Temporal associations between substance use and delinquency among youth with a first time offense

Advancing Youth Justice: The Child and Adolescent Psychiatrist's Role

Child and adolescent psychiatrists (CAPs) play a crucial role beyond the provision of clinical care. CAPs are uniquely placed to understand and help patients navigate the fine line among psychiatric care, health and well-being, and the laws and policies supporting or impairing these processes. Focusing on vulnerable populations, such as legal system impacted youth and families, CAPs can contribute to the ongoing development of a more just and equitable world for the children of today and of tomorrow.

Adolescent delinquent behavior and sleep deficiency: a test of multiple mechanisms using sibling comparison designs

The aim of the study was to investigate the association between adolescent delinquency and sleep deficiency. A comprehensive set of potential mechanisms underlying this association were also examined. Using data from the National Longitudinal Study of Adolescent to Adult Health, the present study employed sibling fixed effects models to account for unobservable family-level confounders, such as genetic predisposition, parenting style, parental ability, and school and neighborhood environments. In Sobel mediation tests, the following mechanism variables were explored: substance use, school-based relationships, and parent-child relationships. An increase in delinquency (measured by the total number of types of delinquent behavior engaged) was associated with an increased risk of sleep deficiency one year later. Sibling fixed effects models with a lagged dependent variable revealed that this association is robust to adjustment for family-level heterogeneity as well as prior sleep deficiency. Substance use was the most salient pathway linking delinquency to sleep deficiency (17% for binge drinking and 26% for marijuana use), followed by student-teacher relationships (17%) and father-child relationships (16%). The results of this study suggest that policymakers and practitioners may consider developing interventions to help delinquent adolescents avoid substance use and restore disruptions of student-teacher and father-child relationships.

Factors associated with family involvement in a family-centered care program among incarcerated French adolescents with conduct disorder

PURPOSE

This study aims to identify the patient characteristics that may influence family involvement in a family-centered care program during detention.

DESIGN/METHODOLOGY/APPROACH

Little is known about the needs of incarcerated adolescents and their families. This exploratory study used a cross-sectional design to collect data from incarcerated adolescents with conduct disorder followed in a French outpatient psychiatric department. Logistic regression models were used to identify the sociodemographic, clinical and family characteristics of these incarcerated adolescents that could predict family involvement in their care.

FINDINGS

Among 44 adolescents with conduct disorder, the probability of family involvement during the adolescent's detention was 9.6 times greater (95% CI 1.2-14.4, p = 0.03) for adolescents with no than for those with cannabis substance use disorder, and family involvement decreased with the age of the adolescent (OR = 0.22, 95% CI 0.1-0.9, p = 0.04).

RESEARCH LIMITATIONS/IMPLICATIONS

Increased knowledge of the characteristics of these adolescents and their families is needed to develop programs that will increase family interventions by specialty treatment services during detention.

ORIGINALITY/VALUE

No study has yet been published on French incarcerated adolescents with conduct disorder. As conduct disorder is one of the most important mental health disorders among delinquent adolescents, this study provides knowledge about these adolescents and the need to involve their parents in their care to prevent the further escalation of problem behaviors.

Factors associated with crack-cocaine early initiation: a Brazilian multicenter study

BACKGROUND

Crack-cocaine dependence is a serious public health issue, related to several psychiatric and psychosocial problems. Crack-cocaine users are usually embedded in a context of great social vulnerability, often associated with violence, poverty, family conflict and easy and early access to alcohol, tobacco and other drugs.

METHODS

This cross-sectional study enrolled a consecutive sample of 577 patients admitted to 20 therapeutic communities located in Southern Brazil, between September 2012 and September 2013. A structured interview assessed life-time exposure to risk and protective factors for drug use, such as parental monitoring in childhood, deviant behaviors and peer pressure.

RESULTS

Presence of family conflict (p = 0.002), maltreatment (p = 0.016), and deviant behavior prior to age 15 in a bivariate analysis predicted an earlier age of crack-cocaine initiation, whereas adolescents experiencing parental monitoring during adolescence started use later (p < 0.001). In the multivariate model, perceptions related to ease of access of illicit drugs (marijuana: p = 0.028, 95% CI = - 3.81, - 0.22; crack-cocaine: p < 0.001, 95% CI = - 7.40, - 4.90), and deviant behavior (threatening someone with a gun: p = 0.028, 95% CI = - 2.57, - 0.14) remained independent predictors of early age of crack-cocaine initiation.

CONCLUSIONS

Early onset of crack-cocaine use seems to be associated with exposure to family conflict, easy access to drugs and deviant behavior. Treatment and preventive programs should take these factors into account when designing and implementing community interventions.

