Director's Report to the National Advisory Council on Drug Abuse
February, 2002
Research Findings
Epidemiology, Etiology and Prevention Research
Effects of Aggregating High Risk Youth
This paper focuses on three-year outcomes associated with a preventive intervention trial in which high-risk youth were aggregated into cognitive-behavioral groups. Participants were 158 at-risk youth between the ages of 11 and 14. The participating youth and their teachers were interviewed each year over a three-year period following the intervention. Analyses of covariance and latent growth modeling revealed that the intervention contributed to three-year escalations in self-reported smoking and teacher-reported delinquency. Interactions between participants’ characteristics (i.e., initial status, age, and gender) and intervention were also tested. A statistically reliable interaction was found, suggesting that those with initially low levels of delinquency were especially affected by the peer intervention group. Poulin, F., Dishion, T. J., and Burraston, B. 3-year Iatrogenic Effects Associated with Aggregating High-risk Adolescents in Preventive Interventions. Applied Developmental Science, 5(4), pp 214-224, 2001.
An Integrated Components Preventive Intervention for Aggressive Elementary School Children: The Early Risers Program
The Early Risers prevention program aims to alter the developmental trajectory of children with early onset aggressive behavior that puts them at significant risk of drug use in adolescence. The program features 4 CORE components: (a) an annual 6-week summer school program, (b) a teacher consultation and student mentoring program, (c) child social skills groups, and (d) parent education and skills-training groups, all delivered in tandem with a FLEX family support program individually tailored to address the unique needs of families. At baseline, the mean age of the sample was 6.6 years. Following 2 years of intervention, program children showed significant improvement relative to controls in academic achievement and school behaviors. Change on behavioral self-regulation was moderated by level of child aggression, with intervention effects found for only the most severely aggressive children. Parents with high program attendance rates showed improvement in discipline methods. August, G.J., Realmuto, G.M., Hektner, J.M., and Bloomquist, M.L. An Integrated Components Preventive Intervention for Aggressive Elementary School Children: The Early Risers Program. Journal of Consulting and Clinical Psychology, 69 (4), pp. 614-626, 2001.
Project Towards No Drug Abuse: Generalizability to a General High School Sample
This study examined the generalizability of a successful classroom-based prevention program developed for youth at alternative high schools (high risk) to youth at general high schools. A replication of a previously tested prevention program in a general high school population was conducted with 1-year follow-up data. Classrooms within each of three schools (n =1208) were randomly assigned to two conditions, classroom education or standard care control. Statistically significant effects on alcohol and illicit drug use were achieved in this population through a 1-year period following the program, although effects were not achieved on cigarette smoking and marijuana use. These results suggest that this program (Project Towards No Drug Abuse) has applicability to a wide range of older teens. Preventive Medicine, 32(6), pp. 514-520, 2001.
Social Skills and Problem-solving Training for Children with Early-onset Conduct Problems
Families of 99 children with early-onset conduct problems were randomly assigned to a child training treatment group utilizing the Incredible Years Dinosaur Social Skills and Problem Solving Curriculum or a waiting-list control group. Children participating in the intervention had significantly fewer externalizing problems at home, less aggression at school, more prosocial behavior with peers, and more positive conflict management strategies than control children. The intervention group children also showed clinically significant improvements on reports and independent observations of aggressive and non-compliant behavior. The differential treatment response was evaluated according to child comorbidity with attention deficit hyperactivity disorder, parenting discipline practices, and family risk factors. The only risk factor related to failure to make improvements in child conduct problems after treatment was negative parenting. Most significant post-treatment changes were maintained at the 1-year follow-up. Webster-Stratton, C., Reid, J., and Hammond, M. Social Skills and Problem-solving Training for Children with Early-onset Conduct Problems: Who Benefits? Journal of Child Psychology and Psychiatry, 42(7), pp. 943-952, 2001.
Session-specific Effects of a Universal Parent-Training Intervention
Preparing for the Drug Free years is a parent training intervention designed to prevent adolescent substance abuse and other problem behaviors. Two hundred nine rural families were randomly assigned to receive the intervention or the wait-list control condition. Analysis of covariance comparing adjusted posttest scores revealed that parents in the intervention condition reported significant improvements in parenting behaviors targeted by specific intervention sessions when compared with controls. Effects were most pronounced among mothers. No significant effects were found for nontargeted parenting behaviors, and targeted behaviors were most improved among parents attending relevant program sessions. These results strengthen the internal validity of the study and increase the plausibility that reported improvements were due to the intervention. Kosterman, R., Hawkins, D.J., Haggerty, K., Spoth, R., and Redmond, C. Preparing for the Drug Free Years: Session-specific effects of a Universal Parent-training intervention with Rural Families. Journal of Drug Education, 31(1), pp. 47-68, 2001.
Modeling Factors Influencing Enrollment in Family-Focused Prevention Intervention Research
This study tests an extension of a previously supported model of family contexts and health belief predictors of parental inclination to enroll in preventive interventions. Model testing was conducted with a sample of 635 parents of 6th graders who completed a prospective participation factors survey and were recruited for an intervention research project six months later. The model fit was strong and all but one of the primary hypothesized effects were supported. Both stated inclination to enroll in an intervention and in the research project had significant positive effects on actual project enrollment occurring 6 months later. Perceived intervention benefits and barriers had significant effects on both types of stated inclination to enroll. Examination of modification indices for the model suggested an additional path linking educational attainment with actual enrollment. Spoth, R., Redmond, C., and Shin, C. Modeling Factors Influencing Enrollment in Family-Focused Preventive Intervention Research. Prevention Science, 1(4), pp. 213-225, 2000.
