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Bullying is a common experience among youths with many adverse consequences. Research indicates that those who identify as lesbian, gay, and bisexual experience bullying at greater levels than heterosexuals. Studies also indicate that sexual minorities are more likely to use alcohol and other drugs, including synthetic cannabinoids (SCs). This paper examines whether the relationship between sexual minority status and SC use is mediated by differential exposure to bullying victimization. Data from the 2015 and 2017 Youth Risk Behavior Study were used. Participants include 30,389 adolescents. Supplemental analyses were conducted with state and district data as those collection efforts incorporated additional bullying measures. Ianobucci's zmediation was used to assess the relationships between sexual orientation, bullying victimization, and SC use. Results confirm the higher prevalence of bullying and SC use among LGBQ students. Multiple forms of bullying victimization (e.g., in-person, online, because of weight/appearance) mediate the relationship between sexual orientation and SC use. The greater prevalence of SC use within the LGBQ population is partially attributed to coping as a result bullying victimization.

Purpose: Existing studies have identified sexual minorities as being at enhanced risk for reporting synthetic cannabinoid (SC) use. It is unclear whether this association is the result of those that identify as a minority due to sexual orientation being more likely to use SCs, due to those that identify as transgender using SCs more, or both. Deconstructing this relationship will allow for targeted clinical advice and public health campaigns. Methods: Data from the 2015 and 2017 Youth Risk Behavior Study are utilized. In total, 31,279 youth were asked about their gender identity, sexual orientation, and SC use history. Bivariate analyses and logistic regression models were completed to explore relevant associations. Results: Identifying as lesbian, gay, bisexual, or questioning was linked to SC use and continuing SC use. Similarly, identifying as transgender was linked to SC use and continuing use. Regression analyses showed no significant interactive effect; identifying as both LGBQ and transgender does not have a compounding effect on use likelihood. Conclusions: Both sexual orientation and gender identity contribute to the relationship between sexual minority status and SC use noted in extant literature. This relationship is hypothesized to be tied to increased exposure to discrimination, victimization, and social isolation. Thus, efforts to directly counsel LGBTQ patients about the dangers associated with SC use are warranted as well as social policy reforms to better protect and support members of the LGBTQ community.

Aims To examine the continuing role of daily popular social media use in youth hazardous alcohol consumption in four countries across continents. Methods A web-based survey was given to youths aged 15–25 in the USA (n = 1212), South Korea (n = 1192), Finland (n = 1200) and Spain (n = 1212). Hazardous alcohol use (alcohol use disorders identification test-C) was the dependent variable. Main independent variables measured daily use of different social media services. Controls included compulsive Internet use, offline belonging, psychological distress, impulsivity, risk-taking, age and gender. Linear regression models and mediation analyses with bootstrapping were done for each country. Results Daily use of Facebook and Instagram was associated with higher hazardous alcohol use among youths in Finland, South Korea and Spain. Daily instant messaging was related to higher hazardous alcohol use among South Korean and Finnish youths. Daily YouTube use was associated with higher hazardous alcohol use among youths in South Korea, but lower hazardous alcohol use among youths in the USA and Finland. Daily Twitter use was related to lower hazardous drinking among youths in Finland but higher hazardous drinking among youths in Spain. The mediation analyses revealed that uploading pictures to social media is a possible facilitator of social media-related hazardous alcohol use among youths in the USA and Spain. Conclusion Certain social media platforms might inspire and/or attract hazardously drinking youths, contributing to the growing opportunities for social media interventions.

From the anti-tobacco and anti-marijuana campaigns of the twentieth century to the current controversies surrounding vaporizer use and the opioid epidemic, substances and substance use have been at the forefront of cultural, public health, and legal debates for decades. This work explores treatment outcomes among those with substance use disorders (SUD) by 1) comparing legal, semi-legal, and illegal drug types and their impact on treatment outcomes and 2) evaluating the extent that there exist discrepancies between those who need and those who receive treatment.

