Comprehensive quantitative analyses of fetal magnetic resonance imaging in isolated cerebral ventriculomegaly.

Isolated cerebral ventriculomegaly (IVM) is the most common prenatally diagnosed brain anomaly occurs in 0.2-1 % of pregnancies. However, knowledge of fetal brain development in IVM is limited. There is no prenatal predictor for IVM to estimate individual risk of neurodevelopmental disability occurs in 10 % of children. To characterize brain development in fetuses with IVM and delineate their individual neuroanatomical variances, we performed comprehensive post-acquisition quantitative analysis of fetal magnetic resonance imaging (MRI). In volumetric analysis, brain MRI of fetuses with IVM (n = 20, 27.0 ± 4.6 weeks of gestation, mean ± SD) had revealed significantly increased volume in the whole brain, cortical plate, subcortical parenchyma, and cerebrum compared to the typically developing fetuses (controls, n = 28, 26.3 ± 5.0). In the cerebral sulcal developmental pattern analysis, fetuses with IVM had altered sulcal positional (both hemispheres) development and combined features of sulcal positional, depth, basin area, in both hemispheres compared to the controls. When comparing distribution of similarity index of individual fetuses, IVM group had shifted toward to lower values compared to the control. About 30 % of fetuses with IVM had no overlap with the distribution of control fetuses. This proof-of-concept study shows that quantitative analysis of fetal MRI can detect emerging subtle neuroanatomical abnormalities in fetuses with IVM and their individual variations.

Comparing three forms of early intervention for youth with borderline personality disorder (the MOBY study): study protocol for a randomised controlled trial.

BACKGROUND: Borderline personality disorder is a severe mental disorder that usually has its onset in youth, but its diagnosis and treatment are often delayed. Psychosocial 'early intervention' is effective in improving symptoms and behaviours, but no trial has studied adaptive functioning as a primary outcome, even though this remains the major persistent impairment in this patient group. Also, the degree of complexity of treatment and requirements for implementation in mainstream health services are unclear. The primary aim of this trial is to evaluate the effectiveness of three forms of early intervention for borderline personality disorder in terms of adaptive functioning. Each treatment is defined by combining either a specialised or a general service delivery model with either an individual psychotherapy or a control psychotherapy condition. METHODS/DESIGN: The study is a parallel-group, single-blind, randomised controlled trial, which has randomised permuted blocking, stratified by depression score, sex and age. The treatments are: (1) the specialised Helping Young People Early service model plus up to 16 sessions of individual cognitive analytic therapy; (2) the Helping Young People Early service plus up to 16 sessions of a control psychotherapy condition known as 'befriending'; (3) a general youth mental health care model plus up to 16 sessions of befriending. Participants will comprise 135 help-seeking youth aged 15-25 years with borderline personality disorder. After baseline assessment, staff blind to the study design and treatment group allocation will conduct assessments at 3, 6, 12 and 18 months. At the 12-month primary endpoint, the primary outcome is adaptive functioning (measures of social adjustment and interpersonal problems); secondary outcomes include measures of client satisfaction, borderline personality disorder features, depression and substance use. DISCUSSION: The results of this trial will help to clarify the comparative effectiveness of a specialised early intervention service model over and above general youth mental health care, along with the contribution of individual cognitive analytic therapy over and above specialised general clinical care in early intervention for borderline personality disorder. Consequently, the findings will also inform the level of training and competency required for effective delivery of early intervention services. TRIAL REGISTRATION: Registered with the Australian New Zealand Clinical Trial Registry ACTRN12610000100099 on 1 February 2010.

Empirically derived subtypes of full and subthreshold anorexia nervosa in adolescent females: understanding general psychopathology and treatment implications.

The aim of this study was to derive clinically relevant subtypes of anorexia nervosa (AN) and subthreshold AN using general psychopathology variables and to determine how they differ on eating pathology. Participants were 39 adolescent females aged 13 to 18 years, diagnosed with AN or subthreshold AN. Cluster analysis revealed two subtypes that differed significantly in eating pathology. Cluster 1 patients were typically underweight with no clinical elevations on eating or psychopathology measures. Cluster 2 patients were mostly of healthy weight with greater eating and psychological problems. Findings allow clinicians to classify and understand AN beyond diagnostic criteria, and implement interventions that consider presentation beyond eating pathology.

