Associations between alcohol use and sex-specific maturation of subcortical gray matter morphometry from adolescence to adulthood: Replication across two longitudinal samples.

Subcortical brain morphometry matures across adolescence and young adulthood, a time when many youth engage in escalating levels of alcohol use. Initial cross-sectional studies have shown alcohol use is associated with altered subcortical morphometry. However, longitudinal evidence of sex-specific neuromaturation and associations with alcohol use remains limited. This project used generalized additive mixed models to examine sex-specific development of subcortical volumes and associations with recent alcohol use, using 7 longitudinal waves (n = 804, 51% female, ages 12-21 at baseline) from the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA). A second, independent, longitudinal dataset, with up to four waves of data (n = 467, 43% female, ages 10-18 at baseline), was used to assess replicability. Significant, replicable non-linear normative volumetric changes with age were evident in the caudate, putamen, thalamus, pallidum, amygdala and hippocampus. Significant, replicable negative associations between subcortical volume and alcohol use were found in the hippocampus in all youth, and the caudate and thalamus in female but not male youth, with significant interactions present in the caudate, thalamus and putamen. Findings suggest a structural vulnerability to alcohol use, or a predisposition to drink alcohol based on brain structure, with female youth potentially showing heightened risk, compared to male youth.

Did the acute impact of the COVID-19 pandemic on drinking or nicotine use persist? Evidence from a cohort of emerging adults followed for up to nine years.

OBJECTIVE: This study examined the impact of the COVID-19 pandemic on drinking and nicotine use through June of 2021 in a community-based sample of young adults. METHOD: Data were from 348 individuals (49% female) enrolled in a long-term longitudinal study with an accelerated longitudinal design: the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) Study. Individuals completed pre-pandemic assessments biannually from 2016 to early 2020, then completed up to three web-based, during-pandemic surveys in June 2020, December 2020, and June 2021. Assessments when individuals were 18.8-22.4 years old (N = 1,458) were used to compare drinking and nicotine use pre-pandemic vs. at each of the three during-pandemic timepoints, adjusting for the age-related increases expected over time. RESULTS: Compared to pre-pandemic, participants were less likely to report past-month drinking in June or December 2020, but there was an increase in drinking days among drinkers in June 2020. By June 2021, both the prevalence of past-month drinking and number of drinking days among drinks were similar to pre-pandemic levels. On average, there were no statistically significant differences between pre-pandemic and during-pandemic time points for binge drinking, typical drinking quantity, or nicotine use. Young adults who reported an adverse financial impact of the pandemic showed increased nicotine use while their peers showed stable or decreased nicotine use. CONCLUSION: Initial effects of the pandemic on alcohol use faded by June 2021, and on average there was little effect of the pandemic on nicotine use.

Association Between Habitual Snoring and Cognitive Performance Among a Large Sample of Preadolescent Children.

