Substance abuse and personality disorder comorbidity in adolescent outpatients: Are girls more severely ill than boys?

Background

Substance use disorders (SUDs) constitute a major health problem and are associated with an extensive psychiatric comorbidity. Personality disorders (PDs) and SUDs commonly co-occur. Comorbid PD is characterized by more severe addiction problems and by an unfavorable clinical outcome. The present study investigated the prevalence of SUDs, PDs and common Axis I disorders in a sample of adolescent outpatients. We also investigated the association between PDs and SUDs, and how this association was influenced by adjustment for other Axis I disorders, age and gender.

Methods

The sample consisted of 153 adolescents, aged 14–17 years, who were referred to a non-specialized mental health outpatient clinic with a defined catchment area. SUDs and other Axis I conditions were assessed using the mini international neuropsychiatric interview. PDs were assessed using the structured interview for DSM-IV personality.

Results

18.3 % of the adolescents screened positive for a SUD, with no significant gender difference. There was a highly significant association between number of PD symptoms and having one or more SUDs; this relationship was practically unchanged by adjustment for gender, age and presence of Axis I disorders. For boys, no significant associations between SUDs and specific PDs, conduct disorder (CD) or attention deficit hyperactivity disorder (ADHD) were found. For girls, there were significant associations between SUD and BPD, negativistic PD, more than one PD, CD and ADHD.

Conclusions

We found no significant gender difference in the prevalence of SUD in a sample of adolescents referred to a general mental health outpatient clinic. The association between number of PD symptoms and having one or more SUDs was practically unchanged by adjustment for gender, age and presence of one or more Axis I disorders, which suggested that having an increased number of PD symptoms in itself may constitute a risk factor for developing SUDs in adolescence. The association in girls between SUDs and PDs, CD and ADHD raises the question if adolescent girls suffering from these conditions may be especially at risk for developing SUDs. In clinical settings, they should therefore be monitored with particular diligence with regard to their use of psychoactive substances.

Below:  PD symptoms in adolescents with SUD and other Axis I disorders. PD Symptoms any PD criteria meeting a score of 1,2 or 3 when measured with the SIDP-IV; SUD substance use disorders; alcohol and/or drug abuse or dependence. Alcohol alcohol abuse or dependence; CannabisCannabis abuse or dependence; Anxiety anxiety disorders, simple phobias, generalized anxiety disorder, panic disorder, agoraphobia, social phobia and post-traumatic stress disorder; Mood mood disorders, dysthymia and major depressive episode; CD conduct disorder; ADHDattention deficit hyperactivity disorder. ** p < 0.05

Full article at:   http://goo.gl/szh4O2

By:  Hans Ole Korsgaard, Svenn Torgersen, Tore Wentzel-Larsen, and Randi Ulberg

Department for Child and Adolescent Mental Health (The Nic Waal Institute), Lovisenberg Diakonale Hospital, Oslo, Norway

Department of Psychology, University of Oslo, Oslo, Norway

Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway

Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway

Vestfold Hospital Trust, Tønsberg, Norway

Institute of Clinical Medicine, University of Oslo, Oslo, Norway

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Neighborhood Context and Binge Drinking by Race and Ethnicity in New York City

BACKGROUND:

Neighborhood context is associated with binge drinking and has significant health, societal, and economic costs. Both binge drinking and neighborhood context vary by race and ethnicity. We examined the relations between neighborhood characteristics-neighborhood norms that are accepting of drunkenness, collective efficacy, and physical disorder-and binge drinking, with a focus on examining race and ethnic-specific relationships.

METHODS:

Respondent data were collected through 2005 random digit-dial-telephone survey for a representative sample of New York City residents; neighborhood data were based on the 2005 New York City Housing and Vacancy Survey. Participants were 1,415 past-year drinkers; Whites (n = 877), Blacks (n = 292), and Hispanics (n = 246). Generalized estimating equations were used to estimate population average models.