Maladaptive schemas in adolescent females with anorexia nervosa and implications for treatment.

Recent research has highlighted the presence of Young's Early Maladaptive Schemas (EMSs) in individuals with an eating disorder (ED). This study assessed the EMSs reported by adolescent females with Anorexia Nervosa (AN) compared with a community group. Thirty-six adolescent females diagnosed with AN or subthreshold AN and 111 female secondary school students completed a questionnaire that included the Young Schema Questionnaire, the Behavior Assessment System for Children Self-report of Personality, and the Eating Disorder Screen for Primary Care. Two independent AN subtypes and two community subtypes were derived from responses to the questionnaire, and significant differences between the four comparison groups were found. High Pathology AN participants reported the highest level of psychological maladjustment. Social Isolation and Emotional Inhibition appeared to be most characteristic of adolescent AN in this sample. The results suggest that EMSs may require attention in the treatment of AN in adolescent females, and that different AN subtypes may require individualized treatment approaches.

Feasibility and validity of ecological momentary assessment in adolescents with high-functioning autism and Asperger's disorder.

Ecological Momentary Assessment (EMA) may increase accuracy of data compared with retrospective questionnaires by assessing behaviours as they occur, hence decreasing recall biases and increasing ecological validity. This study examined the feasibility and concurrent validity of an EMA tool for adolescents with High-Functioning Autism Spectrum Disorders (HFASD). Thirty-one adolescents with HFASD completed a mobile phone EMA application that assessed stressors and coping for two weeks. Parents and adolescents also completed retrospective measures of the adolescent's coping/stressors. Moderate compliance with the EMA tool was achieved and some concurrent validity was established with the retrospective measure of coping. Concordance was found between the types of stressors reported by parents and adolescents but not the quantity. The results suggest adolescents with HFASD are capable of reporting on their stressors and coping via EMA. EMA has the potential to be a valuable research tool in this population.

Coping, daily hassles and behavior and emotional problems in adolescents with high-functioning autism/Asperger's Disorder.

Although daily hassles and coping are associated with behavior and emotional problems in non-clinical populations, few studies have investigated these relationships in individuals with high-functioning autism/Asperger's Disorder (HFASD). This study examined the relationships between daily hassles, coping and behavior and emotional problems in adolescents with HFASD. Thirty-one adolescents with HFASD completed questionnaires assessing their coping and behavior and emotional problems, and completed an Ecological Momentary Assessment run via a mobile phone application on their coping and daily hassles. Parents completed questionnaires of the adolescents' daily hassles, coping, and behavior and emotional problems. The disengagement coping style was associated with significantly higher levels of behavior and emotional problems regardless of respondent or methodology, suggesting it may be a valuable target for intervention.

A mobile phone application for the assessment and management of youth mental health problems in primary care: health service outcomes from a randomised controlled trial of mobiletype.

BACKGROUND: GPs detect at best 50c of mental health problems in young people. Barriers to detecting mental health problems include lack of screening tools, limited appointment times and young people's reluctance to report mental health symptoms to GPs. The mobiletype program is a mobile phone mental health assessment and management application which monitors mood, stress and everyday activities then transmits this information to general practitioners (GPs) via a secure website in summary format for medical review. The current aims were to examine: (i) mobiletype as a clinical assistance tool, ii) doctor-patient rapport and, iii) pathways to care. METHODS: We conducted a randomised controlled trial in primary care with patients aged 14 to 24 years recruited from rural and metropolitan general practices. GPs identified and referred eligible participants (those with mild or more mental health concerns) who were randomly assigned to either the intervention group (where mood, stress and daily activities were monitored) or the attention-comparison group (where only daily activities were monitored). Both groups self-monitored for 2 to 4 weeks and reviewed the monitoring data with their GP. GPs, participants and researchers were blind to group allocation at randomisation. GPs assessed the mobiletype program as a clinical assistant tool. Doctor-patient rapport was assessed using the General Practice Assessment Questionnaire Communication and Enablement subscales, and the Trust in Physician Scale (TPS). Pathways to care was measured using The Party Project's Exit Interview. RESULTS: Of the 163 participants assessed for eligibility, 118 were randomised and 114 participants were included in analyses (intervention n = 68, attention-comparison n = 46). T-tests showed that the intervention program increased understanding of patient mental health, assisted in decisions about medication/referral and helped in diagnosis when compared to the attention-comparison program. Mixed model analysis showed no differences in GP-patient rapport nor in pathways to care. CONCLUSIONS: We conducted the first RCT of a mobile phone application in the mental health assessment and management of youth mental health in primary care. This study suggests that mobiletype has much to offer GPs in the often difficult and time-consuming task of assessment and management of youth mental health problems in primary care. TRIAL REGISTRATION: ClinicalTrials.gov NCT00794222.

