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In addition to traditionally assessed abuse, neglect, and household dysfunction, adverse childhood experiences (ACEs) include adversities like racial discrimination, community violence, and bullying. Prior research established associations between the original ACEs and substance use, but few used Latent Class Analysis (LCA) to examine patterns of ACEs. Examining patterns of ACEs may yield additional insights beyond cumulative risk studies focusing only on the number of different ACEs experiences. Therefore, we identified associations between latent classes of ACEs and cannabis use. Studies on ACES rarely examine cannabis use outcomes, which is important as cannabis remains one of the most commonly used substances and is associated with negative effects on health. Yet it is still unclear how ACEs influence cannabis use. Participants were adults in Illinois (n = 712) recruited through Qualtrics’ online quota-sampling method. They completed measures of 14 ACEs, past 30-day and lifetime cannabis use, medical cannabis use (DFACQ) and probable cannabis use disorders (CUDIT-R-SF). Latent class analyses were performed using ACEs. We identified four classes, labeled: Low Adversity, Interpersonal Harm, Interpersonal Abuse and Harm, and High Adversity. The largest effect sizes (p

Emerging adult (EA; aged 18–29) military members experience major career, life, and developmental transitions. The conglomeration of these changes may influence or exacerbate anxiety or stress, produce challenges, and lead to negative coping mechanisms, such as substance use. This study sought to understand the utility of the five Emerging Adulthood Theory (EAT) dimensions among a sample of military members and veterans with risky substance use. To our knowledge, the applicability of EAT has not been explored with United States military populations. During 2019, we completed 24 semi-structured interviews. On average, participants were 24.9 years old, male, white, and in the United States Marine Corps. We asked about experiences transitioning into adulthood, military culture, and experiences of the five EAT dimensions. Three coders employed rigorous theory-driven thematic analysis procedures to piece together themes. We report EA military members’ experiences with the EAT dimensions, focusing on nuances related to the influence of military culture.

Medical and recreational cannabis are becoming more accessible and socially accepted across the United States. Emerging adults (EAs; 18 to 29) are the largest group of cannabis users. Studies have found that veterans are more likely to report cannabis use compared to nonveterans. While research exists on the use levels of cannabis, limited knowledge is available on the perceived risks and benefits of using cannabis among EA military and veteran populations. Helping professionals encounter veterans who use cannabis and must consider military cultural factors and attitudes towards cannabis that may influence or exacerbate cannabis use. We conducted a qualitative study with 23 EA veteran and military members with high-risk substance use and asked about their thoughts on the acceptability, risks, and perceived benefits associated with cannabis. Two qualitative coders used NVivo to find themes following the six steps of thematic analysis. Results provide in-depth understanding of EA military members and veterans’ perceptions of cannabis. Overall, we found participants were receptive to using cannabis for pain ailments, mental health issues, and as an alternative to benzodiazepines, opioids, and alcohol. However, they acknowledged restrictions are needed to moderate cannabis use and mitigate negative outcomes. Lastly, participants recognized the incongruence of cannabis use with military job responsibilities and expectations. These findings shed light on potential risk and protective factors related to using cannabis for recreational or medical reasons and should be considered when consulting EA military members and veterans.

BACKGROUND While there is some research on adult recovery from substance use, particularly regarding its definition and correlates, there appears to be little work on defining recovery for adolescents. Definitional research on adolescent recovery, including adolescents’ perceptions of recovery, will create opportunities to enhance adolescent recovery-oriented systems of care. METHODS Data for this study were collected through Qualtrics, an online survey platform. The survey gathered different behavioral and social indicators, including whether adolescents resolved a problem with substances or considered themselves to be in recovery. Youth also responded to a list of statements, indicating whether the item was consistent with their definition of problem resolution or recovery. The final analytic sample included 63 (16.3%) adolescents in recovery and 323 who were not. We analyzed descriptive statistics for both groups and assessed whether perceptions on problem resolution or recovery definitions differed by recovery status using chi-square tests. RESULTS Among all statements presented to youth in reference to problem resolution, the most commonly endorsed was “stop completely” (59.8%), followed by “not hanging out with friends who use a lot” (47.7%) and “getting counseling for alcohol/drug use” (46.1%). Youth in recovery were significantly less likely than those not in recovery to endorse “stop completely” as being associated with problem resolution (p

Students’ experiences of boredom at school are receiving increased research attention. Most inquiries to date have focused on how often students experience boredom in classroom situations and in specific subject areas. Despite its frequency, limited research efforts have explored how students’ boredom experiences might inform positive education initiatives. This paper examines students’ school boredom experiences from a positive education lens through which school mental health professionals can evaluate students’ school boredom experiences systematically. We introduce the School Boredom Mindset (SBM) concept that identifies a subset of high-risk students expressing unfavorable school attitudes. A preliminary analysis of 2,331 California secondary (Grades 7-12) students’ responses on well-being indicators explored the SBM’s viability. The findings show that students with the strongest SBM reported substantially lower well-being than their peers. The discussion offers suggestions for future research needed to evaluate the SBM concept’s meaning and the value of its contribution to positive education. While this research moves forward, we provide practitioners with resources to better evaluate students’ boring feelings at school and consider its meaning within the broader effort of fostering thriving well-being

Emerging adults (EAs; 18 to 29 year olds) experience high rates of substance use and disordered use. Few studies examine whether developmental theories account for elevated use among EAs across the...

