Differential Effects of Parental Controls on Adolescent Substance Use: For Whom Is the Family Most Important?

Investigating key latent factors influencing alcohol consumption among the tribal male adolescents in Dooars region, West Bengal

BACKGROUND

Alcohol consumption among tribal male adolescents in India is a significant social concern. Tribal adolescents are particularly vulnerable and tend to lean toward alcohol addiction. Therefore, it is crucial to introduce some necessary footsteps to reduce alcohol consumption. The primary objective of this study is to investigate the association of various latent factors with the alcohol-drinking behavior of tribal adolescents.

METHODS

The study collected data from 600 tribal adolescents from the Dooars region, with 241 of them reported consuming alcohol. The study aimed to confirm the theoretical development of hypotheses regarding peer pressure, parental discord, stress, attitude toward alcohol, and food insecurity as exogenous latent factors influencing the alcohol-drinking behavior of tribal adolescents. In this context, the study adopted both measurement and structural models using Partial Least Squares-Structural Equation Modeling (PLS-SEM).

RESULTS

The findings revealed a significant path relationship between alcohol drinking behavior and various exogenous factors like peer pressure (β = 0.214, p = .000), parental discord (β = 0.121, p = .009), stress (β = 0.170, p = .000), attitude toward alcohol (β = 0.110, p = .004), and food insecurity (β = 0.510, p = .000). This study developed a reflective measurement model, and the evaluation of reflective measurement models was conducted, assessing internal consistency, convergent validity, and discriminant validity, yielding satisfactory results.

CONCLUSION

To tackle alcohol issues among tribal adolescents in the Dooars region, effective strategies should be employed. These include educating in schools, highlighting tribal role models, aiding peers with alcohol dependence, providing life skills training, and addressing parental discord and food insecurity through awareness campaigns, workshops, and better infrastructure.

Psychometric properties of the family assessment task parental monitoring scenario among adolescents receiving substance use treatment

INTRODUCTION

The Family Assessment Task (FAsTask) is an observer-rated parent-child interaction task used in adolescent substance use intervention. The parental monitoring component of the FAsTask is thought to provide an objective assessment of parental monitoring that can guide treatment planning and circumvent the potential limitations of self-report measures. Yet, the factor structure, measurement invariance, and concurrent validity of the parental monitoring FAsTask has not been evaluated; doing so is essential to effectively guide clinical care. This study examined if the parental monitoring FAsTask can be reliably administered across adolescent age and sex, and to identify which components of the parental monitoring FAsTask are most consistently associated with adolescent substance use.

METHODS

The study pooled data from 388 adolescent-caregiver dyads across six separate clinical trials (adolescents [Mage = 15.7, 57.5% male, 61.9% White, 31.2% Latine]; caregivers [Mage = 42.14, 88.7% female, 72.7% White, 24.2% Latine]). Dyads completed the FAsTask and the Timeline Followback at baseline, prior to randomization. Analyses proceeded in three steps. First, exploratory factor analysis (EFA) was conducted in half of the sample, followed by a confirmatory factor analysis (CFA) in the second half of the sample. Second, measurement invariance was tested as a function of adolescent age and biological sex. Third, a series of structural equation models were used to assess the associations of each factor with alcohol use, binge drinking, and cannabis use.

RESULTS

EFA and CFA indicated the presence of four factors (labeled Supervised/Structured, Active Monitoring, Task Engagement, and Parental Rules/Strategies). Evidence of measurement invariance was found across adolescent age and sex. The Supervision/Structure was negatively associated with adolescent alcohol use, binge drinking, and cannabis use.

CONCLUSIONS

The parental monitoring FAsTask demonstrates validity and retains its structure across adolescent age and sex. Items focused on parental supervision and structure are most strongly associated with adolescent substance use and may best inform clinical care for adolescent substance use.

Multilevel Factors Associated With Lifetime, Current, and Binge Drinking Among Korean Adolescents Based on the Ecological Model

BACKGROUND

Drinking usually begins in adolescence and is a major public health concern. Few studies have identified multilevel factors considering the frequency and amount of drinking among adolescents. This study aimed to identify the multilevel factors associated with lifetime, current, and binge drinking among Korean adolescents based on the ecological model.

METHODS

This cross-sectional study used data from the 2018 Korea Youth Risk Behavior Survey (N = 60,040). Hierarchal multinomial logistic regression analyses were performed using complex sample data.

