Prevention of Adolescent Substance Use

Research and evaluation in the domain of adolescent alcohol and drug use indicates the important role of parents in promoting as well as in preventing substance use by their offspring. The role of parents in a comprehensive substance use prevention program is described wherein parents were involved in education, treatment, and counseling.     

The Social Contextual Approach and Rural Adolescent Substance Use: Implications for Prevention in Rural Settings

Adolescents in rural areas use substances at rates comparable to urban adolescents; understanding causes of rural adolescent substance use is critical if prevention efforts are to succeed. The present review has three primary goals: (1) to define rural, (2) to evaluate the empirical evidence regarding correlates and causes of rural adolescent substance use from a social contextual framework (L. V. Scaramella, R. D. Conger, R. Spoth, & R. L. Simons, in press), and (3) to discuss the malleability of theoretically based risk or protective factors in rural settings. The review concludes with a discussion of the difficulties and challenges of implementing prevention programs in rural areas.     

Smoking on School Property as a Risk Factor for Substance Use Among Adolescent Smokers

The purpose of the current study was to determine if smoking on high-school property was associated with increased risk for other substance use among U.S. adolescents. Secondary analyses were carried out with data from the 2011 Youth Risk Behavior Survey (YRBS, N = 15,503). Only adolescents who reported smoking at least one cigarette in the last 30 days were selected for analyses (n = 2531, 44% female). Alcohol, marijuana, and cocaine use was assessed among participants. Binary logistic regression analysis was carried out to examine the relationship between smoking on school property (yes versus no) with each of the substance use variables. Adolescent smokers who reported smoking on school property were significantly more likely to report substance use across all substances examined compared to smokers who did not smoke on campus. For example, campus smokers were 3.91 times more likely to use marijuana in their lifetime and 3.85 times more likely to have used crack or cocaine in their lifetime compared to smokers who did not smoke on campus. Health care providers who provide services to adolescents should screen for smoking on school property to help identify adolescents at increased risk for substance use.     

School Substance Use Norms and Racial Composition Moderate Parental and Peer Influences on Adolescent Substance Use

Parental and peer influences on adolescent substance use have been well demonstrated. However, limited research has examined how parental and peer influences vary across school contexts. This study used a multilevel approach to examine the effects of school substance use norms and school racial composition in predicting adolescent substance use (a composite measure of alcohol, tobacco, and marijuana use) and in moderating parental and peer influences on adolescent substance use. A total of 14,346 adolescents from 34 schools in a mid‐western county completed surveys electronically at school. Analyses were conducted using hierarchical linear modeling. Results indicated that school‐level disapproval against substance use and percentage of minority students at school were negatively associated with adolescent substance use. School‐level disapproval moderated the association between peer substance use and adolescent substance use, with the association being stronger when school‐level disapproval was lower. School racial composition moderated the influence of parental disapproval and peer substance use on adolescent substance use. Specifically, both the association between parental disapproval and adolescent substance use and the association between peer substance use and adolescent substance use were weaker for adolescents who attended schools with higher percentages of minority students. Findings highlighted the importance of considering the role of school contexts, in conjunction with parental and peer influences, in understanding adolescent substance use.     

Personality,Problem Solving,and Adolescent Substance Use

The major aim of this study was to examine the role of social problem solving in the relationship between personality and substance use in adolescents. Although a number of studies have identified a relationship between personality and substance use, the precise mechanism by which this occurs is not clear. We hypothesized that problem-solving skills could be one such mechanism. More specifically, we sought to determine whether problem solving mediates, moderates, or both mediates and moderates the relationship between different personality traits and substance use. Three hundred and seven adolescents were administered the Substance Use Profile Scale, the Social Problem-Solving Inventory–Revised, and the Personality Experiences Inventory to assess personality, social problem-solving ability, and substance use, respectively. Results showed that the dimension of rational problem solving (i.e., effective problem-solving skills) significantly mediated the relationship between hopelessness and lifetime alcohol and marijuana use. The theoretical and clinical implications of these results were discussed.     

Callous-Unemotional Traits as Unique Prospective Risk Factors for Substance Use in Early Adolescent Boys and Girls

Youth with elevated conduct disorder (CD) symptoms who also have callous-unemotional (CU) traits exhibit more antisocial behavior than youth without CU traits. However, evidence regarding whether CU traits increase risk of substance use over and above CD symptoms, and whether these associations differ for boys and girls, is scarce. Using the Developmental Pathways Project sample of 521 middle school students, we examined whether adolescent- and parent-reported CU traits measured in 6th grade prospectively predicted the onset and recurrence of substance use and use-related impairment by 9th grade. We also examined the degree to which CU traits uniquely predicted substance use and impairment over and above CD symptoms, as well as whether gender moderated these associations. Results indicated that adolescent-reported CU traits increased the likelihood of substance use and impairment onset and recurrence by 9th grade. Analyses revealed that CD symptoms accounted for prospective associations between adolescent-reported CU and substance use, but gender moderated these associations. Boys with elevated CU traits and CD symptoms were not more likely to report alcohol use onset or recurrence, but they were at highest risk of recurrent marijuana use, use of both alcohol and marijuana, and use-related impairment by 9th grade. Girls with low CU traits and high CD symptoms were most likely to report onset and recurrent use of alcohol, as well as recurrent marijuana use, use of both substances and impairment. Study findings highlight the importance of accounting for CD symptoms and gender when examining links between CU traits and substance use in early adolescence.     