Importance: Previous studies have identified an association between habitual snoring and lower cognitive performance in children. However, whether and to what extent this association is confounded by pertinent demographic, anthropometric, and socioeconomic characteristics is unknown. Objective: To assess the extent to which potential confounding factors modify the association between parent-reported habitual snoring and cognitive outcomes among a large and diverse sample of typically developing preadolescent children. Design, Setting, and Participants: This cross-sectional analysis used a baseline data set (version 2.0.1) from children enrolled in the ongoing Adolescent Brain Cognitive Development study between September 1, 2016, and October 15, 2018. Children aged 9 to 10 years without serious psychiatric or neurological comorbidities were recruited at 21 research sites in the US. Study recruitment was designed to approximate the racial and socioeconomic diversity of the US population. Data were analyzed from February 1 to March 31, 2020. Exposures: Parent-reported habitual snoring in children that occurs 3 or more nights per week. Main Outcomes and Measures: Associations between habitual snoring and cognitive performance were assessed using the Sleep Disturbance Scale for Children and the National Institutes of Health Toolbox Cognition Battery, which includes 7 domain-specific and 3 composite (total cognitive function, fluid cognition, and crystallized cognition) standard scores that are uncorrected for covariates. Cognitive performance was examined before and after adjustment for covariates, which included age, sex, body mass index percentile, annual household income before taxes, and highest educational level of caregiver. The extent of confounding was assessed by the effect size, represented by Cohen d, before and after inclusion of covariates using linear mixed-effects models. Results: A total of 11 873 children aged 9 to 10 years (6187 boys [52.1%]; 6174 White [52.0%]) with available data were included in the study. Of those, habitual snoring (≥3 nights per week) was reported in 810 children (6.8%), and nonhabitual snoring (1-2 nights per week) was reported in 4058 children (34.2%). In the unadjusted models, the total cognitive function composite score among children who habitually snored was significantly lower compared with children who never snored (Cohen d, 0.35; 95% CI, 0.28-0.42). Differences were also identified in the crystallized cognition (Cohen d, 0.34; 95% CI, 0.26-0.41) and fluid cognition (Cohen d, 0.28; 95% CI, 0.21-0.35) composite scores. The association between habitual snoring and cognitive performance was substantially attenuated after adjustment for covariates (Cohen d, 0.16 [95% CI, 0.09 to 0.24] for total cognitive function, 0.14 [95% CI, 0.07 to 0.21] for crystallized cognition, and 0.13 [95% CI, 0.06 to 0.21] for fluid cognition). Similar mitigation was also observed for all domain-specific scores. Conclusions: In this cross-sectional study, when adjusted for baseline demographic, anthropometric, and socioeconomic characteristics, the association between parent-reported habitual snoring and cognitive performance was substantially attenuated among children aged 9 to 10 years.

Drinking beyond the binge threshold in a clinical sample of adolescents.

BACKGROUND AND AIMS: Nearly all the research conducted on high-intensity drinking has focused on college and school-based samples, with recent calls for research to understand this risky drinking pattern in non-school-based samples and across time. This study aimed to characterize predictors and consequences of non-binge drinking, age- and gender-adjusted binge drinking (level I) and drinking at levels representing two or more times (level II) and three or more times the level I binge threshold (level III) in a clinical sample of adolescents followed into young adulthood. DESIGN: Cross-sectional associations between non-binge drinking, binge levels, and negative alcohol-related consequences were examined during adolescence; prospective analyses tested whether adolescent non-binge drinking and binge levels predicted alcohol use disorder (AUD) symptoms in young adulthood and whether changes in drinking motives over time were associated with binge levels in young adulthood. SETTING: US clinical settings. PARTICIPANTS: A total of 432 adolescents (aged 12-18 years) with alcohol-related problems followed into young adulthood (aged 19-25 years). MEASUREMENTS: Life-time drinking history, Structured Clinical Interview for DSM AUDs, and Inventory of Drinking Situations. FINDINGS: Results were generally consistent with a distinction between binge level I versus levels II-III on various negative alcohol-related consequences in adolescence (Ps < 0.05) that were maintained in young adulthood (Ps < 0.01). The maintenance of relatively high endorsement of enhancement and social motives over time was associated with binge levels II-III in young adulthood (Ps < 0.001); decreases in coping motives were associated with less risky drinking in adulthood (P = 0.003). CONCLUSIONS: Among US adolescents with alcohol-related problems who were followed-up in young adulthood (aged 19-25 years), standard threshold binge drinking (five or more drinks per occasion; level I) was generally associated with fewer alcohol-related consequences and problem behaviors than binge drinking at two or more times (level II) or three or more times (level III) the standard binge threshold.

Correspondence Between Perceived Pubertal Development and Hormone Levels in 9-10 Year-Olds From the Adolescent Brain Cognitive Development Study.

