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National Institute on Drug Abuse

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

May, 1998

Research Findings

Epidemiology, Etiology and Prevention Research

The Effect of Home Environment on Adolescent Substance Use and Depressive Symptoms

Researchers at the National Opinion Research Center (NORC) used data from the screening phase and first two waves of a panel study to compare the home environments of families with a substance abusing parent, families with a depressed parent, and families in a comparison group. They diagnosed substance use disorder and affective disorder by administering the Structural Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (3rd edition, revised) to each participating parent.The data suggested that families in which parents display a substance use disorder are very similar to those in which parents suffer from affective disorder, in terms of negative life events and lower family cohesion. The results of structural equation modeling indicated that parental substance use disorder and parental affective disorder influence adolescent substance use and depressive symptoms. In addition, parental substance use disorder were found to have a direct influence on adolescent substance use at the time the first-wave data were collected, but this effect does not persist over time. Su, S.S., Hoffman, J.P., Gerstein, D.R., and Johnson, R.A. J of Drug Issues, pp. 851-878, 1997.

Early Stages of Drug Use: Transitions from Opportunity to Use

In research at Johns Hopkins University focusing on the earliest stages of drug involvement investigators studied the transition from an initial opportunity to try marijuana to the subsequent use of this drug through secondary analysis of self-report interview data gathered from nationally representative samples of the United States National Household Surveys on Drug Abuse, 1979-1994. The evidence indicates that the estimated prevalence of an opportunity to try marijuana has been rather stable for 15 years. However, there are recent increases in the probability of rapidly progressing from first marijuana opportunity to first marijuana use, among persons given an opportunity to use. In addition, the transition from first marijuana opportunity to eventual marijuana use seems to depend upon age at first opportunity. This epidemiological evidence on the transition from marijuana opportunity to marijuana use, the first to be published based on a nationally representative US sample, highlights directions for future research and a focus for prevention efforts. Van Etten, M.L., Neumark, Y.D., Anthony, J.C. Drug and Alcohol Dependence., 49(1), pp. 1-7, 1997.

Adolescent Versus Adult Onset and the Development of Substance Use Disorders in Males

While the adolescent onset of substance use disorders has been thought to be characterized by specific features, previous studies on the importance of age of onset have not distinguished adolescent from early-adult onset. Drs. Clark, Kirisci and Tarter of CEDAR examined the influence of adolescent age of onset on the development of substance use disorders by comparing adolescents with substance use disorders and adults divided into three groups by age of onset: adolescent, early-adult and late-adult. Adolescent-onset groups, compared with adult-onset groups, had higher lifetime rates of cannabis and hallucinogen use disorders, shorter times from first exposure to dependence, shorter times between the development of their first and second substance dependence, and higher psychopathology rates, including conduct disorder and major depression. The results suggest that adolescent-onset SUD is a distinct subtype involving different substances and more rapid development than adult-onset SUD. Clark, D.B., Kirisci, L., and Tarter, R.E. Drug and Alcohol Dependence, 49, pp. 115-121, 1998.

Association Between a Microsatellite Polymorphism at the DRD5 Gene and the Liability to Substance Abuse

This population-based study of the relationship between the risk for substance abuse and the dopamine D5 receptor locus (DRD5) was conducted in a sample of adult males and females with a DSM-III-R diagnosis of substance dependence (SD) or without any psychiatric disorder who are participants in a longitudinal family/high-risk study of substance abuse (Center for Education and Drug Abuse Research, CEDAR). To lessen the potential influence of the stratification bias, only European-American subjects' DNA samples were used in this pilot study. To maximize the phenotypic differences for the liability to substance abuse between the affected and nonaffected subsamples, the control subjects were selected to be older than 35 years of age (males' age range, 35-64; females', 35-52), and thus had predominantly been beyond the age of risk for development of SD. The data showed an increased frequency of the modal, 148 base pairs repeat length, allele of a dinucleotide polymorphism (allele 9) among SD males. This finding was reproduced in females with even greater contrast between affected and nonaffected individuals. The association was also found to be significant when all the alleles of the polymorphism were taken into account in a likelihood ratio test. The case-control and sex differences were also observed for genotypes coded in accordance with the number of alleles 9 (0 to 2). It is noteworthy that none of the SA females had the non-9/non-9 genotype, while the frequency of this genotype among control females was 37%; among males, the respective frequencies were 25 and 47%. The genotype was also found to be associated with novelty seeking in females, but not in males, in whom even a trend for such an association was absent. Interestingly, there were no sex differences in novelty seeking among substance abusers or controls, while the relationship between this temperament/personality trait and the risk for SD was more pronounced in males than females. The findings suggest that the DRD5 locus is involved in the variation and sex dimorphism of the liability to substance abuse and related traits. Vanyukov, M.M., Moss, H.B., Gioio, A.E., Hughes, H.B., Kaplan, B.B., and Tarter, R.E. Behavior Genetics, 28, pp. 75-82, 1998.

School Differences in Rates of Substance Use

Previous research has noted that schools vary in substance use prevalence rates, but explanations for school differences have received little empirical attention. This article assesses variability across elementary schools (N=36) in rates of early adolescent alcohol, cigarette, and marijuana use. Characteristics of neighborhoods and schools were measured using student, parent, and archival data. Findings show substantial variation across schools in substance use. Attributes of neighborhoods and schools are statistically significant related to school rates of lifetime alcohol use, lifetime cigarette use, and current cigarette use. Contrary to expectations, lifetime alcohol and cigarette use rates are higher in schools located in neighborhoods having greater social advantages as indicated by the perceptions of residents and archival data. Neighborhood effects are expressed both directly and indirectly through school characteristics. Ennett, S.T., Flewelling, R.L., Lindrooth, R.C. & Norton, E.C. School and Neighborhood Characteristics Associated With School Rates of Alcohol, Cigarette, and Marijuana Use. Journal of Health and Social Behavior, 38, pp. 55-71, 1997.

