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National Institute on Drug Abuse

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

February, 2000

Research Findings

Epidemiology, Etiology and Prevention Research

Ethnographic Study Explores Link Between Non-injecting Heroin Use and Heroin Markets

Ethnographers in New York City explored the shifting dynamics of the retail heroin markets on the Lower East Side, how market conditions affected non-injecting heroin users' routes of administration and patterns of use, and the ways in which non-injecting heroin users adapt to illegal heroin markets experiencing increased attention from law enforcement. Heroin markets have proven to be highly adaptable in response to increased police enforcement activities aimed at controlling the supply of heroin. This adaptability is reflected in the increasing number of heroin users in spite of police surveillance and crackdowns. Two key changes in the heroin markets are linked to the rise in heroin use as law enforcement also had increased: one is an expansion of the market through mobile communication devices (e.g., pagers and cellular phones) and the other is direct retail sales through loosely organized drug networks that provide delivery services for heroin distribution to the suburbs. Changes in the retail heroin market are associated with an increasingly more heterogeneous and dispersed customer base, including many more women who sniff heroin and become intermediates in drug distribution and marketing. Use patterns are "elastic" in response to changes in heroin supply and purity of the drug; occasional users are more likely to stop using when purity declines and supply diminishes, but heavily dependent non-injectors are more likely to transition to injecting drug use to achieve their high. Andrade, X., Sifaneck, S., and Neaigus, A. Dope Sniffers in New York City: An Ethnography of Heroin Markets and Patterns of Use. J Drug Issues, 29(2), pp. 271-298, 1999.

Drug Paraphernalia Laws and Injection-Related Infectious Diseases among IDUs

Drug paraphernalia laws in 47 U.S. states make it illegal for IDUs to possess syringes. Researchers examined the relationship between concern about arrest while carrying drug paraphernalia and injection-related risk behaviors among street-recruited IDUs in Northern California. They found that, of 424 IDUs interviewed, 150 (35%) reported concern about being arrested while carrying drug paraphernalia. In multivariate analysis, IDUs concerned about being arrested were significantly more likely than others to share syringes and injection supplies. The authors argue for a reconsideration of the consequences of drug paraphernalia laws to help IDUs reduce their risks for transmitting blood-borne viruses. Bluthenthal, R., Kral, A., Erringer, E., and Edlin, B. Drug Paraphernalia Laws and Injection-Related Infectious Diseases among Drug Injectors. J Drug Issues, 29(1), pp. 1-16, 1999.

ADHD and Early Drug Use

This study followed a community-based sample of low birth weight and normal birth weight children and their mothers, initially assessed at age 6 and followed up at age 11. Several findings are of note. Both low birth weight and normal birth weight subjects with ADHD (attention deficit hyperactivity disorder) were found to have increased risk of substance use by age 11. However, there was an interaction effect between ADHD and externalizing problems: children with low levels of externalizing problems were at low risk, and children with high levels of externalizing problems were at high risk for drug use, regardless of ADHD status. It was at moderate levels of externalizing problems that children with ADHD demonstrated increased risk for early drug use. Internalizing problems did not predict early drug use. The risk for drug use did not differ between those children who did or did not receive pharmacotherapy [usually methylphenidate (Ritalin)] as treatment for ADHD. Low parental monitoring and peer drug use were associated with increased risk for early drug use. Maternal history of depression, anxiety disorder, or substance abuse or dependence did not change the relationship between ADHD and children's drug use. Chilcoat, H.D. and Breslau, N. Pathways From ADHD to Early Drug Use. Journal of the American Academy of Child and Adolescent Psychiatry, 38, pp. 1347-1354, 1999.

Childhood Victimization and Drug Abuse: Comparison of Prospective and Retrospective Findings

This study examined whether childhood victimization increases risk for drug abuse using prospective and retrospective victimization information. Substantiated cases of child abuse/neglect from 1967 to 1971 were matched on gender, age, race, and approximate social class with nonabused/nonneglected children and followed prospectively into young adulthood. Between 1989 and 1995, 1,196 participants (676 abused/neglected and 520 control) were administered a 2-hr interview, including measures of self-reported childhood victimization and drug use/abuse (NIMH Diagnostic Interview Schedule--Version III--Revised). Prospectively, abused/neglected individuals were not at increased risk for drug abuse. In contrast, retrospective self-reports of childhood victimization were associated with robust and significant increases in risk for drug abuse. The relationship between childhood victimization and subsequent drug problems is discussed and is more complex than originally anticipated. Widom, C.S., Weiler, B.L., and Cottler, L.B. Childhood Victimization and Drug Abuse: Comparison of Prospective and Retrospective Findings. Journal of Consulting and Clinical Psychology, 67(6), pp. 867-880, 1999.

Smoking Initiation and Escalation in Early Adolescent Minority Girls

The objective of this study was to examine the effectiveness of a drug abuse prevention program in reducing the initiation and escalation of smoking in a sample of predominantly minority 7th grade girls. The 15-session prevention intervention teaches social resistance skills within an intervention designed to promote personal and social competence skills. Smoking rates among girls from 29 New York City public schools who received the program (n=1,278) were compared with those of a control group of girls (n=931). Participants were less likely to initiate smoking compared to controls. There were also significant program effects on smoking intentions, smoking knowledge, perceived peer and adult smoking norms, drug refusal skills, and risk taking. Experimental smokers in the intervention group were less likely to escalate to monthly smoking relative to controls. Botvin, G.J., Griffin, K.W., Diaz, T., Miller, N. and Ifill-Williams, M. Smoking Initiation and Escalation in Early Adolescent Girls: One-Year Follow-Up of a School-Based Prevention Intervention for Minority Youth. Journal of the American Medical Women's Association, 54, pp. 1-6, 1999.

