilerine göre; 12-17 yaş aralığında yaşam boyu an az bir defa ya-sadışı madde kullanım oranı %24.5 olarak bildirilmiştir. 4 Ergenlik dönemi madde kul-lanım bozuklukları (MKB) da dahil olmak üzere psikiyatrik bozuklukların en sık ortaya çıktığı dönemdir. 5 Beyin gelişiminin prenatal dönem ve yaşamın ilk yıllarında tamam-landığına dair görüş geçerliliğini yitirmiştir. Modern görüş beyin gelişiminin yaşam boyu devam ettiği şeklindedir. Ergenlik döneminde beyin gelişimi; nöron oluşumu, hücre Pandemi Dönemi ve Madde Kullanım Bozuklukları Substance Use Disorders During the Pandemic Period ÖZET COVID-19 pandemisi yaklaşık bir yıldır ülkemiz ve Dünya gündemini meşgul etmektedir. Pan-demi kitlesel bir travma olarak kabul edilmektedir. Kitlesel travmaların sonucunda yeni psikopatoloji-ler ortaya çıkabileceği gibi var olan psikopatolojilerin de şiddeti artabilir. Madde kullanım bozukluğu olan ergenler kırılgan ve korunmasız grup olarak kabul edebilmektedirler. Bu süreçten olumsuz olarak etki-lenecekleri düşünülse de kısıtlı sayıda çalışmada böyle olmadığı gösterilmiştir. Bunun nedeninin, er-genlik döneminde madde kullanım bozukluğunda risk faktörleri olarak kabul edilen ulaşılabilirlik, akran etkisinin azalması olduğu düşünülmektedir. Öte yandan kısıtlamalar sosyal desteği azaltmış ve okul gibi koruyuculuğu gösterilmiş bir ortamdan gençleri uzaklaştırmıştır. Bu nedenle madde kullanım bozuk-luğu olan ergenlerin bu süreçten nasıl etkilendiklerini, uzun dönemde nasıl etkileneceklerini araştıran ça-lışmalara ihtiyaç vardır. Anah tar Ke li me ler: Adölesan; madde kullanımına bağlı bozukluklar; COVID-19; pandemik ABS TRACT The COVID-19 pandemic has been on the agenda of our country and the world for about a year. Pandemic is considered as a mass trauma. As a result of mass traumas, new psychopathologies may emerge, as well as the severity of existing psychopathologies. Adolescents with substance use disorders can be considered as a vulnerable and unprotected group. Although it is thought that they will be adversely affected by this process, a limited number of studies have been shown to be not. The reason for this is thought to be the decrease in accessibility and peer effect, which are accepted as risk factors in substance use disorder during adolescence. On the other hand, restrictions reduced social support and removed young people from a protective environment such as school. For this reason, studies investigating how adolescents with substance use disorders are affected by this process and how they will be affected in the long term are needed.
... 627 ergenin dahil edildiği 4 yıllık bir kohort çalışmasında başlangıçtaki unipolar depresyon ve anksiyetenin takipte madde kulanım bozukluğu için öngörücü olduğu, tersinin ise geçerli olmadığı gösterilmiştir. 19 Deneysel modeller SMH ile ilgili kanıtlar sunsa da, aynı durum her zaman geçerli olmayabilir. Stresli durumlar her zaman madde kullanımı ile so-nuçlanmayabilir. ...
COVID-19 pandemisi yaklaşık bir yıldır ülkemiz ve Dünya gündemini meşgul etmektedir. Pan- demi kitlesel bir travma olarak kabul edilmektedir. Kitlesel travmaların sonucunda yeni psikopatoloji- ler ortaya çıkabileceği gibi var olan psikopatolojilerin de şiddeti artabilir. Madde kullanım bozukluğu olan ergenler kırılgan ve korunmasız grup olarak kabul edebilmektedirler. Bu süreçten olumsuz olarak etki- lenecekleri düşünülse de kısıtlı sayıda çalışmada böyle olmadığı gösterilmiştir. Bunun nedeninin, er- genlik döneminde madde kullanım bozukluğunda risk faktörleri olarak kabul edilen ulaşılabilirlik, akran etkisinin azalması olduğu düşünülmektedir. Öte yandan kısıtlamalar sosyal desteği azaltmış ve okul gibi koruyuculuğu gösterilmiş bir ortamdan gençleri uzaklaştırmıştır. Bu nedenle madde kullanım bozuk- luğu olan ergenlerin bu süreçten nasıl etkilendiklerini, uzun dönemde nasıl etkileneceklerini araştıran ça- lışmalara ihtiyaç vardır.
The COVID-19 pandemic has been on the agenda of our country and the world for about a year. Pandemic is considered as a mass trauma. As a result of mass traumas, new psychopathologies may emerge, as well as the severity of existing psychopathologies. Adolescents with substance use dis- orders can be considered as a vulnerable and unprotected group. Although it is thought that they will be adversely affected by this process, a limited number of studies have been shown to be not. The reason for this is thought to be the decrease in accessibility and peer effect, which are accepted as risk factors in substance use disorder during adolescence. On the other hand, restrictions reduced social support and removed young people from a protective environment such as school. For this reason, studies investi- gating how adolescents with substance use disorders are affected by this process and how they will be affected in the long term are needed.
... Anxiety symptoms begin early in life and are often chronic and persistent [4]. Moreover, anxiety disorders in childhood are associated with social, emotional and academic impairment [5][6][7][8], as well as an increased risk for developing other disorders, such as additional anxiety disorders, depression, conduct disorder or substance abuse later in life [9][10][11][12][13][14]. Thus, early recognition and treatment are particularly desirable [15][16][17], especially to prevent the potential for lifelong impact. ...
The efficacy of the Cool Kids program has been consistently demonstrated both within Australia and internationally, but limited data are available on the use of Cool Kids as a universal program. The purpose of the study is to evaluate Cool Kids as a universal program for preventing childhood anxiety in the school context. There were 73 Italian children (35 boys and 36 girls, ages 10–13 years) attending the last year of primary school and the first year of middle school who participated in an active intervention based on a school adaptation of the Cool Kids protocol. Results of t-test analyses highlighted a downward trend of anxiety symptoms, especially in total anxiety, somatic anxiety, generalized anxiety, separation anxiety, social anxiety and school phobia at post-treatment assessed by children. Even the score of depression symptoms, measured as a second outcome measure, decreased after the treatment. This study contributes to the evidence base for the Cool Kids program as a universal program for preventing childhood anxiety in the school context. Although these preliminary results show some promise, their replication in future research is necessary given current study limitations.
... Therefore, SUD in adolescence and young adulthood (herein referred to as "emerging adulthood") continues to be a serious public health concern (Hasin, Stinson, Ogburn, & Grant, 2007), and new approaches are critically needed. Chronically elevated negative affect (which is typically identified in clinical settings through the diagnosis of anxiety and unipolar mood disorders, herein referred to as "emotional disorders") typically presents by emerging adulthood, and is implicated in the onset, maintenance, and exacerbation of SUD (Compton, Thomas, Stinson, & Grant, 2007;Grant et al., 2004;Kendler, Heath, Neale, Kessler, & Eaves, 1993;Wolitzky-Taylor, Bobova, Zinbarg, Mineka, & Craske, 2012). Emerging evidence suggests that it is not the negative affect itself but the maladaptive cognitive, behavioral, and emotional responses to the negative affect that put an individual at risk of pathological substance use. ...
Introduction
Cannabis use disorder (CUD) is a growing public health concern, and is highly comorbid with negative affective conditions such as anxiety and depression. Late adolescence and early adulthood represents a time of rapid emotion regulation development, as well as the onset of anxiety, mood, and substance use disorders, especially CUD. Maladaptive cognitive, behavioral, and emotional responding to one's own negative affect (in an effort to eliminate it) is associated with substance use, and represents a novel treatment target to improve outcomes of treatment for substance misuse. Method: After development of a manual for a novel intervention, Affect Management Treatment (AMT) for CUD, a pilot randomized clinical trial was conducted in 18–25 year-old participants with CUD to evaluate the impact of this approach on negative affect, constructs (e.g., distress intolerance) representing maladaptive reactivity to negative affect, and cannabis use. Participants (N = 52) received either 12 sessions of standard cognitive behavioral therapy (CBT) for CUD or 12 sessions of AMT and were assessed on measures of negative affect, reactivity to negative affect, cannabis use, and cannabis use problems at baseline, throughout treatment, post-treatment, and 6-mo follow-up. Results: AMT outperformed CBT in reducing negative affect and reactivity to negative affect, and it had a significant impact on cannabis use and cannabis use problems. There were no statistically significant between-group differences on cannabis outcomes. Conclusions: AMT offers a novel, successful approach to the treatment of CUD.
... The negative reinforcement of the substance leads to a pattern of misuse, as well as maintenance of the negative emotions (Stewart & Conrod, 2008). Indeed, the associations between disorders characterized by negative affect and substance use disorders are well-documented (Grant et al., 2004;Wolitzky-Taylor et al., 2012). This study demonstrates that coping motivations (e.g., to alleviate tension/relax or to cope with feelings and emotions) to misuse prescription drugs are similar to those observed with illicit substances. ...
Background
Prescription drug misuse (PDM) is a significant public health problem associated with mental health symptoms.
Objectives
This project investigates the connections between PDM motivations and mental health to inform intervention efforts.
Methods
Using nationally representative adult data from the 2016–2018 National Survey on Drug Use and Health (N = 128,205; 53% female) this project investigated which motivations for misuse are related to past-year mental health problems including any mental illness, serious mental illness, major depressive episode, and suicidal thoughts. Complex samples logistic regression models of the main motivation of PDM for each mental health problem were conducted separately for each prescription drug class (i.e., opioids, tranquilizers, sedatives, and stimulants) while controlling for demographic characteristics.