Long-term follow-up of Brief Family Interventions for General Populations
This study examines the long-term substance use outcomes of two brief interventions designed for general population families of young adolescents. Thirty-three public schools were randomly assigned to three conditions: the 5-session Preparing for the Drug Free Years Program, the 7-session Iowa Strengthening Families Program, and a minimal contact control condition. Assessments included multiple measures of initiation and current use of alcohol, tobacco, and marijuana. The pretest involved 667 6th graders and their families. Follow-up data were collected in the 10th grade. Significant intervention-control differences in initiation and current use were found for both interventions. It is concluded that brief family skills-training interventions designed for general populations have the potential to reduce adolescent substance use. Spoth, R.L., Redmond, C., Shin, C. Randomized Trial of Brief Family Interventions for General Populations: Adolescent Substance Use Outcomes four Years Following Baseline. Journal of Consulting and Clinical Psychology, 69(4), pp. 627-642, 2001.
Preadolescent Predictors of Substance Initiation
This study examines potentially modifiable family and peer factors known to be predictors of early substance initiation. A theoretically derived model of substance initiation was tested using structural equation modeling. Results indicate that both family and peer factors have an impact on early substance initiation when children in this sample were 11 and 12 years old. The model explained 69% of the variance in substance initiation. Prosocial family processes (rules, monitoring, and attachment) had a significant impact on child peer association, decreasing involvement with antisocial peers. These prosocial family processes had a significant negative effect on substance initiation even while modeling the influence of antisocial peers. Oxford, M.L., Harachi, T.W., Catalano, R.F., Abbott, R.D. Preadolescent Predictors of Substance Initiation: A Test of Both the Direct and Mediated Effects of Family Social Control Factors on Deviant Peer Associations and Substance Initiation. American Journal of Drug and Alcohol Abuse, 27(4), pp. 599-616, 2001.
Social Competence and Substance Use Among Rural Youth
Social competence is a construct that has been shown to play a key role in youth development and there has been growth in the study of skills training in social and interpersonal competence in order to prevent drug use, antisocial, and aggressive behavior. This study of 1568 rural junior high school youth was conducted to uncover the mechanisms by which social competence may be associated with substance use during early adolescence. Structural equation modeling indicated that social competence had a direct, protective association with substance use in that those youth who were more socially confident, assertive, and had better communication skills reported less smoking and drinking. Furthermore, the relationship between social competence and substance use was fully mediated by social benefit expectancies of use. Thus, poorly competent youth use cigarettes and alcohol because they perceive that there are important social benefits to these behaviors. Griffin, K.W., Epstein, J.A., Botvin, G.J., and Spoth, R.L. Social Competence and Substance Use Among Rural Youth: Mediating Role of Social Benefit Expectancies of Use. Journal of Youth and Adolescence, 30(4), pp. 485-498, 2001.
Protective Role of Personal Competence Skills in Adolescent Substance Use: Psychological Well-being as a Mediating Factor
Adolescents who use a variety of cognitive and behavioral self-management strategies have been shown to report reduced rates of early-stage substance use, but little is known about how these personal competence skills may be protective. In a series of structural equation models, this study examined the association between competence skills and substance use over a 3-year period among 849 suburban junior high school students, and whether psychological distress, well-being, or both mediated this relation. Findings indicated that well-being fully mediated the relation between early competence and later substance use, but distress did not. Youth with good competence skills reported greater subsequent well-being, which in turn predicted less later substance use. Findings suggest that competence skills protect youth by enhancing well-being and that prevention programs should aim to enhance competence in order to promote resilience. Griffin, K.W., Scheier, L.M., Botvin, G.J., and Diaz, T. Protective Role of Personal Competence Skills in Adolescent Substance Use: Psychological Well-being as a Mediating Factor. Psychology of Addictive Behaviors 15(3), pp. 194-203, 2001.
Drug Use in One’s Social Network and Neighborhood Predicts Use of Heroin and Cocaine
Researchers sought to examine the influence of competing social environmental factors on substance abuse. They conducted a longitudinal study to determine the relative power of social network and neighborhood characteristics in predicting continuing illicit drug use. Adults with a history of injecting drug use (N=342) were followed for one year. Their heroin and cocaine use were assessed semiannually. Multiple logistic regression models were fit to determine the degree to which social network and neighborhood characteristics, assessed at baseline, predicted continuing heroin and/or cocaine use throughout the study period. Of the 342 participants, 236 (69%) reported continuing heroin and/or cocaine use. Drug use by members of the social network was a stronger predictor of participants’ continuing drug use (OR=4.31, 95% CI 2.51, 7.40) than was a high level of drug-related arrests in the participant’s neighborhood (OR=2.41, 95% CI 1.24, 4.71), after adjusting for drug treatment and demographic variables. Both seemed to have independent effects on study participants’ drug use. These findings underscore the importance of breaking social ties with drug-using associates, even for those who reside in high-risk environments. Dissociating from drug-using peers and/or developing relationships with nonusers are generally regarded as important treatment goals and incorporated into drug treatment approaches with demonstrated efficacy. The practical application of these findings is to target the social environment for intervention in the context of drug abuse treatment counseling, but further work will be needed to develop substance abuse treatment and prevention strategies that build coping and social skills to minimize drug abuse in high-risk environments. Schroeder, J.R., Latkin, C.A., Hoover, D.R., Curry, A.D., Knowlton, A.R., and Celantano, D.D. Illicit Drug Use in One’s Social Network and in One’s Neighborhood Predicts Individual Heroin and Cocaine Use. Ann Epidemiol., 11, pp. 389-394, 2001.
