Testing the Effects of Peer Socialization Versus Selection on Alcohol and Marijuana Use Among Treated Adolescents

This study examined the relative influence of peer socialization and selection on alcohol and marijuana use among 106 adolescents who received a brief intervention. Adolescents were recruited between 2003 and 2007 and followed for 12 months as part of a SAMHSA-funded study. Cross-lagged panel models using four assessment points examined the longitudinal relationship between adolescent substance use and peer substance involvement separately for alcohol and marijuana. Consistent with community studies, there was evidence of both peer socialization and peer selection for alcohol use, and only evidence of peer selection for marijuana use. Implications for research and intervention are discussed.     

Book review

There is More To Quitting Drinking than Quitting Drinking. By Dr. Paul O. Sabrina, Laguna Niguel, CA, 1995, 223 pp.     

Book Review: Adolescents, Alcohol and Substance Abuse: Reaching Teens Through Brief Interventions. Edited by Peter M. Monti, Suzanne M. Colby, and Tracy A. O'Leary, New York, The Guilford Press, 2001, 350 pp., ISBN 1-57230-658-0 (Hardback)

The book reviewed in this article discusses the use of brief interventions in the treatment of adolescent substance abuse. Topics covered include the developmental context within which adolescent substance use occurs, the use of the harm reduction approach to reduce substance use, current assessment instruments, and the role of cognitive and genetic factors in the etiology of substance abuse. Examples of specific brief interventions with adolescents are described and possible avenues for future transdisciplinary research are explored. This expansive sourcebook will be of value to clinicians and academicians alike.     

A Social Network Approach to Demonstrate the Diffusion and Change Process of Intervention From Peer Health Advocates to the Drug Using Community

Project RAP (Risk Avoidance Partnership) trained 112 active drug users to become peer health advocates (PHAs). Six months after baseline survey (N_bl = 522), 91.6% of PHAs and 56.6% of community drug users adopted the RAP innovation of giving peer intervention, and 59.5% of all participants (N_6m = 367) were exposed to RAP innovation. Sociometric network analysis shows that adoption of and exposure to RAP innovation was associated with proximity to a PHA or a highly active interventionist (HAI), being directly linked to multiple PHAs/HAIs, and being located in a network sector where multiple PHAs/HAIs were clustered. RAP innovation has diffused into the Hartford drug-using community.     

Risk profiles among adolescent nonmedical opioid users in the United States

Although prior research has provided data on nonmedical use of opioids in adolescents, studies examining the heterogeneity of risk are limited. The present study extends prior research by deepening the understanding of adolescent nonmedical opioid use by specifying empirically meaningful profiles of risk. Using data on adolescent non-medical opioid users (N=1783) from the 2008 US National Survey on Drug Use and Health (NSDUH), latent class analysis and multinomial logistic regression were employed to identify latent classes and determine the effects of covariates on class membership. Four latent classes provided the best fit to the data. Classes consisted of a low risk class (33.7%), a high delinquency/low substance use class (17.8%), a high substance use/low delinquency class (34.2%), and finally a high risk class (14.3%) characterized by high levels of both substance use and delinquent behavior. Study findings advance the understanding of adolescent nonmedical opioid use by specifying distinct latent classes. Results suggest that intervention efforts can fruitfully target a number of risk domains especially programs that enhance effective parenting and supervision.     

An exploratory study of the effects of neighborhood characteristics on adolescent substance use

A substance abuse treatment sample of 53 adolescents in the Washington, DC, area was used to investigate the influence of individual and neighborhood characteristics on substance use utilizing logistic regression. Cross-validation evaluated model performance. Results of separate individual and neighborhood models indicate that subjects’ race and family history of psychological problems influence the likelihood of substance use, as does the racial makeup and population density of subjects’ home neighborhoods. In models that combine individual and neighborhood factors, however, proximity to crime was found to offer a greater degree of explanatory power than a subject's race or neighborhood population density. This finding suggests that the influence of race on substance abuse appears to be mediated in part by geographic characteristics of adolescents’ home neighborhood, particularly urban crime. Results provide support for combining individual and neighborhood variables, or an ecological framework, when examining adolescent health outcomes like substance use.     

