Course of alcohol symptoms and social anxiety disorder from adolescence to young adulthood.

BACKGROUND: There is limited knowledge of the course of social anxiety disorder (SAD) from adolescence into adulthood, and how SAD and alcohol use disorder (AUD) symptoms change together over time. The current study examined how persistent and adolescent-limited SAD relate to alcohol symptom trajectories across adolescence and into adulthood, as well as gender differences in the course of SAD and AUD symptoms. METHODS: Participants were 788 youth (ages 12 to 18 at the baseline assessment; 46.2% female; 80.5% White) recruited from the community (n = 220) and from clinical programs (n = 568). Youth completed clinical interviews on their lifetime history of AUD symptoms and SAD at baseline and were followed through age 25. Multivariate polynomial growth mixture modeling was used to estimate developmental trajectories for SAD and AUD symptoms separately, then together in a dual trajectory model. Gender differences were examined using a classify-analyze approach. RESULTS: Three SAD trajectory classes were identified: adolescent-limited (15%), persistent (6%), and no SAD (79%). For AUD symptoms, 5 trajectories were identified: severe (10%), moderate (22%), remitting (18%), young adult onset (22%), and stable low (28%). Those with a history of SAD were about twice as likely to be in the severe AUD symptom class compared to those without a history of SAD. Compared to those with persisting SAD, those in the adolescent-limited SAD class were more likely to belong to the stable low AUD trajectory. Compared to males with SAD, females with SAD were less likely to be in the moderate AUD symptom class and were more likely to be in stable low and young adult onset AUD symptom classes. CONCLUSIONS: A history of SAD was associated with membership in the severe AUD trajectory group. The association of gender with SAD and AUD differed depending on developmental period. Future research should examine whether treating SAD in early adolescence may prevent subsequent AUD symptoms.

Mechanisms of change in adolescent substance use treatment: how does treatment work?

BACKGROUND: Adolescent substance use treatment outcome research generally shows small to moderate effects in reducing substance use, with no specific "brand" of treatment emerging as clearly superior to any other, and treatment gains that fade over time. The relatively weak and temporary effects of treatment call for improving the potency and durability of intervention effects. In response to this call, this critical narrative review summarizes research on mechanisms of change for both adults and adolescents in substance use treatment, with a particular focus on reviewing what is known regarding "how" adolescent substance use treatment works. METHODS: A comprehensive review of the adolescent (aged 11-18) substance use treatment literature was conducted to identify empirical studies that examined mediators of intervention effects. Relevant databases (e.g., PsychINFO, MEDLINE) were searched using key words (e.g., "mediator"), and relevant articles from reference sections of identified studies and review papers were considered. RESULTS: Studies of mechanisms of psychotherapy change are rare in the adult, and particularly adolescent, substance use treatment outcome literature. The 4 adolescent studies that examined substance use treatment mechanisms found that positive social support, motivation to abstain, and positive parenting behaviors mediated treatment effects. To date, research has not supported therapy-specific mechanisms of change, finding instead that "common" processes of change largely account for improvements in outcome across distinct "brands" of treatment. CONCLUSIONS: The lack of empirical support for treatment-specific mechanisms of change may be due to the need for greater precision in defining and measuring treatment-specific causal chains. Future directions include neuroscience approaches to examining changes in brain functioning that are associated with treatment response and recovery and examining mechanisms in adaptive treatment designs, which can accommodate individual differences in targets for intervention and response to treatment.

Diagnosing Alcohol and Cannabis Use Disorders in Adolescents with Bipolar Disorder: A Preliminary Investigation.