A Six-Year Follow-Up Study of Determinants of Heavy Cigarette Smoking Among High-School Seniors

Most adult cigarette smokers start smoking during adolescence. Few studies, however, have focused on adolescents that are heavy smokers. This study examined the link between risk and protective factors measured during early adolescence and heavy smoking when youth were high-school seniors. As part of a school-based survey, seventh grade students (N=743) reported on experimentation with psychoactive substances and psychosocial factors associated with smoking. By twelfth grade 12% of students (n=88) smoked a pack of cigarettes or more each day. Heavy smoking was predicted by: poor grades, experimentation with cigarettes or alcohol, a mother or many friends that smoke, and risk-taking behaviors in the seventh grade. Anti-smoking attitudes and those of one's parents and friends predicted rates of heavy smoking among girls in high school. Early intervention programs that address the social and psychological determinants of smoking may have important preventive effects in terms of experimental smoking and in later heavy smoking. Thus, prevention efforts that reduce, delay, or prevent early experimentation with smoking may significantly reduce heavy cigarette consumption in later adolescence and adulthood. Griffin, K.W., Botvin, G.J., Doyle, M.M., Diaz, T. and Epstein, J.A. A Six-Year Follow-Up Study of Determinants of Heavy Cigarette Smoking among High-School Seniors. Journal of Behavioral Medicine, 22, pp. 271-284, 1999.

Adverse Effects of Grouping Deviant Youth

Recent research has suggested potential harmful effects of group-based skill training for children and adolescents with externalizing problems. This article reviews four types of evidence from published literature on the role of deviant peers in the socialization of aggressive youth, studies reporting adverse treatment effects for grouped interventions, studies comparing treatment outcomes that differed in the extent to which participants were grouped with deviant peers, and studies that highlight variables that mediate negative treatment outcomes. The review supports the conclusion that grouping deviant youth in treatment may produce unintended, harmful effects. Arnold, M.E. and Hughes, J.N. First Do No Harm: Adverse Effects of Grouping Deviant Youth for Skills Training. Journal of School Psychology, 37, pp. 99-115, 1999.

10-Year Follow-Up of Project DARE

The present study examined the impact of Project DARE (Drug Abuse Resistance Education), a widespread drug-prevention program, 10 years after administration. A total of 1,002 6th grade students who had either received DARE or a standard drug-education curriculum, were reevaluated at age 20. Few differences were found between the 2 groups in terms of actual drug use, drug attitudes, or self-esteem, and in no case did the DARE group have a more successful outcome than the comparison group. Lynam, D.R., Milich, R., Zimmerman, R., Novak, S.P., Logan, T. K., Martin, C. Leukefeld, C., and Clayton, R.R. Project DARE: No Effects at 10-year Follow-Up. Journal of Consulting & Clinical Psychology, 67, pp. 590-593, 1999.

Early Deviance in the Children of Narcotic Addicts

This descriptive study examined the self-reported behaviors of 285 male and female adolescent children (aged 12-17 yr) of narcotic addicts participating in methadone maintenance programs. These children responded to an 2.5-hour interview questionnaire focusing on current and past activities, including criminal activities prior to age 12. Findings revealed that early deviance, assessed by measures of both severity and variety, was related to current adolescent drug and alcohol use, association with deviant peers, a negative view of home atmosphere, and psychological symptomatology. These results are contrasted with the retrospective reports of adolescent behavior obtained from adult male narcotic addicts in a prior study of vulnerability to addiction. The comparability of study results is discussed in the context of developmental risk factors, prevention and treatment strategies, and other considerations specifically related to the development of children of narcotic addicts. Nurco, D.N., Blatchley, R.J., Hanlon, T.E., and O'Grady, K.E. Early Deviance and Related Risk Factors in the Children of Narcotic Addicts. American Journal of Drug & Alcohol Abuse, 25, 25-45, 1999.

Factors in Drug Use Initiation vs. Misuse in Women

This study applied a novel modeling technique to data from a sample of female twins, to estimate the role of genetic and environmental risk factors influencing initiation and subsequent misuse of illicit substances. A key feature of this approach is the capacity to distinguish between factors influencing initiation and misuse. The results suggest that shared environmental factors have a significant impact on the probability of drug use initiation, but no new influence on the risk for misuse once drug use is initiated. Furthermore, it appears that one set of genetic risk factors influences risk for initiation while another set appears important to the liability for misuse, once drug initiation has occurred. Kendler, K.S., Karkowski, L.M., Corey, L.A., Prescott, C.A., and Neale, M.C. Genetic and Environmental Risk Factors in the Aetiology of Illicit Drug Initiation and Subsequent Misuse in Women. British Journal of Psychiatry, 175, pp. 351-356, 1999.

Substance Use and Abuse in Female Twins

This study reports findings on the relative roles of environmental and genetic factors in the risk for use, abuse, and dependence on hallucinogens, opiates, sedatives, and stimulants; previous reports have already examined factors related to use and abuse of marijuana and cocaine. Results suggest that both genetic and familial factors contribute to twin resemblance for the more common patterns of hallucinogen and stimulant use, while twin resemblance on the less common use of opiates and sedatives as well as stimulant abuse and dependence were solely the result of genetic factors. These findings confirm the strong influence of family factors, including genetic factors, in the vulnerability to illicit substance use and abuse in women. Kendler, K.S., Karkowski, L., and Prescott, C.A. Hallucinogen, Opiate, Sedative and Stimulant Use and Abuse in a Population-based Sample of Female Twins. Acta Psychiatrica Scandinavica, 99, pp. 368-376, 1999.

Peer-Influence Versus Peer-Selection in Adolescent Substance Use

The correlation between individual adolescents' substance use and substance use by members of their peer groups may be explained by direct influence of peers who use substances or by substance-using adolescents' self-selection into groups of peers who are also users. Researchers at Yeshiva University used latent growth analyses to contrast peer-influence and peer-selection as mechanisms accounting for 6th-9th graders' tobacco, alcohol, and marijuana use. Participants were surveyed three times, at one-year intervals, about peers' substance use and their own use; Sample 1 had 1,190 participants (initial mean age = 12.4 years), Sample 2 had 1,277 participants (initial mean age = 11.5 years). Latent growth analyses that were based on composite scores indicated that initial peer use was positively related to rate of change in adolescent use, supporting the influence mechanism; there was little evidence for a selection mechanism. Difficult temperament, poor self-control, and deviance-prone attitudes were related to initial levels for both peer and adolescent use. It is concluded that peer influence is the primary mechanism during middle adolescence. Temperament-related attributes may be predisposing to early experimentation and deviant-peer affiliations. Wills, T.A. and Cleary, S.D. Peer and Adolescent Substance Use Among 6th-9th Graders: Latent Growth Analyses of Influence Versus Selection Mechanisms. Health Psychology, 18(5), pp. 453-463, 1999.

