Origins and Pathways to Drug Abuse

Research Findings from February, 2004 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.

Nicotine-Dependence Symptoms In Adolescent Smokers

Although many factors have been identified as related to adolescent smoking, few studies have examined the role of nicotine-dependence (ND) symptoms. The purpose of this study was to investigate the association between ND symptoms and smoking status among adolescents in the early stages of the smoking onset process. The McGill University Study on the Natural History of Nicotine Dependence is an ongoing 6-year prospective investigation of the natural history of ND among 1267 grade 7 students in ten Montreal high schools. The baseline response was 55.4%. Subjects for this cross-sectional analysis of baseline data, collected in 1999, included 241 past 3-month smokers (mean age [SD] =13.0+/-0.7 years at baseline). ND symptoms were measured in five indicators, including a measure based on the criteria for tobacco dependence in the International Classification of Diseases-10th Revision (ICD-10), the Hooked on Nicotine Checklist, and three symptom clusters (withdrawal, self-medication, and ND/cravings symptoms). The association between ND symptom indicators and each of sporadic, monthly, weekly, and daily smoking relative to less frequent smoking was investigated in multiple logistic regression analysis. Dr. Difranza and colleagues found that low cigarette exposure, 16.6% of past 3-month smokers were tobacco dependent. The proportion increased from 0%, 3.1% and 4.6% among triers, sporadic smokers, and monthly smokers, respectively, to 19.4% and 65.9% among weekly and daily smokers, respectively. ND/cravings consistently distinguished each smoking category from less frequent smokers. These data challenge current smoking onset models, which suggest that ND develops only after several years of heavy or daily smoking. ND symptoms are associated, at least cross-sectionally, with increased smoking in adolescents. To increase the likelihood of being effective, tobacco-control programs for children and adolescents will need to take early ND symptoms into account. O'Loughlin, J., DiFranza, J., Tyndale, R.F., Meshefedjian, G., McMillan-Davey, E., Clarke, P.B.S., Hanley, J. and Paradis, G. Nicotine-Dependence Symptoms are Associated with Smoking Frequency in Adolescents. American Journal of Preventive Medicine, 25(3), pp. 219-225, 2003.

Nicotine Self-Administration In Adolescent and Adult Female Rats

A rat model was used to determine the impact of the age of onset on nicotine self-administration. In Experiment 1, nicotine self-administration of female Sprague-Dawley rats over a range of acute doses (0.01-0.08 mg/kg per infusion) was determined in adolescent (beginning at 54-62 days) versus adult (beginning at 84-90 days). In Experiment 2, chronic nicotine self-administration over 4 weeks from adolescence into adulthood was compared with the chronic self-administration beginning in adulthood. In Experiment 3, adolescent-adult differences in nicotine effects on body temperature and locomotor responses were determined. Adolescent-onset rats showed increased nicotine intake compared with adult-onset rats in an eight-fold range of acute unit doses/infusion. Significant age differences were also seen in the chronic level of nicotine self-administration. Over 4 weeks, the adolescent-onset group had nearly double the rate of nicotine self-administration of the benchmark nicotine dose (0.03 mg/kg per infusion) compared to the adult-onset group. This increased nicotine intake persisted into adulthood. Adolescent rats had a significantly greater response than adults to the hypothermic effects of nicotine, but had significantly less response than adults to the reduction in locomotor activity seen after nicotine. Thus, adolescent-onset nicotine self-administration in female rats was associated with significantly higher levels of nicotine self-administration versus rats that began nicotine self-administration in adulthood. This greater self-administration persists into adulthood and may underlie greater propensity of adolescents to nicotine addiction. Levin, E.D., Rezvani, A.H., Montoya, D., Rose, J.E. and Swartzwelder, H.S. Adolescent-Onset Nicotine Self-Administration Modeled In Female Rats. Psychopharmacology, 169(2), pp.141-149, 2003.

