Participants were excluded from the sample if they had severe cognitive impairment assessed by physicians. This was verified by checking the participant’s medical records. Also, participants seeking follow-up care and those admitted for court-ordered treatment were excluded because they were deemed to have non-active substance use in the last 30 days. This study was approved by the university and the internal review board of participating mental health settings. Before recruitment and data collection, participant informed consent was sought and obtained by research assistants, who were trained nurses and psychologists with at least their first degree.The study collected data using structured face-face interviews that were conducted at one point in time; typically, a week before the patient was discharged from the hospital. Data collection interviews were conducted by research assistants, registered mental health nurses, and psychologists who received 1-week training in the use of the study protocol. Data were transferred from paper-based questionnaires into an SPSS database by one research team member, and a second member checked and validated the accuracy of the entered data.Data analysis was conducted in IBM Statistical Package for Social Sciences, 26th version.
Initially, analyses consisted of conducting descriptive statistics for sociodemographic variables and bivariate analyses between addiction severity and potential confounding variables, including the level of education in years ,flood tray areas of residence, sex, motives, living with active alcohol, and non-prescribed drugs using one-way analysis of variance . Then, a hierarchical regression model consisted of entering the age at first substance use, followed by the other variables, PTSD as well as the level of education, area of residency, as both of which showed significant bivariate relationships with addiction severity. Regression diagnostics were performed to check whether there were potential violations of the linear regression assumptions. The present study examined the extent to which age, motives for the first substance use, and PTSD influence later addiction severity. The study results demonstrate that first substance use occurs as early as 5 years old. Half of the sample have had their initial psychoactive substance before or at their 18th birthday. The majority of participants were male , which suggests that fewer female participants sought addiction services in Rwandan mental health settings during the study period. This gender difference in addiction service utilization may require further exploration. The study results also suggest that the Rwandan clinical cohort had the first substance use 2 years earlier compared with other SSA populations . Among the study participants, substance use patterns could be as severe as using seven different types of psychoactive substances, and up to nearly three times daily. The identified substance patterns are worrisome because of potential increases in risks for negative neurobiological changes that result from regular substance and polydrug use, especially before the brain fully matures.
Such brain changes have the potential to contribute to maladaptive cognition, motivation, and affective states throughout a person’s entire lifetime . In many ways, the study results support previous studies which indicated that early-age exposure to substance use increases risks for severe addiction. The results suggest that delayed first substance use may be associated with a significant reduction of risks for addiction severity. Such risks may vary with the type of substance consumed. Previous research has shown significant associations between poor mental health outcomes, such as psychosis onset, and age at onset of cannabis use but not of alcohol use . Progressing from first cannabis use to cannabis use disorders takes a shorter time than for alcohol and nicotine, whereas poly-substance use speeds up transitions to addiction disorders . By establishing the contribution of age at first substance use and addiction severity, these results reinforce previous findings on the progression of addiction trajectories following the first substance use . The study also supports previous evidence on increased risks for poly-substance use among individuals exposed to earlier psychoactive drug use . As such, the present study results call for research testing the effectiveness of health promotion and prevention interventions aimed at delaying the age of exposure to first substance use. The implementation of such interventions may face difficulties since drinking cultural norms, in some SSA countries, permit alcohol drink during childhood, especially at family social events. Moreover, long-term instability predominant in SSA countries may add to the complexity of earlier substance use. Long-term instability may lead to the absence of adults moderating how and when young people can drink and use of a substance to self-medicating for post traumatic disorders. The present study further underscores the influence of PTSD on later complications of addiction problems after early-age first substance use. Besides, coupling PTSD and young age at first substance use indicate a statistically significant increase in addiction severity .
The identified increase in variance explained by PTSD emphasizes that PTSD is a significant predictor of later addiction severity among individuals who face early substance use problems. These results are consistent with previous research, which associated early childhood experience of trauma with early substance use onset and transition to poly drug use . Additionally, previous handful evidence has consistently established associations between SUD and PTSD and provided explanatory hypotheses underlying these associations. Given that at SSA populations such Rwandans had experienced horrific events , these results may be interpreted through well-documented risky use of psychoactive substances for coping with post disaster distress . However, it is challenging to delineate which of the two conditions occurs first because SUD and PTSD affect the stress processing system. Chronic SUD, such as alcohol use disorders,grow table increased individual vulnerability to PTSD due to alcohol related defects of endocrinal response to distress events and reduced cortisol release . On the other hand, PTSD influences neurotransmitters changes, such as serotonin, in the hypothalamic-pituitary-adrenaline axis, which have been linked to risks for worsened SUD . The identified positive association between level of education and addiction severity may be partially explained by the Rwandan cultural and conception of mental illness. Cultural expectations are strict on the use of alcohol that interferes with social and professional functioning . Thus, educated people may find it challenging to seek early help for their SUD due to fear of being subject to attached stigma and use psychoactive substances as self-medication.The present study, to our knowledge, is the first to investigate the contributions of age, motives for first substance use, and post traumatic distress to later addiction problems using a clinical sample in sub-Saharan Africa. The study used a compelling alternative to the random sampling strategy, recruiting every participant presenting for inpatient addiction care in two existing settings over 8 months. This study has a few limitations, including relying on self-reported data that may be prone to recall and social desirability biases. However, we attempted to minimize these biases by collecting data through face-to-face semi-structured interviews conducted by trained and qualified mental health professionals who were not part of a healthcare circle .Alcohol use and binge drinking in youth aged 12 to 21 are frequent causes of accidents and injuries, preventable death, disease and psychosocial problems. Though past-month binge drinking1 and alcohol use among adolescents and young adults in the United States have declined over the past decade, rates remain high: 23 % report current alcohol use and 14 % binge drinking. Over the past several decades, there have been extensive efforts to address alcohol use among young people.
