Epidemiology of Youth Drug Abuse

Research Findings from May, 2003 Director's Report

This section lists selected summaries from NIDA funded research projects that investigate the epidemiology, etiology, and prevention research. The summaries provided were selected from recent issues of the Director's Report to the National Advisory Council on Drug Abuse. For a more comprehensive listing of NIDA funded projects see the Director's Report.

Drug Use Patterns and STIs among Young Adults in a High-Risk Neighborhood of NYC

Researchers sought to examine whether and how drug users, particularly IDUs and crack smokers, may be a core group for some sexually transmitted infections (STIs). They conducted a cross-sectional survey on drug use and assays for HIV, hepatitis B and C, syphilis, gonorrhea, and other sexually transmitted infections among 363 young (18-24) adults in an impoverished New York City minority neighborhood with major drug markets. They found that hepatitis C and HIV were concentrated among IDUs and that herpes, syphilis, and hepatitis B increased among women in relation to "hardest drug ever used." These findings suggest that using harder drugs (defined in increasing order of hardness as no drug use, marijuana use, non-injected heroin or cocaine use, crack smoking and injection drug use) is associated with some but not all of these STIs. The findings underscore the importance of targeted HIV prevention efforts to reduce unsafe sex and drug use among high-risk youth. Friedman, S.R., Flom, P.L., Kottiri, B.J., Zenilman, J., Curtis, R., Neaigus, A., Sandoval, M., Quinn, T. and Des Jarlais, D. Drug Use Patterns and Infection with Sexually Transmissible Agents Among Young Adults in a High-Risk Neighborhood in New York City. Addiction, 98, pp. 159-169, 2003.

Behavioral Problems in HIV-Infected Children

In an effort to increase understanding of previously-reported behavioral problems among HIV-infected children, investigators have analyzed data from the Women and Infants Transmission Study (WITS), a large multi-site, longitudinal study of maternal-infant HIV infection and the health and developmental outcomes of the children. The analyses examined influences of HIV infection, drug exposure, and family characteristics on behavioral outcomes of 307 children born to HIV-positive mothers (96 HIV-infected and 211 seroreverters). The age range of behavioral outcome assessment was 3 to 8 years. Analyses indicated a high prevalence of behavioral problems in this sample, but the multivariate analyses did not find an association between either HIV status or prenatal drug exposure and poor behavioral outcomes. The strongest associations with increased behavioral problems involved demographic characteristics. Mellins, C.A., Smith, R. and O'Driscoll, P., et al. High Rates of Behavioral Problems in Perinatally HIV-Infected Children Are Not Linked to HIV Disease. Pediatrics, 111, pp. 384-393, 2003.

Racial/Ethnic and Gender Differences in the Incidence and Onset Age of DSM-IV Alcohol Use Disorder Symptoms among Adolescents

Several investigators have questioned the validity of the DSM-IV Alcohol Use Disorders criteria for diagnosing alcohol use problems among teenagers, with specific concerns about their utility across different subgroups. In the current study, authors examined whether particular racial/ethnic or gender subgroups varied in the incidence and onset age of Alcohol Use Disorder symptoms. Members of a sample composed of 1,045 community-dwelling "drinkers" (59.4% male; 13.8% black, 21.2% foreign-born Hispanic, 30.7% U.S.-born Hispanic and 33.6% non-Hispanic white) were interviewed retrospectively using the Composite International Diagnostic Interview. The first occurrence of each DSM-IV symptom in a participant was examined by race/ethnicity and gender. Discrete-time event history analysis compared onset patterns from ages 14 through 20 years. The cumulative incidence of Alcohol Abuse and Alcohol Dependence diagnoses, as well as one alcohol abuse symptom and four dependence symptoms, varied by race/ethnicity. The incidence of both diagnoses, as well as two alcohol abuse symptoms, varied by gender. Event history analysis revealed no significant subgroup variation in first onset patterns for only three of the eleven symptoms. Racial/ethnic variation, but not gender variation, was significant for three symptoms, and both racial/ethnic variation and gender variation was significant for the remaining five symptoms. Study authors' findings indicate that most of the DSM-IV Alcohol Use Disorder symptoms, when applied to adolescents, demonstrate significant subgroup variation in incidence and onset age patterns. These results speak to the urgent need for additional research concerning the nosology and diagnosis of alcohol use problems among younger drinkers, especially among specific racial/ethnic and gender subgroups. Wagner, E.F., Lloyd, D.A., and Gil, A.G. Journal of Studies on Alcohol, 63, pp. 609-619, 2002.

