Director's Report to the National Advisory Council on Drug Abuse
Epidemiology, Etiology and Prevention Research
Increased Smoking and Drug Use Among Students
Presenting the findings of the 1995 Monitoring the Future (MTF) Study, Drs. Lloyd Johnston, Patrick O'Malley, and Jerald Bachman of the University of Michigan reported that between 1994 and 1995, use of cigarettes and many illicit drugs increased among students in all three grades surveyed. In addition, fewer students expressed negative perceptions of drug use. In most cases, these changes continued recent trends that began in the early 1990's and reversed a decade or more of decreases in drug use. The 1995 MTF Survey was the 21st annual survey of seniors and the fifth survey to include 8th and 10th graders. All changes noted below are statistically significant.
- Between 1994 and 1995, past month (30 day) cigarette use increased from 25.4 to 27.9 percent among 10th graders and from 31.2 to 33.5 percent among seniors. Similarly, daily smoking increased from 14.6 to 16.3 percent for 10th graders and from 19.4 to 21.6 percent for seniors.
- Since 1991, past month smoking has increased from 14.4 to 19.1 percent for 8th graders, 20.8 to 27.9 percent for 10th graders, and 28.3 to 33.5 percent for 12th graders.
- Although African American students continue to have the lowest rates of smoking, rates are going up for students in all racial/ethnic groups. Current cigarette use increased from 1992 to 1995 among white and black students in all three grades and among white, black, and Hispanic 8th graders.
Illicit Drug Use
- Use of marijuana/hashish continued to climb. Between 1994 and 1995, lifetime and past year marijuana use increased among 8th, 10th, and 12th graders, and past month use increased among 8th and 12th graders. This was the third consecutive increase in lifetime and past year marijuana use among 10th and 12th graders and the fourth for 8th graders. Among seniors, marijuana use in 1995 was the highest since 1989 for lifetime use, 1987 for past year use, and 1986 for past month use. In addition, daily marijuana use, an index of very high-risk use, increased for 10th and 12th graders.
- Driven in large part by the rise in marijuana, lifetime, past year, and past month use of any illicit drug increased among 8th and 10th graders. Past year use of any illicit drug increased among seniors.
- Past year use of hallucinogens, including LSD, increased among 8th, 10th, and 12th graders between 1994 and 1995, and past month use of these drugs increased for 10th and 12th graders.
- Past month use of cocaine in any form increased for 10th graders; this increase was primarily due to crack, which showed increases in lifetime, past year, and past month use among 10th graders.
- Heroin use in the lifetime, past year, and past month increased among seniors, and past month heroin use increased for 10th graders. For seniors, lifetime heroin use was at 1.2 percent in 1994 and at 1.6 percent in 1995. These increases appear mainly to reflect use of heroin in noninjectable forms.
- Use of stimulants increased among 10th graders for all three levels of recency of use.
Perceived Harmfulness and Availability
- The perceived risk of drug use continued to decrease. The percentage of 8th, 10th, and 12th graders reporting "great risk" in trying marijuana once or twice or in smoking the drug occasionally decreased. Among seniors, the percent of seniors reporting "great risk" in regular marijuana use has decreased steadily from 78.6 percent in 1991 to 60.8 percent in 1995.
- The percent reporting "great risk" in trying crack or cocaine powder or in using these drugs occasionally decreased among 8th and 10th graders.
- The perceived risk of smoking a pack or more of cigarettes per day decreased among 10th graders.
- The percentage reporting that marijuana was "fairly easy" or "very easy" to get increased among 8th, 10th, and 12th graders. The perceived availability of LSD increased for 8th and 10th graders.
- Alcohol use continued at unacceptably high levels. Notably, however, daily drinking increased among 12th graders, and more 10th graders reported having "been drunk" daily in the past month.
