Substance Abuse Among Adolescents

Substance abuse represents a major concern to our society. Although no one sector of our populace is immune to the effects of substance use, perhaps nowhere is the risk greater than for adolescents. The various physiological changes, psychosocial stressors and emotional factors confronting adolescents seem to make them particularly susceptible to adverse effects of alcohol and drugs. The purpose of this article, therefore, is to describe the phenomena of substance abuse among adolescents and to discuss its implications for special service providers in schools. In particular, emphasis will be placed on examining substance abuse in k-risk populations including handicapped adolescents. Implications are considered for school-based prevention and treatment approaches.     

Antecedents of risk-taking behaviour among South African adolescents

This study aimed to investigate contextual predisposition to risk-taking behaviour among South African adolescents. Participants included 194 black adolescents from central South Africa (female = 50.5% between the ages of 16 and 19 years). The adolescents completed a youth risk behaviour survey as well as a questionnaire on their parental, peer, school, and community relationships. Data were analysed by means of multivariate analyses of variance and standard multiple regression analyses in order to predict risk-taking behaviour (violence, substance use, and risky sexual behaviour) from various relationship contexts (parents, peers, school, and community). Irrespective of relationship context, males portray a higher risk for all types of risky behaviour, and the more time adolescents spend with their peers, the higher their risk for engagement in risk-taking behaviour. Parental monitoring predicted a lower risk for portraying risky behaviour.     

Shared and unique predictors of antisocial and substance use behavior among a nationally representative sample of South African youth

There are well-documented high prevalence rates of violence, aggression, and substance use in South Africa. We examined theoretically salient risk factors for antisocial behavior and substance use identified in high income countries (e.g., abuse and poverty; Shaw & Gross, 2008) and whether they had predictive effects among South African youth, for whom longitudinal research examining predictors of violence is lacking. We collected data from a large, high-risk longitudinal sample of youth from two provinces in South Africa, encompassing rural and urban sites (N = 3515; 97% retained at one year; 56.7% female; M age = 13.45). We assessed antisocial behavior and substance use using an adapted version of the CBCL-YSR and items from national surveys. Finally, we assessed risk factors using previously-validated indices of risk. Antisocial behavior and substance use were reciprocally related over time. Controlling for this overlap, as well as for relevant demographic covariates, child abuse predicted increases in antisocial behavior over time, and exposure to high levels of community violence predicted increases in both antisocial behavior and substance use one year later. The findings suggest that contextual risk factors underpinning etiological models of antisocial behavior and substance in high income countries are also relevant within the South African context. In particular, both harsh home and community environments were related to the development of youth antisocial and substance use behavior outcomes. We discuss the implications of these findings for preventative interventions to reduce youth engagement in risky antisocial and/or substance use behavior in South Africa.     

Examining the impact of psychiatric diagnosis and comorbidity on the medical lethality of adolescent suicide attempts

Specific psychiatric diagnoses and comorbidity patterns were examined to determine if they were related to the medical lethality of suicide attempts among adolescents presenting to an urban general hospital (N=375). Bivariate analysis showed that attempters with substance abuse disorders had higher levels of lethality than attempters without substance abuse. Regression results indicated having depression comorbid with any other diagnosis was not associated with medical lethality. However, having a substance abuse disorder was associated with higher suicide attempt lethality, highlighting the importance of substance abuse as a risk factor for lethal suicide attempts in adolescents. This finding stimulates critical thinking around the understanding of suicidal behavior in youth and the development and implementation of treatment strategies for suicidal adolescents with substance abuse disorders.     