Adolescent Drug Use, Abuse, and Dependence: Epidemiology and Heterogeneity of Symptom Expression by Drug Type and Gender

This study evaluates symptom profiles based on DSM-IV abuse and dependence criteria for tobacco, alcohol and marijuana, including a gender comparison. Participants are 3,072 adolescents (12-18 years) drawn from three community-based family samples in Colorado. Age trends suggest that substance use is a developmental phenomenon, which increases almost linearly from early to late adolescence. Substance use disorders are less common than experimentation in adolescence, but approximately 1 in 4 adolescents in the oldest cohorts meets criteria for abuse for at least one substance, and 1 in 5 meets criteria for substance dependence. By age 18, nearly one in three adolescents report daily smoking and 8.6% meet criteria for tobacco dependence. Although alcohol is the most commonly abused substance (10%), a slightly larger proportion of adolescents meet criteria for dependence on marijuana (4.3%) than alcohol (3.5%). Males more frequently meet criteria for dependence on alcohol and marijuana in late adolescence, while females are more often nicotine dependent. A comparison of abuse and dependence symptom profiles shows variability across substances, and suggests that manifestations of a subset of symptoms are gender specific. Young, S.E., Corley, R.P., Stallings, M.C., Rhee, S.H., Crowley, T.J. and Hewitt, J.K. Substance Use, Abuse, and Dependence in Adolescence: Prevalence, Symptom Profiles and Correlates. Drug and Alcohol Dependence, 68(3), pp. 309-322, 2002.

Psychiatric and Substance Use Disorders in South Florida: Racial/Ethnic and Gender Contrasts in a Young Adult Cohort

Prevalence rates of psychiatric and substance use disorders among young adults in South Florida are presented. Unique aspects of the study include the large sample size, its ethnic diversity, and the fact that a substantial proportion of Hispanic participants were foreign born. This study builds on a previous cohort study of students who entered middle school in 1990. A random subsample of this representative cohort (N = 1803) was interviewed between 1998 and 2000 when most were between 19 and 21 years of age. Disorders were assessed through computer-assisted personal interviews utilizing the DSM-IV version of the Michigan Composite International Diagnostic Interview. More than 60% of the sample met lifetime criteria for 1 or more study disorders, and 38% did so within the preceding year. Childhood conduct and major depressive and alcohol abuse disorders were the most prevalent. Although rates of affective and anxiety disorders in females were double that in males, this gender difference disappeared when attention-deficit/hyperactivity disorder, conduct disorders, and antisocial personality disorders were also considered (46.6% vs. 45.7% for females vs. males, respectively). Substantially lower rates were observed among African Americans for depressive disorders and substance abuse and dependence. Among Hispanics, rates tend to be lower among the foreign-born in comparison with their US-born counterparts, particularly for the substance disorders. The documented presence of psychiatric and substance disorders in middle and high school populations emphasizes the importance of prevention efforts in school settings. Research on the origins of ethnic and nativity differences is called for. Turner, R.J., and Gil, A.G., Archives of General Psychiatry, 59, pp. 43-50, 2002.

Drug Use and the Risk of Major Depressive Disorder, Alcohol Dependence, and Substance Use Disorders

The Children in the Community Study is a prospective longitudinal study investigating the association between early drug use (childhood, adolescence, and early 20's) and later psychiatric disorders (in the late twenties). Utilizing data from a community-based sample of 736 adults (50% female) from upstate New York, the subjects were interviewed at mean ages of 14 years, 16 years, 22 years, and 27 years. Psychiatric disorders, measured by age-appropriate versions of the University of Michigan Composite International Diagnostic Interview (UM-CIDI), and participant drug use were assessed. Adolescent and young adult tobacco use was significantly associated with an increased risk of alcohol dependence and substance use disorders (SUDs) at mean age 27, but not with new episodes of major depressive disorder (MDD). Earlier alcohol use significantly predicted later MDD, alcohol dependence and SUDs in the late twenties, as did early marijuana use and other illicit drug use. Except for the effect of tobacco use on MDD, early drug use was significantly related to later psychiatric disorders, even after statistically controlling for age, gender, parental education, family income, and prior episodes of MDD and SUDs. Results suggest that early drug use is associated with and predicts later psychiatric disorders. Preventive implications stem from the importance of studying a range of psychiatric disorders in the context of substance use assessed over a wide age range. Brook, D.W., Brook, J.S., Zhang, C., Cohen, P. and Whiteman, M. Drug Use and the Risk of Major Depressive Disorder, Alcohol Dependence, and Substance Use Disorders. Archives of General Psychiatry, 59, pp. 1039-1044, 2002.

