Christopher S. Martin’s research while affiliated with University of Pittsburgh and other places

Objective: Recent studies have examined the extent to which alcohol dependence (AD) criteria prospectively predict the course of AD. Critically, these studies have lacked a developmental perspective. However, the differential performance of criteria by age might indicate overendorsement in younger individuals. The current study examined AD criteria in terms of persistence and prediction of AD course and alcohol use by age in order to identify criteria that are likely to be overly endorsed by younger individuals. Method: The current study used longitudinal data from the National Epidemiologic Survey on Alcohol and Related Conditions to depict age differences in rates of new onset, recurrence, and persistence for each AD criterion, thereby showing how these three factors contribute to the overall age-prevalence curve of each criterion. Additionally, we tested age moderation of the predictive association between each criterion at baseline and new onset, recurrence, and persistence of syndromal AD. Results: Some criteria (particularly, persistent desire or unsuccessful efforts to cut down or control drinking, and drinking despite physical/psychological problems) are both less persistent and less predictive of AD course among younger adults compared to older adults. Conclusions: These findings raise the possibility of elevated rates of false-positive AD among younger adults and suggest ways to improve the assessment of AD criteria. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background and aims: Nearly all of the research conducted on high intensity drinking has focused on college and school-based samples, with recent calls for research to understand this risky drinking pattern in non-school-based samples and across time. This study aimed to characterize predictors and consequences of non-binge drinking, age- and gender-adjusted binge drinking (Level I), and drinking at levels representing 2 or more times (Level II), and 3 or more times the Level I binge threshold (Level III) in a clinical sample of adolescents followed into young adulthood. Design: Cross-sectional associations between non-binge drinking, binge levels, and negative alcohol-related consequences were examined during adolescence; prospective analyses tested whether adolescent non-binge drinking and binge levels predicted alcohol use disorder (AUD) symptoms in young adulthood, and whether changes in drinking motives over time were associated with binge levels in young adulthood. Setting: US clinical settings. Participants: 432 adolescents (ages 12-18) with alcohol-related problems followed into young adulthood (ages 19-25). Measurements: Lifetime Drinking History, Structured Clinical Interview for DSM AUDs, and Inventory of Drinking Situations. Findings: Results were generally consistent with a distinction between Binge Level I versus Levels II-III on various negative alcohol-related consequences in adolescence (ps<.05) that were maintained in young adulthood (ps<.01). The maintenance of relatively high endorsement of enhancement and social motives over time was associated with Binge Levels II-III in young adulthood (ps<.001); decreases in coping motives were associated with less risky drinking in adulthood (p=.003). Conclusions: Among US adolescents with alcohol-related problems who were followed up in young adulthood (19-25 years), standard threshold binge drinking (5+ drinks per occasion; Level I) was generally associated with fewer alcohol-related consequences and problem behaviors than binge drinking at two or more times (Level II) or three or more times (Level III) the standard binge threshold.

Psychiatric diagnostic systems, such as The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), use expert consensus to determine diagnostic criteria sets and rules (DCSRs), rather than exploiting empirical techniques to arrive at optimal solutions (OS). Our project utilizes complete enumeration (i.e., generating all possible subsets of item combinations A and B with all possible thresholds, T) to evaluate all possible DCSRs given a set of relevant diagnostic data. This method yields the entire population distribution of diagnostic classifications (i.e., diagnosis of the disorder versus no diagnosis) produced by a set of dichotomous predictors (i.e., diagnostic criteria). Once unique sets are enumerated, optimization on some predefined correlate or predictor will maximally separate diagnostic groups on one or more, disorder-specific “outcome” criteria. We used this approach to illustrate how to create a common Substance Use Disorder (SUD) DCSR that is applicable to multiple substances. We demonstrate the utility of this approach with respect to alcohol use disorder and Cannabis Use Disorder (CUD) using DSM-5 criteria as input variables. The optimal SUD solution with a moderate or above severity grading included four criteria (i.e. 1) having a strong urge or craving for the substance (CR), 2) failure to fulfill major role obligations at work school or home (FF), 3) continued use of the substance despite social or interpersonal problems caused by the substance use (SI) and 4) physically hazardous use (HU)) with a diagnostic threshold of two. The derived DCSR was validated with known correlates of SUD and performed as well as DSM-5. Our findings illustrate the value of using an empirical approach to what is typically a subjective process of choosing criteria and algorithms that is prone to bias. The optimization of diagnostic criteria can reduce criteria set sizes, resulting in decreased research, clinician, and patient burden.

Binge drinking, commonly defined as consuming five or more standard drinks per occasion for men and four or more drinks for women, typically begins in adolescence. Adolescents, although they may drink less often, tend to consume higher quantities of alcohol per occasion compared with adults. This developmental difference in pattern of alcohol consumption may result, in part, from maturational changes that involve an adolescent-specific sensitivity to certain alcohol effects and greater propensity for risk-taking behaviors, such as binge drinking. Adolescent binge drinking is associated with a range of acute alcohol-related harms, some of which may persist into adulthood. The prevalence of binge drinking, including high-intensity drinking (i.e., 10 or more and 15 or more drinks per occasion), has declined among adolescents in recent years. Overall, however, the proportion of youth who engage in binge drinking remains high. This article reviews the definition and prevalence of binge drinking in adolescence, trajectories of binge drinking and their correlates, and implications for prevention.

