Drug Abuse Prevention

Research Findings from May, 2000 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.

Competence Skills Help Deter Smoking Among Inner City Adolescents

This study tested whether higher levels of general competence are linked to more frequent use of refusal assertiveness, that is in turn related to less subsequent smoking among inner city adolescents. It was based on a longitudinal study conducted during a 3-year middle school or junior high school period. A sample of 1459 students attending 22 middle (ages 11-14 years) and junior high (ages 12-15 years) schools in New York City participated. Students completed surveys at baseline, one year follow up, and two year follow up. The students self reported smoking, decision making skills, personal efficacy, and refusal assertiveness. Teams of three to five data collectors administered the questionnaire following a standardized protocol. These data were collected in school during a regular 40 minute class period. Results from structural equation modeling showed that decision making and personal efficacy (that is, general competence) predicted higher refusal assertiveness and this greater assertiveness predicted less smoking at the two year follow up. The tested model had a good fit and was parsimonious and consistent with theory. The authors concluded that smoking prevention programs often teach refusal skills in order to help youth resist peer pressure to smoke. The present findings suggest that teaching general competence skills may help to reduce smoking because youth with better personal efficacy and decision making skills are better able to implement smoking refusal strategies. Epstein, J.A., Griffin, K.W., Botvin, G.J. Competence Skills Help Deter Smoking Among Inner City Adolescents. Tobacco Control, 9(1), pp. 33-39, 2000.

Developmental Associations between Substance Use and Violence

In a study of the developmental associations between substance use and violence, investigators focused on the trends in each behavior throughout adolescence, how the behaviors covaried over time, and the symmetry of associations taking into account frequency and severity of each behavior. They also examined whether changes in one behavior affected changes in the other behavior over time. Six years of annual data were analyzed for 506 boys who were in the 7th grade at the first assessment. Concurrent associations between frequency of substance use and violence were relatively strong throughout adolescence and were somewhat stronger for marijuana than alcohol, especially in early adolescence. Type or severity of violence was not related to concurrent alcohol or marijuana frequency, but severity of drug use was related to concurrent violence frequency. Depending, to some degree, on the age of the subjects, the longitudinal relationships between substance use and violence were reciprocal during adolescence and slightly stronger for alcohol and violence than for marijuana and violence. Further, increases in alcohol use were related to increases in violence; however, when early alcohol use was controlled, increases in marijuana use were not related to increases in violence. Only in early adolescence was the longitudinal relationship between marijuana use and later violence especially strong. The strength of the longitudinal associations between violence and substance use did not change when common risk factors for violence and substance use were controlled. Overall, the data lend more support for a reciprocal than for a unidirectional association between substance use and violence. Prevention efforts should be directed at aggressive males who are multiple-substance users in early adolescence. White, H.R., Loeber, R., Stouthamer-Loeber, M., Farrington, D.P. Developmental Associations between Substance Use and Violence. Development and Psychopathology, 11(4), pp. 785-803, 1999.

Childhood Peer Rejection and Aggression Predicting Delinquency in Adolescence

In this study sociometric surveys were completed at third grade for a predominantly low-socioeconomic status, urban sample of African American boys and girls, and youth reports of delinquency were gathered at grades 6, 8, and 10. Results showed that patterns of association between childhood peer rejection and aggression and delinquency severity varied by gender. For boys, the additive effect of childhood peer rejection and aggression was a strong predictor of more serious delinquency, whereas for girls only aggression predicted more serious delinquency. For boys, the combination of peer rejection and aggression was associated with felony assaults, and aggression was associated with a wide variety of offenses during adolescence, whereas for girls only peer rejection predicted involvement in minor assault. Results of the study were discussed in terms of the early starter pathway of antisocial behavior as it relates to peer rejection and aggression for boys, differing predictive patterns for girls, and implications for intervention with children with emotional and behavioral disorders. Miller-Johnson, S., Coie, J.D., Maumary-Gremaud, A., Lochman, J., and Terry, R. Relationship Between Childhood Peer Rejection and Aggression and Adolescent Delinquency Severity and Type Among African American Youth. Journal of Emotional and Behavioral Disorders, 7 (3), pp. 137-146, 1999.

