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Background: Previous studies have identified common trajectories of single type substance use over the course of adolescence; however, no study to date has examined joint trajectories of cannabis and alcohol concurrent use. Given that expansion of legal cannabis has increased availability, it is important to understand patterns of concurrent use in adolescents and factors that place male and female youth at risk for harmful trajectories of concurrent use. The current study sought to identify joint trajectories of cannabis and alcohol use - and predictors of harmful use trajectories - among male and female adolescents., Method: We used 4 waves of data from 6997 early adolescent participants (age 12-14 years at Wave 1) in the Population Assessment of Tobacco and Health, a nationally representative longitudinal study in the United States. Participants reported their cannabis and alcohol use reassessed yearly for 5 years (2013-2018). We used joint trajectory growth mixture modeling to identify trajectory groups as defined by changes in alcohol and cannabis use over time., Results: Five classes of alcohol and cannabis concurrent use trajectories were identified. Both internalizing and externalizing symptoms at Wave 1 increased the odds of membership in trajectory groups characterized by more harmful use trajectories. Internalizing symptomatology was a stronger predictor of membership in escalating use trajectories among girls, whereas externalizing symptomatology stronger predictor among boys., Conclusions: These findings underscore the utility of jointly considering alcohol and cannabis use when describing common developmental trajectories of use and identifying risk factors for trajectories characterized by harmful use., Competing Interests: Declaration of Competing Interest No conflict declared., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Alcohol use disorders (AUDs) are among the most prevalent behavioral and mental health diagnoses. Individuals with an AUD are at increased risk for numerous consequences across their social, health, and psychological functioning. Research suggests that differences may exist in the prevalence and consequences of AUD and in the efficacy of AUD treatment across demographic characteristics (i.e., sex/gender and race/ethnicity). This meta-epidemiologic review examined the inclusion of diverse groups (sex/gender and race/ethnicity) in published randomized controlled trials of nonpharmacological treatments for AUD since 1994, following passage of the National Institutes of Health Revitalization Act of 1993. We systematically searched databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement criteria. The initial search strategy yielded 7931 articles. After excluding ineligible articles, 155 were included in the present review for synthesis. Of the articles included in this review, only 57 (36.8%) fully reported on both their sample's sex/gender and racial/ethnic breakdown. Of the total sample, seven articles specifically examined one racial/ethnic group and 32 specifically examined one sex/gender group. Six articles (3.9%) reported no information regarding the racial/ethnic breakdown of their sample and five articles (3.2%) reported no information regarding the sex/gender breakdown of their participants. Only two articles (1.3%) reported on subgroup analyses that examined differences in treatment outcomes by both sex/gender and race/ethnicity, despite guidelines set forth by NIH. Only 46 articles (29.7%) described the failure to include diverse sex/gender or racial/ethnic groups or concerns about the generalizability of study findings given their sample's sex/gender or racial/ethnic composition as methodological limitations. These results indicate that substantial efforts must be put forth by the scientific community to ensure the inclusion, analysis, and reporting of data focused on women/females and members of minoritized racial/ethnic groups., (© 2022 by the Research Society on Alcoholism.)