Background Epidemiological surveys are designed to collect representative trend data. School-based surveys are important to utilize so systems can effectively create prevention and intervention programs to alter youths' perceptions and behaviors related to substance use. However, there are many barriers when implementing a school-based survey. Methods This mixed methods study sought to uncover 30 school personnel's challenges when making the decision to implement the Illinois Youth Survey (IYS). Through a descriptive and interpretive approach, participants' thoughts to improve future recruitment procedures and reduce barriers for implementation were analyzed. Results Results found challenges included: (1) time; (2) parent-opt out consent letter; (3) wording of the survey responses; (4) honesty of the students' responses; (5) importance and use of the data. Moreover, the most common suggestions to improve recruitment included: (1) sharing knowledge about trend data; (2) year-round communication with school personnel; (3) targeting school personnel groups; and (4) providing examples of data use. Conclusions Findings can be used to improve recruitment procedures for others who have similar challenges. If schools, counties, and states have representative data they can more precisely tailor their programming to meet the needs of their population.

Objectives: The rapidly shifting landscape of social media technology presents challenges to researchers and clinicians attempting to understand the impact of such technology on individuals’ psycho...

Objective It is estimated that up to 75% of patients with severe mental illness (SMI) also have substance use disorder (SUD). The aim of this systematic review was to explore the scope, quality and inclusivity of international clinical guidelines on mental health and/or substance abuse in relation to diagnosis and treatment of co-existing disorders and considerations for wider social and contextual factors in treatment recommendations. Method A protocol (PROSPERO CRD42020187094) driven systematic review was conducted. A systematic search was undertaken using six databases including MEDLINE, Cochrane Library, EMBASE, PsychInfo from 2010 till June 2020; and webpages of guideline bodies and professional societies. Guideline quality was assessed based on ‘Appraisal of Guidelines for Research & Evaluation II’ (AGREE II) tool. Data was extracted using a pre-piloted structured data extraction form and synthesized narratively. Reporting was based on PRISMA guideline. Result A total of 12,644 records were identified. Of these, 21 guidelines were included in this review. Three of the included guidelines were related to coexisting disorders, 11 related to SMI, and 7 guidelines were related to SUD. Seven (out of 18) single disorder guidelines did not adequately recommend the importance of diagnosis or treatment of concurrent disorders despite their high co-prevalence. The majority of the guidelines (n = 15) lacked recommendations for medicines optimisation in accordance with concurrent disorders (SMI or SUD) such as in the context of drug interactions. Social cause and consequence of dual diagnosis such as homelessness and safeguarding and associated referral pathways were sparsely mentioned. Conclusion Despite very high co-prevalence, clinical guidelines for SUD or SMI tend to have limited considerations for coexisting disorders in diagnosis, treatment and management. There is a need to improve the scope, quality and inclusivity of guidelines to offer person-centred and integrated care.

Objective: It is estimated that up to 75% of patients with severe mental illness (SMI) also have substance use disorder (SUD). The aim of this systematic review is to explore the scope, quality and inclusivity of international clinical guidelines on mental health and/or substance misuse in relation to diagnosis and treatment of such co-existing disorders and considerations for wider social and contextual factors in treatment recommendations.Method: A protocol (PROSPERO CRD42020187094) driven systematic review was conducted. A systematic search was undertaken using six databases including MEDLINE, Cochrane Library, EMBASE, PsychInfo from 2010 till June 2020; and webpages of guideline bodies and professional societies. Guideline quality was assessed based on ‘Appraisal of Guidelines for Research & Evaluation II’ (AGREE II) tool. Data was extracted using a pre-piloted structured data extraction form and synthesized narratively. Reporting was based on PRISMA guideline.Result: A total of 12,644 records were identified. Of these, 21 guidelines were included in this review. Three of the included guidelines were related to coexisting disorders, 11 related to SMI, and 7 guidelines were related to SUD. Seven (out of 18) single disorder guidelines did not adequately recommend the importance of diagnosis or treatment of concurrent disorders despite their high co-prevalence. The majority of the guidelines (n = 15) lacked recommendations for medicines optimisation in accordance with concurrent disorders (SMI or SUD) such as in the context of drug interactions. Social cause and consequence of dual diagnoses such as homelessness and safeguarding and associated referral pathways were sparsely mentioned.Conclusion: Despite very high co-prevalence, clinical guidelines for SUD or SMI tend to have limited considerations for coexisting disorders in diagnosis, treatment and management. There is a need to improve the scope, quality and inclusivity of guidelines to offer person-centred and integrated care.

