Etiology, Prevention, and Epidemiology Research
Increased Smoking Among Adolescents and Link to Marijuana Use:
Reporting on their 20th national survey of American high school seniors and their fourth national survey of eighth and tenth grade students (both conducted in 1994), Drs. Lloyd Johnston, Patrick O'Malley, and Jerald Bachman, all at the University of Michigan, reported that cigarette smoking is on the increase among students at all three grade levels. The national smoking results were released separately for the first time this year because smoking data usually get lost in the larger story about illicit drug use. After more than a decade of level cigarette usage rates, twelfth graders showed an increase which began in 1992, with 30-day prevalence rising from 27.8% in 1992 to 31.2% in 1994. The increases among the younger students started earlier and were greater in proportional terms: among eighth graders, 30-day prevalence increased from 14.3% to 18.6% between 1991 and 1994, and among tenth graders it increased from 20.8% to 25.4% over the same interval. Increases in the daily smoking rates were of the same order of magnitude. Increases appear to be very broad and are found in virtually all demographic subgroups. The investigators note that peer norms against smoking have been receding in the past few years, advertising and promotion have been increasing, and that portrayals of cigarette smoking in entertainment programming may be on the rise. They find that youngsters seriously underestimate the dangers of smoking, with only about half of the eighth graders saying that a person runs a "great risk of harming themselves (physically or in other ways)" if they smoke a pack-or-more of cigarettes per day. They also report from their panel studies that many smokers have not been able to quit smoking five years after high school even though they said they would in twelfth grade. The study's latest findings on marijuana use, presented at the NIDA-sponsored National Marijuana Conference in July, noted the very high degree of association between cigarette smoking and all forms of drug use, but particularly between cigarette smoking and marijuana use. For example, among eighth graders fewer than 3% of those who never smoked cigarettes had ever tried marijuana versus 73% of those who were current pack-a-day smokers. In the great majority of cases cigarette use began prior to the use of the illicit drugs. The increase in cigarette smoking in recent years may be one factor contributing to the increase in marijuana use.
Community Epidemiology Work Group Reports:
The biannual meeting of the Community Epidemiology Work Group (CEWG) was held in Chicago, Illinois on June 13-16, 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 remains the most serious drug problem in the country in terms of prevalence and consequences, but data suggest an aging effect and level or declining trends in many areas. Reports also suggest an increasingly negative image of cocaine among youth.
- Indicators of heroin use, including morbidity, mortality and treatment data, continue to show an increasing trend. Treatment admission for primary heroin use has surpassed cocaine admissions in Newark, New York, Boston, San Francisco and Los Angeles. Three populations of abusers are appearing: an aging cohort of addicts who are switching to intranasal use; crack users who combine heroin with crack; and in some areas a cohort of new younger users among which heroin has become part of the club scene.
- As reported previously, a variety of opiates other than heroin are abused in various CEWG sites: propoxyphene in Seattle, New Orleans, Dallas and Phoenix; codeine in Detroit, San Francisco, Minneapolis/St. Paul, Chicago, New York and Phoenix; hydrocodone in Detroit, Phoenix, Dallas, New Orleans and San Francisco; oxycodone in Boston, Philadelphia and New York; hydromorphone in Atlanta, New Orleans, New York, Phoenix and St. Louis and fentanyl in Boston.
- Quantitative data and qualitative reports continue to indicate increasing marijuana use, especially among adolescents, across the country. The use of blunts (gutted cigars refilled with marijuana is prevalent throughout the country both in urban areas and in the suburbs. In many areas blunts are combined with other drugs, such as crack and PCP.
- Methamphetamine abuse is the most frequently reported primary drug of abuse among treatment admissions in San Diego and Honolulu and indicators of abuse have are increasing in Denver, Los Angeles, Minneapolis/St. Paul, San Francisco, Seattle and areas of Texas. Trafficking appears to be shifting from outlaw bikers to large-scale operations run by Mexican nationals. Among other stimulants, methylphenidate is commonly abused in Chicago, MDMA is reported in Atlanta, Denver, Detroit, Miami, New Orleans, St. Louis, San Francisco and in various areas of New Jersey and Texas; and methcathinone indicators suggest availability and abuse in Michigan's Upper Peninsula, Wisconsin and Minnesota.
