High power
Adolescents from upper middle class communities: Substance misuse and addiction across early adulthood
Suniya Luthar, Phillip Small & Lucia Ciciolla
Development and Psychopathology, forthcoming
Abstract:
In this prospective study of upper middle class youth, we document frequency of alcohol and drug use, as well as diagnoses of abuse and dependence, during early adulthood. Two cohorts were assessed as high school seniors and then annually across 4 college years (New England Study of Suburban Youth younger cohort [NESSY-Y]), and across ages 23–27 (NESSY older cohort [NESSY-O]; ns = 152 and 183 at final assessments, respectively). Across gender and annual assessments, results showed substantial elevations, relative to norms, for frequency of drunkenness and using marijuana, stimulants, and cocaine. Of more concern were psychiatric diagnoses of alcohol/drug dependence: among women and men, respectively, lifetime rates ranged between 19%–24% and 23%–40% among NESSY-Os at age 26; and 11%–16% and 19%–27% among NESSY-Ys at 22. Relative to norms, these rates among NESSY-O women and men were three and two times as high, respectively, and among NESSY-Y, close to one among women but twice as high among men. Findings also showed the protective power of parents’ containment (anticipated stringency of repercussions for substance use) at age 18; this was inversely associated with frequency of drunkenness and marijuana and stimulant use in adulthood. Results emphasize the need to take seriously the elevated rates of substance documented among adolescents in affluent American school communities.
The Impact of Alcohol on Mental Health, Physical Fitness, and Job Performance
Marigee Bacolod, Jesse Cunha & Yu-Chu Shen
NBER Working Paper, June 2017
Abstract:
We study the impact of legal access to alcohol on a range of behavioral and physical outcomes of U.S. Army soldiers in a regression discontinuity design. The wealth of novel data collected by the military on cognitive ability, psychological health, and family history allows us to explore how impacts vary with risk factors for alcohol consumption. Overall, we observe a large and significant increase in drinking after the 21st birthday, but the increases are largest amongst those who were depressed, had a family history of mental health problems, had better coping ability, and had higher cognitive ability. Despite the large increase in consumption, we do not find any meaningful impacts of legal access to alcohol - overall or in any sub-group - on any of the short-term outcomes we observe, including suicidal tendencies, depression, tobacco use, physical fitness, psychological health, deployability, smoking, and job-related infractions. Acknowledging the limitations for extrapolation out of sample, we discuss the policy implications of our results.
Examining the influence of adolescent marijuana use on adult intelligence: Further evidence in the causation versus spuriousness debate
Cashen Boccio & Kevin Beaver
Drug and Alcohol Dependence, August 2017, Pages 199–206
Methods: We employed change scores and ordinary least squares (OLS) analysis to test for associations between marijuana use and changes in intelligence scores from adolescence (ages 12 to 21) to adulthood (ages 18 to 26) using data drawn from the National Longitudinal Study of Adolescent to Adult Health.
Results: The findings revealed that while a binary measure of marijuana use (ever/never) maintains a statistically significant association with changes in intelligence scores, the effect sizes are relatively small (β = .043 to .051). Additionally, our findings did not reveal a significant association between cumulative marijuana use and changes in intelligence scores.
Conclusions: Taken together, the results suggest that while the binary measure of marijuana use (ever/never) has a statistically significant association with changes in intelligence scores, the binary measure accounts for at most a 1 to 2 point change in intelligence scores.
Is Legal Pot Crippling Mexican Drug Trafficking Organizations? The Effect of Medical Marijuana Laws on US Crime
Evelina Gavrilova, Takuma Kamada & Floris Zoutman
Economic Journal, forthcoming
Abstract:
We show that the introduction of medical marijuana laws (MMLs) leads to a decrease in violent crime in states that border Mexico. The reduction in crime is strongest for counties close to the border (less than 350km), and for crimes that relate to drug trafficking. In addition, we find that MMLs in inland states lead to a reduction in crime in the nearest border state. Our results are consistent with the theory that decriminalization of the production and distribution of marijuana leads to a reduction in violent crime in markets that are traditionally controlled by Mexican drug trafficking organisations.
