The moderating effect of family involvement on substance use risk factors in adolescents with severe emotional and behavioral challenges

Objective

The current study longitudinally examined the moderating effects of family involvement, which previous research has shown to be a protective factor against adolescents' substance use involvement, on the associations between internalizing and externalizing problems, respectively, and substance use (alcohol, marijuana, and tobacco) and problems in a unique sample of adolescents with severe emotional and behavioral problems.

Method

Adolescents (n = 4786) and their parents were assessed at three waves over a 1-year period as part of the SAMHSA funded Comprehensive Community Mental Health Initiative (CMHI). Multilevel growth curve models were estimated using Hierarchical Linear Modeling (HLM) to examine the associations between time-varying internalizing and externalizing problems, respectively, and substance use involvement over time as a function of family involvement at baseline.

Results

Results supported the hypothesis that family involvement protects against adolescent substance use involvement by buffering the adverse effects of both internalizing and externalizing problems. Specifically, for alcohol use, family involvement buffered the negative effects of high externalizing problems. For tobacco use, family involvement buffered the negative effects of both internalizing and externalizing problems, respectively. For substance use problems, family involvement buffered the effects of only internalizing problems. Family involvement did not moderate effects of emotional and behavioral problems on marijuana use, however, a significant main effect was observed such that family involvement was negatively related to marijuana use.

Conclusions

Results suggest that the beneficial effects of family involvement on at-risk adolescents' substance use involvement are dependent on the type of emotional and behavioral problems the adolescent experiences as well as the type of substance the adolescent uses. Implications for family- and adolescent-focused treatment are discussed.     

Adolescent Sexual Minority Girls Are at Elevated Risk for Use of Multiple Substances

Background: Sexual minority youth, especially girls, are at risk for alcohol, cigarette, and marijuana use when these substances are examined individually. However, little is known about concurrent use of these substances (i.e., three-substance use) in relation to sexual orientation. Objectives: The present study compared profiles of past year alcohol, cigarette, and marijuana use between SMGs and heterosexual girls. In addition, because internalizing and externalizing symptoms are associated with substance use, we examined whether sexual orientation was associated with substance use profile over and above co-occurring psychopathology. Methods: Mixture modeling was used to identify patterns of alcohol (including binge drinking), cigarette, and marijuana use in the past year using a cross-sectional sample of urban adolescent girls (Pittsburgh Girls Study; N = 2,064; mean age = 17). Approximately 8% (n = 173) of the girls endorsed a lesbian or bisexual identity. Results: Five substance using classes were identified: low-level substance use (72%), marijuana use (5%), cigarette use (8%), alcohol use (8%), and three-substance use (7%). SMGs were at an increased risk for substance use than heterosexual girls, particularly three-substance use (OR = 6.69, p < .001), cigarette use (OR = 6.26, p < .001), and marijuana use (OR = 3.86, p < .001) classes. Substance use patterns were regressed on sexual orientation, internalizing symptoms (i.e., depression, anxiety), and externalizing symptoms (i.e., conduct problems, oppositional defiant disorder). The disparities remained robust after controlling for internalizing and externalizing symptoms. Conclusions/Importance: Clinicians and researchers should be aware of potential three-substance use among SMGs. Substance use interventions for SMG may benefit from targeting risk factors that cut-across several substances, particularly externalizing symptoms.     

Prevalence of marijuana and other substance use before and after Washington State's change from legal medical marijuana to legal medical and nonmedical marijuana: Cohort comparisons in a sample of adolescents

ABSTRACT

Background: A growing number of states have new legislation extending prior legalization of medical marijuana by allowing nonmedical marijuana use for adults. The potential influence of this change in legislation on adolescent marijuana and other substance use (e.g., spillover or substitution effects) is uncertain. We capitalize on an ongoing study to explore the prevalence of marijuana and other substance use in 2 cohorts of adolescents who experienced the nonmedical marijuana law change in Washington State at different ages. Methods: Participants were 8th graders enrolled in targeted Tacoma, Washington public schools and recruited in 2 consecutive annual cohorts. The analysis sample was 238 students who completed a baseline survey in the 8th grade and a follow-up survey after the 9th grade. Between the 2 assessments, the second cohort experienced the Washington State nonmedical marijuana law change, whereas the first cohort did not. Self-report survey data on lifetime and past-month marijuana, cigarette, and alcohol use were collected. Results: Multivariate multilevel modeling showed that cohort differences in the likelihood of marijuana use were significantly different from those for cigarette and alcohol use at follow-up (adjusting for baseline substance initiation). Marijuana use was higher for the second cohort than the first cohort, but this difference was not statistically significant. Rates of cigarette and alcohol use were slightly lower in the second cohort than in the first cohort. Conclusions: This exploratory study found that marijuana use was more prevalent among teens shortly after the transition from medical marijuana legalization only to medical and nonmedical marijuana legalization, although the difference between cohorts was not statistically significant. The findings also provided some evidence of substitution effects. The analytic technique used here may be useful for examining potential long-term effects of nonmedical marijuana laws on adolescent marijuana use and substitution or spillover effects in future studies.     