- Flunitrazepam abuse has been spreading rapidly across Florida and Texas among a variety of populations, including gang members, cocaine addicts and high school students. Indicator data and other reports confirm its availability and abuse throughout the country, but largely concentrated in Florida, Louisiana, Texas and Arizona.
- A resurgence of PCP abuse appears to be occurring, especially in the Washington, D.C. area and in Chicago, Miami and in Texas. LSD also appears to be resurging in San Francisco and in Atlanta, Denver, Minneapolis/St. Paul, Miami and New York. Club drugs that are appearing include ketamine in Miami and St. Louis and "nexus" in Atlanta.
Natural History of Drug Use:
The natural history of involvement in various classes of drugs, and in particular, patterns of initiation, persistence and cessation, was investigated from adolescence to the mid-thirties by Dr. Denise Kandel and her colleagues. The period of risk for initiation into alcohol, cigarettes and marijuana largely terminates by the early twenties, while for cocaine it lasts until the late twenties. The largest proportion of new use after age 29 is observed for prescribed psychoactives. There appears to be a maturational trend in the use of marijuana and alcohol but not for cigarettes. The late teens and early twenties are the periods of highest use for alcohol, marijuana and cocaine, with sharp declines thereafter. This is in contrast to cigarettes, for which periods of highest use are distributed almost evenly from the early twenties through the end of the observational period at age 34-35. Not only does the prevalence of high frequency use decline in adulthood, but for most substances, except cigarettes, the quantities consumed during periods of heavy use decline as well. Furthermore, persistent use of the less commonly used illicit drugs preserves the use of more commonly used illicit and licit drugs. Cigarettes smoking, manifested in regular and persistent usage throughout adulthood, constitutes one of the most serious drug-related health problems in the population. Most drug-related intervention programs, whether focused on prevention or on treatment, must target adolescents and young adults in their early to mid-twenties. By the mid-twenties, most drug use is discontinued. Chen, K. & Kandel, D.B. The Natural History of Drug Use from Adolescence to the Mid-Thirties in a General Population Sample. American Journal of Public Health 85 (1):41-47, 1995.)
Research Center for Education and Drug Abuse Research (CEDAR), University of Pittsburgh:
Research studies on vulnerability to drug use at the University of Pittsburgh (Ralph Tarter, PI) demonstrate that childhood conduct disturbances (Moss, Vanyukov, Majumder, et al., 1995), heightened aggression (Moss, Mezzich, Yao, et al., 1995), and temperament deviations (B1ackson, 1995) are over-represented in children from substance abuse families. Such children also have significantly lower IQ scores, poorer school performance and impairments of the executive functions of the brain, which are generally accepted to be localized to the prefrontal cortex. CEDAR studies show that these conduct disturbances are transmissible within families. These findings have been integrated into an epigenetic model of substance abuse liability describing the developmental trajectory that unfolds concomitant to quality of person-environment interactions (Tarter, Moss, and Vanyukov, 1995). CEDAR research on biological components of substance abuse liability provides electrophysiological evidence of altered neurocognitive functioning among high risk children (Brigham, Herning, Moss, et al, 1995), and preliminary evidence of an association between a polymorphic gene and early-onset substance abuse (Vanyukov, Moss, Yao, et al., 1995). CEDAR research projects are based on prospective, longitudinal data from high and low risk 10-12 year old subjects (250 male and 200 female) drawn from substance abuse and control families tracked biannually. The studies employ a comprehensive biopsychosocial protocol including methods from molecular and quantitative genetics, neuro- and reproductive endocrinology, neurochemistry, electro- and psychophysiology, diagnostic psychiatric evaluation, neuropsychological tests of brain function, self-report and laboratory tests of psychological functioning, in vivo family interaction study, home and neighborhood visits to assess child's ecology and peer as well as teacher informant reporting. CEDAR's overarching mission is to disaggregate the multifactorial liability to substance abuse. These findings are based on a few of over 40 papers published and accepted for publication by CEDAR researchers between January and July 1995:
Blackson, T., Temperament and IQ Mediate the Effects of Family History of Substance Abuse and Family Dysfunction on Academic Achievement. Journal of Clinical Psychology, 51:1955:113-122.