Acceptability and feasibility of a brief substance use intervention for adolescents in Cape Town,South Africa: A pilot study

Substance use is prevalent among South African adolescents, but few interventions exist to reduce risk of harm. This study assesses the feasibility, acceptability and preliminary effects of a brief intervention for reducing adolescent substance use and other risk behaviours. This single-arm feasibility test recruited 30 substance-using adolescents and their primary caregiver. Participants received separate interventions (2 sessions for adolescents, 1 session for caregivers), with a subsample randomly selected for post-intervention interviews. Feasibility was measured by the proportion of eligible adolescents who were enrolled and retained in the study. Interviews explored acceptability, and changes in outcomes from baseline to 1-month follow-up assessed preliminary effects of the intervention. Thirty of 43 (69.8%) eligible adolescents and their caregivers were enrolled, with 29 adolescents (96.7%) and 28 caregivers (93.3%) completing the intervention. Twenty-eight adolescents (93.3%) and 29 caregivers (96.7%) were retained at follow-up. Frequency of alcohol, cannabis use and delinquent-type behaviours decreased significantly from baseline to follow-up. Participants appreciated the intervention content and delivery and felt that it facilitated behaviour change. Suggestions for improving the intervention were provided. This study found that the intervention is feasible, acceptable and had promising effects on adolescent behaviour. Efficacy must be established with a randomised controlled trial.     

Comorbid Substance Use and Anxiety Disorders in Adolescents

To explore the coexistence of substance use disorders and anxiety disorders in adolescents, we assessed adolescents presenting for treatment to an inpatient substance abuse treatment facility (SUH), an inpatient psychiatric treatment facility (IPH), and a community-based psychiatric facility (CMHC) for comorbid substance use and psychiatric diagnoses. Thirty subjects from each facility (N=90) were interviewed using the revised Child Schedule for Affective Disorders and Schizophrenia (K-SADS) and the Structured Clinical Interview DSM-III-R (SCID-R) for substance use diagnoses. Overall, comorbidity (anxiety and substance use disorders) prevalence was 67% (20/30) of adolescents in the SUH group, 33% (10/30) of the CMHC adolescents, and 33% (10/30) of the IPH adolescents. Alcohol and marijuana were the most frequently abused substances. Anxiety disorders commonly coexist with substance use disorders in adolescents. Early identification and treatment of anxiety disorders may in fact prevent substance abuse in this population.     

Romantic attachment,sexual activity,and substance use: findings from substance‐using runaway adolescents

Research on adolescent attachment is limited, but is growing. Studies to date have focused primarily on high‐functioning, college student samples with minimal attention given to at‐risk, early adolescents. The current study assessed the relationship between sexual activity, substance use, physical and sexual abuse, and attachment avoidance and anxiety in a sample of substance using, runaway youth. Seventy‐three adolescents between the ages of 12 and 17 years were recruited from a local runaway shelter. The main finding was that attachment avoidance was related to a later age at first use of marijuana. Results provide some support for the utility of the attachment framework in understanding problem behaviors among runaway adolescents. Implications and suggestions for future research are discussed.     

The impact of a history of sexual abuse on high-risk sexual behaviors among females attending alternative schools

The goal of this study was to explore whether a history of sexual abuse is associated with high-risk sexual behaviors among female adolescents attending alternative schools in a large urban city in the southwestern United States, and to examine the role of depression and substance abuse in explaining this association. One hundred eighty-four sexually active female adolescents constituted the sample for this analysis. Forty-nine (26.6%) reported that they were forced to have sex. Having a history of sexual abuse substantially increased sexual risk behaviors. Adolescents reporting a history of sexual abuse, compared to those who did not report such a history, were significantly more likely to have initiated sexual activity (intercourse) before age 14, to have had three or more sexual partners in the last 3 months, and to have had a history of sexually transmitted diseases. These associations remained significant after controlling for age, ethnicity, and family income. Depression and substance abuse did not explain the association between sexual abuse and high-risk sexual behaviors. It seems reasonable to conclude that adolescents with a history of sexual abuse have greater difficulty practicing safe sexual behaviors than do those who have not been sexually abused. Given the prevalence of child sexual abuse and the extent of its impact, it is critical that intervention strategies for adolescent females address the issue of abuse and help them adopt self-protective sexual behaviors. The findings also highlight the importance of targeting adolescents who attend alternative schools.     