The Effect of Insurance Expansions on Smoking Cessation Medication Use: Evidence from Recent Medicaid Expansions
Johanna Catherine Maclean, Michael Pesko & Steven Hill
NBER Working Paper, May 2017
Abstract:
In this study we explore the early effects of recent Medicaid expansions on prescriptions and Medicaid payments for evidence-based smoking cessation prescription medications: Zyban, Chantix, and Nicotrol. We estimate differences-in-differences models using data on the universe of prescription medications sold in retail and online pharmacies for which Medicaid was a third-party payer. Our findings suggest that expansions increased prescriptions for smoking cessation medications by 36% and total payments for these medications increased by 28%. We provide evidence these payments were financed by state Medicaid programs and not patients themselves. Overall our findings suggest that the recent Medicaid expansions allowed low-income smokers to access effective cessation medications.
Does Previous Marijuana Use Increase the Use of Other Drugs: An Almost Ideal Demand System Approach
Alexi Thompson & Yamaura Koichi
B.E. Journal of Economic Analysis & Policy, forthcoming
Abstract:
From a policy standpoint, the legalization of marijuana may affect other drug markets. The Almost Ideal Demand Model is used to estimate drug substitution between the most common illegal street drugs in the US including cocaine, heroin, marijuana, and methamphetamines. We control for past marijuana consumption. Results indicate that past marijuana consumption does not contribute to increased current consumption of other drugs. Further, marijuana is a weak complement to methamphetamines but marijuana price changes do not affect heroin or cocaine consumption.
Age-related patterns in nonmedical prescription opioid use and disorder in the US population at ages 12-34 from 2002 to 2014
Mei-Chen Hu et al.
Drug and Alcohol Dependence, August 2017, Pages 237–243
Objectives: To estimate age-related patterns in nonmedical prescription opioid (NMPO) use in the US population and disorder among past-year users at ages 12-34 between 2002-2014, controlling for period and birth-cohort effects.
Methods: Data are from 13 consecutive cross-sectional National Surveys on Drug Use and Health (N = 542,556). Synthetic longitudinal cohorts spanning ages 12-34 were created and an age-period-cohort analysis was implemented based on the Intrinsic Estimator algorithm.
Results: In every birth cohort, past-year NMPO use increases during adolescence, peaks at ages 18-21, decreases through ages 30-34; disorder among past-year users increases from ages 18-21 through 30-34. Use at ages 12-34 decreased from the 1984-87 birth cohorts to more recently-born cohorts. Peak prevalence of use at ages 18-21 has also decreased, and the rates of increase from ages 14-17 to ages 18-21 are slowing down. Disorder at ages 18-34 increased from the 1976-79 to 1992-95 cohorts, but decreased at ages 12-17 from the 1992-95 to the most recently-born 2000-02 cohorts. The years 2010-2014 were characterized by lower NMPO use but higher disorder than 2002-2009.
Conclusions: Increasing NMPO disorder among users aged 18-34 warrants concern. However, declining NMPO use among 12-34 year-olds, a declining rate of increase from adolescence to early adulthood, and a suggestive decline in disorder among the most recent adolescent cohorts may forecast a potential reduction in the public health crisis associated with NMPO drugs.
Racial and ethnic trends in illicit drug use and binge drinking among adolescent and young adult offenders in the United States
Michael Vaughn et al.
Journal of Criminal Justice, forthcoming
Methods: Survey data collected between 2002 and 2013 as part of the National Survey on Drug Use and Health (NSDUH). Trend analyses were restricted to non-Hispanic whites, African-Americans, and Hispanic adolescents (ages 12–17) and young adults in the sample (ages 18–25) who report being arrested and booked for a crime.
