Personality disorders in adolescents with major depression, substance abuse disorders, and coexisting major depression and substance use disorders.

This study examined the presence of personality disorders in adolescent inpatients with major depression (MDD; n?=?45), substance use disorders (SUD; n?=?27), or both disorders combined (MDD-SUD; n?=?42). A consecutive series of patients were given structured diagnostic interviews for Axes I and II disorders. The groups did not differ with regard to age, gender, ethnicity, socioeconomic status, psychiatric history, or global assessment of functioning. Borderline personality disorder was diagnosed more frequently in the MDD-SUD group than in the MDD or SUD groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pubertal timing and substance use: Associations between and within families across late adolescence.

In the present study, between-family analyses of data from adolescent twin girls offer new evidence that early menarche is associated with earlier initiation and greater frequency of smoking and drinking. The role of personality factors and peer relationships in that association was investigated, and little support was found for their involvement. Novel within-family analyses replicating associations of substance use with pubertal timing in contrasts of twin sisters selected for extreme discordance for age at menarche are reported. Within-family replications demonstrated that the association of pubertal timing with substance use cannot be explained solely by between-family confounds. Within-family analyses demonstrated contextual modulation of the influence of pubertal timing: Its impact on drinking frequency is apparent only among girls in urban settings. Sibling comparisons illustrate a promising analytic tool for studying diverse developmental outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of substance abuse in psychotherapy clients: The effectiveness of the MMPI-2 substance abuse scales.

The Minnesota Multiphasic Personality Inventory—2 (MMPI—2) contains 3 scales, the MacAndrew Alcoholism Scale—Revised (MAC—R), the Addiction Potential Scale (APS), and the Addiction Acknowledgement Scale (AAS), that were developed to identify alcohol and drug abusing individuals. The current study was designed to measure the effectiveness of these scales at detecting substance abuse problems in a community-based mental health sample. MAC—R, APS, and AAS scores were obtained from 64 therapists who identified 68 substance abusing and 392 nonabusing psychotherapy clients. The results indicated that mean scores on all 3 scales were higher for the substance abusers than for nonabusers. Furthermore, discriminant analysis found all 3 scales to be effective screening tools. The AAS was the best single predictor, and a combination of the AAS and MAC—R provided the best overall discrimination. The implications of early substance abuse detection on treatment effectiveness are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emergence of delinquency and depressed mood throughout adolescence as predictors of late adolescent problem substance use.

Delinquency is a positive predictor of adolescent problem substance use, and depressed mood may increase risk for substance problems. The extent to which effects of delinquency and depressed mood on problem substance use vary depending on when during adolescence the predictors are assessed is unknown. The authors used 5 multigroup path analyses to examine effects of delinquency and depressed mood at ages 11, 12, 13, 14, and 16 years on problem substance use at age 18, and mediation of those effects through alcohol use at age 16 across gender. Participants were 429 rural youths (222 girls and 207 boys) and their families. Indirect positive effects of delinquency on the outcome were observed for boys; direct positive effects of depressed mood were observed for girls. Prevention implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The co-occurrence of spouse and physical child abuse: A review and appraisal.

For more than 20 years, there have been periodic reports in the research literature about the co-occurrence of spouse abuse and physical child abuse. This review compiles and evaluates those reports. Forty-two studies were found that provided some data concerning co-occurrence; 31 of the studies included sufficient detail to be used in this review. The different types of studies are classified and methodological issues are discussed. The base rate of co-occurrence found in representative community samples was about 6%. In clinical samples of either battered women or physically abused children, the percentage of overlap ranged from 20% to 100%. When a conservative definition of child abuse was used, a median co-occurrence rate of 40% was found. Five models depicting the directionality of abuse in violent families are proposed and discussed in relation to the data and theories of violence. Recommendations for methodological improvements and theory-driven studies are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intervening in adolescent substance abuse

Violence towards health professionals is defined as any incident in which a health professional experiences abuse, threat, fear or the application of force arising out of the course of his or her work, whether or not they are on duty. It emerges that no single theory can adequately explain the phenomenon, and perceptions about incidence and prevalence are distorted by the media. There is consistent and variable reporting but a high incidence and prevalence undoubtedly exists within health care. Health professionals and less experienced nurses in particular have been found to be most at risk. A strategic approach is needed to the development and implementation of workplace-specific solutions. Health professionals have a right to expect that violence at work is minimized but it would be unrealistic to expect it to be eradicated.     

Ecology of depression in late childhood and early adolescence: A profile of daily states and activities.

