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CORK Bibliography: Adolescents and Psychopathology (Dual Diagnosis)

97 citations. January 2006 to present

Prepared: December 2011

Abbott PJ. Co-morbid alcohol/other drug abuse/dependence and psychiatric disorders in adolescent American Indian and Alaska Natives. Alcoholism Treatment Quarterly 24(4): 3-21, 2006

Adolescent American Indians and Alaska Natives are a diverse and heterogeneous population with significant social, psychological, and substance use risk factors. This paper reviews the adolescent research to date that has examined the overlap between alcohol/other drug abuse/dependence, mental disorders, and psychiatric symptoms. In the few studies that have been completed there has been significant overlap. No national studies have been done, but there are scattered local and tribal reports. Of the studies that were surveyed, many of them report a significant co-morbidity of alcohol/other drug abuse/dependence with affective and disruptive disorders (ADHD, conduct, oppositional defiant).

Anderson KG; Frissell KC; Brown SA. Relapse contexts for substance abusing adolescents with comorbid psychopathology. Journal of Child & Adolescent Substance Abuse 17(1): 65-82, 2007. (34 refs.)

The relationship of diagnosis, developmentally relevant factors (e.g., life stress, peer substance use) and mental health symptoms to contexts of a return to substance use were examined for 103 substance abusing adolescents with Axis I psychopathology (ages 12-17) following inpatient treatment. Proximal psychiatric symptoms and developmentally relevant factors, but not psychiatric diagnosis at treatment entry, predicted contexts in which youth returned to alcohol and drug use in the 6 months following treatment. The findings suggest that comorbid youth are similar to same-aged peers without comorbid psychopathology and adults with comorbid psychopathology in regard to contexts associated with a return to substance involvement.

Apodaca TR; Abrantes AM; Strong DR; Ramsey SE; Brown RA. Readiness to change smoking behavior in adolescents with psychiatric disorders. Addictive Behaviors 32(6): 1119-1130, 2007. (45 refs.)

There has been recent increased interest in utilizing motivational interviewing (MI) to increase adolescent readiness to quit smoking, but attempts to impact quit rates have thus far been discouraging. A better understanding of factors associated with adolescent readiness to quit smoking prior to receiving any intervention may provide guidance when tailoring future MI interventions in order to increase their effectiveness with this population. Adolescent smokers (N=191) who had been admitted to a psychiatric hospital and enrolled in a clinical trial evaluating MI completed questionnaires that assessed smoking behavior and variables thought to be related to smoking. Confidence to quit smoking and negative beliefs about smoking were significant predictors of adolescents' baseline readiness to quit smoking. The failure to demonstrate relationships between health consequences and readiness suggest that caution may be warranted in the use of feedback, a common component of MI-based interventions. Such feedback tends to focus on health consequences, which was unrelated to adolescent baseline readiness to change smoking behavior in the current study. Parallels between current results and the Theory of Planned Behavior are discussed in consideration of developing more effective MI-based interventions for adolescent smokers.

August GJ; Winters KC; Realmuto GM; Fahnhorst T; Botzet A; Lee S. Prospective study of adolescent drug use among community samples of ADHD and non-ADHD participants. Journal of the American Academy of Child and Adolescent Psychiatry 45(7): 824-832, 2006. (45 refs.)

Objective: To describe the late adolescent drug use outcomes from a relatively large, community-identified sample of children with attention-deficit/hyperactivity disorder (ADHD) who have been assessed longitudinally from childhood through late adolescence. Method: Adolescent drug use outcomes were compared between ADHD-only (n = 27), ADHD-externalizing (mostly oppositional defiant disorder) (n = 82), and normal control (n = 91) groups. Results: The ADHD-externalizing group revealed significantly worse drug use outcomes (drug use frequency and substance use disorders) compared to the other two groups, and the ADHD-only group showed outcomes comparable to the community control group. Conclusions: ADHD without a comorbid externalizing disorder is not associated with an increased risk of drug abuse. ADHD with a comorbid externalizing disorder, primarily oppositional defiant disorder, is associated with an elevated risk of drug use, particularly with respect to marijuana and tobacco involvement.

Ballon B; Chaim G. HELP!!! An interactive experiential simulation of youth with concurrent disorders accessing help from "the system''. Addiction Research & Theory 14(6): 603-617, 2006. (8 refs.)

HELP!!! is an interactive, experiential simulation of the health care system that youth with concurrent mental health and addiction issues need to access for help. Using this exercise after a didactic teaching session reinforces the learning, synthesizes the knowledge for application and encourages group discussion and the sharing of participants' knowledge. This exercise was originally developed to create an opportunity for interprofessional learning groups to experience the gaps and barriers youth encounter as they attempt to navigate the system and to act as a catalyst for creative problem solving and system change. By participating, learners experience a simulation of what youth, family members, and various professionals usually encounter in the system. This exercise elicits key issues for discussion and provides a forum for networking and the initiation of collaborative ventures for healthcare providers.

Becker SJ; Curry JF; Yang CM. Factors that influence trajectories of change in frequency of substance use and quality of life among adolescents receiving a brief intervention. Journal of Substance Abuse Treatment 41(3): 294-304, 2011. (65 refs.)

This study aimed to identify factors influencing trajectories of change in two outcome domains, frequency of substance use and quality of life (QOL), among adolescents receiving a brief evidence-based intervention. Participants were 106 adolescents, aged 13 to 21 years, who met criteria for a substance use disorder. The adolescents received a five-session intervention and completed four assessments over 12 months. Based upon a theoretical and empirical review, five putative predictors were tested: gender, age, severity of conduct disorder, severity of depression, and peer substance involvement. Results of a parallel-process latent growth curve model indicated that higher peer substance involvement and conduct severity predicted higher frequency of use at baseline, whereas higher peer substance involvement and depression severity predicted poorer QOL at baseline. Counter to predictions, higher depression severity predicted greater improvements in QOL following substance use treatment. The implications of baseline risk factors on adolescents' response to intervention are discussed.

Biederman J; Monuteaux MC; Mick E; Spencer T; Wilens TE; Silva JM. Young adult outcome of attention deficit hyperactivity disorder: A controlled 10-year follow-up study. Psychological Medicine 36(2): 167-179, 2006. (58 refs.)

Background. Our objective was to estimate the lifetime prevalence of psychopathology in a sample of youth with and without attention deficit hyperactivity disorder (ADHD) through young adulthood using contemporaneous diagnostic and analytic techniques. Method. We conducted a case-control, 10-year prospective study of ADHD youth. At baseline, we assessed consecutively referred male, Caucasian children with (n = 140) and without (n = 120) DSM-III-R ADHD, aged 6-18 years, ascertained from psychiatric and pediatric sources to allow for generalizability of results. At the 10-year follow-up, 112 (80%) and 105 (88%) of the ADHD and control children, respectively, were reassessed (mean age 22 years). We created the following categories of psychiatric disorders: Major Psychopathology (mood disorders and psychosis), Anxiety Disorders, Antisocial Disorders (conduct, oppositional-defiant, and antisocial personality disorder), Developmental Disorders (elimination, language, and tics disorder), and Substance Dependence Disorders (alcohol, drug, and nicotine dependence), as measured by blinded structured diagnostic interview. Results. The lifetime prevalence for all categories of psychopathology were significantly greater in ADHD young adults compared to controls, with hazard ratios and 95% confidence intervals of 6(.)1 (3(.)5-10(.)7), 2(.)2 (1(.)5-3(.)2), 5(.)9 (3(.)9-8(.)8), 2(.)5 (1(.)7-3(.)6), and 2(.)0 (1(.)3-3(.)0), respectively, for the categories described above. Conclusions. By their young adult years, ADHD Youth were at high risk for a wide range of adverse psychiatric outcomes including markedly elevated rates of antisocial, addictive, mood and anxiety disorders. These prospective findings provide further evidence for the high morbidity associated with ADHD across the life-cycle and stress the importance of early recognition of this disorder for prevention and intervention strategies.

Bolognini M; Plancherel B; Winnington ME; Bernard M; Stephan P; Halfon O. Substance use early initiation among violent and nonviolent antisocial adolescents. Addiction Research & Theory 15(6): 561-574, 2007. (48 refs.)

The relationship between delinquency and substance use and abuse has been much studied. Investigating this relationship as a function to the type of adolescent delinquent behavior presented, whether antisocial or violent, might help explain this complex issue. To this end, 211 adolescents completed the Adolescent Drug Abuse Diagnosis ( ADAD), a multidimensional evaluation instrument that provided information regarding their substance use and antisocial behavior. Subjects were separated into three groups ( violent, antisocial, and control) as a function of their reported antisocial behavior. The three groups were compared on the lifetime use of tobacco, alcohol and cannabis, and any illicit substance. The ages of initiation for these substances were also examined. Results indicated a high percentage of lifetime and problem substance use among violent and antisocial adolescents. However, on the issue of substance use initiation age, the violent adolescents

Bonnet U. Modern treatment of cannabis dependence.(German). Suchttherapie 8(1): 33-40, 2007. (48 refs.)

The prevalence of cannabis use is rising also in Germany. The number of treatment seeking adolescents and adults increases simultaneously. Cannabis-related psychosoc.ial sequels have driven controlled clinical trials of principally psychotherapeutic interventions in USA and Australia. Considering these trials brief interventions using motivational and cognitive behavioural techniques have been shown to be effective in cannabis dependent adults, adjunct to individual counselling. Regarding the specific treatment of young people, besides motivational and cognitive-behavioural also milieu and family therapeutic interventions were efficacious The only available controlled pharmacological study did not reveal any superiority of valproate. Meanwhile, also in Germany the first public studies have been started: "Realize-it (Sudbaden), "CANDIS" (Dresden), "INCA" (Bonn/Essen). Against the background of the high vulnerability of adolescents the "INCANT" project addresses the efficacy of multidimensional family therapy in the treatment of cannabis dependent adolescents and young adults. Unfortunately, no trial to date has taken account of relevant psychiatric co-morbidity. Nearly 70% of cannabis dependent adults suffer from concomittant anxiety or affective disorders, addictive diseases, personality disorders or schizophrenia. Therapeutical recommendations of these dual disorders still lean on the opinion of experts, such as collected in the AWMF-guideline: "cannabis-related disorders" (http www.uni-duesseldorf.de/www/AWMF/II/076-005.htm).

Brook JS; Duan T; Zhang CS; Cohen PR; Brook DW. The association between attention deficit hyperactivity disorder in adolescence and smoking in adulthood. American Journal on Addictions 17(1): 54-59, 2008. (35 refs.)

This longitudinal study examined the interrelationships between early and/or middle adolescent attention deficit hyperactivity disorder (ADHD), middle adolescent conduct disorder (CD), and later adult smoking behavior. This is a prospective longitudinal study. Data were collected via structured interviews of representative families in the northeastern United States (N=641). The mean ages of the offspring were as follows: 14 years (T2, 1983), 17 years (T3, 1985 - 1986), and 32 years (T6, 2002). The dependent variable was the participants' daily cigarette smoking in their early thirties. Logistic regression analyses indicated that the relationship between ADHD and daily smoking behavior was mediated by CD with control on gender, age, SES, and adolescent smoking. CD had a direct effect on daily smoking in adulthood. Our findings suggest that ADHD is related to CD, which in turn is associated with daily smoking. Therefore, interventions with ADHD adolescents who have ADHD at an early age might lead to some reduction in later smoking provided that the intervention has a positive effect on CD. For those adolescents who never had ADHD, our findings suggest that prevention or treatment aimed at reducing CD may be most successful in reducing daily smoking later in adulthood.

Bukstein OG; Cornelius J. Psychopharmacology of adolescents with substance use disorders: using diagnostic-specific treatments. IN: Liddle HA; Rowe CL, eds. Adolescent Substance Abuse: Research and Clinical Advances. Cambridge: Cambridge University Press, 2006. pp. 241-263. (133 refs.)

This is one of four chapters dealing with comprehensive assessment and integrated treatment planning with adolescent substance abusers. The goal of this chapter is to explore the current status of pharmacotherapy in respect to care of adolescents, including the available research. It is noted that the research with adolescent populations is rather limited, and accordingly findings from adult studies are also considered, with an eye to potential insights for adolescents as well as the cautions to doing so. The major pharmacotherapy considered include: withdrawal treatment, substitution therapy, craving reduction and blocking strategies, aversion therapy, and nicotine cessation. The issues related to psychiatric co-morbidity are also addressed.

2006, Project Cork

Cannon TD; Cadenhead K; Cornblatt B; Woods SW; Addington J; Walker E et al. Prediction of psychosis in youth at high clinical risk. Archives of General Psychiatry 65(1): 28-37, 2008. (64 refs.)

Context: Early detection and prospective evaluation of individuals who will develop schizophrenia or other psychotic disorders are critical to efforts to isolate mechanisms underlying psychosis onset and to the testing of preventive interventions, but existing risk prediction approaches have achieved only modest predictive accuracy. Objectives: To determine the risk of conversion to psychosis and to evaluate a set of prediction algorithms maximizing positive predictive power in a clinical high-risk sample. Design, Setting, and Participants: Longitudinal study with a 2 1/2-year follow-up of 291 prospectively identified treatment-seeking patients meeting Structured Interview for Prodromal Syndromes criteria. The patients were recruited and underwent evaluation across 8 clinical research centers as part of the North American Prodrome Longitudinal Study. Main Outcome Measure: Time to conversion to a fully psychotic form of mental illness. Results: The risk of conversion to psychosis was 35%, with a decelerating rate of transition during the 2 1/2year follow-up. Five features assessed at baseline contributed uniquely to the prediction of psychosis: a genetic risk for schizophrenia with recent deterioration in functioning, higher levels of unusual thought content, higher levels of suspicion/paranoia, greater social impairment, and a history of substance abuse. Prediction algorithms combining 2 or 3 of these variables resulted in dramatic increases in positive predictive power (ie, 68%, 80%) compared with the prodromal criteria alone. Conclusions: These findings demonstrate that prospective ascertainment of individuals at risk for psychosis is feasible, with a level of predictive accuracy comparable to that in other areas of preventive medicine. They provide a benchmark for the rate and shape of the psychosis risk function against which standardized preventive intervention programs can be compared.

Chi FW; Sterling S; Weisner C. Adolescents with co-occurring substance use and mental conditions in a private managed care health plan: Prevalence, patient characteristics and treatment initiation and engagement. American Journal on Addictions 15(Supplement 1): 67-79, 2006. (62 refs.)

This study examined the prevalence, patient characteristics, and treatment initiation and engagement of adolescents with co-occurring substance use (SU) and serious mental health (MH) diagnoses in a private, managed care health plan. We identified 2,005 adolescents aged 12-17, who received both SU and MH diagnoses within a 1-year window between 1/1/2000 and 12/31/2002; 57% were girls. Gender variations were found in diagnoses received and point of identification. Being dually diagnosed in specialty departments (rather than Primary Care and Emergency) and receiving both diagnoses within a shorter time period were associated with treatment initiation and engagement.

Chiang SC; Chen SJ; Sun HJ; Chan HY; Chen WJ. Heroin use among youths incarcerated for illicit drug use: Psychosocial environment, substance use history, psychiatric comorbidity, and route of administration. American Journal on Addictions 15(3): 233-241, 2006. (49 refs.)

