Origins and Pathways to Drug Abuse

Research Findings from September, 2000 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.

Gender Differences in Adolescent Drug Abuse: Issues of Comorbidity and Family Functioning

Dr. Gayle Dakof, University of Miami, investigated gender differences in patterns of co-morbidity and family functioning among a sample of 95 youths (42 girls) referred by juvenile justice (80%), education (10%) and social welfare (10%) for substance abuse treatment. Findings indicate that male and female adolescent substance users (13-17 years) entering treatment do differ. The girls not only used drugs and engaged in externalizing behaviors as extensively as did their male counterparts but they also were distinguished by their higher levels of internalizing symptoms and family dysfunction. Dakof, G. Journal of Psychoactive Drugs, 32(1), pp. 25-32, 2000.

A Mendelian Genetic Model for Smoking Behavior was Supported in an Analysis of Three-Generation Families

Gary Swan of SRI International conducted a complex segregation analysis in three generation-families to determine the best model for transmission of smoking behavior. This is the first study to date to use three generations for this determination. It was found that the best-fitting model was that of a dominant major gene with low estimated frequency and residual familial correlations. These correlations demonstrate strong influence of mothers (negative) and spouses (positive) toward smoking behavior. However, it should be noted that the sample was selected from those participating in a longitudinal study of aging and health and not selected for smoking behavior per se. Therefore, it is presumed that these results underestimate genetic transmission because heavy-smoking individuals are less likely to volunteer for the study, and many more smokers in the registry may have already died. Nevertheless, these results encourage future linkage studies. Cheng, L.S., Swan, G.E., and Carmelli, D. A Genetic Analysis of Smoking Behavior in Family Members of Older Adult Males. Addiction, 95(3), pp. 427-435, 2000.

Various Significant Genetic Influences Are Associated with Transitions between Levels of Use of Illicit Drugs

Using phone interviews of more than 3000 male-male twin pairs conditional probabilities were determined for different illicit drugs between levels of use, from exposure to dependence and addiction. Marijuana had the highest conditional probabilities for the transition from exposure to use, from use to use more than five times, and from use more than five times to regular use. Heroin had a higher rate of transition to regular use than amphetamines, cocaine, psychedelics, or sedatives. Finally, cocaine had the highest conditional probability for transition from regular use to abuse/dependence. Tsuang, M.T., Lyons, M.J., Harley, R.M., Xian, H., Eisen, S., Goldberg, J., True W.R., and Faraone S.V. Genetic and Environmental Influences on Transitions in Drug Use. Behavior Genetics, 29(6), pp. 473-479, 1999.

Adolescent Personality and Social-Environmental Antecedents to Drug Use in the Late Twenties

This research focused on the interrelation of the parent-child attachment, drug use in the late twenties, unconventionality, friends' drug use, and the young adult's use of drugs. Data were collected from participants at 4 points in time: early adolescence, late adolescence, early 20s, and late 20s. Data were collected from mothers at the 3 points in time that corresponded with the first 3 collections of data from their children. Both the youths and their mothers were individually interviewed. The findings indicated that the effect of parent-child mutual attachment was mediated through early adolescent personality attributes of greater responsibility, less rebelliousness, and intolerance of deviance. These non-drug-prone personality and behavioral attitudes, in turn, insulated the young adult from affiliating with drug-using peers, and these attitudes were related to less drug use in the early 20s and ultimately in the late 20s. The results suggest that interventions focused on enhancing parent-child mutual attachment should result in a reduction of the risk factors conducive to drug use during the late 20s. The fact that these findings cover a decade and a half, from early adolescence to the late 20s, underscores the significance of placing drug use in a perspective that includes familial and behavioral aspects. Brook, J.S., Whiteman, M., Finch, S., and Cohen, P. Longitudinally Foretelling Drug Use in the Late Twenties: Adolescent Personality and Social-Environmental Antecedents. J Genet Psychol, 161(1), pp. 37-51, 2000.

