Madde Kullanım Bozukluğu Tanılı Ergenlerde Kokain Kullanım Bozukluğu Gelişimi ile ilişkili Faktörler: Kesitsel bir Regresyon Analizi

Öz

Amaç: Bu çalışma, Madde Kullanım Bozukluğu (MKB) tanısıyla tedavi başvurusu yapmış ergenlerde, Kokain Kullanım Bozukluğu (KKB) gelişimiyle ilişkili bireysel, davranışsal ve zamansal belirleyicileri ortaya koymayı amaçlamaktadır. Yöntemler: Kesitsel ve retrospektif tasarımla yürütülen bu çalışmaya, Nisan 2019– Şubat 2024 tarihleri arasında MKB tanısıyla takip edilen ve en az bir kez kokain kullanmış 87 ergen dâhil edilmiştir. DSM-5’e göre KKB tanısı alanlar “KKB grubu” (n = 31), yalnızca kokain deneyimi olanlar ise “KKB olmayan grup” (n = 56) olarak sınıflandırılmıştır. Grup karşılaştırmaları Ki-kare/Fisher’s Exact ve Mann–Whitney U testleriyle yapılmış; ikili analizlerde anlamlı bulunan değişkenler Backward LR yöntemiyle çok değişkenli lojistik regresyona alınmıştır. Bulgular: KKB grubu, kokainle daha erken yaşta tanışmış (medyan = 15) ve ilk madde deneyiminden kokain kullanımına daha kısa sürede geçmiştir (medyan = 2 yıl). Ayrıca, hayat boyu MKB tanı sayısı KKB grubunda belirgin olarak daha yüksektir (p < 0,01). Buna karşın, ilk maddeyle tanışma yaşı ve hayat boyu toplam madde sayısı açısından anlamlı fark saptanmamıştır. Tercih maddeleri incelendiğinde, yalnızca esrar tercihi farklılık göstermiş; esrarı tercih maddesi olarak bildirenlerde KKB olasılığı anlamlı ölçüde daha düşük bulunmuştur (p = 0,002). Lojistik regresyon analizinde, dört değişken KKB ile bağımsız ilişkili kalmıştır: daha yüksek hayat boyu MKB tanı sayısı (OR = 1,81), daha erken kokainle tanışma yaşı (OR = 0,61), daha kısa geçiş süresi (OR = 0,69) ve esrar tercihi (OR = 0,13). Sonuç: Ergenlerde KKB gelişiminin özellikle kokainle karşılaşma zamanlaması, kullanım hızındaki artış ve birikimli bağımlılık yüküyle ilişkili olduğunu; bu göstergelerin erken müdahalede önemli olduğunu ortaya koymaktadır.

Anahtar Kelimeler

• Ergen
• Madde kullanım bozukluğu
• Kokain kullanım bozukluğu
• Erken başlangıç
• Lojistik regresyon

Factors Associated with the Development of Cocaine Use Disorder in Adolescents with Substance Use Disorder: A Cross-Sectional Regression Analysis

Öz

Objective: This study aimed to identify individual, behavioral, and temporal determinants associated with the development of Cocaine Use Disorder(CUD) among adolescents presenting for treatment with a Substance Use Disorder(SUD) diagnosis. Methods: This cross-sectional and retrospective study included 87 adolescents who had been followed with a SUD diagnosis and had used cocaine at least once between April 2019 and February 2024. According to DSM-5 criteria, adolescents diagnosed with CUD formed the “CUD group” (n = 31), while those with cocaine experimentation only formed the “non-CUD group” (n = 56). Group comparisons used Chi-square/Fisher’s Exact tests and Mann–Whitney U tests. Variables that were significant in bivariate analyses were entered into a multivariable logistic regression model using the Backward LR method. Results: The CUD group encountered cocaine at a younger age (median = 15) and transitioned more rapidly from first substance use to cocaine (median = 2 years). They also had higher lifetime SUD diagnosis counts (p < 0,01). In contrast, no significant differences emerged in age at first substance use or total number of substances used. Among preferred substances, only cannabis preference differed; adolescents reporting cannabis as a preferred substance had a markedly lower likelihood of CUD (p = 0,002). Logistic regression identified four independent predictors: higher lifetime SUD diagnosis count (OR = 1,81), younger age at cocaine initiation (OR = 0,61), shorter transition time (OR = 0,69), and cannabis preference (OR = 0,13). Conclusion: CUD development in adolescents is closely linked to cocaine exposure timing, accelerated use trajectories, and cumulative dependence burden.

Anahtar Kelimeler

• Adolescent
• Substance use disorder
• Cocaine use disorder
• Early onset
• Logistic regression.

Kaynakça

1. 1.Goldstein MA, Goldstein MC. Substance use. In:How Technology, Social Media, and Current EventsProfoundly Affect Adolescents. 1st edn. New York:Oxford University Press; 2024. p. 90-106.
2. 2.Ambresin AE, Leuchter R. Enfance, adolescence etrisque d'addiction: une perspectivedeveloppementale. Rev Med Suisse. 2024; 20(862):377-81.
3. 3.Srivastava S, Agrawal S, Nandy A, Singh A, Kostova I.Consumption of drugs and substances of abuseamong adolescents: risk and reasons. In: Singh A,Nandy A, editors. Lifestyle Diseases in Adolescents:Addressing Physical, Emotional, and BehavioralIssues. Bentham Science Publishers; 2024. p. 121-40.
4. 4.Nath A, Choudhari SG, Dakhode SU, Rannaware A,Gaidhane AM. Substance abuse amongstadolescents: an issue of public health significance.Cureus. 2022; 14(11): e31193.
5. 5.European Monitoring Centre for Drugs and DrugAddiction. European drug report 2024.Luxembourg: Publications Office; 2024.
6. 6.Öztürk FC. Uyuşturucu madde bağımlılığı veTürkiye'de uyuşturucu madde kullanımınınincelenmesi. Ankara Ecz Fak Derg. 2023; 47(3):1071-83.
7. 7.Nestler EJ. Is there a common molecular pathwayfor addiction? Nat Neurosci. 2005; 8(11): 1445-9.
8. 8.Volkow ND, Koob GF, McLellan AT. Neurobiologicadvances from the brain disease model of addiction.N Engl J Med. 2016; 374(4): 363-71.