This study examines differences in psychosocial characteristics, substance use history, and psychiatric comorbidity in relation to heroin use among youths aged 15 to 22 incarcerated in 2003 for illicit drug use in northern Taiwan. Factors associated with heroin use included experiences of child abuse, having friends with illicit drug use, poor school attendance, polydrug use, and early age of drug initiation. Heroin users were found to have more severe clinical manifestation and experiences of conduct and anxiety disorders than non-heroin users; injection users tended to have a longer heroin history. This information may help guide future prevention programs to reduce heroin problems in youth.

Chung T; Martin CS; Clark DB. Concurrent change in alcohol and drug problems among treated adolescents over three years. Journal of Studies on Alcohol and Drugs 69(3): 420-429, 2008. (26 refs.)

Objective: Many adolescents engage in polydrug use; however, little is known about whether alcohol and other drug problems show similar posttreatment trajectories of change. We examined concurrent patterns of change for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, symptoms related to the use of alcohol, marijuana, and other drugs and identified predictors of the most common cross-drug patterns of change. Method: Adolescents (N=542) recruited from addictions treatment were assessed at baseline and at 1- and 3-year follow-up. Latent class mixture modeling identified trajectories for alcohol, marijuana, and other-drug symptoms. Latent class analysis identified cross-drug patterns of change and was used to examine conduct disorder and depression as predictors of cross-drug patterns of change. Results: For alcohol users, three improving groups (72%), stable-low (19%) and stable-high (6%) groups, and groups with increasing trajectories (3%) were identified. For marijuana users, an asymptomatic class (230/6), two improving classes (46%), stable-low (13%) and stable-high (13%) classes, and a class with an increasing trajectory (4%) were found. For users of other drugs, groups with asymptomatic (57%), improving (20%), increasing (12%), and stable-high (11%) trajectories were identified. Latent class analysis of cross-drug patterns of change identified three subtypes representing generally concordant cross-drug patterns of change and one subtype that involved stable-high marijuana problems, decreasing alcohol problems, and increasing other-drug problems. Conduct disorder was associated with greater persistence of substance problems. Conclusions: The majority of treated adolescents had similar cross-drug patterns of change for alcohol, marijuana, and other drugs; however, exceptions exist. Furthermore, adolescents with co-occurring psychopathology may benefit from continuing intervention, because they tend to report more persistent posttreatment substance-related problems.

Costello EJ. Psychiatric predictors of adolescent and young adult drug use and abuse: What have we learned? (editorial). Drug and Alcohol Dependence 88(Supplement 1): S97-S99, 2007. (14 refs.)

Costello EJ. Psychiatric predictors of adolescent and young adult drug use and abuse. (editorial). Drug and Alcohol Dependence 88(Supplement 1): S1-S3, 2007. (27 refs.)

Couwenbergh C; van den Brink W; Zwart K; Vreugdenhil C; van Wijngaarden-Cremers P; van der Gaag RJ. Comorbid psychopathology in adolescents and young adults treated for substance use disorders. (review). European Child & Adolescent Psychiatry 15(6): 319-328, 2006. (60 refs.)

In a recent review, the prevalence of comorbid psychiatric disorders in non-treated adolescents and young adults with substance use disorders (SUD) in the general population was summarized. This review looks into the prevalence of psychiatric comorbidity in adolescents and young adults treated for SUD. A computerized literature search was conducted resulting in ten eligible studies. The prevalence of comorbid psychiatric disorders varied from 61% to 88%. Externalizing disorders, especially Conduct Disorder (CD), were most consistently linked to SUD in treatment seeking adolescents. Girls are distinguished by their high rate of comorbid internalizing disorders. Comparison with data from community and juvenile justice studies shows an ascending trend of comorbidity rates of externalizing disorders from community to clinical and finally to juvenile justice samples. It seems that young addicts with comorbid disorders are at high risk of ending up in the juvenile justice system.

Crone MR; Reijneveld SA. The association of behavioural and emotional problems with tobacco use in adolescence. Addictive Behaviors 32(8): 1692-1698, 2007. (15 refs.)

Smoking is a highly addictive behaviour, often initiated during adolescence. It is suggested that smoking is associated with behavioural and emotional problems. This study aims to assess the impact of psychosocial problems on smoking initiation and vice versa. Method: We obtained data on self-reported psychosocial problems and smoking of adolescents at the age of 13 years and 2 years later. The baseline questionnaire was completed by 1789 students. 68% of the baseline questionnaire could be linked to a questionnaire of the second measurement. Results: 15% smoked at baseline and 29% two years later. Respectively 8% and 9% had a clinical Externalizing problem score or a clinical Internalizing problem score at baseline, 14% had these problems two years later. Externalizing problems at baseline predicted the onset of smoking two years later. Internalizing problems only predicted smoking among girls. This association between psychosocial problems and smoking is most obvious for the onset of regularly smoking and less for the onset of experimenting. Reversibly smoking at baseline is only associated with the onset of externalizing problems two years later. Conclusion: Clinical Externalizing and Internalizing problems make the initiation of regular smoking more likely. The effects on experimental smoking are less obvious.

Deck D; Vander Ley K. Medicaid eligibility and access to mental health services among adolescents in substance abuse treatment. Psychiatric Services 57(2): 263-265, 2006. (9 refs.)

Objective: The co-occurrence of a mental disorder is common among adolescents who present for substance abuse treatment. This study was conducted to determine whether Medicaid eligibility was associated with greater use of mental health services. Methods: The study used administrative data for 25,813 adolescents in Oregon. Propensity score analysis was used to assess the likelihood that the adolescents would use mental health services, with group differences and mental health need controlled for. Results: Medicaid-eligible youths were nearly five times as likely to receive mental health services in the year they entered substance abuse treatment compared with non-Medicaid-eligible youths. In both groups, there was evidence of racial disparities as well as factors such as foster care that may facilitate access. Conclusions: The fact that Medicaid-eligible youths have greater access to mental health services should be considered in both state policies and research design. States considering ways to better serve adolescents with co-occurring disorders would do well to examine ways to promote Medicaid enrollment or expand eligibility.

Dennis ML; Chan YF; Funk RR. Development and validation of the GAIN Short Screener (GSS) for internalizing, externalizing and substance use disorders and crime/violence problems among adolescents and adults. American Journal on Addictions 15(Supplement 1): 80-91, 2006. (73 refs.)

The Global Appraisal of Individual Needs (GAIN) is a 1-2 hour standardized biopsychosocial that integrates clinical and research assessment for people presenting to substance abuse treatment. The GAIN - Short Screener (GSS) is 3-5 minute screener to quickly identify those who would have a disorder based on the full 60-120 minute GAIN and triage the problem and kind of intervention they are likely to need along four dimensions (internalizing disorders, externalizing disorders, substance disorders, and crime/ violence). Data were collected from 6,177 adolescents and 1,805 adults as part of 77 studies in three dozen locations around the United States that used the GAIN. For both adolescents and adults the 20-item total disorder screener (TDScr) and its four 5-item sub-screeners (internalizing disorders, externalizing disorders, substance disorders, and crime/violence) has good internal consistency (alpha of .96 on total screener), is highly correlated (r = .84 to .94) with the 123-item longer scales in the full GAIN. The GSS also does well in terms of its receiver operator characteristics (90% or more under the curve in all analyses) and has clinical decision-making cut points with excellent sensitivity (90% or more) for identifying people with a disorder and excellent specificity (92% or more) for correctly ruling out people who did not have a disorder. The GSS has good potential as an efficient screener for identifying people with co-occurring disorders across multiple systems and routing them to the right services and more detailed assessments.

Diamond G; Panichelli-Mindel SM; Shera D; Dennis M; Tims F; Ungemack J. Psychiatric syndromes in adolescents with marijuana abuse and dependency in outpatient treatment. Journal of Child & Adolescent Substance Abuse 15(4): 37-54, 2006. (40 refs.)

Objective: The purpose of the current study to assist in understanding the prevalence and clinical correlates of psychiatric distress in adolescents seeking outpatient services for marijuana abuse or dependency. Methods: In a multi-site randomized clinical trial, 600 adolescents and their parents were assessed at intake using the Global Appraisals of Individual Needs. DSM-IV criteria were used to diagnose marijuana use disorders, and a symptom check list was used to measure symptoms on five syndromes: conduct disorder, ADHD, depression, anxiety, and disorders of traumatic distress. Results: Patients endorsed acute levels of conduct disorder (74%), ADHD (77%), depression (37.7%), anxiety (28.8%), and traumatic distress (13.8%), and 72% endorsed acute levels on two or more syndromes. Adolescents with a diagnosis of dependency and females evidenced the greatest severity of mental health distress, and minimal differences were found between racial groups. Patients with acute levels of both internalizing and externalizing syndromes reported problems with substance use, criminal activities, trauma experience, and family environments. Conclusion: Co-occurring psychiatric distress is the norm for adolescents seeking outpatient services for marijuana disorders. Better integration of substance use and mental health services would likely improve the quality of care for these troubled youth.

Dierker LC; Sledjeski EM; Botello-Harbaum M; Ramirez RR; Chavez LM; Canino G. Association between psychiatric disorders and smoking stages within a representative clinic sample of Puerto Rican adolescents. Comprehensive Psychiatry 48(3): 237-244, 2007. (61 refs.)

Objective: We examined the prevalence of smoking behaviors and their association with specific psychiatric disorders in a representative sample of youth from behavioral health clinics in Puerto Rico. Method: A complex sampling design was used to select the sample, and analyses were conducted to account for the unequal selection probability, stratification, and clustering. All analyses were weighted back to the clinical population from which they were drawn. Psychiatric and substance use disorders were assessed using the parent and youth versions of the Diagnostic Interview Schedule for Children, Version 4.0. Results: More than one third of the sample reported experience with cigarette smoking, and approximately one quarter reported smoking at least once per week (23.4%). As expected, the alcohol and drug use disorders demonstrated some of the strongest associations with individual smoking stages. These were the only disorders that remained significantly associated with nicotine dependence after controlling for comorbidity. Conclusions: Our findings confirm the need for screening of smoking behavior and nicotine dependence in treatment settings and the integration of psychiatric/substance use treatments with smoking cessation.

Dilsaver SC; Akiskal HS; Akiskal KK; Benazzi F. Dose-response relationship between number of comorbid anxiety disorders in adolescent bipolar/unipolar disorders, and psychosis, suicidality, substance abuse and familiality. Journal of Affective Disorders 96(3): 249-258, 2006. (60 refs.)

Objectives: To ascertain rates of panic, obsessive-compulsive (OCD) and social phobic disorders among adolescents with bipolar disorder (BP), unipolar major depressive disorder (MDD) and psychiatric comparison patients, to assess their relationships to suicidality, psychosis, comorbidity patterns and familiality. Methods: The first author (SCD) interviewed 313 Latino adolescents using a structured interview based on the SLID. Family history was ascertained by live interview or interview by proxy. Patients were classified as BP, MDD, or non-affectively ill comparison controls (CC). Data regarding suicidality and psychosis were collected. Regression analysis was used to test associations and control for confounding effects. Positive likelihood ratios were used to measure the dose-response relationships between number of anxiety disorders and measures of severity of illness and familial loading for affective illness. Results: Of the total sample, 36.7% were BP, 44.7% MDD and 18.5% CC. In BP vs. MDD the odds of panic disorder were 4.4, of OCD 5.1, and of social phobia 3.3. MDD, in turn, were more likely to have these disorders than CC. BP (but not MDD) with panic disorder and social phobia, were more likely to have suicidal ideation; among the anxiety disorders, only social phobia was associated with having greater odds of suicide attempts. Among BP and MDD, patients with all three anxiety disorders were more likely to be psychotic. Presence of any mood disorder among first-degree relatives substantially increased the odds of having panic disorder and social phobia. The presence of one comorbid anxiety disorder increased the odds of having another. Finally, there were dose-response relationships between number of anxiety disorders and measures of severity of illness and familial loading for affective illness. Limitations: Single interviewer using the SLID; cross sectional exploratory study. Conclusions: BP adolescents have a greater anxiety disorder burden than their MDD counterparts. The results are compatible with the hypothesis that heavy familial-genetic loading for affective illness in juveniles is associated with bipolarity, cumulative anxiety disorder comorbidity, suicidality and psychosis. These observations are in line with pioneering psychopathologic observation in the early 1900s by two French psychiatrists, Gilbert Ballet and Pierre Kahn, who saw common ground between what until then had been considered the distinct categories of the neuroses and cyclothymic (circular) psychoses. This perspective has much in common with current complex genetic models of anxious diatheses in bipolar disorder.

Edwards J; Elkins K; Hinton M; Harrigan SM; Donovan K; Athanasopoulos O et al. Randomized controlled trial of a cannabis-focused intervention for young people with first-episode psychosis. Acta Psychiatrica Scandinavica 114(2): 109-117, 2006. (41 refs.)

Objective: To evaluate a cannabis-focused intervention (cannabis and psychosis therapy: CAP) for patients continuing to use cannabis following initial treatment for first-episode psychosis (FEP). Method: Consecutive admissions to an early psychosis program were screened and consenting individuals using cannabis in the 4 weeks prior to assessment participated. A single-blind randomized controlled trial compared CAP (n = 23) with a clinical control condition (psychoeducation, PE; n = 24). Results: There were no significant differences between the CAP and PE groups on cannabis use at end of treatment and 6 months post-intervention. There were no significant group differences on psychopathology and functional ratings at follow-up. A significant reduction in cannabis use was observed for both groups over time. Conclusion: PE and specific cannabis-focused intervention are associated with similar reductions in cannabis use in an FEP cohort. Simple interventions may therefore be worth considering prior to intensive psychotherapeutic efforts with this population.

Englund MM; Egeland B; Oliva EM; Collins WA. Childhood and adolescent predictors of heavy drinking and alcohol use disorders in early adulthood: a longitudinal developmental analysis. Addiction 103(Supplement 1): 23-35, 2008. (77 refs.)

Aims: To identify childhood and adolescent factors differentiating heavy alcohol users in early adulthood from more moderate users or abstainers. Design Low-income participants followed from birth to age 28 years. Participants A total of 178 adults (95 males) who were first-born children of low-income mothers recruited in Minneapolis, Minnesota, during their third trimester of pregnancy. Measurements Maternal hostility (24/42 months), externalizing and internalizing behavior problems (9 years), peer acceptance and academic achievement (12 years), maternal alcohol use and participants' drinking behavior (16 years), quantity of alcohol use per occasion (19, 23 and 26 years), alcohol use disorders (28 years). Findings For men: (i) higher amounts of alcohol consumption at age 16 increased the odds of being a heavy drinker compared to an abstainer (age 19) and a moderate drinker (ages 23 and 26); (ii) lower achievement scores at age 12 and having a mother who drank more when the participant was age 16 increased the odds of being a heavy drinker compared to moderate drinker (age 26). Higher levels of externalizing behavior problems at age 9 and drinking more when the participants were age 16 increased the odds that men would have a current alcohol use disorder at age 28. For women: (i) drinking more at age 16 increased the odds of being a heavy drinker compared to being either an abstainer or a moderate drinker (age 26); (ii) having higher levels of achievement at age 12 increased the odds of being a heavy drinker compared to an abstainer at age 23. Adolescent alcohol use mediated the relation between externalizing behavior at age 9 and alcohol use at age 26 for women. Conclusions: Problem drinking may be the result of a long-term developmental process wherein childhood externalizing behavior problems sets a pathway leading to heavy drinking during and after adolescence.

