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AIMS: This study examined the personality traits of negative emotionality and constraint and the ability to resist drinking during negative affective states as correlates of solitary drinking in adolescence. We hypothesized that higher levels of negative emotionality and lower levels of constraint would predict solitary drinking and that these relationships would be mediated by the ability to resist drinking in response to negative emotions. DESIGN: Structural equation modeling was used to fit a path model from the personality traits of negative emotionality and constraint to solitary drinking status through intermediate effects on the ability to resist drinking during negative emotions using cross-sectional data. SETTING: Clinical and community settings in Pennsylvania, USA. PARTICIPANTS: The sample included 761 adolescent drinkers (mean age = 17.1). MEASUREMENTS: Adolescents completed the Lifetime Drinking History, the Multidimensional Personality Questionnaire, the Constructive Thinking Inventory, and the Situational Confidence Questionnaire. FINDINGS: The path model provided good fit to the data. The association between trait negative emotionality and solitary drinking was fully mediated by adolescents' ability to resist drinking during negative affective states (OR=1.05, b=.05, p=.01). In contrast, constraint had a direct effect on solitary drinking (OR=.79, b=-.23, pCONCLUSIONS: The ability to resist drinking while experiencing negative feelings or emotions may be an important underlying mechanism linking trait negative emotionality (a tendency toward depression, anxiety, and poor reaction to stress) and constraint (lack of impulsiveness) to adolescent solitary drinking. Language: en

Background Sleep disturbances are both common and well-characterized in adults with alcohol use disorders (AUDs), but have received little study in adolescents with AUDs. Furthermore, a handful of studies suggest that sleep complaints are a risk factor for AUDs. However, no published studies have yet examined the longitudinal course of sleep complaints in adolescents with AUDs; in particular, it remains unclear how persistent AUD-associated sleep complaints are in this age group, and what types of sleep complaints are most relevant to alcohol-use symptoms. We investigated these questions in a 5-year longitudinal study of adolescents with and without AUDs at baseline. Methods Participants were 696 adolescents (age 12 to 19) from a longitudinal study at the Pittsburgh Adolescent Alcohol Research Center. At baseline, 347 participants had a current AUD (AUD+), while 349 had no current or past AUD (AUD−). We examined sleep and alcohol involvement at baseline as well as 1-, 3-, and 5-year follow-up visits. Sleep variables included self-reported insomnia and hypersomnia, as well as variability in weekday–weekend sleep duration, all at baseline. Covariates included sex, age, current alcohol symptoms, and depression severity. Results The AUD+ group reported more overall sleep disturbance at baseline, including greater insomnia and hypersomnia complaints, and greater variability in weekday–weekend sleep duration. Group differences in insomnia and hypersomnia complaints persisted to the 5- and 3-year follow-ups, respectively. In the AUD− group, greater insomnia complaints at baseline predicted an increase in alcohol symptoms at the 1-year follow-up, while greater variability in sleep duration at baseline predicted an increase in alcohol symptoms at the 3- and 5-year follow-ups. Conclusions These results complement previous findings in other samples, indicating that insomnia and other sleep problems are a chronic predicament for adolescents with AUDs. The findings also suggest that sleep disturbances may place adolescents without AUDs at an elevated risk of developing alcohol problems.

Aims This commentary critically evaluates the use of substance-related negative psychosocial and health consequences to define and diagnose alcohol and other substance use disorders. Methods Narrative review. Results The consequences of substance use cause much suffering and are major public health and economic problems. However, there are a number of conceptual and measurement problems with using consequences as diagnostic criteria for substance disorders. Data indicate that substance-related consequences introduce systematic bias and degrade the validity of diagnostic systems. Conclusions Negative psychosocial and health consequences of substance use should play a fundamentally reduced role in modern diagnostic systems for, and definitions of, addictive disorders.

