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Tests substance-related and non-substance-related psychiatric disorders as predictors of attempted suicide among adolescents. Bipolar disorder, cocaine use disorders, and conduct disorder were found to be predictive of attempted suicide in univariate testing. Higher rates of cocaine use disorder/conduct disorder, hallucinogen use disorder/conduct disorder, and alcohol use disorder/ conduct disorder were found among suicide attempters. (Contains 44 references and 2 tables.) (GCP)

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2006.06.027 Byline: Jack R. Cornelius, Duncan B. Clark, Maureen Reynolds, Levent Kirisci, Ralph Tarter Keywords: Early sexual behavior; Substance use disorders (SUDs); Deviant peers Abstract: A recent study has reported that early sexual behavior predicts the development of substance use disorders (SUD). However, that relationship was considered by its authors to be only tentative, because it was based on cross-sectional data rather than longitudinal data. Another recent study reported that deviant activities of peers predict development of SUD, although that relationship has not yet been confirmed. The objective of this study was to assess whether early onset of sexual intercourse and affiliation with deviant peers serve as predictors of the development of SUD, using a prospective longitudinal study design. Author Affiliation: Center for Education and Drug Abuse Research (CEDAR), University of Pittsburgh, 3811 O'Hara Street, PAARC Suite, Pittsburgh, PA 15213, USA Article Note: (footnote) [star] Presented in part at the 67th Annual Scintific Meeting of the College on Problems of Drug Dependence (CPDD), Orlando, Florida, June 18-23, 2005.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2006.05.007 Byline: Ihsan M. Salloum (a), Antoine Douaihy (a), Jack R. Cornelius (a), Levent Kirisci (b), Thomas M. Kelly (a), Jeanine Hayes (a) Keywords: Bipolar disorder; Comorbidity; Cocaine dependence; Divalproex; Treatment; Dual diagnosis Abstract: The aim of this open-label pilot study was to evaluate the utility of divalproex in decreasing cocaine use and stabilizing mood symptoms among patients with bipolar disorder with comorbid cocaine dependence. Author Affiliation: (a) Western Psychiatric Institute and Clinic of the University of Pittsburgh Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, United States (b) Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15213, United States

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2006.03.016 Byline: Duncan B. Clark (a), Bobby L. Jones (b), D. Scott Wood (a), Jack R. Cornelius (a) Keywords: Substance use disorders; Course; Phenotypes Abstract: Substance use disorders (SUDs) may be characterized by onset age, severity, substance type, course, and outcomes. SUD phenotypes in the literature typically consider each of these features in isolation. Conceptual frameworks and data collection procedures for assessing SUD phenotypes are increasingly 'diachronic' in approach, providing for characterizations 'throughout time'. The recent availability of statistical procedures for the identification of latent classes offers the possibility of developing SUD phenotypes integrating these developmental features. This article illustrates the utilization of SAS-TRAJ mixture modeling to characterize variations in SUD symptom trajectories to define phenotypes. Author Affiliation: (a) Center for Education and Drug Abuse Research, University of Pittsburgh, USA (b) Carnegie Mellon University, USA

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2005.10.003 Byline: Amy M. Kilbourne (a)(b)(c), Ihsan Salloum (a)(c), David Dausey (c)(d), Jack R. Cornelius (a)(c), Joseph Conigliaro (e), Xiangyan Xu (a), Harold Alan Pincus (c)(d) Keywords: Mental disorders; Substance use disorders; Psychotic disorders; Quality of care; Quality indicators Abstract: We assessed the quality of care for substance use disorders (SUDs) among 8,083 patients diagnosed with serious mental illness from the VA mid-Atlantic region. Using data from the National Patient Care Database (2001-2002), we assessed the percentage of patients receiving a diagnosis of SUD, percentage beginning SUD treatment 14 days or earlier after diagnosis, and percentage receiving continued SUD care 30 days or less. Overall, 1,559 (19.3%) were diagnosed with an SUD. Of the 1,559, 966 (62.0%) initiated treatment and 847 (54.3%) received continued care. Although patients diagnosed with bipolar disorder were more likely to receive a diagnosis of SUD than those diagnosed with schizophrenia or schizoaffective disorder (22.7%, 18.9%, and 17.7%, respectively; I.sup.2 = 26.02, df = 2, p < .001), they were less likely to initiate (49.1%, 70.7%, and 68.6%, respectively; I.sup.2 = 59.29, df = 2, p < .001) or continue treatment (39.9%, 63.2%, and 62.2%, respectively; I.sup.2 = 72.25, df = 2, p Author Affiliation: (a) VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA (b) Department of Medicine; University of Pittsburgh; Pittsburgh, PA 15213, USA (c) Department of Psychiatry; University of Pittsburgh; Pittsburgh, PA 15213, USA (d) RAND-University of Pittsburgh Health Institute; Pittsburgh, PA 15213, USA (e) University of Kentucky Medical Center, Lexington, KY, USA Article History: Received 21 June 2005; Revised 18 October 2005; Accepted 25 October 2005 Article Note: (footnote) [star] The authors of this manuscript warrant that we have no actual or perceived conflicts of interest -- financial or nonfinancial (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, royalties) -- in the procedures described in the enclosed manuscript.