Personal Competence Skills, Distress, and Well-Being as Determinants of Substance Use in a Predominantly Minority Urban Adolescent Sample

Several previous studies have investigated the relationship between psychological distress and substance use among youth. However, less research has investigated the potentially protective role of psychological well-being on adolescent substance use, and the extent to which personal competence skills may promote well-being. The present study examined personal competence skills, psychological distress and well-being, and adolescent substance use over a three-year period in a predominantly minority sample of urban students (N = 1,184) attending 13 junior high schools in New York City. Structural equation modeling indicated that greater competence skills predicted less distress and greater well-being over time. While psychological well-being was associated with less subsequent substance use, distress did not predict later substance use. Findings indicate that competence skills promote resilience against early stage substance use in part by enhancing psychological well-being, and suggest that school-based prevention programs should include competence enhancement components in order to promote resilience. Griffin, K.W., Botvin, G.J., Scheier, L M., Epstein, J.A., and Diaz, T. Prevention Science, 3, pp. 23-33, 2002.

Earlier Marijuana Use and Later Problem Behavior in Colombian Youth

The study examined the relationship between earlier adolescent marijuana use and later adolescent behavioral problems. A community-based sample of Colombian adolescents was interviewed in 1995-1996 and 1997-1998. The time 2 (T2) sample consisted of 1151 males and 1075 females. The psychosocial measures assessed adolescent problem behavior, the peer and sibling social network, and ecological/ environmental stress and cultural domains. Logistic regression analyses included controls on demographic and time 1 (T1) dependent measures. The findings suggest that T1 adolescent marijuana use was associated with increased risks for T2 adolescent difficulty at work or school, violent experiences, peer marijuana use, and sibling marijuana problems. This study provides important evidence in this cohort of the specific relationship between T1 adolescent marijuana use and (T2) adolescent problem behavior in a society in which drug use, crime, violence, and low educational attainment are pervasive. Similar findings have been shown in previous research with U.S. adolescents. The findings suggest that early adolescent marijuana use is associated with an increase in problem behavior during later adolescence. Brook, J.S., Brook, D.W., Rosen, Z. and Rabbitt, C.R. Earlier Marijuana Use and Later Problem Behavior in Colombian Youth. Journal of the American Academy of Child and Adolescent Psychiatry, 42 (4), pp. 1-8, 2003.

Tobacco Use as a Predictor of Illicit Drug Use and Drug-Related Problems in Colombian Youth

To examine the extent to which personality and peer factors mediate the relationship between early cigarette use and later illicit drug use, as well as associated drug use problems, in a population of Colombian adolescents. A longitudinal study (2-year interval), using face-to-face structured interviews was begun in 1996 using a community-based sample, randomly selected from census data in three cities in Colombia, South America. The participants were 2,837 adolescents with a mean age of 15.0 (SD +/- 1.6) years at time 1 (T1). Males comprised 52% of the sample and 65% resided with two parents. Approximately 78% (N = 2,226) completed the second structured interview 2 years later (T2). The main outcome measures were marijuana use, other illicit drug use, and associated drug use problems at T2. Three series of logistic regressions were conducted. The odds of marijuana use (adjusted odds ratio [AOR] = 1.64-2.01; confidence interval [CI]: 1.11-2.94), other illicit drug use (AOR = 1.77-2.49; CI: 1.03-4.19), and associated drug use problems (AOR = 2.25-3.47; CI: 1.45-5.26) at T2, was increased two- to three-fold among adolescents reporting cigarette use at T1, with control on the demographic, personality, and peer factors, as well as T1 drug use variables. Earlier adolescent cigarette smoking was directly associated with later marijuana use, other illicit drug use, and problems with drug use. Siqueira, L.M. and Brook, J.S. Tobacco Use as a Predictor of Illicit Drug Use and Drug-related Problems in Colombian Youth. Journal of Adolescent Health, 32, pp. 50-57, 2003.

