James W. McKowen

Maternal Depression, Maternal Expressed Emotion, and Youth Psychopathology

Across development, maternal depression has been found to be a risk factor for youth psychopathology generally and youth depression specifically. Maternal Expressed Emotion (EE) has been examined as a predictor of outcome among youth with depression. The present study explored the associations between youth psychopathology and two predictors–maternal depression within the child’s lifetime and maternal EE–in a study of children at risk for depression. One hundred and seventy-one youth, ages 8–12, and their mothers participated. To assess maternal and youth psychopathology, dyads were administered structured diagnostic assessments, and mothers and children completed self-report measures of their own depressive symptoms. In addition, mothers completed the Achenbach Child Behavior Checklist–Parent Report Version (CBCL) for their children. Maternal EE was assessed based on the Five Minute Speech Sample. History of maternal depression was associated with high maternal EE, and the combination of maternal depression history and maternal EE was associated with children’s own reports of higher depressive symptoms. Current maternal depressive symptoms were associated with mothers’ reports of children’s Internalizing scores on the CBCL, and maternal depression history, current maternal depressive symptoms, and maternal EE were strongly associated with mothers’ reports of children’s Externalizing and Total Problem scores on the CBCL. History of maternal depression and a rating of high or borderline Critical EE (characterized by maternal critical comments and/or reports of a negative relationship) were independently associated with children’s depression diagnoses.

Longitudinal Associations Between Depression and Problematic Substance Use in the Youth Partners in Care Study

Large-scale treatment studies suggest that effective depression treatment and reduced depression are associated with improved substance use outcomes. Yet information is limited regarding the longitudinal association between depressive symptoms and problematic substance use and its predictors, particularly in real-world practice settings. Using latent growth modeling, we examined the (a) longitudinal association between depressive symptoms and problematic substance use, (b) impact of depressive symptoms on problematic substance use, (c) impact of problematic substance use on depressive symptoms, and (d) role of co-occurring symptoms on depression and problematic substance use. Participants were part of the Youth Partners in Care study, an effectiveness trial evaluating a quality improvement intervention for youth depression through primary care. This ethnically diverse sample included youths aged 13 to 21 years screening positive for depression from 5 health care organizations. Participants were followed 4 times over an 18-month period and assessed for both depressive symptoms and problematic substance use. Both depressive symptoms and problematic substance use declined over time. Higher baseline depressive symptoms predicted a slower decline in problematic substance use, but baseline problematic substance use did not predict changes in depressive symptoms. These prospective associations remained robust controlling for co-occurring symptoms. Results support prior large-scale depression studies indicating depression burden negatively impacts substance use outcome and extends these findings to real-world practice settings. Findings underscore the importance of addressing depression severity in youth with concurrent substance use problems, even in the context of comorbid symptoms of anxiety, delinquency, and aggression.

Brief Report: Autism Spectrum Disorder and Substance Use Disorder: A Review and Case Study

There is limited literature available on the comorbidity between autism spectrum disorder (ASD) and substance use disorder (SUD). This paper reviews existing literature and exemplifies the challenges of treating this population with a case report of an adult male with ASD and DSM-5 alcohol use disorder. This review and case study seeks to illustrate risk factors which predispose individuals with ASD to developing SUD and discuss the obstacles to and modifications of evidence-based treatments for SUD. A review of the therapeutic interventions implemented in the treatment of this young male are described to highlight potential recommendations for the general management of SUD in those with ASD.

Sex and bipolar subtype association with self-reported hazardous alcohol consumption in bipolar depression

ABSTRACT Despite the high rate of co-morbid alcoholism in bipolar disorder, the relationship between mood state, sex, and alcohol consumption patterns has not been well studied. An anonymous Internet survey was conducted from August 2002 to September 2005. The survey asked participants with bipolar disorder to self-report alcohol “quantity” consumed when euthymic, manic, or depressed. Of 366 persons with bipolar disorder, significantly more males (38%) than females (23%) and bipolar II (31%) than bipolar I (16%) respondents self-reported consuming a hazardous amount of alcohol during depression. These preliminary findings suggest that hazardous drinking in bipolar depression is more common in men and in patients with bipolar II disorder. Further study is encouraged to assess whether this alcohol intake increase is a possible attempt at self-medication of mood symptoms or an independent co-morbid factor related to alcoholism.

Risk Factors for Overdose in Treatment-Seeking Youth With Substance Use Disorders

OBJECTIVEnOverdoses (ODs) are among the leading causes of death in youth with substance use disorders (SUDs). Our aim was to identify the prevalence of OD and characteristics associated with a history of OD in youth presenting for SUD outpatient care.nnnMETHODSnA systematic retrospective medical record review was conducted of consecutive psychiatric and SUD evaluations for patients aged 16 to 26 years with DSM-IV-TR criteria SUD at entry into an outpatient SUD treatment program for youth between January 2012 and June 2013. Unintentional OD was defined as substance use without intention of self-harm that was associated with a significant impairment in level of consciousness. Intentional OD was defined as ingestion of a substance that was reported as a suicide attempt. T tests, Pearson χ² tests, and Fisher exact tests were performed to evaluate characteristics associated with a history of OD.nnnRESULTSnWe examined the medical records of 200 patients (157 males and 43 females) with a mean ± SD age of 20.2 ± 2.8 years. At intake, 58 patients (29%) had a history of OD, and 62% of those patients had a history of unintentional OD only (n = 36). Youth with ≥ 2 SUDs were 3 times more likely to have a history of OD compared to youth with 1 SUD (all P < .05). Compared to those without a history of OD, those with an OD were more likely to be female and have lifetime histories of alcohol, cocaine, amphetamine, anxiety, depressive, and/or eating disorders (all P < .05).nnnCONCLUSIONSnHigh rates of OD exist in treatment-seeking youth with SUD. OD was associated with more SUDs and psychiatric comorbidity.

Factors associated with attrition in substance using patients enrolled in an intensive outpatient program

BACKGROUND AND OBJECTIVESnData suggest individuals with substance use disorders (SUD) have high rates of attrition from treatment and exhibit impairments on measures of executive functioning (EF). The primary aim of this pilot study was to investigate if EF is associated with attrition from a 1 month intensive outpatient program (IOP) for SUD, and examine the feasibility of implementing the project.nnnMETHODSnBaseline neurocognitive functioning was assessed by the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the self-reported Behavior Rating Inventory of Executive Functioning (BRIEF-A) questionnaire.nnnRESULTSnThirty subjects enrolled in the pilot study: including 20 completers (age 39.5u2009±u200913.1 years) and 10 drop-outs who discontinued the IOP prior to completion (age 32u2009±u200911.1 years). IOP drop-out was associated with earlier age of substance use onset (all p-values <0.05) and male gender, as well as greater SUD, opiate use, and past week substance use. Overall a high level of executive dysfunction was found on the BRIEF-A and CANTAB assessments, and specific differences emerged between completers and drop outs. However, no statistically significant differences were found between these groups on measures of depression, anxiety, or ADHD.nnnCONCLUSIONS AND SCIENTIFIC SIGNIFICANCEnOverall, findings from this pilot study suggest high levels of self-reported executive dysfunction, but EFs predictive association with drop-out was limited. Measures of addiction severity were more strongly associated with attrition, suggesting potential utility of brief motivational interventions prior to commencing an IOP may improve retention. Further investigations with larger and more diverse samples are warranted. (Am J Addict 2017;26:780-787).