Review of Teenlink: A health service for children and adolescents of parents with substance use.

AIM: To evaluate Teenlink, a wide-ranging medical and psychological health service addressing the needs of children and adolescents in substance-using families, who are at increased risk of developmental and psychosocial problems. METHODS: Retrospective record review of 124 children, from 92 families seen over a 13 year period. RESULTS: Polysubstance use and mental illness were common amongst parents. Children often presented with emotional and behavioural problems. Teenlink provided parenting skills, individual and family work, medical care, case management, advocacy, collaboration and education with adult drug and alcohol services. CONCLUSIONS: The chronic and complex nature of parental addiction, need for ongoing support and tailored service utilisation, reflected the length of engagement.

Alcohol, drugs and Australian young people.

Experimentation with alcohol and other drugs is often seen as a normal part of adolescent development. The harm associated with substance misuse in young people include injury, violent behaviour, sexual risk taking, drink-driving, overdose, toxicity and death (1-4). Australian young people are drinking alcohol and using illicit substances at an earlier age than previous cohorts (5). hey are more likely to binge drink, have poly-substance use and are at risk of co-morbid mental health problems (1-3). The reasons young people use drugs are complex and varied. An effective response to illicit drug use by young people has to be holistic, as complex and varied as the needs it addresses. It must seek to prevent minimize and manage harm caused by drug use and must be provided to and involve young people in the context of their family, peer group, school and community. Reaching out to young people with drug and alcohol problems is everyone's responsibility. Australia has developed specific prevention and early intervention programs for young people at risk of substance abuse however, further research and development is still needed for effective prevention, early intervention and treatment programs.

Substance abuse and harm minimisation in adolescents.

BACKGROUND: Adolescent substance use is prevalent among Australian school students. Although a degree of risk taking is a normal developmental task it can lead to serious consequences. For some it is a short lived risk taking experience. For others it is a flag for other life difficulties and a possible trajectory to addiction. OBJECTIVE: This article outlines an approach to engaging with the adolescent to identify substance abuse and the context in which it occurs. The process outlined allows for identification of multiple concerns and opportunities to reduce harm. DISCUSSION: The key to addressing adolescent substance use is engagement. This involves allowing for time with the adolescent alone and with a support person if they wish, discussing confidentiality issues and using a framework for obtaining a comprehensive psychosocial history. This enables identification of multiple concerns, comorbid conditions and opportunities to reduce harm.

Gene-gene interaction between the monoamine oxidase A gene and solute carrier family 6 (neurotransmitter transporter, noradrenalin) member 2 gene in anorexia nervosa (restrictive subtype).

We earlier found an association between anorexia nervosa (AN) restrictive subtype (AN-R) and an inserted sequence within the NETpPR, a polymorphic region located in the promoter of the solute carrier family 6 (neurotransmitter transporter, noradrenalin) member 2 (SLC6A2) gene. To further examine the noradrenergic system in AN-R we performed an association study with a functional polymorphism (MAOA-uVNTR) in the promoter of the monoamine oxidase A (MAOA) gene. Since monoamine oxidase A metabolises noradrenalin, a positive association with the MAOA gene would be biologically plausible. The transmission disequilibrium test and 95 trios/duos (AN-R females+biological parents) showed the main effect of the longer, more transcriptionally active form of the MAOA-uVNTR (MAOA-L) to be statistically non-significant (McNemar's chi(2)=1.4, df=1, P=0.238, odds ratio: 1.4, 95% CI 0.8-2.7). A case-control approach supported this finding. We then stratified the MAOA-uVNTR TDT data according to the (a) NETpPR genotype of the AN-R females, and (b) NETpPR allele transmitted from NETpPR-S4/L4 heterozygous mothers. In both cases, contingency table analysis revealed previously unreported gene-gene interaction between the MAOA and SLC6A2 genes (P=0.019 and 0.019, respectively). Receiving an MAOA-L allele more than doubles the risk for developing AN-R, conditional on an individual also being a NETpPR-L4 homozygote (stratum-specific odds ratio: 2.4, 95% CI 1.1-6.0). These results suggest important involvement of the noradrenergic system in the biological underpinnings of AN-R.