Pharmacological treatments for opioid use disorders (OUDs) may have mixed efficacy across diverse groups, i.e., sex/gender, race/ethnicity, and socioeconomic status (SES). The present systematic review aims to examine how diverse groups have been included in U.S. randomized clinical trials examining pharmacological treatments (i.e., methadone, buprenorphine, or naltrexone) for OUDs. PubMed was systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The initial search yielded 567 articles. After exclusion of ineligible articles, 50 remained for the present review. Of the included articles, 14.0% (n = 7) reported both full (i.e., accounting for all participants) sex/gender and race/ethnicity information; only two of those articles also included information about any SES indicators. Moreover, only 22.0% (n = 11) reported full sex/gender information, and 42.0% (n = 21) reported full racial/ethnic information. Furthermore, only 10.0% (n = 5) reported that their lack of subgroup analyses or diverse samples was a limitation to their studies. Particularly underrepresented were American Indian/Alaska Native (AI/AN), Asian, Native Hawaiian/Other Pacific Islander (NH/OPI), and multiracial individuals. These results also varied by medication type; Black individuals were underrepresented in buprenorphine randomized controlled trials (RCTs) but were well represented in RCTs for methadone and/or naltrexone. In conclusion, it is critical that all people receive efficacious pharmacological care for OUDs given the ongoing opioid epidemic. Findings from the present review, however, support that participants from diverse or marginalized backgrounds are underrepresented in treatment trials, despite being at increased risk for disparities related to OUDs. Suggestions for future research are advanced. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background : Military veterans are at greater risk for substance misuse. Positive emotional intensity is one well-established antecedent of substance misuse in this population. Positive emotional avoidance, or attempts to alter the form, frequency, or context of positive emotions, may help to explain this association. While clinical practice typically aims to increase positive emotions, such approaches may have iatrogenic effects, as high-intensity positive emotions may be experienced as distressing and prompt avoidance for some populations. This suggests a need to better understand responses to positive emotions to inform clinical practice. Objectives : The goal of the current study was to advance theory, research, and clinical practice by exploring the role of positive emotional avoidance in the associations between positive emotional intensity and both alcohol and drug misuse. We hypothesized that positive emotional intensity would indirectly influence alcohol and drug misuse through positive emotional avoidance. Methods : Participants were a community sample of United States military veterans recruited through Amazon's Mechanical Turk ( n = 535, M age  = 37.45, 71.8% male, 69.5% White). Results : Correlations among positive emotional intensity, positive emotional avoidance, and alcohol and drug misuse were significant and positive ( r s range from.13 to.41). Further, positive emotional avoidance was found to account for the relations of positive emotional intensity to alcohol (indirect effect: b =.04, 95% CI [.01,.08]) and drug misuse (indirect effect: b =.01, 95% CI [.01,.02]). Conclusions : Results provide preliminary support for the potential clinical utility of targeting avoidance responses to positive emotions in interventions targeting alcohol and drug misuse among military veterans.

Tobacco use is among the top preventable causes of death in the United States, and American Indian (AI) adolescents tend to use tobacco at higher rates compared to the general population. To examine regional and gender differences in rates of smoked, smokeless, and poly-tobacco use among AI adolescents as compared to White counterparts, participants were sampled as part of a larger ongoing study examining substance use among American Indian adolescents who completed the American Drug and Alcohol Survey. A multilevel analytic approach was used to examine the effects of demographic variables on tobacco use. AI disparities were present for past month and lifetime rates of smoked and smokeless tobacco use, and these disparities varied by region and gender. AI disparities in smoked tobacco use were largest in the Upper Great Lakes region, with odds of current and ever smoking among AIs 3.34 to 4.15 times that of Whites, respectively, p < .001. Regional differences in AI disparities were not significant for lifetime smokeless or poly-tobacco use, p ≥ .675. With regard to gender differences, AI disparities in reports of ever smoking were largest among females, OR = 2.61, p < .001. Similar to cigarette smoking, AI disparities in reports of ever using smoked, smokeless, or poly-tobacco were largest among females, OR = 2.51 and 2.56, respectively, p < .001. Our results suggest a need for prevention and intervention programs to be implemented with consideration for adolescents' demographic characteristics, including geographic region, gender, and AI status.

