Troubled parents,motivated adolescents: Predicting motivation to change substance use among runaways

Runaway adolescents engage in high rates of substance use and report significant family and individual problems. However, in general, adolescents report low motivation to change their substance use. Because a higher level of motivation for changing substance use is associated with greater substance abuse treatment success, identifying variables associated with motivation for change can be useful for enhancing treatment success. In this study, predictors of motivation for changing substance use were examined among 140 shelter-recruited adolescents and their parents/primary caretakers. Several findings were noteworthy. A perceived negative family environment increased parents' and adolescents' depressive symptoms, which increased adolescent's motivation to change. Also, greater severity of adolescent substance use predicted higher motivation to change. Consideration of the family environment and parent problems when addressing motivation for changing substance use among these adolescents might be important foci for motivational interventions and future research.     

The effects of employment among adolescents at-risk for future substance use

Objective

This paper explores the association between work intensity, alcohol and/or other drug (AOD) use, and related risk factors and consequences among an at-risk youth sample that has received a first-time AOD offense. This study extends previous research focused primarily on school-based samples.

Method

We examined the association between work intensity, AOD use, AOD-related consequences, and social environment among adolescents referred to a diversion program called Teen Court (N = 193). Participants were surveyed prior to the start of the Teen Court program. Mean age was 17 (SD = 1.1), 67% of the sample was male; 45% Hispanic or Latino/a; 45.1% White; 10% Other.

Results

Greater work intensity among these youth was related to greater alcohol-related negative consequences and greater contact with co-workers who engaged in risky behaviors, but it was not significantly associated with past month AOD use.

Conclusions

Understanding the relationship between work intensity and AOD use among youth who are at-risk is critical to informing clinicians and public officials about the potential effects of employment in this population. Findings suggest that work intensity may be associated with negative consequences from alcohol use and increased contact with risky co-workers, all of which could contribute to the development of problems in the future.     

Self-initiated tobacco cessation and substance use outcomes among adolescents entering substance use treatment in a managed care organization

Purpose

Adolescents with substance use (SU) problems have high rates of tobacco use, yet SU treatment has historically ignored treatment for tobacco use. Barriers to such efforts include the belief that tobacco cessation could compromise other SU abstinence. This study examines self-initiated tobacco cessation and 12-month alcohol and drug abstinence in adolescents entering SU treatment in a private, managed care organization.

Results

Self-initiated tobacco cessation at 6 months, and at both 6 and 12 months, were related to higher odds of drug abstinence but not alcohol abstinence.

Conclusion

Self-initiated tobacco cessation was not related to poor SU outcomes, and may be important to maintaining drug abstinence. Implementing tobacco cessation efforts in SU treatment can be challenging, but comprised SU outcomes may not be a barrier. The positive associations for drug abstinence and lack of associations for alcohol abstinence could be due to differences in motivation, medical conditions, or to the illicit nature of drug use. Tobacco use has serious long-term health consequences, and tobacco cessation efforts in adolescent SU treatment programs need further research.     

Motivation for reducing substance use among minority adolescents: Targets for intervention

Motivation to change substance use is considered to be one of the most important predictors of client readiness for alcohol and other drug treatment and ability to benefit from treatment. Enhancing motivation to change substance use is an important emphasis of many substance use intervention programs. The specific factors predicting motivation to change substance use remain largely unidentified and poorly understood, particularly among racial/ethnic minority youth. This study examines the influence of adolescent and parental factors on motivation to change substance use among 310 alcohol-using and/or drug-using racial/ethnic minority adolescent males. The analytic plan involved the use of structural equation modeling. Adolescents' motivation to change substance use was influenced directly and indirectly by parental factors, as well as by adolescent substance use severity and externalizing disorders. Findings have implications for treatment with racial/ethnic minority youth, as parental factors may be exceptionally useful targets for interventions aimed at enhancing motivation to reduce substance use among these at-risk youth.     

