Familial, interpersonal, and intrapersonal correlates of drug use: a longitudinal comparison of adolescents in treatment, drug-using adolescents not in treatment, and non-drug-using adolescents

Prospective Risk Factors and Treatment Outcomes among Adolescents in DATOS-A

The relationships between risk factors and outcomes in adolescents participating in the Drug Abuse Treatment Outcome Studies for Adolescents (DATOS-A) were examined. The study included 292 admissions to nine outpatient drug-free (ODF) and 418 admissions to eight residential (RES) programs. Assessments were administered at intake into treatment and 12 months following discharge. For ODF participants, (a) severity of drug use predicted less retention in treatment, and (b) family drug involvement predicted more alcohol use after treatment. For RES participants, (a) family drug involvement and criminal involvement predicted less treatment retention, and (b) conduct disorder predicted more marijuana use at follow-up. The findings underscore the need for intervention strategies that address the intrapsychic and interpersonal functioning of drug-abusing adolescents to improve their behavioral outcomes.

Parent substance use as a predictor of adolescent use: A six-year lagged analysis

The present study investigated the role of parental use of alcohol, cigarettes, and marijuana on lagged changes in the specific substance use of their adolescent offspring over a six-year period. The analyses also examined the relative influence of mothers and fathers and their interaction as moderated by marital status and age and gender of the adolescent. A generalized estimating equations approach, analogous to quasi-like-lihood, was employed to estimate regression coefficients via an iterative weighted least squares algorithm. Findings indicated that, when employed as time-varying covariates, parental substance use resulted in substance-specific effects on fluctuations in the adolescent's own use. Age, parent marital status, and each parent's marijuana use independently were jound to significantly affect adolescent marijuana use. In contrast, the complex relationship between parent and adolescent use of alcohol and cigarettes showed variation by substance, age, and gender of both parents and adolescents. Within a developmental context, the results suggest that parent use of substances must be considered risk factors with particular effects on their younger offspring. Thus, prevention efforts should be directed at middle childhood and include components aimed at parents as well as their children.

Genetic and environmental influences on the relationship between peer alcohol use and own alcohol use in adolescents

AIMS

Genetically influenced aspects of adolescent behaviour can play a role in alcohol use and peer affiliation. We explored the correlations between friends' alcohol use and adolescent own use with a genetically sensitive design.

DESIGN

Genetic and environmental factors were estimated on adolescent reports of their friends' alcohol use and their own use and problem use of alcohol. The correlations between the genetic and environmental factors that influence friends' alcohol use and adolescent own alcohol use and problem use were also estimated.

PARTICIPANTS

A total of 862 twin pairs aged 11-17 years sampled from the UK population-based Cardiff Study of All Wales and North-west of England Twins (CaStANET).

MEASUREMENTS

Data on adolescent own alcohol use and problem use and the alcohol use of their three best friends were obtained using self-report questionnaires.

FINDINGS

A significant genetic influence was found on adolescent friends' alcohol use (about 30%). Significant correlations of 0.60 and 0.70 were found between the genetic influences on friends' alcohol use and adolescents' own use and problem use of alcohol. Common environmental influences were almost completely correlated for friends' alcohol use and adolescents' own alcohol use and problem use (0.91 and 0.94).

CONCLUSIONS

There is considerable overlap in the common environmental and genetic factors that contribute to the relationship between adolescents' own alcohol use and that of their friends. These findings contribute to understanding of the mechanisms by which friends' alcohol use influences adolescent drinking behaviour.

Physical health outcomes of childhood exposure to intimate partner violence: a systematic review

BACKGROUND

Children exposed to intimate partner violence (IPV) are at increased risk for adverse mental and behavioral health sequelae, as has been documented by both systematic reviews and meta-analyses. Studies addressing the physical health impact of childhood IPV exposure, however, have not been summarized in a manner that might facilitate additional hypothesis-driven research and accelerate the development of targeted interventions.