Temperament and Antisocial Behavior in Sons of Fathers With and Without a History of Substance Abuse

A study using data from the University of Pittsburgh CEDAR sample was conducted to determine the relations between different dimensions of temperament, and their interactions, with antisocial behavior (ASB) in 351 preadolescent boys with (n=175) or without (n=176) a family history of a substance use disorder (SUD) and to determine whether these relationships are moderated by family history of SUD. Participants were administered the Revised Dimensions of Temperament Survey (DOTS-R) and multiple measures of ASB. Factor analysis reduced the DOTS-R subscales into three factors: Rhythmicity, Behavioral Regulation, and Positive Affectivity. Boys with a family history of SUD demonstrated lower scores on the Behavioral Regulation factor and increased levels of ASB compared to those without a family history of SUD. Results also indicated that above and beyond the effects of age and socioeconomic status, low rhythmicity, low behavioral regulation, and low positive affectivity, as well as some of their higher order interactive effects, are important indicators of different types of ASB and, in some cases, only in boys with a family history of SUD. These findings suggest that ASB and SUD prevention efforts should include components aimed at improving the regulation of behavior, increasing positive affectivity, and improving the rhythmicity of daily eating, sleeping, and other routine behaviors. Giancola, P.R. Temperament and Antisocial Behavior in Preadolescent Boys with or Without a Family History of a Substance Use Disorder. Psychology of Addictive Behaviors, 14(1), pp. 56-68, 2000.

Psychopathology and Substance-Related Problems During Early Adolescence

Another study with the CEDAR sample examined the chronological and statistical relations among onsets of psychopathology, alcohol and cannabis use, and substance-related problem from late childhood through early adolescence. Boys of fathers with substance use disorder (SUD; high average risk: n = 177) and without SUD (low average risk: n = 203) were compared using survival analysis. Proportional hazard models indicated that antisocial disorders were predicted by risk group (i.e., positive or negative family history of SUD). Antisocial disorders mediated the observed relation between risk group and substance-related problems. Negative affect disorders were predicted by risk group but did not predict substance involvement in early adolescence. Results support a model in which paternal SUD predisposes to increased antisocial and negative affect disorders in boys, and antisocial disorders lead to substance-related problems in early adolescence. Clark, D.B., Parker, A.M., and Lynch, K.G. Psychopathology and Substance-related Problems During Early Adolescence: A Survival Analysis. Journal of Clinical Child Psychology, 28(3), pp. 333-341, 1999.

Stressful Life Events and Development of Drug Use in Adolescents

In a study of the increase in drug use during early and mid-adolescence, investigators examined the cumulative effects of stressful life experiences over time taking into account possible moderating factors such as sex, income, family attachment, self-esteem, and mastery. Using 4 years of panel data from the Family Health Study (n=651 adolescents ages 11-14 during Year 1), they estimated a hierarchical growth curve model that examined the time-varying effects of stressful life events and peer relations on drug use. Stressful life events were measured by a checklist of 16 items derived from the Junior High Life Experiences Survey and the Family Inventory of Life Events and Life Changes; they included incidents such as death, illness, or accidents among family or friends, changes of school or residence, parental divorce or separation, and family financial problems. The results indicated that experiencing a high number of life events over time is related to a significant "growth" of drug use, even after controlling for "growth" due to age or peer relations. In addition, this relationship is moderated by family attachment; high levels of attachment serve to diminish this growth significantly. Hoffmann, J.P., Cerbone, F.G., and Su, S.S. A Growth Curve Analysis of Stress and Adolescent Drug Use. Substance Use & Misuse, 35(5), pp. 687-716, 2000.

Natural History of Cigarette Smoking from Adolescence to Adulthood

Previous research on the natural history of smoking has focused on overall group trajectories without considering the possibility of risk subgroup variation, but recent advances in quantitative methods have made it feasible to consider subgroups of trajectories within an overall longitudinal design. Taking advantage of these advances, researchers at Arizona State University used data from a cohort-sequential study of a large community sample (N = 8,556) with measurements spanning ages 11-31 and sought to identify subgroups with varying trajectories of smoking behavior. After removing 2 a priori groups (abstainers and erratics), the investigators empirically identified 4 trajectory groups Ð early stable smokers (characterized by smoking onset at age 12-13 and continuation on smoking at subsequent ascertainments), late stable smokers (who typically reach a criterion of weekly smoking around age 18 and remained stable through the course of the study), experimenters (who typically initiated smoking early but had discontinued cigarette use by the age of 20), and quitters (who started smoking at an age between that of the early-stable and late-stable groups and achieved a high level of cigarette use but quit around the age of 25). The study also identified psychosocial variables from adolescence and young adulthood that distinguished among these groups. Chassin, L., Presson, C.C., Pitts, S.C., and Sherman, S.J. The Natural History of Cigarette Smoking from Adolescence to Adulthood in a Midwestern Community Sample: Multiple Trajectories and Their Psychosocial Correlates. Health Psychology, 19(3), pp. 223-231, 2000.

