Differentiation of early adolescent predictors of drug use versus abuse: a developmental risk-factor model

Social Risk Factors of Black and White Adolescents' Substance Use: The Differential Role of Siblings and Best Friends

Efforts to understand peer influence among adolescents have established the robust relationship between having substance using peers and future substance use. Still, research suggests that peer influence affects different types of adolescents in different ways. Black adolescents may be less susceptible to friends compared to white adolescents and possess stronger family-orientation, suggesting that siblings may affect deviance of Black adolescents whereas friends will have a minimal impact. This study used data from the first two waves of the National Longitudinal Study of Adolescent to Adult Health to evaluate the relative strength of best friend and siblings' influence as risk factors for Black and White adolescents' alcohol and cigarette use. Approximately 182 Black sibling pairs (37 % male) and 657 white sibling pairs (46 % male) that ranged in ages from 11 to 19 were in the longitudinal analyses for the current study. The findings demonstrated that sibling and best friends' substance use explained white adolescents' cigarette and alcohol use, whereas Black adolescents' cigarette and alcohol use was predominantly explained by siblings' substance use. Ultimately, the results indicated the nuanced role that two types of peers have in explaining variation in substance use across Black and White adolescents.

Health Disparities in Drug- and Alcohol-Use Disorders: A 12-Year Longitudinal Study of Youths After Detention

OBJECTIVES

To examine sex and racial/ethnic differences in the prevalence of 9 substance-use disorders (SUDs)--alcohol, marijuana, cocaine, hallucinogen or PCP, opiate, amphetamine, inhalant, sedative, and unspecified drug--in youths during the 12 years after detention.

METHODS

We used data from the Northwestern Juvenile Project, a prospective longitudinal study of 1829 youths randomly sampled from detention in Chicago, Illinois, starting in 1995 and reinterviewed up to 9 times in the community or correctional facilities through 2011. Independent interviewers assessed SUDs with Diagnostic Interview Schedule for Children 2.3 (baseline) and Diagnostic Interview Schedule version IV (follow-ups).

RESULTS

By median age 28 years, 91.3% of males and 78.5% of females had ever had an SUD. At most follow-ups, males had greater odds of alcohol- and marijuana-use disorders. Drug-use disorders were most prevalent among non-Hispanic Whites, followed by Hispanics, then African Americans (e.g., compared with African Americans, non-Hispanic Whites had 32.1 times the odds of cocaine-use disorder [95% confidence interval = 13.8, 74.7]).

CONCLUSIONS

After detention, SUDs differed markedly by sex, race/ethnicity, and substance abused, and, contrary to stereotypes, did not disproportionately affect African Americans. Services to treat substance abuse--during incarceration and after release--would reach many people in need, and address health disparities in a highly vulnerable population.

A longitudinal study of risk factors for incident drug use in adults: findings from a representative sample of the US population

OBJECTIVE

To examine baseline mental disorders and other correlates among people who have not previously used drugs as potential risk factors for incident drug use at 3-years' follow-up.

METHOD

Data came from the National Epidemiologic Survey on Alcohol and Related Conditions (commonly referred to as the NESARC) Wave 2 (2004 to 2005; n = 34 653), a longitudinal nationally representative survey of mental illness in community-dwelling adults. The study group consisted of people who reported no history of any illicit drug use or prescription drug misuse at Wave 1 (2001 to 2002). Logistic regression analyses were used to compare people with first-episode drug use at Wave 2 (n = 1145) to those who remained abstinent (n = 25 790) across various Wave 1 correlates, including sociodemographic factors, mental disorders (including alcohol use disorders and nicotine dependence), childhood adversity, and family history of substance use disorders.

RESULTS

All measures of childhood adversity were associated with an increased risk of incident drug use, as were alcohol or drug problems in first-degree relatives. In models adjusted for childhood adversity and a family history of addiction, a pre-existing mood disorder (AOR 1.31; 95% CI 1.04 to 1.64), personality disorder (AOR 1.82; 95% CI 1.50 to 2.20), previous nicotine dependence (AOR 1.41; 95% CI 1.09 to 1.83), and alcohol abuse or dependence (AOR 1.96; 95% CI 1.48 to 2.60) were independently associated with new-onset drug use at follow-up.

CONCLUSIONS

Specific mental disorders independently increase the risk of progression to incident drug use among people who were previously abstinent. Early-life adversities and addiction in family members accounts for some, but not all, of this observed relation.

