- Email: [email protected]
Adult ADHD subtypes, autistic traits, and substance use
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Abstracts / Drug and Alcohol Dependence 140 (2014) e2–e85
p = 0.000) and ACH and CM+ (6.39 vs 12.19 weeks p = 0.000), and differences in days housed between DT+ and ACH (35.10 vs 23.35 days p = 0.005) and ACH and CM+ (23.35 vs 32.40 days p = 0.017). Conclusions: Differences in abstinence suggests improved treatment effectiveness over subsequent trials. That both DT+ and CM+ had better homelessness outcomes than ACH suggests the abstinence contingent work therapy, incorporated in DT+ and CM+, but not a component of ACH, was more effective for sustaining housing. Financial support: Partially supported by NIDA grant R01 DA11789-04, RTI International and UAB. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.140 Development and evaluation of the marijuana reduction strategies self-efficacy scale Alan K. Davis, J. Leith, L.A. Osborn, H. Rosenberg, E. Bannon, S. Jesse, L. Ashrafioun, A. Hawley, S. Kraus, E. Kryszak, N. Cross, K. Lauritsen Psychology, BGSU, Bowling Green, OH, United States Aims: Develop and evaluate key psychometric properties of a self-report questionnaire designed to assess young regular marijuana users’ self-efficacy to employ 21 different strategies intended to reduce the amount, frequency and/or speed with which they consume marijuana. Methods: Following approval of the project by our institutional review board, we sent an email during the spring semester, 2012, to a random sample of 8000 undergraduate students enrolled at a large public Midwestern university asking them to consider participating in an online survey asking about their use of marijuana. 273 regular marijuana users rated their confidence that they could employ each of the strategies. Additionally, they completed measures assessing their problems with marijuana and other substances, refusal self-efficacy, marijuana use history, and motives for using marijuana. Results: Based on principal components analysis, internal consistency reliability, and mean inter-item correlation, we retained all 21 items in a single scale. This evaluation supported several elements of convergent and criterion validity; specifically, self-efficacy to reduce marijuana use scores were significantly positively correlated with refusal self-efficacy, and significantly negatively correlated with quantity and frequency of marijuana use, marijuana-related problems, and several motives for using marijuana. Conclusions: This relatively short and easily-administered questionnaire could be used to identify marijuana users who have low self-efficacy to employ specific marijuana reduction strategies and as an outcome measure to evaluate educational and skilltraining interventions designed to increase one’s confidence that they could employ protective behavioral strategies to reduce their use of marijuana. Financial support: There was minimal (less than $200) financial support provided by the psychology department at BGSU. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.141
Pyrolysis studies of synthetic cannabinoids in herbal products R.C. Daw, M. Grabenauer, Poonam G. Pande, A.O. Cox, A.L. Kovach, K.H. Davis, J.L. Wiley, P.R. Stout, B.F. Thomas Analytical Chemistry and Pharmaceutics, RTI International, RTP, NC, United States Aims: To determine the chemical fate and biological exposures that occur during the smoking of synthetic cannabinoids in herbal formulations through the characterization of the chemical composition and delivery (yields) of mainstream smoke constituents. Methods: Herbal cigarettes laced with synthetic cannabinoids such as JWH-018, JWH-250 and AM-2201 were prepared and smoked using a Borgwaldt KC smoking machine. The smoke condensate was collected, dissolved in solvent and analyzed using a Waters Synapt 2 Q-TOF-MS and an Agilent 7001B triple quad GC/MS. Samples were analyzed against standard material and blank cigarette smoke to confirm identity and determine recovery. Mass defect filtering and precursor ion searching allowed us to identify likely pyrolysis products in the chromatograms. We identified a number of active pyrolytic products in the smoke of hand-rolled synthetic cannabinoid cigarettes by LC/MS. GC/MS was used to confirm the identity of the parent and pyrolysis compounds found. Results: Precursor ion searching based on the 127 ion of AM-2201 smoke indicated that at least 5 pyrolysis degradation products, including JWH-018, JWH-022 and three other compounds had been formed. Precursor ion search of JWH-018 smoke showed JWH-022 as a degradation product (loss of 2 hydrogens). JWH-167 was also formed during the pyrolysis of JWH-250 (loss of methoxy group). Conclusions: Synthetic cannabinoids degrade to other products when smoked. These pyrolysis products can be components that have an altered affinity to the CB1 and CB2 receptor, or entities of unknown pharmacology and toxicology. Financial support: This work was funded by RTI International as an internal research and development project. