Background
Adolescence represents a period of development during which critical biological, as well as social and cognitive, changes occur that are necessary for the transition into adulthood. A ...number of researchers have suggested that the pattern of normative brain changes that occurs during this period not only predisposes adolescents to engage in risk behaviours, such as experimentation with drugs, but that they additionally make the adolescent brain more vulnerable to the direct pharmacological impact of substances of abuse. The neural circuits that we examine in this review involve cortico‐basal‐ganglia/limbic networks implicated in the processing of rewards, emotion regulation, and the control of behaviour, emotion and cognition.
Findings and Conclusions
We identify certain neurocognitive and personality/comorbidity‐based risk factors for the onset of substance misuse during adolescence, and summarise the evidence suggesting that these risk factors may be further impacted by the direct effect of drugs on the underlying neural circuits implicated in substance misuse vulnerability.
Adolescence represents a period of development during which critical biological, as well as social and cognitive, changes occur that are necessary for the transition into adulthood. This pattern of normative brain changes not only predispose adolescents to engage in risk behaviours, such as experimentation with drugs, but also make the adolescent brain more vulnerable to the direct pharmacological impact of substances of abuse. The neural circuits that we examine in this review involve cortico‐basal‐ganglia/limbic networks implicated in the processing of rewards, emotion regulation, and the control of behaviour, emotion and cognition. On the basis of a synthesis of the evidence, we identify neurocognitive and personality/comorbidity‐based risk factors for the onset of substance misuse during adolescence, and summarise the evidence suggesting that these risk factors may be further impacted by the direct effect of drugs on the underlying neural circuits implicated in substance misuse vulnerability. We summarise the types of selective and universal interventions needed to reduce risk in vulnerable individuals and the further research required to develop tailored interventions and better understand how prevention and recovery can be acheived and maintained.
Read the Commentary on this article at doi: 10.1111/jcpp.12532
Impulsivities and addictions Vassileva, Jasmin; Conrod, Patricia J.
Philosophical transactions - Royal Society. Biological sciences,
02/2019, Volume:
374, Issue:
1766
Journal Article
Peer reviewed
Open access
Impulse control is becoming a critical survival skill for the twenty-first century. Impulsivity is implicated in virtually all externalizing behaviours and disorders, and figures prominently in the ...aetiology and long-term sequelae of substance use disorders (SUDs). Despite its robust clinical and predictive validity, the study of impulsivity is complicated by its multidimensional nature, characterized by a variety of trait-like personality dimensions, as well as by more state-dependent neurocognitive dimensions, with variable convergence across measures. This review provides a hierarchical framework for linking self-report and neurocognitive measures to latent constructs of impulsivity and, in turn, to different psychopathology vulnerabilities, including substance-specific addictions and comorbidities. Impulsivity dimensions are presented as novel behavioural targets for prevention and intervention. Novel treatment approaches addressing domains of impulsivity are reviewed and recommendations for future directions in research and clinical interventions for SUDs are offered.
This article is part of the theme issue 'Risk taking and impulsive behaviour: fundamental discoveries, theoretical perspectives and clinical implications'.
Purpose of Review
Personality factors have been implicated in risk for substance use disorders through longitudinal and neurobiologic studies for over four decades. Only recently, however, have ...targeted interventions been developed to assist individuals with personality risk factors for substance use disorders manage their risk. This article reviews current practices in personality-targeted interventions and the eight randomised trials examining the efficacy of such approaches with respect to reducing and preventing substance use and misuse.
Recent Findings
Results indicate a moderate mean effect size for personality-targeted approaches across several different substance use outcomes and intervention settings and formats.
Conclusions
Personality-targeted interventions offer several advantages over traditional substance use interventions, particularly when attempting to prevent development of problems in high-risk individuals or when addressing concurrent mental health problems in brief interventions.