Do Classes of Polysubstance Use in Adolescence Differentiate Growth in Substances Used in the Transition to Young Adulthood?

Background: Past studies have differentiated classes of polysubstance use in adolescence, however, the associations of adolescent polysubstance use classes with longitudinal substance use trajectories from adolescence to young adulthood have not been studied. Objective: The current study examined substance use classes during adolescence and longitudinal trajectories of each substance used across the transition to young adulthood. Method: Data were collected biennially from 662 youth and followed 10 years across six measurement assessments. Using baseline data (T1), latent class analysis was used to identify classes of polysubstance use (cigarette, alcohol, marijuana, and illicit drug use) during adolescence. Using T2 through T6 data, we fit latent growth models for cigarette, alcohol, marijuana, and illicit drug use to examine longitudinal trajectories of each substance used by class. Results: A three-class model fit the data best and included a poly-use class, that had high probabilities of use among all substances, a co-use class, that had high probabilities of use among alcohol and marijuana, and a low-use class that had low probabilities of use among all substances. We then examined trajectories of each substance used by class. Strong continuity of substance use was found by class across 14 years. Additionally, for some substances, higher average levels of use of at age 14 were associated with change in growth of other substances used over time. Conclusions/Importance: Efforts that only target a single drug type may be missing an important opportunity to reduce the use and subsequent consequences related to the use of multiple substances.     

A comparison of treatment outcomes for adolescent community reinforcement approach participants with and without co-occurring problems

This study examined the relationship between Adolescent Community Reinforcement Approach (A-CRA) participation with treatment engagement, retention, and satisfaction, and with substance use and emotional problem outcomes. Participants had substance use disorders (SUD) only or co-occurring substance use and psychiatric problems. Those with co-occurring problems reported more days of substance use and emotional problems at intake to treatment than those with SUD only. All groups received equivalent exposure to A-CRA during treatment implementation. At the 12-month follow-up, adolescents classified as externalizers (n = 468) or those with both externalizing and internalizing problems (n = 674) had significantly greater improvement in their days of abstinence and substance problems relative to adolescents with substance use disorders only (n = 666). Additionally, adolescents reporting symptoms of internalizing (n = 154), externalizing, or both externalizing and internalizing disorders had significantly greater improvements in days of emotional problems relative to adolescents with SUD only.     

Child maltreatment and age of alcohol and marijuana initiation in high-risk youth

IntroductionYouth with a history of child maltreatment use substances and develop substance use disorders at rates above national averages. Thus far, no research has examined pathways from maltreatment to age of substance use initiation for maltreated youth. We examined the longitudinal impact of maltreatment in early childhood on age of alcohol and marijuana use initiation, and whether internalizing and externalizing behaviors at age 8 mediates the link between maltreatment and age of substance use initiation.Materials and methodsData were drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) at ages 4, 8, 12, and 18. Maltreatment was assessed through reviews of administrative records and youth self-reports. Behavior problems were assessed with the Child Behavior Checklist. Age of substance use initiation was assessed with the Young Adult version of the Diagnostic Interview Schedule for Children.ResultsPath analyses indicated mediated effects from a history of maltreatment to age at first alcohol and marijuana use through externalizing behaviors. Considering type of maltreatment, direct effects were found from physical abuse to age of alcohol initiation, and mediated effects were found from sexual abuse and neglect to initial age of alcohol and marijuana use through externalizing behaviors. Direct effects for marijuana use initiation and indirect effects through internalizing behavior problems were not significant for either substance.ConclusionsExternalizing behavior is one pathway from childhood maltreatment to age of substance use initiation. Services for maltreated youth should incorporate substance use prevention, particularly among those with early externalizing problems.     

The topography of multiple drug use among adolescent Australians: Findings from the National Drug Strategy Household Survey

Introduction and aims

Despite evidence that many Australian adolescents have considerable experience with various drug types, little is known about the extent to which adolescents use multiple substances. The aim of this study was to examine the degree of clustering of drug types within individuals, and the extent to which demographic and psychosocial predictors are related to cluster membership.

Design and method

A sample of 1402 adolescents aged 12–17 years were extracted from the Australian 2007 National Drug Strategy Household Survey. Extracted data included lifetime use of 10 substances, gender, psychological distress, physical health, perceived peer substance use, socioeconomic disadvantage, and regionality. Latent class analysis was used to determine clusters, and multinomial logistic regression employed to examine predictors of cluster membership.

