Causes and correlates of adolescent drug abuse and implications for treatment

Early Childhood Behavioral and Academic Antecedents of Lifetime Opioid Misuse among Urban Youth

OBJECTIVE

Opioid misuse has become an epidemic in the United States. In the present study, we examine potential malleable early childhood predictors of opioid misuse including whether childhood achievement, aggressive behavior, attention problems, and peer social preference/likability in first grade predicted opioid misuse and whether these relationships differed depending on participant sex.

METHOD

Data are drawn from three cohorts of participants (N = 1,585; 46.7% male) recruited in first grade as part of a series of elementary school-based, universal preventive interventions conducted in a Mid-Atlantic region of the US. In first grade, participants completed standardized achievement tests, teachers reported on attention problems, and peers nominated their classmates with respect to their aggressive behavior and social preference/likability. At approximately age 20, participants reported on their misuse of opioids defined as lifetime use of heroin or misuse of prescription opioids.

RESULTS

Higher levels of peer nominations for aggressive behavior in first grade predicted a greater likelihood of opioid misuse. An interaction between participant sex and attention problems was observed such that females higher in attention problems were more likely to misuse opioids, particularly prescription opioids, than females lower in attention problems. An interaction was also found between participant sex and peer likability such that males lower in peer-nominated likability were more likely to misuse opioids relative to males higher in likability.

CONCLUSION

Given the malleable nature of attention problems, aggression, and social skills in early childhood, prevention programs that target these behaviors during this developmental period may attenuate risk for opioid misuse.

Cannabis Use and Parenting Practices among Young People: The Impact of Parenting Styles, Parental Cannabis-Specific Rules, and Parental Cannabis Use

Cannabis is the most commonly used illicit drug. Its use typically starts in adolescence, and parents play a key role in young people’s cannabis use. Our study aimed to examine and compare the effects of parenting styles, parental cannabis-specific rules, and parental cannabis use on young people’s cannabis use. The research sample consisted of 839 students from various secondary education programs in Slovenia, aged 14 to 21. Associations between the young people’s lifetime cannabis use and their experience of parenting practices were assessed using logistic regression, with demographic, socioeconomic, educational, health, and risk behaviors controlled in a multivariate model. Maternal authoritative parenting (in comparison with permissive parenting), strict maternal, cannabis-specific rules, and parental cannabis non-use statistically significantly reduced the likelihood of young people’s cannabis use. Its strongest predictor was parental cannabis use, followed by the mother’s specific cannabis-use rules and maternal parenting style. The findings of our study can contribute to the development of public health policies to more effectively prevent cannabis use among adolescents and emerging adults, including by designing prevention programs aimed at strengthening parents’ general and cannabis-specific practices and competences.

Adolescents with substance abuse problems in outpatient treatment: A one-year prospective follow-up study

Aim:

There is a lack of knowledge about how adolescents with substance abuse problems manage after taking part in treatment. It is also difficult to perform traditional follow-up studies with this group. This article presents the outcome of a prospective study of 455 adolescents who underwent outpatient treatment, based on data taken from official registers. It aims to describe and analyse indications of continued use of substance (CUS) and how various risk and protective factors predict outcomes after initiated treatment at a Maria clinic in Sweden.

Design:

The study is based on structured interviews at intake, and the data that indicated CUS were taken from several different national registers. The analyses included descriptive data and bivariate associations, logistic regressions and a CHAID analysis.

Results:

Almost two thirds of the adolescents have no indication of CUS at one-year follow-up. The ten studied risk factors independently were weak predictors of CUS and it was instead the accumulation of risk factors that were linked to a negative outcome.

Conclusion:

The majority of adolescents who start outpatient treatment for substance abuse problems return to a lesser extent in registers that may indicate a continued problem with alcohol and drugs one year later. A concentration of more than five risk factors appears to be associated with a registration. The study also provides an example of an alternative method for following up adolescents with alcohol and drug abuse problems.

Criminality among Young People With Substance Use Problems in Sweden: A One-Year Follow-Up Study

Swedish drug policy has a strong focus on minor drug violations. This longitudinal study analyses the association between criminality and substance use problems among young people who have received outpatient treatment and risk factors that predict continued problems with criminality. Research on this target group is under development in Sweden, but there are few follow-up studies. The study indicates that about one-quarters of the young people who begin outpatient treatment have been convicted of crimes at 1-year follow-up. Most of them who had been convicted with offences also have ongoing problems with substance use and three-quarters of the young people had been charged with a drug-related offence. More than five risk factors give an elevated risk of continued criminality. Interventions meeting the needs of young people, moving away from the current emphasis on penal law principles, may also contribute to reduced criminality in this target group.

Exploring substance use disorders and relapse in Mauritian male addicts

Background

Substance Use Disorder (SUD) places a heavy burden on societal and health systems given its association with high mortality and morbidity rates worldwide, including Mauritius. Illicit substances act as a positive reinforcement and stimulate addiction through its pleasure-seeking attributes.

Aim

This study focused on identifying the risk factors leading to SUD among Mauritian male addicts as well as examining the potency of those factors in SUD development. The study also aimed at determining the prevalence of relapse and its causation.

Research setting

A cross-sectional study was conducted over a period of six months using a sample of 180 male addicts registered in a public hospital. A questionnaire investigating dimensions such as risk factors, self-esteem and peer pressure was administered.

