Importance: Adolescent cannabis use is a growing concern due to its associations with long-term adverse mental health outcomes. However, the distinct, temporal associations of neurodevelopmental factors and childhood adverse life experiences (ALEs) with adolescent substance use in have not yet been fully elucidated. The Adolescent Brain Cognitive Development (ABCD) Study offers an unprecedented opportunity to prospectively examine neurobiological and socioenvironmental predictors of cannabis onset. Objective: To investigate magnetic resonance imaging-derived neurodevelopmental cortical brain Age Gap Estimate (brainAGE) and adverse life events as risk factors of early cannabis initiation. Design, Setting, and Participants: The ABCD Study is a longitudinal study across 22 sites in the United States. Data are collected starting at approximately 10 years old (currently at year-7 follow-up). Our analyses comprised 6688 (48% female) youth after exclusions. Main Outcomes and Measures: Cox proportional hazard models were computed to investigate brainAGE-sex interactions and 10 adversity dimensions at baseline as predictors of time to cannabis initiation up to age 18. Results: Mean age of initiation was 14.8 years (SD=1.43). Global brainAGE was modestly associated with cannabis initiation in females only (Hazard Ratio [HR]=1.05; 95% Confidence Interval [CI]=1.00-1.10, p = .049). Low socioeconomic status, caregiver substance use, family anger and arguments, and caregiver lack of supervision were associated with initiation (HRs = 1.11, 1.56, 1.09, 0.85, respectively; CIs = 1.04-1.19, 1.44-1.69, 1.09-1.19, 0.76-0.91, respectively; p's < .05). Other ALE dimensions and network-specific brainAGEs were not significantly associated with initiation. Conclusions and Relevance: Findings suggest that while cortical brainAGE may be somewhat increase vulnerability to adolescent cannabis use in females, its contributions are modest at best. In contrast, early childhood adversities such as socioeconomic factors and familial characteristics may present more substantive targets for prevention and intervention.
K. Thiessen, Y. Yu, L. Schmid et al.· medRxiv· 0 citations
INTRODUCTION
People with concurrent substance use and mental disorders (CD) experience a disproportionately higher risk of overdose compared to people with substance use disorder alone. However, predictors among individuals with severe concurrent disorders (SCD) in tertiary care settings remain poorly characterized. We aimed to identify factors associated with frequent non-fatal overdose using statistical learning methods.
METHODS
Data were obtained from the Reducing Overdose and Relapse: Concurrent Attention to Neuropsychiatric Ailments and Drug Addiction (ROAR CANADA) longitudinal cohort of individuals with SCD treated at three tertiary centres in British Columbia (N = 326). Frequent overdose (FO) was defined as more than the median number of lifetime self-reported overdoses (>2). Candidate variables included sociodemographic characteristics, substance use patterns, impulsivity, and trauma history. Elastic Net regularized regression with bootstrap stability selection identified key predictors. Stability-selected variables were entered into a principal component logistic regression model to assess predictive performance.
RESULTS
Recent heroin or fentanyl use was the most stable predictor of FO (100% selection), followed by Hepatitis C diagnosis (98%), being single (98%), recent crack cocaine use (95%), history of sexual abuse (88%), and history of physical abuse (87%). Being unhoused, prior hospitalization, and life-threatening illness were also associated with increased risk. Variables inversely associated with FO included recent cannabis use (94%), white ethnicity (87%), and perceived access to instrumental support (84%). Chi-square analyses showed significant associations between FO and recent heroin or fentanyl use (OR 6.99; 95% CI 4.29-11.38), Hepatitis C diagnosis (OR 4.02; 95% CI 2.12-7.64), recent crack cocaine use (OR 2.36; 95% CI 1.49-3.75), and history of physical trauma (OR 2.06; 95% CI 1.28-3.31). The model demonstrated moderate discrimination (area under the curve (AUC) = 0.78; sensitivity 66.2%; specificity 77.5%).
CONCLUSION
To address the prolonged overdose crisis, findings suggest that integrated treatment of patients' polysubstance use, comorbidities, and social support is important for risk prevention. Future studies should involve validation in a larger, demographically diverse, sample.
M. Song, Zayed Shahjahan, K. Thiessen et al.· General Hospital Psychiatry· 0 citations
