Parental social support as a moderator of self-medication in adolescents

Potential Pathways From Peer Victimization to Alcohol Use Among Biracial Adolescents: The Intervening Role of Parental Support

BACKGROUND

This study examined pathways from peer victimization to alcohol use and the role of parental support in mediating potential peer effects among biracial youth. Given a significant dearth of research on biracial youth, this study addresses this significant gap in the extant literature.

METHODS

Secondary data analyses were conducted using the Health Behavior in School-Aged Children (HBSC) study in the United States. This study enrolled 492 self-identified biracial school-aged youth using a nationally representative sampling of public and private schools.

RESULTS

Structural equation modeling was computed to test the mediational effects of low number of close friends, affiliation with delinquent friends, and parental support on alcohol use. Major findings indicated that affiliation with delinquent friends was correlated with higher alcohol use, higher levels of parental support were correlated with lower peer victimization, and higher levels of parental support were negatively correlated with affiliation with delinquent peers and alcohol use.

CONCLUSIONS

Parental and peer effects remain salient for biracial youth who are navigating adolescence and experiencing peer victimization. School-based interventions that include parents and friends of biracial youth are likely to be effective in reducing peer victimization and its negative sequelae.

Positive but not negative affect is associated with increased daily drinking likelihood in non-clinical populations: systematic review and meta-analyses

Background: Recent meta-analytical findings indicate that affect regulation plays an important role in alcohol craving, consumption volume, and substance use. However, in view of mixed findings, the affect and drinking likelihood literature remains in need of clarification and consolidation.Objectives: This systematic review with meta-analyses interrogated the results from peer-reviewed studies among non-clinical populations that examined the relationship between daily affective states and intraday likelihood of alcohol consumption.Method: A PRISMA guided search of PsychINFO, PsycARTICLES, Science Direct, Wiley Online Library, PubMed, SCOPUS, and JSTOR databases was conducted. Multilevel meta-analyses yielded 11 eligible negative affect studies (2751 participants, 23 effect sizes) and nine studies on positive affect (2244 participants, 14 effect sizes).Results: The pooled associations between intra-day affect and alcohol consumption likelihood revealed no significant association between negative affective state and drinking likelihood (OR = .90, 95% CI [.73, 1.12]) and that positive affect was associated with increased drinking likelihood (OR = 1.17, 95% CI [1.09, 1.27]). Egger's test, P-curve, fail-safe N, and selection models analyses suggested that the obtained results were unlikely to be the product of publication bias and p-hacking alone.Conclusions: Results converge to suggest that, independent of age, affect measure used, and study design, a significant albeit modest relationship between positive affect and alcohol consumption likelihood exists, which does not appear to be the case for negative affect. In conjunction with other recent meta-analyses, current findings help map out a more nuanced understanding of the affect-alcohol/substance use relationship, with potential implications for interventions.

Non-medical use of prescription drugs by young men: impact of potentially traumatic events and of social-environmental stressors

Background: Non-medical use of prescription drugs (NMUPD) is an increasing phenomenon associated with physical and psychological consequences. This study investigated the effects of distinct forms of stress on NMUPD. Methods: Data from 5308 young adult men from the Swiss cohort study on substance use risk factors (C-SURF) were analysed regarding NMUPD of sleeping pills, tranquilizers, opioid analgesics, psychostimulants, and antidepressants. Various forms of stress (discrete, potentially traumatic events, recent and long-lasting social-environmental stressors) during the period preceding the NMUPD assessment were measured. Backward log-binomial regression was performed and risk ratios (RR) were calculated. Results: NMUPD was significantly associated with the cumulative number of potentially traumatic events (e.g. for opioid analgesics, RR = 1.92, p < .001), with problems within the family (e.g. for sleeping pills, RR = 2.45, p < .001), and the peer group (e.g. for tranquilizer use, RR = 2.34, p < .01). Factors describing family functioning in childhood showed very few significant associations. Sexual assault by acquaintances was associated only with use of sleeping pills (RR = 2.91, p p <.01); physical assault by acquaintances was not associated with NMUPD. Physical (e.g. for psychostimulants, RR = 2.01, p < .001) or sexual assaults (e.g. for antidepressants, RR = 4.64, p < .001) perpetrated outside the family context did show associations with several drug categories. Conclusion: NMUPD appears to be more consistently associated with discrete and potentially traumatic events and with recent social-environmental stressors than with long-lasting stressors due to family functioning during childhood and youth. Physical and sexual assaults perpetrated by strangers showed more associations with NMUPD than those perpetrated by a family member.

