Transitions from first substance use to substance use disorders in adolescence: Is early onset associated with a rapid escalation?

ArticleinDrug and alcohol dependence 99(1-3):68-78 · October 2008with86 Reads
DOI: 10.1016/j.drugalcdep.2008.06.014 · Source: PubMed
Abstract
Early substance use (SU) in adolescence is known to be associated with an elevated risk of developing substance use disorders (SUD); it remains unclear though whether early SU is associated with more rapid transitions to SUD. To examine the risk and speed of transition from first SU (alcohol, nicotine, cannabis) to SUD as a function of age of first use. N=3021 community subjects aged 14-24 years at baseline were followed-up prospectively over 10-years. SU and SUD were assessed using the DSM-IV/M-CIDI. (1) The conditional probability of substance-specific SU-SUD transition was the greatest for nicotine (36.0%) and the least for cannabis (18.3% for abuse, 6.2% for dependence) with alcohol in between (25.3% for abuse; 11.2% for dependence). (2) In addition to confirming early SU as a risk factor for SUD we find: (3) higher age of onset of any SU to be associated with faster transitions to SUD, except for cannabis dependence. (4) Transitions from first cannabis use (CU) to cannabis use disorders (CUD) occurred faster than for alcohol and nicotine. (5) Use of other substances co-occurred with risk and speed of transitions to specific SUDs. Type of substance and concurrent use of other drugs are of importance for the association between age of first use and the speed of transitions to substance use disorders. Given that further research will identify moderators and mediators affecting these differential associations, these findings may have important implications for designing early and targeted interventions to prevent disorder progression.
    • "High rates of alcohol and drug use during adolescence overlap with a critical period for brain development, which may partially explain the increased vulnerability of young people to SUD [7][8][9]. Adolescents who initiate alcohol or drug use during adolescence are at increased risk of becoming dependent or having other adverse health consequences in later years [5,[10][11][12][13][14], and risk of developing an SUD is greatest within the first 5 to 10 years of use for alcohol and most illicit drugs [14][15][16] . Thus, the value of providing interventions for adolescent substance misuse and related disorders is particularly high, and developing or refining interventions for young people can have far-reaching benefits that extend into adulthood. "
    [Show abstract] [Hide abstract] ABSTRACT: Adolescence is a key period in the development of substance use and misuse. Substance use typically begins during adolescence, and prevalence rates for many substance use disorders peak before age 21 years. Yet, despite clinical demand, treatments for youth rely almost entirely on psychosocial interventions that yield only modest benefit. One potential way to improve treatment effects is to augment the best available psychosocial interventions with pharmacotherapy. Although pharmacotherapy research has advanced care for adults with substance use disorders, no medication is indicated for adolescents and controlled trials with teenagers are scant. Optimizing treatments for youth will require closing this important gap in medication development research. In this paper, we review the paucity of pharmacotherapy research for adolescent substance misuse, and we discuss how we can leverage human laboratory paradigms and technology to advance our understanding regarding if and how medications may improve treatment options for youths.
