Nikola Zaharakis

Text Messaging Interventions for Adolescent and Young Adult Substance Use: a Meta-Analysis

Tobacco and alcohol use continues to be associated with negative health outcomes among adolescents and young adults. New technologies such as text messaging can increase access to substance use interventions and have now been established as an evidence-based, recommended approach towards substance use prevention. This review presents results from a meta-analysis examining the effectiveness of text message interventions for tobacco and alcohol cessation within adolescent and young adult populations. Results from 14 studies with effect sizes are ranging from −0.25 to 0.54. Combining the effect sizes across studies yielded a summary effect size of 0.25, indicating that in general, text interventions have a positive effect on reducing substance use behaviors. Results are discussed in the context of prevention opportunities and recommendations for future text messaging intervention research.

Peer Attitudes Effects on Adolescent Substance Use: The Moderating Role of Race and Gender

We examined the relationship between adolescents’ perceptions of their close friends’ attitudes about substance use, and their own use of cigarettes, alcohol, and marijuana. Using data from the 2010 National Survey on Drug Use and Health, a multistage area probability sample sponsored by the Substance Abuse and Mental Health Services Administration (n = 17,865), we tested the direct and moderating effects of subgroups of race and gender on perceptions of adolescents’ close friends on past month substance use. Significant effects were found on peer attitudes influencing substance use for all race and gender subgroups. Close friends’ attitudes of indifference were associated with increased substance use and disapproval associated with reduced use, controlling for age, income, family structure, and adolescents’ own attitudes of risk of substance use. Significant moderating effects of peer attitudes on cigarette and marijuana use were found for both gender and race moderators. Conditional effects of the moderation by race were also examined for gender subgroups. The moderating effect of race on close friends’ attitudes impacting cigarette and marijuana use was stronger in magnitude and significance for females compared to males. Female marijuana and cigarette use was more influenced by close friends’ attitudes than males, and whites were more influenced by their close friends than Hispanics and blacks. White females are more susceptible to close friends’ attitudes on cigarette use as compared to white males and youth of other races. Implications for socially oriented preventive interventions are discussed.

Covariates of Craving in Actively Drinking Alcoholics

The goal of this cross-sectional study was to assess the relationship of alcohol craving with biopsychosocial and addiction factors that are clinically pertinent to alcoholism treatment. Alcohol craving was assessed in 315 treatment-seeking, alcohol dependent subjects using the Penn Alcohol Craving Scale questionnaire. Standard validated questionnaires were used to evaluate a variety of biological, addiction, psychological, psychiatric, and social factors. Individual covariates of craving included age, race, problematic consequences of drinking, heavy drinking, motivation for change, mood disturbance, sleep problems, and social supports. In a multivariate analysis (R(2)= .34), alcohol craving was positively associated with mood disturbance, heavy drinking, readiness for change, and negatively associated with age. The results from this study suggest that alcohol craving is a complex phenomenon influenced by multiple factors.

Social Networks, Substance Use, and Mental Health in College Students

Abstract Objectives: The relationship between social network risk (alcohol-using close friends), perceived peer closeness, substance use, and psychiatric symptoms was examined to identify risk and protective features of college students’ social context. Participants: Six hundred and seventy undergraduate students enrolled in a large southeastern university. Methods: An online survey was administered to consenting students. Results: Students with risky networks were at a 10-fold increase of hazardous drinking, 6-fold increase for weekly marijuana use, and 3-fold increase for weekly tobacco use. College students’ who feel very close to their peers were protected against psychiatric symptoms yet were at increased risk for marijuana use. Perceived closeness of peers was highly protective against psychiatric symptoms, adding a natural preventive effect for a population at great risk for mental illness. Conclusions: Results support targeting college students through network-oriented preventive interventions to address substance use as well as mental health.

Time-varying effects of a text-based smoking cessation intervention for urban adolescents

INTRODUCTION Craving to smoke is understood as an important mechanism for continued smoking behavior. Identifying how smoking interventions operate on craving with particular populations is critical for advancing intervention science. This studys objective was to investigate the time-varying effect of a text-delivered smoking cessation intervention. METHODS Toward this end, we used ecological momentary assessment (EMA) data collected from a five-day, automated text-messaging smoking cessation randomized clinical trial with 200 urban adolescents. We employed a time-varying effect model (TVEM) to estimate the effects of stress (time-varying covariate) and baseline nicotine dependence level (time-invariant covariate) on craving over six months by treatment condition. The TVEM approach models behavioral change and associations of coefficients expressed dynamically and graphically represented as smooth functions of time. RESULTS Controlling for gender, age, and current smoking, differences in trajectories of craving between intervention and control conditions were apparent over the course of the study. During months 2 to 3, the association between stress and craving was significantly stronger among the control group, suggesting treatment dampens this association during this time period. The intervention also reduced the salience of baseline dependence among treatment adolescents, with craving being reduced steadily over time, while the control group increased craving over time. CONCLUSIONS These results provide insight into the time-varying nature of treatment effects for adolescents receiving a text-based smoking cessation intervention. The ability to specify when in the course of an intervention the effect is strongest is important in developing targeted and adaptive interventions that can adjust strategically with time.

The role of tobacco outlet density in a smoking cessation intervention for urban youth.

