Origins and Pathways to Drug Abuse

Research Findings from February, 2003 Director's Report

This section lists selected summaries from NIDA funded research projects that investigate the origins and pathways to drug abuse. 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.

Early Life Stress in an Animal Model Accelerates Tolerance and Sensitization

A common procedure for inducing early life stress is maternal separation (MS), wherein rat pups are removed from the dam for several hours each day. Maternal separation produces profound changes in the brain's endogenous stress system and alters an animal's ability to respond to stress during adulthood. Concomitant with these changes in stress reactivity, animals are more responsive to behavioral effects of psychostimulants and more readily acquire drug self-administration. Dr. Stephen Holtzman and colleagues have reported that tolerance to the analgesic effects of morphine is also altered by early MS, and in a recent study, his research group found evidence that early life stress affects neuroadaptations that give rise to the behavioral effects of repeated morphine. These studies examined the effects of daily MS upon reactivity to a novel environment and to morphine-induced sensitization and tolerance when animals were tested as adults (more than 90 days old). MS litters were removed for 3 hrs daily on neonatal days 2-14. Handled (H) control pups were treated similarly but removed for only 15 min daily, and non-handled (NH) controls were left undisturbed with the dam until weaning. Results indicated that MS had a significant effect on the offspring's reactivity to a novel environment and to the development of opiate tolerance and sensitization as measured by changes in locomotor activity. Thus, MS rats exhibited robust increases (50-75%) in locomotor activity in a novel environment compared to NH controls; whereas H rats showed only modest increases (30%). When treated with 10mg/kg morphine repeatedly, only MS and H rats showed suppression of activity (horizontal counts) after the first and second injection. Tolerance to this initial behavioral suppression was observed over 10 drug administrations so that at the end of the 10 day treatment regimen, drug-induced activity seen in MS rats was double that of the NH controls, suggesting a sensitization of opiate-induced behavioral stimulation. Next, animals were withdrawn for 2 days and challenged with saline in an environment that had been paired with morphine. On this test for conditioned sensitization, only MS rats showed locomotor stimulation, suggesting that these animals had become conditioned to the drug paired environment. This observation is intriguing, in light of previous findings to suggest that repeated early MS is associated with enhanced long-term potentiation (LTP) -- a neural mechanism that may subserve associative processes of conditioning. The authors suggest that MS animals show an enhanced sensitivity to opiate-induced neuroadaptive phenomena, brought about by early life stress. Moreover, the acceleration of these neuroadpative processes may be linked to early developmental alterations in opioid receptor systems. Kalinichev, M., Easterling, K.W. and Holtzman, S.G. Early Neonatal Experience of Long-Evans Rats Results in Long-lasting Changes in Reactivity to a Novel Environment and Morphine-induced Sensitization and Tolerance. Neuropsychopharmacology, 27, pp. 518-533, 2002.

