Deconstructing the heterogeneity of alcohol use disorder: lifetime comorbid non-alcohol substance use disorder as a distinct behavioral phenotype?

BACKGROUND: Alcohol use disorder (AUD) is an etiologically and clinically heterogeneous condition. Accumulating evidence suggests that persons with lifetime histories of comorbid AUD and non-alcohol substance use disorder (DRUG) constitute an important subgroup of AUD. This study evaluated the distinctiveness of the comorbid AUD/DRUG behavioral phenotype in a community sample with respect to risk factors, AUD course features, and outcome variables assessed at age 30. Contrast groups included persons with histories of AUD only, DRUG only, and neither AUD nor DRUG. METHODS: This research utilized a prospective study design with an age-based cohort (n = 732). Participants completed four comprehensive diagnostic evaluations during the high-risk periods of adolescence, emerging adulthood, and young adulthood. RESULTS: The comorbid AUD/DRUG group was distinguished from the AUD only group by risk factors, AUD course features, and outcomes. Group differences in outcomes were also explained by overall substance use disorder (SUD) severity. Persons with AUD/DRUG comorbidity were indistinguishable from those with DRUG only histories with respect to risk factors and outcomes but demonstrated greater overall SUD severity. Persons with AUD only were indistinguishable from those with neither AUD nor DRUG histories in risk factor endorsements and were mostly similar in outcomes. CONCLUSIONS: Findings collectively suggest that young adults with histories of AUD only and those with comorbid AUD/DRUG are drawn from dissimilar populations. Similarities between the AUD only group with those absent AUD or DRUG histories are likely related to the former group's developmentally limited AUD course accompanied by relatively few or short-lived alcohol-related problems.

Meteorology and British film studios: an article of the London fog.

Industrial winter fogs posed an almost existential threat to filmmaking in Britain during the first decades of the twentieth century, disrupting outdoor or location filming, penetrating studio buildings and delaying production schedules and increasing costs. The problem was exacerbated by many British studios being located in, or on the outskirts of London, a city famous for its 'pea soupers'. This article, having outlined the nature and extent of the problem, explores the ways in which the British film industry responded to the fog. Some studios ceased operations in the winter, whilst some producers relocated to less meteorologically-challenging climes. Two other responses, however, allowed for year-round production in Britain: the installation of specially designed fog-dispersal plant, and the construction of new studios outside the London 'fog-zone.' Using fog to explore the impact of climate on the siting, design and equipping of British film studios, the article is intended to encourage recognition of the ways in which the spaces and infrastructure of film production develop in relation to specific local, regional or national level factors, and stimulate discussion of the relationship between filmmakers, studios and the natural (or, in the case of the London fog, anthropogenic) environments within which they operate.

Family-Based Predictors of Alcohol Use Disorder (AUD) Recurrence and New Non-Alcohol Substance Use Disorder Onset Following Initial AUD Recovery.

OBJECTIVE: Knowledge of factors that predict alcohol use disorder (AUD) recurrence or the subsequent switching to a different substance use disorder (SUD) after initial AUD recovery is especially crucial for preventive efforts that seek to alter life courses dominated by problematic substance use. This study evaluated whether the proportions (or densities) of first-degree relatives with AUD and non-alcohol substance use disorder (NASUD) histories predicted AUD recurrence or a new NASUD onset in a family member (i.e., proband) following initial AUD episode recovery. METHOD: This research is based on a prospective and multigenerational data set collected as part of the Oregon Adolescent Depression Project (OADP). The initial proband cohort was selected randomly from nine high schools in western Oregon. The sample for this research consisted of OADP probands with histories of AUD who recovered from their first AUD episode by age 30 (n = 244). Lifetime SUD histories were also assessed for first-degree adult relatives of probands (n = 790). RESULTS: In unadjusted and partially adjusted analyses, family densities of AUD predicted AUD recurrence among probands, and family densities of NASUDs predicted the onset of a new NASUD following first-episode AUD recovery. In fully adjusted analyses, the effect for AUD family histories on proband AUD recurrence remained, whereas the effect for family NASUD histories on new NASUD emergence was not maintained. CONCLUSIONS: Family SUD histories have predictive relevance for the course of AUD following initial recovery as well as some specificity for the type of SUD recurrence subsequently experienced.