Aim: To examine individual variability between perceived physical features and hormones of pubertal maturation in 9-10-year-old children as a function of sociodemographic characteristics. Methods: Cross-sectional metrics of puberty were utilized from the baseline assessment of the Adolescent Brain Cognitive Development (ABCD) Study-a multi-site sample of 9-10 year-olds (n = 11,875)-and included perceived physical features via the pubertal development scale (PDS) and child salivary hormone levels (dehydroepiandrosterone and testosterone in all, and estradiol in females). Multi-level models examined the relationships among sociodemographic measures, physical features, and hormone levels. A group factor analysis (GFA) was implemented to extract latent variables of pubertal maturation that integrated both measures of perceived physical features and hormone levels. Results: PDS summary scores indicated more males (70%) than females (31%) were prepubertal. Perceived physical features and hormone levels were significantly associated with child's weight status and income, such that more mature scores were observed among children that were overweight/obese or from households with low-income. Results from the GFA identified two latent factors that described individual differences in pubertal maturation among both females and males, with factor 1 driven by higher hormone levels, and factor 2 driven by perceived physical maturation. The correspondence between latent factor 1 scores (hormones) and latent factor 2 scores (perceived physical maturation) revealed synchronous and asynchronous relationships between hormones and concomitant physical features in this large young adolescent sample. Conclusions: Sociodemographic measures were associated with both objective hormone and self-report physical measures of pubertal maturation in a large, diverse sample of 9-10 year-olds. The latent variables of pubertal maturation described a complex interplay between perceived physical changes and hormone levels that hallmark sexual maturation, which future studies can examine in relation to trajectories of brain maturation, risk/resilience to substance use, and other mental health outcomes.

A brief validated screen to identify boys and girls at risk for early marijuana use.

To guide recruitment, the ABCD Study requires a method for identifying children at high risk for early-onset substance use that may be utilized during the recruitment process. This study was undertaken to inform the development of a brief screen for identifying youths' risk of early-onset substance use and other adverse outcomes. To be acceptable by participants in this context, consideration of potential items was limited to child characteristics previously determined to be potentially pertinent and parental cigarette smoking. To focus the analyses on a single target substance use outcome pertinent to the stated goals of the ABCD Study, early-onset marijuana use was selected. Utilizing data collected prior to the initiation of the ABCD Study, four longitudinal data sets were used in nine secondary data analyses to test, replicate and validate a brief screening assessment for boys and girls to identify those at risk for early-onset marijuana use by ages 14-15. The combination of child externalizing problems reported by the parent (4 items: destroys things belonging to his/her family or others; disobedience at school; lying or cheating; steals outside the home) and parent smoking (1 item) proved to be the optimal screen. This was largely replicated across the four data sets. Indicators of predictive efficiency were modest in magnitude and statistically significant in 8 out of the 9 analyses. The results informed the screen's optimal threshold for identifying children at risk for early-onset marijuana use. The addition of child internalizing problems did not improve these predictions. Further analyses showed the predictive utility of the screen for several other substance use outcomes at ages 15 to 18, including alcohol and nicotine use. The results support the use of a short screening assessment to identify youth at risk for early-onset substance use in the ABCD Study and other research.

Structural brain anomalies in healthy adolescents in the NCANDA cohort: relation to neuropsychological test performance, sex, and ethnicity.

Structural MRI of volunteers deemed "normal" following clinical interview provides a window into normal brain developmental morphology but also reveals unexpected dysmorphology, commonly known as "incidental findings." Although unanticipated, these anatomical findings raise questions regarding possible treatment that could even ultimately require neurosurgical intervention, which itself carries significant risk but may not be indicated if the anomaly is nonprogressive or of no functional consequence. Neuroradiological readings of 833 structural MRI from the National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA) cohort found an 11.8 % incidence of brain structural anomalies, represented proportionately across the five collection sites and ethnic groups. Anomalies included 26 mega cisterna magna, 15 subarachnoid cysts, 12 pineal cysts, 12 white matter dysmorphologies, 5 tonsillar ectopias, 5 prominent perivascular spaces, 5 gray matter heterotopias, 4 pituitary masses, 4 excessively large or asymmetrical ventricles, 4 cavum septum pellucidum, 3 developmental venous anomalies, 1 exceptionally large midsagittal vein, and single cases requiring clinical followup: cranio-cervical junction stenosis, parietal cortical mass, and Chiari I malformation. A case of possible demyelinating disorder (e.g., neuromyelitis optica or multiple sclerosis) newly emerged at the 1-year NCANDA followup, requiring clinical referral. Comparing test performance of the 98 anomalous cases with 619 anomaly-free no-to-low alcohol consuming adolescents revealed significantly lower scores on speed measures of attention and motor functions; these differences were not attributed to any one anomaly subgroup. Further, we devised an automated approach for quantifying posterior fossa CSF volumes for detection of mega cisterna magna, which represented 26.5 % of clinically identified anomalies. Automated quantification fit a Gaussian distribution with a rightward skew. Using a 3SD cut-off, quantification identified 22 of the 26 clinically-identified cases, indicating that cases with percent of CSF in the posterior-inferior-middle aspect of the posterior fossa ≥3SD merit further review, and support complementing clinical readings with objective quantitative analysis. Discovery of asymptomatic brain structural anomalies, even when no clinical action is indicated, can be disconcerting to the individual and responsible family members, raising a disclosure dilemma: refrain from relating the incidental findings to avoid unnecessary alarm or anxiety; or alternatively, relate the neuroradiological findings as "normal variants" to the study volunteers and family, thereby equipping them with knowledge for the future should they have the occasion for a brain scan following an illness or accident that the incidental findings predated the later event.