Relationships among parental monitoring and sensation seeking on the development of substance use disorder among college students

Substance use disorder is a serious health problem that tends to manifest in late adolescence. Attempting to influence targetable risk and protective factors holds promise for prevention and treatment. Survey data from 1253 college students (48.5% male, 26.9% non-White) were used to investigate the independent and combined effects of two prominent factors, sensation seeking and parental monitoring, on the probability of alcohol and/or cannabis dependence during the first year of college. In multivariate analyses that controlled for high school use, gender, race, mother's education, and importance of religion, retrospective reports by the student of parental behavior during the last year of high school indicated that higher levels of parental monitoring had a direct effect on reducing risk for alcohol dependence during the first year of college, but not on cannabis dependence. High levels of sensation seeking were associated with increased risk for both alcohol and cannabis dependence. No interaction effects were found. The results extend prior findings by highlighting influences of pre-college parental monitoring and sensation seeking on the probability of alcohol and/or cannabis dependence during the first year of college. The findings also suggest that these two factors are useful in identifying college students at high risk for alcohol and/or cannabis dependence.     

Patterns of substance use among Argentinean adolescents and analysis of the effect of age at first alcohol use on substance use behaviors

Objective

The present study used an empirically based method to characterize substance use in a sample of Argentinean adolescents and analyzed the association between age at drinking onset and substance use behaviors. Differences in alcohol expectancies and personality traits as a function of different patterns of substance use were also explored.

Method

Data were obtained from 583 adolescents aged 13–18 years (M = 15.01 years; SD = 1.5 years; 59.5% female) from the city of Cordoba, Argentina. Alcohol, tobacco, and drug use and age at first alcohol use were measured. Personality traits, including extroversion, conscientiousness, impulsivity, and aggression, and positive and negative alcohol expectancies were assessed. Latent Class Analysis was applied to examine the structure of five co-occurring substance use behaviors: frequency of alcohol use, quantity of alcohol use, prevalence of drunkenness episodes, tobacco use, and drug use.

Results

Latent Class Analysis revealed five distinct patterns of substance use. The classes differed in substance use behaviors, personality traits, and alcohol expectancies. Adolescents with early drinking onset were more likely to show heavier alcohol use, more drunkenness episodes, and more drug use than adolescents with late drinking onset.

Conclusions

Latent Class Analysis allowed the detection of groups of adolescents with distinct patterns of substance use. These groups exhibited significantly different personality and alcohol expectancy profiles, likely representing subgroups who are at greater risk for developing alcohol-related problems.     

Further evidence of differences in substance use and dependence between Australia and the United States

The current study compared the prevalence of substance use and DSM-IV dependence in the USA and Australia. Participants aged 18–54 were selected from two cross-sectional nationally representative Australian (National Survey on Mental Health and Well-Being – NSMHWB, 1997, n = 7570) and American (National Epidemiologic Survey on Alcohol and Related Conditions – NESARC, 2001–2002, n = 29,673) household surveys. The NSMHWB utilised the Composite International Diagnostic Interview, whereas the NESARC used the Alcohol Use Disorder and Associated Disabilities Interview Schedule. The 12-month prevalence of alcohol use was lower in the USA (56.5%) than in Australia (77.2%), although the rates of alcohol dependence were similar in both countries. The USA had higher rates of alcohol dependence conditional on use (9.0%) compared to Australia (6.8%). Australians had higher levels of drug use, dependence, and conditional dependence than Americans (except for sedatives and opioids). The absence of significant interactions between country of interview and the common correlates of substance use disorders indicated that the influence of these factors was similar in the USA and Australia. In conclusion, the current investigation revealed striking differences in the rates of conditional drug dependence between Australia and the USA. The cross-national generalizability of the relationships between the common correlates and prevalence of substance use and dependence indicates that a similar process of vulnerability to dependence may be operating in the USA and Australia. In the future, these cross-national differences could be used to help better understand the factors that influence drug use and the development of dependence.     

