Web Site Review of World Health Organization,Mental Health and Substance Dependence Department

The major studies investigating substance use among Spanish university students are reviewed, their results and limitations noted, and current and future substance use trends are discussed.     

A Bibliographic Essay: The Relationship between Stress and Substance Use

The purpose of this review is to outline and critique studies that have examined the link between stress and substance use. Studies are categorized according to the age of the sample and the type of substance use measure considered. The research is mostly limited to studies that operationalize stress as stressful life events, daily hassles, or subjective stress. This paper concludes that there is a robust relationship between stress and substance use. However, there is a clear need for general population studies to address age, gender, and cultural differences to better assess the specificity and complexity of the stress/substance use relationship.     

我院医务人员合理用药认知程度调查分析

目的:了解本院医务人员对合理用药的认知程度.方法:采用问卷法.除合理用药的基础知识为共同题外,按照不同的业务职能范围,分别从处方行为、处方调配、执行医嘱操作等方面对本院医、药、护人员进行调查.结果:调查表回收率为86%,较好者仅占20.97%,一般为73.87%,较差为5.16%.职称不同无统计学差异(P＞0.05),类别不同则有显著影响(P＜0.05),表明军队人员对合理用药的认知程度优于合同制及其他人员,但就整体而言,各级职称人员均有待于提高.结论:必须进一步加强合理用药观念,规范处方行为,提高处方调配及执行医嘱的科学性.     

Tri-city study of Ecstasy use problems: a latent class analysis

This study used latent class analysis to examine distinctive subtypes of Ecstasy users based on 24 abuse and dependence symptoms underlying standard DSM-IV criteria. Data came from a three site, population-based, epidemiological study to examine diagnostic nosology for Ecstasy use. Subject inclusion criteria included lifetime Ecstasy use exceeding five times and once in the past year, with participants ranging in age between 16 and 47 years of age from St. Louis, Miami, U.S. and Sydney, Australia. A satisfactory model typified four latent classes representing clearly differentiated diagnostic clusters including: (1) a group of sub-threshold users endorsing few abuse and dependence symptoms (negatives), (2) a group of 'diagnostic orphans' who had characteristic features of dependence for a select group of symptoms (mild dependent), (3) a 'transitional group' mimicking the orphans with regard to their profile of dependence also but reporting some abuse symptoms (moderate dependent), and (4) a 'severe dependent' group with a distinct profile of abuse and dependence symptoms. A multinomial logistic regression model indicated that certain latent classes showed unique associations with external non-diagnostic markers. Controlling for demographic characteristics and lifetime quantity of Ecstasy pill use, criminal behavior and motivational cues for Ecstasy use were the most efficient predictors of cluster membership. This study reinforces the heuristic utility of DSM-IV criteria applied to Ecstasy but with a different collage of symptoms that produced four distinct classes of Ecstasy users.     

A Longitudinal Study of Coping Strategies and Substance Use in Adolescent Boys

ABSTRACT

The authors examined the extent to which religious coping predicted subsequent drug use in adolescent boys. Three hundred and twenty-six adolescent boys completed the Wills Coping Questionnaire (Wills, 1985) as well as a number of drug use inventories. Results showed that religious coping, measured at 12–14 years of age, predicted a significant reduction in number of drugs used, frequency of drug use, and problems associated with drug use measured at 15–16 years of age. These results were maintained even when controlling for age and other key coping variables. These findings may have implications for treatment and prevention efforts, specifically for populations who are amenable to “spiritual” interventions.     

Substance Use,Mental Disorders,Abuse, and Crime: Gender Comparisons Among a National Sample of Adolescent Drug Treatment Clients

ABSTRACT

This paper describes important gender comparisons in drug and alcohol use, illegal activity, physical and sexual abuse, and mental health problems among a large sample of adolescents (N = 3,382) who were treated from 1993 to 1995 in adolescent-oriented drug programs that participated in the Drug Abuse Treatment Outcome Study of Adolescents. Most of the adolescents reported regular use of marijuana and alcohol; males had higher rates of illegal activity and involvement with the juvenile justice system; females reported more sexual abuse, while males reported more physical abuse; and males and females had equal rates of conduct disorder and attention deficit hyperactivity disorder.     

