Substance Use and Violence Among Youth: A Daily Calendar Analysis

Background: While researchers have identified factors that contribute to youth violence, less is known about the details of violent incidents. In addition, substance use has been linked to youth violence; however, little is known about actual substance use on days in which violence occurs. Objective: This study examined reasons for peer violence and the association between substance use and violence using daily calendar-based analyses among at-risk urban youth. Methods: Data were collected from Emergency Department (ED) patients (ages 14–24; n = 599; 59% male, 65% African American) who screened positive for substance use in the past 6 months. Daily data regarding past 30-day substance use and violence and reasons for violent incidents were obtained via semi-structured interviews. Multi-level multinomial regression models were conducted to test the associations between substance use and peer violence incidents (i.e., none, moderate and severe). Results: Conflict over ‘personal belongings’ was a common reason for violence among males; ‘jealousy’/‘rumors’ were common reasons among females. Moderate victimization was more likely to be reported on days in which participants reported alcohol and cocaine use. Severe victimization was more likely to be reported on days in which participants reported alcohol use. Moderate or severe aggression was more likely to be reported on days in which participants reported alcohol and non-medical sedative use. Conclusions: Results suggest that youth violence prevention that addresses differential reasons for violence among males and females as well as substance use would be beneficial.     

The Temporal Effects of Parental Divorce on Youth Substance Use

This article examines how the parental divorce process affects youth substance use at various stages relative to the divorce. With child-fixed-effect models and a baseline period that is long before the divorce, the estimates rely on within-child changes over time. Youth are more likely to use alcohol 2–4 years before a parental divorce. After the divorce, youth have an increased risk of using alcohol and marijuana, with the effect for marijuana being 12.1 percentage points in the two years right after the divorce (p = .010). The magnitudes of the effects persist as time passes from the divorce.     

Adolescent Substance Use Following Participation in a Universal Drug Prevention Program: Examining Relationships With Program Recall and Baseline Use Status

ABSTRACT. Background: The study examined whether adolescents receiving a universal, school based, drug prevention program in Grade 7 varied, by student profile, in substance use behaviors post program implementation. Profiles were a function of recall of program receipt and substance use at baseline. Methods: A secondary analysis was conducted on data from the Adolescent Substance Abuse Prevention Study, a large, geographically diverse, longitudinal school-based cluster-randomized controlled trial of the Take Charge of Your Life drug prevention program. Profiles were created using self-reported substance use (preintervention) and program recall (postintervention) at Grade 7. First, characteristics of each of the 4 profiles of treatment students who varied by program recall and baseline substance use were explored. Then, multilevel logistic regression analyses were used to examine differences in the odds of substance use (alcohol, tobacco, and marijuana) among student profiles at the 6 additional study waves (Time 2 [Grade 7] through Time 7 [Grade 11]). Results: Pearson's chi-square tests showed sample characteristics varied by student profile. Multilevel logistic regression results were consistent across all examined substance use behaviors at all time points. Namely, as compared with students who had no baseline substance use and had program recall (No Use, Recall), each of the remaining 3 profiles (No Use, No Recall; Use, Recall; Use, No Recall) were more likely to engage in substance use. Post hoc analyses showed that for the 2 subprofiles of baseline substance users, there were only 2 observed, and inconsistent, differences in the odds of subsequent substance use by recall status. Conclusions: Findings suggest that for students who were not baseline substance users, program recall significantly decreased the likelihood of subsequent substance use. For students who were baseline substance users, program recall did not generally influence subsequent substance use. Implications for school-based drug prevention programs are discussed.     