Findings

A high percentage of relapse was noted amongst users within the first year of abstinence. Majority of respondents originated from nuclear or single parents’ family and were deprived of adequate social supports given their marital status. 57.5% of participants had a positive family history of SUD. Cannabis was the most commonly abused substance and 76.2% of the addicts were introduced to drugs through curiosity. Transposing the results against the Gateway Drug Theory showed a constant progression from soft to hard drugs for male addicts, a trend which was consistent with literature. Lastly, a theoretical model was developed based on the strong statistical association found between impulsivity and reduced thought processes prior to relapse; data revealing increased impulsivity which is a common trait in antisocial personality disorder and borderline personality disorder as being largely responsible for relapse.

Conclusion

The study was successful in bringing out the most common risk factors of SUDs which are linked to low socioeconomic status. The inability of addicts to progress with their rehabilitation given the alarming 92% of relapse was related to social pressure as prime deterrent to successful remission. Programmes involving relapse prevention must implemented in the first year of abstinence to facilitate rehabilitation.

Relationship between Substance Use and Socioeconomic Variables in Pennsylvania Adolescents: 2009-2017

Purpose: The goal of the current study is to analyze the substance use trends in Generation Z youth (in both middle and high school environments) and to determine if any correlation exists between substance use behaviors and demographic variables. Methods: Analysis is based on substance use data collected through the Pennsylvania Youth Survey (PAYS) from 2009 to 2017 and the 2016 US census data. Results: Our results suggest that substance use in Gen Z adolescents is mainly linked to alcohol, marijuana, cigarettes, smokeless tobacco, vaping, and narcotic prescription drugs. Alcohol is the most prevalent high-risk substance used by 12th grade students with 69.8% of students having consumed alcohol over their lifetime. Vaping is the next highly used substance with 28.9% of students in 12th grade having vaped 30 day prior to the survey. There is a significant correlation among adolescents between smoking cigarettes and using smokeless tobacco. A student using either alcohol, cigarettes or smokeless tobacco is highly likely to use the other two substances as well. Adolescents from counties with a high Caucasian population were at high risk for cigarette and smokeless tobacco use, while the opposite held true for counties with a high number of foreign-born persons or higher Asian or Hispanic populations. Higher median household incomes and higher adult education levels in a county were both protective factors against smokeless tobacco use. Conclusions: Results of the study suggest that students start experimenting with high-risk substance use in early grades and to combat the prevalence, we suggest the importance of educating adolescents of the dangers of drug use in early grades.

Academic Achievement and Drug Abuse Risk Assessed Using Instrumental Variable Analysis and Co-relative Designs

Importance

Low academic achievement (AA) in childhood and adolescence is associated with increased substance use. Empirical evidence, using longitudinal epidemiologic data, may provide support for interventions to improve AA as a means to reduce risk of drug abuse (DA).

Objective

To clarify the nature of the association between adolescent AA and risk of DA by using instrumental variable and co-relative analysis designs.

Design, Setting, and Participants

This study, assessing nationwide data from individuals born in Sweden between 1971 and 1982, used instrumental variable and co-relative analyses of the association between AA and DA. The instrument was month of birth. Co-relative analyses were conducted in pairs of cousins (263 222 pairs), full siblings (154 295), and monozygotic twins (1623) discordant for AA, with raw results fitted to a genetic model. The AA-DA association was modeled using Cox regression. Data analysis was conducted from October 2017 to January 2018.

Exposures

Academic achievement assessed at 16 years of age (for instrumental variable analyses), and estimated discordance in AA in pairs of monozygotic twins (for co-relative analyses).

Main Outcomes and Measures

Drug abuse registration in national medical, criminal, or pharmacy registries.

Results

This instrumental variable analysis included 934 462 participants (478 341 males and 456 121 females) with a mean (SD) age of 34.7 (4.3) years at a mean follow-up of 19 years. Earlier month of birth was associated with a linear effect on AA, with the regression coefficient per month equaling -0.0225 SDs (95% CI, -0.0231 to -0.0219). Controlling for AA, month of birth had no association with risk of DA (hazard ratio [HR], 1.000; 95% CI, 0.997-1.004). Lower AA had a significant association with risk of subsequent DA registration (HR per SD, 2.33; 95% CI, 2.30-2.35). Instrumental variable analysis produced a substantial but modestly attenuated association (HR, 2.04; 95% CI, 1.75-2.33). Controlling for modest associations between month of birth and parental educational status and DA risk reduced the association to a HR of 1.92 (95% CI, 1.67-2.22). The genetic model applied to the results of co-relative analyses fitted the observed data well and estimated the AA-DA association in monozygotic twins discordant for AA to equal a HR of 1.79 (95% CI, 1.64-1.92).

Conclusions and Relevance

Two different methodological approaches with divergent assumptions both produced results consistent with the hypothesis that the significant association observed between AA at 16 years of age and risk of DA into middle adulthood may be causal. These results provide empirical support for efforts to improve AA as a means to reduce risk of DA.

When the party continues: Impulsivity and the effect of employment on young adults' post-college alcohol use

BACKGROUND

The transition from college to work is both an exciting and potentially high risk time for young adults. As students transition from academic settings to full-time employment, they must navigate new social demands, work demands, and adjust their drinking behaviors accordingly. Research has shown that there are both protective factors and risk factors associated with starting a new job when it comes to alcohol use, and individual differences can moderate these factors.