Students Who Bring Weapons to School and Drug Use

Social, demographic, and behavioral characteristics and self-reported carrying of a weapon to school among middle school students provide a statistical profile of youth most likely to bring weapons to school and help to identify characteristics that are only spuriously related to this behavior. Study respondents were part of an ongoing randomized evaluation of a school-based drug use prevention program in Illinois. Self-administered questionnaires were completed by 1,503 seventh and eight graders. Fifteen percent of respondents brought some type of weapon to school in the past month. Weapon carrying was significantly associated with being male, not living with both parents, not feeling close to parents, heavy drinking, participating in fights, damaging school property, and perceiving that at least a few other students bring weapons to school. Victimization and fear for safety in school were not significantly associated with weapon carrying. Study results suggest that the structure and the dynamics of the family and perceived normative influences play important roles in weapon carrying behavior. Weapon carrying also appears to cluster with other deviant behaviors including drug use. Bailey, S.L., Flewelling, R.L., Rosenbaum, D.P. Characteristics of Students Who Bring Weapons to School. Journal of Adolescent Health, 20, pp. 261-270, 1997.

African-American and Puerto Rican Drug Use: A Longitudinal Study

The objective of this study was to examine the interrelationship of acculturation, family, personality, ecology, and peer domains measured in adolescence as they impact drug use 5 years later and to assess the role of family variables as buffers against personality risks. Youths completed questionnaires in classrooms at T1 and were individually interviewed at T2 (mean age = 20 years). Data were analyzed separately for African-American and Puerto Ricans using correlations, hierarchical multiple regressions, and two-way interactions. Most results were similar or both ethnic groups. Eighty percent of the T1 variables significantly related to T2 stage of drug use. A mediational model of the path to drug use was supported. Acculturative influences were associated with family relations, which in turn were related to personality attributes. A reciprocal relationship emerged between the personality and peer domains in their impact on drug use. Family variables primarily enhanced the effect of protective personality traits on drug use. Results suggest that the stability of drug use alone cannot explain the relationship between the earlier domains and later drug use. Specific adolescent risks have long-lasting effects. The personality domain has a direct effect on later drug use despite a benign picture in the acculturation, family, and peer domains. Brook, J S., Whitemans, M., Balka, E.B., Win, P.T., and Gursen, M.D. Journal of American Academy of Child Adolescent Psychiatry, 36(9), pp. 1260-1268, 1997.

Jump Start: A Targeted Anti-Drug Prevention Program

A substance abuse prevention and life skills program for economically disadvantaged, high sensation seeking African American teens was developed and tested. Formative research was conducted to determine program content and format. Over two implementations, 289 individuals in the target population were recruited as participants for the field test of the program. For the first implementation, participants were randomly selected from a summer youth employment program. For the second, a media campaign was designed to recruit participants. Participants evaluated the program extremely positively. Analysis indicated that the significant pretest difference in liquor and marijuana use between high and low sensation seekers was neutralized in both years of the program as were attitudes toward drugs in the first year of the program. These results suggest that sensation seeking is a useful message design and audience-targeting variable for substance abuse prevention program design. Harrington, N.G., & Donohew, L. Jump start: A Targeted Substance Abuse Prevention Program. Health Education and Behavior. 24(5), pp. 568-586, 1997.

The Association of Early Risk Factors to Opiate Addiction and Psychological Adjustment

Family/parental, peer and individual risk factors that appear early in life contribute to increased susceptibility to addiction. This study aimed to determine the relationship between risk factors, the development of opiate addiction, and the development of psychological maladjustment in addicts. A total of 252 addict subjects, age 12-39 years at the onset of opiate addiction and 342 nonaddict controls from the same neighborhood, matched for age, race and place of residence were selected. Ten risk factors related to family disruption, peer deviance, personal deviance and psychological symptoms were studied. White addicts scored significantly higher than African American addicts on all of the risk factors, whereas African American addicts scored significantly higher than African American nonaddicts on risk factors. Addicted individuals with a diagnosable psychiatric disorder on a standardized psychological instruments as young adults had also experienced related symptoms during the adolescent years prior to addiction. Thus, in addition to problems directly attributable to addiction, there were many problems that either coincided with, or pre-dated, severe drug abuse. Nurco, D.N., Hanlon, T.E., O'Grady, K.F., & Kinlock, T.W. Risk Factors for Opiate Addiction. Criminal Behavior and Mental Health, 7, pp. 213-228, 1997.

A County Survey of Mental Health Services in Drug Treatment Programs

Forty-five administrators from randomly selected drug treatment programs in Los Angeles County were surveyed between December 1994 and October 1995 about the adequacy of mental health services within their program and the drug treatment system. Approximately half agreed that dually diagnosed clients are not served within the system, and the majority (about 70%) noted that their programs restrict admission of such clients. Agreement was highest among administrators of residential and day treatment programs and lowest among administrators of outpatient drug-free programs and methadone maintenance programs. Administrators of outpatient drug-free programs and methadone maintenance programs were more likely to characterize their mental health services as inadequate or unavailable than were administrators of other types of programs. Yet, despite this poor assessment, administrators expressed only mild support for providing additional training in this area either for themselves or for their counselors. Administrators may not perceive a need to enhance their mental health services if severely mentally ill clients are restricted from entering their programs. Grella, C.E., and Hser, Y.I. A County Survey of Mental Health Services in Drug Treatment Programs. Psychiatric Services, 48(7), pp. 950-952, 1997.

