Drug Abuse Prevention

Research Findings from September, 1999 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.

Attention Deficit Disorder and Substance Abuse

Timothy Wilens, M.D. and his colleagues at Harvard Medical School have shown that boys with attention deficit hyperactivity disorder (ADHD) who are treated with stimulants such as Ritalin are 84 percent less likely to abuse drugs and alcohol when they get older. Research showed that 75 percent of the non-medicated ADHD boys had at least one substance use disorder, compared to 25 percent of the medicated ADHD boys and 18 percent of the boys without ADHD. Researchers calculated that treating ADHD with stimulants was associated with an 84 percent reduction in risk of developing a substance use disorder. Rather than being concerned that boys with ADHD might be prescribed stimulant medication, scientists are now concerned when they are not. Appropriate treatment of ADHD appears to be quite helpful in preventing the later emergence of substance abuse in these vulnerable individuals with ADHD. The use of interventions in childhood to prevent the later emergence of substance abuse is a promising avenue for future research investigations. Biederman et al., Pediatrics, Vol 104(2), August 1999.

Deviance Training

Aggregating high-risk youth into groups can increase their substance use involvement and delinquency. Two random assignment studies are reviewed that reveal three-year and 30-year negative effects. These effects are most likely secondary to using high-risk peer groups to intervene. Analysis of videotaped interactions in the three-year outcome study and archival data in the 30-year study suggests that interest in and verbal and non-verbal expressions of deviancy within the group may increase investment in a delinquent lifestyle. "Deviance training" is defined as contingent positive reactions to rule breaking discussions. This study suggests a need for caution in using interventions that aggregate high-risk children in prevention and treatment. Dishion, T.J., McCord, J., and Poulin, F. Iatrogenic Effects that Aggregate High Risk Youth. American Psychologist, Vol. 54, September 1999.

Inhalant Use and Delinquent Behavior Among Adolescents

To evaluate the association between inhalant use and delinquent or criminal behavior, an analysis of a large statewide sample survey of high school students was conducted. Five groups were identified based on reported drug use: inhalant experimenters, other drug experimenters, inhalant users, other drug users and non-users. Inhalant users were compared with other drug users and inhalant experimenters with other drug experimenters on measures of problem behavior. Over 13,000 students in grades 7-12 participated in the 1993 survey on drug use. Three measures of problem behavior were included: drinking and drug-taking, "trouble behavior", and minor criminal activity. Among upper (9-12) grade level students only, both inhalant users and inhalant experimenters reported more minor criminal activity than other drug users and other drug experimenters, respectively. A similar trend was noted for trouble behavior. The same was not found for drinking and drug-taking behavior. The findings suggest that inhalant use is categorically different from other drug use, and that it has more in common with general delinquency than with general drug use. Prevention and treatment strategies should take this into consideration. Mackesy-Amiti, M.E. and Fendrich, M. Addiction, 94(4), pp. 555-564, 1999.

High Rate of Coexisting Psychiatric Disorders among Adolescents with Substance Use Disorders in the Community

To investigate the extent to which adolescents in the community with current substance use disorders (SUD) experience co-occurring psychiatric disorders, diagnostic data were obtained from probability samples of 401 children and adolescents, aged 14 to 17 years, and their mothers/caretakers, who participated in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Results indicate the rates of mood and disruptive behavior disorders are much higher among adolescents with current SUD than among adolescents without SUD. Comparison with adult samples suggests that the rates of current comorbidity of SUD with psychiatric disorders are the same among adolescents as adults, and lower for lifetime disruptive disorders/antisocial personality disorder among adolescents than adults. The high rate of coexisting psychiatric disorders among adolescents with SUD in the community needs to be taken into account in prevention and treatment programs.. Kandel, D.B., Johnson, J.G., Bird, H.R., Weissman, M.M., Goodman, S.H., Lahey, B.B., Regier, D.A., and Schwab-Stone, M.E. Psychiatric Comorbidity among Adolescents with Substance Use Disorders: Findings from the MECA Study. Journal of the American Academy of Child and Adolescent Psychiatry, 38(6), pp. 693-699, 1999.

Cloninger's Constructs Related to Substance Use Level and Problems in Late Adolescence

Cloninger's constructs of novelty seeking, harm avoidance, task-reward dependence, and social reward dependence have been related to smoking and alcohol use in adolescence and adulthood. A study at Yeshiva University tested the role of these constructs as mediators related to substance use level and substance use problems. Participants were 1,225 adolescents with average age of 15.5 years. Structural modeling showed indirect effects for novelty seeking, harm avoidance, and task reward dependence, mediated through self-control; harm avoidance also had an inverse direct path to substance use level. Social reward dependence had a positive direct path to coping motives for substance use. Good self-control had inverse paths to negative life events and deviant peer affiliations; poor self-control had positive paths to negative life events and coping motives; and risk taking had positive paths to coping motives and peer affiliations. These findings suggest that substance abuse prevention programs should incorporate components focusing on beliefs about the functions of substance use and that treatment programs for substance abusers should include self-control training that targets behavior patterns such as anger proneness and impulsive responding. Wills, T.A., Sandy, J.M., and Shinar, O. Cloninger's Constructs Related to Substance Use Level and Problems in Late Adolescence: A Mediational Model Based on Self-Control and Coping Motives. Experimental and Clinical Psychopharmacology, 7(2), pp. 122-134, 1999.