METHODS

To identify a comprehensive set of articles examining the association between childhood IPV exposure and physical health, we searched online bibliographic databases including Medline, CINAHL, PsychInfo, and Sociological Abstracts using the keywords "domestic" or "intimate partner violence" and "infant," "child," or "pediatric." From >2000 articles retrieved in the initial search, we used online abstract and bibliographic information to identify 94 articles potentially meeting the inclusion criteria of studies that (1) examined a postnatal physical health outcome related to IPV exposure and (2) had a contemporaneous control group. Thorough review of these 94 published studies yielded 22 that met these inclusion criteria. The data then were abstracted independently by 2 of the authors, and differences were settled with the assistance of a third author.

RESULTS

Childhood exposure to IPV increases the likelihood of risk-taking behaviors during adolescence and adulthood and is likely associated with underimmunization. Minimal data and study limitations preclude establishing a clear connection between IPV exposure and general health and use of health services, breastfeeding, or weight gain.

CONCLUSIONS

The impact on physical health from exposure to IPV during childhood is still uncertain. Future studies should be grounded in a theoretical model that specifies how IPV exposure can affect child health, should adjust for confounders adequately, should include a community-based sample, and should be of larger scale.

Autonomy and Relatedness in Inner-City Families of Substance Abusing Adolescents

This study examined parent-adolescent autonomous-relatedness functioning in inner-city, ethnic minority families of adolescents exhibiting drug abuse and related problem behaviors. Seventy-four parent-adolescent dyads completed a structured interaction task prior to the start of treatment that was coded using an established autonomous-relatedness measure. Adolescent drug use, externalizing, and internalizing behaviors were assessed. Parents and adolescents completed assessment instruments measuring parenting style and family conflict. Confirmatory factor analysis found significant differences in the underlying dimensions of parent and adolescent autonomous-relatedness in this sample versus previous samples. It was also found that autonomous-relatedness was associated with worse adolescent symptomatology and family impairment. Results based on both self-report and observational measures contribute to the understanding of key family constructs in this population and provide insight for both researchers and the treatment community.

Family risk factors for cannabis use: a population-based survey of Australian secondary school students

The objective of this study was to investigate relationships between adolescent cannabis use and indices of parent - child attachment, family functioning and parent attitudes to drugs and delinquency. A total of 2848 year 9 and 2363 year 11 students participated in the Victorian Adolescent Health and Well-Being Survey (1999). The study was a school-based random sample of 535 metropolitan and rural, government and non-government secondary schools throughout Victoria, Australia. Cannabis use was defined as 'any' and 'weekly' use in the last 30 days. Multivariate logistic regression was used to identify independent associations between cannabis use and parent - child attachment, family functioning and parent attitudes to drugs and delinquency. Cannabis use in year 9 was associated with permissive parent attitudes to drugs and delinquency (any use: adjusted odds ratio (OR) = 8.1; weekly use: adjusted OR = 7.6), and was particularly sensitive to small changes in the quality of the parent - child relationship with risk increasing threefold for those describing their attachment as 'good' compared with 'very good' (any use: adjusted OR = 2.8, weekly use adjusted OR = 2.9). A similar, but more moderate pattern association was evident in year 11. After adjusting for other family and background factors, poor family functioning showed minimal association with level of cannabis use at both year levels. Results suggest that intervention efforts might sensibly target strengthening parent - children relationships and promoting less permissive parent attitudes to drug use.