Correlates of Moderate Alcohol Use Versus Problem Alcohol Use

To evaluate the assumption that moderate alcohol use and problem alcohol use represent variations along the same continuum, researchers used a longitudinally ascertained community sample of 15-17-year-old children of alcoholics (COAs) and a demographically matched comparison group (non-COAs) and identified the correlates of adolescent alcohol use and those of problem use. A typology of adolescent alcohol use was created, and alcohol use groups were compared on variables chosen from nine psychosocial domains (parent alcohol use, family functioning, maternal parenting, paternal parenting, stress and emotional distress, peer influences, alcohol expectances, adolescent temperament/personality, and adolescent externalizing symptoms. The correlates of problem alcohol use were different from those of moderate use. Problem use was associated with fundamental family disruptions and poor psychological functioning. In contrast, the determinants of moderate alcohol use reflected unconventionality and socialization specific to alcohol. Few psychosocial variables distinguished abstainers from light drinkers. The findings are consistent with the idea that moderate drinking is associated with a sociocultural context that supports alcohol use while problem alcohol use is associated with psychosocial impairment. This implies that intervention researchers should articulate their outcome of interest and design interventions accordingly; prevention of alcohol problems, for example, might focus on reducing family disruptions and enhancing coping skills, whereas prevention of moderate adolescent drinking might focus on increasing negative expectances about alcohol use and encouraging affiliations with peers who do not use alcohol. Colder, C.R. and Chassin, L. The Psychosocial Characteristics of Alcohol Users Versus Problem Users: Data from a Study of Adolescents at Risk. Development and Psychopathology, 11(2), pp. 321-348, 1999.

Gender Differences in Drug Use Traced to Differences in Opportunity to Use

Researchers at Johns Hopkins University used data from the 1979-1994 National Household Surveys on Drug Abuse to examine whether male-female differences in rates of drug use could be traced back to differences in rates of exposure to initial opportunities to try drugs, rather than to sex differences in the probability of making a transition to use, once opportunity has occurred. Survey respondents were 131,226 US residents aged 12 years and older. The investigators estimated proportion of males and females with an opportunity to use marijuana, cocaine, hallucinogens and heroin; proportions reporting use among those having an opportunity to use each drug; proportion making a "rapid transition" from initial opportunity to initial use. They found that males were more likely than females to have an initial opportunity to use drugs. Once an opportunity had occurred, however, few male-female differences were observed in the probability of making a transition into drug use,. These results suggest that the previously documented male excess in rates of drug use may be due to greater male exposure to opportunities to try drugs, rather than to greater chance of progressing from initial opportunity to actual use. This suggests that sex differences in drug involvement emerge early in the process. Van Etten, M.L., Neumark, Y.D., and Anthony, J.C. Male-Female Differences in the Earliest Stages of Drug Involvement. Addiction, 94(9), pp. 1413-1419, 1999.

Boys' Externalizing Behavior Predicted by Individual Traits and Family Context

Evidence suggests the development of substance abuse is related to prior externalizing behaviors which, in turn, may be related to the temperament traits of parent and child and the quality of the parent-child relationship. These factors may play a mediational role in intergenerational transmission of substance abuse. In research using the CEDAR sample, investigators examined individual traits in a family context to identify processes that account for the relationship between fathers' SUD + status and sons' externalizing behaviors. Results obtained from SUD + (n = 89) and SUD - (n = 139) families show that individual traits, family contextual variables and deviant peer affiliations accounted for 58% of the variance on sons' externalizing behavior scale (EBS) scores. Fathers' abusive propensities toward their sons mediated the relationship between fathers' SUD + status and sons' EBS scores 2 years later. Also, high risk cluster (HRC) and low risk cluster (LRC) memberships were derived from cluster analyses of the continuous risk factor scores that predicted sons' EBS scores. Preliminary relative risk ratios show that sons classified into the HRC at age 10-12 were at greater risk for DSM-III-R conduct disorder and SUD outcomes at age 16 than sons assigned to the LRC, SUD + or SUD - groups. The results support the notion of an ontogenetic pathway to externalizing behavior problems that may be prodromal to CD and SUD outcomes and suggest the need for family-based prevention programs to that take account of family members' temperament traits and abusive propensities of parents toward their offspring in order to reduce the risk of CD and SUD outcomes. Blackson, T.C., Butler, T., Belsky, J., Ammerman, R.T., Shaw, D.S., and Tarter, R.E. Individual Traits and Family Contexts Predict Sons' Externalizing Behavior and Preliminary Relative Risk Ratios for Conduct Disorder and Substance Use Disorder Outcomes. Drug and Alcohol Dependence, 56(2), pp. 115-131, 1999.

The Epidemiology of Alcohol, Tobacco, and Other Drug Use Among Black Youth

This study examined the patterns, trends, and sociodemographic correlates of alcohol, tobacco, and other drug use within the black youth population. The data indicate that the drug most prevalent among black secondary students is alcohol, followed by tobacco and marijuana. By twelfth grade, 7 in 10 black secondary students have used alcohol, less than 50 percent have smoked cigarettes, 25 percent have used marijuana, and less than 2 percent have used cocaine. Trend data indicate that there were significant declines in drug use among black (and other) youth throughout the 1980s, but tobacco, alcohol, and marijuana have been on the increase throughout the 1990s. Data on the sociodemographic correlates of black students' drug use reveal that levels of substance use are, on average, higher among males than females and among students who do not live with either of their parents than among those who live with one or both parents. Although there is a trend toward lower levels of drug use among youth as parents' level of education increases, the relationship varies across drugs and grade level. The relationship between urbanicity and drug use varies considerably by drug. Finally, cigarette use is highest in the Northeast followed by the North Central region, the South, and the West; alcohol use is highest in the North Central region; and marijuana and cocaine prevalence rates vary by region, with use generally being lowest in the South. Wallace, J.M., Jr., Forman, T.A., Guthrie, B.J., Bachman, J.G., O'Malley, P.M., and Johnston, L.D. The Epidemiology of Alcohol, Tobacco and Other Drug Use among Black Youth. Journal of Studies on Alcohol, 60(6), pp. 800-809, 1999.

