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Background and Objectives: There may be substantial overlap in the risk factors for substance use and substance use disorders (SUD). Identifying risk factors for substance use initiation is essential for understanding the etiology and natural history of SUD and to develop empirically-based preventive interventions to reduce initiation.Methods: Analyses were done on Wave 1 participants of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) (n = 43,093). Estimates of the cumulative probability of substance use initiation were obtained separately for nicotine, alcohol, cannabis, and cocaine. Survival analyses with time-varying covariates were implemented to identify risk factors for substance initiation.Results: The lifetime cumulative probabilities of substance initiation were 45.5% for nicotine, 82% for alcohol, 19.6% for cannabis, and 6.4% for cocaine. Among respondents with lifetime nicotine use, 50% had used it by age 15.3, whereas for alcohol, cannabis, and cocaine the respective ages were 17.8, 16.6, and 19.8. Previous use of another substance, being male, having a cluster B personality disorder, family history of SUD, and being separated, divorced, or widowed increased the risk of use of all the substances assessed, whereas social anxiety disorder and some personality disorders were associated with specific substances.Discussion and Conclusions: Although the age of substance use initiation varies by substance, in more than 50% of cases initiation of use occurs in the first two decades of life. Although most risk factors for substance use initiation are common across substances, some are substance-specific.Scientific Significance: This information may help in the development of empirically-based preventive interventions. (Am J Addict 2018;27:477-484). [ABSTRACT FROM AUTHOR]

Abstract: Aims: To conduct a systematic review and meta‐analysis of studies in order to estimate the effect of US medical marijuana laws (MMLs) on past‐month marijuana use prevalence among adolescents. Methods: A total of 2999 papers from 17 literature sources were screened systematically. Eleven studies, developed from four ongoing large national surveys, were meta‐analyzed. Estimates of MML effects on any past‐month marijuana use prevalence from included studies were obtained from comparisons of pre–post MML changes in MML states to changes in non‐MML states over comparable time‐periods. These estimates were standardized and entered into a meta‐analysis model with fixed‐effects for each study. Heterogeneity among the study estimates by national data survey was tested with an omnibus F‐test. Estimates of effects on additional marijuana outcomes, of MML provisions (e.g. dispensaries) and among demographic subgroups were abstracted and summarized. Key methodological and modeling characteristics were also described. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed. Results: None of the 11 studies found significant estimates of pre–post MML changes compared with contemporaneous changes in non‐MML states for marijuana use prevalence among adolescents. The meta‐analysis yielded a non‐significant pooled estimate (standardized mean difference) of −0.003 (95% confidence interval = −0.012, +0.007). Four studies compared MML with non‐MML states on pre‐MML differences and all found higher rates of past‐month marijuana use in MML states pre‐MML passage. Additional tests of specific MML provisions, of MML effects on additional marijuana outcomes and among subgroups generally yielded non‐significant results, although limited heterogeneity may warrant further study. Conclusions: Synthesis of the current evidence does not support the hypothesis that US medical marijuana laws (MMLs) until 2014 have led to increases in adolescent marijuana use prevalence. Limited heterogeneity exists among estimates of effects of MMLs on other patterns of marijuana use, of effects within particular population subgroups and of effects of specific MML provisions. [ABSTRACT FROM AUTHOR]

Background: Loneliness is a widespread problem, with demonstrated negative health effects. However, prospective data on the relationship between loneliness and problematic substance use are lacking, and few studies have examined specific commonplace substances, such as alcohol and cannabis. This study used prospective data from a community sample of US adults with problematic alcohol or cannabis use to examine whether loneliness was a predictor of subsequent increased substance use.Methods: Participants (N = 210) were recruited between 05/2016-06/2019 from a New York City medical center. At baseline, 3-month, and 6-month follow-ups, participants completed identical computerized questionnaires. We used generalized estimating equations to assess the average effect of past 2-week loneliness on subsequent number of days of alcohol or cannabis use, controlling for baseline days of use, demographic characteristics, and past 2-week DSM-5 depression.Results: Compared with individuals who were never lonely, participants with moderate or severe loneliness had a significantly higher frequency of alcohol or cannabis use at the subsequent assessment (β = 0.25 95% CI: 0.08-0.42).Conclusion: Individuals experiencing loneliness at least a few times in the past 2 weeks reported more days of subsequent alcohol or cannabis use compared with individuals who were not lonely. This is cause for concern, as national surveys of US adults indicate increasing rates of loneliness, depression and substance use during the COVID-19 pandemic. These results suggest the need for health care providers to screen for feelings of loneliness and potentially harmful coping behaviors such as substance use, and to offer healthier alternative coping strategies. [ABSTRACT FROM AUTHOR]

Background: Marijuana use has been decreasing in the past several years among adolescents, though variation in the extent and rate of decrease across racial/ethnic groups is inadequately understood.Methods: The present study utilized nationally-representative data in Monitoring the Future from 2006 to 2015 to examine trends over time in past 30-day marijuana use. We examine whether differences in trends over time by race and ethnicity also differ by individual-level, school-level, and state-level factors. Sample included 131,351 8th grade students, 137,249 10th grade students, and 123,293 12th grade students; multi-level models and difference-in-differences tests were used.Results: In 10th grade, Black students had a positive linear increase in marijuana use (est=0.04, SE=0.01, p<0.001), and the magnitude of the increase was significantly greater than among non-Hispanic White students (est=0.38, SE=0.009, p<0.001). The increase trend among Black students was greater among those in large class sizes. In 12th grade, all racial ethnic groups except non-Hispanic Whites demonstrated a linear increase in prevalence across time. The magnitude of the increase among Hispanic students was greater among those in urban areas and large class sizes. The magnitude of the increase among Black students was greater in states with a medical marijuana law before 2006 (est=0.06, SE=0.03, p=0.02), among other state-level covariates.Conclusion: Together these results suggest that the next stage of public health approaches to reducing the harms associated with adolescent drug use should attend to shifting demographic patterns of use among adolescents and ensure that services and programmatic approaches to adolescent prevention are applied equitably. [ABSTRACT FROM AUTHOR]