OBJECTIVE: The aim of this report was to examine the accuracy of diagnosing substance use disorders in manic adolescents with bipolar disorder. METHODS: The substance use disorder modules of the KSADS-PL were administered to a sample of 80 manic adolescents (12-21 years old) with co-occurring bipolar and substance use disorders. Initial substance use disorder diagnoses obtained from the KSADS-PL were then compared to a best-estimate diagnosis derived from all available information, including a second diagnostic interview, the Child Semi-Structured Assessment for the Genetics of Alcoholism, Adolescent version (C-SSAGA-A). RESULTS: Relatively low diagnostic agreement was achieved across the initial and the best estimate diagnoses for both alcohol and cannabis use disorders. Age, race, and sex did not predict diagnostic agreement between the two evaluations. CONCLUSIONS: Results of this study call for more research on diagnosing substance use disorders and suggest that a single interview alone may not be accurate for diagnosing substance use disorders in manic adolescents with bipolar disorder.

Exploring the cold-to-hot empathy gap in smokers.

Many decisions related to cigarette smoking require people in an affectively neutral, or "cold," state to predict how they will feel or behave when in a craving, or "hot," state. Research in other domains has revealed that individuals in cold states often underestimate the impact of being in a hot state on their own future behavior. In a study testing whether this is true of cigarette craving, 98 smokers were assigned to one of three conditions: hot (during a high-craving first session, they made predictions about a high-craving state in a second session), cold (during a low-craving first session, they made predictions about a high-craving state in a second session), and comparison (they experienced a high-craving session only). As predicted, in contrast to smokers in the hot group, smokers in the cold group underpredicted the value they would place on smoking during the second session. Results support the existence of a cold-to-hot empathy gap in smokers and help to explain diverse aspects of tobacco addiction.

An overview of common psychiatric problems among adolescent and young adult females: Focus on mood and anxiety.

Adolescence is a dynamic period of learning and adaptation. It provides unique opportunities in which adolescents strive to become independent, generative young adults. However, with these strides come increased prevalence in psychiatric symptomatology. Among adolescent girls, anxiety disorders are the most common condition followed by mood disorders. Mood disorders, specifically depression, result in the greatest impairment. Factors such as body mass index and early pubertal onset are associated with poorer mental health such as depression. In addition, depression is a top risk factor for suicide particularly among youth aged 13-17 years. We provide a brief description of the most common mood disorders, along with assessment tools, among teen and young adult females. Then, special considerations for psychiatric presentation among this young population will be presented.

The reinforcement enhancing effects of nicotine depend on the incentive value of non-drug reinforcers and increase with repeated drug injections.

We have hypothesized that nicotine has two effects on reinforcement; it increases the probability of responses resulting in nicotine delivery (primary reinforcement) and enhances the apparent reward value of non-nicotine reinforcers (reinforcement enhancing effect). The present studies investigated two predictions generated by this hypothesis: (1) that the reinforcement enhancing effect will depend on apparent stimulus reward value and (2) that the temporal profile of this effect would depend on the pharmacological profile of nicotine. In Experiment 1, rats were trained to lever press for one of two audio-visual stimuli that differed in their intrinsic reinforcing value and then the effect of pre-session nicotine (0.4 mg/kg base) or saline injections was tested. The stimulus that supported very low rates of operant responding displayed smaller increases in responding after pre-session injections of nicotine. In Experiment 2 the effect of nicotine injected 5 min before the session was compared to the effect of nicotine injected 1h after the session using the more reinforcing stimulus condition from the first experiment. A control group received only vehicle injections. In contrast to nicotine injected just prior to the session, post-session injections of nicotine had no detectable effect on responding for the more reinforcing stimulus. These results indicate that the reinforcement enhancing action of nicotine depends on the intensity of the primary reinforcer and that enhanced reinforcement by nicotine depends on coincident access to a stimulus with reinforcing properties.

Mood and Ambulatory Monitoring of Physical Activity Patterns in Youth with Polycystic Ovary Syndrome.