Results
Adults that reported PDM were more likely than those with no PDM to endorse past year mental health problems. Compared to those that reported PDM of other medications, those misusing prescription opioids and tranquilizers to help with emotions and misusing sedatives to “relax or relieve tension” were more likely to have all categories of mental health problems. Those that misused prescription stimulants to “help study” had lower odds of all mental health problems.
Conclusions
While there were differences based on prescription drug class, a range of motivations increased adults’ likelihood to have mental health problems and common themes were found across drug classes. While causality is still undetermined, prevention and intervention efforts that are multifaceted and individualized, while broadly providing adults with other ways to cope with negative emotions are likely to help reduce PDM.
... Because psychological distress increases dramatically during middle to late adolescence (Hankin et al., 1998;Kleppang, Thurston, Hartz, & Hagquist, 2019;Rohde, Lewinsohn, & Seeley, 1991;Vannucci, Flannery, & Ohannessian, 2018;Zahn-Waxler, Klimes-Dougan, & Slattery, 2000), this period can be regarded as a critical time of vulnerability for individuals. Psychological distress, that is, experiencing a state of mental suffering characterized by symptoms of anxiety (e.g., worrying, restlessness, feeling tense) and depression (e.g., hopelessness, negative affect) (Drapeau, Marchand, & Beaulieu-Pr evost, 2012;Mirowsky & Ross, 2002), constitutes a major risk factor for suicide (Davidson, Wingate, Grant, Judah, & Mills, 2011;Windfuhr et al., 2008), educational impairments (Fletcher, 2008;Van Ameringen, Mancini, & Farvolden, 2003), increased rate of smoking, substance/alcohol misuse, and obesity (Hasler et al., 2005;Keenan-Miller, Hammen, & Brennan, 2007;Wolitzky-Taylor, Bobova, Zinbarg, Mineka, & Craske, 2012), as well as maladjustment (Benjamin, Harrison, Settipani, Brodman, & Kendall, 2013;Essau, Lewinsohn, Olaya, & Seeley, 2014). During recent decades, the prevalence of adolescents who experience psychological distress has been relatively stable in countries like the United States, France, and Latvia (Ottov a-Jordan et al., 2015). ...
This study investigated the temporal relationship between social self‐efficacy and psychological distress during 3 years in middle to late adolescence. The sample comprised 1508 participants (60.7% female; baseline mean age = 16.33, SD = .62; 52.9% high perceived family wealth; 70.6% born in Norway). We used a random intercept cross‐lagged panel model to investigate the concurrent and subsequent associations between the two constructs. The results indicated (1) small to moderate and negative associations between the trait‐like components and within‐person fluctuations of social self‐efficacy and psychological distress, (2) positive and significant carry‐over stability effects on both constructs across time, and (3) that psychological distress predicted subsequent social self‐efficacy more consistently across four time points, than social self‐efficacy predicted later psychological distress.
... Internalizing and externalizing disorders can interact in unique ways, acting as both risk and protective factors for SU in youth (Colder et al., 2013;Colder et al., 2014;Colder et al., 2017). The early presence of internalizing, externalizing and co-occurring internalizing-externalizing symptoms may reflect distinct trajectories, with the possibility of shared risk factors (Copeland et al., 2013;Kessler et al., 2005;Wolitzky-Taylor, Bobova, Zinbarg, Mineka, & Craske, 2012). Longitudinal studies have identified that co-occurring internalizing and externalizing symptoms are associated with higher rates of SU problems (Colder et al., 2013;Colder et al., 2014;Colder et al., 2017), while a pooled review of studies further identified that co-occurrence was strongly associated with dependence (Chan, Dennis, & Funk, 2008). ...
Objectives:
This study characterizes patterns of mental health, substance use and their co-occurrence, and identifies developmental trajectories associated with progression from single to concurrent mental health and substance use concerns in an Ontario school-based population. It is a longitudinal extension of the Ontario Student Drug Use and Mental Health Survey, as part of the RAFT collaborative project.
Methods:
In this study, an Ontario-wide survey was administered to students across three biennial waves starting in grades 7-8 (ages 12-14). We explored how developmental patterns of externalizing, internalizing and co-occurring symptoms were differentially associated with late-adolescent (ages 17-19) problematic substance use.
Results:
On average, students exhibited early (ages 12-14) moderate risk of an internalizing and/or externalizing disorder and approached the low threshold for a diagnostic concern for substance use disorder at age 17-19. The pattern confirmed a potential pathway from early mental health concerns to later adolescent problematic substance use, with rates of co-occurrence increasing with age. Youth with early moderate-to high externalizing and co-occurring internalizing and externalizing symptomology had the highest levels of problematic substance use, with scores indicating high likelihood of a substance use disorder diagnosis.
Conclusions:
Given the overall pattern of progression, early identification and referral of at-risk youth, especially youth with co-occurring mental health concerns, is of critical importance. Findings support the importance of integrated and co-located mental health and substance use services for youth to more effectively serve a diverse population of youth with varying levels of need.
... Within community samples presenting with internalizing problems, comorbidity of substance use is estimated to range between 10 and 14% for principal depression (Lansford et al., 2008;Rohde et al., 1991), between 9 and 11.9% for principal anxiety (Lansford et al., 2008;Lewinsohn et al., 1997), and at 21% for co-occurring depression and anxiety (Lansford et al., 2008). Current evidence for the directionality of the temporal associations between depression, anxiety, and substance use remains inconclusive (Garey et al., 2020), with some suggesting a bidirectional relationship between internalizing problems and substance use (Esmaeelzadeh et al., 2018;Marmorstein, 2009), some indicating that internalizing problems generally appear to precede substance use (O'Neil et al., 2011;Wolitzky-Taylor et al., 2012), and some indicating that substance use appears to precede internalizing problems (Fergusson et al., 2011). Additionally, some evidence suggests that depression in particular is associated with subsequent substance use, whereas the link between anxiety and later substance use is weaker (Hussong et al., 2017;Schleider et al., 2019). ...
Internalizing problems (e.g., depression, anxiety) and substance use are common among young people and often co-occur. However, youths face myriad barriers to access needed treatment, and existing evidence-based interventions tend to focus on internalizing problems or substance use, rather than both simultaneously. Brief interventions that target both problems may, therefore, be an efficient and accessible resource for alleviating youth difficulties; however, this possibility has been insufficiently evaluated. This systematic review evaluated the intervention characteristics and quality of six studies spanning 2015 to 2019 that examined intervention effects on internalizing and substance use outcomes. Based on independent calculations and author reports (respectively), 3–4 interventions significantly reduced youth internalizing symptoms; 3–5 reduced youth substance use; and 2–3 reduced symptoms in both domains. All six interventions identified substance use as a primary target. Four interventions were administered by interventionists to youths in inpatient, outpatient, primary care, or school settings. The remaining two studies delivered content through voicemail messages or an online design. Interventions ranged from ~ 15 to 240 min. Results highlight the sparsity and heterogeneity of youth-focused brief interventions that have evaluated program effects on both internalizing problems and substance use outcomes, suggesting a clear need for integrated supports that are also designed for accessibility. Future investigations of brief youth-focused interventions should assess program effects on both internalizing and substance use outcomes; examine mechanisms driving the varied efficacy of identified interventions; and create, refine, and test interventions with potential to address co-occurring internalizing problems and substance use in young people.
... These findings are consistent with the evidence from high-income countries. [9][10][11][12][13][14][15][16] To our knowledge, this is the first systematic review and meta-analysis of the effect of depressive symptoms on risky behaviors among adolescents in LMICs. ...
Objective
Several studies conducted in high-income countries have found an association between depressive symptoms and risky behaviors among adolescents. Evidence from low- and middle-income countries (LMICs), where 90% of the world's adolescents live, remains scarce. The objective of this review was to systematically review the evidence examining the association between depressive symptoms and risky behaviors among adolescents in LMICs.
Method
We searched 15 electronic databases for published or unpublished cohort and case-control studies about adolescents in LMICs. We applied no restrictions on date or language. The primary outcome was the association (odds ratio [ORs]) between depressive symptoms and risky sexual behavior and substance use. Secondary outcomes included delinquency, adverse school behavior, self-harm, and suicidal behavior. We pooled the ORs from all studies using the random-effect model. We assessed the quality of the studies using the Newcastle-Ottawa scale, and the strength of the overall body of evidence using GRADE. The study protocol was registered on PROSPERO (CRD42019131262).
Results
The searches yielded 31,148 potentially relevant studies. After screening, we included 33 records in the systematic review, of which 30 comprised the meta-analysis. All studies encompassed a total of 35,918 adolescents living in 17 LMICs: 5 from Africa, 7 from Asia, and 5 from Latin America and the Caribbean. We found that adolescents with depressive symptoms are more likely to engage in risky sexual behavior (OR 1.3, 95% CI: 1.1-1.5) and substance use (OR 1.8, 1.4-2.2) compared to non-depressed adolescents. Results for the secondary outcomes showed a similar pattern, with higher delinquency (OR 3.2, 1.8-5.6), self-harm (OR 4.4, 1.3-14.4), and suicidal behavior (OR 6.6, 2.3-18.9) among adolescents with depression compared to healthy adolescents.
Conclusion
This study suggests that adolescents with depression in LMICs carry a double burden: they both suffer from depression, and are at an increased risk of engaging in risky behaviors. This combination may lead to further psychological and physical health problems that persist over the life course, and may impose a health burden on society as a whole. Taken together, these findings highlight the urgent need for scalable and sustainable approaches to prevent and/or treat depression among adolescents in resource-poor settings.