Early Onset of Substance Use Among African American Children

This research tested predictions from a self-regulation model of factors relevant for early onset of tobacco and alcohol use with a community sample of 889 African American children (mean age = 10.5 years), a population for whom relatively little evidence is available at early ages. Criterion variables were peer substance use, willingness to use substances, and resistance efficacy (intention to refuse substance offers). Structural modeling indicated effects of temperament dimensions were mediated through self-control and risk-taking constructs, which were related to school involvement, life events, and perceived vulnerability to harmful effects of substances. Peer use was predicted by life events, poor self-control, and parent-child conflict; willingness to use substances was predicted by life events, risk taking, and (inversely) parental support; and resistance efficacy was predicted by perceived vulnerability and (inversely) poor self-control. Findings are discussed with reference to theoretical models of early protection and vulnerability processes. Wills, T.A., Gibbons, F.X., Gerrard, M., and Brody, G.H. Protection and Vulnerability Processes Relevant for Early Onset of Substance Use: A Test Among African American Children. Health Psychology, 19(3), pp. 253-263, 2000.

Developmental Taxonomy of Marijuana Users

This study applied cluster analysis to a community-based sample of marijuana users followed from adolescence to mid-30's, to create a taxonomy for marijuana use similar to those proposed for alcohol. Four groups with distinguishing characteristics emerged: early onset (age 15)-heavy use; early onset-light use; mid onset (age 16)-heavy use; and late onset (age 19.5)-light use. Of note, early onset of use did not in itself signify risk for later drug dependence; a concurrent psychiatric problem was strongly associated with risk for dependence in the early onset group, and absence of psychopathology distinguished the users who did not progress to heavy use. Association with marijuana-using peers and peer delinquency also distinguished those early users who progressed to heavy use. These findings add to our understanding about the course and risk for marijuana use, and make important distinctions among different typologies. Kandel, D.B., and Chen, K. Types of Marijuana Users by Longitudinal Course. Journal of Studies on Alcohol, 61, pp. 367-378, 2000.

Genetics of Smoking Initiation vs. Persistence

Using data from three different cultural groups, this study analyzed twin data to assess genetic influences on smoking initiation vs. persistence in several age groups and both sexes. While the contributions of genetics to smoking persistence was very similar among the various age groups and both sexes, findings suggest that the genetic factors accounting for variance in smoking initiation differ from those accounting for smoking persistence. This suggests that future studies seeking to find genes for smoking behavior will need to differentiate between those for initiation and those for persistence, and that identifying genes for persistence may have great public health significance. Madden, P.A. F., Heath, A.C., Pedersen, N.L., Kaprio, J., Koskenvuo, M.J., and Martin, N.G. The Genetics of Smoking Persistence in Men and Women: A Multicultural Study. Behavior Genetics, 29, pp. 423-431, 1999.

Adolescent Religiousness and Substance Use

The authors used data from the Mid-Atlantic School Age Twin Study to examine associations between religiousness and substance use. Adolescent religiousness was at least somewhat inversely correlated with drug and alcohol use and with other behavior problems. Religiousness was also related to lower peer conduct problems and drug use, and strongly negatively correlated with sensation seeking, especially in females. From analysis of this twin data, religiousness in adolescents appears to be largely a function of shared environmental factors, with only modest heritability; thus it may prove more important in protecting against initial adolescent use than against more heritable later drug use problems if drugs are initiated. D'Onofrio, B.M., Murrelle, L., Eaves, L.J., McCullough, M.D., Landis, J.L., and Maes, H.H. Adolescent Religiousness and its Influence on Substance Use: Preliminary Findings from the Mid-Atlantic School Age Twin Study. Twin Research, 2, pp. 156-168, 1999.