Results: Findings reveal a severity-based gradient in which the prevalence of illicit drug use is lowest among African-Americans, incrementally higher among Hispanics, and highest among non-Hispanic whites. This gradient, observable among both developmental subgroups, is particularly evident among young adult offenders.
Mitigating the heroin crisis in Baltimore, MD, USA: A cost-benefit analysis of a hypothetical supervised injection facility
Amos Irwin et al.
Harm Reduction Journal, 2017
Background: In Baltimore, MD, as in many cities throughout the USA, overdose rates are on the rise due to both the increase of prescription opioid abuse and that of fentanyl and other synthetic opioids in the drug market. Supervised injection facilities (SIFs) are a widely implemented public health intervention throughout the world, with 97 existing in 11 countries worldwide. Research has documented the public health, social, and economic benefits of SIFs, yet none exist in the USA. The purpose of this study is to model the health and financial costs and benefits of a hypothetical SIF in Baltimore.
Methods: We estimate the benefits by utilizing local health data and data on the impact of existing SIFs in models for six outcomes: prevented human immunodeficiency virus transmission, Hepatitis C virus transmission, skin and soft-tissue infection, overdose mortality, and overdose-related medical care and increased medication-assisted treatment for opioid dependence.
Results: We predict that for an annual cost of $1.8 million, a single SIF would generate $7.8 million in savings, preventing 3.7 HIV infections, 21 Hepatitis C infections, 374 days in the hospital for skin and soft-tissue infection, 5.9 overdose deaths, 108 overdose-related ambulance calls, 78 emergency room visits, and 27 hospitalizations, while bringing 121 additional people into treatment.
Frequent Binge Drinking Among US Adolescents, 1991 to 2015
Joy Bohyun Jang et al.
Pediatrics, forthcoming
Background and objectives: Scientific understanding of the forces involved in the decades-long decline of adolescent alcohol use in the United States is limited. This study examines specific changes in US adolescent frequent binge drinking (FBD) by age (variation due to maturation), period (variation across time that does not covary across age), and cohort (variation common to adolescents born around the same time).
Methods: We analyzed nationally representative, multicohort data from 8th, 10th, and 12th grade students sampled between 1991 and 2015 from Monitoring the Future (n = 1 065 022) to estimate age, period, and cohort effects on adolescents’ FBD (defined as ≥2 occasions of ≥5 drinks in a row during the past 2 weeks). Age-Period-Cohort analyses were stratified by sex, race/ethnicity, and socioeconomic status (SES). Trends in the associations between demographics and FBD across historical time were examined.
Results: Decreases in FBD during adolescence were attributable to period and cohort effects independent of age variations. Birth cohorts between 1985 and 1990 showed the greatest decline in FBD. The Age-Period-Cohort results were consistent across sex, race/ethnicity, and SES, with the exception of slower declines seen among African American adolescents compared with white adolescents since 2007. We also found convergence in FBD by sex and divergence by SES.
Alcohol Availability, Prenatal Conditions, and Long-Term Economic Outcomes
Peter Nilsson
Journal of Political Economy, forthcoming
Abstract:
This study examines how a policy that sharply increased alcohol availability during 8.5 months affected the labor productivity of those exposed to it in utero. Compared to the surrounding cohorts, the prenatally exposed children have substantially worse labor market and educational outcomes and lower cognitive and noncognitive ability. Effects on earnings are found throughout the distribution but are largest below the median. Males are more affected than females, consistent with growing evidence that boys are less resilient to early environmental insults. The long-term effects seem primarily driven by changes in prenatal health rather than changes in the childhood environment.
Dose-related effects of delta-9-THC on emotional responses to acute psychosocial stress
Emma Childs, Joseph Lutz & Harriet de Wit
Drug and Alcohol Dependence, August 2017, Pages 136–144
Methods: Healthy volunteers (N = 42) participated in two experimental sessions, one with psychosocial stress (Trier Social Stress Test, TSST) and another with a non-stressful task, after receiving 0 (N = 13), 7.5 mg (N = 14) or 12.5 mg (N = 15) oral THC. Capsules were administered under randomized, double blind conditions, 2.5-h before the tasks began. We measured subjective mood and drug effects, vital signs and salivary cortisol before and at repeated times after the capsule and tasks. Subjects also appraised the tasks, before and after completion.