Social Influences on Adolescent Problem Behavior

The social context model of development of adolescent antisocial behavior advanced by G. R. Patterson et al. (1992) appears to generalize the development of a diverse set of problem behaviors. Structural equation modeling methods were applied to 18-month longitudinal data from 523 14-17 yr old adolescents. The problem behavior construct included substance use, antisocial behavior, academic failure, and risky sexual behavior. Families with high levels of conflict were less likely to have high levels of parent-child involvement. Such family conditions resulted in less adequate parental monitoring of adolescent behavior, making associations with deviant peers more likely. Poor parental monitoring and associations with deviant peers accounted for 46% of the variance in engagement in problem behavior. Although association with deviant peers was the most proximal social influence on problem behavior, parental monitoring and family factors (conflict and involvement) were key parenting practices that influenced this developmental process. Ary, D.V., Duncan, T.E., Biglan, A. Metzler, C.W., Noell, J.W., and Smolkowski, K. Development of Adolescent Problem Behavior. Journal of Abnormal Child Psych, 27, pp. 141-150, 1999.

Delaying Onset and Progression of Adolescent Substance Abuse

This study examined the effects of the Iowa Strengthening Families Program (ISFP) and the Preparing for the Drug Free Years Program (PDFY) on young adolescent transitions from nonuse of substances to initiation and progression of substance use. Analyses incorporated three waves of data collected over a 2_-year period from 329 rural young adolescents. Outcomes were analyzed by using log linear models that incorporated substance use status frequencies derived from latent transition analyses. Effects on delayed substance use initiation were shown for both the ISFP and PDFY at a two-year follow-up. Also at this follow-up, the PDFY showed effects on delayed progression of use among those previously reporting initiation. Spoth, R., Reyes, M. L., Redmond, C., and Shin, C. Assessing a Public Health Approach to Delay Onset and Progression of Adolescent Substance Use: Latent Transition and Log Linear Analyses of Longitudinal Family Preventive Intervention Outcomes. Journal of Consulting and Clinical Psychology, 67, pp. 619-630, 1999.

Primary Socialization Theory: Drug Use and Deviance

In a series of five articles, Oetting and colleagues present primary socialization theory. The theory proposes that drug use and deviant behaviors emerge from interactions with primary socialization sources-the family, the school, and peer clusters. Each of these sources can transmit either pro-social or deviant norms. Cultural norms for substance use are transmitted through interactions and can differ across cultures; in some, substance use is culturally required, in others tolerated, and in others sanctioned. Therefore, ethnicity and cultural identification do relate to substance use. Individual personality characteristics and traits however, are not found to directly relate to drug use and deviance. Rather, in nearly all cases they influence outcomes through interactions between the individual and the primary socialization sources. The theory develops a parsimonious explanation of how characteristics of both the local community and the larger extended community influence drug use and deviance. Oetting, E.R. & Donnermeyer, J.F. Primary Socialization Theory: The Etiology of Drug Use and Deviance I, Substance Use & Misuse, 33,(4) pp. 995-1026, 1998.; Oetting, E.R., Deffenbacher, J.L., & Donnermeyer, J.F., Primary Socialization Theory. The Role Played by Personal Traits in the Etiology of Drug Use and Deviance II, Substance Use & Misuse, 33(6) pp. 1337-1366, 1998.; Oetting, E.R., Donnermeyer, J.F., & Deffenbacher, J.L. Primary Socialization Theory: The Influence of the Community on Drug Use and Deviance III, Substance Use & Misuse, 33(8), pp.1629-1665, 1998.; Oetting, E.R., Donnermeyer, J.F., Trimble, J.E., & Beauvais, F. Primary Socialization Theory: Culture, Ethnicity, and Cultural Identification the Links between Culture and Substance Use IV, Substance Use & Misuse, 33(10), pp. 2075-2107, 1998.;Oetting, E.R. Primary Socialization Theory: Developmental Stages, Spiritually, Government Institutions, Sensation Seeking, and Theoretical Implications V, Substance Use & Misuse, 34(7), pp. 947-982, 1999.

Younger Sibling Drug Use

The purpose of this study was to examine older brother correlates of younger brother drug use in the context of parental influences and younger brother personality. The sample consisted of 278 White male college students and their oldest brothers, who volunteered to answer self-administered questionnaires. Results indicated that 3 domains of influence each had an independent impact on younger brother drug use: (a) parent-younger brother relationships and parent drug use, (b) older brother-younger brother relationships and older brother drug use, and (c) younger brother personality. Modeling of nondrug use and a strong attachment relationship in the parent-younger brother and sibling dyads, as well as younger sibling traits of conventionality, had strong links to low younger brother drug use. Our findings highlight the importance of modeling and mutual parent-child attachment relationships as well as sibling relationships as they relate to the possible etiology of drug use. Brook, J.S., Brook, D.W., and Whiteman, M. Older Sibling Correlates of Younger Sibling Drug Use in the Context of Parent-Child Relations. Genet Soc Gen Psychol Monogr, 125(4), pp. 451-68, 1999.