Identifying as American Indian/Alaska Native in Urban Areas: Implications for Adolescent Behavioral Health and Well-Being

American Indian and Alaska Native (AI/AN) youth exhibit multiple health disparities, including high rates of alcohol and other drug (AOD) use, violence and delinquency, and mental health problems. Approximately 70% of AI/AN youth reside in urban areas, where negative outcomes on behavioral health and well-being are often high. Identity development may be particularly complex in urban settings, where youth may face more fragmented and lower density AI/AN communities, as well as mixed racial-ethnic ancestry and decreased familiarity with AI/AN lifeways. This study examines racial-ethnic and cultural identity among AI/AN adolescents and associations with behavioral health and well-being by analyzing quantitative data collected from a baseline assessment of 185 AI/AN urban adolescents from California who were part of a substance use intervention study. Adolescents who identified as AI/AN on their survey reported better mental health, less alcohol and marijuana use, lower rates of delinquency, and increased happiness and spiritual health.

Retention and Treatment Outcome of Youth with Cannabis Use Disorder Referred By the Legal System

Background

Youth with Substance Use Disorders (SUDs) referred to treatment from the Juvenile Justice System (JJS) account for approximately half of the treatment admissions nationwide. The objective of this paper is to report a comparison of retention and outcomes for JJS referrals to those from the general community.

Methods

A total of 172 adolescents, 13-18 years of age, 83% males, 70% JJS referrals, diagnosed with DSM-IV Cannabis Use Disorder (CUD), enrolled in this outpatient, randomized, continued care study. Following a 7-session weekly motivational enhancement and cognitive behavioral therapy intervention (MET/CBT-7), only poor responders were randomized into a 10-week second phase of either an individualized enhanced CBT or an Adolescent Community Reinforcement Approach (ACRA) intervention.

Results

JJS referrals' retention rates were significantly higher than those of non-JJS referrals (X ² (1) = 11.21, p < .01) at the end of Phase I (i.e. week 7). However, there was no difference in abstinence rates between the groups at the end of phase I or II and any of the quarterly additional follow-up assessments up to one year from treatment onset.

Conclusions

Additional research examining how to capitalize on improved retention rates among youth JJS referrals is necessary in order to advance abstinence.

Assessing reciprocal association between drunkenness, drug use, and delinquency during adolescence: Separating within- and between-person effects

INTRODUCTION

Longitudinal reciprocal associations between substance use and delinquency are understudied in general adolescent populations, with previous research showing differing findings. This study aims to assess reciprocal associations between drunkenness, drug use and delinquency in a prospective, age-homogenous cohort study, using an analytical strategy that separates within- from between-person variance.

MATERIAL AND METHODS

Data comes from the Longitudinal Research on Development in Adolescence (LoRDIA) study in Sweden. Adolescents were surveyed at baseline (age 13, grade 7, N = 1409) and followed-up at grades 8 and 9. Random-intercept cross-lagged panel analysis was undertaken.

RESULTS

Between-person variance in the development of drunkenness, drug use, and delinquency were between 26% and 47%. At the within-person level, the links between these behaviors were only weak: delinquency was associated with later drug use across grades 7-9, and with drunkenness between grades 8-9 only; drunkenness was associated with later drug use between grades 7-8. Drug use was not associated with later delinquency or drunkenness at any time point.

DISCUSSION

Stable individual factors play a larger than a hitherto known role in within- and over-time relationships between drunkenness, drug use, and delinquency. Longitudinal reciprocal associations between these behaviors are at best weak and such associations may not be of primary importance in practice with general adolescent populations. Moreover, the behaviors appear to follow three distinct developmental pathways, to which intervention design may need to pay attention.

CONCLUSION

Reciprocal associations between drunkenness, drug use, and delinquency were assessed, highlighting the differential developmental pathways of these behaviors in early-mid adolescence.

Early age at childhood parental incarceration and STI/HIV-related drug use and sex risk across the young adult lifecourse in the US: Heightened vulnerability of black and Hispanic youth

BACKGROUND

We measured associations between parental incarceration and STI/HIV-related drug use and sex risk, assessing differences by race, age at first parental incarceration, and potential mediators of the relationship.

METHODS

We used Waves I (adolescence), III (young adulthood), and IV (adulthood) of the National Longitudinal Study of Adolescent to Adult Health (n = 11,884) to measure associations between age of parental incarceration (never; <8; 8-17; ≥18 years old) and marijuana and cocaine use, multiple partnerships, and STI in adolescence and adulthood among white, Black, and Hispanic participants and assessed mediation by sexual and physical abuse, mental disorder symptoms, and drug use.

