The Symptom-Associated Pathway to Substance Use and Misuse during Adolescence

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PROJECT SUMMARY Pain and other symptoms such as anxiety, fatigue, and somnolence often co-occur, persist into adulthood, and heighten health risks for adolescents. For instance, poorly managed pain, fatigue and psychological symptoms may contribute to risky self-management behavior such as use and misuse of prescription drugs and other substances. These risky behaviors and drug exposures during teenage years have been associated with prescription drug misuse and substance use (PDM/SU) into adulthood. Importantly, we know little about how persistent symptom trajectories develop during childhood and adolescence. We also know little about how family and other environmental factors influence children’s symptom trajectories or how they contribute to symptom-motivated PDM/SU behavior. Since persistent or recurrent pain, psychologic problems, and PDM/SU often emerge during adolescence, a better understanding of the relationship between these factors is critical. Equally important is that we understand the family and environmental factors that can help protect teens with persistent symptom trajectories from engaging in risky self-medication or PDM/SU behavior. Our overall goal with this research is to identify and strategize optimal interventions to prevent or reduce symptom-associated PDM/SU among teens. Our first objective is to identify a symptom profile (or “signature”) during early adolescence that indicates vulnerability to 1) persistent or worsening pain, psychological, and somatic (body) symptoms (P-PSS). We will also identify key factors in the family and environment that are relevant and primary targets for early intervention. To accomplish this, we will use data from the 11,875 children enrolled in the national longitudinal Adolescent, Brain, and Cognitive Development (ABCD) Study. In Aim 1, we will differentiate children based on their P-PSS (symptom) trajectories at age 13 years, and will determine the degree to which child health, family health and environmental factors influence these trajectories. In Aim 2, we will demonstrate how children with the most vulnerable (persistent/worsening) symptom trajectory are at risk for ongoing symptoms and PDM/SU behavior by age 15/16 years. We will also identify key interventional targets (child, family and environmental) that enhance or reduce the risk for ongoing symptoms and PDM/SU behavior. In Aim 3, we will use dynamic simulation modeling to examine the potential impact of selected interventions addressing these prime targets to disrupt the path from symptoms to PDM/SU. This research will provide the most comprehensive understanding of the symptom-related pathway to PDM/SU in teens, to date. Our findings will not only improve our knowledge about adolescent symptom progression and key risk factors, but will inform the optimal application of interventions to prevent or curtail the symptom-to-substance use pathway.