Results showed deterioration of white matter integrity in youth who drank heavily compared with age- and sex-matched controls. Moreover, the slope of this reduction over time corresponded with days of drinking since the study entry.Within-subject analyses contrasted developmental trajectories of youth before and after they initiated heavy drinking. These analyses suggested that drinking onset was associated with, and appeared to precede, disrupted white matter integrity. This disruption was greater in younger adolescents than in older adolescents, and was most pronounced in the genu and body of the corpus callosum.It is possible that these brain structure changes may occur concomitantly with modifications in certain neurotransmitter and hormone secretion systems, which markedly influence the refinement of certain brain areas and neural circuits.Along with altered development and maturation of gray and white matter, studies have reported neurocognitive consequences of underage drinking, such as impairments in attention, verbal learning, visuospatial processing, and memory.Neurocognitive deficits linked to moderate to heavy drinking during this critical developmental period may lead to direct and indirect changes in neuromaturational course, with effects that may extend into adulthood. Squeglia et al. examined neurocognitive function in adolescents who drank heavily, moderately, or not at all, based on the Cahalan classification system.Their findings suggested that initiation of moderate to heavy alcohol use and incurring hangovers during adolescence may adversely influence neurocognitive functioning. For females, more drinking days in the past year predicted a greater reduction in performance on visuospatial tasks, in particular visuospatial memory, from baseline to follow-up. For males,vertical farming greenhouse a tendency was seen for more hangover symptoms in the year before follow-up testing to predict a relative worsening of sustained attention.Another set of studies demonstrated that youths who drank heavily exhibited greater brain activation while viewing alcohol advertisements than while viewing ads for nonalcoholic beverages.
Adolescents are exposed to alcohol advertising materials on a daily basis in many countries. As studies in adults with AUD have shown atypical responses to alcohol related materials,Tapert and colleagues used fMRI analyses to determine whether similar response patterns existed in adolescents who drink. The study included 15 adolescents ages 14 to 17 with AUD and 15 demographically similar adolescents who drank infrequently. The participants were shown pictures of alcoholic and nonalcoholic beverage advertisements during neuroimaging. Adolescents with histories of heavy drinking showed greatly enhanced neural activation while viewing the pictures of alcoholic beverages compared with pictures of nonalcoholic beverages. The extent of alcohol-related activation was greatest for those with the highest levels of monthly alcohol intake . In contrast, youth with limited drinking histories showed similar levels of activation while viewing the two beverage picture types. These results demonstrated pronounced alcohol cue reactivity in heavy drinking teens, particularly in reaction to alcohol advertising materials. Studies examining longer-term impacts of adolescent alcohol misuse have yielded mixed results. Some studies reported a maturing-out without significant consequences in adulthood, while others found ongoing effects on mental health, physical health, and social functioning, as well as higher levels of alcohol use and AUD.Analyses using data from the National Longitudinal Alcohol Epidemiologic Survey determined that 40% of those initiating alcohol use before age 15 were diagnosed with AUD at some point in their lives compared to only 10% of those who delayed the onset of drinking until age 21 or later.The first study of adolescents to assess the association between age of adolescent drinking onset and neurocognitive performance found that earlier age of drinking onset predicted poorer performance on tasks requiring psychomotor speed and visual attention. Similarly, an earlier age of onset of regular drinking predicted poorer performances on tests of cognitive inhibition and working memory.This study suggested that early onset Several studies have reported that the associations between alcohol and brain structure and function differ by sex, especially in adolescents engaging in binge drinking. While not conclusive across the literature, female adolescents who engaged in binge drinking appeared to show effects such as blunted activation in frontal, temporal, and cerebellar cortices compared to females who did not drink, whereas male adolescents who engaged in binge drinking showed the opposite activation pattern.Female adolescents ages 15 to 17 meeting criteria for AUD showed larger prefrontal cortex volumes than female controls, while male adolescents with AUD had smaller prefrontal cortex volumes than male controls.
