Juvenile probation officers delivering an intervention for substance use significantly reduces adolescents' risky sexual behaviours.

BACKGROUND: Risky sexual behaviour (RSB) is a serious public health problem for adolescents. We examined whether a contingency management intervention implemented by juvenile probation officers (JPOs) targeting substance use also impacted RSB. METHODS: A total of 218 adolescents on probation were randomly assigned to contingency management or to probation as usual. RESULTS: The substance use intervention delivered by JPOs reduced rates of RSB over time (ß =-0.32, P =0.041 at 6months; ß =-0.32, P =0.036 at 9months). CONCLUSIONS: Adolescents receiving a substance use intervention from JPOs demonstrated reduced/prevented RSB. Interventions targeting single risk behaviours in juvenile probation populations should measure changes in other risk behaviours . Under-resourced communities lacking clinicians might consider JPOs delivering interventions.

Linkage facilitation services for opioid use disorder: Taxonomy of facilitation practitioners, goals, and activities.

INTRODUCTION: This article proposes a taxonomy of linkage facilitation services used to help persons with opioid use disorder access treatment and recovery resources. Linkage facilitation may be especially valuable for persons receiving medication for opioid use disorder (MOUD) given the considerable barriers to treatment access and initiation that have been identified. The science of linkage facilitation currently lacks both consistent communication about linkage facilitation practices and a conceptual framework for guiding research. METHODS: To address this gap, this article presents a taxonomy derived from expert consensus that organizes the array of practitioners, goals, and activities associated with linkage services for OUD and related needs. Expert panelists first independently reviewed research reports and policy guidelines summarizing the science and practice of linkage facilitation for substance use disorders generally and OUD specifically, then met several times to vet the conceptual scheme and content of the taxonomy until they reached a final consensus. RESULTS: The derived taxonomy contains eight domains: facilitator identity, facilitator lived experience, linkage client, facilitator-client relationship, linkage activity, linkage method, linkage connectivity, and linkage goal. For each domain, the article defines basic domain categories, highlights research and practice themes in substance use and OUD care, and introduces innovations in linkage facilitation being tested in one of two NIDA-funded research networks: Justice Community Opioid Innovation Network (JCOIN) or Consortium on Addiction Recovery Science (CoARS). CONCLUSIONS: To accelerate consistent application of this taxonomy to diverse research and practice settings, the article concludes by naming several considerations for linkage facilitation workforce training and implementation.

JUVENILE PROBATION OFFICER PERCEPTIONS OF PARENTAL INVOLVEMENT IN JUVENILE PROBATION AND WITH CONTINGENCY MANAGEMENT.

Probation is a common sanction for youth substance users, and as such, juvenile probation officers (JPOs) shoulder much of the burden for treatment and rehabilitation. To improve youth outcomes and alleviate some of the burden, JPOs may seek parental involvement in the probation and substance use desistance processes. Using focus group data, we analyzed JPO perceptions of the role parents play in contingency management (CM)-an incentive system designed to produce and reward decreased substance use-and whether they perceived any value in CM. We found that most JPOs perceived parental involvement as critical to the success of both substance use treatment and CM for youth. Our findings also suggest JPOs found parental involvement in CM valuable given that CM was employed on nonstudy clients and future clients. This has implications for the practicality and sustainability of CM as a youth probation intervention.

Delinquency, Substance Use, and Risky Sexual Behaviors among Youth who are involved in the Justice System and Predominantly Reside in Rural Communities: Patterns and Associated Risk Factors.

There is a significant gap in research examining the prevalence of problem behaviors among youth involved in the juvenile justice system in rural areas. The current study sought to address this gap by exploring the behavioral patterns of 210 youth who were on juvenile probation in predominantly rural counties and who were identified as having a substance use disorder. First, we examined the correlation among 7 problem behaviors representing different forms of substance use, delinquency, and sexual risk-taking and 8 risk factors related to recent service utilization, internalizing and externalizing difficulties, and social support networks. Then, we used latent class analysis (LCA) to identify distinct behavioral profiles based on the observed problem behaviors. LCA identified a 3-class model representing distinct groups labeled Experimenting (70%), Polysubstance Use + Delinquent Behaviors (24%), and Diverse Delinquent Behaviors (6%). Finally, we assessed differences (i.e., ANOVA, χ2) in each risk factor across the behavioral profiles. Important similarities and differences in the association among the problem behaviors, behavioral profiles, and the risk factors were revealed. These findings underscore the need for an interconnected behavioral health model within rural juvenile justice systems that is able to address youths' multidimensional needs including criminogenic, behavioral, and physical health needs.