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.142 Adult ADHD subtypes, autistic traits, and substance use Duneesha De Alwis, A. Todorov, Arpana Agrawal, A. Reiersen Psychiatry, Washington University School of Medicine, St. Louis, MO, United States Aims: Individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) are more likely to report substance use but few studies have investigated this relationship within ADHD subtypes. ADHD symptoms and Autism Spectrum Disorder (ASD) traits tend to coaggregate, but the combined effect of ADHD and ASD traits on substance use is not understood. This study examines the occurrence of substance use in ADHD subtypes and the relationship between ADHD, ASD, and substance use. Methods: Subjects were 3273 young adults between the ages of 18–39 years with available parent-report data from a populationbased study of Missouri large sib-ship families. They were classified as inattentive (ADHD-I), hyperactive-impulsive (ADHD-HI), combined (ADHD-C) or unaffected based on application of the DSM-IV ADHD symptom criterion to parent-report SWAN (Strengths and Weaknesses of ADHD-symptoms and Normal behavior) questionnaire responses. Substance use (tobacco, alcohol, and drugs) and ASD trait data were derived from the ABCL (Adult Behavior Check-
Abstracts / Drug and Alcohol Dependence 140 (2014) e2–e85
list) and SRS (Social Responsiveness Scale). Group differences in mean T-scores were assessed using clustered linear regression and appropriate post-hoc tests. SRS score of 65 or higher was defined as above- threshold ASD traits. Results: Adults with ADHD used substances more frequently compared to controls, and the ADHD-C subgroup showed significantly higher use than other sub-types (i.e., mean T-scores for the frequency of tobacco use statistically differed across ADHD groups as follows: ADHD-I = 53.87, ADHD-HI = 55.14, ADHD-C = 58.87, Controls = 51.47). In subjects with ADHD, high ASD traits further increased risk for frequent substance use. For instance, excessive drinking was reported in 24% of individuals with ADHD plus high ASD traits, compared to 10% with ADHD but low ASD traits, 5% with high ASD traits but no ADHD, and 3% with neither ADHD nor high ASD traits. Conclusions: Individuals with ADHD (especially combined subtype) are vulnerable to frequent use of alcohol, tobacco and drugs. Elevated ASD traits, when they co-aggregate with ADHD, further increase this vulnerability. Financial support: MH-083823 MH-080287 NIDAT32 Postdoctoral Fellowship. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.143 A brief behavioral telehealth intervention for veterans with alcohol misuse problems in VA primary care Joseph A. De Leo 1,2 , K. Lamb 2 , S. LaRowe 2 , Elizabeth J. Santa Ana 2,1 1 2
MUSC, Charleston, SC, United States Charleston VAMC, Charleston, SC, United States
Aims: Alcohol misuse disorders are prevalent among veterans and the availability of effective treatments in primary care is a significant health care need. The aim of this study is to present preliminary treatment outcome data based on the self-reports of 11 VA primary care patients with alcohol misuse disorders who completed a brief telehealth intervention, based on motivational interviewing and cognitive behavioral therapy (BIAM-PC; Santa Ana, 2010), regarding their average and peak amount of alcohol consumption. Methods: This project is a prospective within-subject repeated measures design with 1 treatment group, BIAM-PC, delivered to a total of 25 primary care patients who identified as having an alcohol misuse disorder using validated assessment instruments. Participants were evaluated at three time points (pre-, post-treatment, and at 2-month follow-up). Four individual therapy sessions were delivered in the participant’s home via 1-h one-on-one videoconferencing sessions over a 4-week period. Results: Paired samples t-tests indicate a significant reduction (t = −2.63, p < .05) in participants’ reported Standard Ethanol Content (SEC) from baseline (M = 124.13, S.D. = 101.48) to the 2-month follow up (M = 48.21, S.D. = 46.43). Also, a significant reduction in peak SEC scores (t = −3.74, p < .01) was found (baseline M = 17.04, S.D. = 8.63, 2-month follow up M = 4.86, S.D. = 4.88). These data suggest that BIAM-PC is associated with reductions in average and peak alcohol consumption in primarily alcohol dependent veterans. Conclusions: These preliminary findings suggest that the BIAMPC intervention may prove effective in reducing harmful or hazardous drinking behavior in veterans who present to primary care. Results are part of a larger study evaluating feasibility of BIAMPC. Financial support: This project was supported by the South Carolina Clinical & Translational Research (SCTR) Institute with an