RESULTS

Overall, 15,030 (25.4%), 4,629 (8.0%), and 5,038 (8.9%) subjects were involved in lifetime, current, and binge drinking, respectively. The following multilevel factors revealed significant associations with lifetime, current, and binge drinking: boys, high school students, depression, suicidal ideation at individual level, family acceptance of alcohol use, poor household economic status at family level, poor academic achievement, not receiving education on alcohol use at school level, possible alcohol access, and harm caused by drinkers at social level (all ps < .01). The main risk factors were family acceptance of alcohol use (lifetime, current, and binge drinking vs. OR = 3.95, 6.88, and 5.46, respectively) and possible alcohol access (OR = 5.65, 19.78, and 93.62).

DISCUSSION

This study revealed multilevel factors associated with lifetime, current, and binge drinking. School nurses and community leaders are necessary to develop customized drinking prevention programs considering drinking frequency and amount, and individual, family, school, and social factors. Especially, the implementation of a drinking prevention program that reduces family acceptance of alcohol use and access to alcohol could be an effective strategy.

Assessing Differential Effects of Somatic Amplification to Positive Affect in Midlife and Late Adulthood-A Regression Mixture Approach

This study aims to provide an empirical demonstration of a novel method, regression mixture model, by examining differential effects of somatic amplification to positive affect and identifying the predictors that contribute to the differential effects. Data derived from the second wave of Midlife in the United States. The analytic sample consisted of 1,766 adults aged from 33 to 84 years. Regression mixture models were fitted using Mplus 7.4, and a two-step model-building approach was adopted. Three latent groups were identified consisting of a maladaptive (32.1%), a vulnerable (62.5%), and a resilient (5.4%) group. Six covariates (i.e., age, education level, positive relations with others, purpose in life, depressive symptoms, and physical health) significantly predicted the latent class membership in the regression mixture model. The study demonstrated the regression mixture model to be a flexible and efficient statistical tool in assessing individual differences in response to adversity and identifying resilience factors, which contributes to aging research.

Adolescent Development in Context: A Decade Review of Neighborhood and Activity Space Research

Over the last decade, two lines of inquiry have emerged from earlier investigations of adolescent neighborhood effects. First, researchers began incorporating space-time geography to study adolescent development within activity spaces or routine activity locations and settings. Second, cultural-developmental researchers implicated neighborhood settings in cultural development, to capture neighborhood effects on competencies and processes that are salient or normative for minoritized youth. We review the decade's studies on adolescent externalizing, internalizing, academic achievement, health, and cultural development within neighborhoods and activity spaces. We offer recommendations supporting decompartmentalization of cultural-developmental and activity space scholarship to advance the science of adolescent development in context.

Adolescent Marijuana Dependence: The Role of Social Bonds and Social Learning Theory

Using the 2017 National Survey of Drug Use and Health (NSDUH) data, this research examines the extent to which social bonds and social learning theory predict adolescent marijuana dependence. Full information maximum likelihood (FIML) for logistic regression analyses were conducted in four models to test the competing theories. The results revealed partial support for both theories, such that adolescents with stronger parental bonds and negative definitions of substance use were less likely to be dependent on marijuana, while adolescents who associated with substance using peers were more likely to be dependent on marijuana. The multi-theoretical model suggested that only the social learning theory concepts of differential association and negative definitions were significant theoretical predictors of adolescent marijuana dependence. Additional analyses revealed that first using marijuana at 14 or 15 years old was also significantly related to adolescent marijuana dependence. Implications for future research and risk prevention programs are discussed.

Physical health, school performance and delinquency: A comparative study of left-behind and non-left-behind children in rural China

BACKGROUND

China's rapid economic development since the late 1970s has resulted in a large-scale migrant population from rural to urban areas, with millions of Chinese children being left behind at home by their parents who migrated to city for work.

OBJECTIVE

The primary objective of this study is to test the effects of family, school and background characteristics on left-behind children's (LBC) and non-left-behind children's (NLBC) physical health, school performance, and delinquent behavior.

PARTICIPANTS

A total of 765 LBC and 468 NLBC in elementary and middle schools participated in the study.

SETTING

Survey data were collected from three middle schools and seven elementary schools in Wuhan, China.

METHODS

The dependent variables included three measures of child development: physical health, school performance and delinquent behavior. The independent and control variables were divided into four groups: school and community attachment, parental attachment, parental and children commitment, and background characteristics. Mean comparisons and regression analyses were conducted to assess whether LBC and NLBC differ in their physical health, academic performance and delinquent behavior.