Sex and Sexual Identity Differences in Poly-tobacco Use and Psychological Distress in U.S. Adults: Results From the National Health Interview Survey.

INTRODUCTION: Poly-tobacco use (PTU), or the concomitant use of two or more nicotine and tobacco products, are a growing public health concern. Adults reporting increased psychological distress (PD) experience profound nicotine and tobacco health-related disparities. Sexual minority (SM) adults report more PTU and higher levels of PD than heterosexuals, yet little is known about patterns of nicotine and tobacco use and its relationship to PD in SM populations. AIMS AND METHODS: The purpose of this study was to investigate sexual identity differences in PD and PTU. Data were drawn from the 2016-2018 National Health Interview Survey (N = 83 017), an annual cross-sectional survey of a nationally representative sample of U.S. adults. PD was assessed using the Kessler Psychological Distress Scale (K6). We fit sex-stratified, weighted, adjusted logistic models to compare PTU and PD by sexual identity. RESULTS: PTU was more prevalent in adults with higher K6 scores. Female adults and SM adults had significantly higher K6 scores and were significantly more likely to experience serious PD when compared to their male and heterosexual counterparts. CONCLUSIONS: The current study provides a snapshot of trends in PTU in relation to PD, gender, and sexual identity. Findings suggest higher rates of both PD and PTU in SM adults. Further research examining the mechanisms underlying this disparity is critical to the development of effective intervention and prevention strategies. IMPLICATIONS: Little is known about sex and sexual identity differences in the relations between patterns of tobacco product use and PD. This study is the first to examine the effect of gender and sexual identity on both PD and PTU. SMs reported higher rates of PD and were more likely to be poly-tobacco users. As new ways of engaging nicotine/tobacco continue to proliferate, health risks will endure especially for marginalized populations. An increased understanding of the psychological and social correlates of PTU in SMs is warranted.

Examining the measurement precision of behavior problems among a sample of primarily rural youth on juvenile probation and their parents.

Accurate and timely intervention in the justice system is particularly critical in rural communities, given documented barriers to accessible, evidence-based services for youth. As youth in the juvenile justice system have a high prevalence of behavioral health needs, accurate assessment of those needs is a critical first step in linking youth to appropriate care. The goal of the current study is to examine the reliability of a brief assessment (the Brief Problem Checklist [BPC]) among a sample of 222 justice-involved youth and their caregivers who primarily reside in rural communities in the United States. Using a series of reliability analyses and tests of agreement, we examined whether youth and caregiver BPC produces reliable scales, the strength of the convergence among each of the BPC scales, and youth and caregiver agreement on the BPC scales. Findings support the reliability of the BPC, but not inter-rater reliability. Poor agreement between youth and caregiver reports exists for both youth internalizing and externalizing problems. Additionally, the BPC was significantly related to several theoretically relevant constructs, including treatment, substance use disorder severity, and family history of substance use. These findings lend merit to discussions about the need for more research on the reliability and validity of assessment instruments before their widespread use in guiding youth- and agency case planning decisions, along with informing conclusions about program effectiveness.

Misunderstanding and Sensemaking Among Juvenile Probation Officers Working with Evidence-Based Practices.

Evidence-based practices and programs (EBPs) have been adopted in juvenile probation agencies nationwide to maximize the number of successful probation cases. However, various pragmatic studies have found that JPOs are not yielding the expected benefits when compared to efficacy studies (Lipsey et al., 2010; Taxman & Belenko, 2011). Using focus group and survey data, the current study sought to increase our understanding of the gap between pragmatic and efficacy studies in juvenile probation settings by examining JPOs' perceptions and utilization of EBPs. The findings suggest that JPOs are misunderstanding how to use EBPs in daily practice, leaving them with negative perceptions of EBPs. Implications for improving JPO understanding and use of EBPs are discussed.

