Correlates of Treatment Retention Among Multi-Ethnic Youth with Substance Use Problems: Initial Examination of Ethnic Group Differences

ABSTRACT

Aims: To explore (1) the influence of pretreatment and treatment factors on treatment retention among a multi-ethnic sample of adolescents and (2) the potential differential influence of pretreatment and treatment factors on treatment retention within each ethnic subgroup. Participants: A multi-ethnic sample of 420 adolescent juvenile offenders in treatment for substance use problems (U.S.-born Hispanics n = 222; foreign-born Hispanics n = 94; African-Americans n = 66; and non-Hispanic Whites n = 38). Design: Cross-sectional data were examined using analysis of variance (ANOVA) testing putative differences in treatment retention for the entire sample (N = 420) for the following factors: (1) ethnicity, (2) psychiatric comorbidity, and (3) treatment variables. The second set of analyses examines differences in treatment retention associated with these factors within the ethnic subgroups. Finally, supplementary analyses were conducted to explore the potential influence on retention of the following cultural factors: (a) ethnic orientation, (b) perceived discrimination, and (c) acculturation level (for Hispanic youth only). Findings: Consistent with prior research, results indicated that non-Hispanic White adolescents had significantly higher treatment retention than the ethnic minority adolescents (p = .003). The particular factors related to treatment retention varied greatly across the four ethnic subgroups; however there were no differences in treatment retention by any of the cultural variables. Conclusions: Taken together, the results suggest that ethnic minority youth continue to drop out of treatment at higher rates than their non-Hispanic White counterparts, and the factors associated with treatment retention vary greatly across ethnic groups.     

Race and Ethnic Differences in Attempts to Cut Down or Quit Substance Use in a High School Sample

Abstract

Much attention has been given to the initiation and progression of substance involvement of youth. Less is known about decrements in substance use and cessation efforts among adolescents from diverse race/ethnic backgrounds. The present study examined substance use and attempts to reduce or quit substance use among adolescents from three race/ethnic groups. Participants were 3,756 Asian-American, Latino, and White high-school students surveyed regarding use of cigarettes, alcohol, illicit drugs, alcohol-related consequences, and substance use cessation efforts. Results indicated that Latino and White students had similar lifetime prevalence rates of alcohol, cigarette, and illicit drug use relative to Asian Americans. Although Latino youths reported lower or comparable rates of alcohol use compared to Whites, they experienced more legal consequences related to their use. A higher proportion of Latinos indicated attempts to reduce or stop alcohol use in comparison to Asian Americans and Whites, and to reduce/stop drug use in comparison to Whites. Adolescents experiencing negative alcohol-related consequences were more apt to attempt to change their substance use than students reporting no consequences. However, few race/ethnic differences were identified in regard to preferred strategies to restrict or cease substance involvement. Implications for adolescent substance use interventions are discussed.     

Contextual Factors Related to Alcohol Abuse Among Intimate Partner Violence Offenders

Background: The association between alcohol consumption and intimate partner violence (IPV) has been reiterated in numerous studies. Some authors have found higher levels of risk factors in intimate partner violence offenders (IPVOs) with alcohol problems than in IPVOs without such problems. Objective: The aim of this study is to analyze the relationship of contextual variables with harmful alcohol use in a sample of IPVOs. Method: This cross-sectional research analyzes data from 231 IPVOs. In addition to demographic data, information was collected on alcohol use, ethnicity, accumulation of stressful life events and perceived social support and rejection. The sample was divided into hazardous and nonhazardous alcohol users, according to the AUDIT test scale. Results: No differences were found between groups on demographic variables. The results of a hierarchical logistic regression analysis supplemented with ROC curves revealed that Latin American immigrants as opposed to Spanish nationality, accumulating stressful life events, and perceiving low social support significantly increased the likelihood of alcohol abuse, with adequate predictive power. Conclusion: Contextual variables such as ethnicity, accumulation of stressful life events, and lack of social support may explain harmful alcohol consumption. These variables should be taken into account in batterer intervention programs in order to reduce one of the most relevant risk factors of IPV: alcohol abuse.     

