Drug Abuse Treatment

Research Findings from February, 2000 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.

Validity of Diagnostic Criteria for Adolescent Alcohol and Cannabis Use Disorders

Until recently, few studies focused on adolescent drug abuse utilized formal diagnostic criteria for substance use disorders. Reluctance to use diagnostic criteria was, in part, based on concerns that adult-based criteria and related diagnostic instruments were not developmentally appropriate for adolescent patient populations. But utilization of a common set of criteria and related measures would facilitate cross-study comparisons and collaborations in drug treatment research. Toward identifying adolescent-appropriate criteria, Dr. Winters and colleagues at the University of Minnesota School of Medicine examined DSM-III-Revised and DSM-IV criteria for alcohol and cannabis use disorders in a sample of 772 adolescents (42% 12-15 years; 63% boys; 77% white) enrolled in outpatient drug treatment. Results indicate that, compared to DSM-III-Revised criteria, application of DSM-IV criteria for alcohol and cannabis use results in more abuse cases and fewer dependence cases, with the shift in diagnostic assignments largely due to a broadening of abuse criteria rather than a tightening of dependence criteria when applied to adolescents. Although further research is necessary, external validity supported the DSM-IV abuse and dependence distinction in this adolescent patient population. Winters, K.C., Latimer, W., and Stinchfield, R.D. J. Studies on Alcohol, 60, pp. 337-344, 1999.

Adverse Effects of Grouping Deviant Youth

Recent research has suggested potential harmful effects of group-based skill training for children and adolescents with externalizing problems. This article reviews four types of evidence from published literature on the role of deviant peers in the socialization of aggressive youth, studies reporting adverse treatment effects for grouped interventions, studies comparing treatment outcomes that differed in the extent to which participants were grouped with deviant peers, and studies that highlight variables that mediate negative treatment outcomes. The review supports the conclusion that grouping deviant youth in treatment may produce unintended, harmful effects. Arnold, M.E. and Hughes, J.N. First Do No Harm: Adverse Effects of Grouping Deviant Youth for Skills Training. Journal of School Psychology, 37, pp. 99-115, 1999.

Early Deviance in the Children of Narcotic Addicts

This descriptive study examined the self-reported behaviors of 285 male and female adolescent children (aged 12-17 yr) of narcotic addicts participating in methadone maintenance programs. These children responded to an 2.5-hour interview questionnaire focusing on current and past activities, including criminal activities prior to age 12. Findings revealed that early deviance, assessed by measures of both severity and variety, was related to current adolescent drug and alcohol use, association with deviant peers, a negative view of home atmosphere, and psychological symptomatology. These results are contrasted with the retrospective reports of adolescent behavior obtained from adult male narcotic addicts in a prior study of vulnerability to addiction. The comparability of study results is discussed in the context of developmental risk factors, prevention and treatment strategies, and other considerations specifically related to the development of children of narcotic addicts. Nurco, D.N., Blatchley, R.J., Hanlon, T.E., and O'Grady, K.E. Early Deviance and Related Risk Factors in the Children of Narcotic Addicts. American Journal of Drug & Alcohol Abuse, 25, 25-45, 1999.

Girls' Smoking Influenced More By Parents but Boys' Smoking Influenced More By Peers

In a study of the effects of parental and peer approval of smoking on adolescent smokers' current levels of cigarette use, researchers analyzed data for 913 California 7th-grade students who had previously initiated cigarette use. They applied a Poisson random-effects regression model to examine the number of cigarettes smoked in the past month as a function of race/ethnicity, gender, number of friends approving smoking, and parental approval. Results show a clear correlation between level of smoking and extent of peer and parental approval. However, a stronger relationship between parental approval of smoking and current level of smoking was found for female adolescents than for male adolescents. Conversely, a stronger relationship between peer approval of smoking and current level of smoking was found for male adolescents than for female adolescents. With respect to race, the influence of parental approval of smoking on adolescents' current level of smoking was generally more pronounced for minority adolescents, relative to white adolescents. However, the influence of peer approval of smoking on current level of smoking was strongest for white adolescents and was less strong for black, Hispanic, and Asian adolescents. The findings suggest that smoking cessation programs among adolescents may need to target both parent and peer influences, but these influences may vary by gender and race/ethnicity. Siddiqui, O., Mott, J., Anderson, T., and Flay, B. The Application of Poisson Random-Effects Regression Models to the Analyses of Adolescents' Current Level of Smoking. Preventive Medicine, 29(2), pp. 92-101, 1999.

Variations in Risk and Protective Factors for American Indian Adolescents

High levels of social stress are related to behavior problems in both Caucasian and American Indian adolescent boys, while high levels of self/family-concept are related to less problem behavior in both groups when using self-report. In contrast, teacher report models indicated that negative life events were the only significant predictor of perceived problem behavior in American Indian boys. For Caucasian males a low self/family-concept predicted teachers' perceptions of problematic behavior. For females, negative events predicted self-reported problem behaviors in American Indians while both negative events and positive self/family-concept contributed significantly for Caucasians. This pattern remained the same when using teacher reports of female problem behaviors. Interventions must address the discrepancy between self and teacher report and the increased likelihood of teachers' observing problematic behaviors in male adolescents. Fisher, P.A., Storck, M., and Bacon, J.G. In the Eye of the Beholder: Risk and Protective Factors in Rural American Indian and Caucasian Adolescents. American Journal of Orthopsychiatry, 69, pp. 294-304, 1999.

Impact of Early Adolescent Marijuana Use On Late Adolescent Problem Behaviors

The purpose of this study was to assess the impact of early adolescent marijuana use on late adolescent problem behaviors, drug-related attitudes, drug problems, and sibling and peer problem behavior. African American (n = 627) and Puerto Rican (n = 555) youths completed questionnaires in their classrooms initially and were individually interviewed 5 years later. Logistic regression analysis estimated increases in the risk of behaviors or attitudes in late adolescence associated with more frequent marijuana use in early adolescence. Early adolescent marijuana use increased the risk in late adolescence of not graduating from high school; delinquency; having multiple sexual partners; not always using condoms; perceiving drugs as not harmful; having problems with cigarettes, alcohol, and marijuana; and having more friends who exhibit deviant behavior. These relations were maintained with controls for age, sex, ethnicity, and, when available, earlier psychosocial measures. Early adolescent marijuana use is related to later adolescent problems that limit the acquisition of skills necessary for employment and heighten the risks of contracting HIV and abusing legal and illegal substances. Hence, assessments of and treatments for adolescent marijuana use need to be incorporated in clinical practice. Brook, J.S., Balka, E.B., and Whiteman, M. The Risks for Late Adolescence of Early Adolescent Marijuana Use. Am J Public Health, 89(10), pp. 1549-1554, 1999.