Brigham J., Herning, R.I., Moss, H.B., Murrelle E.L. & Tarter, R.E. Event-Related Potentials and Alpha Synchronization in Preadolescent Boys at Risk for Substance Abuse. Biological Psychiatry, 37:1995:834-846.
Moss, H.B., Vanyukov, M.M., Majumder, P.P., Kirisci, L. & Tarter, R.E. Prepubertal Sons of Substance Abusers: Influences of Parental and Familial Substance Abuse on Behavioral Disposition, IQ, and School Achievement. Addictive Behaviors, 20:1995:1-4.
Moss, H.B., Mezzich, A, Yao, J.K., Gavaler, J. & Martin, C. Aggressivity Among Sons of Substance Abusing Father: Association with Psychiatric Disorder in the Father and Son, Paternal Personality, Pubertal Development and Socioeconomic Status. American Journal of Drug and Alcohol Abuse, 21(2):1995:195-208.
Tarter, R.E., Moss, H.B. & Vanyukov, M. Behavior Genetic Perspective of Alcoholism Etiology. In H Begleiter & B Kissin (Eds.), Alcohol and Alcoholism (Vol 1): Genetic Factors and Alcoholism. New York: Oxford University Press, 1995.
Vanyukov, M.M., Moss, H.B., Yu, L.M., Tarter, R.E. & Deka R. Preliminary Evidence for an Association of a Dinucleotide Repeat Polymorphism at the MAO-A Gene with Early Onset Alcoholism/Substance Abuse. American Journal of Medical Genetics (Neuropsychiatric Genetics), 60:1995:122-126.
Drug Use and Deviant Behavior:
Stacy and Newcomb explored the extent to which drug use, as one form of deviance, may influence another form of deviance (crime and violence) over time. The effects of adolescent drug use on criminal deviance and social conformity, an attempt to see if theories of associations between different forms of deviance showed merit, were examined over an 8 year period (N=536; 72% women). The predictive effects of several constructs relevant to traditional theoretical perspectives (strain, control, and differential association theories) were also investigated. Results showed that a general factor of drug use in adolescence (rather than use of only certain, specific drugs) significantly predicted criminal deviance in adulthood. This finding is consistent with several theories suggesting that different forms of deviance may influence each other over time. In particular, the results were consistent with theories that suggest that effects of drug use on crime operate through a general factor of polydrug use on deviance, unmediated by differential association or by specific drug effects. Theories that rely on disinhibiting, addictive, and/or illegal properties of a specific drug were not supported by these results. Finally, social support was found to negatively predict one specific type of criminal deviance (violent confrontations) over time, consistent with control theory. That is, individuals with greater social support in adolescence exhibited less violence as adults. Stacy AW & Newcomb MD. LongTerm Social Psychological Influences on Deviant Attitudes and Behavior. In H.B. Kaplan (Ed.), Drugs, Crime and Other Deviant Adaptations. New York: Plenum: 1995.
Gene-Environment Interaction in Genesis of Aggressivity and Conduct Disorder:
This study examined the effect of an adverse adoptive home environment upon adoptee conduct disorder, adult antisocial behavior, and two measures of aggressivity - behaviors which contribute to adult antisocial personality and which also are associated with increased vulnerability to drug abuse/dependency. Remi J. Cadoret, M.D. and his colleagues used an adoption paradigm in which adopted away (at birth) offspring of biologic parents with documented (by prison and hospital records) antisocial personality and/or alcohol abuse/dependency were followed up as adults. Multiple regression analysis was used to measure separately genetic and environmental effects. Conclusions indicated that environmental effects and gene-environment interaction account for significant variability in adoptee aggressivity, conduct disorder and adult antisocial behavior. Cadoret, R.J., Yates, W.R., Troughton, E, Woodworth, G. & Stewart, M.A. Gene-Environment Interaction in Genesis of Aggressivity and Conduct Disorders. Archives of General Psychiatry, 10, 1995.