Child welfare involvement and adjustment among care alumni and their children: A systematic review of risk and protective factors.

BACKGROUND: Recent research and policy recognize care alumni (i.e., adults formerly in out-of-home care [OHC]) as a population with a high accumulation of disadvantages well into adulthood, often in combination with early parenthood compared to the general population. OBJECTIVE: The aim of this systematic review is to provide an overview on the impact of parental OHC on outcomes for both parents (i.e. parental adjustment, parenting) and their children (i.e. prevalence rates of OHC or child welfare system (CWS) involvement, adjustment, development), as well as protective and risk factors associated with those outcomes. METHODS: Relevant articles were searched in four electronic databases from conception to 16 February 2022 according to PRISMA guidelines for systematic reviews; supplemented with hand-searched citations from relevant references. Evidence was synthesized via a qualitative summary. RESULTS: A total of 38 studies were included (19 quantitative, 14 qualitative, and 5 mixed-methods studies). Studies confirm increased rates of early parenthood among care alumni and an elevated risk of OHC among their children. However, most children remain with their care alumni parents, and some parents were met with the needed support to cope with challenging circumstances. Qualitative studies point to a great need for specialized services, including parenting programs that address past trauma and attachment issues. They also highlight potential protective factors. CONCLUSIONS: Findings suggest that care alumni parents experience compounding disadvantage, which may increase their children's risk of OHC. More research is needed on child adjustment, and on protective factors that can be leveraged to design effective interventions that decrease transgenerational CWS involvement.

Juvenile Probation Officers' Perceptions of Sanctions and Incentives as Compliance Strategies.

In juvenile probation, noncompliance with probation conditions is a common occurrence. To deal with this, juvenile probation officers (JPOs) may use different strategies, such as sanctions and incentives. This study uses survey and focus group data from 19 JPOs to evaluate their perceptions of the effectiveness of sanctions and incentives in reducing youth noncompliance, specifically in the form of substance use. Results show that there are two distinct groups of JPOs: those who believe sanctions are an effective deterrent strategy and those who do not. Perceptually and demographically these two groups contain significant differences. Notably, both groups have similar views of social incentives, but JPOs who believe sanctions are ineffective are significantly more likely to have positive views of tangible incentives. This study has implications for how the field of juvenile probation can target JPO perceptions to move toward incentive-based strategies rather than sanction-based strategies for reducing youth substance use.

Motivations for Prescription Drug Misuse Related to Mental Health Problems in Adults.

BACKGROUND: Prescription drug misuse (PDM) is a significant public health problem associated with mental health symptoms. OBJECTIVES: This project investigates the connections between PDM motivations and mental health to inform intervention efforts. METHODS: Using nationally representative adult data from the 2016-2018 National Survey on Drug Use and Health (N = 128,205; 53% female) this project investigated which motivations for misuse are related to past-year mental health problems including any mental illness, serious mental illness, major depressive episode, and suicidal thoughts. Complex samples logistic regression models of the main motivation of PDM for each mental health problem were conducted separately for each prescription drug class (i.e., opioids, tranquilizers, sedatives, and stimulants) while controlling for demographic characteristics. RESULTS: Adults that reported PDM were more likely than those with no PDM to endorse past year mental health problems. Compared to those that reported PDM of other medications, those misusing prescription opioids and tranquilizers to help with emotions and misusing sedatives to "relax or relieve tension" were more likely to have all categories of mental health problems. Those that misused prescription stimulants to "help study" had lower odds of all mental health problems. CONCLUSIONS: While there were differences based on prescription drug class, a range of motivations increased adults' likelihood to have mental health problems and common themes were found across drug classes. While causality is still undetermined, prevention and intervention efforts that are multifaceted and individualized, while broadly providing adults with other ways to cope with negative emotions are likely to help reduce PDM.

Family-based treatments for disruptive behavior problems in children and adolescents: An updated review of rigorous studies (2014-April 2020).