Community Epidemiology Work Group (CEWG)
The latest CEWG findings were released at the biannual meeting which was held in Honolulu, Hawaii on December 5-8, 1995. The CEWG is composed of researchers from 20 selected 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 use and abuse; and, negative health and social consequences. Reports are based on 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 research findings from ethnographic studies.
Highlights from findings from the most recent CEWG meeting include:
- Cocaine - Crack cocaine continues to dominate as the most serious drug of abuse in most areas of the country. Indicator data show that the epidemic may be leveling off in many urban areas and rebounding in others. Field reports from some areas, such as Atlanta, show increases in rural areas. Most indicators suggest an aging population of users who increasingly are suffering from health related consequences. Involvement in cocaine among youth appear to be limited largely to sales and distribution, often as part of gangs. Minneapolis/St. Paul may be a possibly emerging exception: some indicator data suggest growing numbers of new, younger cocaine users.
- Heroin - Health and law enforcement indicator data now confirm previous field reports of three heroin-using cohorts: a small, but growing number of young relatively recent initiates (particularly in Chicago, Detroit, Minneapolis/St. Paul, Newark, Phoenix, San Francisco, Seattle, St. Louis, and Texas); crack users who are starting to combine their crack with heroin; and a larger population of aging addicts who are switching to intranasal use and, in some cases, to smoking. An increase in smoking heroin is reported in Atlanta, Chicago, Los Angeles and San Francisco. The general trend appears to be a continued shift from injection to intranasal use in the East and parts of the Midwest, where lower priced, higher quality heroin remains readily available. In Atlanta and Philadelphia, however, some relatively new heroin users have begun shifting from intranasal use to injection. There is growing concern that a similar change in route of administration may occur in other areas with recent initiates as they no longer get the desired effect via snorting or smoking.
- Marijuana - Continuing last year's upward trend, indicator data and field reports show escalating marijuana use, especially by adolescents, across the Nation. Use of "blunts" (gutted cigars refilled with marijuana) continues to increase and increasingly are being used in combination with other drugs. In some cities, they are combined with cocaine ("primos"), crack ("woolies"), or PCP. There are also reports that marijuana is increasingly being sold by crack dealers, a change from past street trafficking trends.
- Stimulants - There has been a recent shift from small-scale domestic manufacture and trafficking of methamphetamine to large-scale Mexican operations. Availability, purity, and use continue to increase in mainland States where it has been a longstanding problem: California (especially San Diego), Texas, and Arizona. Other areas including Denver, Minneapolis/St. Paul, and Miami also report increases in indicators of methamphetamine use. There are reports that new distribution routes for methamphetamine trafficking may follow those for cocaine and heroin, potentially introducing methamphetamine to areas where its prevalence is currently low. New user populations, such as some Native Americans in Arizona, are beginning to inject for the first time and the drug is increasingly involved in violent behavior, including child abuse and homicide. In addition, smokeable methamphetamine (ice) continues as one of the most serious substance abuse problems in Hawaii and has spread to a number of Pacific Island nations, such as Palau, Guam, the Commonwealth of the Northern Marianas and Papua New Guinea. Abuse is also prevalent in Southeast Asia, especially Thailand and the Philippines.
Methylphenidate (Ritalin, or "west coast") is commonly abused in Chicago (sometimes as a "speedball," with heroin or with heroin and cocaine), especially by African-American stimulant users. There also has been a reported increase among young users in Phoenix. It is also available in Texas and Michigan. In the latter, there are reports of theft of the drug from school clinics by adolescents or buying it from classmates who take it for attention deficit disorder.
The use and manufacture of methcathinone ("cat", "goob"), first reported in Michigan in 1990, has spread to other midwestern and western States, including Wisconsin and, more recently, Minnesota. Production of this ephedrine-based stimulant is becoming increasingly clandestine in the Michigan Upper Peninsula.