RESULTS:

For the overall sample, neighborhood norms that were more accepting of drunkenness were associated with greater binge drinking; collective efficacy and physical disorder were not significant. However, when examining this by race/ethnicity, greater collective efficacy and greater physical disorder were associated with less binge drinking for Whites only. Neighborhood norms that were more accepting of drunkenness were associated with binge drinking among Whites and, while not significant (perhaps due to power), the associations were similar for Hispanics and slightly lower for Blacks.

CONCLUSIONS:

Overall, results suggest that neighborhood characteristics and binge drinking are shaped, in part, by factors that vary across race/ethnicity. Thus, disaggregating data by race/ethnicity is important in understanding binge drinking behaviors.

Purchase full article at:   http://goo.gl/AeTW66

By:  Chauhan P1, Ahern J2, Galea S3, Keyes KM4.

• 1Department of Psychology, John Jay College of Criminal Justice, New York, New York.
• 2Department of Epidemiology , University of California, Berkeley, Berkeley, California.
• 3School of Public Health, Boston University, Boston, Massachusetts.
• 4Department of Epidemiology, Columbia University, New York, New York. 
• Alcohol Clin Exp Res. 2016 Apr;40(4):785-93. doi: 10.1111/acer.13011. Epub 2016 Mar 10.

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Social-Context Factors, Refusal Self-Efficacy, and Alcohol Use among Female Sex Workers in China

Excessive alcohol use is considered as a health risk behavior that may produce negative health outcomes. Examining predictors of alcohol use in a social or individual context can advance understanding of why people indulge in alcohol use. 

Our research on female sex workers (FSWs) examined associations among several social-context factors (alcohol use by family members, alcohol use by peers, and client-perpetrated pressure or violence), refusal self-efficacy, and alcohol use. 

Seven hundred FSWs were recruited from two cities in Southern China. Structural equation modeling (SEM) was used to analyze the direct effects of alcohol use by family members, alcohol use by peers, and client-perpetrated pressure or violence on FSWs’ alcohol use. In addition, the mediation effects of refusal self-efficacy were also examined in the SEM model. 

Results showed that alcohol use by family members and alcohol use by peers significantly predicted FSWs’ alcohol use; the prediction effect of alcohol use by peers on FSWs’ alcohol use was stronger than that of alcohol use by family members; client-perpetrated pressure or violence directly predicted FSWs’ alcohol use and indirectly influenced FSWs’ alcohol use through refusal self-efficacy; refusal self-efficacy directly predicted FSWs’ alcohol use. Administrators of effective intervention programs focused on alcohol use in China should adopt a multilevel approach to reduce negative social influences, particularly the influence from peer, and sex work establishments on FSWs’ alcohol use. 

Meanwhile, training to improve refusal self-efficacy should also be included in intervention programs to reduce FSWs’ alcohol use.

Below:  Associations among social-context factors, refusal self-efficacy and alcohol use of FSWs (N=688)

Full article at: http://goo.gl/kwYF36

By:  Shaobing Su,1 Xiaoming Li,2,* Danhua Lin,3 Chen Zhang,4 Shan Qiao,2 and Yeujiao Zhou5

¹ Eliot-Pearson Department of Child and Human Development, Tufts University, Medford, MA 02155, USA.

² Carman and Ann Adams Department of Pediatrics Prevention Research Center, Wayne State University School of Medicine, Detroit, MI 48201, USA

³ Institute of Developmental Psychology, Beijing Normal University, Beijing, 100875, China

⁴ Division of Epidemiology, Vanderbilt Institute of Global Health, Nashville, TN, USA

⁵ Center for Disease Control and Prevention, Guangxi, China.

Psychol Health Med. 2015; 20(8): 889–895.

Published online 2014 Oct 15. doi:  10.1080/13548506.2014.966727

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Risk of Heavy Drinking among Sexual Minority Adolescents: Indirect Pathways through Sexual Orientation-Related Victimization & Affiliation with Substance-Using Peers

AIMS:

To test two indirect pathways through which sexual minority adolescents (SMAs) may be at risk for heavy episodic drinking (HED) including a socialization pathway via substance-using peer affiliations and social marginalization pathway via sexual minority-specific victimization and subsequent substance-using peer affiliations.