Risk and risk management for Australian sex workers

In this article, we address the experiences of female sex workers in urban Australia through analysis of interviews using a feminist approach. Although many previous studies have been conducted, our focus was on the voices of sex workers in an area that was rapidly gentrifying, leading to local community tensions. Intensive analysis of interview transcripts was employed to derive thematic codes for understanding how the women viewed and managed everyday risk in sex work. They were well aware of the health risks associated with sex work. For women working on premises, domain separation between sex work and other life domains was an important management strategy for maintaining self-esteem. For women working on the street, instincts honed by years of dangerous work provided a measure of safety. Our findings have implications for health and other agencies dealing with sex workers in situations in which community pressure is exerted to move sex workers away from the area.

A critical review of adolescent substance abuse group treatments

OBJECTIVE

Evidence-based social work requires the use of interventions that are supported by good research evidence. This article reviews the empirical research on adolescent alcohol and other drug (AOD) abuse group treatments. Despite the popularity of group work, searches of the academic literature yielded only 13 adolescent group treatments for which AOD use outcomes have been reported. These treatments and the studies that evaluated them are systematically reviewed.

METHOD

Methodological, efficacy rating, and treatment factor criteria are applied to these studies.

RESULTS

Statistically significant reductions in pre-, post-, and/or follow-up use rates of one or more substances were reported for 10 of the 13 reviewed treatments, but only two met Chambless and Hollon's (1998) criteria for "possible efficacy." Similarities between the two possibly efficacious treatments, as well as among the three treatments with no indication of positive outcomes are described. A major limitation of the studies overall was the lack of group treatment factor descriptions and analyses.

CONCLUSION

If the state of the science is to advance, adolescent AOD group treatment researchers must improve study designs and reporting on group-related treatment factors. Based on the limited information provided, treatment factors and/or active ingredients that may distinguish effective vs. ineffective group work are discussed. Finally, the evidence suggests that group work is a viable modality for treating adolescent AOD abuse despite recent concerns to the contrary. Recommendations for advancing the state of the science are made.

Development of a questionnaire to examine the role of counsellors working with school students and their families with alcohol or other drug-related problems

The Role Perception Questionnaire (RPQ) was developed to measure the perceptions of school-based counsellors who work with students or their families with alcohol, tobacco or other drug-related problems. The Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ) was used as a guide in developing the RPQ. This paper addresses the conceptual development, factor structure and internal reliability of this new questionnaire. Content and face validity were examined using expertise from the field. Statistical analysis of the 47 items resulted in the identification of four factors (sub-scales) described as Role Adequacy, Role Support, Role Perception and Role Definition. Recommendations are made for further development of the questionnaire and its use as a tool for assessing training needs for those who work with young people in schools.

HIV/sexually transmitted infection risk behaviors in delinquent youth with psychiatric disorders: a longitudinal study

OBJECTIVES

To examine the prevalence and persistence of 20 human immunodeficiency virus (HIV)/sexually transmitted infection (STI) sexual and drug use risk behaviors and to predict their occurrence in four mutually exclusive diagnostic groups of delinquent youths: major mental disorder (MMD), substance use disorder (SUD), comorbid MMD and SUD (MMD+SUD), and neither disorder.

METHOD

At the baseline interview, HIV/STI risk behaviors were assessed in 800 juvenile detainees, ages 10 to 18 years; youths were reinterviewed approximately 3 years later. The final sample (N = 689) includes 298 females and 391 males.

RESULTS

The prevalence and persistence of HIV/STI risk behaviors were high in all of the diagnostic groups. Youths with an SUD at baseline were greater than 10 times more likely to be sexually active and to have vaginal sex at follow-up than youths with MMD+SUD (adjusted odds ratio [AOR] 10.86, 95% confidence interval [CI] 1.43-82.32; AOR 11.63, 95% CI 1.49-90.89, respectively) and four times more likely to be sexually active and to have vaginal sex than youths with neither disorder (AOR 4.20, 95% CI 1.06-16.62; AOR 4.73, 95% CI 1.21-18.50, respectively). Youths with an MMD at baseline were less likely to have engaged in unprotected vaginal and oral sex at follow-up compared with youths with neither disorder (AOR0.11, 95% CI 0.02-0.50; AOR 0.07, 95% CI 0.01-0.34, respectively), and with youths with an SUD (AOR 0.10, 95% CI 0.02-0.50; AOR 0.10, 95% CI 0.02-0.47, respectively). Youths with MMD+SUD were less likely (AOR 0.28, 95% CI 0.09-0.92) to engage in unprotected oral sex compared with those with neither disorder.