METHOD

1361 students were recruited from 4 geographically diverse universities and followed 1month pre- and 1month post-graduation. Drinking frequency, quantity, consequences, and impulsivity were assessed.

RESULTS

Full-time employment was related to increased drinking quantity but not related to changes in other drinking outcomes. However, impulsivity moderated the relationship between employment and drinking. For those reporting higher levels of impulsivity at baseline, full-time employment was associated with an increase in drinking variables (quantity and frequency), whereas drinking was unaffected by full-time employment status among those reporting lower levels of impulsivity. Implications for future research are discussed.

Experiences of victimization among adolescents with Substance Abuse Disorders in Sweden

Background

Adolescents who initiate treatment for substance abuse often have a history of victimization in the form of physical, psychological, or sexual abuse. These experiences can have serious adverse consequences that may affect their lives and social functioning.

Objective

This article describes and analyzes victimization among adolescents who are in outpatient treatment for substance abuse disorders with respect to gender, social circumstances, alcohol and drug abuse, and mental health.

Method

This cross-sectional study is based on structured interviews with 748 adolescents from seven outpatient clinics in Sweden. Chi-squared tests were performed to examine significant differences between gender and victimization (or lack of victimization). The study also included a quantitative content analysis of interview utterances.

Results

The analysis showed that more than half of the adolescents had experienced violence or another type of abuse. There are also significant gender differences: two thirds of the girls and slightly less than half the boys had experienced abuse in some form, and the girls had more severe needs at treatment admission.

Conclusions

This study established that experiences of victimization and exposure to violence are widespread among adolescents with substance abuse disorders in Sweden. This is an important issue that requires attention and action, with preventive and therapeutic interventions needed to provide support for both substance abuse disorders and psychiatric symptoms.

Differences Between Japanese and U.S. Children's Performance on "Zoo U": A Game-Based Social Skills Assessment

OBJECTIVE

The purpose of this study was to test whether and how performance on a digital game-based social skills assessment tool, "Zoo U" (3C Institute, Durham, NC), differed for children in the United States and Japan across six core social skills.

MATERIALS AND METHODS

"Zoo U" was administered to 497 third and fourth grade children from the United States and Japan (46 percent Japanese) by teachers and researchers, respectively. U.S. children received the original version of "Zoo U," and Japanese children received a fully translated Japanese version of the program. Scoring of each of the six social skills is built into the "Zoo U" software, with specific scoring algorithms for each grade level that provide both a continuous scale score and cutoffs for three distinct performance categories: high, average, and low.

RESULTS

A multivariate analysis of variance (MANOVA) was conducted to assess differences by cultural group on each of the six continuous social skill scores, controlling for gender and grade level. Results revealed significant differences on four of the six skills in expected directions. Chi-squared and odds ratios analyses were then conducted on the assignment of children into each of the performance categories by cultural group, revealing additional nuance to the cultural differences identified in the MANOVA consistent with existing literature.

CONCLUSIONS

We were able to replicate known cultural differences between U.S. and Japanese children with a simple direct translation of a Web-based social skills assessment game, "Zoo U." Our results provide preliminary support for the potential of game-based assessment methods to provide efficient and valid social skill assessments to children around the world.

The role of general parenting and cannabis-specific parenting practices in adolescent cannabis and other illicit drug use

AIMS

To investigate general and cannabis-specific parenting practices in relation to adolescent cannabis and other illicit drug use.

METHODS

Data were derived from the Dutch National School Survey on Substance Use among students (N=3209; aged 12-16 years) and one of their parents in 2011.

RESULTS

Logistic regression analyses revealed that 1) parental cannabis use was significantly related to more adolescent lifetime and recent cannabis use, and 2) restrictive cannabis-specific parental rules were associated with less adolescent recent cannabis and lifetime use of other illicit drugs, even when controlled for sociodemographic factors, general parenting, adolescent tobacco use, and tobacco-specific parenting. In addition, no significant interaction was observed between parental cannabis use and cannabis-specific rules in their relation to adolescent cannabis and other illicit drug use, indicating that cannabis rules are evenly associated with adolescent drug use for families with and without parental cannabis experience.

CONCLUSIONS

In addition to general parenting practices, restrictive cannabis-specific rules are related to lower adolescent cannabis and other illicit drug rates. Parents who ever used cannabis have children with a higher prevalence of cannabis use. However, their restrictive cannabis-specific rules are equally related to a lower chance of adolescent cannabis use.

Etiology of drug abuse: a narrative analysis

Introduction and Aim. Further gains in the prevention of drug abuse disorders require in-depth and holistic understanding of the risk factors of addiction from different perspectives. Lay persons and experts have different concepts of risk which could complement each other. The purpose of this study was to elaborate drug abuse risk factors through the story of individuals who had become drug dependent. Design and Methods. In this qualitative research, 33 individuals attending treatment centres for drug abuse were interviewed about the story of their addiction in Kerman, Iran. Interview questions were around the story of the participants. Results. All participants were male and in the age range of 18–40 years. Narrative analysis identified five themes as the main risk factors: family factors, peer pressure, the effect of gateway drugs (especially waterpipe), individual characteristics, and the community factors. More emphasis was placed upon the role of family factors, peer influence, and gateway effect. Discussion and Conclusion. This study elicited information from drug dependent subjects regarding the risk factors of drug abuse. According to drug dependent individuals' views, more attention should be devoted to family and peer influences by policy makers, in developing culture-based preventive strategies.