- Flunitrazepam (Rohypnol) - Abuse continues its recent spread across various parts of the country. It is increasingly reported by adolescent and young adult treatment admissions, especially in Florida and Texas. The drug is now involved in Drug Enforcement Administration (DEA) prosecutions in 25 States. Populations of users include college students, heroin and cocaine users, gang members, and polysubstance abusers in methadone treatment clinics. The drug is reported to be used as an alcohol (especially beer) enhancer. Its disinhibitive effects often lead to high-risk sexual activity as well as date rape, drag racing, and other destructive behavior. Miami has successfully included flunitrazepam in its DUI testing program.
- Hallucinogens - After a generally declining trend since 1988, indicators of phencyclidine (PCP) use appear to be rebounding in several cities, particularly Washington, DC. In some areas, such as Chicago, Miami, and Texas, PCP is increasingly used with marijuana, often in blunts. In addition, a resurgence in LSD availability is reported in several areas, particularly Atlanta and San Francisco. Decreased LSD potency and changing motivations are resulting in new patterns of abuse by youth.
Maternal Drug Use, Personality, Child-Rearing Practices, and Toddlers' Sadness
Dr. Judith Brook of Mount Sinai School of Medicine investigated the influence of maternal drug use, personality attributes, and child-rearing on 2-year-olds' sadness. The sample consisted of 62 girls and 53 boys and their mothers. A pattern of poor emotional control, difficult interpersonal relations, and poor intrapsychic functioning on the part of the mothers contributed to the children's sadness. Close mother-child attachments and low use of power-assertive discipline methods on the children insulated the children from sadness. Results of hierarchical regression analyses showed that the maternal-child relationship has a direct effect on the children's sadness and also serves as a mediator for the effect of the mothers' personalities on the children. Maternal intrapsychic harmony enhanced low alcohol and drug use leading to the least sadness in the children. Brook, JS & Tseng, LJ. Maternal Drug Use, Personality, Child-Rearing Practices, and Toddlers' Sadness. Psychological Reports, 76:
pp. 912-914, 1995.
Cognitive Capacity of Female Adolescent Substance Abusers
In a study at the Center for Education and Drug Abuse Research (CEDAR), 106 female adolescents who qualified for a DSM-III-R diagnosis of psychoactive substance abuse disorder were compared to 74 normal controls on a battery of cognitive, intellectual, and achievement tests. The substance abuse group was found to perform deficiently on tests requiring language skills, sustained attention, and perceptual efficiently, and to score lower than controls on standardized tests of intelligence and academic achievement. While it is not known whether the differences in cognitive capacity preceded or followed onset of substance abuse, the investigators report that no dose-response-type relationship was observed, suggesting preexisting cognitive deficits. The results suggest that the impulsivity frequently reported in substance abusers has a cognitive component and may partially reflect the effects of impaired linguistic ability. Tarter RE, Mezzich AC, Hsieh YC, & Parks, SM. Cognitive Capacity in Female Adolescent Substance Abusers. Drug and Alcohol Dependence, 39: pp. 15-21, 1995.
Coping Capacity of Female Adolescent Substance Abusers
A related CEDAR study compared coping capacity among the same population as the above described study--female adolescents who qualified for a DSM-III-R diagnosis of psychoactive substance abuse disorder (n=133)--with that of depressed (n=34), conduct disordered (n=23) and normal control (n=113) female adolescents. Depressed and conduct disordered subjects excluded those who met the criteria for substance abuse disorder. Substance abusers were found to score lower on coping measures, assessed by the Constructive Thinking Inventory (Epstein & Meier, 1989), than did normal controls, but depressed and conduct disordered subjects showed patterns of deficient coping indistinguishable from those of substance abusers. Age at onset of substance use, interval between age of first use and age of diagnosis of abuse, and severity of substance use involvement did not correlate with coping capacity. These results suggest that the association between deficient coping and substance abuse is not as simple as previously thought. Deficient coping does not appear to be related specifically to drug abuse but rather, when present, to be concomitant to comorbid psychopathology among females who have substance abuse disorder. Mezzich AC, Tarter RE, Kirisci, L, Hsieh, YC, & Grimm, M. Coping Capacity in Female Adolescent Substance Abusers. Addictive Behaviors, 20: pp. 181-187, 1995.