CONCLUSIONS

Irrespective of diagnostic group, delinquent youths are at great risk for HIV/STIs as they enter into adulthood. SUD increases risk. Because detained youths are released after approximately 2 weeks, their risk behaviors become a community health problem. Pediatricians and child and adolescent psychiatrists must collaborate with corrections professionals to develop HIV/STI interventions and ensure that programs started in detention centers continue after youths are released.

Psychological and social sequelae of cannabis and other illicit drug use by young people: a systematic review of longitudinal, general population studies

BACKGROUND

Use of illicit drugs, particularly cannabis, by young people is widespread and is associated with several types of psychological and social harm. These relations might not be causal. Causal relations would suggest that recreational drug use is a substantial public health problem. Non-causal relations would suggest that harm-reduction policy based on prevention of drug use is unlikely to produce improvements in public health. Cross-sectional evidence cannot clarify questions of causality; longitudinal or interventional evidence is needed. Past reviews have generally been non-systematic, have often included cross-sectional data, and have underappreciated the extent of methodological problems associated with interpretation.

METHODS

We did a systematic review of general population longitudinal studies reporting associations between illicit drug use by young people and psychosocial harm.

FINDINGS

We identified 48 relevant studies, of which 16 were of higher quality and provided the most robust evidence. Fairly consistent associations were noted between cannabis use and both lower educational attainment and increased reported use of other illicit drugs. Less consistent associations were noted between cannabis use and both psychological health problems and problematic behaviour. All these associations seemed to be explicable in terms of non-causal mechanisms.

INTERPRETATION

Available evidence does not strongly support an important causal relation between cannabis use by young people and psychosocial harm, but cannot exclude the possibility that such a relation exists. The lack of evidence of robust causal relations prevents the attribution of public health detriments to illicit drug use. In view of the extent of illicit drug use, better evidence is needed.

Ethnic and gender differences in psychosocial risk, protection, and adolescent alcohol use

Theoretical models suggest that many diverse psychosocial factors contribute to the etiology of substance use among youth. It has been suggested that substance use is a function of the total number of etiologic factors, rather than a specific type or set of factors. This study examined whether cumulative psychosocial risk and protection measured in the 7th grade predicted alcohol use in the 9th grade across ethnically diverse samples of adolescents. Participants consisted of black (n = 775) and Hispanic (n = 467) inner-city youth and white suburban youth (n = 708). Prevalence rates for alcohol use and risk/protection varied more widely based on ethnic group compared to gender. Black youth reported the fewest risk factors and lowest levels of alcohol use, white youth reported the most risk factors and highest levels of alcohol use, and Hispanic youth reported the fewest protective factors and intermediate levels of alcohol use. Despite these differences, structural equation modeling indicated that a latent factor consisting of cumulative risk, protection, and their interaction significantly predicted later alcohol use for the combined sample as well as for each ethnic/ gender subgroup. However, the proportion of variance explained in alcohol use varied across subgroups, and moderator analyses indicated that protection significantly buffered the effects of risk differentially across subgroups. The strongest protective effects were observed among black inner-city youth. Findings suggest that prevention approaches should focus on enhancing protection in addition to reducing risk, particularly among youth with lower levels of psychosocial protection.

Welchen Einfluß haben erste Erfahrungen und Begleitumstände zu Beginn des Drogenkonsums auf den weiteren Verlauf?

Zusammenfassung. Effektive Prävention erfordert mehr empirisch abgesicherte Kenntnisse zu Risiko- und Schutzfaktoren für den Beginn und den Verlauf des Drogenkonsums. In der vorliegenden Analyse wurde der Einfluß situativer Faktoren beim Erstkonsum und das Erleben des Erstkonsums im Hinblick auf die Entwicklung eines problematischen Drogenkonsums untersucht. Problematischer Konsum ist operationalisiert durch das Auftreten einer Abhängigkeits- bzw. Mißbrauchsdiagnose nach DSM-IV. Die Analysen wurden für eine Gruppe reiner Cannabiskonsumenten und für Opiatkonsumenten durchgeführt. Getrennte Survivalanalysen nach logistischem Modell für Männer und Frauen zeigen für beide Konsumentengruppen, daß die Konsumfrequenz bzw. -intensität zu Beginn des Drogenkonsums ein wichtiger Prädiktor für den weiteren Verlauf ist. Ein frühes Einstiegsalter in den Konsum erwies sich dagegen nur bei weiblichen Opiatkonsumenten als signifikante Einflußvariable. Ein problematischer Konsum legaler Drogen vor dem Erstkonsum illegaler Drogen scheint für Männer und Frauen von unterschiedlicher Bedeutung zu sein.