Predicting early initiation of alcohol use: a prospective study of Australian children.

This study explores the social, contextual and individual factors that predict early initiation of alcohol use. A state-wide representative sample of 927 fifth-grade students, in Victoria, Australia were surveyed. Students were resurveyed in the sixth and seventh grade. Risk and protective factors were measured with a modified version of the Communities That Care youth survey. Alcohol use was measured to assess transition from alcohol nonuse to use. Social contexts perceived to provide easier access to alcohol and drugs were found to be the clearest predictors of early onset alcohol use. The limitations and implications of these findings are discussed.

Temporal mood changes associated with different levels of adolescent drinking: using mobile phones and experience sampling methods to explore motivations for adolescent alcohol use.

INTRODUCTION AND AIMS: Alcohol use during adolescence is associated with the onset of alcohol use disorders, mental health disorders, substance abuse as well as socially and physically damaging behaviours, the effects of which last well into adulthood. Nevertheless, alcohol use remains prevalent in this population. Understanding motivations behind adolescent alcohol consumption may help in developing more appropriate and effective interventions. This study aims to increase this understanding by exploring the temporal relationship between mood and different levels of alcohol intake in a sample of young people. DESIGN AND METHODS: Forty-one secondary school students used a purpose-designed mobile phone application to monitor their daily mood and alcohol use for 20 random days within a 31 day period. Generalised estimating equations were used to examine the relationship between differing levels of alcohol consumption (light, intermediate and heavy) and positive and negative mood three days before and after drinking episodes. RESULTS: While there was no relationship between light and heavy drinking and positive mood, there was an increase in positive mood before and after the drinking event for those that drank intermediate amounts. No statistically significant relationships were found between negative mood and any of the three drinking categories. DISCUSSION AND CONCLUSION: Adolescents who drank in intermediate amounts on a single drinking occasion experienced an increase in positive mood over the three days leading up to and three days following a drinking event. These findings contribute to an understanding of the motivations that underpin adolescent alcohol use, which may help inform future interventions.

Using a mobile phone application in youth mental health - an evaluation study.

BACKGROUND: This study evaluates a mobile phone self monitoring tool designed to assist paediatricians in assessing and managing youth mental health. METHODS: Patients from an adolescent outpatient clinic monitored mental health symptoms throughout each day for 2-4 weeks. Paediatricians specialising in adolescent health and participants reviewed the collated data displayed online and completed quantitative and qualitative feedback. RESULTS: Forty-seven adolescents and six paediatricians participated. Completion was high, with 91% of entries completed in the first week. Paediatricians found the program helpful for 92% of the participants and understood 88% of their patients' functioning better. Participants reported the data reflected their actual experiences (88%) and was accurate (85%), helpful (65%) and assisted their paediatrician to understand them better (77%). Qualitative results supported these findings. DISCUSSION: Self monitoring facilitates communication of mental health issues between these paediatricians and patients and is a promising tool for the assessment and management of mental health problems in young people.

Self-monitoring using mobile phones in the early stages of adolescent depression: randomized controlled trial.