Differences in the age-drug use curve among students and non-students in the UK

INTRODUCTION AND AIMS

The aim of this study is to assess whether the delayed peak in the age-drug use prevalence curve among college students compared with non-college students observed in studies in the USA would be replicated in the UK.

DESIGN AND METHODS

The analysis was based on data collected as part of the Crime Survey for England and Wales 2010-2011, a national general household survey of young people and adults. A random sample of approximately 26 000 respondents was asked questions covering use of 19 drugs.

RESULTS

The study provides evidence of a delayed age-drug use peak among students compared with non-students of similar age. During the period of age 20-22, drug use prevalence among students was similar to, or higher than, that of non-students. The relationship of student status and elevated drug use only occurred during the narrow age range associated with emerging adulthood (ages 20-22). University attendance before or after this period was not associated with higher prevalence rates among students compared with non-students.

DISCUSSION AND CONCLUSION

Explanations of the age-drug use peak among students would need to take into account that university attendance alone might not result in higher drug use prevalence rates. This would mean that explanations that focus on the interaction between university life and emerging adulthood might provide the most promising lines of enquiry.

Society and its influences on drug use among young individuals in Tehran, Iran

Illicit Drug use poses a substantial public health problem around the world, mainly affecting young people. Current estimates suggest that Iran has the highest rate of opium addiction per capita in the world. It has been suggested that multiple elements contribute to the process of drug use. The aim of this study is to explore the probable components in the society that might play a role in the initiation of drug use among young adults. The study is qualitative in nature. Twenty four in-depth interviews were conducted with drug-using young men (n = 10) and women (n = 10) and their family members (n = 4). Based on our data analysis, developing a pro-drug attitude, conformist attitude of society toward treating youth and young individuals, and having weak approach toward prevention were identified as important determinants of substance use. We recommend the need for early intervention, especially for at-risk communities. The results of this research suggest that dealing with a major problem such as drug use needs a comprehensive assessment of the context in which young people live and use substances. According to our findings, exploring young drug users experiences is not only important but also useful for policy makers to develop more effective prevention and intervention programs.

Psychological Distress and Drug Use Patterns of Young Adult Ecstasy Users: A Complementary Analysis of Australian Datasets

We examine psychological distress (PD) in young adult Ecstasy users in relation to age of initiation and frequency of use of Ecstasy, cannabis, alcohol, and tobacco. Using two Australian community samples, we assess whether different sampling methods produce comparable estimates of these associations. The Natural History Study of Drug Use (NHSDU; N = 339) in 2009 used population sampling and the 2009 Ecstasy and Related Drug Reporting System (EDRS; N = 359) used purposive sampling. Participants, aged 19-23 years, were recurrent Ecstasy users. PD was assessed using Kessler 10 in the EDRS and Hospital Anxiety Depression Scale in the NHSDU. In both samples, PD was associated with daily tobacco use and early drug initiation, but not frequent Ecstasy use. One-third smoke tobacco daily. Study limitations and implications are noted.

Circumstances of initiation into new-type drug use among adults in Shanghai: are there differences by types of first new-type drug used?

BACKGROUND

This study investigated circumstances of initiating new-type drug use among adult new-type drug users and differences among those who first used methamphetamine, ecstasy and ketamine.

METHODS

A total of 276 participants were recruited, using respondent-driven sampling (RDS) from nine seeds recruited through NGOs, social workers and outreach workers in Shanghai, China.

RESULTS

Methamphetamine was the most frequently reported first new-type drug used (37.1%), followed by ecstasy (35.6%) and ketamine (20.0%). 38.7% of participants initiated new-type drug use before the age of 21 years. 47.8% knew at initiation that club drugs can be harmful. Most were introduced to new-type drug use by friends, spouses or boy/girlfriends. The three most common reasons for initiation were curiosity, peer influence, and wishing to dull one's emotions. Those first using methamphetamine were more likely to be female, have a monthly individual income less than 3000 Yuan (approx. $476), initiate use at 21 years or older and at private setting than those first using ecstasy and ketamine.

CONCLUSIONS

There is an urgent need for drug education efforts in China to raise awareness of the harms of new-type drugs, as well as to increase knowledge about the paradox of new-type drug effects. Drug prevention and intervention programs should be tailore to target populations and their social context.

Methadone maintenance treatment versus methadone maintenance treatment plus auricular acupuncture: impacts on patient satisfaction and coping mechanism

This study intended to (1) describe the baseline patient satisfaction level and preferred coping strategies and (2) assess patient satisfaction and coping mechanisms pre- and postintervention. Patients on methadone maintenance treatment (MMT) in Terengganu, Malaysia, were randomized into either MMT or MMT plus auricular acupuncture (MMT + AA) groups. All received the standard MMT, while participants on MMT + AA underwent concurrent AA session thrice weekly for 2 months (each session = 30 minutes). Data analysis was carried out using SPSS 16.0, employing descriptive and nonparametric statistics. Participations were received from 97 eligible male patients (median age = 36.0 years; Malay = 97.9%). After screening for dropouts, only 69 patients were considered for subsequent analysis (MMT = 40; MMT + AA = 29). At preintervention, both groups did not differ significantly in the parameters investigated. During postintervention, no significant difference was detected for satisfaction level but coping-wise, substance use was significantly and frequently adopted by MMT + AA patients compared to MMT respondents (P < .05). On separate analysis, those who received MMT alone adopted active coping, venting, and self-blame significantly more frequently postintervention (P < .05). Nevertheless, no significant difference for coping styles of MMT + AA patients was exhibited over time (P >.05). The addition of AA therapy into the standard MMT treatment did not seem to influence patient satisfaction and their coping ways.