Drug Use, Delinquency and Dropping Out of School:
This study based on data from the Rochester Youth Development Study, examines the effect of drug use and delinquency on the probability that adolescents will drop out of school and the effect that dropping out of school has on subsequent drug use and delinquency. Dr. Terence P. Thornberry and his colleagues found that prior drug use increased the probability of dropping out of school by 18%, while serious delinquency did not significantly increase the likelihood of dropping out. Dropping out of school predicts subsequent drug use but not serious delinquency when other school related variables are not included in the equation. However, when school related variables are included in the equation the relationship between dropping out and subsequent drug use is not significant. This suggests that dropping out of school may be a proxy for other sources of dissatisfaction with school. To respond to problems of both drug use and school drop outs, the reasons for dissatisfaction with and failure in school must be addressed. Krohn MD, Thornberry T.P., Collins-Hall L & Lizotte, A.J. School Dropout, Delinquent Behavior, and Drug Use: An Examination of Causes and Correlates of Dropping Out of School. In Howard B. Kaplan (Ed.), Drugs, Crime, and Other Deviant Adaptations: Longitudinal Studies. New York: Plenum Press, 1995, 163-183.
Cumulative Effect of Protective Factors
The Rochester Youth Development Study is an ongoing panel study of urban adolescents. Terence P. Thornberry, Ph.D. first selected youth at high risk for drug use and then identified protective factors associated with resilient outcomes. A number of variables in the areas of school (e.g., high achievement), family (e.g., supervision), and peer relations (e.g., having conventional friends) were found to protect against the risk of drug use. The most important finding concerns the cumulative effect of protective factors; only 14% of the high-risk youth who had at least six protective factors actually used drugs, an effect that persisted but at diminished levels over the next three years. Smith C, Lizotte, A.J., Thornberry, T.P. & Krohn, M.D. Resilient Youth: Identifying Factors that Prevent High-Risk Youth from Engaging in Delinquency and Drug Use. In John Hagan (Ed.), Delinquency and Disrepute in the Life Course. Greenwich, C.T.: JAI Press, 1995, 217-247.
Fatal Injuries After Cocaine UseP
The neurobehavioral effects of cocaine use may increase the likelihood that users will receive fatal injuries. In a toxicologic study of 14,843 New York City residents who died of fatal injuries from 1990 to 1992, cocaine use, as detected by benzoylcgonine in the urine or blood, was found in 26.7 percent of decedents, and free cocaine was detected in 18.3 percent. Among fatal injury victims 15 to 44 years of age, cocaine was as likely to be detected as alcohol. Approximately one-third of deaths after cocaine use were the direct result of drug intoxication, but two-thirds involved traumatic injuries resulting from homicides, suicides, traffic accidents, and falls. If considered as a separate cause of death, fatal injury after cocaine use ranked among the five leading causes of death of persons 15 to 44 years old in New York City. In some age groups, the number of these fatal injuries exceeded deaths from AIDS, other fatal injuries not known to involve cocaine, cancer, and heart disease. This study suggests that despite reported declines in the overall rate of cocaine use in the 1990s, certain segments of the population, particularly members of minority groups, may be continuing their heavy drug use and are at high risk of fatal consequences. Marzum, PM; Tardiff, K; Leon, A.C., Hirsch, C.S., Stajic, M., Portera, L., Hartwell, N., Iqbal, MI. Fatal Injuries After Cocaine Use as a Leading Cause of Death Among Young Adults in New York City. New England Journal of Medicine, 332:1995:17531757.
Antecedents and Consequences of Drug Abuse:
Predictors and outcomes of various types of drug use are examined in prospective data spanning four years in the lives of young adult men and women (N=547, 156 women). It was hypothesized that the causes and consequences of drug use are different for this stage of life (compared to childhood and adolescence) and would involve gender-role expectations that women are most directed toward communality issues, whereas men are concerned with agenetic tasks. It was also hypothesized that failure in these gender-specific tasks would lead to more future drug use and that earlier drug use would hinder the development of these skills for men and women. Analyses were conducted with structural equation models incorporating repeatedly-measured constructs of polydrug use, communality, and agency. Results generally supported these expectations when both specific and general effects were considered. In addition, women's drug use also interfered with their agenetic goals and men's drug use damaged their communal relationships. Newcomb, M.D., & Jack, L.E. Drug Use, Agency, and Communality: Causes and Consequences Among Adults. Psychology of Addictive Behaviors, 9:1995:67-82.
