Adolescent substance abuse: practice implications

The incidence of substance abuse and implications for practice are reviewed. Variables that might be altered to prevent abuse among clients are discussed. Substance abuse theory, school and peer environment, family, the media, community movements, and business and industry are explored in regard to prevention and treatment.     

Adolescent alcohol and substance abuse: parent and peer effects

There has been considerable research into the effects of peer and parent drug usage on substance abuse by the adolescent. A correlation has been shown to exist between parent usage and increased adolescent substance usage. The parental attitude toward illicit substance use has been positively correlated with adolescent substance use. Once the adolescent starts using illicit drugs, the influence of parents decreases, and the peer influence increases. The research provides further support to Kandel's theory of stages of substance use. In addition, it provides support to the theory that adolescent substance usage is learned, in part, by modeling and imitation. The results are not as conclusive in predicting personality characteristics of the adolescent and parental influence that predate adolescent substance abuse.     

Neurocognitive insights into substance abuse

Cognitive studies are revealing key aspects of how drug abusers monitor and respond to negative feedback differently from non-abusers, and in doing so are adding an important piece to the conceptual puzzle that must be solved to understand, treat, and prevent drug abuse. In this review, we bring together two quite different lines of research, one addressing the selection of gambles in a risky decision task, and the other focused on imaging neural systems related to the detection and processing of errors. We suggest that diminished behavioural control, which is a cardinal feature of drug abuse, may be linked to alterations in the psychological and neural mechanisms that detect error signals and which, in turn, lead to optimization of behavioural responses.     

Multinational efforts in substance abuse prevention

This article is a review of the world-wide efforts of clinicians and researchers in the area of diagnosis, treatment, and prevention of multiple substance abuse. Represented are studies in cross-cultural prevention research and substance abuse which address the new and burgeoning area of clinical prevention research from a multidisciplinary perspective. The article also discusses the theory and methods in prevention in New York City, Israel, Italy, Spain, and in Cali, Columbia. The authors hope that this information will result in greater recognition for the need to understand effective measures of drug prevention, and to develop new research directions which shall enrich and enhance our present state of knowledge in substance abuse prevention programming.     

Prevention education and substance abuse treatment

Relapse prevention is influenced by a number of variables including stress and negative mood states, motivation and commitment to abstinence, social support, physiological factors, withdrawal symptoms, and a repertoire of cognitive and behavioral strategies utilized in responding to the relapse process. Diverse theoretical approaches have emphasized conditioning models as well as information processing, cognitive and affective components of treatment, cognitive and behavioral coping responses, and a variety of other procedures. Outcome studies related to treatment have failed to consistently support the effectiveness of several of these components. To overcomes this, the authors advocate a single subject design in the study of these approaches. This article emphasizes the role of relapse prevention, and training and education in facilitating long-term abstinence, particularly with those intervention methods that are based on social learning theory and cognitive-behavioral models.     

Treatment of co-occurring child maltreatment and substance abuse

Despite high prevalence and severe negative consequences of child maltreatment (e.g., Brown, G. R., & Anderson, B., (1991). Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse. American Journal of Psychiatry, 148, 55–61; Jaudes, P. K., Ekwo, E., & Van Voorhis, J.V., (1995). Association of drug abuse and child abuse. Child Abuse and Neglect, 19, 1065–1075; Murphy, J. M., Jellinek, M., Quinn, D., Smith, G., & Goshkom, M., (1991). Substance abuse and serious child mistreatment: Prevalence, risk, and outcome in a court sample. Child Abuse and Neglect, 15, 197—211), the treatment of perpetrators and victims of child abuse and neglect remains grossly understudied (Behl, L. E., Conyngham, H. A., & May, P. F., (2003). Trends in child maltreatment literature. Child Abuse and Neglect, 27, 215–229). More than half of parentes founded for the abuse and neglect of their children have evidenced drug abuse, yet no treatments have been validated that concurrently address these problems. The reciprocal interaction between substance abuse and child maltreatment supports the need to concurrently treat these problems. This article illustrates the relationship between child maltreatment and parental substance abuse and proposes a behavioral model to explain the reciprocal influence of drug abuse and child maltreatment. A behavioral treatment plan that is designed to concurrently address drug abuse and child abuse is proposed and suggestions are made for future directions in this area.     