Adolescent Rats Respond Differently to Repeated Cocaine than Adults

Behavioral and neurochemical models of drug reactivity during the adolescent period are useful for studying influences on the vulnerability to acquire drug abuse behaviors or escalation to drug addiction during the teen years. Dr. Sari Izenwasser and colleagues have recently compared adult (170-200 g body weight) and periadolescent rats (75-100 g body weight) with behavioral and receptor-binding measures during repeated treatments with cocaine. Rats in these studies were given 50 mg/kg cocaine daily (in two injections) for 7 days. On day 8 and 16, a probe was conducted to determine if conditioned sensitization of locomotor activity was induced in the cocaine-paired environment. Then, on day 17, all animals were challenged with 15 mg/kg cocaine, and locomotor behavior and stereotypy were measured. In separate groups of animals, quantitative autoradiography was performed on post-mortem samples to measure D1 and D2 dopamine receptors, along with dopamine (DAT) and serotonin (SERT) transporter density. Cocaine increased behavioral activity over all seven days, in both adult and adolescent rats. However, whereas adult animals showed a sensitization  i.e., increased locomotor activity over the 7 days, adolescent rats had an enhanced level of responding that remained constant, suggesting that they did not develop the behavioral sensitization seen in adults. Stereotypy was constant over all 7 days for both groups, indicating that this difference cannot be attributed to changes in stereotypical behaviors. None of the animals showed a conditioned behavioral response when injected with saline on days 8 or 16. However, upon challenge with 15 mg/kg cocaine after the chronic treatment regimen, only the adult rats with chronic cocaine experience showed a sensitized locomotor response (i.e., greater than the adult rats treated for 7 days with saline). By contrast, periadolescent rats treated with 7 days of 50mg/kg cocaine or the vehicle had a very similar level of behavioral stimulation to the test dose of cocaine. This observation further demonstrates that periadolescent rats did not develop behavioral sensitization, whereas the adults clearly did. Neurochemical findings parallel these behavioral data, in that adult animals had an increase in DAT density in caudate putamen areas, whereas periadolescent animals showed no change from controls. Furthermore, while D1 and D2 receptors were unchanged in both groups, SERT densities were increased in several areas measured from adults, but not periadolescents. Collectively these observations suggest that adolescent rats are less sensitive to neuroadaptations induced by repeated psychostimulant treatment than are adults. The authors suggest that perhaps a neurobiological developmental process may counteract the development or expression of these drug-induced neuroadaptive changes. Collins, S.L. and Izenwasser, S. Cocaine Differentially Alters Behavior and Neurochemistry in Periadolescent Versus Adult Rats. Developmental Brain Res., 138, pp. 27-34, 2002.

Childhood Emotional Neglect May Influence Monoamine Function in Adults

Childhood stress has been shown in animal models and implied in humans to influence the vulnerability to drug abuse in adults. Roy has demonstrated that abstinent cocaine-abusing adults with retrospective reports of childhood neglect had low levels of both 5-HIAA, the metabolite of serotonin, and HVA, the metabolite of dopamine in significant correlation with symptom scores. Aggression and behavioral disorders, including suicide, are associated with low serotonergic function that may have developmental antecedents in childhood environment. The relevance to drug abuse vulnerability needs to be explored. Roy, A., Psychiatry Research, 112, pp. 69-75, 2002.

Effectiveness of a Universal Drug Abuse Prevention Approach For Youth At High Risk For HOPA Polymorphism Associated With Major Depression, Phobia, and Antisocial Diathesis

This study examined the relationship between thyroid receptor co-activator named HOPA polymorphisms and neuropsychiatric illness in a cohort of Iowa adoptees. Consistent with prior findings, HOPA polymorphisms were associated with an increased risk for major depression and phobia. There was suggestive evidence of gene-by-gene interactive effects (i.e., epistasis) in that the increased psychiatric morbidity was elevated in subjects with alcoholic or antisocial behavior in the biologic father. For example, 80% of females positive for HOPA variants, compared to 41% of females negative for HOPA variants, had this high-risk biologic background. In summary, HOPA polymorphisms may be a moderate risk factor for increased susceptibility to a broad spectrum of neuropsychiatric illness and that the type of illness manifested might be related to a separate genetic diathesis. Philibert, R., Caspers, K., Langbehn, D., Troughton, E.P., Yucuis, R., Sandhu, H.K., Cadoret, R.J. The Association of a HOPA Polymorphism with Major Depression and Phobia. Comprehensive Psychiatry, 43(5), pp. 404-410, 2002.

Poor Self-Control Associated With Escalation of Substance Use

This research tested predictions about the role of temperament and self-control in substance use (tobacco, alcohol, and marijuana) in a sample of 1,526 participants assessed in 6th grade (mean age = 11.5 years) and followed with yearly assessments through 9th grade. Latent growth curve modeling indicated that the rate of growth in substance use was higher among participants who showed increases in poor self-control and lower among participants who showed increases in good self-control. Wills, T.A. and Stoolmiller, M. Journal of Consulting and Clinical Psychology, 70(4), pp. 986-997, 2002.