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    • "Respecto de la edad del inicio del consumo de sustancias , los datos obtenidos son coherentes con los resultados de estudios longitudinales que informan que el consumo por parte de mujeres es más elevado al comienzo de la adolescencia , mientras que en los varones es más elevado a edades mayores (Chen y Jacobson, 2012). Es más, dado que se asocia una menor edad de inicio de consumo con un pronóstico peor en cuanto al desarrollo de un trastorno por uso de sustancias (Behrendt, Wittchen, Höfler, Lieb, y Beesdo, 2009 ), requiere una atención especial el grupo de adolescentes jóvenes con trastornos mentales y, en particular, las mujeres jóvenes. Los resultados, de manera similar a otros estudios realizados en otros países (Chun et al., 2010; Chung et al., 2003; Sindelar-Manning et al., 2008; Stolle, Sack, y Thomasius, 2009), muestran que el alcohol y el cannabis son las sustancias detectadas más frecuentemente en los servicios de urgencias infantojuveniles. "
    [Show abstract] [Hide abstract] ABSTRACT: In recent years, both the prevalence of drug use and related child and adolescent psychiatric emergencies have risen sharply. There are few studies about the impact on child and adolescent emergency services. This study has a twofold aim. The first is to describe the prevalence of substance use disorders, mental disorders and dual diagnosis (substance use problems plus mental disorder) in adolescents in psychiatric emergency service. The second is to analyze clinical and healthcare differences between patients with dual diagnosis and patients with a mental disorder without substance use disorder.We retrospectively reviewed 4012 discharge forms for emergencies treated at the psychiatric emergency department during the period 2007-2009. We obtained a sample of 1795 visits. This sample was divided into two groups: the dual diagnosis group (n = 477) and the psychiatric disorder group (n = 1318).The dual diagnosis group accounted for 26.5% of psychiatric emergencies analyzed. Compared to the psychiatric disorder group,the dual diagnosis group had significantly more conduct disorders, social problems, involuntariness in the visit, less hospital admissions and less connection with the healthcare network.Adolescents with a dual diagnosis account for a high percentage of visits at child and adolescent psychiatric emergency services. This patient group requires specialized care both at emergency services and in specific units. Accordingly, these units should play a triple role when handling dual diagnosis: detection, brief treatment and referral to a specialised unit.
    Full-text · Article · Mar 2016
    • "Similarly, no research to date has explored whether there is overlap between factors associated with earlier opportunity and those associated with the speed of progression to dependence. These include other substance use (Behrendt et al., 2009), some mental health factors (Behrendt et al., 2011) and gender (Ridenour et al., 2006; Wittchen et al., 2008). Exploring speed of transition to cannabis opportunity will determine whether risk factors for dependence are already exerting influence on drug use behaviours at the start of an individual's cannabis involvement, which has utility for improving understanding of how dependence develops (Hines et al., 2015a). "
    [Show abstract] [Hide abstract] ABSTRACT: Background: There is a developing body of research looking at cannabis use opportunity, but little research examining timing of opportunity to use cannabis. Aims: Identify factors associated with 1) earlier opportunity to use cannabis and 2) faster progression from opportunity to cannabis dependence. Method: Cross-sectional study of 3824 Australian twins and siblings, measuring age of onset of cannabis use opportunity and DSM-IV cannabis dependence. Survival analysis identified factors associated with faster progression to opportunity or dependence. Results: Factors associated with both speed of progression to opportunity and dependence were conduct disorder (opportunity HR 5.57, 95%CI 1.52-20.47; dependence HR 2.49, 95%CI 1.91-3.25), parental drug problems (opportunity HR 7.29, 95%CI 1.74-30.62; dependence HR 3.30, 95%CI 1.63-6.69), weekly tobacco use (opportunity HR 8.57, 95%CI 3.93-18.68; dependence HR 2.76, 95% CI 2.10-3.64), and female gender (opportunity HR 0.69, 95%CI 0.64-0.75; dependence HR 0.44, 95%CI 0.34-0.55). Frequent childhood religious attendance (HR 0.74, 95%CI 0.68-0.80), parental conflict (HR 1.09, 95%CI 1.00-1.18), parental alcohol problems (HR 1.19, 95%CI 1.08-1.30) and childhood sexual abuse (HR 1.17, 95%CI 1.01-1.34) were uniquely associated with transition to opportunity. Depressive episode (HR 1.44, 95%CI 1.12-1.85), tobacco dependence (HR 1.36, 95%CI 1.04 – 1.78), alcohol dependence (HR 2.64, 95%CI 1.53-4.58), other drug use (HR 2.10, 95%CI 1.64-2.69) and other drug dependence (HR 2.75, 95%CI 1.70-4.43) were uniquely associated with progression to dependence. Conclusion: The profile of factors associated with opportunity to use cannabis and dependence only partially overlaps, suggesting targeting of interventions may benefit from being tailored to the stages of drug use.
    Full-text · Article · Jan 2016
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