School Contextual Influences on the Risk for Adolescent Alcohol Misuse

This study investigates the association between school context and adolescent alcohol misuse. Data are from the first two waves of the National Longitudinal Study of Adolescent Health (N = 10,574 adolescents nested within 128 schools). Multilevel multinomial logistic regression is used to assess the association between school-level characteristics and the risk for non-, moderate, and heavy drinking. The risk for adolescent alcohol misuse varies significantly across schools after adjusting for adolescent-level predictors. Several school-level characteristics predict alcohol misuse. Notably, the risk for heavy drinking is elevated in schools located in communities that are socioeconomically advantaged, have high proportions of Non-Hispanic White residents, and are located in suburban (versus urban) areas. High aggregate levels of intoxication in schools increases the risk for heavy drinking among individual adolescents. Results suggest that the influence of social contexts on health is not uniform and that adolescent drinking is more likely in communities that are conceptualized as advantaged.     

Pathways to Adolescent Substance Use Among Sexually Abused Girls

This study examined the link between childhood sexual abuse and adolescent substance use among girls, and evaluated depressive self-concept and behavioral under-control (BUC) as pathways to substance use for sexually abused girls. Participants (n = 150) were drawn from a longitudinal study of the impact of domestic violence on the lives of women and children. Structural equation modeling revealed that girls childhood sexual abuse was associated prospectively with their later substance use. This relationship persisted when age, co-occurring forms of child abuse (physical, exposure to domestic violence), childhood depression and aggression, family income, maternal substance use, and parenting practices were controlled. Behavioral under-control mediated the relationship between childhood sexual abuse and later substance use, but depressive self-concept did not. Implications, limitations, and directions for future research are discussed.     

Substance Use,Related Problem Behaviors and Adult Attachment in a Sample of High Risk Older Adolescent Women

We tested a hypothesis about the usefulness of attachment theory in aiding our understanding of substance use and related problem behaviors among a high-risk group of women. The data were from an ongoing longitudinal study of pregnant and parenting adolescents, and were collected via interview at 5.5 and 6 years postpartum (n = 232). At enrollment, the respondents were an average age of 16. Using regressing analysis (OLS and logistic), differences in attachment security were found to be related to substance use and related problem behaviors and attachment differences in behavior were found to be partially mediated by psychological distress.     

Adolescent Substance Use: Preliminary Examinations of School and Neighborhood Context

In considering the influences of microsystems on adolescent substance use, familial and peer contexts have received the most extensive attention in the research literature. School and neighborhood settings, however, are other developmental contexts that may exert specific influences on adolescent substance use. In many instances, school settings are organized to provide educational services to students who share similar educational abilities and behavioral repertoires. The resulting segregation of students into these settings may result in different school norms for substance use. Similarly, neighborhood resources, including models for substance use and drug sales involvement, may play an important role in adolescent substance use. We briefly review literature examining contextual influences on adolescent substance use, and present results from two preliminary studies examining the contribution of school and neighborhood context to adolescent substance use. In the first investigation, we examine the impact of familial, peer, and school contexts on adolescent substance use. Respondents were 283 students (ages 13 to 18) from regular and special education classrooms in six schools. Although peer and parental contexts were important predictors of substance use, school norms for drug use accounted for variance in adolescent use beyond that explained by peer and parental norms. Data from a second study of 114 adolescents (mean age = 15) examines neighborhood contributions to adolescent substance use. In this sample, neighborhood indices did not contribute to our understanding of adolescent substance use. Implications for prevention are presented.     

Trajectories of Parenting Processes and Adolescent Substance Use: Reciprocal Effects

Drawing on transactional theories of child development, we assessed bidirectional links between trajectories of adolescent substance use and parenting processes from early through mid adolescence. Hierarchical generalized models estimated trajectories for 3,317 adolescents from the National Longitudinal Survey of Youth 1997, exploring both between- and within-individual effects. Between individuals, adolescents reporting more regular family activities and greater father and mother knowledge of friends and teachers experienced lower levels of substance use through mid adolescence. Similarly, adolescents with more frequent substance use reported lower family activities, father knowledge, and mother knowledge, though these differences dissipated over time. More conservative within-individual differences indicated a prospective protective effect of family activities, with increases in adolescent participation in family activities predicting later declines in substance use. Results support the central importance of engagement in regular family activities, and suggest the need for further exploration of transactional processes between parents and children in the development of risk behaviors.     

Alcohol Use in Adolescent Twins and Affiliation with Substance Using Peers

Affiliation with substance using peers is one of the strongest predictors of adolescent alcohol use. This association is typically interpreted causally: peers who drink incite their friends to drink. This association may be complicated by uncontrolled genetic and environmental confounds because teens with familial predispositions for adolescent substance use may be more likely to select into social networks where drinking is common. We test this alternative hypothesis using a sample of 1,820 twin and sibling pairs, and their same-sex best friends, from three waves of the National Longitudinal Study of Adolescent Health. Across all three waves, peer report of substance use did not influence adolescent alcohol use when genetic and shared environmental predispositions for drinking were considered. The association between alcohol use and peer behavior may be a spurious association attributable to a shared genetic liability to drink alcohol and associate with peers who drink alcohol.     