Postgraduate Medical Education in Substance Abuse: An International Perspective on Dissemination of Treatment Research

The relationship of temperament to different patterns and types of alcohol abuse has received much attention over the last decade in order to provide clues to matching patients optimally to treatment strategies. The purpose of this study was to examine the relationship of temperament with a number of relevant substance abuse characteristics in a substance abusing population. One hundred forty‐five male veterans were interviewed on their lifetime use of substances and on their psychiatric symptoms, problems associated with use, context, and family history of substance abuse. Subjects filled out the TPQ and the MPQ, which were subjected to factor analysis and revealed four factors: (1) Negative Affectivity/Impulsivity, (2) Positive Affectivity/Sociability, (3) Persistence/Achievement, and (4) Constraint. There was partial support for the hypotheses. Impulsivity was negatively correlated with age of onset and positively correlated with substance‐related problems and a family history of substance abuse. Subjects with a history of depression scored significantly lower on the Positive Affectivity/ Sociability factor than those who had not experienced a significant depression. Individuals who used alone scored lower on this factor than those who used in social contexts. The temperament factors of Persistence/Achievement and Constraint were, for the most part, unrelated to substance abuse.     

Shifting the Paradigm: Adolescent Cannabis Abuse and the Need for Early Intervention

ABSTRACT

This article describes the increasing risks of use of marijuana and related products by adolescents. As THC content increases and methods such as “dabbing” increase frequency of use, risks of marijuana use as perceived by youth are decreasing. At a time when marijuana access is increasing nationally, a new marijuana landscape is forming in which both adolescents and treatment providers must adjust their perceptions of what was once thought of as a “harmless” drug. This article describes this new landscape, and what it may mean for adolescent drug treatment.     

The effects of general and alcohol-specific peer factors in adolescence on trajectories of alcohol abuse disorder symptoms from 21 to 33 years

Background

The present study examines whether general and alcohol-specific peer risk factors from age 10 to 18 are associated with longitudinal patterns of adult alcohol abuse disorder symptoms from age 21 to 33.

Methods

Using growth mixture modeling, trajectory groups of alcohol abuse disorder symptoms from age 21 to 33 were identified. We then examined the relationships between the identified trajectory groups of alcohol abuse disorder symptoms and respondents’ own adolescent binge drinking, a general negative peer factor, and an alcohol-specific peer factor (having drinking peers) in adolescence using pseudo-class Wald Chi-square tests, and multinomial logistic regressions.

Results

Four different trajectory groups of alcohol abuse disorder symptoms were identified: persistor group (3%), decreaser group (23%), escalator group (3%), and a no-disorder group (71%). Bivariate Wald Chi-square tests indicated that adolescent binge drinking behavior and general and alcohol-specific peer factors differentiated the adult alcohol abuse trajectory groups. Multivariate multinomial logistic regression showed that the general negative peer factors distinguished those who later persisted in alcohol abuse from those who desisted (i.e., persistor group vs. decreaser group) during young adulthood, even after adjusting for respondents’ adolescent binge drinking. On the other hand, associating with drinking peers did not distinguish these trajectories.

Conclusion

Alcohol-specific peer influences appear to influence alcohol abuse disorder symptoms in the early 20s, while general negative peer exposure in adolescence increases in importance as a risk factor for alcohol abuse disorder symptom persistence in the late 20s and the early 30s.     

Beck Depression Inventory for depression screening in substance-abusing adolescents

Co-occurring major depressive disorder (MDD) in adolescents with substance use disorders (SUD) has been linked to poor treatment outcomes. Use of validated depression screens in adolescent SUD populations may improve the detection of depression. In this study, we evaluated the diagnostic efficiency of the Beck Depression Inventory (BDI) in detecting MDD, as assessed by psychiatrists administering the Diagnostic Interview for Children and Adolescents, and its factor structure, internal consistency, and discriminant validity in a clinical sample of adolescents with SUD (n = 145). Results indicate that BDI scores of 12 and higher had the most optimal sensitivity (73%), whereas BDI scores of 17 and higher, the most optimal specificity (75%). Five factors accounted for approximately 56% of the variance. Overall, internal consistency was high, and the BDI adequately discriminated MDD from non-MDD cases. Results support the use of BDI as a screen for MDD with moderate to high psychometric properties in an adolescent SUD sample.     

Adolescent-only substance abuse treatment: Availability and adoption of components of quality

There are few studies of the availability and quality of adolescent-only treatment programs. Drawing upon existing samples of publicly and privately funded treatment programs, this research considers whether organizational characteristics are associated with the availability of adolescent-only programming and measures components of quality within these programs. Significant organizational correlates of adolescent-only services included organizational size, location within a hospital setting, center accreditation, adherence to a 12-step treatment model, and reliance on public sources of funding. In-depth interviews were then conducted with 154 managers of adolescent-only treatment programs regarding levels of care offered and service quality. The most prevalent levels of care were standard outpatient and intensive outpatient. Analysis of nine domains of treatment quality revealed a medium level of quality. Treatment quality was significantly greater in programs offering more intensive levels of care. These results are largely consistent with other recent research and suggest a need for continued quality improvement efforts in this treatment sector.     