Outcomes of Universal Family-Focused Preventive Interventions: One- and Two-Year Follow-ups of a Controlled Study

This article summarizes the literature on alcohol initiation outcomes of universal family interventions and examines the long-term effects of the Iowa Strengthening Families Program (ISFP), a drug abuse prevention program. The ISFP was a longitudinal, controlled efficacy study with 446 families from 22 rural school districts. Alcohol initiation has been shown to be a precursor to drug initiation. In this study, a four-item index of alcohol initiation was used (Alcohol Initiation Index - AII), with low scores representing a lower level of initiation. Higher- and lower-dosage intervention groups were compared on individual initiation behaviors. AII scores were significantly lower among intervention group adolescents than among control group adolescents (e.g., onset of drinking without parental permission, onset of drunkenness) ranged from approximately 30% to 60% lower) at one- and two-year follow-up assessments. Intervention dosage-related initiation differences were evident only at the one-year follow-up. Spoth, R., Redmond, C., & Lepper, H. Alcohol Initiation Outcomes of Universal Family-Focused Preventive Interventions: One- and Two-Year Follow-ups of a Controlled Study. Journal of Studies on Alcohol, (Suppl. 13), pp. 103-111, 1999.

Initial Positive Impact of Using Fast Track with A High Risk Child Sample

Fast Track is a multisite, multicomponent preventive intervention for young children at high risk for long-term antisocial behavior. Based on a comprehensive developmental model, the intervention included a universal-level classroom program plus social skills training, academic tutoring, parent training, and home visiting to improve competencies and reduce problems in a high-risk group of children selected in kindergarten. Results at the end of first grade showed moderate positive effects on children's social, emotional, and academic skills, peer interactions and social status, and conduct problems and special-education use. Parents reported less use of physical discipline, greater ease and/or satisfaction in parenting, more positive involvement with their children, and increased school involvement. There was minimal evidence of differential intervention effects across child gender, race, site, and cohort. Bierman, K.L., Coie, J.D., Dodge, K.A., Greenberg, M.T., Lochman, J.E., McMahon, R.J., and Pinderhughes, E.E. Initial Impact of the Fast Track Prevention Trial for Conduct Problems: I. The High-Risk Sample. Journal of Consulting and Clinical Psychology, 67 (5), pp. 631-647, 1999.

Effectiveness of the PATHS Curriculum and Teacher Consultation in the Fast Track Prevention Model

Protective Effect of Social-Environmental Factors on Future Drug Use

This research focuses on the interrelation of the parent-child attachment, 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, .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.

Predicting Boys' Externalizing Behavior and Risk of Developing Substance Use Disorder

Applying an ontogenetic framework for understanding the development of substance use disorders (SUD), researchers at the Pennsylvania State University and the University of Pittsburgh examined individual traits in family context to identify processes that account for the relationship between fathers' substance use (SUD+ or SUD-) status and sons' externalizing behaviors. Results obtained from SUD+ (n = 89) and SUD- (n = 139) families show that fathers' abusive propensities toward their sons mediated the relationship between fathers' SUD+ status and sons' externalizing behavior scale (EBS) scores 2 years later. Thus, fathers' abusive propensities toward their sons may reflect a process in which SUD liability is transmitted, in part, through a harsh, unnurturing family. Individual traits, family contextual variables, and deviant peer affiliations accounted for 58 percent of the variance on sons' EBS scores. The authors speculate that children reared in harsh, controlling family contexts may develop callous traits such as lack of empathy for others, and such traits in children have been associated with greater levels of conduct problems. They conclude that family-based prevention programs that take account of members' temperament traits and the abusive propensities of parents toward offspring may help to reduce children's liability to Conduct Disorder and Substance Use Disorder outcomes. Blackson, T.C., Butler, T., Belsky, J., Ammerman, R.T., Shaw, D.S., and Tarter, R.E. Individual Traits and Family Contexts Predict Sons' Externalizing Behavior and Preliminary Relative Risk Ratios for Conduct Disorder and Substance Use Disorder Outcomes. Drug and Alcohol Dependence, 56(2), pp. 115-131, 1999.

Hormonal and Behavioral Homeostasis in Boys at Risk for Substance Abuse

A study at the Center for Education and Drug Abuse Research (CEDAR) at the University of Pittsburgh examined the influences of cortisol reactivity, androgens, age-corrected pubertal status, parental personality, and family and peer dysfunction on behavioral self-regulation (BSR) in boys at high average risk (HAR) and low average risk (LAR) for substance abuse. Differences between risk groups in cortisol and androgen concentrations, and cortisol reactivity were also examined. Subjects were 10-12-year-old sons of substance abusing fathers (HAR; n = 150) and normal controls (LAR; n = 147). A multidimensional construct of BSR was developed based on multiple measures and multiple informants. Boys reported on family dysfunction and deviant behavior among their peers. Parents reported on their propensity to physically abuse their sons, and their own number of DSM-III-R Antisocial Personality Disorder symptoms. Endocrine measures included plasma testosterone, dihydrotestosterone, and salivary cortisol. HAR boys, compared to LAR boys, had lower mean concentrations for testosterone, dihydrotestosterone, salivary cortisol prior to evoked related potential testing, and lower cortisol reactivity. The number of maternal Antisocial Personality Disorder symptoms, parental potential for physical abuse, degree of family dysfunction, and peer delinquency were significantly associated with BSR. Parental aggression, antisocial personality symptoms, and parental physical abuse potential are likely to influence sons' behavioral dysregulation and homeostatic stress reactivity. These key components of liability are posited to increase the likelihood of developing suprathreshold Psychoactive Substance Use Disorder (PSUD). The authors suggest that interventions to prevent exacerbation of poor behavioral self regulation should address family dysfunction and deviant peer affiliation as well as the severity of current BSR impairment. Dawes, M.A., Dorn, L.D., Moss, H.B., Yao, J.K., Kirisci, L., Ammerman, R.T., and Tarter, R.E. Hormonal and Behavioral Homeostasis in Boys at Risk for Substance Abuse. Drug and Alcohol Dependence, 55(1-2), pp. 165-176, 1999.