Proposed Diagnostic and Statistical Manual (DSM) of Mental Disorders, fifth edition (DSM-5), substance use disorder (SUD) criteria (www.dsm5.org) would involve more change for nicotine, compared to other drug classes in DSM-IV (1–3). Specifically, proposed DSM-5 nicotine use disorder (NUD) criteria would increase the number of criteria used for diagnosis from 7 to 11, with the addition of three DSM-IV abuse criteria (used for most other substances in DSM-IV with the exception of nicotine), and a new Craving criterion. In addition, the threshold for nicotine diagnosis would be lowered from 3 to 2 symptoms. The implications of proposed changes to NUD criteria with regard to the prevalence and validity of nicotine diagnoses, and diagnostic concordance across iterations of DSM warrant study prior to the publication of DSM-5 in 2013. DSM-IV recognizes two SUDs: substance abuse and dependence. A diagnosis of substance abuse requires 1 of 4 criteria representing certain negative consequences resulting from substance use: recurrent failure to meet Role Obligations, Hazardous Use, Interpersonal Problems, and Legal Problems. DSM-IV substance dependence requires the co-occurrence of 3 of 7 criteria within 1-year: Tolerance, Withdrawal, use more or longer than intended (Larger/Longer), failed attempts or strong desire to limit use (Quit/Cut), Much Time spent using, Reduce Activities in order to use, and psychological or physical problems exacerbated or caused by use (Psych/Phys). Importantly, DSM-IV acknowledges that some of the generic dependence criteria used to determine a nicotine diagnosis do not appear to directly apply to nicotine or require some explanation as to how they might apply to nicotine (2: page 243; 3: page 264). Proposed DSM-5 NUD criteria include 11 symptoms (1): 3 DSM-IV abuse criteria (i.e., Role Obligations, Hazardous Use, Interpersonal Problems), all 7 DSM-IV dependence criteria, and a new Craving symptom (i.e., strong desire to engage in use). Proposed DSM-5 NUD requires the co-occurrence of two or more of 11 symptoms within 1-year. Presence of 2–3 symptoms represents “moderate” NUD, and 4 or more symptoms represents “severe” NUD. The use of a criterion set that combines abuse and dependence symptoms in DSM-5 is based on the idea that the proposed criteria represent a single dimension, which has been supported for alcohol and some other drugs (e.g., 4, 5, 6). To date, only 1 study has examined the dimensionality of proposed DSM-5 NUD criteria (7), and like other studies of nicotine-related symptoms (e.g., 8, 9), found support for a single dimension. Because few existing datasets include data relevant to examining proposed DSM-5 NUD criteria, we attempted to replicate (cf. 7) the dimensionality and performance characteristics of 10 of the 11 (Role Obligation not assessed) proposed DSM-5 NUD criteria. Decisions to include new diagnostic criteria, such as Craving, need to consider whether the criteria improve diagnosis in terms of reliability, validity, and case identification (10). This study examined concordance of DSM-IV dependence and proposed DSM-5 NUD, and evidence for concurrent validity of the two algorithms in adolescents and young adults, who were initially recruited from substance use treatment. This study addresses the DSM-5 workgroup’s call for field trials in patient samples because patient samples tend to have more, and more severe symptoms, compared to the general population (1). We focus on adolescents and young adults because nicotine addiction often has origins in adolescence, and peak rates of tobacco use emerge in young adulthood (11). For analyses comparing the prevalence of DSM-IV dependence and proposed DSM-5 NUD, we predicted greater prevalence of proposed DSM-5 NUD compared to DSM-IV, due to proposed DSM-5’s lower threshold and expanded array of symptoms. We also predicted that lowering the threshold to 2 symptoms would result in limited concurrent validity for proposed DSM-5 NUD, relative to DSM-IV nicotine dependence. We tested the unidimensionality of proposed DSM-5 NUD criteria, and used Item Response Theory (IRT) to examine symptom performance characteristics. We predicted that the 3 DSM-IV abuse items would show poor psychometric performance (e.g., low rates of endorsement) when included in the proposed DSM-5 algorithm.

Aims Controversy exists regarding the inclusion of cannabis withdrawal as an indicator of dependence in the next revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). This study contrasted the concurrent and predictive validity of three operational definitions of cannabis withdrawal in a sample of treated adolescents. Design Prospective study of treated adolescents with 1-year follow-up. Setting and participants Adolescents (n = 214) were recruited from intensive out-patient treatment programs for substance abuse, and followed at 1 year (92% retention). Youth who were included in the analyses reported regular cannabis use. Measurements The number of DSM-IV cannabis abuse and dependence symptoms at baseline and 1-year follow-up, past year frequency of cannabis use at baseline and follow-up, and periods of abstinence at 1-year follow-up. Cannabis withdrawal was defined based on (i) the presence of two or more cannabis withdrawal symptoms; (ii) a definition proposed by Budney and colleagues (2006) that requires four or more withdrawal symptoms (foursymptom definition); and (iii) the use of latent class analysis to identify subgroups with similar cannabis withdrawal symptom profiles. Findings and conclusions All three definitions of cannabis withdrawal demonstrated some concurrent validity. Only the four-symptom and latent class-derived definitions of withdrawal predicted severity of cannabis-relatedproblemsat1-yearfollow-up.Nocannabiswithdrawaldefinitionpredictedfrequencyof useatfollowup. Further research is needed to determine the clinical utility and validity of the four-symptom definition, as well as alternative definitions of cannabis withdrawal, to inform revisions leading to DSM-V and ICD-11.