DESIGN:

Analysis of the first three waves (six-months apart) of a longitudinal adolescent health risk study (2011-2014). Participants were referred by medical providers or a screening system in providers' waiting rooms.

SETTING:

Two large urban adolescent health clinics in Pennsylvania and Ohio, USA.

PARTICIPANTS:

290 adolescents (ages 14-19, mean: 17) who were 71% female, 33% non-Hispanic White, and 34% SMAs.

MEASUREMENTS:

Self-reported sexual minority status (wave 1) and affiliation with substance-using peers (waves 1 and 2), and latent sexual-minority specific victimization (waves 1 and 2) and HED (waves 1 and 3) variables.

FINDINGS:

Using mediation analyses in a structural equation modeling framework, there was a significant indirect effect of sexual minority status (wave 1) on HED (wave 3) via affiliation with substance-using peers (wave 2; indirect effect = 0.03, 95%CI: 0.01, 0.07), after accounting for the indirect effect of sexual-orientation related victimization (wave 2; indirect effect = .10, 95%CI: 0.02-0.19). The social marginalization pathway was not supported as victimization (wave 1) was not associated with affiliation with substance-using peers (wave 2; β = -.04, p = .66). Sex differences in the indirect effects were not detected (ps > .10).

CONCLUSIONS:

Sexual minority adolescents in the US appear to exhibit increased heavy episodic drinking via an indirect socialization pathway including affiliations with substance-using peers and a concurrent indirect pathway involving sexual minority-related victimization. The pathways appear to operate similarly for boys and girls.

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By:  Dermody SS1, Marshal MP2,3, Burton CM2, Chisolm DJ4.

• 1Department of Psychology, University of Pittsburgh.
• 2Department of Psychiatry, School of Medicine, University of Pittsburgh.
• 3Department of Pediatrics, School of Medicine, University of Pittsburgh.
• 4Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital. 
• Addiction. 2016 Mar 28. doi: 10.1111/add.13409. 

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Depression, Posttraumatic Stress & Alcohol Misuse in Young Adult Veterans: The Transdiagnostic Role of Distress Tolerance

BACKGROUND:

Alcohol misuse is common among young adult veterans, and is commonly associated with depression and posttraumatic stress disorder (PTSD). In fact, rates of comorbid depression, PTSD, and problem drinking are high in this population. Although distress tolerance, the capacity to experience and withstand negative psychological states, has been examined as a potential transdiagnostic factor that accounts for the development of mental health disorders, problem drinking, and the comorbidity between these presenting concerns, its role has not been evaluated in a veteran population.

METHODS:

Young adult veterans were recruited for an online survey related to alcohol use. Participants (n=783) completed self-report measures of alcohol use, depression and PTSD symptoms, and distress tolerance. Mediation models were conducted to examine whether distress tolerance mediated the relationship between (1) probable PTSD, (2) probable depression, and (3) comorbid probable PTSD and depression with alcohol misuse. Moderated mediation models were conducted to examine gender as a moderator.

RESULTS:

Significant bivariate associations were observed among mental health symptoms, distress tolerance, and alcohol misuse. Distress tolerance significantly mediated the relationship between probable depression and PTSD (both alone and in combination) and alcohol misuse. Evidence of moderated mediation was present for probable PTSD and probable comorbid PTSD and depression, such that the indirect effect was stronger among males.

CONCLUSIONS:

These results suggest that distress tolerance may be a transdiagnostic factor explaining the comorbidity of depression and PTSD with alcohol misuse in young adult veterans. These findings may inform screening and intervention efforts with this high-risk population.

Purchase full article at:   http://goo.gl/n2o104

By:  Brooks Holliday S1, Pedersen ER2, Leventhal AM3.