Association between Attention Deficit Hyperactivity Disorder (ADHD) and Cigarette Smoking

In a follow-up study of siblings of ADHD and control probands, it was found that found that ADHD in probands increased the risk for cigarette smoking in siblings regardless of the sibling's own ADHD status or the presence of other psychiatric conditions. Moreover, ADHD in the siblings was associated with higher rates of cigarette smoking along with a significantly younger age at onset. In like manner, conduct disorder, major depression and drug abuse were associated with high rates of cigarette smoking. In addition, cigarette smoking appeared to be familial among the ADHD families but not the control families. Finally, male gender did not appear to be a risk factor for cigarette smoking in the sample. Using DSM-III-R structured diagnostic interviews and blind raters, we conducted a four-year follow-up of siblings from ADHD (N=149) and control families (N=117). The mean age of the siblings was 17.2 (range 9 to 41) and roughly half were males. First we analyzed the data using univariate methods (i.e., Chi-square tests) which were followed by multivariate logistic regression models which simultaneously controlled for confounding variables such as high risk status (i.e., whether a sibling of an ADHD or normal control proband), socioeconomic status, age, IQ, gender and psychiatric disorders. Since ADHD is a prevalent, childhood onset disorder that is often characterized by impulsive behavior, it could represent a large group of youth at high risk for smoking, illicit drug use, medical morbidity and premature mortality. Since ADHD children and their siblings comprise a large portion of the population at high risk for smoking, they may represent an excellent group to be targeted for prevention programs. Further Evidence of an Association between Attention Deficit Hyperactivity Disorder (ADHD) and Cigarette Smoking: Findings from a High Risk Sample of Siblings. Milberger, S., Biederman, J., Faraone, S.V., Chen, L., and Jones J. American Journal on Addictions, 6, pp. 205-217, 1997.

Using the National Youth Survey Data Socioeconomic Status Has a Nonlinear Relationship with Marijuana Use

This may account for many null findings that used linear methods to describe the relationship. This study also found that predictors for females were substantially different from males. However, weekly alcohol use was the strongest predictor for both groups (both odds ratios greater than 11.0). Other predictors for both sexes included having a job, having friends who use marijuana and having used some alcohol in the past year. For females, prior victimization and low school aspirations were also significant. For males, GPA, commitment to friends, urbanicity, time spent with friends and peer strain were also significant predictors. Miller, D.S., and Miller, T.Q. Addictive Behaviors, 22(9), pp. 479-489, 1997.

Similar and Different Precursors to Drug Use and Delinquency Among African-Americans and Puerto Ricans

Correlational and net regression techniques were used to examine the commonalities and differences in adolescent risks for later drug use and delinquency among African-Americans and Puerto Rican youths. Eighty-eight percent of the risks were significantly related to both problem behaviors. Within the personality, family, peer, ecology, and acculturation domains many risks independently contributed to the prediction of each problem. Only three risks had a significantly stronger relationship to one of the problem behaviors than to the other. Finding so many common intrapersonal and interpersonal predictors supports a general dimension of problem behavior. The commonalities suggest that interventions targeting these adolescent risks might reduce both problem behaviors. Brook, J.S., Whiteman, M., Balka, E.B., Win, P.T., and Gursen, M.D. Journal of Genetic Psychology, 159 (1), pp. 13-29, 1998.

Tobacco Use Among Mexican American Youth

Increases in smoking/tobacco-related diseases among the Hispanic population call for an examination of tobacco use among this population. This study examined the relationship between gender, level of cultural identification, migrant status, grade level, tobacco use, and perception of harm among Mexican American youth. Results showed males were more likely to use cigarettes (occasional and daily) and smokeless tobacco than females when grade, cultural identification, and migrant status of parent are held constant. No gender effect was found for lifetime cigarette use. The odds of using cigarettes and smokeless tobacco were found to 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 the regular use of tobacco harmful. Casas, M.J., Bimbela, A., et. al. Cigarette and Smokeless Tobacco Use Among Migrant and Nonmigrant Mexican American Youth. Hispanic Journal of Behavioral Sciences, 20(1), pp. 102-121, 1998.

A Regression Analysis Estimating the Number of Drug-using Arrestees in 185 U.S. Cities

A prevalence model for drug-using arrestees was developed by relating selected social indicators from 1990 Census data and drug use rates from Drug Use Forecasting data using logistic regression analysis. An estimation of the total arrestee population was based upon the FBI's Uniform Crime Reports (UCR). Of the originally selected 200 largest cities (indicated by total population size), 16 did not report to UCR; arrest data for Chicago were obtained separately from local officials. Thus, 185 cities were included in the present analysis. A separate logistic regression was conducted for each of the following dependent variables: the urine positive rates for cocaine, opiates, amphetamines, intravenous drug users, and any drug, for each of the eight subgroups defined by the cross-combination of gender and offense type (violent, drug-related, income-generating, and others). Predictors were five social indicators from Census data hypothesized to be associated with drug use levels in different cities: Census population, and percentages of unemployment, poverty, high school graduates, and youths. It was estimated that in 1990, about 925,000 arrestees used cocaine; 317,000 used opiates; 213,000 used amphetamines; 389,000 were drug injectors; and 1,296,000 used some illicit drug. This approach represents a cost-efficient method for prevalence estimation that is based on empirically demonstrable relationships between social indicators and drug use rates. Hser, Y.I., Prendergast, M.L., Anglin, M.D., Chen, J., and Hsieh, S. American Journal of Public Health, 88(3), pp. 487-490, 1998.