... For example, adverse childhood events are associated with increased risk of problematic substance use, gambling, addictive-like eating, and risky sexual behavior. 22,23 Other potential transdiagnostic correlates include self-reported impulsivity, 24 depression, 25 and anxiety, 26 which are robustly tied to substance use disorders. However, empirical investigation is needed to determine if these correlates predict nonsubstance addictions or related behaviors. ...
Background and Objectives
Patients receiving opioid agonist therapies have high rates of psychiatric comorbidity. Some data suggest that comorbidity is associated with poorer treatment outcomes. The current study assessed predictors of multiple putative addictive behaviors among patients receiving opioid agonist therapies.
Methods
Adults (N = 176) recruited from an outpatient clinic providing opioid agonist therapy completed self‐report measures of depression, anxiety, impulsivity, adverse childhood events, and the Recognizing Addictive Disorders (RAD) scale, which includes seven subscales assessing symptoms related to alcohol use, drug use, tobacco use, gambling, binge‐eating, hypersexual behavior, and excessive video‐gaming. Linear regression and hurdle models identified significant predictors of RAD subscales. Hurdle models included logistic regression estimation for the presence/absence of symptoms and negative binomial regression for estimation of the severity of symptoms.
Results
Most patients did not report significant symptoms beyond drug or tobacco use. However, 7% to 47% of participants reported some symptoms of other addictive behaviors (subscale score > 0). Higher impulsivity predicted the presence and/or increased severity of symptoms of drug use, gambling, binge‐eating, and hypersexuality. Higher depression significantly predicted increased severity of drug use and binge‐eating symptoms. Increased anxiety predicted lower severity of alcohol use and binge‐eating and higher severity of smoking symptoms.
Conclusion and Scientific Significance
A broader range of potentially addictive symptoms may be present among patients engaged in treatment for opioid use disorder. Few studies have assessed symptoms of binge‐eating, hypersexuality, and excessive video‐gaming among patients receiving opioid agonist therapy. This study contributes to preliminary findings and highlights important future directions. (Am J Addict 2021;00:00–00)
... In a given year, 13% of individuals with AUD also meet criteria for an anxiety disorder (Grant et al. 2004). Importantly, these disorders are longitudinally linked, as individuals with anxiety disorders are more than seven times as likely to later develop an AUD as individuals without AUD (Buckner and Turner 2009); and anxiety disorders predict later AUD but not vice versa (Wolitzky-Taylor et al. 2012). Neurobiological elements, including circuits in the amygdala, influence feedback loops between negative affect (including anxiety) and alcohol, contributing to onset and maintenance of these co-occurring disorders (for reviews see Anker and Kushner 2019;Gilpin et al. 2015). ...
Co-occurring anxiety and alcohol use disorders lead to poorer treatment outcomes for both disorders. Compounding risk for poor outcomes related to these disorders, individuals living in rural areas face barriers receiving evidence-based mental health treatment. Video to home telehealth (VTH) has been implemented broadly within the Veterans Health Administration to improve access to care for rural veterans. However, VTH may not be utilized equally across disorders and comorbidities, including co-occurring anxiety and alcohol use disorders, potentially contributing to gaps in care that are not available in person. A cohort of veterans who received at least one VTH mental health visit between fiscal years 2016–2019 was compiled from VA administrative data. Multilevel linear growth curve models were used to examine growth in VTH use over time among veterans with anxiety only, alcohol use disorder only, and co-occurring disorders. Fixed effects were significant for both time and diagnosis group and a significant interaction between time and group. For each subsequent fiscal year, the percentage of total MH visits that were VTH increased for all groups but less so for those with co-occurring anxiety and alcohol use diagnoses. Despite VTH being an important tool to reach underserved rural veterans, rural veterans with AUD and co-occurring anxiety and AUD are at risk for not receiving care using this modality. Findings suggest that veterans with co-occurring anxiety and AUD are especially at risk for being underserved, given that a major goal of VTH is to increase access to mental health services.
... respectively [6], but the incidence of subclinical depression and anxiety levels is much higher [7,8]. Depression and anxiety in youtheven at levels below the threshold of a psychiatric diagnosisincrease risk for suicide, substance misuse, obesity [9,10], poorer social development, and worse academic performance [11]. ...
Background:
To elucidate the populations and conditions where screen-based sedentary behaviors (SB) and internalizing symptoms are coupled, this review synthesized the evidence for factors that may moderate the associations between screen-based SB, depressive symptoms, and anxiety symptoms among youth.
Methods:
Two independent researchers conducted a systematic literature search of the Medline, psycINFO, and Scopus electronic databases in late 2018 for observational studies assessing moderators of the association between screen-based SB and depressive and anxiety symptoms. Studies among children and adolescents were eligible if moderation was assessed by statistical test (interaction) or stratification; and a narrative synthesis of eligible studies was conducted in accordance with PRISMA guidelines.
Results:
Seventy empirical studies (46 cross-sectional, 19 longitudinal, and 5 both) of 13 different moderating variables of screen-based SB-internalizing symptom associations met the eligibility criteria. Of these, 40 studies were of depressive symptoms, 2 were of anxiety symptoms, and 28 studies assessed symptoms of both. The most consistent evidence of moderation was for screen-type, such that TV viewing was not as strongly associated with internalizing symptoms compared to other forms of screen-based SB. There was also inconsistent evidence for physical activity buffering screen-based SB-internalizing symptom associations and for female sex amplifying screen-based SB-internalizing symptom associations. In general, the body of evidence for anxiety symptoms was more limited than that for depressive symptoms, and were therefore more inconsistent.
Conclusions:
Screen-type, physical activity, and sex may influence the magnitude of screen-based SB-internalizing symptom coupling; highlighting potential sources of heterogeneity of screen-based SB-internalizing symptom associations. Additional studies aimed at understanding potential mechanistic explanations for the above moderators are needed prior to the development of tailored intervention strategies designed to decouple screen-based SB and internalizing symptoms among youth.
... It is estimated that nearly 70% of the population across the globe will experience at least one traumatic event (e.g., physical/sexual abuse, natural disasters, automobile/man-made accidents, gun or other violence) in their lifetimes [1], and approximately 10-15% of individuals experiencing such distressing events will go on to develop significant mental health problems as a result, such as post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), specific phobias, depression, substance use disorder, and other related mental health issues [2,3]. In addition, the occurrence of these mental health issues following exposure to a traumatic event is associated with significant healthcare burden and distress for those experiencing such events, including greater number of days missed from work, significantly higher overall healthcare costs, and a distinct reduction in quality of life and life functioning [4][5][6]. In particular, trauma exposure is notable in the Caribbean region, which consists of some 13 sovereign countries (in addition to a dozen other territories) and some 45 million individuals across the entire region, with studies finding elevated prevalence rates and subsequently greater functional impairment due to common mental health consequences of trauma exposure (such as PTSD, suicidality, and drug use, particularly in women and adolescent survivors of trauma) specifically for individuals coming from this island archipelago [7][8][9]. ...
The independent island nation of Saint Lucia and surrounding Caribbean countries have fairly well-documented high reported rates of trauma, but limited training infrastructure for trauma-related mental health support and treatment services. This study addresses this disparity between high trauma exposure and sparse trauma-related resources by studying how a one-day training workshop impacted self-rated knowledge about trauma and stigma towards trauma survivors. The training was provided by a licensed clinical psychologist in partnership with a local women’s rights group. Participants (n = 41) included school counselors, nurses, psychiatric providers, health educators, and advocates on the island. Participants completed pre- and post-workshop measures examining the variables of interest. The one-day workshop provided training on trauma types, post-trauma reactions, options for treatment, and hands-on training for trauma crisis-management and short-term interventions. Following the workshop, participants reported increased knowledge of trauma, more accurate perceptions of its prevalence, better understanding of evidence-based treatments, and lower trauma survivor-related stigma. This is the first trauma-focused workshop tested in St. Lucia, where the need for such training is considerable given few treatment options for trauma survivors in this area. Work is underway to provide more expansive services for trauma across the Caribbean region, given these preliminary promising findings.
Background
Substance use problems and anxiety disorders are both highly prevalent and frequently cooccur in youth. The present study examined the benefits of successful anxiety treatment at 3–12 years after treatment completion on substance use outcomes (i.e. diagnoses and lifetime expected use).
Methods
The sample was from the Child/Adolescent Anxiety Multimodal Extended Long‐term Study (CAMELS), a naturalistic follow‐up study to the Child/Adolescent Anxiety Multimodal Study (CAMS) which randomized youth to cognitive behavioral therapy (CBT; Coping cat ), medication (sertraline), their combination, or pill placebo. The first CAMELS visit occurred an average of 6.5 years following CAMS randomization. Participants were 319 youth (65.4% of the CAMS sample), aged 7–17 years at CAMS baseline assessment with a mean age of 17.6 years (range: 11–26 years) at the time of the first CAMELS follow‐up. Substance use outcomes included diagnoses as well as lifetime substance use (i.e. alcohol and tobacco use).
Results
Eleven of 319 (3.4%) CAMELS participants were diagnosed with a substance use disorder at the initial follow‐up visit. When compared to the population lifetime rate of 11.4%, the rate of diagnoses in the posttreated sample was significantly lower. Additionally, rates of lifetime alcohol use were lower than population rates at the initial and final follow‐up visits. Rates of lifetime tobacco use were similarly lower than lifetime population rates at the initial visit (driven by significantly lower rates in the CBT treatment condition), but higher by the final visit. Furthermore, treatment remission (but not treatment response) was associated with a lower rate of substance use diagnoses at the initial follow‐up visit, although rates of lifetime alcohol and tobacco use did not differ by treatment outcome.
