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Director's Report to the National Advisory Council on Drug Abuse
February, 2001


Research Findings

Epidemiology, Etiology and Prevention Research

Monitoring the Future (MTF) Study

Results from the MTF study were released on December 14, 2000. The major findings are summarized below. For more information, go to http://www.nida.nih.gov and to http://monitoringthefuture.org, the MTF website at the University of Michigan.

Results from the 2000 Monitoring the Future (MTF) study indicate that use of marijuana and most other illicit drugs by 8th, 10th, and 12th grade students remained stable from 1999 to 2000, continuing their recent moderating trend. However, MDMA (ecstasy) use increased among students in each grade, and steroid use increased among 10th graders; this is the second year of increases for these drugs. Past year heroin use by seniors increased to its highest level since the survey began, based largely on an increase in noninjection use of the drug. On the positive side, hallucinogen use decreased among 10th and 12th graders, and cocaine use declined among 12th graders. Notably, use of cigarettes decreased in each grade. Alcohol use remained mostly unchanged. Attitudes toward substance use, which are often seen as harbingers of changes in use, showed little systematic change from 1999 to 2000. Exceptions to that included increases in disapproval of trying marijuana among 8th and 12th graders, declines in perceived risk of cocaine use among 10th graders, increases in perceived risk of cigarette use among 8th and 10th graders, and a decrease in perceived risk of steroid use among 12th graders. Unless otherwise noted, the changes discussed are statistically significant.

Illicit Drug Use

  • For the second year in a row, lifetime, past year, past month, and daily use of marijuana/hashish remained unchanged from 1999 to 2000. The same held true for the any illicit drug use measure. Seniors' rate of lifetime marijuana use is at the lowest point since 1997.

  • Use of MDMA (ecstasy) in the lifetime and past year increased among 8th and 12th graders, and current use of the drug increased among 8th and 10th graders. This continues a trend seen last year for the older students and extends it to the younger students in the study.

  • Lifetime and past year steroid use by 10th graders increased, continuing an increase begun last year; steroid use among 8th and 12th graders remained stable.

  • Among seniors, past year use of cocaine in any form decreased from 1999 to 2000. Lifetime use of crack and current use of other cocaine also declined for seniors.

  • Hallucinogen use in general and use of LSD in particular declined among 10th and 12th graders, with current use down for both grades and past year use down among 12th graders.

  • Heroin use showed mixed trends, with an increase in past year overall heroin use and use without a needle among 12th graders and a decline in past year use overall use and use with a needle in the lifetime and past year among 8th graders.

  • Ever use of inhalants by 8th graders decreased in 1999 to its lowest level since 1993.

  • Use of marijuana, PCP, narcotics other than heroin, methamphetamine, crystal methamphetamine ("ice"), barbiturates, tranquilizers, and Rohypnol remained stable for all three grades and for lifetime, past year, past month, and daily (where applicable) use.

Perceived Harmfulness, Disapproval, and Perceived Availability of Illicit Drugs

  • Disapproval of trying marijuana once or twice increased among 8th and 12th graders.

  • Perceived harmfulness of taking crack occasionally or taking cocaine powder once or twice or occasionally decreased among 10th graders.

  • Perceived harm from steroid use decreased among seniors, the only class for whom measured.

  • Disapproval of regular LSD use decreased among 8th graders.

  • Perceived availability of MDMA and of hallucinogens other than LSD increased among seniors.

  • Perceived availability of crack and cocaine powder decreased among 10th graders.

Alcohol Use

  • Most measures of alcohol use remained unchanged from 1999 to 2000. The sole exception was a decrease in daily alcohol use among 8th graders.

  • Perceived harm from trying one or two drinks of an alcoholic beverage decreased among 12th graders, and perceived availability of alcohol declined among 8th graders.

Use of Cigarettes and Smokeless Tobacco

  • Use of cigarettes decreased notably in several categories from 1999 to 2000. Lifetime cigarette use declined among 8th and 10th graders; past month use decreased for 8th and 12th graders; and daily use in the past month and use of _ pack or more per day decreased among 10th and 12th graders.

  • Perceived harm from cigarette use increased among 8th and 10th graders, and perceived availability of cigarettes declined among 8th and 10th graders (availability is not measured for seniors). Perceived harm from regular use of smokeless tobacco increased among 10th graders.

Community Epidemiology Work Group The 49th biannual meeting of the Community Epidemiology Work Group (CEWG) chaired by Mr. Nicholas J. Kozel, DESPR, was held in San Francisco, California, on December 12-15, 2000. The CEWG is composed of researchers from 21 metropolitan areas of the United States who meet semiannually to report on patterns and trends of drug abuse in their respective areas, emerging drugs of abuse, vulnerable populations and factors that may place people at risk of drug abuse, and negative health and social consequences. Reports are based on a variety of drug abuse indicator data, such as morbidity and mortality information, treatment data and local and State law enforcement data. Additional sources of information include criminal justice, correctional, medical and community health data, local and State survey information and findings from focus groups and qualitative research studies.

The following are highlights from the meetings:

Cocaine/Crack - Indicators continue to decline, a trend reported in 18 of the 21 CEWG areas. The downward trend is especially striking in areas where abuse of these drugs has been highly concentrated in the past, such as the Northeast, mid-Atlantic, and northern Midwest region of the Nation. There appears to be an aging factor among crack abusers. Nevertheless, cocaine/crack indicators remain elevated in most CEWG areas, and cocaine ranked first in DAWN ME drug-related deaths in nine CEWG sites. Indicator data show that cocaine is frequently used concurrently or sequentially with other substances.

Heroin - Indicators are trending upward in 15 CEWG sites located across the Nation. Heroin/morphine ranked first in DAWN ME drug-related mentions in eight CEWG areas. As in the past, CEWG members continued to report increases in heroin indicators among young populations. Data also show that heroin is often used in combination with cocaine (either concurrently or sequentially).

Marijuana - Indicators were mixed across CEWG areas, but there were signs that abuse of the drug is stabilizing in some areas after the dramatic upsurge from 1990-1998. While decreases or stabilization were characteristic of such indicators as ED mentions, almost all CEWG members reported increases in primary marijuana treatment admissions. Recent indicator data also show that marijuana is more likely than other illicit drugs to be used in combination with different substances, including hydrocodone and MDMA (methylenedioxymethamphetamine or ecstasy).

Methamphetamine - Indicators, which appeared to be trending downward from 1997 through the first half of 1999, showed signs of increasing again during the last half of 1999. Reports from 11 CEWG areas indicate that methamphetamine is being used along with other drugs at dance venues such as raves. There are signs also that methamphetamine is increasing in areas where it has not been a major problem in the past. A serious and sometimes fatal practice of using Viagra in combination with methamphetamine and other drugs is being reported by ethnographers.

MDMA (ecstasy) - is being closely monitored in CEWG areas. CEWG members from 17 areas report that ecstasy abuse has become more widespread recently. Members also report that ecstasy is now being used in a variety of settings, including raves, house parties and singles bars and age groups appear to be getting younger. DAWN ED mentions show that MDMA use in combination with marijuana/hashish increased from 8 in 1990 to 796 in 1999.

Emerging Drugs - Among emerging drugs of abuse are several licit substances: clonazepam (a benzodiazepine) and hydrocodone, hydromorphone, and oxycodone (controlled substances). Hydrocodone, e.g., Lorect, Lortab, appears to be the most widely abused. From 1993 to 1999, DAWN ED hydrocodone mentions increased 139 percent (from 6,115 to 14,639).