A similar finding was observed for white matter.Adolescence is the peak time for both onset of substance misuse and emergence of mental illness, including anxiety disorders, bipolar disorder, major depression, eating disorders, and psychosis.The National Survey on Drug Use and Health estimated that 20% of adolescents had a mental illness that persisted into adulthood.Moreover, adolescents with a past-year major depressive episode were more likely to be current binge alcohol users .However, it remains unclear how comorbid mental health problems contribute to and exacerbate the neurobiological effects of alcohol misuse.4 Frontal and temporal cortical thinning may predict increased vulnerability to development of adolescent depression. In the NCANDA sample of 692 adolescents without a history of depression, the 101 youth who transitioned into depression were found at study baseline to have thinner cortices in the superior frontal cortex, precentral and postcentral regions, and superior temporal cortex, beyond effects attributable to age and sex.Childhood trauma and post-traumatic stress symptoms have been shown to confer increased risk for adolescent and adulthood AUD, mental illness, and physical health problems.Youth with trauma exposure showed thinner frontal cortices, and those with chronic post-traumatic stress disorder had smaller orbital frontal cortices and less superior posterior cortical and cerebellar gray matter volume.These observations indicate that trauma may be associated with structural brain aberrations. NCANDA has also examined the relationship between childhood trauma and subsequent adolescent alcohol use.In a sample of 392 NCANDA participants, adverse childhood event history was linked to greater self-reported executive dysfunction spanning four annual follow-ups. Greater childhood trauma also was linked to less connectivity in sensorimotor and cognitive control networks at baseline. This reduced connectivity explained the relationship between executive dyscontrol and subsequent increased frequency of adolescent binge drinking .Sleep patterns change substantially during adolescence and emerging adulthood.Lack of sleep, going to sleep relatively late, and large weekend-weekday sleep differences all are risk factors for alcohol use in adolescents and young adults.Similarly, in the NCANDA sample, sleep difficulties in adolescence predicted later substance use problems.The reverse has also been seen, with acute and chronic alcohol intake altering sleep structure and electroencephalography patterns in older adolescents and adults.NCANDA will continue to longitudinally examine whether these changes remain evident into adulthood and how alcohol use influences sleep neurobiology.
Co-use of multiple substances may influence the relationship between alcohol use and neural integrity. For example, during a spatial working memory task, adolescents with co-occurring AUD and cannabis use disorder showed less inferior frontal and temporal neural activation but a greater medial frontal response compared to adolescents with AUD alone.Co use of alcohol with cannabis also may adversely influence executive functioning.Given the high rates of co-occurring alcohol and other substance use during adolescence,future well-powered studies will benefit from detailed analyses of various combinations of substances of abuse on neural and neurocognitive outcomes. In adults with AUD, improvements in attention and concentration, reaction time, and memory are generally seen after 2 to 8 weeks of abstinence;however, executive functioning, processing speed, visuospatial,vertical farming supplies and verbal skills appear more resistant to recovery,and spatial processing deficits may persist for years.Younger adults tend to recover more quickly and completely than older adults .As mentioned previously, preliminary evidence suggested that adolescent heavy drinkers showed greater response to alcohol cues,more emotional reactivity and poorer distress tolerance,and poorer visuospatial performance compared with adults.These effects remitted after a month of abstinence, indicating that some deficits are linked to alcohol intake and may be transitory. However, executive dysfunction and negative mood states did not remit within 4 weeks of abstinence, suggesting that these differences may have predated the onset of heavy drinking or may take more time to recover. As reported by Infante et al., cortical gray matter volume decreases were greater in proximity to reported drinking episodes in a dose response manner, suggesting a causal effect and raising the possibility that normal growth trajectories may recover with alcohol abstinence.However, other studies have suggested that impaired visuospatial functioning following adolescent AUD persisted even after reduced levels of use.Problematic substance use trajectories among people living with HIV during the COVID-19 pandemic are poorly understood . Addressing this omission is critical for several reasons. The onset of the COVID-19 pandemic in the United States drastically disrupted people’s daily routines, livelihoods, and outlets for social participation . Recommended transmission mitigation strategies, like limiting social contact and physical distancing, required people to adapt their personal and professional lives to comply with support infection control mandates . Although critical for mitigating the spread of COVID-19, these strategies have also adversely affected the general public’s mental health . Researchers have suggested that the social circumstances arising from the COVID-19 pandemic may have contributed to increases in psychosocial stress , problematic alcohol and recreational drug use, and limited access to mental health support, harm reduction, and substance use treatment .