Marijuana Abstinence Effects in Marijuana Smokers Maintained in their Home Environment
Budney and his colleagues assessed withdrawal effects in a group of 12 daily marijuana smokers on 16 consecutive days during which they smoked marijuana as usual (days 1-5), abstained from smoking marijuana (days 6-8), returned to smoking (days 9-13) and again abstained on days (14-16). The authors reported that the study validated several specific effects of marijuana abstinence in heavy marijuana smokers, i.e., irritability, aggression, decreased appetite, restlessness, sleep difficulty, depression, craving for marijuana and general discomfort and showed that they were reliable across at least one abstinence period and clinically significant. These withdrawal effects appear similar in type and magnitude to those observed in studies of nicotine withdrawal. Budney, A., Hughes, J.R., Moore, B.A., and Novy, P.L. Arch. Gen. Psychiatry, 58, pp. 917-924, 2001.
Drug Use and Lifestyle Among College Undergraduates: A 30-year Longitudinal Study
In order to examine trends in the prevalence of substance use and its relationship to attributes of lifestyle among college students over a 30-year period, Pope and his colleagues distributed anonymous questionnaires to seniors at a large New England college in 1999, using methodology identical to that they had used in 1969, 1978, and 1989. In 1999, the sample size was: 424 ‘non-users’, and 369 ‘users’. Most forms of drug use rose to peak in 1978, then fell over the next 21 years with the exception of MDMA. These observations were similar to those from the Monitoring the Future Study. For example, according to the MTF survey, the lifetime prevalence of marijuana fell from a peak of 65% in 1980 to 49.9% in 1998, similar to the authors’ findings of 76% in 1978 to 46% in 1999. Cocaine use fell from 22% in 1978 to 8% in 1999 (MTF), similar to their findings of 29.8% to 6.9%. MDMA use (which has now become the second most frequently tried illegal drug after marijuana) rose from 3.8% in 1989, 4.6% in 1997 to 6.8% in 1998, similar to authors’ numbers of 4.1% in 1989 and 10.1% in 1999. On several variables, college substance users differed more sharply from non-users in 1999 than in previous decades. In earlier decades, drug users differed from non-users only on visits to a psychiatrist and level of heterosexual activity. In 1999, the users and non-users differed in terms of homosexual activity and time spent in extracurricular activities. The authors conclude that although limited to a single institution, the findings suggest that college drug use has been declining, and that users have increasingly diverged from non-users in their values and lifestyles. Pope, H., Ionescu-Pioggia, M., and Pope, K.W. Drug Use and Lifestyle Among College Undergraduates: A 30-year Longitudinal Study, Am J. Psychiatry, 158, pp. 1519-1521, 2001.
Ethnic Labels and Ethnic Identity Predict Drug Use
This article examines the value of ethnic labels and ethnic identity in predicting self-reported drug use and exposure to drugs of an ethnically diverse group of seventh grade students from a southwestern US city. Four hundred eight Mexican American (52%), non-Hispanic white (23%), mixed ethnicity (14%), and African American (12%) students completed a questionnaire where they reported frequency of cigarette, alcohol, marijuana, and hard drug use in the past month. Students also reported on lifetime use of specific drugs and age of initial use. Ethnic minority students with stronger ethnic pride reported less frequent drug use and exposure than those with a weaker sense of ethnic pride while ethnic pride among white students is associated with increased risk. Ethnic minority students who viewed their behavior, speech, and appearance as consistent with their ethnic group reported more drug use and exposure, while their white counterparts reported less. This study demonstrates that ethnic labels are superior explanatory constructs when used in combination with ethnic identity measures. Marsiglia, F.F., Kulis, S., and Hecht, M.L. Ethnic Labels and Ethnic Identity as Predictors of Drug Use among Middle School Students in the Southwest. Journal of Research on Adolescence, 11(1), pp. 21-48, 2001.
School-Based Support Groups for Adolescents with an Addicted Parent: Using Principles of Solution Focused Therapy
In every classroom, there are approximately 5 children on average with chemically dependent parents. Few of these children receive supportive services, despite the fact that they attend school less often, are often late for school, and have a higher incidence of learning disabilities. To address this, many school districts offer school-based support groups (SBSG). Consistent with the principles of solution-focused therapy, the SBSG emphasizes the strengths and resiliency of these youth and helps them develop problem-solving strategies and find solutions. This study was a qualitative evaluation of SBSG for adolescents with an addicted parent. Gance-Cleveland, B.L., and Rothman, A. School-Based Support Groups for Adolescents with an Addicted Parent: Using Principles of Solution Focused Therapy. The Drug and Alcohol Professional, 1(1), pp. 17-29, 2001.