RESULTS

LBC's physical health is significantly lower than that of NLBC. Being a LBC decreases the odds of being healthy by 51 percent. LBC and NLBC do not differ in their school performance and delinquent behavior.

CONCLUSIONS

Being left behind without proper parental care appears to be detrimental to child physical wellbeing. The damaging impact of left-behind is limited to physical health as LBC and NLBC reported similar levels of educational performance and delinquent acts.

Alcohol Use, Binge Drinking, and Drunkenness Experience in Adolescence: Complex Associations with Family, Peers, Social Context, and Risk Perceptions

Background: A number of correlates to adolescent substance use have been shown, yet their unique predictive influence is unclear. We investigated the incremental validity of demographics, family background, school variables, risk perception, parental alcohol attitudes, age of first alcohol use, peer group influence, and behavioral variables as they concurrently predicted last month alcohol use, binge drinking, and drunkenness experience frequency. Methods: Hierarchical multiple regression analyses in a sample of N = 743 adolescents (mean age = 15.01). Results: All predictors explained 26-40% of the total variance. Alcohol use was predicted by age, gender, having two working parents, academic family background, relationship to parents, relative risk perception, parental acceptance of alcohol use, age of first use, talking about positive aspects of alcohol, normality of alcohol use among peers, time spent with friends, and going out to clubs. Binge drinking was predicted by age, working parents, school problems, relative risk perception, parental alcohol acceptance, age of first use, talking about positive aspects of alcohol, time spent with friends, and going out to clubs. Drunkenness was predicted by age, relationship to parents, school problems, relative risk perception, age of first use, talking about positive aspects of alcohol, and going out to clubs. Conclusions: Researchers need to take the complexity of adolescent substance use into account when designing studies and interventions. Relative risk perception emerged as the strongest (positive) predictor, indicating that adolescents are able to rather accurately assess their own risk and risk awareness alone does not suffice to engage in protective behavior.

Individual, Family, and School Correlates across Patterns of High School Poly-substance Use

Background: Recent popularity in e-cigarette use among high school students and the legalization of marijuana across many states resulted in new patterns of poly-substance use (PSU). Objective: The purpose of this study is to understand contemporary patterns of PSU and their associations with individual social-emotional characteristics (sensation seeking, perceived harm, life satisfaction) and social-contextual factors (parental involvement, school norms, academics, and behaviors). Methods: Latent class analysis (LCA) was used to identify patterns of PSU among 12th-grade students (n = 8417) from the 2016 Monitoring the Future project. Multinomial logistic regression was used to understand the relationship among individual characteristics, social-contextual factors, and patterns of PSU. Results: From the LCA, three patterns of PSU were identified: (1) low-use (72.2%); (2) pre-dominantly marijuana use with some co-occurring substance use (23.8%); and (3) high PSU (4.0%). Results indicate that students with pre-dominant marijuana use were differentiated from those with PSU by having higher perceived harm of electronic and regular cigarette, heavy alcohol use, and better academic grades. Furthermore, students with both polysubstance and pre-dominant marijuana use, when compared to those with low-use, had lower life satisfaction, higher sensation seeking, lower perceived harm of substance use, poorer grades, and more disciplinary problems. Conclusion/Importance: Findings draw attention to the importance of understanding levels of life satisfaction, sensation seeking, perceived harm, academic grades, and disciplinary problems as they pertain to contemporary patterns of PSU. Schools should consider a tailored and multi-tiered approach to addressing students' substance use.

Doping among high school students: findings from the French ESPAD survey

BACKGROUND

The increasing use of doping by youth is a growing public health concern. The present study aimed to calculate robust estimates of the prevalence of doping among French high school students and study factors related to the use of licit vs. banned agents.

METHODS

The European School Project on Alcohol and other Drugs (ESPAD), a nationally representative school-based survey, was distributed across France from April to May 2015, generating a final sample size of 6642 students. Multilevel modelling was used to examine covariates of doping to enhance athletic performance in sport in this population.

RESULTS

Overall, 2.3% of students used banned agents, and 6.1% used licit and banned substances to improve athletic performance. Significant gender differences existed for both, with males more prone to doping than females. Our findings provide support for the existing gateway hypothesis that nutritional supplementation leads to doping banned agents. Multilevel modelling revealed the presence of both school and class-level influences on individual use of licit substances, vs. solely class-level factors impacting the use of banned agents, suggesting a strong peer-effect.

