ERANID ImagenPathways preliminary findings - PowerPoint Presentation

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ERANID ImagenPathwayspreliminary findings

PI: Reinout Wiers (UvA)co-PIs:

Lisbon Addictions 2019

Gunter Schuman

King’s College London 

Valerie

Curran

University College London

Andreas Heinz

Charité

-

Universitätsmedizin

Berlin

Vincent Frouin

Commissariat

d’Energie

Atom

.

Neurospin

, Paris

Anita Hardon

University of Amsterdam

Jean Luc

Martinot

Inserm

Slide2

Eranid ImagenPathwaysSetup ProjectFirst impressions…I. First impression mixed methodsII. First impression online data

III. First impression hair-analysisGlance into the future

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ImagenPathways

(IP) - aims

Predictors of initiation of drug use

Predictors of escalation/controlled drug use

Better phenotyping, using anthropological methods, may later be adapted for use in whole sample

Slide4

4

ImagenPathways

(IP)

Extension of Imagen: Unique Prospective Sample

Imagen, FP6 project, led by King’s College (UK)

N ~ 2000 adolescents (14

yrs

)

Four countries:

Ger

, UK, Fra, Ireland

Genetics, Environmental variables, brain imaging

Wave-2: 16 years (86%)

Wave-3: 18/19 years (80%)Wave-4 (now): 22/23 years old.See for details: http://www.imagen-europe.com/

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5

ImagenPathways

(IP)

Eranid

: Extension Imagen Database (f-up age 23), UK,

Ger

, Fra (Ireland not part of

eranid

)

Self-reported illicit drug use:

hair – sample

+ invitation IP-1

No Self-reported illicit drug use: hair – sample

IP-1: 3 f-up hair analyses (UCL)

+ TLFB (+3, 6, 9 months)

IP-3 In depth interviews Drug use pathways

UvA

(Hardon)

IP-2 Online extension

UvA

(Wiers)

Unique:

Link back

To database

questionnaire whole sample?

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I Mixed Methods Approaches (combining Quantitative + Qualitative)

TriangulationResults and Methods check each other

E.g. comparing questionnaires with follow-up observations

Facilitation

One approach helps to develop the other

E.g. using qualitative data to build questionnaires or debriefing subjects after testing in order to find out why they did certain things

Complementation

Two approaches provide different information about two aspects of the same phenomenon

E.g. using qualitative methods to understand perspectives and quantitative methods to measure frequencies and patterns

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Ethnographic interviews(lead UvA

Anthropology)Prof. Anita Hardon, UvA and team

Ethnographic interview: First Grand tour; then Probing; 2 day recalls; Projective techniquesWith interviewers in Berlin, Paris, London, trained in Amsterdam

Aim

: is to understand the systems of shared ideas, concepts, rules, meanings and behaviour that are expressed in the ways humans live – in specific contexts, as well as

insights in dynamics of change

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51 participants completed 3 cycles of ethnographic interviews (31 Lnd, 20 Berlin)Between 2 and 3 month between interviews

II: Ethnographic interviews

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Emerging themes: Materials (e.g., associated with use)

Space-Time (locations, use at work, weekends etc)Identity and Self-Image

Social environment

Personal ethics (e.g., change of norms)

Meaning and representation (e.g., rituals, combinations, meaning to their life)

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Meaning of Substance use “(

Drugs are) experiences that precisely not everybody shares and that, especially with hallucinogens have a strong influence on me because they give experiences that one can barely describe to people who never tried them”.

(Nala, 23, student)

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Predictors of escalation (interviews):Intimate

partners (both directions)Work

environmentDisruption

of family unit (

parents

abandoning

child

,

death

)

Disruption

from schooling (

increase

after

failing

a

year

and

staying

on campus)

Prescription drugs (

opioids)

after

injury/chronic

pain

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Qualitative: Profilesurban illicit drug users

Self portrait as “informed users”,

often times trying out the highest amount of different substances compared to the others, emphasize control in their use, selective in terms of place and time (clubs, festivals etc.), selective and limited periods of intense use (weekends for the most part)

Often times exposed to substances relatively early, tend to use substances in adverse life situations and crises.

Not the broadest variety of substances, can be even only 1 substance. Not very selective in terms time (weekdays, weekends, weeks) and place of drugs (homes, work, clubs,…)

Using substances only for a brief period in life, often times after school, in university or in between other life and career stages. In that sense very limited time which can stretch to a year or even two.

Usually discontinuation after that phase of use

.

Moritz

Berning

Hayley Murray

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Can we find some of these patterns backin quantitative data?

hypothesis: early use + conformity & coping motives predictive of later use?

first test in Imagen database

1. latent profile analysis

use

age

233 groups:

1. alcohol (2.2),

some

cannabis (1.5) +

narcotics (1.9) n = 856

2. alcohol (2.8), cigarettes (2.5), cannabis (2.4), n = 207

3. cigarettes (4.5), cannabis (3.2), alcohol (2.5), coke (1.4) n = 180interesting that narcotics go with lightest

group

.