Predicting resistance to health education messages for cannabis use: The role of rebelliousness, autic mastery, health value and ethnicity

The prevalent use of cannabis by adolescents and young adults, combined with the common misconception that smoking cannabis is relatively harmless, warrants the exploration of factors influencing resistance to health education messages about cannabis use. This investigation did so within a Reversal Theory framework. One hundred and thirteen undergraduate students responded to an informative leaflet detailing the health effects of smoking cannabis. The most significant independent predictor of message resistance was frequency of cannabis use, followed by proactive rebelliousness, autic mastery, health value and ethnicity. These findings have implications for the development, design and targeting of cannabis health education programmes.

Zoo U: A Stealth Approach to Social Skills Assessment in Schools

This paper describes the design and evaluation ofZoo U, a novel computer game to assess children’s social skills development.Zoo Uis an innovative product that combines theory-driven content and customized game mechanics. The game-like play creates the opportunity forstealth assessment, in which dynamic evidence of social skills is collected in real time and players’ choices during gameplay provide the needed data. To ensure the development of an engaging and valid game, we utilized an iterative data-driven validation process in which the game was created, tested, revised based on student performance and feedback, and retested until game play was statistically matched to independent ratings of social skills. We first investigated whether the data collected through extensive logging of student actions provided information that could be used to improve the assessment. We found that detailed game logs of socially relevant player behavior combined with external measures of player social skills provided an efficient vector to incrementally improve the accuracy of the embedded assessments. Next, we investigated whether the game performance correlated with teachers’ assessments of students’ social skills competencies. An evaluation of the final game showed (a) significant correlations between in-game social skills assessments and independently obtained standard psychological assessments of the same students and (b) high levels of engagement and likeability for students. These findings support the use of the interactive and engaging computer game format for the stealth assessment of children’s social skills. The created innovative design methodologies should prove useful in the design and improvement of computer games in education.

Early childhood experiences, parenting and the process of drug dependency among young people in Tehran, Iran

INTRODUCTION AND AIMS

Substance abuse has become a major public health problem in Iran. The process of developing an addiction is complex and multifaceted. Early childhood experiences are thought to be one of the important determinants of addictive behaviour. The aim of this qualitative study is to explore the early childhood experiences, especially the experiences within the immediate family, of current substance-using young adults in Iran.

DESIGN AND METHODS

The study is qualitative in nature. In-depth interviews were conducted with 15 young men and women who were either in treatment for their addiction or were active drug users at the time of the interviews. Moreover, four interviews have been conducted with family members of participants.

RESULTS

The majority of the participants experienced traumatic events during childhood and came from dysfunctional families. There appears to be a significant disconnect between these individuals and their families. An obedience-instilling parenting style and parents' knowledge and attitude toward drug using and prevention were also identified as important determinants of substance use.

DISCUSSION AND CONCLUSIONS

The results of this research point out the need for early interventions for at-risk families as well as at-risk individuals.

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

OBJECTIVE

We examined the moderating effects of parenting on the temporal relationship between negative affect and subsequent alcohol use in adolescents as an indicator of self-medication. Specifically, we tested whether youth are more likely to self-medicate if they receive less parental social support.

METHOD

We used a multi-method, multi-reporter strategy and an experience sampling paradigm to examine these mechanisms in an elevated-risk sample preparing for the transition to high school. Seventy-one adolescents and their parents completed home-based interviews and adolescents completed a 21-day experience sampling protocol in which they reported their alcohol use daily and their affect thrice daily.

RESULTS

Parent-reported family communication, though no other parental support indicators, moderated the relation between daily negative affect and alcohol use. Plotting of interactions showed a greater likelihood of drinking on days characterized by greater negative affect only in adolescents with higher levels of parent-reported family communication.

CONCLUSIONS

This study offers tentative support for parental support as a moderator of the relation between daily negative affect and alcohol use. Parental support may be a response to alcohol use and self-medication in teens such that parents become more involved and open in talking with their teens when they notice these patterns of behavior.

The Impact of Children's Social Adjustment on Academic Outcomes

This study tested whether social adjustment added to the prediction of academic outcomes above and beyond prior academic functioning. School records and peer-, teacher-, and self-report measures were collected for 1,255 third grade children in the fall and spring of the school year. Social acceptance by and aggression with peers were included as measures of social adjustment. Academic outcomes included math and reading GPA, classroom behavior, academic self-esteem, and absenteeism. As expected, support for the causal model was found where both forms of social adjustment contributed independently to the prediction of each area of academic adjustment. Gender differences in the patterns of results were present, particularly for the impact of aggression on academic adjustment. Discussion focuses on the implications for social-emotional literacy programs to prevent negative academic outcomes.