BACKGROUND: The stepped-care approach, where people with early symptoms of depression are stepped up from low-intensity interventions to higher-level interventions as needed, has the potential to assist many people with mild depressive symptoms. Self-monitoring techniques assist people to understand their mental health symptoms by increasing their emotional self-awareness (ESA) and can be easily distributed on mobile phones at low cost. Increasing ESA is an important first step in psychotherapy and has the potential to intervene before mild depressive symptoms progress to major depressive disorder. In this secondary analysis we examined a mobile phone self-monitoring tool used by young people experiencing mild or more depressive symptoms to investigate the relationships between self-monitoring, ESA, and depression. OBJECTIVES: We tested two main hypotheses: (1) people who monitored their mood, stress, and coping strategies would have increased ESA from pretest to 6-week follow-up compared with an attention comparison group, and (2) an increase in ESA would predict a decrease in depressive symptoms. METHODS: We recruited patients aged 14 to 24 years from rural and metropolitan general practices. Eligible participants were identified as having mild or more mental health concerns by their general practitioner. Participants were randomly assigned to either the intervention group (where mood, stress, and daily activities were monitored) or the attention comparison group (where only daily activities were monitored), and both groups self-monitored for 2 to 4 weeks. Randomization was carried out electronically via random seed generation, by an in-house computer programmer; therefore, general practitioners, participants, and researchers were blinded to group allocation at randomization. Participants completed pretest, posttest, and 6-week follow-up measures of the Depression Anxiety Stress Scale and the ESA Scale. We estimated a parallel process latent growth curve model (LGCM) using Mplus to test the indirect effect of the intervention on depressive symptoms via the mediator ESA, and calculated 95% bias-corrected bootstrapping confidence intervals (CIs). RESULTS: Of the 163 participants assessed for eligibility, 118 were randomly assigned and 114 were included in analyses (68 in the intervention group and 46 in the comparison group). A parallel process LGCM estimated the indirect effect of the intervention on depressive symptoms via ESA and was shown to be statistically significant based on the 95% bias-corrected bootstrapping CIs not containing zero (-6.366 to -0.029). The proportion of the maximum possible indirect effect estimated was κ(2 )=.54 (95% CI .426-.640). CONCLUSIONS: This study supported the hypothesis that self-monitoring increases ESA, which in turn decreases depressive symptoms for young people with mild or more depressive symptoms. Mobile phone self-monitoring programs are ideally suited to first-step intervention programs for depression in the stepped-care approach, particularly when ESA is targeted as a mediating factor. TRIAL REGISTRATION: ClinicalTrials.gov NCT00794222; http://clinicaltrials.gov/ct2/show/NCT00794222 (Archived by WebCite at http://www.webcitation.org/65lldW34k).

A mobile phone application for the assessment and management of youth mental health problems in primary care: a randomised controlled trial.

BACKGROUND: Over 75% of mental health problems begin in adolescence and primary care has been identified as the target setting for mental health intervention by the World Health Organisation. The mobiletype program is a mental health assessment and management mobile phone application which monitors mood, stress, coping strategies, activities, eating, sleeping, exercise patterns, and alcohol and cannabis use at least daily, and transmits this information to general practitioners (GPs) via a secure website in summary format for medical review. METHODS: We conducted a randomised controlled trial in primary care to examine the mental health benefits of the mobiletype program. Patients aged 14 to 24 years were recruited from rural and metropolitan general practices. GPs identified and referred eligible participants (those with mild or more mental health concerns) who were randomly assigned to either the intervention group (where mood, stress, and daily activities were monitored) or the attention comparison group (where only daily activities were monitored). Both groups self-monitored for 2 to 4 weeks and reviewed the monitoring data with their GP. GPs, participants, and researchers were blind to group allocation at randomisation. Participants completed pre-, post-, and 6-week post-test measures of the Depression, Anxiety, Stress Scale and an Emotional Self Awareness (ESA) Scale. RESULTS: Of the 163 participants assessed for eligibility, 118 were randomised and 114 participants were included in analyses (intervention group n = 68, comparison group n = 46). Mixed model analyses revealed a significant group by time interaction on ESA with a medium size of effect suggesting that the mobiletype program significantly increases ESA compared to an attention comparison. There was no significant group by time interaction for depression, anxiety, or stress, but a medium to large significant main effect for time for each of these mental health measures. Post-hoc analyses suggested that participation in the RCT lead to enhanced GP mental health care at pre-test and improved mental health outcomes. CONCLUSIONS: Monitoring mental health symptoms appears to increase ESA and implementing a mental health program in primary care and providing frequent reminders, clinical resources, and support to GPs substantially improved mental health outcomes for the sample as a whole. TRIAL REGISTRATION: ClinicalTrials.gov NCT00794222.