Disruptive behavior problems in youth are common and costly, lead to adverse outcomes, and are often left untreated. This article builds on previous work by providing an updated evaluation of family-based treatments based on results from randomized controlled trials (RCTs) for three populations: (1) children with disruptive behavior, (2) adolescents with disruptive behavior, and (3) adolescents with juvenile justice involvement. Using a comprehensive process, 28 new reports on 27 RCTs were identified for the 2014-April 2020 period, which when combined with the prior evidence base of all rigorous RCTs, resulted in 3 well-established, 11 probably efficacious, and 7 possibly efficacious family-based treatment categories. Many of the RCTs lent further support to existing treatment categories, more countries were represented, and several RCTs incorporated technology. Notable issues that remain include a limited number of family-based treatments for adolescents and for youth with juvenile justice involvement, as well as methodological concerns.

Demographic risk factors for co-occurring suicidality and cannabis use disorders: Findings from a nationally representative United States sample.

OBJECTIVE: Burgeoning research suggests a link between suicidality (i.e., ideation, attempts) and cannabis use; however, little is known about which demographic groups are at increased risk of co-occurring suicidality and cannabis use disorders (CUD). This study tested differences in suicidality, CUD, and their co-occurrence by gender, age, race/ethnicity, and sexual orientation in a nationally representative U.S. METHOD: Five years (2015-2019) of National Survey of Drug Use and Heath surveys were combined. Multinomial logistic regressions tested demographic differences in odds of suicidality only, CUD only, and co-occurring CUD and suicidality, relative to neither suicidality nor CUD. Covariates included survey year, major depressive episode, and other substance use disorders. RESULTS: Men had higher odds of co-occurring suicidal ideation and CUD than women (AOR = 2.06). All older age groups reported lower odds of co-occurring suicidal ideation and CUD and co-occurring suicide attempts and CUD than emerging adults (AORs = 0.06-0.39). Black/African American (AOR = 1.42) and Native (AOR = 2.16) adults reported higher odds of co-occurring suicidal ideation and CUD than White adults. Black/African American (AOR = 4.05) and Hispanic/Latinx (AOR = 2.49) adults reported higher odds of co-occurring CUD and suicide attempts than White adults. Gay/lesbian (AOR = 2.04) and bisexual (AOR = 3.16) adults reported higher odds of co-occurring suicidal ideation and CUD than heterosexual adults. CONCLUSIONS: Men, emerging adults, Black/African American, Native, and sexual minority groups had elevated risk of co-occurring suicidal ideation and CUD. Emerging adults, Black/African American, and Hispanic/Latinx groups had elevated risk of co-occurring suicide attempts and CUD.

College students' using marijuana to sleep relates to frequency, problematic use, and sleep problems.

OBJECTIVE: Given the rising rates of insufficient sleep and the popularity of marijuana, we investigated using marijuana as a sleep aid, marijuana use frequency, problematic marijuana use, and sleep problems. Participants: Participants included a convenience sample of college students who endorsed using marijuana in the past year from May to December 2013 (N = 354; 68% female, 57% White). Methods: Path analyses investigated if using marijuana to sleep predicted: (1) marijuana use outcomes and (2) sleep problems; and if sleep problems predicted marijuana use outcomes. Results: Using marijuana to sleep was related to increased use and problematic use, as well as worse sleep efficiency. Daytime dysfunction related to sleepiness was associated with elevated levels of marijuana use and problematic use. Similar associations were found across sex and race. Conclusions: College students should be informed of the potential misconceptions between marijuana and improved sleep and provided with evidence-based alternatives to improve their sleep.

A Longitudinal Study of the Bidirectional Relations Between Anxiety Symptoms and Peer Victimization in Urban Adolescents.

The current study examined bidirectional relations between anxious symptoms and two forms of peer victimization (i.e., overt and relational) within an underrepresented sample of urban adolescents during key transition periods (i.e., elementary to middle school; middle school to high school) and the following 2 years. A predominantly African American sample (91%) of 358 adolescents (56% female, mean age = 12.10 years) living in low-income urban areas were assessed annually across 4 years. Using self-report measures, adolescents reported on their past year experiences of anxiety and peer victimization. Longitudinal path analyses tested progressively complex models for each type of victimization. Anxious symptoms predicted both overt and relational victimization at the time of transition (Wave 1 to Wave 2) and the following year (Wave 2 to Wave 3). Furthermore, whereas previous levels of victimization and future anxious symptoms were positively correlated over time, only relational victimization at Wave 1 predicted anxious symptoms at Wave 2. Prior levels of each construct were the strongest predictor of future outcomes (e.g., anxious symptoms at Wave 1 predicting anxious symptoms at Wave 2). Overall, there was little support for bidirectional relations between anxiety symptoms and peer victimization. Intervention and prevention programs seeking to reduce peer victimization or anxiety should start by targeting the symptom/behavior of interest. Interventions that target anxious thoughts and feelings during these key transition times in adolescence should be assessed as areas of priority.