Conclusions
Anxiety treatments confer a beneficial impact on problematic substance use (i.e. diagnoses) as well as on expected substance use (i.e. alcohol and tobacco use) for on average, a period of 6.5 years.
Purpose:
Although gender differences in adolescent substance use are complex and substance use accompanies mental health problems, most previous studies have focused on gender-specific association between single substance use and mental health. This study aimed to investigate gender-specific substance use patterns and to examine their association with mental health characteristics.
Methods:
Nationally representative data from the Korea Youth Risk Behavior Survey collected in 2018 were analyzed. To identify substance use patterns among male adolescents (n = 30,463) and female adolescents (n = 29,577), multiple-group latent class analysis was conducted using eight substance use indicators. In addition, we conducted a latent class analysis with covariates to examine the association between substance use patterns and mental health characteristics.
Results:
Among both gender samples, the four-class model best fit the data: nonusers (86.4%), frequent smokers (2.9%), risky drinkers (7.1%), and heavy tobacco and alcohol users with lifetime heated tobacco product use (3.6%) for male adolescents, and nonusers (89.8%), frequent smokers (0.5%), risky drinkers (8.0%), and heavy tobacco and alcohol users with a drunkenness episode (1.7%) for female adolescents. Depression, suicidal plans, and suicidal attempts predicted the latent class model for both genders. In addition, stress level predicted the latent class model for female adolescents.
Conclusions:
The findings indicate that homogeneous patterns of substance use by gender are differentially associated with mental health problems. Therefore, health professionals should develop interventions tailored to gender-specific substance use patterns, taking into account the mental health characteristics of each pattern.
Though anxiety sensitivity (AS)—fear of anxiety-related experiences—is primarily tied to anxiety vulnerability, AS has also been prospectively associated with general negative affect and depression. Furthermore, depression has been longitudinally associated with different forms of substance use, and some AS subfactors (e.g., cognitive concerns) have been associated more consistently with depression and substance use than others. However, no previous study has investigated if longitudinal associations of AS with substance use may be mediated by depression or whether aspects of AS may be prospectively associated with substance use among adolescents. Hence, the present study tested depressive affect (the negative affective aspect of depression) as a prospective mediator of AS associations with substance use and examined longitudinal AS subfactor associations with substance use and problems. High school 9th graders (N = 2,877; Mage = 14.1 years; 55.3% female) completed self-report measures at baseline and at 6 months and 1 year later. Depressive affect mediated AS associations with subsequent alcohol, cigarette, electronic cigarette, cannabis, benzodiazepine, and opioid use. Also, AS cognitive and social concerns (vs. physical concerns) were more consistently associated with later depressive affect and substance use and problems. Current findings suggest that adolescents high in anxiety sensitivity tend to prospectively experience greater depressive affect, which in turn is related to a higher likelihood of engaging in several different forms of substance use. Thus, it is possible that interventions which target AS (particularly AS cognitive concerns) may help to treat or prevent depression and substance use among adolescents.
Background:
Internalizing (anxiety and mood) disorders (INTD) commonly co-occur (are "comorbid") with alcohol use disorder (AUD). The literature suggests that excessive alcohol use aimed at coping with INTD symptoms is, at best, a partial explanation for the high comorbidity rates observed. We hypothesized that individuals with INTD experience greater susceptibility to developing AUD symptoms due to the partially shared neurobiological dysfunctions underlying both conditions. We probe this hypothesis by testing the prediction that, after accounting for the volume of alcohol intake, individuals with INTD experience higher levels of alcohol-related symptoms.
Methods:
Data from the National Epidemiological Survey on Alcohol-Related Conditions (NESARC) Wave 3 were used for the primary analyses, and NESARC Wave 1 data were used for independent replication analyses. Individuals who reported any alcohol use in the prior year were categorized as: (1) never having had an INTD diagnosis ("INTD-Never"); (2) having a remitted INTD diagnosis only ("INTD-Remitted"); or (3) having current INTD diagnosis ("INTD-Current"). Between-group contrasts of alcohol-related symptoms controlled for total alcohol intake (past year), drinking pattern (e.g., binging) and variables previously shown to mark exaggerated AUD symptoms relative to drinking amount (e.g., SES, gender, and family history).
Results:
With all covariates in the model, individuals in the INTD-Current group and the INTD-Remitted group reported significantly greater alcohol-related symptoms than those in the INTD-Never group but did not themselves differ in level of alcohol-related symptoms. These results were replicated in the NESARC 1 dataset.
Conclusions:
Individuals with INTD experience more alcohol-related symptoms than those who drink at the same level. While considering other explanations, we argue that this "harm paradox" is best explained by the view that INTD confers a neurobiologically mediated susceptibility to the development of AUD symptoms.
Background
Over a quarter of people have an anxiety disorder at some point in their life, with many first experiencing difficulties during childhood or adolescence. Despite this, gaps still exist in the current evidence base of the multiple consequences of childhood anxiety problems and their costs.
Methods
A systematic review of Medline, PsycINFO, EconLit and the National Health Service Economic Evaluation Database was conducted for longitudinal and economic studies reporting on the association between childhood anxiety problems and at least one individual‐, family‐ or societal‐level outcome or cost. All studies were synthesised narratively. For longitudinal studies, ‘effect direction’ was used as a common metric, with random effects meta‐analysis undertaken where possible.
Results
Eighty‐three studies met inclusion criteria and were synthesised narratively. We identified 788 separate analyses from the longitudinal studies, which we grouped into 15 overarching outcome domains. Thirteen of the studies were incorporated into 13 meta‐analyses, which indicated that childhood anxiety disorders were associated with future anxiety, mood, behaviour and substance disorders. Narrative synthesis also suggested associations between anxiety problems and worse physical health, behaviour, self‐harm, eating, relationship, educational, health care, employment, and financial outcomes. ‘Effect direction’ was conflicting in some domains due to a sparse evidence base. Higher economic costs were identified for the child, their families, healthcare providers and wider society, although evidence was limited and only covered short follow‐up periods, up to a maximum of 2 years. Total annual societal costs per anxious child were up to £4040 (2021 GBP).
Conclusions
Childhood anxiety problems are associated with impaired outcomes in numerous domains, and considerable economic costs, which highlight the need for cost‐effective interventions and policies to tackle them. More economic evidence is needed to inform models of the long‐term, economic‐related, consequences of childhood anxiety problems.
Background:
Child maltreatment and peer victimization are pervasive public health problems associated with adolescent substance use. Although child maltreatment has been identified as a risk factor for peer victimization, few studies have investigated their co-occurrence (i.e., polyvictimization). The study objectives were to: examine sex differences in the prevalence of child maltreatment, peer victimization, and substance use; identify polyvictimization patterns; and examine the associations between the identified typologies and adolescent substance use.
Methods:
Data were self-reported from a sample of adolescents aged 14 to 17 years (n = 2910) who participated in the provincially-representative 2014 Ontario Child Health Study. Latent class analysis with distal outcomes was conducted to identify typologies of six types of child maltreatment and five types of peer victimization and examine the associations between the polyvictimization typologies and use of cigarettes/cigars, alcohol, cannabis, and prescription drugs.
Results:
Four typologies were identified: Low victimization (76.6 %), Violent home environment (16.0 %), High verbal/social peer victimization (5.3 %), and High polyvictimization (2.1 %). The Violent home environment and High verbal/social peer victimization typologies were associated with increased odds of adolescent substance use (adjusted odds ratio range: 2.06-3.61). The High polyvictimization typology showed increased, but non-significant, odds of substance use.
Conclusions:
Adolescent-serving health and social services professionals should be aware of polyvictimization patterns and the impact on substance use. For some adolescents, polyvictimization may include exposure to multiple child maltreatment and peer victimization types. Upstream strategies to prevent child maltreatment and peer victimization are needed, which may also contribute to reductions in adolescent substance use.
Background
The objective of this paper is to present a systematic review of studies dealing with the prevalence of dual diagnoses among children and adolescents with substance use disorders. The main objective of the study is to describe prevalence of dual diagnoses and to identify the relevant topics.
Methods
The Preferred Reporting Items for Systematic Reviews protocol and guidelines were used to conduct the systematic review. The EBSCO, Medline, Scopus, and Web of Science databases were searched for relevant articles published in English between 2010 and 2020.
Results
The areas of interest were identified as (a) prevalence of dual diagnoses among substance-using children and adolescents, (b) methods for diagnosing psychiatric conditions, (c) psychiatric comorbidity diagnoses, (d) types of substances used, (e) differences between outpatient and inpatient participants. Literature on dual diagnoses in children and adolescents is scarce. The mean prevalence of dual diagnoses in target population with substance use disorders was 59.6%. As the most common psychiatric disorders, the studies indicate conduct disorders, anxiety and depressive disorders. We suggest that further research with study designs included valid diagnostic tools.
Conclusion
The care of the target group should be provided with the respect of high prevalence of dual diagnoses.
Objective:
Two predominate phenotypic models of causality exist to explain the high co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD): the self-medication and susceptibility models. Population-based longitudinal studies that simultaneously examine both models are needed. Thus, the goal of the present study is to test these models using the Swedish National Registries.
Method:
Registires were used to conduct longitudinal Cox proportional hazard models (N~1.5 million) and cross-lagged panel models (N~3.8 million) with follow-up periods of ~23 years.