• 1RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States. Electronic address: holliday@rand.org.
• 2RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States.
• 3University of Southern California, Los Angeles, CA 90089, United States. 
• Drug Alcohol Depend. 2016 Apr 1;161:348-55. doi: 10.1016/j.drugalcdep.2016.02.030. Epub 2016 Feb 27.

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The Effect of Glass Shape on Alcohol Consumption in a Naturalistic Setting: A Feasibility Study

BACKGROUND:

Alcohol-related harms are a major public health concern, and population-level interventions are needed to reduce excessive alcohol consumption. Glass shape is an easily modifiable target for public health intervention. Laboratory findings show beer is consumed slower from a straight glass compared to a curved glass, but these findings have not been replicated in a naturalistic setting. The purpose of this study is to investigate the feasibility of conducting a randomised controlled trial investigating the effect of glass shape on alcohol consumption in public houses.

METHODS:

Straight and curved half-pint and pint glasses were delivered to three public houses over two weekends. Glass type was counterbalanced over the two weekends and between the public houses. Monetary takings were recorded as an indirect measure of consumption.

RESULTS:

Replacing stocks of glassware in public houses was feasible and can be enacted in a short space of time. One landlord found the study too disruptive, possibly due to a laborious exchange of glassware and complaints about the new glassware from some customers. One public house's dishwasher could not accommodate the supplied curved full-pint glasses. Obtaining monetary takings from public house staff was a feasible and efficient way of measuring consumption, although reporting absolute amounts may be commercially sensitive. Monetary takings were reduced by 24 % (95 % confidence interval 77 % reduction to 29 % increase) when straight glasses were used compared to curved glasses.

CONCLUSIONS:

This study shows that it is feasible to carry out a trial investigating glass shape in a naturalistic environment, although a number of challenges were encountered. Brewery owners and landlords are willing to engage with public health research in settings where alcohol is consumed, such as public houses. Good communication with stakeholders was vital to acquire good data, and highlighting the potential commercial benefits of participating was vital to the study's success. A full scale evaluation of the effects of glass shape on alcohol consumption could inform local and national policy.

Below:  Shapes of glasses. a Sahm’s Tokyo glass, pint glass: Art. Nr. 1005428 and half-pint glass: Art. Nr. 1005930. b Arcoroc’s Geo glass 20 oz (58.5 cl) glass. c Paşabahçe’s highball long drinking glass can hold 285 cc, 9.5 oz (US) and 10.25 oz (UK)

Full article at:   http://goo.gl/prVkw8

By:  Troy DM1, Maynard OM1, Hickman M2, Attwood AS1, Munafò MR1.

• 1MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK ; UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol BS8 1TU, UK.
• 2School of Social and Community Medicine, University of Bristol, Bristol, UK. 
• Pilot Feasibility Stud. 2015 Dec 1;1(1):27.

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Prevalence of Binge Drinking & Associated Behaviours among 3,286 College Students in France

BACKGROUND:

Studies conducted on characteristics of binge drinking and associated behaviours in college student populations are scarce especially in France. Hence, it is important to identify risk factors for binge drinking at university, especially those which may be changed. The aim of this study was to assess the prevalence of binge drinking and associated behaviours across a large sample of college students in Upper Normandy (France).

METHODS:

A cross sectional study was performed between November 2009 and February 2013 and data on socioeconomic characteristics and behavioural risk factors were collected: alcohol (consumption and misuse of alcohol, occasional and frequent binge drinking), tobacco, cannabis, cyberaddiction, stress and depression. An anonymous self-administered questionnaire was filled out by college student volunteers from Upper Normandy (France) either online or by paper questionnaire. Analyses were performed using multivariate logistic regression models.

RESULTS:

A total of 3286 students were included. The mean (Standard Deviation (SD)) age of students was 20.8 years (SD = 2.1) with a male-female ratio of 0.60. The prevalence of binge drinking in the never, occasional and frequent categories was respectively 34.9 %, 51.3 %, and 13.8 %. The mean number of units of alcohol consumed per week (except BD episodes) was 0.78 for never, 3.7 for occasional and 10.5 for frequent binge drinkers (p < 0.0001). A positive relation was observed between frequent binge drinking and the following: male gender, living in rented accommodation, attending business school, regular practice of sport, smoking, occasional cannabis use, and alcohol abuse. A negative association was observed between frequent binge drinking and grant holder status, living in couples, and stress.

