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To provide insights into the biology of opioid dependence (OD) and opioid use (i.e., exposure, OE), we completed a genome-wide analysis comparing 4503 OD cases, 4173 opioid-exposed controls, and 32,500 opioid-unexposed controls, including participants of European and African descent (EUR and AFR, respectively). Among the variants identified, rs9291211 was associated with OE (exposed vs. unexposed controls; EUR z = -5.39, p = 7.2 × 10-8). This variant regulates the transcriptomic profiles of SLC30A9 and BEND4 in multiple brain tissues and was previously associated with depression, alcohol consumption, and neuroticism. A phenome-wide scan of rs9291211 in the UK Biobank (N > 360,000) found association of this variant with propensity to use dietary supplements (p = 1.68 × 10-8). With respect to the same OE phenotype in the gene-based analysis, we identified SDCCAG8 (EUR + AFR z = 4.69, p = 10-6), which was previously associated with educational attainment, risk-taking behaviors, and schizophrenia. In addition, rs201123820 showed a genome-wide significant difference between OD cases and unexposed controls (AFR z = 5.55, p = 2.9 × 10-8) and a significant association with musculoskeletal disorders in the UK Biobank (p = 4.88 × 10-7). A polygenic risk score (PRS) based on a GWAS of risk-tolerance (n = 466,571) was positively associated with OD (OD vs. unexposed controls, p = 8.1 × 10-5; OD cases vs. exposed controls, p = 0.054) and OE (exposed vs. unexposed controls, p = 3.6 × 10-5). A PRS based on a GWAS of neuroticism (n = 390,278) was positively associated with OD (OD vs. unexposed controls, p = 3.2 × 10-5; OD vs. exposed controls, p = 0.002) but not with OE (p = 0.67). Our analyses highlight the difference between dependence and exposure and the importance of considering the definition of controls in studies of addiction.

Persons with high temporal discounting tend to value immediate gratification over future gains. Low self-reported lifespan (SRL)-an individual's assessment of a relatively short future lifespan-concentrates in low-income populations and may reflect high temporal discounting. We use casino-based cash dividends among the Eastern Band of Cherokee Indians (EBCI) as a quasi-experiment to test whether large income gains among EBCI members translate into increased SRL. We used SRL data for EBCI and White youth, aged 19 to 28, participating in two waves of the Life Time Trajectory of Youth (LTI-Y) survey from 2000 to 2010. We controlled for unobserved confounding across individuals, time, and region through a longitudinal design using a difference-in-difference analytic approach (N = 294). We conducted all analyses separately by gender and by quartile of socioeconomic status. Cash dividends correspond with a 15.23 year increase in SRL among EBCI men below the lowest socio-economic quartile at baseline relative to Whites (standard error = 5.39, p

We examine the effects of a quasi-experimental unconditional household income transfer on child emotional and behavioral health and personality traits. Using longitudinal data, we find that there are large beneficial effects on children's emotional and behavioral health and personality traits during adolescence. We find evidence that these effects are most pronounced for children who start out with the lowest initial endowments. The income intervention also results in improvements in parental relationships which we interpret as a potential mechanism behind our findings.

Background: Quantifying diagnostic transitions across development is needed to estimate the long-term burden of mental illness. This study estimated patterns of diagnostic transitions from childhood to adolescence and from adolescence to early adulthood. Methods: Patterns of diagnostic transitions were estimated using data from three prospective, longitudinal studies involving close to 20,000 observations of 3,722 participants followed across multiple developmental periods covering ages 9-30. Common DSM psychiatric disorders were assessed in childhood (ages 9-12; two samples), adolescence (ages 13-18; three samples), and early adulthood (ages 19 to age 32; three samples) with structured psychiatric interviews and questionnaires. Results: Having a disorder at an early period was associated with at least a threefold increase in odds for having a disorder at a later period. Homotypic and heterotypic transitions were observed for every disorder category. The strongest evidence of continuity was seen for behavioral disorders (particularly ADHD) with less evidence for emotional disorders such as depression and anxiety. Limited evidence was found in adjusted models for behavioral disorders predicting later emotional disorders. Adult substance disorders were preceded by behavioral disorders, but not anxiety or depression. Conclusions: Having a disorder in childhood or adolescence is a potent risk factor for a range of psychiatric problems later in development. These findings provide further support for prevention and early life intervention efforts and suggest that treatment at younger ages, while justified in its own right, may also have potential to reduce the risk for disorders later in development. (Contains 3 tables.)