Studies are conducted on heterogeneity in treated adolescents' patterns of alcohol use and symptoms over a one- year follow up. Alcohol use trajectories and alcohol symptom trajectories are identified and studied and the most frequent joint outcome of alcohol use and symptom trajectory is identified.

The results of a twelve-week open label acute phase trial and a five-year follow-up study of fluoxetine in adolescents with major depression and a substance use disorder (SUD) are reviewed. It is observed that the long-term clinical course for the Alcohol Dependence, Cannabis Dependence and academic functioning of comorbid adolescents following acute phase treatment is generally good but the clinical course for the Major Depression of that comorbid adolescent population is poor.

Adolescent alcohol use disorders (AUDs) are investigated to predict adult borderline personality disorder (BPD) symptoms by using details of childhood physical and/or sexual abuse (PSA) history, semi-structured interviews and young adult follow-up assessment. Results are consistent with the conceptualization of BPD as a severe manifestation of a multiplicity of phenotypes indicating psychological dysregulation and a model, which mediated between PSA and BPD, is presented.

Young adults who are treated in Level-I emergency departments (ED) are studied using comprehensive psychiatric interviews, the Alcohol Use Disorders Identification Test (AUDIT) and the Cognitive Appraisal of Risky Events (CARE) to examine the relationship between alcohol use disorder (AUD) symptoms and risk for injury. It is found that young adults treated for alcohol-related medical problems often display DSM-IV defined symptoms of AUD and engage in risk-taking behaviors.

Studies are conducted on bipolar alcoholic patients with comorbid marijuana abuse using randomized, double blind, placebo-controlled trial tests and the impact of marijuana abuse on alcohol and mood outcome are examined. Results reveal that patients with bipolar alcoholism with comorbid marijuana abuse are younger and less educated than those without marijuana abuse and are more likely to be involved in psychiatric comorbidity.

An open-label study is conducted on adolescents with alcohol dependence using ondansetron, which is a 5-HT(sub 3) antagonist. Results show that ondansetron reduces 'craving' in the subjects as measured by the Adolescent Obsessive-Compulsive Drinking Scale (A-OCDS) and that irresistibility and A-OCDS scores decrease significantly during treatment.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2005.07.005 Byline: Thomas M. Kelly (a), John E. Donovan (b), Jack R. Cornelius (a), Oscar G. Bukstein (a), Theodore R. Delbridge (c), Janet M. Kinnane (d) Keywords: Alcohol use disorder; Injury; Emergency department; Risk-taking behavior Abstract: Studies of alcohol-positive patients in emergency departments are not clear on the relationship between alcohol use disorder (AUD) symptoms and risk for injury. Author Affiliation: (a) Pittsburgh Adolescent Alcohol Research Center, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara St., Pittsburgh, PA, 15213, United States (b) Tween to Teen Project, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, United States (c) Emergency Services, UPMC Health System Presbyterian Hospital, United States (d) UPMC, Children's Hospital of Pittsburgh, Department of Pediatrics, Division of Emergency Medicine, United States

Ondansetron is shown to be effective in the treatment of early-onset adult alcohol dependence. Preliminary data from studies conducted suggest that ondansetron is safe and well tolerated in adolescents with alcohol dependence and findings of decreased drinking underscore the need for future double-blind, placebo-controlled studies in this adolescent population.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2004.08.025 Byline: Jack R. Cornelius, Duncan B. Clark, Oscar G. Bukstein, Thomas M. Kelly, Ihsan M. Salloum, D. Scott Wood Abstract: The goal of this 3-year follow-up evaluation was to determine whether the decreases in drinking and in depressive symptoms that were noted during our acute phase study with fluoxetine in comorbid adolescents persisted at a 3-year follow-up evaluation. At the 3-year follow-up evaluation, the group continued to demonstrate significantly fewer DSM criteria for an AUD and fewer BDI depressive symptoms and also consumed fewer standard drinks than they had demonstrated at the baseline of the acute phase study. However, 7 of the 10 participants demonstrated MDD at the 3-year follow-up assessment, and 4 demonstrated an AUD. The presence of a MDD was significantly correlated with the presence of an AUD at both the 1-year and the 3-year follow-up assessments. Four of the participants restarted SSRI medications during the follow-up period. Half of the subjects graduated from college during the 3-year assessment period, despite their residual depressive symptoms and drinking. We conclude that the long-term therapeutic effects of an acute phase trial of fluoxetine plus psychotherapy slowly decrease but did not disappear when fluoxetine is discontinued shortly after the acute phase trial. The high rate of MDD at follow-up suggests that longer term antidepressant medication treatment may be needed for at least some comorbid adolescents. Author Affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, PAARC Suite, Pittsburgh, PA 15213, USA Article Note: (footnote) [star] Presented in part at the 65th Annual Meeting of the College on Problems of Drug Dependence (CPDD), Bal Harbour, FL, June 14, 2003, and at the 26th Annual Scientific Meeting of the Research Society on Alcoholism (RSA), Fort Lauderdale, FL, June 21, 2003.