Results:
Covarying for cohort and socioeconomic status, Cox proportional hazards model results found strong support for the self-medication model. Results showed that PTSD predicted increased risk for AUD among both men (HR=4.58 [4.42-4.74]) and women (HR=4.14 [3.99-4.30]), significantly moreso for men (interaction HR=1.11 [1.05-1.16]). Support was also found for the susceptibility model, although the effects were lower in magnitude than those for the self-medication model. AUD increased risk for PTSD among men (HR=2.53 [2.47-2.60]) and women (HR=2.06 [2.01-2.12]), and signifantly moreso for men (interaction term HR=1.23 [1.18-1.28]). Cross-lagged model results of simultaneously testing both models found support for bidirectionality. The PTSD→AUD paths and the AUD→PTSD paths were of modest effect for males and females.
Conclusions:
The results from both complimentary statistical approaches demonstrate that the models of comorbidity are not mutually exclusive. While the Cox model results evidenced more support for the self-medication pathway, the cross-lagged model results suggest the prospective relationships between these disorders are nuanced across development.
Gambling and anxiety are major public health concerns in adolescents and have been linked to emotion dysregulation and mood-modulating behaviors. While previous studies have shown links between positively reinforcing excitement-motivated gambling, health and functioning measures, and gambling perception and behavioral correlates in adolescents, few studies have examined such relationships relative to negatively reinforcing anxiety-motivated gambling (AMG). This study systematically examined relationships between adolescents reporting gambling to relieve anxiety (compared to those who gambled but did not report AMG) and measures of health/functioning and gambling-related measures. Participants included 1,856 Connecticut high-school students. Chi-square and logistic regression models were conducted. AMG was reported by 6.41% of the sample and was associated with identifying with a minority group (Black, Asian-American, Hispanic), at-risk/problem gambling, more permissive attitudes towards gambling, and higher odds of heavy alcohol, tobacco and other drug use, and violence-related measures. Adolescents with AMG were more likely to report non-strategic gambling, and gambling to escape/relieve dysphoria and due to feeling pressure. Additional between-group differences were found for gambling types, locations, motivations, and partners. Together, AMG may represent a mood-modulating behavior indicative of multiple problematic concerns, suggesting that emotional dysregulation may be an important factor in understanding the relationship between anxiety, problem gambling, and risky behaviors in youth. Additionally, the negative reinforcing motivations to gamble to relieve anxiety may be relevant particularly to adolescents from underrepresented minority racial/ethnic groups, and the specific factors underlying this relationship warrant further investigation.
Objectives
Social anxiety disorder (SAD) and alcohol use disorder (AUD) are highly comorbid and this comorbidity is associated with poorer clinical outcomes. Integrating exposure-based treatment for SAD into the context of typical AUD treatment programs should improve engagement and treatment outcomes for this population.
Methods
After initial development of a fully integrated, intensive outpatient program (IOP) for individuals with comorbid SAD and AUD, patients with SAD and AUD were recruited from a community-based SUD specialty clinic (N = 56) and randomized to either (a) usual care (UC), consisting of the evidence-based Matrix Model of Addiction IOP; or (b) the Fully Integrated Treatment (FIT) for comorbid SAD and AUD IOP. Participants were assessed on indices of social anxiety and alcohol use.
Results
By the 6-month follow-up, those in FIT showed superior improvement to UC on number of drinking days in the past 30 days and social anxiety severity at follow-up, but there were no differences between groups on quantity of alcohol consumed on drinking days. Alcohol-related problems improved in both groups, with no statistically significant differences. Within-group improvement was observed in FIT (but not in UC) on drinking to cope with social anxiety and avoidance of social situations without alcohol, but between-group effects were non-significant. In sum, the integrated treatment of SAD and AUD led to greater reductions in both the frequency of drinking and in social anxiety symptoms than usual care.
Conclusions
Targeting social anxiety in the context of AUD treatment is a promising approach to improving the treatment of this common comorbidity.
Williams’s need-threat model proposes that ostracism responses are reflexive and, because of their evolutionary significance, difficult to diminish. Alcohol is widely consumed in social contexts and for reasons of coping with social stress, and major theories of alcohol propose that intoxication disrupts cognitive appraisal of environmental threats, leading to stress relief. Surprisingly, though, no well-powered experimental research has examined the impact of alcohol intoxication on distress from social ostracism. In three studies across two independent laboratories ( N = 438), participants were randomly assigned to receive either an alcoholic or nonalcoholic (i.e., no-alcohol control or placebo) beverage and were exposed to an ostracism (or social inclusion) manipulation. Results, which emerged as remarkably consistent across all studies, indicated strong and consistent effects of ostracism on mood and needs satisfaction among both intoxicated and sober participants. Findings have important implications for ostracism theory and speak to boundary conditions for alcohol’s ability to relieve stress.
To design, implement and monitor effective child well-being policies, policy-makers need data that better capture children’s lives, measure what is important to them and detect emerging problems and vulnerabilities early on. Despite improvements in recent decades, there are still important gaps in both national and cross-national child data. Countries can achieve progress if the right actions are taken. Measuring What Matters for Child Well-being and Policies lays the groundwork for improved child well-being measurement and better data to inform better child well-being policies. It outlines an “aspirational” framework for child well-being measurement, setting out which aspects of children’s lives should be measured, and how, to better monitor child well-being. It also outlines priorities for child data development and identifies key data gaps, all with the aim of motivating improvements in child data infrastructures.
Introduction: Post-traumatic stress disorder (PTSD) and substance use disorder frequently co-occur and tend to have their onset during adolescence. Although research has highlighted the importance of treating these disorders in an integrated fashion, there is a dearth of empirically validated integrated treatment options for adolescents with this comorbidity. This paper describes the study protocol for a randomised controlled trial (RCT) examining the efficacy of an integrated trauma-focused cognitive–behavioural treatment for traumatic stress and substance use among adolescents (Concurrent Treatment of PTSD and Substance Use Using Prolonged Exposure - Adolescent (COPE-A)), relative to a supportive counselling control condition (Person-Centred Therapy (PCT)).
Methods and analysis: A two-arm, parallel, single-blind RCT with blinded follow-up at 4 and 12 months poststudy entry will be conducted in Sydney, Australia. Participants (n~100 adolescents aged 12–18 years) and their caregivers (caregiver participation is optional) will be allocated to undergo either COPE-A or PCT (allocation ratio 1:1) using minimisation. Both therapies will be delivered individually by project psychologists over a maximum of 16 sessions of 60–90 min duration and will include provision of up to four 30 min optional caregiver sessions. The primary outcome will be between-group differences in change in the severity of PTSD symptoms from baseline to 4-month follow-up, as measured by the Clinician-Administered PTSD Scale for Children and Adolescents for DSM-5.
Ethics and dissemination: Ethical approval has been obtained from the human research ethics committees of the Sydney Children’s Hospital Network (HREC/17/SCHN/306) and the University of Sydney (HREC 2018/863). Findings will be published in peer-reviewed journals and presented at scientific conferences.
Trial registration number: ACTRN12618000785202; Pre-reults.
Background:
Young people with substance use problems face a high risk of co-occurring mental health problems, something that may involve a more difficult life situation, social problems as well as worse treatment outcomes. The aim of this study is to analyse self-reported mental health problems among young people receiving outpatient treatment for substance use problems in Sweden. We explore what types of mental health problems are more or less predominant, and whether there are significant differences between boys and girls. In addition, we analyse how various mental health problems covary with indicators of substance abuse severity.
Methods:
The study is based on structured interviews with 1970 young people enrolled at outpatient clinics in 11 Swedish cities. The data was analysed through frequency- and averages-calculations, Chi-square tests and multivariate logistic regression analyses.
Results:
Self-reported mental health problems were common among the young people in the study. A relatively large percentage of the total group (34-54%) reported problems such as concentration difficulties, sleeping difficulties, anxiety and depression. At the same time, many of the young people did not report any symptoms and only a small group, about 20%, reported diagnosed mental health disorders. The results show substantial gender differences, with girls reporting significantly higher levels of mental health problems. Multivariate logistic regression analyses demonstrated significant associations between severity of drug use problems and anxiety, concentration difficulties, aggression, hallucinations and mental stress caused by experiences of trauma.
Conclusions:
Treatment needs are diverse within this group of young people who use drugs. Since girls report higher levels of all mental health problems, and a larger burden of psychosocial risk factors than boys, they are likely to require more comprehensive treatment interventions. The link between more severe drug problems and mental health problems points to the importance of exploring this relationship in treatment. A multidisciplinary approach, in which co-occurring problems can be addressed simultaneously, may be the best treatment form for many young people with drug problems.
An integrated theoretical conceptualization of the cooccurrence of panic disorder and smoking (PDSM) is presented. First, the nature and prevalence of this apparently costly, yet largely unrecognized, co-occurrence of health care problems is described. Second, a theoretical analysis regarding how smoking may negatively impact panic disorder is described. Third, the negative impact of panic disorder on smoking outcomes is discussed. Finally, primary implications of this conceptualization for the research and treatment of individuals with PDSM are elaborated, including the need to assess for smoking among persons with panic disorder and the potential need for specialized treatment approaches.
To assess the prevalence and clinical impact of co-morbid social anxiety disorder (SAD) and alcohol use disorders (AUD, i.e. alcohol abuse and alcohol dependence) in a nationally representative sample of adults in the United States.
Data came from a large representative sample of the US population. Face-to-face interviews of 43093 adults residing in households were conducted during 2001-2002. Diagnoses of mood, anxiety, alcohol and drug use disorders and personality disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule - DSM-IV version.