Introduction: The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol misuse presents a pervasive and clinically relevant concern among US military veterans., Objective: The current investigation sought to examine the role of positive emotion dysfunction in the relation between PTSD symptomatology and alcohol misuse. To do so, we examined the separate and sequential roles of positive emotional intensity and positive emotional avoidance in the relation between PTSD symptoms and alcohol misuse among US military veterans., Method: Cross-sectional data were collected from 468 US military veterans (M age = 37.74, 70.5% male, 69.0% White) who responded to an online survey., Results: Findings suggest that positive emotional avoidance, separately, and positive emotional intensity and positive emotional avoidance, sequentially, mediated the relation between PTSD symptoms and alcohol misuse., Conclusions: Findings advance theory on the role of positive emotions and related processes in the co-occurrence of PTSD and alcohol misuse, and highlight important avenues for future research and treatment focused on the PTSD-alcohol misuse co-occurrence., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Post-traumatic stress disorder (PTSD) is characterized by avoidance of trauma-related emotions. Research indicates that this avoidance may extend to any emotional experience that elicits distress, including those that are unrelated to the trauma. Literature in this area has been limited in its exclusive focus on negative emotions. Despite evidence of gender differences in PTSD and emotional avoidance separately, no studies to date have examined gender as a moderator of their association. The goal of the current study was to extend research by exploring the moderating role of gender in the relation between PTSD symptom severity and positive and negative emotional avoidance. Participants were 276 trauma-exposed individuals (65.9% female, 65.6% White, M age = 19.24) from a university in the north-eastern United States. Moderation results indicated a main effect for PTSD symptom severity on both positive (b = 0.07, p < .001) and negative (b = 0.04, p = .03) emotional avoidance. The interaction of gender and PTSD symptom severity was significant for positive emotion avoidance (b = 0.97, p = .01). Analysis of simple slopes revealed that PTSD symptom severity was significantly associated with positive emotional avoidance for males (b = 0.13, p < .001) but not females (b = 0.03, p = .08). Results suggest the importance of gender-sensitive recommendations for assessment and treatment of emotional avoidance in PTSD., (© 2020 John Wiley & Sons, Ltd.)

Research has identified heterogeneous subgroups of individuals based on posttraumatic stress disorder (PTSD) and depression symptoms. Using data collected from military personnel in India (N = 146) and U.S. (N = 194), we examined (1) the best-fitting latent class solution; (2) multi-group invariance of the class solution; and (3) construct validity of optimal class solution. Results indicated that the optimal 4-class solution differed in severity and severity/type in the India and U.S. samples respectively. With similarity in the optimal number of classes across cultural samples, the meaning/nature of classes differed. In the India sample, anxiety severity predicted the Low Severity Class vs. all other classes, and the Moderately High Severity/High Severity Classes vs. the Moderately Low Severity Class; number of traumas predicted the High Severity Class vs. other classes; and resilience predicted the Moderately Low Severity Class vs. the Moderately High Severity Class. In the U.S. sample, alcohol use predicted the High Severity Class vs. all other classes, and the High Depression-Low PTSD Class vs. the Low Severity Class; rumination significantly predicted the High Severity and High Depression-Low PTSD Classes vs. each of the High PTSD-Low Depression and Low Severity Classes. Thus, meaning and nature of PTSD-depression subgroups may vary culturally; hence, culturally-sensitive interventions need to account for this heterogeneity., Competing Interests: Declaration of Competing Interest None, (Copyright © 2020 Elsevier Ltd. All rights reserved.)

American Indian (AI) adolescents experience disproportionately higher rates of alcohol use and related consequences. While self-esteem has been found to be associated with alcohol use in non-AI samples, little is known about this relationship in AI adolescents. Further, there is a dearth of literature examining the psychometric properties of self-esteem measures for AI adolescents. The current study aims to examine the factor structure of the self-esteem items of the American Drug and Alcohol Survey (ADAS) and to better understand the relationships among self-esteem, alcohol use, and alcohol-related problems in AI adolescents. The present study represents secondary analyses of cross-sectional data collected between 2009 and 2013. Participants ( n = 3,498) were AI adolescents ( M age = 14.8, 47.7% female) attending schools on or near reservations across 11 states. Participants completed the American Drug and Alcohol Survey. Factor analytic results suggested 2 factors, representing intrapersonal (from intrinsic sources) and interpersonal self-esteem (from extrinsic sources). Multilevel regression analyses revealed that, with both factors entered into the model, intrapersonal self-esteem was negatively associated with alcohol consumption and alcohol-related problems, while interpersonal self-esteem was positively associated with alcohol consumption and alcohol-related problems. Results suggest the importance of examining the properties of assessment tools before they are used with a community for whom they were not developed. Further, self-esteem does not appear to be universally protective. Rather, interventions should aim to consider sources from which AI adolescents are drawing self-esteem and focus on promoting more intrinsic sources rather than aiming to increase self-esteem in general. (PsycInfo Database Record (c) 2020 APA, all rights reserved).