Tobacco Policy Effects on Youth

Tobacco policy may be differentially enforced with youth, depending on their risk for school failure and other problem behavior. An analysis of the policy change component of a multi-component community intervention for adolescent drug abuse prevention was conducted. Effects of the community intervention (program or control) on tobacco policy change and tobacco were assessed, as well as effects of policy (level of restrictiveness) on tobacco use were evaluated. Results showed that intervention decreased tobacco use over the study period and had an effect on changing tobacco policy toward more restrictiveness. However, existing level of policy restrictiveness (prior to and independent of intervention) was associated with higher tobacco use, suggesting that schools adopt more restrictive policies on their own in reaction to a greater tobacco use problem. Pentz, M.A., Sussman, S., & Newman, T. The Conflict Between Least Harm and No Use Tobacco Policy for Youth: Ethical and Policy Implications. Addiction, 92(9), pp. 1165-1173, 1997.

Ethnicity and Gender in Adolescent Drug Resistance

While ethnic and gender differences have been reported in the amount and type of drug use, little is known about how drugs get offered to adolescents and how members of different cultural groups respond to those offers. Interviews (30-40 minutes) were conducted with 158 middle school students. Adolescent "near-peer" interviewers were trained for this project and matched to participants by ethnicity and gender. Data were content analyzed and results showed that for all groups, simple offers were more likely than complex, pressure-filled strategies, and these offers were typically resisted through simple refusals (i.e., "no") rather than more complex techniques (e.g., explanations). Drugs tended to be most frequently offered to all groups at home or in public rather than at school or parties. Gender and ethnic differences were observed in other areas. Latinos/Latinas were significantly more likely to experience drug offers than other males and females. Hecht, M., Trost, M., Bator, R., & MacKinnon, D. Ethnicity and Gender Similarities and Differences in Drug Resistance. Journal of Applied Communication Research, 25, pp. 1-23, 1997.

Parental and Family Risk Factors for Substance Use in Inner-City African-American Children and Adolescents

The purpose of this study was to develop and test a multi- dimensional model of parental and family influences on risk for substance use in inner-city African-American primary grade children and their adolescent siblings. The risk factors investigated were conceptually grouped into three broad domains of family influences and the respective indices computed: parental risk attributes, family risk attributes, and parenting styles. Parenting styles were captured as indicators of a latent construct, "poor parenting." In study 1, it was hypothesized that the parental and family risk variables would be mediated through parenting styles to predict intentions to use drugs, actual drug use, positive drug attitudes, and negative drug attitudes in a sample of 455 inner-city African-American families and their primary-grade children. In study 2, the substance use risk model was tested on a sample of 59 adolescent siblings to determine whether the pattern of parental and family factors that contributed to early high-risk attitudes and behaviors in children would predict drug attitudes and behaviors in teen siblings. The results confirmed expectations that parental and family risks were important predictors of children's negative drug attitudes and intentions to use drugs in the future and that positive parental and family characteristics would protect against future risk by enhancing negative drug attitudes. Also, substance use attitudes and behaviors in teen siblings were predicted primarily by family risk characteristics. The family risk index also predicted frequency of use of hard drugs, but only when mediated through poor parenting. The implications of these results for future research are discussed. Newcomb, M.D. Journal of Psychopathology and Behavioral Assessment, 19(2), pp. 369-400, 1997.

Longitudinal Study of Co-occuring Psychiatric Disorders and Substance Use

The objective of this study was to examine the temporal priority in the relation between psychiatric disorders and drug use. Psychiatric assessments and drug use were completed at three different points in time, spanning nine years, Structured interviews were administered to a cohort of youths and their mothers. Structureed interviews were administered to a cohort of youths and their mothers. Subjects were selected on the basis of their residence in either or two counties in upstate NewYork. The sample was predominantly white male and female youth, aged 1-10 upon initial collction of data. Psychiatric diagnoses were assessed by a supplemented version of the DISC 1, using computer algorithms designed to match DSM III-R criteria to combine information from mothers and youth. Substance use information was obtained in the interviews. A significant relationship was found to exist between earlier adolescent drug use and later depressive and disruptive disorders in young adulthood, not of earlier psychiatric disorders. Psychiatric disorders did not predict changes in young adult drug use. Implications for policy, prevention, and treatment include: (1) more medical attention needs to be given to the use of legal and illegal drugs: and (2) a decrease in the use of drugs may result in a decrease in the incidence of later psychiatric disorders. Brook, J.S., Cohen P., and Brook, D.W. Journal of American Academy of Child and Adolescent Psychiatry, 37, pp. 322-330, 1998.

Adolescent School Experiences and Dropout, Adolescent Pregnancy, and Young Adult Deviant Behavior

Predictive effects of school experiences were studies over a 7-year interval in a random community sample of 452 adolescents, 12 through 18 years of age. Outcomes examined included dropping out of school, adolescent pregnancy, engaging in criminal activities, criminal conviction, antisocial personality disorder, and alcohol abuse. Logistic regression showed academic achievement, academic aspirations, and learning-focused school settings to be related to a decline in deviant outcomes independent of the effects of disadvantaged socioeconomic background, low intelligence, childhood conduct problems, and having deviant friends during adolescence. Associations between school conflict and later deviancy were mediated by deviant peer relationships in adolescence and other school characteristics. Prior research reporting continuity of childhood conduct problems and the influence of adolescent affiliations with deviant peers on negative outcomes was supported. Implications for using the school context in risk factor research and the practical applications of such research for intervention are discussed. Kasen, S., Cohen, P., and Brook, J.S. Journal of Adolescent Research, 13(1), pp. 49-72, 1998.