Adolescent Sensitivity to Nicotine and Cross-sensitization to Cocaine Effects in Adulthood

In 2002, Dr. Sari Izenwasser reported that peri-adolescent rats were less sensitive to the development of behavioral sensitization with repeated cocaine administration than their adult counterparts. This was an important observation, as sensitization is believed to reflect an underlying change in the neurobiological substrate for reinforcing effects of drugs of abuse, and therefore may be involved in the addiction process. More recently, she has examined the behavioral and neurochemical effects of repeated nicotine treatments in this model. The study of nicotine mechanisms in adolescence is also an important area of investigation, since it has been reported that adolescents show a more rapid progression to dependence on smoking than do adults. Moreover, girls may show an even more precipitous course. In this study, adult and peri-adolescent rats (postnatal day 28 to 40) received 0.4mg/kg of nicotine/day via intra-peritoneal administration for 7 days. Matched age and sex control groups received vehicle instead. After each injection, locomotor activity was measured for one hour. On day 8, all rats were challenged with a cumulative dosing regimen of i.p. cocaine and their locomotor activity tested for 10-min after each injection to probe for cross-sensitization. This portion of the study design addresses concerns that smoking or nicotine exposure may "prime" subsequent illicit drug abuse. Both developmental and gender differences were observed in acute effects of nicotine and in the development of sensitization to locomotor stimulation: The young male group had a higher activity count (and greater stereotypy) after the first nicotine injection than all other groups, and did not show a behavioral sensitization. All other groups (female adolescent, and both adult groups) sensitized to nicotine's behavioral activating and stereotypy effects. However, female adolescents showed a significant sensitized response after only one nicotine exposure (versus adults, who showed significant sensitization on day five for both behavioral measures). Unlike their response on locomotor measures, male adolescents did show a sensitized stereotypy that emerged on the fourth nicotine injection. When all groups were challenged with cocaine on day 8, adolescent males - who had not shown locomotor sensitization to repeated nicotine - were sensitized to all doses of cocaine tested (i.e., had higher activity counts than males treated with vehicle) and, in fact, showed greater cross-sensitization than their adult counterparts. By contrast, neither female group showed any greater response than their chronic vehicle controls after cocaine. These findings, in conjunction with previous reports of gender differences in rats treated acutely, or chronically, with behaviorally active doses of nicotine, highlight potential neurobiological differences in the substrates for addictive processes in adolescence. Thus, although methodological differences between these various studies must be considered (e.g., varied routes of administration and schedules), male adolescents may be initially more behaviorally responsive to nicotine, whereas females may show a more rapid neuroadaptation that gives rise to changing behavioral profiles. Collins, S.L. and Izenwasser, S. Chronic Nicotine Differentially Alters Cocaine-induced Locomotor Activity in Adolescent vs. Adult Male and Female Rats. Neuropharmacology, Available online December 10, 2003.

Family Transmission for Use, Abuse, and Dependence of Marijuana

Researchers in the program project of Thomas Crowley, University of Colorado, have shown family transmission of three levels of marijuana use, abuse, and dependence in a clinic-referred sample of adolescents. This study expands the literature that had previously only focused on use in adolescents or abuse and dependence in adults. Risk ratios ranged from 1.5 to 3.3; spousal correlations ranged from .33 to .70; parent-offspring correlations ranged from .17 to .30, and sibling correlations ranged from .34 to .44. The proportion of variance attributed to parent transmission ranged between 25% and 44%. These results document the not surprising observation of significant risk of transmission from parents, environmental influence from siblings, and assertive mating for all levels of marijuana use. Hopfer, C.J., Stallings, M.C., Hewitt, J.K., and Crowley, T.J. Family Transmission of Marijuana Use, Abuse, and Dependence. Journal of the American Academy of Child and Adolescent Psychiatry, 42(7), pp. 834-841, 2003.

Boundary-Crossing and Drug Use Among Young Adults in a Low-Income, Minority, Urban Neighborhood

In this paper, researchers examined the relationship between boundary-crossing sexual partnerships (i.e., those between partners who are 5 or more years older, of a different race or ethnicity, or live in a different neighborhood or borough) and use of crack or injected drugs among young adults in Bushwick, Brooklyn. Women who smoked crack or injected drugs were more likely to have a sexual partner who was older, of a different race/ethnicity, or from a different borough than were women who did not use these drugs; men who used these drugs were more likely to have older sex partners than men who did not. Young people who use these drugs are known to be at higher risk of having HIV and a number of other sexually-transmittable infections such as hepatitis B, genital herpes, and syphilis. These results imply that this risk may be even higher for people who cross these boundaries. In addition, if these young people become infected, they may be particularly likely to serve as a gateway for spreading infection to other social groups. Flom, P., Friedman, S., Neaigus, A. and Sandoval, M. Boundary-Crossing and Drug Use Among Young Adults in a Low-Income, Minority, Urban Neighborhood. Connections, 25 (2), pp. 77-87, 2003.

