Sequences of substance use among American Indian adolescents

OBJECTIVE: To determine whether the predominant pattern of the sequence of use of different classes of substances among a large sample of American Indian (AI) adolescents is consistent with Stage Theory [i.e., (1) alcohol, (2) marijuana, (3) other illicit drugs, and (4) cocaine]. METHOD: Data came from surveys completed by 1,562 AI high school students in 1993. Pairwise comparisons of age of first use for alcohol, marijuana, inhalants, cocaine, and other illicit drugs were examined, as were the prevalence rates of specific sequences of substance use. RESULTS: Thirty-five percent of the AI youths who had used both alcohol and marijuana reported using alcohol first. Seventy-five percent of youths who had used three or more substances reported a sequence of first use that was inconsistent with Stage Theory. However, a general pattern of using alcohol, marijuana, and/or inhalants prior to the use of cocaine and other illicit drugs was observed. Sequences of first use varied by gender, age of first substance use, community, and number of classes of substances used. CONCLUSIONS: To enhance the validity of Stage Theory for AI adolescents, the authors recommend its revision to include alcohol, marijuana, and inhalants as initiating substances.     

Adolescent sex-role orientation and ego identity

This study investigated the relationship between sex-role development and ego development in a sample of 9th-12th grade Anglo-American and Mexican-American students attending high school in a southwestern state. All students were administered: (a) the Extended Objective Measure of Ego Identity Status (Grotevant and Adams, 1984) as a measure of ego development (i.e., diffusion, foreclosure, moratorium, and identity achievement), and (b) the Personal Attributes Questionnaire Short Form (Spence, Helmreich and Stapp, 1975) as a measure of masculinity and femininity. Results indicated no ethnic differences in the relationship between ego identity and masculinity/femininity. Adolescents who were identity achieved on ideological identity formation had significantly higher levels of masculinity than did moratorium, foreclosed, and diffused individuals. For interpersonal identity, identity achieved adolescents had higher levels of both masculinity and femininity than did individuals who were foreclosed, diffused, or in moratorium. Discussion centered on these results in light of the additional finding that there was little shared variance (eta2) between masculinity, femininity and ego identity.     

Ethnic differences in adolescents'' identity status and associated behavior problems

The relationships between ethnicity and identity status and between identity status and behavior problems, social competence, and self-esteem were examined among 330 White, Black, Puerto Rican and Filipino students in an integrated high school. Identity status (i.e., achieved, moratorium, foreclosed, or diffuse) was defined on the basis of a 24-item self-report inventory on which students rated their explorations of options and/or commitments to choices in their occupational, political, and religious domains. Ethnic status was also assessed in an 8-item questionnaire which assessed exploration and commitment to one's ethnic role. White students in the upper grades reported significantly higher moratorium scale scores and perceived themselves as more likely to have explored and be committed to their ethnic role than minority youth. There were no significant ethnic differences in the relationships of identity status to behavior problems, social competence or self-esteem. Adolescent boys were significantly more likely to be in moratorium regarding their ethnic role than girls. Grade and sex differences in identity status were consistent with those predicted by developmental researchers. Across all ethnic groups, ratings of moratorium status were associated with significantly more behavior problems, less social competence, and lower self-esteem.     

American Indian substance use: the hazards for substance use initiation and progression for adolescents aged 14 to 20 years

OBJECTIVE: To describe the risks and risk factors for substance use initiation and progression among a large sample of American Indian (AI) adolescents. METHOD: Data came from surveys completed by 2,356 AI adolescents aged 14 to 20 years who participated in two or more consecutive waves of a longitudinal study between 1993 and 1996 (response rate 74%). Discrete-time survival analysis was used to describe the risks and risk factors for substance use initiation and progression. RESULTS: The risk for initiating use of any substance accelerated in early adolescence and peaked at age 18. The risk for progression from use of alcohol, marijuana, and/or inhalants to the use of other illicit drugs (e.g., cocaine) increased over the first 4.5 years after initiating substance use, then diminished in subsequent years. The risk of substance use initiation and progression varied across the four participating communities and by season of the year. Compared to adolescents who initiated substance use with alcohol only, adolescents who initiated substance use with marijuana or inhalants were more likely to progress to use other illicit drugs. CONCLUSIONS: Prevention programs for AI communities should be designed to address these community, age, and seasonal variations in the risks for substance use initiation and progression.     