Background: Little is known about changes in the prevalence of psychiatric disorders between childhood and adolescence, and adolescence and adulthood. Methods: We reviewed papers reporting prevalence rates of psychiatric disorders separately for childhood, adolescence, and early adulthood. Both longitudinal and cross-sectional papers published in the past 15 years were included. Results: About one adolescent in five has a psychiatric disorder. From childhood to adolescence there is an increase in rates of depression, panic disorder, agoraphobia, and substance use disorders (SUD), and a decrease in separation anxiety disorder (SAD) and attention-deficit hyperactivity disorder (ADHD). From adolescence to early adulthood there is a further increase in panic disorder, agoraphobia, and SUD, and a further decrease in SAD and ADHD. Other phobias and disruptive behavior disorders also fall. Conclusions: Further study of changes in rates of disorder across developmental stages could inform etiological research and guide interventions.

Objective: No longitudinal studies beginning in childhood have estimated the cumulative prevalence of psychiatric illness from childhood into young adulthood. The objective of this study was to estimate the cumulative prevalence of psychiatric disorders by young adulthood and to assess how inclusion of not otherwise specified diagnoses affects cumulative prevalence estimates. Method: The prospective, population-based Great Smoky Mountains Study assessed 1,420 participants up to nine times from 9 through 21 years of age from 11 counties in the southeastern United States. Common psychiatric disorders were assessed in childhood and adolescence (ages 9 to 16 years) with the Child and Adolescent Psychiatric Assessment and in young adulthood (ages 19 and 21 years) with the Young Adult Psychiatric Assessment. Cumulative prevalence estimates were derived from multiple imputed datasets. Results: By 21 years of age, 61.1% of participants had met criteria for a well-specified psychiatric disorder. An additional 21.4% had met criteria for a not otherwise specified disorder only, increasing the total cumulative prevalence for any disorder to 82.5%. Male subjects had higher rates of substance and disruptive behavior disorders compared with female subjects; therefore, they were more likely to meet criteria for a well-specified disorder (67.8% vs 56.7%) or any disorder (89.1% vs 77.8%). Children with a not otherwise specified disorder only were at increased risk for a well-specified young adult disorder compared with children with no disorder in childhood. Conclusions: Only a small percentage of young people meet criteria for a "DSM" disorder at any given time, but most do by young adulthood. As with other medical illness, psychiatric illness is a nearly universal experience. (Contains 2 tables and 3 figures.)

Objective: To identify the predictors of nonmedical ADHD medication use by college students. Participants: A total of 843 undergraduates attending one public or one private university in southeastern United States. Method: Students completed a Web-based survey inquiring about ADHD medication use during the first semester freshman of their year and a second time during the second semester of their sophomore year. Results: A total of 45 participants (5.3%) reported the onset of nonmedical ADHD use between the two survey administrations. The majority of these students were high substance users as freshman. Attention difficulties also predicted the onset of nonmedical use, especially in the absence of excessive substance use. Compared with other nonmedical users of ADHD medication, those reporting attention difficulties had lower GPAs, greater academic concerns, and higher levels of depressive symptoms. Conclusion: Attention difficulties contribute to the onset of nonmedical ADHD medication use in a significant minority of nonmedical users. These students may begin using ADHD medication to address attention problems they experience as undermining their academic success. (Contains 4 tables.)

Recent research has shown how quantifiable aspects of community context affect a wide range of behaviors and outcomes. Due partially to the historical development of this field, currently published work focuses on urban rather than rural areas. We draw upon data from a longitudinal study of families and health in Appalachia--the Great Smoky Mountains Study (GSMS), and an ethnographically based interview tool--the Life Trajectory Interview for Youth (LTI-Y), to examine the impact of community and family poverty and educational attainment on educational goals and attainment among rural white youth (n=200). Exposure to family poverty and more educated parents were associated with youths' educational attainment. Meanwhile, both community education levels and parental education were associated with college goal-setting. These relationships were particularly strong among rural white males. This evidence suggests that more attention should be focused on how rural environments affect the lives and life chances of their inhabitants. (Contains 4 tables.)

The national comorbidity survey that seeks to determine the prevalence and correlates of mental disorders among U.S. adolescents is based on a dual-frame design that includes 904 adolescents from a previous household survey and 9,244 adolescent students from a sample of 320 schools. Replacement schools for those that refuse to participate do not produce bias.

The goals and measures of the National Comorbidity Survey Replication Adolescent Supplement are discussed. The survey seeks to provide the first nationally representative estimate of mental disorders among U.S. adolescents aged 13 to 17 years. The survey can also be used to generate patterns of service use and barriers to treatment.

