Mental health and well-being for the prevention of substance use disorders
Year: 2024
Type: article
Abstract: INTRODUCTION Mental health is defined as “a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community.” Well-being is defined as “a good or satisfactory condition of existence; a state characterized by health, happiness, and prosperity; welfare.” It encompasses but is not limited to physical, emotional, social, occupational, and economic well-being. The relationship between the use of substances and well-being is complex. Historically, the normative use of different substances has been documented in cultures across the world. Substances (such as cannabis and psychedelics) have been used as a means to heighten spiritual experiences, gain greater insight and understanding about the world, and enhance well-being. They have also been used in healing rituals by medicine men or shamans. In recent times, substance use (particularly alcohol and cannabis) in social contexts has become common. A cross-sectional study, which used data from the Danish National Youth Study 2019 (25,910 students aged 15–25 years), found that there was a U-shaped association between weekly alcohol consumption and poor well-being; for example, students who never drank, students who only drank occasionally, and students who drank a lot (22 units of alcohol or more a week) had higher odds of poor well-being, compared with the reference group (1–7 units a week).[1] The relationship between excessive use of substances or substance use disorders (SUDs) and decreased well-being is indisputable, with the relationship appearing to be a bidirectional one. This is borne out by a study in a random national sample of 9493 adolescents aged between 12 and 18 years recruited as part of My World Survey 2-Second Level (MWS2-SL), which found that the “low” health-promoting cluster was characterized by high alcohol, cannabis, and social media use; moderate sport and hobby participation; and low sleep duration. They also demonstrated the highest levels of anxiety and depression and the lowest levels of life satisfaction, self-esteem, and daily functioning.[2] ETIOLOGY OF SUD There are a number of etiological factors that seem to be associated with the development of SUD. Figure 1 provides an overview of these factors and how they can contribute to the risk of developing SUD.Figure 1: Framework for understanding the etiology of psychiatric disorders, including SUDIt is important to recognize that a number of the factors outlined confer risk or protection for a range of mental health conditions, including psychosis, depression, anxiety, and SUD. Furthermore, they seem to operate from the antenatal period through infancy, childhood, and adolescence, long before the symptoms of mental illness become apparent. This risk or protection is likely mediated by deviations in the normative trajectories of brain structure, function, and neuropsychological functioning, which are also transdiagnostic in nature. This, in turn, leads to differences in temperament, which can increase the risk of developing psychopathology. These same factors are also likely to contribute to resilience and well-being. This framework can also be used to study the effect of preventive interventions that modify these risk and protective factors. PREVENTIVE INTERVENTIONS FOR SUD The Institute of Medicine (IOM) classifies preventive interventions based on the level of risk into the following: Universal (targeting the population in general) Selective (targeting those at a higher-than-average risk of substance use, e.g. children of substance users) Indicated (targeting those who are already using substances or engaging in high-risk behaviors) The Centre for Substance Abuse Prevention (CSAP) further identifies six domains where risk and protective factors can operate, namely: Individual Family Peer School Community Society or environment In this section, we will describe interventions across different developmental stages and further divide them based on the risk level and the domain of the intervention. The impact of these interventions will be described on both intermediate outcomes, such as neurodevelopment, and terminal outcomes, such as well-being and psychopathology, with a focus on substance use. We will also summarize the certainty of the evidence for each type of intervention using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) [Table 1]. We feel that this will serve as a way to both review the current evidence and highlight the gaps in the same, which can guide future studies.Table 1: GRADE certainty ratingsPrenatal and antenatal interventions There is accumulating evidence that health-related factors, such as nutritional deficiencies, obesity, substance use, infections or inflammation, and exposure to environmental toxins, and psychosocial factors, such as exposure to intimate partner violence and psychopathology, including anxiety and depression during pregnancy, can affect neurodevelopment and are associated with the development of internalizing and externalizing psychopathology in childhood.[3] Given that these factors predispose individuals to develop SUD, interventions to address them in the prenatal, antenatal, and postnatal periods may reduce the future occurrence of SUD. The interventions in this section are mostly universal and delivered to pregnant mothers, although fathers may also be involved in certain cases. The evidence for these interventions directly influencing terminal outcomes, such as well-being and substance use, is sparse, as most of the studies described have not followed up children into adolescence and adulthood. Nutritional Interventions A large longitudinal study from Central America clearly showed that nutritional interventions starting in the antenatal period till 2 years of age were associated with improved neurodevelopmental and neurocognitive outcomes starting from infancy, into early and middle childhood, adolescence, and young adulthood.[4] It was also associated with enhanced executive functioning and psychological well-being in adulthood.[5] However, as demonstrated in another study from Latin America, providing nutritional counseling alone may not be sufficient with no differences in intelligence, mental health, or alcohol use and smoking among adolescents in the treatment and control groups.