Inhalant use, abuse, and dependence among adolescent patients: commonly comorbid problems

OBJECTIVE: Little is known about adolescents with DSM-IV-defined inhalant abuse and dependence. The aim of this study was to compare comorbidity among (1) adolescents with inhalant use disorders, (2) adolescents who reported using inhalants without inhalant use disorder, and (3) other adolescent patients drawn from an adolescent drug and alcohol treatment program. METHOD: The authors examined 847 admissions of patients who had completed structured diagnostic assessments. The three groups were compared for noninhalant substance use disorders, posttraumatic stress disorder, conduct disorder, major depression, previous suicide attempts, and physical/sexual abuse and neglect. RESULTS: Adolescents with inhalant abuse or dependence (group 1; n = 28) were significantly more likely to meet lifetime criteria for abuse or dependence on alcohol, hallucinogens, nicotine, cocaine, and amphetamines, to have had major depression, and to have attempted suicide compared with other adolescent patients who reported never using inhalants (group 3); adolescents with inhalant use disorders also reported significantly more abuse and neglect. Adolescents with inhalant abuse or dependence (group 1) did not differ significantly on any measure compared with adolescents who reported using inhalants without an inhalant use disorder (group 2). CONCLUSIONS: Adolescent patients with a history of inhalant use, abuse, or dependence entering treatment should be carefully screened for noninhalant substance use disorders, major depression, suicidality, and abuse and neglect.     

Cigarette smoking in the early course of bipolar disorder: association with ages-at-onset of alcohol and marijuana use

Objectives: Despite the high prevalence of smoking among individuals with bipolar disorder, few studies have attempted to identify correlates of smoking status in this group. We examined illness characteristics of bipolar disorder as well as co-occurring alcohol and marijuana use as correlates of cigarette smoking, including the developmental timing of the onset of regular alcohol and cannabis use (i.e., three or more times per week for a month or more). Methods: Demographic and clinical characteristics of 134 patients with bipolar I disorder, the majority of whom were adolescents, who were hospitalized for their first manic episode were analyzed to identify correlates of smoking status. Results: A total of 61 (45.5%) of the patients were smokers at the time of their first hospitalization. Smokers were significantly more likely than nonsmokers to report recent use of marijuana (55.7% versus 18.1%) and alcohol (67.2% versus 25.4%). Among those who had ever used marijuana (48.5%) or alcohol (45.5%) regularly, current cigarette smokers reported a significantly earlier age-at-onset of regular use of both substances than reported by nonsmokers. Earlier age-at-onset of marijuana use was the only significant predictor of current smoking in a multivariate analysis. None of the bipolar disorder characteristics examined (i.e., symptom severity, age-at-onset of illness, rapid cycling, and psychosis) were correlated with smoking status. Conclusions: Smoking status in the early course of bipolar disorder is related to both current and past alcohol and marijuana use, but not to characteristics of bipolar illness. Earlier initiation of regular marijuana use is associated with an increased risk of smoking cigarettes.     

Adolescent drug abuse. Diagnosis, treatment, and prevention

There are clear temporal developmental stages in drug use beginning with cigarettes and alcohol, then progressing to marijuana and finally cocaine, hallucinogens, and other drugs. Of considerable interest is the decline in prevalence of marijuana use and the stabilization of alcohol use in the face of a rise in the incidence of cocaine use. This decline occurs in the face of a decrease in the age of first initiation into drug use. Cocaine use is accompanied by serious medical, psychological, and social consequences including seizures, depression, paranoia, and suspension from school. These findings have definite implications for designing treatment and prevention programs. Inpatient and outpatient programs must require abstinence from drug use. Dysfunctional development, poor interpersonal skills, learning deficits, and concurrent psychiatric illness must be addressed. Family involvement in treatment is mandatory. Every chemically dependent person has a significant impact on the lives of several other people. The social pressures model is the most recent approach to drug prevention and the one most likely to succeed. Direct informational appeals to adolescents are unlikely in themselves to produce immediate changes in drug-related behavior but may assist in gradually changing community norms. School prevention programs need to be designed to target adolescents before the onset of drug use. The seventh grade or before is the correct point to begin. Finally, methods to assess the success of such pilot programs can greatly assist future development efforts. More research into the biologic and behavioral consequences of current drug use patterns including marijuana, cocaine, and hallucinogens is greatly needed.     