Several school-based prevention programmes have been developed and used to prevent, delay, or reduce substance misuse, and related problems among community samples of adolescents. However, findings ...indicate that many of these interventions are associated with null, small, or mixed effects in reducing adolescent substance misuse, in particular for those mostly at risk of transitioning to substance use disorders. These findings highlight the need to shift the focus of substance use prevention efforts toward intervention strategies which directly target high-risk adolescents. The Preventure programme was designed to target four personality risk factors for substance misuse: hopelessness, anxiety sensitivity, impulsivity, and sensation seeking. This article reviews findings from the previous trials of personality-targeted interventions (i.e., Preventure programme) with adolescents and discuss the promises and benefits of these interventions for targeting community samples of high-risk adolescents at school level for reducing substance misuse and related mental health problems. Findings indicated that this programme has been successful in reducing the rates of alcohol and illicit drug use and substance-related harms by ~50% in high-risk adolescents with the effects last for up to 3 years. These interventions were also associated with a 25% reduction in likelihood of transitioning to mental health problems, such as anxiety, depression, suicidal ideation, and conduct problems. The programme is particularly beneficial for youth with more significant risk profiles, such as youth reporting clinically significant levels of externalizing problems, and victimized adolescents. A key strength of the Preventure programme is that it is embedded in the community and provides substance use intervention at school level to the general samples of high-risk adolescents who might not otherwise have access to those programmes.
Background: Personality factors are implicated in the vulnerability to adolescent alcohol misuse. This study examined whether providing personality‐targeted interventions in early adolescence can ...delay drinking and binge drinking in high‐risk youth.
Methods: A randomised control trial was carried out with 368 adolescents recruited from years 9 and 10 (median age 14) with personality risk factors for substance misuse. Participants received either a personality‐targeted intervention or no intervention. Outcome data were collected on alcohol use through self‐reports at 6 and 12‐month post intervention and analyses were conducted on the full intent to treat sample.
Results: Multi‐group analysis of a latent growth curve model showed a group difference in the growth of alcohol use between baseline and 6‐months follow‐up, with the control group showing a greater increase in drinking than the intervention group for this period. Interventions were particularly effective in preventing the growth of binge drinking in those students with a sensation seeking (SS) personality. SS drinkers in the intervention group were 45% and 50% less likely to binge drink at 6 (OR = .45) and 12 months (OR = .50) respectively, than SS drinkers in the control group, p = .001, phi = .49, Number Needed to Treat = 2.0.
Conclusions: Considering the robust, inverse relationship between age of onset of alcohol use and later alcohol dependence, this intervention strategy may prove effective in preventing the onset of adult alcohol use disorders, by helping high‐risk youth delay the growth of their drinking to a later developmental stage.
Abstract The Substance Use Risk Profile Scale (SURPS) is based on a model of personality risk for substance abuse in which four personality dimensions (hopelessness, anxiety sensitivity, impulsivity, ...and sensation seeking) are hypothesized to differentially relate to specific patterns of substance use. The current series of studies is a preliminary exploration of the psychometric properties of the SURPS in two populations (undergraduate and high school students). In study 1, an analysis of the internal structure of two versions of the SURPS shows that the abbreviated version best reflects the 4-factor structure. Concurrent, discriminant, and incremental validity of the SURPS is supported by convergent/divergent relationships between the SURPS subscales and other theoretically relevant personality and drug use criterion measures. In Study 2, the factorial structure of the SURPS is confirmed and evidence is provided for its test–retest reliability and validity with respect to measuring personality vulnerability to reinforcement-specific substance use patterns. In Study 3, the SURPS was administered in a more youthful population to test its sensitivity in identifying younger problematic drinkers. The results from the current series of studies demonstrate support for the reliability and construct validity of the SURPS, and suggest that four personality dimensions may be linked to substance-related behavior through different reinforcement processes. This brief assessment tool may have important implications for clinicians and future research.
Selective school-based alcohol prevention programs targeting youth with personality risk factors for addiction and mental health problems have been found to reduce substance use and misuse in those ...with elevated personality profiles.
To report 24-month outcomes of the Teacher-Delivered Personality-Targeted Interventions for Substance Misuse Trial (Adventure trial) in which school staff were trained to provide interventions to students with 1 of 4 high-risk (HR) profiles: anxiety sensitivity, hopelessness, impulsivity, and sensation seeking and to examine the indirect herd effects of this program on the broader low-risk (LR) population of students who were not selected for intervention.
Cluster randomized controlled trial.
Secondary schools in London, United Kingdom.
A total of 1210 HR and 1433 LR students in the ninth grade (mean SD age, 13.7 0.33 years).