A parenting group for women dealing with child sexual abuse and substance abuse

This article describes a group developed to address the parenting needs of women dealing with child sexual abuse and substance abuse. A solution-focused 12-week group intervention is described, and the results of an evaluation are presented. Participants included 29 women who attended seven parenting groups. The results suggest that the group was perceived as beneficial by the women, who reported an increase in self-esteem, parenting satisfaction, and parenting self-esteem and an improvement in their attitudes toward their children.     

Cultural context and substance abuse in Hispanic adolescents

Much emphasis has been placed on the significant substance abuse problem being faced by Hispanic as well as other minority youth in the United States. However, little research has focused on the relative importance of culturally determined factors in the development of substance abuse in Hispanic youths. In this study, we propose an approach to measuring cultural factors through the activity orientations that youths endorse. We studied over 4000 Mexican-American and Mexican youths living along the U.S.-Mexico border with respect to their recent drug use, problem drug use, depressive symptomatology, and their activity orientation. While culturally related activity orientation does significantly increase risk for substance abuse, we found that symptoms of distress/depression and sociodemographic factors exerted a stronger effect on these youths.     

Dual diagnosis: Clinical issues in substance abuse treatment

Dual diagnosis within the context of alcohol and substance abuse has become the focus of considerable interest, particularly when related to anxiety and depression. Depressive symptomatology is frequently associated with substance abuse and chemical dependency and numerous studies report a high concordance with these diagnostic entities and major affective disorder (Galanter,Casteneda, & Ferman, 1988). Depressive symptoms are also related to post treatment of alcohol and substance abuse with reported occurrences of 75 percent occurring with patients who have experienced relapse (Biedermann, Newcome, & Sprich, 1991).     

Neurorobiology and evidence-based biological treatments for substance abuse disorders

Behavioral patterns of addiction include compulsive drug-seeking, persistent abuse of substances despite the often dire consequences on social functioning and physical health, and the high probability of relapse even after prolonged drug-free periods. The recent focus on the biological basis of addiction has provided evidence to support the hypothesis that behavioral manifestations for addiction are influenced by biological factors, and biological factors often produce behavioral changes that can further increase risk. The current understanding of the role of the dopaminergic, glutamatergic, Upsilon-aminobutyric acidergic, and opioid receptor systems in the pathophysiology of addiction as well as the clinical implications of these systems for new and emerging treatments will be discussed. This article will also review the pharmacologic agents used in the treatment of substance abuse disorders and presents evidence-based data for their safety, efficacy, and feasibility of use in different patient populations.     

The role of theory in treating adolescent substance abuse

The adolescent substance abuser, like adult addicts, is most commonly considered from the perspective of the disease model. The usefulness of the disease model in conceptualizing adolescent substance abuse is questioned, and an alternative view of the topic is set forth. Substance abuse, is regarded as an adaptive aspect of the ongoing interactive processes within the family. The developmental process of the adolescent substance abuser is seen as a functional dynamic in the family's preservation. Three characteristic elements of parental interaction common to the development of adolescent substance abuse are highlighted.An earlier version of this paper was presented at the Texas Association for Marriage and Family Therapy annual conference on January 28, 1993 in Houston Texas.a research associate and director of the Don D. Jackson Archive at the Mental Research Institute, Palo Alto, CA. Authors are listed alphabetically.     

A cross-validation of MMPI-2 substance abuse scales.

We evaluated the efficacy of the Addiction Potential Scale (APS) and the Addiction Acknowledgement Scale (AAS), two new scales designed to assess substance abuse problems with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), in samples from settings different from those used in their development. Results replicate earlier findings that both scales discriminate between psychiatric and substance abuse samples and do so more effectively than other substance abuse scales designed for use with the MMPI and carried over to the MMPI-2. Results also suggest that APS may be more resistant than AAS to response distortion.     