The Reciprocal Relation Between Adolescents' School Engagement and Alcohol Consumption, and the Role of Parental Support

While school engagement and the use of alcohol are subject to change during the course of adolescence, studies have shown that being engaged in school equates with a later onset of alcohol consumption. Cross-sectional studies also indicate that alcohol use correlates to school engagement, but the reciprocal nature of these factors has never been investigated. This study examines the reciprocal relation between school engagement and alcohol consumption during adolescence. Further, the moderating effect of perceived parental support in this reciprocal relation between school engagement and alcohol consumption is tested. Data were obtained from Dutch high school students (n = 906, 52.5 % boys, mean age = 12.19 years) who annually completed a digital questionnaire over 4 years (age 12 to 15). A cross-lagged autoregressive model was applied in AMOS. Results showed that more school engagement at ages 12 and 14 predicted lower levels of alcohol use 1 year later. In addition, more alcohol consumption at ages 12 and 14 predicted lower levels of school engagement 1 year later. Higher school engagement at age 13 predicted less alcohol use at age 14, whereas no significant effect of alcohol use on school engagement was found at this age period. Furthermore, a reciprocal relation was found only for adolescents who perceived high parental support. The reciprocal nature of school engagement and alcohol consumption should be a consideration in future research and prevention program development.

A Within-Person Analysis of the Association between Borderline Personality Disorder and Alcohol Use in Adolescents

Many studies examining the association between borderline personality disorder (BPD) and alcohol use during adolescence have focused on between-individual differences (rank order stability), comparing whether adolescents with elevated rates of alcohol use have higher BPD symptoms than those with lower rates of alcohol use. As such, the extent to which an individual's alcohol use is associated with concurrent and future BPD symptoms has been relatively unstudied. The current study assessed year-to-year fluctuations in alcohol use and BPD symptoms in a large urban sample of girls from age 14 to age 17 (N = 2450). The primary aim was to examine whether increases in alcohol use were associated with increases in adolescent girls' BPD symptoms in the same year and in the following year. Results of fixed-effects (within-individual) models revealed that even while controlling for the time-varying impact of symptoms of both internalizing and externalizing disorders, prior and concurrent other substance use, and all time invariant, pre-existing differences between individuals, higher past-year alcohol use was associated with higher levels of BPD symptoms. Furthermore, this association did not vary by age, or by sociodemographic factors, including child race and socioeconomic status of the family. The results of this study indicate heightened risk for the exacerbation of BPD symptoms following increases in alcohol use frequency and highlight the potential utility of interventions targeting drinking behavior for preventing escalations in BPD symptoms.

Negative affect variability and adolescent self-medication: The role of the peer context

INTRODUCTION

Findings in the literature show mixed support for adolescent self-medication. Following recent reformulations of the self-medication hypothesis, we tested within-person effects of daily fluctuations in sadness and worry on daily substance use, and explored the moderating role of the peer context on self-medication. We hypothesized that greater daily fluctuations in mood would predict greater daily substance use, and lower levels of peer social support and higher levels of peer drug use would further increase this risk.

DESIGN AND METHODS

Experience sampling methods captured within-person daily variations in mood and substance use over 21 days among 73 adolescents. An observational coding system was employed to characterize enacted peer social support. Multilevel modeling was used to parse between- versus within-person differences in risk for daily substance use.

RESULTS

Greater within-person daily fluctuations in feelings of worry (but not sadness) significantly predicted increased daily substance use, consistent with self-medication. Moreover, greater daily fluctuations in negative affect were a stronger predictor of daily use than total level of daily negative affect. Peer social support moderated this relationship such that those with more supportive friendships were less likely to engage in self-medication.

DISCUSSION

This is the first reported study to examine within-person processes of adolescent self-medication related to daily variability in mood and the peer context. Adolescent self-medication processes appear to differ depending on the type of negative affect and whether daily affective experiences are chronic or fluctuating, suggesting that the affective processes that cue adolescents to engage in substance use are quite nuanced.