Alcohol Use Behaviors Among Pharmacy Students

Objective. To identify reasons for drinking, determine the patterns of alcohol abuse, and explore relationships between drinking motives and alcohol abuse patterns in pharmacy students.Methods. A cross-sectional anonymous, voluntary, self-administered paper survey instrument was administered to first-year (P1) through third-year (P3) pharmacy students as part of a professional seminar.Results. Survey instruments were completed by 349 pharmacy students (95.9% cooperation rate). Using the Alcohol Use Disorders Identification Test criteria, 23.2% of students reported hazardous or harmful use and 67.2% of students reported consuming alcohol at hazardous levels during the past year. Students who were male (37.0%), single (25.3%), and attended the main campus (26.2%) were more likely than their counterparts to report hazardous or harmful alcohol use. Pharmacy students reported social motives as the most common reason for drinking; however, coping and enhancement motives were more predictive of harmful or hazardous alcohol use.Conclusion. Approximately 1 in 4 pharmacy students (23%) reported hazardous or harmful alcohol use. Education about the dangers of alcohol abuse and intervention programs from colleges and schools of pharmacy are recommended to help address this issue.     

A Case Report of Non-beverage Alcohol Abuse by Cooking Extract

ABSTRACT

A 14-year-old male presented to the emergency department with altered mental status. He was unable to protect his airway and required emergent intubation. Laboratory evaluation showed an elevated serum ethanol concentration of 233 mg/dL. The patient required care in a pediatric hospital intensive care unit. The patient's friends acknowledged that he consumed several small bottles of lemon cooking extract in order to become intoxicated. He chose lemon extract because the product label showed it had a higher alcohol concentration than the other available extracts. Cooking extracts are a relatively unregulated source of alcohol that can be purchased and abused by minors.     

Widening the Disparity Gap: Differences in Outcomes for Racial and Ethnic Groups in Youth Substance Abuse Prevention Programming

Abstract

This study examined racial and ethnic differences in the outcomes of a universal evidence-based program targeted to children and adolescents. Using data collected in 2015 and 2016 from the Alcohol: True Stories Hosted by Matt Damon program (N?=?925), the study found the outcome of perceptions on risk of harm from alcohol use significantly different between the group of White respondents and the group of non-White respondents, and between the group of Hispanic respondents and the group of non-Hispanic respondents. Program effectiveness was found only among White and non-Hispanic respondents, widening the already existing gap between these populations.     

Characterizing Blunt Use Among Twitter Users: Racial/Ethnic Differences in Use Patterns and Characteristics

Background: Young adult Twitter users are exposed to and often participate in tweets that promote risky behaviors, such as blunt use. Blunts are hollowed out cigars or cigarillos that are filled with marijuana. Objectives: The current study was designed to determine the use patterns and characteristics of African American, Hispanic and White young adult Twitter users who reported past month blunt use. Methods: Young adults (N = 753, 74% male) who reported past month blunt use were recruited via Twitter to participate in a brief anonymous online survey about their blunt use. Results: Findings revealed that African American young adults initiated blunt smoking at an earlier age (14.8 years), reported more days of blunt smoking in the past month (23.2 days) and smoked more blunts in the past month (27.2 blunts) than their Hispanic (16.5 years, 19.7 days, and 15.4 blunts) and White (18.1 years, 15.8 days, and 22.2 blunts) counterparts, p <.01. African American young adults were more likely than their White counterparts to report physical craving as an obstacle to quitting blunt smoking. Several racial/ethnic differences were also found on attitudes about blunt use and reasons for initiating and continuing to smoke blunts. Conclusions: Findings suggest that blunt use patterns and attitudes about blunt use vary by race/ethnicity. Understanding racial/ethnic differences in blunt use patterns and characteristics offers opportunities to tailor future interventions and enhance outcomes among African American, Hispanic and White young adults.     

Alcohol Use Among Young Men Who Have Sex With Men

This study reveals associations between alcohol use and demographic variables, as well as the relation between alcohol use and sexual activity, using episodic data. Data were obtained during summer and fall from a sample of 558 gay, bisexual, and other young men who have sex with men (YMSM), ages of 13–29 years in New York City. Recruitment strategies targeted potential participants at gay-related venues and public spaces often frequented by YMSM. Alcohol use varied by race/ethnicity, with White YMSM consuming significantly more alcohol than other races/ethnicities. Participants over the age of 21 drank significantly more alcohol than participants ages 13–20. Alcohol use was not found to be associated with sexual risk-taking activity. Our findings are enriched by a large, diverse sample of urban YMSM. Study limitations are noted.     