Evans AS; Spirito A; Celio M; Dyl J; Hunt J. The relation of substance use to trauma and conduct disorder in an adolescent psychiatric population. Journal of Child & Adolescent Substance Abuse 17(1): 29-49, 2007. (59 refs.)

Substance abuse is one of the most problematic health risk behaviors among adolescents. Given that research consistently finds increased levels of substance use among adolescents with conduct problems as well as trauma-related symptoms, it is important that substance abuse be examined to better understand its role in Conduct Disorder (CD) and Post-Traumatic Stress Disorder (PTSD). This study further explored whether these relationships were better understood with additive and interactive processes. Adolescents (N = 192) admitted to a psychiatric inpatient unit completed a standard intake evaluation, including checklists and a semi-structured interview. Levels of substance abuse were greater for those with comorbid CD and PTSD as compared with either CD only or PTSD only. This difference was best explained by interactive rather than additive processes. Therefore, treatment implications are discussed.

Ferrett HL; Cuzen NL; Thomas KGF; Carey PD; Stein DJ; Finn PR et al. Characterization of South African adolescents with alcohol use disorders but without psychiatric or polysubstance comorbidity. Alcoholism: Clinical and Experimental Research 35(9): 1705-1715, 2011. (72 refs.)

Background: Individuals who begin drinking during early adolescence and exhibit externalizing pathology and disinhibitory/dysregulatory tendencies are more vulnerable to developing alcohol use disorders (AUDs) in adulthood. Previous research has focused on in-treatment populations with substantial comorbid psychopathology and polysubstance use. Here, we characterize a unique sample of treatment-naive adolescents without such comorbidity to help identify vulnerable youth who may benefit from early intervention. Methods: We compared externalizing propensity, disinhibitory characteristics, and school performance in adolescents with AUDs (but without comorbid psychopathology or other substance use; n = 70) to those of demographically matched controls (n = 70). Within the AUD group, we compared measures of substance use and the disinhibitory syndrome between boys and girls with differing severity of externalizing propensity. Results: Adolescents with AUDs demonstrated more externalizing propensity and disinhibitory personality traits (impulsivity, novelty seeking, and excitement seeking), poorer self-monitoring and response inhibition, more bullying and sexual risk-taking behavior, poorer first-language performance, and greater use of alcohol, cannabis, and nicotine (p < 0.05). Within the AUD group, participants with higher externalizing propensity began drinking earlier, more frequently, and for a longer duration than those with lower externalizing symptoms (p < 0.05). Disinhibitory features (personality, cognition, and behavior) were, however, not stronger in those with higher externalizing propensity. Conclusions: We suggest that the constructs of externalizing propensity and disinhibitory syndrome are useful in characterizing treatment-naive adolescents with AUDs but without comorbid psychopathology or polysubstance use. These results support the importance of these constructs in understanding adolescent AUDs, even when the frank externalizing diagnoses of childhood (oppositional defiant disorder and conduct disorder) are excluded.

Fidalgo TM; da Silveira ED; da Silveira DX. Psychiatric comorbidity related to alcohol use among adolescents. American Journal of Drug and Alcohol Abuse 34(1): 83-89, 2008. (24 refs.)

Introduction: Alcohol use is apparently related to high prevalences of psychiatric comorbidity, although scientific studies focusing the problem among adolescents are still lacking. Objective: To evaluate the performance of adolescents with different patterns of alcohol use on screening instruments for psychiatric disorders. Method: Forty-one adolescents seeking assistance for alcohol-related problems were compared to a nonclinical sample of 43 adolescents. These 84 users were divided in three sub-groups according to pattern of recent alcohol intake. All subjects responded to validated versions of screening scales for mental disorders. Comparison of groups was held through Analysis of variance (ANOVA). Results: Self Report Questionnaire (SRQ) aims to evaluate the presence of mental disorders. Heavy users presented significant higher scores than the other groups (p < .05) and half of them presented a psychiatry diagnosis. The same was observed for the CES-D. Using the cut-off, 76.9% of daily-users adolescents were considered depressive. In the Beck Anxiety Inventory the same was observed and 50.0% of those adolescents who drank daily could be considered at risk of presenting anxiety disorders. Conclusion: We detected higher prevalences of mental disorders among heavy alcohol users. This reinforces the importance of detailed diagnostic investigation of patients.

Fragola AO. Depression among adolescents and their vulnerability to addictive disorders. Addictive Disorders and Their Treatment 5(1): 27-34, 2006. (30 refs.)

This paper examines some aspects of etiopathogenia and addiction clinics in regard to adolescents. Within this context, vulnerability is one of the core issues, and depressive elements are closely associated with this vulnerability. There is a brief review of the confluence of neurobiological, epidemiologic, and psychologic data about addiction, adolescent development, and depression. The adolescent crisis generates affective unbalance, which expresses itself in depressive symptoms, emotional unstableness, lability of self-esteem, and tendency to impulsivity. These disorders act as predisposing factors weighing on the onset and persistence of drug abuse. The paper reviews different explanatory models as well as the concept of self-regulation and the effect of drugs on the limitation of personal freedom.

Francis K; Katsani G; Sotiropoulou X; Roussos A; Roussos C. Cigarette smoking among Greek adolescents: Behavior, attitudes, risk, and preventive factors. Substance Use & Misuse 42(8): 1323-1336, 2007. (48 refs.)

This study was produced in the context of the first author's thesis at Athens University and was a collaboration between the Department of Clinical Care Medicine, Athens University, and Attiki Child Psychiatric Hospital. It was supported by a project grant from the THORAX Foundation, Greece. Objective: To study the smoking behavior, attitudes, and beliefs of Greek adolescents, as well as the risk and preventive factors for the onset of smoking and to obtain data to serve in the planning of comprehensive antismoking campaigns tailored to the Greek adolescent's specific profile. Sample and Method: A stratified, nationwide, representative, school-based sample of 3827 Greek adolescents was surveyed during the academic year 2001-2002, using a questionnaire on smoking and Achenbach's Youth Self-Report. Results: Cigarette smoking is a serious problem among Greek youth. Family and peers play a primary role in shaping smoking attitudes and habits. Adolescents who smoke regularly have increased rates of psychopathology as indicated by higher scores on the Externalising and Attention Problem scales of Achenbach's Youth Self-Report, compared to adolescents who are non-smokers. The data obtained can indeed guide smoking prevention strategies in Greece.

Frojd S; Marttunen M; Pelkonen M; von der Pahlen B; Kaltiala-Heino R. Perceived financial difficulties and maladjustment outcomes in adolescence. European Journal of Public Health 16(5): 542-548, 2006. (31 refs.)

Background: Studies using traditional SES indicators in strictly adolescent populations have usually failed to find class differences in adolescent mental health. The present study aimed to find out whether there is an association between adolescent perceived financial difficulties of the family and adolescent maladjustment, and to explore the possible sex differences in this association. Methods: School-based survey on 3278 ninth grade students (15-16 years old) in two economically well developed Finnish cities. Results: One-fifth of the adolescents reported that their family had financial difficulties in the previous 12 months. Perceiving financial difficulties was significantly more common among girls than boys. Perceived financial difficulties were associated with known risk factors of poverty and with depression and harmful drinking patterns in both sexes. Adjusting for parental educational levels, parental unemployment and family structure did not change the significant association with maladjustment outcomes. Additional adjustment with comorbidity, however, levelled out the significance of the association of perceived financial difficulties and harmful drinking patterns in boys. Conclusion: While adolescent perception of financial difficulties is probably associated with the objective financial situation of the family it may also be an indicator of the psychological meaning attached to the situation and should thus be considered a possible risk factor for adolescent maladjustment in clinical practice.

Goldstein RB; Asarnow JR; Jaycox LH; Shoptaw S; Murray PJ. Correlates of "non-problematic" and "problematic" substance use among depressed adolescents in primary care. Journal of Addictive Diseases 26(3): 39-52, 2007. (75 refs.)

Substance use and related problems were assessed in a sample of primary care patients (n = 450) ages 13-21 who screened positive for depression at a clinic visit. Patients were classified as having no substance use (n = 248), non-problematic use (substance use without reported school, work, social, or family problems, n = 90), or use that reportedly caused problems in at least one area (n = 112). In logistic regression models, older age, externalizing symptoms, and not being African American were significantly associated with non-problematic use; older age, male gender, externalizing symptoms, Caucasian/White ethnicity/race, and more friends were associated with problematic use. Odds ratios were similar for patients reporting non-problematic and problematic use, suggesting that, in the presence of depression, any substance use merits evaluation and monitoring to determine treatment needs and to prevent escalation of dysfunction.

Gray KM; Riggs PD; Min SJ; Mikulich-Gilbertson SK; Bandyopadhyay D; Winhusen T. Cigarette and cannabis use trajectories among adolescents in treatment for attention-deficit/hyperactivity disorder and substance use disorders. Drug and Alcohol Dependence 117(2-3): 242-247, 2011. (52 refs.)

Background: Cigarette smoking is common in adolescents with attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUD). However, little is known about the relationship between cigarette and cannabis use trajectories in the context of treatment for both ADHD and SUD. To address this research gap, we report collateral analyses from a 16-week randomized, controlled trial (n = 303) of osmotic-release methylphenidate (OROS-MPH) in adolescents with ADHD concurrently receiving cognitive behavioral therapy (CBT) targeting non-nicotine SUD. Methods: Participants completed cigarette and cannabis use self-report at baseline and throughout treatment. Analyses were performed to explore the relationships between cigarette smoking, cannabis use, and other factors, such as medication treatment assignment (OROS-MPH versus placebo). Results: Baseline (pre-treatment) cigarette smoking was positively correlated with cannabis use. Negligible decline in cigarette smoking during treatment for non-nicotine SUD was observed in both medication groups. Regular cigarette and cannabis users at baseline who reduced their cannabis use by >50% also reduced cigarette smoking (from 10.8 +/- 1.1 to 6.2 +/- 1.1 cigarettes per day). Conclusions: Findings highlight the challenging nature of concurrent cannabis and cigarette use in adolescents with ADHD, but demonstrate that changes in use of these substances during treatment may occur in parallel.

Greenbaum PE; Dedrick RF. Changes in use of alcohol, marijuana, and services by adolescents with serious emotional disturbance: A parallel-process growth mixture model. Journal of Emotional and Behavioral Disorders 15(1): 21-32, 2007. (42 refs.)

For the study reported here, the authors used growth mixture modeling to analyze changes in alcohol and marijuana use and the use of drug and alcohol treatment services for a sample of 180 adolescents with serious emotional disturbance (ages 12-14 years at the beginning of the 7-year longitudinal study). Three latent classes of substance users were identified, two of which exhibited significant linear increases in substance use. As expected, adolescents who were heavily involved in substance use at the beginning of the study and who significantly increased their substance use were the most likely to receive the greatest number of alcohol and drug services. Adolescents who had low levels of substance use at the beginning of the study but whose substance use increased significantly during the study received fewer services. The fact that the initially low substance-use class eventually ended up resembling the high substance-use class at the end of the 7-year study underscores the importance of collecting longitudinal data on substance use and employing the rate of change in substance use as an indicator of the need for treatment. Advantages of growth mixture and parallel processing modeling for studying changes in substance use and services are discussed.

Hakko H; Lintunen J; Lappalainen J; Makikyro T; Rasanen P; Timonen M. Nicotine use and dependence and their association to psychiatric disorders in a large sample of adolescent psychiatric inpatients. Addictive Behaviors 31(10): 1873-1880, 2006. (22 refs.)

The purpose of this research was to evaluate the level of nicotine dependence (ND) and to examine its association to psychiatric disorders in a representative clinical sample of adolescent psychiatric inpatients. The modified Fagerstrom Tolerance Questionnaire (mFTQ) was used to assess the level of ND. Psychiatric DSM-IV diagnoses were obtained by using the Schedule for affective disorder and schizophrenia for school-age children (K-SADS-PL). Of the total of 342 inpatients in the study sample, 259 (75.7%) reported to be current smokers. A sum score 6 or higher in the mFTQ, indicating a high level of ND, was found in 37.9% of all smokers. An increased likelihood for high level of ND was associated with substance related disorders (OR 5.1, 95% Cl 2.8-9.3), conduct disorder and oppositional defiant disorders (OR 2.4, 95% CI 1.4-4.4). The usefulness of mFTQ in measuring ND among adolescent inpatients is apparent. Therefore, it can be recommended to be used as a routine screening instrument for ND among adolescents hospitalized due to psychiatric disorders.

Hall W; Degenhardt L. Prevalence and correlates of cannabis use in developed and developing countries. Current Opinion in Psychiatry 20(4): 393-397, 2007. (51 refs.)

Purpose of review: The aim of this article is to review recent research on the prevalence, antecedents and correlates of cannabis use in young adults in developed and developing countries. Recent findings Cannabis is the most widely used illicit drug globally and its use appears to be increasing in developed and developing countries. In developed countries rebelliousness, antisocial behaviour, poor school performance, and affiliation with drug-using peers are risk factors for early and regular cannabis use. Similar antecedents are now being reported in developing countries. Dependence is an underappreciated risk of cannabis that affects one in six to seven adolescents who use cannabis in developed countries. Adolescent cannabis dependence is correlated with an increased risk of using other illicit drugs, symptoms of depression, and symptoms of psychosis. The plausibility of cannabis playing a contributory causal role has increased for symptoms of psychosis in longitudinal studies but remains contentious. In the case of other illicit drug use and mood disorders common causal explanations remain difficult to exclude. Summary: Early and regular cannabis use in adolescence predicts an increased risk of cannabis dependence which in turn predicts an increased risk of using other illicit drugs, and reporting symptoms of mood and psychotic disorders.

Handley ED; Chassin L; Haller MM; Bountress KE; Dandreaux D; Beltran I. Do executive and reactive disinhibition mediate the effects of familial substance use disorders on adolescent externalizing outcomes? Journal of Abnormal Psychology 120(3): 528-542, 2011. (104 refs.)

The present study examined the potential mediating roles of executive and reactive disinhibition in predicting conduct problems, attention-deficit/hyperactivity disorder (ADHD) symptoms, and substance use among adolescents with and without a family history of substance use disorders. Using data from 247 high-risk adolescents, parents, and grandparents, structural equation modeling indicated that reactive disinhibition, as measured by sensation seeking, mediated the effect of familial drug use disorders on all facets of the adolescent externalizing spectrum. Executive disinhibition, as measured by response disinhibition. spatial short term memory, and "trait" impulsivity, was associated with ADHD symptoms. Moreover, although executive functioning weakness were unrelated to familial substance use disorders, adolescents with familial alcohol use disorders were at risk for "trait" impulsivity marked by a lack of planning. These results illustrate the importance of "unpacking" the broad temperament style of disinhibition and of studying the processes that underlie the commonality among facets of the externalizing spectrum and processes that predict specific externalizing outcomes.