Parental Bonding and Its Effect on Adolescent Substance Use and Sexual Debut

The purpose of this study was to examine associations among parental bonding factors and the early onset of sexual behaviors and substance use. Significant differences were found in the levels of care among the parental status groups and among the ages of onset for alcohol use.     

Pick Your Poison: Examining Adolescent Substance Use through Opportunity Theory

The present study examines substance use behaviors of middle and high school students, focusing on how varying influences of opportunity measures impact use of specific types of substances. The data used in the present study come from almost 4,000 students within 89 school contexts from students attending public school in a Southern state. Hierarchical logistic modeling is used to explore the influence of various opportunities at both the student and school levels on the use of different types of substances. Results indicate measures of opportunity at both the student and school levels were significant; however, measures at the individual level were consistently more influential.     

Understanding Adolescent Substance Abuse: Prevalence,Risk Factors,and Clinical Implications

From a developmental perspective, adolescence is a time of gaining independence, experimentation, and taking risks. One area of experimentation associated with adolescence is substance use. For counselors working with adolescents who use or abuse substances, or both, it is important to understand the scope of the problem and ways to effectively work with this population. This article provides counselors with current information on adolescent substance abuse and suggestions for clinical work.     

Negative Life Events and Substance Use Moderate Cognitive Behavioral Adolescent Depression Prevention Intervention

Investigate factors that amplify or mitigate the effects of an indicated cognitive behavioral (CB) depression prevention program for adolescents with elevated depressive symptoms. Using data from a randomized trial (Registration No. NCT00183417; n = 173) in which adolescents (M age = 15.5, SD = 1.2) were assigned to a brief cognitive behavioral prevention program or an educational brochure control condition, we tested whether elevated motivation to reduce depression and initial depressive symptom severity amplified intervention effects and whether negative life events, social support deficits, and substance use attenuated intervention effects. Hierarchical linear modeling (HLM) indicated differential intervention effects for two of the five examined variables: negative life events and substance use. For adolescents at low and medium levels of substance use or negative life events, the CB intervention produced declines in depressive symptoms relative to controls. However, at high levels of substance use or negative life events, the CB intervention did not significantly reduce depressive symptoms in comparison to controls. Results imply that high-risk adolescents with either high rates of major life stress or initial substance use may require specialized depression prevention efforts.     

Testing Whether and When Parent Alcoholism Uniquely Affects Various Forms of Adolescent Substance Use

The current study examined the distal, proximal, and time-varying effects of parents’ alcohol-related consequences on adolescents’ substance use. Previous studies show that having a parent with a lifetime diagnosis of alcoholism is a clear risk factor for adolescents’ own substance use. Less clear is whether the timing of a parent’s alcohol-related consequences differentially predicts the adolescent’s own substance involvement. Using a multilevel modeling approach, we tested whether adolescents showed elevated rates of alcohol, heavy alcohol, marijuana and other illegal drug use (a) at the same time that parents showed alcohol-related consequences (time-varying effects), (b) if parents showed greater alcohol-related consequences during the child’s adolescence (proximal effects), and (c) if parents had a lifetime diagnosis of alcoholism that predated the child’s adolescence (distal effects). We tested these effects in a high-risk sample of 451 adolescents assessed over three waves beginning at ages 11–15 from 1988 to 1991 (53?% male, 71?% non-Hispanic Caucasian, 54?% children of alcoholic parents and 46?% matched controls). Strong and consistent distal effects of parent alcoholism on adolescent’s substance use were found, though no additional risk was associated with proximal effects. Limited time-varying effects were also found. The importance of differentiating the timing effects of parent alcoholism in identifying underlying mechanisms of risk for adolescent substance use is discussed.     

Prospective Associations of Internalizing and Externalizing Problems and Their Co-Occurrence with Early Adolescent Substance Use

The literature is equivocal regarding the role of internalizing problems in the etiology of adolescent substance use. In this study, we examined the association of internalizing and externalizing behavior problems and their co-occurrence with early adolescent substance use to help clarify whether internalizing problems operate as a risk or protective factor. A large community sample (N?=?387; mean age at the first assessment 12 years old; 83 % White/non-Hispanic) was assessed annually for 3 years. Externalizing problem behavior in the absence of internalizing problems showed the strongest prospective association with alcohol, cigarette, and marijuana use. A weaker, albeit statistically significant prospective positive association was found between co-occurring internalizing and externalizing behavior problems and substance use. Internalizing problems in the absence of externalizing problems protected adolescents against cigarette and marijuana use. Clarifying the role of internalizing problems in the etiology of adolescent substance use can inform the development of early intervention and prevention efforts. Our results highlight the importance of further considering the co-occurrence of internalizing and externalizing behavior problems in developmental pathways to substance use.