Self-Reported High-Risk Locations of Drug Use Among Drug Offenders
The present study used a detailed, multiple-choice, self-report questionnaire to collect and analyze data on home, work, and other public locations where drug offenders report using drugs. In addition, these settings were examined as a function of gender, ethnicity, type of drug used, and drug abuse/dependence status. The participants for the present study were 462 individuals attending drug diversion programs in southern California. The single most frequently reported location of use was the subjects' living room with a small group of friends. However, heavier users used different drugs across a greater variety of locations. Not surprisingly, drugs were used least at work (though a surprising 47% had used at work). Popular situations of drug use among drug offenders are similar to that of high-risk youth. Sussman, S., Ames, S.L., Dent, C.W., and Stacy, A.W. Self-Reported High-Risk Locations of Drug Use Among Drug Offenders. American Journal of Drug and Alcohol Abuse, 27 (2), pp. 281-299, 2001.
Workplace Substance Abuse Prevention: Comparison of Two Approaches
Employees fail to seek help for alcohol or drug (AOD) abuse because of unhealthy work climates, stigma, and distrust in Employee Assistance Programs (EAPs). To address such problems, the authors randomly assigned groups of municipal employees (N = 260) to 2 types of training: a 4-hr informational review of EAPs and policy and an 8-hr training that embedded messages about AOD reduction in the context of team building and stress management. Pre- and post-training and 6-month follow-up surveys assessed change. Group privacy regulation, EAP trust, help seeking, and peer encouragement increased for team training. Stigma of substance users decreased for information training. EAP/policy knowledge increased for both groups. A control group showed little change. Help seeking and peer encouragement also predicted EAP utilization. Integrating both team and informational training may be the most effective for improving help seeking and EAP utilization. Bennett, J.B., and Lehman, W.E.K. Workplace Substance Abuse Prevention and Help Seeking: Comparing Team-oriented and Informational Training. Journal of Occupational Health Psychology, 6(3), pp. 243-254, 2001.
Multilevel Modeling of Individual and Group Level Mediated Effects
This article combines procedures for single-level mediational analysis with multilevel modeling techniques in order to appropriately test mediational effects in clustered data. A simulation study compared the performance of these multilevel mediational models with that of single-level mediational models in clustered data with individual- or group-level initial independent variables, individual- or group-level mediators, and individual level outcomes. The standard errors of mediated effects from the multilevel solution were generally accurate, while those from the single-level procedure were downwardly biased, often by 20% or more. The multilevel advantage was greatest in those situations involving group-level variables, larger group sizes, and higher intraclass correlations in mediator and outcome variables. Multilevel mediational modeling methods were also applied to data from a preventive intervention designed to reduce intentions to use steroids among players on high school football teams. This example illustrates differences between single-level and multilevel mediational modeling in real-world clustered data and shows how the multilevel techniques may lead to more accurate results. Krull, J.L. and MacKinnon, D.P. Multilevel Modeling of Individual and Group Level Mediated Effects. Multivariate Behavioral Research, 36(2), pp. 249-277, 2001.
A Further Look at the Prognostic Power of Young Children’s Reports of Depressed Mood and Feelings
A primary objective of this study was to determine the validity of first graders’ self-reports of depressed mood and feelings. To that end, the prognostic power of first grade self-reports of depressed mood and feelings was examined with respect to later psychopathology and adaptive functioning in a population of urban school children (N=496). First grade self-reports of depressed mood predicted later child academic functioning, the need for and use of mental health services, suicidal ideation, and a diagnosis of major depressive disorder by age 14. The prognostic power of these early self-reports suggests that children as young as 5 or 6 years of age are capable of providing valid reports of depressed mood and feelings. Ialongo, N.S., Edelsohn, G., and Kellam, S.G. A Further Look at the Prognostic Power of Young Children’s Reports of Depressed Mood and Feelings. Child Development, 72(3), pp. 736-747, 2001.
Reported Motivations for Drug and Alcohol Use
Norm Focus theory distinguishes between injunctive, norms (what people ought to do), descriptive norms (what people actually do) and personal norms (internalized values & expectations for one’s own behavior). Based on Norm Focus Theory, this study describes alcohol and other drug use norms of adolescents and their perceived motivation for their behavioral norms. Structured interviews were conducted with sixty-seven African American and European American adolescents from an urban area (mean age 13). Drugs were viewed as available and commonly used. European Americans only, and mostly males, used justifications for their alcohol and marijuana use. Motivations to use drugs included social needs and enjoyment, however European American adolescents only mentioned using drugs for curiosity, boredom, problem solving, and protecting or furthering one’s image. Reasons to avoid drugs offered by European American adolescents included motivations related to self-concept while African American adolescents described physical and psychosocial threats. Barnett, J.M. and Miller, M. Adolescents’ Reported Motivations to Use or Not to Use Alcohol or Other Drugs. The Social Studies, 92, pp. 209-212, 2001.
Children of Substance Abusers are at Risk for Psychiatric Disorders
Investigators compared psychiatric disorders and problem behavior scores in pre-adolescent children of fathers with alcohol or other drug dependence and ASP (SD+/ASP+), children whose fathers had substance dependence without ASP (SD+/ASP-), and children whose fathers were without either disorder (SD-/ASP-). SD+/ASP+ children showed elevated rates of major depression, conduct disorder, attention deficit hyperactivity disorder, oppositional defiant disorder, and separation anxiety disorder when compared to SD+/ASP- and SD-/ASP- children. SD+/ASP+ children had higher internalizing and externalizing problem behavior scores than the other two groups of children. The results suggest that SD+/ASP+ children are at significant risk for internalizing and externalizing psychopathology. Moss, H.B., Baron, D.A., Hardie, T.L., and Vanyukov, M.M. Am J Addict, 10(3), pp. 269-78, 2001.