[6] This underlines the role of maternal micronutrient supplementation to both treat nutritional deficiencies and, in certain cases, to mitigate the effects of environmental exposures, such as substance use or infections. This may help to prevent the future occurrence of mental illness[7] and also enhance well-being. Prenatal and antenatal iron and folic acid (IFA) supplementation seems to have a positive impact on neurodevelopment in infancy and early childhood.[8,9] These effects also seem to persist into adolescence, as seen in a 14-year follow-up of a large randomized controlled trial (RCT) from rural China, which compared multiple micronutrient (MMN) supplementation, IFA supplementation, and folic acid supplementation alone, which found that the MMN and IFA groups showed improved measures of intellectual development[10] and also reduced levels of total and externalizing psychopathology.[11] The evidence for B-complex vitamins is less consistent. A small RCT conducted in India found that B12 supplementation from preconception to delivery was associated with better neurodevelopmental outcomes at 2 years of age as compared to placebo.[12] There was no association between ω-3 long-chain polyunsaturated fatty acid, docosahexaenoic acid (DHA) supplementation, and childhood behavior or cognitive development.[8,13] A number of longitudinal studies have shown a link between lower maternal choline concentrations and poorer performance on attentional and processing speed tasks in early childhood.[14,15] A review of uncontrolled interventional studies found that higher maternal choline intakes during the second half of pregnancy and early postnatal period (550 to 1000 mg/day, apart from diet) demonstrated favorable effects on several domains of child neurocognition, such as memory, attention, and visuospatial learning versus the comparison groups.[16] A small RCT comparing choline supplementation at 480 mg/day to 930 mg/day in the third trimester of pregnancy found that mothers of children receiving 930 mg/day had improved performance on sustained attention tasks at 7 years of age.[17] In addition, maternal choline supplementation may ameliorate some of the cognitive problems seen in offspring born to alcohol-exposed pregnancies.[18,19] Psychosocial Interventions Evidence from longitudinal cohort studies has highlighted the association between antenatal maternal depressive and anxiety symptoms and infant and child development[20] and internalizing and externalizing psychopathology.[21,22] These are likely to be mediated by epigenetic changes,[23] which may influence brain structure and function.[24] Furthermore, exposure to stressful life events and intimate partner violence during pregnancy is also associated with child executive functioning problems and externalizing problems, a relationship that was moderated by maternal parenting quality, such that higher parenting quality is protective for the associations between stressful life events and outcomes in the child.[25] This emphasizes the importance of interventions that can reduce stress, enhance well-being, and address depression and anxiety in pregnant mothers. Parenting or Family interventions A meta-analysis evaluating the effect of universal prevention interventions among 2559 pregnant women found that there was a moderate effect of preventive interventions implemented during pregnancy on maternal distress, depressive symptoms, and stress. The effects were not associated with intervention timing, intervention type, intervention delivery mode, timing of posttest, and methodological quality.[26] Another meta-analysis on the impact of parenting interventions on symptoms of perinatal depression and infant outcomes found significant reductions in maternal depressive symptoms at postintervention for mothers allocated to receive parenting interventions. For both studies, data on infant development outcomes were scarce and therefore not analyzed.[27] Summary and recommendationsInterventions during early (birth to 6 years) and middle (6 to 12 years) childhood Childhood nutritional deficiencies, obesity, parenting, and home, school, and community environment have been strongly associated with cognitive development, child well-being, and the development of psychopathology in early and middle childhood. As in the previous section, the direct evidence of these interventions influencing terminal outcomes, such as the risk of developing substance use-related problems, is limited, but encouraging. Nutritional Interventions The use of micronutrient supplementation for improving cognitive outcomes in early childhood has shown promise. Among them, iron and multi-micronutrient supplementation have been shown to be most effective in improving cognitive abilities, particularly in undernourished children.[28] A meta-analysis of iron supplementation in schoolchildren (aged between 6 and 12 years) has shown significant improvements in intelligence, attention and concentration, and memory, although there was no impact on overall school performance. The improvements were more in children who were anemic at baseline.[29] These findings were also partly replicated in another meta-analysis, including studies from only low and middle income countries.[30] Psychosocial Interventions Psychosocial interventions in early and middle childhood may be universal, selective, or indicated. The domain of interventions is usually parents or families and schools. Parenting or family interventions Universal parenting interventions may have a positive impact on childhood development and lead to better emotional and behavioral adjustment of children. This, in turn, may be associated with a decreased likelihood of developing substance use later in life. These interventions, in most cases, focus on providing feedback either in-person or through recorded videos on parenting practices to improve parent–child interactions. The Family Check-Up (FCU) is one such well-researched family intervention. It is a brief intervention that is based on motivational interviewing principles and consists of a broad assessment of the family context and parenting practices, an initial “get-to-know-you” meeting with the family, and a formal feedback session. It includes a menu of empirically supported child and family interventions that reduce problem behavior and promote emotional well-being in children and families. There is also a mechanism for periodic contact (at least once a year) with families.