Parental Threatening Behaviors and Offspring Substance Use: The Moderating Role of Anxiety Sensitivity

ABSTRACT

Despite extensive evidence linking childhood exposure to adverse parenting and subsequent substance use, the extant research literature is more limited regarding individual difference factors that may moderate this association. This study examines the moderating role of anxiety sensitivity (AS) in the association between childhood exposure to parental threatening behaviors and substance use in a sample of late adolescents with clinical anxiety. One hundred fifty-one late adolescents with clinical levels of anxiety (18.61 years old; SD = 0.91) completed measures assessing childhood exposure to parental threatening behaviors, AS, alcohol/tobacco and illicit substance use frequency, negative affect, and history of negative life events. A significant moderating effect of AS in the association between childhood exposure to parental threatening behaviors and both average and illicit drug use was found—even after controlling for participants' age and history of negative life events. Specifically, for individuals with high AS, as childhood exposure to parental threatening behaviors increased so too did average and illicit substance use frequency; however, for individuals with low AS, childhood exposure to parental threatening behaviors was not significantly associated with either substance use frequency. Findings underscore the profound impact that early negative experiences have on substance use outcomes, particularly for individuals with high AS who have difficulty coping with and regulating physiological arousal. Limitations and clinical implications of these findings are discussed.     

Gender Differences in Youth Substance Use: The Effects of Parenting Through a Deviant Peer Group

The aim of this study is to analyze the effects of parental knowledge, parental support, and family conflict through the affiliation with deviant peers on youth substance use (i.e., alcohol, cannabis, and other illicit substances), as well as unhealthy and antisocial behavior derived from substance consumption. A Spanish community sample was used and gender differences were taken into account. The sample was composed of 584 secondary school students ages 14 to 20, 46.9% of whom were male. The results of structural equation modeling indicate that the affiliation with deviant peers was the factor most directly related to the dependent variables. The results also indicate that family factors influence the dependent variables indirectly and significantly through the mediation of a deviant peer group. Finally, some gender differences were found. Conclusively, substance use prevention programs should be based on managing peer exposure and carried out under a gender-sensitive approach.     

Social Support,Family Empowerment,Substance Use,and Perceived Parenting Competency during Pregnancy for Women with Substance Use Disorders

Background: Parenting self-efficacy has been linked to positive parent and child outcomes however, little research exists on factors that influence parenting self-efficacy among pregnant women with substance use disorders. Objectives: This study explored substance use severity, social support, and family empowerment as predictors of parenting self-efficacy among pregnant women (N = 71) entering SUD treatment. Methods: The study used a quantitative cross-sectional design. Results: Statistically significant positive correlations emerged between social support and parenting self-efficacy as well as family empowerment and parenting self-efficacy. Family empowerment and social support were also correlated. A backward elimination regression analysis revealed family empowerment to be the strongest predictor of parenting self-efficacy. No relationships were found among substance use severity and the study variables. Conclusions: When promoting parenting self-efficacy, both social support and family empowerment are important domains to consider for treatment planning and resource development among pregnant women with substance use disorders.     

Parental Style as a Possible Mediator of the Relationship Between Religiosity and Substance Use in African-American Adolescents

Abstract

Objectives: In both the general adolescent literature and African-American adolescent substance use literature, several facets of family relationships have been identified as protective factors for adolescent substance use. Two such factors are religiosity and parental style. The relationship of these variables, however, may not be direct in relation to adolescent substance use. There are gaps in the knowledge base for African-American youths living in poverty that would benefit from further exploration.

Method: A sample of 2,317 African-American adolescents, living in metropolitan low-income areas and ranging in age from 9 to 19 years old, were surveyed. An exploratory analysis was performed to determine if parental style was a mediator variable for religion and substance use.

Results: The results suggest that parental style is a mediating variable. Results were significant for several parental style and religiosity variables.

Conclusions: The parent-adolescent relationship is an important factor influencing adolescent substance use. Also, the influence of religiosity appears to be a significant factor in this relationship. This relationship should also be targeted when considering any intervention for treating these adolescents. Further research should be conducted in this domain.     