Poor school satisfaction and number of cannabis using peers within school classes as individual risk factors for cannabis use among adolescents

There is little information available on the topic of poor school satisfaction as a risk factor for cannabis use among adolescents. We examined if there was an association between poor school satisfaction, school class cannabis use and individual cannabis use. Further, we investigated if many cannabis users within the school class statistically interacted with poor school satisfaction upon the association with individual cannabis use. A cross-sectional study of 1317 Danish 15-year-olds in 95 school classes in a random sample of schools. The exposure variables were school satisfaction and school class cannabis use. The criterion variable was individual cannabis use, three times or more (last 12 months). Poor school satisfaction (OR 2.78, 95% CL = 1.83—4.23), attending a school class with >2 cannabis users (OR 3.68, 95% CL = 2.21—6.12) were associated with cannabis use. In our study there was not a significant statistically interaction between number of cannabis users in school classes and poor school satisfaction upon individual cannabis use (p = 0.183). We found that poor school satisfaction and school class cannabis use where both associated with higher individual cannabis use. The risk factors did not significantly interact and may suggest that they function as individual exposure factors towards adolescent cannabis use.

Applying Stafford and Warr's reconceptualization of deterrence theory to drug driving: can it predict those likely to offend?

In December 2007, random roadside drug testing commenced in Queensland, Australia. Subsequently, the aim of this study was to explore the preliminary impact of Queensland's drug driving legislation and enforcement techniques by applying Stafford and Warr's [Stafford, M.C., Warr, M., 1993. A reconceptualization of general and specific deterrence. Journal of Research in Crime and Delinquency, 30, 123-135] reconceptualization of deterrence theory. Completing a comprehensive drug driving questionnaire were 899 members of the public, university students, and individuals referred to a drug diversion program. Of note was that approximately a fifth of participants reported drug driving in the past six months. Additionally, the analysis indicated that punishment avoidance and vicarious punishment avoidance were predictors of the propensity to drug drive in the future. In contrast, there were indications that knowing of others apprehended for drug driving was not a sufficient deterrent. Sustained testing and publicity of the legislation and countermeasure appears needed to increase the deterrent impact for drug driving.

The influence of representations of attachment, maternal-adolescent relationship quality, and maternal monitoring on adolescent substance use: a 2-year longitudinal examination

The present study examined the hypotheses that more secure representations of attachments to parents are associated with less adolescent substance use over time and that this link is mediated through relationship quality and monitoring. A sample of 200 adolescents (M = 14-16 years), their mothers, and close friends were assessed over 2 years. Higher levels of security in attachment styles, but not states of mind, were predictive of higher levels of monitoring and support and lower levels of negative interactions. Higher levels of security in attachment styles had an indirect effect on changes in substance use over time, mediated by maternal monitoring. These findings highlight the roles of representations of attachments, mother-adolescent relationship qualities, and monitoring in the development of adolescent substance use.

Substance Use Disorders and Cluster B Personality Disorders: Physiological, Cognitive, and Environmental Correlates in a College Sample

Substance use disorders (SUDs) and Cluster B personality disorders (PDs) are both marked by impulsivity and poor behavioral control and may result in part from shared neurobiological or executive cognitive functioning deficits. To examine the potential utility of such models in explaining variance in SUDs and PDs at the lower end of symptom expression and impairment, 123 (73 female) volunteer college students were administered 2 measures of executive cognitive functioning; a task assessing autonomic reactivity to aversive noise blasts; a life events and a peer substance use measure; and structured clinical interviews to assess symptoms of substance abuse/dependence and antisocial, borderline, histrionic, and narcissistic PDs. As expected, symptoms of SUDs and PDs were significantly positively correlated. Antisocial PD, alcohol and cannabis use disorder symptoms were significantly positively related to proportion of friends who use alcohol and drugs regularly and drug use among romantic partners. Number of negative life events was positively related to PD symptoms and to alcohol use disorder symptoms. Executive cognitive functioning was not related to SUD and PD symptoms in the expected direction. Findings suggest that, among higher functioning young adults, environmental factors may be particularly relevant to our understanding of SUDs and certain PDs.

Pilot randomized controlled trial of a brief alcohol intervention group for adolescents

The aim of this study was to identify whether a brief motivational interviewing and cognitive-behavioural-based alcohol intervention group (AIG) programme is feasible with young people at risk of developing a problem with alcohol, and to assess the short-term effectiveness of the intervention. Participants were assigned randomly to receive a group intervention of four sessions duration (n=17; AIG) or no treatment (n=17, control group). Participants were volunteers recruited from a youth centre on the Central Coast of New South Wales, Australia, comprising youths aged 12-19 years who were interested in participating in the study. The Readiness to Change Questionnaire, items from the AUDIT, the DAP Quick Screen and a knowledge questionnaire were administered at pretreatment, post-treatment and at 1- and 2-month follow-ups. Participants in the AIG programme showed an increase in readiness to reduce their alcohol consumption. They also reduced their frequency of drinking at post-treatment and the first follow-up assessment, while the control group reported increases at the second follow-up assessment. The control group also increased their hazardous drinking and frequency of binge drinking compared to the AIG. The intervention appeared to improve the AIG participants' knowledge about alcohol and its effects. The results provide preliminary evidence for the effectiveness of the AIG programme in training young people to set limits on alcohol consumption, increase awareness of safe drinking levels and the effects of alcohol abuse. This pilot study also showed that young people who are identified as being 'at risk' of developing alcohol abuse, and who are also ambivalent about changing drinking behaviours, can be recruited and retained in a treatment programme.