Female Gangs and Involvement of Women in Drug Distribution:
Joan Moore and John Hagedorn who previously studied male gangs, conducted an ethnographic study of female gangs. As with the males, not all gang members are the same: Legits have left the gang and "hood" behind; Dope fiends are addicted to cocaine and need drug treatment; New jacks have given up on the legal economy and see no wrong in selling cocaine to anyone; Homeboys/Homegirls, the majority, work regular jobs but when they can't make enough money, sell cocaine which bothers them because they want to settle down and have a decent life. Gangs fall apart over selling drugs which is typically done by individuals who compete with one another. Among African American and Hispanic gangs, sales are more to Whites, outsiders, and middle class customers; markets are closed to rival gangs and as profits increase, gangs tend to become more organized. Latinos tend to stay involved with their gang as adults while adult African Americans tend to be less involved with their gang. Moore, J. & Hagedorn, J. Gangs in America, R. Huff, (ed.), 1995.
Prevention Interventions for Tobacco Use
The development of interventions for the prevention of tobacco use is an ongoing concern, particularly in minority communities. Examination was made of the prevalence and sociodemographic predictors of having a cigarette brand preference in African-American, Mexican-American, and White primary and secondary school students. Cross-sectional data were used from a school based survey of drug use sequencing conducted in 1992 which included students from 47 schools. The prevalence of having a preferred brand of cigarette increased with grade level, with over 20% of 11th graders reporting a preference. White females and males, and Mexican-American males were more likely to have a preferred brand of cigarette than African-American females and males, and MexicanAmerican females. Brand preference was related to cigarette use in a dose response fashion for all subgroups, with African-American "regular" smokers most likely to report a preferred brand of cigarette. Cigarette brand preference was a strong risk factor for daily cigarette use. Volk, R.J., Edwards, D.W., Lewis, R., Schulenberg, J. Paper presented at Research Society on Alcoholism, June 1995.
The Role of Sexual Assault in Adolescent Pregnancy and Drug Use:
In a longitudinal natural history of drug use among young women who become pregnant before reaching age 18 (N=241) 32% reported a history of early forced sexual intercourse (rape or incest) according to Dr. Lewayne Gilchrist and her colleagues at the University of Washington, Seattle. These adolescents compared with non-victims used more crack, cocaine, and other drugs (excepting marijuana), had lower self-esteem, and engaged in a higher number of delinquent activities. A discriminant function analysis incorporating a model of negative consequences of early forced intercourse (which included drug use variables) distinguished reported victims from non-victims 67% of the time. Roughly half the sample is non-white (28% African-American; 8% American Indian, 5% Latinas, 4% Asian; 4% mixed ethnicity). All are low-income. They represent the population of young urban women who received at least minimal services from health and social service providers serving pregnant women and were not recruited on the basis of known drug use. Being pregnant, unmarried, under 18, and planning to parent their child were the inclusion criteria. Subjects average age was 16 (range=12 to 17). Self report and urine toxicology analyses were used to assess drug use. Less than 0.5% of self-report drug use had to be adjusted based on lab results. The principle question eliciting the intercourse data was "Have you ever been forced to have sex when you had no choice and had to do it?" Findings indicate that drug use among the teen pregnancy population may be part of a syndrome of effects associated with sexual abuse among girls. Rates for sexual abuse as well as for drug use before and after pregnancy in this school-age sample were high. Forced sex may be one of many aspects of a context of risk that affect drug initiation and maintenance of drug use among young women of child-bearing age. The effects of early forced intercourse are detectable in their women's psychological, behavioral, and social functioning several years after the original incident. (Lanz, J.B. Psychological, Behavioral, and Social Characteristics Associated with Early Forced Sexual Intercourse Among Pregnant Adolescents. Journal of Interpersonal Violence, 10(2):1995:188-200.)
