Background: Despite policy and practice guidelines highlighting the need to identify and treat substance use early and concurrently with other mental health symptoms, efforts remain uncoordinated and guidelines lack specificity. Limited evidence characterizing patterns and correlates of co-occurring substance use and mental health symptoms hinders our ability to effectively address these concerns early during adolescence. This dissertation deepens our understanding of the patterns and correlates of co-occurring substance use and mental health symptoms among adolescents, how to collect relevant data in inpatient settings, and how to rigorously analyze and report findings. Methods: The first paper is a systematic review of 70 cluster-based studies examining patterns of multiple substance use among adolescents. The second examines patterns and correlates of co-occurring substance use and mental health symptoms through multilevel latent profile analysis and multilevel multinomial regression using a large, representative sample of secondary students and schools across Ontario. The third paper is a pilot study examining the feasibility, acceptability, and importance of standardized assessments of substance use and mental health symptoms in an adolescent psychiatric inpatient unit. Results: The substantive findings of this work include: 1) multiple substance use is common; 2) co-occurrence of substance use and mental health symptoms is common, though not universal; 3) substance use may be related to mental health symptom severity, comorbidity, and hospital service use; 4) school climate, belonging, and safety represent important targets for school-based interventions; and 5) adolescent psychiatric inpatient units may represent important contexts for standardized assessments, though more professional training and standardization in assessments and interventions are needed. Methodological recommendations are also presented to improve the collection, analysis, and reporting of similar work in the field. Conclusions: Collectively, this dissertation provides novel, timely, and actionable insight into adolescent substance use patterns, correlates, and potential targets for assessment and intervention efforts. / Dissertation / Doctor of Philosophy (PhD) / This dissertation deepens our understanding of the patterns of co-occurring substance use and mental health concerns among adolescents. First, a review of all existing studies that explore patterns of multiple substance use among adolescents was conducted. Second, patterns of substance use and mental health symptoms were identified in secondary students and schools across Ontario. Third, the feasibility of assessing substance use and mental health symptoms using standardized approaches on an inpatient adolescent psychiatric unit was evaluated. Overall, this work suggests that substance use and mental health concerns commonly co-occur, and that schools and inpatient psychiatric units are important settings for prevention, assessment, and intervention. This work provides actionable next steps to inform assessment, prevention, and intervention efforts designed to address co-occurring substance use and mental health concerns among adolescents.

The purpose of this thesis is to analyze changes over time in the interactions of street-involved youth with their risk environments and to investigate how their integration into local, provincial, and federal systems and services impacts their lives, health, and substance use. This thesis employs a sequential explanatory mixed methods design and uses closed and open-ended questions collected over five waves of interviews during the longitudinal study Risky Business? Experiences of Street-Involved Youth. Quantitative (n = 50) methods of analysis include descriptive statistics and bivariate comparisons complemented by a qualitative (n = 15) thematic analysis comprised of open-ended interview questions. The risk environment framework proposed by Tim Rhodes is used to highlight structural and systemic forces informing the lives of street-involved youth, allowing for an analysis on three levels of influence (micro, meso, macro) and four types of environment (economic, physical, social, policy). Results indicate that comparatively high substance use and harms of substance use among street-involved youth decrease as they become integrated into local, provincial, and federal systems and services. Intersecting demographic and structural factors correspond with higher substance use for male youth and youth who had been involved with the foster care system during their life. Given the diversity of backgrounds and risk environment experiences, street-involved youth expressed diverse opinions and perspectives regarding the effectiveness of healthcare, harm reduction, and outreach services. Policy recommendations and suggestions for future research are suggested, with the aim of developing safer environments and environment interventions for street-involved youth that reduce substance use-related harms. / Graduate

by Connie Wong Sau Ying. / Includes questionnaire in Chinese. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1994. / Includes bibliographical references (leaves 74-81). / ABSTRACT --- p.ii / ACKNOWLEDGMENTS --- p.iii / TABLE OF CONTENTS --- p.iv / LIST OF TABLES --- p.vi / LIST OF FIGURES --- p.viii / LIST OF APPENDICES --- p.ix / CHAPTER / Chapter 1 --- INTRODUCTION AND LITERATURE REVIEW --- p.1 / Substance Abuse: Definition and Consequences --- p.1 / Prevalence of Substance Abuse Amongst Adolescents in Hong Kong and the States / Antecedents of Substance Abuse --- p.4 / Role of Family --- p.5 / Role of Peer Influences --- p.7 / Individual Difference Variables --- p.8 / A Conceptual Model on Adolescent Substance Use --- p.12 / Purposes of the Research --- p.13 / Chapter 2 --- METHOD --- p.16 / Participants --- p.16 / Measures --- p.22 / Procedure --- p.26 / Chapter 3 --- RESULTS --- p.27 / Internal Consistency of Measures --- p.27 / Mean Prevalence Rates: Proportion of Participants Using Substances --- p.27 / Poly Substance Users --- p.31 / Means Comparison for Drug Use Frequency --- p.32 / Means Comparison for Psychosocial Variables --- p.35 / Intercorrelations Among Psychosocial Variables --- p.37 / Correlations Between Psychosocial Variables and Drug Use Frequency --- p.41 / Multiple Regression Analyses on Drug Use Measures --- p.47 / Distal and Proximal Antecedents of Drug Use: A Structural Model --- p.51 / Chapter 4 --- DISCUSSION --- p.64 / REFERENCES --- p.74 / APPENDICES --- p.82 / A QUESTIONNAIRE FOR THE STUDY --- p.82