Early and Mid-adolescence Risk Factors for Later Substance Abuse by African Americans and European Americans

This study examined the relationship between risk factors experienced during adolescence by African Americans and European Americans and DSM-IV alcohol dependence and marijuana abuse or dependence in early adulthood. The authors followed a cohort of adolescents from 1990-91 (grades 6 and 7) to 1998-2000 (ages 19-21), evaluating risk factors during early adolescence as predictors of DSM-IV alcohol dependence and marijuana abuse and dependence. African Americans had higher exposure to school, family structure, delinquency, and psychosocial factors. School factors and drug-use modeling of peers and family were the most important risk factors for marijuana abuse or dependence for both European and African Americans. Personal, familial, and social context factors during early adolescence affect adult drug-use problems, particularly for African Americans. Levels of drug use are lower among African Americans, but exposure to risks is higher and there are clear differences in the long-range impact of risk factors. These findings highlight the importance of developing and timing appropriate prevention efforts. Gil, A., Vega, W., and Turner, R.J. Public Health Reports, 117, Supplement 1:S15-S29, 2002.

Intergenerational Transmission of Risks for Problem Behavior

The intergenerational transmission of risk factors for problem behaviors was examined across three generations. Two hundred fifty-four 2-year-old toddlers, one or two of their parents, and one grandmother of each toddler were studied. Grandmothers and parents were individually interviewed. Data were analyzed for the male and female toddlers combined. Correlations and hierarchical multiple regression analyses were performed. Findings indicate that the grandmother-parent relationship, parental personality attributes, marital harmony, and drug use and the parent-toddler relationship, predict the toddlers' behavior. The investigation provides evidence for a longitudinal, intergenerational process whereby the grandmother-parent relationship and the parents' personality and behavioral attributes are transmitted across generations through their association with the parent-child relationship. Brook, J.S., Balka, E.B., Whiteman, M. and Zheng, L. Intergenerational Transmission of Risks for Problem Behavior. Journal of Abnormal Child Psychology, 30(1), pp. 65-76, 2002.

Maladaptive Parenting and the Association Between Parental and Offspring Psychiatric Disorders

A longitudinal study was conducted to investigate the role of maladaptive parental behavior and the association between parent and offspring psychiatric disorders. Psychosocial and psychiatric interviews were carried out in a representative community sample of 593 biological parents and their offspring from two counties in the state of New York in 1975, 1983, 1985-86, and 1991-93. In 1975, the mean age of offspring was 6 years. Maladaptive parental behavior was assessed in 1975, 1983, and 1985-86. Parent and offspring psychiatric symptoms were assessed in 1983, 1985-86, and 1991-93. Maladaptive parental behavior substantially mediated a significant association between parental and offspring psychiatric symptoms. Parents with psychiatric disorders had higher levels of maladaptive behavior in the household than did parents without psychiatric disorders. Maladaptive parental behavior, in turn, was associated with increased offspring risk for psychiatric disorders during adolescence and early adulthood. Most of the youths that experienced high levels of maladaptive parental behavior during childhood had psychiatric disorders during adolescence or early adulthood, independent of whether or not their parents had psychiatric disorders. In contrast, the offspring of parents with psychiatric disorders were not at increased risk for psychiatric disorders unless there was a history of maladaptive parental behavior. Maladaptive parental behavior is associated with increased risk for the development of psychiatric disorders among the offspring of parents with and without psychiatric disorders. Maladaptive parental behavior appears to be an important mediator of the association between parental and offspring psychiatric symptoms. Johnson, J.G., Cohen, P., Kasen, S., Smailes, E. and Brook, J.S. Maladaptive Parenting and the Association Between Parental and Offspring Psychiatric Disorders. Zeitschrift fÙr Psychosomatische Medizin und Psychotherapie, 48, pp. 396-410, 2002.

Adolescent Substance Use Related to Risky Sex Behaviors in Early Adulthood

This study examined the developmental relationship between adolescent substance use and risky sexual behavior in young adulthood. A sample of 808 children was surveyed at age 10 and followed prospectively to age 21 years. Different trajectory groups were identified, including binge-drinking, cigarette smoking, marijuana use, and the use of other illicit drugs. Membership in these groups significantly predicted risky sexual behavior at age 21, after other substance use and early measures of sexual behavior were controlled. Early binge-drinkers had significantly more sex partners than non-binge drinkers. Late onset binge-drinkers and marijuana users had significantly more sex partners and were less likely to use condoms consistently than those who did not binge drink or use marijuana. Experimenters in cigarette smoking, who did not escalate smoking, were more likely to use condoms consistently than nonsmokers. In contrast, the use of other illicit drugs in adolescence did not predict risky sexual behavior at age 21. Guo, J., Chung, I., Hill, K.G., Hawkins, J.D., Catalano, and Abbott, R.D. Developmental Relationships Between Adolescent Substance Use and Risky Sexual Behavior in Young Adulthood. J. of Adolescent Health, 31(4), pp. 354-362, 2002.