Introduction: Substance use peaks during the transition to adulthood, beckoning additional research on its developmental influences. This article reports initial findings on the validity and reliab...

Background Cocoa extract and multivitamins have been proposed to reduce the risk of cardiovascular disease (CVD) and cancer, respectively. However, few randomized clinical trials have tested their long-term effects on these outcomes. Methods The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) is a randomized, double-blind, placebo-controlled, 2 × 2 factorial trial of a cocoa extract supplement and a multivitamin supplement to reduce the risk of CVD and cancer. Here we describe the pragmatic, hybrid design of the trial and baseline characteristics of the trial participants. Results The nationwide study population includes 21,442 U.S. women aged ≥65 years and men aged ≥60 years without baseline myocardial infarction (MI), stroke, or a recent (within the past 2 years) cancer diagnosis. Participants were randomized in a 2 × 2 factorial design to one of four groups: (1) cocoa extract (containing 500 mg/d flavanols, including 80 mg (-)-epicatechin) and a multivitamin (Centrum Silver©); (2) cocoa extract and multivitamin placebo; (3) multivitamin and cocoa extract placebo; or (4) both placebos. Randomization successfully distributed baseline demographic, clinical, behavioral, and dietary characteristics across treatment groups. Baseline biospecimens were collected from 6867 participants, with at least one follow-up biospecimen from 2142 participants. The primary outcome for the cocoa extract intervention is total CVD (a composite of MI, stroke, cardiovascular mortality, coronary revascularization, unstable angina requiring hospitalization, carotid artery surgery, and peripheral artery surgery); the primary outcome for the multivitamin intervention is total invasive cancer. Conclusion COSMOS will provide important information on the health effects of cocoa extract and multivitamin supplementation in older U.S. adults. Clinical Trials Registration: clinicaltrials.gov #NCT02422745.

The study examines how family structure and race/ethnicity are jointly associated with the discrepancy of adolescent past-year Major Depressive Episode (MDE) rates and the use of mental health services and psychotropic medications. Results through analyzing data from the National Survey on Drug Use and Health (2009–2016, N = 131,777) show that past-year MDE rates were low for adolescents in two-parent families (9.68%) relative to those in one-parent (11.09%) and non-parent families (12.26%, p

Although field education is considered the signature pedagogy in social work, few studies examine preparing field supervisors for clinical supervision. This study describes findings from a 3-year project during which field education supervisors were trained to supervise students’ use of screening, brief intervention and referral to treatment (SBIRT) and motivational interviewing. The core components of the supervisory training model are described (i.e., didactic training, coaching, in-person visits), and self-reported field supervisor outcomes are examined using pre-training and post-training assessments. On our 30-day post training assessment, field supervisors (n = 79) reported increased personal use of motivational interviewing (86.5% vs. 73.9% at baseline) and SBIRT (43.2% vs.17.4% at baseline) in their own practice, as well as increased agency-level use of these models. Field supervisory trainings focused on implementing specific empirically-supported treatments to promote their dissemination in social work practice. The next generation of field supervisory training research should link supervisory trainings to both student performance and client-level outcomes.

Objective Mindfulness based relapse prevention (MBRP) has demonstrated efficacy in alleviating substance use, stress, and craving but how MBRP works for marginalized young adults has not been investigated. The current study used a novel rolling group format for MBRP as an additional intervention for young adults in residential treatment. We tested the hypothesis that MBRP (plus Treatment as usual (TAU)) would reduce stress, craving, and substance use among young adults in residential treatment relative to treatment-as-usual plus 12-step/self-help meetings (TAU only). Further, we examined whether reduced stress during treatment was a potential mechanism of change operating in MBRP. Method Seventy-nine young adults (Mage = 25.3, SD = 2.7; 35 % female) were randomly assigned to MBRP (n = 44) or TAU (n = 35). Follow-up assessments were conducted bi-monthly for self-reported measures of stress, craving, and substance use. Results At treatment completion young adults receiving MBRP had lower substance use (d = −0.58, [−0.91, −0.26]), craving (d = −0.58, [−1.0, −0.14]), and stress (d = −0.77 [−1.2, −0.30]) relative to TAU condition. Reduced stress during treatment partially mediated observed outcome differences between MBRP and TAU for substance use (βindirect = −0.45 [−0.79, −0.11]). Conclusions Results suggest that MBRP is a useful and appropriate intervention for marginalized young adults. Further, our results suggest that the effects of MBRP on long-term substance use outcomes may be partially explained by reduced stress.

Changes to the Council on Social Work Education’s Educational Policy and Accreditation Standards encourage students to develop competencies in empirically supported treatment models. Although there...