Lifetime prevalence of co-morbid AUD and SAD in the general population was 2.4%. SAD was associated with significantly increased rates of alcohol dependence [odds ratio (OR) 2.8] and alcohol abuse (OR 1.2). Among respondents with alcohol dependence, SAD was associated with significantly more mood, anxiety, psychotic and personality disorders. Among respondents with SAD, alcohol dependence and abuse were most strongly associated with more substance use disorders, pathological gambling and antisocial personality disorders. SAD occurred before alcohol dependence in 79.7% of co-morbid cases, but co-morbidity status did not influence age of onset for either disorder. Co-morbid SAD was associated with increased severity of alcohol dependence and abuse. Respondents with co-morbid SAD and alcohol dependence or abuse reported low rates of treatment-seeking.
Co-morbid lifetime AUD and SAD is a prevalent dual diagnosis, associated with substantial rates of additional co-morbidity, but remaining largely untreated. Future research should clarify the etiology of this co-morbid presentation to better identify effective means of intervention.
There has been a great deal of research on the comorbidity between alcohol abuse or dependence (AAD) and major depression (MD). However, it is unclear whether AAD increases the risk of MD or vice versa.
To examine the associations between AAD and MD using fixed-effects modeling to control for confounding and using structural equation models to ascertain the direction of causality.
Data were gathered during the course of the Christchurch Health and Development Study, a 25-year longitudinal study of a birth cohort of children from New Zealand (635 boys, 630 girls).
General community sample.
The analysis was based on a sample of 1055 participants with available data on AAD and MD at ages 17 to 18, 20 to 21, and 24 to 25 years.
Symptom criteria for AAD and MD from the DSM-IV at ages 17 to 18, 20 to 21, and 24 to 25 years as well as measures of life stress, cannabis use, other illicit drug use, affiliation with deviant peers, unemployment, partner substance use, and partner criminality at ages 17 to 18, 20 to 21, and 24 to 25 years.
There were significant (P < .001) pooled associations between AAD and MD. Controlling for confounding factors using conditional fixed-effects models and time-dynamic covariate factors reduced the magnitude of these associations, but they remained statistically significant. Structural equation modeling suggested that the best-fitting causal model was one in which AAD led to increased risk of MD.
The findings suggest that the associations between AAD and MD were best explained by a causal model in which problems with alcohol led to increased risk of MD as opposed to a self-medication model in which MD led to increased risk of AAD.
The purpose of the study was to evaluate the prevalence of posttraumatic stress disorder (PTSD) among substance users in the general population.
The St. Louis Epidemiologic Catchment Area study, a survey of psychiatric illness in the general population, collected data on PTSD and substance use with the Diagnostic Interview Schedule. Among the 2,663 respondents, 430 reported a traumatic event that could qualify for PTSD; however, the rate of PTSD was low, 1.35% overall. To evaluate the relationship between PTSD and substance use, respondents were hierarchically classified into one of four substance use categories ranging from polydrug use to alcohol use only. Substance users from each category as well as substance users in general were compared with persons who did not meet the substance use threshold (comparison subjects).
Findings indicate that cocaine/opiate users are over three times as likely as comparison subjects to report a traumatic event, report more symptoms and events, and are more likely to meet diagnostic criteria for PTSD. Physical attack, but not combat-related events, was the most prevalent event reported among cocaine/opiate users. Onset of substance use preceded onset of posttraumatic symptoms, suggesting that substance use predisposes the individual to exposure to traumatic events. When other variables--including antisocial behavior--were controlled, female gender and use of cocaine/opiates predicted PTSD.
These analyses of the co-occurrence of substance abuse and PTSD warrant further study and suggest that PTSD is much more common among substance abusers than was previously known.
Experienced drug takers and clinicians report that cocaine causes panic attacks. This claim is supported by laboratory evidence on the pharmacologic activity of the drug. In this paper, the authors have used an epidemiologic strategy to examine the suspected cocaine-panic association, with interview data from 5,896 adult household residents sampled in the early 1980s and followed prospectively for a collaborative multisite study of mental disorders in five US metropolitan areas: New Haven, Connecticut; Baltimore, Maryland; St. Louis, Missouri; Durham, North Carolina; and Los Angeles, California. The risk of panic attacks was observed to be greater for identified cocaine users in this sample, as compared with subjects who did not use cocaine during the follow-up interval. The cocaine-panic association remained strong after statistical adjustment for preexisting psychiatric conditions, use of alcohol and marijuana, and suspected sociodemographic risk factors for panic attacks. The risk was greatest among cocaine users who reported no marijuana use during the follow-up interval (estimated relative risk = 13.0, 95% confidence interval: 2.24-75.8). The study also identified other determinants for panic attack, including sex, marital status, employment status, job prestige, major depression, and heavy drinking.
Literature on temperament, personality, and mood and anxiety disorders is reviewed. The review is organized primarily around L. A. Clark and D. Watson's (1991b) tripartite model for these disorders, but other influential approaches are also examined. Negative affectivity (or neuroticism) appears to be a vulnerability factor for the development of anxiety and depression, indicates poor prognosis, and is itself affected by the experience of disorder. Positive affectivity (or extraversion) is related more specifically to depression, may be a risk factor for its development, suggests poor prognosis, and also may be affected by the experience of disorder. Other personality dimensions (e.g., anxiety sensitivity, attributional style, sociotropy or dependence, autonomy or self-criticism, and constraint) may constitute specific vulnerability factors for particular disorders. More longitudinal and measurement-based research that jointly examines anxiety and depression is needed.
The authors assessed the relation between personality and mental disorder in a representative birth cohort of 897 men and women. Personality was assessed at age 18 with the Multidimensional Personality Questionnaire (MPQ; A. Tellegen, 1982), and 4 types of mental disorder (affective, anxiety, substance dependence, and conduct disorder) were assessed at ages 15, 18 and 21, using age-appropriate standardized diagnostic interviews. All disorder groups had MPQ profiles that were very different from those of controls. When comorbid cases were excluded, fewer significant differences between diagnosed cases and controls remained. Relations between personality and mental disorder were not affected by the measurement of disorder as continuous versus discrete, gender, or the age at which disorder was diagnosed. Relations between personality and mental disorders appear to be robust, and individual personality differences may be particularly relevant to understanding the most severe (comorbid) expressions of psychopathology.
The relationship between substance use disorders and comorbid psychiatric conditions was investigated among 425 persons in drug treatment who met DSM-III-R criteria for drug dependence. Using the NIMH Diagnostic Interview Schedule to ascertain DSM-III-R psychiatric disorders among these drug dependent subjects, lifetime prevalence rates were 64% for alcohol abuse/dependence, 44% for antisocial personality disorder, 39% for phobic disorders, 24% for major depression, 12% for dysthymia, and 10% for generalized anxiety disorder. We found that antisocial personality disorder and phobias generally had onsets prior to the onset of drug dependence (that is, they were primary disorders). The majority of drug dependent persons with generalized anxiety disorder reported an onset after the onset of drug dependence (that is, they had secondary generalized anxiety). Alcohol dependence, depression, and dysthymia were divided nearly evenly between earlier (primary disorder) and later (secondary disorder). These results are consistent with the body of literature indicating the importance of antisocial syndromes in the etiology of substance abuse and the literature indicating the complex, varying nature of the relationship of psychiatric disorders to substance dependence. Finally, a precise nomenclature for "age of onset," "primary," and "secondary" was developed for this study that is critical to understanding these issues and is recommended for other studies.
The rationale for proposing the "kindling"/stress hypothesis is to provide a conceptual basis for the insidious development and maintenance of alcohol abuse.
An objective of the hypothesis is to emphasize how continued alcohol abuse is linked to progressive neural adaptation. Work has shown that repeated withdrawals from chronic low levels of alcohol sensitize ("kindle") anxiety-like behavior ("anxiety") in rats, a finding consistent with multiple withdrawal kindling of seizure activity. Additionally, stress substitutes for initial cycles of the multiple withdrawal protocol to sensitize withdrawal-induced anxiety, which is indicative that stress is capable of facilitating neuroadaptive processes related to withdrawal. The persistence of adaptation caused by stress and multiple withdrawals is revealed by the appearance of withdrawal-induced anxiety following a future re-exposure to a single 5-day period of alcohol. This persisting adaptation also permits stress to induce anxiety during a period of abstinence--a response not observed in animals without previous exposure to alcohol. Furthermore, stress interacts with repeated withdrawals to enhance voluntary alcohol drinking. Results of other preclinical and clinical studies reported in the literature are integrated with these investigations in support of the proposed hypothesis.
The "kindling"/stress hypothesis is based on the premise that repeated withdrawals from cycles of chronic alcohol exposure contribute to a progressive development of persisting adaptive change that sensitizes withdrawal-induced anxiety and allows stress to evoke symptoms associated with negative affect during abstinence. Thus, these consequences of repeated withdrawals account for the evolution of major characteristics of alcoholism, which include worsened acute withdrawal symptoms and increased stress-induced negative affect during abstinence, both of which enhance the likelihood of relapse--and with relapse an inability to limit an abusive pattern of alcohol intake. The "kindling"/stress hypothesis provides a clear strategy for future studies to explore the advancing neural adaptation proposed to contribute to the pathogenesis of alcoholism.
Little is known about the general population prevalence or severity of DSM-IV mental disorders.
To estimate 12-month prevalence, severity, and comorbidity of DSM-IV anxiety, mood, impulse control, and substance disorders in the recently completed US National Comorbidity Survey Replication.
Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using a fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview.
Nine thousand two hundred eighty-two English-speaking respondents 18 years and older.
Twelve-month DSM-IV disorders.
Twelve-month prevalence estimates were anxiety, 18.1%; mood, 9.5%; impulse control, 8.9%; substance, 3.8%; and any disorder, 26.2%. Of 12-month cases, 22.3% were classified as serious; 37.3%, moderate; and 40.4%, mild. Fifty-five percent carried only a single diagnosis; 22%, 2 diagnoses; and 23%, 3 or more diagnoses. Latent class analysis detected 7 multivariate disorder classes, including 3 highly comorbid classes representing 7% of the population.