Academic Beliefs and Behaviors Related to Increased Cigarette and Marijuana Use

This study examined substance use between 10th and 12th grades in a predominantly African American sample of 785 adolescents from an urban environment. Psychological distress, academic factors, and perceptions of parents and peers were used to examine 10th-grade substance use and changes in use. Results indicated that low achievement and motivation, high truancy, and perceptions of peer substance use were associated with higher 10th-grade substance use. Growth curve analyses revealed that adolescents who perceived negative school attitudes among peers were more likely to increase their cigarette and marijuana use. Among high-achieving students, low motivation was a risk factor for increased cigarette use. Bryant, A.L., and Zimmerman, M.A. Examining the Effects of Academic Beliefs and Behaviors on Changes in Substance Use Among Urban Adolescents. J. of Educational Psychology, 94 (3), pp. 621-637, 2002.

Gender and Ethnic Differences in Students' Smoking, Drinking and Illicit Drug Use

Researchers affiliated with Monitoring the Future at the University of Michigan examined ethnic differences in licit and illicit drug use among American 8th, 10th and 12th grade students over the period from 1972 through 2002, with a particular focus on girls. The study used cross-sectional data from the large, ethnically diverse, nationally representative MTF samples of 8th, 10th and 12th graders including 40,416 8th grade girls and 37,977 8th grade boys; 35,451 10th grade girls and 33,188 10th grade boys; and 33,588 12th grade girls and 31,014 12th grade boys. Across ethnic groups, drug use was found to be highest among Native American girls and lowest among black and Asian American girls. Trend data suggested that there have been important changes in girls' drug use over time and girls' and boys' drug use patterns are converging. The authors concluded that drug use is widespread among American adolescent girls and that further research is needed to determine whether risk and protective factors identified in the past, using predominantly white samples, are also applicable to drug use among non-white girls. Wallace, J.M., Bachman, J.G., O'Malley, P.M., Schulenberg, J.E., Cooper, S.M. and Johnston, L.D. Gender and Ethnic Differences in Smoking, Drinking and Illicit Drug Use Among American 8th, 10th and 12th Grade Students, 1976-2000. Addiction, 98(2), pp. 225-234, 2003.

Outcomes of the Minnesota DARE PLUS Project

In the past, the Drug Abuse Resistance Education (DARE) has been the most widely used drug use prevention program in elementary schools. Several evaluations have shown the program's lack of effectiveness; other evaluations of the DARE curriculum have reported short-term changes in cigarette smoking that have been modest in size. The Minnesota DARE PLUS Project was designed to capitalize on the successful elements of DARE and also provide additional, complementary components based on state-of-the-art prevention strategies. DARE PLUS curriculum focuses on middle/junior high school level, and is designed to reduce tobacco, alcohol and marijuana use, and violent behavior among 7th and 8th grade students. The evaluation study of DARE PLUS involved 24 middle and junior high schools in Minnesota that were matched on socio-economic measures, drug use, and size, and were randomly assigned to three conditions: 1) DARE; 2) DARE PLUS, and 3) delayed DARE PLUS control. The principal outcomes of the study were measured by self-administered questionnaires. Differences between the three conditions were tested using a three-level, linear, random coefficients model. DARE PLUS was found to significantly improve the DARE middle/junior high curriculum, and was an effective intervention for reducing alcohol, tobacco, and multi-drug use and victimization among adolescent boys. However, DARE PLUS did not demonstrate similar effects among adolescent girls. The gender differences in outcomes need further exploration. Perry, C.L., Komro, K.A., Veblen-Mortenson, S., Bosma, L.M., Farbakhsh, K., Munson, K.A., Stigler, M.H., and Lytle, L.A. A Randomized Controlled Trial of the Junior High DARE and DARE PLUS programs. Archives of Pediatrics and Adolescent Medicine, 157, pp. 178-184, 2003.

Protective Aspects of American Indian Culture

American Indian youth have notably high rates of use of alcohol and certain illicit substances, yet prevention efforts for this population have been limited. This study examines whether and in what ways differences in ethnic and cultural identities among American Indian youth relate to their drug use norms. Four hundred thirty-four seventh graders from a large southwestern U.S. city who self-identified as American Indian provided self-reports of their norms in use of alcohol, tobacco, marijuana, and other drugs as well as the strength of their ethnic self-identities. Regression analysis indicated that ethnic pride was predictive of some anti-drug norms. For example, students who had a more intense sense of ethnic pride were more likely to report that it was not OK for someone their age to use alcohol, cigarettes, or marijuana. Intragroup ethnic diversity and speaking English only at home and with friends were unrelated to drug norms when other predictors were controlled, and there were few differences by gender, socioeconomic status, or age. Kulis, S., Napoli, M., and Marsiglia, F.F. Ethnic Pride, Biculturalism, and Drug Use Norms of Urban American Indian Adolescents. Social Work Research, 26(2), pp. 101-112, 2002.