Research indicates that youths are particularly susceptible to peer influence and that identifying with substance using peer groups predicts substance use. Today, youth spend more time interacting with distal peer groups via the Internet and have increased access to online drug cultures. Theoretically, this should have important implications for substance use. This study employs a nationally representative sample of U.S. youth (n = 1212), ages 15–25 years old, to examine whether online peer group identification and social media homophily predict substance use. Results indicate that online belonging and social media homophily are associated with some forms of substance use. While these factors were not significantly associated with regular marijuana or alcohol use among those who had initiated use, they predicted regular stimulant and opioid use among substance users. This suggests that online peer groups may promote progression into more problematic forms of substance use. Additional analyses of adolescent and young adult subgroups revealed important similarities and differences among the groups. The findings imply several directions for future research, and suggest that prevention policies and programs should continue to consider the role of online peers, and the Internet generally, in substance use initiation, escalation, and prevention. acceptedVersion

Background Underage college students who obtain and use false identification (fake ID) are at risk for negative outcomes. However, it is currently unclear how uniquely the fake ID itself serves as a vehicle to subsequent harm (i.e., the “fake ID effect”) over and above general and trait-related risk factors (e.g., deviant peers, low self-control). Methods To investigate whether the “fake ID effect” would hold after accounting for phenotypic risk, we utilized propensity score matching (PSM) in a cross-sectional sample of 1,454 students, and a longitudinal replication sample of 3,720 undergraduates. Individuals with a fake ID were matched with individuals without a fake ID, in terms of a number of trait-based and social risk factors. These matched groups were then compared on 5 problematic outcomes (i.e., frequent binge drinking, alcohol-related problems, arrests, marijuana use, and hard drug use). Results Findings showed that “fake ID effects” were substantially—although not fully—diminished following PSM. The “fake ID effect” remained strongest for alcohol-related arrests. This may relate to issues of enforcement and students’ willingness to engage in deviant behavior with a fake ID, or it may be a function of combined processes. Conclusions Overall, the findings suggest that interventions should not only be aimed at reducing the fake ID-related alcohol access specifically, but should also be aimed more generally toward at-risk youths’ access to alcohol. Future research might examine whether fake IDs have their strongest potency as moderators of the effects of risky traits—such as impulsiveness—on drinking outcomes.

Purpose: Most research examining patient-based drug diversion neglects to assess physician deception directly. We attempt to determine if motives for deception are linked to success, and, similarly, if any health, demographic, or substance use history characteristics of the patients are predictive of being able to successfully deceive a physician. Methods: Stratified random sampling was utilized to obtain a sample of 2349 young adults. Respondents completed a survey detailing their substance use histories and whether they had ever deceived a physician for medication. Ninety-three of these respondents reported attempting to deceive a physician for a medication and compose the analytic sample for the study. Results: Of the 93 young adults who reported having attempted to deceive a physician for pharmaceuticals (4.0% of the general sample), 64 (68.8%) were successful. This included 24 only seeking medications for their own use, 9 only for financial purposes, and 31 with both motives. Respondents who reported recreationally using pharmaceuticals in the past were more likely to report successful attempts at obtaining a prescription compared with respondents without a history of abuse. With respect to demographic characteristics of the respondents, only race/ethnicity distinguished between successful attempts and failure. Conclusions: Although a rare occurrence in the overall sample, significant correlates of successful deception did emerge. Respondents motivated to obtain a prescription in order to sell it to others were overwhelmingly likely to succeed in their pursuit to deceive as compared with respondents who sought prescriptions for their own abuse. Successful deceivers were also more likely to have been legitimately prescribed medication in the past. Successful respondents were more likely to be Caucasian than any other race/ethnicity.

Background Though case studies, media reports, and anecdotal evidence point to creative forms of alcohol use such as “eyeballing,” inhalation through vaporizers and other “alcohol without liquid” (AWOL) devices, and “slimming” as a growing trend, no empirical study has assessed the veracity of these claims. The present study attempts to debunk, confirm, or alter the popular perception that young adults are administering alcohol in novel ways. Methods A self-report paper survey was administered to 2349 young adults selected for inclusion using a stratified random sampling technique. Respondents were asked to indicate all of the ways in which they had administered alcohol and presented options ranging from traditional oral consumption from a cup, can, or bottle to innovative techniques referenced by medical reports and news outlets. The prevalence of each form of innovative use was reported and explored. Results Innovative alcohol use was very rare in the sample. Only 25 of 2349 participants (1.1%) had engaged in one or more of the creative methods of alcohol consumption. Among these individuals, most reported either using an AWOL device and/or administering alcohol anally. Vaginal administration and “eyeballing” were only reported by three and one respondents, respectively. Conclusions It appears that innovative alcohol use is more than an urban legend but that innovative use, even among a population with high rates of alcohol and drug use, is rare. Regardless, physicians and emergency medical personnel need to be aware of and prepared for dealing with innovative alcohol use.