Predictors of Adolescent Substance Use in Children with ADHD

This study followed up 142 subjects who had been assessed and treated for attention deficit/hyperactivity disorder (ADHD) in childhood, to assess risk for substance use in adolescence (ages 13-18) compared with matched adolescent controls without ADHD. As noted by the authors, previous studies of the risks associated with ADHD have resulted in discrepant findings, particularly when conduct problems, often associated with ADHD, are taken into account. To help address these issues, this study assessed the roles of two key components of ADHD, inattention and impulsivity-hyperactivity, separately, as well as the roles of persistence of ADHD and of the development of conduct disorder in adolescence. Several important findings emerged. First, in this sample, childhood ADHD was associated with greater use and abuse of alcohol, and heavier and earlier use of tobacco and other drugs. Second, childhood inattention was a significant predictor of most categories of adolescent substance use even when controlling for childhood impulsivity-hyperactivity and oppositional-conduct disorder symptoms (ODD/CD), although the latter predicted illicit drug use. Third, while those ADHD subjects who developed conduct disorder showed the highest levels of substance use and related problems, those with persistent ADHD without conduct disorder also showed significantly elevated levels of substance use. Thus, this study suggests that ADHD may pose a risk for substance use problems separately from its relationship to conduct disorder, and points to particular features, namely severe inattention problems and persistence of ADHD symptoms into adolescence, that may identify those at elevated risk. Molina, B.S.G., and Pelham, W.E. Childhood Predictors of Adolescent Substance Use in a Longitudinal Study of Children with ADHD. J Abnorm Psychol, 112, pp. 497-507, 2003.

Poverty Influences Some Forms of Child Psychopathology

The authors took advantage of a natural experiment to test the role of social selection vs. social causation of childhood psychopathology. During the course of their longitudinal study, the opening of a casino on an Indian reservation provided an income supplement to a subsample that moved 14% of the study families out of poverty. The findings confirmed previous reports of an inverse relationship between family income and child psychiatric diagnoses and symptoms, in both Indian and non-Indian children. Those children whose families moved out of poverty with the income supplement demonstrated drops in their psychiatric symptoms to the low levels of children who were never poor, while those whose families remained poor continued to have the high levels of symptoms seen in other poor children. These findings applied specifically to conduct and oppositional defiant disorders; anxiety and depressive disordered showed no significant change. Findings were replicated in non-Indian children whose families moved out of poverty during the same period. Given that this income supplement was not the result of family characteristics, the findings support a social causation theory for behavioral disorders in children. Because conduct and oppositional defiant disorders are strongly associated with risk for drug abuse, this study has significant implications for understanding drug abuse etiology and targeted interventions. Costello, E.J., Compton, S.N., Keeler, G. and Angold, A. Relationships Between Poverty and Psychopathology. JAMA, 290, pp. 2023-2029, 2003.

Comorbid Substance Use and Psychiatric Disorders Among Juvenile Detainees

To estimate the prevalence of comorbid psychiatric disorders in the past 6 months, the Diagnostic Interview Schedule for Children Version 2.3 was administered to 1,829 randomly selected detainees (1172 males, 657 females, aged 10-18) in the Cook County Juvenile Temporary Detention Center. Overall, more than 10 percent of males and almost 14 percent of females had a substance abuse disorder and a major mental disorder, such as psychosis, manic episode, or major depressive episode. Approximately 600 of these 1,829 young people had substance abuse disorders and behavioral disorders. In the subset of 305 youth with major mental disorders, more than 50 percent of females and nearly 75 percent of males also reported a substance abuse disorder. When the subset of 874 youth with substance abuse disorders was examined, 30 percent of the females and 21.4 percent of the males were found to also have a major mental disorder. About 25 percent of juvenile justice system detainees with major mental disorders reported that their psychiatric problem preceded their substance abuse disorder by more than 1 year. Almost 67 percent of females and more than 54 percent of males developed their mental and drug abuse disorders within the same year. Overall, these findings point to the need for assessment and treatment of juvenile detainees with comorbid substance abuse and mental health disorders. Abram, K.M., Teplin, L.A., McClelland, G.M. and Dulcan, M.K. Comorbid Psychiatric Disorders in Youth in Juvenile Detention. Arch Gen Psychiatry, 60(11), pp. 1097-1108, 2003.

