Gender differences in risk pathways for adolescent substance abuse and early adult alcoholism

ScienceDaily (June 11, 2011) — Clinically ascertained reports suggest that boys and girls with attention deficit hyperactivity disorder (ADHD) may differ from each other in their vulnerability to substance use problems, say the researchers of the University of Helsinki and University of Jyväskylä, Finland.

A total of 1545 Finnish adolescents were assessed for DSM-IV-based ADHD symptoms by their parents and classroom teachers using standardized rating scales at age 11-12 years. At age 14, substance use disorders and psychiatric co-morbidity were assessed with the Semi-Structured Assessment for the Genetics of Alcoholism, providing DSM-III-R/DSM-IV diagnoses for Axis I disorders. At age 17.5, substance use was assessed by multi-item questionnaire.

Baseline ADHD symptoms were less common among girls than boys, but among girls they were more predictive of adverse substance use outcomes once conduct disorder and previous substance use were controlled for. Only in females were baseline ADHD symptoms significant predictors of alcohol abuse and dependence and illicit drug use at age 14. At the age of 17.5, parents' reports of inattentiveness and hyperactivity were significant predictors for frequent alcohol use in both sexes, but they were more predictive of frequent alcohol and illicit drug use in girls.

Impulsivity in teachers' ratings predicted frequent alcohol use and illicit drug use in boys. Parental reports of inattentiveness in their 11-/12-year-old daughters were a consistent predictor for illicit drug use across adolescence.

"Inattentiveness and hyperactivity may be more predictive of alcohol use disorders and maladaptive patterns of alcohol and illicit drug use among girls than boys," says psychiatrist, Dr. Elina Sihvola.

"The importance of these behavioural symptoms should be assessed further in the community, as they could jeopardize adolescents' successful transitioning into adult roles," she adds.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Helsinki, via EurekAlert!, a service of AAAS.

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Cognitive behavioral therapy may benefit patients in residential substance abuse treatment programs

ScienceDaily (June 6, 2011) — Patients in residential treatment programs for drug and alcohol abuse may benefit from cognitive behavioral therapy for depressive symptoms, according to a report in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

The article notes, as background information, that depression and substance abuse often co-occur, but that individuals with both disorders are not always treated for both. "The consequences of this unmet need are great," report the authors. "The interactive nature of the two disorders leads to poorer depression and substance abuse treatment outcomes compared with the outcomes when only one disorder is treated."

Katherine E. Watkins, M.D., M.S.H.S., from RAND Corporation, Santa Monica, Calif., and colleagues conducted the study at four Behavioral Health Services facilities in Los Angeles County, Calif. Between August 2006 and January 2009, the sites alternated every four months between usual care for substance abuse and usual care plus cognitive behavioral therapy as modeled in the Building Recovery by Improving Goals, Habits, and Thoughts (BRIGHT) study. The intervention comprised 16 two-hour BRIGHT sessions over the course of eight weeks.

Initially, 1,262 patients were screened for participation in the study. The researchers enrolled 140 patients in the intervention group and 159 patients in the control group. On average, participants scored in the clinically severe range on a scale of depression symptoms and nearly half (45.8%) had a past 12-month depressive disorder.

On the depression-symptom instrument used in the study, at three months patients receiving the intervention generally had mild symptoms and patients receiving usual care alone generally had moderate symptoms. At three months, 55.8 percent of patients in the BRIGHT group had minimal symptoms, compared with 33.6 percent in the control group; at six months, these numbers increased to 63.9 percent and 43.8 percent, respectively. Among patients no longer living in a treatment center at the six-month mark, those in the intervention group had fewer days of problem substance abuse and fewer drinking days than did those in the usual care group.

With the study, the authors hope to address a gap in the substance abuse treatment system, particularly in the public sector. They note that the BRIGHT intervention involved substance abuse counselors, as opposed to other mental health professionals and resources that some substance abuse programs cannot access. "The study demonstrates that it is possible to develop the capacity of substance abuse programs to deliver evidence-based mental health care by enhancing the skills and expanding the clinical roles of substance abuse counselors," the researchers state. This is important, they add, because "Lack of access to efficacious depression treatment for substance abusers is an important public health problem."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by JAMA and Archives Journals.

Journal Reference:

K. E. Watkins, S. B. Hunter, K. A. Hepner, S. M. Paddock, E. de la Cruz, A. J. Zhou, J. Gilmore. An Effectiveness Trial of Group Cognitive Behavioral Therapy for Patients With Persistent Depressive Symptoms in Substance Abuse Treatment. Archives of General Psychiatry, 2011; 68 (6): 577 DOI: 10.1001/archgenpsychiatry.2011.53

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here

Cognitive behavioral therapy may benefit patients in residential substance abuse treatment programs

ScienceDaily (June 6, 2011) — Patients in residential treatment programs for drug and alcohol abuse may benefit from cognitive behavioral therapy for depressive symptoms, according to a report in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

The article notes, as background information, that depression and substance abuse often co-occur, but that individuals with both disorders are not always treated for both. "The consequences of this unmet need are great," report the authors. "The interactive nature of the two disorders leads to poorer depression and substance abuse treatment outcomes compared with the outcomes when only one disorder is treated."