Links Between School Misbehavior, Academic Achievement, and Cigarette Use

The directionality of the association between substance abuse behaviors and negative school behaviors is unclear. In a study using the Monitoring the Future follow-up panel data, investigators at the University of Michigan examined relations among academic achievement, school bonding, school misbehavior, and cigarette use from 8th to 12th grade in two national panel samples of youth (n=3056). A series of competing conceptual models developed a priori was tested using structural equation modeling (SEM). The findings suggest that during middle adolescence the predominant direction of influence is from school experiences to cigarette use. School misbehavior and low academic achievement contribute to increased cigarette use over time both directly and indirectly. Two-group SEM analyses involving two cohorts -- gender and ethnicity -- showed robust findings. In addition, comparisons between high school dropouts and non-dropouts and between 8th grade cigarette use initiators and nonusers revealed few differences in direction or magnitude of effects. Results suggest that prevention programs that attempt to reduce school misbehavior and academic failure, as well as to help students who misbehave and have difficulty in school constructively avoid negative school- and health-related outcomes, are likely to be effective in reducing adolescent cigarette use. Bryant, A.L., Schulenberg, J., Bachman, J.G., O'Malley, P.M., and Johnston, L.D. Understanding the Links Among School Misbehavior, Academic Achievement, and Cigarette Use: A National Panel Study of Adolescents. Prevention Science, 1(2), pp 71-87, 2000.

Executive Cognitive Functioning Mediates the Relation Between Language Competence and Antisocial Behavior in Conduct-Disordered Adolescent Females

Researchers affiliated with the Center for Education and Drug Abuse Research (CEDAR) at the University of Pittsburgh conducted a study to determine (1) whether adolescent females with a conduct disorder (CD) demonstrate inferior language skills and lower executive cognitive functioning (ECF) compared with controls and (2) whether the relations between language abilities and different forms of antisocial behavior (ASB) are mediated by ECF. Language skills were measured using the Test of Language Competence-Expanded, ECF was measured using multiple neuropsychological tests, and ASB was assessed using various self-report and psychiatric interview indices reflecting mild delinquency to severe violence. Subjects were 223 adolescent females with a CD and 97 normal controls ranging between 14 and 18 years of age (N = 320). The CD group demonstrated significantly poorer language skills and lower ECF compared with the controls. Moreover, even when controlling for chronological age and socioeconomic status, ECF still fully mediated the relations between language competence and each measure of ASB. The results are discussed in relation to a neurobehavioral model of ASB. Giancola, P.R. and Mezzich, A.C. Executive Cognitive Functioning Mediates The Relation Between Language Competence and Antisocial Behavior in Conduct- Disordered Adolescent Females. Aggressive Behavior, 26(5), pp. 359-375, 2000.

Learning Disorders in Boys with Parental History of Substance Use Disorders

In an analysis based on the CEDAR sample, investigators examined whether learning disorders (LDs) among 10- to 12-year-old boys are related to a parental history of alcohol and other substance use disorders (SUDs). Subjects were boys with (SA+; n = 179) and without (SA-; n = 203) a parental history of SUDs. LD diagnoses were made according to DSM-IV criteria using several standardized intelligence tests, and mother and teacher reports of academic and cognitive difficulties. The results indicated a higher rate of DSM-IV LDs in SA+ compared to SA- boys. This association remained significant after accounting for the effects of socioeconomic status and ethnicity. SA+ boys with a lower socioeconomic status had particularly high rates of LDs (15.3%). The results suggest that LDs are associated with a parental history of SUDs. SA+ children with lower SES may be at particularly high risk for cognitive and academic difficulties. Martin, C.S., Romig, C.J., and Kirisci, L. DSM-IV Learning Disorders in 10- to 12-Year-Old Boys With and Without a Parental History of Substance Use Disorders. Prevention Science, 1(2), pp. 107-113, 2000.

Correlates of Mental Health Service Utilization and Unmet Need Among a Sample of Male Adolescents

Researchers at CEDAR sought to identify the correlates of mental health services utilization and unmet need for these services among a sample of adolescent males. They hypothesized that their findings would replicate and extend those of the recent Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) study, which found that parental factors play a major role in their children's unmet mental health care needs. The CEDAR study involved an evaluation of mental health service utilization and unmet need during the prior 2 years, as reported by the subjects at a follow-up assessment at age 16. Four factors were found to predict increased mental health services utilization, including attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) among the adolescent males, the father's alcohol use disorder, and the mother's amphetamine use disorder. One factor was found to predict decreased utilization, the father's cannabis use disorder. Four factors significantly predicted unmet treatment need, including conduct disorder, the mother's amphetamine use disorder, a higher number of siblings, and a parental history of having had a childhood anxiety disorder. The results of this study suggest that parental psychopathology, parental substance abuse, the presence of conduct disorder, and an increased number of siblings act as barriers to adequate mental health treatment among adolescents. These findings confirm the crucial role that parental factors play in the treatment utilization and the unmet treatment need of their children, and also suggest that an increased number of siblings can also be associated with unmet treatment need. Cornelius, J.R., Pringle, J., Jernigan, J., Kirisci, L. and Clark, D.B. Correlates of Mental Health Service Utilization and Unmet Need Among a Sample of Male Adolescents. Addictive Behaviors, 26(1), pp. 11-19, 2001.

Inhalant Use Among High School Students in Illinois

Researchers at the University of Illinois at Chicago analyzed data from two years (1993 and 1995) of a statewide survey of high school students on drug use. Changes in the rates of inhalant use, and associations between inhalant use and sociodemographic variables, were examined across the two survey years. Measures of inhalant use included lifetime use, past year use, and past month use. Analyses showed no significant difference in the rates of inhalant use across years. Associations with sex, ethnicity, and age were partly consistent with previous research findings. Both lifetime and recent inhalant use were more prevalent among males than females. Blacks were less likely to use inhalants (lifetime and recent) than other racial/ethnic groups in both survey years. Native Americans showed elevated rates of recent inhalant use in 1993 but not in 1995. While patterns in age-specific rates in the 1993 survey were consistent with expectations, those in the 1995 survey were not: recent inhalant use was constant across age groups in the 1995 sample. Also contrary to expectations, inhalant use was not more prevalent in low-income or high- poverty areas. The associations of inhalant use with family intactness and academic performance varied by race/ethnicity. Family intactness was a significant protective factor only for whites and Hispanics. Poor grades were not a significant predictor of lifetime inhalant use for blacks, and the protective effect of high grades was found only for whites. Poor grades were highly predictive of lifetime inhalant use for Asians. Mackesy-Amiti, M.E. and Fendrich, M. Trends in Inhalant Use Among High School Students in Illinois: 1993-1995. American Journal of Drug and Alcohol Abuse, 26(4), pp. 569-590, 2000.

Gender Differences in Validity of Drug Use Reporting by Juvenile Arrestees

In an exploratory study, investigators at the University of Illinois at Chicago looked at the validity of drug use reporting among arrestees. Past studies on this topic have not included enough females to study gender differences. This study examined gender differences in the validity of drug use reporting among juvenile arrestees, using a gender-matched sample (n = 6,377) drawn from the Drug Use Forecasting Program for 1992-1996. Self-reported marijuana and crack and/or cocaine use was compared to urinalysis results to test gender differences in the accuracy of disclosure. Among urine positives, girls were more willing than boys to disclose past month and lifetime marijuana use. Gender was not a significant main effect for cocaine use reporting but interacted with race/ethnicity and family structure in predicting valid disclosure. Hispanic girls were significantly more likely than Hispanic boys to under report recent cocaine use. Among arrestees from homes with one or no parents, girls were significantly more likely than boys to disclose recent cocaine use. Kim, J.Y., Fendrich, M., and Wislar, J.S. The Validity of Juvenile Arrestees' Drug Use Reporting: A Gender Comparison. Journal of Research in Crime and Delinquency, 37(4), pp. 419-432, 2000.