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academic home at the Medical University of South Carolina CTSA, NIH/NCRR Grant Number UL1RR029882. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or NCRR. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.144 Initiation into drug dealing among street-involved youth in a Canadian setting Kora DeBeck 1 , C. Feng 2 , W. Small 1 , K. Chan 1 , T. Kerr 1 , Evan Wood 1 1 BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada 2 University of Saskatchewan, Saskatoon, SK, Canada
Aims: Drug dealing is a risky activity common among streetinvolved youth in many urban settings. While participation in illicit drug markets is associated with violence and a range of drugrelated harms, little attention has been given to factors that may be associated with initiation into drug dealing among street-involved youth. We sought to identify demographic, economic, and drug use factors associated with initiation into drug dealing and hypothesized that specific drug use patterns would predict entry into drug dealing among this vulnerable population of youth. Methods: Data for this longitudinal analysis were derived from the At-Risk Youth Study (ARYS), a NIDA funded prospective cohort of street-involved youth aged 14–26 in Vancouver, Canada. Cox proportional hazards regression was used to identify factors independently associated with time to drug dealing initiation. Results: Between September 2005 and May 2012, 1006 participants were recruited into ARYS and 768 (76%) had a history of drug dealing at baseline. Among the 238 participants with no history of drug dealing, 157 returned for study-follow-up and where included in our analysis. Over study follow-up we observed 46 drug dealing initiation events, for an incidence density of 15.2 per 100 person-years. Factors that were independently associated with drug dealing initiation in multivariate Cox regression were: younger age (Relative Hazard [RH] = 1.3, 95% CI: 1.1–1.50), male gender (RH = 2.4, 95% CI: 1.2–4.5), recent crystal methamphetamine use (RH = 3.5, 95% CI: 1.9–6.3) and recent crack cocaine smoking (RH = 4.0, 95% CI: 2.1–7.4). Conclusions: These findings highlight that drug dealing is extremely prevalent among street-involved youth and indicate that stimulant drug use is a key risk factor for drug dealing initiation among this population. Innovative stimulant addiction treatment and economic empowerment interventions for street-youth may help prevent drug dealing among this high-risk population. Financial support: US NIH (R01DA028532) and CIHR (MOP102742). http://dx.doi.org/10.1016/j.drugalcdep.2014.02.145
Abstracts / Drug and Alcohol Dependence 140 (2014) e2–e85
p = 0.000) and ACH and CM+ (6.39 vs 12.19 weeks p = 0.000), and differences in days housed between DT+ and ACH (35.10 vs 23.35 days p = 0.005) and ACH and CM+ (23.35 vs 32.40 days p = 0.017). Conclusions: Differences in abstinence suggests improved treatment effectiveness over subsequent trials. That both DT+ and CM+ had better homelessness outcomes than ACH suggests the abstinence contingent work therapy, incorporated in DT+ and CM+, but not a component of ACH, was more effective for sustaining housing. Financial support: Partially supported by NIDA grant R01 DA11789-04, RTI International and UAB. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.140 Development and evaluation of the marijuana reduction strategies self-efficacy scale Alan K. Davis, J. Leith, L.A. Osborn, H. Rosenberg, E. Bannon, S. Jesse, L. Ashrafioun, A. Hawley, S. Kraus, E. Kryszak, N. Cross, K. Lauritsen Psychology, BGSU, Bowling Green, OH, United States Aims: Develop and evaluate key psychometric properties of a self-report questionnaire designed to assess young regular marijuana users’ self-efficacy to employ 21 different strategies intended to reduce the amount, frequency and/or speed with which they consume marijuana. Methods: Following approval of the project by our institutional review board, we sent an email during the spring semester, 2012, to a random sample of 8000 undergraduate students enrolled at a large public Midwestern university asking them to consider participating in an online survey asking about their use of marijuana. 273 regular marijuana users rated their confidence that they could employ each of the strategies. Additionally, they completed measures assessing their problems with marijuana and other substances, refusal self-efficacy, marijuana use history, and motives for using marijuana. Results: Based on principal components analysis, internal consistency reliability, and mean inter-item correlation, we retained all 21 items in a single scale. This evaluation supported several elements of convergent and criterion validity; specifically, self-efficacy to reduce marijuana use scores were significantly positively correlated with refusal self-efficacy, and significantly negatively correlated with quantity and frequency of marijuana use, marijuana-related problems, and several motives for using marijuana. Conclusions: This relatively short and easily-administered questionnaire could be used to identify marijuana users who have low self-efficacy to employ specific marijuana reduction strategies and as an outcome measure to evaluate educational and skilltraining interventions designed to increase one’s confidence that they could employ protective behavioral strategies to reduce their use of marijuana. Financial support: There was minimal (less than $200) financial support provided by the psychology department at BGSU. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.141
