Adolescent Alcohol use Predicts Cannabis use over a three Year follow-up Period

Abstract

Background: Alcohol and cannabis use frequently co-occur, which can result in problems from social and academic impairment to dependence (i.e., alcohol use disorder [AUD] and/or cannabis use disorder [CUD]). The Emergency Department (ED) is an excellent site to identify adolescents with alcohol misuse, conduct a brief intervention, and refer to treatment; however, given time constraints, alcohol use may be the only substance assessed due to its common role in unintentional injury. The current study, a secondary data analysis, assessed the relationship between adolescent alcohol and cannabis use by examining the National Institute of Alcohol Abuse and Alcoholism (NIAAA) two question screen's (2QS) ability to predict future CUD at one, two, and three years post-ED visit. Methods: At baseline, data was collected via tablet self-report surveys from medically and behaviorally stable adolescents 12–17 years old (n = 1,689) treated in 16 pediatric EDs for non-life-threatening injury, illness, or mental health condition. Follow-up surveys were completed via telephone or web-based survey. Logistic regression compared CUD diagnosis odds at one, two, or three-year follow-up between levels constituting a single-level change in baseline risk categorization on the NIAAA 2QS (nondrinker versus low-risk, low- versus moderate-risk, moderate- versus high-risk). Receiver operating characteristic curve methods examined the predictive ability of the baseline NIAAA 2QS cut points for CUD at one, two, or three-year follow-up. Results: Adolescents with low alcohol risk had significantly higher rates of CUD versus nondrinkers (OR range: 1.94–2.76, p < .0001). For low and moderate alcohol risk, there was no difference in CUD rates (OR range: 1.00–1.08). CUD rates were higher in adolescents with high alcohol risk versus moderate risk (OR range: 2.39–4.81, p < .05). Conclusions: Even low levels of baseline alcohol use are associated with risk for a later CUD. The NIAAA 2QS is an appropriate assessment measure to gauge risk for future cannabis use.

Keywords

Alcohol cannabis adolescents emergency department screening

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References

Johnston

, Miech

, O'Malley

, Bachman

, Schulenberg

, Patrick

ME.

Monitoring the Future National Survey Results on Drug Use, 1975-2020: Overview, Key Findings on Adolescent Drug Use. Ann Arbor: Institute for Social Research, University of Michigan; 2021.

Johnston

, Miech

, O'Malley

, Bachman

, Schulenberg

, Patrick

ME.

Monitoring the Future National Survey Results on Drug Use, 1975-2019: Overview, Key Findings on Adolescent Drug Use. Ann Arbor: Institute for Social Research, University of Michigan; 2020.

Ellickson

, Tucker

, Klein

DJ.

Ten-year prospective study of public health problems associated with early drinking. Pediatrics. 2003;111(5 Pt 1):949–955.

Patrick

, Kloska

, Terry-McElrath

, Lee

, O'Malley

, Johnston

LD.

Patterns of simultaneous and concurrent alcohol and marijuana use among adolescents. Am J Drug Alcohol Abuse. 2018;44(4):441–451.

Terry-McElrath

, O'Malley

, Johnston

LD.

Simultaneous alcohol and marijuana use among U.S. high school seniors from 1976 to 2011: trends, reasons, and situations. Drug Alcohol Depend. 2013;133(1):71–79.

Khan

, Secades-Villa

, Okuda

Gender differences in cannabis use disorders: results from the National Epidemiologic Survey of Alcohol and Related Conditions. Drug Alcohol Depend. 2013;130(1–3):101–108.

Cunningham

, Bernstein

, Walton

Alcohol, Tobacco, and other drugs: future directions for screening and intervention in the emergency department. Acad Emerg Med. 2009;16(11):1078–1088.

Naeger

Emergency Department Visits Involving Underage Alcohol Use: 2010 to 2013. The CBHSQ Report. Rockville, MD: Center for Behavioral Health Statistics and Quality; May 16, 2017.

John

, Wu

LT.

Problem alcohol use and healthcare utilization among persons with cannabis use disorder in the United States. Drug Alcohol Depend. 2017;178:477–484.

10.

Samuels

, Dwyer

, Mello

, Baird

, Kellogg

, Bernstein

Emergency department-based opioid harm reduction: moving physicians from willing to doing. Acad Emerg Med. 2016;23(4):455–465.

11.

Cherpitel

CJ.

Alcohol and Injuries: Emergency Department Studies in an International Perspective. Geneva, Switzerland: World Health Organization; 2009.

12.

Hawk

, D'Onofrio

Emergency department screening and interventions for substance use disorders. Addict Sci Clin Pract. 2018;13(1):18.

13.

Spirito

, Bromberg JR , Casper

Reliability and validity of a two-question alcohol screen in the pediatric emergency department. Pediatrics. 2016;138(6):e20160691.

14.

Bromberg JR , Spirito

, Chun

Methodology and demographics of a brief adolescent alcohol screen validation study. Pediatr Emerg Care. 2019;35(11):737–744.

15.

Linakis

, Bromberg JR , Casper

Predictive validity of a 2-question alcohol screen at 1-, 2-, and 3-year follow-up. Pediatrics. 2019;143(3):e20182001.

16.

Spirito

, Bromberg JR , Casper

Screening for adolescent alcohol use in the emergency department: what does it tell us about Cannabis, Tobacco, and other drug use?

Subst Use Misuse. 2019;54(6):1007–1016.

17.

Vanyukov

, Tarter

, Kirillova

Common liability to addiction and “gateway hypothesis”: theoretical, empirical and evolutionary perspective. Drug Alcohol Depend. 2012;123(Suppl 1):S3–S17.

18.

Fisher

, Shaffer

, Piacentini

Sensitivity of the diagnostic interview schedule for children, 2nd edition (DISC-2.1) for specific diagnoses of children and adolescents. J Am Acad Child Adolesc Psychiatry. 1993;32(3):666–673.

19.

Linakis

, Bromberg JR , Casper

Reliability and validity of the newton screen for alcohol and cannabis misuse in a pediatric emergency department sample. J Pediatr. 2019;210:154–160.