Sexual Minority Disparities in Substance Use Willingness Among Youth

Background: Disparities in substance use have been observed in sexual minority youth, but less is known about willingness to use substances, an important precursor to actual use. Objective: The goal of this study was to examine willingness to use cigarettes, alcohol, and marijuana among sexual minority youth compared to their non-sexual minority counterparts using both cross-sectional and longitudinal data. Methods: The present study drew on two waves (Times 1 and 2; 6 months apart) of data collected during high school as part of a prospective study of substance use initiation and progression in Rhode Island. At Time 1, participants (N = 443) ranged in age from 15 to 20 years (M age = 16.7 years, 26.6% sexual minority, 59.5% female, 72.0% White). Participants self-reported their sexual identity and attraction, lifetime use of alcohol, cigarettes and marijuana, and cigarette, alcohol, and marijuana use willingness (i.e., if offered by a best friend or group of friends). Results: In cross-sectional multivariate regression models, sexual minority youth were more likely to report willingness to use cigarettes (p <.05) and marijuana (p <.01) compared to their non-sexual minority counterparts. Longitudinal multivariate regression models revealed that sexual minorities were only significantly more likely to report cigarette willingness at Time 2 compared to their non-sexual minority counterparts (p <.01). There were no significant differences in alcohol use willingness in multivariable cross-sectional or longitudinal models by sexual minority status. Conclusions: Sexual minority youth reported more willingness than non-sexual minority youth to use substances offered by peers; however, longitudinal analyses revealed that peers appear to play a role only in willingness to smoke cigarettes for these youth, and thus peer influence may be a contributing factor in explaining tobacco-related disparities among sexual minority youth. Given that stigma and peer groups may a particular risk factor for tobacco among sexual minority youth, our findings highlight the importance of prevention programs such as social marketing approaches that correct social norms, reduce stigma, and provide refusal-skills training to reduce tobacco-related disparities among sexual minorities.     

Ethnographic Lessons on Substance Use and Substance Abusers

Abstract

The primary purpose of this article is to introduce broadly comparative ethnographic studies on the role of psychoactive substance use. Examples are cited from case studies across Africa, Asia, Australia, Europe, North, and South America. These varied studies are synthesized to provide the basis for a brief analysis of meaning and function on the integration of use, including ritual and the public nature of use. There is also discussion on the cultural construction of intoxication and of the abuser, along with some thoughts regarding humanizing the drug user and avoiding stereotypes.     

Retention of African-American and White Youth in a Longitudinal Substance Use Study

Abstract

The current investigation discusses successful strategies used to retain N = 405 African-American and White target youth in a longitudinal, non-intervention study focused on alcohol and other drug use. Ninety-one percent of youth remained in the study for all 4 years, including 87% of African-Americans and 96% of Whites. In a logistic regression model incorporating age, ethnicity, income, sex, parent/guardian marital status, parent alcohol use, and family cohesion, only sex significantly predicted retention, with girls being more likely to remain in the study compared with boys, although ethnicity neared significance.     

Trajectories of Substance Use Disorders in Youth: Identifying and Predicting Group Memberships

This study used latent class regression to identify latent trajectory classes based on individuals' diagnostic course of substance use disorders (SUDs) from late adolescence to early adulthood as well as to examine whether several psychosocial risk factors predicted the trajectory class membership. The study sample consisted of 310 individuals originally recruited as children in a long-term prospective study. Diagnoses of alcohol or cannabis use disorders (abuse or dependence) were assessed when individuals were 18 (T1), 20 (T2), and 22 (T3) years old. The results showed that two trajectory classes were identified for both alcohol and cannabis use disorder cases and that the trajectory class membership was predicted by being male, dropping out of high school, receiving a diagnosis of CD or ODD in childhood, having an early age of onset of alcohol or cannabis use, previously using illicit drugs other than cannabis, and the number of risk factors an individual is exposed to. Prevention work should focus on the individuals exposed to these risk factors previously to decrease their likelihood of transition from drug use or single diagnosis to repeated diagnosis during the early years of emerging adulthood.     