Background: Pharmaceutical abuse is a burgeoning problem, and various forms of drug diversion are becoming more common. At present, little is known about those who attempt to deceive physicians to receive medications, and even less is known about those who successfully avoid detection and abuse-related repercussions. The goal of this study is to assess the prevalence of attempted physician deception in a general population, explore common motives, and evaluate risk factors associated with the behavior. Methods: A stratified random sampling technique was used to obtain a locally representative sample of 2349 young adults. The sample was 48.4% male, 68.9% white, 24.4% black, and 2.8% Hispanic. Selected individuals were surveyed using a self-report instrument (80.4% response rate). Results: Of the respondents, 93 (4.0%) self-reported having attempted to deceive a physician to obtain a pharmaceutical. Most of these indicated that they were at least partially motivated by their own abuse. Approximately half reported that selling a portion of the prescription was a motivating factor. Alcohol use, marijuana use, and pharmaceutical misuse each were risk factors associated with attempted deception. Although no traits were definitively linked to the behavior, attempted deception was more commonly reported by men, Hispanics, self-identified lesbian/gay/bisexual/transgender individuals, and those at the lowest and highest extremes of the income spectrum. Logistic regression models of rare events indicated that past substance use along with sexual orientation and family income were related to attempted deception when controlling for other factors. Conclusion: Results suggest that attempted physician deception may be more common than previously believed. Practicing physicians should attempt to use risk factor information presented within this study, albeit very cautiously. This study identifies general characteristics of young people who might divert medications but notes that only a small minority of any patient group will do so. Awareness should not equal bias in the treatment of these patients; instead, it should reinforce the need for careful clinical interviewing and the utilization of prescription drug monitoring programs and local law enforcement databases.

This research examines the characteristics of users of synthetic stimulants marketed as "bath salts." Synthetic stimulants such as MDPV (3,4-Methylenedioxypyrovalerone), Mephedrone (4-Methylmethcathinone), and Methylone (3,4-Methylenedioxymethcathinone) are often contained in products sold at convenience stores and over the Internet in the United States. Despite the recent legal action banning these types of synthetic stimulants, little is known about the characteristics of the users of these substances. This research provides a profile of bath salt users in the United States among an emerging adult population. A self-report survey instrument was administered to 2,349 students at a large university in the southeastern United States. Respondents indicated whether they had used synthetic stimulants and reported demographic characteristics. Results indicated that users of bath salts were more likely to be male, Hispanic or Native American, student athletes, employed, identify as a members of the LGBT community, and users of other substances.

While marijuana remains the most widely used illicit drug in the United States1 and is the subject of countless medical, psychological, and sociological studies,2 its potential harms are not fully ...

Misperceptions of peer substance use have previously been implicated as significant influences on individual use of both alcohol and illicit drugs. However, research on perceived social norms and related interventions are typically limited to binge drinking and marijuana and no empirical studies have explored misperceptions related to “novel drugs.” The present study explored the extent of use and perceptions of use among a college sample ( N = 2,349) for three categories of novel drugs: synthetic cannabinoids (Spice, K2, Mr. Miyagi, Pot-Pourri, etc.), synthetic cathinones (commonly known as “bath salts”), and Salvia divinorum. Results indicate that overall perceived use was significantly higher than actual reported use. The frequency of overestimation of peer use was particularly large for the emerging drugs when compared to alcohol and marijuana. This finding is concerning as these misperceptions have the potential to influence students toward experimentation with these substances and suggests that a possible target for intervention is misperceptions of emerging novel substances.

