Origins and Pathways to Drug Abuse

Research Findings from May, 2001 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.

Predictors of Engagement in Adolescent Drug Abuse Treatment

Drs. Dakof, Tejeda, and Liddle from the University of Miami Center for Treatment Research on Adolescent Drug Abuse studied 224 adolescents referred for drug abuse treatment and their parents. These researchers compared adolescents considered to be successfully engaged in treatment (n = 118) to those not successfully engaged (n = 106), defining successful engagement as participation in four or more sessions. Both parent and adolescent perceptions distinguished between successful and unsuccessful engagement. Adolescents who were successfully engaged in treatment had parents who described them as exhibiting significantly more "externalizing behavior", including delinquency and aggression, than adolescents who were not successfully engaged. Also, parents of successfully-engaged adolescents reported significantly higher expectations of academic success for their child than did unsuccessfully-engaged adolescents. Finally, adolescents who reported higher degrees of family conflict were more likely to be engaged successfully in treatment than adolescents who reported less family conflict. These results suggest a particular family profile at higher risk for treatment dropout, and inform clinical interventions aimed to engage drug-abusing adolescents and their families in treatment. Dakof, Tejeda, and Liddle, Journal of the American Academy of Child and Adolescent Psychiatry, 40, pp. 274-281, 2001.

Efficacy of a Preventive Intervention for Youths Living with HIV

HIV transmission behaviors and health practices were examined among youth living with HIV (YLH) over 15 months after youth received a preventive intervention. YLH aged 13-24 years were assigned by small cohort to (1) a two-module intervention totaling 23 sessions ("Stay Healthy" and "Act Safe"), or (2) a Control condition. 73% in the Intervention Condition attended at least one session. Following the Stay Healthy module, females who attended the Intervention Condition increased their number of positive lifestyle changes and increased active coping styles more often than those in the Control Condition. Following the Act Safe Module, YLH who attended the Intervention Condition reported 82% fewer unprotected sexual acts, 45% fewer sexual partners, 50% fewer HIV-negative sexual partners, and 31% less substance use on a weighted index than those in the Control Condition. It was concluded that prevention programs can effectively reduce risk acts among YLH. Alternative formats need to be identified for delivering the intervention. Efficacy of a Preventive Intervention for Youths Living with HIV. Rotheram-Borus, M.J., Lee, M.B., Murphy, D.A., Futterman, D., Duan, N., Birnbaum, J.M., Lightfoot, M., and the Teens Linked to Care Consortium. American Public Health Association, 91(3), pp. 400-405, 2001.

Preventing Illicit Drug Use in Adolescents: Long-Term Follow-Up Data from a Randomized Control Trial of a School Population

National survey data indicate that illicit drug use has steadily increased among American adolescents since 1992. This upward trend underscores the need for identifying effective prevention approaches capable of reducing the use of both licit and illicit drugs. The present study examined long-term follow-up data from a large scale randomized prevention trial to determine the extent to which participation in a cognitive-behavioral skills-training prevention program led to less illicit drug use than for untreated controls. Data were collected by mail from 447 individuals who were contacted after the end of the 12th grade, 6.5 years after the initial pretest. Results indicated that students who received the prevention program (Life Skills Training) during junior high school reported less use of illicit drugs than controls. Prevention effects were also found for specific illicit drugs including the use of hallucinogens and narcotics. This study shows that significant prevention effects are observable 5.5 years after the primary year of intervention. Botvin, G.J., Griffin, K.W., Diaz, T., Scheier, L.H., Williams C. and Epstein, J.A. Preventing Illicit Drug Use in Adolescents: Long-Term Follow-Up Data from a Randomized Control Trial of a School Population. Addictive Behaviors, 25(5), pp. 769-774, 2000.