Objective: Beyond the initial relapse episode, little is known about short-term patterns of alcohol and other drug use in treated adolescents. This study characterized treated teens' short-term alcohol and other drug use trajectories over 1-year follow-up. Method: Adolescents (N = 110, ages 12-18, 65% male, 94% white) recruited from addictions treatment, with a current DSM-1V alcohol diagnosis, reported on daily alcohol and other drug use in monthly telephone contacts over 1-year follow-up using the Timeline Follow-Back procedure. Latent class mixture modeling identified trajectories based on maximum number of consecutive abstinent days per month, separately for alcohol and other drugs. Results: Four alcohol trajectories were identified: high abstinence (53%), decreasing abstinence (10%), increasing abstinence (16%) and low abstinence (21%). The alcohol trajectories were distinguished by gender, age, readiness to change substance use and alcohol-related coping. To characterize changes in alcohol abstinence in relation to abstinence from other drugs, four other drug trajectories were identified: high (59%), decreasing (12%), increasing (14%) and low (15%) abstinence. Crass-classification of the alcohol and drug trajectories indicated a moderate level of concordance (kappa 0.49). Conclusions: Multiple pathways of short-term change in alcohol and other drug use were identified. Although changes in abstinence from alcohol and other drug use tended to co-occur, exceptions were observed. Differences between alcohol trajectories in readiness to change substance use and use of substance coping suggest the potentially positive impact of targeted and effectively timed interventions that focus on motivational enhancement and on improving substance coping for certain adolescent subgroups. (J. Stud. Alcohol 65:105-114, 2004), RESEARCH ON adolescent substance use disorder (SUD) treatment outcomes indicates that adolescents tend to show reductions in substance use severity and improvements in psychosocial functioning at 1-year follow-up (Williams et [...]

Objective: This study was undertaken to explore the characteristics of young patients treated in emergency departments (EDs) who follow through with an evaluation for psychiatric disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and to investigate differences in rates of psychiatric disorders between ED-treated adolescents and demographically similar adolescents recruited from the community. Method: Sixty three older adolescents (40 males) who were treated at two urban university hospital EDs were matched one-to-one on age, gender and race with 63 adolescents recruited from the community for participation in studies at an alcohol research center. Comprehensive psychiatric interviews were conducted with both groups. Results: ED-treated adolescents were diagnosed with higher rates of current alcohol use disorders (AUDs), current drug use disorders and current major depression than were community controls. The ED sample had a particularly high rate of the DSMIV 'hazardous use' of alcohol symptom. ED-treated adolescents also had a higher rate of lifetime comorbid alcohol use disorders and drug use disorders, as well as a higher rate of lifetime comorbid alcohol use disorders and major depression, compared with the community controls. Conclusions: Adolescents who are treated in EDs should be routinely assessed for the presence of AUD, drug involvement and depressive disorders., RESEARCH EFFORTS with adolescents seen in emergency departments (EDs) have recently moved toward initiation of treatment for young alcohol abusers in EDs so that detected problems can be addressed quickly [...]

A trial of the effects of the anti-depressive drug fluoxetine on adolescent patients with depression and alcohol dependency problems. Research showed that the fluoxetine helped reduce alcohol dependency as well as depressive symptoms.

This article discusses the mental health of female alcoholics with bipolar disorder. The authors maintain that females with bipolar disorder who are dependent on alcohol are more likely to report feelings of depression than females with bipolar disorder who are not dependent on alcohol and men bipolar alcoholics.

Research into the clinical factors distinguishing adolescents with heavy smoking from those with light smoking is presented. The strong link between substance-use disorders and heavy smoking among adolescents was confirmed.

Research is presented concerning the factors which influence the need for mental health service utilization among adolescent males. The importance of parental factors in the unmet treatment needs of children is discussed.

The efficacy of fluoxetine persists for treating the depressive symptoms and the excessive drinking of patients with comorbid major depressive disorder and alcohol dependence. This research involved a one-year naturalistic follow-up of 31 patients who had previously participated in a three-month double-blind, placebo-controlled study of fluoxetine in depressed alcoholics. It appears that a prolonged course of up to 12 months of continuation pharmacotherapy is generally appropriate for depressed alcoholics.

An evaluation of the efficacy of the SSRI antidepressant fluoxetine versus placebo for the marijuana use of depressed alcoholics indicated efficacy for fluoxetine in decreasing the marijuana consumption as well as for decreasing the depressive symptoms and drinking of this group. The total number of marijuana cigarette used during the study was nearly 20 times as high in the placebo group as in the fluoxetine group, while the number of days of marijuana use was five times higher in the placebo group than in the fluoxetine group.