This study investigated daily states and time use patterns associated with depression. Four hundred eighty-three 5th to 9th graders reported on their experience when signalled by pagers at random times. Depressed youth reported more negative affect and social emotions, lower psychological investment, lower energy, and greater variability in affect. These differences were weaker for 5th and 6th graders, suggesting that self-reported feeling states are a poor indicator of depression prior to adolescence. No differences were found in the daily activities of depressed youths nor in the amount of time spent alone, but depressed youths experienced other people as less friendly and more often reported wanting to be alone, especially when with their families. They also spent less time in public places and more time in their bedrooms. Finally, depressed boys, but not girls, spent much less time with friends, particularly of the same sex, suggesting that social isolation is more strongly associated with depression for boys. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Munchausen's syndrome and substance abuse

The syndrome of factitious disorders with physical symptoms was named "Munchausen's syndrome" by Richard Asher (1951). The present article contains an interesting case report of a patient who has a history of Munchausen's syndrome, substance abuse, and genuine physical illness. A review of the literature supports a strong association of substance abuse in patients with Munchausen's syndrome. Also important for clinicians to remember is that patients with Munchausen's syndrome often have true physical illnesses which need appropriate treatment. The patient described here has successfully begun treatment with methadone maintenance, but further study will be needed regarding methadone maintenance's role in the management of Munchausen's syndrome.     

Binge drinking trajectories from adolescence to emerging adulthood in a high-risk sample: Predictors and substance abuse outcomes.

This study describes binge drinking trajectories from adolescence to emerging adulthood in 238 children of alcoholics and 208 controls. Mixture modeling identified three trajectory groups: early-heavy (early onset, high frequency), late moderate (later onset, moderate frequency), and infrequent (early onset, low frequency). Nonbingers were defined a priori. The early-heavy group was characterized by parental alcoholism and antisociality, peer drinking, drug use, and (for boys) high levels of externalizing behavior, but low depression. The infrequent group was elevated in parent alcoholism and (for girls) adolescent depression, whereas the nonbinger and late-moderate groups showed the most favorable adolescent psychosocial variables. All 3 drinking trajectory groups raised risk for later substance abuse or dependence compared with the nonbingers, with the early-heavy group at highest risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The intimate connection between antisocial personality and substance abuse

This section of the series introduces the topic of WWW search engines and directory sites; showing you how to find information using a search engine and a directory. It also covers other ways of searching for information on the internet.     

Adolescent substance abuse treatment outcome: The role of substance abuse problem severity, psychosocial, and treatment factors.

A structural equation model incorporating substance abuse problem severity, psychosocial risk and protection, and treatment variables examined adolescent drug abuse treatment outcome pathways across 6- and 12-month follow-up points. Findings on resiliency factors and an empirical method adapted from previous research were used to select and assign 10 psychosocial factors to either a multiple protective factor index or a risk factor index. Gender, substance abuse problem severity, treatment modality, treatment length, and aftercare participation were also examined as outcome predictors. The findings suggest that treatment intensity decisions may be better informed by pretreatment psychosocial risk level rather than by substance abuse problem severity. The present study also suggests that drug-abusing adolescents who receive sufficiently long treatment, participate in aftercare, and possess at least 1 individual or interpersonal protective factor during their recovery process have the best chance to maintain gains made during treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The emergence of gender differences in depression during adolescence.

There are no gender differences in depression rates in prepubescent children, but, after the age of 15, girls and women are about twice as likely to be depressed as boys and men. In this article, 3 models for how gender differences in depression might develop in early adolescence are described and evaluated. According to Model I, the causes of depression are the same for girls and boys, but these causes become more prevalent in girls than in boys in early adolescence. According to Model 2, there are different causes of depression in girls and boys, and the causes of girls' depression become more prevalent than the causes of boys' depression in early adolescence. According to Model 3, girls are more likely than boys to carry risk factors for depression even before early adolescence, but these risk factors lead to depression only in the face of challenges that increase in prevalence in early adolescence. Evidence for the variables most commonly thought to contribute to gender differences in depression in children and adolescents is reviewed, and this evidence is related to the 3 models for how these differences develop. It is concluded that Model 3 is best supported by the available data, although much more research is needed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contemporary trends in substance abuse.

A clinical consensus has evolved as to the specific areas to be addressed in a comprehensive clinical interview with substance abusers. Knowledge of specific psychopathology and associated comorbidities among addicts will refine this assessment. There are several reasonably reliable and valid objective psychological tests that can be used to provide supplementary information for diagnostic and treatment decisions. Etiological theories, including the disease concept, family systems theory, psychodynamic formulations, and behavioral approaches, have generated treatment interventions of clinical utility. Recent research suggests that psychotherapy, combined with traditional approaches, results in increased therapeutic benefits that were heretofore considered unlikely. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Future trends in substance abuse.

Argues that as illicit drugs with increased abuse liability come into vogue, a broader segment of the population will be at risk for becoming addicted. Consequently, the attendant effects of abuse, including acquired immune deficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection, will grow proportionately. Health care providers will need to become more astute and creative to provide effective rehabilitation for addicted individuals. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention.

