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.     

Efficacy of a Self-Administered Home-Based Parent Intervention on Parenting Behaviors for Preventing Adolescent Substance Use

A growing body of literature suggests that parenting practices characterized by careful monitoring, firm and consistent limit setting, and nurturing communication patterns with children are protective against adolescent substance use and other problem behaviors. Family-based prevention programs that promote these behaviors can be an effective way to prevent adolescent substance use. However, low participation rates remain problematic for many such programs, particularly programs that require parents to attend scheduled meetings outside the home. The purpose of this study was to determine the efficacy of a newly developed substance use prevention program when self-administered at home by parents of middle school students. As part of a randomized trial, 338 parents of middle school students either received the parent prevention program or served as control group participants. Parents completed self-report surveys at home that assessed parenting behaviors at pre-test, post-test, and one-year follow-up time points. A series of mixed model ANCOVAs were conducted, examining the post-test and one-year follow-up means for the parent outcomes, controlling for pre-test levels on these outcomes. Analyses showed that at the post-test assessment, intervention parents reported significant increases relative to controls in appropriate role modeling, disciplinary practices, family communication, and parental monitoring skills. At the one-year follow-up assessment, intervention effects on family communication skills remained significant and effects on parental role modeling were marginally significant. This study shows that a theoretically rich prevention program can be effectively self-administered by parents at home and improve key parenting skills that have been shown to prevent adolescent 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.     

Profiles of Contextual Risk at Birth and Adolescent Substance Use

This study examined whether there are subgroups of families with distinct profiles of prenatal/birth contextual risk, and whether subgroup membership was differentially related to adolescent substance use. Data from the Northern Finland Birth Cohort 1986 were used. A five-class model provided the most meaningful solution. Large Family Size (7.72%) and Low Risk (69.69%) groups had the lowest levels of alcohol, cigarette, and illegal drug use. Similar high levels for each of the three substance-related outcomes were found for Parent Substance Misuse (11.20%), Maternal School Dropout (4.66%), and Socioeconomic Disadvantage (6.72%) groups. Maternal smoking and drinking while pregnant and paternal heavy alcohol use were found to be key prenatal risk factors that tended to cluster together and co-occur with other prenatal risk factors differently for different subgroups of youth.     

Parent and Adolescent Reports of Parenting When a Parent Has a History of Depression: Associations with Observations of Parenting

The current study examined the congruence of parent and adolescent reports of positive and negative parenting with observations of parent-adolescent interactions as the criterion measure. The role of parent and adolescent depressive symptoms in moderating the associations between adolescent or parent report and observations of parenting also was examined. Participants were 180 parents (88.9 % female) with a history of clinical depression and one of their 9-to-15 year old children (49.4 % female). Parents and adolescents reported on parenting skills and depressive symptoms, and parenting was independently observed subsequently in the same session. Findings indicated adolescent report of positive, but not negative, parenting was more congruent with observations than parent report. For negative parenting, depressive symptoms qualified the relation between the parent or adolescent report and independent observations. For parents, higher levels of depressive symptoms were associated with more congruence with observed parenting (supporting a depressive realism hypothesis) whereas an opposite trend emerged for adolescents (providing some supporting evidence for a depression-distortion hypothesis).     

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.     

The Use of the MacAndrew Alcoholism Scale in Detecting Substance Abuse and Antisocial Personality

We evaluated the hypothesis that characterological factors, particularly antisocial personality, influence scores on the MacAndrew Alcoholism Scale (MAC). Using the Washington University research criteria to establish diagnoses, the following subgroups were defined: subjects who received no psychiatric diagnoses; subjects who received diagnoses other than alcoholism, drug dependence, or antisocial personality; and subjects who received a diagnosis of alcoholism, drug dependence, and/or antisocial personality, alone or in combination with other psychiatric diagnoses. The highest MAC scores were obtained by subjects diagnosed as having antisocial personality without alcoholism or drug dependence and subjects diagnosed with antisocial personality, drug dependence, and alcoholism. Alcoholics without antisocial personality or drug dependence, and subjects with other psychiatric diagnoses scored lowest. Although higher MAC scores were obtained by males, MAC scores greater than 24 correctly classified the greatest number of males and females as alcoholic, drug dependent and/or antisocial. These findings are interpreted as consistent with MacAndrew's reinterpretation of the scale as assessing a dimension of personality, rather than solely a tendency to addiction.     

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.     

Testing Structural Models of DSM-IV Symptoms of Common Forms of Child and Adolescent Psychopathology

Confirmatory factor analyses were conducted of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) symptoms of common mental disorders derived from structured interviews of a representative sample of 4,049 twin children and adolescents and their adult caretakers. A dimensional model based on the assignment of symptoms to syndromes in DSM-IV fit better than alternative models, but some dimensions were highly correlated. Modest sex and age differences in factor loadings and correlations were found that suggest that the dimensions of psychopathology are stable across sex and age, but slightly more differentiated at older ages and in males. The dimensions of symptoms were found to be hierarchically organized within higher-order “externalizing” and “internalizing” dimensions, which accounted for much of their variance. Major depression and generalized anxiety disorder were substantially correlated with both the “externalizing” dimension and the “internalizing” dimension, however, suggesting the need to reconceptualize the nature of these higher-order dimensions.     

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.     