[31] The FCU has been used to intervene with families across age groups from early childhood to adolescence[32] and also in diverse ethnic and cultural settings.[33] It has been seen to reduce externalizing and internalizing psychopathology in adolescence[34,35] and reduce the likelihood of getting into high-risk trajectories of alcohol, tobacco, and cannabis use.[36,37] The Attachment and Biobehavioural Catch-Up (ABC) is another 10-session home-visiting program developed to enhance parental sensitivity. The intervention provides parents practice and feedback in interacting sensitively with their children. It has been used in a number of different settings across the world and has also adapted for specific situations. The ABC has been shown to be effective in enhancing parental sensitivity and children's attachment security and regulatory capabilities.[38] It has also been associated with greater high-frequency power (beta, 12–20 Hz) on electroencephalogram (EEG)[39] and increased activation in the amygdala–prefrontal cortex (PFC) circuitry in response to faces in functional magnetic in to is another universal intervention that to improve reduce and stress, and improve social, emotional, and behavioral functioning in using a RCT found reductions in in parental and greater in parental and There were also greater reductions in among intervention but not control group The to Parenting and is another program that used six of intervention of and was found to have a positive effect on behavioral problems, with improvements in symptoms, and was also found to be compared with at A large meta-analysis, which positive of parenting interventions on child cognitive development, development, development, development, and attachment and reductions in behavior were also found in parenting parenting practices, and parent–child interactions. There was no evidence of effect by child intervention or study risk of Another meta-analysis, which and evaluating the of parenting found that they reduced overall emotional and behavioral problems and total externalizing problems but had no effect on total internalizing the quality of evidence was In to the universal interventions described or interventions may be among families at higher risk of substance use. These interventions are and more but they focus on and with a to improve the quality of and well-being in families. The is an prevention program for parents and children between the of and in families. 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randomized to the intervention or control groups and found the of substance use in the intervention In the of specific interventions, the Abuse which was to help and high school students the of with tobacco, and alcohol, is the most focus was providing children with about use that them to The program was by a the has usually once a for to a large meta-analysis found that was not effective in the prevention of substance use or and behavior substance This to a in the and the and with the focus to for development, including and understanding relationship and and and using This has been found to be more effective in the prevention of substance and has also been in different with positive have also been found to be effective delivered and may be an to conducted a school A intervention of feedback and and social, and substance use was in students from in and showed in smoking and cannabis Individual interventions In to life there are also a number of universal SUD prevention interventions in adolescents and young which focus on providing feedback about substance use, risk health, and well-being. such the a feedback based on the to a alcohol use, use, and mental health, showed positive in of of health-related quality of life and mental health in a cluster RCT conducted among adolescents from the A for students risk for substance use and providing feedback on risk domains and with and was found to lead to reductions in alcohol and cannabis use, in a There is also evidence for the of interventions based on well-being in substance use-related A cluster RCT conducted in to the of a well-being intervention compared with intervention or no intervention found in cannabis use, and which were most in the intervention For who are already at high risk of developing problems with substance use, the use of more selective, or interventions has been found to be A longitudinal of enhanced for children of parents found improvements in positive reduced internalizing psychopathology, and 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prevention of SUD focus on early of of substance use, and brief interventions for the same and to treatment where is for the use of such an for the and use of alcohol in and There is also evidence for the use of interventions to reduce and alcohol use in community These interventions the about alcohol use, which is followed by feedback and about how to on Interventions during age Prevention interventions for people are not and those for groups to address the and of A review of the evidence from studies found that most studies different of brief and The on and or which to Interventions to with of health and well-being and be delivered in where people or receive There is a relationship between substance use and poor well-being across different age The that influence the risk of developing mental health such as substance use, with those that resilience and well-being. Interventions that reduce risk or increase protective factors can lead to greater well-being and reduced mental including substance use. Universal interventions, which multiple such as and from the antenatal infancy, and early childhood are likely to have greater effects on well-being and mental but direct evidence for the same Universal interventions seem to have a greater effect on the prevention of substance use among children and adolescents compared to universal or interventions. The of the community in interventions, which address the social and environmental of substance use, seems to improve the well-being of the community and reduce substance use. and of There are no of
Source: Indian Journal of Psychiatry
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4391177466