Adolescent Substance Abuse and Psychiatric Comorbidity

As part of a special journal section on child psychopathology and drug abuse, the authors reviewed published studies using community samples and DSM or ICD classifications to assess rates, specificity, timing, and differential patterns of comorbidity by gender, race/ethnicity, and other factors. They found high rates of comorbidity in community samples; about 60% of youths with substance use, abuse, or dependence have a comorbid psychiatric disorder, with conduct disorder and oppositional defiant disorder the most common. Psychopathology was generally associated with earlier onset of substance use and with substance abuse. The nature of the data limited the authors' ability to explore risk factors, but they feel that current studies show promise for further work in this area. Armstrong, T.D. and Costello, E.J. Community Studies on Adolescent Substance Use, Abuse, or Dependence and Psychiatric Comorbidity. Journal of Consulting and Clinical Psychology, 70, pp. 1224-1239, 2002.

Child Neglect Associated With Increased Risk For Substance Abuse

This article critically reviews the empirical literature pertaining to the prevalence, origins, and consequences of neglectful parenting as it relates to substance abuse. Available evidence indicates that children who experience parental neglect, with or without parental alcohol or drug abuse, are at high risk for substance use disorder (SUD). The effects of parental substance abuse on substance abuse outcome of their children appear to be partly mediated by their neglectful parenting. The discussion concludes with presentation of a developmental multifactorial model in which neglect, in conjunction with other individual and environmental factors, can be integratively investigated to quantify the child's overall liability across successive stages of development as well as to map the trajectory toward good and poor outcomes. Dunn, M.G., Tarter, R.E., Mezzich, A.C., Vanyukov, M., Kirisci, L., and Kirillova, G. Clinical Psychology Review, 22(7), pp. 1063-1090, 2002.

Diminished Cortisol Response Among Offspring of Drug-Dependent Fathers

This report examines the salivary cortisol responses in preadolescent sons and daughters of fathers with and without drug-dependence, and the relative role of family environment. The high-risk boys and girls, relative to offspring of controls, demonstrated a diminished cortisol response in anticipation of a moderate stressor. Girls had significantly higher salivary cortisol concentrations, pre- and post-stressor. No association was found between salivary cortisol responses and measures of the family environment, however. These results suggest that there may be a sex difference in salivary cortisol dynamics in at-risk preadolescent children that is unrelated to current family environment. Hardie, T.L., Moss, H.B., Vanyukov, M.M., Yao, J.K., and Kirillovac, G.P. Psychiatry Research, 112(2), pp. 121-131, 2002.

Parental Smoking Cessation May Help Decrease Adolescent Smoking

This study examined the relation of parent smoking cessation and adolescent smoking behavior. Participants were 446 adolescents and their parents who completed a computerized measure of implicit attitudes toward smoking and questionnaires assessing smoking, parenting, and explicit attitudes. Parental smoking cessation was associated with less adolescent smoking, except when the other parent currently smoked. Children's reports of parents' antismoking behavior partially mediated the relation between parental smoking and adolescent smoking. Although children's implicit and explicit attitudes were unrelated to parental smoking, mothers' implicit attitudes were related to both their own smoking and their child's smoking. Findings suggest that parental smoking cessation may help lower risk for adolescent smoking - but only if the other parent does not currently smoke. Chassin, L., Presson, C., Rose, J., Sherman, S.J., and Prost, J. Journal of Pediatric Psychology, 27(6), pp. 485-496, 2002.

Child Maltreatment and Adulthood Violence: The Contribution of Attachment and Drug Abuse

This study examined the association between child maltreatment and adult violence in a high-risk sample of women with and without a history of cocaine abuse and the contribution of working models of childhood attachment relationships in understanding this association. Results indicated that whereas childhood physical abuse was associated with adult sexual victimization for cocaine-abusing women, sexual abuse was associated with both partner violence victimization and perpetration for comparison women. Insecure working models of attachment were associated with partner violence victimization for comparison women, independent of the effect of sexual abuse. These findings suggest the importance of research focused on understanding the processes by which child maltreatment may lead to later violence and that examines both childhood and adulthood experiences in understanding pathways to adult violence. Feerick, M.M., Haugaard, J.J., and Hien, D.A. Child Maltreatment, 7(3), pp. 226-240, 2002.