Parent-Child Conversations About Tobacco Use

In this study parents engaged their 6th- and 8th-grade daughters in a conversation about tobacco, using a pamphlet designed to encourage effective family communication about tobacco. Results indicated that parent-daughter conversations about tobacco use were successfully carried out in a nonaversive manner. The conversations were perceived to have gone well, with very little conflict reported. The daughters reported that the parental advice was helpful and they did not resist receiving such advice. The pamphlet topics most frequently discussed included: consequences of smoking as experienced by friends and relatives, difficulty of quitting, promotional tactics of tobacco companies, making rules about tobacco use, and deciding on the consequences of rules adherence or violation. Ary, D.V., James, L., and Biglan, A. Parent-Daughter Discussions to Discourage Tobacco Use: Feasibility and Content. Adolescence, 34 (134), pp. 275-282, 1999.

After-School Self-Care and Adolescent Smoking

This study examined the independent contributions of the setting and the intensity of after-school self-care to the cigarette smoking behaviors of 2,352 ninth graders. The authors found that the intensity of the self-care experience was significantly associated with adolescent smoking behavior irrespective of the typical setting of the adolescents' after-school activities. The findings indicated that a nonpermissive parenting style, family rule-setting about cigarettes, and in absentia parental monitoring may reduce the likelihood of cigarette smoking among both latchkey and nonlatchkey adolescents. Targeting these aspects of the home lives of all adolescents has the potential to reduce smoking behaviors among latchkey as well as nonlatchkey children. Mott, J.A., Crowe, P.A., Richardson, J., and Flay, B. After-School Supervision and Adolescent Cigarette Smoking: Contributions of the Setting and Intensity of After-School Self-Care. Journal of Behavioral Medicine, 22(1), pp. 35-58, 1999.

Long-term Outcomes of Two Universal Parenting Prevention Interventions

The present investigation extends prior work that reported findings on two universal family-focused preventive intervention programs. At posttest, each had direct effects on one proximal parenting outcome (intervention-targeted parenting behavior) and indirect effects on two global/distal outcomes (parent-child affective quality and general child management). A replication of the previously tested parenting outcome model was conducted with one-year follow-up data using procedures identical to those in the earlier study. Results of the present study (N = 404 families) indicate that statistically significant effects on parenting behaviors were sustained at the one-year period following the posttest. Redmond, C., Spoth, R., Shin, C., and Lepper, H. Modeling Long-Term Parent Outcomes of Two Universal Family-Focused Preventive Interventions: One-Year Follow-up Results. Journal of Consulting and Clinical Psychology, 67(6), pp. 975-984, 1999.

Drug Use and Personality Factors Affect Parent-Child Attachment Relationship

In this longitudinal study, data were collected during early adulthood in 1992 and in 1996/1997 via a structured questionnaire. The researchers assessed the extent to which participants' personality attributes, substance use, and relationships with their mothers predicted the quality of the parent-child bond. Participants with certain personality attributes (e.g., high sensitivity), less frequent marijuana use, or a close relationship with their mothers were found to have a greater likelihood of having a close parent-child attachment relationship with their own children at a later time. Results also showed that the risk of earlier substance use on the parent-child relationship was offset by protective factors in the parents' personality domain. In addition, protective factors in the various parental domains synergistically interacted with a low frequency of marijuana use, relating to a closer parent-child attachment relationship. The findings suggest that certain parenting styles are transmitted across generations and interventions in the personality and drug use domains can help increase the likelihood that parents will form close attachment relationships with their own children. Brook, J.S., Richter, L., and Whiteman, M. Effects of Parent Personality, Upbringing, and Marijuana Use on the Parent-Child Attachment Relationship. J. Am. Acad. Child. Adolesc. Psychiatry, 39(2), pp. 240-248, 2000.