Acetyl fentanyl, a fentanyl analogue emerging onto the recreational drug scene, has been responsible for numerous recent fatal overdoses in the USA, Europe and Russia. Studies reporting acetyl fentanyl use are presently limited to case studies and mortality reports. This study explores the nature of acetyl fentanyl use through the collection of first-hand qualitative data from users to inform public health and drug control policy responses.A series of focus group interviews within a correctional setting-Delaware County (Ohio) Jail, USA. Participants were 102 individuals in one of two US Bureau of Justice Assistance Second Chance Act substance use treatment initiatives participating in at least one focus group session. Five of these individuals reported acetyl fentanyl use. Semi-structured qualitative focus group sessions queried subjects' drugs of choice and nature of drug use. Responses were explored through follow-up organic discourse.Acetyl fentanyl users were generally unaware that they had administered the substance until after use (initially believing that they were administering heroin). They described the effects of acetyl fentanyl as stronger and qualitatively different from heroin. These individuals showed no interest in using acetyl fentanyl again describing it as unpleasant and more risky, both because of potency and the threat of a 'bad batch'.Acetyl fentanyl is reaching heroin users, some of which administer it unknowingly. Regulation of acetyl fentanyl is recommended in all countries as is increasing public awareness that the substance is distinct from and being sold as heroin. [Miller JM, Stogner JM, Miller BL, Blough S. Exploring synthetic heroin: Accounts of acetyl fentanyl use from a sample of dually diagnosed drug offenders. Drug Alcohol Rev 2018;37:121-127].

Background A plant with dissociative and psychoactive properties began to attract the attention of the media and United States policymakers following a well-publicized suicide in 2006 and reports that the plant served as a ‘legal high' and substitute for cannabis. As a result, Salvia divinorum and its active ingredient, salvinorin A, were classified as Schedule I substances by the Florida Legislature on July 1, 2008. As of yet, no research has explored the efficacy of this policy or similar policies in other jurisdictions. Methods Three self-report studies collected from young adults both prior to and following the policy's implementation are employed to investigate the potential relationship between the policy and usage rates. In addition, law enforcement personnel from the state's most populated areas were interviewed to determine the extent to which they were encountering salvia in their work. Results It was indicated that less than two-thirds of those surveyed were aware of the drug's legal status. Lifetime prevalence of salvia use was largely unchanged. However, the rates of self-reported past year and past month use in Florida were significantly lower following the scheduling. Though use of Salvia divinorum appears to have decreased, perceptions of peer use increased markedly. Law enforcement officers and laboratories reported rarely, if ever, dealing with cases of salvia possession. Conclusions Data suggests the classification of Salvia divinorum as a Schedule I drug was followed by a substantial reduction in recreational use. We caution that other factors may have influenced use, that the efficacy of scheduling novel substances is likely to vary by drug type, that such a reduction in reported use may only exist transiently until a sophisticated illicit market develops to replace the legitimate one, and that a state's success in regulating salvia may be related to their regulation of and enforcement of other drug prohibitions.

The recreational use of Salvia divinorum has received increased attention by media outlets and policy-makers in recent years. The vast absence of research to guide the dissemination of information has prompted this research note describing the use of this substance in a large public institution of higher education. The prevalence of Salvia divinorum is described in this context and a description of patterns of use, methods of acquisition, and a subjective estimation of continuance are proffered.

The practice of "dabbing" has seen an apparent upswing in popularity in recent months within American drug subcultures. "Dabbing" refers to the use of butane-extracted marijuana products that offer users much higher tetrahydrocannabinol content than flower cannabis through a single dosage process. Though considerably more potent than most marijuana strains in their traditional form, these butane hash oil products and the practice of dabbing are underexplored in the empirical literature, especially in prohibition states. A mixed-methods evaluation of a federally funded treatment program for drug-involved offenders identified a small sample (n = 6) of butane hash oil users and generated focus group interview data on the nature of butane hash oil, the practice of dabbing, and its effects. Findings inform discussion of additional research needed on butane hash oil and its implications for the ongoing marijuana legalization debate, including the diversity of users, routes of administration, and differences between retail/medical and prohibition states.