Habilidades sociais e abuso de drogas em adolescentes

O presente estudo propõe uma revisão bibliográfica sobre habilidades sociais e abuso de substâncias. Este artigo foi elaborado a partir de pesquisa nas Bases de Dados Pschynfo, Web of Science, Cochrane Library, Proquest, Medline e Lilacs, entre 1996 e 2006. Os descritores foram: social skills, social skills training, social competence, assertiveness, adolescents, teeenagers, substance abuse, drug abuse, cannabis e marijuana. Nas bases de língua portuguesa, foram: habilidades sociais, treinamento em habilidades sociais, assertividade, adolescentes, abuso de substâncias, drogas e maconha. Os estudos, a maioria de língua inglesa, apontaram a existência de déficits, principalmente a dificuldade em resistir às drogas e dizer não. Conclui-se que a construção de habilidades de resistência ao oferecimento de drogas, a auto-eficácia e o estímulo à capacidade de tomada de decisões pode reduzir o uso de substâncias. Poucos estudos brasileiros foram encontrados abordando esta temática.

Recent substance use and high levels of psychological distress among secondary school students in New South Wales

In 2002, the NSW Department of Health, in conjunction with The Cancer Council NSW, carried out the NSW School Students Health Behaviours Survey. The methodology and summary descriptive results have been previously described [NSW Department of Health. The health behaviours of secondary school students in New South Wales 2002. N S W Public Health Bull 2004; 15(S-2): 1-86]. In the survey, 18% of NSW secondary school students reported high levels of psychological distress, 30% reported recently using alcohol, 13% reported recently using tobacco, and 9% reported recently using cannabis. With regard to the other illicit drugs, 2.0% reported recently using amphetamines, 1.0% cocaine, 1.4% hallucinogens (LSD, heroin) and 1.9% ecstasy. The survey did not, however, examine associations between substance use and high levels of psychological distress. These associations are described in this article.

The role of drug use outcome expectancies in substance abuse risk: an interactional-transformational model

While a variety of risk factors for substance abuse have been identified, the psychological mechanisms underlying the transmission of risk is unclear based on studies using traditional risk-outcome research designs. The present paper identifies drug use outcome expectancies as a common etiological mechanism involved in substance abuse risk. Existing literature findings are reviewed and integrated according to an interactional-transformational (IT) model of developmental psychopathology. This model identifies the preliminary (mediating) and secondary (moderating) role of drug expectancies as important operations involved in the development of substance use patterns. Advantages of the IT model over traditional trait-based or environmental models are discussed, along with implications for intervention and future research.

The role of the family in preventing and intervening with substance use and misuse: a comprehensive review of family interventions, with a focus on young people

The family plays a key part in both preventing and intervening with substance use and misuse, both through inducing risk, and/or encouraging and promoting protection and resilience. This review examines a number of family processes and structures that have been associated with young people commencing substance use and later misuse, and concludes that there is significant evidence for family involvement in young people's taking up, and later misusing, substances. Given this family involvement, the review explores and appraises interventions aimed at using the family to prevent substance use and misuse amongst young people. The review concludes that there is a dearth of methodologically highly sound research in this area, but the research that has been conducted does suggest strongly that the family can have a central role in preventing substance use and later misuse amongst young people.

Psychological symptoms and drug use severity among Israeli adolescents presenting for outpatient drug abuse treatment

The objective of this study was to assess the rates of externalizing and internalizing symptoms, and the relation between psychological symptoms and drug use severity, among 117 Israeli adolescents presenting for outpatient drug abuse treatment. Psychological symptoms were assessed via both adolescent self-report and parent report. Drug use was assessed using both adolescent self-report and urinalysis. Results showed that 58% of the sample evidenced clinical levels of psychological symptoms, with girls evidencing higher rates of externalizing and mixed symptomatology than boys. Parents' report of adolescents' internalizing symptoms predicted severity of drug use. These findings suggest that treatment for this population should be multidimensional, and address not only drug use per se, but also psychological risk factors.

Long-term impact of a district-wide school/community-based substance abuse prevention initiative on gateway drug use

This study examined long-term effects of a school/family/community substance abuse prevention partnership intervention lead by a Midwestern school district. Previous findings suggested that the program contributed to decreased tobacco and marijuana, but not alcohol, use prior to and after implementation between 1987 and 1991. The current study examined 8th-12th grade student drug use prevalence data from 1991 and 2003 to determine whether previous program effects were sustained. With one exception, reported lifetime and monthly cigarette use decreased below 1991 levels for all grades. Lifetime and monthly alcohol use decreased below 1991 levels for most grades, a result not previously detected. While still below national rates, reported lifetime use of marijuana increased for all grades over time. The intervention was effective in reducing cigarette and alcohol use over time and in suppressing marijuana use levels below national rates; however, these gains tended to erode in later high school grades.

