Smoking Intervention With Adolescent Substance Abusers: Initial Recommendations

Recent increases in adolescent cigarette smoking have provided an impetus for developing effective youth smoking-cessation interventions. Adolescents treated for substance abuse are a particularly important target for tobacco use intervention given the high prevalence and persistence of smoking among this subgroup of youth. The few studies to date of adolescent smoking cessation have demonstrated little success in effecting change in tobacco use. In the absence of empirical evidence, recommendations for tobacco intervention with substance-abusing adolescents are proposed based on information from several sources: studies of adolescent smoking cessation, adolescent developmental considerations, issues specific to substance abusers, motivational concerns, and adult smoking-cessation techniques. An outline is provided of components to consider for inclusion in a substance-abusing adolescent smoking intervention. It is suggested that tobacco-focused interventions be incorporated as a routine part of treatment for adolescent substance abuse.     

Children and Adolescent Substance Abuse:

No abstract available for this article.     

Preventing HIV/AIDS: A Brief Intervention for Adolescent Substance Abusers

ABSTRACT

HIV/AIDS infection has become a serious threat to many adolescents, as reflected by the increase in the number of AIDS cases among adolescents and young adults. Substance abusing adolescents, in particular, tend to engage in high risk HIV behaviors despite their knowledge of HIV/AIDS. To determine the effectiveness of a brief educational motivation intervention, 60 treatment-seeking male and female substance abusing adolescents were randomly assigned to an experimental intervention or to a control group. The results did not demonstrate any group differences at either 3 or 6 months follow-up after hospital discharge. Risky sexual behaviors decreased from baseline in both groups. A longer follow-up period may be required to unmask any treatment impact.     

Validity of Adolescent Self-Report of Substance Use

The validity of self-report of substance use was examined in 367 adolescents referred for a substance use assessment between 1996 and 2000. Referrals came from a wide variety of sources, including pediatricians, the courts, and social services, as well as their parents. Average age of the sample was 15, 52% were male, and 82% were Caucasian. Adolescents were first asked about the details of their substance use by a clinician using a structured interview with established reliability and validity (Adolescent Drug and Alcohol Diagnosis). They were subsequently asked to provide a urine sample, a requirement they were unaware of when being interviewed about their substance use. If the urine sample was deemed valid by the laboratory technician, it was analyzed by means of fluorescence polarization immunoassay and paper chromatography. If positive screens were obtained for any substance, the sample was subjected to gas chromatography/mass spectrometry for confirmation and quantification. Biochemical test results were compared to self-report. Overall, 28% (96/338) of the self-reports were not corroborated by urinalysis. In adolescents who reported nonuse of a substance, 26% (56/219) had a positive urinalysis. More surprisingly, 34% (40/119) of adolescents reporting substance use in the urinalysis detection window had a negative urinalysis. The present study found self-report of substance use in adolescents to only have fair validity. It is recommended that biochemical corroboration be routinely used for this population.     

Reliability and Construct Validity of the Needle Sharing Inventory

The Needle Sharing Inventory (NSI) is a 59-item test developed to specify and assess behavior patterns associated with drug use and needle sharing. In order to determine its reliability and construct validity, the NSI was administered to 80 intravenous drug users (IVDUs) recruited from a methadone maintenance program in New York City. Patients were included in the study if they reported using intravenous drugs during the previous month. Factor analysis was performed indicating that 31 of the items loaded onto 6 factors similar to those hypothesized: four dealing with the social context of needle sharing — indiscriminate sharing, social sharing, intimate sharing, and use of shooting galleries; and two dealing with the emotional context of intravenous drug use — negative affect states and positive affect states. These variables accounted for 71% of the total variance, suggesting internal consistency of these items. Factor scores significantly correlated to subjects' self- reported estimates of time using nonsterile needles and sharing needles. These data suggest that the NSI is both a reliable and a valid measure which may be used in future studies of intravenous drug use and needle sharing behavior patterns. The NSI may prove useful for the purpose of developing and evaluating interventions aimed at preventing or reducing the spread of HIV through needle sharing.     

Classifying Clinically Referred Adolescent Substance Abusers by Level of Externalizing and Internalizing Symptoms

ABSTRACT

Adolescent substance abusers demonstrate numerous emotional and behavioral difficulties in conjunction with drug problems. In this study, 236 clinically referred substance abusing adolescents were grouped on level of self-reported and parent-reported internalizing and externalizing symptoms and compared on important variables. Three groups emerged: Externalizers, Exclusive Substance Abusers, and Mixed (adolescents with both internalizing and externalizing symptoms). Exclusive Substance Abusers showed a general pattern of more positive functioning than adolescents in the other groups. This study reveals that clinically referred adolescent substance abusers can be meaningfully distinguished on levels of externalizing and internalizing problems, and that family characteristics differentiate these groups.     