Are Parental Alcohol Use Disorder Histories Associated With Offspring Behavior Problems at Age 2?

OBJECTIVE: Studies of clinical and high-risk samples have demonstrated associations between parental alcohol use disorders (AUDs) and offspring's internalizing and externalizing behavior problems during adolescence and early adulthood. It remains unclear, however, whether associations between parental AUD histories and offspring behavior problems are evident among very young offspring who were not directly exposed to a parent who experienced an active AUD episode during the child's lifetime. The present study sought to evaluate internalizing and externalizing behavior problems among young children as a function of paternal and maternal AUD histories and associated clinical features. METHOD: The community sample consisted of 160 families with a 2-year-old child and parents who did not experience an AUD episode since the child was born. Parental AUD histories and associated clinical features were evaluated with semistructured interviews, and parental reports of child internalizing and externalizing behaviors were assessed with an age-appropriate behavior checklist. RESULTS: In contrast to previous findings from clinical and high-risk samples, when paternal and maternal AUD histories and associated clinical features were evaluated as predictors of child behavior problems, no statistically significant associations were detected (ßs ranged from .01 to .18). Moderating effects of sex of the offspring were also not significant. CONCLUSIONS: Parental AUD histories do not appear to confer risk for offspring internalizing or externalizing behavior problems at age 2. The emergence of such behavior problems may be limited to specific developmental periods during childhood or reflect the impact of direct exposure to parents with alcohol-related problems.

The number of biological parents with alcohol use disorder histories and risk to offspring through age 30.

OBJECTIVE: We investigated associations between the number of parents with histories of alcohol use disorder (AUD) and several offspring (proband) variables through age 30: occurrence of AUD and, separately, alcohol dependence; onset age of the initial AUD episode; time to recovery from the first AUD episode; number of distinct AUD episodes; and cumulative duration of AUD across episodes. METHODS: Offspring data were collected during four assessment waves of a longitudinal epidemiological study of psychiatric disorders with a regionally representative sample. The reference sample included 730 offspring with diagnostic data from at least one parent. Offspring were assessed with semi-structured diagnostic interviews between mid-adolescence and young adulthood and parents were assessed when offspring were approximately 24 years of age. RESULTS: As the number of parents with AUD increased, offspring risk for AUD and alcohol dependence also increased. Latent growth model results indicated that offspring AUD risk trajectories increase in severity as a function of the number of parents with AUD. This pattern of results was not observed for other AUD course-related features in offspring (i.e., number of distinct episodes; months required for recovery from initial episode; cumulative duration across episodes). CONCLUSIONS: The number of parents with a history of AUD is associated with overall offspring risk for AUD and alcohol dependence and elevated AUD risk trajectories through age 30. The number of parents with AUD may be a more relevant risk factor for onset-related characteristics of AUD in offspring than for its longitudinal course.

Family Aggregation of Substance Use Disorders: Substance Specific, Nonspecific, and Intrafamilial Sources of Risk.

OBJECTIVE: The primary aim of this investigation was to evaluate substance-specific and nonspecific associations between parental and sibling histories of alcohol, cannabis, amphetamine, and hallucinogen use disorders with proband risk for these conditions. A second aim was to evaluate whether the specificity of substance use disorder (SUD) risk to probands varied by family member (i.e., father, mother, and any sibling). METHOD: Lifetime SUD diagnostic data for this family-based investigation were derived from semistructured interviews of community residents. Participants were an age-based cohort (probands), selected at random during adolescence and followed longitudinally until age 30, and their first-degree family members (n = 803 probands and families). RESULTS: Findings generally supported substance-specific and nonspecific forms of familial risk related to a particular type of SUD in probands. Family-based alcohol use disorder (AUD) demonstrated the greatest degree of risk specificity of any substance category, in that no other family SUD category predicted proband AUD. Family-based AUD, however, was also the most consistent nonspecific predictor of nonalcohol forms of SUD among probands. Among family members, the most consistent unique effects associated with a substance-specific risk to probands were observed for siblings. CONCLUSIONS: Findings support both the generality and specificity of risk associated with the abuse of or dependence on specific substances within families and highlight the impact of siblings on SUD risk to other siblings. Study findings underscore the need for a better understanding of malleable family-based factors that promote and reduce SUD risk among members.

