Drug Abuse Treatment

Research Findings from September, 1999 Director's Report

This section lists selected summaries from NIDA funded research projects that investigate the child and adolescent drug abuse treatment. The summaries provided were selected from recent issues of the Director's Report to the National Advisory Council on Drug Abuse. For a more comprehensive listing of NIDA funded projects see the Director's Report.

The DSM-IV Criteria for Adolescent Alcohol and Cannabis Use Disorders

The aims of this study are to compare DSM-IV criteria for alcohol and cannabis use disorders with its predecessor, DSM-III-R, and to examine the validity of the new criteria in an adolescent drug clinic sample. During evaluation, a sample of 772 adolescents (63% boys, 77% white) were administered a structured interview of diagnostic symptoms and additional problem severity measures. Independent staff ratings of problem severity and treatment referral were collected as well. Compared to its predecessor, DSM-III-R, application of the DSM-IV criteria for alcohol and cannabis users resulted in more abuse assignments and fewer dependence assignments. The shift in assignments appeared to be largely due to a lowering of the abuse threshold, rather than to a tightening of the dependence criteria. The external validity data generally supported the DSM-IV abuse and dependence distinction in adolescents, and the newer criteria were as valid as the older criteria. In contrast to DSM-III-R, the DSM-IV system yields more abuse cases and fewer dependence cases among adolescent alcohol and cannabis abusers. Validity evidence for the new criteria are defensible, yet the findings are seen as a starting point for discussing the need for tailoring substance use disorder criteria for adolescents. Winters, K.C., Latimer, W., and Stinchfield, R.D. J Stud Alcohol, 60(3), pp. 337-344, May 1999.

Deviance Training

Aggregating high-risk youth into groups can increase their substance use involvement and delinquency. Two random assignment studies are reviewed that reveal three-year and 30-year negative effects. These effects are most likely secondary to using high-risk peer groups to intervene. Analysis of videotaped interactions in the three-year outcome study and archival data in the 30-year study suggests that interest in and verbal and non-verbal expressions of deviancy within the group may increase investment in a delinquent lifestyle. "Deviance training" is defined as contingent positive reactions to rule breaking discussions. This study suggests a need for caution in using interventions that aggregate high-risk children in prevention and treatment. Dishion, T.J., McCord, J., and Poulin, F. Iatrogenic Effects that Aggregate High Risk Youth. American Psychologist, Vol. 54, September 1999.

Deviance Training Among Anti-Social Boys

One of the key risk factors in the etiology of adolescent problem behavior is association with deviant peers. This study examined the early adolescent friendships of 206 Oregon Youth Study boys who were recruited into the study at ages 9-10 from schools in neighborhoods with high rates of delinquency. Data were collected again at ages 13-14 and 15-16. Results suggest that boys identified as anti-social in childhood showed poor-quality friendships at ages 13 -14 and were the most vulnerable to subsequent peer influences in the following two years. Boys with both poor-quality friendships and a high level of delinquency at age 13-14 escalated in delinquent behavior in the subsequent two years. This study suggests that problem behavior in early adolescence, on occasion, functions to initiate and establish friendships. This process of deviancy training is highly related to an adolescent metamorphosis, in that early patterns of antisocial behavior turn into drug abuse and other forms of problem behavior. Poulin, F., Dishion, T.J., and Hass, E. The Peer Influence Paradox: Friendship Quality and Deviance Training Within Male Adolescent Friendships. Merrill-Palmer Quarterly, 45(1), pp. 42-61, 1999.