Decreased Drug Reporting in a Cross-Sectional Student Drug Use Survey

Longitudinal cohort studies have suggested that reinterviews about drug use often lead to decreased reports of lifetime substance use (recanting). Respondents may edit their answers on reinterview because of perceptions regarding question threat. Since reinterviews usually occur after long periods of time, the influence of inadequate recall (memory), cannot be ruled out. In order to evaluate the relative importance of editing and memory on recanting, researchers examined a cross-sectional survey administered in 1993 to a probability sample of Illinois students who were in the 7th through 12th grade. Two sets of self-administered survey questions assessed drug use in this survey: the I-SAY drug-use questionnaire, and a supplemental questionnaire asked at the end of the survey. Rates of "new use " (i.e., cases where use of a drug was not reported in the I-SAY questionnaire but was reported on the supplement) with rates of recanting (use for a drug reported on the I-SAY but no use for the drug reported on the supplement). Findings indicate that recanting was generally more pronounced than was new use, especially for cocaine, heroin, marijuana, and inhalants. Those classified as light or inconsistent users on the I-SAY were significantly more likely to recant their drug use reports. Fendrich, M. and Mackesy-Amiti, M.E. Decreased Drug Reporting in a Cross-sectional Student Drug Use Survey. Journal of Substance Abuse, 11(2), pp. 161-172, 2000.

Adolescents' Reactions to Rock Stars in Anti-Drug-Abuse Commercials

Two studies by Michael Newcomb and his affiliates examined adolescents' perceptions and effectiveness of rock stars in antidrug-abuse public-service announcements (PSAs). In the pilot study (N = 24 teenagers), adolescents expected rock musicians, and in particular heavy metal musicians, to be drug users. In this experimental study (N = 78 high school students aged I5 to 16 years), one group was shown 4 PSAs produced by Rock Against Drugs®, using rock stars Jon Don Jovi, Aimee Mann, Gene Simmons, and Belinda Carlysle as spokespersons. The comparison group was shown 4 equivalent PSAs that were created using unknown actors selected for their similarity to the rock stars in terms of age, ethnicity, and gender, but without any reference to rock music. PSA ratings were taken on 4 scales: attractiveness, expertness, trustworthiness, and overall PSA rating. Pretest and posttest measures of drug attitudes supported the hypotheses that countermessages from rock stars denormalize the connection between rock music and drugs, and that adolescents respond more positively to PSAs with rock stars than to PSAs without rock stars. Newcomb, M.D., Mercurio, C.S., and Wollard, C.A. Rock Stars in Anti-drug-abuse Commercials: An Experimental Study of Adolescents' Reactions. Journal of Applied Social Psychology, 30(6), pp. 1160-1185, 2000.

Implicit Cognition, Polydrug Use, and HIV Risk Behavior

Implicit cognition theory differs from most other approaches to health behavior in that it emphasizes neurobiologically plausible and experimentally documented memory association processes rather than rational decisions, considerations of pros and cons, or beliefs. In a study of adults from a community population, investigators examined the predictive effects of implicit cognition, as well as behavioral and personality variables (sensation seeking, hostility, conscientiousness, and polydrug use), on risky sexual behaviors (lack of condom use, sex after drug use, and multiple sexual partners). In addition, the study investigated the predictors in both a high-risk and a low-risk sample. Results showed that polydrug use was the strongest and most consistent predictor of the sexual behaviors. The implicit cognition indicator was a significant, independent predictor of lack of condom use in the high-risk sample. Sensation seeking also had an important predictive effect. The results encourage more research on implicit cognition in health behavior and further document links among drug use, personality, and HIV risk behavior. Stacy, A.W., Newcomb, M.D., and Ames, S.L. Implicit Cognition and HIV Risk Behavior. Journal of Behavioral Medicine, 23(5), pp. 475-499, 2000.

Predictors of Early High School Dropout

This study compared the adequacy of 5 theories to predict dropping out of high school before the 10th grade. These theories include full mediation by academic achievement and direct effects related to general deviance, deviant affiliation, family socialization, and structural strains. High drug use was one of the components of general deviance. Nested latent variable models were used to test these theories on prospective data from an ethnically diverse urban sample. Poor academic achievement mediated the effect of all independent factors on school dropout, although general deviance, bonding to antisocial peers, and socioeconomic status also retained direct effects on dropping out. Therefore, none of the theories tested was fully adequate to explain the data, although partial support was obtained for each theory. Implications for prevention of early high school dropout are discussed. Battin-Pearson, S., Newcomb, M.D., Abbott, R.D., Hill, K.G., Catalano, R.F., and Hawkins, J.D. Predictors of Early High School Dropout: A Test of Five Theories. Journal of Educational Psychology, 92(3), pp. 568-582, 2000.

The Role of Problem Severity, Psychosocial, and Treatment Factors in Adolescent Substance Abuse Treatment Outcome

Dr. Michael Newcomb collaborated with investigators from the University of Minnesota in developing a structural equation model looking at substance abuse problem severity, psychosocial risk and protection, and treatment variables as factors in adolescent drug abuse treatment outcome pathways across 6- and 12-month follow-up points. Findings on resiliency factors and an empirical method adapted from previous research were used to select and assign 10 psychosocial factors to either a multiple protective factor index or a risk factor index. Gender, substance abuse problem severity, treatment modality, treatment length, and aftercare participation were also examined as outcome predictors. The findings suggest that treatment intensity decisions may be better informed by pretreatment psychosocial risk level rather than by substance abuse problem severity. The present study also suggests that drug-abusing adolescents who receive sufficiently long treatment, participate in aftercare, and possess at least 1 individual or interpersonal protective factor during their recovery process have the best chance to maintain gains made during treatment. Latimer, W.W., Newcomb, M., Winters, K.C., and Stinchfield, R.D. Adolescent Substance Abuse Treatment Outcome: the Role of Substance Abuse Problem Severity, Psychosocial, and Treatment Factors. Journal of Consulting and Clinical Psychology, 68(4), pp. 684-696, 2000.

Risk and Protective Factors Influencing Adolescent Problem Behavior

Investigators at Oregon Research Institute examined the dynamic relations between adolescent- problem behaviors (alcohol, marijuana, deviance, academic failure) over time and predictors of these behaviors using data from the National Youth Survey, which included 1,044 adolescents (53.5% male; mean age at year 1 = 13.20). Dependent measures were adolescent alcohol use, marijuana use, deviance, and academic failure; assessments were conducted annually over 4 years. Independent measures included age, gender; marital status, income, family time, family support, time with friends, friend deviance, knowledge of friends, activities, and neighborhood problems. An associative latent growth modeling (LGM) analysis showed significant increases and relations between the four behaviors in both initial status and development. Second-order multivariate LGM analyses indicated that the four behaviors could be modeled by a higher-order problem behavior construct. Significant effects on the common problem behavior intercept or slope included time with friends, deviant friends, age, marital status, family time, and support. Additional effects were found to be specific to the initial status and slopes of individual problem behaviors. Overall, results indicate the importance of assessing the relations between adolescent problem behaviors as they change over time and identifying risk and protective factors that have both common and individual influences on these behaviors. Duncan, S.C., Duncan, T.E., and Strycker, L.A. Risk and Protective Factors Influencing Adolescent Problem Behavior: A Multivariate Latent Growth Curve analysis. Annals of Behavioral Medicine, 22(2), pp. 103-109, 2000.