Overview of Measuring Risks and Outcomes in Drug Abuse Research

This paper describes principles and procedures for developing a comprehensive assessment of childhood risk factors and substance abuse outcomes. A conceptual framework is provided, procedures for identifying relevant measurement domains are described, steps necessary in creating an assessment protocol are outlined, selected instruments are described as examples, and resources available for more comprehensively identifying available measures are described. The risks specifically reviewed in this article include family history, childhood maltreatment, peer relationships, and psychopathology. The substance use measures reviewed include substance type, consumption quantity and frequency and substance related problems. Clark, D.B., and Winters, K.C. Measuring Risks and Outcomes in Substance Use Disorders Prevention Research. J of Consulting and Clinical Psychology, 70(6), pp. 1207-1233, 2002.

Correlates of Marijuana Use in Colombian Adolescents: A Focus on the Impact of the Ecological/Cultural Domain

This study examined the influence of ecological/cultural factors and family, personality, and peer factors present during early adolescence that influence marijuana use in late adolescence. A community sample of 2,226 Colombian adolescents living in mixed urban-rural communities and their mothers were interviewed in their homes by trained Colombian interviewers, first in 1995-1996 and then again two years later. The scales used were based on item intercorrelations and grouped into the following categories: (1) adolescent personality, (2) family traits, (3) peer factors, (4) ecological/ cultural variables, and (5) marijuana use. Data were examined using hierarchical regression modeling to determine the relationship between each of the domains and late adolescent marijuana use. The findings supported the family interactional theory of adolescent drug use behavior and found that factors in all of the domains had both a direct effect on late adolescent marijuana use as well as indirect effects mediated through the more proximal domains in the model. Of particular interest was the strength of the influence of the ecological/cultural factors, which far exceeded that observed in similar studies done in the United States. Due to the similarity with findings from studies conducted in the U.S., interventions designed domestically could effectively be directly applied to adolescents in Colombia. The findings also suggest that prevention programs designed specifically to target ecological or cultural factors may have the most profound influence for reducing marijuana use in late adolescence. Brook, D.W., Brook J.S. and Rosen, Z. Correlates of Marijuana Use in Colombian Adolescents: A Focus on the Impact of the Ecological/Cultural Domain. Journal of Adolescent Health, 31, pp. 286-298, 2002.

Marijuana Use Among the Adolescent Children of High-Risk Drug-Abusing Fathers

This study examines marijuana use among children of male drug abusers. Subjects were 83 African-American and European-American male drug abusers (the majority of whom were injection drug users) and their children. Thirty-one of the fathers were HIV-positive and 52 were HIV-negative. Using logistic regression analyses, we explored cross-sectionally the relationship between four psychosocial domains (i.e., paternal attributes, adolescent problem behaviors, father-adolescent relations, and the environment) and adolescent marijuana use. The father's use of illegal drugs and his failure to cope adaptively predicted adolescent marijuana use, while a close father-child bond were associated with less adolescent marijuana use. Adolescent problem behaviors were associated with an increased likelihood of marijuana use. Furthermore, hierarchical regression analysis demonstrated that the adolescent's problem behavior mediated the associations between the father-adolescent relationship as well as environmental factors with adolescent marijuana use. Reducing the risk factors and enhancing the protective factors within each of the domains could help reduce marijuana use among the adolescent children of drug-abusing fathers. Moreover, if a father is a drug abuser, it is important to help him establish a close bond with his child in order to help attenuate the influence of his drug use on the child's marijuana use. Brook, D.W., Brook, J.S., Richter, L., Whiteman, M. and Arencibia-Mireles, O. Marijuana Use Among the Adolescent Children of High-Risk Drug-Abusing Fathers. The American Journal on Addictions, 11, pp. 95-110, 2002.

Psychiatric Disorders Associated with Risk for the Development of Eating Disorders During Adolescence and Early Adulthood

Longitudinal data were used to investigate whether anxiety, depressive, disruptive, personality, or substance use disorders are associated with risk for the development of eating disorders during adolescence or early adulthood. Psychiatric disorders were assessed among 726 youths from a random community sample during adolescence and early adulthood. Depressive disorders during early adolescence were associated with elevated risk for the onset of eating disorders, dietary restriction, purging behavior, and recurrent weight fluctuations after preexisting eating problems and other psychiatric disorders were controlled statistically. Disruptive and personality disorders were independently associated with elevated risk for specific eating or weight problems. The present findings suggest that depressive disorders during early adolescence may contribute to the development of eating disorders during middle adolescence or early adulthood. Johnson, J.G., Cohen, P., Kotler, L., Kasen, S. and Brook J.S. Psychiatric Disorders Associated with Risk for the Development of Eating Disorders During Adolescence and Early Adulthood. Journal of Consulting and Clinical Psychology, 70 (5), pp. 1119-1128, 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. v

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. Substance Use & Misuse, 37, pp. 225-238, 2002.