Ego-identity differences among Anglo-American and Mexican-American adolescents

This study investigated potential differences in Ideological/Occupational and Interpersonal ego-identity among Anglo-American and Mexican-American adolescents. Subjects were 841 9th-12th graders attending high school in a southwestern state. All students were administered the Extended Objective Measure of Ego Identity Status to determine their level of identity diffusion, foreclosure, moratorium, and identity achievement. Multivariate analyses of co-variance with discriminant analysis were conducted separately for the two types of identity. Mothers' and fathers' education were included as covariates. Results indicated that Mexican-American youth are more foreclosed than Anglo-American youth in Ideological/Occupational identity, and may therefore be more inclined to adopt their parents' commitments to religious and political beliefs, occupational preferences, and philosophical lifestyles. Results also indicated that Mexican-American youth differ from Anglo-American youth in Interpersonal Identity as a function of grade. Discussion focused on interpretation of these results from both cultural and minority status perspectives.     

Resident physician substance use, by specialty.

OBJECTIVE: This study compares substance use by medical specialty among resident physicians. METHOD: The authors estimated the prevalence of substance use of 11 medical specialties from a national sample of 1,754 U.S. resident physicians. RESULTS: Emergency medicine and psychiatry residents showed higher rates of substance use than residents in other specialties. Emergency medicine residents reported more current use of cocaine and marijuana, and psychiatry residents reported more current use of benzodiazepines and marijuana. Contrary to recent concerns, anesthesiology residents did not have high rates of substance use. Family/general practice, internal medicine, and obstetrics/gynecology were not among the higher or lower use groups for most substances. Surgeons had lower rates of substance use except for alcohol. Pediatric and pathology residents were least likely to be substance users. CONCLUSIONS: The authors' previous research indicates that residents overall have lower rates of substance use than their age peers in society. Yet resident substance use patterns do differ by specialty. Residents in some specialties are more likely to use specific classes of drugs, to use a greater number of drug classes, and to be daily users of alcohol or cigarettes.     

The relation between identity status and romantic attachment style in middle and late adolescence

This study examined the linkages between identity formation and romantic attachment in an ethnically diverse sample of high school (n=189) and college students (n=324). Individuals in the foreclosed identity status group had significantly lower relationship avoidance scores than the diffused identity status group, and the foreclosed group had significantly lower relationship anxiety scores than both the achieved identity and moratorium groups. Identity status and romantic attachment style were significantly related among the college sample, but not among the high school sample. Some ethnic differences in attachment style were noted. Developmental implications are discussed.     

Adolescent Initiation of Drug Use: Effects of Prenatal Cocaine Exposure

ObjectiveTo investigate the direct effects of prenatal cocaine exposure (PCE) on adolescent drug use, while controlling for other predictors of adolescent use.MethodData are from a longitudinal study of PCE in which women and their offspring were assessed throughout childhood. Adolescents were interviewed at 15 years about their age at initiation of alcohol, marijuana, and tobacco. The sample consisted of 214 adolescents and their caregivers: 50% was of white ethnicity, and 50% African American.ResultsFirst trimester cocaine exposure significantly predicted earlier adolescent marijuana and alcohol initiation. The hazard of marijuana and alcohol initiation among exposed adolescents was almost two times greater than among nonexposed adolescents, adjusting for other significant factors. There were no differences in tobacco initiation. Other significant predictors of adolescent drug use were family history of alcohol problems, exposure to violence, and childhood maltreatment.ConclusionsCocaine exposure during early pregnancy was associated with initiation of marijuana and alcohol use. Exposure to violence, childhood maltreatment, and familial factors also predicted adolescent initiation, but did not mitigate the effects of PCE. The combination of these risk factors has significant implications for the development of later substance use, social, and psychiatric problems.     