2.

predictors

?

Erin Quinlan (KCL)

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Can we find some of these patterns back in quantitative data?

Erin Quinlan (KCL)Impulsivity*

Sensation Seeking

Negative Thinking

coping-depression

enhancement

social (conformity ns)

personality (SURPS age 14) predicts drug-use class age 23

motives to drink age 14 (DMQ-R)

* +

impulsivity x age-onset cannabis

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And back to qualitative...

Impulsivity (& conformity, which did not come out of quantitative)I You know, like, I know that I shouldn’t do ketamine cos most of the time I throw up when I take it

, (...)“Hey

Klaas

you want a line of

ket

?” There’s no part of me that can say no to that at that point. Cos I am being a bit of a nit [fool] I am hungering for what they’ve got. And like,

yeah, give me that line of

ket

, even if I’m going to throw up

, I’ll take that line, cos like, I want to be where they are at, and it annoys me that I can’t be. And that’s when it gets the better of me and that’s when I feel a bit disgusted with myself at that point.

But fuck it, it doesn’t matter.

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Online Assessments (

UvA

Psy

)

FP7 project

AliceRap

: safe multilingual and multi-device internet platform

Questionnaires (short): drug use

consumption peers, romantic partner

Implicit drug &

a

lcohol identity

Explicit drug

& alcohol i

dentity

Stress past 3 months

Instruction video hair sample at home

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1st assessment

2nd assessment

3

rd

assessment

n = 586

n = 167

n = 140

N = 877

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I: Online Assessment (UvA Psy)

Identity = a set of meaningful definitions, ascribed or attached to self

In young people, drinking (or smoking pot) could become part of their identity

Can be assessed directly (questionnaire) and indirectly (e.g. IAT)

For alcohol several studies showing unique prediction use

(Lindgren et al, ‘13,’15,’16)

Cannabis?

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Explicit Cannabis-Identity

Cannabis Self-Concept Scale (CSCS)

Using cannabis is a part of my self-image.

Using cannabis is part of "who I am".

Using cannabis is a part of my personality.

Using cannabis is a large part of my daily life.

Others view cannabis use as part of my personality.

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if alcohol, no cannabis > alcohol IAT & explicit identity

idem cannabis

both/neither: random

Me

Cannabis

Not

me

Non-cannabis

Self

Me

Non-cannabis

Not

me

Cannabis

Joint

error!

Implicit

Alcohol/

Cannabis-Identity

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Alcohol/Cannabis ID and behaviorAlcohol (Multiple Regression), N = 663- concurrent use (Audit-C) predicted by both explicit alcohol-ID

with unique contribution alcohol-ID IAT (~ Lindgren in US);prospective use (IP2), idemchange in use: unique prediction explicit IDCannabis (Multiple Regression), N = 214prediction Cudit IP2.1 by baseline cannabis-ID (explicit only)> some preliminary evidence identity also important with other substances than alcohol

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Alcohol/Cannabis ID and behaviorBack to interviews...Madonna (F, 23) smokes cannabis daily with her partner and they live together in his parents basement. She consistently expressed an inner conflict; she smokes nightly as a way to relax but feels that

no one else would accept this part of her identity, so she keeps it hidden from her friends and family; who she believes would judge her. In our second meeting, she articulated that she does not want her identity to be associated to that of a ‘stoner’; directionless, unmotivated, and disengaged and does a lot of work to distance herself from these characteristics.

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Hair samplesOnly method of

objectively indexing chronic drug useBoth qualitatively (which drugs) AND quantitatively (How much of each drug)

Hair grows ~1cm/month so 3cm taken close to scalp: past 3 months drug use

Hair samples at baseline, +3, +6, +9 months: use over 1 year

Can compliment subjective measures (Time-Line Follow Back Interview)

Hair Analysis

Subjective measures

Optimise accuracy of drug estimation

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Measures of d9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in hair (Morgan & Curran, 2008)

Hair samples tested for THC and CBD in 140 individuals Three clear groups: ‘THC only’, ‘THC+CBD’, no cannabinoids in hairLevels of positive Schizophrenia-like symptoms:

THC only > THC+CBD groupLevels of delusions:

THC only > no cannabinoid group

This study was the first to demonstrate that hair analytic techniques can be used to define subsets of cannabis users

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Analyses

CannabinoidsCannabidiol, Cannabinol, THC,

Carboxy-THC, Hydroxy-THC

Alcohol

FAEE, Ethyl

Laurate

, Ethyl

myristate

, Ethyl palmitate, Ethyl stearate, Total Ethyl Ester, ETG

Stimulants

Amphetamines, Cocaine, Cocaine metabolites (Ecgonine methyl ester, Benzoylecgonine), MDMA, Mephedrone; Ketamine

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Samples analysed 528 mixed samples currently being analysed

 

Cannabinoids (n)

Alcohol (n)

Stimulant (n)

Total (n)

 

London

IP1

77

45

71

77

IP2.1

-

-

-

0

IP2.2

-

-

-

0

 