Developmental and Adjustment Issues of Gay, Lesbian, and Bisexual Adolescents: A Review of the Empirical Literature

Various studies have reported adjustment problems experienced by gay, lesbian, and bisexual (GLB) adolescents. A primary purpose of this paper is to critically review this literature. Difficulties that have been studied include past suicide attempts, substance use and abuse, conduct problems, and academic concerns. For example, a considerable number of GLB youth report a history of suicide attempts, with prevalence rates ranging from 11 to 42%. However, among other methodological concerns, studies in this area have not used a comparison sample of heterosexual youths. Characteristics of development particular to GLB adolescents are described, the empirical research on adjustment issues is reviewed, and potential risk and protective factors for GLB youths are discussed.     

Substance Abuse in Middle Eastern Adolescents Living in Two Different Countries: Spiritual,Cultural, Family and Personal Factors

It is estimated that the percentage of students using illicit substances by sixth grade has tripled over the last decade not only in developed countries but in developing countries as well probably due to the transition to a more Western society. Although much has been done to understand the mechanisms underlying substance abuse, few studies have been conducted with minority ethnic and religious groups such as Middle Eastern Youth. The primary goal of this study was to determine whether there are differences in factors contributing to substance abuse in adolescents from Lebanon versus the USA and to decipher the role of spirituality, religion, and culture among other factors that may influence substance abuse. A correlational cross-sectional design was used with adolescents living in two different countries: Los Angeles, California and Beirut, Lebanon. Muslim adolescents had significantly less rates of alcohol and substance use than Christians in both Lebanon and Los Angeles. More years lived in the USA increases the likelihood of abuse for both Muslims and Christians. Attachment to God and family was negatively associated with substance abuse. These results among others facilitate a better understanding of the influence of culture, religion, family and personal factors on substance abuse. Culturally sensitive interventions could benefit from the findings of this pilot study.     

Peer Substance Use and Homelessness Predicting Substance Abuse from Adolescence Through Early Adulthood

Adolescents who experience homelessness are at higher risk for abusing substances, and for being exposed to substance-using peers. The current study used a longitudinal design to track substance abuse, affiliation with substance-using peers, and episodes of homelessness among a sample of 223 adolescents who were housed at the baseline data collection and 148 adolescents who were housed at baseline. Participants were interviewed at six waves over 6.5 years, covering an age range from 13 to 25. Many participants experienced a recurrence of homelessness during follow-up, with 64.6 % of the baseline homeless group and 22.6 % of the baseline housed group reporting an additional episode of homelessness. Both alcohol abuse and other drug abuse symptoms showed an increase in adolescence followed by slowing in early adulthood. Recent homelessness and friend alcohol use predicted alcohol abuse symptoms, and the strength of the influence of friend use decreased over time. Recent homelessness and friend drug use predicted other drug abuse symptoms. Duration of the initial episode of adolescent homelessness showed no influence on substance abuse over time, or the effects of other predictors, highlighting the importance of conceptualizing the experience of homelessness as a recent stressor rather than an enduring personal characteristic.     

Correlations for perceived family environmental factors with substance use among adolescents in South Africa

Perceived family environmental factors were used to predict self-reported use of substances (drugs or alcohol) among adolescents in South Africa. 435 high school students (ages 15 to 19 years, M=17.2 yr., SD=1.34) answered a questionnaire which included questions on demographic variables, the Family Environmental Scale, and questions on substances used (drugs or alcohol). Logistic regression analysis indicated that scores on family conflict and low family moral-religious emphasis were significantly associated with drug use (57.9% of the variance was accounted for) and use of alcohol (62.3% of the variance was accounted for). Programmes for the reduction of substance use among adolescents should include activities designed to reduce family conflict and strengthen family moral-religious emphasis.     

The Relationship Between Perceptions of Neighborhood Characteristics and Substance Use Among Urban African American Adolescents

Although the neighborhood microsystem is recognized as an important domain for adolescent development, relative to the family and peer contexts, neighborhood factors have been understudied in relation to adolescent substance abuse. In addition, recent research suggests that risk factors for adolescent substance use may differ for African Americans when compared to Caucasian youth. This study investigated the association between perceived neighborhood disorganization and later substance use, as well as possible mediators of that association, among a community sample of urban African American adolescents. Perceptions of neighborhood disorganization (i.e., violence/safety and drug activity) in grade 7 were associated with increased tobacco, alcohol, and marijuana use in grade 9. For females, this association was mediated by attitudes about drug use and perceptions of drug harmfulness. Findings highlight the importance of neighborhood contextual variables for African American substance use. Implications and directions for future research are presented.     