Drinking and Driving Among U.S. High School Seniors

This article reports the prevalence of, and trends in, driving after drinking and riding in a car with a driver who has been drinking among American high school seniors, based on data from more than a decade (1984-1997) of annual national surveys. Logistic regression was used to assess the effects of demographic factors (gender, region of country, population density, parental education and race/ethnicity) and selected "lifestyle" factors (religious commitment, high school grades, truancy, illicit drug use, evenings out per week, and miles driven per week). Rates of adolescent driving after drinking and riding with a driver who had been drinking declined significantly from the mid-1980s to the early or mid-1990s, but the declines have not continued in recent years. Rates of driving or riding after drinking were higher among high school seniors who are male, White, living in the western and northeastern regions of the United States, and living in rural areas. Truancy, number of evenings out, and illicit drug use all related significantly positively with the dependent variables, whereas grade point average and religious commitment had a negative relationship. Miles driven per week related positively to driving after drinking. O'Malley, P.M., and Johnston L.D. American Journal of Public Health, 89(5), pp. 678-684, 1999.

Adolescent School Experiences and Dropout, Adolescent Pregnancy, and Young Adult Deviant Behavior

Predictive effects of school experiences were studied over a 7-year interval in a random community sample of 452 adolescents, 12 through 18 years of age. Outcomes examined included dropping out of school, adolescent pregnancy, engaging in criminal activities, criminal conviction, antisocial personality disorder, and alcohol abuse. Logistic regression showed academic achievement, academic aspirations, and learning-focused school settings to be related to a decline in deviant outcomes independent of the effects of disadvantaged socioeconomic background, low intelligence, childhood conduct problems, and having deviant friends during adolescence. Associations between school conflict and later deviancy were mediated by deviant peer relationships in adolescence and other school characteristics. Prior research reporting continuity of childhood conduct problems and the influence of adolescent affiliations with deviant peers on negative outcomes was supported. Implications for using the school context in risk factor research and the practical applications of such research for intervention are discussed. Kasen, S., Cohen, P., and Brook, J.S. Journal of Adolescent Research, 13 (1), pp. 49-72, 1998.

Parents Educational Attainment Influences Prevention Assessment Attrition

This study examined whether family risk factors predict attrition in a prevention intervention project that incorporated procedures to increase retention in assessment and intervention activities. Data from 667 rural families collected in four waves were analyzed. Data consisted of young adolescent and parent reports of internalizing and externalizing problems, observer rating of distress in parent-child interactions, and family socioeconomic status (SES). SES was a significant predictor of assessment attrition: follow-up analyses indicated that this relationship was due to lower educational attainment rather than income. None of the social-emotional or SES factors examined predicted intervention participation. Spoth, R., Goldberg, C., and Redmond, C. Engaging Families in Longitudinal Preventive Intervention Research: Discrete-Time Survival Analysis of Socioeconomic and Social-Emotional Risk Factors. Journal of Clinical and Consulting Psychology, 67(1), pp. 157-163, 1999.

Vulnerability to Drug Use Among Latino Adolescents

In this study, risk and protective factor indices were developed to examine vulnerability to drug use among Latino high school students. Survey data were collected from 516 Latino 9th and 10th grade youth in the Los Angeles area. Frequency and quantity of use data were collected for cigarettes, alcohol, marijuana, inhalants, cocaine, and other illicit drugs. Few gender differences emerged in prevalence of drug use and about 25% were already involved in heavy drug use. Seventeen variables were examined for inclusion in a risk factor index (RFI) or protective factor index (PFI). Bivariate, multivariate, and structural equation models (SEM) were employed in the analysis of data. All of the variables except for one were more risk-inducing than protective for these Latino youth. However, as a group, the PFI predicted several types of drug use for boys and girls, and moderated the adverse effects of the RFI. At a high level of risk, a high level of protection was associated with reduced use for some types of drugs. In the SEM, vulnerability to drug use as indicated by the RFI and PFI was strongly associated with drug use for both boys and girls and more strongly related to drug use than the RFI or PFI alone. These results have exciting implications for intervention. Felix-Ortiz, M. and Newcomb, M.D. Journal of Community Psychology, 27(3), pp. 257-280, John Wiley & Sons, Inc., 1999.

Family and Peer Correlates of Behavioral Self-Regulation in Boys at Risk for Substance Abuse

A study at CEDAR focused on behavioral self-regulation (BSR), which was operationally defined as the degree to which one can control one's own activity and reactivity to environmental stimuli. BSR has been posited to be an important determinant of the onset of adolescent substance abuse. The goal of this study was to clarify particular family and peer correlates of BSR in at-risk sons. Subjects were 10-12-year-old sons of substance- abusing fathers (high-average risk [HAR]; n = 176) and normal controls (low-average risk [LAR]; n = 199). A BSR latent trait was developed using multiple measures and multiple informants. Analyses included separate hierarchical linear regressions for HAR and LAR groups. In the hierarchical linear model for HAR sons, family dysfunction and deviant peer affiliation were significantly associated with BSR, whereas for LAR sons, only peer affiliation was significantly associated with BSR. These findings suggest that empirical, theory-guided interventions to prevent worsening of BSR in HAR boys should address specific interpersonal family, and peer factors. Dawes, M., Clark, D., Moss, H. Kirisci, L., and Tarter, R. American Journal of Drug and Alcohol Abuse, 25(2), pp. 219-237, 1999.