CONCLUSIONS:

This study highlights the spread of binge drinking among college students and identifies student populations at risk: male gender, living in rented accommodation, regular practice of sport, and other risk behaviours such as use of tobacco, cannabis and alcohol. These behaviours increase with the frequency of binge drinking.

Below:  Frequency of consumption of binge drinking according to the gender of college students (France; 2010-2012) (N=3286)

Full article at:   http://goo.gl/xH28Bs

By:  Tavolacci MP1,2, Boerg E3, Richard L4, Meyrignac G5, Dechelotte P6,4, Ladner J6,7.

• 1Rouen University Hospital, Clinical Investigation Center 1404, 1 Rue de Germont, Rouen Cedex, 76031, France. marie-pierre.tavolacci@chu-rouen.fr.
• 2Rouen University Hospital, IRIB, Inserm U1073, Rouen, France. marie-pierre.tavolacci@chu-rouen.fr.
• 3Rouen University Hospital, Clinical Investigation Center 1404, 1 Rue de Germont, Rouen Cedex, 76031, France.
• 4Department of Nutrition, Rouen University Hospital, Rouen, France.
• 5Department of Preventive Medicine of University, Rouen University, Rouen, France.
• 6Rouen University Hospital, IRIB, Inserm U1073, Rouen, France.
• 7Department of Epidemiology and Health Promotion, Rouen University Hospital, Rouen, France. 
• BMC Public Health. 2016 Feb 23;16(1):178. doi: 10.1186/s12889-016-2863-x.

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Association of Alcohol Misuse with Sexual Identity and Sexual Behavior in Women Veterans

BACKGROUND:

Sexual minority women report greater alcohol misuse than heterosexual women in the general population, with more pronounced differences found among younger age groups. It is unknown whether these differences exist among women veterans.

OBJECTIVE:

We evaluated differences in alcohol misuse across two dimensions of sexual orientation (identity and behavior) among women veterans, and examined whether these differences were modified by age.

METHODS:

Women veterans were recruited via the internet to participate in an online survey. Participants provided information on their self-reported sexual identity and behavior and responded to the validated 3-item Alcohol Use Disorders Identification Test-Consumption questionnaire (AUDIT-C). Regression models were used to compare the prevalence of alcohol misuse (AUDIT-C ≥ 3) and severity (AUDIT-C scores) across sexual identity and behavior and to test effect modification by age.

RESULTS:

Among the 702 participants (36% lesbian/bisexual), prevalence and severity of alcohol misuse varied by both sexual identity and behavior, but there were significant interactions with age. Prevalence and severity of alcohol misuse were higher among relatively younger self-identified lesbians compared to heterosexual women. Similarly, both prevalence and severity of alcohol misuse were generally higher among younger women who had any sex with women compared to those who had sex only with men. Conclusions/Importance: In this online study of women veterans, younger sexual minority women were more likely to screen positive for alcohol misuse, and they had more severe alcohol misuse, than their heterosexual counterparts. Prevention and treatment efforts focused specifically on sexual minority women veterans may be needed.

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By:  Lehavot K1,2,3,4, Williams EC1,4, Millard SP2, Bradley KA1,4,5, Simpson TL2,3,6.

• 1a VA Health Services Research & Development, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound , Seattle , Washington , USA.
• 2b Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System , Seattle , Washington , USA.
• 3c Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle , Washington , USA.
• 4d Department of Health Services, University of Washington , Seattle , Washington , USA.
• 5e Group Health Research Institute , Seattle , Washington , USA.
• 6f Center of Excellence in Substance Abuse Treatment and Education (CESATE), VA Puget Sound Health Care System , Seattle , Washington , USA. 
• Subst Use Misuse. 2016 Jan 22:1-14.

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