STUDY OBJECTIVE: To provide initial insight into physical activity patterns and predictors of moderate to vigorous physical activity (MVPA) in youth with polycystic ovary syndrome (PCOS) by using a multisensor activity monitor. DESIGN: Cross-sectional study analyzing baseline MVPA data using real-time continuous monitoring of physical activity. Body mass index (BMI) and depressive symptoms were examined as predictors of MVPA. SETTING: A large, urban children's hospital in the United States. PARTICIPANTS: Thirty-five youth (aged 12 to 21 years) previously diagnosed with PCOS (mean BMI = 38.0 kg/m(2); mean age = 15.4 years, 79% white) who were participants in a behavioral lifestyle intervention. MAIN OUTCOME MEASURES: Total steps, total MVPA, longest continuous bout of MVPA, and frequency of MVPA bouts lasting for 5 to 9 minutes and 10 or more minutes. RESULTS: Sixty percent of youth averaged at least 1 daily MVPA bout lasting 10 or more minutes, and 14% averaged a daily MVPA bout lasting 30 or more minutes. BMI was negatively correlated with MVPA bout duration (P = .04). Parental ratings of depression, but not self-report ratings, were predictive of participants' total MVPA (ß = -.46; P = .01), number of 5- to 9-minute bouts (ß = -.39; P = .03), and bouts of 10 or more minutes (ß = -.35; P = .05). CONCLUSION: Youth with PCOS may benefit from being prescribed multiple bouts of MVPA lasting less than 30 continuous minutes to meet national recommendations and achieve health benefits. BMI and parental endorsement of child's depression symptoms may be important to consider when assessing and prescribing MVPA to youth with PCOS.

Personality, negative affect coping, and drinking alone: a structural equation modeling approach to examine correlates of adolescent solitary drinking.

AIMS: This study examined the personality traits of negative emotionality and constraint and the ability to resist drinking during negative affective states as correlates of solitary drinking in adolescence. We hypothesized that higher levels of negative emotionality and lower levels of constraint would predict solitary drinking and that these relationships would be mediated by the ability to resist drinking in response to negative emotions. DESIGN: Structural equation modeling was used to fit a path model from the personality traits of negative emotionality and constraint to solitary drinking status through intermediate effects on the ability to resist drinking during negative emotions using cross-sectional data. SETTING: Clinical and community settings in Pennsylvania, USA. PARTICIPANTS: The sample included 761 adolescent drinkers (mean age = 17.1). MEASUREMENTS: Adolescents completed the Lifetime Drinking History, the Multidimensional Personality Questionnaire, the Constructive Thinking Inventory and the Situational Confidence Questionnaire. FINDINGS: The path model provided a good fit to the data. The association between trait negative emotionality and solitary drinking was fully mediated by adolescents' ability to resist drinking during negative affective states (b = 0.05, P = 0.01). In contrast, constraint had a direct effect on solitary drinking (odds ratio (OR) = 0.79, b = -0.23, P<0.01), as well as an indirect effect through the ability to resist drinking during negative affective states (b = -0.03, P = 0.02). CONCLUSIONS: The ability to resist drinking while experiencing negative feelings or emotions may be an important underlying mechanism linking trait negative emotionality (a tendency toward depression, anxiety and poor reaction to stress) and constraint (lack of impulsiveness) to adolescent solitary drinking.

Brain volume and white matter in youth with type 2 diabetes compared to obese and normal weight, non-diabetic peers: A pilot study.

Type 2 Diabetes Mellitus (T2DM) and obesity are linked to specific patterns of subcortical brain atrophy and decreased microstructural integrity of white matter. Fifteen adolescents (12-21-years-old, 80% Caucasian, 15% African American, mean BMI=32)-five with T2DM confirmed by oral glucose tolerance test, five matched obese adolescent controls without diabetes (OBCN), and five matched (race, sex) normal-weight controls (NWCN)-underwent Magnetic Resonance Imaging (MRI) for the collection of gray matter volume and white matter integrity. Analyses of Variance (ANOVAs) of the neuroimaging data revealed significant differences in caudate nucleus volume [F(2,12)=7.79, p<0.05] such that the normal-weight group had significantly greater volume than the obese and T2DM groups (NWCN>OBCN, p=0.020; OBCN>T2DM, p=0.042; and NWCN>T2DM; p=0.003) after controlling for participant Body Mass Index (BMI). Similarly, there was a main effect for the volume of the thalamus [F(2,12)=4.39, p<0.05] with greater volume for both the NWC and the OBC groups in comparison to the T2DM group (NWC>T2DM, p=0.020; OBC>T2DM; p=0.040). Finally, an examination of white matter integrity among the three groups illustrated a pattern of white matter integrity reduction between normal-weight participants and both obese controls and T2DM participants, with T2DM demonstrating the greatest deficit in functional anisotropy (FA) volume, but these results were not significant after further controlling for BMI. Results from the current pilot study illuminate a host of brain morphology differences between youth with T2DM, obese youth, and normal-weight controls; future research with a larger sample size is critical.