Cross-national Comparisons of the Prevalences and Correlates of Mental and Substance Use Disorders

Researchers at Harvard University, other U.S. and foreign research institutions and the World Health Organization (WHO) have formed an International Consortium in Psychiatric Epidemiology (ICPE) in order to carry out cross-national comparative studies of the prevalences and correlates of mental disorders. This article describes the findings of surveys in seven countries in North America (Canada and USA), Latin America Brazil and Mexico), and Europe (Germany, Netherlands, and Turkey), using a version of the WHO Composite International Diagnostic Interview (CIDI) to generate diagnoses. The results are reported using DSM-III-R and DSM-IV criteria without diagnostic hierarchy rules for mental disorders and with hierarchy rules for substance-use disorders. Prevalence estimates varied widely--from >40% lifetime prevalence of any mental disorder in Netherlands and the USA to levels of 12% in Turkey and 20% in Mexico. Comparisons of lifetime versus recent prevalence estimates show that mental disorders were often chronic, although chronicity was consistently higher for anxiety disorders than for mood or substance-use disorders. Retrospective reports suggest that mental disorders typically had early ages of onset, with estimated medians of 15 years for anxiety disorders, 26 years for mood disorders, and 21 years for substance-use disorders. All three classes of disorders were positively related to a number of socioeconomic measures of disadvantage (such as low income and education, unemployed, unmarried). Analysis of retrospective age-of-onset reports suggest that lifetime prevalences had increased in recent cohorts, but the increase was less for anxiety disorders than for mood or substance-use disorders. Delays in seeking professional treatment were widespread, especially among early- onset cases, and only a minority of people with prevailing disorders received any treatment. The authors conclude that there is a need for demonstration projects of early outreach and intervention programs for people with early-onset mental disorders, as well as quality assurance programs to look into the widespread problem of inadequate treatment. Andrade, L., Caraveo-Anduaga, J.J., Berglund, P., Bijl, R., Kessler, R.C., Demler, O., Walters, E., Kylyc, C., Offord, D., Ustun, T.B., and Wittchen, H.U. Cross-national Comparisons of the Prevalences and Correlates of Mental Disorders. Bulletin of the World Health Organization, 78(4), pp. 413-426, 2000.

Initiation of Alcohol and Marijuana Use

Guided by the social development model, this study examined dynamic patterns and predictors of alcohol and marijuana use initiation. The sample was derived from a longitudinal study of 808 youth interviewed annually from 10 to 16 years of age and at 18 years of age. Rate of alcohol initiation rose steeply up to the age of 13 years and then increased more gradually; most participants had initiated by 13 years of age. Marijuana initiation showed a different pattern, with more participants initiating after the age of 13 years. The study showed that: (1) the risk of initiation spans the entire course of adolescent development; (2) young people exposed to others who use substances are at higher risk for early initiation; (3) proactive parents can help delay initiation; and (4) clear family standards and proactive family management are important in delaying alcohol and marijuana use, regardless of how closely bonded a child is to his or her mother. Kosterman R., Hawkins J.D., Guo J., Catalano R.F., and Abbott, R.D. The Dynamics of Alcohol and Marijuana Initiation: Patterns and Predictors of First Use in Adolescence. American Journal of Public Health, 90(3), pp. 360-366, 2000.