Asociality and engagement in adult offenders in substance abuse treatment

In therapeutic community models for drug treatment, individual recovery is principally structured around group meetings and positive peer influences. Research shows that asocial group members with resistant behaviors and attitudes are at risk for poor treatment outcomes and have the potential to adversely impact the therapeutic group. To gain a better understanding of the asocial client's role in the larger treatment process, in-prison treatment data were used: (1) to model and confirm a two-factor solution of asociality consistent with the literature, and (2) to examine the relationship between asocial clients and treatment engagement for validation of the two-factor model. Exploratory analysis resulted in a three-factor solution representing behavioral responsivity, cognitive distortion, and social disassociation dimensions. Nested ANOVA (i.e., clients nested within prison programs) demonstrated that asocial levels (low, medium, and high risk) predicted treatment engagement. Furthermore, comparisons among asocial risk levels indicated that high asocial clients reported significantly lower engagement levels when compared with low and medium asocial clients. Copyright ? 2012 John Wiley & Sons, Ltd.     

Domestic violence shelter residents' substance abuse treatment needs and options

The association between intimate partner aggression and alcohol and other substance use problems is well-established in the literature. However, the nature and scope of alcohol and other substance use problems in women who seek or are likely to seek domestic violence shelter services is difficult to ascertain. The first goal of the current review was to identify and synthesize the findings of studies in which alcohol and other substance use, problem use, or diagnoses in shelter residents was assessed. Despite methodological limitations, this body of studies provides compelling evidence that a substantial number of domestic violence shelter residents (22–72%) have current or past problems with alcohol or other substances and may benefit from treatment. The second goal of the current review was to provide an overview of the availability and limitations of options that are currently available to address domestic violence shelter residents' substance abuse treatment needs. Although substance abuse is a largely under-met need of women seeking domestic violence shelter, promising findings from model integrated treatment programs, as well as the knowledge gained through implementation of these programs provide useful future directions for addressing these co-occurring issues.     

Delinquency,substance abuse,and risk taking in middle-class adolescents

Risk-taking attitudes are strong predictors of delinquency and substance abuse among male and female middle-class adolescents. Risk-taking measures make strong and independent contributions to predicting self-reported delinquency and drug and alcohol use, even taking into account bonding to family and school and attitudes toward one's religious faith and employment. A measure of involvement with a delinquent peer group also predicts delinquency and drug and alcohol use. Moreover, those adolescents who are more likely to be involved in delinquent activity, or to be heavier users of substances, are less likely to turn to parents or formal helpers (e.g., counselors, teachers, etc.), and more likely to turn to peers for help. Delinquency and substance abuse prevention programs should take into account adolescent risk taking and should affect peer group norms if they are to be effective.     

Ego atrophy in substance abuse: addiction from a socio-cultural perspective

The use of intoxicants is indexed in American history adopting a social perspective of the role of alcoholism in traditional American society. Appealing to societal patterns, the elaboration of substance abuse as a disease is explored with a diagnostic focus on intervention as it relates to pathogenesis. Using clinical vignettes, the ego is proposed as the focus of pathology in the addiction process, featuring a regression to the defenses of projection and denial. Following the model proposed in Zinberg's seminal paper on addiction and ego function, various deficits are annotated that typify such regression. The ultimate clinical picture is one of ego atrophy, where basic interests and object relations are usurped by the all-consuming preoccupation with the substance of abuse.     

Brain damage,diagnosis, and substance abuse among violent offenders

Neuropsychological functioning, diagnoses, and substance abuse were compared among killers, nonhomicidal assaulters, and nonviolent offender controls. The Reitan and Luria-Nebraska Neuropsychological test batteries, the WAIS-R, CT scans, and EEGs were examined with a trend to more neuropathology found in killers and assaulters than in controls. There were no group differences in ICD-9 diagnosis nor on the MMPI, although considerable personality pathology was noted in all groups. Violent offenders scored higher on the Michigan Alcoholism Screening Test (MAST). The violent offenders were more likely to experience alcohol and drug-related mood dysphoria. The interaction of neuropsychological, personality, and substance abuse variables is discussed.     

Factor analysis of the substance abuse attitude survey with college undergraduates

Few standardized instruments measure attitudes and beliefs towards substance abuse. The Substance Abuse Attitude Survey, developed for measuring drug attitudes in medical education, was administered to 598 college undergraduates, and a factor analysis was performed. Three coherent and stable factors were identified, e.g., Stereotypes and Moralism, Treatment, and Permissiveness. Internal consistency and 6-wk. test-retest measures indicated moderate to high reliability factor structure. Results are discussed in terms of sample differences between this effort and a previous validation.