Family Risk and Resiliency Factors, Substance Use, and the Drug Resistance Process in Adolescence

Recent approaches to drug prevention have emphasized risk and resiliency factors. Two models have been developed to explain these factors, one which posits that separate elements make up each set and the other which posits that a single factor can be either a risk or a resiliency factor depending on, for example, if it is present (resiliency) or absent (risk). This study tested these models and attempted to compare the effects of risk and resiliency across gender and ethnicity. Results support the model in which risk and resiliency are discrete sets of factors and demonstrate that overall resiliency factors play a larger role than risk factors in substance use and drug resistance processes. However, gender proved to be an important moderator of these effects. For adolescent males, resiliency has an indirect effect on overall substance use through age of first use, while risk has a direct effect on overall substance use. For adolescent females, resiliency has a direct effect on overall substance use and risk has an indirect effect through age of first use. This indicates that while early interventions are important for both genders, resiliency factors must be dealt with before initiation of substance use for males. Findings did not differ substantially across ethnicity, although the small African-American sample size may have limited power to detect differences. Moon, D.G., Jackson, K.M. and Hecht, M.L. Family Risk and Resiliency Factors, Substance Use, and the Drug Resistance Process in Adolescence. Journal of Drug Education, 30(4), pp. 373-398, 2000.

Verifying Drug Abuse Prevention Program Effects Using Reciprocal Best Friend Reports

Considerable research suggests that social influences-based drug abuse prevention programming has produced the most consistently successful preventive effects. However, a common criticism of this literature is that most prevention intervention studies rely solely on self-reported substance use. The purpose of this study was to assess the effects of normative education, arguably the most successful component of social influence based prevention programs, on alcohol and cigarette consumption using both self- and reciprocal best friend reports of substance use. Analyses of subsamples of data from 11,995 students participating in the Adolescent Alcohol Prevention Trial revealed that normative education significantly delayed the onset of alcohol use across the eighth, ninth, and tenth grades among public school students. A similar but somewhat less robust pattern was found for cigarette use. These results suggest that self-report bias does not account for previous findings and demonstrate rather convincingly that normative education is an effective drug prevention strategy for public school settings. Donalson, S.I., Thomas, C.W., Graham, J.W., Au, J.G. and Hansen, W.B. Verifying Drug Abuse Prevention Program Effects Using Reciprocal Best Friend Reports. Journal of Behavioral Medicine, 23(6), pp. 585-601, 2000.

Effectiveness of Monetary Incentives for Recruiting Adolescents to an Intervention Trial to Reduce Smoking

This study's objective was to evaluate the effect of monetary incentives on response rates of adolescents to a smoking-related survey as the first step toward participation in an intervention trial. A sample of 4,200 adolescent members of a managed care organization were randomized to one of four incentive groups: a $2 cash group, a $15 cash group, a $200 prize drawing group, or a no-incentive group. Group-specific response rates and willingness to be contacted about future study activities were compared. Incentives increased survey response rates (55% response without incentive verses a 69% response with incentives), with response of 74% in the $15 cash group, 69% in the token group, and 63% with a prize incentive. Incentives did not adversely affect willingness of adolescents to be contacted about a smoking intervention, (65% willing with incentives verses 60% without). In terms of costs per additional survey completed, token and prize groups were marginally more expensive than the no-incentive group ($0.40 and $1.42, respectively) while the large cash incentive was substantially more costly ($11.37). Monetary incentives improve response rates to a mailed survey, without adverse impact on willingness to further participate in intervention activities. However, a variety of issues must be considered when using incentives for recruitment to intervention studies. Martinson, B.C., Lazovich, D., Lando, H.A., Perry, C.L., McGovern, P.G. and Boyle, R.G. Effectiveness of Monetary Incentives for Recruiting Adolescents to an Intervention Trial to Reduce Smoking. Preventive Medicine, 31(6), pp. 706-713, 2000.

Television Campaigns Impact Adolescent Marijuana Use

This study evaluated the effectiveness of targeted televised public service announcement campaigns in reducing marijuana use among sensation-seeking adolescents. Sensation-seeking has been identified as a personality characteristic associated with the need for novel, complex, ambiguous, and emotionally intense stimuli and the willingness to take risks to obtain such stimulation. People ranked high on the need for sensation are more associated with the risk for drug use than those ranked low. This study designed special advertising to address sensation-seekers with anti-marijuana messages. Two televised anti-marijuana campaigns were conducted in 1 county and 1 campaign in the comparison community. Personal interviews were conducted with 100 randomly selected teenagers monthly in each county for 32 months. All 3 campaigns reversed upward developmental trends in 30-day marijuana use among high-sensation seekers. As expected, low-sensation seekers had low use levels and no campaign effects were evident. Televised campaigns with high reach and frequency that use PSAs designed for and targeted at high-sensation-seeking adolescents can significantly reduce substance use in this high-risk population. Palmgreen, P., Donohew, L., Lorch, P., Hoyle, R.H. and Stephenson, M.T. American Journal of Public Health, 91(2), pp. 292-296, 2001.