Prevalence, incidence, recovery, and recurrence of alcohol use disorders from childhood to age 30.

BACKGROUND: Little is known about the course of alcohol use disorders (AUDs) in representative samples during high-risk periods of adolescence and early adulthood. The primary objective of this research is to describe the prevalence and course of initial AUD episodes experienced between childhood and age 30 in a regionally representative cohort sample. METHODS: Study data are from an epidemiological study of 816 youth. Participants were initially selected at random from nine high schools in western Oregon, USA. Four waves of data collection were conducted between ages 16 and 30. AUD course milestones are referenced to participants' age. RESULTS: Results indicated that male participants (43%) were significantly more likely to be diagnosed with a lifetime AUD than female participants (28%), OR [CI95] = 1.97 [1.47-2.65], and rate of first incidence was especially high between ages 18 and 24.9, a developmental period that also corresponded to the peak interval in prevalence rates. The rate of first AUD incidence substantially diminished beginning around age 25. Among those with an initial AUD episode, 87% recovered by age 30 and, of these, the average episode length was 23 months. Among recovered cases, 33% went on to experience a second AUD episode (i.e., a recurrence) after a minimum 12-month asymptomatic recovery period. Risk for recurrence remained relatively high within the 5 years following initial AUD offset. CONCLUSIONS: AUDs are common lifetime conditions in representative samples, whereby most affected individuals by age 30 experience a time-limited course rather than a recurring or persistent course.

Clinical features associated with an increased risk for alcohol use disorders among family members.

This study evaluated the risk for alcohol use disorders (AUDs) among first-degree relatives depending on whether a specific family member (proband) had an AUD history. For probands with AUD histories, we also evaluated whether certain clinical features were associated with higher rates of AUDs in family members as a means for identifying markers that signify a more familial form of AUD. The proband sample was recruited from high schools in Western Oregon communities at Age 16 and followed longitudinally until Age 30. Structured psychiatric histories of 2,414 first-degree relatives of 732 probands were ascertained when the proband was Age 24. For the full sample, a significant association was observed between proband AUD history and the density (proportion) of first-degree relatives with AUD histories. Univariate analyses indicated that several clinical features among probands with AUD histories were significantly associated with AUD family density. In multivariate analyses, proband AUD episode recurrence and anxiety disorder history features emerged as trend-level or statistically significant unique predictors of AUD family density. One of these features, AUD episode recurrence, demonstrated a significant association with AUD family density once other forms of psychopathology among first-degree relatives were controlled. No evidence of gender moderation of effects was observed. Findings overall indicate that the familial risk for AUDs is related to probands' AUD history status and clinical features they exhibit. (PsycINFO Database Record

No Reliable Evidence That Emotional Disorders Are Proximal Antecedents, Concomitants, or Short-Term Consequences of First Episode Alcohol Use Disorders in a Representative Community Sample.

OBJECTIVE: Emotional disorders and alcohol use disorders (AUDs) frequently demonstrate significant 12-month and lifetime comorbid associations. This comorbidity has been incorporated into influential theories of addiction processes that posit direct or indirect causal associations between these disorder categories. There is currently no consensus, however, about the sequencing of these disorders. In this research, longitudinal data from a regionally representative community sample were used to evaluate whether emotional disorders constitute a proximal antecedent, concomitant, or short-term consequence of first episode (or index) AUDs. METHOD: Participants were 131 persons with index AUD episodes lasting 12 months or more and 131 matched controls. For each participant with an AUD, the presence or absence of an emotional disorder was coded for three time intervals: (a) the 12 months preceding full syndrome AUD episode onset; (b) the last 12 months of the AUD episode; and (c) the 12 months following complete symptom AUD episode offset. These intervals, referenced to participant age, were matched to those of control participants, and emotional disorder rate comparisons subsequently performed both within and between groups. RESULTS: Findings indicated an absence of significant within- or between-subject differences in emotional disorder rates, suggesting that the association between AUDs and emotional disorders is neither directional nor systematic. There was also no indication that the length of the AUD episode increased risk for an emotional disorder in the year following AUD offset. CONCLUSIONS: Overall, this research suggests that emotional disorders are generally independent events in relation to the index AUD episode.