Screening for Underage Drinking and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Alcohol Use Disorder in Rural Primary Care Practice.

OBJECTIVE: To examine the National Institute on Alcohol Abuse and Alcoholism Youth Guide alcohol frequency screening thresholds when applied to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) diagnostic criteria, and to describe alcohol use patterns and alcohol use disorder (AUD) characteristics in rural youth from primary care settings. STUDY DESIGN: Adolescents (n = 1193; ages 12 through 20 years) visiting their primary care practitioner for outpatient visits in six rural primary care clinics were assessed prior to their practitioner visit. A tablet computer collected youth self-report of past-year frequency and quantity of alcohol use and DSM-5 AUD symptoms. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined. RESULTS: For early adolescents (ages 12 through 14 years), 1.9% met DSM-5 criteria for past-year AUD and ≥3 days with alcohol use in the past year yielded a screen for DSM-5 with optimal psychometric properties (sensitivity: 89%; specificity: 95%; PPV: 37%; NPV: 100%). For middle adolescents (ages 15 through 17 years), 9.5% met DSM-5 AUD criteria, and ≥3 past year drinking days showed optimal screening results (sensitivity: 91%; specificity: 89%; PPV: 50%; NPV: 99%). For late adolescents (ages 18 through 20 years), 10.0% met DSM-5 AUD criteria, and ≥12 past year drinking days showed optimal screening results (sensitivity: 92%; specificity: 75%; PPV: 31%; NPV: 99%). The age stratified National Institute on Alcohol Abuse and Alcoholism frequency thresholds also produced effective results. CONCLUSION: In rural primary care clinics, 10% of youth over age 14 years had a past-year DSM-5 AUD. These at-risk adolescents can be identified with a single question on alcohol use frequency.

The National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA): A Multisite Study of Adolescent Development and Substance Use.

OBJECTIVE: During adolescence, neurobiological maturation occurs concurrently with social and interpersonal changes, including the initiation of alcohol and other substance use. The National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA) is designed to disentangle the complex relationships between onset, escalation, and desistance of alcohol use and changes in neurocognitive functioning and neuromaturation. METHOD: A sample of 831 youth, ages 12-21 years, was recruited at five sites across the United States, oversampling those at risk for alcohol use problems. Most (83%) had limited or no history of alcohol or other drug use, and a smaller portion (17%) exceeded drinking thresholds. A comprehensive assessment of biological development, family background, psychiatric symptomatology, and neuropsychological functioning-in addition to anatomical, diffusion, and functional brain magnetic resonance imaging-was completed at baseline. RESULTS: The NCANDA sample of youth is nationally representative of sex and racial/ethnic groups. More than 50% have at least one risk characteristic for subsequent heavy drinking (e.g., family history, internalizing or externalizing symptoms). As expected, those who exceeded drinking thresholds (n = 139) differ from those who did not (n = 692) on identified factors associated with early alcohol use and problems. CONCLUSIONS: NCANDA successfully recruited a large sample of adolescents and comprehensively assessed psychosocial functioning across multiple domains. Based on the sample's risk profile, NCANDA is well positioned to capture the transition into drinking and alcohol problems in a large portion of the cohort, as well as to help disentangle the associations between alcohol use, neurobiological maturation, and neurocognitive development and functioning.