Pyrolysis studies of synthetic cannabinoids in herbal products R.C. Daw, M. Grabenauer, Poonam G. Pande, A.O. Cox, A.L. Kovach, K.H. Davis, J.L. Wiley, P.R. Stout, B.F. Thomas Analytical Chemistry and Pharmaceutics, RTI International, RTP, NC, United States Aims: To determine the chemical fate and biological exposures that occur during the smoking of synthetic cannabinoids in herbal formulations through the characterization of the chemical composition and delivery (yields) of mainstream smoke constituents. Methods: Herbal cigarettes laced with synthetic cannabinoids such as JWH-018, JWH-250 and AM-2201 were prepared and smoked using a Borgwaldt KC smoking machine. The smoke condensate was collected, dissolved in solvent and analyzed using a Waters Synapt 2 Q-TOF-MS and an Agilent 7001B triple quad GC/MS. Samples were analyzed against standard material and blank cigarette smoke to confirm identity and determine recovery. Mass defect filtering and precursor ion searching allowed us to identify likely pyrolysis products in the chromatograms. We identified a number of active pyrolytic products in the smoke of hand-rolled synthetic cannabinoid cigarettes by LC/MS. GC/MS was used to confirm the identity of the parent and pyrolysis compounds found. Results: Precursor ion searching based on the 127 ion of AM-2201 smoke indicated that at least 5 pyrolysis degradation products, including JWH-018, JWH-022 and three other compounds had been formed. Precursor ion search of JWH-018 smoke showed JWH-022 as a degradation product (loss of 2 hydrogens). JWH-167 was also formed during the pyrolysis of JWH-250 (loss of methoxy group). Conclusions: Synthetic cannabinoids degrade to other products when smoked. These pyrolysis products can be components that have an altered affinity to the CB1 and CB2 receptor, or entities of unknown pharmacology and toxicology. Financial support: This work was funded by RTI International as an internal research and development project. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.142 Adult ADHD subtypes, autistic traits, and substance use Duneesha De Alwis, A. Todorov, Arpana Agrawal, A. Reiersen Psychiatry, Washington University School of Medicine, St. Louis, MO, United States Aims: Individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) are more likely to report substance use but few studies have investigated this relationship within ADHD subtypes. ADHD symptoms and Autism Spectrum Disorder (ASD) traits tend to coaggregate, but the combined effect of ADHD and ASD traits on substance use is not understood. This study examines the occurrence of substance use in ADHD subtypes and the relationship between ADHD, ASD, and substance use. Methods: Subjects were 3273 young adults between the ages of 18–39 years with available parent-report data from a populationbased study of Missouri large sib-ship families. They were classified as inattentive (ADHD-I), hyperactive-impulsive (ADHD-HI), combined (ADHD-C) or unaffected based on application of the DSM-IV ADHD symptom criterion to parent-report SWAN (Strengths and Weaknesses of ADHD-symptoms and Normal behavior) questionnaire responses. Substance use (tobacco, alcohol, and drugs) and ASD trait data were derived from the ABCL (Adult Behavior Check-
Abstracts / Drug and Alcohol Dependence 140 (2014) e2–e85
list) and SRS (Social Responsiveness Scale). Group differences in mean T-scores were assessed using clustered linear regression and appropriate post-hoc tests. SRS score of 65 or higher was defined as above- threshold ASD traits. Results: Adults with ADHD used substances more frequently compared to controls, and the ADHD-C subgroup showed significantly higher use than other sub-types (i.e., mean T-scores for the frequency of tobacco use statistically differed across ADHD groups as follows: ADHD-I = 53.87, ADHD-HI = 55.14, ADHD-C = 58.87, Controls = 51.47). In subjects with ADHD, high ASD traits further increased risk for frequent substance use. For instance, excessive drinking was reported in 24% of individuals with ADHD plus high ASD traits, compared to 10% with ADHD but low ASD traits, 5% with high ASD traits but no ADHD, and 3% with neither ADHD nor high ASD traits. Conclusions: Individuals with ADHD (especially combined subtype) are vulnerable to frequent use of alcohol, tobacco and drugs. Elevated ASD traits, when they co-aggregate with ADHD, further increase this vulnerability. Financial support: MH-083823 MH-080287 NIDAT32 Postdoctoral Fellowship. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.143 A brief behavioral telehealth intervention for veterans with alcohol misuse problems in VA primary care Joseph A. De Leo 1,2 , K. Lamb 2 , S. LaRowe 2 , Elizabeth J. Santa Ana 2,1 1 2