Child Psychopathology Predicts Heavier Drug Use in Adolescence
The authors examined early psychopathology as a predictor of trajectories of drug use from ages 13-18 years. Six years of annual data were analyzed for 506 boys using a mixed effects polynomial growth curve model. They tested whether distinct measures of psychopathology and behavioral problems (i.e., attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, depression, and violence) assessed in early adolescence could prospectively predict level and change in alcohol and marijuana use. Higher levels of all of the types of psychopathology predicted higher levels of alcohol use, and higher levels of attention-deficit/hyperactivity disorder, conduct disorder, and violence predicted higher levels of marijuana use. Only conduct disorder predicted linear growth in alcohol use, and none of the measures predicted growth in marijuana use. The results suggest that drug use prevention programs should target youths with early symptoms of psychopathology. White, H.R., Xie, M., Thompson, W., Loeber, R., Stouthamer-Loeber, M. Psychology of Addictive Behaviors, 15(3), pp. 210-218, 2001.
The Adult Antisocial Syndrome with and without Antecedent Conduct Disorder: Comparisons from an Adoption Study
DSM antisocial personality disorder (ASPD) requires a retrospective diagnosis of conduct disorder-historical behavior not present in everyone with adult ASPD criteria. Using adoption study data, we examined the impact of this requirement on biological and environmental risk associations. We defined three subgroups: DSM-III ASPD (n = 30), adult antisocials without conduct disorder (n = 25), and controls (n = 142). Having an antisocial biological parent was a specific risk factor for ASPD. In contrast, fetal alcohol exposure, male gender, and adverse environment were associated with the adult antisocial syndrome, regardless of conduct disorder history. The two antisocial groups were similar with respect to sociopathy scales, co-occurring diagnoses, and the incidence of most individual symptoms. However, the phenotypic expression of the biological-possibly genetic-risk for ASPD appears to be manifest before adulthood. Despite this, we could not detect clinically important differences between the two sociopathic groups. The conduct disorder requirement therefore may be more relevant to etiological than clinical understanding of adult antisocial behavior. Langbehn, D.R., and Cadoret, R.J. Comprehensive Psychiatry, 42(4), pp. 272-282, 2001.
Drug use in Vietnam Associated with Premature Death
Large numbers of young men were exposed to high-quality opiates for a relatively short time period during military service in Vietnam. This study examined the relationships of opiate and other drug abuse before, during, and shortly after their time of service in Vietnam with the subsequent 25-year mortality among the cohort of 1227 US Army enlisted returnees and their matched civilians previously studied in 1972 and 1974. Results of path analytic models applied to selected significant measures showed that both in-Vietnam and post-Vietnam drug use factors were large and significant predictors of mortality, controlling for pre-service drug use, continuity to later drug use, and demographic and other behavioral measures. The magnitude of the direct effect of drug use on mortality was larger than those of the covariates that were entered in the path analyses, except age. Notwithstanding the high remission rate from opiate addiction, drug use in Vietnam had considerable predictive utility for premature death in this cohort. In light of the re-emergence of increased heroin use since the mid-1990s, the findings point to the importance of early intervention of drug use and comorbid problems for today's youth now initiating heroin use. Price, R.K., Risk, N.K., Murray, K.S., Virgo, K.S., and Spitznagel, E.L. Drug Alcohol Depend, 64(3), pp. 309-318, 2001.
Temperament Related to Early-onset Substance Use
We tested a theoretical model of early-onset substance (tobacco, alcohol, and marijuana) use. A sample of 1,810 public school students was surveyed in sixth grade (M age 11.5 years) and seventh grade. Temperament dimensions were related to substance use, and structural modeling analyses showed indirect effects through self-control constructs. Good self-control had a path to higher academic competence and had direct effects to less peer use and less adolescent substance use; poor self-control had a path to more adolescent life events and more deviant peer affiliations. Academic competence and life events had indirect effects to adolescent substance use, through peer affiliations. Findings from self-report data were corroborated by independent teacher ratings. Effects were also noted for family variables and demographic characteristics. Implications of epigenetic theory for prevention research are discussed. Wills, T.A., Cleary, S., Filer, M., Shinar, O., Mariani, J., and Spera, K. Prev Sci, 2(3), pp. 145-163, 2001.
Patterns of Remission and Treatment Use among Vietnam Veterans
Using an epidemiologically obtained sample, investigators examined patterns of illicit drug use, abuse, and remission over a 25-year period and recent treatment use. The surviving members of the cohort (n = 841), previously surveyed in 1972 and 1974, comprised 3 subsamples of Vietnam War enlisted men and civilian controls. Retrospectively obtained year-to-year measures from the 1996-1997 survey included use and remission of sedatives, stimulants, marijuana, cocaine, and opiates, as well as substance abuse and psychiatric treatment use. Relatively stable patterns of frequent use in adulthood were found, with the mean duration from initiation to the last remission ranging from 9 to 14 years. A majority attempted to quit; however, most did not use traditional drug treatment in their last attempts. Fewer than 9% of the then-current drug users were treated in inpatient or outpatient settings at the time of data collection. Most drug abusers who had started using drugs by their early 20s appeared to gradually achieve remission. Spontaneous remission was the rule rather than the exception. Nonetheless, considerable unmet needs existed for those who had continued use into middle age. Price, R.K., Risk, N.K., and Spitznagel E.L. Am J Public Health, 91(7), pp. 1107-1113, 2001.