Investigating the utility of mobile phones for collecting data about adolescent alcohol use and related mood, stress and coping behaviours: lessons and recommendations.

INTRODUCTION AND AIMS: The trajectory from alcohol use to alcohol use disorders in adolescence is yet to be understood. Momentary sampling may assist in capturing 'real-time' data on young people's alcohol use and associated motivational factors. This paper aims to review the feasibility and usefulness of a mobile phone momentary sampling program to capture data about alcohol use and related behaviours. DESIGN AND METHODS: Two studies were conducted: a school-based study with 18 Year 9 and 11 students and a clinical study with eight high-risk adolescent drinkers. Participants answered questions about their daily activities, alcohol use, stressors and negative mood four times a day for 1 week using a mobile phone momentary sampling program. RESULTS: In the school-based study, 61% of participants reported drinking alcohol. On drinking days participants spent less time studying (14% vs. 26%), more time sleeping or resting (35% vs. 12%) and more time hanging out (21% vs. 11%) than on non-drinking days. In the high-risk sample, 88% of participants reported drinking alcohol. On drinking days, these participants spent a greater proportion of their waking time with their boyfriend or girlfriend (19.2% vs. 6%) and generally had higher negative mood than on non-drinking days. DISCUSSION AND CONCLUSIONS: The current mobiletype program was well suited to capturing data on alcohol use in younger, school-attending adolescents. However, to capture alcohol use in older adolescents who lead less routine lives, it is necessary to make some amendments including targeting particular behaviours and symptoms. Recommendations for future studies are proposed.

A mobile phone program to track young people's experiences of mood, stress and coping. Development and testing of the mobiletype program.

BACKGROUND: Research examining adolescent mood, stresses, and coping has tended to use retrospective questionnaires which are affected by recall biases. The aim of this study was to develop, pilot, and evaluate a youth-friendly mobile phone program to monitor, in real-time, young people's everyday experiences of mood, stress, and their coping behaviours. METHOD AND DESIGN: A momentary sampling program was designed for mobile phones, and ran for 7 days, administering a brief questionnaire four random times each day, capturing information on current activity, mood, responses to negative mood, stresses, alcohol and cannabis use. Eleven high school students reviewed the program in focus groups, and 18 students completed 7 days of monitoring. RESULTS: Engagement with the mobiletype program was high with 76% of 504 possible entries completed and 94% (17/18) of the participants reporting that the program adequately captured their moods, thoughts, and activities. The mobiletype program captured meaningful and analyzable data on the way young people's moods, stresses, coping strategies, and alcohol and cannabis use, vary both between and within individuals. CONCLUSIONS: The mobiletype program captured a range of detailed and interesting qualitative and quantitative data about young people's everyday mood, stresses, responses, and general functioning.

Do acamprosate or naltrexone have an effect on daily drinking by reducing craving for alcohol?

AIM: To explore the effect of acamprosate and naltrexone on craving and alcohol consumption in the treatment of alcohol dependence. DESIGN: A randomized, double-blind, single-dummy, placebo-controlled trial. SETTING: Three treatment centres in Sydney, Australia. PARTICIPANTS: A total of 169 alcohol-dependent subjects were given naltrexone (50 mg/day), acamprosate (1998 mg/day) or placebo for 12 weeks, in conjunction with manualized medication compliance therapy. INTERVENTION: During the course of the trial, participants kept a daily diary which included the number of standard drinks they consumed and their peak craving for alcohol that day rated on a 0-10 scale. MEASUREMENTS: Subjective ratings of daily craving and daily drinking for the first 6 weeks of treatment. FINDINGS: Mixed/hierarchical linear models were employed on an intention-to-treat basis. Analyses revealed that craving was a significant predictor of daily drinking and baseline levels of depression were the best predictor of daily craving. There was no significant improvement in model fit when treatment group was added both in models of daily craving and daily drinking. Daily alcohol consumption was best predicted by a model incorporating baseline dependence and depression scores, and daily craving, entered as a time-varying covariate. However, there was a significant craving x time x treatment interaction (t = -3.365, df = 4413.712, P < 0.001), suggesting that at higher levels of craving drinking was reduced at a significantly greater rate with naltrexone compared to acamprosate. CONCLUSIONS: Naltrexone had a greater effect on drinking when craving was high. These results support the role of naltrexone in reducing craving when that craving is highly salient. The role of acamprosate in reducing craving was not supported by these findings.