Executive Functioning and Temperament in Adolescent Females with Substance Use Disorders

This study was designed to assess the role of temperament in the association between executive functioning (EF) and adolescent females substance use disorders (SUD). The sample included 340 drug using females between 14 and 18 years of age. This included 240 adolescent females with SUD diagnoses. Results suggest that temperament mediates the association between EF and adolescent females' drug use. Furthermore, EF and temperament interact to account for unique variance in drug use involvement, above and beyond the main effects of age, EF, and temperament. Interestingly, the investigators found that low EF was only significantly related to increased drug use involvement for participants with a "good" temperament and not for those with a difficult temperament. Participants with a difficult temperament exhibited significantly greater drug use involvement than those with a good temperament. In conclusion, these findings suggest that a difficult temperament may be a more important risk factor for adolescent females' drug use than low EF. Giancola, P.R. and Mezzich, A.C. Executive Functioning, Temperament, and Drug Use Involvement in Adolescent Females with a Substance Use Disorder. J Child Psychol Psychiatry, 44(6), pp. 857-866, 2003.

Liability to Substance Use Disorders: A Quantitative Approach

Liabilities to complex disorders present difficulties in measurement related to the arbitrariness of diagnostic threshold definitions and problems with discrimination between trait values, especially within the 'normal' individuals. The inability to quantitatively estimate the risk for a disorder, such as substance use disorders (SUD), is an obstacle for studying etiological (e.g. genetic) mechanisms and developing efficient prevention and treatment measures. Based on the concept of common liability to SUD, this paper delineates an application of the longitudinal family/high-risk design and item response theory to the development of a continuous index of liability. The method has been tested in both simulation study and empirical data. The approach described affords the opportunity to quantitatively estimate the risk for SUD at an early age and before any drug exposure. This method is also applicable to measuring liabilities to other complex disorders, especially those with relatively late onset. Vanyukov, M.M., Kirisci, L., Tarter, R.E., Simkevitz, H.F., Kirillova, G.P., Maher, B.S. and Clark, D.B. Liability to Substance Use Disorders: 2. A Measurement Approach. Neurosci Biobehav., Rev 27, pp. 517-526, 2003.

Marijuana Use Affects Completion of High School

Cross-sectional research has shown a link between adolescent substance use and educational motivation. The purpose of the current study was to examine this link in a longitudinal sample of African American youth. The study examined the interrelationships between alcohol and both marijuana use and school motivation over the high school years and their effect on graduation in 681 African American adolescents (50.8% female). School motivation was shown to relate to subsequent alcohol use throughout high school and marijuana use early in high school. School motivation did not affect graduation status, but alcohol and marijuana use were related to a lower likelihood of graduating from high school. Some gender differences and differences among those who had tried alcohol or marijuana at the first wave as opposed to those who had not tried each substance were found. The findings support a systems model where school experiences can affect substance use, which, in turn, can affect the completion of high school. Zimmerman, M.A., Schmeelk-Cone, K.H. A Longitudinal Analysis of Adolescent Substance Use and School Motivation Among African American Youth. J Res Adolesc, 13(2), pp. 185-210, 2003.

Tryptophan Ratio Related to Suicidal Behavior in Prospective Study

A lower ratio of tryptophan to other amino acids in serum (tryptophan ratio), established as an index of serotonin precursor available to the brain, has been shown to be associated with increased suicidal behavior in cross-sectional studies. The purpose of this study was to conduct the first prospective examination of the utility of the tryptophan ratio along with clinical variables in predicting suicidal behavior in high-risk and reference adolescents. Adolescents with alcohol use disorders (AUDs) and prior suicidal attempts (n=20), adolescents with AUDs without suicide attempts (n=20), and community controls with neither of these characteristics (n=20) were matched on demographic variables. These groups were not significantly different on the tryptophan ratio at baseline. Of 56 subjects who completed follow-up assessments, six had suicidal behavior in the follow-up period. The tryptophan ratio, along with demographic and clinical variables, was examined using Cox regression with a backward stepwise variable elimination procedure. In the final model, the tryptophan ratio and major depressive disorder both significantly contributed to the prediction of suicidal behavior. This finding suggests that the tryptophan ratio may improve the identification of adolescents at high risk for suicidal behavior. Clark, D.B. Serum Tryptophan Ratio and Suicidal Behavior in Adolescents: A Prospective Study. Psychiatry Res, 119(3), pp. 199-204, 2003.