These predictions warrant prioritized attention for PLHIV given this population’s disproportionate vulnerability to adverse outcomes, even in pre-pandemic times . Many studies have investigated problematic alcohol and recreational drug use trajectories in PLHIV, particularly in the contexts of stress, coping, and sexual risk-taking . Prior studies have found that problematic alcohol consumption and recreational drug use commonly co-occur with other adverse psychosocial conditions, including depressive symptoms, loneliness, and inadequate social support . Problematic alcohol, heavy marijuana, and recreational drug use are linked to sub-optimal HIV outcomes and quality of life, including sexual risk-taking, impaired cognitive function, non-adherence to HIV care recommendations, weakened immunity, and premature mortality . Yet, few studies have investigated whether problematic alcohol, marijuana, and recreational drug use have changed since the COVID-19 pandemic in PLHIV. Our study’s objective was to compare the short-term trajectories in binge drinking, marijuana, and recreational drug use spanning preCOVID-19 pandemic to early pandemic time points among a prospective cohort of PLHIV. We hypothesized that substance use would increase during the pandemic. Additionally, we hypothesized that depressive symptoms and loneliness would be linked to increased substance use behaviors and social support would be associated with decreased substance use behaviors. We argue that psychosocial conditions and a lack of social support at the start of the pandemic may serve as proxies for prevalent adversity in participants’ lives and their potential to avoid negative trajectories. We developed group-based trajectory models in SAS 9.4 to identify clusters of individuals who shared similar trajectories in binge drinking, daily marijuana use, and recreational drug use over time. We used the multi-variable mixture modeling macro, PROC TRAJ, which employs maximum likelihood to estimate model parameters and handles missing values .Following these iterative processes, we evaluated improved model fit based on Bayesian Information Criterion , the size of each group, and the probability of membership in a specific group; specifically lower BIC values, > 5% of the sample in each group, and an average probability of ≥ 0.70 for participants in each trajectory group . After finding the best-fit number of group trajectories, we adjusted each trajectory for the best shape . We iteratively compared models with increasing numbers of groups, omitting and adding parameters based on BIC values to assess improvements in goodness-of-fit. Based on the group-based trajectory analyses, we derived a categorical variable representing trajectory group membership for each substance use behavior to test their associations with other co-factors. Fisher’s exact tests were used for categorical variables and student’s tests for continuous variables. We tested bivariate and multivariate logistic regression models to estimate the association between trajectory group membership and co-factors. Finally, we tested generalized linear mixed models using repeated measures for each substance use outcome to further confirm our results. We did not assume any structured error correlations due to limited time points; therefore, we modeled our data using unstructured correlation matrices. We included time along with co-factors used in the group-based trajectory models as independent variables. We also tested an interaction of sex assigned at birth by time to account for potential cohort effects. We allowed only the intercept to vary between subjects and the regression slopes as fixed. The current study is among the first to examine short-term problematic alcohol, marijuana, and recreational drug use trajectories during the beginning of the COVID-19 pandemic in a large, prospective cohort of PLHIV in the United States. We observed two-level, short-term, group based trajectories that distinguished participants as non-binge drinkers versus binge drinkers, non- or infrequent marijuana users versus daily marijuana users, and users versus non-users of recreational drugs.