Self-Reported Drug Use: Results of Selected Empirical Investigations of Validity

This article reviews the literature and discusses two series of empirical studies. The literature shows some evidence that drug abusers self-reports are generally reliable and accurate, but the studies are more strikingly marked by findings of wide variations in accuracy and in the samples and procedures used to obtain them. In the authors first study, data from 323 narcotics addicts were collected through two interviews held 10 years apart. This set of analyses examined the quality of the longitudinal retrospective self-report from narcotics addicts, including validity of recent narcotics use, reliability of various measures, stability of relationships among these measures, and pattern reliability among latent constructs. Results contribute strongly to confidence in the validity of the relationships among these data derived from addicts self-report. The second set of analyses focused on validity of self-reported drug use among 3,493 clients from Los Angeles County sexually transmitted disease clinics, hospital emergency rooms, and jails. Results suggest that the accuracy of self-report of recent drug use varies by the sample sources, drug types, and subject characteristics. Targeting these high-risk groups may improve prevalence estimation. The article concludes that empirical validation of self-report is always necessary to enhance the utility of collected self-report data and provide means of controlling for potential biases. Hser, Y.I. Self-Reported Drug Use: Results of Selected Empirical Investigations of Validity. In L. Harrison and A. Hughes (Eds.), The Validity of Self-Reported Drug Use: Improving the Accuracy of Survey Estimates (NIDA Research Monograph 167, pp. 320-343). Washington, DC: U.S. Government Printing Office, 1997.

Predicting Treatment Entry among Treatment-Seeking Drug Abusers

Treatment-seeking drug abusers were recruited from two sources: a community resource center which provided treatment referrals and also from a separate descriptive study conducted at the Drug Abuse Research Center at the University of California at Los Angeles. All respondents were provided with a referral to drug treatment at the end of their first interview; a second interview was conducted approximately six months later. At the six-month follow-up, 171 (62.0%) subjects had entered treatment. Subject characteristics related to treatment entry were examined, which included severity of problem drug use, severity of other problems (e.g., alcohol use, legal, family, psychological, medical, housing), social enabling factors (legal coercion, health insurance, employment obligations, social support), and prior drug treatment experiences. Treatment-entry and non-entry subjects did not differ in demographics, type of drug use, or years of use. Treatment-entry subjects were more likely to have had a prior successful treatment experience and legal system involvement, but less severity in current drug use, psychological distress, and family problems. Prior treatment experience and legal coercion were factors promoting treatment entry. Those that had more severe problems (drug and others) seemed less likely to enter treatment indicating that psychological distress and problems with families may undermine a drug abusers motivation to follow through on treatment referral. These results suggest that while external pressure such as legal coercion may help motivate drug users to enter treatment, referral and outreach efforts need to be sensitive to the distress of drug users who are suffering from significant psychological problems. Hser, Y.I., Maglione, M.A., Polinsky, M.L., and Anglin, M.D. Journal of Substance Abuse Treatment, 14(5), pp.1-8, 1997.

Drug Addiction and Treatment Careers among Clients in DATOS

Considerable heterogeneity in patterns of addiction and treatment career histories was observed among 10,010 clients interviewed by the Drug Abuse Treatment Outcome Study (DATOS). Drug use history, mental health status, physical health status, history of criminal behavior, and social functioning data were collected between 1991 and 1993 at clients entry into treatment in 96 programs in 11 cities purposely chosen across the United States. First treatment entry was on average seven years after the initiation of use of heroin or cocaine; about one-half of the clients admitted to DATOS were entering their first treatment episode. The mean number of prior treatment episodes was 3.5 among those who had any treatment prior to DATOS admission. Regression analyses showed that prior treatment utilization was associated with more severe levels of drug dependence, HIV-risk behaviors, and criminal activities. The present findings suggest that policy efforts have encouraged drug treatment among individuals at high risk for HIV, as well as among drug users involved with the criminal justice system. Anglin, M.D., Hser, Y.I., and Grella, C.E. Drug Addiction and Treatment Careers among Clients in DATOS. Psychology of Addictive Behaviors, 11(4), 1997.

Factors Associated with Early Sexual Activity among Urban Adolescents

This study uses lifespan and ecological frameworks to investigate the factors associated with early adolescent sexual activity. Data from a longitudinal study of urban teenagers of color address three issues: (1) the prevalence and pattern of sexual activity among boys and girls ages 15 and younger, (2) the link between early sexual activity and high-risk sexual behavior, and (3) the life contexts linked with early sexual activity. Results from 803 African American and Hispanic adolescents suggest a high prevalence of early sexual activity, which is associated with higher rates of childbearing and risky sexual behavior than sexual activity initiated in later adolescence. Somewhat different factors are associated with early sexual activity for boys and girls, although family composition, parent attachment, and substance use are important for both genders. Implications for intervention are discussed. Smith, C.A. Social Work, 42, pp. 334-346, 1997.

Interrelationships Between Adolescent Drug Use and Drug Use 5 Years Later

In 1990 (T1), African American (n=695) and Puerto Rican (n=637) youths in East Harlem schools completed questionnaires on six domains: personality attributes, family relationships, peer factors, ecological variables, acculturation measures, and stage of drug use. Five years later (T2), 459 of the African American youth and 423 of the Puerto Rican youth were re-contacted to complete a follow-up questionnaire on the same domains. At T1, there were no significant differences in self-reported drug use between the African American and Puerto Rican youths but at T2, significantly more Puerto Ricans used drugs than did African Americans. The variables within the different domains were analyzed to determine those in T1 which were related to T2 drug use. Acculturation, family, personality, and peer domains were found to be related to stage of drug use in young adulthood, with control for stage of drug use in adolescence. The study suggests that stability of drug use alone cannot explain the relationship between earlier domains and later drug use, and that specific adolescent risk factors have long-lasting effects into young adulthood. Targeting risk factors related to adolescent drug use during adolescence is likely to reduce contemporaneous and later drug use. Brook, J.S., et al. African-American and Puerto Rican Drug Use: A Longitudinal Study, J. Am. Acad. Child Adolesc. Psychiatry, 36 (9), pp. 1260-1268, 1997.