School Achievement and Dropout Status Among Anglo and Indian Youth
This prevention research study assessed data from an NIAAA project on Indiana dropouts and data from a NIDA sponsored project on Anglo dropouts. The analysis looked at both females and males and showed that problems with teachers and problems with language skills increased the chances of becoming a dropout for both Anglos and Indians. Indian cultural identification by itself, did not predict success or failure, but the combination of Indian and Anglo cultural identification (biculturalism) was related to school success. Indian students who reported high levels of use of a tribal language in childhood were more likely to be dropouts. Those with an Anglo identification and high levels of use of English were more likely to succeed. James, K, Chavez E., Beauvais, F., Edwards, R., Oetting, G. School Achievement and Dropout Among Anglo and Indian Females and Males: A Comparative Examination. American Indian Culture and Research Journal, 19(3), 1995.
Links Among Violence, Drug Use, and Gang Involvement
Ruth Edwards of the Tri-Ethnic Prevention Research Center presents data from three types of Western communities (rural, small urban, and a large urban) to illustrate that youth who use drugs are more likely to perpetrate violence as well as to be victims of violence. A link between gang involvement and higher levels of both drug use and violence also appears in both the rural and urban communities. In S.M. Blaser, J. Blaser, and K. Pantoja (Eds.), Perspectives on Violence and Substance Use in Rural America, Oakbrook, IL: North Central Regional Educational Laboratory.
Preventive Interventions for High-Risk Youth: The Adolescent Transitions Program
Drs. Dishion, Andrews, Kavanagh and Soberman present findings from a controlled test of a drug abuse prevention intervention focused upon at-risk youth and their families. The program called the Adolescent Transitions Program (ATP) provides a variety of intervention and assessment resources to prevent problem behavior throughout the developmental stages of childhood and adolescence. The basic intervention components offer protective skills to parents and teens for problem behavior reduction and prevention across contexts in early adolescence. The chapter imparts theory, practical intervention tools and suggests future directions for the treatment and prevention of behavior problems in adolescence. In B. McMahon and R. D. Peters (Eds.), Childhood Disorders, Substance Abuse and Delinquency: Prevention and Early Intervention Approaches, Newbury, CA: Sage, 1995.
Continuation High Schools: Youth At-risk for Drug Abuse
A prevention research study by Dr. Steven Y. Sussman and colleagues finds that students at alternative high schools may be at substantial risk for drug abuse. In California, youth remain at the same elementary and junior high school, but when reaching high school age, those youth who are unable to remain in the comprehensive (i.e. regular) school system for emotional, behavioral, or other functional reasons, including substance use, are transferred to a continuation high school. Continuation schools require continued (part-time) education for all California youth until reaching 18 years of age. A total of 144 students and 96 staff were interviewed from 20 continuation high schools. Continuation high school students reported use rates three to five times higher than comprehensive high school youth. However, only 20% of the students reported that they received any drug abuse prevention programming. The researchers conclude that continuation high schools students are at risk for substance abuse and prevention programming is sorely needed.
Driving Under the Influence
The frequency and success rate of different types of informal drunk-driving interventions were examined. From students who completed a drinking and driving questionnaire (N=388), 303 subjects (78%) who reported having been in a DUI situation within the last year and 206 (68%) who reported having intervened at least once in the past year were studied to explore the influence of the gender of the intervenor and the intoxicated individual and the intervenor's familiarity with the individual on the use and success of the different interventions. Women were just as likely as men to intervene. Findings reveal few gender differences in the frequency and success rates of the different interventions. Familiarity with the intoxicated individual increased the frequency and success of intervention. Hernandez ACR, Newcomb MD & Rabow J. Types of Drunk Driving Intervention: Prevalence, Success, and Gender. Journal of Studies on Alcohol, 56: pp. 408-413, 1995.
