Outcomes of conduct problems in adolescence: 40 year follow-up of national cohort

BMJ 2009;338;a2981

To describe long term outcomes associated with externalising behaviour in adolescence, defined in this study as conduct problems reported by a teacher, in a population based sample.

Main outcome measures Mental disorder, alcohol abuse, relationship difficulties, highest level of education, social class, unemployment, and financial difficulties at ages 36-53.

348 adolescents were identified with severe externalising behaviour, 1051 with mild externalising behaviour, and 2253 with no externalising behaviour. All negative outcomes measured in adulthood were more common in those with severe or mild externalising behaviour in adolescence, as rated by teachers, compared with those with no externalising behaviour. Adolescents with severe externalising behaviour were more likely to leave school without any qualifications (65.2%; adjusted odds ratio 4.0, 95% confidence interval 2.9 to 5.5), as were those with mild externalising behaviour (52.2%; 2.3, 1.9 to 2.8), compared with those with no externalising behaviour (30.8%). On a composite measure of global adversity throughout adulthood that included mental health, family life and relationships, and educational and economic problems, those with severe externalising behaviour scored significantly higher (40.1% in top quarter), as did those with mild externalising behaviour (28.3%), compared with those with no externalising behaviour (17.0%).

Adolescents who exhibit externalising behaviour experience multiple social and health impairments that adversely affect them, their families, and society throughout adult life.

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Ethanol and Stress Activate Catecholamine Synthesis in the Adrenal
Annals of the New York Academy of Sciences Volume 1148 Issue Stress, Neurotransmitters, and Hormones Neuroendocrine and Genetic Mechanisms, Pages 542 - 551

Ethanol consumption and mental stress activate the sympathetic nervous system, which can adversely affect bone.

We compared six groups of 10 young adult rats, three with and three without 2 h daily restraint stress. Two groups consumed food and water ad libitum, two received food and 6% (w/v) ethanol as drinking water, and two received the amount of food consumed by ethanol rats the previous day plus water ad libitum (pairfed). After 6 weeks, rats were killed. Plasma, femurs, lumbar vertebrae, and adrenals were harvested. Femoral dimensions were measured and biomechanical properties were tested by three-point bending. Plasma osteocalcin, vertebral osteocalcin mRNA levels, and adrenomedullary tyrosine hydroxylase (TH), dopamine beta-hydroxylase (DBH), and phenylethanolamine N-methyl transferase (PNMT) mRNA levels were quantified.

Daily restraint decreased weight gain and femoral length compared to dietary controls, and appeared to partially preserve bone strength, especially in calorie-restricted pairfed rats. Femoral strength was significantly affected by treatment in that bones of pairfed controls were weakest, ethanol drinkers were intermediate, and ad libitum restrained were strongest. Femoral yield load, displacement, and work at yield load were negatively correlated with TH and DBH mRNA levels, but not PNMT, suggesting a negative influence of norepinephrine.

Plasma osteocalcin and dry weight of lumbar 3–5 vertebrae were unaffected; however, osteocalcin mRNA in second lumbar vertebrae was positively correlated with TH, DBH, and PNMT levels.

Ethanol consumption at this level had little effect on femur morphology or strength. In contrast, the data suggested possible stimulation rather than inhibition of vertebral bone formation.

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Central Neuropeptide Y in Anxiety- and Stress-related Behavior and in Ethanol Intake

Annals of the New York Academy of Sciences Volume 1148 Issue Stress, Neurotransmitters, and Hormones

Neuroendocrine and Genetic Mechanisms, Pages 136 - 140

One of the most profound properties of central neuropeptide Y (NPY) is its anxiolytic, or anti-anxiety, effect. This has been demonstrated repeatedly in a number of animal models. In addition, stressors affect NPY expression in the central nervous system, with acute and repeated (chronic) stress having differential effects.

Here, a brief summary of some work performed in our laboratory is presented that supports a role for NPY in regulation of stress responses and behaviors.

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Request Reprint E-Mail: annika.thorsell@mail.nih.gov

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Alcohol Use and Patterns of Delinquent Behaviour in Male and Female Adolescents
Alcohol and Alcoholism Advance Access published online on January 8, 2009

The overall aim was to study patterns of delinquent behaviour in relation to adolescent alcohol use. The more specific aims were to examine whether alcohol use varied between groups of adolescents with different patterns of delinquent behaviour, and to explore whether the association between delinquent behaviour patterns and alcohol use was similar for males and females.

