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Background: Alcohol use in early adolescence is associated with increased health concerns and other negative consequences. Given the needs of this vulnerable population, it is critical to understand their risk factors and clinical characteristics. Objective: This cross-sectional study explores the clinical and demographic characteristics of serviceseeking youth with and without early alcohol use onset. Method: 655 youth seeking services at a Canadian substance use and concurrent disorder service participated. Evaluations of mental health, substance use, demographic characteristics, and other risk factors were collected and compared among youth who reported an age of onset for alcohol use of under 14 years of age versus 14 years or older. Results: Youth who started using alcohol before age 14 were significantly more likely to report mental health difficulties, indicate use of a greater number of substances, and report experiencing more crime and violence problems. They also reported exposure to more types of trauma. Notably, more problems with crime and violence were significantly, and uniquely associated with an earlier age of alcohol use onset in a multivariate model. Conclusion: The present study identifies unique and clinically significant differences among youth who initiated alcohol use in early adolescence compared to later in adolescence. Stronger integrations between mental health and substance use services for youth with early alcohol use should be considered, given the vulnerability and concurrent difficulties they tend to face. [ABSTRACT FROM AUTHOR]

Background: Opioid use disorder (OUD) has arguably the highest mortality rate of mental health conditions; opiate-related deaths are identified as the number one cause of accidental deaths in Canada and the United States. Specialized care for OUD is often described as lacking, fractured, and with frequent periods of disengagement. Digital health strategies may support connection to evidence-based resources even during periods of disengagement. However, sustained engagement in digital interventions remains a barrier, and as such, experts recommend using co-design approaches to develop interventions., Methods: The current study outlines the results from a qualitative co-design project that engaged 6 lived experts and 8 clinical experts in a series of focus groups and interviews to adapt an existing intervention for use in OUD. Focus groups and interviews were recorded and transcribed before undergoing thematic analysis. This co-design process is the first stage of a larger project that will lead to the development of a novel digital health intervention for OUD populations., Results: Transcripts underwent thematic analysis, and themes were divided into Crosscutting Themes, Feasibility and Engagement, and Specific Features. Each theme was divided into specific subthemes, which were reviewed by the design team and informed the design of the digital health platform. Key resulting directions included creating a psychologically safe digital space, curating resources for OUD as a multifaceted condition, and being mindful of barriers to implementation from both lived and clinical expert perspectives. Specific features are discussed in detail in the article., Conclusion: Lived experts and clinicians strongly supported integrating digital tools into OUD care. Ongoing work is needed to better understand the role of technology in existing OUD structures as well as the implementation of key features such as digital peer support and creating effective and safe social connections. This study also validates co-design as an essential step in digital health development., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The technology behind the core architecture of the platform, A4i Schizophrenia, was developed and owned by the joint for-profit venture A4i. The company Memotext owns 50% of this company, the Centre for Addiction and Mental Health owns 35% of this company, and Dr Sean A. Kidd owns 15% of this company. COI has been reviewed by legal professionals, and a mitigation plan has been implemented.