Polysubstance Use among Minority Adolescent Males Incarcerated for Serious Offenses

BACKGROUND:

Adolescent juvenile offenders are at high risk for problems associated with drug use, including polysubstance use (i.e., use of a variety of drugs). The combination of juvenile offending and polysubstance use presents a significant public and child health concern.

OBJECTIVE:

This study explored polysubstance use among a sample of youth incarcerated for serious offenses. We examined several risk factors for substance use and delinquency (i.e., early and frequent substance use, prior history of arrests, school expulsion, Black ethnicity), as well as the association between aggression and polysubstance use.

METHODS:

Data were collected via questionnaires from 373 serious male juvenile offenders upon intake into a secure locked facility. Youth were on average 16 years old, and minority youth were overrepresented (28.1% Black, 53.1% Latino). Poisson regressions were used to assess the associations between the risk factors, aggression, and polysubstance use.

RESULTS:

Consistent with the literature, Black youth reported less polysubstance use and later age of drug use onset than White and Latino youth. Findings suggest that Latino juvenile offenders and those with an early and problematic pattern of substance use are at heightened risk for polysubstance use. Aggression was not significantly related to polysubstance use, over and above the risk factors.

CONCLUSIONS:

Given that Latino youth experience low rates of treatment for substance use, the development of culturally-sensitive interventions for these youth is needed. Interventions should also be multifaceted to address the multitude of risk factors associated with polysubstance use among juvenile offenders.

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By:  Racz SJ1, Saha S2, Trent M3, Adger H2, Bradshaw CP4, Goldweber A5, Cauffman E6.

• 1Eunice Kennedy Shriver National Institute of Child Health and Human Development.
• 2Johns Hopkins School of Medicine.
• 3Johns Hopkins School of Medicine; Johns Hopkins Bloomberg School of Public Health.
• 4Johns Hopkins Bloomberg School of Public Health; University of Virginia.
• 5Johns Hopkins Bloomberg School of Public Health.
• 6University of California, Irvine. 
• Child Youth Care Forum. 2015 Apr 16;45(2):205-220. Epub 2015 Sep 5.

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Differences in Polysubstance Use Patterns & Drug-Related Outcomes between People Who Inject Drugs Receiving & Not Receiving Opioid Substitution Therapies

AIMS:

To test if polysubstance use profiles and drug-related outcomes differ between those receiving and not receiving opioid substitution therapies (OST), among people who inject drugs (PWID).

DESIGN:

An annual cross-sectional, sentinel sample of PWID across Australia 

SETTING: 

Data came from three years (2011-2013) of the Illicit Drug Reporting System (IDRS).

PARTICIPANTS:

A total of 2,673 participants who injected drugs from the combined national IDRS samples of 2011 (n = 868), 2012 (n = 922), and 2013 (n = 883) 

MEASUREMENTS: 

Latent Class Analysis (LCA) was used to summarise participants' self-reported use of 18 types of substances, with the resulting polysubstance use profiles then associated with participant experience of a number of drug-related outcomes.

FINDINGS:

Polysubstance use profiles exhibiting a broad-range of substance use were generally at increased risk of negative drug-related outcomes whether participants were receiving OST or not: including thrombosis among OST receivers [odds ratio (OR)=2.13, 95% confidence intervals (CI) = 1.09-4.17], injecting with used needle among OST receivers and non-receivers respectively, and violent criminal offences among OST receivers and non-receivers respectively. An important exception was non-fatal overdose which was specifically related to a class of PWID who were not receiving OST and used morphine frequently.

CONCLUSION:

Regardless of opioid substitution therapies usage, people who inject drugs (PWID) who use a broad-range of substances experience greater levels of injecting-related injuries and poorer health outcomes and are more likely to engage in criminal activity than other groups of PWID.

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By:  Betts KS1, Chan G2, McIlwraith F3, Dietze P4, Whittaker E5, Burns L5, Alati R6.

• 1School of Population Health, The University of Queensland, 4th floor, Public Health Building, Herston Rd, Herston, QLD, 4006, Australia.
• 2Centre for Youth Substance Abuse, University of Queensland, Brisbane, Australia.
• 3QADREC, School of Population Health Building, University of Queensland, Brisbane.
• 4MacFarlane Burnet Institute for Medical and Public Health Research, Melbourne, Australia.
• 5National Drug and Alcohol Centre, University of New South Wales, NSW, 2052, Australia.
• 6School of Public Health and Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Australia.
• Addiction. 2016 Feb 8. doi: 10.1111/add.13339.

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Nonmedical Use of Prescription Medication among Adolescents Using Drugs in Quebec

OBJECTIVE:

To determine the prevalence and factors associated with nonmedical use of prescription medication (NMUPM) among adolescents who use drugs (ages 12 to 17 years) in Quebec.

METHOD:

Secondary data analyses were carried out with data from a 6-month study, namely, the 2010-2011 Quebec Health Survey of High School Students-a large-scale survey that sought to gain a better understanding of the health and well-being of young Quebecers in high school. Bivariate and multivariate logistic regression analyses were conducted to study NMUPM among adolescents who use drugs, according to sociodemographic characteristics, peer characteristics, health indicators (anxiety, depression, or attention-deficit disorder [ADD] with or without hyperactivity), self-competency, family environment, and substance use (alcohol and drug use) factors.