The results revealed that the occurrence of excessive alcohol use and drunkenness varied between groups of adolescents with different delinquency patterns, and that the associations between alcohol use and patterns of delinquent behaviours were relatively similar for males and females.

Adolescents with patterns characterized by more serious non-violent delinquency or by violent delinquency reported the highest occurrence of alcohol use and frequency of drunkenness. Adolescents with well-adjusted behaviour or occasional minor delinquency were less likely to report drinking large amounts of alcohol or to the point of feeling drunk.

The present results further emphasize the importance of distinguishing between different offender groups when examining the relationship between delinquent behaviour and associated problems, such as excessive alcohol use.

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Request Reprint E-Mail: jenny.eklund@chess.su.se
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Media Relase - New Plan to Deliver Increased Support for Tasmanians Affected by Alcohol and Drugs


A new five year plan has been released paving the way for additional and improved services for Tasmanians affected by alcohol and drugs.

The Chief Executive of Mental Health and Statewide Services, Dr John Crawshaw, said the plan would guide spending and set direction for the sector.

Dr Crawshaw said the plan represented an important milestone in the reform process.
. . . . .

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Tellus 3 - Ofsted survey of young people

A major new survey of almost 150,000 10 to 15 year-olds in England reveals that a large majority are happy, healthy and feel safe in their schools and local areas – but almost half are worried about their future.

The annual Tellus3 survey of children and young people published today also found that bullying was still a problem, and that smoking, drinking and drugs remain concerns. The study, staged during spring this year, asked children and young people in Years 6, 8 and 10 from 3114 schools in 145 local authorities in England how they viewed their lives - and how good local authorities are at providing services for young people.

Results indicate a positive picture for the vast majority, though there remain long-standing problems, with the level of drinking, drug use and smoking needing to be addressed.

Download the full publication and available documents

Available Downloads

Tellus3 National Report.pdf

TellUs3 National Report.xls

Tellus3_ Key questions by Year group and Gender.doc

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Convergent genome wide association results for bipolar disorder and substance dependence
American Journal of Medical Genetics Part B: Neuropsychiatric Genetics Published Online 6 January 2009

Twin studies document substantial heritability for substance dependence and bipolar disorder [Shih et al. ([2004]); Uhl et al. ([2008a])]. Individuals with bipolar disorder display substance use disorders at rates that are much higher than those in the general population [Krishnan ([2005])].

We would thus predict: 1) substantial overlap between different genome wide association (GWA) studies of bipolar disorder 2) significant overlap between results from bipolar disorder and substance dependence.

Recent GWA studies [Baum et al. ([2007]); Sklar et al. ([2008]); Uhl et al. ([2008a]); Wellcome Trust Consortium (2007)] allow us to test these ideas, although 1) these datasets display difficult features that include use of differing sets of SNPs, likely polygenic genetics, likely differences in linkage disequilibrium between samples, heterogeneity both between and within loci and 2) several, though not all, reports have failed to identify any allele of any single nucleotide polymorphism (SNP) (same SNP same allele) that is reproducibly associated with bipolar disorder with genome wide significance.

We now report analyses that identify clustered, SNPs within genes that overlap between the bipolar samples . Overlapping data from at least three of these studies identify 69 genes. 23 of these genes also contain overlapping clusters of nominally-positive SNPs for substance dependence.

Variants in these addiction/bipolar genes are candidates to influence the brain in ways that manifest as enhanced vulnerabilites to both substance dependence and bipolar disorder.


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Bulletins provide further insight into implications of Brief Interventions

Drug and Alcohol findings, a project that aims to bridge the gap between research and practice, has released a series of bulletins focusing on learnings relating to alcohol Screening and Brief Interventions in the UK.
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Summer Programmes - Alcohol, Drugs and Addiction

- updated 11 - 24 July 2009 (tentative)

Courses, seminars and dialogues in Amsterdam on theories and concepts as they have been developed in the field of addiction studies. The Summer Institute on Addiction is an intensive two week summer programme, which focuses on the study of addiction across cultures and is taught by an international faculty team.