Substance Abuse and Personality Disorders in Adolescence and Risk of Major Mental Disorders and Suicidality During Adulthood

A community-based longitudinal study was conducted to investigate whether personality disorders (PDs) during adolescence increase the risk for Axis I psychiatric disorders and suicidality during early adulthood. Psychosocial and psychiatric interviews were administered to a representative community sample of 717 youths and their mothers from 2 counties in the state of New York in 1975, 1983, 1985-1986, and 1991-1993. Anxiety, disruptive, eating, mood, personality, and substance use disorders and suicidal ideation and behavior were assessed in 1983 and 1985-1986, when the participants were adolescents, and in 1991-1993, when they were young adults. Adolescents with PDs were more than twice as likely as those without PDs to have anxiety, disruptive, mood, and substance use disorders during early adulthood. These associations remained statistically significant after co-occurring Axis I disorders during adolescence were controlled statistically. Cluster A, B, and C PDs and DSM-IV Appendix B PDs during adolescence were all associated with elevated risk for Axis I disorders during early adulthood after co-occurring Axis I and Axis II disorders during adolescence were controlled statistically. Cluster C PDs during adolescence were associated with elevated risk for suicidal ideation or behavior during early adulthood after co-occurring psychiatric disorders and suicidality during adolescence were controlled statistically. The authors concluded that adolescents in the community with personality disorders are at elevated risk for major mental disorders and suicidal ideation or behavior during early adulthood. This increase in risk is not accounted for by co-occurring Axis I disorders or suicidality during adolescence. Johnson, J.G., Cohen, P., Skodol, A.E., Oldham, J.M., Kasen, S., and Brook, J.S. Personality Disorders in Adolescence and Risk of Major Mental Disorders and Suicidality During Adulthood. Archives of General Psychiatry, 56(9), pp. 805-811, 1999.

Psychiatric Comorbidity Among Adolescents

This study analyzed rates of comorbid psychiatric disorders among adolescents with substance use disorders (SUD) in a community-based sample from the MECA (Methods for the Epidemiology of Child and Adolescent Mental Disorders) Study, and compared the results with findings from other community-based studies of adolescents and adults. Diagnoses were established using the DISC. Three quarters of the subjects with an SUD had a comorbid anxiety, mood or disruptive behavior disorder, compared with one quarter of adolescents without SUD. The relationship with disruptive behavior disorder was the strongest and remained significant after controlling for other co-occurring disorders. Rates of comorbidity were comparable with those found in other studies of adolescents and adults, including some studies of adolescent treatment populations. The cross-sectional data did not shed light on sequence of development of the disorders. Kandel, D.B., Johnson, J.G., Bird, H.R., Weissman, M.M., Goodman, S.H., Lahey, B.B., Regier, D.A., and Schwab-Stone, M.E. Psychiatric Comorbidity Among Adolescents With Substance Use Disorders: Findings From the MECA Study. Journal of the American Academy of Child and Adolescent Psychiatry, 38, pp. 693-699, 1999.

Substance Use Disorders in Youth with Bipolar Disorder

This study uses a new sample to further investigate the relationships between youth bipolar disorder and adolescent substance use disorder (SUD). Youth with adolescent-onset bipolar disorder were at significantly greater risk for SUD than were those with child-onset bipolar disorder, even when controlling for conduct disorder. The findings again suggest that adolescent-onset bipolar disorder is an independent risk factor for SUD meriting further investigation. Wilens, T.E., Biederman, J., Millstein, R.B., Wozniak, J., Hahesy, A.L., and Spencer, T.J. Risk for Substance Use Disorders in Youths With Child- and Adolescent-Onset Bipolar Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 38, pp. 680-685, 1999.

Effects of Adoption Agency Disclosure on Gene-Environment Interaction

This study tested for potential biasing effects of open adoption on studies of gene-environment interaction. For several of the analyses, parent knowledge of the physical or psychiatric/medical history of the biologic parents interacted with biologic risk for alcoholism or antisocial personality in predicting adoptee outcomes on various behavioral measures. As a retrospective study, the findings could not distinguish the direction of the effect; that is, whether parents with difficult children sought further information about biological risk, or whether the knowledge of risk influenced parenting, perception, or recall. In any case, the findings suggest that adoption studies of gene-environment interaction need to take into account the possibility of bias resulting from openness. Further research may also be indicated to examine the results of open adoption on child outcomes. Riggins-Caspers, K., Cadoret, R.J., Panak, W., Lempers, J.D., Troughton, E., and Stewart, M.A. Gene x Environment Interaction and the Moderating Effect of Adoption Agency Disclosure on Estimating Genetic Effects. Personality and Individual Differences, 27, pp. 357-380, 1999.

Girls' Smoking Influenced More By Parents but Boys' Smoking Influenced More By Peers

In a study of the effects of parental and peer approval of smoking on adolescent smokers' current levels of cigarette use, researchers analyzed data for 913 California 7th-grade students who had previously initiated cigarette use. They applied a Poisson random-effects regression model to examine the number of cigarettes smoked in the past month as a function of race/ethnicity, gender, number of friends approving smoking, and parental approval. Results show a clear correlation between level of smoking and extent of peer and parental approval. However, a stronger relationship between parental approval of smoking and current level of smoking was found for female adolescents than for male adolescents. Conversely, a stronger relationship between peer approval of smoking and current level of smoking was found for male adolescents than for female adolescents. With respect to race, the influence of parental approval of smoking on adolescents' current level of smoking was generally more pronounced for minority adolescents, relative to white adolescents. However, the influence of peer approval of smoking on current level of smoking was strongest for white adolescents and was less strong for black, Hispanic, and Asian adolescents. The findings suggest that smoking cessation programs among adolescents may need to target both parent and peer influences, but these influences may vary by gender and race/ethnicity. Siddiqui, O., Mott, J., Anderson, T., and Flay, B. The Application of Poisson Random-Effects Regression Models to the Analyses of Adolescents' Current Level of Smoking. Preventive Medicine, 29(2), pp. 92-101, 1999.