RESULTS:

Among adolescents who had used drugs in the previous 12 months, 5.4% reported NMUPM. Based on multivariate analyses, having an ADD, anxiety disorder, low self-esteem, low self-control, low parental supervision, regular alcohol use, and polysubstance use were associated with increased odds of reporting NMUPM.

CONCLUSIONS:

The observed prevalence of NMUPM was lower than expected. However, the associations noted with certain mental health disorders and regular or heavy use of other psychoactive substances are troubling. Clinical implications are discussed.

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By:   Roy É1, Nolin MA2, Traoré I3, Leclerc P4, Vasiliadis HM5.

• 1Full Professor, Faculty of Medicine, Université de Sherbrooke (http://www.usherbrooke.ca/), Sherbrooke, Quebec; Researcher, Research Chair on Addiction, Université de Sherbrooke, Sherbrooke, Quebec.
• 2Graduate Student, Clinical Sciences Program, Université de Sherbrooke, Sherbrooke, Quebec.
• 3Research Assistant, Direction des statistiques de santé, Institut de la statistique du Québec, Montreal, Quebec.
• 4Public Health Officer, Direction de santé publique de l'agence de la santé et des services sociaux de Montréal, Montreal, Quebec.
• 5Associate Professor, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Quebec; Researcher, Charles LeMoyne Hospital Research Centre, Greenfield Park, Quebec.
• Can J Psychiatry. 2015 Dec 1;60(12):556-63.
• 
  
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Unique Versus Cumulative Effects of Physical & Sexual Assault on Patterns of Adolescent Substance Use

The present study assessed the unique versus cumulative effects of physical and sexual assault, on patterns of substance-use in adolescents. It was hypothesized that experiencing a single assault (physical or sexual) when compared with exposure to both physical and sexual assault would be more strongly related to membership of polysubstance use classes. 

From the National Survey of Adolescents-1995 (N= 4023) 918 adolescents (age range=12-17 years, M=14.92, 49.6% female) with reports of physical assault and/or sexual assault were selected. Using information on alcohol-use, cigarette-smoking, chewing tobacco, non-prescribed use of medicines, and drug-use, latent class analysis indicated a three class solution for substance-use, namely, Experimental use, Light polysubstance-use, and Polysubstance-use. 

Multinomial logistic regression analyses indicated that as compared to adolescents exposed to a single type of assault those exposed to both physical and sexual assault were two-to-three times more likely to be in the heavier polysubstance-use class. 

Females were more likely to be members of the polysubstance-use class than of the experimental use class. Gender did not emerge as a significant moderator. 

It was concluded that assessing for single type or co-occurring assault can facilitate identification of adolescents at elevated risk for polysubstance-use.

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By:  Charak R1, Koot HM2, Dvorak RD3, Elklit A4, Elhai JD5.

• 1Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE, USA. Electronic address: charakruby@gmail.com.
• 2Department of Developmental Psychology, VU University Amsterdam, The Netherlands.
• 3Department of Psychology, North Dakota State University, Fargo, ND, USA.
• 4National Centre for Psychotraumatology, Department of Psychology, University of Southern Denmark, Campusvej, Denmark.
• 5Department of Psychology, and Department of Psychiatry, University of Toledo, Toledo, OH, USA. 

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"Get drunk. Smoke weed. Have fun.": A Content Analysis of Tweets About Marijuana and Alcohol

Purpose: To explore the sentiment and themes of Twitter chatter that mentions both alcohol and marijuana. 

Design: Cross-sectional analysis of tweets mentioning both alcohol and marijuana during 1 month was performed. 

Setting: The study setting was Twitter. 

Participants: Tweets sent from February 4 to March 5, 2014, were studied. 

Method: A random sample (n = 5000) of tweets that mentioned alcohol and marijuana were qualitatively coded as normalizing both substances, preferring one substance over the other, or discouraging both substances. Other common themes were identified. 

Results: More than half (54%) of the tweets normalized marijuana and alcohol (without preferring one substance over the other), and 24% preferred marijuana over alcohol. Only 2% expressed a preference for alcohol over marijuana, 7% discouraged the use of both substances, and the sentiment was unknown for 13% of the tweets. Common themes among tweets that normalized both substances included using the substances with friends (17%) and mentioning substance use in the context of sex or romance (14%). Common themes among tweets that preferred marijuana over alcohol were the beliefs that marijuana is safer than alcohol (46%) and preferences for effects of marijuana over alcohol (40%). 

Conclusion: Tweets normalizing polysubstance use or encouraging marijuana use over alcohol use are common. Both online and offline prevention efforts are needed to increase awareness of the risks associated with polysubstance use and marijuana use.

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By:  Krauss MJ, Grucza RA, Bierut LJ, Cavazos-Rehg PA.