Results: In comparison to placebo, 7.5 mg THC significantly reduced self-reported subjective distress after the TSST and attenuated post-task appraisals of the TSST as threatening and challenging. By contrast, 12.5 mg THC increased negative mood overall i.e., both before and throughout the tasks, and pre-task ratings of the TSST as threatening and challenging. It also impaired TSST performance and attenuated blood pressure reactivity to the stressor.
Conclusions: Our findings suggest that a low dose of THC produces subjective stress-relieving effects in line with those commonly reported among cannabis users, but that higher doses may non-specifically increase negative mood.
Smoked marijuana attenuates performance and mood disruptions during simulated night shift work
Diana Keith et al.
Drug and Alcohol Dependence, forthcoming
Abstract:
Individuals who work nonstandard schedules, such as rotating or night shifts, are more susceptible to workplace injuries, performance decrements, and reduced productivity. This population is also almost twice as likely to use illicit drugs as individuals working a standard day shift. The purpose of this study was to examine the effects of smoked marijuana on performance, mood, and sleep during simulated shift work. Ten experienced marijuana smokers completed this 23-day, within-participant residential study. They smoked a single marijuana cigarette (0, 1.9, 3.56% Δ9-THC) one hour after waking for three consecutive days under two shift conditions: day shift and night shift. Shifts alternated three times during the study, and shift conditions were separated by an ‘off’ day. When participants smoked placebo cigarettes, psychomotor performance and subjective-effect ratings were altered during the night shift compared to the day shift: performance (e.g., vigilance) and a few subjective ratings were decreased (e.g., “Self-Confident”), whereas other ratings were increased (e.g., “Tired”). Objective and subjective measures of sleep were also disrupted, but to a lesser extent. Marijuana attenuated some performance, mood, and sleep disruptions: participants performed better on vigilance tasks, reported being less miserable and tired and sleep a greater number of minutes. Limited negative effects of marijuana were noted. These data demonstrate that abrupt shift changes produce performance, mood, and sleep decrements during night shift work and that smoked marijuana containing low to moderate Δ9-THC concentrations can offset some of these effects in frequent marijuana smokers.
A comparison of nicotine dependence among exclusive E-cigarette and cigarette users in the PATH study
Guodong Liu et al.
Preventive Medicine, forthcoming
Abstract:
Electronic cigarettes (“e-cigs”) have recently gained in popularity, but their health risks, including dependence potential are unclear. This study analyzed the adult database from the Wave 1 Population Assessment of Tobacco and Health (PATH) Study, a nationally representative survey of tobacco use in the United States, to assess the relative level of dependence among adult, exclusive everyday users of e-cigarettes and cigarettes. Of the total 32,320 observations from the Wave 1 PATH adult database, 3586 (5.9%, weighted) were eligible for our analysis population. Among those who met the eligibility criteria, 156 (4.6%) were exclusive e-cig users, and 3430 (95.4%) were exclusive cigarette smokers. Our results show that e-cig users reported a significantly longer time-to-first-use of the day after waking (measured in minutes) compared to cigarette smokers after adjusting for confounders (adjusted geometric mean [95% confidence limits (CL)]: 29.2 [24.4–34.9] vs. 20.0 [18.7, 21.5]). In addition, cigarette smokers were significantly more likely to consider themselves addicted (Adj. Odds Ratio [95% CL]: 6.9 [4.5–10.7]); have strong cravings (2.9 [1.9–4.2]); find it difficult in the past 12 months to refrain from using their product in places where it was prohibited (6.4 [2.9–14.3]); and feel like they really needed to use their product (3.9 [2.4–6.4]). These results are consistent with previous studies, in finding that exclusive daily e-cigarette users are less dependent on their respective product than comparable cigarette smokers.