Hanson RF; Self-Brown S; Fricker-Elhai A; Kilpatrick DG; Saunders BE; Resnick H. Relations among parental substance use, violence exposure and mental health: The national survey of adolescents. Addictive Behaviors 31(11): 1988-2001, 2006. (42 refs.)

Objective: To study the relations among parental substance use, violence exposure and psychopathology in a nationally representative sample of adolescents. Method: Random digit dialing methodology was used to obtain a nationally representative sample of 4023 adolescents, ages 12-17. Telephone surveys, conducted in 1995, assessed demographics, parental substance use, violence exposure, and three psychiatric disorders: major depressive disorder (MDE), posttraumatic stress disorder (PTSD), and substance abuse/dependence (SA/D). Results: Obtained prevalence rates included: 8.2% for sexual assault, 22.5% for physical assault, and 39.7% for witnessing violence at home or in the community. Substance use by a family member was reported by 18.4% (n = 721) of adolescents, with 50.6% reporting parental alcohol use and 19.1% (n = 138) reporting parental drug use. Consistent with hypotheses, violence exposure and parental substance use, particularly parental alcohol abuse, were independently associated with outcomes. Additionally, parental substance use emerged as a moderator for MDE, PTSD, and SA/D; however, the moderating relations varied according to the outcome variable investigated. Conclusions: Violence-exposed adolescents reporting parental alcohol or drug use had the highest rates of psychiatric diagnoses.

Hayatbakhsh MR; Mcgee TR; Bor W; Najman JM; Jamrozik K; Mamun AA. Child and adolescent externalizing behavior and cannabis use disorders in early adulthood: An Australian prospective birth cohort study. Addictive Behaviors 33(3): 422-438, 2008. (56 refs.)

This study examined the association between age of onset and persistence of externalizing behavior and young adults' cannabis use disorders (CUDs). Data were from a 21 year follow-up of a birth cohort study in Brisbane, Australia. The present cohort consisted of 2225 young adults who had data available about CUDs at 21 years and externalizing behavior at 5 and 14 years. Young adults' CUDs were assessed using the CIDI-Auto. Child and adolescent externalizing behavior were assessed at the 5- and 14-year phases of the study. After controlling for confounding variables, children who had externalizing behavior at both 5 and 14 years (child-onset-persistent) (COP) had a substantial increase in risk of CUD at age 21 years (Odds ratio (OR)=2.5; 95% CI: 1.5, 4.2). This association was similar for those who had 'adolescent onset' (AO) externalizing behavior. However, there was no association between 'childhood limited' (CL) externalizing behavior and CUD. Externalizing behavior in adolescence is a strong predictor of subsequent CUD. Smoking and drinking at 14 years partially mediated the link between externalizing behavior and CUD.

Ilomaki R; Riala K; Hakko H; Lappalainen J; Ollinen T; Rasanen P et al. Temporal association of onset of daily smoking with adolescent substance use and psychiatric morbidity. European Psychiatry 23(2): 85-91, 2008. (27 refs.)

Objective. - The association between cigarette smoking and psychiatric disorders is well established for adult populations. However, only limited number of studies has investigated whether the young onset age of daily smoking (DS) among adolescents is associated with psychiatric morbidity and vice versa. Methods. - Data from 508 adolescents admitted to psychiatric hospitalization were collected. Cox proportional hazard model were used to compare the initiation of DS between adolescents with and without substance use (SUD), and other psychiatric disorders. Results. - Rates of DS were high in each diagnostic category. Boys started smoking at younger age (mean 12.4 years) than girls (13.0 years). Both boys and girls diagnosed with conduct or oppositional defiant disorders (COD) and also girls with SUD started daily smoking earlier as compared to those of same gender without these disorders. COD were found to be primary to the initiation of DS among boys. SUD, psychotic, and depressive disorders (DEP) were found to be secondary to DS among both genders. Conclusions. - DS in adolescence is related with later SUD. COD are associated with subsequent initiation of DS among boys. The temporal gap between smoking initiation and COD is shorter among girls. Gender difference plays a role in association of DS and DER Initiation of DS at very early age should alert health care professionals of development of later psychopathology, especially SUD.

Kemp R; Harris A; Vurel E; Sitharthan T. Stop Using Stuff: Trial of a drug and alcohol intervention for young people with comorbid mental illness and drug and alcohol problems. Australasian Psychiatry 15(6): 490-493, 2007. (19 refs.)

Objective: Substance abuse is a significant problem in the treatment of young people with their first psychosis. This study reports a randomized trial of a brief manualized cognitive behavioural therapy for substance abuse in young people with psychosis. Method: Subjects were randomized between the study treatment and a group treated as usual. Treatment was a four to six session brief cognitive behavioural therapy (CBT) intervention developed specifically for this patient group - Stop Using Stuff (SUS). Results: Both groups improved across the trial. However, those exposed to the active treatment improved significantly on measures of the frequency of cannabis and alcohol abuse. Conclusions: Brief interventions in substance abuse in young people with psychosis can help moderate substance use in this difficult to treat group.

Keyes CLM. Mental health in adolescence: Is America's youth flourishing? American Journal of Orthopsychiatry 76(3): 395-402, 2006. (36 refs.)

A continuous assessment and a categorical diagnosis of the presence of mental health, described as flourishing, and the absence of mental health, characterized as languishing, are proposed and applied to data from the second wave of the Child Development Supplement (CDS-11) of the Panel Study of Income Dynamics (PSID), in which a comprehensive set of subjective well-being items were administered to a sample of 1,234 youth ages 12-18. Flourishing was the most prevalent diagnosis among youth ages 12-14; moderate mental health was the most prevalent diagnosis among youth ages 15-18. Depressive symptoms decreased as mental health increased. Prevalence of conduct problems (arrested, skipped school, alcohol use, cigarette smoking, and marijuana use) also decreased and measures of psychosocial functioning (global self-concept, self-determination, closeness to others, and school integration) increased as mental health increased. Findings suggest the importance of positive mental health in future research on adolescent development.

King KM; Chassin L. Adolescent stressors, psychopathology, and young adult substance dependence: A prospective study. Journal of Studies on Alcohol and Drugs 69(5): 629-638, 2008. (67 refs.)

Objective: There is much theory, but sparse empirical evidence, supporting the notion that internalizing symptoms and negative affect are the mechanism by which exposure to stressful life events influence the development of substance-use disorders in adolescence and young adulthood. However, many empirical studies have shown that, in addition to elevations in internalizing symptoms, exposure to stressful life events also produces elevations in externalizing behaviors and conduct problems, which are important risk factors for substance-use disorders. The current study tested adolescent externalizing and internalizing symptoms as competitive mediators of the effects of stressors on young adult drug dependence. Method: Data from an ongoing study of children of alcoholics (n = 223) and matched controls (n = 204) were collected in two annual interviews in adolescence and two follow-ups in young adulthood. Results: Experiencing stressful life events during adolescence led to increases in both externalizing and internalizing symptoms, but only externalizing symptoms mediated the later effects of adolescent stressors on young adult drug dependence. Conclusions: These findings suggest that understanding how stressors produce elevations in behavioral problems may provide important insights into understanding how broad environmental risk factors lead to substance dependence and suggests that processes other than affect regulation may operate in the pathway from the experiences of stressors to substance use and disorder.

Kirisci L; Tarter R; Mezzich A; Reynolds M. Screening current and future diagnosis of psychiatric disorders using the revised Drug Use Screening Inventory. American Journal of Drug and Alcohol Abuse 34(5): 653-665, 2008. (17 refs.)

The revised Drug Use Screening Inventory (DUSI-R) is a valid and reliable self-report questionnaire used for quantifying problems that frequently precede and co-occur with substance abuse. The present investigation determined whether the DUSI-R's items can be aggregated into scales that implicate current and future psychiatric disorders. Scales were derived to screen for attention deficit, conduct, antisocial, anxiety, depression, and substance use disorders in a longitudinally tracked cohort of 328 boys. Evaluationions were conducted when the boys were 12-14, 16, 19, and 22 years of age. All of the scales identified youths qualifying for current DSM-IV diagnosis with excellent accuracy. Predictive validity of the scales ranged from good to excellent. Accordingly cut-off scores were determined for each scale for use in practical settings to identify youths who require comprehensive diagnostic evaluation. Thus in addition to its utility for detecting problems that precede and correlate with substance abuse, the DUSI-R is cost-efficient for screening youths for mental disorders.

Kratochvil CJ; Kazura A; Deas D; Martin CA; Dosh T; Wilens TE. Pharmacological management of a teen with significant alcohol use and depression. Journal of the American Academy of Child and Adolescent Psychiatry 45(8): 1011-1015, 2006. (14 refs.)

The following case is presented for consideration with attention to pharmacological therapies: A 16-year-old girl in the 10th grade is referred by her parents because of concerns about her significant alcohol use. She started drinking alcohol only sporadically in eighth grade, but escalated her alcohol consumption to almost every Friday and Saturday night throughout ninth grade. For most of this academic year, she has been drinking to intoxication three times per week, despite attempts to limit use, recently experiencing blackouts. The volume of alcohol required to become intoxicated has increased. She admits to several incidents of driving while intoxicated and twice has had, after drinking heavily, sexual intercourse with men she barely knew. On examination, she reported feeling depressed, demoralized, and angry. She described low energy and interest, academic underachievement, and withdrawal from her previous long-standing friends. She has passive suicidality. Various drug therapies are considered along with the strong caution that a comprehensive assessment is critical to identify comorbidities.

Laukkanen M; Hakko H; Riala K; Rasanen P. Association of family background with adolescent smoking and regular use of illicit substances among underage psychiatric in-patients. Journal of Addictive Diseases 27(4): 69-79, 2008. (19 refs.)

This study investigated whether adolescent's family type was associated with regular smoking or the use of illicit substances (cannabis or hard drugs) among underage adolescent psychiatric in-patients. The sample consisted of 471 adolescents aged 12-17 years admitted to psychiatric hospital between April 2001 and March 2006 at Oulu University Hospital, Finland. The information on family factors and substance use was based on the Schedule for Affective Disorder and Schizophrenia for School-Age Children, Present and Lifetime interview and the European modification of the Addiction Severity Index questionnaire. Compared to adolescent boys from two-parent families, those from child welfare placement were more likely to regularly use both cannabis (odds ratio [OR] = 4.4; 95% confidence interval [CI] = 1.4-13.7; P = .012) and hard drugs (OR = 8.4; 95% CI = 1.7-42.1; P = .01). Among girls, no association was found between family type and the use of illicit substances. Two-parent or foster family units may protect adolescents from involvement with illicit substances. In clinical adolescent psychiatric practice more attention should be paid to family interventions and parental support.

Lubman D; Hides L; Elkins K. Developing integrated models of care within the youth alcohol and other drug sector. Australian Psychiatry 16(5): 363-366, 2008. (18 refs.)

Objective: The aim of this paper is to describe an initiative in Victoria, Australia, aimed at improving the detection and management of co-occurring mental health issues within the youth Alcohol and Other Drug (AOD) sector. Conclusions: Over the past 4 years, in partnership with local youth AOD services, we have developed a successful service model that addresses co-occurring mental health issues within the youth AOD sector. However, such capacity-building requires the full support of workers and senior management, and a cultural shift whereby the assessment and management of mental health issues are seen as a priority and core service issue. The capacity-building process was facilitated by embedding experienced mental health clinicians within each service to support and implement the initiative. This model offered learning opportunities through the modelling of relevant skills and the provision of 'on-the-job' training. Such approaches demonstrate that integrated models of care can be delivered within youth AOD services, although further research is needed to determine their effectiveness.

Lubman DI; Allen NB; Rogers N; Cementon E; Bonomo Y. The impact of co-occurring mood and anxiety disorders among substance-abusing youth. Journal of Affective Disorders 103(1-3): 105-112, 2007. (31 refs.)

Background: Co-occurring mood and anxiety disorders are highly prevalent amongst substance-using young adolescents, and have been associated with a range of adverse outcomes. Few studies however have examined the impact of affective disorders in samples of older adolescents and young adults attending youth drug treatment services. Methods: One hundred young people (mean age 19.4 years) were recruited from two youth drug treatment services in Melbourne, Australia. A structured interview and questionnaires assessing drug use, psychopathology, risk-taking behaviours and quality of life were administered at a mutually convenient location. Results: Fifty percent of the sample met criteria for at least one current mental health disorder. Excluding individuals with a current psychotic illness (n = 3), 49% met criteria for a current mood or anxiety disorder, with 68% reporting a lifetime history. There were high rates of current Major Depressive Disorder (MDD; 27%) and Post-traumatic Stress Disorder (PTSD; 26%) within the sample. Participants with these disorders were more likely to have a higher number of comorbid disorders, report more substance-related problems and a poorer quality of life. Limitations: Cross-sectional design, lack of biological assays. Conclusions: In older adolescence and emerging adulthood, young drug users with comorbid affective disorders have greater mental health and substance use morbidity than those with substance use problems alone. These findings have important clinical implications for the management and rehabilitation of young people with substance use disorders.

Lubman DI; Hides L; Jorm AF. Beliefs of young people and their parents about the harmfulness of alcohol, cannabis and tobacco for mental disorders. Medical Journal of Australia 187(5): 266-269, 2007. (18 refs.)

Objective: To ascertain the beliefs of young people and their parents about the role of alcohol, tobacco and marijuana in the prevention and treatment of mental disorders. Design, setting and participants: Between May and August 2006, a national computer-assisted telephone survey was conducted on a representative sample of Australian youths aged 12-25 years. 3746 young people and 2005 of their parents were presented with a case vignette portraying psychosis, depression, depression with alcohol misuse, or social phobia in a young person. Main outcome measures: Participants' beliefs regarding the role of substance use in preventing or dealing with mental disorders in young people. Results: Over 85% of participants agreed that alcohol, tobacco and marijuana were harmful for the young people in the vignettes, and over 80% of youths agreed that not using marijuana or drinking alcohol in excess would reduce the risk of developing a similar problem. Conclusion: Young people and their parents are fully aware of the negative impact of substance use on mental disorders. Translating this knowledge into behavioural change will be a major challenge for future public health campaigns.

MacPherson L; Strong DR; Kahler CW; Abrantes AM; Ramsey SE; Brown RA. Association of post-treatment smoking change with future smoking and cessation efforts among adolescents with psychiatric comorbidity. Nicotine & Tobacco Research 9(12): 1297-1307, 2007. (50 refs.)

Little is known about how initial change following a smoking intervention relates to longer-term smoking outcomes among adolescent smokers with psychiatric comorbidity. The present study investigated this relationship among psychiatrically hospitalized adolescents (N=183) who participated in a controlled trial comparing motivational interviewing to brief advice. Quit attempters (n=37), reducers (n=45), and maintainers (n=101) were assembled based on, respectively, having made a quit attempt, having reduced smoking by at least 50%, and having reduced smoking by less than 50% in the first week after hospital discharge. Hierarchical linear models and generalized estimating equations were conducted to test group differences in average number of cigarettes per smoking day and odds of making a quit attempt during subsequent weeks of a 12-month continuous follow- up, and in cotinine-verified abstinence rates at 1, 6, and 12 months posthospitalization. Baseline smoking levels and presence of a substance use disorder or anxiety disorder were predictive of outcomes. After controlling for covariates, we found that quit attempters smoked less during follow-up than did the other change groups and that reducers smoked less than maintainers. Quit attempters evidenced a higher percentage of quit attempts during follow- up than did the other change groups. Reducers had a greater average percentage of quit attempts during follow-up than did maintainers. However, groups did not differ on cotinine-verified abstinence rates across the follow-up period. Findings have implications for initial post-treatment change as it relates to subsequent smoking and cessation outcomes among adolescent smokers at especially high risk for smoking persistence.