A novel method for fabricating ultra-thin croconic acid (CA) films with a very low surface roughness on Si wafers is reported. With a thickness of approximately 20 nm and surface roughness of ±2.0 nm, the film obtained far exceeds the quality and smoothness of previously reported CA thin films. The film is prepared by applying a high electric field in situ during thermal vapor deposition, promoting alignment of the CA molecules due to their high dipole moment. The result is compared with that of the best-reported film produced via a combination of thermal evaporation at low substrate temperature with subsequent slow heating, to demonstrate the greatly enhanced uniformness of the film. In addition, the film’s ferroelectric behavior is demonstrated using piezoresponse force microscopy measurements. A mechanism for film formation under electric field assisted deposition is proposed.

Background and Aim Screening adolescents at risk for cannabis use disorders is critical. The CRAFFT is a screening tool designed to address both alcohol and drug use among youth. Current study tests the psychometric properties of the CRAFFT and attempts to modify one of the screening items to compare the efficiency. Design We examined the ideal cut-off point of the CRAFFT for identifying persons with heavy cannabis use and compared the utility of the original and revised CRAFFT. Participants Sample (N = 132,555) averaged 16.19 (±1.21) years of age; 51.0% were female, 59.7% were White, 15.2% were Latino/Latina, and 6.7% were African-American. Majority resided in non-rural area and 34.5% were receiving free or reduced lunch at school. Measurements Heavy cannabis use was defined as using cannabis 10 or more times in the past 30 days. Sensitivity, specificity, the area under the receiver operating characteristic curve, and Youden value were analyzed to determine the ideal cut-off point. Findings Maximum overall predictive accuracy was at a cutoff score of 2 or higher when using the original CRAFFT questions. At a cutoff score of 2, sensitivity was 82.0%, specificity was 83.7%, with an AUC of 0.880. On the contrary, when an alternative CAR question was used, maximum predictive accuracy was at a cutoff score of 1 or higher when predicting heavy cannabis use. At a cutoff score of 1, sensitivity was 92.7%, specificity was 75.5%, with an AUC of 0.900. Conclusions The results provide evidence that the CRAFFT is a promising brief diagnostic instrument for heavy cannabis use among youth. Modification to Car item may have potential in reducing disparities in sensitivity among different racial ethnic groups, as well as those who with low socioeconomic status.

OBJECTIVE: The multiracial adult population is one of the fastest growing segments of the U.S. population, yet much remains to be learned about multiracial health. Considerable research finds racial/ethnic disparities in self-rated health, however subgroups within the multiracial population have not been consistently described. DESIGN: We use data from the National Longitudinal Survey of Adolescent Health (Add Health) and multivariate logistic regression analyses to compare self-rated health of multiracial and monoracial young adults (n=7880). RESULTS: Overall, there were no significant differences in poor self-rated health status of multiracial adults as a single group odds ratio 0.84 (95% CI: 0.52–1.36) compared to monoracial White adults. Analyses further revealed important variations in health-status by specific subgroups and show that some multiracial subgroups may not fit existing patterns of health disparities. For instance, Asian-White multiracial adults do not fit documented patterns of health disparities and report better health than monoracial Asian and monoracial White adults. CONCLUSION: This study illustrates that the inclusion of specific multiracial categories provides evidence to enhance understanding of the pathways that are linked to health outcomes and the implications for health disparities.

Objective: Few studies have examined which measures of motivation for change predict abstinence and early remission outcomes (AER) for emerging adults with substance-use disorders, and recent research suggests that single-item measures may perform as well as longer readiness-to-change scales. This study extends findings to emerging adults (ages 18–25) treated in outpatient settings by investigating the predictive validity of a single-item motivational measure. Method: Using a national data set of emerging adults receiving outpatient substance-use disorder treatments (N = 1,951), we predicted AER at 3 and 6 months in logistic regression models that controlled for demographics, global severity, and baseline values of the dependent variable. Separate models were run based on self-reported quit status at intake, and all models were corrected for site differences. Results: The single-item motivational measure significantly predicted AER status for quitters at both 3 and 6 months and for nonquitters at ...

Emerging Adults (ages 18-25) have the highest prevalence of substance use disorders and rarely receive treatment from the specialty care system. Thus, it is important to have screening instruments specifically developed for emerging adults for use in Screening, Brief Intervention and Referral to Treatment (SBIRT) models. Optimal cutoffs for the widely-used GAIN Short-Screener's (GAIN-SS) Substance Disorder Screener (SDScrY) are not established specifically for emerging adults. Therefore, this study examined the sensitivity and specificity of the SDScrY in predicting emerging adult (ages 18-25) substance use disorders.We analyzed data from emerging adults in a large clinical sample (n=9,808) who completed both the five-item SDScrY (α=0.85) and the full criteria set for DSM-IV Substance Use Disorders. We estimated the sensitivity, specificity and area under the curve to determine optimal cutoffs.Analyses revealed a high correlation between the SDScrY screener and its longer parent scale (r=0.95, p0.001). Sensitivity (83%) and specificity (95%) were highest at a cutoff score of two (AUC=94%) on the SDScrY for any past year substance use disorder. Sensitivity (85%) was also high at a cutoff score of two on the SDScrY for any past year alcohol disorder.The five-item Substance Use Disorder Screener is a sensitive and specific screener for emerging adults, and could be used to identify emerging adults who may benefit from SBIRT interventions.