Peer Isolation and Drug Use among White non-Hispanic and Mexican American Adolescents
The social-emotional characteristics and drug-use patterns of adolescents who reported having no friends (i.e., isolates) were compared to those of adolescents in drug-using and non-drug-using peer groups. Adolescents who did not have drug-using peers reported the lowest drug use and those with drug-using peers had the highest drug use, with adolescents who were isolated falling in between. Isolated youth reported more shyness, greater feelings of alienation, and lower social acceptance than did those in the other groups. Isolated youth also reported more anger and depression than did youth with non-drug-using peers, but less anger and equivalent depression when compared to adolescents with drug-using peers. Results are discussed in terms of social-emotional characteristics of isolated youth and risk/protective factors. Tani, C.R., Chavez, E.L., and Deffenbacher, J.L. Adolescence, 36(141), pp. 127-139, 2001.
Gender Differences in the Relationship of Homelessness to Symptom Severity, Substance Abuse, and Neuroleptic Noncompliance in Schizophrenia
This study examined gender differences in the relationship of homelessness in schizophrenia to symptom severity, risk behaviors, and prognostic features. Four hundred subjects with schizophrenia were studied: 100 homeless men, 100 homeless women, 100 never homeless men, and 100 never homeless women. Assessments included derivation of five symptom factors by using the Positive and Negative Syndrome Scale (PANSS). Homelessness for the entire sample was associated with greater severity of positive, activation, and autistic preoccupation symptoms, younger age at first hospitalization, and substance abuse (SA). For men only, homelessness was associated with neuroleptic noncompliance (NN). When NN and SA were statistically controlled, symptom severity was not different between the homeless and never homeless. Women, independent of residential status, had more severe negative, activation, and autistic preoccupation symptoms that were not associated with prognostic features or risk behaviors. For both men and women, SA was associated with homelessness, but independent of residence, SA was less severe in women. Additionally, SA was less severe in homeless women than never homeless men. Thus, symptom severity in homeless individuals with schizophrenia appears as an interaction of symptom profiles and risk behaviors that are gender specific. Although cross-sectional analyses cannot distinguish cause from effect, these findings suggest gender-specific routes to homelessness among indigent urban adults with schizophrenia. Opler, L.A., White, L., Caton, C.L., Dominguez, B., Hirshfield, S., and Shrout, P.E., J Nerv Ment Dis, 189(7), pp. 449-456, 2001.
The Effects of a High-risk Environment on the Sexual Victimization of Homeless and Runaway Youth
Based on the structural-choice theory of victimization, the current study examines the effects of a high-risk environment on the sexual victimization of 311 homeless and runaway youth. Results from logistic regression revealed that survival sex, gender, and physical appearance were significantly associated with sexual victimization. Results from a series of interactions also revealed that the effects of deviant behaviors on sexual victimization varied by gender and age. Although males and females engaged in similar activities, young women were more likely to be victims of sexual assault. These findings suggest that engaging in high-risk behaviors predispose some people to greater risks but it is the combination of these behaviors with gender and/or age that determines who will become victimized. Tyler, K.A., Hoyt, D.R., Whitbeck, L.B., Cauce, A.M., Violence Vict.,16(4), pp. 441-455, 2001.
Social Learning Processes and Smoking Cessation
Maturing out and social learning are the two predominant hypotheses to explain cessation from various psychoactive drugs. This study examined the predictors of smoking cessation in a nonclinical sample of 134 male and 190 female, young adult, regular (daily) smokers within a social learning and maturing-out framework. Four waves of prospective, longitudinal data from a community sample followed from adolescence into young adulthood were analyzed. Logistic regression analyses were used to test the effects of differential associations, definitions, differential reinforcement, and changes in adult role status on smoking cessation in young adulthood. Becoming married to a nonsmoker and decreases in the proportion of friends who smoked were significant predictors of cessation. Current smokers and stoppers did not differ significantly in terms of prior intensity of cigarette use or alcohol abuse/dependence. They also did not differ in terms of psychological characteristics, including depression and prior coping use of cigarettes. Social networks were more important than social roles for predicting cessation in young adulthood. Thus, smoking cessation programs should focus on social learning processes. Chen, P.H., White, H.R., and Pandina, R.J. Addict Behav, 26(4), pp. 517-529, 2001.
Risk Factors for Adolescent Marijuana Use across Cultures and across Time
This integrated analysis of data from 3 different longitudinal studies was conducted to examine the early psychosocial predictors of later marijuana use among adolescents. The data used in the analysis were derived from (a) a sample of 739 predominantly White adolescents representative of the northeastern United States, (b) a sample of 1,190 minority adolescents from the East Harlem section of New York City, and (c) a sample of 1,374 Colombian adolescents from two cities in Colombia, South America. In 2 of the samples, participants were interviewed in their homes, and in the 3rd study, participants were assessed in school. The predictors included a number of variables from (a) the personality domain, reflecting the adolescents' conventionality and intrapsychic functioning; (b) the family domain, representing the parent-child mutual attachment relationship and parental substance use; (c) the peer domain, reflecting the peer group's delinquency and substance use; and (d) the adolescents' own use of legal drugs. The dependent variable was adolescent marijuana use. The results of the analysis demonstrated remarkable consistency in the risk and protective factors for later marijuana use across the 3 samples, attesting to the robust nature of these predictors and their generalizability across gender, time, location, and ethnic/cultural background. These findings have important implications for designing intervention programs. Programs aimed at preventing adolescent marijuana use can be designed to incorporate universal features and still incorporate specific components that address the unique needs of adolescents from different groups. Brook, J.S., Brook, D.W., Arencibia-reles, O., Richter, L., and Whiteman, M. J Genet Psychol, 162(3), pp. 357-374, 2001.