Maggs JL; Patrick ME; Feinstein L. Childhood and adolescent predictors of alcohol use and problems in adolescence and adulthood in the National Child Development Study. Addiction 103(Supplement 1): 7-22, 2008. (92 refs.)

Aims: To identify childhood and adolescent predictors of alcohol use and harmful drinking in adolescence and adulthood. Design: Longitudinal data from childhood to mid-life from the National Child Development Study (NCDS) were used, including predictors collected at ages 7, 11, 16 years and alcohol outcomes collected at ages 16, 23, 33 and 42 years. Setting The NCDS is an ongoing longitudinal study of a cohort of 1 week's births in Britain in 1958. Participants Childhood and adolescent predictors and alcohol use data from at least one adolescent or adult wave were available from 7883 females and 8126 males. Measurements Social background, family, academic and behavioural predictors measured at ages 7, 11 and 16 years were entered into hierarchical multiple and logistic regressions to predict quantity of alcohol use at ages 16, 23, and 33 years and harmful drinking [i.e. Cut-down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire score] by age 42 years. Findings: Previous drinking was controlled in final models to predict change. Drinking was heavier among those with greater childhood and adolescent social advantage (especially females), less harmonious family relationships, more social maladjustment, greater academic performance, less internalizing problems, more truancy and earlier school-leaving plans. Conclusions: Alcohol use and problems in adulthood can be predicted by indicators of social background, adjustment and behaviour in childhood and adolescence. Results: demonstrate that the early roots of adolescent and adult alcohol use behaviours begin in childhood.

Malmberg K; Edbom T; Wargelius HL; Larsson JO. Psychiatric problems associated with subthreshold ADHD and disruptive behaviour diagnoses in teenagers. Acta Paediatrica 100(11): 1468-1475, 2011. (31 refs.)

Aim: To study the coexistence of subthreshold diagnoses of both attention deficit hyperactivity disorder (ADHD) and disruptive behaviour disorders (DBD) with other symptoms of child and adolescent psychiatric disorders as well as risk behaviours associated with smoking, alcohol and drug use. Methods: A population-based sample of twins including 177 girls and 135 boys was interviewed using the Swedish version of Kiddie-SADS Present and Lifetime Version (K-SADS-PL). Subthreshold diagnoses were compiled based on the ADHD and DBD criteria, where each criterion was assessed as 'possible' or 'certain' according to K-SADS-PL. The odds ratios (OR) between the subthreshold diagnoses and each of the screening questions in K-SADS-PL were calculated. Results: Subthreshold diagnoses of ADHD and DBD coexisted with the screening questions concerning depression, mania, panic attack, phobias, anorexia nervosa, motor tics and posttraumatic stress disorder (PTSD) in girls. In boys, these subthreshold diagnoses coexisted with symptoms of depression and PTSD. For both boys and girls, smoking and high alcohol consumption contributed to a high OR with regard to ADHD and DBD. Conclusion: Subthreshold diagnoses of ADHD and DBD were risk factors for several other psychiatric symptoms as well as smoking and high alcohol consumption. Thus, a broad clinical assessment is needed for adolescents with such preliminary diagnoses.

Mark TL; Song X; Vandivort R; Duffy S; Butler J; Coffey R et al. Characterizing substance abuse programs that treat adolescents. Journal of Substance Abuse Treatment 31(1): 59-65, 2006. (19 refs.)

Few systematic studies have examined the characteristics of substance abuse treatment programs serving adolescents. An expert panel recently identified nine key elements of effective adolescent substance abuse treatment. We measured the percentage of treatment programs in the United States with at least 10 adolescent clients on a given day that reported these elements using data from the 2003 National Survey of Substance Abuse Treatment Services. This first look into the characteristics of facilities serving significant numbers of adolescents indicates that many facilities may be lacking in components considered important. The most significant measured potential areas for improvement occurred in the areas of including mental health as well as medical issues in comprehensive assessments and developing curricula to meet the developmental and cultural needs of clients. On a more encouraging note, many facilities were conducting discharge planning and providing aftercare, although the specifics of these services were not determined.

Marsh A; DaleA. Addiction Counselling: Content and Process. Melbourne: IP Communications, 2006

Both the "content" of addiction counselling and the "process" of working with addiction clients are addressed. Part I addresses the effects, harms, and etiology of drug use. Part II, in 18 chapters, addresses content, focusing on the therapeutic alliance, assessment, suicide assessment and management, motivational interviewing, harm reduction, treatment planning, problem solving, cognitive restructuring, anger management, assertiveness training, grief and loss, drug therapies, referral and supervision. Part III deals with process. In 8 chapters it addresses developmental needs, transference and counter-transference, client ambivalence, core themes, and termination. Part IV considers special populations -- the coerced client, adolescents and young people, and working with co-occurring substance abuse and mental health disorders. Case studies illustrate addiction counselling principles and challenges. 'Tip-sheet' summaries of core material are provided. In addition, client handouts and work sheets are provided.

Martin CA; Cook C; Woodring JH; Burkhardt G; Guenthner G; Omar HA et al. Caffeine use: Association with nicotine use, aggression, and other psychopathology in psychiatric and pediatric outpatient adolescents. TheScientificWorldJOURAL 8: 513-516, 2008. (8 refs.)

The objective of this study was to evaluate the relationship between caffeine use, other drug use, and psychopathology in adolescents, using self-report measures. The study group consisted of 132 adolescents ( average age 14.01 +/- 2.06 years, 52% female, 19% African American, 5% other categories, 76% Caucasian). Most (47%) were recruited from a child psychiatry clinic with emphasis on youth with disruptive disorders, with 35% from an adolescent pediatric clinic with emphasis on prevention of risk-taking behavior and 18% from a pediatric clinic for families with limited resources. Subjects were consecutively recruited before or after regular clinic visits. Consent was obtained from parents and assent from the youth. High caffeine consumption was associated with daily cigarette use; aggressive behavior; conduct, attention deficit/hyperactivity, and social problems; and increased somatic complaints in adolescents.

Mason WA; Hitchings JE; Spoth RL. The interaction of conduct problems and depressed mood in relation to adolescent substance involvement and peer substance use. (review). Drug and Alcohol Dependence 96(3): 233-248, 2008. (102 refs.)

Conduct problems are strong positive predictors of substance use and problem substance use among teens, whereas predictive associations of depressed mood with these outcomes are mixed. Conduct problems and depressed mood often co-occur, and such co-occurrence may heighten risk for negative outcomes. Thus, this study examined the interaction of conduct problems and depressed mood at age 11 in relation to substance use and problem use at age 18, and possible mediation through peer substance use at age 16. Analyses of multirater longitudinal data collected from 429 rural youths (222 girls) and their families were conducted using a methodology for testing latent variable interactions. The link between the conduct problems x depressed mood interaction and adolescent substance use was negative and statistically significant. Unexpectedly, positive associations of conduct problems with substance use were stronger at lower levels of depressed mood. A significant negative interaction in relation to peer substance use also was observed, and the estimated indirect effect of the interaction on adolescent use through peer use as a mediator was statistically significant. Findings illustrate the complexity of multiproblem youth.

Mayes R; Rafalovich A. Suffer the restless children: The evolution of ADHD and paediatric stimulant use, 1900-80. History of Psychiatry 18(4): 435-457, 2007. (78 refs.)

This article traces the historical evolution of Attention Deficit/Hyperactivity Disorder (ADHD) and the controversial use of stimulants as a treatment for children diagnosed with the disorder in North America. While the children in question have exhibited similar behaviour over the last century, the diagnostic labels used to identify them have changed due largely to cultural, medical and scientific changes and discoveries. For decades, children's treatment with psychotropic drugs was sufficiently controversial that pharmaceutical companies would not finance research in the area. The only substantial source of research funding for paediatric psychopharmacology in the USA from the 1950s to the 1970s was the National Institute of Mental Health (NIMH). In 1970, the first in a long-running series of controversies erupted over children's treatment with stimulants.

Measelle JR; Slice E; Hogansen JM. Developmental trajectories of co-occurring depressive, eating, antisocial and substance abuse problems in female adolescents. Journal of Abnormal Psychology 115(3): 524-538, 2006. (98 refs.)

Growth trajectories of co-occurring symptomatology were examined in a community sample of 493 female adolescents who were followed annually from early to late adolescence. On average, depression, eating disorder, and substance abuse symptoms increased over time, whereas antisocial behavior decreased. Increases in each symptom domain were associated with relative increases in all other domains. Initial depressive and antisocial behavior symptoms predicted future increases in the other; substance abuse and antisocial behavior symptoms also showed prospective reciprocal relations. Initial depression predicted increases in eating disorder and substance abuse symptoms. Initial eating disorder symptoms predicted increases in substance abuse problems. Finally, the results suggest that the developmental covariation between depressive and eating disorder symptoms and between antisocial behavior and substance abuse symptoms was accounted for by distinct but related 2nd-order growth parameters.

Moolchan ET; Frazier M; Franken FH; Ernst M. Adolescents in smoking cessation treatment: Relationship between externalizing symptoms, smoking history and outcome. Psychiatry Research 152(2/3): 281-285, 2007. (25 refs.)

Previous research has indicated a potential bi-directional link between youth substance use and externalizing psychiatric comorbidities. We hypothesized that the degree of externalizing symptoms predicts the likelihood of successful smoking cessation (prolonged abstinence) among adolescent smokers participating in a cessation trial. We also explored the association of extemalizing symptoms with age at smoking initiation. Ninety one adolescents (mean +/- S.D.; age 15.1 +/- 1.4 years, cigarettes per day 18.4 +/- 8.1, Fagerstrom Test for Nicotine Dependence 7.1 +/- 1.3) were included. The Child Behavior Checklist/4-18 and Youth Self-Report assessed the degree of externalizing symptoms. Regression analysis indicated that lower CBCL externalizing scores significantly predicted the likelihood of prolonged abstinence. Pearson's correlation analysis indicated a significant association of lower externalizing scores with later onset of smoking initiation. Our findings highlight the importance of addressing externalizing behaviors in adolescent smoking cessation programs.

Najavits LM; Gallop RJ; Weiss RD. Seeking Safety therapy for adolescent girls with PTSD and substance use disorder: A randomized controlled trial. Journal of Behavioral Health Services & Research 33(4): 453-463, 2006. (39 refs.)

This randomized, controlled trial evaluated a manualized psychotherapy, Seeking Safety (SS), for posttraumatic stress disorder (PTSD) and substance use disorder (SUD) in adolescent females. To our knowledge, no prior study has evaluated any psychotherapy designed for this population. SS was compared to treatment as usual (TAU) for 33 outpatients, at intake, end-of-treatment, and 3 months follow-up. SS evidenced significantly better outcomes than TAU in a variety of domains at posttreatment, including substance use and associated problems, some trauma-related symptoms, cognitions related to SUD and PTSD, and several areas of pathology not targeted in the treatment (e.g., anorexia, somatization). Effect sizes were generally in the moderate to high range. Some gains were sustained at follow-up. SS appears a promising treatment for this population, but needs further study and perhaps additional clinical modification.

Niemela SM; Sourander A; Poikolainen K; Elonheimo H; Helenius H; Sillanmaki L et al. Adaptive functioning, psychopathology and service use among 18-year-old boys with drunkenness-related alcohol use. Alcohol and Alcoholism 41(2): 143-150, 2006. (37 refs.)

Aims: To study the associations between drunkenness frequency and adaptive functioning, psychopathology and service use among 18-year-old Finnish boys in a nation-wide population-based study. Methods: Information about drunkenness frequency within the previous six months was collected from the Finnish boys born in 1981 (n = 2306) at the boys' obligatory military call-up in 1999. Self-report questionnaires were used to study demographic factors, adaptive functioning, risk behaviour, life events, and mental health service use. Psychopathology and adaptive functioning was assessed with the Young Adult Self-Report (YASR) questionnaire. Results: Of the boys, 85% reported drunkenness within the previous 6 months. Most of the subjects were occasionally drunk: 39% reported drunkenness less than a month, and 35% less than once a week, while 10% reported being frequently drunk once a week or more often. Occasional drunkenness was associated with better adaptive functioning and psychosocial well-being in general. Refraining from drunkenness was associated with suicidal ideation and internalizing problems in the YASR scale. Frequent drunkenness associated with daily smoking, illicit drug use, and externalizing problems in the YASR scale, especially delinquent behaviour. In the multivariate analysis, number of friends, having a regular relationship and cigarette smoking had a linear association with frequency of drunkenness, while drunkenness-related alcohol use was less common among those with poor friendship quality. Among the participants, entering substance use treatment was rare (0.2%). Frequent drunkenness was found to be common among mental health service users. Conclusions: Among late- adolescent boys, occasional drunkenness is a normative alcohol use pattern and associates with social competence and good psychosocial functioning. Late-adolescent boys refraining from drunkenness in addition to those with frequent drunkenness may be in a need of mental health assessment. As entering substance use treatment is infrequent, establishing integrated services with multi-professional co-operation for late-adolescent males with frequent drunkenness is emphasized.

Nolen-Hoeksema S; Stice E; Wade E; Bohon C. Reciprocal relations between rumination and bulimic, substance abuse, and depressive symptoms in female adolescents. Journal of Abnormal Psychology 116(1): 198-207, 2007. (60 refs.)

The authors examined the reciprocal relations between rumination and symptoms of depression, bulimia, and substance abuse with longitudinal data from 496 female adolescents. Rumination predicted future increases in bulimic and substance abuse symptoms, as well as onset of major depression, binge eating, and substance abuse. Depressive and bulimic, but not substance abuse, symptoms predicted increases in rumination. Rumination did not predict increases in externalizing symptoms, providing evidence for the specificity of effects of rumination, although externalizing symptoms predicted future increases in rumination. Results suggest rumination may contribute to the etiology of depressive, bulimic, and substance abuse pathology and that the former two disturbances may foster increased rumination. Results imply that it might be beneficial for prevention programs to target this cognitive vulnerability.

Office of Applied Studies, Substance Abuse and Mental Health Administration. The DASIS Report: Adolescent Treatment Admissions by Gender, 2005. (May 24, 2007). Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (5 refs.)

Based on SAMHSA's Treatment Episode Data Set (TEDS), of the 142,600 adolescent admissions aged 12 to 17 in 2005, about 31% (44,600) were female. Adolescent female substance abuse treatment admissions were less likely than adolescent male admissions to report marijuana as their primary substance of abuse (51% vs. 72%) and more likely to report alcohol (23% vs. 16%) or stimulants (12% vs. 4%) as their primary substance of abuse. Adolescent females admissions were more likely than males to have a co-occurring psychiatric disorder (23% vs. 18%).