Substance Use Coping as a Mediator of the Relationship Between Trauma Symptoms and Substance Use Consequences Among Incarcerated Females With Childhood Sexual Abuse Histories

Rates of substance use and maltreatment are alarmingly high among incarcerated women. Although the direct link between trauma and substance use has been established, less is known about potential mediators. Thus, we examined substance use coping as a mediator between trauma symptoms and substance use consequences among a sample of incarcerated females (N = 111) who were survivors of childhood sexual abuse. Trauma symptoms predicted the severity of substance use consequences, with this relationship being mediated fully by avoidance coping (e.g., using substances to cope). Overall, trauma histories are important in predicting outcomes but must be examined in the context of current coping behaviors and substance use. Findings (data collected in 2007/2008) may help promote interventions that target patterns of coping and/or emotional avoidance among trauma survivors with substance use problems in incarcerated populations. The study's limitations are noted.     

Computer-Assisted HIV Prevention for Youth With Substance Use Disorders

We developed an interactive, customizable, Web-based program focused on the prevention of HIV, sexually transmitted infections, and hepatitis among youth. Results from a randomized, controlled trial with youth in treatment for substance use demonstrated that this Web-based tool, when provided as an adjunct to an educator-delivered prevention intervention, increased accurate prevention knowledge, increased intentions to carefully choose partners, and was perceived as significantly more useful relative to the educator-delivered intervention when provided alone. Results suggest this Web-based program may be effective and engaging and may increase the adoption of effective HIV and disease prevention science for youth. Limitations are discussed.     

Reported Maternal Styles and Substance Use: A Cross-Sectional Study Among Educated Albanian Young Adults

The study explored a predictive model of substance use including perceived maternal parenting style, age and gender. Participants were 347 Albanian young adults (144 males and 203 females) aged 18 to 28 years. They completed the Parental Authority Questionnaire and the Adolescent Alcohol and Drug Involvement Scale. Gender, perceived authoritative maternal style, and age predicted a proportion of substance use involvement. Gender and perceived authoritative maternal style also predicted the proportion of young people at risk for substance use or abuse. Implications of the findings and limitations of the study are discussed.     

Preventing Child Behavior Problems and Substance Use: The Pathways Home Foster Care Reunification Intervention

This study evaluated the Pathways Home manualized selective preventive intervention that was designed to prevent reunification failures once children are returned home to their biological parent(s) after first-time stays in foster care (N = 101). The theoretically-based intervention focused on support and parent management practices designed to prevent the development of child behavior problems, including internalizing and externalizing problems and also substance use. Intent-to-treat analyses employed probability growth curve approaches for repeated telephone assessments over 16 weeks of intervention. Findings showed that relative to “services as usual” reunification families, the Pathways Home families demonstrated better parenting strategies that were, in turn, associated with reductions in problem behaviors over time. Growth in problem behaviors predicted foster care reentry. Maternal substance use cravings were a risk factor for growth in problem behaviors; this risk was buffered by participation in the Pathways Home intervention.     

Correlation Between Ancillary Community Services with Adolescent Substance Use Disorders Treatment Outcome

ABSTRACT

Objective: This study explores whether participation in ancillary out-of-program services predicts outcomes of adolescents treated for substance use disorders.

Method: Eighty-eight consenting adolescents, 13–18 years of age recruited at an outpatient program, filled the Teen Treatment Services Review (T-TSR) during eight weekly sessions, and at 3-and 9-Month Post-Treatment. Outcome variables included urinalysis and three subscales of the Teen-Addiction Severity Index (T-ASI) During Treatment (DT) and at follow-ups. The predictor variable was the number of reported Out-of-Program Service Contact Days (OD).

Results: While DT OD did not correlate with DT urinalysis, high DT OD days showed a trend toward predicting negative3-month (3-M) urinalysis. By contrast, high 3-M OD days predicted positive 3-M urinalyses as well as high use on all three T-ASI subscales. Out-of-Program services between 3- and 9-M post-treatment were not correlated with 9-M objective or subjective outcomes.

