Background Current and comprehensive information on the epidemiology of DSM-IV 12-month and lifetime drug use disorders in the United States has not been available. Objectives To present detailed information on drug abuse and dependence prevalence, correlates, and comorbidity with other Axis I and II disorders. Design, Setting, and Participants Face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule of the National Institute on Alcohol Abuse and Alcoholism in a large representative sample of US adults (N = 43 093). Main Outcome Measures Twelve-month and lifetime prevalence of drug abuse and dependence and the associated correlates, treatment rates, disability, and comorbidity with other Axis I and II disorders. Results Prevalences of 12-month and lifetime drug abuse (1.4% and 7.7%, respectively) exceeded rates of drug dependence (0.6% and 2.6%, respectively). Rates of abuse and dependence were generally greater among men, Native Americans, respondents aged 18 to 44 years, those of lower socioeconomic status, those residing in the West, and those who were never married or widowed, separated, or divorced (all P Conclusions Most individuals with drug use disorders have never been treated, and treatment disparities exist among those at high risk, despite substantial disability and comorbidity. Comorbidity of drug use disorders with other substance use disorders and antisocial personality disorder, as well as dependence with mood disorders and generalized anxiety disorder, appears to be due in part to unique factors underlying each pair of these disorders studied. The persistence of low treatment rates despite the availability of effective treatments indicates the need for vigorous educational efforts for the public and professionals.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/482282/yoa60081_566_576.pdf

Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Alcohol Abuse and Dependence in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Hardly a family in America has been untouched by mental illness. As many as one third of American adults will suffer a diagnosable mental disorder sometime in their life, and 20 percent have a mental disorder at any given time. Although research on the causes and treatment of mental disorders remains vitally important—and indeed major advances are leading to better lives for increasing numbers of people—much greater effort than ever before needs to be directed to prevention. The Senate Appropriations Committee of the U.S. Congress believed that a strategic approach to the prevention of mental disorders was warranted. The Congress mandated the National Institute of Mental Health to enter into an agreement with the Institute of Medicine (IOM) to prepare an integrated report of current research with policy-oriented and detailed long-term recommendations for a prevention research agenda. The specific tasks of the IOM committee, as negotiated with NIMH and the co-funding agencies, were as follows: • Review the status of current research on the prevention of mental illness and problem behaviors and on the promotion of mental health throughout the life span. This should include an understanding of available research knowledge, research priorities, and research opportunities in the prevention research area. • Review the existing federal presence in the prevention of mental disorders and the promotion of mental health, spanning the continuum from research to policy and services. • Provide recommendations on federal policies and programs of ABSTRACT xi Ab ou t th is P D F fil e: T hi s ne w d ig ita l r ep re se nt at io n of t he o rig in al w or k ha s be en r ec om po se d fro m X M L fil es c re at ed f ro m t he o rig in al p ap er b oo k, n ot f ro m t he or ig in al ty pe se tti ng fi le s. P ag e br ea ks a re tr ue to th e or ig in al ; l in e le ng th s, w or d br ea ks , h ea di ng s ty le s, a nd o th er t y pe se tti ng -s pe ci fic fo rm at tin g, h ow ev er , c an no t b e re ta in ed , a nd s om e ty po gr ap hi c er ro rs m ay h av e be en a cc id en t a lly in se rte d. P le as e us e th e pr in t v er si on o f t hi s pu bl ic at io n as th e au th or ita tiv e ve rs io n fo r a ttr ib ut io n.

Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research

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The Growth of Logical Thinking from Childhood to Adolescence

OBJECTIVES. Project Northland is an efficacy trial with the goal of preventing or reducing alcohol use among young adolescents by using a multilevel, communitywide approach. METHODS. Conducted in 24 school districts and adjacent communities in northeastern Minnesota since 1991, the intervention targets the class of 1998 (sixth-grade students in 1991) and has been implemented for 3 school years (1991 to 1994). The intervention consists of social-behavioral curricula in schools, peer leadership, parental involvement/education, and communitywide task force activities. Annual surveys of the class of 1998 measure alcohol use, tobacco use, and psychosocial factors. RESULTS. At the end of 3 years, students in the intervention school districts report less onset and prevalence of alcohol use than students in the reference districts. The differences were particularly notable among those who were nonusers at baseline. CONCLUSIONS. The results of Project Northland suggest that multilevel, targeted prevention programs...

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Project Northland: outcomes of a communitywide alcohol use prevention program during early adolescence

Race and Health Outcomes: Historical Perspectives and Implications for Aphasia Outcomes • 2000 – Congress passed the Minority Health and Health Disparities Research and Education Act of 2000 (Public Law 106‐525) • Authorized the Institute of Medicine’s (IOM) landmark study “Unequal Treatment” documenting longstanding disparities in healthcare across a variety of settings and health conditions. • The report also noted that racial minorities were far less likely to receive routine medical procedures, were more likely to experience lower quality healthcare services, but more likely to receive lower limb amputations and other less desirable treatment options for diabetes and other conditions.

Unequal Treatment—Confronting Racial and Ethnic Disparities in Healthcare

The American Academy of Pediatrics recommends pediatric providers routinely screen for, assess, and treat substance use and substance use disorders among adolescents, a process called “Screening, B...

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Substance Use Screening, Brief Intervention, and Referral to Treatment in Pediatric Practice: A Quality Improvement Project in the Maryland Adolescent and Young Adult Health Collaborative Improvement and Innovation Network.

With changes to drug-related policies and increased availability of many drugs, we currently face a public health crisis related to substance use and associated health consequences. Substance use and substance use disorders (SU/SUDs) are complex developmental disorders with etiologies that emerge through the intergenerational transmission of biological, familial, and environmental factors. The family ecosystem both influences and is influenced by SU/SUDs, particularly in children and adolescents. Family dynamics and parent functioning and behaviors can represent either risk or protective factors for the development of SU/SUDs in children. Primary care providers who provide care for children, adolescents, and families are in an ideal position to deliver prevention messages and to intervene early in the development of substance misuse and SUD among their patients. Despite recommendations from the American Academy of Pediatrics, few pediatric primary care providers provide anticipatory guidance to prevent or screen for substance misuse. Many barriers to those practices can be overcome through the integration and application of findings from the field of prevention science and the many lessons learned from the implementation of evidence-based interventions. Consideration of the implications of prevention science findings would help clarify the relevant roles and responsibilities of the primary care clinician, and the benefit of referral to and consultation from addiction specialists. Additionally, the past decade has seen the development and validation of a continuum of evidence-based prevention and early SU/SUD intervention activities that can be adapted for use in primary care settings making wide-spread implementation of prevention feasible. We propose a paradigm shift away from a model based on diagnosis and pathology to one upstream, that of family-focused prevention and early intervention. Adapting and scaling out empirically based prevention and early SU/SUD interventions to primary care settings and removing barriers to collaborative care across primary care, addiction medicine, and mental health providers offer the potential to meaningfully impact intergenerational transmission of SU/SUD - addressing a leading health problem facing our nation.

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Hoover Adger

Papers

Substance Use Screening, Brief Intervention, and Referral to Treatment in Pediatric Practice: A Quality Improvement Project in the Maryland Adolescent and Young Adult Health Collaborative Improvement and Innovation Network.

State of the Art in Substance Use Prevention and Early Intervention: Applications to Pediatric Primary Care Settings.

Substance use by pregnant adolescents.

Prenatal Use of Marijuana: How do Adolescent and Young Adult Women Compare to Older Women?

32. Receipt of Addiction Treatment Following Opioid-Related Overdose Among Medicaid-Enrolled Youth