Public Domain

Oshri A; Tubman JG; Jaccard J. Psychiatric symptom typology in a sample of youth receiving substance abuse treatment services: Associations with self-reported child maltreatment and sexual risk behaviors. AIDS and Behavior 15(8): 1844-1856, 2011. (92 refs.)

Latent profile analysis (LPA) was used to classify 394 adolescents undergoing substance use treatment, based on past year psychiatric symptoms. Relations between profile membership and (a) self-reported childhood maltreatment experiences and (b) current sexual risk behavior were examined. LPA generated three psychiatric symptom profiles: Low-, High- Alcohol-, and High- Internalizing Symptoms profiles. Analyses identified significant associations between profile membership and childhood sexual abuse and emotional neglect ratings, as well as co-occurring sex with substance use and unprotected intercourse. Profiles with elevated psychiatric symptom scores (e.g., internalizing problems, alcohol abuse and dependence symptoms) and more severe maltreatment histories reported higher scores for behavioral risk factors for HIV/STI exposure. Heterogeneity in psychiatric symptom patterns among youth receiving substance use treatment services, and prior histories of childhood maltreatment, have significant implications for the design and delivery of HIV/STI prevention programs to this population.

Pardini D; White HR; Stouthamer-Loeber M. Early adolescent psychopathology as a predictor of alcohol use disorders by young adulthood. Drug and Alcohol Dependence 88(Supplement 1): S38-S49, 2007. (73 refs.)

Few prospective studies have examined the relation between early adolescent conduct disorder (CD) symptoms and the development of alcohol use disorders (AUD) by young adulthood. The relative contribution of other forms of adolescent psychopathology (i.e., attention-deficit hyperactivity disorder, depression, anxiety/withdrawal) to the development of AUD also remains poorly understood. There is some suggestion that the co-occurrence of conduct disorder symptoms with other forms of psychopathology may interact synergistically in predicting later alcohol use problems. The current study explores these issues using data on 506 boys from the oldest sample of the Pittsburgh Youth Study (PYS). Consistent with prior research, early conduct disorder symptoms emerged as a consistent predictor of increased AUD symptoms and an alcohol dependence diagnosis by young adulthood. In contrast, adolescent boys with high levels of anxiety/withdrawal had lower levels of AUD symptoms and were less likely to develop alcohol dependence by young adulthood. Increased depression in early adolescence was associated with higher AUD symptoms and alcohol abuse and dependence diagnoses by young adulthood, but only for boys with high levels of conduct disorder symptoms. No evidence was found for a relation between attention-deficit hyperactivity disorder symptoms and AUD symptoms or diagnoses after controlling for co-occurring psychopathology.

Pat-Horenczyk R; Peled P; Miron O; Brom D; Villa Y; Chemtob CM. Risk-taking behaviors among Israeli adolescents exposed to recurrent terrorism: Provoking danger under continuous threat? American Journal of Psychiatry 164(1): 66-72, 2007. (9 refs.)

OBJECTIVE: This study aimed to assess 1) the relationship between risk-taking behaviors and exposure to terrorism, 2) the relationship between posttraumatic symptoms and risk-taking behaviors, and 3) gender differences in the type and frequency of risk-taking behaviors and their differential associations with posttraumatic symptoms. METHOD: The participants were 409 Israeli adolescents 15 to 18 years of age. Exposure to terrorism was assessed with a questionnaire developed specifically for the Israeli security situation. Posttraumatic symptoms were measured with the University of California at Los Angeles Reaction Index. Functional impairment was measured with the Diagnostic Interview Schedule for Children. Risk-taking behavior-and the adolescents' perceptions of such behavior-was assessed with a self-report questionnaire. RESULTS: Israeli adolescents exposed to continuous threats of terrorist attacks reported high levels of risk-taking behaviors. The severity of risk-taking was associated with greater terrorism exposure. Adolescents suffering from posttraumatic symptoms reported more risk-taking behaviors than nonsymptomatic adolescents. Although there was no gender difference in the degree of exposure to terrorism, boys reported taking more risks than girls. The association between posttraumatic symptoms and risk-taking behaviors was stronger in boys than girls. Functional impairment, gender, avoidance symptoms, level of exposure, and degree of fear predicted the severity of risk-taking behaviors. CONCLUSIONS: Clinicians and educators should be aware of the strong link between posttraumatic distress and risk-taking behaviors. Risk-taking behaviors may be a manifestation of functional impairment and posttraumatic distress, especially for boys exposed to terrorism.

Pillai A; Patel V; Cardozo P; Goodman R; Weiss HA; Andrew G. Non-traditional lifestyles and prevalence of mental disorders in adolescents in Goa, India. British Journal of Psychiatry 192(1): 45-51, 2008. (48 refs.)

Background: Adolescents comprise a fifth of the population of India, but there is little research on their mental health. We conducted an epidemiological study in the state of Goa to describe the current prevalence of mental disorders and its correlates among adolescents aged between 12 and 16 years. Aims: To estimate the prevalence and correlates of mental disorders in adolescents. Method: Population-based survey of all eligible adolescents from six urban wards and four rural communities which were randomly selected. We used a Konkani translation of the Development and Well-Being Assessment to diagnose current DSM-IV emotional and behavioural disorders. All adolescents were also interviewed on socio-economic factors, education, neighbourhood, parental relations, peer and sexual relationships, violence and substance use. Results Out of 2684 eligible adolescents, 2048 completed the study. The current prevalence of any DSM-IV diagnosis was 1.81%; 95% CI 1.27-2.48. The most common diagnoses were anxiety disorders (1.0%), depressive disorder (0.5%), behavioural disorder (0.4%) and attention-deficit hyperactivity disorder (0.2%). Adolescents from urban areas and girls who faced gender discrimination had higher prevalence. The final multivariate model found an independent association of mental disorders with an outgoing 'non-traditional' lifestyle (frequent partying, going to the cinema, shopping for fun and having a boyfriend or girlfriend), difficulties with studies, lack of safety in the neighbourhood, a history of physical or verbal abuse and tobacco use. Having one's family as the primary source of social support was associated with lower prevalence of mental disorders. Conclusions The current prevalence of mental disorders in adolescents in our study was very low compared with studies in other countries. Strong family support was a critical factor associated with low prevalence of mental disorders, while factors indicative of adoption of a non-traditional lifestyle were associated with an increased prevalence.

Pirkle EC; Richter L. Personality, attitudinal and behavioral risk profiles of young female binge drinkers and smokers. Journal of Adolescent Health 38(1): 44-54, 2006. (49 refs.)

Purpose: Analyses were conducted to identify personality, attitudinal and behavioral correlates of binge drinking and smoking among adolescent girls and young women, a population whose substance use attitudes and behaviors have received only limited attention in the literature. Methods: A nationally representative sample of girls and young women (n = 929) from three age cohorts completed a telephone interview assessing various personality, attitudinal, and behavioral characteristics. Respondents were categorized into four groups based on self-reported binge drinking and smoking (binge drinker/nonsmoker, smoker/non-binge drinker, binge drinker/smoker, or nonbinge drinker/nonsmoker) and were assessed on a number of variables, including self-monitoring, depressive symptoms, coping style, religiosity/spirituality, popularity, dieting behavior, and smoking- and alcohol-related expectations. Univariate and multiple regression analyses were conducted to identify characteristics that best describe each of these types of substance users. Results: Risk profiles varied across the groups. Girls and young women who binge drank but did not smoke were more likely to be high self-monitors, to engage in disordered dieting, and to believe drinking provided an excuse to act with less inhibition. Those who smoked but did not binge drink were more likely to report depressive symptoms. Those who binge drank and smoked were more likely to be popular and to report depressive symptoms. Certain forms of avoidant coping and low religiosity were associated with all three types of substance use. Conclusion: Understanding the risk profiles of girls and young women who engage in specific forms of substance use can facilitate the identification of those at risk and the development of more targeted and effective prevention programs and interventions.

Pisetsky EM; Chao YM; Dierker LC; May AM; Striegel-Moore RH. Disordered eating and substance use in high-school students: Results from the youth risk behavior surveillance system. International Journal of Eating Disorders 41(5): 464-470, 2008. (31 refs.)

Objective: To examine the association between disordered eating (fasting, diet product use, and vomiting or laxative use) and use of 10 substances (cigarettes, alcohol, marijuana, cocaine, inhalants, heroin, methamphetamines, ecstasy, steroids, and hallucinogens) in a nationally representative adolescent sample. Method: Participants were 13,917 U.S. high-school students participating in the 2005 Youth Risk Behavior Surveillance System. Results: Disordered eating was significantly associated with the use of each substance. Using effect size estimates that take base rates into consideration, for female students, associations between substance use and disordered eating were weak for all but three forms of substance use: current smoking, binge drinking, and inhalants. Among male students, strong (marijuana, steroids, and inhalants) or moderate effects (all other substances) were observed. Conclusion: Future research needs to focus on inhalant use and methamphetamine use in males. Increased medical attention should be directed toward adolescents who practice disordered eating behaviors because they are also at elevated risk for using cigarettes, alcohol, inhalants, methamphetamines, and steroids.

Renaud J; Berhin MT; McGirr A; Tousignant M; Turecki G. Current psychiatric morbidity, aggression/impulsivity, and personality dimensions in child and adolescent suicide: A case-control study. Journal of Affective Disorders 105(1-3): 221-228, 2008. (46 refs.)

Objective: The present study was designed to evaluate psychiatric risk factors for child and adolescent suicide, and to determine the association between impulsive-aggressive and other personality traits, and suicide completion in this population. Method: Psychiatric diagnoses, impulsive-aggressive and other personality traits were assessed in 55 child and adolescent suicide victims and 55 community controls using semi-structured proxy-based interviews and questionnaires. Results: The most significant psychiatric risk factors associated with child and adolescent suicide were depressive disorders (OR=48.414, 95% CI 6.247-375.185), substance/alcohol abuse disorder (OR=5.365, 95% CI 1.434-20.076), and disruptive disorders (OR=13.643, 95% CI 2.292-23.16). Additionally, suicide victims showed higher scores on lifetime aggression/impulsivity, and harm avoidance. However, after logistic regression, the only independent significant predictors of suicide in this age group were the presence of depressive disorders (Adjusted OR (AOR)=39.652, 95% CI 4.501-349.345), substance/alcohol abuse disorders (AOR=7.325, 95% CI 1.127-47.62), and disruptive disorders (AOR=6.464, 95% CI 1.422-29.38). Limitations: Relatively small sample size, and cross-sectional design. Conclusions: Our findings confirm the existence of a particular clinical profile of children and adolescents at high risk for suicide. Additionally, our results reinforce the need for improved understanding of the interrelationships between stressors, depression, substance/alcohol abuse disorders, disruptive disorders and personality traits/dimensions in youth suicidal behavior.

Rhee SH; Hewitt JK; Young SE; Corley RP; Crowley TJ; Neale MC et al. Comorbidity between alcohol dependence and illicit drug dependence in adolescents with antisocial behavior and matched controls. Drug and Alcohol Dependence 84(1): 85-92, 2006. (41 refs.)

Background: Knowledge regarding the causes of comorbidity among substance use disorders can have significant impact on future research examining the etiology of these disorders. Unfortunately, the conclusions of past studies examining the comorbidity among substance use disorders are conflicting; some studies emphasize familial influences common to multiple substances, while others emphasize substance-specific influences. Discrepancies in results may reflect different analytical approaches or differences in the samples. Here, we examine the causes of comorbidity between alcohol dependence and illicit drug dependence in adolescents. Methods: We ascertained a clinical sample of adolescents treated for antisocial behavior and substance use disorders and their siblings and a matched control sample. A model fitting approach was used to test 13 alternative hypotheses for the causes of comorbidity. Results: The best supported hypothesis for the comorbidity between alcohol dependence and illicit drug dependence was a model hypothesizing that comorbid disorders are alternate forms of a single underlying liability. The next best fitting models were two of the correlated liabilities models (correlated risk factors and reciprocal causation). Discussion: The results suggest that the best hypotheses explaining the comorbidity between alcohol and illicit drug dependence in adolescents are that alcohol dependence and illicit drug dependence are manifestations of a single general liability to develop substance dependence or that there are separate liabilities that are highly correlated.

Ribeiro SN; Jennen-Steinmetz C; MH; Becker K. Nicotine and alcohol use in adolescent psychiatric inpatients: Associations with diagnoses, psychosocial factors, gender and age. Nordic Journal of Psychiatry 62(4): 315-321, 2008. (49 refs.)

The aim of the survey was to describe the proportion of smokers and alcohol users in a group of children and adolescents admitted to a German department of child and adolescent psychiatry and psychotherapy. In addition, the proportion of smokers in this group of patients was compared with the proportion in the general population of the same age. The sample was composed of all children and adolescent inpatients (n = 432, 8-17 years old meeting inclusion criteria) admitted to a German department of child and adolescent psychiatry between May 2001 and June 2003. A shortened adaptation of the questionnaire on legal and illegal drug use, developed by the Swiss Professional Service for Alcohol Problems, Lausanne, was used. Initiation, frequency and quantity of drug use, and parental substance use were assessed. The results showed an association between conduct disorder (CD) and attention-deficit/hyperactivity disorder (ADHD) and an early initiation of nicotine and alcohol use. Girls and boys with CD and ADHD were significantly more likely to be involved in higher levels of nicotine use compared with the general population. Parental nicotine use was associated with smoking in girls, while maternal nicotine use was associated with smoking in boys. Furthermore, regular alcohol use in both girls and boys was associated with nicotine use. To conclude, early initiation and elevated rates of nicotine and alcohol use are a particular risk for adolescents with CD and ADHD.

Roberts RE; Roberts CR; Xing Y. Comorbidity of substance use disorders and other psychiatric disorders among adolescents: Evidence from an epidemiologic survey. Drug and Alcohol Dependence 88(Supplement 1): S4-S13, 2007. (59 refs.)

This paper extends our knowledge of comorbidity of substance use disorders (SUDS) and other psychiatric disorders by examining comorbidity of specific types of SUDS and risk of comorbidity separately for abuse and dependence. The research question is whether there is specificity of risk for comorbidity for different SUDS and whether greater comorbidity is associated with dependence. Data are presented from a probability sample of 4175 youths aged 11-17 assessed with the NIMH DISC-IV and self-administered questionnaires. SUDS outcomes are alcohol, marijuana and other substances in past year. Mean number of other comorbid disorders ranged from 1.9 for marijuana abuse to 2.2 for other substance abuse and 1.9 for marijuana dependence to 2.8 for other substance dependence. None of the abuse SUDS does not increase risk of anxiety disorders, but dependence does. Both abuse and dependence increased risk of comorbid mood disorders. Similar results were observed for disruptive disorders. Patterns of comorbidity varied by substance, by abuse versus dependence, and by category of other psychiatric disorders. In general, there was greater association of comorbidity with other disorders for dependence versus abuse. Marijuana is somewhat less associated with other disorders than alcohol or other substances. The strongest association is for comorbid disruptive disorders, regardless of SUDS category. Having SUDS and comorbid other psychiatric disorders was associated with substantial functional impairment. Females with SUDS tended to have higher rates of comorbid disorders, as did older youths. There were no differences observed among ethnic groups. When comorbidity of SUDS with other disorders was examined, controlling for other non-SUDS disorders for each specific disorder examined, the greater odds for dependence versus abuse essentially disappeared for all disorders except disruptive disorders, suggesting larger number of comorbid non-SUDS in part account for the observed effects for dependence.