School Dropout and Injecting Drug Use in a National Sample of White Non-Hispanic American Adults

Researchers at Johns Hopkins conducted a study to extend their previous finding of an association between school dropout and injecting drug use (IDU) among African Americans by testing the association in a sample of White non-Hispanic Americans. A nationally representative sample of White non-Hispanic Americans age eighteen years and older was drawn from public use data files of the 1995-1996 National Household Surveys on Drug Abuse (NHSDA). Adults with a self-report history of IDU were identified, and were matched to non-IDU adults in the same neighborhoods of residence. Conditional logistic regression was used to estimate the association between dropping out of high school and the occurrence of IDU. White non-Hispanic American high school dropouts were more likely than high school graduates to have injected a drug at least once. The findings of this research on non-Hispanic Whites are generally consistent with earlier evidence on the association between educational status and a history of IDU among African-American adults. School dropout prevention programs may merit attention in an overall strategy of preventing injecting drug use and HIV/AIDS. Obot, I.S. and Anthony, J.C. School Dropout and Injecting Drug Use in a National Sample of White Non-Hispanic American Adults. Journal of Drug Education, 30(2), pp. 145-155, 2000.

Clusters of Drug Involvement in Panama

Researchers at Johns Hopkins University reported on the first epidemiological investigation of clustering of tobacco, alcohol, inhalant, and other drug involvement within individual schools using data from Panama's 1996 National Youth Survey on Alcohol and Drug Use. Clustering was estimated with the Alternating Logistic Regression method. Adjusted estimates of pair-wise cross-product ratios (PWCPR), a measure of clustering, show modest clustering (i.e. PWCPR > 1.0) at the school level for tobacco smoking (PWCPR = 1.41; 95% confidence interval, CI = 1.22-1.64), alcohol consumption (PWCPR = 1.33; 95% CI = 1.22-1.45), use of inhalants, (PWCPR = 1.35; 95%CI = 1.07-1.69), and other drug use (PWCPR = 1.38; 95%CI = 1.14-1.68). These findings provide preliminary evidence that the odds of drug use among youth who attend school increase when other youth in the same school use drugs. This suggests the need for new research on within-school diffusion, which should include the identification of school-level factors that contribute to student drug use. Delva, J., Bobashev, G., Gonzalez, G., Cedeno, M., and Anthony, J.C. Clusters of Drug Involvement in Panama: Results from Panama's 1996 National Youth Survey. Drug and Alcohol Dependence, 60(3), pp. 251-257, 2000.

Implications of Genetic Epidemiology for the Prevention of Substance Use Disorders

Despite advances in characterizing human genotypes, the complex process through which genes exert their influence limits the application of molecular genetics to human diseases. Substance use disorders are necessarily complicated by gene-environment interaction because exposure to an exogenous substance is required for their development. The methods of genetic epidemiology are specifically designed to identify sources of complexity that impede etiologic findings and prevention efforts. Researchers at Yale report a study illustrating the application of family study methods to identify risk factors for substance abuse and their implications for prevention. The Yale Family Study is a controlled family study of the comorbidity of substance and psychiatric disorders. The sample consists of 223 probands with substance use and/or an anxiety disorders and community controls, 1218 adult first degree relatives and spouses, and 203 offspring (ages 7-17) followed for 8 years. Results indicated familial aggregation of substance disorders in adults and children, independence of familial aggregation of alcoholism and drug dependence, and specificity of familial clustering of some drugs of abuse. Familial factors are more strongly associated with substance dependence than abuse, with an attributable risk of 55%. Premorbid psychiatric disorders -social phobia and bipolar affective disorder in adults, and depression, anxiety, conduct, and oppositional defiant disorders in children - were strongly associated with the subsequent development of substance dependence (attributable risks ranging from 44 to 86%). A family history of substance abuse and premorbid psychopathology are strongly associated with the development of substance use disorders. As specific genetic vulnerability markers for substance use disorders become identified, application of the tools of genetic epidemiology may be employed to identify specific environmental risk factors that may serve as targets for prevention. Merikangas, K.R. and Avenevoli, S. Implications of Genetic Epidemiology for the Prevention of Substance Use Disorders. Addictive Behaviors, 25(6), pp. 807-820, 2000.

Methamphetamine Use by High School Students

Researchers at the Tri-ethnic Center for Prevention Research at Colorado State University analyzed data on 9th through 12th graders' methamphetamine use reported in the American Drug and Alcohol Survey (n=629,722). From 1989 through 1992, methamphetamine use rates remained relatively stable. Since then, rates have increased, almost doubling, especially in Western states. There were no significant differences in methamphetamine use across year in school, but males were more likely to use than females though use among females has also increased. American Indians and Hispanics were more likely to use methamphetamine, followed (in order) by Asian Americans, White non-Hispanics, and African Americans. Compared to other heavily drug involved youth, methamphetamine users were more likely to use other drugs. The most commonly reported other drugs used by students who used methamphetamine were alcohol, marijuana, hallucinogens, uppers, and cocaine. Methamphetamine users were also more likely than other drug users to suffer drug use consequences such as traffic tickets, car accidents, being arrested, trouble at school, fighting, and other adverse consequences. Oetting, E.R., Deffenbacher, J.L., Taylor, M.J., Luther, N., Beauvais, F., and Edwards, R.W. Methamphetamine Use by High Schools Students: Recent Trends, Gender and Ethnicity Differences, and Use of Other Drugs. Journal of Child and Adolescent Substance Abuse, 10(1), pp. 33-50, 2000.

Childhood Sexual Abuse Predicts Adult Psychiatric and Substance Use Disorders in Women

Dr. Kenneth Kendler and colleagues at the Medical College of Virginia used a genetically-informed design and population-based sample of 1411 female adult twins to explore the association between childhood sexual abuse and adult psychiatric disorders, including alcohol and substance abuse, assessed retrospectively. They found that women who reported childhood sexual abuse are at substantially increased risk to develop a range of psychopathologic outcomes, particularly alcohol and substance use disorders, primarily due to more severe sexual abuse. Of note, this relationship held when parental psychopathology was controlled in the analyses, suggesting that the relationship between childhood sexual abuse and adult outcomes is indeed causal. Although the association between sexual abuse and psychopathology has been reported previously, this study is remarkable for applying methodology that can help distinguish between association and causation by including family factors and using a co-twin report method in a population-based sample. Kendler, K.S., Bulik, C.M., Silberg, J., Hettema, J.M., Myers, J., and Prescott, C.A. Childhood Sexual Abuse And Adult Psychiatric And Substance Use Disorders In Women: An Epidemiological And Cotwin Control Analysis. Archives of General Psychiatry, 57, pp. 953-959, 2000.