Social Influence and Psychological Determinants of Smoking Among Inner-City Adolescents

Adolescent economically disadvantaged households appear at high risk for smoking. This study focused on a sample of economically disadvantaged adolescents attending New York City schools (N=1875). Longitudinal predictors of smoking from four domains (socio-demographic background, social influences, social and personal competence, and individual differences) were tested. Social influences to smoke from mothers and friends both predicted smoking one year later. Poor decision-making skills and low psychological well-being also predicted subsequent smoking. Results suggest that training adolescents to resist social influences to smoke, problem solve, make sound decisions, and to cope with psychological distress are key components for effective smoking prevention approaches. Epstein, J.A., Botvin, G.J., and Diaz, T. Social Influence and Psychological Determinants of Smoking Among Inner-City Adolescents. Journal of Child & Adolescent Substance Abuse, 8(3), pp. 1-19, 1999.

Marijuana Use Among Minority Youths Living in Public Housing Developments

Youths residing in public housing developments are at heightened risk for drug use. The purpose of this study was to develop and test a model of marijuana etiology with adolescents (N=624) residing in public housing. African-American and Hispanic seventh graders completed questionnaires about their marijuana use, social influences to smoke marijuana, and sociodemographic and psychosocial characteristics. Results indicate that social influences, such as friends' marijuana use and perceived ease of availability of marijuana significantly predicted both occasional and future intentions to use marijuana. Individual characteristics such as anti-marijuana attitudes and drug refusal skills also predicted marijuana use. The findings imply that effective prevention approaches that target urban youths residing in public housing developments should provide them with an awareness of social influences to use marijuana, correct misperceptions about the prevalence of marijuana smoking, and train adolescents in relevant psychosocial skills. Williams, C, Epstein, J., Botvin, G.J., and Ifill-Williams, M. Marijuana Use Among Minority Youths Living in Public Housing Developments. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 76(1), pp. 85-101, 1999.

Comparison of Live and Video Prevention Messages

A Perception of Performance Scale was developed to compare delivery of a single drug prevention message which was modified into one of two modalities: live performance versus video performance. Scale development was undertaken in a pilot study with 334 undergraduate students at a large university in the southwestern U.S. Exploratory and Confirmatory Factor Analysis showed the scale had three dimensions; identification, interest, and realism with reliabilities of .86, .89 and .90, respectively. The main study consisted of 465 students (52% female, 75% European American, 12% Hispanic, and 13% other) in a single high school who were randomly assigned to either performance condition. Results indicate that live performance was significantly more interesting and realistic than video performance, suggesting that live performance may be a more effective medium for engaging high school aged youth. Miller, M., Hecht, M. & Stiff, J. An Exploratory Measurement of Engagement of Live and Film Media. Journal of the Illinois Speech and Theatre Association, 49, pp. 69-83, 1998.

Close Parent-Child Bond Mitigates Risks of Adolescent Drug Use and Delinquency

A study was conducted to identify general and differentiating risk and protective factors from domains of culture and ecology, peer, family, and personality, related to adolescent delinquency and marijuana use, and to examine the protective role of the parent-child mutual attachment in offsetting cultural and ecological risk factors, leading to less delinquency and marijuana use. The study design consisted of a cross-sectional analyses of interview data collected in Colombia. A total of 2837 Colombian adolescents, 12 to 17 years of age participated. Adolescents were interviewed in their homes. Independent variables included measures from 4 domains: culture and ecology, peer, family, and personality. The dependent variables were delinquency and marijuana use. Results show that several risk factors, such as tolerance of deviance and sensation seeking, were similarly related to both delinquency and marijuana use, suggesting that a common cause underlies the propensity to engage in different deviant behaviors. Some risk factors were more involved in delinquency and other risk factors were more highly related to the adolescent's marijuana use. Finally, when violence is endemic and illegal drugs are readily available, a close parent-child bond was capable of mitigating these risk factors, leading to less marijuana use and delinquency. The findings have implications for public health policy related to interventions in countries in which violence and drug use are prevalent. The results point to intervention procedures aimed at adolescents vulnerable to marijuana use and delinquency as well as efforts aimed at specific vulnerabilities in these areas. For example, reducing the risk factors and enhancing the protective factors for marijuana use and delinquency may result in less adolescent marijuana use and delinquency. Brook, J., Brook, D., De La Rosa, M., Whiteman, M., and Montoya, I. The Role of Parents in Protecting Colombian Adolescents from Delinquency and Marijuana Use. Arch Pediatr Adolesc Med, 153(5), pp. 457-64, 1999.