Melissa J. Krauss, MPH; Richard A. Grucza, PhD, MPE; Laura J. Bierut, MD; and Patricia A. Cavazos-Rehg, PhD, are with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.

Send reprint requests to Melissa J. Krauss, MPH, Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110; kraussm@psychiatry.wustl.edu.

 

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A Longitudinal Study of Suicidal Ideation among Homeless, Mentally Ill Individuals

Previous cross-sectional studies have indicated that homeless individuals may present with high rates of suicidal ideation, which are strongly associated with completed suicide. We conducted the first known longitudinal study of suicidal ideation in the homeless.

We used data collected over 24 months in the Vancouver At Home project (N = 497), comprised two randomized-controlled trials of housing interventions for homeless individuals with mental disorders. Presence of suicidal ideation was determined using the Colorado symptom index.

Suicidal ideation significantly decreased over time. Baseline diagnoses of mood and anxiety disorders, as well as depressive mood, use of any substance, and polysubstance use were significantly associated with suicidal ideation in the multivariate model. Baseline diagnosis of a psychotic disorder (protective effect), daily substance use, intravenous drug use, recent arrest, multiple physical illnesses and history of traumatic brain injury were significantly associated with suicidal ideation in the unadjusted model only.

Interventions targeting depressive symptoms and substance use could help decrease suicide risk in homeless individuals. Mental health services need to be tailored to address the complex needs of socially marginalized individuals.

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By: Noël F1,2, Moniruzzaman A3, Somers J3, Frankish J4, Strehlau V5,6, Schütz C5,6, Krausz M5,6. 

• 1Department of Psychiatry, Université de Montréal, Montreal, Canada. francois.noel@umontreal.ca.
• 2Institut Universitaire en Santé Mentale de Montréal, 7401 Hochelaga, Montreal, QC, H1N 3M5, Canada. francois.noel@umontreal.ca.
• 3Faculty of Health Sciences, Simon Fraser University (SFU), Burnaby, Canada.
• 4School of Population and Public Health (SPPH), University of British Columbia, Vancouver, Canada.
• 5Department of Psychiatry, University of British Columbia, Vancouver, Canada.
• 6CHEOS Centre of Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada.  

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Social Influence on Adolescent Polysubstance Use: The Escalation to Opioid Use

Fewer than 9% of 12-17 year olds in need (∼146,000 of 1.7 million) receive inpatient or outpatient substance abuse recovery services or other mental health services (SAMHSA, 2012). The literature on adolescent addiction is sparse, however, as most published addiction recovery efforts involve adult populations-often college students.

The present study examined social influences on escalating substance use (from tobacco, alcohol, and marijuana use to polysubstance use involving opioids) for students enrolled in recovery high schools.

A sample of 31 adolescents enrolled in substance use recovery high schools were surveyed on their patterns of substance use leading to their abuse of opioids.

Youth who begin their substance use as young as age 8 are often pressured by peer culture to do so and come from substance-using families. Their escalation in polysubstance use to a pattern including opioids was also most often attributed to peer influence over several years. 

This paper is one of scant few that address patterns of use in high school students. Perhaps most salient from this study are the tertiary prevention implications: similar to their adult counterparts, students enrolled in recovery high school programs are likely from substance-using families and have combined complex constellations of substances including opioids by dint of their relationships with substance-using peers.

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By: Russell BS1, Trudeau JJ2, Leland AJ3.

• 1a Human Development & Family Studies, University of Connecticut , Storrs , Connecticut , USA.
• 2b Health Economics and Outcomes Research , Boehringer Ingelheim, Ridgefield , Connecticut , USA.
• 3c HDFS, University of Connecticut , Storrs , Connecticut , USA. 

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Identifying Classes of Conjoint Alcohol and Marijuana Use in Entering Freshmen

The current study identified classes of conjoint marijuana and alcohol use in entering college freshmen using latent profile analysis (N = 772; 53% male, 60% White; Mage = 18). 

Results yielded 4 distinct groups: 

• Class 1 (moderate drinking with recent marijuana use: 22% of sample), 
• Class 2 (moderate drinking with no recent marijuana use: 25%), 
• Class 3 (light drinking with no recent marijuana use: 40%) and 
• Class 4 (heavy drinking with recent marijuana use: 14%). 

Separate pairwise contrasts examined cross-class differences in demographics and drinking behaviors, comparing differences in drinking when current marijuana use was controlled (Class 1 vs. 4) and differences in marijuana use when drinking was held relatively constant (Class 1 vs. 2). 

Among moderate drinkers, recent marijuana users were more likely to drink more than intended, drink to get drunk, and had more problems (including higher rates of blackouts, physical injury, and DUI) relative to peers who refrained from marijuana. No cross-class differences were found for alcohol expectancies or behavioral motives. 

Findings from these analyses show the presence of distinct groups of conjoint users with different drinking behaviors and consequence profiles, and suggest that conjoint alcohol-marijuana use may be more problematic overall than single substance involvement and highlight the need for developing campus prevention and intervention programs that address the increased risk from polysubstance involvement.

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By: Haas AL, Wickham R, Macia K, Shields M, Macher R, Schulte T.