Risking risk: the influence of types of capital and social networks on the injection practices of drug users

Although syringe exchange and other harm reduction interventions have generally been effective in reducing bloodborne pathogen incidence among injection drug users (IDUs), in some cases a minority of IDUs continues to engage in risky injection behavior. Building on emerging perspectives in social epidemiology and research on drug use in anthropology that point to the importance of examining fundamental social causes of risk behavior, or what puts individuals at risk for risk, this study used a multilevel perspective to explore whether forms of capital, social network characteristics, and other contextual factors influence continued risky injection behavior. Quantitative and qualitative data were collected on IDUs in the city of Marseilles, France, where sterile injection equipment has been legal and officially promoted since 1995. In multivariate analysis on data concerning active users, location in the densest part of a large, interconnected network of IDUs greatly increased the likelihood of risky injection practices, while there was a non-significant tendency for low Acquired Cultural and Economic Capital to predict this behavior. Among the strongest individual-level characteristics to predict this outcome were illicit use of prescribed medication, generally high dose buprenorphine, and unprotected sex. Parental abuse of psychoactive drugs during the subject's childhood, on the other hand, greatly decreased the chances of engaging in risky injection behavior. Additionally, qualitative data analysis suggests that risky injection may be linked to lack of resources to procure drugs, and not simply to inadequate sterile injection equipment. Further research, including ecological models, is needed to better understand how fundamental social conditions are related to "risk for risk". However, public health interventions can already address the need for community-level interventions, while rethinking the consequences of inaccessible drugs and unintended "leakage" from the introduction of buprenorphine and other medicalized treatments for opiate dependency.

What predicts incident use of cannabis and progression to abuse and dependence? A 4-year prospective examination of risk factors in a community sample of adolescents and young adults

OBJECTIVES

To determine risk factors of incident onset of use, abuse and dependence of cannabis in a community sample of adolescents and young adults.

METHODS

Risk factors were examined in a prospective longitudinal design across 4 years in a representative sample (N = 2,446) aged 14-24 at the outset of the study (EDSP). Patterns of DSM-IV defined cannabis use, abuse and dependence were assessed with the Composite International Diagnostic Interview (M-CIDI). Potential risk factors were assessed at baseline. Incident cannabis use, abuse and dependence at second follow-up (on average 42 months after baseline) were the main outcome measures in this study. Associations were analyzed with logistic and negative binomial regressions.

RESULTS

Using 11 of a total of 56 variables examined, the predictive value of the final multiple logistic regression for incident cannabis use was moderately good (area under the ROC curve = 0.78). Cannabis use frequency was predicted in the final model by 18 variables, cannabis abuse by two variables in the younger subsample and nine factors in the older group, and dependence by eight variables (dependence: ROC curve area = 0.97). Incident cannabis use was predicted mainly by availability of drugs, peers' drug use, a more 'positive' attitude towards future drug use, and regular previous use of licit drugs, while cannabis dependence was predicted primarily by parental death before age 15, deprived socio-economic status, and baseline use of other illicit drugs.

CONCLUSION

Different factors predict the onset or severity of cannabis use and the progression to abuse and dependence. In addition to well-documented risk factors such as peer group pressure, drug availability, and low self-esteem, findings suggest that family history (e.g. parental mental disorders, early parental death), and prior experiences with legal drugs play a significant role in the initiation of cannabis consumption and the transition to cannabis use disorders in adolescents and young adults. Findings suggest that early intervention and prevention might be improved by better targeted treatment.

Adolescent substance use and family-based risk and protective factors: a literature review

Adolescent substance use has become a serious concern nationwide. Although there are many ways of viewing adolescent substance use, family influence has been established as one of the strongest sources of risk and protection. A review of the literature indicated relevant theories for understanding adolescent substance use and specific family-based variables influencing adolescent substance use. In general, there seems to be a relationship between adolescent substance use and family-based risk and protective factors. Relevant theories identified in the literature review include family systems theory, social cognitive theory, social control theory, and strain theory. Specific family-based risk and protective factors include family relationships such as with siblings and parents and family characteristics such as ethnicity and religious backgrounds. Future implications for research and prevention/intervention in relation to family-based risk and protective factors are discussed.

