Julian Santaella

Nonmedical Prescription Opioid Use in Childhood and Early Adolescence Predicts Transitions to Heroin Use in Young Adulthood: A National Study

OBJECTIVES To examine the relationship between nonmedical use of prescription opioids and heroin initiation from childhood to young adulthood, and to test whether certain ages, racial/ethnic, and income groups were at higher risk for this transition. STUDY DESIGN Among a nationally representative sample of US adolescents assessed in the 2004-2011 National Surveys on Drug Use and Health cross-sectional surveys (n = 223,534 respondents aged 12-21 years), discrete-time hazard models were used to estimate the age-specific hazards of heroin initiation associated with prior history of nonmedical use of prescription opioids. Interactions were estimated between prior history of nonmedical use of prescription opioids and age of nonmedical use of prescription opioid initiation, race/ethnicity, and income. RESULTS A prior history of nonmedical use of prescription opioids was strongly associated with heroin initiation (hazard ratio 13.12, 95% CI 10.73, 16.04). Those initiating nonmedical use of prescription opioids at ages 10-12 years had the highest risk of transitioning to heroin use; the association did not vary by race/ethnicity or income group. CONCLUSIONS Prior use of nonmedical use of prescription opioids is a strong predictor of heroin use onset in adolescence and young adulthood, regardless of the users race/ethnicity or income group. Primary prevention of nonmedical use of prescription opioids in late childhood may prevent the onset of more severe types of drug use such as heroin at later ages. Moreover, because the peak period of heroin initiation occurs at ages 17-18 years, secondary efforts to prevent heroin use may be most effective if they focus on young adolescents who already initiated nonmedical use of prescription opioids.

Childhood maltreatment, stressful life events, and alcohol craving in adult drinkers

BACKGROUND Little is known about the relationship between stressful life events and alcohol craving in the general population, and whether a history of childhood maltreatment sensitizes individuals to crave alcohol after adult stressors. METHODS Participants were 22,147 past-year drinkers from Wave 2 (2004 to 2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. A structured, face-to-face interview assessed past-year stressful life events, alcohol craving, and history of childhood maltreatment. Logistic regression was used to generate adjusted odds ratios (aOR) to evaluate the relationship between stressful life events and craving, adjusting for demographic characteristics and parental history of alcoholism. Interaction between stressful life events and childhood maltreatment was also assessed. RESULTS Compared to participants with no stressful life events, those with ≥ 3 events had increased odds of moderate alcohol craving (aOR = 3.15 [95% CI = 2.30 to 4.33]) and severe craving (aOR = 8.47 [95% CI = 4.78 to 15.01]). Stressful life events and childhood maltreatment interacted in predicting severe craving (p = 0.017); those with ≥ 3 events were at higher risk of craving if they had been exposed to childhood maltreatment. CONCLUSIONS A direct relationship between stressful life events and risk of alcohol craving was observed. Further, history of childhood maltreatment increased the salience of stressful life events in adulthood. Future studies should examine the role of psychiatric comorbidity in more complex models of stress sensitization and alcohol craving.

Age of first arrest varies by gambling status in a cohort of young adults

BACKGROUND AND OBJECTIVES To describe the association between social and problem gambling and first criminal arrest by age 23 in a cohort of urban, mainly African-American youth. METHODS Data for this study were derived from several annual interviews being completed on a community sample of 617 participants during late adolescence until age 23. Information on gambling status, engagement in deviant behaviors, illegal drug use, and arrest history were collected through yearly interviews. Analysis was carried out using Nelson-Aalen cumulative hazard models and simple and adjusted Cox proportional hazards models. RESULTS More problem gamblers had been arrested before age 23 than social gamblers and non-gamblers, ie, 65% of problem gamblers were arrested before age 23, compared to 38% of social gamblers and 24% non-gamblers. Social gambling was only significantly associated with the hazard of first arrest by age 23 in the unadjusted model (HR: 1.6, p < .001), but not after adjustment for covariates (HR: 1.1, p = .47). Problem gambling was significantly associated with the hazard of first arrest by age 23 years in the unadjusted (HR: 3.6, p < .001) and adjusted models (HR: 1.6, p = .05). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Problem gambling was significantly associated with earlier age of being arrested. Dilution effects after adjustment for several deviant behaviors and illegal drug use by age 17 suggest that youth exposure to certain common factors may result in engagement in multiple risky behaviors, including problem gambling. Studies are needed to investigate the developmental pathways that lead to these combined behaviors among youth. (Am J Addict 2014;23:386-392).