Nicotine Dependence Rates Vary by Gender, Ethnicity, and Age

This study used data from the National Household Survey on Drug Abuse to look at the relationship between numbers of cigarettes used and symptoms of nicotine dependence, for various groups. The authors found that rates of nicotine dependence were highest among females, whites, and adolescents and younger adults (below age 50); each of these groups experienced more dependence symptoms while using the same or fewer number of cigarettes. Dependence rates increase sharply up to half a pack of cigarettes smoked per day. This study is unusual in using epidemiologic data from a large study to begin examining population prevalence and differential rates of nicotine dependence symptoms. It suggests that different thresholds of quantity and duration of smoking should be used in assessing different groups for risk for nicotine dependence, and that the risk for developing dependence increases sharply at lower levels of smoking (up to half a pack per day). Of particular note is the finding that adolescents, women, and whites were particularly vulnerable to the development of dependence symptoms at lower levels of consumption than their counterparts. Kandel, D.B. and Chen, K. Extent of Smoking and Nicotine Dependence in the United States: 1991-1993. Nicotine and Tobacco Research, 2, pp. 263-274, 2000.

Heritability of Tobacco Consumption Varies by Gender and Time Cohort

This article reports the largest and most comprehensive analysis to date of twin data yielding heritability estimates for tobacco use. The probands were obtained from a Swedish registry of twins born since 1886. By comparing monozygotic (MZ) and dizygotic (DZ) twin pairs, heritabilities for males was 56% with considerably lower contributions to the variance for use of tobacco; 24% and 20% for familial-environment and individual-specific environment risk factors, respectively. The pattern for females was not the same and subsequent analyses were needed to understand the differences. What seemed to matter for females was the era of their birth: those born in the first and second third of the cohort had much less heritability than those born in the last third (since 1940). In fact, those females born most recently had essentially the same heritability as males. The authors' conclude that "a reduction in the social restrictions on smoking in women in Sweden as the twentieth century progressed permitted genetic factors influencing the risk for regular tobacco use to increasingly express themselves."

A second result from this study is noteworthy. Twin correlations for amount of tobacco consumed were significant in MZ twins but not DZ twins, supporting the hypothesis that substance use is a two stage process: initiation and continued use (or misuse). Finally, the large number of twins studied allowed comparison of both MZ and DZ twin pairs who were either reared together or reared apart. This is important to address what is known as the "equal environment assumption" that assumes MZ and DZ twins are correlated in their exposure to their environment. In analyses addressing this issue, it was found that that the equal environment assumption was sufficiently valid so as not to introduce particular environmental biases due to zygosity. Kendler, K.S., Thornton, L.M., and Pedersen, N.L. Tobacco Consumption in Swedish Twins Reared Apart and Reared Together. Archives of General Psychiatry, 57, pp. 886-892, 2000.

Ethnicity and Gender in Polydrug Use

The purpose of this study was to determine if ethnic and gender differences in polydrug use exist among a cohort of inner-city adolescents during the three-year middle school period. Students in 22 urban schools completed self-report questionnaires with measures of drug use (smoking, drinking, and marijuana use) at three annual assessments. For participating students, (N=2354), analyses of variance were conducted to test for ethnic group (Asian, Black, Hispanic, and White) and gender differences in polydrug use. Ethnic differences were found for polydrug use measures at each assessment point. Asian and Black adolescents generally reported less polydrug use than White and Hispanic youth. When gender differences were evident, boys engaged in more use than girls. The relatively high rates of polydrug use indicate that prevention intervention programs that target multiple substances may be more efficient in reducing overall risk than prevention programs that focus on a single substance (e.g., smoking prevention only). Epstein, J.A., Botvin, G.J., Griffin, K.W., and Diaz, T. Role of Ethnicity and Gender in Polydrug Use Among a Longitudinal Sample of Inner-City Adolescents. Journal of Alcohol and Drug Education, 45, pp. 1- 12, Fall 2000.

Risk Factors for Early Tobacco Experimentation

This prospective study examines the relations between the mother's prenatal and current smoking and the offspring's smoking experimentation. A low SES birth cohort of 589 10-year-olds, who have been followed since their gestation, completed a self-report questionnaire about their substance use. Half were female, and 52% were African-American. Detailed data on exposure to tobacco and other substances in the prenatal and postnatal periods were collected from the mothers. During pregnancy, 52.6% of the mothers were smokers; 59.7% were smokers when their children were 10. Six per cent of the children (37/589) reported ever-smoking cigarettes, 3% had had one full alcoholic drink, and none had started to use other drugs. Maternal smoking during pregnancy was significantly associated with an increased risk of the child's tobacco experimentation. Offspring exposed to more than _ pack per day during gestation had a 5.5-fold increased risk for early experimentation. Structural equation modeling showed that prenatal tobacco exposure had a direct and significant effect on the child's smoking and that maternal current smoking was not significant. Prenatal tobacco exposure also predicted child anxiety/depression and externalizing behaviors, and these outcomes affected child smoking through the mediating effect of peer tobacco use. Cornelius, M.D., Leech, S.L., Goldschmidt, L., and Day, N.L., Prenatal Tobacco Exposure: Is It A Risk Factor For Early Tobacco Experimentation? Nicotine & Tobacco Research, 2, 45-52, 2000.

Monthly Bursts in Adolescent Drug Use

The goal of this study was to determine the extent to which monthly bursts in substance use (i.e., tobacco, marijuana, alcohol) were related to family and peer relations. Using a structured protocol, monthly interviews were conducted with 181 young adolescents, ages 11-14 yrs old, and their parents. Scores derived from monthly telephone reports described variation in parent involvement, exposure to deviant peers, peer conflicts, and level of family stress. Consistent with an ecological framework of development, environmental factors varied by gender and family membership. Across gender in both 1- and 2-parent families, exposure to peer problem behavior co-varied with increased substance use in the same month. Other monthly predictors varied by gender. Findings suggest that intervention programs for high-risk youth targeting adolescent problem behavior need to focus on managing the peer environment. Dishion, T.J. and Medici Skaggs, N. An Ecological Analysis of Monthly "Bursts" in Early Adolescent Substance Use. Applied Developmental Science, 4(2), pp. 89-97, 2000.

Youth Violence

This study replicates earlier research findings on developmental risk factors for youth violence and explores the effects of violent behavior on factors shown to increase risk for other problem behaviors. Risk factors from the individual, family, school, peer, and community domains are examined. Prospective longitudinal data on 808 young people participating in the Seattle Social Development Project were used. Potential risk factors for violence at age 18 measured at ages 10, 14, and 16 years. Results show that at each age examined, risk factors strongly related to later violence were distributed among the 5 domains. Ten of 15 risk factors measured at age 10 were significantly predictive of violence at age 18. Twenty of 25 constructs measured at age 14 and 19 of 21 constructs measured at age 16 were significantly predictive of later violence. The hyperactivity, low academic performance, peer delinquency, and availability of drugs, were measured at all 4 ages and all 4 predicted later violence. Subjects exposed to multiple risks were more likely than others to engage in later violence. The overall accuracy in predicting those who would go on to commit violent acts was limited. Herrenkohl, T.I., Maguin, E., Hill, K.G., Hawkins, J.D., Abbott, R.D. and Catalano, R.F. Developmental Risk Factors for Youth Violence. Journal of Adolescent Health, 26(3), pp. 176-186, 2000.

Aggression and Drug Use Related in Inner-City Youth

In a study of 517 inner-city eighth graders, investigators found that self-reported aggressive and unsafe behaviors were associated with initiation of drug use (use of tobacco, alcohol, and marijuana). Sex differences were found for aggressive behavior, victimization, and unsafe behavior. Epstein, J.A., Botvin, G.J., Diaz, T., Williams, C., and Griffin, K. Aggression, Victimization and Problem Behavior Among Inner-City Minority Adolescents. J. of Child and Adolescent Substance Abuse, 9(3), pp. 51-66, 2000.