This article presents the proceedings of a symposium held at the June 2005 meeting of the Research Society on Alcoholism in Santa Barbara, California. Impaired control over substance use has long been considered a central feature of alcohol and drug dependence. However, much remains to be learned about the nature of impaired control, the mechanisms by which acute and chronic substance use can lead to impaired control, and how this construct is best assessed in the laboratory and the clinic. The goal of this symposium was to describe current perspectives on impaired control over alcohol and drug use from diverse research areas, to promote future multidisciplinary work in this area. Four speakers described their work on impaired control using human clinical samples (Dr. Chung), animal models (Dr. Miczek), experimental laboratory paradigms in humans (Dr. Fillmore), and neuroimaging studies (Dr. Easdon). Taken together, the talks highlighted the heterogeneous nature of constructs such as impaired inhibitory control, and patterns of impulsive and compulsive substance use. Future clinical and experimental research should attempt to carefully define and measure particular aspects of impaired control and to seek insights from other disciplines.

This article presents the proceedings of a symposium at the 2002 RSA Meeting in San Francisco, California. Deborah S. Hasin organized the symposium and co-chaired it with Marc Schuckit. The purpose of the symposium was to provide an overview of what is known about the validity of DSM-IV and ICD-10 alcohol dependence and abuse, with a focus on work done since 1994. Presentations included: (1) Validity of DSM-III-R alcohol dependence in adolescents, by Christopher S. Martin; (2) Reliability and validity of DSM and ICD formulations of alcohol use disorders: findings from epidemiology, by Bridget F. Grant; (3) Validity and reliability of the alcohol-dependence phenotype in the context of genetic studies, by Kathleen K. Bucholz; and (4) DSM-IV and beyond: uniting the clinical utility of categories with the precision of dimensions, by John E. Helzer. The findings supported the validity of DSM-IV alcohol dependence across numerous study designs and samples, suggested some value in a dimensional dependence measure, and raised questions about the validity of the diagnosis of alcohol abuse as currently defined. Marc Schuckit, as discussant for the symposium, placed the issues in perspective for the upcoming DSM-V.

Knowledge of the clinical course in treated adolescents is fundamental to determining the influence of treatment on long-term functioning and the factors associated with change in the severity of alcohol problems over time. This symposium, held at the 2002 annual Research Society on Alcoholism meeting and organized by Tammy Chung and Christopher S. Martin, presented research on the course of alcohol-related problems in treated adolescents who were followed prospectively for 1 to 8 years. Presentations included (1) Alcohol use outcomes at 1 year among adolescents in the drug abuse treatment outcomes studies (DATOS-A), by Christine E. Grella; (2) Pathways and predictors of the course of adolescent alcohol problems across 1- and 3-year follow-ups, by Tammy Chung; (3) Young adult outcomes of an adolescent clinical sample at 5-year follow-up, by Ken C. Winters; and (4) Trajectories of alcohol involvement following addiction treatment through 8-year follow-up in adolescents, by Ana M. Abrantes, Denis M. McCarthy, Gregory A. Aarons, and Sandra A. Brown. Sandra A. Brown, discussant, commented on the presentations. Results from these studies indicate multiple pathways of change, distinguished by fluctuations in the chronicity and severity of alcohol problems. Across studies, most adolescents showed reductions in alcohol use and problems after treatment, with concurrent improvements in psychosocial functioning. Findings highlight the influence of other drug use on posttreatment patterns of alcohol involvement and the need to consider the effect of normative developmental transitions on the course of adolescent-onset substance use disorders.