Physical and Sexual Abuse, Depression and Alcohol Use Disorders in Adolescents: Onsets and Outcomes

This study examined the relationships among physical and sexual abuse (PS Abuse), major depressive disorder (MDD), and alcohol use disorders (AUD) in adolescence, as well as related young adult outcomes. Adolescents (mean age: 16.4 years; range: 14-18 years) were recruited from clinical and community sources and classified into four groups: (1) AUD+PS Abuse (n=154), (2) AUD only (n=255), (3) PS Abuse only (n=74), and (4) Controls (n=268). Subjects were longitudinally assessed through young adulthood (age 19 years or older). Measures included interview assessments of DSM-IV AUD and MDD, classified as "primary" or "secondary", and questionnaire measures of alcohol consumption and depression. Primary MDD preceded AUD whereas secondary MDD had a later onset than AUD. PS Abuse accelerated the onsets of primary MDD, secondary MDD and AUD. While affected adolescents had typically improved in both alcohol consumption and depression at the young adult assessment, the majority of those with adolescent AUD had AUDs in young adulthood, and MDD remained common in those with a history of PS Abuse. These results indicate that MDD among adolescents with AUD may be partly attributable to PS Abuse. Clark, D.B., DeBellis, M.D., Lynch, K.G., Cornelius, J.R and Martin, C.S. Physical and Sexual Abuse, Depression and Alcohol Use Disorders in Adolescents: Onsets and Outcomes. Drug Alcohol Depend, 69(1) pp. 51-60, 2003.

Racial/Ethnic Differences in Smoking Accounted for, in Part, by Social Influence

Using data from a longitudinal panel of nearly 3000 adolescents to predict current smoking among young adults, this study tested whether considering variables that tap prior social bonds and influences eliminates race/ethnicity as a significant predictor of current smoking. At age 23, African Americans and Asians exhibited substantially lower rates of current smoking than Whites and Hispanics. Controlling for social influences during high school, particularly exposure to siblings and friends who smoked plus parental disapproval of smoking, accounted for these differences. Social bonding variables, in contrast, had a limited effect on these differences. Interventions aimed at decreasing adolescent vulnerability to prosmoking influences, reducing overall levels of peer cigarette use, and helping parents better convey their disapproval of smoking should help curb young adult smoking and diminish racial/ethnic differences in tobacco use. Ellickson, P.L., Perlman, M. and Klein, D.J. Explaining Racial/Ethnic Differences in Smoking During the Transition to Adulthood. Addict Behav., 28(5), pp. 915-931, 2003.

Role Models and Psychosocial Outcomes Among African American Adolescents

The authors examined who 679 African American ninth-graders (aged 14-17 yrs) from urban environments look up to and how their role model choices relate to substance use, delinquency, academic engagement, and psychological well-being. Male adolescents without male role models and females identifying brothers as role models reported the most problem behavior. Adolescents with paternal male role models had the most positive school outcomes, no differences were found in psychological well-being among adolescents in terms of their male role models. The presence of female role models, in contrast, was associated with psychological well-being such that adolescents with maternal role models reported the least distress. Adolescents without female role models had the lowest grades and most negative school attitudes. These findings remained when parental support, family conflict, and father presence in the household were controlled, suggesting role model effects are separate from parenting effects. Findings support and expand on the notion that having someone to look up to is critical for African American youths' development. Bryant, A.L. and Zimmerman, M.A. Role Models and Psychosocial Outcomes Among African American Adolescents. J Adolesc Res., 18(1), pp. 36-67, 2003.

Predictors of the Transition to Regular Smoking

This study identified predictors of the transition from experimentation to regular smoking in middle adolescence, late adolescence, and young adulthood. Students completed self-report surveys assessing the following potential predictors of the transition to regular smoking from grades 8 to 10, grades 10 to 12, and grades 12 to age 23 years: demographic characteristics, smoking-related attitudes, behaviors and environment, other problem behaviors; academic orientation; parental bonding; and mental health. Regression techniques which adjust for weighting and clustering of observations were used to determine the independent associations of the predictor variables on subsequent smoking status. Risk factors for the transition to regular smoking during middle adolescence included being white, prosmoking attitudes, friend smoking, weak academic orientation, and less parental support. During late adolescence, being African-American was protective, whereas risk factors included prosmoking attitude, drinking, non-intact nuclear family, and less parental support. Risk factors in young adulthood include younger age and prosmoking attitudes. Results point to several smoking-related attitudes, social influences, and behaviors that prevention efforts may target to curb the escalation of smoking. Tucker, J.S., Ellickson, P.L., and Klein, D.J. Predictors of the Transition to Regular Smoking During Adolescence and Young Adulthood, J Adolesc Health, 32(4), pp. 314-324, 2003.