Nottingham

IP1

55

29

46

55

IP2.1

-

-

-

0

IP2.2

0

Berlin

IP1

104

69

50

106

IP2.1

37

30

23

38

IP2.2

19

17

17

21

Hamburg

IP1

46

7

0

51

IP2.1

33

24

9

33

IP2.2

-

-

-

0

Mannheim

IP1

-

-

-

0

IP2.1

22

11

5

26

IP2.2

-

-

-

0

Dresden

IP1

27

12

7

27

IP2.1

17

16

13

17

IP2.2

10

9

4

10

Totals

IP1 = 316 samples

IP2.1 = 114 samples

IP2.2 = 31 samples

Total = 461 samples

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Discussion-Cannabinoids in hair:

high false positive and high false negative rate, when comparing the hair results to self-report. -Sheffield reprocessed data – stimulant data increased confidence in hair analysis. Self-report unreliable?

Contamination at collection?

Contamination at analysis?

Samples - require enough hair to run all 3 analyses

BUT procedure is not pleasant for participants.

Data set currently incomplete but will improve with next set of analysis received

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Mixed methods paper(s): iterative procedure from interviews to data and back > substance-use trajectories

Further links with Imagen database, e.g. polygenic risk-score and alcohol-ID

Methods paper on self-report vs. hair-analysis

(...)

Policy implications... study confirms early alcohol/drug use associated with later problems. Personality age

14 predictor >

Personality-focused

prevention (> Preventure

, Conrod)

III Glance into the future

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29

Questions?

Slide30

Protocol

Participants:

Participants who reported illicit drug use during past 3 months

Randomly selected subset of other participants who use licit drugs

Method:

As close to the scalp as possible

Thickness equal to 1.5cm diameter

No use of hair dyes, bleach, anti-dandruff shampoo (4 prior hair washes)

Slide31

Correlations (Spearman’s Rho) alcohol 1st assessment

IP-1Alcohol use (audit-c)

Alcohol Identity

Alcohol IAT

Alcohol ID IAT

.277

***

.239

***

 

Explicit Alcohol Identity

.481

***

 

.239

***

n

660

662

662

*** = significant at p < .0005 (2-tailed)

Slide32

Spearman’s rho: 1st assessment

IP-1 Cannabis Identity IAT Cannabis

.254***

n

213

*** = significant at p < .0005 (2-tailed)

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Hair Analysis current statusMost worryingly, 36% of those who self-reported recent cannabis use had a positive hair result for THC and THC-COOH, while 37% of those who self-reported no 

recent cannabis use had a positive hair result.Sensitivity = 36% (i.e. probability that the hair test result will be positive when they have self-reported cannabis use i.e. true positive rate)Specificity = 63% (i.e. probability that the hair test result will be negative when they have self-reported no cannabis use i.e. true negative rate)Accuracy (taking self-report as true): 56%

Alarmingly poor..

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What makes your project valuable?   Unique combination of qualitative and quantitative research…….which also brings some difficulties > to translate findings to quantitative analyses we need to translate some qualitative findings to mass quantitative measures (e.g., Imagen fMRI data)

Slide35

6. Identity and Self-ImageInitiations and first uses

Learning from substance experiencesDisruptive life events in relationship to substance useDiscontinuation of specific substancesStigma Future use

Slide36

Meaning of Substance use “(…) when I think back to my school time,

nobody of those people understands remotely what I am doing here and what a part of my life it is. It is not a big part in the sense of time, but they do not understand what I am doing there and they judge what I do”. (Nala

, 23, student)

Slide37

Emerging themes:

Materials (e.g., associated with use)Space-Time (locations, temporality of use (work, weekends etc)

Meaning and representation (e.g., rituals, combinations, meaning to their life)Self-regulation and harm reduction

E.g. dosing, combining, info

Slide38

Self-regulation, dose, and setting

“I reduce the dosage when I go out with my friends. I pay attention to the dose (cannabis and MDMA) when I am outside, I do not go extreme because here the goal is only to take a good dose. But if I stay at home or at a friend's house and I do not have anything important the next day (…) I will increase the dosage

”

(Charlotte, 22, unemployed)

Slide39

Example: Disruptive Life EventsHow do life events impact substance use? What events do participants see as having an impact on their substance use? This interviewee discovered her father’s affair with a close family friend and hasn’t seen him since she confronted him 6 years ago. This was the first time she was able to share this narrative (the event, her resulting choices, and possible explanations for her mental health issues in the context of this interview)

Slide40

Yeah, yeah, that is more not really relating to substances it's just all the questions they'd be asking about my mental health, a lot of it has been focused on that as well, the last time I was here. And I was never given a chance why I might have these things

, so I don't know if that's relevant for this actual thing, it just definitely affected my life. But a lot of the other questions were about how I am mentally, which now I'm the best I've ever been but I definitely have been unstable, so, yeah, I don't know (laughs)…And then yeah, sort of trying to focus on dancing but lost all my confidence and you know, just completely, it really hit me hard, I was very, very down.