Drug Abuse Prevention

Research Findings from February, 1998 Director's Report

This section lists selected summaries from NIDA funded research projects that investigate youth drug abuse prevention. 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.

Sequence of Drug Use among Serious Drug Users: Typical vs Atypical Progression

The "typical" sequence of drug use onset identified in previous studies (alcohol, then marijuana, followed by other illicit drugs) was found to be much less prevalent among serious drug users than in samples of high school students. Sequence of drug use was examined in a secondary analysis of two samples of serious drug users: one of 152 men and one of 133 women. The data were collected in ethnographic studies of adult drug users and distributors in New York City between 1984 and 1987. The proportions of drug users following specified patterns of drug use onset were compared to proportions obtained in previous research in samples of high school youth, and serious drug users. Only 33% of the serious drug users followed the typical sequence, compared to 75-93% of subjects in previous studies of high school students. The serious drug users were more likely to have used marijuana before using alcohol, and more likely to have used other illicit drugs before using marijuana. In addition, atypical sequencing was associated with earlier initiation of the use of illicit drugs other than marijuana and greater lifetime drug involvement. These findings suggest that for a large number of serious drug users, marijuana does not play the role of a gateway drug. Prevention efforts that focus on alcohol and marijuana may be of limited effectiveness for youth who are at risk for serious drug abuse. Mackesy-Amiti, M.E., Fendrich, M., and Goldstein, P.J. Drug and Alcohol Dependence, 45, pp. 185-196, 1997.

Violence, Suicidality, and Alcohol/Drug Use Involvement in Adolescent Females with a Psychoactive Substance Use Disorder and Controls

This study had three aims: (1) to determine the relationship between behavioral dysregulation, negative affectivity, and familial impairment with violence and suicidality (i.e., severity of ideation and attempts) in a sample of adolescent females with a psychoactive substance use disorder and controls; (2) to determine whether these relations are mediated by internalizing (depression/anxiety) and externalizing (nonviolent antisocial behavior) symptomatology; and (3) to determine whether severity of alcohol/drug use involvement moderates the relations between the mediating variables with violence and suicidality. Multiple behavioral, psychiatric interview, and self-report measures were used to index behavioral dysregulation, negative affectivity, familial impairment, internalizing and externalizing symptomatology, and violence and suicidality in 161 14- to 18- year old adolescent females with a psychoactive substance use disorder and in 80 controls. Structural equation modeling was used to determine the proposed relations. Results indicated that behavioral dysregulation, negative affectivity, and familial impairment were related to violence, whereas only familial impairment was related to suicidality. Internalizing symptomatology mediated the relation between familial impairment and suicidality, and was related to violence, where as externalizing symptomatology mediated the relations between behavioral dysregulation, negative affectivity, and familial impairment with violence. Severity of alcohol/drug use involvement did not moderate the relations between internalizing or externalizing symptomatology with suicidality or violence. Nevertheless, the relation between internalizing symptomatology and suicidality was stronger in females with a greater degree of alcohol/drug use involvement, compared with those with a milder degree of involvement. Therefore, from a prevention standpoint, behavioral dysregulation, negative affectivity, familial impairment, as well as internalizing and externalizing symptoms, may serve as clinical "points of intervention" for altering the development of violence and suicidality in high risk and substance abusing youth. Mezzich, A.C., Giancola, P.R., Tarter, R.E., Lu, S., Parks, S.M., and Barrett, C.M. Alcoholism Clinical and Experimental Research, 21 (7), pp. 1300-1307, 1997.

Associations Between Attention Deficit Hyperactivity Disorder (ADHD) and Psychoactive Substance Use Disorders (PSUD)

In a sample of siblings of ADHD and non-ADHD probands, ADHD, conduct disorder, anxiety disorders, and male gender in the sibling were associated with higher rates of PSUD. There was also a statistical interaction between ADHD and conduct disorder in which nearly all siblings with both disorders had PSUD and a particularly early onset of that disorder. Using DSM-III-R structured diagnostic interviews and blind raters, a four-year follow-up of siblings from ADHD (N=152) and control families (N=117) was conducted. The mean age of the siblings was 17.3 (range 9 to 41) and roughly half were males. Information on PSUD was obtained in a standardized manner blind to the proband's clinical status. Cox proportional hazards models evaluated baseline diagnoses of ADHD and other psychiatric disorders (conduct, anxiety, and mood) as potential predictors of PSUD. These Cox analyses simultaneously controlled for confounding variables such as age, gender, intactness of family, and SES. These findings linking ADHD and PSUD could have significant public health significance. Since ADHD is a prevalent, childhood-onset disorder that is often characterized by impulsive behavior, it could represent a large group of youth at high risk for illicit drug use. Considering that the earliest age at onset of PSUD in our sample was 12 years and that the latest age at onset of ADHD is 7 years, there may be a window of several years where prevention and early intervention efforts could be targeted. Milberger, S., Biederman, J., Faraone, S.V., Wilens, T., and Chu, M.P. American Journal on Addictions, 6, pp. 318-329, 1997.