Predictors of Adolescent Use of Illicit Drugs Other Than Marijuana

Researchers at RAND used multivariate techniques to identify Grade 10 predictors of illicit drug use other than marijuana in Grade 12. A broad range of environmental and personal predictor variables were examined to determine whether social bonds play a protective role and whether certain social bonds have a greater importance for some racial/ethnic groups. The 4,070 subjects in the study sample were drawn from the RAND Adolescent Panel Study that followed adolescents originally drawn from 30 middle schools in eight California and Oregon communities that included urban, suburban, and rural environments. The study population was 75% non-Hispanic Whites, 8% African-Americans, 8% Mexican-Americans, and 9% Asian-Americans. Bonds with family were inversely related to any use of illicit drugs other than marijuana. Prior drug use, especially problem use of "gateway" substances and prior "hard" drug use, were positively related to both any and frequent use. However, variables other than social bonds and prior use were equal to or stronger predictors of both outcomes. African-Americans were less likely to use illicit drugs other than marijuana. Mexican-Americans were more affected by family factors than other groups. Asian-Americans were more affected by school failure. Most predictors of frequent use also presage any use, suggesting that successful efforts to prevent the onset of "hard" drug use should also curb its escalation. Ellickson, P.L., Collins, R.L., and Bell, R.M. Adolescent Use of Illicit Drugs Other Than Marijuana: How Important Is Social Bonding and for Which Ethnic Groups? Substance Use and Misuse, 34(3), pp. 317-346, 1999.

Influence of Child and Adolescent Psychiatric Disorders on Young Adult Personality Disorder

This study examines associations between childhood psychopathology and young adult personality disorder in a random sample of 551 youths, who were 9 to 16 years old at first assessment. Subjects were evaluated for DSM-III-R psychiatric disorders. Information was obtained prospectively from youths and their mothers at three points over 10 years. The predictive effects of prior axis I disorders and adolescent axis II personality disorder clusters A, B, and C on young adult personality disorder were examined in logistic regression analyses. The odds of young adult personality disorder increased given an adolescent personality disorder in the same cluster. Prior disruptive disorders, anxiety disorders, and major depression all significantly increased the odds of young adult personality disorder independent of an adolescent personality disorder. In addition, comorbidity of axis I and axis II disorders heightened the odds of young adult personality disorder relative to the odds of a disorder on a single axis. In conclusion, assessment of personality pathology before late adolescence may be warranted. Childhood or adolescent axis I disorders may set in motion a chain of maladaptive behaviors and environmental responses that foster more persistent psychopathology over time. Identification and treatment of childhood disorders may help to reduce that risk. Kasen, S., Cohen, P., Skodol, A.E., Johnson, J.G., and Brook, J.S. Influence of Child and Adolescent Psychiatric Disorders on Young Adult Personality Disorder. Am J Psychiatry, 156(10), pp. 1529-1535, 1999.

Developmental Trends for Adolescent Substance Use Linked with those for Risky Sexual Behavior

Researchers at the Oregon Research Institute examined associations between the development of adolescent alcohol, cigarette, and marijuana use and risky sexual behavior over time, using latent growth modeling methodology. Gender differences in the development and relationships between use of substances and risky sexual behavior were also examined. Participants were 257 adolescents (mean age = 15.96 years) assessed at three time points over an 18-month period. The intercepts of marijuana with cigarettes and alcohol, and all three substances with risky sexual behavior were significantly related. Development of the three substances showed similar patterns and development of cigarette use covaried with development of risky sexual behavior. There were no significant differences for boys and girls in these relationships. Results are discussed in relation to the need for greater understanding of nonsexual and sex-related problem behaviors and for analyses examining development and change in these behaviors during adolescence. Duncan, S.C., Strycker, L.A., and Duncan, T.E. Exploring Associations in Developmental Trends of Adolescent Substance Use and Risky Sexual Behavior in a High-Risk Population. Journal of Behavioral Medicine, 22(1), pp. 21-34, 1999.

Cigarette and Smokeless Tobacco Use Among Minority Youth

Increases in smoking/tobacco-related diseases among the Hispanic population call for an examination of its use among this population. This study examined the relationship between gender, cultural identification, migrant status, and grade level and the use of tobacco and perception of harmfulness among Mexican American youth. Results showed that when grade, cultural identification, and migrant status of parents was held constant, males more likely to use cigarettes (occasional and daily) and smokeless tobacco than females. No gender effect was found for lifetime cigarette use. The odds of using cigarettes and smokeless tobacco increase substantially across grades. Effects were found for Mexican American/Spanish and Anglo/White American cultural identification and daily cigarette use. Youths who belonged to nonmigrant families or who identified with a traditional Mexican American/Spanish culture were more likely to consider regular tobacco use harmful. Casas, J.M., Bimbela, A., Corral, C.V., Yanez, I., Swaim, R.C., Wayman, J.C., and Bates, S. Cigarette and Smokeless Tobacco Use among Migrant and Nonmigrant Mexican American Youth. Hispanic Journal of Behavioral Sciences, 20, pp. 102-121, 1998.

Assessing the Benefits of Attending a Parenting Skills Program

Using a theoretical model to ground this investigation, hypotheses about factors that moderate the benefits of attending the Preparing for the Drug Free Years (PDFY) program were tested. PDFY is a skills-training program designed to teach parents and children skills that reduce a child's risk for drug and alcohol use. It was hypothesized that high levels of family stress (i.e., marital difficulties or financial concerns) reduce the benefits of program attendance, and that strong pre-program skills (i.e., parental communication, parental negativity, or parent-child relationship quality) increase the benefits of program attendance. These hypotheses were tested on a sample of families that each included a sixth or seventh grade child. The results for fathers (N = 144) supported the study hypotheses, while mothers (N = 150) who benefited most from the program showed the weakest pre-program communication skills and reported the greatest marital difficulties. Rueter, M.A., Conger, R.D., and Mikler, S. Assessing the Benefits of Attending a Parenting Skills Program: A Theoretical Approach to Predicting Direct and Moderating Effects. Family Relations, 48, pp. 67-77, 1999.

Variations in Risk and Protective Factors for American Indian Adolescents

High levels of social stress are related to behavior problems in both Caucasian and American Indian adolescent boys, while high levels of self/family-concept are related to less problem behavior in both groups when using self-report. In contrast, teacher report models indicated that negative life events were the only significant predictor of perceived problem behavior in American Indian boys. For Caucasian males a low self/family-concept predicted teachers' perceptions of problematic behavior. For females, negative events predicted self-reported problem behaviors in American Indians while both negative events and positive self/family-concept contributed significantly for Caucasians. This pattern remained the same when using teacher reports of female problem behaviors. Interventions must address the discrepancy between self and teacher report and the increased likelihood of teachers' observing problematic behaviors in male adolescents. Fisher, P.A., Storck, M., and Bacon, J.G. In the Eye of the Beholder: Risk and Protective Factors in Rural American Indian and Caucasian Adolescents. American Journal of Orthopsychiatry, 69, pp. 294-304, 1999.