Parental representations in drug-dependent patients and their parents

The Parental Bonding Instrument (PBI), a measure of perceived parental care and protection, was administered to drug-dependent patients and their parents with the aim to assess the reliability of the instrument in such samples and to compare the parental representations across generations. Ninety drug-dependent patients and 44 mothers and 35 fathers participated. Reliability indices were calculated, and parental representations of parents and their offspring were compared. Linear regression analyses were performed with the patient's PBI score as the dependent variable and the mother's and father's PBI scores as predictor variables. The reliability indices were highly satisfactory and varied between 0.61 and 0.91. The parental bonding of patients, fathers, and mothers was similar. All three groups reported high maternal and paternal control and low maternal care, a pattern characteristic of an "affectionless control" rearing style. Maternal care received by the fathers and paternal protection received by the mothers predicted the care and protection they themselves gave to their drug-dependent offspring.

Correlates of alcohol and drug use among low-income Hispanic immigrant childbearing women living in the USA

Alcohol and drug use is a widespread and serious problem with deleterious consequences for the health and well-being of childbearing-age women and their children. Little information exists regarding etiological factors for substance use among Hispanic childbearing-age women immigrating to the United States (USA). This research provides a correlational analysis of factors associated with alcohol and drug use. The Social Stress Model for Substance Use Prevention provided the conceptual framework for this cross-sectional, interview-administered survey of 60 low-income predominantly Mexican-American women. The outcome variable was alcohol and drug use (alcohol, cigarettes, marijuana, cocaine and opiates). Independent variables included the major constructs of the model: stress, social support, social influences, personal competencies and community resource utilization patterns. Findings suggested that the levels of drug use were lower among this study sample than in the general USA population regardless of pregnancy status. Bivariate correlations demonstrate that women with higher drug use indices had more lenient attitudes regarding drug use and were more likely to have family and friends that used alcohol and drugs. Although drug use was relatively low among this sample of women, both women who used alcohol themselves and women whose partners used alcohol and drugs reported significantly higher levels of stress, weaker social support and poorer levels of self esteem. Implications for practice and future research are suggested.

Early deviance and related risk factors in the children of narcotic addicts

This descriptive study examines the self-reported behaviors of 285 male and female adolescent children (ages 12-17) of narcotic addicts participating in methadone maintenance programs. These children responded to an extensive 2.5-hour interview questionnaire focusing on current and past activities, including criminal activities prior to age 12. The findings revealed that early deviance, assessed by self-report measures of both severity and variety, is related to current adolescent drug and alcohol use, association with deviant peers, a negative view of home atmosphere, and psychological symptomatology. These results are contrasted with the retrospective reports of adolescent behavior obtained from adult male narcotic addicts in a prior study of vulnerability to addiction. The comparability of study results is discussed in the context of developmental risk factors, prevention and treatment strategies, and other considerations specifically related to the development of children of narcotic addicts.

The role of intergenerational discrepancy of cultural orientation in drug use among Latina adolescents

The role of intergenerational discrepancy for cultural orientation was examined in the etiology of drug use among Latina adolescents and in the context of family support. Intergenerational discrepancy occurs when a family member of one generation differs from a family member of another generation in cultural identity factors; this is usually manifested in conflict between a first generation child and the immigrant generation parent. It was hypothesized that the Latina adolescents experiencing intergenerational discrepancy might use drugs more frequently than Latina adolescents who were not; and that family support would be an important moderator of the relationship. A sample of 295 ninth and tenth grade Latina students (approximately 80% Mexican-American) from four Los Angeles area schools were surveyed as part of a larger study. In this secondary analysis, a 2 (family support ) x 2 (discrepancy) ANOVA revealed that intergenerational discrepancy was associated with more drug use in certain cases, and that family support did not moderate this relationship. Results partially validate and extend a theoretical model presented by Szapocznik and Kurtines (1980), and indicate a need to focus on cultural variables when intervening in drug use/misuse among Latina adolescents.