Dramatic-erratic Personality Disorder Symptoms: I. Continuity from Early Adolescence into Adulthood
This longitudinal study examined dramatic-erratic personality disorder symptoms (histrionic, borderline, and narcissistic symptoms) in a community sample of 407 adolescents to assess whether this diagnostic construct is meaningful in young people. Based on latent variable models and dimensional symptom scales, these so-called Cluster B symptoms were highly stable across an eight-year interval from early adolescence to early adulthood. Furthermore, when compared with internalizing and externalizing symptoms, dramatic-erratic symptoms were more stable over time than these well-established Axis I symptom clusters. Based on high correlations with co-occurring internalizing and externalizing symptoms, Cluster B symptoms clearly reflect emotional distress during adolescence. These analyses reinforce recent efforts to establish personality disorders as a clinically significant and valid diagnostic construct in young people. Crawford, T.N., Cohen, P., and Brook, J.S. J Personal Disord, 15(4), pp. 319-35, 2001.
Dramatic-erratic Personality Disorder Symptoms: II. Developmental Pathways from Early Adolescence to Adulthood
This study examined the relationship over time between Cluster B personality disorder symptoms (borderline, histrionic, and narcissistic symptoms) and comorbid internalizing and externalizing symptoms in a community sample of 407 adolescents. Cross-lagged longitudinal models tested (a) the hypothesis that Cluster B symptoms reflect primary disturbances that give rise to co-occurring internalizing and externalizing symptoms; and (b) the alternative hypothesis that these Axis I symptom clusters reflect primary problems that interfere with normal personality development. Internalizing and externalizing symptoms each predicted subsequent Cluster B symptoms in girls, although these effects occurred only at specific developmental stages. Cluster B symptoms in boys and girls at ages 10 to 14 years predicted externalizing symptoms two years later. Instead of clearly supporting one hypothesis over the other, longitudinal models suggested gender-specific developmental effects that were partially consistent with both hypotheses. Crawford, T.N., Cohen, P., and Brook, J.S. J Personal Disord, 15(4), pp. 36-50, 2001.
Monitoring the Future (MTF) Study
Results from the MTF study were released on December 19, 2001. The findings summarized below focus on statistically significant changes from 2000 to 2001. This year's sample consisted of a total of 44,346 8th, 10th, and 12th grade students in 424 schools. For more information, go to http://www.nida.nih.gov and to http://monitoringthefuture.org, the MTF website at the University of Michigan.
Major Findings
The major findings of the 2001 MTF study were (1) a decrease in cigarette use by 8th and 10th graders from 2000 to 2001; (2) a slowing of the rise in MDMA (ecstasy) use; and (3) a decline in heroin use among 10th and 12th graders. With a few isolated exceptions, use of most other drugs and alcohol remained stable, as did most beliefs and attitudes regarding drug use.
The decline in cigarette use in the 2001 survey continued a general pattern of declining rates seen between 1996 and 2000. Decreases were observed in the lifetime, past month, and daily smoking measures for 8th and 10th graders. Past month cigarette use declined from 14.6 percent to 12.2 percent among 8th graders, and from 23.9 percent to 21.3 percent among 10th graders. 12th graders’ rates of smoking declined significantly from 1999 to 2000 and continued to decline, although not statistically significantly from 2000 to 2001. The increase in students' MDMA use reported in the last two MTF surveys slowed in 2001. While increases were observed in all three grades, they were generally not as steep as in the past two years and were not statistically significant. In addition, the perceived risk of harm from trying MDMA once or twice increased among seniors from 37.9 percent to 45.7 percent. Increases in perceived risk are often harbingers of future reductions in rates of use.
Lifetime and past year use of heroin decreased from 2000 to 2001 among 10th and 12th graders, and past month use decreased among 12th graders. For 10th graders, past year use decreased from 1.4 percent to 0.9 percent, and for 12th graders it was down from 1.5 percent to 0.9 percent. This decrease resulted largely from a decline in use of the drug without a needle (i.e., snorting or smoking it). For 12th graders, this year's decrease in heroin use reverses an increase between 1999 and 2000 that brought it to the highest level seen in the history of the survey; the rate for 2001, 0.9 percent for past year use, is the lowest since 1994.
Use of most other illicit drugs remained stable from 2000 to 2001. Illicit drug use rates are below their recent peaks in 1996 for 8th graders, but for 10th and 12th graders, they remain largely unchanged from recent peak levels seen in 1997. However, 27-year trend data for 12th graders indicate current levels of illicit drug use are well below their peaks in the late 1970s and early 1980s.
Other Findings
Illicit Drugs
- Marijuana use in the lifetime, past year, and past month remained statistically unchanged from 2000 to 2001 in each grade. Among 8th graders, marijuana use is below its recent peak in 1996. Rates of use among 10th and 12th graders have been stable since their recent high points in 1997. In 2001, past year rates of marijuana use were 15.4 percent of 8th graders, 32.7 percent for 10th graders, and 37.0 percent for 12th graders.