Suggests that the most promisng route to effective strategies for the prevention of adolescent alcohol and other drug problems is through a risk-focused approach. This approach requires the identification of risk factors for drug abuse, identification of methods by which risk factors have been effectively addressed, and application of these methods to appropriate high-risk and general population samples in controlled studies. The authors review risk and protective factors for drug abuse, assess a number of approaches for drug abuse prevention potential with high-risk groups, and make recommendations for research and practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trajectories of school engagement during adolescence: Implications for grades, depression, delinquency, and substance use.

Using longitudinal data from the 4-H Study of Positive Youth Development, the authors assessed 1,977 adolescents across Grades 5 to 8 to determine if there were distinctive developmental paths for behavioral and emotional school engagement; if these paths varied in relation to sex, race/ethnicity, and family socioeconomic status (SES); and whether links existed between trajectories of school engagement and grades, depression, substance use, and delinquency. Four trajectories for behavioral school engagement and four trajectories of emotional engagement were identified using a semiparametric mixture model. These trajectories were distinct with regard to initial levels of and changes in engagement, as well as to their shapes. Trajectories varied in regard to sex, SES, and race/ethnicity. Different trajectories of behavioral and emotional engagement were linked to grades, depression, delinquency, and substance use. Directions for future research and application are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of the EAP in the identification and treatment of substance abuse

Employee Assistance Programs (EAPs) are cost-effective strategies for employers to contain the substantial direct and indirect costs of substance abuse in the workplace. EAPs offer prevention, early detection, assessment of referral, and after-care programs to help stem the enormous costs of substance abuse in the workplace. Most effective employer substance abuse programs integrate drug-testing and EAP services to ensure a well coordinated, cost-effective program.     

Cost-effectiveness of inpatient substance abuse treatment

OBJECTIVE: To identify the characteristics of cost-effective inpatient substance abuse treatment programs. DATA SOURCES/STUDY SETTING: A survey of program directors and cost and discharge data for study of 38,863 patients treated in 98 Veterans Affairs treatment programs. STUDY DESIGN: We used random-effects regression to find the effect of program and patient characteristics on cost and readmission rates. A treatment was defined as successful if the patient was not readmitted for psychiatric or substance abuse care within six months. PRINCIPAL FINDINGS: Treatment was more expensive when the program was smaller, or had a longer intended length of stay (LOS) or a higher ratio of staff to patients. Readmission was less likely when the program was smaller or had longer intended LOS; the staff to patient ratio had no significant effect. The average treatment cost $3,754 with a 75.0% chance of being effective, a cost-effectiveness ratio of $5,007 per treatment success. A 28-day treatment program was $860 more costly and 3.3% more effective than a 21-day program, an incremental cost-effectiveness of $26,450 per treatment success. Patient characteristics did not affect readmission rates in the same way they affected costs. Patients with a history of prior treatment were more likely to be readmitted but their subsequent stays were less costly. CONCLUSIONS: A 21-day limit on intended LOS would increase the cost-effectiveness of treatment programs. Consolidation of small programs would reduce cost, but would also reduce access to treatment. Reduction of the staff to patient ratio would increase the cost-effectiveness of the most intensively staffed programs.     

Genetic contributions to continuity, change, and co-occurrence of antisocial and depressive symptoms in adolescence

In adolescence, antisocial and depressive symptoms are moderately stable and modestly correlated with each other. We examined the genetic and environmental origins of the stability and change of antisocial and depressive symptoms and their co-occurrence cross-sectionally and longitudinally in a national sample of 405 adolescents. Monozygotic (MZ) and dizygotic (DZ) twins and full, half, and unrelated siblings 10-18 years of age from non-divorced and step-families were studied over a 3-year period. Composite measures of adolescent self-reports, parent reports, and observational measures of antisocial and depressive symptoms were analysed in multivariate behavioural genetic models. Results indicated that the majority of the stability in and co-occurrence between dimensions could be accounted for by genetic factors. Non-shared environmental risks and, for antisocial symptoms, shared environmental risks also contributed to the stability. Genetic influences on change were observed, but only for antisocial behaviour. In addition, the longitudinal association between antisocial behavioural and later depressive symptoms was also found to be genetically mediated, but this effect was nonsignificant after controlling for stability. Results were discussed in light of the potential contributions of development behavioural genetic research in understanding individual differences in the stability and change of maladjustment.     

Handwriting in assessing treatment for substance abuse

Analysis of Mathematics and Language Arts scores for 11,438 fourth- and 8,972 seventh-grade students in compensatory education programs on the performance assessments for the Iowa Test of Basic Skills indicated the students performed poorly, particularly in mathematics.