Risk Factors for Teenage Fatherhood

The study of teen parenthood has become almost synonymous with the study of teen mothers, but relatively little research attention has been devoted to the study of teen fathers. Nevertheless, because it appears that becoming a teen father has negative developmental consequences for both the teen father and his children, it is an important area of inquiry. This article uses data from the Rochester Youth Development Study, an ongoing panel study of urban youth, to identify early risk factors for the likelihood of becoming a teen father. The study is well suited to this task because the prevalence of teen fatherhood in this sample is quite high, and the project has collected extensive data in a range of developmental domains. Teen fatherhood is related to a variety of risk factors, such as social class, educational performance, precocious sexual activity, and drug use. Perhaps most important is the finding that teen fatherhood is strongly related to the cumulation of risk factors across many domains. Thornberry, T.P., Smith, C.A., and Howard, G.J. Journal of Marriage and the Family, 59, pp. 505-522, 1997.

Patterns by Gender and Ethnicity Among School Attenders and Dropouts

Differences in patterns of volatile solvent use were explored with special emphasis on use as related to school enrollment status. The sample included American Indian, Mexican-American and White American youth. Three enrollment status categories were identified: dropout, academically at-risk (enrolled), and control. A self report survey was used to assess both level and intensity of volatile solvent use. Findings indicated that a higher proportion of the dropout cohort have used volatile solvents, used volatile solvents regularly, and used volatile solvents with more intensity than either the academically at-risk group or the control group. An interaction between gender and ethnicity was also revealed; American Indian females reported higher lifetime prevalence and thirty-day prevalence than did American Indian males, whereas for both the Mexican-American and White American samples, males report higher rates than females. Findings are discussed in terms of the influence of volatile solvent abuse and school success as well as previous findings. Bates, S.C., Plemons, B.W., Jumper-Thurman, P. Beauvais, F. Patterns by Gender and Ethnicity Among School Attenders and Dropouts. Drugs and Society, 10, pp. 67-78, 1997.

The ATLAS Program: Effects During Two Seasons

The largest group of adolescents who use anabolic steroids (AS) participate in high school football. The greatest risk for initiating AS appears to occur during the football season. The effect of an educational intervention designed to prevent AS use and promote healthy behaviors was tested. ATLAS capitalized on the social influences of a team sport setting. Thirty-one football teams were separated into experimental and control schools with new subjects assessed over two successive years in a randomized trial. An interactive intervention presented by coaches, research staff and student team leaders, included weight room sessions, sports nutrition and strength training, alternatives to AS use, drug knowledge, drug refusal role play, and anti-AS media campaigns. Pre- and post-intervention questionnaires assessed risk factors, intentions and use of AS, and dietary and exercise habits. Compared to the controls, experimental subjects reported greater understanding of the effects of alcohol, marijuana and AS, greater belief in personal harm by AS use, more negative feelings toward AS users, reduced impulsivity, improved feeling of athletic abilities and self-esteem, greater belief that coaches were anti-AS, less belief in media, and improved refusal skills. There was reduced intent to use AS and less than half the new AS users were among experimental group. In addition, beneficial changes in strength training self-efficacy and nutrition behaviors were present. Goldberg, L., Elliot D., MacKinnon, D., Moe, E., Clarke, G., Lapin, A., Green, C., Miller, D. & Greffrath, E., The ATLAS (Adolescents Training and Learning to Avoid Steroids) Intervention: Effects During 2 Seasons. Med Sci Sports Exercise (Supplement), pp. 29S:S293, 1997.

Methylphenidate Use and Dysfunctional Causal Attributions

Researchers affiliated with CEDAR investigated the effects of 0.3 mg/kg methylphenidate (MPH) and expectancy regarding medication on the performance and task persistence of 60 boys with attention deficit hyperactivity disorder (ADHD). In a balanced-placebo design, boys in 4 groups (received placebo/drug crossed with told placebo/drug) completed the task in success and failure conditions. Medication improved participants' task persistence following failure. Participants' task performance was not affected by whether they thought they had received medication or placebo. Children made internal attributions for success and made external attributions for failure, regardless of medication or expectancy. These findings confirm previous reports that it is the pharmacological activity of MPH that affects ADHD children's self-evaluations and persistence. The results contradict anecdotal reports that MPH causes dysfunctional attributions and confirm previous studies showing that medication does not produce adverse effects on the causal attributions of children with ADHD. Pelham, W.E., Hoza, B., Kipp, H.L., Gnagy, E.M., Trane, S.T. Experimental and Clinical Psychopharmacology, 5(1), pp. 3-13, 1997.

Temperament and Novelty Seeking in Adolescent Substance Use: Convergence of Dimensions of Temperament With Constructs From Cloninger's Theory

This study investigated the convergence of temperament dimensions with constructs from C. R. Cloninger's (1987) theory using data from a sample of 949 adolescents (M age = 13.6 years). Substantial convergence was found, and both types of constructs were related in predicted ways to self-regulation variables and adolescent substance use. Structural modeling procedures tested a mediational model for substance use; results showed mediation through self-control, academic competence, negative life events, and deviant peer affiliations. Interactions indicated that substance use could be predicted from a balance of systems for good control and poor control. Poor self-control was present for dimensions implicated in both externalizing and internalizing disorders. Results are discussed with reference to self-regulation models of substance use and the comorbidity of substance abuse and mental disorder. Wills, T.A., Windle, M., and Cleary, S.D. Journal of Personality and Social Psychology, 74(2), pp. 387-406, 1998.

Effect of Parental Mental Health Status on Adolescents' Dietary Behaviors

In a study by NORC, investigators examined whether adolescents of substance-abusing and depressed parents were more likely to have poor dietary behaviors that those in the health comparison families the examined 841 adolescents in families of substance-abusing parents, depressed parents, and parents without diagnosable psychiatric disorder. All adolescents were given a food frequency questionnaire. Adolescents whose parents had substance abuse disorder had lower intakes of fruits and higher intakes of high fat foods, and also ate more frequently at fast-food restaurants and purchased more snacks. Adolescents whose parents were depressed had lower intakes of all food groups. Mothers' mental health status impacted more on adolescents dietary behaviors than did the father's mental health status. This research suggests that at-risk behaviors among youth of psychiatrically impaired parents may extend to food behaviors. Su, L.J., Story, M., and Su., S.S. Journal of Adolescent Health, 20, pp. 426-433, 1997.