Protective Factors Against Serious Violent Behavior in Adolescence

This study used data from the Seattle Social Development Project to examine factors in adolescence that affect the probability of violent behavior at age 18 among youths who received high teacher ratings of aggression at age 10. The study found a lower probability of violence among youths at age 18 was associated with attendance at religious services, good family management by parents, and bonding to school at age 15. A higher probability of later violence was associated with living in a disorganized neighborhood and having the opportunity for and involvement with antisocial peers at age 15. The likelihood of violence at age 18 among aggressive youths was reduced when they were exposed to multiple protective factors at age 15, even for those simultaneously exposed to risk factors. Herrenkohl, T.I., Hill, K.G., Chung, I.J., Guo, J., Abbott, R. and Hawkins, J.D. Protective Factors Against Serious Violent Behavior in Adolescence: A Prospective Study of Aggressive Children. Soc Work Res., 27(3), pp. 179-191, 2003.

Common Predictors of Cigarette Smoking, Alcohol Use, Aggression, and Delinquency Among Inner-City Minority Youth

The present study examined the prevalence rates and common predictors of substance use, aggression, and delinquency among inner-city minority youth entering middle school. A survey was administered to 6th grade students (N = 5423) from 42 New York City schools. Aggressive behaviors were reported most frequently, followed by delinquent behaviors, alcohol use, and cigarette smoking. Across all behavioral outcomes, social and environmental influences explained the largest proportion of variance, followed by individual characteristics and skills, bonding to conventional institutions, and demographic variables. For the majority of predictor variables there was substantial overlap in patterns of prediction across outcomes. These findings indicate that several factors that correspond to the predominant psychosocial theories of adolescent development explain variation across different problem behavior outcomes among inner-city minority youth. Griffin, K.W., Botvin, G.J., Scheier, L.M., Doyle, M.M. and Williams, C. Common Predictors of Cigarette Smoking, Alcohol Use, Aggression, and Delinquency Among Inner-City Minority Youth. Addictive Behaviors, 28, pp. 1141-1148, 2003.

Sports Participation and Substance Abuse In Young Adults

The widely held notion that sports participation reduces subsequent risk of substance use is evaluated with longitudinal data of a representative sample of youth when they were in their preteen and young adult years. Unlike previous inquiries into the deterrence hypothesis, the present study controls for other major factors previously found to be predictive of alcohol and drug use. Results of analyses revealed that contrary to the deterrence hypothesis, playing high school sports does not appear to be a protective factor that lowers one's involvement in young adult alcohol or drug use--with one exception. Subgroup analyses revealed that among blacks, the greater the extent of high school sports participation, the less the risk of substance use. In direct contradiction to the deterrence hypothesis, playing high school sports was found to be positively associated with alcohol use for whites, even in the context of other major predictors of alcohol use. Further analyses revealed that the positive association between sports participation and alcohol use appeared to exist only for white males. The implications of these results are discussed. Eitle, D., Turner, R.J. and Eitle, T.M. The Deterrence Hypothesis Reexamined: Sports Participation and Substance Abuse Young Adults. Journal of Drug Issues, 33, pp. 193-222, 2003.

Predictors of Early Sexual Risk in High Risk Youth

This longitudinal study assessed the characteristics that predicted the timing of first sexual intercourse in a high-risk sample of adolescents between the ages of 11 and 14. A high-risk community sample was recruited through advertisement and a telephone interview with parents, who were asked to reported on their child's current risk factors, such as low grades, suspected drug use, and aggression. Youth were eligible to participate in the study if parents reported the presence of at least four risk factors. Following recruitment, families participated in a 2-3 hour assessment involving questionnaires, structured interviews, and a family assessment task. Following the assessment, participants were administered brief telephone interviews. The analyses were conducted with 162 adolescents who were virgins at baseline and for whom it was possible to determine the date of first sexual intercourse. The modal age of first intercourse was 14. Pubertal status, externalizing ratings, delinquency, substance use, monitoring, and deviant-peer involvement were univariate predictors of age of first sexual intercourse, whereas deviant-peer involvement was the sole predictor in the multivariate analysis. These results suggest that precocious sexual initiation can be understood using models of the etiology of other problem behavior and that deviant-peer involvement is a particularly salient dimension of this trajectory. French, D. and Dishion, T.J. Predictors of Early Initiation of Sexual Intercourse Among High-Risk Adolescents. Journal of Early Adolescence, 23(3), pp. 295-315, 2003.