Although mental disorders are widespread, serious cases are concentrated among a relatively small proportion of cases with high comorbidity.
Background:
This study addressed the prevalences, correlates, co-morbidity and disability of DSM-IV generalized anxiety disorder (GAD) and other psychiatric disorders in a large national survey of the general population, the National Institute on Alcohol Abuse and Alcoholism's (NIAAA) National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The study presents nationally representative data, for the first time, on prevalence, correlates, co-morbidity, and comparative disability of DSM-IV GAD.
Method:
Data are taken from a large (n=43093) representative sample of the adult USA population.R: Prevalences of 12-month and lifetime GAD were 2.1% and 4.1%. Being female, middle-aged, widowed/separated/divorced, and low income increased risk, while being Asian, Hispanic, or Black decreased risk. GAD was highly co-morbid with substance use, and other anxiety, mood, and personality disorders. Co-morbidity in GAD was not substantially greater than for most other Axis I and II disorders. Disability and impairment in pure GAD were equivalent to pure mood disorders, but significantly greater than in pure substance use, and other anxiety and personality disorders. Individuals co-morbid for GAD and each mood disorder were more disabled than those with pure forms of GAD or each mood disorder. When co-morbid with GAD, nicotine dependence and other anxiety and personality disorders were not associated with increased disability over that associated with pure GAD, but GAD did show increased disability over that due to each of these disorders in pure form.Conclusions. Associations between GAD and Axis I and II disorders were strong and significant, with variation among specific disorders. Results strongly support GAD as an independent disorder with significant impairment and disability.
To present nationally representative data on the lifetime prevalence and comorbidity of 8 specific drug use disorders, separately for abuse and dependence, and mood and anxiety disorders.
Data come from a representative sample (N=43,093) of the United States civilian, noninstitutional population 18 years and older. Diagnoses of mood, anxiety, and drug use disorders were based upon face-to-face personal interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version (AUDADIS-IV).
Associations between specific mood and anxiety disorders and specific drug use disorders were virtually all positive and statistically significant (p<.05). In general, associations were greater for dependence than abuse, greater for mood than anxiety disorders, and in some instances stronger among women than men (p<.05). Large odds ratios also were observed for individuals with comorbid mood and anxiety disorders.
The comorbidity between specific mood and anxiety disorders and specific drug use disorders is pervasive in the U.S. population. Findings suggest that comorbid psychiatric disorders may increase the risk of greater involvement in more serious illicit drug use disorders and that the greater comorbidity between mood and anxiety and drug use disorders among women may reflect greater deviance and psychopathology among drug-using women than men. Findings also suggest that drug abuse prevention and intervention efforts should address other psychiatric conditions. Further, definitions of drug use disorder phenotypes should give careful consideration to other psychiatric conditions as meaningful characteristics of case heterogeneity.
To investigate among adolescents whether (i) drinking motives are related to beverage preference; (ii) beverage preference is related to alcohol use (drinking levels and risky drinking occasions); (iii) the association between beverage preference and alcohol use is moderated or mediated by drinking motives.
Data from a national representative sample of 5379 8th-10th graders in Switzerland (mean age 15.1, SD = 0.95) were analysed using multiple regression analyses. Beverage preference was based on the proportion of a specific beverage in the total amount of drinks consumed at the last drinking occasion. Drinking motives were assessed by the drinking motive questionnaire revised (DMQ-R).
A significant positive association was found between enhancement motives and a preference for beer and spirits; the association was negative with regard to a preference for wine and alcopops. Conformity motives were positively related to a wine preference but negatively to a beer preference. Only a preference for beer and spirits was significantly associated with alcohol use in models that exclude motives. However, the association between beer preference and adolescent alcohol use was mediated by drinking motives. A preference for alcopops and spirits was moderated by motives: social drinkers who preferred alcopops drank less than those who did not prefer alcopops. Coping drinkers who preferred spirits drank more than those who preferred other alcoholic drinks.
Drinking motives are potential explanatory factors for the association between beverage preference and alcohol use. Prevention approaches should target coping motives, particularly for adolescents who show a preference for spirits.
Current and comprehensive information on the epidemiology of DSM-IV 12-month and lifetime drug use disorders in the United States has not been available.
To present detailed information on drug abuse and dependence prevalence, correlates, and comorbidity with other Axis I and II disorders. Design, Setting, and
Face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule of the National Institute on Alcohol Abuse and Alcoholism in a large representative sample of US adults (N=43093).
Twelve-month and lifetime prevalence of drug abuse and dependence and the associated correlates, treatment rates, disability, and comorbidity with other Axis I and II disorders.
Prevalences of 12-month and lifetime drug abuse (1.4% and 7.7%, respectively) exceeded rates of drug dependence (0.6% and 2.6%, respectively). Rates of abuse and dependence were generally greater among men, Native Americans, respondents aged 18 to 44 years, those of lower socioeconomic status, those residing in the West, and those who were never married or widowed, separated, or divorced (all P<.05). Associations of drug use disorders with other substance use disorders and antisocial personality disorder were diminished but remained strong when we controlled for psychiatric disorders. Dependence associations with most mood disorders and generalized anxiety disorder also remained significant. Lifetime treatment- or help-seeking behavior was uncommon (8.1%, abuse; 37.9%, dependence) and was not associated with sociodemographic characteristics but was associated with psychiatric comorbidity.
Most individuals with drug use disorders have never been treated, and treatment disparities exist among those at high risk, despite substantial disability and comorbidity. Comorbidity of drug use disorders with other substance use disorders and antisocial personality disorder, as well as dependence with mood disorders and generalized anxiety disorder, appears to be due in part to unique factors underlying each pair of these disorders studied. The persistence of low treatment rates despite the availability of effective treatments indicates the need for vigorous educational efforts for the public and professionals.
An integrated theoretical conceptualization of the cooccurrence of panic disorder and smoking (PDSM) is presented. First, the nature and prevalence of this apparently costly, yet largely unrecognized, co-occurrence of health care problems is described. Second, a theoretical analysis regarding how smoking may negatively impact panic disorder is described. Third, the negative impact of panic disorder on smoking outcomes is discussed. Finally, primary implications of this conceptualization for the research and treatment of individuals with PDSM are elaborated, including the need to assess for smoking among persons with panic disorder and the potential need for specialized treatment approaches.
Experimental literature is reviewed to show that reinforcement theory can explain the rewards of drinking behavior, even in the case of the man who is apparently punished by such behavior. Differential effects can be understood by reference to inhibition of response by fear through alcohol, or by depression of other drives which might be inhibited, or by different effects on two incompatible response tendencies, or by the overriding effects of learning. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The present study sought to address a gap in the literature by providing preliminary evidence of the prevalence and clinical characteristics of comorbid generalized anxiety disorder (GAD) and alcohol use disorders (AUD) in a front-line outpatient substance abuse clinic. Of 39 outpatients meeting criteria for an AUD, nearly half (46%) also met criteria for current GAD. The onset of GAD occurred prior to AUD in 67% of comorbid cases, with an average time lag of 12.5 years among individuals with primary GAD. Participants with comorbid GAD–AUD endorsed higher levels of worry severity and worry-reduction alcohol expectancies, and 55.6% of comorbid participants had a history of suicide attempts. Groups did not differ on anxiety sensitivity, social anxiety, or depression. Comorbid participants were more likely to indicate that worry interfered with their substance abuse treatment, and to indicate interest in concurrent treatment targeting their worry. Study findings provide initial evidence that GAD may be a prevalent and relevant factor among individuals with AUD seeking outpatient substance abuse treatment.
Although numerous studies have demonstrated an association between PTSD and substance use disorders, little is known about the causal nature of this relationship. In this article, we put forth and test major causal hypotheses. Specific hypotheses to be tested include self-medication of PTSD symptoms, substance users’ high risk of exposure to traumatic events, and drug users’ increased susceptibility to PTSD following a traumatic exposure. We also examine the possibility of an indirect pathway linking drug use disorders and PTSD via a shared vulnerability. Evidence for these causal hypotheses is evaluated using Hill’s criteria for causal inference: strength, consistency, specificity, temporality, gradient, plausibility, coherence, experimental evidence, and analogy. We present data analytic strategies that exploit information about the temporal order of PTSD and drug use disorders to shed light on their causal relationship. Finally, we present findings on the PTSD/drug use disorder association from an epidemiologic study of young adults.
Our objective was to evaluate the prevalence and temporal sequence of co-occurrence of anxiety disorders with opiate dependence in order to better define the relationship between these two disorders and to improve diagnosis and treatment. The search used Medline and Toxibase up to January 1, 2009, and was based on a systematic review method. Eighteen studies were found. Prevalence of anxiety disorders assessed by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria was high in opiate-dependent treated persons (lifetime prevalence ranged from 26% to 35%). Among anxiety disorders, phobic disorders have been shown to often precede the onset of opiate dependence. The identification of substance-induced versus independent anxiety disorder has important treatment implication. The monitoring of anxiety symptoms after several weeks of abstinence may allow physicians to determine the relationship between dependence and anxiety and make a reliable diagnosis of any initial anxious disorder. Specific management of anxiety disorder may then be used.