Parents' Readiness to Change Affects BMI Reduction Outcomes in Adolescents with Polycystic Ovary Syndrome.

Evidence supports the importance of parental involvement for youth's ability to manage weight. This study utilized the stages of change (SOC) model to assess readiness to change weight control behaviors as well as the predictive value of SOC in determining BMI outcomes in forty adolescent-parent dyads (mean adolescent age = 15 ± 1.84 (13-20), BMI = 37 ± 8.60; 70% white) participating in a weight management intervention for adolescent females with polycystic ovary syndrome (PCOS). Adolescents and parents completed a questionnaire assessing their SOC for the following four weight control domains: increasing dietary portion control, increasing fruit and vegetable consumption, decreasing dietary fat, and increasing usual physical activity. Linear regression analyses indicated that adolescent change in total SOC from baseline to treatment completion was not predictive of adolescent change in BMI from baseline to treatment completion. However, parent change in total SOC from baseline to treatment completion was predictive of adolescent change in BMI, (t(24) = 2.15, p = 0.043). Findings support future research which carefully assesses adolescent and parent SOC and potentially develops interventions targeting adolescent and parental readiness to adopt healthy lifestyle goals.

Drinking refusal self-efficacy and tension-reduction alcohol expectancies moderating the relationship between generalized anxiety and drinking behaviors in young adult drinkers.

Despite the substantial comorbidity between generalized anxiety disorder (GAD) and alcohol use disorders (AUD), little is known about contributing factors to this relationship. This lack of knowledge has limited the development of theoretical models explicating the interesting yet complex relationship between GAD and AUD. The current study examined the roles of generalized anxiety, tension-reduction alcohol expectancies, and drinking refusal self-efficacy in accounting for the variance of alcohol consumption and alcohol-related consequences in a sample of young adult drinkers (N = 474; 18-25 years of age, median age 19, 66% female) from a large, urban Midwestern university. Results showed that generalized anxiety level interacted with both tension-reduction alcohol expectancies and drinking refusal self-efficacy to predict alcohol consumption and alcohol-related consequences. Findings support the assessment of both alcohol-related consequences and alcohol consumption, and highlight the importance of drinking refusal self-efficacy, which is a currently underexamined variable. Study results also enhance the knowledge about the underlining mechanisms of GAD and AUD comorbidity, which facilitates the development of an empirically based theoretical paradigm for their relationship.

Alcohol expectancies and social self-efficacy as mediators of differential intervention outcomes for college hazardous drinkers with social anxiety.

The current pilot study examined the roles of two cognitive factors - positive alcohol expectancies of social anxiety reduction and drink refusal self-efficacy relevant to social situations - in mediating greater reduction in alcohol behaviors by the Brief Intervention for Socially Anxious Drinkers (BISAD; n=21) compared to an alcohol psychoeducation (n=20) in a sample of college hazardous drinkers with social anxiety. Mediation analysis results indicated that decreased positive alcohol expectancies and increased drink refusal self-efficacy relevant to social situations accounted for an average of 67% of the variance in treatment outcomes as measured by total quantity of alcohol consumption, heavy drinking days and problems related to alcohol use in the past month. Study results may enhance the understanding of cognitive factors' role in alcohol treatment outcomes, which could in turn improve the efficacy of interventions aimed to reduce hazardous drinking and comorbid social anxiety.