Conclusion: The more therapeutic services received during treatment, the better the short-term outcome. The more therapeutic services received post-treatment, however, the poorer the short-term outcome. Use of outside services presented a response rather than a cause of substance use.     

The Relationship Between Hope and Adolescent Likelihood to Endorse Substance Use Behaviors in a Sample of Marginalized Youth

Background: Hopefulness has been associated with increased treatment retention and reduced substance abuse among adults, and may be a promising modifiable factor to leverage in substance abuse treatment settings. Few studies have assessed the relationship between hopefulness and substance use in adolescents, particularly those with high-risk backgrounds. Objective: We explored whether high hope is associated with less likelihood for engaging in a variety of substance use behaviors in a sample of marginalized adolescents. Methods: Using logistic regression, we assessed results from a cross-sectional anonymous youth behavior survey (n = 256 youth, ages 14 to 19). We recruited from local youth serving agencies (e.g., homeless shelters, group homes, short-term detention). Results: The sample was almost 60% male and two thirds African American. Unadjusted models showed youth with higher hope had a 50-58% (p = <.05) decreased odds of endorsing heavy episodic drinking, daily tobacco use, recent or lifetime marijuana use, and sex after using substances. Adjusted models showed a 52% decreased odds of lifetime marijuana use with higher hope, and a trend towards less sex after substance use (AOR 0.481; p = 0.065). No other substance use behaviors remained significantly associated with higher hope scores in adjusted models. Conclusions/Importance: Hopefulness may contribute to decreased likelihood of substance use in adolescents. Focusing on hope may be one modifiable target in a comprehensive primary or secondary substance use prevention program.     

Implications of DSM-IV to DSM-5 Substance Use Disorder Diagnostic Changes in Adolescents Enrolled in a School-Based Intervention

ABSTRACT

This study aimed to examine (a) the impact of the change in the Diagnostic and Statistical Manual of Mental Disorders (DSM) from a categorical to dimensional classification of substance use diagnoses, (b) the elimination of the legal criterion, and (c) the inclusion of a craving criterion in the DSM-5. Specifically, we aimed to compare the differential diagnostic outcomes among high-risk substance-using adolescents enrolled in a school-based Motivational Enhancement Therapy (MET) intervention. We explored the alterations of diagnoses of adolescents in this sample and the prevalence of diagnostic promotions and demotions. We hypothesized that the dimensional approach of the DSM-5 would improve the utility of diagnosis in predicting severity of consequences and treatment outcomes in our sample. Method: Participants included 273 adolescents enrolled in a school-based intervention and were primarily male (76%) and Caucasian (47%), with 17% Asian/Pacific Islander, 17% Hispanic, 7% African-American, and 1% American Indian/Alaska Native. Results: We found that adolescents who lost diagnoses in the DSM-5 generally used substances less frequently and had fewer non-diagnostic negative consequences than those who remained consistently diagnosed across systems. Those who gained a diagnosis via the dimensional system tended to show higher use patterns and have more negative consequences than those who were never diagnosed. These findings indicate that the changes in the DSM are appropriate in this school-based clinical sample, at least in matching diagnostic status with substance use topography and negative consequences.     

Association of Educational Attainment and Adolescent Substance Use Disorder in a Clinical Sample

This study explores substance use, psychosocial problems, and the relationships to educational status in 193 adolescents (school dropouts, 63; alternative education, 46; mainstream students, 84) who attended a substance abuse treatment facility in Dublin, Ireland, within a 42-month period. For each adolescent, data on demographics, family background, substance use, psychiatric history, and offending behaviors were collected. The study found that the 3 groups exhibited statistically significant differences in their substance use problems, with the school dropouts displaying significantly more problems. The need for early detection and intervention of at-risk students, and collaborative interagency work aimed at addressing substance use, cannot be overemphasized as strategies to ultimately prevent school dropout.