Parentification and its Impact on Adolescent Children of Parents with AIDS

Parentification refers to children or adolescents assuming adult roles before they are emotionally or developmentally ready to manage those roles successfully. An assessment of the predictors and outcomes of parentification was made among adolescent children of Parents with AIDS (PWAs) in two phases. In Phase 1, relationships among parental AIDS-related illness, parent drug use, parent and adolescent demographics, and parentification indicators (parental, spousal, or adult role-taking) were assessed among 183 adolescent-parent pairs (adolescents: 11 to 18 years, M = 14.8 years, 54 percent female; parents: 80 percent female). Adult role-taking was associated with maternal PWAs, female adolescents, and greater parent drug use. Greater parental AIDS-related illness predicted more spousal and parental role-taking. Parent drug use predicted more parental role-taking. In Phase 2, the impact of parentification on later adolescent psychological adjustment was examined (N = 152 adolescents). Adult role-taking predicted more internalized emotional distress; parental role-taking predicted externalized problem behaviors, sexual behavior, alcohol and marijuana use, and conduct problems. Given these dysfunctional outcomes, interventions to mitigate parentification among children of PWAs are discussed. Stein, J.A., Riedel, M., Rotheram-Borus, M.J. Parentification and Its Impact on Adolescent Children of Parents with AIDS. Family Process, 38(2), pp. 193-208, 1999.

The Minnesota DARE PLUS Project:

Creating Community Partnerships to Prevent Drug Use and Violence The Minnesota DARE PLUS Project is a randomized trial of 24 schools and communities. Students in eight schools receive the usual junior high Drug Abuse Resistance Education (DARE) curriculum in the 7th grade; eight schools receive the curriculum with the addition of parent involvement, peer leadership, and community components in the 7th and 8th grades; eight schools serve as controls. This article describes the background and conceptualization, the curriculum, the added intervention components, and the evaluation strategy for the DARE PLUS Project. Perry, C.L., Komro, K.A., Veblen-Mortenson, S., Bosma, L., Munson, K, Stigler, M., Lytle, L.A., Forster, J.L., and Welles, S.L. The Minnesota DARE PLUS Project: Creating Community Partnerships to Prevent Drug Use and Violence. J. School Health. 70(3), pp. 84-88, 2000.

Examining Ethnic-Group Differences in the Predictors of Substance Use

The authors describe some approaches to studying ethnic-group differences in the predictors of substance use. They include probing for mediators, multisample analyses of structural models and an experimental trial of a preventive intervention. In their studies they found some ethnic-group differences as well as many similarities in the structure of constructs and the relationships between variables. It was noted that the challenge for researchers is using appropriate research methods for studying ethnicity, uncovering the basis for ethnic-group differences when they occur, knowing when statistical differences are meaningful, and acknowledging when developmental models are comparable. Barrera, M., Castro, F.G., and Biglan, A. Ethnicity, Substance Use, and Development: Exemplars for Exploring Group Differences and Similarities. Development and Psychopathology, 11 (4), pp. 805-822, 1999.

Safety First: A Reality-Based Approach to Teens, Drugs, and Drug Education

This monograph reviews findings from research on the epidemiology and etiology and of drug abuse among young people and drug abuse prevention programs. It presents the information in terms appropriate for policy makers, program designers and evaluators, and laymen to rethink approaches to prevention of drug abuse. She concludes there are fundamental problems with drug education because the foundations of conventional school-based drug education are fundamentally flawed. Many programs are based on the conviction that any use of illegal drugs is inherently pathological, an indication that something is wrong, whereas alternative explanations acknowledge the importance of culture. As a sociologist, she notes that American people and their children are bombarded with messages that encourage them to imbibe and medicate with a variety of substances, including alcohol, tobacco, caffeine, and prescription drugs. Fifty-one percent of Americans use alcohol regularly and one-third have tried marijuana at some time. Teenage drug use appears to mirror American proclivities. Dr. Rosenbaum's review of the literature arrives at a reality-based alternative: safety-first drug education. The first assumption of safety-first drug education is that teenagers can make responsible decisions if given honest, science-based drug education (students were motivated to quit using marijuana for health reasons or negative drug effects they themselves experienced or learned about from sources they trust). The second assumption of safety first is that total abstinence may not be a realistic alternative for all teenagers. Proclaiming a drug-free American culture by some arbitrary date is not deemed realistic, but reduction of drug use and drug problems is realistic and a key measure of success. A third assumption of safety-first drug education is to differentiate between use, abuse, and dependency. The youthful user must know he/she is not trapped and has a choice and can reduce use and influence the outcome. Dr. Rosenbaum's book provides scientific support for these positions and some guidelines for developing safety-first drug education to equip students with information they can trust and use as a the basis for making responsible decisions. Rosenbaum, M. Safety First: A Reality-Based Approach to Teens, Drugs, and Drug Education. San Francisco, CA: The Lindesmith Center, pp. 1-12, 1999.