Ethnic and Gender Differences and Similarities in Adolescent Drug Behaviors

This study examined relationships among ethnicity, gender, drug use, and resistance to drug offers in a sample of 2,622 African American, Mexican American, and White American seventh graders. Findings included: first, the adolescents did not possess large or sophisticated repertoires of drug resistance strategies. Second, most offers came from acquaintances in contrast to data on older adolescents where offers generally come from intimate friends. Third, ethnicity had significant effects on use and the offer process. Mexican Americans received more offers, used more drugs, and were more likely to be offered drugs by peers, family members and at parties. European Americans were more likely to receive drug offers from acquaintances and at friends' homes and on the street. African Americans were more likely to receive offers from dating partners and parents, and in the park, and were more likely to resist offers of drugs-using explanations. Fourth, gender significantly affected drug offers and types of offers. Males were more at risk for offers and use at a younger age. Offers of drugs to males were more likely to come from parents or other males, while offers to females were more likely to come from other females or dating partners. Males were also more likely to receive drug offers that appealed to their social standing or self-image whereas females received either simple offers or those that minimize effects. Finally, offers of drugs to males were more likely to be made in public, while those to females were more likely to occur in private. Moon, D.G., Hecht M.L., Jackson, K.M., and Spellers R.E. Ethnic and Gender Differences and Similarities in Adolescent Drug Use and Refusals of Drug Offers. Substance Use and Misuse. 34 (8), pp. 1059-1083, 1999.

Developing Attachment through Prosocial Family Activities

Child attachment to parents has been shown to reduce the likelihood of problem behaviors, such as substance abuse, through enhancing resiliency. Research examining attachment and its relationship to antisocial behavioral outcomes in adolescents has been shaped largely by social control theorists who have theorized that attachment to prosocial others inhibits the expression of antisocial behavioral outcomes. This paper expands the literature by investigating the development of child attachment to parent(s) during the early elementary school years. The social development model posits that consistently applied opportunities for prosocial interactions and involvement with family, praise and recognition by parents, and child social and decision-making skills, predict future level of attachment. Results indicate that level of attachment in grade one or two is the strongest predictor of attachment in grade three or four. In addition, the socializing activities of parents (opportunities and involvement) had a strong positive relationship with rewards, which was a significant predictor of attachment in grade three or four over and above the effects of prior attachment. Only child skill was unrelated to reward. This may be due to the developmental status of the children and parents expectations. Oxford, M.L., Harachi, T.W., Catalano, R.F., Haggerty, K.P., and Abbott, R.D. Early Elementary School-aged Child Attachment to Parents: A Test of Theory and Implications for Prevention. Prevention Science, 1(2), pp. 61-69, 2000.

Peer Clique Participation and Social Status in Preadolescence

A method is described to identify peer cliques based on a consensus of group members. It provides quantitative measures of preadolescents' involvement in cliques and their association with peers who often get in trouble. The relationship between peer rejection and participation in peer cliques was of primary interest. Characteristics of peer cliques were assessed for 824 fourth-grade youth as a function of their sociometric status, gender, and aggressiveness. Rejected youth were less central members of their group than were average-status peers; however, aggressive preadolescents were no less centrally involved than their non-aggressive peers. Rejected preadolescents also belonged to smaller cliques and to cliques comprised of other low-status peers. Aggression was the primary factor associated with being a central member of deviant peer cliques. Bagwell, C.L., Coie, J.D., Terry, R.A., and Lochman, J.E. Peer Clique Participation and Social Status in preadolescence. Merrill-Palmer Quarterly-Journal of Developmental Psychology, 46 (2), pp. 280-305, 2000.

Demographic, Individual, and Interpersonal Predictors of Adolescent Alcohol and Marijuana Use Following Treatment

A vulnerability model of adolescent substance abuse treatment outcome provided the basis for investigating demographic, individual, interpersonal, and treatment factors to predict the follow-up use of alcohol and marijuana in a sample of adolescents (N = 225) with psychoactive substance use disorders. Pretreatment levels of sibling substance use and aftercare participation predicted alcohol and marijuana use during the first 6 months posttreatment. Pretreatment levels of deviant behavior also predicted the use of marijuana at 6-month follow-up. Peer substance use at intake and 6-month posttreatment both predicted substance use frequency outcomes at 12-month follow-up. Alcohol and marijuana use frequencies at 6-month follow-up also predicted continued use for these substances throughout the remainder of the 1st posttreatment year. Shorter treatment length and being male were risk factors for alcohol use during the 2nd half of the 1st posttreatment year. Elevated psychological substance dependence at 6-month follow-up was a unique risk factor for subsequent marijuana use. Latimer, W.W., Winters, K.C., Stinchfield, R., and Traver, R.E. Psychol Addict Behav, 14(2), 162-173, 2000.