Undernutrition Significantly Associated With More Drug Use:
Factors associated with undernutrition in a broad community-based sample of 457 homeless adults (M=344, F=113; 16 to 78 years, mean age 34 years) were examined. Latent variables representing drug use, alcohol use, a stereotyped homeless appearance, mental illness, poor physical health status and measured variables of age, gender, income, and number of free food sources were used as predictors of undernutrition. Undernutrition was indicated with three anthropometric measures (weight, triceps skinfold, and upper arm muscle area in the lowest 15th percentile) and one observational measure. Of this sample, 33% was undernourished as defined by at least one of the anthropometric measures. Undernutrition was significantly associated with more drug use, fewer free food sources, less income, and male gender. Gelberg L, Stein J.A. & Neumann C.G. Determinants of Nutritional Status Among Homeless Adults. Public Health Reports, 110:1995:448-454.
Drug Use and the Severity of Homelessness:
Latent variable multiple-group confirmatory factor analyses assessed gender differences in relations among drug and alcohol use, measures indicating severity of homelessness, criminal history, prior institutionalization, and mental illness (N=531 homeless persons, [145 women]; age 16-78; mean age 34 years). Severity was indicated by time homeless, housing quality, and victimization. Men reported more substance use, a longer time homeless, poorer housing quality, greater criminal involvement, and less likelihood of living with a child. Constrained multiple-group models surfaced five significantly different relationships between latent constructs. Men had stronger relationships between mental illness and prior institutionalization, drug use and mental illness, and drug use and victimization, whereas women had stronger relationships between drug use and alcohol use, and criminal involvement and drug use. Stein, J.A., & Gelberg L. Homeless Men and Women: Differential Associations Among Substance Abuse, Psychosocial Factors, and Severity of Homelessness. Experimental and Clinical Psychopharmacology, 3:1995:75-86.
Long-term Efficacy of Intervention Efforts to Reduce Anger:
Oetting et al. have conducted a fifteen month follow up (n=140) comparing three different intervention approaches to general anger reduction in college students. The three compared approaches were inductive social skills training, assembly social skills training, and cognitive-relaxing coping skills. Findings for anger reduction at the 15 month follow-up showed consistent, long term maintenance of intervention effects including less trait and general anger, less anger in response to various situations, and lower anger related physiological arousal than did members of the control group. Intervention groups did not differ significantly from one another. However, there was a lack of change on nontargeted measures. This argues that the effects obtained were specific to the planned intervention and there was no generalizability to other situations. It appears that generalization of principles and strategies to other concerns (e.g., drug abuse prevention intervention efforts) would need to be systematically built into the anger reduction drug abuse prevention programs. Deffenbacher, J.L., Oetting, E.R., Huff, M.E., Thwaites, G.A., Fifteen-Month Follow-Up of Social Skills and Cognitive-Relaxation Approaches to General Anger Reduction, Journal of Counseling Psychology, 42(3) 400-405, 1995.
Factors Mediate Relationship Between Temperament and Substance Abuse
Recent research has shown that the temperament characteristic of high activity level among early adolescents is a risk factor for substance use, whereas positive mood protects against substance use. The effect of temperament is not direct, but is mediated through self-regulation and coping variables. In this model derived by Thomas Wills and his colleagues from their data, the mediating variables of behavioral coping and self-control are related to constructs of maladaptive coping (anger and helplessness) and novelty seeking (sensation seeking and risk taking), which in turn are related to affiliation with substance-using peers, the proximal factor for becoming involved in substance use. These findings are based on cross-sectional data from a sample of 1,826 7thgrade public school students (mean age 12.3 years) who were 27% African-American ethnicity, 24% Hispanic ethnicity, and 36% Caucasian ethnicity. Self-report questionnaires were administered to students in classrooms by project staff using a standardized protocol. The questionnaire included five scales from the Revised Dimensions of Temperament Survey (Windle & Lerner, 1986) and items on tobacco, alcohol, and marijuana use. The study findings emphasize the importance of self-regulation ability as a construct that is antecedent to deviant peer affiliations. (Wills, T.A., DuHamel, K. & Vaccaro, D. Activity and Mood Temperament as Predictors of Adolescent Substance Use: Test of a Self-Regulation Mediational Model. Journal of Personality and Social Psychology, 68:1955:901-916.)