CONCLUSIONS

These findings support the need to engage in early doping prevention through high schools. Programmes should draw attention to the role of licit substances, including nutritional supplementation, in the progression to using banned agents and encompass the continuum of adolescent risk taking through a behaviour-based approach to doping prevention.

Prosocial Peers as Risk, Protective, and Promotive Factors for the Prevention of Delinquency and Drug Use

Risk, protective, and promotive factors are instrumental in predicting and, in some cases, explaining human behavior. In the current study, an attempt was made to determine which of these three functions prosocial peers served with respect their effect on future delinquency and drug use. A sample of 2905 youth (51% female, 47% White, 21% Hispanic, 17% Black, mean age = 12.14 years) from the Gang Resistance Education and Training (GREAT) project were included in this study. Longitudinal analyses, conducted over a period of one year and controlling for age, sex, race, parental knowledge, parental support, unsupervised routine activities, peer delinquency, and prior delinquency/drug use, revealed that associating with prosocial peers led to significant reductions in property offending and drug use. Although there was no evidence that prosocial peers moderated or neutralized the risk generated by delinquent peer associations, they did serve as risk and promotive factors. Hence, associating less often with prosocial peers predicted a rise in property offending and drug use (risk effect), whereas associating more often with prosocial peers predicted a decline in future property offending and drug use (promotive effect).

The Effects of Sample Size on the Estimation of Regression Mixture Models

Regression mixture models are a statistical approach used for estimating heterogeneity in effects. This study investigates the impact of sample size on regression mixture's ability to produce "stable" results. Monte Carlo simulations and analysis of resamples from an application data set were used to illustrate the types of problems that may occur with small samples in real data sets. The results suggest that (a) when class separation is low, very large sample sizes may be needed to obtain stable results; (b) it may often be necessary to consider a preponderance of evidence in latent class enumeration; (c) regression mixtures with ordinal outcomes result in even more instability; and (d) with small samples, it is possible to obtain spurious results without any clear indication of there being a problem.

Family and Peer Influences on Substance Attitudes and Use among Juvenile Justice-Involved Youth

Juvenile justice-involved youth experience high rates of substance use, which is concerning given associated negative consequences, including health and functional deficits. Family and peer factors are associated with a high risk of substance use among justice-involved youth. It is hypothesized that this risk process operates through pro-drug attitudes. However, limited research has been conducted on the mechanisms through which family and peer factors increase risk for substance use among juvenile justice involved youth. The current study examined both the direct and indirect effects of family and peer substance use on youth's substance use (alcohol and illicit drug use). We also examined whether this relationship differs by race. 226 detained youth (81.9% male; 74.3% Black) were recruited from an urban county in the Midwest and completed a clinical interview and substance use assessment battery. A direct effect of family/peer risk on illicit drug use was found for all youth, though the effect was stronger among White youth. Results also supported the indirect effect pathway from family/peer risk to both illicit drug use and alcohol use through pro-drug attitudes. This pathway did not vary by race. These findings suggest that interventions should focus on targeting both family/peer risk and pro-drug attitudes to reduce substance use. Given the racial difference in the direct effect of family/peer risk on illicit drug use, there may be other factors that influence risk more strongly for White youth, which warrants further investigation.

The Mediating Effect of Social Controls on Marijuana Use Among Adolescent Bullies, Victims, and Bully-Victims: A Comparison of Various Approaches to Mediation

This study examines the impact of social control measures (e.g. parental attachment and prosocial peer attachment) on marijuana use among adolescents who were pure bullies, pure victims, and bully-victims. Data from the Health Behavior in School-Aged Children survey was utilized and consisted of a nationwide cross-section of 12,642 adolescents. Results revealed that adolescents who were pure bullies and bully-victims were more likely to use marijuana. Additionally, parental and peer attachments were significant in decreasing the likelihood of marijuana use for two of the bullying statuses (pure bullies and bully-victims). Further, the social control measures partially mediated the relationship between two of the bullying statuses and marijuana use despite having no significant relation of bullying victimization to marijuana use. Considering that parental and peer attachments had significant and direct effects on adolescent marijuana use in the predicted (inverse) direction, prevention programs should focus on building and strengthening these relationships as a means of reducing deviant behaviors such as marijuana use among adolescents.