Childhood sexual abuse and eating disorders in females: findings from the Victorian Adolescent Health Cohort Study.

OBJECTIVE: To examine the relationship between childhood sexual abuse (CSA) before the age of 16 years and later onset of bulimia and anorexia nervosa symptoms in females. DESIGN: A longitudinal cohort study of adolescents observed from August 1992 to March 2003. The cohort was defined in a 2-stage cluster sample using 44 Australian schools in Victoria. SETTING: Population based. PARTICIPANTS: A total of 1936 persons participated at least once and survived to the age of 24 years, including 999 females. The mean (SD) age of females at the start of follow-up was 14.91 (0.39) years; and at completion, 24.03 (0.55) years. Main Exposure Self-reported CSA before the age of 16 years was ascertained retrospectively at the age of 24 years. OUTCOME MEASURES: Incident Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition)-defined partial syndromes of anorexia and bulimia nervosa were identified between waves 4 (mean age, 16.3 years) and 6 (mean age, 17.4 years) using the Branched Eating Disorder Test. RESULTS: The incidence of bulimic syndrome during adolescence was 2.5 (95% confidence interval, 0.80-8.0) times higher among those who reported 1 episode of CSA and 4.9 (95% confidence interval, 1.9-12.7) times higher among those who reported 2 or more episodes of CSA, compared with females reporting no episodes, adjusted for age and background factors. The association persisted after adjusting for possible confounders or mediators measured 6 months earlier, including psychiatric morbidity and dieting behavior. There was little evidence of an association between CSA and partial syndromes of incident anorexia nervosa. CONCLUSION: Childhood sexual abuse seems to be a risk factor for the development of bulimic syndromes, not necessarily mediated by psychiatric morbidity or severe dieting.

Variation in the gene coding for the M5 muscarinic receptor (CHRM5) influences cigarette dose but is not associated with dependence to drugs of addiction: evidence from a prospective population based cohort study of young adults.

BACKGROUND: The mesolimbic structures of the brain are important in the anticipation and perception of reward. Moreover, many drugs of addiction elicit their response in these structures. The M5 muscarinic receptor (M5R) is expressed in dopamine-containing neurones of the substantia nigra pars compacta and ventral tegmental area, and regulates the release of mesolimbic dopamine. Mice lacking M5R show a substantial reduction in both reward and withdrawal responses to morphine and cocaine. The CHRM5, the gene that codes for the M5R, is a strong biological candidate for a role in human addiction. We screened the coding and core promoter sequences of CHRM5 using denaturing high performance liquid chromatography to identify common polymorphisms. Additional polymorphisms within the coding and core promoter regions that were identified through dbSNP were validated in the test population. We investigated whether these polymorphisms influence substance dependence and dose in a cohort of 1947 young Australians. RESULTS: Analysis was performed on 815 participants of European ancestry who were interviewed at wave 8 of the cohort study and provided DNA. We observed a 26.8% increase in cigarette consumption in carriers of the rs7162140 T-allele, equating to 20.1 cigarettes per week (p=0.01). Carriers of the rs7162140 T-allele were also found to have nearly a 3-fold increased risk of developing cannabis dependence (OR=2.9 (95%CI 1.1-7.4); p=0.03). CONCLUSION: Our data suggest that variation within the CHRM5 locus may play an important role in tobacco and cannabis but not alcohol addiction in European ancestry populations. This is the first study to show an association between CHRM5 and substance use in humans. These data support the further investigation of this gene as a risk factor in substance use and dependence.

Problem alcohol use in young Australian adults.