The Potential Role of Deviant Talk in Adolescent Antisocial Behavior

Deviant talk in adolescent friendships has been previously found to predict escalation in substance use, delinquency, and violence. The current paper extends past work on deviant talk by examining its dynamic, self-organizing properties. From the direct observations of peer interactions, a simple measure was developed that indicated whether, as an interaction unfolded, deviant talk bouts became longer in duration, indicating an "attractor state" according to dynamic systems principles. Participants included 102 high-risk adolescents and their friends. A time series of the duration of each successive deviant talk bout over the course of an interaction was created for all dyads. Slope values were derived from the time-series and used as an index of attractor strength. As hypothesized, the attractor index predicted serious authority conflict (arrests, school expulsion) and drug abuse three years later, after controlling for problem behavior, family coercion, and deviant peer associations. The findings suggest that the process by which adolescents become increasingly absorbed in deviant talk is an important underlying mechanism in the development of serious antisocial behavior. Granic, I. and Dishion, T.J. Deviant Talk in Adolescent Friendships: A Step Toward Measuring a Pathogenic Attractor Process. Social Development, 12(3), pp. 314-334, 2003.

Young Adults with Attention-Deficit/Hyperactivity Disorder and Conduct Disorder are at Unique Risk for Drug Dependence

Prior research examining relations among attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and substance abuse has suggested that CD fully accounts for relationships between ADHD and substance abuse. This study tested an alternate theory that ADHD and CD interact to produce substance use problems. The 481 participants were part of a 10- to 12-year longitudinal study of the etiological pathways to substance use and psychopathology. Results indicated that college aged youth with a history of a greater number of symptoms of both hyperactivity-impulsivity-inattention (HIA) and conduct problems (CP) when they were younger had the highest rates of marijuana and hard drug use dependence symptoms. Interestingly, youth with higher HIA and lower CP symptoms often had the lowest rates of substance use and dependence symptoms, suggesting that HIA, in the absence of CP, may serve as a protective factor. This subtype is often characterized by relatively low levels of impulsivity and an anxious, shy or socially withdrawn personality style, which could account for the low levels of substance use. The only substance to which HIA was uniquely related after controlling for the overlap between ADHD and CD was tobacco. Since stimulant medications are the most effective medical treatment for reducing symptoms of HIA, the authors speculate that individuals with HIA may use the socially acceptable stimulant drug nicotine as a way to decrease their HIA symptoms. As a whole, these study findings support the hypothesis that there may be unique characteristics, such as impulsivity, executive deficits or peer rejection, that are associated with HIA-CP that impose a particularly high risk for antisocial behavior, substance use and dependence. Flory, K., Milich, R., Lynam, D.R., Leukefeld, C., and Clayton, R. Relation Between Childhood Disruptive Behavior Disorders and Substance Use and Dependence Symptoms in Young Adulthood: Individuals With Symptoms of Attention-Deficit/Hyperactivity Disorder and Conduct Disorder Are Uniquely at Risk. Psychology of Addictive Behaviors, 17(2), pp. 151-158, 2003.

The Associations of Social Self-Control, Personality Disorders, and Demographics With Drug Use Among High-Risk Youth

A 10-item self-report measure of social self-control was examined for its association with substance use, controlling for its associations with 12 personality disorder indices and 4 demographic variables among a sample of 1,050 high-risk youth. Social self-control was found to be associated with 30-day cigarette smoking, alcohol use, marijuana use, and hard drug use, controlling for these other variables. The most consistent concurrent predictors of substance use were male gender, antisocial personality disorder, and social self-control. These results highlight the importance of social self-control as a unique concurrent predictor of substance use and suggest that social self-control skill training is relevant in substance abuse prevention programming. Sussman, S., McCuller, W.J., and Dent, C.W. Implications for Social Self-Control Training. Addictive Behaviors, 28(6), pp. 1159-1166, 2003.