M.A. / Die doel van hierdie studie is om riglyne vir n geïntegreerde seksualiteit program vir adolosente daar te stel wat aandag skenk aan dwelmmisbruik en verhoogde HIV risiko. Daar is nie hipoteses geformuleer nie. Navorsing vrae is gestel en n literatuurstudie is aan die hand van die vrae gedoen. Daar is gepoog om die profiel van die skool gaande adolosent wat dwelmmiddels misbruik vas te stel. Verder is daar gepoog om die frekwensie van dwelmmisbruik by adolosente vas te stel, sowel as hulle kennis oor die verwantskap tussen HIV/Vigs en dwelmmisbruik. Daar is na die aard en effektiwiteit van huidige seksualiteit programme in die onderwys gekyk om vas te stel of hulle doeltreffend is. n Kwantitatiewe data insamelings metode is gebruik. n Beskrywende en n ondersoekende navorsings ontwerp is gebruik in die studie. Twee honderd-en-vyftig vraelyste is by twee skole versprei. Adolosente van graad agt tot graad elf het die vraelyste ewekansig beantwoord. Die hulp van Statistiese Konsultasie Dienste, te RAU, is ingewin met die optrek van die vraelys sowel as die verwerking van die data. Die profiel van die respondente toon dat die meerderheid 15 jaar en ouer is. Die meeste van die respondente was meisies. Graad nege leerders was die meerderheid van respondente terwyl die ander drie grade eweredig versprei was. Die respondente het meestal by beide of minstens by een biologiese ouer gewoon. Afrikane was die meerderheid van respondente. Blankes was tweede meeste verteenwoordig en die res was verteenwoordig deur Asiërs en Kleurlinge. Leerders het hul skool prestasie as gemiddeld beleef. Belangstelling in skoolwerk was matig. Die misbruik van dwelmmiddels het n verhoogde misbruik oor die naweek getoon. Al die dwelmmiddels was in n mate gebruik, met dagga as die gewildste middel. Die respondente was ambivalent oor die invloed van verhoogde risiko vir HIV met alkohol misbruik. Die meerderheid het bevestig dat daar n verhoogde risiko vir HIV is met die misbruik van dwelmmiddels. Die meerderheid van die adolosente is nie seksueel aktief nie. Die respondente wat wel seksueel aktief is, erken dat hulle in meeste gevalle onder die invloed van dwelmmiddels was tydens hulle laaste seksuele omgang. Die skool is geïdentifiseer as die prominentste plek waar leerders oor dwelmmiddels leer. Die media en tweedens, die skool, is aangedui as die belangrikste plek van leer aangaande HIV. Die leerders verkies klasse waar beide geslagte teenwoordig is. Die medium van onderwys wat verkies word, is n dialoog vorm. Daar is twee groepe adolosente geïdentifiseer in die studie. Die minderheid van adolosente is in gevaar van HIV/Vigs. Die ontwikkeling van n omvattende geïntegreerde seksualiteit program moet gemik wees op die groep adolosente. Aanbevelings met betrekking tot die ontwikkeling van n geïntegreerde seksualiteit program word aan die hand gedoen. / Prof. L. Patel

The purposes of this study were to examine the prevalence of current substance use and early risk indicators for substance abuse and dependence, and to investigate the relationships among religiousness, current substance use, and early risk indicators among nursing students at seven Seventh-day Adventist colleges. Data for this descriptive study were collected through Efinger's Alcohol Risk Survey (EARS) (Efinger, 1984), the CAGE Questionnaire ( Ewing , 1984), and the Intrinsic/Extrinsic-Revised Scale (Gorsuch & McPherson, 1989). Participants were 241 nursing students enrolled in their first year of nursing courses at seven colleges and universities located across the United States . Findings indicated that 42% of students scored higher than the EARS mean; 24% reported current substance use; and 15% scored in the probable abuse/dependence category of CAGE. Students who reported current substance use and those scoring in the probable substance abuse/dependence category were significantly more likely to score above the EARS median. Intrinsic religiousness demonstrated a significant inverse relationship with current substance use. Significantly lower rates of current substance use were associated with higher rates of attendance at religious services. Respondents who indicated that their religion prohibited alcohol consumption reported significantly lower rates of current substance use than those who answered "No" or "I don't know" to their religion's prohibition of alcohol consumption. A substantial number of nursing students were found to have high numbers of early risk indicators for substance abuse and dependence that warrant intervention. The majority of students who scored in the probable substance abuse/dependence category also had higher EARS scores, thereby increasing their risk for substance impairment. Religious variables appear to have had a mediating influence on current substance use with this sample. Prevention programs should be aimed at risks that are modifiable, thus enabling students to make healthy decisions about using substances.