Rationale and design of a brief substance use intervention for homeless adolescents

The rationale and design for a brief feedback and motivational intervention for substance use among homeless adolescents is described. Homeless adolescents use substances at extremely high rates compared to other youth, and experience considerable negative consequences as a result. Yet homeless adolescents are not reached by, or are not responsive to, traditional prevention and treatment programs for substance use and abuse. The rationale for the use of brief feedback interventions is reviewed, and one such program that was designed to reduce substance use risk among homeless youth is described. The intervention is consistent with tenants of harm reduction in its effort to encourage engagement via its structure, minimal demands, and flexible clinical strategies and goals. Modifications made to the intervention based on lessons learned from an initial trial are described, and highlight the importance of tailoring harm reduction programs to facilitate engagement based on clients’ life circumstances, availability, and motivation.     

Childhood abuse and harmful substance use among criminal offenders

Childhood abuse is a serious problem that has been linked to harmful alcohol and drug use in non-offender samples. In a sample of 219 criminal offenders, we examined the associations between childhood physical and sexual abuse and three indices of harmful substance use. Results indicate that physical abuse was associated with symptoms of alcohol use disorder and sexual abuse was associated with symptoms of drug use disorder among offenders. Both forms of childhood abuse were associated with substance use consequences, even after taking into account substance type and frequency of use. No gender by childhood abuse interactions were found. Symptoms of depression and generalized anxiety partially mediated relationships between childhood abuse and substance use consequences. Findings underscore the importance of assessing childhood abuse and treating anxiety and depression among offenders who exhibit harmful substance use.     

Socioeconomic differences in alcohol and drug use among Ghanaian adolescents

Socioeconomic differences in experimental alcohol use, drunkenness, marijuana use and other drug uses among adolescents in Ghana was investigated using multiple socioeconomic indicators. A school-based cross-sectional survey of a representative sample of 12-18-year-olds (N = 1195, response rate = 89.7%) was conducted in Ghana in 2008. Logistic regression analysis was applied to model the associations between substance use and socioeconomic status. Use of marijuana and drugs was associated with lower material affluence while experimental alcohol use was associated with higher material affluence. Living in non-nuclear family was predictive of other drug uses and drunkenness. Other drug uses were associated with lower paternal education and occupation while drunkenness was associated with lower paternal education. Individual anticipated future social position measured by plans after graduation was the strongest predictor of experimental alcohol use, drunkenness, marijuana and other drug uses. Interventions are need to prevent adolescence substance use especially among those in danger of discontinuing schooling and those in less affluence families.     

Correlates of motivation to change in adolescents completing residential substance use treatment

This research identified psychosocial correlates of motivation to change in adolescents being discharged from residential treatment for substance use disorders. Using a naturalistic longitudinal design, adolescents in a residential treatment program in southeast Ohio were assessed at intake and discharge using self-administered questionnaires. Surveys assessed motivation to change one's drug and alcohol use, ways of coping to avoid future alcohol/substance use, and social support. The 68 participants (mean age = 16.0, range = 12-18) were predominantly Caucasian (87%) and male (69%). Over the course of treatment, adolescents reported significant increases in active-cognitive coping, avoidant-behavioral coping, and attachment and marginally significant increases in motivation to change and reliable alliance. Adolescents who reported higher discharge levels of motivation to change also reported greater levels of social integration at discharge. Strengthening adolescents' social integration may also increase their motivation to avoid using drugs and alcohol as they prepare to exit treatment and return to their home communities.     

Attitude and risk of substance use in adolescents diagnosed with Asperger syndrome

Background

Adolescence is a stage of development with increased risk of drug use. Individual personality traits are among those factors that influence the onset of substance use in adolescence and its psychiatric comorbidity. Little research has been done on the comorbidity between substance abuse risk and Asperger syndrome, and none specifically in adolescence. The objective of this study is to assess the risk of drug use by adolescents with Asperger syndrome and compare it with that risk in control subjects. A secondary objective was to analyze the personality factors that may be associated with substance use in the same two groups.

Methods

We used three self-administered questionnaires, one for drug risk assessment (FRIDA) and the other two for personality trait assessment (MACI and SSS-V).