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.     

创伤暴露程度对青少年物质滥用的影响：创伤后应激障碍与依恋的中介作用

为了考察汶川地震后青少年的创伤暴露程度、创伤后应激障碍（PTSD）、父母依恋和同伴依恋与物质滥用之间的关系,采用创伤暴露程度问卷、儿童创伤后应激障碍症状量表、父母与同伴依恋问卷和物质滥用问卷对汶川县和茂县的1435名中学生进行调查,选取有物质滥用的青少年354名作为本研究的对象。结果发现：创伤暴露程度可以直接正向预测作用物质滥用。不过,在创伤暴露与物质滥用直接关系之间加入PTSD、父母和同伴依恋之后,创伤暴露程度对物质滥用的直接预测作用不再显著,并且创伤暴露程度不能通过同伴依恋预测物质滥用,也不能通过PTSD经同伴依恋对物质滥用发挥多重中介作用;但创伤暴露程度能通过PTSD正向预测物质滥用,可以通过父母依恋负向预测物质滥用,并且创伤暴露程度还可以通过PTSD经过父母依恋对物质滥用发挥正向的多重中介作用。     

Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD

Children diagnosed with attention-deficit/hyperactivity disorder (ADHD; n = 142) were prospectively monitored into adolescence (13-18 years old) to evaluate their risk for elevated substance use relative to same-aged adolescents without ADHD (n = 100). Probands reported higher levels of alcohol, tobacco, and illicit drug use than did controls. Group differences were apparent for alcohol symptom scores but not for alcohol or marijuana disorder diagnoses. Within probands, severity of childhood inattention symptoms predicted multiple substance use outcomes: childhood oppositional defiant disorder/conduct disorder (ODD/CD) symptoms predicted illicit drug use and CD symptoms. Persistence of ADHD and adolescent CD were each associated with elevated substance use behaviors relative to controls. Further study of the mediating mechanisms that explain risk for early substance use and abuse in children with ADHD is warranted.     

Classes of substance abuse relapse situations: a comparison of adolescents and adults

Research in the process of relapse has uncovered important developmental differences in the situations that make adolescents and adults most vulnerable to relapse after substance abuse treatment. This study takes a developmental, person-centered approach to relapse by examining the latent class structure of relapse precursors in adolescents and adults. Adults (N = 160) and adolescents (N = 188) in substance abuse and psychiatric treatment were followed up to 18 months after discharge to gather detailed information about their first relapse after treatment. Both adolescents and adults exhibited a 2-class structure of relapse precursors. Adult classes were labeled social and urges situations (primary precursors: social pressure and urges; 67%) and negative and urges situations (primary precursors: negative affect and urges; 33%), while teen classes were labeled social and positive situations (primary precursors: enhancing a positive emotional state and social pressure; 69%) and complex situations (primary precursors: negative affect, negative interpersonal situations, social pressure, and urges; 31%). Findings are discussed in relation to developmental and clinical considerations in treating clients with substance use disorders and comorbid psychopathology.     

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.     

Substance use and abuse among children and teenagers

During the past several years, there has been a renewed national concern about drug abuse, culminating in the current "war on drugs." In this review, we emphasize that even though child or teenage drug use is an individual behavior, it is embedded in a sociocultural context that strongly determines its character and manifestations. Our focus is on psychoactive substances both licit (cigarettes and alcohol) and illicit (e.g., cannabis and cocaine). We feel that it is critical to draw a distinction between use and abuse of drugs and to do so from a multidimensional perspective that includes aspects of the stimulus (drug), organism (individual), response, and consequences. Our selective review of substance use and abuse among children and adolescents covers epidemiology (patterns and extent of drug use), etiology (what generates substance use), prevention (how to limit drug use), treatment (interventions with drug users), and consequences (effects and outcomes of youthful drug use).