Roncero C; Collazos F; Valero S; Casas M. Cannabis consumption and development of psychosis: State of the art. (review). Actas Esponolas de Psiquiatria 35(3): 182-189, 2007. (30 refs.)

Cannabis is the most widely used illegal drug in Spain. Currently, its use is on the rise as risk perception is decreasing, primarily among young people. It is well known that cannabis negatively influences course and prognosis in schizophrenic patients. However, the relationship between cannabis use and development of a psychotic or schizophrenic disorder remains controversial. The study of this topic has been approached using longitudinal cohort studies, which study cannabis use and psychotic or schizophrenic disorders. In addition to the classic Swedish conscript study published by Andreasson et al. 1987, during the past years, six more longitudinal cohort studies have been published. The data demonstrate that there are both temporal and dose-response relationships, and that early initiation of cannabis use is highly correlated with the development of psychotic symptoms. Cannabis consumption can increase the risk of developing schizophrenia in a vulnerable population twofold, to the extent that some studies suggest a causal relationship. The current knowledge base makes it necessary to warn the population about the relationship between cannabis use and the development of psychosis.

Rumpold G; Klingseis M; Dornauer K; Kopp M; Doering S; Hofer S et al. Psychotropic substance abuse among adolescents: A structural equation model on risk and protective factors. Substance Use & Misuse 41(8): 1155-1169, 2006. (23 refs.)

The use of psychotropic substances in adolescents represents a serious public health problem. In this study a representative sample of 485 Austrian students between 14 and 18 years of age were investigated with a semistructured interview about substance-related issues and completed the general health questionnaire. The following rates of regular psychotropic substance use were found: cigarettes 41.4%, alcohol 44.5%, cannabis 10.1%, and other illicit substances 3%. Logistic regression analyses and structural equation modeling revealed the following major risk factors for substance use: peer pressure, negative family atmosphere, school difficulties, and psychopathology. Knowledge about substance use acted as a protective factor. Prevention of adolescent substance use and misuse should aim at these different targets. Information about coping with peer pressure may be a particularly promising route of intervention.

Solorio MR; Milburn NG; Andersen RM; Trifskin S; Rodriguez MA. Emotional distress and mental health service use among urban homeless adolescents. Journal of Behavioral Health Services & Research 33(4): 381-393, 2006. (22 refs.)

The Expanded Behavioral Model for Vulnerable Populations was used to examine the predisposing, enabling, and need factors associated with mental health service use in a homeless adolescent sample (N=688). Among all youth, 32% perceived a need for help with mental health problems and 15% met Brief-Symptom Inventory (BSI) criteria for emotional distress. The rate of mental health service use in our sample was 32%. One enabling factor, having a case manager/discussed mental health concerns, and one need factor, which met criteria for BSI, were found to be associated with mental health service use in the past 3 months. The majority of youth who used mental health services had obtained services from crisis centers. Among those who perceived a need for help with mental health problems but who did not use services, the most common barrier was not knowing where to go or what service to use (57%). These findings suggest that due to the high prevalence of mental health problems among homeless youth, it would be helpful for service providers coming into contact with youth to make them aware of existing community resources for mental health services; making youth aware of these resources may in turn decrease the rate of crisis center use and instead allow youth to receive mental health services in outpatient settings that provide continuity of care.

Staller JA. Diagnostic profiles in outpatient child psychiatry. American Journal of Orthopsychiatry 76(1): 98-102, 2006. (7 refs.)

Outpatient child psychiatrists appear to be treating a broadening array of complex, highly comorbid, and difficult-to-treat youths. In this study, designed to evaluate the current demographic and diagnostic profile of outpatient child psychiatric patients 1,292 outpatient records from 8 treatment settings were reviewed. Patient age, race, gender, and diagnoses were recorded and analyzed. Externalizing disorders (ADHD and/or behavior disorders) were diagnosed most frequently, followed by internalizing (depressive and anxiety) disorders. Comorbidity was evident in nearly half of all patients, regardless of age. Substance abuse was infrequently reported as a comorbid condition. Externalizing and internalizing pathology frequently co-occurred. Findings reinforce the need for clinician vigilance and thorough assessment of outpatient children and adolescents.

Stathis SL; Letters P; Doolan I; Whittingham D. Developing an integrated substance use and mental health service in the specialised setting of a youth detention centre. Drug and Alcohol Review 25(2): 149-155, 2006. (53 refs.)

This article describes the frequency of co-morbid substance use and mental health problems of young people within the youth justice system and demonstrates that mental health and drug and alcohol services can be integrated and work effectively. The establishment of an integrated Mental Health Alcohol Tobacco and Other Drugs Service (MHATODS) to juveniles in detention represents a shift away from the traditional paradigm of separate services frequently found throughout Australia. The development of referral procedures and adolescent-focused treatment programmes that are tailored to the specific needs of this disadvantaged population are discussed. A wide-ranging literature review illustrates the consequences of the high prevalence of co-morbid substance use and mental health problems in juveniles within the youth justice system. A retrospective and descriptive account is given of the expansion of the MHATODS, including the recruitment of an Indigenous health worker, the incorporation of an automatic referral process for young people with substance use problems and the development of a brief four-session drug and alcohol counselling programme and a group relapse prevention programme. The proportion of Indigenous clients referred to MHATODS is now equitable to referrals of non-Indigenous youth. The introduction of an automatic voluntary referral process resulted in an increase in referrals for drug and alcohol assessment and counselling from 17% to 64% of total referrals. Of those young people commencing the drug and alcohol programme, 32% completed all sessions. While young people reportedly enjoyed the group programme, feedback from participants indicated that they felt vulnerable in a group setting. MHATODS recognises the limitations of the prevailing paradigm of separate service delivery for mental health and drug and alcohol treatment, and has developed an integrated treatment service for juveniles in detention. The service has expanded its referral base for substance use problems by employing an Indigenous health worker, and initiating an automatic referral process for young people admitted into detention who have a history of significant substance use. Early evidence indicates increased utilisation of drug and alcohol services by young people in detention.

Steuber TL; Danner F. Adolescent smoking and depression: Which comes first? (rapid communication}. Addictive Behaviors 31(1): 133-136, 2006. (7 refs.)

Despite the well-known health risks of smoking, adolescents continue to smoke at alarming rates. Smoking is also known to be associated with depression, but the direction of this relation is unclear. This study used data from the National Longitudinal Study of Adolescent Health (Add Health) to evaluate the direction of the relation between cigarette smoking and depression among adolescents. A total of 14,634 adolescents (7132 males and 7502 females) completed in-home surveys in 1995 and 1996 and were split into four smoking status groups. Adolescents who were Starters, Quitters, and Maintainers were found to be 1.5, 1.4, and 2.0 times more likely, respectively, than Nevers to be depressed at Time 2. In addition, females showed a striking pattern of increases in depression around the onset of smoking and decreases around the time of quitting. While these findings do not prove that smoking leads to depression, they are consistent with such a prediction.

Strong DR; Kahler CW; Abrantes AM; MacPherson L; Myers MG; Ramsey SE et al. Nicotine dependence symptoms among adolescents with psychiatric disorders: Using a Rasch model to evaluate symptom expression across time. Nicotine & Tobacco Research 9(5): 557-569, 2007. (62 refs.)

Little is known about the longitudinal course of symptoms of nicotine dependence among adolescents following interventions designed to affect smoking behavior, particularly among high-risk samples. We used an item-response modeling strategy to examine how well nicotine dependence symptoms cohere to a latent construct, the stability of the construct over time, and the sensitivity of the nicotine dependence symptoms to changes in smoking patterns among adolescents with comorbid psychopathology. Assessments occurred prior to cessation treatment delivered within a randomized clinical trial and again at 6 and 12 months after treatment. We used a Rasch item-response modeling approach to examine nicotine dependence as measured by a structured Adolescent Nicotine Dependence Interview (ANDI) and by the Modified Fagerstrom Tolerance Questionnaire (mFTQ). These analyses provided support for a unidimensional latent measurement model that can be used to organize symptoms of nicotine dependence obtained from ANDI and mFTQ measures. The derived measure showed good construct validity with significant relationships to smoking levels and salivary cotinine levels. The typical symptom patterns and the relative severity of nicotine dependence symptoms remained stable over multiple assessments. Changes in smoking levels were related longitudinally to changes in nicotine dependence, and changes in nicotine dependence were related to changes in motivation to quit and readiness to change smoking behavior. Several behavioral symptoms were sensitive to change in smoking rate over time, whereas core symptoms of physiological dependence did not evidence significant changes. Results suggest that DSM-IV and mFTQ measures of nicotine dependence provide complementary information when assessing nicotine dependence levels among adolescents with psychiatric disorders.

Tao FB; Xu ML; Kim SD; Sun Y; Su PY; Huang K. Physical activity might not be the protective factor for health risk behaviours and psychopathological symptoms in adolescents. Journal of Paediatrics and Child Health 43(11): 762-767, 2007. (24 refs.)

Aim: This study aims to examine the effect of physical activity (PA) intensity on tobacco or alcohol abuse, suicide behaviours and psychopathological symptoms in junior and senior high school students in China. Methods: A total of 5453 students from nine middle schools participated in a self-administered anonymous survey to report their frequency of moderate and vigorous physical activity at a normal learning week. Tobacco or alcohol use in the past 30 days, suicide behaviours during the past 12 months were asked. The Symptoms Checklist 90 was used to assess general mental problem and nine special psychopathological symptoms. The Rosenberg's Self-esteem Scale and School Life Satisfaction Rating Questionnaire for Adolescent were selected to rate the respondents' self-esteem and school life satisfaction. Results: Percentage of high-, low-moderate- and very-low-intensity physical activity was 22.0%, 37.0% and 41.0%, respectively. By using multivariable multinomial logistic regression, it was indicated that low-moderate-intensity physical activity was a protective factor of depression (odds ratio (OR) was 0.61, 95% confidence interval (CI) was 0.40-0.91) and psychotic symptoms (OR 0.54, 95% CI 0.31-0.93), while high-intensity physical activity was a risk factor of binge drinking (OR: 1.81, 95% CI: 1.29-2.54), suicide ideation (OR: 1.26, 95% CI: 1.04-1.54), general psychological disorders (OR: 1.43, 95% CI: 1.11-1.84), and hostile symptoms (OR: 1.46, 95% CI: 1.03-2.07). Conclusion: Different intensity physical activity in adolescents had different association with risk health behaviours and psychopathological symptoms. The reasons are worth further researching.

Vanheusden K; Van Lenthe FJ; Mulder CL; Van der Ende J; Van de Mheen D; Mackenbach JP et al. Patterns of association between alcohol consumption and internalizing and externalizing problems in young adults. Journal of Studies on Alcohol and Drugs 69(1): 49-57, 2008. (37 refs.)

Objective: This study examined levels of internalizing and externalizing problems over the full spectrum of alcohol consumption in young adults and identified whether social factors account for the associations of alcohol consumption with internalizing and externalizing problems. Method: This study was a cross-sectional random sample study among 2,258 young adult men and women from the general population of southwest Netherlands. Five groups were distinguished: (1) nondrinkers; (2) occasional drinkers (monthly or less); and regular drinkers (two or more times monthly) who were further classified into (3) low-level drinkers (one to two drinks per occasion), (4) higher-level drinkers (three to four drinks per occasion), or (5) excessive drinkers (five or more drinks per occasion). Internalizing problems and externalizing problems, social support, and negative social exchange were measured with standardized questionnaires. Results: U-shaped associations were found between alcohol consumption and various internalizing problems. Low social support accounted for higher rates of internalizing problems in nondrinkers and negative social exchange accounted for higher rates of internalizing problems in excessive drinkers. Also, excessive drinking was associated with various externalizing problems. A J-shaped association was found between alcohol consumption and aggressive behavior, with higher rates for occasional and excessive drinkers compared with low-level drinkers. Negative social exchange partly accounted for associations between alcohol consumption and externalizing problems. Conclusions: Nondrinkers and excessive drinkers differ from low-level drinkers in risk factors for poor mental health, and these factors may contribute to their elevated rates of mental health problems. Interventions that address the experience of negative social exchange may produce both mental health benefits and a reduction of excessive drinking.

Vaughn MG; Ollie MT; McMillen JC; Scott L; Munson M. Substance use and abuse among older youth in foster care. Addictive Behaviors 32(9): 1929-1935, 2007. (5 refs.)

The purpose of this study was to explore prevalence and predictors of current and lifetime substance use, substance abuse disorder, and polysubstance use among older youth in foster care. Interviews were conducted with 406 17-year old youth (90% of those eligible) in one state's foster care system between December 2001 and June 2003. Forty-five percent of foster care youth reported using alcohol or illicit drugs within the last six months; 49% had tried drugs sometime during their lifetime and 35% met criteria for a substance use disorder. Having a diagnosis of Conduct Disorder and/or living in an independent living situation significantly increased the likelihood of current and lifetime substance use and disorder. A diagnosis of Post Traumatic Stress Disorder also predicted increased likelihood of polysubstance use and substance abuse disorder. In conclusion, older youth in the foster care system report similar levels of lifetime alcohol and illicit substance use when compared to the general adolescent population. However, rates of substance use disorder are high. Particularly at risk for both high rates of use and disorder are youth in independent living situations and youth with a diagnosis of Conduct Disorder or Post Traumatic Stress Disorder.

Vignier N; Lert F; Salomon C; Hamelin C. Kava drinking associated with suicidal behaviour among young Kanaks using kava in New Caledonia. Australian and New Zealand Journal of Public Health 35(5): 427-433, 2011. (41 refs.)

Objective: To examine associations between recreational use of kava and indicators of suicidal behaviour among youth in New Caledonia. Methods: This cross-sectional community-based survey was administered to 1,400 young people aged 16-25 years. A multivariate analysis tested for associations between lifetime kava use and lifetime suicidal ideation and attempts. Because ethnicity affected the correlation between kava use and suicidal behaviour, data were analysed separately for Kanak youth and youth of other ethnic communities. Results: Overall, 42% of respondents reported any lifetime kava use, 34% reported past suicidal ideation and 12% any suicide attempts. Among Kanak youth, kava use increased the likelihood of reporting both suicidal ideation (aOR = 2.40, 95% CI: 1.58-3.66) and suicide attempts (aOR = 1.98, 95% CI: 1.11-3.52). No such association was found in the non-Kanak group. Conclusions: The discrepancy between the effects of kava drinking on suicidal behaviour between Kanak youth and youth of other ethnic groups may be related to differences in patterns and quantity of kava use. In view of the paucity of data on the effects of kava on mental health in young people, further investigation is required. Implications: The results call for an increased awareness of the potential adverse health effects of kava consumption in New Caledonia where it has spread in recent times and among communities where previously it was never used.

Wade D; Harrigan S; McGorry PD; Burgess PM; Whelan G. Impact of severity of substance use disorder on symptomatic and functional outcome in young individuals with first-episode psychosis. Journal of Clinical Psychiatry 68(5): 767-774, 2007. (28 refs.)