Friendships and Substance Use: Bi-directional Influence

The reciprocal relationship between deviant friendships and substance use was examined from early adolescence to young adulthood. Deviance within friendships was studied using direct observations of videotaped friendship interaction and global reports of deviant interactions with friends as well as time spent with friends. Substance use was assessed through youth self-report at all time points. Multivariate modeling revealed that substance use in young adulthood is a joint outcome of friendship influence and selection processes. In addition, substance use appears to influence the selection of friends in late adolescence. Findings suggest that effective prevention should target peer ecologies conducive to substance use and that treatment should address both the interpersonal underpinnings and addiction processes intrinsic to chronic use, dependence, and abuse. Dishion, T.J. and Owen, L.D. A Longitudinal Analysis of Friendships and Substance Use: Bi-directional Influence from Adolescence to Adulthood. Developmental Psychology, 38(4), pp. 480-491, 2002.

Sibling Collusion and Problem Behavior

Sibling collusion is a process whereby siblings form coalitions that promote deviance and undermine parenting. Collusive sibling processes were identified and measured using macro ratings of videotaped family interactions. Using a multiethnic urban 6th grade sample, investigators examined multiple questions, including whether more sibling collusion occurs in families with a high-risk child that with a normative child and whether sibling collusion can predict problem behavior. High-risk youth were identified by a smoking measure and a 16-item teacher rating of risk. High-risk youth who participated in a family assessment and had a sibling aged 10 or older (n=26) were matched with a normative target child on age, gender, ethnicity, and parental marital status (n=26). Siblings in families with a high-risk target child showed reliably higher rates of collusion than those in families with a normative target child. Sibling collusion also accounted for variance in problem behavior after controlling for involvement with deviant peers. Findings suggest that deviant conduct forms a common ground among siblings, potentially amplifying risk of mutuality in problem behavior during early adolescence. Attention to sibling relationship processes is relevant to family interventions to prevent behavior problems. Bullock, B.M. and Dishion, T.J. Sibling Collusion and Problem Behavior in Early Adolescence: Toward a Process Model for Family Mutuality. Journal of Abnormal Child Psychology, 30(2), pp. 143-153, 2002.

Family Processes Predict Smoking Initiation

This study examined the relationship between family processes measured when children are in early elementary school and initiation of cigarette smoking in sixth or seventh grade in a sample of 810 suburban school children. Family process measures included both protective factors, such as attachment to parents and parent contact with school, and risk factors such as inconsistent discipline and family conflict. Measures of child attachment to parent and parent involvement with the child's school were significantly and negatively associated with smoking initiation when controlling for household structure and income, parent smoking, and peer and child characteristics. The results of these analyses suggest that enhancing the bonding process between parents and children and encouraging parents to be involved in the child's school may help prevent the initiation of smoking at the end of elementary school and the beginning of middle school. Fleming, C.B., Kim, H., Harachi, T.W., and Catalano, R.F. Family Processes for Children in Early Elementary School as Predictors of Smoking Initiation. Journal of Adolescent Health, 30, pp. 184-189, 2002.

Elementary School Alcohol, Tobacco and Marijuana Use Increases Middle School Use

Most drug-use data come from cross-sectional surveys that do not allow assessment of the seriousness of early experimentation on later use. This study utilized longitudinal data to assess whether ATOD use in elementary school has serious implications for continued ATOD use in middle school and beyond. Longitudinal analyses were conducted on questionnaire data from 331 middle school students who had previously provided ATOD-use data during elementary school. The sample of students was ethnically and geographically diverse, including students from a range of low socioeconomic status backgrounds living in rural, urban or inner-city environments. Middle school alcohol use was almost three times as likely to occur if alcohol use occurred in elementary school (OR = 2.94, p < .001). Elementary school use of tobacco and marijuana also greatly increased the likelihood of middle school use of these substances (OR = 5.35, p < .001 and OR = 4.25, p < .05, respectively). This study indicates that early use of ATOD is associated with greatly increased odds of later use, pointing to the importance of drug prevention programs; preventive interventions designed for use in pediatric practice settings should commence no later than elementary school. Wilson, N., Battistich,V., Syme, L., and Boyce, W.T. Does Elementary School Alcohol, Tobacco, and Marijuana Use Increase Middle School Risk? Journal of Adolescent Health, 30, pp. 442-447, 2002.

