Sources of Care for Alcohol and Other Drug Problems: The Role of the African American Church

African Americans experience significant disparities in treatment access, retention, and quality of care for alcohol and drug use (AOD) problems. Religious congregations, often the first point of contact for help with AOD problems, can play an integral role in improving access to treatment. However, little is known about the role of African American churches in addressing AOD problems. We administered a survey to a faith-based collaborative of 169 African American churches in Los Angeles to examine how AOD problems are identified in congregations, the types of support provided, barriers to providing treatment referrals, and factors associated with the provision of treatment referrals. Seventy-one percent of churches reported caring often for individuals with AOD problems. AOD problems came to the attention of congregations most commonly via a concerned family member (55%) and less frequently through individuals with AOD problems directly approaching clergy (30%). In addition to providing spiritual support, a substantial proportion of churches reported linking individuals to AOD services through referrals (62%) and consultation with providers (48%). Barriers to providing treatment referrals included lack of affordable programs (50%), stigma (50%), lack of effective treatments (45%), and insufficient resources or staff (45%). The likelihood of providing treatment referrals was greater among mid-sized versus smaller-size congregations (OR 3.43; p < .05) and among congregations with clergy that had attended seminary (OR 3.93; p < .05). Knowing how to effectively coordinate informal sources of care provided by African American churches with the formal service sector could make a significant impact on AOD treatment disparities.     

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.     

青少年高冒险行为与大脑发展

青少年时期是一个转折期,也是冒险行为多发的时期。以往有关青少年冒险行为的研究大多集中在心理学视角与社会关系学视角,双系统竞争理论从生物学视角对青少年高冒险行为作出解释。该理论认为青少年高冒险行为的产生主要是由于大脑中的社会情绪系统与认知控制系统相互竞争作用的结果。社会情绪系统对奖赏寻求起作用,而认知控制系统对执行功能起作用。较早发展的社会情绪系统与较晚才成熟的认知控制系统间的竞争是青少年冒险行为产生的原因。     

Description of a Behavioral Intervention to Reduce Substance Use and Related Risk and Increase Positive Parenting among Urban Mothers with Alcohol and Other Drug Problems

The abuse of alcohol and other substances by mothers raising adolescent children has serious adverse effects on family functioning and youth outcomes, and on mothers’ own health and adaptation. Mothers who are also HIV-infected face additional challenges. In the present report, we describe a multi-session intervention conducted in individual sessions for mothers with alcohol and other substance use problems who are raising adolescent children. We outline the primary components of the intervention and include case studies and examples of exercises and tools. We found that engagement with the intervention and high rates of attendance were facilitated by tapping into mothers’ desires to improve their relationships with their adolescent children, the use of a harm reduction approach toward substance use, and intensive outreach. We also discuss lessons learned in the course of implementing and evaluating the intervention.     

Demands for Privacy Among Adolescents in Multimodal Alcohol and Other Drug Abuse Treatment

Adolescent clients' perceptions of the limits of confidentiality, as well as their privacy demands within the counseling relationship, were assessed. A total of 30 adolescents involved in individual, group, and family counseling for alcohol and other drug abuse served as participants. Participants were asked to respond to vignettes of confidentiality issues in terms of what they believed the counselor should do and what they would prefer the counselor to do. Results suggested that adolescents generally want higher levels of confidentiality than they expect to receive. This group of adolescent clients, however, made clear distinctions in their privacy expectations and demands according to specific situations.     

The Effects of Cumulative Risks and Promotive Factors on Urban Adolescent Alcohol and Other Drug Use: A Longitudinal Study of Resiliency

Resiliency theory provides a conceptual framework for studying why some youth exposed to risk factors do not develop the negative behaviors they predict. The purpose of this study was to test compensatory and protective models of resiliency in a longitudinal sample of urban adolescents (80% African American). The data were from Years 1 (9th grade) and 4 (12th grade). The study examined effects of cumulative risk and promotive factors on adolescent polydrug use including alcohol, tobacco and marijuana. Cumulative measures of risk/promotive factors represented individual characteristics, peer influence, and parental/familial influences. After controlling for demographics, results of multiple regression of polydrug use support the compensatory model of resiliency both cross-sectionally and longitudinally. Promotive factors were also found to have compensatory effects on change in adolescent polydrug use. The protective model of resiliency evidenced cross-sectionally was not supported in longitudinal analysis. The findings support resiliency theory and the use of cumulative risk/promotive measures in resiliency research. Implications focused on utilizing multiple assets and resources in prevention programming are discussed.     

Alcohol and Other Drug Use Among African-American Students in a Southern University

This analysis of the circumstances of alcohol and other drug use among African-American students at a predominantly White university indicated that the majority of these students drank in a responsible manner. Other drug use was almost nonexistent. Strong peer disapproval was exhibited toward drug users and alcohol abusers. Counselors dealing with such problems must be cognizant of the multicultural aspects of these behaviors.     