MUSC, Charleston, SC, United States Charleston VAMC, Charleston, SC, United States
Aims: Alcohol misuse disorders are prevalent among veterans and the availability of effective treatments in primary care is a significant health care need. The aim of this study is to present preliminary treatment outcome data based on the self-reports of 11 VA primary care patients with alcohol misuse disorders who completed a brief telehealth intervention, based on motivational interviewing and cognitive behavioral therapy (BIAM-PC; Santa Ana, 2010), regarding their average and peak amount of alcohol consumption. Methods: This project is a prospective within-subject repeated measures design with 1 treatment group, BIAM-PC, delivered to a total of 25 primary care patients who identified as having an alcohol misuse disorder using validated assessment instruments. Participants were evaluated at three time points (pre-, post-treatment, and at 2-month follow-up). Four individual therapy sessions were delivered in the participant’s home via 1-h one-on-one videoconferencing sessions over a 4-week period. Results: Paired samples t-tests indicate a significant reduction (t = −2.63, p < .05) in participants’ reported Standard Ethanol Content (SEC) from baseline (M = 124.13, S.D. = 101.48) to the 2-month follow up (M = 48.21, S.D. = 46.43). Also, a significant reduction in peak SEC scores (t = −3.74, p < .01) was found (baseline M = 17.04, S.D. = 8.63, 2-month follow up M = 4.86, S.D. = 4.88). These data suggest that BIAM-PC is associated with reductions in average and peak alcohol consumption in primarily alcohol dependent veterans. Conclusions: These preliminary findings suggest that the BIAMPC intervention may prove effective in reducing harmful or hazardous drinking behavior in veterans who present to primary care. Results are part of a larger study evaluating feasibility of BIAMPC. Financial support: This project was supported by the South Carolina Clinical & Translational Research (SCTR) Institute with an
e45
academic home at the Medical University of South Carolina CTSA, NIH/NCRR Grant Number UL1RR029882. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or NCRR. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.144 Initiation into drug dealing among street-involved youth in a Canadian setting Kora DeBeck 1 , C. Feng 2 , W. Small 1 , K. Chan 1 , T. Kerr 1 , Evan Wood 1 1 BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada 2 University of Saskatchewan, Saskatoon, SK, Canada
Aims: Drug dealing is a risky activity common among streetinvolved youth in many urban settings. While participation in illicit drug markets is associated with violence and a range of drugrelated harms, little attention has been given to factors that may be associated with initiation into drug dealing among street-involved youth. We sought to identify demographic, economic, and drug use factors associated with initiation into drug dealing and hypothesized that specific drug use patterns would predict entry into drug dealing among this vulnerable population of youth. Methods: Data for this longitudinal analysis were derived from the At-Risk Youth Study (ARYS), a NIDA funded prospective cohort of street-involved youth aged 14–26 in Vancouver, Canada. Cox proportional hazards regression was used to identify factors independently associated with time to drug dealing initiation. Results: Between September 2005 and May 2012, 1006 participants were recruited into ARYS and 768 (76%) had a history of drug dealing at baseline. Among the 238 participants with no history of drug dealing, 157 returned for study-follow-up and where included in our analysis. Over study follow-up we observed 46 drug dealing initiation events, for an incidence density of 15.2 per 100 person-years. Factors that were independently associated with drug dealing initiation in multivariate Cox regression were: younger age (Relative Hazard [RH] = 1.3, 95% CI: 1.1–1.50), male gender (RH = 2.4, 95% CI: 1.2–4.5), recent crystal methamphetamine use (RH = 3.5, 95% CI: 1.9–6.3) and recent crack cocaine smoking (RH = 4.0, 95% CI: 2.1–7.4). Conclusions: These findings highlight that drug dealing is extremely prevalent among street-involved youth and indicate that stimulant drug use is a key risk factor for drug dealing initiation among this population. Innovative stimulant addiction treatment and economic empowerment interventions for street-youth may help prevent drug dealing among this high-risk population. Financial support: US NIH (R01DA028532) and CIHR (MOP102742). http://dx.doi.org/10.1016/j.drugalcdep.2014.02.145