Objective: To investigate whether severity of substance use disorder is independently associated with 15-month symptomatic or functional outcome in young individuals with first-episode Psychosis. Method: Ninety-two individuals aged 15 to 30 years with first-episode psychosis participated in a 15-month prospective follow-up study. DSM-IV criteria were used to diagnose psychotic disorders, and DSM-III-R criteria were used to diagnose substance use disorder (abuse or dependence). Measures of outcome included severity of positive and negative symptoms, quality of life, and level of social functioning. Data were collected between March and July 2001 at a specialist first-episode psychosis service and between January and December 1997 at 2 generic mental health services. Results: Multiple linear regression showed that heavy substance use disorder was significantly associated with more severe positive symptoms at 15 months after controlling for the effects of gender, duration of untreated psychosis, and medication adherence (vs. no Substance use disorder, p =.006; vs. mild substance use disorder, p =.023). Heavy substance use disorder was also significantly associated with poorer social functioning at 15 months after controlling for the effects of gender, duration of untreated psychosis, medication adherence, and positive symptoms (vs. no substance use disorder, p =.025; vs. mild substance use disorder, p =.047). Heavy substance use disorder was not associated with negative symptoms or quality of life after controlling for the effects of potential confounding variables. Conclusion: Heavy but not mild substance use disorder appears to be independently associated with poorer symptomatic and functional outcome in young patients with first-episode psychosis.

Weaver MF; Dupre MA; Cropsey KL; Koch JR; Sood BA; Wiley JL et al. Addiction epidemiology in adolescents receiving inpatient psychiatric treatment. Addictive Behaviors 32(12): 3107-3113, 2007. (7 refs.)

This study sought to characterize adolescent psychiatric inpatient populations from two sites and to determine correlates of substance use disorders (SUD). Screening procedures for SUD differ substantially between these sites. A retrospective review of adolescent inpatients (n = 636) revealed that the populations were similar in gender, race and age. Rates of SUD at the site with a formalized SUD screening regimen were higher (39%) than those at the other site (16.5%). Similar correlates of SUD were observed across sites, including older age, legal involvement, sexual activity, childhood disruptive disorder, and tobacco use. These results suggest that SUD is a major issue in adolescent psychiatric patients. More rigorous screening for SUD and its correlates may facilitate earlier detection of substance use in this vulnerable population.

Whitbeck LB; Johnson KD; Hoyt DR; Walls ML. Prevalence and comorbidity of mental disorders among American Indian children in the Northern Midwest. Journal of Adolescent Health 39(3): 427-434, 2006. (42 refs.)

Purpose: To investigate the prevalence of mental disorder and comorbidity among American Indian children aged 10-12 years from four U.S. reservations and five Canadian reserves in the Northern Midwest. Method: Specially, trained Native interviewers administered the Diagnostic Interview for Children-Revised for 11 diagnostic categories to 736 tribally enrolled children (mean age 11 years) and their female caretakers. Results: Prevalence rates are reported by child self-report, female caretaker reports, and combined caretaker-child reports. Twenty-three percent (combined caretaker-child reports) of the children met criteria for one of the 11 disorders and 9% met criteria for two or more of the disorders. Externalizing disorders were more prevalent than internalizing disorders or substance abuse disorders. The strongest predictor of child mental disorder was a depressed female caretaker. Conclusions: Nearly one-fourth of Native children met criteria for at least one mental disorder. The presence of early mental disorder is an important risk factor for substance use and mental health problems in later life. We need systematic research to identify risk and protective factors for early mental health problems and to identify barriers to services utilization so that we can develop empirically informed, culturally specific prevention programs that address these needs.

Whitbeck LB; Yu M; Johnson KD; Hoyt DR; Walls ML. Diagnostic prevalence rates from early to mid-adolescence among indigenous adolescents: First results from a longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry 47(8): 890-900, 2008. (37 refs.)

Objective: Investigate change in prevalence rates for mental and substance abuse disorders between early and mid-adolescence among a cohort of indigenous adolescents. Method: The data are from a lagged, sequential study of 651 indigenous adolescents from a single culture in the northern Midwest U0nited States and Canada. At waves 1 (ages 10-12 years) and 4 (ages 13-15 years), one adult caretaker and one tribally enrolled adolescent completed a computer-assisted personal interview that included Diagnostic Interview Schedule for Children-Revised assessment for 11 diagnoses. Multivariate analyses investigate effects of wave 1 adolescent diagnosis and wave 1 biological mother diagnosis (University of Michigan Composite International Diagnostic Interview) on wave 4 diagnostic outcomes. Results: The findings show a increase in prevalence rates for substance abuse disorders and conduct disorders between ages 10 and 12 years and 13 and 15 years among indigenous adolescents, with these disorders affecting more than one fourth of the children. The rate of lifetime conduct disorder is about twice that expected in general population studies (23.4% versus 5%-10%), and the rate of lifetime substance abuse disorder (27.2%) is three times that reported in the 2004 National Survey on Drug Use and Health (9.4%) for individuals 12 years or older. Prevalence rates for any single mental or substance use disorder (44.8 lifetime) for the 13- to 15-year-olds are similar to the lifetime prevalence rates reported in the National Comorbidity Survey-Replication (46.4%) for individuals 18 years and older. Conclusions: A mental health crisis exists on the indigenous reservations and reserves that participated in this study. Current service systems are overwhelmed and unable to meet the demands placed upon them.

Whitmore EA; Riggs PD. Developmentally informed diagnostic and treatment considerations in comorbid conditions. IN: Liddle HA; Rowe CL, eds. Adolescent Substance Abuse: Research and Clinical Advances. Cambridge: Cambridge University Press, 2006. pp. 264-283. (97 refs.)

This is one of four chapters dealing with comprehensive assessment and integrative treatment planning with adolescent substance abusers. The primary goals are to understand the clinical impact and treatment implications of comorbidity; to be familiar with the current standards for treatment of comorbid conditions; and to derive an algorithm for integrating the treatment of both substance use disorders and comorbid psychiatric disorders.

2006, Project Cork

Wilens TE; Biederman J; Adamson JJ; Henin A; Sgambati S; Gignac M et al. Further evidence of an association between adolescent bipolar disorder with smoking and substance use disorders: A controlled study. Drug and Alcohol Dependence 95(3): 188-198, 2008. (89 refs.)

Although previous work suggests that juvenile onset bipolar disorder increases risk for substance use disorders and cigarette smoking, the literature on the subject is limited. We evaluated the association of risk for substance use disorders and cigarette smoking with bipolar disorder in adolescents in a case-control study of adolescents with bipolar disorder (n = 105, age 13.6 +/- 2.5 years [mean]; 70% male) and without bipolar disorder ("controls"; it = 98, age 13.7 +/- 2.1 years; 60% male). Rates of substance use and other disorders were assessed with structured interviews (KSADS-E for subjects younger than 18, SCID for 18-year-old subjects). Bipolar disorder was associated with a significant age-adjusted risk for any substance use disorder (hazard ratio[95% confidence interval] = 8.68[3.02 25.0], chi(2) = 16.06, p < 0.001, df = 1), alcohol abuse (7.66 [2.20 26.7], chi(2) = 10.2, p = 0.001, df = 1), drug abuse (18.5 [2.46 139.10], chi(2) = 8.03, p = 0.005, df = 1) and dependence (12.1 [1.54 95.50], chi(2) = 5.61, p = 0.02, df = 1), and cigarette smoking (12.3 [2.83 53.69], chi(2) = 11.2, p < 0.001, df = 1), independently of attention deficit/hyperactivity disorder, multiple anxiety, and conduct disorder (CD). The primary predictor of substance use disorders in bipolar youth was older age (BPD - SUD versus BPD + SUD, logistic regression: chi(2) = 89.37, p < 0.001). Adolescent bipolar disorder is a significant risk factor for substance use disorders and cigarette smoking, independent of psychiatric comorbidity. Clinicians should carefully screen adolescents with bipolar disorder for substance and cigarette use.

Wilson JJ. ADHD and substance use disorders: Developmental aspects and the impact of stimulant treatment. American Journal on Addictions 16(Supplement 1): 5-13, 2007. (74 refs.)

Adolescents and adults with substance use disorders often demonstrate symptoms of inattention, impulsivity, and hyperactivity. These core symptoms of ADHD may contribute to the development of substance use disorders by promoting antisocial behavior and substance use; conversely, substance use itself can adversely affect these symptoms. Common deficits in self-regulatory processes could underlie the developmental progression of these disorders, deficits further worsened by ongoing substance use. Some investigators have questioned whether stimulant treatment itself could promote substance abuse, while others have argued that such treatment reduces substance abuse. With an increased awareness of the phenomenon of adult ADHD and its relevance to substance-abusing persons, there is an increased awareness of the potential benefit of ADHD treatment on substance abuse treatment outcome. Consideration of an individual's developmental relationship between attention deficit/hyperactivity symptoms and substance use can inform treatment planning among patients seeking substance abuse treatment.

Winters KC; Stinchfield RD; Latimer WW; Stone A. Internalizing and externalizing behaviors and their association with the treatment of adolescents with substance use disorder. Journal of Substance Abuse Treatment 35(3): 269-278, 2008. (53 refs.)

Whereas the treatment outcome research literature for adolescent alcohol and other drug abuse has shown recent advances (R. J. Williams, S. Y. Chang, & Addiction Centre Adolescent Research Group, 2000), significant knowledge gaps remain. A. E. Kazdin (2001) recently observed that one of the key questions for the field is to identify if client characteristics meaningfully mediate or moderate treatment outcome. There is support from the adolescent clinical literature that internalizing and externalizing personality subtypes are related to the onset and course of youth substance use disorders (D. B. Clark & O. G. Bukstein, 1998). The study extends this literature by examining the association of drug use behaviors outcome and subtyped adolescents (internalizers and externalizers; n = 141) who sought treatment at a 12-Step program. The analysis also includes a community-based control group (n = 94). Specifically, we examined the association of subtype and treatment retention and short-term (Year 1) and long-term (Year 4 and Year 5.5) drug involvement outcomes. Externalizers consistently showed poorer outcomes, including poorer treatment retention and greater drug use and drug disorder symptoms at each follow-up point. The treatment implications of the study are discussed.

Yen CF; Chong MY. Comorbid psychiatric disorders, sex, and methamphetamine use in adolescents: A case-control study. Comprehensive Psychiatry 47(3): 215-220, 2006. (45 refs.)

The purpose of this case-control study was to elucidate the relative proportions of amphetamine use disorder (AUD) and amphetamine-induced disorder (AID) in a group of adolescents with the use of methamphetamine (MAMP) and to examine the risks for psychiatric comorbidity and sex for MAMP use. Psychiatryric comorbidity in the preceding year was determined for 200 adolescent MAMP users and 400 drug-free control subjects by diagnostic interview using the Kiddie epidemiologic version of the Schedule for Affective Disorders and Schizophrenia. The proportions of AUD and AID were calculated, and the association between psychiatric comorbidity, sex, and MAMP use was assessed. The results revealed that among the MAMP users, 65 subjects (32.5%) had AUD, whereas 19 (9.5%) had AID. Early use of MAMP use was seen in AUD, whereas high-frequency MAMP use was associated with the Occurrence of AID. Alcohol, nicotine, and betel nut use disorders were more prevalent in MAMP users for both sexes. By applying conditional logistic regression analysis, it was demonstrated that MAMP use was associated with conduct disorder in males, whereas in females, it was associated with conduct disorder and adjustment disorder. The results indicated that age of first use and subsequent frequency of MAMP use appeared to be associated with the development of amphetamine-related disorders. Sex differences in the association between psychiatric comorbidity and MAMP use were demonstrated. These factors have to be taken into consideration when intervening for adolescent MAMP use.

Yen CF; Su YC. The associations of early-onset methamphetamine use with psychiatric morbidity among Taiwanese adolescents. Substance Use & Misuse 41(1): 35-44, 2006. (23 refs.)

The purpose of this study was to examine the associations of early-onset methamphetamine (MAMP) use in early adolescence with psychiatric morbidity in adolescents with MAMP use by gender. A total of 299 adolescents with MAMP use in Taiwan were recruited from two juvenile detention centers in Kaohsiung and Taipei from September 1998 to March 2002. Using the Kiddie epidemiological version of the Schedule for Affective Disorders and Schizophrenia (K-SADS-E), each adolescent was interviewed by a child psychiatrist to determine what psychiatric conditions, including substance use disorders (SUDs) and other psychiatric comorbidities might be associated with the early-onset (15 years old or below) MAMP use according to gender In females, early-onset MAMP use was significantly associated with the diagnoses of depressive disorder conduct disorder and amphetamine use disorder In males, however early-onset MAMP use was only significantly associated with amphetamine use disorder Gender differences exist in the association between early-onset MAMP use and psychiatric morbidity. The association between early-onset MAMP use and psychiatric morbidity may have important implications for public health policy and treatment for adolescents with MAMP use.

Yu JW; Buka SL; Fitzmaurice GM; McCormick MC. Treatment outcomes for substance abuse among adolescents with learning disorders. Journal of Behavioral Health Services & Research 33(3): 275-286, 2006. (34 refs.)

This paper assesses whether chemically dependent adolescents with comorbid learning disorders (LDs) derived less effective treatment results when compared to chemically dependent adolescents without LD and examines the moderating effects of prior treatments, treatment length, and treatment completion. Two hundred one adolescents were recruited between 1992 and 1993 from Massachusetts residential treatment centers and subsequently followed up 6 months after enrollment. Compared to chemically dependent teenagers without LD, those with LD were twice as likely to re-use substances at least once by follow-up. LD teenagers were more likely to attend Alcoholics/Narcotics Anonymous if they had prior admissions to treatment programs and longer treatment length. LD teenagers who completed treatment also experienced a greater decrease in current depression compared to LD teenagers not completing the treatment. This study is the first to consider outcomes of substance abuse treatment for adolescents with LD and contributes to the growing literature on comorbidity and substance abuse treatment.

Zimmermann US; Blomeyer D; Laucht M; Mann KF. How gene-stress-behavior interactions can promote adolescent alcohol use: The roles of predrinking allostatic load and childhood behavior disorders. (review). Pharmacology, Biochemistry and Behavior 86(2): 246-262, 2007. (209 refs.)

A variety of environmental and genetic factors modulating the risk for alcoholism have been described, which predominantly act by interacting with each other. For example, the family, peers and society determine the level of exposure to stress and alcohol, while genes modulate how sensitive an individual responds to both. The resulting behaviors feed back to the social environment, modulating and in the worst case increasing further stress exposure. We here review neurobiological evidence how such a process of mutual interaction can involve and affect drinking. In at-risk adolescents it may have been in force for many years before they have their first alcoholic drink, increasing their risk for addiction by generating allostatic load. As an example, psychiatric disorders involving attention deficit, hyperactivity, or disruptive behaviors first evolve during childhood and are influenced by all the above factors. They are also strongly associated with harmful adolescent drinking and later alcohol use disorders. One important implication of this concept is that issues such as family adversity, adolescent psychiatric disorders, or adolescent drinking might not only be associated with, but causally related to, the risk for later addiction. They are targets for preventive interventions, which should start as early as possible in subjects at-risk.