Gender of Physicians with Substance Use Disorders: Clinical Characteristics,Treatment Utilization,and Post-treatment Functioning

Gender has emerged as an important variable in both the course and treatment of substance-use disorders. This study examines the role of gender in a sample of physicians (n = 73) treated for substance-use disorders. Pilot data gathered on physicians treated during 1995 to 1997, included initial pretreatment characteristics, service utilization, and posttreatment functioning. Although there were many similarities, important differences emerged among the groups. These differences have implications for physician education and training and warrant more systematic clinical research.     

Trends in Substance Use among US Military Personnel: The Impact of Changing Demographic Composition

This paper examines the impact of the military population's changing demographic composition on observed changes in substance use by military personnel. Cross-sectional data are drawn from the six Department of Defense Worldwide Surveys of Substance Abuse and Health Behaviors Among Military Personnel conducted in 1980, 1982. 1985. 1988. 1992. and 1995. Using the method of direct standardization to adjust for changes in demographic composition, trends in substance use are examined. Changes in heavy alcohol use were more affected by demographic changes in the military population than were changes in illicit drug use or cigarette use. Findings indicate that changes in demographic composition may need to be controlled when assessing trends from cross-sectional surveys. [Translations are provided in the International Abstracts Section of this issue.]     

Relationship of Substance Use and Associated Predictors of Violence in Early,Middle, and Late Adolescence

ABSTRACT

This study examined relationships among selected predictors of violence, including victimization, low conflict management efficacy, hostile anger and drug use in 8th-, 10th-, and 12th-grade adolescents. The study was a secondary analysis of data from a population-based, cross-sectional survey of health behaviors among adolescents (N = 3922). For each cohort, it was hypothesized that victimization and low conflict management efficacy would predict low hostile anger control, which would predict gateway drug use, and the subsequent development of hard drug use and violence. Overall model fit and the magnitude of specific paths were expected to increase across grades. Using structural equation modeling (SEM), results indicated acceptable model fit for 8th-grade (CFI = .95), 10th-grade (CFI = .93) and 12th-grade (CFI = .94) cohorts. Results suggest that the influence of relational victimization and conflict management efficacy on hard drug use may be mediated through low hostile anger control and gateway drug use.     

Trends in Adolescent Alcohol and Other Substance Use: Relationships to Trends in Peer,Parent, and School Influences

The aim of this study is to improve understanding of trends in adolescent substance use by comparing them with trends in peer substance use, school problem behavior, parental disapproval of alcohol and drugs, and exposure to school prevention information. These trends were determined using data from three large comparable representative surveys of 7–12th grade students in New York State conducted in 1983, 1990, and 1994. Analysis of variance was used to test the significance of the trends and to identify meaningful differences in trends by demographic subgroups (gender, grace level, and ethnicity). Adolescent alcohol and substance use declined in the 1980s, then increased from 1990 to 1994. Trends in friend's substance use and school problem behavior paralleled the alcohol and other substance use trends, consistent with their being part of the same adolescent problem behavior syndrome. Parental disapproval also followed a trend consistent with the substance use trends, i.e., parental disapproval increased in the 1980s but then decreased in the 1990s. However, the trend in school prevention influences did not parallel these substance use trends: student exposure to school primary prevention programs continued to increase from 1990 to 1994. Use of alcohol, cigarettes, marijuana, and other illicit drugs from 1990 to 1994, increased fastest among the younger students, despite increased school prevention exposure. Other factors must be sought as possible explanations of the increasing alcohol and substance use among adolescents.     

Attachment,Adolescent Competencies,and Substance Use: Developmental Considerations in the Study of Risk Behaviors

Social-control-based deviance theories highlight parental bonding as a protective factor for problem behaviors in that bonds are viewed as reflecting the adolescent's adoption of conventional societal attitudes and values. Developmental theory and research suggest an alternative conceptualization of the linkages between family bonding and adolescent risk behaviors. This conceptualization requires concurrent examination of a range of adolescent competencies as well as consideration of parent and peer contexts. Support is found for several hypotheses derived from a developmental approach proposing: (a) positive associations between adolescent-parent attachment and adolescent competencies–autonomy, peer relationship competency, and coping; (b) coherence in the pattern of negative associations between attachment/competencies and substance use problems; and (c) a disjunctive pattern of associations with substance use reflected by positive associations with peer competencies but not with parental attachment.     