Professionals have the option to attend either one or both weeks.
The Institute welcomes individuals with a focused interest in addiction research and treatment, Master's and PhD students, NGO staff working on addiction-related issues, professionals in human services, practitioners, advocates and participants in other International School programmes

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CALIFORNIA STATE BOARD OF EQUALIZATION

SPECIAL NOTICE TO WINE GROWERS AND IMPORTERS

The Board of Equalization (BOE) approved regulations necessary to clarify the definition of “distilled spirits” under the Alcoholic Beverage Tax Law. The regulations were approved by the Office of Administrative Law (OAL) and became fully operative on October 1, 2008.

The regulations create a rebuttable presumption that all alcoholic beverages, except wine, as defined by Business and Professions Code section 23007, contain 0.5 percent or more alcohol by volume derived from flavors or other ingredients containing alcohol obtained from the distillation of fermented agricultural products and are “distilled spirits.” The regulations also prescribe a procedure for rebutting this presumption.

Accordingly, unless a manufacturer files the attached form BOE-505 Alcoholic Beverage Tax Report for Board of Equalization Rebutting Regulation 2559 to rebut the presumption, any product (including any wine-based products) that does not meet the definition of wine under Business and Profession Code section 23007, is presumed to be a distilled spirit for purposes of the Alcoholic Beverage Tax Law.

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What advice should be given to patients with NAFLD about the consumption of alcohol?

Nature Clinical Practice Gastroenterology & Hepatology (2009) 6, 18-19

Nonalcoholic fatty liver disease (NAFLD) is one of the most common liver diseases in the Western world. NAFLD is associated with chronic metabolic disorders such as obesity, type 2 diabetes, and dyslipidemia. Several studies have shown that individuals with NAFLD are more likely to have atherosclerosis and a heightened risk of cardiovascular disease than individuals without NAFLD. In fact, cardiovascular disease is the single most common cause of death in patients with NAFLD.1

Although heavy alcohol use has many detrimental effects, the cardiovascular benefits of moderate alcohol consumption are beyond doubt. In a prospective study of 490,000 people, Thun et al. demonstrated that individuals who consumed one alcoholic drink daily had a decrease in mortality from all causes of 20% and cardiovascular-associated mortality of 30–40% compared with nondrinkers.2 In the Copenhagen City Heart Study, individuals who consumed between three and five drinks of wine daily had a decreased relative risk of death from all causes, including cardiovascular and cerebrovascular events, of 50% compared with non-wine drinkers. No risk reduction was seen, however, with consumption of beer or liquor, suggesting that the nonalcohol constituents of wine were accountable for the protective effects observed in this study.3 A systematic review that evaluated the effects of alcohol on the incidence and progression of diabetes found that moderate alcohol consumption was associated with a decreased incidence of diabetes and with a decreased incidence of cardiovascular events in those already diagnosed with diabetes.4 These data raise the dilemma of whether patients with NAFLD who have a heightened risk of cardiovascular disease should, or should not, consume alcohol.

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Recovery coaches and substance exposed births: An experiment in child welfare
Child Abuse & Neglect Volume 32, Issue 11, November 2008, Pages 1072-1079


Substance exposed infants present a major challenge to child welfare and public health systems. Prenatal substance exposure and continued substance abuse in the home are associated with a wide range of adverse social, emotional, and developmental outcomes.

The objective of the current study is to evaluate the use of recovery coaches in child welfare.

The current study is longitudinal and utilizes an experimental design. The sample includes 931 substance abusing women enrolled in a Title IV-E Waiver Demonstration, 261 in the control group, and 670 in the experimental group. Women in the experimental group received traditional services plus the services of a recovery coach. Administrative records are used to indicate substance exposure at birth.

Of the 931 women enrolled in the waiver demonstration, 21% of the control group and 15% of the experimental group were associated with a subsequent substantiated allegation indicating substance exposure at birth. Cox proportional hazards modeling indicates that women in the experimental group were significantly less likely to be associated with a new substance exposed birth.

The use of recovery coaches in child welfare significantly decreases the risk of substance exposure at birth. Integrated and comprehensive approaches are necessary for addressing the complex and co-occurring needs of families involved with child protection.

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Request Reprint E-Mail: jpryan@illinois.edu
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Mental Health and Substance Use Problems of Parents Involved With Child Welfare: Are Services Offered and Provided?
Psychiatr Serv 60:56-60, January 2009


This study examined service delivery to parental caregivers with mental health problems, substance use problems, or both. The study sought to determine whether, once need is identified, suitable services are offered and then provided.

Of parents with mental problems, 77.9% were offered services and 84.0% of those were provided services. Of parents with substance use problems, 65.7% were offered treatment and 67.5% of those were provided it. Other problems included lack of parenting skills, lack of education and job skills, parent-child conflict, and lack of income.