Trajectories of cannabis use disorder: risk factors, clinical characteristics and outcomes.

AIMS: To estimate cannabis use disorder (CUD) trajectory classes from ages 14 to 30 years and compare classes on clinical characteristics, risk factors and psychosocial outcomes. DESIGN: Four waves (T1-T4) of data from an epidemiological study of psychopathology among a regionally representative sample. Trajectory classes described risk for CUD as a function of age. The number of classes was determined by model fit. SETTING: Participants were selected randomly from nine high schools in western Oregon, USA. PARTICIPANTS: The sample included 816 participants [age at T1 mean = 16.6, standard deviation (SD) = 1.2; 44% male; 8% non-white]. MEASUREMENTS: Participants completed diagnostic interviews, Child Trauma Questionnaire, Social Adjustment Scale and items adapted from the Wisconsin Manual for Assessing Psychotic-Like Experiences. FINDINGS: There were three CUD trajectory classes (Lo-Mendell-Rubin likelihood ratio test < 0.001): (1) persistent increasing risk; (2) maturing out, with increasing risk then decreasing risk; and (3) stable low risk. The persistent increasing class had later initial CUD onsets (η2  = 0.16, P < 0.001) and greater cumulative CUD durations (η2  = 0.26, P < 0.001). Male sex [odds ratio (OR) = 2.57, P = 0.018], externalizing disorders between ages 24 and 30 years (OR = 2.64, P < 0.001) and psychotic experiences during early adulthood (Cohen's d = 0.44, P = 0.016) discriminated between the persistent increasing and the maturing-out classes. CONCLUSIONS: Evidence suggests three distinguishable types of trajectory for development of cannabis use disorder starting in early teens: (1) persistent increasing risk; (2) maturing out, with increasing risk then decreasing risk; and (3) stable low risk.

Internalizing and externalizing disorders as predictors of alcohol use disorder onset during three developmental periods.

BACKGROUND: The developmental pathways associated with an enhanced risk for future alcohol use disorders (AUDs) continue to be a topic of both interest and debate. In this research, internalizing and externalizing disorders were evaluated as prospective predictors of the index AUD episode onset, separately within three developmental periods: early-to-middle adolescence (age 13.0-17.9), late adolescence (18.0-20.9), and early adulthood (21.0-30.0). METHODS: Participants (N=816) were initially randomly selected from nine high schools in western Oregon and subsequently interviewed on four separate occasions between ages 16 and 30, during which current and past AUDs were assessed as well as a full range of psychiatric disorders associated with internalizing and externalizing psychopathology domains. RESULTS: In adjusted analyses for each of the three developmental periods investigated, externalizing domain psychopathology from the most proximal adjoining developmental period predicted AUD onset. Distal externalizing psychopathology also predicted AUD onset among early adult onset cases. Proximal or distal internalizing psychopathology, in comparison, was not found to be a significant predictor of AUD onset in adjusted analyses for any of the developmental periods examined. CONCLUSIONS: Findings overall suggest that externalizing developmental histories are robust predictors of AUD onset within the age range during which index episodes are most likely to occur, and that gender does not moderate this association.

Association of comorbid psychopathology with the duration of cannabis use disorders.