The Association of Selected Sociodemographic Factors and Differences in Patterns of Substance Use: A Pilot Study in Selected Areas of Northeast India

Emergence of new addictive substances and progressive increase of “drug abuse” has become a serious problem in many countries. Despite legal restriction and administrative control, the use of illicit drugs (like opium, heroin, proxyvan, etc.) has increased considerably in many parts of Northeast India. A sample of 1831 people (age 10 years and above) were interviewed during 1997–1998 about their drug use habits, if any, and types of substance used, in Meghalaya and upper Assam. Prevalence of substance use was 29.4% tobacco (20.5% chewers and 12.7% smokers), 12.5% alcohol, and 4.9% opium. In Meghalaya, prevalence of tobacco use was high (41.7%), which was mainly due to the large number of female chewers and male smokers. Opium and cannabis users were mainly confined in Assam close to the Arunachal Pradesh border, indicating a regional influence. Wide differences were observed in the prevalence pattern of tobacco and alcohol use across location, sex, age, education, and occupation. An association of sociodemographic factors with substance use was documented. Religion and ethnic group have significant association with tobacco use patterns but are insignificant with regard to alcohol use. Use of multiple substances and use of cannabis as a substitute for opium are the major problems indicating drug dependence. Mean ages for substance use initiation were: 18.5 years for tobacco, 21.8 years for alcohol, and 25.8 years for opium. Not with-standing the study's limitations, these findings are useful for planned prevention efforts and formulation of a specific program considering the importance of regional and sociodemographic factors.     

Approaches to Ethnicity: Clearing Roadblocks in the Study of Ethnicity and Substance Use

This paper reviews a number of indicators of ethnicity commonly used in alcohol/drug use studies. These include the racial, natal, symbolic and cultural approaches to ethnicity. The utility and limitations of each of these approaches is scrutinized. Because ethnicity is a multidimensional concept, using only one dimension, as is the case in many alcohol/drug use studies, is inadequate. One of the major weaknesses of studies of ethnicity and substance use is the failure to recognize the presence of subcultural differences within an ethnic group. Implications of the present review for future research in ethnicity and substance use/misuse and for future development of culturally sensitive programs and services are discussed.     

Inconsistencies over Time in Young Adolescents' Self-Reports of Substance Use and Sexual Intercourse

When surveyed twice within a 6-month period, to what extent do young adolescents give inconsistent answers to questions about sexual behavior and substance use (cigarettes, alcohol, marijuana, inhalants, cocaine)? Data were collected from 1,575 urban African American and Hispanic students during fall and spring of 7th grade. For each behavior examined, less than 2% of the sample gave inconsistent answers within a survey and less than 7.5% did so over time. Retraction of baseline answers at follow-up was greater for rarer and more socially undesirable behaviors (e.g., cocaine versus cigarette use). Over-time inconsistencies were associated with lower reading comprehension and an overall reduction in risk behaviors at follow-up. [Translations are provided in the International Abstracts Section of this issue.]     

Substance Use and Antisocial Behavior in Adolescents: The Role of Family and Peer-Individual Risk and Protective Factors

Extant literature reports a frequent co-occurrence of substance consumption and antisocial behaviors. It is also postulated, therefore, that risk and protective factors are shared by the two behaviors. The purpose of this research is to test this notion by exploring whether family and peer-individual risk and protective factors are similarly associated with unique and co-occurring substance consumption and antisocial behaviors. A sample of 1,599 school students ranging between the ages of 11 and 19 completed a Spanish-language version of the Communities That Care Youth Survey (CTCYS). This instrument measures risk and protective factors and also captures adolescent drug consumption and antisocial behaviors. We find that risk and protective factors seem to operate in distinct ways for drug consumption and antisocial behaviors when they occur separately. Our findings indicate that the co-occurrence of both behaviors is related to risk factors, but it should not be inferred that the same factors will be present when only one behavior is observed.     

The Development and Validation of a Transformational Leadership Survey for Substance Use Treatment Programs

Directors in substance use treatment programs are increasingly required to respond to external economic and socio-political pressures. Leadership practices that promote innovation can help offset these challenges. Using focus groups, factor analysis, and validation instruments, the current study developed and established psychometrics for the Survey of Transformational Leadership. In 2008, clinical directors were evaluated on leadership practices by 214 counselors within 57 programs in four U.S. regions. Nine themes emerged: integrity, sensible risk, demonstrates innovation, encourages innovation, inspirational motivation, supports others, develops others, delegates tasks, and expects excellence. Study implications, limitations, and suggested future directions are discussed.