On the question of non-medical cognitive enhancers among in-school adolescents: prevalence, predictors and potential health-related harms

Little is known about the use of non-medical cognitive enhancers (NCEs) in the general population, and even less among youth. The study utilises a nationally representative, cross-sectional survey of adolescents attending high schools to provide a comprehensive overview of NCEs and to assess risk factors such as socio-demographics, schooling, mental health and related substance use among French adolescents. A total of 6692 students attending high school (secondary schools) answered an anonymous questionnaire collecting information on demographics, health, psychoactive substance uses (neuroleptics, tobacco, alcohol, cannabis, illicit substances) and patterns of sociability. The use of cognitive enhancers appears to be an underestimated phenomenon among youth. Prevalence of use is heavily gender-influenced, with females twice as likely to use NCEs than males. More than daily school commitments, the use of cognitive enhancers is related to the proximity of the national secondary education examination. Moreover, mental health, use of prescribed anxiolytics and other psychoactive substances are significantly independently associated with the use of cognitive enhancers, particularly among females. The unregulated use of cognitive enhancers is a predictor of potential mental frailty and a substance-based response to stressful events, a behaviour likely to persist during adulthood. The study underpins the lack of contextual and comparable data. Systematic monitoring of younger students in neighbouring countries is required to develop reliable prevention programmes.

Parental monitoring protects against the effects of parent and adolescent depressed mood on adolescent drinking

OBJECTIVE

Parental monitoring is a well-established protective factor for adolescent drinking. This study examined whether parental monitoring protected against three common risk factors for alcohol use in a sample of high-risk adolescents: parental depressed mood, adolescent depressed mood, and parental alcohol use.

METHODS

Participants included 117 adolescents (mean age=15.5; 52% female) who presented to the hospital emergency department due to an alcohol-related event and their primary parent/guardian. Adolescents completed self-report measures of alcohol use frequency, depressed mood, and parental monitoring, while parents completed self-report measures of problematic alcohol use and depressed mood.

RESULTS

Hierarchical regression confirmed that parental monitoring was associated with lower frequency of adolescent alcohol use, even after controlling for the three risk factors. Significant interactions were found between parental monitoring and both adolescent and parental depressed mood. Parental monitoring had significant protective effects against drinking frequency among adolescents with higher levels of depressed mood, but not among adolescents with lower levels of depressed mood. By contrast, parental monitoring only had protective effects among those parents with lower levels of depressed mood. Parental problematic alcohol use did not affect the relationship between parental monitoring and adolescent alcohol use.

CONCLUSIONS

Our results suggest that adolescents with high levels of depressed mood may be more likely to benefit from parental monitoring, whereas parents with high levels of depressed mood may be less likely to monitor effectively. Interventions targeting parental monitoring in high-risk adolescents should take into account the influence of both adolescent and parental depressed mood.

Constructing tailored parental monitoring strategy profiles to predict adolescent disclosure and risk involvement

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Many parents use multiple monitoring strategies in different combinations over time to monitor their adolescents.

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Adolescents of parents who use multiple strategies reported greater risk involvement.

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Parents who solicited information only from adolescents had greater knowledge and adolescent disclosure.

Impact of an equality constraint on the class-specific residual variances in regression mixtures: A Monte Carlo simulation study

Regression mixture models are a novel approach to modeling the heterogeneous effects of predictors on an outcome. In the model-building process, often residual variances are disregarded and simplifying assumptions are made without thorough examination of the consequences. In this simulation study, we investigated the impact of an equality constraint on the residual variances across latent classes. We examined the consequences of constraining the residual variances on class enumeration (finding the true number of latent classes) and on the parameter estimates, under a number of different simulation conditions meant to reflect the types of heterogeneity likely to exist in applied analyses. The results showed that bias in class enumeration increased as the difference in residual variances between the classes increased. Also, an inappropriate equality constraint on the residual variances greatly impacted on the estimated class sizes and showed the potential to greatly affect the parameter estimates in each class. These results suggest that it is important to make assumptions about residual variances with care and to carefully report what assumptions are made.

Violence Exposure and Early Substance Use in High-Risk Adolescents

This study examines the relationship between violence exposure and early substance use as mediated by trauma symptoms. The Assessment of Liability and Exposure to Substance Use and Antisocial Behavior Scale was used to assess violence exposure at age 10 and substance use by age 12. Mediation analysis indicated direct relationships between violence exposure and tobacco/illegal drug use and indirect relationships between violence exposure and girls' substance use through trauma symptoms. Practitioners should consider violence exposure as a risk factor for early substance use in high-risk youths and potential gender differences in trauma symptom pathways to early substance use.