Results

Adolescents diagnosed with Asperger syndrome are at less risk for drug use derived from family and access to drugs factors. Subjects with Asperger syndrome did score higher on introversive, inhibited, doleful, and borderline tendency prototypes than healthy controls, and scored lower on all sensation-seeking traits. Being male, a diagnosis of Asperger syndrome, and unruly, introversive, and sensation-seeking traits were all independently associated with the risk of drug abuse.

Conclusions

Both identified personality factors and other variables associated with the Asperger syndrome contribute to the low risk of drug abuse observed in this population. Exploring protective factors for drug use in these subjects may prove useful for interventions with adolescents at risk for consumption.     

Modeling associations between posttraumatic stress symptoms and substance use

Comorbid substance use and posttraumatic stress disorders (SUD-PTSD) predict poorer treatment outcomes. Self-medication has been forwarded as a symptom-level explanatory model. However, research has yet to be conducted that can provide detailed examination of SUD and PTSD symptom fluctuations over time as posited by such a process. This pilot study examined associations between PTSD and substance dependence (SD) symptoms/substance use using two established methodologies that assess week-by-week symptom and substance use/dependence status. Outpatients (N = 35) in SUD treatment completed the Longitudinal Follow-Up Evaluation and the Time Lime Follow-Back Interview, retrospectively reporting weekly PTSD and SD symptoms, and substance use over the previous 6-months. Results indicated that weekly PTSD symptom fluctuations were concurrently associated with the presence of alcohol and cocaine dependence symptoms and were associated with the presence of opiate dependence symptoms in the following week. These findings support a self-medication conceptualization, underscore the utility of using a more detailed process analysis of PTSD and SD symptoms, and suggest that PTSD fluctuations are associated with substance problems, rather than with substance use per se.     

Tobacco use and psychiatric comorbidity among adolescents in substance abuse treatment

Adolescents in substance abuse treatment have approximately four times higher rates of tobacco use compared with adolescents in the general population, yet many substance abuse treatment programs do not provide tobacco cessation interventions. This study examined change in tobacco use among 151 adolescents in state-funded substance abuse treatment from intake to 12-month follow-up in relation to psychiatric comorbidity and substance use. Most adolescents (67.5%) used tobacco at intake and follow-up. Having a diagnosis of a mood, anxiety, or behavioral disorder was significantly associated with change in tobacco use. Individuals with a psychiatric disorder were less likely to be nonusers of tobacco than to be individuals who continued tobacco use (adjusted odds ratio [OR] = 0.153, 95% confidence interval [CI] = 0.040-0.587, p < .01), and they were less likely to have initiated tobacco use at follow-up than individuals who continued tobacco use (adjusted OR = 0.320, 95% CI = 0.105-0.970, p < .05). Contrary to the hypothesis, alcohol use and drug use during the 12-month follow-up was not significantly related to change in tobacco use. Adolescents in substance abuse treatment with comorbid psychiatric disorders may be particularly vulnerable to continuing tobacco use.     

A cross-national study on Mexico-US migration, substance use and substance use disorders

Background

Epidemiologic research has consistently found lower prevalence of alcohol and drug use disorders among Hispanic immigrants to the US than among US-born Hispanics. Recent research has begun to examine how this change occurs in the process of assimilation in the US. We aimed to study immigration, US nativity, and return migration as risk factors for alcohol and drug use among people of Mexican origin in both the US and Mexico.

Methods

Data come from nationally representative surveys in the United States (2001-2003; n = 1208) and Mexico (2001-2002; n = 5782). We used discrete time event history models to account for time-varying and time-invariant characteristics.

Results

We found no evidence that current Mexican immigrants in the US have higher risk for alcohol or alcohol use disorders than Mexicans living in Mexico, but current immigrants were at higher risk for drug use and drug use disorders. Current Mexican immigrants were at lower risk for drug use and drug disorders than US-born Mexican-Americans. US nativity, regardless of parent nativity, is the main factor associated with increasing use of alcohol and drugs. Among families of migrants and among return migrants we found increased risk for alcohol use, drug use and alcohol and drug use disorders. Evidence of selective migration and return of immigrants with disorders was found regarding alcohol use disorders only.