Adolescent marijuana use: risk factors and implications

A sample of 1,270 students in Years 7, 10 and 11 attending seven State high schools in a middle class area of Sydney answered a self-report questionnaire designed to measure many aspects of their family situation, school performance, spare time activities, drinking and drug taking behaviour and sexual activity. Data on the reported prevalence of marijuana use and the variables significantly associated with marijuana use are presented and discussed. Marijuana use was reported by 4.2% of 12 year olds (Year 7), 26.5% of 15 year olds (Year 10) and 26.7% of 16 year olds (Year 11). More than half of those who had ever used marijuana had used it during the week prior to the survey and there were no significant differences in the characteristics between these recent and the remaining users. Marijuana users reported significantly poorer family relationships than non-users and were about twice as likely as non-users to come from a broken home and/or to have a mother who works full-time, which is often a consequence of marital break-up. Marijuana users also displayed poorer school performance, spent less time on homework and had more school absenteeism than non-users. Marijuana users were more than three times as likely as non-users to have had heterosexual intercourse, drunk alcohol 3 or more times in the past week and to smoke cigarettes. Also, the reported use of stimulants, hallucinogens, narcotics (heroin) and sedatives was almost entirely restricted to those who reported marijuana use. Improvements in the quality of family life may prevent the use of marijuana and other probably more harmful drugs, as well as the indulgence in other acting-out behaviours.     

A multi-dimensional measure of vocational identity status

Establishing a worker identity is among the most central aspects of the transition from adolescence to adulthood. Despite its importance, few measures with acceptable psychometric and conceptual characteristics exist to assess vocational identity statuses. This study reports the development and evaluation of the Vocational Identity Status Assessment (VISA), which is derived from established conceptual models and includes career exploration, commitment, and reconsideration dimensions. Results show that the VISA exhibited metric invariance across a high school and university sample. Cluster analyses demonstrated that the VISA consistently resolved six identity statuses across the two samples, supporting the previously established achieved, moratorium, foreclosed, and diffused statuses along with two additional statuses termed searching moratorium and undifferentiated. The identity statuses predicted differences in participants’ work valences and well-being with the achieved and diffused statuses respectively exhibiting the most and least favorable characteristics. Implications, limitations, and suggestions for future research based upon these findings are offered.     

Substance initiation sequences among Taiwanese adolescents using methamphetamine

The aim of this study was to examine substance initiation sequences in Taiwanese adolescent methamphetamine (MAMP) users. Three hundred adolescent MAMP users were questioned about their use of cigarettes, alcohol, areca quid, benzodiazepine, glue, marijuana, MAMP and heroin. The sequences of substance use before MAMP use were determined in every subject according to their age at substance initiation. The sequences of substance initiation were compared between genders and between early-onset and late-onset MAMP users. The results revealed that the adolescents had used cigarettes, alcohol and areca quid before MAMP, and very few (4%) adolescents had started using MAMP before using other substances. Female MAMP users were more likely to use MAMP as their first substance and were less likely to use areca quid than males. Male early-onset MAMP users were more likely to drink alcohol and chew areca quid before MAMP use than were late-onset users. This study found that the sequences of substance initiation were different between genders and between the early-onset and late-onset MAMP users. There are several findings that are different from those in Western studies on the sequence of substance initiation in the adolescent population.     

Family correlates of female adolescents' ego-identity development

Past research has suggested that parents may contribute to the positive development of their daughter's identity formation. Theoretical notions from both social learning and symbolic interaction indicate that parents can either facilitate or hinder positive growth. Therefore, to test the predictions that (a) more mature (moratorium and achieved) identity status parents would have daughters with more mature identities, and (b) that both positive and negative parenting styles can be detected to differentiate between less (diffused and foreclosed) and more mature identity status youths, 45 families (145 subjects) were assessed on parent-child relations and identity status formation. In contrast to much past research, parent-child relations were assessed from both the adolescents' and the parents' perspectives. The findings indicate that parental identity status formation may have an effect on the adolescent's identity formation and that parent-child relations differentiate between less and more mature female adolescent identities.     