Katherine E. Watkins, M.D., M.S.H.S., from RAND Corporation, Santa Monica, Calif., and colleagues conducted the study at four Behavioral Health Services facilities in Los Angeles County, Calif. Between August 2006 and January 2009, the sites alternated every four months between usual care for substance abuse and usual care plus cognitive behavioral therapy as modeled in the Building Recovery by Improving Goals, Habits, and Thoughts (BRIGHT) study. The intervention comprised 16 two-hour BRIGHT sessions over the course of eight weeks.

Initially, 1,262 patients were screened for participation in the study. The researchers enrolled 140 patients in the intervention group and 159 patients in the control group. On average, participants scored in the clinically severe range on a scale of depression symptoms and nearly half (45.8%) had a past 12-month depressive disorder.

On the depression-symptom instrument used in the study, at three months patients receiving the intervention generally had mild symptoms and patients receiving usual care alone generally had moderate symptoms. At three months, 55.8 percent of patients in the BRIGHT group had minimal symptoms, compared with 33.6 percent in the control group; at six months, these numbers increased to 63.9 percent and 43.8 percent, respectively. Among patients no longer living in a treatment center at the six-month mark, those in the intervention group had fewer days of problem substance abuse and fewer drinking days than did those in the usual care group.

With the study, the authors hope to address a gap in the substance abuse treatment system, particularly in the public sector. They note that the BRIGHT intervention involved substance abuse counselors, as opposed to other mental health professionals and resources that some substance abuse programs cannot access. "The study demonstrates that it is possible to develop the capacity of substance abuse programs to deliver evidence-based mental health care by enhancing the skills and expanding the clinical roles of substance abuse counselors," the researchers state. This is important, they add, because "Lack of access to efficacious depression treatment for substance abusers is an important public health problem."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by JAMA and Archives Journals.

Journal Reference:

K. E. Watkins, S. B. Hunter, K. A. Hepner, S. M. Paddock, E. de la Cruz, A. J. Zhou, J. Gilmore. An Effectiveness Trial of Group Cognitive Behavioral Therapy for Patients With Persistent Depressive Symptoms in Substance Abuse Treatment. Archives of General Psychiatry, 2011; 68 (6): 577 DOI: 10.1001/archgenpsychiatry.2011.53

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here

Link between childhood ADHD and substance abuse risk supported by long-term study data

ScienceDaily (May 31, 2011) — Analysis of data from two long-term studies of the impact of attention-deficit hyperactivity disorder (ADHD) on the development of psychiatric disorders in young adults confirms that ADHD alone significantly increases the risk of cigarette smoking and substance abuse in both boys and girls.

The report from a team of Massachusetts General Hospital (MGH) investigators will appear in the Journal of the American Academy of Child & Adolescent Psychiatry and has been released online.

"Our study, which is one of the largest set of longitudinal studies of this issue to date, supports the association between ADHD and substance abuse found in several earlier studies and shows that the increased risk cannot be accounted for by co-existing factors such as other psychiatric disorders or family history of substance abuse," says Timothy Wilens, MD, of the MGH Pediatric Psychopharmacology Unit, who led the study. "Overall, study participants diagnosed with ADHD had a one and a half times greater risk of developing substance abuse than did control participants."

While previous studies from investigators at MGH and elsewhere found an increased risk of substance abuse in adolescents and young adults with ADHD, questions have been raised about whether specific aspects of ADHD such as impulsive behavior, cognitive problems, school problems, accompanying conditions such as bipolar disorder or conduct disorder, or family factors were actually responsible for the risk. To get a clearer picture of the factors behind the increased risk, the researchers examined data from two previous studies -- one of boys, one of girls -- that analyzed the prevalence of a broad range of psychiatric and behavioral disorders in participants diagnosed with ADHD as children.

From those two studies, a decade of more of follow-up information was available for a total of 268 participants with ADHD and 220 control participants, both groups equally divided by gender. Among the ADHD participants, 32 percent developed some type of substance abuse, including cigarette smoking, during the follow-up period, while only 25 percent of control participants had substance abuse problems. Factors such as gender, cognitive difficulties, mood disorders, school problems or family history of substance abuse did not impact the risk. The only additional diagnosis that had an effect was conduct disorder, which tripled the risk when combined with ADHD.

"Anyone with ADHD needs to be counseled about the risk for substance abuse, particularly if they have any delinquency," explains Wilens. "We still need to understand why some kids with ADHD develop substance abuse and others don't, whether particular treatment approaches can prevent substance problems and how best to treat young adults that have both ADHD and substance abuse." Wilens is an associate professor of Psychiatry at Harvard Medical School.

Additional authors of the JAACAP report are MaryKate Martelon, MPH; Gagan Joshi, MD; Clancey Bateman; Ronna Fried, EdD; Carter Petty, MA, and Joseph Biederman, MD, all of the MGH Pediatric Psychopharmacology Unit. The study was supported by grants from the National Institutes of Health, the Eli Lilly and Company Foundation and the MGH Pediatric Psychopharmacology Philanthropy Fund.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Massachusetts General Hospital, via EurekAlert!, a service of AAAS.

Journal Reference:

Timothy E. Wilens, MaryKate Martelon, Gagan Joshi, Clancey Bateman, Ronna Fried, Carter Petty, Joseph Biederman. Does ADHD Predict Substance-Use Disorders? A 10-Year Follow-up Study of Young Adults With ADHD. Journal of the American Academy of Child & Adolescent Psychiatry, 2011; DOI: 10.1016/j.jaac.2011.01.021

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here