Objective: This study developed and tested a student-report measure of motivational interviewing (MI) teaching quality called the Evaluation of Motivational Interviewing Teaching (EMIT) scale. Method: Social work students (N = 297) receiving course content on motivational interviewing completed the EMIT, and exploratory factor analysis investigated whether theory-based dimensions of teaching emerged as EMIT subscales, including: interactivity/skill building, MI content coverage, modeling MI during teaching, trainee autonomy violation, and encouraging ongoing training in MI. Results: Two subscales emerged representing MI-consistent (28 items, α = .92) and MI-inconsistent teaching practices (7 items, α = .73). Conclusions: Although more research is needed on the EMIT, this study supports the initial reliability of the instrument and can help social work educators evaluate MI teaching quality.

Croconic acid is the first single molecular organic ferroelectric material exhibiting very high spontaneous polarization (~ 20 μC/cm2) at room temperature. Maximizing polarization depends on minimizing void defects in croconic acid crystals. In this experiment, the change in void defects upon the thermal treatment is characterized using positron annihilation lifetime spectroscopy. Both defect void size and intensity are measured, and their dependence upon the thermal treatment duration is studied. In addition, the relation between the void defect and ferroelectric hysteresis of croconic acid is established.

Compared with older adults, emerging adults (18-29 years old) entering treatment typically have less severe alcohol use consequences. Also, their unique clinical presentations (e.g., modest initial abstinence motivation) and developmental contexts (e.g., drinking-rich social networks) may make a straightforward implementation of treatments developed for adults less effective. Yet, this has seldom been examined empirically. This study was a secondary analysis of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) data examining (a) overall differences between emerging adults and older adults (≥30 years old) on outcomes during treatment and at 1-year follow-up, and (b) whether emerging adults had poorer outcomes on any of the three Project MATCH treatments in particular.Participants were 267 emerging adults and 1,459 older adults randomly assigned to individually delivered cognitive-behavioral therapy (CBT), motivational enhancement therapy (MET), or 12-step facilitation (TSF). Multilevel growth curve models tested differences on percentage of days abstinent (PDA) and drinks per drinking day (DDD) by age group and treatment assignment.During treatment, compared with older adults, emerging adults reported more DDD but similar PDA. Further, emerging adults assigned to TSF had less PDA and more DDD than emerging adults and older adults assigned to CBT or MET during treatment (i.e., emerging adults in TSF has poorer outcomes initially), but this matching effect was not evident at 1-year follow-up.This study is among the first to test age group differences across three psychosocial interventions shown to be efficacious treatments for alcohol use disorder. Although emerging adults generally did as well as their older counterparts, they may require a more developmentally sensitive approach to bolster TSF effects during treatment.

Background: Recent popularity in e-cigarette use among high school students and the legalization of marijuana across many states resulted in new patterns of poly-substance use (PSU). Objective: The...

INTRODUCTION Approximately 5% of the global population used an illicit drug in 2013. Regarding licit drugs, alcohol is responsible for the occurrence of approximately 200 diseases, among them depression. In addition to health impairments, alcohol is also implicated in many acts of violence. This study aimed to measure the properties of the Rasch model of the Portuguese version of the Global Appraisal of Individual Needs-Short Screener based on evidence obtained during care for users of alcohol and other drugs. METHOD To collect the data, 128 interviews were held at the Psychosocial Care Center for Alcohol and Other Drugs in the state capital, during which the scale was applied. RESULTS The Rasch model revealed that the subscales of the instrument were appropriate, with all items having mean infit and outfit values from 0.5 to 1.5, considered optimal for measurement. There was no evidence of differential performance for gender. Substance use and crime and violence items presented redundancy for severity measures. CONCLUSION Given the need for validated instruments for use in Brazil, it is encouraging that the Portuguese version of the scale was valid for the Rasch model. The results are consistent with studies using the other American, Brazilian, and Canadian versions of the instrument.

Few studies have investigated the impact of adolescent change language on substance use treatment outcomes and even fewer have examined how adolescents respond to normative feedback. The purpose of this study was to understand the influence normative feedback has on adolescent change language and subsequent alcohol and cannabis use 3 months later. We examined how percent change talk (PCT) was associated with subsequent alcohol and drug use outcomes. Adolescents (N = 48) were randomly assigned to receive brief motivational interviewing (MI) or MI plus normative feedback (NF). Audio recordings were coded with high interrater reliability. Adolescents with high PCT who received MI + NF had significantly fewer days of alcohol and binge drinking at follow up. There were no differences between groups on cannabis use or treatment engagement. Findings indicate that NF may be useful for adolescents with higher amount of change talk during sessions and may be detrimental for individuals with higher sustain talk.