Friendship Intimacy, Close Friend Drug Use, and Self-Medication in Adolescence

The current study examined between- and within-person processes related to friendship intimacy, close-friend substance use, negative affect, and self-medication. We tested between-person hypotheses that global negative affect, friendship intimacy, and close-friend drug use predict increased substance use, and the within-person hypothesis that friendship intimacy and close-friend substance use moderate the temporal relationship between daily negative affect and subsequent substance use (i.e., self-medication). Experience sampling methodology (ESM) was employed to capture daily variations in mood and substance use, and multilevel modeling techniques were used to parse between- versus within-person differences in risk for use. Findings supported between-person hypotheses that higher levels of negative affect and lower levels of friendship intimacy predicted greater substance use, and a consistent trend indicated that friendship intimacy and close-friend drug use interact to predict substance use more generally (though not for self-medication). Risk and protective mechanisms emerged from this interaction such that the effect of friendship intimacy on adolescent use depends on the degree of close-friend drug use. More specific reformulations of the risk processes involving friendships and self-medication among younger youth are indicated.

The developmental psychopathology of alcohol use and alcohol disorders: research achievements and future directions

The last 25 years have seen significant advances in our conceptualization of alcohol use and alcohol use disorders within a developmental framework, along with advances in our empirical understanding that have been potentiated by advances in quantitative methods. These include advances in understanding the heterogeneity of trajectories of alcohol outcomes; new insights about early childhood antecedents, and adolescence and emerging adulthood as important developmental periods for alcohol outcomes; a more nuanced understanding of the influences of developmental transitions, and their timing and contexts; a greater appreciation for the importance of considering multiple levels of analysis (including an increasing number of genetically informative studies); a continuing focus on studying multiple pathways underlying alcohol outcomes; and an increasing focus on studying the effects of alcohol exposure on future development. The current paper reviews these advances and suggests directions for future study.

The developmental psychopathology of alcohol use and alcohol disorders: research achievements and future directions

The last 25 years have seen significant advances in our conceptualization of alcohol use and alcohol use disorders within a developmental framework, along with advances in our empirical understanding that have been potentiated by advances in quantitative methods. These include advances in understanding the heterogeneity of trajectories of alcohol outcomes; new insights about early childhood antecedents, and adolescence and emerging adulthood as important developmental periods for alcohol outcomes; a more nuanced understanding of the influences of developmental transitions, and their timing and contexts; a greater appreciation for the importance of considering multiple levels of analysis (including an increasing number of genetically informative studies); a continuing focus on studying multiple pathways underlying alcohol outcomes; and an increasing focus on studying the effects of alcohol exposure on future development. The current paper reviews these advances and suggests directions for future study.

Emotional Distress May Increase Risk for Self-Medication and Lower Risk for Mood-related Drinking Consequences in Adolescents

The current study examines indicators of emotional distress and coping that may define sub-populations of adolescents at risk for two potential affect-related mechanisms underlying substance misuse: self-medication and mood-related drinking consequences. Although theory and empirical evidence point to the salience of affect-related drinking to current and future psychopathology, we have little knowledge of whether or for whom such mood-related processes exist in adolescents because few studies have used methods that optimally match the phenomenon to the level of analysis. Consequently, the current study uses multilevel modeling in which daily reports of negative mood and alcohol use are nested within individuals to examine whether adolescents with more emotional distress and poorer coping skills are more likely to evidence self-medication and mood-related drinking consequences. Seventy-five adolescents participated in a multi-method, multi-reporter study in which they completed a 21-day experience sampling protocol assessing thrice daily measures of mood and daily measures of alcohol use. Results indicate that adolescents reporting greater anger are more likely to evidence self-medication. Conversely, adolescents displaying lower emotional distress and more active coping are more likely to evidence mood-related drinking consequences. Implications for identifying vulnerable sub-populations of adolescents at risk for these mechanisms of problematic alcohol use are discussed.

Parental involvement protects against self-medication behaviors during the high school transition

We examined how drinking patterns change as adolescents transition to high school, particularly as a function of parental involvement. Stress associated with the transition to high school may deplete psychological resources for coping with negative daily emotions in an environment when opportunities to drink are more common. A cohort of elevated-risk middle school students completed daily negative affect (sadness, worry, anger, and stress) and alcohol use assessments before and after the transition to high school, resulting in a measurement burst design. Adolescents who reported less parental involvement were at higher risk for drinking on any given day. After (but not before) the transition to high school, daily within-person fluctuations of sadness predicted an increased probability of same-day alcohol use for adolescents who reported that their parents were minimally involved in their lives. The other negative affect indicators were not predictive of use. Our results suggest that the transition to high school may represent an important intervention leverage point, particularly for adolescents who lack adequate parental support to help them cope with day-to-day changes in sadness.