Solitary cannabis use in adolescence as a correlate and predictor of cannabis problems.

BACKGROUND: Most adolescent cannabis use occurs in social settings among peers. Solitary cannabis use during adolescence may represent an informative divergence from normative behavior with important implications for understanding risk for cannabis problems. This longitudinal study examined associations of adolescent solitary cannabis use with levels of cannabis use and problems in adolescence and in young adulthood. METHODS: Cannabis using-adolescents aged 12-18 were recruited from clinical programs (n=354; 43.8% female; 83.3% Caucasian) and community sources (n=93; 52.7% female; 80.6% Caucasian). Participants reported on cannabis use patterns and diagnostic symptoms at baseline and multiple follow-ups into young adulthood. RESULTS: Compared to social-only users, adolescent solitary cannabis users were more likely to be male and reported more frequent cannabis use and more DSM-IV cannabis use disorder (CUD) symptoms. Regression analyses showed that solitary cannabis use in adolescence predicted CUD symptom counts in young adulthood (age 25) after controlling for demographic variables and the frequency of adolescent cannabis use. However, solitary adolescent cannabis use was no longer predictive of age 25 CUD symptoms after additionally controlling for adolescent CUD symptoms. CONCLUSIONS: Solitary cannabis use is associated with greater cannabis use and problems during adolescence, but evidence is mixed that it predicts young adult cannabis problems.

Greater prevalence of proposed DSM-5 nicotine use disorder compared to DSM-IV nicotine dependence in treated adolescents and young adults.

AIMS: Compared to DSM-IV nicotine dependence, proposed DSM-5 nicotine use disorder (NUD) would lower the threshold from three to two symptoms, and increase the number of criteria used for diagnosis from seven to 11. The impact of the proposed changes on nicotine disorder prevalence and the concurrent validity of diagnostic criteria were examined. DESIGN: Cross-sectional survey to compare DSM-IV and proposed DSM-5 algorithms. SETTING AND PARTICIPANTS: Adolescent (n = 179) and young adult (n = 292) past-year cigarette users recruited from addictions treatment. MEASUREMENTS: Semi-structured clinical interview to evaluate DSM-IV nicotine dependence, and 10 of the 11 proposed DSM-5 NUD criteria; 30-day time-line follow-back; and the Fagerström Test for Nicotine Dependence (FTND). FINDINGS: Prevalence of proposed DSM-5 NUD (two-symptom threshold) was much higher (adolescents: 68.7%, young adults: 86.0%) than DSM-IV nicotine dependence (33.0% and 59.6%, respectively), although prevalence of DSM-5 severe NUD (four-symptom threshold) was similar to DSM-IV nicotine dependence. Concurrent validity analyses in both samples indicated consistent support for DSM-5 severe NUD diagnosis (four symptoms) but not for the moderate NUD (two symptoms) diagnosis, which had modest relations with only FTND score. IRT analyses indicated strong support for the new craving item, but not for the proposed interpersonal problems and hazardous use items. CONCLUSIONS: The proposed DSM-5 nicotine use disorder criteria have substantial limitations when applied to adolescents and young adults, and appear to have low concurrent validity.

Brief assessment of readiness to change tobacco use in treated youth.

This study examined the concurrent and predictive validity of four brief measures of readiness to change tobacco use for use with adolescents in clinical practice (Readiness Ruler, Thoughts About Abstinence, motivation to abstain, and confidence to abstain) and a single-item measure of difficulty to abstain. Participants were 154 adolescent smokers recruited from outpatient addictions treatment, who completed assessments shortly after admission and at 6- and 12-month follow-up. Concurrent validity analyses indicated that the four readiness measures were moderately correlated at each time point. Predictive validity analyses indicated that the Ruler and the motivation to abstain ratings predicted number of cigarettes smoked at 6 and 12 months. Perceived difficulty to abstain predicted cigarette use over and above the readiness to change measures. Results support the clinical utility of the Ruler and motivation to abstain as brief measures of readiness to change, and perceived difficulty to abstain as a tool to aid adolescent tobacco cessation.