Association between Substance Abuse Treatment and Cigarette Use

The influence of risk-behavior bias, drug use, prior cigarette use, and prior and current participation in drug treatment on cigarette use was analyzed using a 3-wave survey of 346 drug abusers. Participation in drug treatment and a risk-behavior bias were hypothesized to predict greater cigarette use. After controlling for prior levels of cigarette use with a longitudinal path model, it was found that participation in drug treatment at Wave 2 significantly predicted increased cigarette use at Wave 2. There were similar results at Wave 3. Additional analyses indicated that reduced heroin use was especially associated with more smoking. Risk-behavior bias predicted more drug and cigarette use and predicted less participation in drug treatment at Wave 3. These results suggest that drug treatment, reduced heroin use, and a tendency toward risky behavior may lead to increased cigarette use, which may represent a form of substance replacement. Conner, B.T., Stein, J.A., Longshore, D., and Stacy, A.W. Associations Between Drug Abuse Treatment and Cigarette Use: Evidence of Substance Replacement. Experimental Clinical Psychopharmacology, 7(1), pp. 64-71, Feb 1999.

Developmental Differences in Beliefs About How Alcohol and Cocaine Affect Behavior

This study examines age group differences in children's knowledge and understanding of how drugs affect behavior. African-American and White children ages 5-7, 8-10, 11-14 years, and a comparison group of college students were asked about alcohol and cocaine. In descriptions of the routes drugs take in the body, mention of gastrointestinal sites decreased across age groups for cocaine but increased for alcohol; mention of vital organs peaked among 8 to 10 year olds; emphasis on peripheral body parts decreased across age groups; and emphasis on blood and brain increased. Knowledge of key elements of a physiological theory of how drugs affect behavior was greater among college students than among younger children. Understanding (causal complexity of explanations) increased with age for cocaine, though not for alcohol. Knowledge and understanding were moderately correlated, suggesting that they represent distinct aspects of thinking about drugs. This study provides data about when children come to know about and understand the effects of drugs. It suggests that younger children think at a more concrete level. They understand that drugs damage the body but are unable to provide coherent and specific physiological explanations of what happens. Sigelman, C.K., Alyson S., Goldberg, F., Davies, E.P., Dwyer, K.M., Leach, D. and Mack, K. Developmental Differences in Beliefs about How Alcohol and Cocaine Affect Behavior. Journal of Applied Developmental Psychology, 20, pp. 1-18, 1999.

Physician Substance Use by Medical Specialty

Self-reported past year use of alcohol, tobacco, marijuana, cocaine, and two controlled prescription substances (opiates, benzodiazepines); and self-reported lifetime substance abuse or dependence was estimated and compared for 12 specialties among 5,426 physicians participating in an anonymous mailed survey. Logistic regression models controlled for demographic and other characteristics that might explain observed specialty differences. Emergency medicine physicians used more illicit drugs. Psychiatrists used more benzodiazepines. Comparatively, pediatricians had overall low rates of use, as did surgeons, except for tobacco smoking. Anesthesiologists had higher use only for major opiates. Self-reported substance use disorders (abuse and dependence) were at highest levels among psychiatrists and emergency physicians, and lowest among surgeons. With evidence from studies such as this one, a specialty can organize prevention programs to address patterns of substance use specific to that specialty, the specialty characteristics of its members, and their unique practice environments that may contribute risk of substance abuse and dependence. (The response rate for this mailed survey was 59 percent. Across specialties, the only significant variation in response rate across specialties was 50 percent for internists, a group for whom no extreme prevalence rates were found.) Hughes, P.H., Storr, C.L., Brandenburg, N.A., Baldwin, D.C., Anthony, J.C., and Sheehan, D.V. Physician Substance Use by Medical Specialty, Journal of Addictive Diseases, 18(2), pp. 23-37, 1999.

Association Between Socioeconomic Status and Psychiatric Disorders

Social causation theory and social selection theory have been put forth to explain the finding that low socioeconomic status (SES) is associated with risk for psychiatric disorders. The predictions of both theories were investigated using data from a community-based longitudinal study. Psychosocial interviews were administered to 736 families from 2 counties in New York State in 1975, 1983, 1985-1986, and 1991-1993. Results indicated that (a) low family SES was associated with risk for offspring anxiety, depressive, disruptive, and personality disorders after offspring IQ and parental psychopathology were controlled, and (b) offspring disruptive and substance use disorders were associated with risk for poor educational attainment after offspring IQ and parental psychopathology were controlled. These findings indicate that social causation and social selection processes vary in importance among different categories of psychiatric disorders. Johnson, J.G., Cohen, P., Dohrenwend, B.P., Link, B.G., and Brook, J.S. A Longitudinal Investigation of Social Causation and Social Selection Processes Involved in the Association between Socioeconomic Status and Psychiatric Disorders. J Abnorm Psychol, 108(3), pp. 490-499, 1999.

Influence of the Teacher-Student Relationship on Childhood Conduct Problems: A Prospective Study

The influence of the quality of the teacher-student relationship on children's adjustment and subsequent levels of aggression was examined in a sample of 61 second and third-grade children nominated and rated by teachers as aggressive. The stability of teachers' and children's reports of relationship quality across academic years was in the low to moderate range. Teachers and children showed little agreement in their reports of relationship quality. However, reports of relationship quality in Year 1 (Y1) predicted teacher-rated aggression the following year. Teachers' reports of relationship quality across Y1 and Y2 predicted peer-rated aggression, but not teacher-rated aggression, in Y3. A positive teacher-student relationship was of greatest benefit to children whose mothers reported rejecting parenting histories. Hughes, J.N., Cavell, T. A., and Jackson, T. Influence of the Teacher-Student Relationship on Childhood Conduct Problems: A Prospective Study. Journal of Clinical Child Psychology, 28, pp. 173-184, 1999.