The family experiences of narcotic addicts and their subsequent parenting practices

This survey study of male and female narcotic addicts participating in methadone maintenance programs examined self-reported retrospective data on parental behavior experienced by addicts during their adolescent years. These findings were contrasted with the addicts' self-report of their current parenting practices with their own adolescent children. Results showed addicts as perceiving their mothers as significantly more functional in their parenting practices than their fathers on indices of parental involvement, attachment, and responsibility. Significant parenting differences between addicts and their parents were reported for the three indices mentioned, as well as for parent discipline and punitive actions, with the addicts rating their current parenting practices as more effective than those of their parents. Reported parenting practices were further analyzed in the context of how the ratings of parental functioning were related to problems of drug and alcohol abuse exhibited in the home. Findings are discussed in terms of the implications for prevention and treatment approaches for addicts and their children.

Competence and drug use: theoretical frameworks, empirical evidence and measurement

Statistics show that use of harmful substances (alcohol, cigarettes, marijuana, cocaine) among women of childbearing age is widespread and serious. Numerous theoretical models and empirical studies have attempted to explain the complex factors that lead individuals to use drugs. The Social Stress Model of Substance Abuse [1] is one model developed to explain parameters that influence drug use. According to the model, the likelihood of an individual engaging in drug use is seen as a function of the stress level and the extent to which it is offset by stress modifiers such as social networks, social competencies, and resources. The variables of the denominator are viewed as interacting with each other to buffer the impact of stress [1]. This article focuses on one of the constructs in this model: that of competence. It presents a summary of theoretical and conceptual formulations for the construct of competence, a review of empirical evidence for the association of competence with drug use, and describes the preliminary development of a multi-scale instrument designed to assess drug protective competence among low-income Hispanic childbearing women. Based upon theoretical and empirical studies, eight domains of drug protective competence were identified and conceptually defined. Using subscales from existing instruments with psychometric evidence for their validity and reliability, a multi-scale instrument was developed to assess drug protective competence. Hypothesis testing was used to assess construct validity. Four drug protective competence domains (social influence, sociability, self-worth, and control/responsibility) were found to be statistically associated with drug use behaviors. Although not statistically significant, expected trends were observed between drug use and the other four domains of drug protective competence (intimacy, nurturance, goal directedness, and spiritual directedness). Study limitations and suggestions for further psychometric testing of the instrument are described.

Integration of generalized vulnerability to drug and alcohol addiction

The vulnerability to develop addiction to alcohol has been well established in familial and genetic studies. Similar familial and genetic studies have supported a vulnerability to drug addiction. The co-occurrence of alcohol and drug addiction in the same individuals is highly prevalent in clinical populations. Common putative neurochemical mechanisms underlie addiction to both alcohol and drugs, namely, in the mesolimbic pathway and the locus ceruleus in the brain. Treatment strategies are directed at both alcohol and multiple drug addictions in patient populations. The formulation of a generalized vulnerability that extends to both alcohol and drug addiction is not only possible but necessary to explain the substantial numbers of individuals who develop both alcohol and drug addictions. Future research that is pertinent and relevant may depend on the understanding of a generalized vulnerability to develop alcohol and drug addiction and its application in diagnostic strategies and treatment models.

Young adults' drug use: a 17-year longitudinal inquiry of antecedents

This longitudinal study examined the interrelation of personality and peer factors on young adults' drug use and also the influence of the interaction of personality and peer factors on drug use. The sample of 756 males and females were interviewed four times between the M ages of 6 and 22. Personality attributes in childhood were related to peer factors in early adolescence which, in turn, were related to personality traits in later adolescence. These traits were linked with selection of peers and, ultimately, drug use in young adulthood. Additionally, the adolescent and young adult domains had direct effects on young adults' drug use. Significant interactions indicated that a few protective childhood personality traits buffer the risk of deviant peers in adolescence on young adults' drug use. More earlier protective characteristics from one domain enhanced the effect of later protective traits from the other domain.