Concurrent Versus Simultaneous Polydrug Use: Prevalence, Correlates, Discriminant Validity, and Prospective Effects on Health Outcomes

Few studies have addressed the distinction between concurrent polydrug use (various drugs used on separate occasions) and simultaneous polydrug use (the use of more than 1 drug at the same time). The authors assessed simultaneous polydrug use in a community sample to examine the prevalence of drug combinations, whether simultaneous can be distinguished from concurrent, and the prospective effects of these styles of drug use on subsequent health service utilization, physical symptoms, and psychological distress 4 years later. Marijuana and alcohol were the most common drugs used simultaneously, followed by alcohol and cigarettes. Simultaneous and Concurrent Polydrug Use formed 2 correlated but discriminable constructs. Neither Simultaneous nor Concurrent Polydrug use predicted subsequent Health Service Utilization, Physical Symptoms, or Psychological Distress. Data did reveal unique effects of specific drugs used simultaneously on these outcomes that were larger and more numerous than specific effects of concurrent drug use. Earleywine, M., and Newcomb, M.D. Experimental and Clinical Psychopharmacology, 5(4), pp. 353-364, 1997.

A Test of Reciprocal Causal Relationships Among Parental Supervision, Affective Ties, and Delinquency

Current family-delinquency research suggests that the relationships between parenting and delinquency should be viewed from interactional and developmental perspectives. The relationship between parent and child is thought to change over time, partly as a function of reciprocal causal influences between them. In this study, using panel data from a representative sample of 838 urban adolescents, the authors test the hypothesis that parenting and delinquency are reciprocally related. They also hypothesize that two central parenting dimensions, affective ties and supervision, are bidirectionally related. It is found that delinquency and parental supervision are reciprocally related, whereas affective ties appear to be a consequence rather than a cause of delinquency, at least by middle adolescence. In general, the interrelationships among these variables are more complex than those suggested by earlier unidirectional theories, and they underline the importance of interactional perspectives in understanding the interrelationship of adolescent behavior and parenting. Jang, S.J., and Smith, C.A. Journal of Research in Crime and Delinquency, 34(3), pp. 307-336, 1997.

Childhood, Adolescent, Familial, and Peer Antecedents of Cigarette Smoking in Young Adults

This study examined the interrelation of personality, family, and peer determinants and their effects on tobacco use by young adults. Mothers were first interviewed about their children when they were between the ages of 1 and 10 years old. Three subsequent interviews were conducted with the children when they reached adolescence and young adulthood. Results show support for the mediational model, which is derived from the family interactional theory framework to examine pathways that may lead to adolescent legal and illegal drug use and other problem behavior. There was a sequence in patterning: from parenting during early adolescence, to personality and peer factors, extending to smoking in late adolescence and culminating in smoking in adulthood. With a developmental approach, a number of psychosocial measures appear related in both younger and older children. Developmental differences also emerged, suggesting four possible targets for therapeutic or preventive intervention: the parent, the child, the adolescent, and the peer group. Brook, J.S., et al. Cigarette Smoking in Young Adults: Childhood and Adolescent Personality, Familial, and Peer Antecedents, J. Genetic Psychology, 158(2), pp. 172-188, 1997.

Implementation Issues in Drug Abuse Prevention Research

Methodological issues evaluating quality of implementation of drug use prevention programs are reviewed: definition (adherence, exposure, reinvention), measurement (self-report, other's report, behavioral observation), and parameters of influence (person, situation, environment). When implementation is defined as the interaction of person, situation, and environment, the "true" drug use prevention program effect is established as the average of effect generated from experimental assignment and program implementation. Differences between researcher and programmer standards of implementation quality are interpreted in terms of an efficacy/effectiveness continuum. Pentz, M.A. & Trebow, E. Implementation Issues in Drug Abuse Prevention Research. Substance Use and Misuse, 32, pp. 1655-1660, 1997.

Drug-User Treatment Programs in a Large Metropolitan Area

In 1993/1994 a compre- hensive survey of the Los Angeles County drug-user treatment systems was undertaken. The system contains more than 300 programs covering over 4,000 sq. miles and serves clients from a diverse population of over nine million people. Overall, 58% of the 14,860 clients being served at the time of the survey were male; about 35% were White, 34% Latino/Latina, 26% African-American, 2% Asian/Pacific Islander, 0.5% Native American and 2.5% of unknown ethnicity. Almost all programs reported a smaller number of current clients than allowed by maximum capacity, indicating that waiting lists were not necessarily related to lack of treatment slots, but more a lack of affordable (i.e., publicly-funded or insurance-covered) treatment slots. Waiting times ranged from one day to over one year. Polinsky, M.L., Hser, Y.I., Anglin, M.D., and Maglione, M.A. Subs. Use & Misuse, 33(8), pp. 1739-1765, 1998.

Consideration of Special Populations in the Drug Treatment System of a Large Metropolitan Area

Findings are based on a recent comprehensive survey of 294 drug treatment programs in Los Angeles County. Special populations were grouped by health status, ethnic background, language needs, and gender-related needs (groups are not mutually exclusive.) Survey results indicated a generally high proportion of programs capable of meeting the unique needs of a variety of special population clients and most programs have some mix of special population clients in their current caseload. About 62% of programs reported being able to serve clients who were primarily Spanish speakers. Clients using American Sign Language could be served by 11% of programs. About 40% of programs reported not being able to serve pregnant women, including almost half of the hospital inpatient programs and a quarter of the outpatient drug-free programs. Although almost 70% of programs reported being able to serve clients with mobility impairments, only 26% of the residential programs reported this capacity. Polinsky, M.L., Hser, Y.I., and Grella, C.E. Journal of Behavioral Health Services & Research, 25(1), pp. 7-21, 1998.