Beliefs Legitimizing Aggression and Deviant Processing of Social Cues

In two studies the authors examined knowledge and social information-processing mechanisms as two distinct sources of influence on child aggression. Data were collected from 387 boys and girls of diverse ethnicity in three successive years. In Study 1, confirmatory factor analyses demonstrated the discriminant validity of the knowledge construct of aggression beliefs and the processing constructs of hostile intent attributions, accessing of aggressive responses, and positive evaluation of aggressive outcomes. In Study 2, structural equation modeling analyses were used to test the mediation hypothesis that aggression beliefs would influence child aggression through the effects of deviant processing. A stronger belief that aggressive retaliation is acceptable predicted more deviant processing 1 year later and more aggression 2 years later. However, this latter effect was substantially accounted for by the intervening effects of deviant processing on aggression. Zelli, A., Dodge, K.A., Lochman, J.E., Laird, R.D., and The Conduct Problems Prevention Research Group. The Distinction Between Beliefs Legitimizing Aggression and Deviant Processing of Social Cues: Testing Measurement Validity and the Hypothesis that Biased Processing Mediates the Effects of Beliefs on Aggression. A Complementary Perspective to Primary Socialization Theory. Social Psychology, 77, pp. 150-166, 1999.

Classifying Aggressive Children

The purpose of this study was to identify clinically relevant subtypes of aggressive children based on measures of children's self-systems and significant others' perceptions of relationship quality. In a sample of aggressive second- and third-graders, a cluster analysis of children's perceptions of support and significant others' (mother, teacher, and peers) perceptions of relationship quality revealed one subgroup in which self- and other-ratings were below the group mean (concordant-negative), one in which ratings were above the sample mean (concordant-positive), and one in which ratings were discrepant (high child-report and low other-report. However, children in the discrepant group were rated as considerably more aggressive and delinquent than those in the two concordant clusters, who did not differ from each other on measures of internalizing and externalizing behaviors. Edens, J.F., Cavell, T.A., and Hughes, J.N. The Self-Systems of Aggressive Children: A Cluster-Analytic Investigation. Journal of Child Psychology & Psychiatry & Allied Disciplines, 40, pp. 441-453, 1999.

Drug Prevention Programming Readiness

An assessment of community readiness for drug use prevention in rural communities indicated that most of these communities were at low stages of readiness. Minority communities were particularly low in readiness, with only 2% having any functioning drug prevention programs. Rural communities at different levels of readiness required different types of programs to increase readiness, i.e., communities at the no awareness stage require analysis of historical and cultural issues that support tolerance of drug use, those at the denial and vague awareness stages need specific information about local problems, and communities at the preplanning and preparation stages need information about effective programs, program components and strategies, help in identifying resources, and assistance with staff training. In addition, building and maintaining effective prevention efforts requires continued evolution of readiness through the stages of initiation, stabilization, confirmation and expansion, and professionalization. Revised and updated scales and methods for assessing community readiness are provided. Plested, B., Smitham, D.M., Jumper-Thurman, P., Oetting, E.R., and Edwards, R.W. Readiness for Drug Use Prevention in Rural Minority Communities. Substance Use & Misuse, 34, pp. 521-544, 1999.

School-based Support Groups for Adolescents with Addicted Parents

A qualitative pilot study that evaluated a school-based support group for adolescents with addicted parents identified mediator variables that are hypothesized to be important for child outcomes. These include knowledge of the impact of addiction on the family, improved relationships with family and friends, enhanced coping strategies, improved resiliency to chaotic environments and improved scholastic performance. In the next phase of this study a profile of adolescents interested in the support group will be developed and the effectiveness of the support groups will also be assessed. Preliminary analyses with a limited sample have indicated that students not interested in participating in the group are more likely to be male, Hispanic, and have a lower grade point average. Murphy-Parker, D. and Gance-Cleveland, B. Examining the Benefits of a School-Based Support Group for Adolescents who have an Addicted Parent. Substance Misuse Bulletin, 12, pp. 7-8, 1999.

A Conceptual Framework to Explain Race Differences in Drug Use

Based upon a study that investigated the influence of race and religion on drug use among Black and White youth conducted by researchers at the University of Michigan, a theoretical framework for explaining variations in drug use between the two racial groups has been proposed. Despite a growing literature on race differences in drug use, few studies have offered theoretical explanations for their existence. The central argument advanced by the investigator of this study is that in order for researchers to understand race differences in drug use outcomes, developmental processes, and mean level differences of antecedent influences on drug use, they must understand the ways in which social systems influence individual, interpersonal, and community risk and protective mechanisms that are linked to race and that, in turn, are responsible for racial variation in drug use. Wallace, J.M. Jr., Explaining Race Differences in Adolescent and Young Drug Use: The Role of Racialized Social Systems, Drugs and Society, 14 (1/2), pp. 21-36, 1999.

Impact of Early Adolescent Marijuana Use On Late Adolescent Problem Behaviors

The purpose of this study was to assess the impact of early adolescent marijuana use on late adolescent problem behaviors, drug-related attitudes, drug problems, and sibling and peer problem behavior. African American (n = 627) and Puerto Rican (n = 555) youths completed questionnaires in their classrooms initially and were individually interviewed 5 years later. Logistic regression analysis estimated increases in the risk of behaviors or attitudes in late adolescence associated with more frequent marijuana use in early adolescence. Early adolescent marijuana use increased the risk in late adolescence of not graduating from high school; delinquency; having multiple sexual partners; not always using condoms; perceiving drugs as not harmful; having problems with cigarettes, alcohol, and marijuana; and having more friends who exhibit deviant behavior. These relations were maintained with controls for age, sex, ethnicity, and, when available, earlier psychosocial measures. Early adolescent marijuana use is related to later adolescent problems that limit the acquisition of skills necessary for employment and heighten the risks of contracting HIV and abusing legal and illegal substances. Hence, assessments of and treatments for adolescent marijuana use need to be incorporated in clinical practice. Brook, J.S., Balka, E.B., and Whiteman, M. The Risks for Late Adolescence of Early Adolescent Marijuana Use. Am J Public Health, 89(10), pp. 1549-1554, 1999.

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