Family Engagement in Preventive Interventions

There has been limited investigation of family engagement in preventive interventions for general populations. Families in eligible general populations can differ to a significant degree in intervention preferences and beliefs that influence their motivation to engage in interventions or in intervention evaluations. Also, a number of stable family member characteristics, such as internalizing/externalizing problems, have not been predictive of family engagement. Educational attainment has been predictive, but the differences between participants and non-participants tend to be small. In addition, there are several common barriers to engagement, including family scheduling conflicts, which place practical limits on participation levels and need to be carefully addressed through engagement techniques. Spoth, R. and Redmond, C. J. Research on Family Engagement in Preventive Interventions: Toward Improved Use of Scientific Findings in Primary Prevention Practice. Primary Prevention, 21(2), pp. 267-284, 2000.

Influences on Enrollment in Family-Focused Prevention Research

This study is an extension of a previously supported model of family context and health belief predictors of parents' inclination to enroll in preventive interventions. The extended model addresses limitations in the prior investigation: i.e. the role intervention-related beliefs and stated inclinations to actually enroll in a skills training intervention research project. Model testing was conducted with a sample of 635 parents of 6th graders who completed a prospective participation factor survey and were recruited for an intervention research project 6 months later. All but one of the primary hypothesized effects were supported. Both stated inclination to enroll in an intervention and in the research project had significant positive effects on actual project enrollment occurring 6 months later. Perceived intervention benefits and barriers had significant effects on both types of stated inclination to enroll. The model also suggests an additional path linking educational attainment with actual enrollment. Spoth, R., Redmond, C., and Chungyeol, S. Modeling Factors Influencing Enrollment in Family-Focused Preventive Intervention Research. Prevention Science, 1(4), pp. 213-226, 2000.

Community Readiness

Communities are at many different stages of readiness for implementing drug abuse prevention programs, and this readiness is a major factor in determining whether a local program can be effectively implemented and supported by the community. The community readiness model was developed to meet research needs (e.g., matching treatment and control communities for an experimental intervention) as well as to provide a practical tool to help communities mobilize for change. The model defines 9 stages of community readiness ranging from "no awareness" of the problem to "professionalization" in the response to the problem within the informant interviews, with questions on 6 different dimensions related to a community's readiness to mobilize to address a specific issue. Edwards, R.W., Jumper-Thurman, P., Plested, B.A., Oetting, E.R., and Swanson, L. Community Readiness: Research to Practice. J. Community Psychology, 28(3), pp. 291-307, 2000.

Methods to Decrease Attrition in Longitudinal Studies with Adolescents

This article presents a summary of methods to decrease attrition in longitudinal school-based studies conducted with adolescents beginning junior high schools or middle schools. These include collection of contact information about students, additional days to collect data from absentee students, data collection in new high schools once students graduate from junior high schools or middle schools, sending questionnaires by mail, and conducting telephone or home interviews. Epstein, J.A. and Botvin, G.J. Methods to Decrease Attrition in Longitudinal Studies with Adolescents. Psychological Reports, 87 (1), pp. 139-140, 2000.