Adolescent Precursors of Intensity of Marijuana and Other Illicit Drug Use Among Adult Initiators

This study examined (a) adolescent psychosocial risk factors for frequency (intensity) of marijuana use and for other illicit drug use among those who started using these drugs in early adulthood (adult initiators) and (b) the protective role of parent-adolescent relations in reducing or preventing drug use when adolescents enter early adulthood. The study's participants were male and female youth from a longitudinal prospective study. The participants' mean ages were 17 and 22 years at late adolescence and early adulthood, respectively. Independent measures assessed personality, parental, peer, and self-drug-use factors during late adolescence; dependent measures assessed frequency of marijuana use and other illicit drug use during early adulthood for initiators of the respective drug categories. The authors found that intensity of marijuana use was directly associated with the personality, parental, and self-drug-use domains and indirectly associated with the peer domain. Intensity of other illicit drug use was directly associated with personality and self-drug use. Analyses also revealed that some parent-adolescent relations factors buffered the effects of risk factors for both marijuana and other illicit drug-use intensity, whereas others enhanced the effects of protective factors against other illicit drug-use intensity. The results indicate that there are both commonalities and differences in precursors of marijuana and other illicit drug-use intensity among initiators of these drugs during early adulthood.     

Pathways of Risk for Accelerated Heavy Alcohol Use Among Adolescent Children of Alcoholic Parents

The current study examined two questions. First, do internalizing symptoms and externalizing behavior each mediate the relations between parent psychopathology (alcoholism, antisocial personality disorder, and affective disorder) and growth in adolescent heavy alcohol use? Second, are there gender differences in these mediated pathways? Using latent curve analyses, we examined these questions in a high-risk sample of 439 families (53% children of alcoholic parents; 47% female). Collapsing across gender, adolescent-reported externalizing behavior mediated both the relation between parent alcoholism and growth in heavy alcohol use and the relation between parent antisociality and growth in heavy alcohol use. Parent-reported externalizing behavior only mediated the relation between parent antisociality and growth in heavy alcohol use in males. No support was found for internalizing symptoms as a mediator of these relations. Avenues are suggested for further exploring and integrating information about different mediating processes accounting for children of alcoholics' risk for heavy alcohol use.     

Maternal Prenatal Stress and Other Developmental Risk Factors for Adolescent Depression: Spotlight on Sex Differences

Maternal stress during pregnancy has been linked to premorbid abnormalities associated with depression (e.g., difficult temperament, cognitive deficits) in offspring. However, few studies have looked across developmental periods to examine maternal stress during pregnancy and offspring depression during adolescence and whether these associations differ by sex. The current study used data from 1711 mother-offspring dyads (offspring sex: 49.8% male) in a longitudinal birth cohort study. Maternal narratives collected during pregnancy were qualitatively coded for stress-related themes by independent raters. Latent class analysis (LCA) identified distinct subgroups of offspring based on exposure to maternal prenatal stress and other developmental factors from the prenatal, childhood, and adolescent periods that have been associated with depression and/or maternal prenatal stress. LCA identified subgroups that were compared to determine whether and to what extent they differed on adolescent depressive symptoms. LCA revealed a subgroup of “high-risk” individuals, characterized by maternal factors during pregnancy (higher ambivalence/negativity and lower positivity towards the pregnancy, higher levels of hassles, lower maternal education and higher maternal age at birth, higher pre-pregnancy BMI) and offspring developmental factors (decreased cognitive functioning during childhood and adolescence, lower perceived parental support during adolescence, and higher levels of maternal depression during adolescence). High-risk females exhibited elevated conduct symptoms and higher birth order, while high-risk males exhibited decreased internalizing symptoms and lower birth order. Both high-risk males and females reported elevated depressive symptoms during adolescence relative to their “low-risk” counterparts.     

Comparison of Alcohol and Other Drug Use Trends Between a Prohibitionist University and National Data Sets

This article provides information on a decade of trends and prevalence of substance use at a Midwestern prohibitionist university. Trends were based on three data collection times, 1995, 2000, and 2005. This information was compared with results of a number of national surveys to identify trends in the data. Total averages for the prohibitionist sample were 42.6% for alcohol use; 18.2% for binge drinking; 35.4% for tobacco use; and 34.1% for marijuana use. With the exception of binge drinking, which remained stable, the gap between substance use rates for the prohibitionist university and the results of national surveys have widened slightly.     