Direct and indirect effects of selected risk factors in producing adverse consequences of drug use

A path analysis was performed to examine the usefulness of multiple pathway risk factors in explaining and predicting youthful alcohol, tobacco, and other drug (ATOD) misuse and its adverse consequences. The risk factors alienation, trait anger, interaction anxiety, and cognitive motivation for drinking were used as exogenous variables with earliness of onset, ATOD use, and adverse consequences of ATOD use serving as endogenous variables. Firm support emerged for both direct and indirect effects of the risk factors on both use and adverse consequences of use.

Three-year results of prevention programs on marijuana use: the New Hampshire study

The effects on marijuana use of 1) a drug prevention curriculum, or 2) this curriculum with added parent and other adult community activities in comparison with 3) a control community were investigated. Baseline information on drug-related behaviors from a sample of fourth, fifth, and sixth graders aged nine to fourteen years in rural New Hampshire (N = 1200) were obtained. The children completed these initial questionnaires in classrooms in 1987. In the comprehensive community intervention regular marijuana use was reduced by over 50 percent. No program had a significant effect on the initiation of marijuana use. The predictors of initiation were being in a higher grade, low school satisfaction, poor academic achievement, feeling unloved by one's family, feeling unpopular, and being part of a drug-using peer group. The baseline predictors of subsequent regular marijuana use were poor academic achievement, feeling unpopular, and being part of a drug-using peer group. In interviews the cultural and social contexts of marijuana use were explored. Strategies to prevent marijuana use need to take into account the profile of the marijuana-using child, the adult community's attitudes and beliefs about drugs, and the access of drug sellers and users to children.

Drug use, binge drinking and attempted suicide among homeless and potentially homeless youth

In order to assess the need for drug-related services for at-risk youth, a survey was conducted among young people aged 12-17 years who, owing to severe family discord, were currently living away from home (homeless) or had experienced periods away from home in the past 12 months (potentially homeless). Prevalence of use and of potentially harmful levels of use of alcohol and other licit and illicit drugs were higher than in a comparative population. Of the 155 people interviewed, 54% reported past physical abuse, 28% reported past sexual abuse, and 73% had a family alcohol or other drug history. Of the total, 62% had been in a youth refuge at some time in the past 12 months. Twenty four per cent had been to hospital as a result of alcohol or other drug use and 45% had attempted suicide. Female sex and an interaction between sexual abuse and binge drinking predicted suicide attempts. This study points to the need for a comprehensive approach to interventions for troubled youth which gives greater recognition to mental health issues related to family circumstances, including abuse.

Factors affecting illicit and licit drug use among adolescents and young adults in Greece

A cross-sectional survey on psychosocial issues, drug use, alcohol and health was carried out in Greece, with a nationwide probability sample of 2448 respondents aged 12-17 and 18-24. Factors potentially associated with illicit and unprescribed licit drug use were tested by logistic regression analysis. Several predictors were revealed. Sex and age were related to a higher lifetime use of illicit drugs, the male young adults reported a higher lifetime use of illicit drugs than the females. Positive attitudes toward hashish use, systematic smoking and use of drugs by close friends were more closely related to illicit than to unprescribed licit drug use. In addition "low self-esteem, family members using tobacco and alcohol" and "problematic drinking" were found only to predict illicit drug use. Other variables, "family members using drugs with or without a doctor's prescription", "being dissatisfied with social life" and "suffering from anxiety, depression and depersonalization symptoms" were found to be significantly associated with licit but unprescribed drug use.

Impact of contextual variables on adolescent situational expectation of substance use

The relationship between contextual variables and situational expectation of drug and alcohol use at the school level suggested by Interactive theory was investigated [1, 2]. A canonical correlation analysis supported a significant relationship between situational expectation of drug and alcohol use and several contextual variables including Students' Perceptions of What Teachers Expect of Them Academically, Percentage of White Students, and the Prosperity of the School. The results indicated that the more prosperous the school and the greater the students' perceptions of what teachers expect of them academically, the lower the situational expectation of smoking cigarettes or taking depressants and the higher the percentage of white students the higher the situational expectation of drinking beer and liquor. Implications for prevention programs and school environment are discussed.