Adolescent and Parent Perspectives on Ethical Issues in Youth Drug Use and Suicide Survey Research

The contributions of adolescent and parent perspectives to ethical planning of survey research on youth drug use and suicide behaviors are highlighted through an empirical examination of 322 7th-12th graders' and 160 parents' opinions on questions related to 4 ethical dimensions of survey research practice: (a)evaluating research risks and benefits, (b)establishing guardian permission requirements, (c)developing confidentiality and disclosure policies, and (d)using cash incentives for recruitment. Generational and ethnic variation in response to questionnaire items developed from discussions within adolescent and parent focus groups are described. The article concludes with a discussion of the potential contributions and challenges of adolescent and parent perspectives for planning scientifically valid and ethically responsible youth risk survey research.     

Temperament Pathways to Childhood Disruptive Behavior and Adolescent Substance Abuse: Testing a Cascade Model

Temperament traits may increase risk for developmental psychopathology like Attention-Deficit/Hyperactivity Disorder (ADHD) and disruptive behaviors during childhood, as well as predisposing to substance abuse during adolescence. In the current study, a cascade model of trait pathways to adolescent substance abuse was examined. Component hypotheses were that (a) maladaptive traits would increase risk for inattention/hyperactivity, (b) inattention/hyperactivity would increase risk for disruptive behaviors, and (c) disruptive behaviors would lead to adolescent substance abuse. Participants were 674 children (486 boys) from 321 families in an ongoing, longitudinal high risk study that began when children were 3 years old. Temperament traits assessed were reactive control, resiliency, and negative emotionality, using examiner ratings on the California Q-Sort. Parent, teacher, and self ratings of inattention/hyperactivity, disruptive behaviors, and substance abuse were also obtained. Low levels of childhood reactive control, but not resiliency or negative emotionality, were associated with adolescent substance abuse, mediated by disruptive behaviors. Using a cascade model, family risk for substance abuse was partially mediated by reactive control, inattention/hyperactivity, and disruptive behavior. Some, but not all, temperament traits in childhood were related to adolescent substance abuse; these effects were mediated via inattentive/hyperactive and disruptive behaviors. This work was supported by NIAAA grant R01-AA12217 to Robert Zucker and Joel Nigg, NIAAA grant R37-AA07065 to Robert Zucker and Hiram Fitzgerald, and NIMH grant R01-MH59105 to Joel Nigg. Martel was supported by 1 F31 MH075533-01A2. The authors thank the participants and Susan Refior, the long term MLS Field Director, whose steadfast commitment and support have made this study possible.     

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.     

Buffering Effect of Parental Monitoring Knowledge and Parent-Adolescent Relationships on Consequences of Adolescent Substance Use

When adolescents begin using substances, negative consequences are not always directly proportional to the amount used; heavy users may have few consequences whereas light users may have numerous consequences. This study examined how parental monitoring knowledge and parent–child relationship quality may serve as buffers against negative consequences when adolescents use substances. Self-report questionnaires were administered to a community sample of 200 healthy adolescents and their parents at two time points, one year apart. Results suggest that both parental monitoring knowledge and parent–child relationship quality serve as buffers against negative consequences of substance use—but only when adolescents report high levels of monitoring knowledge or strong parent–child relationship quality. Results suggests adolescent perceived parental monitoring knowledge and parent–child relationship quality each act independently to buffer adolescents against negative consequences of substance use over a 1-year period.     

Early Adolescent Growth in Depression and Conduct Problem Symptoms as Predictors of Later Substance Use Impairment

Most studies of adolescent substance use and psychological comorbidity have examined the contributions of conduct problems and depressive symptoms measured only at particular points-in-time. Yet, during adolescence, risk factors such as conduct problems and depression exist within a developmental context, and vary over time. Though internalizing and comorbid pathways to substance use have been theorized (Hussong et al. Psychology of Addictive Behaviors 25:390-404, 2011), the degree to which developmental increases in depressive symptoms and conduct problems elevate risk for substance use impairment among adolescents, in either an additive or potentially a synergistic fashion, is unclear. Using a school-based sample of 521 adolescents, we tested additive and synergistic influences of changes in depressive symptoms and conduct problems from 6th to 9th grade using parallel process growth curve modeling with latent interactions in the prediction of late adolescent (12th grade) substance use impairment, while examining gender as a moderator. We found that the interaction between growth in depression and conduct disorder symptoms uniquely predicted later substance use problems, in addition to main effects of each, across boys and girls. Results indicated that adolescents whose parents reported increases in both depression and conduct disorder symptoms from 6th to 9th grade reported the most substance use-related impairment in 12th grade. The current study demonstrates that patterns of depression and conduct problems (e.g., growth vs. decreasing) are likely more important than the static levels at any particular point-in-time in relation to substance use risk.     

遗传、环境和青少年的吸烟饮酒行为：芬兰双生子研究的回溯与前瞻

本文介绍的两个“芬兰双生子（Finn Twin）”研究是对10个出生组的青少年双生子及其家庭的长期跟踪研究。本文概述了这两个项目对遗传与环境的关联和互动对吸烟饮酒行为影响的研究。这些研究的结果提示个体差异对吸烟饮酒行为的长期变动的影响受到兄弟姐妹互动、同伴互动以及父母教养方式的调节。环境对吸烟饮酒的影响主要表现在学校、居住社区与家庭环境的差异上。环境与遗传影响的程度和持久度有城乡差异。遗传的影响受居住社区的制约。多阶段模型的分析揭示了遗传与环境的互动对这些行为的演变（从试吸试饮到发展到滥用）的动态的影响,遗传似乎对吸烟饮酒的共同轨迹更有影响。这些结果对今后本项目对这约1万对芬兰成年双生子的分子遗传学研究提供了有益的线索