Risk and Protective Factors as Predictors of Adolescent Alcohol Involvement and Transitions in Alcohol Use: A Prospective Analysis

Determinants of initial alcohol use may differ from predictors of accelerated or problematic consumption. Social influences may be strong predictors of initial drinking; however, later stages of problem drinking may be linked developmentally to intrapersonal deficits. This study prospectively examined the influence of chronic and changing risk and protective status in predicting adolescent alcohol involvement and transitions in alcohol use. Data were obtained from a three-wave cohort (N=823) of 8th- 10th grade nonintervention students participating in a school-based drug abuse prevention trial. Cognitive, attitudinal and social influence measures were dichotomized using empirical cut-offs to designate risk or protective status. Using a conceptually based assignment scheme, additive risk indices were created assessing chronic (averaging across time) and changing features of competence, psychological and interpersonal functioning, cognitive-affective and social influences. Three chronic and change protective indices were created tapping competence, psychological, and interpersonal functioning. Controlling for initial drinking and gender, chronic risk for social influence and psychological functioning and increased risk for social influences and competency predicted subsequent drinking behavior. Chronic psychological protection attenuated subsequent drinking. Using categorical measures of drinking behavior to designate nonuse, experimental or moderate-heavy use, chronic social influence and competency risk were associated with an increased likelihood of accelerated drinking, whereas improved psychological functioning diminished the likelihood of increased drinking behavior. Findings underscore the need for implementing prevention strategies that reinforce developmentally appropriate skills and enhance personal competence and psychological functioning as effective barriers against initial and more problematic alcohol use. The unique contribution of protective forces also underscores that risk reduction and protection enhancement are complementary processes and are both required to offset social influences for alcohol consumption. Scheier, L.M., Botvin, G.J., and Baker, E. Journal of Studies Alcohol, 58, pp. 652-667, 1997.

Effects of Community Intervention on Drug Use among High Risk Adolescents

In a study of the second site for the Midwestern prevention project (Indianapolis), 3 years effects of a multi-component community-based drug abuse prevention program were evaluated on a panel sample of 3400 students from 57 junior high schools who were randomly assigned to a program or control condition. The study, which has already shown sustained effects on delaying drug use onset and decreasing population-based use prevalence, evaluated effects on decreasing drug use among baseline users, a high risk sample. Results showed significant effects by decreasing drug use among users for tobacco, alcohol, and marijuana. The study counters a commonly held belief that primary prevention works only with non-users or occasional users. Chou, C.P., Montgomery, S.B., Pentz, M.A., Rohrbach, L.A., Johnson, C.A., Flay, B.R., & Mackinnon, D. Effects of a Community-Based Prevention Program on Decreasing Drug Use in High Risk Adolescents. American Journal of Public Health, In Press.

Role of Acculturation in Substance Use among Latino Adolescents

In a study of at-risk multi-ethnic middle school students, 448 Latino adolescents ranging in age from 11 to 14 completed measures of social influence variables (attitudes, subjective norms, and perceived behavioral control), intentions toward substance use, and acculturation. Language use/exposure was not significantly related to the social influence variables nor intentions to use alcohol, cigarettes, and marijuana. However, increased interaction with non-Latino peers was positively related to attitudes and perceived peer norms against substance use. In addition, for those of high acculturation, perceived normative expectations against substance use by referent others appeared to play a key role in future substance use. For those of low acculturation, attitudes against substance use appeared to have a stronger impact on avoidance of future substance use. The findings of this study are relevant to increasing the effectiveness of substance use prevention programs targeting Latino adolescents. Interventions that address risk and protective factors of substance use in Latino adolescents may consider measuring various components of acculturation. Carvajal, S.C., Photiades, J.R., Evans, R.I., & Nash, S.G. Relating a Social Influence Model to the Role of Acculturation in Substance Use among Latino Adolescents. Journal of Applied Social Psychology, pp. 1617-1628, 1997.

Consequences of Sexual Assault

Data were obtained from a nonclinical sample of 1,121 Mexican American and White non-Hispanic adolescent females. The three hundred and three participants who reported being sexually assaulted were compared to the 793 who reported no history of sexual assault on a number of psychosocial characteristics. Although rates of sexual assault differed across ethnicity, ethnicity did not influence the relationship between sexual assault and psychosocial characteristics of victims. Results indicated that sexual assault victims reported more emotional distress, more social isolation and more deviant behaviors than non-victims. Sexual assault victims also reported poorer school adjustment, were more like to affiliate with deviant peers, and were more likely to come from homes in which there was parental substance use and family conflict. Arellano, C.M., Kuhn, J.A., & Chavez, E.L. Psychosocial Correlates of Sexual Assault Among Mexican American and White Non-Hispanic Adolescent Females. Hispanic Journal of Behavioral Sciences, 19 (4), pp. 446-460, 1997.