Risk factors for the development of cannabis use disorders (CUDs) have been well-researched. Comparatively little is known, however, about factors associated with the persistence of CUDs over time. This research explored whether the temporal sequencing of comorbid psychiatric disorders in relation to the onset of the index CUD episode were associated with the length of this episode. Four comprehensive diagnostic assessments were conducted between ages 16 and 30 with a large and regionally representative community sample (n = 816), among which 173 persons were diagnosed with a lifetime CUD. In separate unadjusted analyses, any internalizing disorder and any mood disorder with onset prior to that of the index CUD episode were each significantly and negatively associated with CUD duration. These effects, however, were reduced to trend level in adjusted analyses that controlled for putative confounders. Following the onset of the index CUD episode, the subsequent occurrence of any Axis I disorder, internalizing disorder, externalizing disorder, or other substance use disorder during the index CUD episode was significantly and positively associated with the duration of that episode in both unadjusted and adjusted analyses. These findings collectively suggest that the presence of internalizing-spectrum disorders prior to the onset of the index CUD episode affords some modest protection against protracted episodes, whereas the emergence of broad-spectrum psychopathology within the index CUD episode, most notably noncannabis substance use disorders, is associated with greater disorder persistence. The relevance of these findings for various motivational models of cannabis addiction is discussed.

Prevalence of non-suicidal self-injury and distinct groups of self-injurers in a community sample of adolescents.

PURPOSE: Adolescence is an important developmental period for the first onset of non-suicidal self-injury (NSSI), a behavior known to be associated with elevated suicide risk. Little is currently known, however, about NSSI among adolescents. The primary objectives of this research were to establish the prevalence of non-suicidal self-injury (NSSI) in a representative sample of Turkish high school students and to identify and describe distinct subgroups of self-injurers. METHODS: A total of 1656 of 1676 eligible students (98.8 % participation rate) from 18 schools were surveyed during the 2010-2011 academic year. Questionnaires were administered that assessed prior engagement in a variety of self-injurious behaviors, current psychiatric symptoms, suicide-related risk factors, and participation in health-risk behaviors. Latent class analysis (LCA) methods were used to identify distinct groups of self-injurers. RESULTS: Almost one-third of the sample (N = 519) endorsed some previous engagement in NSSI behaviors. In LCA analyses restricted to youth with prior histories of NSSI, four distinct classes were identified characterized by: (1) low rates of NSSI behaviors (29 %); (2) high rates of self-battery (32 %); (3) high rates of self-cutting (19 %); and (4) high rates of multiple NSSI behaviors (19 %). These classes were further distinguished by current psychiatric symptoms, suicide risk factors, and other health-risk behaviors. CONCLUSIONS: Findings from the present study indicate that NSSI is a common form of behavior among adolescent youth. There is, however, considerable heterogeneity among those with NSSI histories, with about 40 % at particularly high risk for ongoing distress, future acts of intentional self-harm, and suicidal behavior.

Parental transmission of risk for cannabis use disorders to offspring.

AIMS: We investigated the risk of cannabis use disorder (CUD) among probands as a function of parental psychopathology and explored parent-offspring gender concordance as a mechanism of parental CUD transmission to offspring. DESIGN: Four waves of data collection from a longitudinal epidemiological study of psychopathology among a regionally representative sample. SETTING: Participants were selected randomly from western Oregon, USA, and were initially assessed during mid-adolescence. PARTICIPANTS: The reference sample included 719 probands and their biological mothers and fathers. MEASUREMENTS: CUD episodes among probands were assessed with semistructured diagnostic interviews between mid-adolescence and young adulthood. Life-time psychiatric disorders among parents of probands were assessed when probands were approximately 24 years of age. FINDINGS: There was an increased risk for CUD onset among probands with parental histories of CUD [hazard ratio (HR) = 1.93, 95% confidence interval (CI) = 1.30-2.88], hard drug use disorders (HR = 1.96, 95% CI = 1.32-2.90) or antisocial personality disorder (HR = 1.73, 95% CI = 1.06-2.82). A significant parent-offspring gender concordance effect indicated that females with a maternal CUD history were at higher risk for CUD onset compared with females without a maternal CUD (HR = 3.10, 95% CI = 1.52-6.34). Maternal CUD was not associated with CUD onset among males (P = 0.570), nor was there evidence for parent-offspring gender concordance effects for paternal CUD-specific transmission (P = 0.114). CONCLUSIONS: Parental histories of antisocial personality and illicit substance use disorders are associated with increased risk for cannabis use disorder onset in offspring, especially among females with maternal cannabis use disorder histories.