The goals of this study were to examine associations between within- and between-person social risk and victimization and cannabis use among emerging adults in substance-use treatment. We also tested gender differences for both victimization and social risk. Participants consisted of 3,052 emerging adults (M(age) = 20.0 years; SD = 2.21) entering substance-use treatment in a wide range of treatment centers across the United States. Individuals were assessed on all measures at baseline 3, 6, and 12 months. We fitted a taxonomy of multilevel growth curve models to test main effects, and interactive relations between within- and between-person social risk, victimization, and gender on cannabis use. Several significant interactions were evident. Irrespective of gender, within-person increases in social risk were associated with contemporaneous increases in cannabis use; however, the magnitude of this relation was comparatively more pronounced for men. Similar gender differences emerged between individuals. Males experiencing heightened social risk over time tended to show high levels of early cannabis use. Simple slope analyses revealed that reporting more (+1 SD) social risk than one's own mean resulted in significant increases in cannabis use for both men and women. Cross-level simple slope analyses revealed no differences in cannabis use among individuals reporting low (-1 SD) social risk and victimization, but significant increases in cannabis use for individuals reporting high (+ 1 SD) victimization and social risk. Results demonstrate support for gender differences in social risk on cannabis use and the importance of considering within-person effects. (PsycINFO Database Record

Little substance use disorder (SUD) treatment research with emerging adults ages 18–25 has been done in community settings, and it is well-known that peers influence emerging adult substance use. The purpose of this study was to develop and test the feasibility of a peer-enhanced behavioral treatment for emerging adults with substance use problems. Emerging adults (n = 35) received a peer-enhanced version of the Community Reinforcement Approach (Peer-CRA), in which their peers (n = 34) were trained to provide alcohol-specific social support. Both identified clients and peers were interviewed at treatment intake, and again three and six months later. Six month outcomes included days of abstinence adjusted for controlled environment days, social costs due to substance use, and binge drinking days in the past 90 days. Treatments were delivered with high fidelity, and a high proportion of participants were retained in treatment and follow-up assessments. Growth curve analyses revealed that emerging adults and their peers significantly increased their days of abstinence and reduced their binge drinking over time. Larger randomized trials should a) test whether peer-enhanced treatments are efficacious relative to treatment as usual, b) investigate whether secondary benefits exist for non-treatment seeking peers supporting another’s treatment, and c) examine whether proposed mechanisms of change (i.e., peer support and peer reductions in substance use) account for any differences in outcomes.

Background Technology-assisted intervention and prevention strategies present opportunities for substance use–related research with emerging adults (EAs) and their peers. Emerging adulthood is a developmentally distinct period in which individuals between the ages of 18 and 29 years undergo unique emotional, cultural, developmental, and biological changes as they transition into adulthood. Crowdsourcing, or gathering feedback from a large group within web-based communities, offers researchers a unique and cost-effective way to obtain large amounts of information in a short period. Objective This paper presents market feedback obtained via Amazon’s Mechanical Turk from EAs (N=458) on the acceptability and utility of brief intervention scripts for a smartphone app currently under development. The mobile app, Harbor, teaches friends of EAs with substance use problems effective and supportive strategies for helping their friend make changes in their substance use behavior. Methods We examined feedback on the wording of the intervention scripts and estimated the market size of EAs who may use this app. Furthermore, we calculated correlations between script ratings and measures of personal risky drinking (ie, Alcohol Use Disorder Identification Test) and the participants’ use of confrontational, enabling, or supportive behaviors with an existing friend. Results Approximately half of our sample (208/458, 45.4%) indicated that they had a close friend for whom they had concerns about their substance use, suggesting a potentially high demand for an app such as Harbor. Initial findings suggest that peers who engage in less enabling behaviors with friends who have a substance use problem exhibited lower risky drinking behaviors overall (r206=−0.501; P Conclusions There exists a demonstrated level of desirability and acceptability among EAs for a mobile app such as Harbor. EAs who wish to engage in more supportive behaviors with their friends who engage in substance use and who are amenable to assisting their friends with sobriety likely would use and benefit from this app.

Background: Electronic patient portals have become common and offer many potential benefits for patients’ self-management of health care. These benefits could be especially important for older adult patients dealing with significant chronic illness, many of whom have caregivers, such as a spouse, adult child, or other family member or friend, who help with health care management. Patient portals commonly contain large amounts of personal information, including diagnoses, health histories, medications, specialist appointments, lab results, and billing and insurance information. Some health care systems provide proxy accounts for caregivers to access a portal on behalf of a patient. It is not well known how much and in what way caregivers are using patient portals on behalf of patients and whether patients see any information disclosure risks associated with such access. Objective: The objective of this study was to examine how older adult patients perceive the benefits and risks of proxy patient portal access by their caregivers. Methods: We conducted semistructured interviews with 10 older adult patients with chronic illness. We asked them about their relationship with their caregivers, their use of their patient portal, their caregiver’s use of the portal, and their perceptions about the benefits and risks of their caregiver’s use of the portals. We also asked them about their comfort level with caregivers having access to information about a hypothetical diagnosis of a stigmatized condition. Two investigators conducted a thematic analysis of the qualitative data. Results: All patients identified caregivers. Some had given caregivers access to their portals, in all cases by sharing log-in credentials, rather than by setting up an official proxy account. Patients generally saw benefits in their caregivers having access to the information and functions provided by the portal. Patients generally reported that they would be uncomfortable with caregivers learning of stigmatized conditions and also with caregivers (except spouses) accessing financial billing information. Conclusions: Patients share their electronic patient portal credentials with caregivers to receive the benefits of those caregivers having access to important medical information but are unaware of all the information those caregivers can access. Better portal design could alleviate these unwanted information disclosures.