Racial and Ethnic Differences in Reported Criminal Justice Referral at Treatment Admission

Abstract

In the U.S. and elsewhere, the criminal justice system is a frequent referral source for substance abuse treatment admission. To expand and improve pathways to treatment, outreach efforts need additional information about different demographic groups. Locally, clinicians observed racial and ethnic differences between minority groups in self-identifying criminal justice as the referral sources for admission. To test this clinical observation, reported criminal justice referral was examined by race/ethnicity and gender in multiple years of both national and local treatment admissions. Confirming the clinical observations, racial/ethnic referral source by gender systematically differed across years nationally (p < .001) and in an examination of verbatim recorded presenting problems locally (p < .001). African Americans and Puerto Ricans were less likely to have criminal justice referral sources than the White reference group, whereas American Indians, Arab Americans, Asian Americans, and other Hispanic ethnicities were more likely to have criminal justice referral sources. Racial/ethnic groups systematically differed in reported criminal justice involvement, suggesting hypotheses potentially impacting clinical treatment and outreach. Published primary referral sources may underestimate criminal justice involvement in treatment admissions.     

Adverse Childhood Experiences (ACEs) and Alcohol Abuse among South Carolina Adults

Background: Adverse childhood experiences (ACEs) have been associated with negative adult health outcomes, including alcohol misuse. The impact of ACEs on alcohol use may vary by gender, with ACEs impacting women more than men in coping with adulthood stressors. Objectives: The objective of this study is to examine the gender-specific relationships between ACEs and self-reported binge drinking and heavy drinking in adulthood among South Carolina residents. Methods: This study analyzed a sample of 8492 respondents who completed the 2014 or 2015 South Carolina Behavioral Risk Factor Surveillance System (BRFSS) survey. Logistic regression was used to examine the impact of types and the number of ACEs on binge drinking and heaving drinking in adulthood. Results: Thirty-seven percent of men and 22.8% of women survey respondents reported binge drinking and 12.2% of men and 4.1% of women reported heavy drinking. Almost all categories of ACE were associated with increased odds of reporting binge and heavy drinking; household mental illness had the greatest odds for men (aOR 1.31, 95% CI 1.30–1.33) and emotional abuse had the greatest odds for women (aOR 1.42, 95% CI 1.40–1.43). Men and women with four or more ACEs had greater odds of reporting binge and heavy drinking compared to their counterparts. Conclusions/Importance: Given the potential for negative outcomes associated with alcohol misuse and transmission of risky alcohol-related behaviors from parent to child, strategies that utilize a multigenerational approach could have a large impact on population health.     

Maternal and Paternal Alcohol Misuse and Alcohol-Related Outcomes Among College Students

Using a large college student sample (N = 1,095), the present study examined whether the relationship between parental alcohol abuse and offspring alcohol use varied as a function of parent and offspring gender, and whether the relationship to the non-substance-abusing mother or father buffered against the risk associated with being an adult child of an alcoholic (ACOA). Among women, maternal ACOAs (i.e., the mother only was suspected of alcohol misuse) had the greatest risk of problematic alcohol consumption, whereas among men, both parent ACOAs (i.e., both parents were suspected of alcohol misuse) had the greatest risk of problematic alcohol consumption. No support was found for the buffering hypothesis. We discuss implications of our findings and future directions.     

Mechanisms of Association Between Paternal Alcoholism and Abuse of Alcohol and Other Illicit Drugs Among Adolescents

The current study examines the effect of paternal alcohol problems on adolescent use of alcohol and other illicit drugs as a function of maternal communication, as well as adolescent social and coping skills (N = 145). Structural equation modeling (SEM) analyses indicated that adolescents with a paternal history of alcohol problems reported higher levels of problematic communication with their mothers than did adolescents with fathers who were light drinkers or who were non-drinkers. Moreover, problematic maternal communication functioned as a partial mediator for both adolescent negative social skills and self-blame coping skills. Adolescents who reported using self-blame coping skills more frequently also tended to use alcohol more frequently. Findings suggest that these high-risk adolescents might need more intensive and targeted social and psychological services in their schools and communities.     