Violence Exposure and Early Adolescent Alcohol Use: An Exploratory Study of Family Risk and Protective Factors

In this short-term longitudinal exploratory interview study, the relations between exposure to community violence and subsequent alcohol use were examined, with a focus on caregiver and family variables as moderators. Maternal caregivers and their children (N =101 families; 98% African American; M child age = 11.2 yrs) were interviewed separately and completed measures of violence exposure, caregiver and child adjustment, including substance use, and family functioning. Family interaction was also videotaped and coded. Child alcohol use at Time 2 was positively associated with all forms of violence exposure, and was negatively related to felt acceptance from caregiver, but was not associated with caregiver-rated family competence, observer-rated family interaction, maternal problems with alcohol, or maternal psychopathology. Logistic regression analyses predicting child alcohol use at Time 2 indicated that exposure to community violence increased risk of alcohol use, and felt acceptance from the caregiver decreased the likelihood of alcohol use, but did not buffer the effects of violence exposure on alcohol use. Implications and future directions are discussed.     

Family-Based Therapy for Adolescent Drug Abuse: Knowns and Unknowns

Family-based therapy is one of the most thoroughly studied treatments for adolescent drug abuse. Considerable empirical support exists for the efficacy of family-based therapy in curtailing adolescent drug use and cooccurring behavior problems. This article extends knowledge of the effects of family-based therapy for adolescent drug abuse by reviewing 16 controlled trials and 4 therapy process studies from a treatment development perspective. We articulate knowns and unknowns regarding the outcomes of treatment as well as the components, processes, mechanisms, moderators, and boundaries of effective family-based therapy for adolescent drug abuse. The review highlights areas of progress and future research needs within the specialty of family-based therapy for adolescent drug abuse.     

Aetiology of Coexisting Mental Health and Alcohol and Other Drug Disorders: Perspectives of Refugee Youth and Service Providers

In the general population, people with comorbid mental health (MH) and alcohol and other drug (AOD) disorders (comorbidity) have great difficulty accessing appropriate services, and poor outcomes. Little is known about comorbidity in resettled refugees in Australia. This study was designed to identify risk factors and patterns of comorbidity development in young people from refugee backgrounds living in a disadvantaged urban region of Adelaide, South Australia. This qualitative study utilised in‐depth semi‐structured interviews (n = 30) with resettled refugee youth and workers from MH, AOD, and refugee support services. Thematic analyses were conducted to investigate the aetiology of MH and AOD disorders in young refugees. Interviews with both groups revealed how the interrelated nature of risk factors may place young people from refugee backgrounds at heightened risk of experiencing MH and AOD problems. The situations and conditions described by both groups are discussed under six main themes: pre‐migration experiences of torture and trauma; familial factors of intergenerational conflict; post‐migration adjustment difficulties in terms of language, culture, education, and employment; exposure to and availability of substances; maladaptive coping strategies and self‐medication; and access to information and services. Implications for psychologists and MH professionals are identified, emphasising the need for clinicians to understand the complexities surrounding the aetiology of comorbidity in these youth. The initial assessment needs to be comprehensive, including pre‐ and post‐settlement experiences and cultural and family dimensions of their current situation. Treatment may often need to simultaneously address multiple contributing factors and involve culturally sensitive psycho‐education.     

The Association of Group Self-Identification and Adolescent Drug Use in Three Samples Varying in Risk1

This study provides a cross-sectional analysis of the relations between group self-identification and adolescent drug use in 3 samples of youth: comprehensive high-school, continuation high-school, and runaway/street youth. Youth identified with discrete groups in all 3 samples, and similar general groups were formed. In most comparisons, a high-risk group showed greater levels of drug use than did other groups. This is the first study to demonstrate that group self-identification (a) is a generalizable construct across different types of adolescent samples, (b) is related to use of drugs other than tobacco, and (c) remains a significant correlate of drug use controlling for its relations with demographic variables and several other psychosocial variables.     

The Adolescent Brain and the Emergence and Peak of Psychopathology

Adolescence is a period of heightened emotionality and increased risk for mental illness, affecting as many as one in five persons. This article reviews recent human imaging and animal studies that demarcate adolescent specific changes in brain and behavior that may help to explain this period of increased risk for psychopathology. We highlight adolescence as a sensitive period when: 1) the environment has particularly strong influences on brain and behavior and 2) normative changes in brain development can lead to an imbalance between rapidly changing limbic circuitry and relatively slower developing prefrontal circuitry. This imbalance can be exacerbated by both genetic and environmental influences leading to less capacity to regulate emotions and higher risk for psychopathology. We discuss these findings in the context of understanding who may be at greatest risk for psychopathology and when and how to best treat symptoms of emotional dysregulation.     

Alcohol: Effects on Neurobehavioral Functions and the Brain

Alcoholism results from an interplay between genetic and environmental factors, and is linked to brain defects and associated cognitive, emotional, and behavioral impairments. A confluence of findings from neuroimaging, physiological, neuropathological, and neuropsychological studies of alcoholics indicate that the frontal lobes, limbic system, and cerebellum are particularly vulnerable to damage and dysfunction. An integrative approach employing a variety of neuroscientific technologies is essential for recognizing the interconnectivity of the different functional systems affected by alcoholism. In that way, relevant experimental techniques can be applied to assist in determining the degree to which abstinence and treatment contribute to the reversal of atrophy and dysfunction.