Provider, patient, and family perspectives of adolescent alcohol use and treatment in rural settings.

PURPOSE: We examined rural primary care providers' (PCPs) self-reported practices of screening, brief interventions, and referral to treatment (SBIRT) on adolescent alcohol use and examined PCPs', adolescents', and parents' attitudes regarding SBIRT on adolescent alcohol use in rural clinic settings. METHODS: In 2007, we mailed surveys that inquired about alcohol-related knowledge, attitudes, and treatment practices of adolescent alcohol use to all PCPs in 8 counties in rural Pennsylvania who may have treated adolescents. We then conducted 7 focus groups of PCPs and their staffs (n = 3), adolescents (n = 2), and parents (n = 2) and analyzed the narratives using structured grounded theory, evaluating for consistent or discordant themes. RESULTS: Twenty-seven PCPs from 7 counties returned the survey. While 92% of PCPs felt that routine screening for alcohol use should begin by age 14, 84% reportedly screened for alcohol use occasionally, and reportedly 32% screened all adolescent patients. The provider focus groups (n = 20 PCPs/staff) related that SBIRT for alcohol use for adolescents was not currently effective. Poor provider training, lack of alcohol screening tools, and lack of referral treatment options were identified barriers. Adolescents (n = 12) worried that physicians would not maintain confidentiality. Parents (n = 12) acknowledged a parental contribution to adolescent alcohol use. All groups indicated computer-based methods to screen for alcohol use among adolescents may facilitate PCP engagement. CONCLUSIONS: Despite awareness that rural adolescent alcohol use is a significant problem, PCPs, adolescents, and parents recognize that SBIRT for adolescent alcohol use in rural PCP settings is ineffective, but it may improve with computer-based screening and intervention techniques.

Screening and brief intervention for underage drinkers.

In a 2007 report, the US Surgeon General called for health care professionals to renew efforts to reduce underage drinking. Focusing on the adolescent patient, this review provides health care professionals with recommendations for alcohol-related screening, brief intervention, and referral to treatment. MEDLINE and published reviews were used to identify relevant literature. Several brief screening methods have been shown to effectively identify underage drinkers likely to have alcohol use disorders. After diagnostic assessment when germane, the initial intervention typically focuses on education, motivation for change, and consideration of treatment options. Internet-accessible resources providing effective brief interventions are available, along with supplemental suggestions for parents. Recent changes in federal and commercial insurance reimbursement policies provide some fiscal support for these services, although rate increases and expanded applicability may be required to prompt the participation of many practitioners. Nevertheless, advances in clinical methods and progress on reimbursement policies have made screening and brief intervention for underage drinking more feasible in general health care practice.

Child abuse and other traumatic experiences, alcohol use disorders, and health problems in adolescence and young adulthood.

OBJECTIVE: We prospectively examined the health effects of child abuse and other traumatic events, with objective health indicators and consideration of alcohol use disorders (AUD). METHODS: Adolescents (n = 668) were recruited from clinical and community sources. At baseline, we examined child abuse and other traumas, AUD, health-related symptoms, physical findings, and blood assays. Subjects were assigned to Trauma Classes (TC), including witnessing violence, physical abuse, and sexual abuse. Health outcomes were again determined at 1-year and young adult follow-up. RESULTS: In adolescence, higher TC severity was associated with more health-related symptoms, increased age-adjusted body mass index, and stress-response immune system indices. In adolescence and young adulthood, the relationships between TC and health-related symptoms were mediated by anxiety. AUD was associated with liver injury, and cigarette smoking with heart/lung symptoms. CONCLUSIONS: Child abuse predicted persistently elevated health-related symptoms primarily attributable to anxiety, and early signs of liver disease were attributable to AUD.

Different lengths of times for progressions in adolescent substance involvement.