* Abbreviations: BHO — : butane hash oil THC — : tetrahydrocannabinol The practice now known as “dabbing” appears to be quickly proliferating as a fashionable way to use marijuana in the United States.1 Dabbing is the inhalation of a concentrated tetrahydrocannabinol (THC) product created through butane extraction. The use of butane hash oil (BHO) products and the modification of cannabis more generally are not new phenomena, but dabbing has recently moved from relative obscurity to the headlines, leaving cannabis aficionados, adolescents, and parents curious about its effects. Physicians and other health care professionals need to be prepared for discussions about the effects of dabbing to minimize potential harms, particularly because recent marijuana policy changes likely has facilitated youth access to “dabs.” BHO is made from cannabis and in many instances may be used to salvage less potent portions of the plant.2 Because BHO production is uncomplicated, requires few resources, and is the subject of countless instructional videos on social media Web sites, recreational users have created BHO at home in a process colloquially called “blasting.” Blasting involves passing butane through a steel or glass tube packed with dried cannabis trimmings. THC and other hydrophobic compounds in the vegetation’s trichomes dissolve within the butane; the butane–THC solution leaves the tube through a filter and is collected in a dish or tray. Because butane is very volatile, it evaporates (or is purged within a vacuum oven), leaving crystalized resins that can have a THC concentration approaching 80%. This product can take many forms depending on heat, pressure, humidity, and other factors. The form most challenging to produce … Address correspondence to John M. Stogner, PhD, Department of Criminal Justice and Criminology, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223. E-mail: johnstogner{at}uncc.edu

Peer behaviors may significantly influence personal behavior yet individuals may not accurately estimate their peers’ actions. Overestimations of peer substance use may encourage initiation or exacerbate extant problems. The present study examines misperceptions of peer pharmaceutical misuse and explores the relationship between reported misuse and perceptions of misuse for four categories of prescription drugs. Data collected from 2,349 college students in the Southeastern United States were analyzed and results indicated that overall perceptions of misuse were significantly higher than actual misuse. These findings suggest that intervention efforts may benefit from addressing misperceptions of pharmaceutical misuse. Study limitations and implications are addressed.

BackgroundResearch suggests an association between frontal and temporal injury and antisocial conduct. We studied the frequency of antisocial behaviours in fronto-temporal dementia (FTD) where pathology is anterior frontal-temporal, compared with Alzheimer's disease (AD) where pathology is primarily posterior temporal-parietal.MethodThe presence of antisocial conduct was compared in 22 FTD versus 22 AD subjects. All FTD patients had anterior frontal or temporal hypoperfusion with single photon emission computed tomography, whereas those with AD had posterior temporal-parietal hypoperfusion.ResultsTen FTD and one AD subject showed antisocial behaviours, which included assault, indecent exposure, shoplifting and hit-and-run driving. Three FTD subjects were arrested. This difference was highly significant (P = 0.004).ConclusionsDegeneration of frontal and temporal lobes predisposes to antisocial behaviour. This study supports a relationship between frontal-temporal dysfunction and certain types of antisocial activities.

While it is commonly understood that the substance use of peers influences an individual's substance use, much less is understood about the interplay between substance use and friendship quality. Using a sample of 2,148 emerging adults nested within 1,074 dyadic friendships, this study separately investigates how concordance and discordance in binge drinking and marijuana use between friends is related to each friend's perceptions of friendship quality. Because "friendship quality" is a complex construct, we employ a measure containing five sub-elements--companionship, a lack of conflict, willingness to help a friend, relationship security, and closeness. Results for both binge drinking and marijuana use reveal that individuals in friendship pairs who are concordant in their substance use perceive significantly higher perceptions of friendship quality than individuals in dyads who are dissimilar in substance use. Specifically, concordant binge drinkers estimate significantly higher levels of companionship, relationship security, and willingness to help their friend than concordant non-users, discordant users, and discordant non-users. However, the highest amount of conflict in friendships is found when both friends engage in binge drinking and marijuana use. Several interpretations of these findings are discussed. Overall, concordance between friends' binge drinking and marijuana use appears to help some elements of friendship quality and harm others.