No description available.

Syftet med studien var att belysa professionellas uppfattning om och  erfarenhetav multipelt substansbrukssyndrom samt deras tankar om hur problematiken s hanteras och åtgärdas för att skapa positiv förändring hos klienter. Till studi användes kvalitativ metod med utgångspunkt från hermeneutike Semistrukturerade intervjuer genomfördes med fem respondenter från två oli verksamheter. Studiens teoretiska utgångspunkt är West’s (2006) motivationsteo PRIME. Studiens andra teoretiska utgångspunkt är Von Wright’s (201 pedagogiska rekonstruktion av G.H. Meads teori om  människo intersubjektivitet. Resultatet visade att respondenterna kände till diagnossystem DSM-5. De definierade multipelt substansbrukssyndrom som blandmissbru Resultatet visade också att de professionella ser varje klient som unik. Bå motivations- och behandlingsarbetet var individanpassat och såg liknande ut v  ett enskilt missbruk eller beroende. Dock var problematiken mer komple eftersom det har fört med sig allvarligare konsekvenser. Respondentern erfarenhet var att de ofta möter klienter med multipelt substansbrukssyndrom.

The ambition of the study Nyanser av beroende is to analyze and problematize the concept of addiction. A broader aim is to investigate if it in the Swedish population exists different patterns of addiction and how these patterns then look like. The empirical material constitutes of Negativa konsekvenser av ANDT-bruk i den svenska vuxna befolkningen 2014. The selection consists of 26 257 individuals with a response rate of 59, 3 percent (N=15 576). The individuals that at some time during the last year used any narcotic substance and fulfilled at least one of the addiction criterias in the diagnose manual DSM-IV are subjects to the analysis (N=560). By the analyze method of Latent klassanalys (LCA), patterns of addiction have been investigated. The theoretical framework consists of medical and social addiction theory. This to see how different patterns of addiction comply with the medical and social perspectives that can be found in DSM-IV. In the latent class analysis, four different groups with different patterns of addiction are identified: Kontrollförlust, Försökt minska intag, Hard core gruppen och Tolerans. The group’s patterns have further on been connected with sociodemographic factors and substance use. The result of this study indicate that addiction is not a homogeneous concept but that there are differences concerning patterns of use and sociodemographic factors.

Understanding the characteristics of research participants is crucial to ensuring sample representativeness and generalizability of findings to broader patient groups with substance use disorders. Using anonymous computer-administered health survey data, the present study had a unique opportunity to compare patients who chose to participate in an RCT for heavy/problem drinking or drug use (N=713; consenters) with those that chose not to participate (N=625; non-consenters). The sample was 40% male, 76% African American, and had a mean age of 45.2 years. Using multivariate regression, the most parsimonious model found older age, unemployment, prescription misuse, positive screen for drug problems (CAGE), having a grandmother with an alcohol problem, trouble falling asleep (past 30 days), health professional recommendation to go on a diet, and feeling unsafe due to a previous partner were all associated with consenting to participate. The present study provides benchmark data on sample representativeness in a clinical trial of SBIRT.

The purpose of this dissertation study was to investigate the direct and interactive relationships between depression and conduct problems and substance abuse treatment outcomes in a national sample of adolescents participating in substance abuse treatment. This study involved a secondary analysis of data from the National Institute on Drug Abuse's- Drug Abuse Treatment Outcome Study for Adolescence (DATOS-A), a multi-site, longitudinal study of substance abusing adolescents seeking treatment. Participants completed a battery of self-report and interview measures at treatment intake including the Diagnostic Interview Schedule for Children Revised (DISC-R), which assessed depression and conduct problems. Adolescents also completed structured interviews relating to substance use at intake and 12 months after treatment. Results from the multiple regression analyses supported hypotheses relating to greater conduct problems predicting greater post-treatment substance use. Results from the multiple regression analyses failed to support study hypotheses relating to depression and the interaction of conduct problems and depression predicting post-treatment substance use. Significant control variables included age, length of treatment, and intake level of substance use. Results are discussed within the context of the relevant literature.