Racial/Ethnic Differences in Parent-Child Smoking Communication

ABSTRACT

A cross-sectional study of parents and children who presented to the ED at a Cincinnati hospital showed high parental smoking rates and lower rates of anti-smoking communication in African American parents, unlike prior studies.     

Predictors of Alcohol Use Among Status-Offending Adolescents: Youth and Parent Perspectives

Research exploring parent–child relationships suggests parents often have divergent perspectives from their adolescent children. Understanding youths' and parents' reports in predicting alcohol use is particularly important among detained youths who are at elevated risk for substance-related problems. This exploratory study queried youth entrants to a juvenile detention center (N = 150) and their parents (N = 89) on a host of individual and familial factors to determine risks associated with youths' drinking from youth and parent perspectives. Findings suggest that, in addition to assessing youths' self-reports at juvenile detention admission, parents' divergent views of their teens' alcohol use offer a valuable perspective.     

Race/Ethnicity and Gender Differences in the Drugs-Violence Relationship

Abstract

This article examines the drug relatedness of violent events reported by White, Black, and Hispanic male and female street drug users from New York City. The primary purpose is to determine if the drugs-violence relationship varies for these different populations of drug abusers. Drug relatedness is assessed according to a tripartite conceptual model of the general relationship between drugs and violence. Significant race/ethnicity and gender differences were found in regard to the number of violent events manifesting specific drug-related dimensions of violence, the drugs associated with these violent events, and the primary reasons for the occurrence ofthese events. The implications of these findings are discussed.     

Hospitalization due to Alcohol and Drug Abuse in First- and Second-Generation Immigrants: A Follow-Up Study in Sweden

The detrimental effects of substance abuse on the individual and on society are well known. Health care resources must target where they are most needed. This study investigated (1) whether the increased risk of being hospitalized for alcohol abuse and drug abuse among certain immigrant groups is present in the next generation and (2) whether having one parent born in the host country (i.e., Sweden) has a protective effect on the risk of being hospitalized for alcohol abuse and drug abuse among second-generation immigrants. In total, 2,243,546 persons aged 20–39 years were followed from 1 January 1992 until 31 December 1999 for first hospital admission due to alcohol abuse or drug abuse. A Cox regression model was used to estimate hazard ratios for each diagnosis group. When the Swedish majority population was used as reference, the highest risks of alcohol abuse and drug abuse were found among first- and second-generation Finns, after adjustment for income. Among second-generation Finns with one parent born in Sweden, the increased risk of being hospitalized for alcohol abuse and drug abuse was lower than among second-generation Finns with both parents born in Finland. Health care resources need to target certain groups of first- and second-generation immigrants.     

Substance Abuse and Relationship Violence Among Men Court-Referred to Batterers' Intervention Programs

There is extensive theoretical and empirical evidence linking substance abuse and marital violence. However in batterer populations, researchers have not compared hazardous and nonhazardous drinkers' substance use characteristics, marital aggression, extramarital violence (i.e., general violence), depressive symptomatology, marital satisfaction, and other relevant variables. In addition, much of the previous research on substance use and abuse in batterer populations employed a single, nonstandardized measure of substance use, and no previous research has examined substance use in court-mandated batterers' relationship partners. We recruited 150 men who were arrested for violence and court-referred to batterer intervention programs. We administered multiple measures of substance use and abuse and assessed the batterers' marital aggression, relationship satisfaction, depressive symptomatology, use of general violence, and their relationship partners' substance use. We also divided the sample into groups of Hazardous Drinkers (HD) and Nonhazardous Drinkers (NHD). Across the entire sample, half of the batterers had an alcohol-related diagnosis and approximately one third reported symptoms consistent with a drug-related diagnosis. Over one third of the total sample reported that their relationship partners were hazardous drinkers. Relative to the NHD group, the HD group scored significantly higher on measures of general violence, depressive symptomatology, alcohol use, alcohol problems, and drug problems. The HD group also reported significantly higher partner alcohol and drug use and abuse scores, relative to the NHD group. The results of the study suggest that substance use and abuse should routinely be assessed as part of batterer interventions and that batterer programs would be improved by offering adjunct or integrated alcohol treatment.     