Neuroticism has been hypothesized to be a non-specific risk factor for both anxiety and unipolar mood disorders whereas some cognitive and personality-cognitive vulnerabilities have been hypothesized to be more specific to depression. Using a retrospective design with a sample of 575 high school juniors, we tested three competing models of the associations among these variables. Both neuroticism and the cognitive and personality-cognitive vulnerabilities had significant zero-order associations with rates of past diagnoses of both anxiety and unipolar mood disorders. Neuroticism had significant unique associations with past anxiety disorders and comorbid anxiety and unipolar mood disorders whereas the other vulnerabilities did not. In addition, gender interacted with neuroticism but not with the other vulnerabilities in associating with past diagnoses of mood disorders, showing that neuroticism is more highly associated with past unipolar mood diagnoses in males than in females. Finally, the cognitive and personality-cognitive vulnerabilities overlapped with substantial portions of the variance that neuroticism shared with diagnoses. These results suggest that, at least for retrospective associations with past anxiety and unipolar mood disorders, the cognitive and other personality-cognitive vulnerabilities are non-specific facets of neuroticism.
It is well-established that coping and enhancement drinking motives predict college student drinking and that personality traits predict drinking motives. Little is known, however, about personality and drinking patterns among individuals who drink for both enhancement and coping reasons. University students in the current study completed questionnaires assessing personality, alcohol use, and drinking motives. Past year drinkers (N=138) were categorized into one of four groups: coping, enhancement, coping + enhancement, and noninternally motivated drinkers. Drinking was lower among noninternally motivated drinkers and higher among coping motivated drinkers; coping + enhancement motivated drinkers reported drinking at levels most consistent with the coping group. Coping motivated drinkers reported higher levels of neuroticism, negative affect, and anxiety sensitivity, and lower levels of positive affect; coping + enhancement motivated drinkers were not significantly different from the other groups on personality traits. Although coping + enhancement motivated drinkers may be at risk for problem drinking, they may be difficult to identify via personality measures.
The idea that people suffering from anxiety have a proclivity to consume alcohol to relieve their symptoms is supported by reports showing high comorbidity rates of alcohol and anxiety problems. The authors reviewed relevant epidemiologic surveys, family studies, and field studies and conclude that the relationship between alcohol problems and anxiety appears to be variable among the anxiety disorders. In agoraphobia and social phobia, alcohol problems appear more likely to follow from attempts at self-medication of anxiety symptoms, but panic disorder and generalized anxiety disorder may be more likely to follow from pathological alcohol consumption. Simple phobia does not appear to be related to alcohol problems in any meaningful way.
To examine the continuity of substance use disorder (SUD) in adolescent women during the transition to adulthood and to assess psychosocial functioning associated with SUD. Furthermore, to examine concurrent and longitudinal relationships' between major depressive disorder (MDD) and SUD during this developmental transition.
One hundred fifty-five women, aged 17 to 19 years, were recruited from 3 high schools and were followed annually for 5 years. Comprehensive diagnostic and psychosocial assessments were performed with standardized instruments. The primary outcome measures included MDD and SUD during follow-up in those with and without a prior history of MDD or SUD, and psychosocial functioning associated with SUD.
The 5-year incidence of SUD was 9.6% and, by the end of follow-up, 18.7% had a lifetime episode. Prior SUD significantly increased the risk for SUD diagnosis during the study. Co-occurrence of MDD and SUD was high during adolescent and early adult years, with episodes of both disorders occurring in close temporal proximity. SUD also predicted MDD over time, but the reverse was not true. After controlling for the effects of MDD on social adjustment, SUD was associated with significant impairment in school functioning.
These results suggest that the risk for new onset and recurrence of SUD is high during the developmental transition to adulthood. SUD during this developmental period is associated with significant school-related problems. The findings also suggest that SUD and MDD frequently co-occur during the post-high school transition in women. Given the significant psychosocial dysfunction associated with these illnesses, early detection of these problems and effective intervention are crucial.
We examine whether exposure to traumatic events increases the risk for nicotine dependence or alcohol or other drug use disorders, independent of posttraumatic stress disorder (PTSD).
Data come from a longitudinal epidemiologic study of young adults in southeast Michigan. Prospective data covering a 10-year period and retrospective lifetime data gathered at baseline were used to estimate the risk for onset of substance use disorders in persons with PTSD and in persons exposed to trauma without PTSD, compared with persons who have not been exposed to trauma. The National Institute of Mental Health Diagnostic Interview Schedule for DSM-III-R was used. Logistic regression was used to analyze the prospective data, and Cox proportional hazards survival analysis with time-dependent variables was applied to the lifetime data.
The prospective and retrospective data show an increased risk for the onset of nicotine dependence and drug abuse or dependence in persons with PTSD, but no increased risk or a significantly (P =.004) lower risk (for nicotine dependence, in the prospective data) in persons exposed to trauma in the absence of PTSD, compared with unexposed persons. Exposure to trauma in either the presence or the absence of PTSD did not predict alcohol abuse or dependence.
The findings do not support the hypothesis that exposure to traumatic events per se increases the risk for substance use disorders. A modestly elevated risk for nicotine dependence might be an exception. Posttraumatic stress disorder might be a causal risk factor for nicotine and drug use disorders or, alternatively, the co-occurrence of PTSD and these disorders might be influenced by shared risk factors other than traumatic exposure.
Little is known about lifetime prevalence or age of onset of DSM-IV disorders.
To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication.
Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview.
Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older.
Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders.
Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups.
About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
Although alcohol dependence (AD) and major depression (MD) are highly co-morbid, their causal relationship is unclear. In this longitudinal study, we used a genetically informative population-based twin sample to examine the age-at-onset distributions and the temporal relationship of AD and MD.
Our sample included 7477 twins, whose diagnoses of AD and MD and age-at-onset information were obtained from structured interviews. Individual-level survival analyses were conducted based on 2603 monozygotic (MZ) twins, and co-twin diagnosis was included in models as an index of familiar liability to AD and MD.
The age-at-onset distributions of AD and MD differed substantially. Most onsets of AD were in young adulthood, whereas MD had a flatter distribution across age. Most subjects, especially women, had an onset of MD preceding AD. Prior MD significantly affected risk for developing AD, and this risk decreased over time. By contrast, preceding AD had negligible effects on the risk for future MD. Familial risk was transmitted within disorders but there was little evidence of additional familial liability shared across disorders.
Risk for developing AD was substantially increased by a prior episode of MD. The association was only partially accounted for by familial factors, providing support for a direct causal effect such as self-medication. The etiologic path from AD to MD was insignificant.
Although the frequency of social phobia is high among alcoholic patients, this anxiety disorder is often neglected because treatment tends to be focused exclusively on alcohol dependence.
A total of 300 hospitalized alcoholic patients were interviewed using Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and Liebowitz Social Anxiety Scale as well a questionnaire to check the use of medication for social phobia among alcoholics and the relationship between social phobia and alcohol use.
A prevalence of 30.6% was found for specific phobia, 24.7% for social phobia, 22.2% for anxiety disorder induced by alcohol, 19.3% for generalized anxiety disorder, 5% for obsessive-compulsive disorder, 4.6% for posttraumatic stress disorder, and 2% for panic disorder with agoraphobia. Social phobia preceded alcohol dependence in 90.2% of the patients. The frequency of the use of medication for social phobia among social phobic alcoholics was 20.3%.
The study confirms the high prevalence of anxiety disorders among alcoholics, particularly of social phobia. It also suggests that social phobia precedes alcohol dependence but shows that the use of medication for social phobia is still infrequent. Further studies are required to check if the failure to identify this comorbidity can make the recovery of alcoholics even more difficult.
Social anxiety disorder (SAD) is highly comorbid with alcohol use disorders (AUDs) and cannabis dependence. However, the temporal sequencing of these disorders has not been extensively studied to determine whether SAD serves as a specific risk factor for problematic substance use. The present study examined these relationships after controlling for theoretically-relevant variables (e.g., gender, other Axis I pathology) in a longitudinal cohort over approximately 14 years. The sample was drawn from participants in the Oregon Adolescent Depression Project. After excluding those with substance use disorders at baseline, SAD at study entry was associated with 6.5 greater odds of cannabis dependence (but not abuse) and 4.5 greater odds of alcohol dependence (but not abuse) at follow-up after controlling for relevant variables (e.g., gender, depression, conduct disorder). The relationship between SAD and alcohol and cannabis dependence remained even after controlling for other anxiety disorders. Other anxiety disorders and mood disorders were not associated with subsequent cannabis or alcohol use disorder after controlling for relevant variables. Among the internalizing disorders, SAD appears to serve as a unique risk factor for the subsequent onset of cannabis and alcohol dependence.
Understanding the temporal sequencing of alcohol use disorders (AUDs) and comorbid mood and anxiety disorders may help to disentangle the etiological underpinnings of comorbidity. Methodological limitations of previous studies, however, may have led to inconsistent or inconclusive findings.
To describe the temporal sequencing of the onset of AUDs relative to the onset of specific comorbid mood and anxiety disorders using a large, nationally representative survey.
AUD onset tended to follow the onset of 2 of the 9 mood and anxiety disorders (specific and social phobia). The onset of alcohol abuse tended to precede the onset of 5 of the 9 mood and anxiety disorders (GAD, panic, panic with agoraphobia, major depression, and dysthymia), whereas the onset of alcohol dependence tended to precede the onset of only 2 of the 9 mood and anxiety disorders (GAD and panic). Lag times between primary and subsequent disorders generally ranged from 7 to 16 years. Comorbid individuals whose alcohol dependence came after panic with agoraphobia, hypomania, and GAD had increased risk of persistent alcohol dependence.
Alcohol abuse, but not dependence, precedes many mood and anxiety disorders. If the primary disorder does in fact play a causative or contributing role in the development of the subsequent disorder, this role can best be described as "temporally distal." However, in assessing the risk for persistent alcohol dependence, clinicians should not only consider the type of comorbid mood/anxiety disorder, but also the temporal ordering of these disorders.
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