Ethnicity and ethnic identity as predictors of drug norms and drug use among preadolescents in the US Southwest

This article reports the results of research exploring how ethnicity and ethnic identity may "protect" adolescents against drug use and help them form antidrug use norms. This study was conducted in 1998 and is based on a sample of 4364 mostly Mexican American seventh graders residing in a large southwestern city of diverse acculturation statuses. It aims at testing existing findings by conducting the research within the unique geographic and ethnic context of the Southwest region of the United States. This research examines how strength of ethnic identity plays a distinctive role in drug use behavior among the various ethnic groups represented in the sample: Mexican Americans, other Latinos, American Indians, African Americans, non-Hispanic Whites, and those of mixed ethnic backgrounds. Positive ethnic identity (i.e., strong ethnic affiliation, attachment, and pride) was associated with less substance use and stronger antidrug norms in the sample overall. Unexpectedly, the apparently protective effects of positive ethnic identity were generally stronger for non-Hispanic White respondents (a numerical minority group in this sample) than for members of ethnic minority groups. Implications for prevention programs tailored for Mexican/Mexican American students are discussed.

Predicting treatment noncompliance among criminal justice-mandated clients: a theoretical and empirical exploration

Compliance with therapeutic regimens constitutes an important but infrequently studied precursor of treatment engagement and is a necessary condition of successful treatment. This study builds on recent treatment process research and provides a theory-driven analysis of treatment compliance. Five hypotheses are formulated to predict treatment noncompliance among criminal justice-mandated clients. These hypotheses tap different determinants of treatment progress, including physical prime, supportive social network, conventional social involvement, treatment motivation, and risk-taking propensity. Data from 150 addicted felons participating in a diversion program are analyzed to test the hypotheses. Predictors related to these hypotheses correctly identify 58% of the fully compliant clients and 55-88% of the noncompliant clients. Most hypotheses are at least partially corroborated and a few strong correlates emerge across analyses. Clients in their physical prime, those with poorer social support, and those lacking internal desires for change were found especially likely to violate treatment program rules. Clinical implications are discussed.

Reaching adolescents who drink harmfully: Fitting intervention to developmental reality

Alcohol use usually starts in early adolescence. While the greater proportion of young people develop adaptive patterns of drinking, many drink at harmful levels and may be at risk for future alcohol-related problems. Findings from the empirical literature suggest that universal prevention programs may delay onset of drinking among low-risk baseline abstainers; however, there is little evidence supporting their utility for at-risk adolescents. Further research is needed on how risk and protective factors interact to determine substance use trajectory, and intervention outcomes that take substance use trajectories into account may capture change more effectively than the use of absolute measures of substance use. Indicated prevention programs may benefit from modulations that account for adolescent individuation and identity formation. It is argued that motivational interviewing within a harm reduction framework is well suited to adolescents.

Cumulative adversity and drug dependence in young adults: racial/ethnic contrasts

AIMS

To study cumulative exposure to stressors as a risk factor for drug dependence, and evaluate whether group differences in exposure contribute to differences in prevalence.

DESIGN

Cross-sectional community survey of life-time adverse experiences and substance and psychiatric disorders.

SETTING

Data collected between 1997 and 2000 in Miami-Dade County, USA.

PARTICIPANTS

A total of 1803 former Miami-Dade public school students, 93% between ages 19 and 21 years when interviewed. Males and females of Cuban origin, other Caribbean basin Hispanics, African-Americans and non-Hispanic whites are represented equally.

MEASUREMENTS

Drug dependence disorder assessed by DSM-IV criteria using the Composite International Diagnostic Interview, and a 41-item checklist of life-time exposure to major and potentially traumatic experiences. Both measures include age at time of first occurrence.

FINDINGS

Life-time rate of drug dependence disorder (total 14.3%) did not vary significantly (P > 0.05) by socio-economic group. Male rate (17.6%) was significantly greater than female rate (10.9%). The African-American rate (6.5%) was dramatically lower than non-Hispanic white (17.0%), Cuban (18.1%) and non-Cuban Hispanic (16.0%) rates despite their dramatically higher exposure to adversity. Twenty-eight of 33 individual adversities were associated with the subsequent onset of drug dependence (P < 0.05). Cumulative life-time exposure was greatest for males and for African-Americans, and was associated inversely with socio-economic level. Multivariate discrete-time event history analysis revealed significant independent effects of distal (>1 year earlier) and proximal (previous year) exposure to adverse events (P < 0.05), controlling for childhood conduct disorder, attention deficit hyperactive disorder and previous psychiatric disorder.

CONCLUSIONS

Life-time cumulative exposure to distant as well as more recent adversity predicts risk of subsequent drug dependence, although it does not explain ethnic group differences in risk.

Predictors of overall and on-the-job substance use among young workers

Predictors of overall and on-the-job substance (alcohol and marijuana) use were studied in a sample of young workers. The 18 predictors represent 6 general domains of risk factors: demographic, personality, substance use outcome expectancies, workplace substance availability, workplace social control, and work stressors. Data were obtained from a sample of 319 individuals ages 16 to 19. Hierarchical tobit regression analyses revealed that 5 of the 6 domains of risk factors were related to employee substance use. Similarities and differences were found in the predictors of overall and on-the-job substance use and in the predictors of alcohol and marijuana use.

Family stressors and adolescent cannabis use: a pathway to problem use

The extent to which the family environment is characterized by stress may have a substantial impact on life-course trajectories of young people. Illicit drug use is a fairly common part of these trajectories. This paper estimates the direct impact of family stressors on the progression to problem cannabis use, as well as their indirect effects via the youth's school experience among adolescents in Ontario. The results suggest that family stressors have direct and indirect effects increasing the probability of cannabis use outcomes. The implications of these more complex associations between factors believed to influence adolescent drug use trajectories are discussed.