Racial and Ethnic Differences in Referral Source for Substance Abuse Treatment Admissions for Youths

This study examined racial and ethnic differences in admissions to substance abuse treatment and in the referral source in admissions to treatment. The 2012 Treatment Episode Data Set (N = 117,862) was used and included African-American, Hispanic, non-Hispanic White, and other racial/ethnic youths, ages 12 to 17. Age at admission to treatment, racial and ethnic differences in primary substance used, and co-occurrence of a psychiatric problem were found to be statistically significant. Health care providers were 3 times more likely to refer youths with psychiatric problems and the school system was 2 times more likely to refer Hispanic youths to treatment. Implications are discussed.     

Youth Drug Abuse Treatment:

Twenty-six youth received six months of treatment (mean of 15 sessions) after random assignment to either a supportive counseling program or to a newly designed behavioral treatment. The behavioral program included several procedures to restucture family and peer relations and to control urges. Drug use was measured by urinalysis, supplemented by family report and self-report. The results showed that during the last month, 9% of youth receiving supportive counseling were abstinent vs. 73% of youth receiving the new behavioral treatment. A greater reduction of drug use was also apparent when measured in terms of urinalysis data alone, days per month of drug use, or overall number of months of abstinence. Improved functioning of youths in the behavioral program was evidenced by significantly greater school/work attendance, improved youth- and partent-relationship satisfaction ratings, improved conduct ratings, decreased depression, and decreased frequency of alcohol use as compared to youth in the supportive counseling program.     

Differences by Gender in Predictors of Motivation Among Substance Abuse Treatment Participants

Background: Substance-involved females tend to have different clinical profiles than men (Adams, Leukefeld, &; Peden, 2008 Adams, S., Leukefeld, C. G., &; Peden, A. R. (2008). Substance abuse treatment for women offenders: A research review. Journal of Addictions Nursing, 19(2), 61–75. [Google Scholar]); yet they do not appear to have worse treatment outcomes (Green, 2006 Green, C. A. (2006). Gender and use of substance abuse treatment services. Alcohol Research and Health, 29(1), 55–62. [Google Scholar]; Hser, Huang, Teruya, &; Anglin, 2003 Hser, Y.-I., Huang, D., Teruya, C., &; Anglin, M. D. (2003). Gender comparisons of drug abuse treatment outcomes and predictors. Drug and Alcohol Dependence, 72(3), 255–264. [Google Scholar]). As motivation for treatment is considered essential in the substance abuse treatment context (Cahill, Adinoff, Hosig, Muller, &; Pulliam, 2003 Cahill, M. A., Adinoff, B., Hosig, H., Muller, K., &; Pulliam, C. (2003). Motivation for treatment preceding and following a substance abuse program. Addictive Behaviors, 28(1), 67–79. [Google Scholar]; Longshore &; Teruya, 2006 Longshore, D., &; Teruya, C. (2006). Treatment motivation in drug users: A theory-based analysis. Drug and Alcohol Dependence, 81(2), 179–188. [Google Scholar]), it is possible that higher motivation among females could potentially counteract the negative effect of more risk factors. Objective: The purpose of the current study was to examine if females differ from males in their motivation for treatment using the Texas Christian University Motivation Form scales: desire for help, problem recognition, treatment readiness, pressure for treatment, and treatment needs; and whether factors predicting motivation for treatment differed between male and female participants of substance abuse treatment. Methods: The sample included 2,989 substance-involved males and 982 substance-involved females who were referred to substance abuse treatment through a case management program. Linear regression models predicting each motivation scale were analyzed, followed by gender-specific models. Results: Overall, the results did not demonstrate a significant gender difference in the motivation scales. However, among male participants, the findings did show that Hispanic significantly predicted desire for help and alcohol as a primary drug of choice predicted treatment readiness. Conclusion: Findings suggest that motivation for treatment may be a gender-neutral construct, and that there is a need to better understand sociodemographic predictors of motivation.