African American 8th, 10th, and 12th Grade Students:
J.M. Wallace and colleagues at the Institute for Social Research analyzed self-reported drug use data from a nationally representative sample of African American 8th, 10th, and 12th grade students, collected as part of the Monitoring the Future project. In a chapter of Multi-Ethnic Drug Abuse Prevention (edited by G. Botvin, S. Schinke, and M. Orlandi; Sage Publications, in press, 1995), the authors report their findings, including: African American high school students initiated illicit drug use later than their white counterparts; if they used cocaine, they tended to use more of the drug more frequently than white students; prevalence rates of illicit drug use among African American students appear to be increasing over time; and predominately low income, African American communities had a disproportionate share of retail liquor outlets relative to geographic and population densities, indicating that community residents are at an increased risk of alcohol consumption and alcoholrelated morbidity and mortality.
Sensation Seeking and Drug Use Among High Risk Latino and Anglo Adolescents:
Sussman and associates examined the relationship between sensation seeking and drug use in a sample of white and Latino southern California adolescents enrolled in continuation high schools. The 11 item sensation seeking portion of the Zuckerman Kuhlman Personality Questionnaire was found to have adequate reliability and to be positively associated with use of each of the drugs examined. Sensation seeking was examined as a correlate of self reports of tobacco, alcohol, marijuana, cocaine, stimulants, and LSD use. The relationship between sensation seeking and drug use was found to vary across ethnic backgrounds. Among white students sensation seeking was positively associated with drug use only among those with low to moderate scores on sensation seeking. Among the Latino students increased sensation seeking levels were consistently associated with increased drug use. Differences were found in the pattern of drug use across ethnicity. White students reported significantly higher use levels of tobacco, stimulants, and LSD than did the Latino students. Latino students reported trying fewer drugs than white students. The ranking of drugs by level of use also differed across ethnicity. Among white students tobacco was the most commonly used drug and cocaine the least used. Among the Latino students alcohol was the most commonly used drug and LSD showed the lowest use levels. These findings suggest that different norms may be operating across ethnic groups. Adolescents who are high in sensation seeking needs may benefit from programs designed to direct those needs in healthy directions. Simon, T., Stacy, A., Sussman, S., Dent, C. Sensation Seeking and Drug Use Among High Risk Latino and Anglo Adolescents. Personal Individual Differences, 17, 665, 1994.
Integrating Theories of Adolescent Substance Use
Over the decades, scientists have advanced a number of theories in the attempt to understand why some adolescents experiment with substance use while others do not. To make sense of these theories, researchers at the University of Illinois at Chicago have developed a model of adolescent experimental substance use that integrates aspects of theories based on substance-specific cognitions, social learning processes, commitment to conventional values and attachment to families, and intrapersonal processes. Commitment and attachment theories and intrapersonal theories show how adolescents become involved with deviant peers; social learning theories show how this involvement affects an adolescent's beliefs about substance use; and cognitive-affective theories show how substancespecific beliefs affect initial use. A rapprochement among these theories is possible because they are largely complementary. The integrated theory proposes a matrix reflecting the crossing of three types of influence (social, attitudinal, and intrapsychic) and three levels of influence (proximal, distal, and ultimate); definitions and constructs associated with each matrix cell are provided. The cell representing the ultimate level of intrapersonal influences, for example, focuses on personality traits and inherited dispositions that are difficult to modify, such as genetic susceptibility, lack of impulse control, external locus of control, aggressiveness, extraversion, risktaking, sensation seeking, sociability, and chronic emotionality. By contrast, other intrapersonal features appear as distal (i.e., intermediate) causes of experimental substance use because they appear somewhat more controllable by adolescents; these include changeable affective states (e.g., low self-esteem, anxiety, and depressed affect) and general behavioral skills (e.g., poor social and academic skills) that might contribute to experimentation with substance use. Flay B.R., Petratis, J., & Miller T.Q. Reviewing Theories of Adolescent Substance Use: Organizing Pieces of the Puzzle. Psychological Bulletin, 117: 1995:67-86.