Substance Use among Nurses: Differences between Specialties

Valid data on factors that increase a health care worker's likelihood of substance use are integral in assuring professional standards and quality health care for consumers. This study explored the association between nursing speciality and past-year substance use. In an anonymous mailed survey, a balanced stratified sample of registered nurses (n=4438) reported their use of marijuana, cocaine, and prescription-type drugs, as well as cigarette smoking and binge drinking. Prevalence of use of all substances was 32%. Rates varied by specialty, even when sociodemographics were controlled. Compared with nurses in women's health, pediatrics, and general practice, emergency nurses were 3.5 times as likely to use marijuana or cocaine (odds ratio [OR]=3.5, 95% confidence interval [CI]=1.5, 8.2), oncology and administration nurses were twice as likely to engage in binge drinking; and psychiatric nurses were most likely to smoke (OR=2.4, 95% CI=1.6, 3.8). No specialty differences appeared for prescription-type drug use. These data suggest that certain nursing specialities were more likely than others to be associated with substance use. The differences were not explained by demographic characteristics. Inasmuch as a comparison of these results for nurses with prior work on physicians found considerable agreement by speciality, preventive initiatives should consider interdisciplinary approaches to substance use education. Trinkoff, A.M., and Storr, C.L. Amer J Pub Health, 88, pp. 1-5, 1998.

General Deviance and Psychological Distress: Impact of Family Support/Bonding over 12 Years from Adolescence to Adulthood

Comorbidity occurs within and across various domains of human pathology and may be diverse manifestations of a single, general dysfunction in early family support and bonding. Family socialization, pseudo maturity, and self-derogation theories were tested using cross-sectional and 12-year prospective data from a community sample assessed in late adolescence (age 18) and again in adulthood (age 30). All of the hypotheses and expected findings received some support in the data analyses these confirmed that: general deviance and psychological distress were significantly correlated for both men and women and therefore are overlapping and comorbid disorders; both general distress and psychological distress were significantly predicted by family support/bonding fully accounted for the cross-sectional association between general deviance and psychological distress for the women and general deviance for the men: both theories of pseudo maturity and self-derogation explained many of the prospective effects from late adolescence into adulthood: sexual involvement, although an indicator of general deviance, related negatively with indicators of psychological distress; different patterns were evident for the development periods of adolescence compared with adulthood; and many of the processes differed by sex. Newcomb, M.D. Criminal Behavior and Mental Health, 7, pp. 369-400, 1997.

Standardized Test Performance of Children with a History of Prenatal Exposure to Mutiple Drugs/Cocaine

Children with histories of prenatal polydrug exposure which included cocaine scored significantly lower on standardized test measures of language development (Receptive and Expressive subtests of the Sequenced Inventory of Communicative Development -Revised) than nonexposed children. Clinically, 45.8% of the children in the drug-exposed group qualified for early intervention services. Significant differences between groups were also noted on the Bayley Scales of Infant Development. No differences were found on the Peabody Picture Vocabulary Test - Revised. Each group had 24 children, age 14 to 50 months, and included 13 males and 11 females. All children were living in stable, drug-free environments (foster/adoptive/natural homes). Tests were administered by a certified Speech-Language Pathologist and language samples were taken from 30 minute videotaping sessions showing the child and caregiver playing. Results indicate that, due to the cumulative effects of prenatal history, children with histories of prenatal drug exposure should be considered at-risk for language delay. Johnson, J.M., Seikel, J.A., Madison, C.M., Foose, S.M., and Rinard, K.D. Journal of Communication Disorders, 30, pp. 45-73, 1997.

Delinquency and Antisocial Behavior: A Review of Family Processes and Intervention Research

Recent longitudinal research employing complex measurement and analytic strategies has generated new, more intricate conceptualizations of the relationship between family life and delinquency, all of which have important implications for intervention with delinquents and their families. This critical review of the current research on the role of the family, its implications for family-based interventions with delinquents, and the existing treatment outcome research highlights four areas: the link between different family processes and delinquency, reciprocal relationships between parenting and delinquency, the effects of family context on parenting and delinquency, and the family as one cause of delinquency among many. Smith, C.A., and Stern, S.B. Social Service Review, 71, pp. 382-420, 1997.

Survey Finds Parenting Differences Between Narcotic Addicts and Their Parents

A 2-part survey was administered to male and female narcotic addicts receiving methadone maintenance to examine their retrospective self-reports about how they were parented and compare them with their views about their own parenting practices of their adolescent children. The sample of 313 adult addicts included 248 females (79%) and 65 males (21%). The average age was 37.6 years. There were 250 African Americans (80%) and 63 Whites (20%) in the sample. The mean age of addiction (narcotic use 4 days a week for a month or more) was 22.5 years, and the average period of continuous use was 5.4 years. Since the age of addiction, the subjects had spent an average of 10.7 months in prison. The addicts viewed their mothers as significantly more effective at parenting than their fathers, especially in terms of interaction, communication, and affection. Fathers were generally perceived as unavailable and distant. In terms of their own parent practices, the addicts reported being significantly more involved, more responsible, and more closely attached to their children than their parents were to them. They also reported that they were more active disciplinarians and utilized significantly fewer punitive behaviors with their children. Nurco, D.N.,et al., The Family Experiences of Narcotic Addicts and Their Subsequent Parenting Practices. Am. J. Drug Alcohol Abuse, 24(1), pp. 37-59, 1998.

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