Reducing Adolescent Aggressive Behavior

Data from a randomized trial including 22 public schools assigned either to the Iowa Strengthening Families Program or a control condition were examined for long-term effects of this seven-session intervention for parents and their sixth-grade children on aggressive and hostile behaviors of adolescents. Analyses supported sample representativeness of this general population study and failed to show differential attrition effects 4 years after baseline. The multi-informant, multi-method measures included independent observer ratings of adolescent aggressive and hostile behaviors in adolescent-parent interactions, family-member report of aggressive and hostile behaviors in those interactions, and adolescent self-report of aggressive and destructive conduct across settings. Data were collected during the 6th (pre- and post-intervention), 7th, 8th, and 10th grades. All measures showed a generally positive trend in intervention compared to the control group over time. During 10th grade, significant intervention-control differences were found for adolescent self-report of aggressive and destructive conduct with relative reduction rates ranging from 31.7% to 77.0%. Significant differences were shown for observer-rated aggressive and hostile behaviors in adolescent-parent interactions; differences in family member reports of those behaviors were not significant. Supplemental analyses interaction behavior measures, specific to parent gender, indicated significant experimental group differences in interactions with mothers for both measures, but not with fathers. Spoth, R.L., Redmond, C., and Shin, C. Reducing Adolescents' Aggressive and Hostile Behaviors - Randomized Trial Effects of a Brief Family Intervention Four Years Past Baseline. Archives of Pediatrics and Adolescent Medicine, 154 (12), pp. 1248-1257, 2000.

Psychosocial and Behavioral Factors Predict Heavy Drinking

A longitudinal study found that heavy drinking in 12th grade was predicted by multiple factors measured in the 7th grade, including experimentation with alcohol or cigarettes, having had a majority of friends who drink and having had poor behavioral self-control. Several effects were limited to either boys or girls. For example, positive alcohol expectancies in 7th grade predicted greater heavy drinking later in boys, while friends' smoking predicted later heavy drinking in girls. Griffin, K.W., Botvin, G.J., Epstein, J.A., Doyle, M.M. and Diaz, T. Psychosocial and Behavioral Factors in Early Adolescence as Predictors of Heavy Drinking Among High School Seniors. J. of Studies on Alcohol 61(4), pp. 603-606, 2000.

Results Linking Parenting Practices and Problem Behavior Replicated With Urban Minority Youth

A study of 228 6th grade urban minority youth found that boys from single-parent families engaged in the highest rates of problem behavior. The relationship between parenting practices and outcomes was moderated by family structure and gender. More parental monitoring was associated with less delinquency overall, as well as less drinking in boys only. Eating family dinners together was associated with less aggression overall, as well as less delinquency in youth from single-parent families and in girls. Unsupervised time at home alone was associated with more smoking for girls only. Griffin, K.W., Botvin, G.J., Scheier, L.M., Diaz, T. and Miller, N.L. Parenting Practices as Predictors of Substance Use, Delinquency, and Aggression Among Urban Minority Youth: Moderating Effects of Family Structure and Gender. Psychology of Addictive Behaviors, 14(2), pp. 174-184, 2000.

Competence Skills Protect Inner-City Adolescents from Alcohol Use

In a three-wave longitudinal study of inner city students in middle or junior high school at baseline, investigators found that decision making and self-efficacy predicted higher refusal assertiveness relative to alcohol use. Refusal assertiveness in turn predicted less drinking at the 2-year follow-up. Earlier drinking also predicted 2-year follow-up drinking. Epstein, J.A., Griffin, K.W. and Botvin, G.J. Role of General and Specific Competence Skills in Protecting Inner-City Adolescents from Alcohol Use. J. of Studies on Alcohol, 61(3), pp. 379-386, 2000.

The Relation of Perceived Neighborhood Danger and Childhood Aggression

Data from a school-based sample of 732 inner city predominantly African American 5th graders were analyzed to determine whether two mediational mechanisms, parenting practices and children's beliefs about aggression, accounted for the relationship between perceived neighborhood danger and childhood aggression. Results suggested that perceived neighborhood danger was associated with strong positive beliefs about aggression, which in turn was associated with high levels of aggression. The hypothesized mediating role of parenting practices (restrictive discipline, parental monitoring, and parental involvement) on the relation between perceived neighborhood danger and child aggression was not supported. The current findings suggest that children's positive beliefs about aggression mediated the relationship between restrictive discipline and aggression. Colder, C.R., Mott, J., Levy, S., and Flay, B. The Relation of Perceived Neighborhood Danger to Childhood Aggression: A Test of Mediating Mechanisms. American Journal of Community Psychology, 28(1), pp. 83-103, 2000.

Children's Beliefs About Long-Term Health Effects of Alcohol and Cocaine Use

The objective of this study was to assess age differences in children's beliefs about the long-term health effects of alcohol and cocaine, to use such beliefs to predict attitudes toward and intentions to use these substances, and to establish whether accurate beliefs are more predictive of attitudes and intentions than inaccurate ones. Children ages 6 to 12 (N=217) responded to an open-ended question about the effects of long-term alcohol and cocaine use and to 12 structured questions about drug effects. Differentiation of alcohol, cocaine, and tobacco effects was limited but increased with age. Beliefs about health effects had no impact on alcohol attitudes and intentions, but intentions to drink were stronger among older and white children. Anti-cocaine attitudes and intentions were associated with being older and non-White and with having accurate knowledge of cocaine's true health effects-but also with believing falsely that cocaine has tobacco-like effects and that drugs in general have catastrophic effects. With age, children differentiated more sharply between substances. Sigelman, C., Leach, D., Mack, K., Bridges, L., Rinehart, C., Dwyer, K., Elizabeth, D. and Sorongon, A. Children's Beliefs About Long-Term Health Effects of Alcohol and Cocaine Use. Journal of Pediatric Psychology, 25(8), pp. 557-566, 2000.

Development of a Training Program for Workplace Substance Abuse Prevention

This research describes the empirical and theoretical development of a workplace training program to help reduce/prevent employee alcohol and drug abuse and enhance aspects of the work group environment that support ongoing prevention. The paper (1) examines the changing social context of the workplace (e.g., teamwork, privacy issues) as relevant for prevention, (2) reviews studies that assess risks and protective factors in employee substance abuse (work environment, group processes, and employee attitudes), (3) provides a conceptual model that focuses on work group processes (enabling, neutralization of deviance) as the locus of prevention efforts, (4) describes an enhanced team-oriented training that was derived from previous research and the conceptual model, and (5) describes potential applications of the program. It is suggested that the research and conceptual model may help prevention scientists to assess the organizational context of any workplace prevention strategy. The need for this team-oriented approach may be greater among employees who experience psychosocial risks such as workplace drinking climates, social alienation, and policies that emphasize deterrence (drug testing) over educative prevention. Limitations of the model are also discussed. Bennett, J.B., Lehman, W, and Reynolds, G.S. Team Awareness for Workplace Substance Abuse Prevention: The Empirical and Conceptual Development of a Training Program. Prevention Science, 1 (3), pp. 157-172, 2000.