Randomized Controlled Trial of an Integrated Family-Based Treatment for Adolescents Presenting to Community Mental Health Centers.

Most adolescents presenting to community mental health centers have one or more comorbidities (internalizing, externalizing, and substance use problems). We evaluated an integrated family-based outpatient treatment for adolescents (OPT-A) that can be delivered in a community mental health center by a single therapist. A sample of 134 youth/families were randomized to receive OPT-A or usual services, delivered at the same public sector mental health center. Repeated, multi-informant assessments occurred through 18-months post-baseline. At baseline, the sample displayed low internalizing symptoms, moderate substance use, and high externalizing problems. Compared to usual services, OPT-A had effects on abstinence rates, retention, motivation, parent involvement, and satisfaction, but not on internalizing or externalizing problems. While OPT-A achieved some key improvements for youth who present to community mental health centers, and families were satisfied with treatment, continued work is necessary to examine treatments for comorbidity while balancing treatment feasibility and complex strategies to boost treatment effectiveness.

Motivations for the nonmedical use of prescription drugs in a longitudinal national sample of young adults.

INTRODUCTION: People's motivations for nonmedical use of prescription drugs (NMUPD) are not well studied, particularly in longitudinal representative samples. However, understanding which motivations are most popular and how these change over time for specific groups is important to inform interventions for NMUPD. METHODS: The current study examined how young adults' motives for NMUPD changed over young adulthood, using a nationally representative sample of 12,223 young adults in 36 cohorts (1976-2012) as part of the Monitoring the Future study across three biennial waves (waves 1, 2, 3: modal ages 19/20, 21/22, and 23/24 years). We investigated these young adults' motivations for using stimulants, central nervous system depressants, and opioids when controlling for possible cohort effects. We included sex and college attendance as potential moderators. RESULTS: Participants commonly reported recreational and self-treatment motivations over time and across drug classes, reporting four to five popular motivations in each drug class. Generalized estimating equations repeated measure analyses revealed relatively stable NMUPD motivations across young adulthood. Participants reported some reductions in experimentation and boredom as motivations for NMUPD and increases in certain self-treatment motivations, depending on prescription drug class. Overall, men were more likely to endorse recreational motivations, whereas women were more likely to endorse self-treatment motivations, though this varied somewhat by prescription drug class. Young adults not enrolled in college courses were more likely to endorse using stimulants nonmedically for different reasons than their peers who were enrolled. CONCLUSIONS: NMUPD prevention and treatment efforts tailored to the young adult population should include methods to reduce both self-treatment and recreational use and need to consider prescription drug class, sex, and college attendance.

Capacity of juvenile probation officers in low-resourced, rural settings to deliver an evidence-based substance use intervention to adolescents.

Substance use is a major public health problem with a host of negative outcomes. Justice-involved youth have even higher risks and lack access to evidence-based interventions, particularly in rural communities. Task-shifting, or redistribution of tasks downstream to an existing workforce with less training, may be an innovative strategy to increase access to evidence-based interventions. Initial findings are presented from a services research trial conducted primarily in rural communities in which an existing workforce, juvenile probation/parole officers (JPOs), were randomized either to learn and deliver contingency management (CM) or to continue delivering probation services as usual (PAU). This study used the prevailing version of CM for adolescents, that is, family-based with behavior modification and cognitive behavioral components. Data included JPOs' self-reports, as well as audio-recorded youth/family sessions with JPOs rated by expert and trained observational coders. Data also included ratings from a comparison study in which therapists were trained and supervised by experts to deliver CM to justice-involved youth/families. Results showed JPOs can feasibly incorporate CM into their services. When adherence of CM JPOs was compared against CM therapists, JPOs delivered significantly more cognitive behavioral components of CM and similar levels of behavior modification components of CM. These findings suggest that JPOs can be leveraged to provide evidence-based substance use interventions like CM in similar, or even greater, capacities to clinically trained therapists. This task-shifting approach could dramatically expand service access for these high-risk youth, particularly in rural areas where substance use services are limited or nonexistent. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Change in anxiety sensitivity and substance use coping motives as putative mediators of treatment efficacy among substance users.