Effects of a Family-Based Prevention Intervention

A number of family-related factors have been identified that contribute to the risk for or protection against initiation of substance use and other problem behaviors as children move from childhood into early adolescence. This article reports results from an experimental test of the effects of Preparing for the Drug Free Years (PDFY) on targeted parental behaviors. PDFY is based on the social development model; it seeks to reduce risks and enhance protection against early substance abuse initiation by improving patterns of parental behavior and family interaction. The sample consisted of economically stressed, rural Midwestern families. Consistent with hypotheses, the program increased proactive communications between parents and children. Specifically, following the program, intervention group mothers exhibited more proactive communications in general and in problem solving tasks and less negative interactions with their children than did the control group mothers. Intervention group fathers exhibited significantly more proactive communications with children in problem solving situations than did the control group fathers. Kosterman, R., Hawkins, J. D., Spoth, R., Haggerty, K.P., & Zhu, K. Effects of ÔPreparing for the Drug Free Years' on Parenting Behavior and Family Interactions. Journal of Community Psychology, 25(4), pp. 337-352, 1997.

Program Evaluation Approaches for Prevention Data

Recent literature underscores the need for studies of family-based preventive interventions oriented toward public health. This article illustrates a program evaluation approach that is especially suitable to the study of family intervention outcomes in general populations. Thirty-three rural schools were randomly assigned to one of three conditions: the Preparing for the Drug Free Years Program (PDFY), the Iowa Strengthening Families Program (ISFP), and a minimal contact control group. Self-report and observational data collected for 523 families were used to develop measurement models of the three latent parenting constructs that included measurement methods effects. Analyses were conducted (a) to assure initial and attrition-related group equivalencies and (b) to assess school level effects. Structural equation models of the hypothesized sequence of direct and indirect effects for both PDFY and ISFP were then fitted to the data. All hypothesized effects were significant for both interventions. The discussion addresses the potential public health benefits of evaluation research on universal prevention interventions. Spoth, R., Redmond, C., and Shin, C. Direct and Indirect Latent Variable Parenting Outcome of Two Universal Family-Focused Prevention Interventions: Extending a Public Health-Oriented Research Base. Journal of Consulting and Clinical Psychology, In Press.

Cigarette Smoking in Young Adults: Childhood and Adolescent Personality, Familial and Peer Antecedents

Prior research has demonstrated a complex interplay of a number of distinct psychosocial risk factors as they relate to cigarette smoking in young adults. In addressing the risk factors associated with tobacco use by young adults, this study examined: (1) the identification of the specific childhood and adolescent risk factors; (2) the interrelation of personality, family, and peer factors and (3) the extent to which the behaviors related to tobacco use vary by developmental stage. Three models (independent, mediational, and interdependent) were hypothesized to examine the interrelation of these variables and their effects on young adult cigarette smoking. At initial data collection, mothers were interviewed about their children when they were between the ages of 1 and 10. Three subsequent interviews were conducted with the children when they reached adolescence and young adulthood. Results show support for the mediational model and are in accord with the family interactional framework conceptions, developed to examine the pathways that lead to adolescent legal and illegal drug use and other problem behavior. There was a sequence in patterning from parenting during early adolescence to personality and peer factors extending to late adolescent smoking, and culminating in adult smoking. More specifically, difficulty in the parent-child relationship was related to tobacco-prone personality characteristics. Using a developmental approach, a number of psychosocial measures were found to be related in both younger and older children. Nevertheless, some interesting developmental differences emerged. The findings suggest at least four possible targets for therapeutic or preventive intervention: the parent, the child, the adolescent, and the peer group. Brook, J.S., Whiteman, M., Czeisler, L.J., Shapiro, J., Cohen, P. The Journal of Genetic Psychology, 158 (2), pp. 172-188, 1997.

Assessing the Impact of the D.A.R.E. Program after Six Years

The long-term effectiveness of D.A.R.E. was assessed by contrasting drug use and other D.A.R.E.-related attitudinal latent variables among 356 12th-grade students who had received the program in the 6th grade with 264 others who did not receive it. A prior study of these subjects when they were in 9th grade had shown no significant differences. A follow-up survey in 12th grade assessed central D.A.R.E. concepts such as self-esteem, police bonds, delay of experimentation with drugs, and various forms of drug use. Although no relationship between prior D.A.R.E. participation and later alcohol use, cigarette smoking, or marijuana use in 12th-grade was found, there was a significant relationship between earlier D.A.R.E. participation and less use of illegal, more deviant drugs (e.g., inhalants, cocaine, LSD) in a development sample although not in a validation sample. Further analyses indicated that this effect was significant for the males and nonsignificant for the females. Findings from the two studies suggest a possible "sleeper effect" for D.A.R.E. in reference to use of harder drugs, especially among teenage males. Dukes, R., Stein, J.A., and Ullman, J.B. Evaluation Review, 21, pp. 483-500, 1997.