Adolescent substance use: preliminary examinations of school and neighborhood context

In considering the influences of microsystems on adolescent substance use, familial and peer contexts have received the most extensive attention in the research literature. School and neighborhood settings, however, are other developmental contexts that may exert specific influences on adolescent substance use. In many instances, school settings are organized to provide educational services to students who share similar educational abilities and behavioral repertoires. The resulting segregation of students into these settings may result in different school norms for substance use. Similarly, neighborhood resources, including models for substance use and drug sales involvement, may play an important role in adolescent substance use. We briefly review literature examining contextual influences on adolescent substance use, and present results from two preliminary studies examining the contribution of school and neighborhood context to adolescent substance use. In the first investigation, we examine the impact of familial, peer, and school contexts on adolescent substance use. Respondents were 283 students (ages 13 to 18) from regular and special education classrooms in six schools. Although peer and parental contexts were important predictors of substance use, school norms for drug use accounted for variance in adolescent use beyond that explained by peer and parental norms. Data from a second study of 114 adolescents (mean age = 15) examines neighborhood contributions to adolescent substance use. In this sample, neighborhood indices did not contribute to our understanding of adolescent substance use. Implications for prevention are presented.

Drug trafficking and drug use among urban African-American adolescents: a causal analysis

OBJECTIVE

To test the hypothesis that involvement in drug trafficking leads to illicit drug use among urban African-American adolescents.

METHODS

Self-reports of substance use, illicit drug use, and drug trafficking were obtained at baseline and every 6 months for 24 months from 383 African-American early adolescents. Transitions between involvement in drug trafficking and illicit drug use over time were examined. Path analysis was conducted to examine the causal relation between drug trafficking and drug use.

RESULTS

Among the 35 youth who were initially involved only in drug trafficking, 22 (67%) subsequently used illicit drugs. Of the 53 youth who were initially involved only in illicit drug use, only 19 (42%) continued using drugs at later waves (p < 0.05). Path analysis revealed that baseline drug trafficking had a strong effect on subsequent drug trafficking and drug use, whereas baseline drug use did not have an effect on subsequent drug use or drug trafficking.

CONCLUSIONS

Initiation of drug trafficking by adolescents appears to lead to sustained involvement in drug-related activities, including continued drug trafficking and drug use. By contrast, initiation of drug use does not necessarily lead to continued involvement in drug-related behaviors.

Primary socialization theory: the etiology of drug use and deviance. I

The fundamental theorem of primary socialization theory is that normative and deviant behaviors are learned social behaviors, products of the interaction of social, psychological, and cultural characteristics, and that norms for social behaviors, including drug use, are learned predominantly in the context of interactions with the primary socialization sources. During adolescence, learning of social behaviors is frequently dominated by interactions with peer clusters. There are a number of additional postulates: 1) The strength of the bonds between the youth and the primary socialization sources is a major factor in determining how effectively norms are transmitted. 2) Any socialization link can transmit deviant norms, but healthy family and school systems are more likely to transmit prosocial norms. 3) Peer clusters can transmit either prosocial or deviant norms, but the major source of deviant norms is usually peer clusters. 4) Weak family/child and/ or school/child bonds increase the chances that the youth will bond with a deviant peer cluster and will engage in deviant behaviors. 5) Weak peer bonds can also ultimately increase the changes of bonding with deviant peers. Primary socialization theory is consistent with current research, has strong implications for improving prevention and treatment, and suggests specific hypotheses for further research.

Psychosocial predictors and consequences of drug use: a developmental perspective within a prospective study

In this review of my prospective research program, I focus on several topics related to psychosocial factors associated with drug involvement across several developmental periods of life. In particular, I address the first three decades of life. To illustrate these processes, I use selected findings from my 16-year prospective study of adolescent and adult development that examine drug use, other problem behaviors, and psychosocial risk and protective factors as both antecedents and outcomes of drug involvement. Specifically, I: (1) summarize risk and protective factors along a developmental continuum; (2) describe my prospective study; (3) discuss sex differences; (4) introduce the notion of general deviance; (5) consider several child to adolescent predictors of drug use; (6) examine several adolescent to young adult predictors of drug use; (7) introduce the notion of multiple risk and protective factors; (8) test several young adult consequences of teenage drug use; and finally (9) evaluate several antecedents and consequences of adult drug use.