Very little prospective research investigates how cannabis withdrawal is associated with treatment outcomes, and this work has not used the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) thresholds for cannabis withdrawal. The sample included 110 emerging adults entering outpatient substance use treatment who were heavy cannabis users with no other drug use and limited alcohol use. We used survival analyses to predict days to first use of cannabis and logistic regression to predict whether participants were abstinent and living in the community at 3 months. Those meeting criteria for cannabis withdrawal were more likely to return to use sooner than those not meeting criteria for cannabis withdrawal. However, the presence of cannabis withdrawal was not a significant predictor of 3-month abstinence. Emerging adults with DSM-5 cannabis withdrawal may have difficulty initiating abstinence in the days following their intake assessment, implying the need for strategies to mitigate their more rapid return to cannabis use.

Obtaining accurate assessment data from adolescents in treatment aids clinical decision making and facilitates more accurate outcome evaluations. However, findings could be biased due to underreported substance use and mental health symptoms. This article compares self-reports of youth in non-White matched client-assessor dyads and those in nonmatched dyads. There were no differences on self-reported substance use, but matched youth reported significantly fewer attention deficit/hyperactivity disorder symptoms versus the comparison group. One possible reason for these findings is the effect of in-group stereotype threat. Future studies should examine the potential effect that in-group stereotyping and perceived racism have on the therapeutic relationship.

The article explores the use of the Social and Emotional Health Survey—Secondary version (SEHS-S) with a sample of 975 Japanese students in Grades 7–9 attending schools located northwest of Tokyo. A confirmatory factor analysis using half the sample confirmed the four-factor structure of the SEHS-S, and further analyses verified its second-order factor model including Belief-in-Self, Belief-in-Others, Emotional Competence, and Engaged Living, all of which contribute to a latent second-order construct labeled Covitality. Additional SEM validity analyses found that the four identified first-order SEHS constructs and the second-order covitality construct were positively associated with subjective well-being. SEHS-S scores also predicted several variables indicative of positive school engagement for Japanese students, including academic performance, social relationships, and willingness to assist others. Results of the study are discussed in terms of the advantages of using strength-based assessments such as the SEHS-S for Japanese students and in promoting well-being in this population.

Background Many adolescents in need of substance use disorder treatments never engage in treatment. Further, the most promising interventions that could be adapted to target treatment engagement often use normative feedback (NF) despite concerns about its appropriateness for adolescents. This preliminary study will inform a larger trial designed to isolate whether NF is an inert, helpful, or harmful active ingredient within pretreatment motivational interviewing (MI) interventions designed to increase treatment engagement. Methods Adolescents ( N = 48) presenting for treatment intake assessments were randomized to receive MI ( n = 22) or MI+NF ( n = 26) immediately following their assessments. Three-month outcomes included the percentage of youth engaged in treatment, the percentage of youth reporting past-month binge drinking, and the percentage of days of abstinence. Results Treatments were delivered with high fidelity, and a high proportion of eligible participants were recruited and retained in this study. Participants significantly increased their percentage of days of abstinence by approximately 10% at follow-up ( d = .32, P =.03), with no significant differences between groups. Fifty-five percent of youth in MI and 41.7% of youth in MI+NF engaged in treatment (odds ratio [OR] = .60, nonsignificant; 95% confidence interval, CI [0.136–2.68]). Conclusions Larger trials should test whether NF is an active ingredient in adolescent MI interventions, and should also determine the mechanisms through which MI+NF may produce effects.

A critical debate within the field of school psychology has centered on the relationship between bullying and cyberbullying in terms of prevalence, overlap, and impact. The current study sought to address the following questions: (1) Does cyberbullying create new victims or merely a new means of victimization? (2) Does cyberbullying uniquely contribute to negative outcomes above and beyond those of traditional bullying? Utilizing an anonymous survey to examine students’ experiences with cyberbullying, traditional bullying, and negative psychological symptoms, it was found that the vast majority of students who were bullied online were also victims of in-person bullying. Both forms of victimization were independently associated with negative outcomes. However, when controlling for traditional bullying, cyberbullying did not remain a predictor of negative mental health outcomes. In contrast, when controlling for cyberbullying, traditional bullying remained a significant predictor of negative mental health outcomes. These results suggest that although traditional and cyber forms of bullying tend to target the same victims, traditional bullying is more uniquely associated with negative psychological outcomes.

