Objectives: Adolescents with substance use disorders (SUD) frequently report traumatic events (TEs) and symptoms of post-traumatic stress disorder (PTSD). This study aimed to assess whether lifetime prevalence rates of TEs and PTSD are related to SUD severity in adolescent psychiatric patients. Methods:We analyzed N = 114 self-reports of treatment-seeking German adolescents aged 12 to 18 years, who visited a specialized SUD outpatient unit. Standardized questionnaires were applied to assess SUD severity, the number of TEs and DSM-IV PTSD criteria.Results: Patients fulfilling PTSD criteria (28% of the total sample) had a higher Drug Use Disorders Identification Test (DUDIT) score compared to non-PTSD patients with TEs (p <.001), and compared to adolescents without TEs or PTSD (p = .003). Additionally, SUD severity was positively associated with the number of TEs and the number of intrusion, hyperarousal, and avoidance symptoms (all r = .33 to.48, all p <.01).Discussion: Adolescent patients with SUD reported 3-times higher rates of TEs, and a 5time higher prevalence of PTSD following TEs, than the general adolescent population. Adolescent SUD patients with PTSD reported more severe substance use problems than patients without PTSD-regardless of previous TEs. Longitudinal studies are needed in order to investigate the temporal relationship between TEs, PTSD and SUD.
BackgroundA common screening instrument for substance use disorders (SUDs) is the Drug Use Disorders Identification Test (DUDIT) which includes a short form regarding only drug consumption (DUDIT-C). We aim to assess if a German version of the DUDIT, adapted for adolescents, is a suitable screening instrument in a sample of adolescent psychiatric patients.MethodsN = 124 (54 female) German adolescent (M = 15.6 + 1.5 years) psychiatric patients completed the DUDIT and received a diagnostic interview (MINI-KID) assessing DSM-5 SUD criteria. A confirmatory factor analysis (CFA), receiver operating characteristic (ROC) curves, the area under the curve (AUC), and Youden’s Index were calculated.ResultsA two-factor model of the DUDIT shows the best model fit (CFI = 0.995, SRMR = 0.055, RMSEA = 0.059, WRMR = 0.603). The DUDIT as well as the DUDIT-C show high diagnostic accuracy, with AUC = 0.95 and AUC = 0.88, respectively. For the DUDIT a cut-off value of 8.5 was optimal (sensitivity = 0.93, specificity = 0.91, J = 0.84), while for the DUDIT-C the optimal cut-off value was at 1.5 (sensitivity = 0.86, specificity = 0.84, J = 0.70).ConclusionThis is the first psychometric evaluation of the DUDIT in German, adolescent psychiatric outpatients, using the DSM-5 diagnostic criteria. The DUDIT as well as the DUDIT-C are well suited for use in this population. Since in our sample only few patients presented with a mild or moderate SUD, our results need to be replicated in a sample of adolescents with mild SUD.
Background Methamphetamine use disorder (MUD) frequently begins in adolescence, often accompanied by other psychiatric or mental disorders. Up to now, no comprehensive review about MUD and comorbid disorders in adolescents is available. We thus aimed to review the literature on comorbid mental disorders and MUD in adolescents in order to identify future research topics. Method A PubMed search was conducted in July 2019. Relevant comorbidities were defined as attention-deficit disorder with/without hyperactivity, anxiety disorders, depression, eating disorders, post-traumatic stress disorder, psychosis, borderline personality disorder, conduct disorder and antisocial personality disorder, as well as other substance use disorders. For each comorbidity, we summarized prevalence rates, findings on comorbidity mechanisms, and recommended treatment options, if applicable. Results Few articles focused on MUD in adolescents. Prevalence rates differed largely between comorbid disorders, with tobacco use disorder, conduct disorder, post-traumatic stress disorder, anxiety disorders, and attention-deficit disorders being the most prevalent comorbidities while eating disorders were rare. Examined onset patterns and comorbidity mechanisms indicated three groups of comorbidities: preexisting disorders self-medicated with methamphetamine, disorders induced by chronic methamphetamine use, and disorders arising due to risk factors shared with MUD. Reviewed comorbidities were frequently associated with worse treatment outcomes. Conclusions The limited evidence is in stark contrast to the presumably high prevalence and relevance of comorbid mental disorders in adolescents with MUD. Suggestions for future research topics, informed by adult findings, include genetic vulnerabilities, biological changes, and consequences of different use patterns. Surprisingly few MUD treatment programs explicitly integrate comorbid mental disorder modules.
Zusammenfassung. Fragestellung: Nur wenige Kliniken für Kinder- und Jugendpsychiatrie (KJP) bieten eine ambulante Behandlung von Jugendlichen mit Substanzkonsumstörungen (SUDs) an. Daher fehlen Angaben, welche Konsummuster, SUDs und begleitenden psychischen Störungen diese Jugendlichen aufweisen. Methodik: N = 201 Patient_innen einer universitären Spezialambulanz (12–19 Jahre alt) wurden bezüglich Konsummustern, SUDs und aktuellen psychischen Störungen mittels Interview untersucht. Es wurden diesbezüglich deskriptive Darstellungen zu Prävalenzzahlen der SUDs, Konsummustern und begleitenden psychischen Störungen aufgeteilt nach Geschlecht und aktuellem Alter erstellt. Ergebnisse: Tabak (88 %) und Cannabis (86 %) waren die verbreitetsten Substanzen. Bei 67 % aller Patient_innen wurde mehr als eine SUD festgestellt. SUDs bezogen sich am häufigsten auf Cannabis (84 %), gefolgt von Tabak (77 %). 72 % aller Patient_innen zeigten eine die SUD begleitende psychische Störung, insbesondere Störungen des Sozialverhaltens (40 %), hyperkinetische Störungen (21 %) und depressive Störungen (18 %). Schlussfolgerungen: Ambulant behandelte jugendliche KJP-Patient_innen mit SUDs präsentieren sich häufig mit begleitenden psychischen Störungen. Angebotene Behandlungsprogramme sollten in der Behandlung von SUDs insbesondere Störungen des Sozialverhaltens, Depressionen und hyperkinetische Störungen berücksichtigen.
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