The Relations between Perceived Parental Reciprocity, Perceived Parental Approval, and Adolescent Substance Use

The present study examined the additive and interactive associations of 2 parenting variables, Perceived Parental Reciprocity (as measured using the Perception of Parental Reciprocity Scale, POPRS) and Perceived Parental Approval (PPA) of adolescent substance use, with adolescent substance use initiation and escalation. Urban high school students (N = 433) were categorized into abstainers, experimenters, and regular users of alcohol, tobacco, and cannabis. The confirmatory hypotheses thatfrequency ofsubstance use would be associated (a) positively with PPA and (b) negatively with POPRS were supportedfor all 3 substances. The association with POPRS, however, depended on the stage of substance use and the substance in question. The third hypothesis of an interactive association of POPRS and PPA with frequency of substance use was found only for tobacco; however, the direction of the interaction was the reverse of that expected. Implications of thesefindings andfuture directionsfor research are discussed.

The Construction of Risk and Protective Factor Indices for Adolescent Alcohol and other Drug Use

This paper applies the risk factor approach to assess the influence of protection and risk on five measures of substance use: overall involvement in drugs, frequent alcohol use, frequent illegal drug use, frequent drug abuse, and quantity of daily cigarette consumption. For each measure, it was hypothesized that an index of risk factors would serve to increase the likelihood of the occurrence of problem behavior and that an index of protection would result in a reduction. It was also hypothesized that under conditions of high risk the effect of protection would moderate the influence of risk factors more forcefully than under conditions of low risk. Data were obtained from a self-report questionnaire containing over 60 risk and protective measures administered to nearly 400 grade 9 students in 7 high schools located in Toronto, Canada. Measures were tested in a series of regression equations to construct indices of risk and protective factors for each substance measure. Results supported the hypothesis of separate risk and protective factor main effects for all categories of substances. Evidence of moderate to strong interaction effects (i.e., a moderating influence of protection) were also noted. Implications are discussed for methods of identifying high risk youth as well as programs designed to prevent/reduce problem behaviors among this group.

The report of the Surgeon General: preventing tobacco use among young people

This year's surgeon general's report on smoking and health is the first such report to focus on young people. From extensive data that indicate that tobacco use is a pediatric epidemic, the report reached six major conclusions: (1) Nearly all first use of tobacco occurs by age 18. (2) Most adolescent smokers are addicted to nicotine. (3) Tobacco is often the first drug used by young people who subsequently use illegal drugs. (4) There are identified psychosocial risk factors for the onset of tobacco use. (5) Cigarette advertising also appears to increase young people's risk of smoking. (6) Communitywide efforts have successfully reduced adolescent use of tobacco. This commentary restates each of the six conclusions, summarizes the data that support each, and then considers the implications of the conclusions for public health action.

Risk, protection, and vulnerability to adolescent drug use: latent-variable models of three age groups

Much research has focused on the relationships between risk factors and adolescent drug use (DU). Less is known regarding the role of protective factors and how they may inoculate youth from initiating or escalating their DU. Using latent-variable modeling and a risk factor method, we examined the cross-sectional role of risk and protective factors in predicting teenage DU for three age groups, separately by gender. Data are from a biannual statewide survey of California students. A Vulnerability latent construct was reflected in three unit-weighted indexes: risk for initiation to DU, risk for problem DU, and protection from DU. A Polydrug Use construct was reflected in eight measures of alcohol and drug use. Structural equation models revealed that for all age/gender groups, Vulnerability was strongly related to Polydrug Use as well as having specific effects on the DU measures. Effects between Vulnerability and DU were more numerous for seventh and eleventh grade than ninth grade students. Ninth grade females had the fewest effects overall. Number of specific effects between protection and DU remained stable with increasing age. Results underscore two important foci for prevention: 1) the importance of considering age-related developmental phenomena in the overall context of DU prevention; and 2) that programs continue to emphasize risk reduction, while simultaneously developing and reinforcing protective agents.

Association strategies in substance abuse

Classical genetic studies now provide fairly strong support to the idea that polygenic influences contribute to interindividual differences in vulnerability to drug abuse and dependence. Molecular genetic association studies have identified the D2 dopamine receptor gene as a candidate to contribute some of this genetic influence, although several cautions in utilizing association approaches must be recognized in interpreting their data. Clinical features of drug abuse that make association studies likely to play increasingly large roles in elucidating its underlying molecular genetics are discussed.