9. 9.Zhu W, Ge X, Gao P,et al. Adolescent cocaineexposure induces prolonged synaptic modificationsin medial prefrontal cortex of adult rats. Brain StructFunct. 2018; 223(4): 1829-38.
10. 10.Caffino L, Mottarlini F, Zita G, et al. The effects ofcocaine exposure in adolescence: behaviouraleffects and neuroplastic mechanisms inexperimental models. Br J Pharmacol. 2022;179(17): 4233-53.
11. 11.Evren C, Ogel K, Demirci AC, et al. Prevalence oflifetime tobacco, alcohol and drug use among 10thgrade students in Istanbul. Bull ClinPsychopharmacol. 2014; 24(3): 201-10.
12. 12.Yıldız D, Çiftçi A, Yalçın Ö. Substance usepatterns, psychosocial traumas, psychiatriccomorbidities, and gender differences amongadolescent inpatients at an addiction treatmentcenter. Dusunen Adam J Psychiatry Neurol Sci. 2020;33: 190-202.
13. 13.Smith DE, Schwartz RH, Martin DM. Heavycocaine use by adolescents. Pediatrics. 1989; 83(4):539-42.
14. 14.Pianca TG, Rohde LA, Rosa RL, et al. Crackcocaine use in adolescents: clinical characteristicsand predictors of early initiation. J Clin Psychiatry.2016; 77(10): e1205-10.
15. 15.Bisch NK, Moreira TDC, Benchaya MC, et al.Telephone counseling for young Brazilian cocaineand/or crack users. Who are these users? J Pediatr(Rio J). 2019; 95(2): 209-16.
16. 16.Lopez-Quintero C, Cobos JPDL, Hasin DS, et al.Probability and predictors of transition from firstuse to dependence on nicotine, alcohol, cannabis,and cocaine: results of the National EpidemiologicSurvey on Alcohol and Related Conditions(NESARC). Drug Alcohol Depend. 2011; 115(1-2):120-30.
17. 17.Ridenour TA, Lanza ST, Donny EC, Clark DB.Different lengths of times for progressions inadolescent substance involvement. Addict Behav.2006; 31(6): 962-83.
18. 18.Stone AL, Becker LG, Huber AM, Catalano RF.Review of risk and protective factors of substanceuse and problem use in emerging adulthood. AddictBehav. 2012; 37(7): 747-75.
19. 19.Smith RJ, Laiks LS. Behavioral and neuralmechanisms underlying habitual and compulsivedrug seeking. Prog Neuropsychopharmacol BiolPsychiatry. 2018; 87: 11-21.
20. 20.Tiffany ST. A cognitive model of drug urges anddrug-use behavior: role of automatic andnonautomatic processes. Psychol Rev. 1990; 97(2):147-68.
21. 21.Schierenbeck T, Riemann D, Berger M, HornyakM.Effect of illicit recreational drugs upon sleep:cocaine, ecstasy and marijuana. Sleep Med Rev.2008; 12(5): 381-9.
22. 22.Estroff TW, Schwartz RH, Hoffmann NG.Adolescent cocaine abuse: addictive potential,behavioral and psychiatric effects. Clin Pediatr(Phila). 1989; 28(12): 550-5.
23. 23.Lesscher HMB, Vanderschuren LJMJ. Compulsivedrug use and its neural substrates. Rev Neurosci.2012; 23(5-6): 731-45.
24. 24.Flórez-Salamanca L, Secades-Villa R, Hasin DS, etal. Probability and predictors of transition fromabuse to dependence on alcohol, cannabis, andcocaine: results from the National EpidemiologicSurvey on Alcohol and Related Conditions. Am JDrug Alcohol Abuse. 2013; 39(3): 168-79.
25. 25.Butelman ER, Chen CY, Conybeare RA, et al. Aretrait impulsivity and exposure to cannabis or alcoholassociated with the age of trajectory of cocaine use?A gender-specific dimensional analysis in humanswith cocaine dependence diagnosis. Exp ClinPsychopharmacol. 2020; 28(3): 317-27.
26. 26.Kiburi SK, Molebatsi K, Obondo A, Kuria MW.Adverse childhood experiences among patients withsubstance use disorders at a referral psychiatrichospital in Kenya. BMC Psychiatry. 2018; 18(1): 197.
27. 27.Andrews JA, Hops H, Duncan SC. Adolescentmodeling of parent substance use: the moderatingeffect of the relationship with the parent. J FamPsychol. 1997; 11(3): 259-70.
28. 28.Becker JB, Koob GF. Sex differences in animalmodels: focus on addiction. Pharmacol Rev. 2016;68(2): 242-63.
29. 29.Haas AL, Peters RH. Development of substanceabuse problems among drug-involved offenders:evidence for the telescoping effect. J Subst Abuse.2000; 12(3): 241-53.
30. 30.Çiftçi E, Fırat S. The relationship of substanceabuse with attachment and emotion regulation. DicleTip Dergisi. 2023; 50(4): 507-18.