Demographic,Medical History and Sexual Correlates of HIV Seropositive Methadone Maintained Women

Beginning in January 1989, consecutive female admissions to the ARTC MMTP Clinics in NYC were interviewed about their medical, drug, sexual and social experiences during 6 distinct historical years. Bloods were drawn and each sample tested for HIV via ELISA and Western Blot analysis. The data for 256 females was analyzed. The sample was predominantly Black (56%) and Hispanic (36%). Fifty-four percent (140) were between the ages of 31 and 40; 35% (91) were between the ages of 18 and 30; and 10% (27) were 41 or older. The majority, 179 (69%), had less than a high school education, while 79 (31%) had a high school education or greater. The seropositivity for this sample of females was 60.4%. Aside from the common types of illnesses often seen in gay men infected with the HIV virus (i.e., pheumonia, night sweats, sore throat and swollen glands) our sample of females presented with symptoms such as abnormal discharges from the vagina, infections or abcesses of the veins, kidney or bladder infections, bleeding from the bowels and hepatitis infections. The most commonly reported risk factors among our sample of HIV positive females were sharing injecting materials (38%); injecting drugs in veins (37.2%); dividing an injection (24.3%); and blood transfusions (10.9%). Of our HIV positive females, 42 of 97 (43.3%) reported having sex with a man who is potentially infected with the HIV virus only once may be enough for a female to seroconvert. One limitation of this data is that there is no knowledge of when the HIV positive women seroconverted. Some of the behaviors reported could be due to exposure to AIDS education, and not to the knowledge to their HIV serostatus.     

Adolescent Alcohol and Marijuana Use: Concordance Among Objective-, Self-, and Collateral-Reports

SUMMARY

The association of and difference between urinalysis, self- and parent collateral-report of alcohol and substance use at baseline, 3- and 9-month follow-up was assessed for 88 male and female adolescents from a treatment study. While urinalyses rates were higher than self and collateral-report, urinalyses and self-report did not differ significantly at follow-up. Associations between urinalyses and self-report were highest (r = .64, .69), followed by youth-/collateral report (.49, .55), and urinalyses/collateral-report (.28, .43). Change in youth subjective substance use was associated with collateral subjective perceptions of use at follow-up. Higher false-negatives render collateral less reliable than self-report but necessary in the assessment process.     

Peer-Led Seeking Safety: Results of a Pilot Outcome Study with Relevance to Public Health

There is a rich history of peer-led recovery efforts related to substance use disorder (SUD). Yet we know of no peer-led approaches for co-occurring SUD and trauma-related problems. This combination is widespread, has impact on multiple life domains, and presents major recovery challenges. In this pilot, we evaluated peer-led Seeking Safety (SS). SS is the most evidence-based and widely implemented therapy for SUD with co-occurring PTSD or other trauma-related problems. Eighteen women in residential substance-abuse treatment participated. All met SUD criteria (primarily opiate and cocaine dependence); most had a comorbid mental health disorder; and they had elevated trauma-related symptoms. The 25 SS topics were conducted twice-weekly. Participants were assessed at baseline and end-of-treatment, with some measures also collected monthly. Results showed significant positive outcomes in trauma-related problems (the Trauma Symptom Checklist-40); psychopathology (the Brief Symptom Inventory); functioning (the BASIS-32, including impulsive-addictive behavior); self-compassion (the Self-Compassion Scale); and SS coping skills. Effect sizes were consistently large. SS satisfaction and fidelity ratings were high. Substance use levels could not be assessed due to the residential setting. Qualitative data indicated enthusiasm for peer-SS by both peers and staff. Study limitations, future research, and public health relevance are discussed.     

The Patients in Recovery (PIR) Perspective: Teaching Physicians About Methamphetamine

ABSTRACT

Methamphetamine dependence is an emerging epidemic confronting physicians. In an effort to improve understanding of its impact, the authors presented an educational workshop at a national meeting for general internists featuring small group discussions with patients in recovery (PIR) from methamphetamine dependence. Participants rated the workshop highly, stating it would lead to concrete change in their teaching, research, or patient care practices and they would invite the workshop to their institution for presentation. Direct interaction with PIR was the most valued aspect of the workshop. Lessons learned included patient's fear of being “turned in” limits disclosure of methamphetamine use to physicians; active users have little insight into methamphetamine-related changes in physical appearance; and a sense of productivity reinforces ongoing methamphetamine use. Workshops that include small group discussions between physicians and PIR are an innovative, practical, and acceptable method to teach physicians about their role in helping patients with substance dependence.     