Schools were randomized to provide brief personality-targeted interventions to HR youth or treatment as usual (statutory drug education in class).
Participants were assessed for drinking, binge drinking, and problem drinking before randomization and at 6-monthly intervals for 2 years.
Two-part latent growth models indicated long-term effects of the intervention on drinking rates (β = -0.320, SE = 0.145, P = .03) and binge drinking rates (β = -0.400, SE = 0.179, P = .03) and growth in binge drinking (β = -0.716, SE = 0.274, P = .009) and problem drinking (β = -0.452, SE = 0.193, P = .02) for HR youth. The HR youth were also found to benefit from the interventions during the 24-month follow-up on drinking quantity (β = -0.098, SE = 0.047, P = .04), growth in drinking quantity (β = -0.176, SE = 0.073, P = .02), and growth in binge drinking frequency (β = -0.183, SE = 0.092, P = .047). Some herd effects in LR youth were observed, specifically on drinking rates (β = -0.259, SE = 0.132, P = .049) and growth of binge drinking (β = -0.244, SE = 0.073, P = .001), during the 24-month follow-up.
Findings further support the personality-targeted approach to alcohol prevention and its effectiveness when provided by trained school staff. Particularly novel are the findings of some mild herd effects that result from this selective prevention program.
clinicaltrials.gov Identifier: NCT00776685.
Major neurocognitive changes occur during adolescence, making this phase one of the most critical developmental periods of life. Furthermore, this phase in life is also the time in which youth ...substance use begins. Several studies have demonstrated the differential associations of alcohol and cannabis use concerning the neurocognitive functioning of both males and females. Past and contemporary literature on gender-specific effects in neuroscience of addiction is predominantly based on cross-sectional datasets and data that is limited in terms of measurement variability. Given the importance of gender-specific effects in addiction studies, and in order to address the two above-mentioned gaps in the literature, the present study aimed to compare neurocognitive functioning of male and female adolescents in the context of cannabis and alcohol use, while employing a longitudinal design with multiple repeated measurements. Participants were 3,826 high school students (47% female; mean age, 12.7), who were recruited from 31 high schools in the greater Montreal area. Participants were requested to complete annual surveys for five consecutive years, from 7th to 11th grade, assessing their alcohol/cannabis use and neurocognitive functioning (working memory, delayed recall memory, perceptual reasoning, and inhibition control). The analytical strategy focused on the longitudinal association between each predictor (female, male) and each of the outcomes (domains of neurocognitive functioning). Multilevel linear models assessed the association of alcohol and cannabis consumption and the four domains of neurocognitive functioning. Results revealed a gender by within-subject interaction, suggesting a weaker effect of yearly fluctuation of cannabis use on working memory among males compared to females. Our findings suggest a different pattern of neurocognitive impairment of female and male working memory after using cannabis over the course of adolescence. Early initiation of cannabis use potentially results in more spatial working memory deficits in female adolescents. This may negatively influence young females' capacity in academic settings and lead to significant impairment in adulthood, which critically decreases the individual's quality of life.
Bullying victimization is common in adolescence and has been associated with a broad variety of psychopathology and alcohol use. The present study assessed time-varying associations between bullying ...victimization and alcohol use through internalizing and externalizing symptoms and whether this indirect association throughout time is moderated by personality. This 5-year longitudinal study (3,800 grade 7 adolescents) used Bayesian multilevel moderated mediation models: independent variable was bullying victimization; moderators were four personality dimensions (anxiety sensitivity, hopelessness, impulsivity, and sensation seeking); internalizing symptoms (anxiety, depressive symptoms) and externalizing symptoms (conduct, hyperactivity problems) were the mediators; and alcohol use, the outcome. Results indicated significant between, within, and lagged effects on alcohol use through internalizing and externalizing symptoms. There were significant between and within effects on alcohol use through internalizing symptoms for adolescents with high anxiety sensitivity and hopelessness, and significant between, within, and lagged effects on alcohol use through externalizing symptoms for adolescents with high impulsivity and sensation seeking. These findings implicate two risk pathways that account for how bullying victimization enhances alcohol use risk and emphasize the importance of personality profiles that can shape the immediate and long-term consequences of victimization.
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