Effects of the "Preparing for the Drug Free Years" Curriculum on Growth in Alcohol Use and Risk for Alcohol Use in Early Adolescence

Preparing for the Drug-Free Years (PDFY) is a curriculum designed to help parents learn skills to consistently communicate clear norms against adolescent substance use, effectively and proactively manage their families, reduce family conflict, and help their children learn skills to resist antisocial peer influences. This study examined the effects of PDFY on the trajectories of these factors, as well as on the trajectory of alcohol use from early to mid adolescence. The sample consisted of 424 rural families of sixth graders from schools randomly assigned to an intervention or a control condition. Data were collected from both parents and students at pretest, posttest, and 1, 2, and 3 1/2-year follow-ups. Latent growth models were used to examine the data. PDFY significantly reduced the growth of alcohol use and improved parent norms regarding adolescent alcohol use over time. Implications for prevention and evaluation are discussed. Park, J., Kosterman, R., Hawkins, D.J., Haggerty, K.P., Duncan, T.E., Duncan, S.C. and Spoth, R. Effects of the "Preparing for the Drug Free Years" Curriculum on Growth in Alcohol Use and Risk for Alcohol Use in Early Adolescence. Prevention Science, 1 (3), pp. 125-138, 2000.

Childhood Sexual Abuse Among Female Addicts and Subsequent Parenting

The relationship between childhood sexual abuse (CSA), family of origin and the status of 248 female narcotic addicts currently raising adolescent children was examined. Seventy-eight of these women reported a history of CSA. The CSA group and the non- CSA group were compared on variables related to parental substance abuse, parenting behavior, and other family dynamics (retrospectively for families of origin and contemporaneously for current families). Findings suggest that the abuse of alcohol by the mothers of some of the CSA subjects was a contributing factor in creating an environment or set of circumstances in which the abuse took place. The two groups also differed on variables such as involvement, attachment, responsibility, discipline, and punitive actions. CSA was also related to addiction careers, parental substance use, adult psychological symptoms, and home atmosphere. Blatchley, R.J., Hanlon, T.E., Nurco, D.N., and O'Grady, K. Childhood Sexual Abuse Among Female Addicts and Changes in Parenting Across Two Generations. Fishbein, D.H. (Ed), et al. The Science, Treatment and Prevention of Antisocial Behaviors: Application to the Criminal Justice System, Kingston, NJ, US: Civic Research Institute, pp. 27-25, 2000.

Group Self-Identification and Prediction of Drug Use and Violence in High-Risk Youth

This study provides a 1-year prospective analysis of group self-identification as a predictor of adolescent drug use and violence. In most comparisons, 1 year later, a high-risk group reported greater levels of drug use and violence-related exposure than other groups, and the statistical relation between group self-identification and drug use or violence remained after controlling for baseline assessment of the drug use or violence measure. This is the first study to demonstrate that group self-identification is a significant prospective predictor of drug use and other problem behaviors. Sussman, S., Dent, C.W., and McCullar, W.J. Group Self-Identification as a Prospective Predictor of Drug Use and Violence in High-Risk Youth. Psychology of Addictive Behaviors, 14(2), pp. 192-196, 2000.

Prediction of Drug Use from Stress-Related Variables

Six stress-related variables, gender, age, and ethnicity were investigated as concurrent and prospective predictors of three types of drug use (cigarettes, alcohol, and illicit drug use) among 875 "high risk" adolescents. The stress-related variables were socioeconomic status, "missing" one's parent(s), family conflict, victimization, perceived stress, and stress-drug beliefs. In general, findings indicated that those who were lower in socioeconomic status, held beliefs favorable toward drug use and who had been victimized in the last year were more likely to be cigarette, alcohol, or illicit drug users. Those who had used drugs at baseline and had been victimized in the last year were relatively more likely to use drugs the next year. Significant predictors in the multivariable models accounted for between 56 and 85% of those subjects who were above the median on later drug use. Victimization is a relatively important source of stress in the prediction of future drug use. Thus, drug-use interventions need to provide supportive services to those who have been victims of violent attacks on their person or property. Sussman S., and Dent C.W. One-Year Prospective Prediction of Drug Use from Stress-Related Variables. Substance Use & Misuse, 35(5), pp. 717-735, 2000.

Skill Training Appears to Reduce Recidivism in Juvenile Offenders

This study compared juvenile offenders' recidivism following nonrandom assignment to juvenile diversion, juvenile diversion plus skill training, or juvenile diversion plus mentoring. Juvenile diversion with skill training was shown to be most effective, with a re-arrest rate of 37% two or more years after intake compared to 51% in the mentoring program and 46% in the diversion only program. Skills training was also most cost-effective, achieving a 14% relative reduction in recidivism at a savings of $33,600. Blechman, E.A., Maurice, A., Buecker, B. and Helberg, C. Can Mentoring or Skill Training Reduce Recidivism? Observational Study with Propensity Analysis. Prevention Science 1(3), pp. 139-156, 2000.

Paper vs. Computer-assisted Self Interview for Alcohol, Tobacco, and Other Drug Surveys

School surveys of alcohol, tobacco, and other drug use (ATOD) play an important role in evaluating prevention programs and developing policy. Until recently, most surveys are conducted with paper and pencil (PAP) instruments, but computer-assisted self-interviews (CASI) methods are becoming more common. Evidence on CASI methods indicates that they elicit higher rates of positive responses to sensitive questions than traditional measures. This study examines whether ATOD school surveys using CASI are feasible and improve the quality of data. Seventh, ninth, and eleventh grade students in two California communities were randomly assigned to PAP or to CASI (n=2296). The findings indicate that while CASI did not increase reported rates of substance use over PAP it significantly improved the speed of data processing and decreased the incidence of missing data. CASI was well accepted by students and school staff despite problems such as lack of computer resources. Hallfors, D., Khatapoush, S., Kadushin, C., Watson, K., and Saxe, L. A Comparison of Paper vs. Computer-assisted Self Interview for School Alcohol, Tobacco, and Other Drug Surveys. Evaluation and Program Planning, 23, pp. 149-155, 2000.

Trauma, Drugs and Violence Among Juvenile Offenders

Trauma typically occurs when one experiences a situation where life has been threatened or lost. If the trauma is not resolved, negative residual effects may result in alcohol and drug use, involvement in violent activities as well as the development of mental health problems such as posttraumatic stress disorder (PTSD). Findings from a study examining the link between trauma, drug use and violence among youth are presented. Results from interviews with 414 juveniles remanded to the Office of Children and Family Services (formerly New York State Division For Youth) for assault, sexual assault, robbery or homicide, document the trauma experienced by these youth, as well as how it correlated with their drug usage and participation in violent, illegal activities. Discussion of these findings, their implications for understanding and intervening, and recommendations for future research are highlighted. Crimmins, S.M., Cleary, S.D., Brownstein, H.H., Spunt, B.J., Warley, R.M. Trauma, Drugs and Violence among Juvenile Offenders. J Psychoactive Drugs, 32, pp. 43-54, 2000.

Differences in Young Adult Psychopathology Among Drug Abstainers, Experimenters, and Frequent Users

Shedler and Block offered the provocative proposal that individuals who experiment with drugs are psychologically healthier than either those who abstain completely or those who are frequent users. Not all studies have come to such conclusions, however. In an effort to specify under what conditions Shedler and Block's conclusions might hold, the present study examined three groups of drug users (abstainers, experimenters, frequent users) classified according to three different criteria: (a) marijuana use at age 20; (b) alcohol use during 10th grade; and (c) alcohol use at age 20. The three groups were compared at age 20 in terms of personality, deviant behavior, and psychopathology. The results revealed that abstainers were never more psychologically impaired, and were occasionally healthier, than experimenters. Frequent users of marijuana were consistently more impaired than both the abstainers and experimenters, in terms of both internalizing and externalizing disorders. Classification according to marijuana use appeared to be more related to psychopathology than did classification according to alcohol use. Milich, R., Lynam, D., Zimmerman, R., Logan, T.K., Martin, C., Leukefeld, C., Portis, C., Miller, J. and Clayton, R. Differences in Young Adult Psychopathology among Drug Abstainers, Experimenters, and Frequent Users. J Subst Abuse, 11, pp. 69-88, 2000.