RESULTS

By Wave IV, approximately one in six had experienced a parental incarceration; higher prevalence observed among black (26%) and Hispanic (20%) versus white (15%) respondents (p < 0.0001). Parental incarceration at any age was moderately to strongly associated with STI/HIV risk outcomes. In multivariable models, parental incarceration at age <8 years old (versus never) remained strongly associated with STI/HIV risk in both adolescence and adulthood, with strongest associations among non-whites. Among black participants, parental incarceration at <8 years old was associated with over double the odds of adulthood use of marijuana (adjusted odds ratio (AOR): 2.53, 95% confidence interval: 1.62, 3.95) and cocaine (AOR: 4.41, 95% CI: 2.05, 9.48). Delinquency, drug use, and mood disorders appeared to partially mediate the relationship.

CONCLUSIONS

Children impacted by parental incarceration constitute priority populations for substance use and STI/HIV prevention and treatment. The unintended consequences of incarceration for children should be considered in decarceration discussions.

Associations Between Substance Use in Commission of Sexual Crimes and Offense Characteristics Among Youth: Mitigating Effects of Substance Use Treatment

The small extant research base on substance use and youth sexual offending has very few descriptive details. Furthermore, research has yet to test associations between the use of substances in the commission of sexual crimes and offense-related characteristics and how substance use treatment can mitigate these effects. In a sample of residentially housed youth adjudicated of a sexual crime ( N = 332), prevalence patterns are broken down by type of substance use behavior. Sequential regression models are run to test the associations between substance use prior to a sexual crime and number of victims, sexual deviance, and non-sexual criminality. Substance use treatment is tested as a mitigating factor in these relationships. Results reveal high levels of family substance use, and high rates of alcohol, marijuana, and other substance use. There were associations between substance use prior to sexual criminality and sexual deviance and non-sexual criminality. Substance use treatment reduced the effects of substance use on non-sexual criminality. Research and treatment implications are offered.

Alcohol and marijuana use trajectories in a diverse longitudinal sample of adolescents: examining use patterns from age 11 to 17 years

AIMS

We tested race/ethnic differences in alcohol and marijuana (AM) trajectories (comprising an intercept term, reflecting overall probability of use, and a slope term, reflecting change in probability of use) during adolescence, whether AM use trajectories predicted high school outcomes, and whether outcomes differed by race/ethnicity after controlling for trajectory of AM use.

DESIGN

This longitudinal study involved 6509 youth from 16 middle schools in Southern California surveyed from age 11.5 (2008) to age 17 (2015) years; all surveys assessed AM use, and the final survey also examined high school outcomes.

SETTING

Youth completed five surveys in middle school and two on-line surveys in high school.

PARTICIPANTS

The sample was 50% male and 80% non-white.

MEASUREMENTS

Intercept (at 2.75 years post-baseline) and slope of AM use were examined as outcomes for race/ethnic differences. AM use trajectories were examined as predictors of academic performance and unpreparedness, social functioning, mental and physical health and delinquency.

FINDINGS

We found differences in trajectories of use by race/ethnicity, with white youth reporting a higher overall intercept of alcohol use compared to all other groups (versus Asian P < 0.001, black P = 0.001, multi-ethnic P = 0.008). Overall, examination of trajectories of use showed that adolescents with a higher alcohol use intercept term reported greater academic unpreparedness (P < 0.001) and delinquency (P < 0.001) at wave 7 in high school. In addition, youth with a higher intercept for marijuana use reported greater academic unpreparedness (P < 0.001) and delinquency (P < 0.001), and poorer academic performance (P = 0.032) and mental health (P = 0.002) in high school. At wave 7, compared to white youth, Hispanic and multi-ethnic youth reported poorer academic performance (P < 0.001 and P = 0.034, respectively); Asian, black and Hispanic youth reported higher academic unpreparedness (P < 0.001, P = 0.019, and P = 0.001); and Asian youth and multi-ethnic youth reported poorer physical health (P = 0.012 and P = 0.018) controlling for AM use.

CONCLUSIONS

Greater AM use was associated with worse functioning in high school for all youth. After controlling for AM use, non-white youth reported worse outcomes in high school for academics and health.

The Effect of Childhood Supervisory Neglect on Emerging Adults' Drinking

This study investigated the effect of childhood supervisory neglect on emerging adults' drinking. Child supervisory neglect is the most common form of child maltreatment in the United States, but few studies explore supervisory neglect separate from other forms of maltreatment among emerging adults, 18-25 years old. The study sample included (n = 11,117) emerging adults, 18-25 years old who participated in Waves I and III of the National Longitudinal Study of Adolescent Health (Add Health). We conducted separate analyses for male and female emerging adults, because they have different rates of alcohol consumption and alcohol risk behaviors. Our study used latent class analysis to understand how patterns of alcohol risk behaviors clustered together. For males, we found the following four classes: (1) multiple-risk drinkers, (2) moderate-risk drinkers, (3) binge-drinkers, and (4) low-risk drinkers or abstainers. For females, we found the following three classes: (1) multiple-risk drinkers, (2) moderate-risk drinkers, and (3) low-risk drinkers or abstainers. For both males and females, supervisory neglect increased the odds of membership in the multiple-risk drinkers' class compared to the low-risk drinkers or abstainers' class. Single males who did not live with their parents, and who were white had increased odds of being in the multiple-risk drinkers. For females, being more educated, or in a serious romantic relationship increased the odds of membership in the multiple-risk drinkers' class. Practitioners should ask about histories of supervisory neglect among emerging adults who engage in alcohol risk behaviors.