Early Elementary School Intervention to Reduce Conduct Problems

Children's aggressive behavior and reading difficulties during the early elementary school years are risk factors for adolescent problem behaviors such as delinquency, academic failure, and substance use. This study determined if a comprehensive intervention that was designed to address these risk factors could affect teacher, parent, and observer measures of internalizing and externalizing problems. Drawing from 3 communities, 116 European American and 168 Hispanic kindergarten through 3rd grade children who were identified for aggressiveness or reading difficulties were randomly assigned to a multicomponent intervention or no-intervention control condition. Intervention families received parent training, and children received social behavior interventions and supplementary reading instruction over a 2-year period. Post-intervention playground observations showed that the intervention children displayed less negative social behavior than controls. At 1-year follow-up, treated children showed less teacher-rated internalizing and less parent-rated coercive and antisocial behavior than controls. Barrera, M.J.R., Biglan, A., Taylor, T.K., Gunn, B. K., Smolkowski, K., Black, C., Ary, D.V., and Fowler, R.C. Early Elementary School Intervention to Reduce Conduct Problems: A Randomized Trial with Hispanic and Non-Hispanic Children. Prevention Science, 3(2), pp. 83-94, 2002.

Modeling Behavior Problems in Elementary-Grade Children

Youth problem behaviors such as drug use, delinquency, poor academic achievement and truancy are related, and often co-occur. Problem behavior theory (Jessor & Jessor, 1977) suggests that these disparate norm-violating behaviors reflect an underlying problem behavior syndrome. This study uses data from an ongoing longitudinal study to explore the application of a general theory of problem behavior among adolescents in fifth and sixth grades (N=1040). Confirmatory factor analysis including hierarchical latent factor models was used to examine the structure of problem behaviors that include school problems, aggression, delinquency, and substance use. Five measurement models of problem behaviors were tested, ranging from a single-factor model to a four-factor model and a second-order model. Results support the model that includes specific factors related to school problems, aggression, delinquency and substance use, and a higher order problem behavior factor. These results have implications for how predictors of problem behaviors are modeled at this age. The unique aspects of the higher order model suggest that there may be slightly different pathways to specific problems. It would therefore be useful to include both specific and general paths when examining predictors of problem behaviors at this age. For example, school bonding may have a general effect on deviance, as well as a specific effect on school problems. Modeling both general and specific effects is possible given the good fit of a second-order model as a measure of problem behaviors. Kim, S., Harachi, T.W., and Catalano, R.F., The Structure of Aggression, Delinquent Behaviors, Substance Use and School Problems in Elemenatry-grade Children. Korean Journal of Social Welfare Studies, 19, pp. 51-70, 2002.

The Relationship Between Sexual and Physical Abuse and Substance Abuse Consequences

The authors examined the relation between a history of physical and sexual abuse and drug and alcohol related consequences. Cross-sectional data came from 359 male and 111 female patients recruited from an inpatient detoxification unit. The Inventory of Drug Use Consequences was used to measure negative life consequences of substance use. Eighty-one percent of women and 69% of men reported past physical/sexual abuse, starting at a median age of 13 and 11, respectively. The results of bivariate and multivariate analyses indicated that physical and sexual abuse was associated with more substance abuse consequences. For men, age 17 years or younger at first abuse was significantly associated with more substance abuse consequences than an older age at first abuse, or no abuse. For women, the association of abuse with substance use consequences was similar across all ages. Liebschutz, J., Savetsky, J.B., Saitz, R., Horton, N.J., Lloyd-Travaglini, C., and Samet, J.H. Journal of Substance Abuse Treatment, 22, pp. 121-128, 2002.