Sex Differences in Cortisol Level and Neurobehavioral Disinhibition in Children of Substance Abusers

SUMMARY

This investigation determined the extent to which cortisol level, an index of HPA axis activity, covaries with neurobehavioral disinhibition. The sample consisted of 369 boys and 91 girls who were assigned to either a high average risk (HAR) group or a low average risk (LAR) group based on the presence or absence of paternal substance use disorder (SUD). Neurobehavioral disinhibition was assessed using a combination of questionnaires and neuropsychological tests. Saliva was collected for cortisol determination during a mild stressor and again 35 minutes after the task. The results indicated that disinhibition was higher and cortisol level lower in boys compared to girls. Cortisol level was negatively correlated with severity of neurobehavioral disinhibition in girls, accounting for 24% of the variance. A similar trend was observed in the boys; however, the correlation did not attain statistical significance. Based on these findings, it is tentatively concluded that boys and girls differ with respect to biochemical indicators of stress reactivity underlying neurobehavioral disinhibition, a putative phenotype associated with the liability for SUD.     

Validating the Adolescent Form of the Substance Abuse Subtle Screening Inventory

The adolescent form of the Substance Abuse Subtle Screening Inventory (SASSI) was recently developed to detect chemical dependency. In this investigation, we explored possible relationships among SASSI scales, MMPI scales, and sociodemographic variables. The results provided further validation for the SASSI scales, supporting the utility of this instrument. We discuss diagnostic and treatment implications and suggest directions for further research.     

Convergent and Predictive Validity of Scales Measuring Adolescent Substance Abuse

A relatively new adolescent drug abuse instrument, the Personal Experience Inventory (PEI), was evaluated for convergent and predictive validity in a clinical sample of 140 youths being evaluated for drug treatment referral. The tool's problem severity scales were compared to concurrent client (n = 140) and parent (n = 102) measures of drug abuse and related psychosocial functioning at intake and one-year lateer, to counselor intake ratings of problems and treatment need, to client treatment tenure, and to outcome functioning. PEI convergent validity coefficients (r) based on client concurrent measures at both data points and based on counselor ratings of drug abuse problem severity generally exceeded .50, whereas coefficients typically fell below .50 when the PEI was compared to the less direct client measures of psychosocial functioning and the parent measures. The predictive validity results indicate a moderately positive association between PEI scores and treatment and aftercare attendance and client functioning one year later, particularly for the no-treatment subjects. The data are discussed within the context of growing evidence documenting psychometric adequacy for the PEI and the validity of self-report by adolescents in clinical settings.     

Validity of the Drug Use Screening Inventory for Predicting DSM-III-R Substance Use Disorder

SUMMARY

The Drug Use Screening Inventory (DUSI) has been shown to have sound psychometric properties for quantifying the severity of health, behavior and psychosocial problems concomitant to substance use in adolescents. Its utility for identifying youth who will develop a disorder of abuse/dependence has, however, not been investigated. In this longitudinal study, the DUSI was administered to a sample of boys at ages 12–14, 16 and 19 in a repeated measures design. An overall problems severity score of 24% at ages 12–14 and 16 predicted a DSM-III-R substance use disorder (SUD) outcome at age 19 with 73% and 84% accuracy respectively. Parental history of SUD did not increase prediction of SUD outcome in the youth. These findings indicate that the DUSI, taking only 15–20 minutes to complete, is a useful practical instrument to identify youth who could benefit most from prevention interventions.     

Parent Drag Use and Bonding to Parents as Predictors of Substance Use in Children of Substance Abusers

ABSTRACT

The social development model (Catalano and Hawkins 1996) hypothesizes that strong bonds to prosocial others and institutions contribute to prosocial behavior, while strong bonds to antisocial others and institutions contribute to antisocial behavior. Consistent with this perspective, previous research indicates that bonding to parents and child substance use are negatively associated for children of non-substance abusers but are negligibly or positively associated for children of substance abusers. This paper examines the interactive relationship between parent drag use, bonding to parents, and child substance use in a longitudinal study of families headed by substance abusers in methadone treatment for opiate addiction. Bonding to parents and child substance use are moderately negatively correlated in children whose parents ceased using drugs but are weakly positively correlated in children whose parents continued using drugs. These results support the social development model and suggest that family interventions for preventing substance use in children of substance abusers should focus on reducing parent drag use and promote bonding to parents who are abstinent.     

Attention Deficits in Newly Abstinent Substance Abusers:

Attention deficits were studied among 67 consecutive admissions to an adult tertiary care in-patient substance abuse unit. Fifty-four patients completed the testing; of these 15 were excluded due to confounding variables. The majority of the remaining 39 subjects had evidence of current and/or childhood attention dysfunction. There was no correlation with current performance and childhood recollection of dysfunction even when the effect of gender, race and alcohol abuse were taken into account. There are intriguing educational and therapeutic implications of the similarities between cognitive impairments of newly sober substance abusers and adults with persistence of attention deficit-hyperactivity disorder (ADHD).     