OBJECTIVE: To examine the extent to which excessive drinking in young adults is associated with alcohol abuse and dependence. METHOD: Cross-sectional analyses were conducted using data from the eighth wave of the Victorian Adolescent Health Cohort Study, which comprised 1943 Victorians currently aged 24-25 years drawn from 44 secondary schools across the state in 1992. The main outcome measures of interest were short-term risk drinking status (based on daily alcohol consumption) and long-term risk drinking status (based on total weekly alcohol consumption). RESULTS: Two out of 5 participants drank at moderate to high risk levels for short-term harm. Yet, because young people tend to drink on only 1-2 days a week, fewer (22%) were at moderate to high risk for long-term harm. Although 20% of the participants met criteria for a diagnosis of alcohol abuse or dependence, most of those in the moderate- to high-risk drinking categories were not diagnosed with either alcohol disorder. CONCLUSION: Excessive alcohol use in one or two sessions a week appears to be common in young Australian adults. While short- and long-term risky drinking is more common in those with an alcohol use disorder, the majority of moderate- and high-risk drinking is done by those who do not meet criteria for an alcohol use disorder.

Trajectories of adolescent alcohol and cannabis use into young adulthood.

BACKGROUND: Both alcohol and cannabis use carry health risks. Both are commonly initiated in adolescence. To date little research has described trajectories of adolescent cannabis or alcohol use or compared their respective consequences in young adulthood. METHODS: The design was a 10-year eight-wave cohort study of a state-wide community sample of 1943 Victorians initially aged 14-15 years. Moderate- and high-risk alcohol use was defined according to total weekly alcohol consumption. Moderate- and high-risk cannabis use were defined as weekly and daily use, respectively. RESULTS: Around 90% of young adults used either alcohol or cannabis. Although an association existed between alcohol and cannabis use, there was a tendency for heavy users to use one substance predominantly at any one time. Weekly or more frequent cannabis use in the absence of moderate-risk alcohol use in teenagers predicted a sevenfold higher rate of daily cannabis use in young adults but only a twofold increase in high-risk alcohol use. Conversely, moderate-risk adolescent alcohol use in the absence of weekly cannabis predicted an approximately threefold increased rate of both high-risk drinking and daily cannabis use in young adulthood. Selective heavy cannabis use in both adolescence and young adulthood was associated with greater illicit substance use and poorer social outcomes in young adulthood than selective alcohol use. CONCLUSIONS: Heavier teenage cannabis users tend to continue selectively with cannabis use. Considering their poor young adult outcomes, regular adolescent cannabis users appear to be on a problematic trajectory.

Naltrexone versus acamprosate in the treatment of alcohol dependence: A multi-centre, randomized, double-blind, placebo-controlled trial.

AIM: To compare the efficacy of acamprosate and naltrexone in the treatment of alcohol dependence. DESIGN: A double-blind, placebo-controlled trial. SETTING: Three treatment centres in Australia. PARTICIPANTS: A total of 169 alcohol dependent subjects were given naltrexone (50 mg/day), acamprosate (1998 mg/day) or placebo for 12 weeks. INTERVENTION: All subjects were offered manualized compliance therapy, a brief intervention that targets problems that may affect treatment compliance such as ambivalence and misperceptions about medication. MEASUREMENTS: Time to the first drink, time to first relapse, drinks per drinking day and cumulative abstinence. FINDINGS: In intention-to-treat analyses, there were no differences between groups on outcome measures of drinking, craving or biochemical markers. Similarly, analyses of the 94 subjects that completed the study in full and demonstrated 80% compliance, revealed no significant treatment effects. Differential treatment effects were identified after stratification according to scores on the Alcohol Dependence Scale (ADS) and Depression Anxiety and Stress Scale (DASS). A significant beneficial treatment effect on time to first relapse was revealed for subjects with 'no depression' allocated to naltrexone (n = 56; P < 0.01). In addition, a significant beneficial treatment effect was revealed in subjects with 'low dependence' allocated to naltrexone (n = 34; P < 0.05). CONCLUSIONS: The results of this study support the efficacy of naltrexone in the relapse prevention of alcoholism amongst those with low levels of clinical depression and alcohol dependence severity. No effect of acamprosate was found in our sample.