Concurrent Prediction of Drug Use Among High-Risk Youth

Correlates of drug use were examined in a continuation high school sample (n = 1.315), using canonical correlation analysis. Fourteen demographic, attitude/belief. and psychosocial pressure/anxiety-type variables were included as concurrent predictors. Eight drug-use-related measures were also placed into the analysis as outcome variables. Two factors were revealed. White ethnicity, not being Latino, all attitude/belief measures, and family conflict and depression showed relatively high loadings on the first predictor factor, and were associated with all drug-use measures. Latino ethnicity and being relatively unacculturated (i.e., tending to speak Spanish), most of the attitude/belief measures (but not sensation seeking or spirituality), and perceived peer approval to use drugs, trait anxiety, and depression showed relatively high loadings on the second predictor factor, and were associated with the hard-drug-use measures. These results suggest that there is a subgroup of unacculturated Latino youth who are anxious, who perceive they will achieve peer approval by using drugs, and who tend to use hard drugs. Indicated drug abuse prevention strategies may need to be tailored to this subgroup when developing and implementing programming. McCuller, W.J., Sussman, S., Dent, C.W., and Teran, L. Concurrent Prediction of Drug Use Among High-Risk Youth. Addictive Behaviors, 26(1), pp. 137-142, 2001.

Implications of Aggressive Children's Positively Biased Relatedness Views for Future Relationships

The present study examined the tendency of aggressive children to generalize the positive bias in their perceptions of relatedness across different interpersonal relationships. Secondly, it examined the implications of distorted perceptions of relatedness for quality of aggressive children's future relationships. Subjects included 62 second and third grade children nominated and rated by teachers as aggressive. Self- and others' appraisals of relationship quality were gathered across four interpersonal domains (i.e., mother, teacher, mentor, and peer). Children's positively biased perceptions of social relatedness were concordant across adult relationship domains but not across the peer domain, suggesting that children's relationships with adults and peers represent somewhat distinct socialization contexts. As expected, children who inflate levels of social relatedness establish less close relationships with novel partners (mentors). The findings emphasize the need for clinicians to focus on mental representations while planning interventions with aggressive children. Prasad-Gaur, A., Hughes, J.N., and Cavell, T. Implications of Aggressive Children's Positively Biased Relatedness Views for Future Relationships. Child Psychiatry and Human Development, 31(3), pp. 215-231, 2001.

Tobacco Use Among Argentinean High School Students

This study assessed the prevalence and correlates of tobacco use among high school students in Buenos Aires, Argentina. Anonymous, self-administered questionnaires were given to 3,909 8th and 11th graders in a stratified random sample of 49 public and private schools. The instrument included items from American surveys, translated and validated among Argentinean teens. Multiple logistic regression analysis was used to estimate possible effects on smoking behavior of environment, students' personal characteristics, and their knowledge, beliefs, and attitudes regarding smoking. Of 8th and 11th graders, 20% and 43%, respectively, were classified as current smokers. Overall, 29% of males and 32% of females were current smokers. Students attending public schools were more likely to smoke than those in private schools (p < .05). Current smoking was associated with having a best friend who smokes, reporting that more than 50% of friends of the same sex smoke, having positive attitudes and beliefs toward smoking, and having a positive intention to smoke within the next year (all p < .001). Over 20% of the 8th graders in our sample were current smokers; prevention efforts must therefore start early. Morello, P., Duggan, A., Adger, H. Jr, Anthony, J.C., and Joffe, A. Tobacco Use Among High School Students in Buenos Aires, Argentina. American Journal of Public Health, 91(2), pp. 219-224, 2001.

Developmental Factors in Liability to Adolescent Substance Use Disorders

Investigators at CEDAR reviewed the literature on the complex sequence of maturational, psychosocial, and neuroadaptive processes that lead to substance use disorders (SUD) in adolescence and constructed a synthesis of findings. After introducing the concepts of liability to SUD and epigenesis, they present a theory of how affective, cognitive, and behavioral dysregulation in late childhood is exacerbated during early and middle adolescence by family and peer factors, as well as puberty, leading to substance use. Continued exacerbation of the three components of dysregulation by drug and non-drug stressors during late adolescence is posited to result in neuroadaptations that increase the likelihood of developing SUD, particularly in high-risk individuals. Implications for etiologic research as well as clinical and preventive interventions are discussed. Dawes, M.A., Antelman, S.M., Vanyukov, M.M., Giancola, P., Tarter, R.E., Susman, E.J., Mezzich, A., and Clark, D.B. Developmental Sources of Variation in Liability to Adolescent Substance Use Disorders. Drug and Alcohol Dependence, 61(1), pp. 3-14, 2000.