Result

There were 3 latent classes. The great majority (79.6%) of adolescents used alcohol only, 18.3% were limited range multidrug users (encompassing alcohol, tobacco, and marijuana), and 2% were extended range multidrug users. Perceived peer drug use and psychological distress predicted limited and extended multiple drug use. Psychological distress was a more significant predictor of extended multidrug use compared to limited multidrug use.

Discussion and conclusion

In the Australian school-based prevention setting, a very strong focus on alcohol use and the linkages between alcohol, tobacco and marijuana are warranted. Psychological distress may be an important target for screening and early intervention for adolescents who use multiple drugs.     

Risk factors for alcohol and marijuana use among adolescents in foster care

This study examined the influences of individual and social risk factors on alcohol and marijuana use among a sample of foster care adolescents. Data were collected through baseline structured interviews with 320 adolescents (aged 15-18 years) who resided in foster care placements and participated in a larger evaluation study of an independent living program. Approximately 40% of the adolescents reported alcohol use, 36% reported marijuana use, and 25% reported both alcohol and marijuana use during the 6 months prior to the interview. Final logistic regression models indicated that having friends who used marijuana and other substances and having skipped school remained most predictive of using alcohol, marijuana, or both alcohol and marijuana. Recommendations for substance abuse prevention and treatment for these vulnerable adolescents are proposed.     

Technology-based Interventions for Substance Use and Related Issues: Translated Abstracts

Background: Despite insidious effects, use of inhalant substances by adolescents remains an understudied phenomenon. Objective: This research was designed to identify patterns of past year substance use and delinquency among adolescent inhalant users. Method: The study used a sample of adolescent inhalant users (ages ranged from 12–17 years, n = 7,476) taken from a pooled sample of the 2002 through 2012 National Survey of Drug Use and Health (NSDUH). Three-step latent class analyses were conducted with past year substance use and delinquency behaviors as class indicators. Demographic and social covariates were included in the analyses. Results: Analyses yielded a six-class solution comprised of classes of users characterized by low substance use/low delinquency, high substance use/low delinquency, low substance use/fighting, cigarettes/alcohol/marijuana, high substance use/high delinquency, and cigarettes/alcohol/ marijuana/opioids/moderate delinquency. Conclusions: Findings provide insight into the taxonomy of adolescent inhalant user heterogeneity, and may inform future efforts at detection and prevention of inhalant use by suggesting warning signs of co-occurring externalizing behaviors and possible indications of underlying internalized issues.     

Dopamine receptor (D4) polymorphism is related to comorbidity between marijuana abuse and depression

The rates of marijuana abuse are steadily increasing in the U.S. Data suggest that comorbid marijuana abuse and depression is associated with worse outcomes than either diagnosis. Genetic studies independently link the DRD4 gene polymorphism to substance use and to internalizing disorders, but no study has examined whether the DRD4 polymorphism is linked to comorbid marijuana use and depression in a population sample. This study examined associations between the DRD4 gene 48 bp VNTR polymorphism and comorbidity between marijuana use frequency and depression in a diverse, non-clinical adolescent sample (n = 1882; ages 14 to 18) from the National Longitudinal Study of Adolescent Health (Add Health). Multinomial regression analyses indicated that the odds of being comorbid for depressive symptoms and marijuana use are approximately 2.5 ≥ with the ≥ 7R/≥ 7R genotype than youths who carry the < 7R/< 7R genotype, controlling for the effects of ethnicity, gender, age, violent victimization, and alcohol related problems. Findings provide genetic clues for psychopathology characterized by prominent externalizing and internalizing features.     

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.     

High prevalence of substance use disorders among adolescents who use marijuana and inhalants

BACKGROUND: We examined the association between the use of inhalants, marijuana, and other drugs and recent DSM-IV substance use disorders among adolescents aged 12-17 years. METHODS: Data were drawn from 2000 to 2001 National Household Surveys on Drug Abuse. Adolescents aged 12-17 years who reported having ever used an illicit drug in their lifetime were categorized into four mutually exclusive groups: inhalant users (16%), marijuana users (53%), inhalant and marijuana users (16%), and other drug users (15%). Logistic regression models were used to estimate associations with recent substance use diagnoses among lifetime adolescent drug users (N=10,180). RESULTS: We found that 31% of lifetime drug users reported having never used marijuana. One half of these atypical drug users were predominantly nonmedical users of pain relievers. Adolescents who used inhalants or other drugs but not marijuana were least likely to report multidrug use. Adolescents who reported using both inhalants and marijuana were most likely to use three or more classes of drugs (73%) and to receive a diagnosis of past year alcohol (35%) and drug (39%) abuse or dependence. CONCLUSIONS: Our study findings suggest that among lifetime adolescent drug users, those who use both inhalants and marijuana are at very high risk for alcohol and drug use disorders.