Despite the growing interest in integrating peers into emerging adults’ substance use interventions, limited related research is available. Issues of conceptual clarity also remain regarding the integration of peers into interventions based on three distinct approaches used in the field. First, peers could refer to individuals with similar backgrounds who are facilitating an intervention (i.e., peer-delivered). Second, peers could be friends who are invited to participate in an emerging adult target client’s intervention (i.e., peer-enhanced). Finally, peers could represent individuals who formerly suffered from substance use disorder and are currently running peer recovery support-based treatments (i.e., peer recovery support). This chapter provides a review of research with these three types of peer constituencies and proposes language conventions to better identify who comprises a peer in an emerging adult substance use intervention. Based on the promising findings, additional research is recommended for all three models that integrates peers into emerging adults’ treatment episodes.

Brazilian emerging adults are treated for alcohol and other drugs problems in psychosocial care centers for alcohol and other drugs (CAPSad). The treatment for these individuals changed drastically over the past 40 years in Brazil, resulting in numerous positive changes involving deinstitutionalization, harm reduction, and comprehensive care. Against this backdrop, the goal of this chapter is to review the prevalence and etiology of substance use in this population in Brazil, discuss the Brazilian treatment system and which services are offered to this population, and present findings from a study comparing emerging and older adults, assessing the care they received in CAPSad in two states of Brazil. Data were collected from 2013 to 2014 in 15 CAPSad in the State of São Paulo and 14 CAPSad in the State of Minas Gerais. The results show emerging adults were less satisfied with treatment and more likely to be using illicit drugs than older adults. These results show the necessity of implementing treatment strategies focused on these population needs, to increase their treatment satisfaction and prevent the use of illegal drugs.

This chapter reviews state-of-the-art substance use prevention and treatment models available for college-attending and non-college-attending emerging adults. Findings on the widely researched Brief Alcohol Screening and Intervention for College Students (BASICS) model are summarized, as well as those for community-level prevention efforts for college students. For non-college attending emerging adults, motivational interviewing, twelve step facilitation treatment, and cognitive-behavioral therapies have the most empirical support. Few studies are available on the use of primary care–based interventions for emerging adults, which are needed if integrated care is to be realized. There is also new evidence suggesting personalized feedback is less effective than other treatments for emerging adults in non-college settings. Finally, the chapter discusses the mixed findings on electronic interventions and provides recommendations for future research.

Several challenges may hinder accurate screening for and assessment of substance use disorders among emerging adults ages 18–29. This chapter discusses emerging adult–specific research on diagnosing substance use disorders and several empirically supported screeners and assessments that may be useful to those working with emerging adults. First, emerging adult–specific research supporting changes to the most recent version of the Diagnostic and Statistical Manual for Mental Disorders, the DSM-5, is reviewed, and nuances in using the DSM-5 with emerging adults are discussed. The chapter highlights idiosyncrasies in emerging adult symptom patterns using data from large national surveys. Finally, a practice-friendly review of screening and assessment instruments commonly used with emerging adults is provided. For screening instruments, administration time, the instrument’s ability to discern which emerging adults exhibit substance use problems, and emerging adult–specific cutoff points in the literature are addressed. For assessment tools, comprehensiveness of the instrument, administration time, and contexts in which the instrument has been used with emerging adults are discussed.

Developmental processes influence emerging adults’ substance use. Such processes may occur both before and during the period of emerging adulthood, which lasts roughly from ages 18 to 29. This chapter begins by reviewing the prevalence of risky substance use and substance use disorders among emerging adults as well as the sequelae of such use. After a brief review of Arnett’s theory of emerging adulthood, the chapter provides an updated review of how the dimensions of emerging adulthood (i.e., identity exploration, feeling in between, self-focus, instability, optimism) are associated with substance use. Also reviewed are the additional risk factors for substance use that likely interact with these dimensions.

Today’s emerging adults belong to one of the most diverse generations in the United States and show the highest rates of alcohol and illicit drug misuse, facing significant health risks. Thus it is critical to develop effective interventions to reduce alcohol and illicit substance misuse and its related harms among this diverse group. This chapter examines the current literature on the development and effectiveness of existing culturally relevant substance use disorder treatments and makes recommendations for future research and best practices. We argue that given their unique needs, the severity of their substance use, and the low rates of treatment engagement among this population, it is critical that treatment efforts focus on increasing effective treatment access to all emerging adults. We further encourage substance use disorder treatment researchers and practitioners to move beyond addressing culture-bound intervention targets focused on specific cultural groups. The chapter advocates for the development, testing, and adoption of interventions that are responsive to cultural contexts and that (1) target social determinants of health, (2) are equally effective with privileged and marginalized emerging adults, and (3) prepare therapists to effectively deliver interventions to diverse groups and demonstrate cultural competence.