Conclusions

Research efforts that combine populations from sending and receiving countries are needed. This effort will require much more complex research designs that will call for true international collaboration.     

Moderators of the association between peer and target adolescent substance use

Associating with substance using peers is generally considered as one of the most important predictors of adolescent substance use. However, peer association does not affect all adolescents in the same way. To better understand when and under what conditions peer association is most linked with adolescent substance use (SU), this review focuses on the factors that may operate as moderators of this association. The review highlighted several potential moderators reflecting adolescents' individual characteristics (e.g., pubertal status, genes and personality), peer and parental factors (e.g., nature of relationships and parental monitoring), and contextual factors (e.g., peer, school and neighborhood context). As peer association is a broad concept, important methodological aspects were also addressed in order to illustrate how they can potentially bias interpretation. Taking these into account, we suggest that, while the effects of some moderators are clear (e.g., parental monitoring and sensation seeking), others are less straightforward (e.g., neighborhood) and need to be further examined. This review also provides recommendations for addressing different methodological concerns in the study of moderators, including: the use of longitudinal and experimental studies and the use of mediated moderation. These will be key for developing theory and effective prevention.     

Substance use and multiple victimisation among adolescents in South Africa

The aims of the study were to examine the relationship between multiple victimisation and drug use, and the role of drug use and other intra-personal, peer, parental and environmental factors in predicting multiple victimisation among adolescents in South Africa. A cross-sectional design was employed. The participants comprised 1474 male and female adolescents aged between 12 and 17 years, from Durban and Cape Town. They completed questionnaire measures assessing demographic characteristics; self, peer and parental drug use; self and peer delinquency; parental child-centredness and rules; and community drug availability and exposure to violence on television. A measure of multiple victimisation assessed whether or not the respondents had experienced two or more different types of violence in their lifetime. There was a significant association between frequency of tobacco, alcohol and marijuana use and multiple victimisation. Significant predictors of multiple victimisation in multiple logistic regression analyses were variables within intra-personal, peer, parental and environmental domains. Victimisation prevention programmes in South Africa should be comprehensive and target adolescents' drug use as well as their other psychosocial risk factors.     

The relation between interpersonal violence and substance use among a sample of university students: Examination of the role of victim and perpetrator substance use

Objective

To examine the relation between interpersonal violence and substance use and to describe the role of victim and perpetrator substance use within such incidents among university students.

Methods

A random sample of students (N = 1197) participating in this cross-sectional study completed an online survey. Logistic regression models assessed the relation between substance use and sexual and physical victimization. Victim and perpetrator substance use at the time of incident were described.

Results

Females were more likely to report sexual violence compared to males, whereas males were more likely to report physical victimization (p's < 0.05). In logistic regression models, all forms of substance use were significantly associated with physical victimization among males (OR's = 2.0–5.1). Among females, most forms of substance use were associated with sexual victimization (OR's = 2.4–4.7). Both males and females reported high rates of perpetrator and own substance use during victimization incidents.

Conclusions

Findings suggest that previous documentation among victimization studies of a relation between substance use and subsequent risk for victimization may also be attributable to the substance use behavior of the perpetrator.     

Relationship aggression and substance use among women court-referred to domestic violence intervention programs

Although there is extensive theoretical and empirical evidence linking men's alcohol abuse and marital violence, no previous studies have assessed the substance use characteristics of women arrested for domestic violence. We recruited 35 women who were arrested for domestic violence and court-referred to batterer intervention programs. We administered multiple measures of substance use and abuse and assessed the women's marital aggression, marital 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, almost half of the women were classified as HD. Over one-quarter of the women reported symptoms consistent with an alcohol abuse or dependence diagnosis, and approximately one-quarter of the sample reported symptoms consistent with a drug-related diagnosis. Over one-half of the total sample reported that their relationship partners were HD. Relative to the NHD group, the HD group scored higher on measures of drug problems, relationship aggression, general violence, and marital dissatisfaction. 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.