Posttraumatic stress disorder, alcohol use, and perceived safety after the terrorist attack on the pentagon

OBJECTIVE: The authors examined posttraumatic stress disorder (PTSD), alcohol use, and perceptions of safety in a sample of survivors of the September 11, 2001, terrorist attack on the Pentagon. METHODS: Analyses were conducted to examine the effect of past traumatic experience, trauma exposure, initial emotional response, and peritraumatic dissociation on probable PTSD, substance use, and perceived safety among 77 survivors seven months after the attack. RESULTS: Eleven respondents (14 percent) had PTSD. Those with PTSD reported higher levels of initial emotional response and peritraumatic dissociation. Ten respondents (13 percent) reported increased use of alcohol. Women were more than five times as likely as men to have PTSD and almost seven times as likely to report increased use of alcohol. Persons with higher peritraumatic dissociation were more likely to develop PTSD and report increased alcohol use. Those with lower perceived safety at seven months had higher initial emotional response and greater peritraumatic dissociation and were more likely to have PTSD, to have increased alcohol use, and to be female. CONCLUSIONS: The association of perceived safety with gender, the presence of PTSD, and increased alcohol use among survivors of the terrorist attack on the Pentagon warrants further study.     

Construct validity of two identity status measures: the EIPQ and the EOM-EIS-II

The present study was designed to examine construct validity of two identity status measures, the Ego Identity Process Questionnaire (EIPQ; J. Adolescence 18 (1995) 179) and the Extended Objective Measure of Ego Identity Status II (EOM-EIS-II; J. Adolescent Res. 1 (1986) 183). Construct validity was operationalized in terms of how identity status classifications generated by the EIPQ and EOM-EIS related to a measure of psychological agency, the Multi-Measure Agentic Personality Scale (MAPS; J. Adolescence 20 (1997) 421). Results indicated that, for the most part, the agentic personality scales differentiated the EIPQ diffused and moratorium statuses from the foreclosed and achieved statuses, whereas the agentic personality scales differentiated the EOM-EIS-II achieved status from the other three statuses. The EIPQ is recommended as the preferred instrument for making contrasts between or among identity statuses, whereas the EOM-EIS-II is recommended when the objective is to consider continuous measures of the identity statuses.     

Non-suicidal self-injury in high school students: Associations with identity processes and statuses

Non-suicidal self-injury (NSSI) refers to the direct, deliberate destruction of one's body tissue without suicidal intent. Research has highlighted the importance of identity synthesis versus confusion for NSSI. However, the association with identity processes and statuses remains unknown. A total of 568 adolescents reported on NSSI, identity, anxiety, and depression. Although identity processes of identification with commitment (negatively) and ruminative exploration (positively) were related to NSSI variables, these relationships were no longer significant when controlling for anxiety and depression. When examining identity statuses (using cluster analysis), individuals who had engaged in NSSI in the past (but not currently) were more likely to be in the moratorium cluster and less likely to be in the achievement cluster. Individuals who were currently engaging in NSSI were more likely to be in the troubled diffusion cluster. Clinicians should be attentive to the complex interplay between identity and NSSI when treating adolescents.     

Prevalence and correlates of heavy smoking and nicotine dependence in adolescents with bipolar and cannabis use disorders

The study examined the prevalence and correlates of heavy smoking and nicotine dependence in adolescents with bipolar and cannabis use disorders. Participants were 80 adolescents between 13 and 22 years of age with co-occurring bipolar I disorder and cannabis abuse or dependence who reported ever trying a cigarette. Diagnostic and symptom severity measures were completed as part of the baseline assessments for a clinical trial. Almost half (49%) of these participants who ever tried a cigarette were current heavy smokers (≥10 cigarettes/day), and 70% met DSM-IV-TR lifetime criteria for nicotine dependence. Heavy smoking was associated with older age, heavier marijuana use and greater compulsive craving, lifetime diagnoses of attention-deficit/hyperactivity disorder, conduct disorder, illicit drug use disorders, and poorer overall functioning. Nicotine dependence was related to White race, higher current mania severity, and poorer overall functioning. These findings suggest that heavy smoking and nicotine dependence were highly prevalent among these adolescents. Although both were associated with greater physical and psychosocial problems, only heavy smoking was linked to a clear pattern of more severe substance-related and psychiatric problems. Further research to elucidate mechanisms and develop interventions to address early, entrenched patterns of co-use of tobacco and marijuana is warranted.