Socio-demographic profile of substance users seeking treatment

This study was conducted to obtain a personality profile and a descriptive analysis of a typical substance user who is presently enrolled in a treatment center and is receiving professional help for his or her substance use at one of four participating treatment centers in a southwestern city in the United States. According to the findings, a typical substance abuser is a thirty-one year old male who is third born and has parents who are more frequently non-professional. Most respondents became involved with substance use because of peer influence and reported feeling bored/unhappy. First substance use experiences were more frequently with marijuana, although at the time of enrollment at the treatment center, alcohol, cocaine/crack, heroine, marijuana, and a combination of substances were typically used. When ranking the major problems they perceive having in their lives, respondents reported most frequently, substance use and being bored/unhappy in life. When assessing respondent's family type, a difference was found between the balanced and midrange families when considering their plans on having children. Of the substance using respondents, most were planning children in their lives and of this group, many were from extreme (low functioning) families.

Empirical evidence for the Social Stress Model of Substance Abuse

The Social Stress Model of Substance Abuse builds upon and integrates knowledge from numerous psychosocial theories and models. According to this model, the likelihood of an individual engaging in drug abuse is a function of the stress level and the extent to which it is offset by stress modifiers such as social networks, social competence, and resources. This article synthesizes current empirical evidence for this model. Thirty-five primary research studies are described, with special attention to the four psychosocial constructs inherent in the model: stress, social networks, social competence, and resources. Consistencies and inconsistencies in the findings, a critique of key methodological issues, and suggestions for future research are provided.

The influence of parent, sibling, and peer modeling and attitudes on adolescent use of alcohol

This 1-year prospective study of 173 families with two or more children examines the influence of parent, sibling, and peer modeling (i.e., use) and attitudes on adolescent use of alcohol. Independent questionnaire data were obtained from the adolescent, father, mother, and sibling(s). Structural equation modeling methods were employed to examine these relationships. Parent attitude toward youth alcohol use and parent modeling of alcohol use were strongly related to change in adolescent alcohol use, suggesting that parents can influence the future use of alcohol by their children. Peer and sibling modeling and peer attitudes also influenced adolescent alcohol use.

Sociodemographic and attitudinal correlates of alcohol and other drug use among children and adolescents: analysis of a large-scale attitude tracking study

Data from the Partnership Attitude Tracking Study are analyzed to provide a greater understanding of the contributing factors to alcohol and other drug use among children and adolescents. The data were collected from children (ages 9 to 12) and teenagers (ages 13 to 17) in central locations (usually shopping malls) located in 100 primary sampling units across the United States. The analysis, which primarily employed stepwise multiple regression for model estimation, reinforced the importance of friends use, perceived risk, and tobacco and alcohol use in predicting marijuana use. An exposure model, which included antidrug advertisements, was a particularly powerful model. Implications of the findings are discussed.

Treatment paternalism in chemical dependency counselors

This study investigated the degree of paternalism in the treatment philosophies of chemical dependency counselors in three categories of treatment center: adolescent-only, adult, and religious/minority. Counselors were shown picture arrays of either adolescent patients or adult patients and asked to choose a preferred treatment policy, either paternalistic or compensatory in nature. Results showed religious/minority counselors preferred a significantly greater paternalistic approach to all patients than did the adolescent-only and adult center counselors. The adolescent-only counselors responded more paternalistically to the adolescent patients than the adult patients, while the adult and religious/minority counselors did not respond significantly different to either group.