Parent Figure Transitions, Delinquency, and Drug Abuse

Children of substance abusing parents have an elevated risk for experiencing disruptions in household composition, including changes in primary caretakers. This study investigated whether changes in caretakers, also called "parent figure transitions" predicted the likelihood of delinquency and drug use among a sample of youth with parents receiving methadone treatment for opiate addiction. A sample of 67 youth was derived from the Focus on Families program, a family-based intervention study to prevent substance abuse in children of opiate-addicted parents. For this analysis, 67 children ages 9-14 were interviewed (mean age=11.4 years at baseline; 13.8 years at final interview). Controlling for baseline delinquency, child characteristics, family conflict, parental depression, and parent criminal history, a greater number of parenting disruptions during the longitudinal study period was associated with a higher probability of delinquent behavior. Gender moderated the effect of parent figure transitions in a parallel analysis for drug use. After accounting for baseline drug use and other confounders, only adolescent females had a higher likelihood of drug use as the number of family disruptions increased. A subgroup of youth who experienced tremendous family instability and had no single consistent parent figure during the study were at extreme risk for delinquent behavior. Keller, T.E., Catalano, R.F., Haggerty, K.P., and Fleming, C.B. Parent Figure Transitions and Delinquency and Drug Use Among Early Adolescent Children of Substance Abusers. American Journal of Drug and Alcohol Abuse, 28(3), pp. 399-427, 2002.

Factors Associated with Regular Marijuana Use Among High School Students: A Long-Term Follow-up Study

The present study investigated whether several behavioral and psychosocial factors measured during early adolescence predicted regular marijuana use 6 years later in a sample of high school students. As part of a school-based survey, 7th-grade students (N=1132) reported levels of alcohol, tobacco, and marijuana use, and were assessed on several domains of psychosocial functioning potentially relevant in the etiology of marijuana use. When students were followed-up in the 12th grade, 14% smoked marijuana on a regular basis (once or more per month). Findings indicated that early cigarette smoking, alcohol use, and alcohol intoxication predicted later regular marijuana use. For boys, early marijuana use increased the odds for later regular marijuana use. Cigarette smoking by friends and siblings during early adolescence also increased the likelihood of later monthly marijuana use. The findings suggest that early prevention programs for adolescent alcohol, tobacco, and/or other drug use may have important preventive effects in terms of potentially more serious levels of marijuana involvement later in adolescence and early adulthood. Griffin, K.W., Botvin, G.J., Scheier, L.M. and Nichols, T.R. Factors Associated with Regular Marijuana Use among High School Students: A Long-Term Follow-up Study. Substance Use & Misuse, 37, pp. 225-238, 2002.

Mental Health and Addiction Problems Among American Indian Youth

This study examined the addiction and mental health service use of American Indian adolescents. The Diagnostic Interview Schedule and the Service Assessment for Children and Adolescents were used to ask Southwestern American Indian youth about their mental health needs, substance use, and service configurations. Seventy-nine percent had mental health or addiction problems, with half meeting criteria for at least one diagnosis. One in 4 youth met criteria for drug dependence/abuse or conduct disorder, 1 in 5 for depression, and 1 in 8 for alcohol dependence/abuse. Most youth received treatment services from a combination of providers. Youth meeting more diagnostic criteria were increasingly likely to use service configurations with adults, nonspecialist professionals, and specialists, respectively. Regardless of disorder, youth were least likely to use configurations with traditional healers or specialists, and there was little difference in rates of use between the two. The lack of services from specialist providers was potentially offset by use of an extensive range of informal adults, nonspecialist professionals, and peers. Since informal helpers, peers, and nonspecialist providers, but not specialists, are providing the bulk of services to these adolescents, they must be given support and skills so they can function effectively. Stiffman, A.R., Striley, C.W., Brown, E., Limb, G., and Ostmann, E. American Indian Youth: Who Southwestern Urban and Reservation Youth Turn To for Help with Mental Health or Addictions. Journal of Child & Family Studies, 12, pp. 319-333, 2003.