Background: Care leavers transitioning into adulthood represent a highly vulnerable population, confronted with usual developmental tasks under difficult predisposing conditions. Early-risk and... Show moreBackground: Care leavers transitioning into adulthood represent a highly vulnerable population, confronted with usual developmental tasks under difficult predisposing conditions. Early-risk and persistent substance use may be an obstacle for care leavers transitioning from youth residential care settings into an independent adult life.Objectives: This study aims to address the following questions: (1) How stable is high-risk substance use from within care to after youth residential care? (2) Are there differences between longitudinal substance use risk pathways and sociodemographic characteristics, placement history, and adverse exposures? (3) Is the persistency of high-risk substance use associated with impaired young adult psychosocial functioning?Method: In a prospective longitudinal design, with a baseline in youth residential care (t1) and a follow-up ten years later (t2), we investigated the courses of substance use in 182 young adult care leavers in Switzerland (32.4 % women; Mean age = 26.7 years). Psychosocial functioning was assessed across health, legal, educational, and financial domains.Results: We found large prevalence rates of high-risk substance use in and after residential youth care (41.2 % in residential care; 46.2 % after leaving care). Of those care leavers who reported earlier high-risk substance use, 61.3 % persisted, while 38.7 % remitted. Four substance risk pathways were identified longitudinally: low (N = 69, 37.9 %), remitted (N = 29, 15.9 %), newly-developed (N = 38, 20.9 %), and persistent risk (N = 46, 25.3 %). Persistent high-risk substance use was associated with higher rates of adverse functional outcomes in young adulthood.Conclusions: Findings of this study shed light on the high prevalence of earlier and persistent high-risk substance use in youth residential care leavers. High-risk substance use appears to have the potential to coincide with impaired psychosocial functioning during and after the transition to young adulthood. Implications for educational and vocational paths as well as harm-reducing interventions are discussed. More research disentangling risk pathways and intervention research in at-risk populations is warranted. Show less
The ventral tegmental area dopamine (VTA-DA) mesolimbic circuit processes emotional, motivational, and social reward associations together with their more demanding cognitive aspects that involve... Show moreThe ventral tegmental area dopamine (VTA-DA) mesolimbic circuit processes emotional, motivational, and social reward associations together with their more demanding cognitive aspects that involve the mesocortical circuitry. Coping with stress increases VTA-DA excitability, but when the stressor becomes chronic the VTA-DA circuit is less active, which may lead to degeneration and local microglial activation. This switch between activation and inhibition of VTA-DA neurons is modulated by e.g. corticotropin-releasing hormone (CRH), opioids, brain-derived neurotrophic factor (BDNF), and the adrenal glucocorticoids. These actions are coordinated with energy-demanding stress-coping styles to promote behavioral adaptation. The VTA circuits show sexual dimorphism that is programmed by sex hormones during perinatal life in a manner that can be affected by glucocorticoid exposure. We conclude that insight in the role of stress in VTA-DA plasticity and connectivity, during reward processing and stress-coping, will be helpful to better understand the mechanism of resilience to breakdown of adaptation. Show less
Adolescents with delinquency and cannabis abuse, primarily boys, are predisposed to a variety of comorbid psychiatric psychopathology and form an intricate subgroup which is difficult to treat ... Show more Adolescents with delinquency and cannabis abuse, primarily boys, are predisposed to a variety of comorbid psychiatric psychopathology and form an intricate subgroup which is difficult to treat (Merikangas et al., 2010; Zahn-Waxler, Shirtcliff, & Marceau, 2008). Systemic treatments are considered the type of treatment which renders the most promising results in addressing the complex taxonomy of adolescents’ problem behaviours (Carr, 2009; Von Sydow, Retzlaff, Beher, Haun, & Schweitzer,2013; Waldron & Turner, 2008). Clinicians working with this group of adolescents have to deal, on a daily basis, with serious issues and have to make difficult decisions, impacting the adolescent, his/her family, and society as a whole. For the forensic research field, comprehending and grasping the complexity of these adolescents, which could generate insights and practical advises leading to improvement of care, is a tough and demanding task. This dissertation tries to inform clinical and research practice by providing insight and knowledge concerning: the common elements of systemic treatment, the effectiveness of Multidimensional Family Therapy (MDFT), and the predictive value on treatment outcome of baseline characteristics of the adolescent. This to better understand systemic treatments and to be better able to match a treatment with the individual adolescent’s psycho-social make-up. Show less
Marees, A.T.; Hammerschlag, A.R.; Bastarache, L.; Kluiver, H. de; Vorspan, F.; Brink, W. van den; ... ; Derks, E.M. 2018
This thesis describes the development and initial validation of the Benzodiazepine Craving Questionnaire (BCQ), a Rasch-homogeneous self-report questionnaire to assess craving for benzodiazepines.... Show moreThis thesis describes the development and initial validation of the Benzodiazepine Craving Questionnaire (BCQ), a Rasch-homogeneous self-report questionnaire to assess craving for benzodiazepines. This questionnaire was developed as part of the Benzoredux project, which was designed to evaluate a stepped-care approach to reduce long-term benzodiazepine use in general practice. In chapter 1 aspects of (long-term) benzodiazepine use are discussed (definition; prevalence; dependence). We address the role of craving in dependence on addictive substances and find that benzodiazepine craving research is scarce. Chapter 2 describes the development and initial validation of the BCQ. Chapter 3 describes characteristics of patients reporting benzodiazepine craving and associations between benzodiazepine craving and other clinical variables in a general practice population who had made an attempt to discontinue their long-term benzodiazepine use. In chapter 4 we have aimed to assess benzodiazepine craving longitudinally and have described its course by means of the BCQ. Chapter 5 addresses the scope of the craving definition (broad versus narrow). In Chapter 6 we find that in long-term benzodiazepine users who received a supervised tapering off protocol after a failed attempt to quit on their own, benzodiazepine craving predicts relapse during a 15-month follow-up period independent of other predictors. Chapter 7 presents a general discussion. Show less