Interpersonal Relationships of Adult Children of Alcoholics
An examination of the differences between treatment-seeking and non-treatment-seeking adult children of alcoholics (ACOAs) and adult children of non-alcoholics (ACONAs) in regard to numerous aspects of interpersonal relationships indicates numerous differences between ACOAs in treatment and ACONAs not in treatment; however, there were no significant interactions between ACOA and treatment status, nor between ACOAs and ACONAs, regardless of treatment status with the exception of self-regard (ACONAs not in treatment reported higher self-regard than did ACOAs not in treatment). This is consistent with many other studies. Those seeking treatment reported significantly less affectional expression, lower self-regard, more depressive traits, and less dating competence and assertiveness compared to those not in treatment regardless of ACOA status. Subjects were 278 college students, 18-34 years of age. Newcomb MD, Stollman GD & Vargas JH. Adult Children of Alcoholics In and Out of Psychotherapy: Evaluating Problems with Intimacy and Close Relationships. Journal of Applied Social Psychology, 25: pp. 279-296, 1995.
Alcohol Use, Marijuana Use, and Memory
Memory associations between drug-related cues and drug use are likely to have motivational implications. Whether memory associations involving drug cues can be considered both a product and a predictor of alcohol and marijuana use consistent with the motivational model of drug-use memory association was examined. Results from a diverse college sample indicated that subjects' memory associations to ambiguous cues were significantly related to alcohol and marijuana use, independent from a number of possible correlates of these variables (e.g., family history of alcohol use, acculturation, friends' drug use). The analytical models showed that these relationships held whether memory association was analyzed as a predictor, or product, of drug use. Stacy AW. Memory Association and Ambiguous Cues in Models of Alcohol and Marijuana Use. Experimental and Clinical Psychopharmacology, 3: pp.183-194, 1995.
Drug and Alcohol Use among Ethnically Diverse Adolescents in Miami
Drs. Vega, Gil, Warheit, and Aspori report findings from their research comparing cigarette, alcohol, and illicit drug use among an ethnically diverse sample of 5,954 students in the Miami Public Schools. Annual interview data were collected from each student over a three year period. The authors found that African-American adolescents reported less drug use than their non-Hispanic and Hispanic counterparts. Hispanics born in the United States reported higher rates of drug use than foreign born Hispanics. However, drug use rates among foreign born Hispanic youth who had lived more than five years in the U.S. were similar to those of U.S. born Hispanics. The researchers conclude that cultural assimilation is a risk factor for drug use among foreign born Hispanics. J of Health and Social Behavior, in press.
Gang Membership and the Illicit Drug Trade
Dr. Hagedorn presents findings from a three year study involving in-depth interviews with 101 African-American and Hispanic male gang members living in Milwaukee. Contrary to what is generally believed, Dr. Hagedorn found that these youth engaged in the illicit drug trade only sporadically and many of them moved in and out of the conventional labor market as well. Almost all of the gang members interviewed said that they would accept full time employment at modest wages instead of a criminal but lucrative lifestyle associated with the drug trade. Criminology, 32(2): pp. 197-219, 1995.
Use of Illicit Drugs by Female Homicide Offenders
Barry Spunt and his colleagues report findings from extensive life history interviews with 215 female felons convicted of homicides and incarcerated or on parole in New York City. As many as 70% of the felons reported regular use of illicit drugs prior to their incarceration and over 50% said that they were drug addicted. Further, over a third of the respondents said that they were high on drugs when they committed homicide and about 50% said that their victims were high at the time of death. Almost two-thirds of the felons said they perceived the homicides they committed as directly related to their drug use, primarily alcohol, crack cocaine, and powdered cocaine. International J of the Addictions, in press.
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