Background Alcohol withdrawal (AW) is an important clinical and diagnostic feature of alcohol dependence. AW has been found to predict a worsened course of illness in clinical samples, but in some community studies AW endorsement rates are strikingly high, suggesting false positive symptom assignments. Little research has examined the validity of the DSM‐5 algorithm for AW, which requires either the presence of at least 2 of 8 sub‐criteria (i.e., autonomic hyperactivity, tremulousness, insomnia, nausea, hallucinations, psychomotor agitation, anxiety, and grand mal seizures), or, the use of alcohol to avoid or relieve these symptoms. Method We used item and algorithm analyses of data from waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; current drinkers, n = 26,946 at wave 1) to study the validity of DSM‐5 AW as operationalized by the Alcohol Use Disorder and Associated Disabilities Interview Schedule‐DSM‐IV (AUDADIS‐IV). Results A substantial proportion of individuals given the AW symptom reported only modest to moderate levels of alcohol use and alcohol problems. Alternative AW algorithms were superior to DSM‐5 in terms of levels of alcohol use and alcohol problem severity among those with AW, group difference effect sizes, and predictive validity at a three‐year follow‐up. The superior alternative algorithms included those that excluded the nausea sub‐criterion; required withdrawal‐related distress or impairment; increased the AW sub‐criteria threshold from 2 to 3 items; and, required tremulousness for AW symptom assignment. Conclusions The results indicate that the DSM‐5 definition of AW, as assessed by the AUDADIS‐IV, has low specificity. This shortcoming can be addressed by making the algorithm for symptom assignment more stringent. This article is protected by copyright. All rights reserved.

During adolescence, problems reflecting cognitive, behavioral and affective dysregulation, such as inattention and emotional dyscontrol, have been observed to be associated with substance use disorder (SUD) risks and outcomes. Prior studies have typically been with small samples, and have typically not included comprehensive measurement of executive dysfunction domains. The relationships of executive dysfunction in daily life with performance based testing of cognitive skills and structural brain characteristics, thought to be the basis for executive functioning, have not been definitively determined. The aims of this study were to determine the relationships between executive dysfunction in daily life, measured by the Behavior Rating Inventory of Executive Function (BRIEF), cognitive skills and structural brain characteristics, and SUD risks, including a global SUD risk indicator, sleep quality, and risky alcohol and cannabis use. In addition to bivariate relationships, multivariate models were tested. The subjects (n = 817; ages 12 through 21) were participants in the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) study. The results indicated that executive dysfunction was significantly related to SUD risks, poor sleep quality, risky alcohol use and cannabis use, and was not significantly related to cognitive skills or structural brain characteristics. In multivariate models, the relationship between poor sleep quality and risky substance use was mediated by executive dysfunction. While these cross-sectional relationships need to be further examined in longitudinal analyses, the results suggest that poor sleep quality and executive dysfunction may be viable preventive intervention targets to reduce adolescent substance use.

Background: Proposed International Classification of Diseases, 11th edition (ICD-11), criteria for substance use disorder (SUD) radically simplify the algorithm used to diagnose substance dependence. Major differences in case identification across DSM and ICD impact determinations of treatment need and conceptualizations of substance dependence. This study compared the draft algorithm for ICD-11 SUD against DSM-IV, DSM-5, and ICD-10, for alcohol and cannabis. Methods: Adolescents (n = 339, ages 14 to 18) admitted to intensive outpatient addictions treatment completed, as part of a research study, a Structured Clinical Interview for DSM SUDs adapted for use with adolescents and which has been used to assess DSM and ICD SUD diagnoses. Analyses examined prevalence across classification systems, diagnostic concordance, and sources of diagnostic disagreement. Results: Prevalence of any past-year proposed ICD-11 alcohol or cannabis use disorder was significantly lower compared to DSM-IV and DSM-5 (ps < 0.01). However, prevalence of proposed ICD-11 alcohol and cannabis dependence diagnoses was significantly higher compared to DSM-IV, DSM-5, and ICD-10 (ps < 0.01). ICD-11 and DSM-5 SUD diagnoses showed only moderate concordance. For both alcohol and cannabis, youth typically met criteria for an ICD-11 dependence diagnosis by reporting tolerance and much time spent using or recovering from the substance, rather than symptoms indicating impaired control over use. Conclusions: The proposed ICD-11 dependence algorithm appears to "overdiagnose" dependence on alcohol and cannabis relative to DSM-IV and ICD-10 dependence, and DSM-5 moderate/severe use disorder, generating potential "false-positive" cases of dependence. Among youth who met criteria for proposed ICD-11 dependence, few reported impaired control over substance use, highlighting ongoing issues in the conceptualization and diagnosis of SUD.

Purpose of Review The Biphasic Alcohol Effects Scale (BAES) is widely used to assess stimulant and sedative alcohol effects. This paper reviews (a) recent measurement developments, (b) behavioral and physiological correlates, and (c) the role of the BAES in refining theories of SR and pharmacological interventions. Recent Findings An abbreviated scale (B-BAES) and a comprehensive measures of alcohol effects (SEAS) demonstrate strong psychometric properties and use of the BAES has helped refine the Differentiator Model of SR. Importantly, both BAES stimulation and sedation robustly predict risk for later alcohol problems, and the BAES has demonstrated utility in examining mechanisms of pharmacotherapy effects. Summary The BAES is the most widely used measure of SR and has informed both theory and practice. Recent findings point to important future directions including the need to (a) examine developmental influences, (b) refine our understanding of FH effects, and (c) consider expansion to capture novel aspects of SR.