Significant associations were found between caseworkers' identifying problems and offering relevant services. Caregivers with substance use problems were less likely to be offered substance treatment services than caregivers with both mental health and substance use problems.

The child welfare system may facilitate service use for caregivers. More research is needed to understand the process of service delivery to caregivers, including why services are not offered to some caregivers and why some services are not provided after being offered.

Future research should examine why caregivers with substance use problems are vulnerable to not receiving treatment and whether and how service use varies for other problems not examined in this study.

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Request Reprint E-Mail: mstaudt@utk.edu
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Substance Use Disorders as Risk Factors for Psychiatric Hospitalization in Bipolar Disorder
Psychiatr Serv 60:50-55, January 2009


This study developed risk profiles of psychiatric hospitalization for veterans diagnosed as having bipolar disorder.

In this sample 20% of the patients with bipolar disorder were hospitalized psychiatrically during the one-year study period. Patients diagnosed as having both an alcohol use disorder and polysubstance dependence and who also were separated from their spouse or partner had a 100% risk of psychiatric hospitalization; risk of psychiatric hospitalization decreased to 52% if the patients were not separated from their partner. Patients who were not diagnosed as having alcohol use disorders or polysubstance dependence and who were not separated from their partners exhibited the lowest risk of psychiatric hospitalization (12%). Among patients with a psychiatric hospitalization, 41% had longer lengths of stay (<14 days), with the strongest predictor of a longer length of stay being an age older than 77 years, which conferred a 77% risk.

Alcohol use and polysubstance dependence can significantly affect the course of bipolar disorder, as evidenced by their associations with psychiatric hospitalizations. Increased focus on substance abuse among older adults with bipolar disorder may decrease length of psychiatric hospitalization. Our findings suggest that implementing substance treatment programs early in the course of bipolar disorder could reduce health service use.

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Request Reprint E-Mail: : john.brooks@ucla.edu
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The Quality of Asthma Care Among Adults With Substance-Related Disorders and Adults With Mental Illness
Psychiatr Serv 60:43-49, January 2009


The purpose of this study was to investigate whether the presence of substance-related disorders or mental illness may affect the quality of medication management in asthma care.

Odds of achieving the HEDIS measure were lower for patients with substance-related or schizophrenia disorders in two states (range of odds ratio [OR]=.69, 95% confidence interval [CI]=.53–.90, to OR=.81, 95% CI=.69–.96), but the odds increased for patients with depressive disorders in two states (OR=1.34, CI= 1.12–1.61; OR=1.37, CI=1.05–1.77) and for patients with bipolar disorder in one state (OR=1.69, CI=1.13–2.55). Odds of achieving the ratio measure were lower for patients with substance-related disorders in four states (range of OR=.63, CI=.47–.88, to OR=.75, CI=.62–.92) and higher for patients with depressive disorders, although only in one state (OR=1.25, CI=1.03–1.53).

Patients with substance-related disorders and those with schizophrenia disorders may be receiving lower-quality asthma care, whereas patients with some other forms of mental illness may be receiving higher-quality care. Further studies are needed to identify the determinants of high-quality asthma care and the validity of quality measures based on administrative data in these populations.

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Request Reprint E-Mail: jeff.baxter@umassmed.edu
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Impact of Substance Disorders on Medical Expenditures for Medicaid Beneficiaries With Behavioral Health Disorders
Psychiatr Serv 60:35-42, January 2009

This study measured the impact of substance use disorders on Medicaid expenditures for behavioral and physical health care among beneficiaries with behavioral health disorders.

A total of 148,457 beneficiaries met selection criteria, and 43,457 (29.3%) had a substance use diagnosis. Compared with other beneficiaries with behavioral health disorders, individuals with diagnoses of substance use disorders had significantly higher expenditures for physical health problems in five of six states. Approximately half of the additional care and expenditures were for treatment of physical conditions. Differences declined but remained statistically significant after adjustment for higher overall disease burden among beneficiaries with addictions. Medical expenditures for individuals with diagnoses of substance use disorders increased significantly with age in five of six states, whereas behavioral health expenditures were stable or declined. Hospital admissions for psychiatric and general medical reasons were higher for those with diagnoses of substance use disorders.