Inhalant Use and Delinquent Behavior Among Adolescents

To evaluate the association between inhalant use and delinquent or criminal behavior, an analysis of a large statewide sample survey of high school students was conducted. Five groups were identified based on reported drug use: inhalant experimenters, other drug experimenters, inhalant users, other drug users and non-users. Inhalant users were compared with other drug users and inhalant experimenters with other drug experimenters on measures of problem behavior. Over 13,000 students in grades 7-12 participated in the 1993 survey on drug use. Three measures of problem behavior were included: drinking and drug-taking, "trouble behavior", and minor criminal activity. Among upper (9-12) grade level students only, both inhalant users and inhalant experimenters reported more minor criminal activity than other drug users and other drug experimenters, respectively. A similar trend was noted for trouble behavior. The same was not found for drinking and drug-taking behavior. The findings suggest that inhalant use is categorically different from other drug use, and that it has more in common with general delinquency than with general drug use. Prevention and treatment strategies should take this into consideration. Mackesy-Amiti, M.E. and Fendrich, M. Addiction, 94(4), pp. 555-564, 1999.

High Rate of Coexisting Psychiatric Disorders among Adolescents with Substance Use Disorders in the Community

To investigate the extent to which adolescents in the community with current substance use disorders (SUD) experience co-occurring psychiatric disorders, diagnostic data were obtained from probability samples of 401 children and adolescents, aged 14 to 17 years, and their mothers/caretakers, who participated in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Results indicate the rates of mood and disruptive behavior disorders are much higher among adolescents with current SUD than among adolescents without SUD. Comparison with adult samples suggests that the rates of current comorbidity of SUD with psychiatric disorders are the same among adolescents as adults, and lower for lifetime disruptive disorders/antisocial personality disorder among adolescents than adults. The high rate of coexisting psychiatric disorders among adolescents with SUD in the community needs to be taken into account in prevention and treatment programs.. Kandel, D.B., Johnson, J.G., Bird, H.R., Weissman, M.M., Goodman, S.H., Lahey, B.B., Regier, D.A., and Schwab-Stone, M.E. Psychiatric Comorbidity among Adolescents with Substance Use Disorders: Findings from the MECA Study. Journal of the American Academy of Child and Adolescent Psychiatry, 38(6), pp. 693-699, 1999.

Cloninger's Constructs Related to Substance Use Level and Problems in Late Adolescence

Cloninger's constructs of novelty seeking, harm avoidance, task-reward dependence, and social reward dependence have been related to smoking and alcohol use in adolescence and adulthood. A study at Yeshiva University tested the role of these constructs as mediators related to substance use level and substance use problems. Participants were 1,225 adolescents with average age of 15.5 years. Structural modeling showed indirect effects for novelty seeking, harm avoidance, and task reward dependence, mediated through self-control; harm avoidance also had an inverse direct path to substance use level. Social reward dependence had a positive direct path to coping motives for substance use. Good self-control had inverse paths to negative life events and deviant peer affiliations; poor self-control had positive paths to negative life events and coping motives; and risk taking had positive paths to coping motives and peer affiliations. These findings suggest that substance abuse prevention programs should incorporate components focusing on beliefs about the functions of substance use and that treatment programs for substance abusers should include self-control training that targets behavior patterns such as anger proneness and impulsive responding. Wills, T.A., Sandy, J.M., and Shinar, O. Cloninger's Constructs Related to Substance Use Level and Problems in Late Adolescence: A Mediational Model Based on Self-Control and Coping Motives. Experimental and Clinical Psychopharmacology, 7(2), pp. 122-134, 1999.

Parents Educational Attainment Influences Prevention Assessment Attrition

This study examined whether family risk factors predict attrition in a prevention intervention project that incorporated procedures to increase retention in assessment and intervention activities. Data from 667 rural families collected in four waves were analyzed. Data consisted of young adolescent and parent reports of internalizing and externalizing problems, observer rating of distress in parent-child interactions, and family socioeconomic status (SES). SES was a significant predictor of assessment attrition: follow-up analyses indicated that this relationship was due to lower educational attainment rather than income. None of the social-emotional or SES factors examined predicted intervention participation. Spoth, R., Goldberg, C., and Redmond, C. Engaging Families in Longitudinal Preventive Intervention Research: Discrete-Time Survival Analysis of Socioeconomic and Social-Emotional Risk Factors. Journal of Clinical and Consulting Psychology, 67(1), pp. 157-163, 1999.