Cigarette Smoking and Anxiety Disorders

Cigarette smoking has been shown to be associated with some anxiety disorders, but the direction of the association between smoking and specific anxiety disorders has not been determined. This investigation assessed the longitudinal association between cigarette smoking and anxiety disorders among adolescents and young adults. A community-based sample of 688 youths (51% female) participating in this prospective longitudinal study were interviewed in the years 1985-1986, at a mean age of 16 years, and in the years 1991-1993, at a mean age of 22 years. Participant cigarette smoking and psychiatric disorders in adolescence and early adulthood were measured by age-appropriate versions of the Diagnostic Interview Schedule for Children. Results show that heavy cigarette smoking (>/=20 cigarettes/d) during adolescence was associated with higher risk of agoraphobia (10.3% vs. 1.8%; odds ratio [OR], 6.79; 95% confidence interval [CI], 1.53-30.17), generalized anxiety disorder (20.5% vs. 3.71%; OR, 5.53; 95% CI, 1.84-16.66), and panic disorder (7.7% vs. 0.6%; OR, 15.58; 95% CI, 2.31-105.14) during early adulthood after controlling for age, sex, difficult childhood temperament; alcohol and drug use, anxiety, and depressive disorders during adolescence; and parental smoking, educational level, and psychopathology. Anxiety disorders during adolescence were not significantly associated with chronic cigarette smoking during early adulthood. Fourteen percent and 15% of participants with and without anxiety during adolescence, respectively, smoked at least 20 cigarettes per day during early adulthood (OR, 0.88; 95% CI, 0.36-2.14). These results suggest that cigarette smoking may increase risk of certain anxiety disorders during late adolescence and early adulthood. Johnson, J.G., Cohen, P., Pine, D.S., Klein, D.F., Kasen, S. and Brook, J.S. Association between Cigarette Smoking and Anxiety Disorders during Adolescence and Early Adulthood. JAMA, 284(18), pp. 2348-2351, 2000.

Development of Marijuana Use From Childhood to Young Adulthood

The present study was designed to examine the relationship between unconventionality and marijuana use over time. The sample for this paper consisted of 532 male and female participants interviewed during early adolescence, late adolescence, their early twenties, and their late twenties. Latent growth modeling was used. The findings indicated that (1) the influence of initial unconventionality (T2) on initial marijuana use (T2) was stronger for males, (2) unconventionality at T2 was not significantly related to overall rate of growth in marijuana use, and (3) change in unconventionality was related to overall growth rate of marijuana use. The implications of the findings for prevention and treatment are discussed. Brook, J.S., Whiteman, M., Finch, S.J., Morojele, N.K. and Cohen, P. Individual Latent Growth Curves in the Development of Marijuana Use from Childhood to Young Adulthood. J Behav Med 23(5), pp. 451-464, 2000.

Consequences of Adolescent Drug Use on Psychiatric Disorders in Early Adulthood

This article summarizes the existing literature on the relationship between adolescent drug use and abuse and the development of psychiatric disorders in adulthood. In recent years, there has been increased awareness of the co-occurrence of drug abuse and psychiatric disorders in adolescence and young adulthood. Few longitudinal studies, however, have examined specifically the impact of earlier drug use and abuse on later psychiatric disorders. The literature suggests three possible models to explain the relation between drug use and abuse and psychiatric disorders. According to the first model, adolescent psychiatric disorders precede drug use and abuse. A second model postulates that psychiatric disorders and drug use are correlated because they share one or more common etiological factor(s). The third model posits that drug use and abuse predict or precede certain psychiatric disorders. We present data from a recent longitudinal study to support this latter model. As drug use and abuse have been shown to increase the likelihood of psychiatric disorders, it is clear that medical attention needs to be given to adolescents who use drugs of abuse. It is expected that a decrease in adolescent drug abuse should lead to an accompanying reduction in later psychiatric disorders. Brook, J.S., Richter, L. and Rubenstone, E. Consequences of Adolescent Drug Use on Psychiatric Disorders in Early Adulthood. Ann Med., 32(6), pp. 401-407, 2000.

Associations Between Bipolar Disorder and Other Psychiatric Disorders

This study investigated cross-sectional and longitudinal associations between bipolar disorder and other psychiatric disorders during adolescence and early adulthood. Psychiatric interviews were administered to a representative community sample of 717 youths and their mothers in 1983 (mean age of youths=14 years) and again in 1985-1986, and 1991-1993. Findings show a wide range of psychiatric disorders co-occurred with bipolar disorder during adolescence and early adulthood. Adolescent anxiety disorders were uniquely associated with increased risk for early adulthood bipolar disorder after adolescent bipolar disorder was accounted for. Manic symptoms during adolescence were associated with increased risk for anxiety and depressive disorders during early adulthood after adolescent anxiety and depressive disorders were accounted for. Researchers concluded that adolescents with anxiety disorders might be at increased risk for bipolar disorder or clinically significant manic symptoms during early adulthood. Adolescents with manic symptoms may be at increased risk for anxiety and depressive disorders during early adulthood. Johnson, J.G., Cohen, P., and Brook, J.S. Associations between Bipolar Disorder and Other Psychiatric Disorders during Adolescence and Early Adulthood: A Community-Based Longitudinal Investigation. Am J Psychiatry 157(10), pp. 1679-1681, 2000.

Personality Disorders Associated With Violence and Criminal Behavior

This community-based, longitudinal prospective study investigated whether personality disorders during adolescence are associated with elevated risk for violent behavior during adolescence and early adulthood. A community-based sample of 717 youths from upstate New York and their mothers were interviewed in 1983, 1985-1986, and 1991-1993. Axis I and II disorders were assessed in 1983 and 1985-1986. Antisocial personality disorder was not assessed because most participants were less than 18 years of age in 1983 and 1985-1986. Violent behavior was assessed in 1985-1986 and 1991-1993. Results show that adolescents with a greater number of DSM-IV cluster A or cluster B personality disorder symptoms were more likely than other adolescents in the community to commit violent acts during adolescence and early adulthood, including arson, assault, breaking and entering, initiating physical fights, robbery, and threats to injure others. These associations remained significant after controlling for the youths' age and sex, for parental psychopathology and socioeconomic status, and for co-occurring psychiatric disorders during adolescence. Paranoid, narcissistic, and passive-aggressive personality disorder symptoms during adolescence were independently associated with risk for violent acts and criminal behavior during adolescence and early adulthood after the covariates were controlled. Cluster A and cluster B personality disorders and paranoid, narcissistic, and passive-aggressive personality disorder symptoms during adolescence may increase risk for violent behavior that persists into early adulthood. Johnson, J.G., Cohen, P., Smailes, E., Kasen, S., Oldham, J.M., Skodol, A.E. and Brook, J.S. Adolescent Personality Disorders Associated with Violence and Criminal Behavior during Adolescence and Early Adulthood. Am J Psychiatry, 157(9), pp. 1406-1412, 2000.


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