Substance Abuse Among Very Young Juvenile Offenders

Although the relationship between delinquency and substance use in adolescence is well documented, less is known about substance-use initiation in childhood for juvenile delinquent populations. This study examined early substance initiation in childhood as reported by adolescents who were incarcerated for juvenile offenses (93 males, 96 females; 58% African American, 42% European American). Youth were individually interviewed using an adapted version of substance-related questions from the National Household Survey on Drug Abuse. Juvenile justice system records were reviewed to characterize offense histories. A majority of males and females reported using at least one substance (other than cigarettes) such as alcohol, marijuana, or inhalants by age 13. Alcohol use reportedly occurred by age 10 for 17% of the youth. For a substantial portion, early initiation turned into frequent early use. For example, 32% of the males and 39% of the females reported drinking alcoholic beverages at a frequency of at least several times per month by age 13. Limited evidence related early substance initiation with subsequent substance abuse. Offense status is related to early substance initiation for females but not males. Early substance use is a significant problem among youth who end up in the juvenile justice system. Prinz, R.J., and Kerns, S.E.U. Early Substance Use by Juvenile Offenders. Child Psychiatry and Human Development, 33(4), pp. 263-277, 2003.

Comorbid Psychiatric Disorders in Youth in Juvenile Detention

This epidemiological study seeks to estimate 6-month prevalence of comorbid psychiatric disorders among juvenile detainees by demographic subgroups including gender, race/ethnicity, and age. Participants in this longitudinal study include 1,829 youth (age 10-18 years) initially arrested and detained between 1995 and 1998 at the Cook County Juvenile Temporary Detention Center in Chicago, IL. Subjects were randomly selected to participate in the study. Results indicate significantly more females (57%) than males (46%) met the criteria for 2 or more mental health disorders represented in the DSM-III-R. Nearly 14% of the girls and 11% of the boys had both a major mental disorder (psychosis, manic episode, or major depressive episode) and a substance use disorder. Nearly 30% of the girls and 20% of the boys with substance use disorders had major mental health disorders. Rates of comorbidity were higher among non-Hispanic whites and older adolescents. Abram, K.M., Teplin, L.A., McClelland, G.M., and Dulcan, M.K. Comorbid Psychiatric Disorders in Youth in Juvenile Detention. Archives of General Psychiatry, 60, pp. 1097-1108, 2003.

Sense of Belonging in School as a Protective Factor Against Drug Abuse Among Native American Urban Adolescents

This article presents the results of a study conducted with 243 Native American students who were part of a multi-ethnic sample of adolescents attending middle school in a large urban center in the Southwest region of the United States. Native adolescents who felt a stronger sense of belonging in their school were found to report a lower lifetime use of alcohol and cigarettes, lower cigarette and marijuana use in the previous month, lower frequency of current use of these substances, fewer substances ever used, and a later age of initiation into drug use than other Native students. Research implications are discussed in relationship to school environment, culturally-grounded prevention curricula, and school social work practice. Napoli, M., Marsiglia, F.F., and Kulis, S. Sense of Belonging in School as a Protective Factor Against Drug Abuse Among Native American Urban Adolescents. Journal of Social Work Practice in the Addictions, 3(2), pp. 25-41, 2003.

Posttreatment Victimization and Violence Among Adolescents Following Residential Drug Treatment

This article examines the relationships among experiences of childhood abuse, psychiatric disorders, self-reported victimization, and violent behavior, with a focus on gender differences. Data were obtained from interviews at treatment entry and 5-year post-treatment for 446 adolescent clients in therapeutic community (TC) drug treatment programs throughout the United States and Canada. Fifty-eight percent of the sample indicated that they engaged in serious violent behaviors (e.g., beatings, threatening or using weapons against other people, or violent crimes such as assaults, rapes, murders) in the 5 years following their separation from TC treatment. Multivariate logistic regression analyses revealed that victimization in the posttreatment period was the most significant factor associated with violent behavior, and pretreatment childhood abuse experiences and psychiatric disorders were not significantly related to the odds of violent behavior. There were significant gender differences in self-reported victimization and violent behavior. The findings suggest that violence in young adulthood for males is related to increasing involvement in violent lifestyles that include drug trafficking, while violence among females is associated with the social and psychological consequences of drug involvement and victimization. High rates of violent involvement and victimization among former adolescent clients suggests the utility of incorporating interventions such as safety-oriented strategies for females or interventions that address involvement in the drug use lifestyles (i.e., use and dealing) for both males and females into residential treatment to reduce the likelihood of future violence. Hawke, J.M., Jainchill, N. and De Leon, G. Posttreatment Victimization and Violence Among Adolescents Following Residential Drug Treatment. Child Maltreatment, 8(1), pp. 58-71, 2003.