Background: Co-occurrence of psychosocial risk factors is commonplace, but little is known about psychiatrically-predictive configurations of psychosocial risk factors. Methods: Latent class analysis (LCA) was applied to 17 putative psychosocial risk factors in a representative population sample of 920 children ages 9 to 17. The resultant class structure was retested in a representative population sample of 1420 children aged 9 to 13. In each sample, the child and one parent were interviewed with the Child and Adolescent Psychiatric Assessment. Concurrent psychiatric status was used to validate class membership. Results: LCA identified five latent classes in both samples: two low risk classes; two moderate risk classes both involving family poverty configured with various other risk factors; and a high risk class characterized by family relational dysfunction and parental risk characteristics. Of the primary sample, 48.6% were categorized as low risk, 42.8% as moderate risk, and 8.6% as high risk. Moderate risk classes differed in their prediction of disruptive and emotional disorders depending on their specific risk factor configurations. High risk youth had the highest levels of both emotional and disruptive disorders. Combining our latent classes with a cumulative risk approach best accounted for the effects of risk factors on psychopathology in our primary sample. Conclusions: Particular risk configurations have "specific" associations with psychiatric disorders. Configurational approaches are an important asset for large-scale epidemiological studies that integrate information about patterns of risk and disorders.

The last 50 years have witnessed enormous strides in the measurement and classification of child and adolescent psychiatric disorders. Debates about whether we should continue to depend upon a categorical nosology still continue, but we argue that, despite the absence of clear dividing lines between psychiatric disorders and normality and ubiquity of diagnostic comorbidity, the current official approach to nosology has served child and adolescent psychiatric research surprisingly well. In particular we point to the utility of non-developmental diagnostic criteria as tools for discovering developmental effects on psychopathology. We also maintain that the search for sharper boundaries between disorders is fundamentally mistaken. However, official nosologies have tended to privilege information collected in diagnostic interviews and to sideline observational and other methods that cannot easily be made to conform to the format of their criteria. We suggest that it is time to remedy this situation. The ICD-10 and DSM-IV are useless for children under the age of about two, while alternatives, such as the DC:0-3, suffer from a profound lack of empirical support. We suggest a way forward through the integration of methods from temperament and psychopathology research. Finally, we deplore the failure of standardized assessment techniques to have penetrated more deeply into everyday clinical assessment.

Objective: This study assesses the misuse and diversion of prescribed attention-deficit/hyperactivity disorder (ADHD) medications. Method: One hundred fifteen students, attending two universities, with prescriptions for ADHD medications completed a Web survey in spring 2007. Results: Eighty-nine of 115 students (69%) used their ADHD medications as prescribed, whereas 36 (31%) had misused during college by taking larger or more frequent doses than prescribed or by using someone else's medication. Nine students (8%) reported intranasal use during the previous 6 months, and 30 (26%) had diverted medications to peers. Misuse was associated with impulsivity and with other substance use. Enhancing the ability to study outside of class was students' primary motive for misuse, but nonacademic reasons were also reported. Students who misused ADHD medications generally felt that doing so was helpful. Conclusions: Although most students use their ADHD medication as prescribed, misuse and diversion is not uncommon. Because enhancing academic performance was the primary motive for misuse, the results raise questions about whether undergraduates with ADHD perceive their treatment as adequate and the extent to which physicians and students communicate about issues related to medication adjustments. (Contains 4 tables.)

Objective: This study examines why college students without a prescription take ADHD medication, what they perceive the consequences of this to be, and whether attention problems are associated with this behavior. Method: More than 3,400 undergraduates attending one public and one private university in the southeastern United States completed a Web-based survey. Results: Nonmedical ADHD medication use in the prior 6 months was reported by 5.4% of respondents and was positively associated with self-reported attention difficulties. Enhancing the ability to study was the most frequent motive reported; nonacademic motives were less common. Students perceived nonmedical use to be beneficial despite frequent reports of adverse reactions. Conclusion: Students without prescriptions use ADHD medication primarily to enhance academic performance and may do so to ameliorate attention problems that they experience as undermining their academic success. The academic, social, and biomedical consequences of illicit ADHD medication use among college students should be researched further. (Contains 6 tables and 3 notes.)

Background: Most psychosocial risk factors appear to have general rather than specific patterns of association with common childhood and adolescence disorders. However, previous research has typically failed to 1) control for comorbidity among disorders, 2) include a wide range of risk factors, and 3) examine sex by developmental stage effects on risk factor-disorder associations. This study tests the specificity of putative psychosocial risk factors while addressing these criticisms. Methods: Eight waves of data from the Great Smoky Mountains Study (N = 1,420) were used, covering children in the community age 9-16 years old. Youth and one parent were interviewed up to seven times using the Child and Adolescent Psychiatric Assessment, providing a total of 6,674 pairs of interviews. A wide range of putative neighborhood, school, peer, family, and child risk factors, and common and comorbid youth disorders were assessed. Results: The majority of putative risk factors were specific to one disorder or one disorder domain. A unique or "signature set" of putative risk factors was identified for each disorder. Several putative risk factors were associated with a disorder in preadolescent males, preadolescent females, adolescent males, or adolescent females only. Conclusions: Our findings support the need to define risk factors and disorders narrowly, to control comorbidity and other risk factors, and to consider developmental patterns of specificity by sex.