The Use of Required Treatment for Substance Abusers

Studies show that typically less than 10% of alcohol and other drug abusers voluntarily enter treatment for their substance abuse, and once in treatment, drop out rates are high. One controversial way to get clients into, and to participate in, treatment is the use of legally encouraged or required treatment. Grounded in the parents patriae doctrine of state protection, the primary rationale for required treatment is that some substance abusers require external pressure to enter and remain in treatment. The history of required treatment for alcohol and other substance abuse, the primary issues surrounding its use, the use of required treatment in the criminal justice system, the primary treatment models for alcohol and other substance abuse, ways to increase internal and external motivation for treatment, and therapist and treatment personnel responsibilities in using required treatment are discussed.     

Problem Severity and Motivation for Treatment in Incarcerated Substance Abusers

Studies of community-based treatment programs for substance users document that motivation for treatment is a consistent predictor of clients remaining under treatment for a longer period of time. Recent research has replicated this in prison-based treatment programs, implying that motivation is clinically important regardless of setting. The current study examines predictors of treatment motivation using data collected from 661 male drug-involved inmates during in-depth interviews that include components of the Addiction Severity Index, TCU Motivation Scale, and the Heath Services Research Instrument. Findings showed treatment motivation can be measured effectively in prison-based settings. Motivation scores were not significantly different between individuals in a prison-based treatment program and those in the general prison population. Furthermore, higher motivation for treatment scores were associated with greater levels of problem severity, suggesting that individuals with more drug-use related life problems may recognize this need and desire help for beginning long-term recovery.     

Assessing the Reliability of Scores Produced by the Substance Abuse Subtle Screening Inventory

The Substance Abuse Subtle Screening Inventory (SASSI) is a 10 scale indirect screening instrument used to detect substance use disorders. The current meta-analytic study described reliability reporting practices across 48 studies involving the SASSI. Reliability generalization methods were then employed to evaluate typical score reliability for the screening measure. Results showed approximately 73% of studies did not report reliability estimates. Analysis of data from the remaining studies revealed adequate reliability for the total scale (α = .87) and face valid scales (FVA α = .88 and FVOD α = .92), but substantially lower reliability estimates for the indirect scales (range of α = .23–.65). The study's findings underscore the need for improved reliability reporting for the SASSI and suggest cautious use of the measure, especially its indirect scales, as an indicator of problematic substance use/abuse in clinical settings.     

The Effects of ADHD in Adult Substance Abusers

The aim of this study was to evaluate the psychiatric comorbidities and different areas of life functioning in substance abusers with attention deficit hyperactivity disorder symptoms. A cross-sectional, multi-center study involving 285 adult substance abusers from outpatient and inpatient clinics was performed. The Adult ADHD Self-Report Scale, the sixth version of the Addiction Severity Index, and the Mini International Neuropsychiatry Interview were used for data collection. Individuals with comorbid attention deficit hyperactivity disorder and substance use disorders showed increased addiction severity when compared with individuals without attention deficit hyperactivity disorder (53.3 ± 7.3 vs. 48.4 ± 8.4, respectively). Our results suggest that comorbid attention deficit hyperactivity disorder and substance use disorders is associated with a more severe course of substance use and with social and psychiatric impairment.     

Reliability and Validity of Adolescent Self-Reported Drug Use in a Family-Based Study: A Methodological Report

Given the sensitive topic of drug abuse and the private nature of the family, researchers must overcome a number of methodological obstacles when studying drug abuse and the family. The purpose of this study was to determine whether adolescents would provide honest and accurate answers to drug use questions in the context of their homes with their families participating in the same survey. Although there is no direct objective validation of the self-report measures used in this study, evidence from the analysis of the survey data suggests that adolescent self-reports are, in most cases, reliable and valid, and that the setting in which respondents complete questionnaires does not, in general, result in systematic reporting bias.     

Sensation Seeking,State and Trait Anxiety,and Depressive Mood in Adolescent Substance Users

The following hypothesis has been tested: sensation seeking, A-state and A-trait, and depressive mood should positively affect adolescent substance use. The personality variables and alcohol and drug use were assessed among 1,900 Israel adolescents, 14 to 19 years old. The major findings were as follows: (a) Sensation seeking and availability significantly affected the “ever” and “current” substance use among adolescents. On the other hand, contrary to our hypothesis, neither A-trait nor depressive mood significantly affected substance use. (b) A-State affected the use of alcoholic beverages and nonprescribed medications. (c) The data emphasized the significant role of availability of drugs in the understanding of adolescent' substance use. The implications of these findings for interventions among adolescents are discussed.     

Group Work for Black Adolescent Substance Users:

Group counseling with black adolescent substance users has been noticeably absent from the literature. The author addresses some critical issues and provides some recommentdations when providing counseling with this population. The author's clinical experience forms the basis for this article.