Early Substance Use and Subsequent DUI in Adolescents

OBJECTIVE

Little is known about risk factors in early adolescence that lead to driving under the influence (DUI) and riding with a drinking driver (RWDD). In a diverse group of adolescents, we longitudinally explored the influence of alcohol and marijuana (AM) use, AM beliefs, and peer and family factors (including familism) on DUI/RWDD in high school.

METHODS

We conducted 3 surveys 2 years apart of 1189 students recruited from 16 middle schools in Southern California. We used multivariable models to evaluate the effects of AM use, AM beliefs, and peer and family factors at ages 12 and 14 on DUI/RWDD at age 16.

RESULTS

At age 12, adolescents with more positive beliefs about marijuana (odds ratio [OR] = 1.63, 95% confidence interval [CI]: 1.20-2.20) and more ability to resist marijuana offers (OR = 1.89, 95% CI: 1.22-2.92) had significantly higher risk of DUI/RWDD 4 years later. At age 14, youth with more past month alcohol use (OR = 2.10, 95% CI: 1.07-4.11), positive beliefs about marijuana (OR = 1.67, 95% CI: 1.31-2.13), exposure to peer AM use (alcohol: OR = 1.01, 95% CI: 1.00-1.02; marijuana: OR = 2.41, 95% CI: 1.28-4.53), and family marijuana use (OR = 1.54, 95% CI: 1.12-2.11) had higher risk of DUI/RWDD at age 16.

CONCLUSIONS

Findings indicate a need to target adolescents as young as sixth grade at multiple levels to help prevent DUI/RWDD in high school. Given recent changes in legislation in several states, research should begin to focus on the distinction between DUI/RWDD of AM.

Change in Adolescents’ Alcohol-Use Patterns, From Non-Drinking to Non-Heavy Drinking or Heavy Drinking

This study examined risk and protective factors at work when adolescents change from a non-drinking alcohol-use pattern to either non-heavy drinking or heavy drinking. Using a sample of 1,725 non-drinkers extracted from the National Longitudinal Study of Adolescent to Adult Health, we conducted multinomial logistic regression and found that likelihood of change from non-drinking to non-heavy drinking was associated positively with safe neighborhood, female, peers’ drinking, emotional maltreatment, and delinquent behaviors. We found a negative association between such likelihood and being African American. We found that likelihood of change from non-drinking to heavy drinking was associated positively with peers’ drinking, depressive feelings, drug use, and repeating a grade(s) at school. We found a negative association between such likelihood and having a married mother, being African American or some other non-Hispanic minority ethnicity, and maternal supervision. Implications for intervention and future research are discussed.

The effects of purchasing alcohol and marijuana among adolescents at-risk for future substance use

BACKGROUND

Among high-risk youth, those who may be at increased risk for adverse alcohol and other drug (AOD) use outcomes may benefit from targeted prevention efforts; how youth acquire AOD may provide an objective means of identifying youth at elevated risk.

METHODS

We assessed how youth acquired alcohol and marijuana (purchasing vs. other means), demographics, AOD behaviors/consequences, and environment among adolescents referred to a diversion program called Teen Court (N = 180) at two time points (prior to the program and 180 days from baseline). Participants were predominantly White and Hispanic/Latino(a).

RESULTS

In cross-sectional analyses among alcohol and marijuana users, purchasing marijuana was associated with more frequent marijuana use and consequences, time spent around teens who use marijuana, higher likelihood of substance use disorders, and lower resistance self-efficacy compared to non-purchasers. Teens who purchased both alcohol and marijuana experienced similar outcomes to those who purchased only marijuana, and also reported more frequent and higher quantity of drinking, greater alcohol-related consequences, time spent around teens who use other drugs, and prescription drug misuse. Longitudinally, purchasing alcohol and marijuana at baseline was associated with more frequent and higher quantity of drinking compared to non-purchasers at follow-up. Marijuana only purchasers had a greater likelihood of substance use disorders at follow-up compared to non-purchasers.

CONCLUSIONS

In an era where drinking is commonplace and attitudes towards marijuana use are becoming more tolerant, it is essential to evaluate how accessibility to AOD and subsequent purchasing behaviors affect youth consumption and intervene accordingly to prevent future consequences.