OBJECTIVE: Anxiety sensitivity and coping motives for substance use are processes implicated in anxiety and substance use disorder (SUD) comorbidity, and are malleable treatment targets. Little is known about whether changes in anxiety sensitivity or coping motives during cognitive behavioral therapy (CBT) for anxiety disorders (with or without CBT for SUD) mediate substance use outcomes among patients with comorbid anxiety disorders and SUD. We examined whether changes in anxiety sensitivity and coping motives during treatment for comorbid SUD and anxiety disorders (either CBT for SUD only or CBT for SUD and anxiety disorders) were associated with substance use outcomes. METHODS: Repeated measurements of anxiety sensitivity and coping motives throughout treatment were examined from a randomized clinical trial comparing usual, CBT-based treatment at a substance use disorder specialty clinic (UC) to that usual care plus a brief CBT for anxiety program for patients with comorbid anxiety and substance use disorders (CALM ARC). RESULTS: Anxiety sensitivity decline during treatment was significantly steeper among those who received CALM ARC than those in UC. Decreases in anxiety sensitivity mediated the effect of treatment group on alcohol use following treatment such that the greater reduction in anxiety sensitivity in CALM ARC explained the superior outcomes for alcohol use in CALM ARC compared to UC. Declines in substance use coping motives were not observed in either condition, and did not differ between CALM ARC and UC. Thus, declines in coping motives did not mediate substance use after treatment. CONCLUSIONS: These findings provide preliminary evidence suggesting alcohol use outcomes were related to decreasing anxiety sensitivity rather than decreasing coping motives. Implications and future directions are discussed.

Emotion dysregulation, anticipatory cortisol, and substance use in urban adolescents.

Anticipatory cortisol is associated with risk for substance use in adolescents. The present study extended prior literature by testing a model linking family emotional climate, emotion dysregulation, anticipatory cortisol, and substance use. Participants were 229 adolescents (M = 11.94 years, SD = 1.55; 41% male; 92% African American) enrolled in a 4-wave study of stressors, physiological stress responses, and substance use. Caregivers completed measures of family emotional climate at baseline and adolescents' emotion dysregulation one and two years later; adolescents reported on their substance use at baseline and three years later at Wave 4. Adolescents completed a stress task at Wave 4; saliva samples taken immediately prior to the task were analyzed for cortisol. Longitudinal path models revealed that a negative emotional climate at home was associated with elevated emotion dysregulation at subsequent waves for all youth. Emotional dysregulation was prospectively associated with blunted anticipatory cortisol, which in turn was associated with elevated substance use, controlling for baseline substance use and age. However, these associations only were observed for females. This study suggests that helping girls in particular manage their emotional responses to stress more effectively may impact their physiological responses and reduce risk for substance use.

What parents don't know: Disclosure and secrecy in a sample of urban adolescents.

Research with two-parent European households has suggested that secrecy, and not disclosure of information per se, predicts adolescent adjustment difficulties. The present study attempted to replicate this finding using data from a 4-wave study of 358 poor, urban adolescents (47% male; M age = 12 yrs) in the United States, most of whom (>92%) were African American. Adolescents self-reported secrecy, disclosure, depressive symptoms, and delinquency at each wave. Confirmatory factor analyses revealed that a two-factor model with secrecy and disclosure as separate, but correlated, factors was a better fit than a one-factor model. However, predictive models differed from previous research. Secrecy did not predict depressive symptoms, rather depressive symptoms predicted secrecy. For delinquency, there were significant paths from both secrecy to delinquency and delinquency to secrecy, as well as from delinquency to disclosure. These results did not differ by age or sex. Comparisons with previous findings are discussed.