Until recently, synthetic cathinones marketed as 'bath salts' were legally sold at convenience stores and online in the USA. Media reports initiated concerns of a growing 'bath salt' epidemic. Despite media attention and the recent legal action banning synthetic cathinones, little is known about its prevalence or users.A self-report survey was administered to 2349 students in 40 randomly selected courses at a large university in the Southeastern United States. The resulting sample was 51.6% female, 68.9% white, 24.4% black, 2.8% Hispanic and 4.0% other races, with a mean age of 20.06 years and median family income of $75 000-99 999.Only 25 (1.07%) of the students reported using synthetic cathinones at least once. Synthetic cathinone use was found to be more common among men (1.68% vs. 0.50% of women, P = 0.005), Hispanics (4.7%) and Native Americans (4.3% vs. 0.89% of whites and 0.72% of blacks, P = 0.002), and student athletes (4.0% vs. 0.90% of non-athletes, P = 0.001), but in each of these groups, synthetic cathinones were used more rarely than marijuana (58.14%, P 0.001), cocaine (9.08%, P 0.001), Salvia divinorum (7.89%, P 0.001), synthetic cannabinoids (14.28%, P 0.001), methamphetamines (1.92%, P = 0.002), 3,4-methylenedioxy-N-methylamphetamine (MDMA) (12.54%, P 0.001) and several other drugs and pharmaceuticals.'Bath salts' have received a great deal of media attention in the USA, yet the prevalence of synthetic cathinone use among our sample was extremely rare. We suggest that the media attention focusing on synthetic cathinone use as a growing epidemic may be largely misplaced.

Researchers commonly use a person's perception of the drug use of friends to determine the impact that peers exert on one's own behavior. Recently, there has been concern over this measure's validity. Novel drugs, which are either newly discovered drugs or existing substances only recently used for recreational purposes, may be used so infrequently that people have too few observable opportunities to accurately develop perceptions of their peer's use. Employing survey data collected in 2009 from 2,154 individuals within friendship pairs in the Southeast United States, we explore how gender affects perceptions of the infrequently used, novel drug Salvia divinorum. The study's limitations are noted.

A mixture of codeine cough syrup with alcohol and/or a soft drink known as "purple drank" has gained media attention in recent years as a drug associated with professional athletes and southern rap music. The existing research on purple drank consumption has primarily utilized samples of African Americans residing in the Houston, Texas area. This is the first scholarly study of purple drank use outside of the Houston, Texas area among a general population of young adults, and indicates that purple drank use is not limited to African American males. The findings depict higher odds of the use of purple drank among other racial and ethnic groups, males, and homosexual, bisexual, and transgender college students from urban areas.

We present a case of acute alcohol-induced Korsakoff amnesia. A severe amnestic-confabulatory syndrome characterized the early clinical status. The initial neuropsychological tests demonstrated severe learning deficits plus impaired performance on many, but not all, tests of frontal lobe function. Single-photon emission CT (SPECT) at this stage showed hypoperfusion in the orbital and medical frontal regions and the medial diencephalic area. Four months later, the patient's amnesia remained but there was no confabulation. Repeat neuropsychological tests confirmed an ongoing severe amnesia, but performance on the frontal lobe tests now was normal. Repeat SPECT showed a return to normal perfusion in the frontal brain areas but little improvement in the medial diencephalic region. These findings along with data from the clinical literature suggest that confabulation results from dysfunction of orbital and a medial frontal cortex.

Background This study aims to understand which young adults’ drinking behaviors change in the presence of happy hour specials, the ways in which they change, and whether a link exists between happy hour drinking behavior and negative outcomes. Methods Using data collected from bar-going respondents (n = 1,423) within a print survey administered to a general college sample (n = 2,349), we identify significant differences in changes in happy hour behavior between demographic groups using χ2 tests and determine whether this behavior is related to six negative alcohol-related outcomes using logistical and ordinary least squares regression models with a variety of controls, including age of onset and frequency of use. Results Women, students under 21, non-athletes, members of Greek-affiliated organizations, more affluent and unemployed students, and students living on campus were more likely to change their drinking behavior in the presence of happy hour specials. In general, the most robust predictors of negative events are gender, alcohol use frequency, age of alcohol use onset, and increasing drinking due to happy hours/bar specials. While it was linked to various negative and illegal behaviors, altered happy hour drinking was not associated with an increased likelihood of an alcohol-related arrest. Conclusions This study lends support to the idea that alcohol price specials should be regulated in an effort to reduce high consumption and alcohol-related negative consequences. Future research into the relationship between happy hour drinking and negative outcomes is necessary and should examine the impact of happy hour advertisements, different types of specials, and the timing of happy hours.