This study investigates the role of tobacco outlet density in a randomized controlled trial of a text messaging-based smoking cessation intervention conducted among a sample of 187 primarily African American youth in a midsize U.S. city. A moderated mediation model was used to test whether the indirect effect of residential tobacco outlet density on future smoking was mediated by the intention to smoke, and whether this indirect effect differed between adolescents who received the intervention and those who did not. Results indicated that tobacco outlet density is associated with intention to smoke, which predicts future smoking, and that the indirect effect of tobacco outlet density on future smoking is moderated by the intervention. Tobacco outlet density and the intervention can be viewed as competing forces on future smoking behavior, where higher tobacco outlet density acts to mitigate the sensitivity of an adolescent to the interventions intended effect. Smoking cessation interventions applied to youth should consider tobacco outlet density as a contextual condition that can influence treatment outcomes.

Psychiatric Comorbidity and Complications.

This article highlights the prevalence of co-occurring disorders among adolescents and underscores the complexity and opportunities of treating these patients in a systematic, comprehensive approach. As evidenced by this review, the need exists to develop and test models of care that integrate co-occurring disorders into both psychiatric and substance abuse treatment settings. The challenge for pediatric practitioners is to provide detailed assessments linked to evidence-based treatment plans to account for the variations in adolescent development and the unique risk factor profile of each patient. The issues related to co-morbidity are vast and continue to grow with rapidly increasing research literature.

Levels of teen dating violence and substance use in an urban emergency department

Objective: Teen dating violence (TDV) is associated with multiple sequelae including substance use. The objective of this study was to determine the prevalence and association between levels of dating violence and substance use among urban adolescents presenting at a pediatric emergency department (ED). Methods: As part of standard practice, 282 adolescents were screened for relationship status, producing 135 dating violence screens. Scales from the Revised Conflict Tactics Scale and the Youth Risk Behavior Survey were used to capture variables of interest. Logistic regression was performed to test the influence of levels of dating violence on substance use, while controlling for gender, race, age, sexual orientation, and psychiatric symptoms. Results: Over one-quarter of those teens (27.3%) within a current relationship reported experiencing any dating violence, 26.1% experienced psychological violence, and 11.9% experienced physical violence. Teens experiencing psychological violence were at twice the risk for any substance use (alcohol, marijuana, and tobacco use) and specifically for alcohol and marijuana, whereas no increased risk was found for teens experiencing physical violence. Conclusions: This study contributes to the understanding of TDV within the context of high-risk, urban adolescents presenting at a pediatric ED. Identifying levels of TDV and understanding the association with substance use can provide an important foundation for prevention and early intervention for urban youth.

A pilot trial of text-delivered peer network counseling to treat young adults with cannabis use disorder

Approximately 1.8 million young adults aged 18 to 25 had a Cannabis Use Disorder (CUD) in the past year. Unfortunately, engaging young adults in treatment is very challenging. Creative approaches to treat cannabis disorders such as integrating mobile technology with evidence-based treatments are warranted. In light of these challenges, we developed a text message-delivered version of Peer Network Counseling (PNC-txt), which is a substance use intervention that focuses on peer relations. PNC-txt engages participants in 16 automated, personalized text interactions over 4weeks. We conducted a randomized controlled trial to test the efficacy of PNC-txt against a waitlist control group with 30 treatment seeking young adults (ages 18-25) who met DSM-5 criteria for CUD. Self-report and urine analyses were used to test outcomes at the three-month follow-up. The PNC-txt group significantly reduced their cannabis use related problems as well as cannabis cravings, compared to the control group. PNC-txt participants also had a significantly greater percentage with urines negative for cannabis metabolites compared to controls. Moderation analysis showed that CUD severity level moderated treatment, suggesting that PNC-txt is more effective for participants with medium and high levels of CUD severity. All effect sizes ranged from medium to large. Results from this pilot trial are promising and warrant further research on PNC-txt for addressing cannabis use disorder.

Depression Moderates the Relationship Between Pain and the Nonmedical Use of Opioid Medication Among Adult Outpatients.

Background:The nonmedical use of prescription medication among US adults is a growing public health problem. Healthcare providers should proactively address this problem in outpatient encounters. Objective:We sought to understand the interactive effects among prescription drugs, pain, and psychiatric symptoms among adult outpatients to build an empirical foundation for comprehensive screening. Methods:We screened 625 adult neurosurgery and orthopedic patients at a suburban satellite clinic of an urban academic medical center. A convenience sample was screened for psychiatric and substance use disorder symptoms using the American Psychiatric Associations recommended screening protocol. We tested whether psychiatric symptoms moderated the relationship between pain level and nonmedical use of prescription medicine. Results:Patients reported average levels of depression, anxiety, and pain symptoms, within 1 standard deviation of the screeners’ normative data. However, patients reported highly elevated levels of nonmedical use of opioids and benzodiazapines compared with national data. Controlling for age, sex, and race, pain level predicted nonprescription use of opioid and benzodiazapine medications. Patients with high levels of depression and pain were more likely to engage in the unprescribed use of opioids. Likewise, patients with reduced levels of depression and pain were protected against the unprescribed use of opioids. Conclusions:These findings highlight the importance of examining unprescribed medication use even with patients at moderate levels of psychiatric symptoms and pain.