Some costs and challenges of conducting follow-up studies of substance use in remote Aboriginal communities: an example from the Northern Territory

The objective of this study was to describe some costs and challenges for conducting follow-up interviews about substance use in Indigenous groups in northern Australia. In a remote region in the Northern Territory in 2001, 131 Indigenous people (aged 13 - 36 years) were approached for interview regarding their substance use. Of these, 108 (54 males, 54 females) were interviewed successfully. Follow-up interviews were attempted in 2004. Study records traced progress and costs. In 2001, the response rate was 82% (108/131). In 2004, 22 participants could not be found after four attempts although they were known by health workers to still reside in the region. Fifteen were not residing in the region during 2004 and were lost to follow-up, four were in prison and three were deceased. Fourteen contacted either refused directly (n = 1) or repeatedly postponed interview (n = 13). Fifty follow-up interviews were completed, a response rate of 78% among 64 participants contacted. The overall response rate in those approached was 64% (0.82 * 0.78). Costs for 108 interviews were 45 person-days and $A19 000 (32% = travel/associated costs). Costs for 50 follow-up interviews were 60 person-days and $A25 500 (39% = travel/associated costs). Such follow-up studies in these settings could be complemented by retrospective case - control approaches and by using proxy respondents to increase study efficiency. [Clough AR. Some costs and challenges of conducting follow-up studies of substance use in remote Aboriginal communities: an example from the Northern Territory. Drug Alcohol Rev 2006;25:455 - 458]     

The Teen Addiction Severity Index Around the Globe: The Tower of Babel Revisited

ABSTRACT

The objectives of this article are, first, to provide a brief review of screening and assessment of adolescents substance use and substance use disorders; second, to describe the work done with the Teen Addiction Severity Index (T-ASI) in different countries; and third, to address challenges and opportunities in order to improve international collaboration between health professionals responsible for providing substance abuse services for youth and families. It is recommended that the International Society of Addiction Medicine (ISAM) sponsor and coordinate the efforts to disseminate the benefits accrued from already developed assessment and treatment of substance use disorders of youth into different countries and regions. Addiction professionals representing a myriad of cultures, ethnic, and racial groups would be encouraged to translate the assessments into relevant languages and dialects and with the support of the original authors conduct reverse translation and then test the psychometric properties before a wider use commences.     

Heroin use and barriers to treatment in street-involved youth

High rates of drug use and risk behaviours have been reported among street involved youth. The present study examined the drug use and risk behaviours in adolescent heroin users, assessed motivation for treatment, and identified barriers to accessing treatment. Forty-nine heroin-using adolescents from four youth community agencies in Toronto were interviewed. Participants reported having used, on average, four different substances in the previous month. Seventy-nine percent had engaged in injection drug use and of these, 58% had shared their injecting equipment. Significant gender differences were found in the prevalence of psychiatric and family problems, the type of drug programs used, and perceived barriers to treatment. Although more than half of the sample had sought treatment for their substance use problems and were knowledgeable about the treatment options available, many believed factors such as lack of housing, finances, and contact with drug-using acquaintances would hamper their rehabilitation. Treatment programs for these youth should include the assessment and treatment of comorbid psychiatric disorders, and the provision of comprehensive services including ‘safe’ housing, vocational guidance and financial supports.     

Stage of change as a predictor of abstinence among alcohol‐dependent subjects in pharmacotherapy trials

Abstract

Although tobacco use is reported by the majority of substance use disordered (SUD) youth, little work has examined tobacco focused interventions with this population. The present study is an initial investigation of the effect of a tobacco use intervention on adolescent SUD treatment outcomes. Participants were adolescents in SUD treatment taking part in a cigarette smoking intervention efficacy study, assessed at baseline and followed up at 3- and 6-months post-intervention. Analyses compared treatment and control groups on days using alcohol and drugs and proportion abstinent from substance use at follow up assessments. Adolescents in the treatment condition reported significantly fewer days of substance use and were somewhat more likely to be abstinent at 3-month follow up. These findings suggest that tobacco focused intervention may enhance SUD treatment outcome. The present study provides further evidence for the value of addressing tobacco use in the context of treatment for adolescent SUD's.