The impact of addiction on Medicaid populations with behavioral health disorders is greater than the direct cost of mental health and addictions treatment. Higher medical expenditures can be partly attributed to greater prevalence of co-occurring physical disorders, but expenditures remained higher after adjustment for disease burden. Spending estimates based only on behavioral health diagnoses may significantly underestimate addictions-related costs, particularly for older adults.

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Request Reprint E-Mail: robin.clark@umassmed.edu
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Is alcohol consumption good for you? Results from the 2005 Canadian Community Health Survey

Addiction Research & Theory, Volume 16, Issue 6 December 2008 , pages 553 - 563

Data from the Statistics Canada 2005 Canadian Community Health Survey is used to test the hypothesis that classification errors of the type noted by Fillmore et al. (2006) could invalidate the statistical results on the effects of alcohol consumption on self-rated health and the incidence of heart disease and diabetes.

The results obtained in this study show that the beneficial effects of moderate alcohol use that so many studies have found, still appear even when the correct classification of alcohol use is employed.

However, parameter biases and inferential errors can occur when researchers fail to distinguish between former drinkers and never drinkers within the non-drinking group.

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Request Reprint E-Mail: jamesm@vax2.concordia.ca

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Alcohol and the burden of disease
Addiction Research & Theory, Volume 16, Issue 6 December 2008 , pages 541 - 552



World Health Organization (WHO) lists alcohol consumption as a leading risk to health, contributing 4% to the global burden of disease. This serves as justification for far-reaching preventive interventions.

The purpose of this article is to recapitulate in narrative some of the assumptions upon which WHO conclusions rest and to interpret their validity accordingly.

First, it may be misleading to include 'alcohol use' as a risk to health. As alcohol use has beneficial, protective as well as harmful properties, burden assessment should be based on harmful aspects only, e.g., 'hazardous patterns of alcohol use'.

Second, assessments of interventions aimed at reducing risks from alcohol use to disease burden should also consider such interventions' impact on dimensions other than health or disease-in particular, psychosocial benefits of alcohol consumption.

Third, the uncertainties associated with both the database and methodology for estimating the disease burden attributable to alcohol are high and need to be considered in the interpretation of findings.

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Who receives confrontation in recovery houses and when is it experienced as supportive?
Addiction Research & Theory Early View 10 November 2008


The Alcohol and Drug Confrontation Scale (ADCS) is a 72-item instrument that measures a construct of confrontation defined as warnings about potential harm associated with alcohol and drug use.

This analysis describes the characteristics of individuals entering residential recovery homes (N = 323) who received confrontation and when it was experienced as supportive.

A large proportion reported receiving at least one confrontational statement (80%), most commonly from family/friends (71%). Individuals who did and did not receive confrontation did not differ by demographics, but those receiving confrontation had more recent substance use, higher perceived costs of sobriety and more severe family and psychiatric problems. Differences were noted in confrontation from the criminal justice system versus family/friends. Overall, residents experienced confrontation as supportive regardless of who confronted them.

Residents who experienced confrontation the most helpful were those with higher levels of substance use and those who believed maintaining sobriety would be difficult.

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Request Reprint E-Mail: dpolcin@arg.org
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Alcohol's excise taxes bringing in less state revenue

BY PAUL HUGHES REPUBLICAN-AMERICAN

People in Connecticut don't seem to be drowning their economic blues in brews, booze or Beaujolais.

Slumping tax collections suggest folks are buying less beer, liquor and wine amid some of the most depressing times since the Great Depression. The revenue figures also indicate the distribution and sale of alcohol aren't recession-proof businesses, either.
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A new blueprint for alcohol and other drug treatment services 2009-2013 Client-centred, service-focused

Overview

A new blueprint for alcohol and other drug treatment services, 2009–2013 has just been released. It will promote treatment services that respond to the range of needs of clients and are high quality and evidenced based.

The Victorian alcohol and other drug treatment sector has an impressive track record of collaborative work and there are excellent examples of partnership initiatives that are helping to rebuild lives. We need to build on that good work and consolidate a system that provides high quality, evidence-based, integrated services.

The blueprint will sit alongside and complement other related government initiatives including Restoring the balance - Victoria’s alcohol action plan 2008–2013, the forthcoming amphetamine-type (ATS) substances and related drugs strategy, the whole-of-government alcohol and drug prevention strategy and the new mental health strategy.

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Blueprint for alcohol and other drug treatment services, 2009–2013 (PDF file 1.62MB)

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