Some interventions have focused on environmental factors while others have been individual or group level interventions aimed at improving knowledge and attitudes, and reducing alcohol use. These have been primarily face-to-face interventions delivered in structured school or community-based settings.Theories help explain the pathways that lead to or predict behavior and in doing so, provide guidance on how to influence or change behavior. Interventions, that clearly articulate their use of theories, can contribute to a greater understanding of not just what interventions work, but why they work. While the interventions targeting alcohol use among youth have resulted in mixed findings, this vast body of work has contributed to the evidence base for what constitutes effective interventions. Interventions that are grounded in established theories of behavior change, and include approaches that address social norms, build self-efficacy and enhance skills to resist pressure to use alcohol, have been found to be more effective than those lacking a theoretical framework. As the field of preventing/reducing alcohol use among adolescents and young adults is evolving, there has been growing attention to the development and use of computer-based modes of intervention delivery. Computer-based interventions have a number of advantages over traditional face-to-face interventions. They are more likely to be implemented with fidelity because they do not rely on the skills, motivation, or time of the facilitator; and they provide a standardized approach to delivering the intervention content. In addition, recent technology innovations enable CBIs to be interactive, provide individually tailored messages and simulate experiences where adolescents can learn and practice skills in convenient and private settings. CBIs also have the potential to be more cost effective than face-to-face interventions. Additionally, computers have become widely accessible and are especially popular among adolescents and young adults. CBIs provide a promising approach to addressing alcohol use among adolescents and young adults. Over the last decade, there have been five literature reviews that have examined the nascent field of digital interventions for alcohol use prevention targeting adolescents and young adults. Overall, many of the CBIs have been shown to improve knowledge, attitudes, and reduce alcohol use in the short-term. Three of the five literature reviews examined interventions for college students. One review found that CBIs were more effective than no treatment and assessment-only controls, and approximately equivalent to various non-computerized interventions. Another review found that CBIs, when compared to non-CBIs, were more likely to reduce alcohol use. The third review found that CBIs reduced short term alcohol use compared to assessment-only controls, but not compared to face-to-face interventions. In addition to the reviews focused on alcohol use among young adults, there were two reviews of CBIs targeting younger adolescents. One demonstrated that CBIs delivered in middle or secondary schools effectively reduced alcohol, cannabis and/or tobacco use. The other review was a metanalysis focused on computer games to prevent alcohol and drug use among adolescents and concluded that the games improved knowledge, but it did not find sufficient evidence that these games changed substance use attitudes or behaviors. While these reviews suggest that CBIs have the potential to be efficacious, the mechanisms that contribute to improvements in attitudes and behaviors are not well understood. Use of a theoretical framework helps to explain the mechanisms of change by informing the causal pathways between specific intervention components and behavioral outcomes. Understanding these mechanisms improves our understanding of how and why a particular intervention works. There has been little attention as to how theoretical frameworks have informed the development of CBIs focused on alcohol use among adolescents and young adults. Only two of the five aforementioned literature reviews covering CBIs for alcohol use in youth examined the underlying theoretical basis of the CBIs. In both of these reviews, the names of the theory and/or specific theoretical constructs were mentioned; however, there was little examination of how the theories were applied to the CBIs. In addition to the reviews focused specifically on adolescent and young adult substance use, there was an additional systematic review that examined the relationship between the use of theory and the effect sizes of internet-based interventions. This study found that extensive use of theory was associated with greater increases in the effect size of behavioral outcomes. They also found that interventions that utilized multiple techniques to change behavior change tended to have larger effect sizes compared to those using fewer techniques. This review builds on prior work demonstrating that health interventions grounded in established theory are more effective than those with no theoretical basis. However, this review did not exclusively focus on alcohol use or adolescents specifically. It is therefore important to build upon this knowledge base and focus on the application of theory in CBIs to address adolescent/young adult alcohol use.