Modeling predictors of latent classes in regression mixture models

The purpose of the current study is to provide guidance on a process for including latent class predictors in regression mixture models. We first examine the performance of current practice for using the 1-step and 3-step approaches where the direct covariate effect on the outcome is omitted. None of the approaches show adequate estimates of model parameters. Given that the step-1 of the three-step approach shows adequate results in class enumeration, we suggest using an alternative approach: 1) decide the number of latent classes without predictors of latent classes and 2) bring the latent class predictors into the model with the inclusion of hypothesized direct covariates effects. Our simulations show that this approach leads to good estimates for all model parameters. The proposed approach is demonstrated by using empirical data to examine the differential effects of family resources on students' academic achievement outcome. Implications of the study are discussed.

Parents, Peers, Perceived Risk of Harm, and the Neighborhood: Contextualizing Key Influences on Adolescent Substance Use

Recent research has affirmed the need to examine contextual influences on adolescent substance use in a multilevel framework. This study examined the role of neighborhood opportunities for substance use in promoting adolescent substance use. Data came from two components of the Project on Human Development in Chicago Neighborhoods: the Longitudinal Cohort Study, consisting of interviews with youth and their primary caregivers across three waves of data with an average span of 4.5 years; and a Community Survey of neighborhood residents. Analysis used an Item-Response Theory-based statistical approach on 6556 substance use item responses from 1639 youth (49.0 % female) within 80 neighborhoods to assess the extent to which neighborhood opportunities for substance use had direct and indirect effects on adolescent substance use. Neither direct nor mediated effects of neighborhood opportunities for substance use on adolescent substance use were detected. But, analyses revealed moderating effects such that higher levels of neighborhood opportunities for substance use: (1) amplified the detrimental effects of parental substance use and peer substance use on youth substance use; and (2) attenuated the protective effect of adolescents' perceived harm of substance use on adolescent substance use. The results suggest that the ways in which neighborhood characteristics impact adolescent behavior are nuanced. Rather than impact individual-level outcomes directly, neighborhood context may be particularly relevant by conditioning the effects of salient individual-level risk and protective factors for substance use.

Regression Mixture Models: Does Modeling the Covariance Between Independent Variables and Latent Classes Improve the Results?

Regression mixture models are increasingly used as an exploratory approach to identify heterogeneity in the effects of a predictor on an outcome. In this simulation study, we tested the effects of violating an implicit assumption often made in these models; that is, independent variables in the model are not directly related to latent classes. Results indicate that the major risk of failing to model the relationship between predictor and latent class was an increase in the probability of selecting additional latent classes and biased class proportions. In addition, we tested whether regression mixture models can detect a piecewise relationship between a predictor and outcome. Results suggest that these models are able to detect piecewise relations but only when the relationship between the latent class and the predictor is included in model estimation. We illustrate the implications of making this assumption through a reanalysis of applied data examining heterogeneity in the effects of family resources on academic achievement. We compare previous results (which assumed no relation between independent variables and latent class) to the model where this assumption is lifted. Implications and analytic suggestions for conducting regression mixture based on these findings are noted.

Young people in drug treatment in Ireland: their views on substance use aetiology, trajectory, parents' role in substance use and coping skills

OBJECTIVES

The aim of the current study was to gain insight into the process of initiation and progression to problematic use among young people who reach clinically significant levels of substance use requiring treatment.

METHOD

Twenty young people, aged between 15 and 19 years from two different drug treatment centres in Ireland were interviewed regarding their views on their pathway into substance use, their progress to more problematic use, their perception of their parents' role, if any, in their trajectory and their typical coping style before treatment. Content analysis was conducted on the resulting narratives.

RESULTS

The use of substances to cope with life stressors emerged as a prominent theme at initial and problematic stages of use. Multiple maladaptive coping approaches were reported. Both direct and indirect influences from parents in their substance use problem were cited. However, some participants reported that parents had no causal role in their substance use trajectory, in particular regarding mothers.

CONCLUSIONS

The current findings suggest that substance misuse is a multi-determined problem and a number of intervention strategies are suggested to delay onset and related harms associated with adolescent substance use.