Background: Little research has examined impaired control over alcohol consumption in adolescents. This study examined the concurrent and discriminant validity of two DSM-IV dependence criteria that reflect impaired control over drinking: “using more or longer than intended” (Larger/Longer) and “persistent desire or unsuccessful efforts to quit or cut down” (Quit/Cut Down). Methods: Adolescent drinkers, ages 13–19 (N= 173), were recruited from addictions treatment (76%) and community sources (24%). A modified SCID that included assessment of alcohol craving and questionnaires measuring dependence severity, attempts to limit drinking, and impulsivity were administered. Results: Larger/Longer had higher prevalence and an earlier onset than Quit/Cut Down, suggesting that the symptoms respectively represent milder and more severe manifestations of impaired control over drinking. Both symptoms were associated with drinking frequency, dependence severity, episodes of passing out, and an independent measure of unsuccessful attempts to limit drinking. Alcohol craving was associated with both Larger/Longer and Quit/Cut Down. Impulsivity was correlated with Larger/Longer but not Quit/Cut Down. Conclusions: Larger/Longer and Quit/Cut Down demonstrated adequate concurrent validity. The two symptoms were distinguished by severity and differential relations with impulsivity, suggesting that Larger/Longer and Quit/Cut Down reflect different types of impaired control over alcohol consumption. Results suggest the need for improved description and scaling of the impaired control construct in adolescents.

Despite some favorable changes, the proposed DSM-V SUD criteria do not go far enough in improving SUD diagnosis for youth. Some targeted developmental adjustments, including clearer operational symptom definitions (16), are needed to ensure that DSM-V validly identifies SUD across developmental periods. We recommend excluding the Hazardous Use criterion, clarifying the operational definitions of Tolerance, Withdrawal and Craving, and critically evaluating the diagnostic threshold for SUDs in adolescents.

Background: The concurrent validity of subclinical ratings for psychiatric symptoms can help refine symptom definitions and threshold criteria. However, virtually no research has examined subclinical ratings for DSM-IV symptoms in psychiatric diagnostic interviews. This study examined the frequency, reliability, and concurrent validity of subclinical ratings for 11 symptoms of alcohol use disorders among adolescents. Methods: Subjects were 239 male and 164 female adolescents ages 14 to 18 recruited from treatment and community sources. Symptoms and diagnoses were made with an adapted version of the Structured Clinical Interview for the DSM-IV. Results: Subclinical ratings showed acceptable to high interrater reliability. The proportion of subclinical ratings tended to decrease with increasing levels of alcohol problems. For 10 of the 11 symptoms, subjects with subclinical ratings were distinguished from those with absent and/or those with present ratings. Subjects with subclinical ratings were often distinct from those with present ratings but less often distinct from those with absent ratings. Conclusions: For most of the DSM-IV alcohol use disorder symptoms, subclinical ratings appear to be reliable and valid and provide information beyond dichotomous symptom classifications for adolescents. Threshold criteria appear to be appropriate in many cases, but boundaries between absent and subclinical ratings are “fuzzy.” Practical and research implications are discussed.

This paper reviews theoretical and methodological issues in the measurement of drug craving, with an emphasis on self-report assessment. Despite the important role that craving plays in many research and clinical settings, the way in which the construct is conceptualized and measured rarely receives sufficient attention. Issues pertinent to conceptualizing craving are identified. Because there is no single perfect measure of craving, it is essential that researchers understand the limitations of each measure. Measurement performance concerns that affect the validity of different measures are reviewed. Non-verbal assessment methods are also reviewed. Research factors that may help determine the optimal measures for a given study are highlighted. It is concluded that advances in assessment will proceed only when combined with additional research and a better theoretical understanding of craving.

Over the past 30 years in the United States, there have been marked secular increases in polydrug use. Alcohol and other substance use disorders are highly comorbid. Yet, little research has characterized patterns of polydrug use in persons with alcohol dependence. In particular, little is known about this population's use of alcohol and other drugs in combination or on the same day, which is termed simultaneous polydrug use (SPU). This research assessed patterns of SPU in 212 problem drinkers who participated in an alcohol treatment outcome study. Subjects were given a Time-Line Follow-Back interview that assessed the use of alcohol and nine other drug classes for each day of the 120 days before treatment entry. A majority of subjects (61%) reported SPU during this assessment interval. Subjects who reported SPU were disproportionately younger, male, and unmarried, compared with those who did not report SPU. The most common alcohol/drug combinations were alcohol with cocaine (60% of subjects who reported SPU), alcohol with marijuana (51% of SPU subjects), and alcohol with sedatives (31% of SPU subjects). The most common three-drug combination was alcohol, cocaine, and marijuana (23% of SPU subjects). Alcohol use and drug use were associated at the event level, significantly more than association predicted by the base rates of the individual behaviors. Time-Line Follow-Back data correlated highly with a questionnaire measure of SPU. Results indicate that polydrug use is an important focus for assessment and intervention in alcohol treatment programs.