Individual and family characteristics of middle class adolescents hospitalized for alcohol and other drug abuse

The frequency of alcohol and drug use, abuse and severity of dependence, and personality and family characteristics in 280 female and male hospitalized adolescents in treatment for chemical dependence and 120 middle class adolescents were examined. A MANOVA showed that parents' drug and alcohol use was a main effect, increasing frequency of use and severity of dependence upon alcohol and drugs in both groups of adolescents. Sexual and physical abuse studied in the patient group also functioned as a main effect. Patients reported significantly less family interests, and participation in intellectual, cultural and social activities, but more control than the comparison group. It was concluded that adolescent alcohol and other drug abuse is part of a biopsychosocial syndrome of problem behavior, which includes the problem behavior of parents and the interacting family unit.

Family dysfunction and alcohol and drug use in adolescent psychiatric inpatients

This report examines the relationship between family functioning and substance abuse in adolescent psychiatric inpatients. The adolescents, who had been hospitalized after acute psychiatric crises, provided reports of drug and alcohol use, intoxication-related problems, and family functioning during the 4 months preceding hospitalization. Greater degrees of family dysfunction in the areas of affective responsiveness and role functioning were associated with higher levels of substance abuse. When age, sex, and diagnosis were controlled for, family dysfunction in these areas was still significantly associated with alcohol consumption but not with drug use or intoxication-related problems. Implications for treatment are discussed.

Unmet service needs in methadone maintenance

Most drug abuse treatment agencies maintain a wide array of ancillary services, either on-site or through off-site referral resources, for helping meet the diverse social, medical, and psychological needs of clients. The extent to which these needs are met may be an important factor in client retention and outcomes. Perceived unmet service needs and their relationship to client outcomes were therefore studied in relationship to a framework for studying drug abuse treatment process factors. The outcomes in the present study were time in treatment and relapse to opioid use during treatment, and these were examined in relation to perceived need for services and their delivery (whether or not these services were received). The sample consisted of 590 methadone maintenance clients in 21 clinics in the RTI/TOPS data system. The results showed that the measure of unmet needs for services was not significantly related to time to relapse or to time in treatment. However, there appeared to be an indirect effect. There were differences for clinic type and a few significant interactions with other predictor variables used to study treatment process.

Environments and addiction: a proposed taxonomy

When reviewing the broad area that relates environments to addiction one is faced with an enormous volume of research with differing environmental and psychosocial factors, contrasting populations, a variety of addictive substances, and a range of addiction processes. For all these factors, there are important outcome variables. To survey this disparate literature, it is helpful to use a multiaxial model as a framework or taxonomy. In this way it is possible to see the effects that environments, broadly conceived, exert on addictive behaviors. A variety of environments is considered: interpersonal, organizational, cultural and physical, as one axis or dimension. The influence of this dimension on a second dimension relating to type of addiction is also examined. Finally, a dimension pertaining to the "life history" of addictions, from acquisition through maintenance, cessation, and relapse is considered in relation to the first two dimensions. While a variety of environmental factors affect addictive behaviors, current research indicates the need to take individual differences, cognitive mediation, and the interaction of the person with the environment into account. Significant areas that need further exploration are the failure of addictions to occur in some environments, and the development of secondary prevention approaches. Implications for intervention and directions for future research are suggested.

A comparison of the empirical utility of three composite measures of adolescent overall drug involvement

Researchers have relied on a number of measurement techniques to construct a summated index of drug involvement to reflect both the qualitative and quantitative dimensions of adolescent drug-using behavior. The purpose of this study was to examine the adequacy of three strategies for constructing a composite measure--stage-of-drug-use, unweighted sum of frequencies of use of different substances, and a weighted composite index of substance use. Data for this study were derived from two independent samples of adolescents. The three drug-use measures were assessed both as predictors of consequences of drug use and as outcome measures explained by familial, intrapersonal and interpersonal factors. The weighted composite index of substance use, though conceptually and methodologically superior to the simple (unweighted) sum of frequency, did not perform any better as a predictor or as an outcome variable than the unweighted measure. The weighted composite index of drug involvement is somewhat complicated to calculate and requires substantial resources. The decision whether to use a weighted composite index or a simple sum of frequencies measure of overall drug involvement should be based on both scientific and practical considerations.