- Use of cocaine, including both powder and crack, decreased from 2000 to 2001 among 10th graders. Lifetime use of cocaine in any form among students in this grade declined from 6.9 percent to 5.7 percent; lifetime use of crack decreased from 3.7 percent to 3.1 percent; and past year use of cocaine powder declined from 3.8 percent to 3.0 percent.
- Inhalant use continued the gradual declining trend seen in recent years, though the decrease from 2000 to 2001 was statistically significant only in past year use among 12th graders, which went from 5.9 percent to 4.5 percent. In 2001, 9.1 percent of 8th graders, 6.6 percent of 10th graders, and 4.5 percent of 12th graders reported using inhalants in the past year.
- Hallucinogen use overall remained stable from 2000 to 2001 among 8th, 10th and 12th grade students. This stability follows declines between 1999 and 2000 in past month use of these drugs among 10th and 12th graders and in past year use among 12th graders.
- LSD, in an exception to the overall pattern of stability for hallucinogens, showed mixed changes from 2000 to 2001. Past month LSD use among 12th graders increased from 1.6 percent to 2.3 percent, but among 10th graders past year use declined from 5.1 percent to 4.1 percent.
- Steroid use in the lifetime, past year, and past month increased among seniors from 2000 to 2001. Past year use, for example, increased from 1.7 percent to 2.4 percent. Past year steroid use in 2001 stood at 1.6 percent for 8th graders and 2.1 percent for 10th graders.
Alcohol
- Between 2000 and 2001, alcohol use indicators remained mostly stable. Two comparisons were statistically significant: having been drunk in the past year decreased from 18.5 percent to 16.6 percent among 8th graders, and daily alcohol use in the past month increased from 2.9 percent to 3.6 percent among 12th graders.
Tobacco Products Other Than Cigarettes
- Use of bidis decreased among 8th and 10th graders. Past year use of these small, flavored cigarettes went from 3.9 percent to 2.7 percent among 8th graders and from 6.4 percent to 4.9 percent among 10th graders.
- Rates of smokeless tobacco use remained statistically unchanged between 2000 and 2001. In 2001, 4.0 percent of 8th graders, 6.9 percent of 10th graders, and 7.8 percent of 12th graders reported using smokeless tobacco in the past month.
Perceived Harm, Disapproval, and Perceived Availability
- Perceived harmfulness of trying inhalants increased from 41.2 percent to 45.6 percent among 8th and from 46.6 percent to 49.9 percent 10th graders.
- Perceived harmfulness of regularly smoking marijuana decreased from 74.8 percent to 72.2 percent among 8th graders.
- Perceived harmfulness of regularly taking LSD declined from 57.5 percent to 52.9 percent among 8th graders and from 72.0 percent to 68.8 percent among 10th graders.
- As noted above, perceived harmfulness of trying MDMA once or twice increased among seniors, the only grade asked this question.
- Seniors' disapproval of using heroin once or twice without a needle declined from 94.0 percent in 2000 to 91.7 percent in 2001, a change that is somewhat unexpected in view of the decrease in rates of use noninjection use of heroin among these students.
- Disapproval of steroid use decreased among seniors.
- Perceived availability of MDMA (ecstasy) increased sharply among seniors, from 51.4 percent to 61.5 percent.
- Perceived availability of crack and cocaine powder declined among 10th graders. The percent that thought cocaine powder would be "very" or "fairly easy" to get went from 34.5 percent to 31.0 percent.
The Decline of Substance Use in Young Adulthood: Changes in Social Activities, Roles, and Beliefs
The Monitoring the Future team at the University of Michigan published a new book based on their longitudinal panel data. This volume examines how changes in social and religious experiences and changes in attitudes towards substance use among young adults are related to changes in substance use, family transitions, living arrangements, education, and employment. The analysis included over 38,000 young people followed from the initial survey, when they were high school seniors (age 18), into adulthood (up to age 32) and covers the last 25 years, a period when drug use and views about drugs underwent important changes. An earlier book by the MTF investigators showed that the new freedoms of young adulthood are associated with increases in substance use, while the responsibilities of adulthood--marriage, pregnancy, parenthood--contribute to later declines in substance use. The new findings clarify some of the mediators involved in these changes, such as religiosity and perceived risk and disapproval of substance use, factors whose importance is borne out even when controlling for a number of possible confounders. The initial freedoms of young adulthood often lead to frequent evenings out, parties and visits to bars, patterns that may be associated with increases in substance use, but later these behaviors are often crowded out by adult responsibilities to spouse and children. In addition to removing individuals from these higher-risk venues, engagement, marriage, pregnancy, and parenthood tend to heighten both disapproval and perceptions of risk of substance use. The study suggests that while these attitudinal variables are fairly stable, it is important to intervene early to strengthen them if substance use is to be reduced. The authors also discuss the need to intervene with younger adults prior to assumption of full adult roles to involve them in prosocial activities that will compete with substance use. Bachman, J.G., O'Malley, P.M., Schulenberg, J.E., Johnston, L.D. Bryant, A.L., and Merline, A.C. The Decline of Substance Use in Young Adulthood: Changes in Social Activities, Roles, and Beliefs. Mahwah, NJ, US: Lawrence Erlbaum Associates, Inc., Publishers, 2002.
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