Temperament has been hypothesized to mediate the effects of family history of substance abuse (SA) on behavioral maladjustment in children. To date no study has provided empirical evidence to support this mediation hypothesis. In this study the temperament mediation hypothesis was tested employing hierarchical regression and other linear regression procedures. “Difficult affective temperament” in fathers and sons was found to mediate the relationship between SA+ family history and behavior maladjustment in 10- to 12-year-old sons of SA+ (n=41)and SA-(n = 39) families. The authors discuss implications of the phenotype of difficult affective temperament in describing the developmental pathway to substance abuse.

This study compares relationship satisfaction between mother and son in families where the father either qualified for a diagnosis of psychoactive substance use disorder (SA+) or had no lifetime psychiatric diagnosis (SA-). The authors found that there was greater mutual dissatisfaction in SA+ families compared with SA- families. The magnitude of dissatisfaction cov-aried with behavioral disturbance in the children; however, in SA+ families, mother-son dissatisfaction correlated positively with externalizing and internalizing behaviors in the children, whereas in SA- families dissatisfaction correlated only with externalizing behaviors. The results suggest that in SA+families, generalized behavioral deviations in the child, combined with parent-offspring dissatisfaction, may facilitate the child's disengagement from parental influence and promote negative association with peers.

Anticipations of alcohol's effects reportedly covary with the amount consumed. Alcohol's stimulant and sedative properties also may contribute to alcohol consumption. Anticipations of stimulant and sedative effects have not been investigated extensively. The present study examined the stimulant and sedative effects subjects anticipated experiencing if they were on the ascending or descending limb of the blood alcohol curve after consuming two or four standard drinks. One hundred sixty-six undergraduates reported anticipating greater stimulant effects than sedative effects on the ascending limb of the blood alcohol curve, and greater sedative effects than stimulant effects on the descending limb. Subjects also reported anticipating larger effects with larger doses. Men tended to anticipate smaller effects than women. These results support the notion that specific anticipated effects vary with dosage and the limb of blood alcohol curve, suggesting that the study of anticipated effects of alcohol should employ these variables.

Sons of substance-abusing (SA+) fathers and sons of control (SA-) fathers were compared on measures of parental discipline, temperament, and problem behavior. It was found that discipline was less effective in 10-12-year-old boys of SA+ parents compared with boys of SA+ parents. Children in the SA+ group also scored higher on the constellation of traits comprising a difficult temperament. IntheSA+group only, parental discipline explained a significant, albeit modest, amount of variance on the Child Behavior Checklist summary scores measuring the externalizing and internalizing behavior of the boys. Temperament did not exercise a moderating influence on the association between parental discipline and behavior.

Background: It is common for subjective intoxication measures to be administered frequently throughout an experimental session. It is unclear, however, whether repeated assessments affect the experience of intoxication. This study examined the effect of assessing subjective intoxication levels during alcohol consumption on subsequent perceptions of intoxication after drinking. Methods: Forty-two participants consumed a moderate dose of alcohol (men, 82 g/kg; women, 0.74 g/kg) during a 30-min period. Participants either reported or did not report subjective intoxication levels at 10-min intervals during the drinking period. After the drink, all participants rated their level of subjective intoxication on several occasions. Results: Individuals who reported their intoxication during the drinking period reported higher levels after consumption than did those who did not rate their intoxication during drinking. Conclusions: These data suggest the potential for reactivity effects when conducting repeated assessments of perceived subjective intoxication.

This report summarizes the results of a series of studies that examined the effects of alcohol on the acoustic-phonetic properties of speech. Audio recordings were made of male talkers producing lists of sentences under a sober condition and an intoxicated condition. These speech samples were then subjected to perceptual and acoustic analyses. In one perceptual experiment, listeners heard matched pairs of sentences from four talkers and were required to identify the sentence that was produced while the talker was intoxicated. In a second perceptual experiment, Indiana State Troopers and college undergraduates were required to judge whether individual sentences presented in isolation were produced in a sober or an intoxicated condition. The results of the perceptual experiments indicated that groups of listeners can significantly discriminate between speech samples produced under sober and intoxicated conditions. For acoustic analyses, digital signal processing techniques were used to measure acoustic-phonetic changes that took place in speech production when the talker was intoxicated. The results of the acoustical analyses revealed consistent and well-defined changes in speech articulation between sober and intoxicated conditions. Because speech production requires fine motor control and timing of the articulators, it may be possible to use acoustic-phonetic measures as sensitive indices of sensory-motor impairment due to alcohol consumption.