The present study examined Lengths Of Times for important transitions in substance involvement from Initiation to Regular use (LOTIR), first Problem from drug use (LOTIP), and first experience of Dependence (LOTID) for alcohol, tobacco, cannabis, cocaine, and opiates. Data were from a longitudinal study of 590 children (22.2% female) at different levels of risk for substance use disorders based on their fathers' substance use-related diagnoses. Participants' substance involvement was assessed at four ages: 10-12, and follow-ups at two, five, and eight years later. Results suggested that faster transitions were more due to drug-related constructs (including possible social milieus of different drug classes and interactions between drug class and neurophysiology) than intrapersonal constructs. The shortest transition times (and greatest addictive liabilities) were for opiates followed respectively by cocaine, cannabis, tobacco, and alcohol. Females had shorter transition times, though gender differences were small. Some evidence was found for a familial influence on transition times above what was accounted for by differences between substances.

Analyzing milestones in smoking cessation: illustration in a nicotine patch trial in adult smokers.

Tests of addiction treatments seldom reveal where treatment exercises its effect (i.e., promoting initial abstinence, preventing lapses, and/or impeding progression from lapse to relapse). The authors illustrate analyses distinguishing effects on these milestones in a randomized trial of high-dose nicotine patch (35 mg; n = 188) versus placebo (n = 136) in adult smokers, who used electronic diaries to monitor smoking in real time during 5 weeks of treatment. High-dose patch promoted initial abstinence (hazard ratio [HR] = 1.3) and decreased the risk of lapsing among those who achieved abstinence (HR = 1.6). The biggest effect of treatment was to prevent progression to relapse among those who had lapsed (HR = 7.1). Analysis of effects by milestones may enhance understanding of cessation treatments and their mechanisms of action.

Cardiovascular risk factors in adolescents with alcohol use disorders.

Among adults, chronic alcohol dependence is associated with cardiovascular disease (CVD). While it is unlikely that adolescents with alcohol use disorders (AUDs) would exhibit CVD, they might show elevated CVD risk factors. The purpose of this study was to compare CVD risk factors in adolescents with AUDs and an adolescent reference group. Adolescents with AUDs were recruited from treatment sources and reference adolescents were recruited from the community. Information about smoking behavior, exercise, and diet were gathered from interview and self-report measures. Body mass index and blood pressure were determined by physical exam and a blood sample was drawn to measure serum cholesterol and triglycerides. Compared with the reference group, adolescents with AUDs reported significantly more smoking, were less likely to report exercising regularly, and were less likely to report eating a balanced diet. Adolescents with AUDs were not more likely to be overweight or to exhibit hypertension, and lipid levels were also not significantly elevated. These results indicated that adolescents with AUDs endorsed problematic health behaviors while not yet exhibiting the consequences of these behaviors. Interventions focusing on health behaviors in conjunction with addiction treatment might help improve long-term health outcomes in adolescents with AUDs.

Alcohol use frequency as a screen for alcohol use disorders in adolescents.

While screening tools have been developed to identify adolescents likely to have alcohol use disorders (AUDs), none of the available methods are optimal for general medical settings. This study explored the sensitivity and specificity of the frequency of drinking episodes in the prior month as an initial screen for AUDs. The subjects were 219 adolescents (ages 12 through 18) systematically recruited from the community, who participated in a baseline assessment as well as 1-year, 3-year, and 5-year follow-up visits. Subjects completed a self-report form indicating their frequency of use of different substances in the month prior to the assessment. DSM-IV AUD diagnoses were determined by SCID. At baseline, 10 of 219 subjects met DSM-IV criteria for an AUD. At a threshold of 3 or more drinking episodes in the past month, the screen was 90% sensitive, correctly classifying 9 of 10 AUD cases, and 83.7% specific, correctly classifying 175 of 209 cases without AUDs. The diminishing specificity of this screen over the follow-up assessments indicated that this method may be useful for adolescents, but not for young adults. These results indicate that an assessment of the frequency of alcohol use in the prior month provides an initial screen with acceptable sensitivity and specificity for use with adolescents.