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Posttraumatic stress disorder (PTSD) is the most highly co-occurring psychiatric disorder among veterans with cannabis use disorder (CUD). Despite some evidence that cannabis use prospectively exacerbates the course of PTSD, which in turn increases the risk for CUD, the causal nature of the relationship between cannabis and psychiatric comorbidity is debated. The longitudinal relationship between PTSD diagnosis and traumatic intrusion symptoms with cannabis use and CUD was examined using cross-lagged panel model (CLPM) analysis.
Prospective data from a longitudinal observational study of 361 veterans deployed post-9/11/2001 included PTSD and CUD diagnoses, cannabis use, and PTSD-related traumatic intrusion symptoms from the Inventory of Depression and Anxiety Symptoms.
A random intercept CLPM analysis that leveraged three waves (baseline, 6 months and 12 months) of cannabis use and PTSD-related intrusion symptoms to account for between-person differences found that baseline cannabis use was significantly positively associated with 6-month intrusion symptoms; the converse association was significant but reduced in magnitude (baseline use to 6-month intrusions: β = 0.46, 95% CI 0.155–0.765; baseline intrusions to 6-month use: β = 0.22, 95% CI −0.003 to 0.444). Results from the two-wave CLPM reveal a significant effect from baseline PTSD to 12-month CUD (β = 0.15, 95% CI 0.028–0.272) but not from baseline CUD to 12-month PTSD (β = 0.12, 95% CI −0.022 to 0.262).
Strong prospective associations capturing within-person changes suggest that cannabis use is linked with greater severity of trauma-related intrusion symptoms over time. A strong person-level directional association between PTSD and CUD was evident. Findings have significant clinical implications for the long-term effects of cannabis use among individuals with PTSD.
Prior research has shown that sipping of alcohol begins to emerge during childhood and is potentially etiologically significant for later substance use problems. Using a large, community sample of 9- and 10-year-olds (N = 11,872; 53% female), we examined individual differences in precocious alcohol use in the form of alcohol sipping. We focused explicitly on features that are robust and well-demonstrated correlates of, and antecedents to, alcohol excess and related problems later in the lifespan, including youth- and parent-reported externalizing traits (i.e., impulsivity, behavioral inhibition and activation) and psychopathology. Seventeen percent of the sample reported sipping alcohol outside of a religiously sanctioned activity by age 9 or 10. Several aspects of psychopathology and personality emerged as small but reliable correlates of sipping. Nonreligious sipping was related to youth-reported impulsigenic traits, aspects of behavioral activation, prodromal psychotic-like symptoms, and mood disorder diagnoses, as well as parent-reported externalizing disorder diagnoses. Religious sipping was unexpectedly associated with certain aspects of impulsivity. Together, our findings point to the potential importance of impulsivity and other transdiagnostic indicators of psychopathology (e.g., emotion dysregulation, novelty seeking) in the earliest forms of drinking behavior.
The purpose of the present study is to identify child and adult correlates that differentiate (a) individuals with persistent alcohol dependence from individuals with developmentally limited alcohol dependence and (b) individuals with adult-onset alcohol dependence from individuals who never diagnose. There are 1,037 members of the Dunedin Longitudinal Study, which is a birth cohort followed prospectively from birth until age 32. Past-year DSM-IV alcohol dependence diagnoses are ascertained with structured diagnostic interviews at ages 18, 21, 26, and 32. Individuals are classified as developmentally limited, persistent, or adult-onset subtypes based on their time-ordered pattern of diagnoses. The persistent subtype generally exhibits the worst scores on all correlates, including family psychiatric history, adolescent and adult externalizing and internalizing problems, adolescent and adult substance use, adult quality of life, and coping strategies. The prospective predictors that distinguished them from the developmentally limited subtype involved family liability, adolescent negative affectivity, daily alcohol use, and frequent marijuana use. Furthermore, young people who develop the persistent subtype of alcohol dependence are distinguished from the developmentally limited subtype by an inability to reduce drinking and by continued use despite problems by age 18. The adult-onset group members are virtually indistinguishable from ordinary cohort members as children or adolescents; however, in adulthood, adult-onset cases are distinguished by problems with depression, substance use, stress, and strategies for coping with stress. Information about age of onset and developmental course is fundamental for identifying subtypes of alcohol dependence. Subtype-specific etiologies point to targeted prevention and intervention efforts based on the characteristics of each subtype.
Researchers studying longitudinal relationships among multiple problem behaviors sometimes characterize autoregressive relationships across constructs as indicating “protective” or “launch” factors or as “developmental snares.” These terms are used to indicate that initial or intermediary states of one problem behavior subsequently inhibit or promote some other problem behavior. Such models are contrasted with models of “general deviance” over time in which all problem behaviors are viewed as indicators of a common linear trajectory. When fit of the “general deviance” model is poor and fit of one or more autoregressive models is good, this is taken as support for the inhibitory or enhancing effect of one construct on another. In this paper, we argue that researchers consider competing models of growth before comparing deviance and time-bound models. Specifically, we propose use of the free curve slope intercept (FCSI) growth model (Meredith & Tisak, 1990) as a general model to typify change in a construct over time. The FCSI model includes, as nested special cases, several statistical models often used for prospective data, such as linear slope intercept models, repeated measures multivariate analysis of variance, various one-factor models, and hierarchical linear models. When considering models involving multiple constructs, we argue the construct of “general deviance” can be expressed as a single-trait multimethod model, permitting a characterization of the deviance construct over time without requiring restrictive assumptions about the form of growth over time. As an example, prospective assessments of problem behaviors from the Dunedin Multidisciplinary Health and Development Study (Silva & Stanton, 1996) are considered and contrasted with earlier analyses of Hussong, Curran, Moffitt, and Caspi (2008), which supported launch and snare hypotheses. For antisocial behavior, the FCSI model fit better than other models, including the linear chronometric growth curve model used by Hussong et al. For models including multiple constructs, a general deviance model involving a single trait and multimethod factors (or a corresponding hierarchical factor model) fit the data better than either the “snares” alternatives or the general deviance model previously considered by Hussong et al. Taken together, the analyses support the view that linkages and turning points cannot be contrasted with general deviance models absent additional experimental intervention or control.