Internalizing and externalizing psychopathology as predictors of cannabis use disorder onset during adolescence and early adulthood.

Risk-related liabilities associated with the development of cannabis use disorders (CUDs) during adolescence and early adulthood are thought to be established well before the emergence of the index episode. In this study, internalizing and externalizing psychopathology from earlier developmental periods were evaluated as risk factors for CUDs during adolescence and early adulthood. Participants (N = 816) completed 4 diagnostic assessments between the ages 16 and 30, during which current and past CUDs were assessed as well as a full range of psychiatric disorders associated with internalizing and externalizing psychopathology domains. In unadjusted and adjusted time-to-event analyses, externalizing but not internalizing psychopathology from proximal developmental periods predicted subsequent CUD onset. A large proportion of adolescent and early adult cases, however, did not manifest any externalizing or internalizing psychopathology during developmental periods before CUD onset. Findings are consistent with the emerging view that externalizing disorders from proximal developmental periods are robust risk factors for CUDs. Although the identification of externalizing liabilities may aid in the identification of individuals at risk for embarking on developmental pathways that culminate in CUDs, such liabilities are an incomplete indication of overall risk.

Comorbidity and temporal relations of alcohol and cannabis use disorders from youth through adulthood.

BACKGROUND: Alcohol and cannabis are among the most widely used and abused drugs in industrialized societies. Investigations of patterns in comorbidity and temporal sequencing between alcohol use disorders (AUDs) and cannabis use disorders (CUDs) from childhood to adulthood are important for understanding the etiologies of these disorders. METHODS: The sample comprised 816 individuals (59% male, 89% white). Dichotomous measures indicated whether or not a participant was in an AUD or CUD episode during three developmental periods-youth (childhood through adolescence), early adulthood, and adulthood. Structural equation modeling was used to determine relations between AUDs and CUDs across the three developmental periods, and to test for gender differences. RESULTS: Concurrent associations between AUD and CUD were significant. Both AUD and CUD in previous developmental periods significantly predicted the same substance disorders in subsequent periods. Cross-lagged paths from youth AUD to young adult CUD and youth CUD to young adult AUD were both significant. However, only the cross-lagged path from youth CUD to adult AUD was significant. The cross-lagged paths from young adult AUD to adult CUD and young adult CUD to adult AUD were both nonsignificant. Males and females were mostly similar with only three differences found between genders. CONCLUSIONS: Comorbidity of AUDs and CUDs was evident from youth through adulthood but the strength of the relationship lessened in adulthood. Temporal sequencing influences of AUDs and CUDs on each other were similar in youth and adulthood but not young adulthood. Same substance stability was greatest in adulthood.

The impact of acquiescence on the evaluation of personality structure.

Acquiescence, or the tendency to respond to descriptions of conceptually distinct personality attributes with agreement/affirmation (acceptance acquiescence) or disagreement/opposition (counter-acquiescence), has been widely recognized as a source of bias that can substantially alter interitem correlations within scales. Acquiescence is also known to operate differently among some groups of persons; it is, for example, more pronounced among individuals with less formal education. Consequently, the biasing effects of acquiescence are of particular concern when the dimensionality underlying the item set of a measure is examined with representative samples comprised of persons with varying levels of educational attainment and evaluated with correlation-based statistical methods such as factor analysis. In the present study, we extended our earlier research by investigating the biasing effect of acquiescence on personality factor structures derived from the full-scale version of the Big Five Inventory (BFI) when administered to a large sample (N = 1,427) selected to be representative of Germany's adult population. Consistent with previous findings based on a short-scale version of the BFI, factor analyses of the unadjusted BFI item set failed to replicate the expected Big Five-factor structure in the low/medium and high educational groups, with distortions in factor structure more pronounced in the former group. Once acquiescence was controlled in the item responses for both groups, however, the obtained factor structures were consistent with the Big Five framework. The implications of acquiescence on the evaluation of the factor structure of personality inventories and for the validity of personality assessments are discussed.