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MIND & BRAIN, THE JOURNAL OF PSYCHIATRY


REVIEW ARTICLE


Interaction of Genes and Environment in Adolescent Substance Use: Opportunities and Implications for Interventions


Richard Rende Affiliation: Transdisciplinary Research Group, Department of Psychiatry and Human Behavior, Alpert Medical School, Butler Hospital, Brown University, Providence, Rhode Island


ABSTRACT It is well recognized that adolescence is now a period of development in which the roots of substance abuse and dependence are put down.


As such, there is an appreciation of the importance of delivering psychosocial interventions that could curtail adolescent use and prevent escalation into problematic levels of use. This paper reviews the rationale of psychosocial interventions from the perspective of genetic epidemiology. Genetically informative studies are discussed as laying a foundation that emphasizes the importance of shared environmental influences as targets for psychosocial interventions that could reduce early levels of substance use in adolescence, and serve as a blockade for the activation of genes that underlie progression to heavier use, as well as abuse and dependence. Recent conceptual and empirical approaches to gene-environment interplay are discussed with reference to the specific case of delivering psychosocial interventions. The implications for merging the intervention mindset with the tools of genetic epidemiology are discussed.


Keywords: adolescence, substance use, intervention, genetic epidemiology, gene-environment interplay Correspondence: Richard Rende, Transdisciplinary Research Group, Department of Psychiatry and Human Behavior, Alpert Medical School,


Butler Hospital, 345 Blackstone Blvd., Providence 02906, Rhode Island. Tel: (401) 455-2481; Fax: (401) 455-6611; e-mail: r.rende@comcast.net


INTRODUCTION Clinical, developmental, and public health perspectives all


converge on the idea that early use of substances (the most common being tobacco, alcohol, and marijuana)*and parti- cularly onset in early adolescence*is problematic and portends poorly for functioning later in life. Although experimentation in adolescence was once considered norma- tive, there is increasing recognition that use of substances is not inherently benign, especially as some youth may be at biological*and particularly*genetic risk for rapid escala- tion. As such, there have been strong suggestions that early psychosocial interventions are of extreme importance for reducing the likelihood of progression to higher levels of use, abuse, and dependence.14


In this paper, the idea of applying psychosocial interven-


tions to reduce adolescent substance use will be considered from the perspective of genetic epidemiology. In particular, I will argue that the current evidence suggests that possibility of an intriguing model for intervention science: modifying the eventual expression of risk genes via environmental manip- ulation. First, a brief overview of the rationale for intervening to reduce adolescent substance use will be presented. I will then provide an overlay of the genetic epidemiological perspective on the developmental staging of substance use and transitions to abuse and dependence. Finally, reference to


recent theory and findings pertaining to gene-environment interplay will be discussed.


WHY INTERVENE TO REDUCE ADOLESCENT SUBSTANCE USE?


There is compelling new evidence*and new thinking* which emphasizes the profound risks that are associated with early-onset substance use. A flurry of papers in recent years has expanded our understanding of the developmental risks conveyed by early-onset use. Four themes stand out in terms of defining a rationale for intervention programs aimed specifically at early-onset use.


First, there is an abundance of recent papers documenting


how early-onset use*typically defined as initiation before 15 years of age*is highly predictive of the development of substance use disorders. These associations have been documented for early use of alcohol,5 cigarettes,6 and other drugs.7 The risks of early-onset use may be especially profound because there are ‘‘global’’ risks that are not limited to use of a particular substance. Thus, for example, early smoking is linked with subsequent alcohol and cannabis use810 as well as with later alcohol and drug use disorders.11 Similarly, early age of first drink is a predictor of later cigarette use and illicit drug use.12,13 Taken together, early initiation of substance use*whether it involves tobacco,


M&B 2011; 2:(1). July 2011


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