Drug Abuse Treatment

Research Findings from May, 2001 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.

Predictors of Engagement in Adolescent Drug Abuse Treatment

Drs. Dakof, Tejeda, and Liddle from the University of Miami Center for Treatment Research on Adolescent Drug Abuse studied 224 adolescents referred for drug abuse treatment and their parents. These researchers compared adolescents considered to be successfully engaged in treatment (n = 118) to those not successfully engaged (n = 106), defining successful engagement as participation in four or more sessions. Both parent and adolescent perceptions distinguished between successful and unsuccessful engagement. Adolescents who were successfully engaged in treatment had parents who described them as exhibiting significantly more "externalizing behavior", including delinquency and aggression, than adolescents who were not successfully engaged. Also, parents of successfully-engaged adolescents reported significantly higher expectations of academic success for their child than did unsuccessfully-engaged adolescents. Finally, adolescents who reported higher degrees of family conflict were more likely to be engaged successfully in treatment than adolescents who reported less family conflict. These results suggest a particular family profile at higher risk for treatment dropout, and inform clinical interventions aimed to engage drug-abusing adolescents and their families in treatment. Dakof, Tejeda, and Liddle, Journal of the American Academy of Child and Adolescent Psychiatry, 40, pp. 274-281, 2001.

Development of a Skill Training Program for Parents of Substance-Abusing Adolescents

Dr. Neil McGillicuddy and colleagues at the Research Institute on Addictions, State University of New York at Buffalo, have developed a coping skill training program for parents of substance abusing adolescents. The behavioral-analytic model of program development was used to sample representative problematic situations experienced by parents of substance abusing adolescents, obtain an effectiveness-scaling of responses to these situation, and derive alternate forms of a situational role-play measure of parental coping. These situations and scoring guidelines were then used to create the skill training program. Parents of substance abusing adolescents not in treatment subsequently were randomly assigned in a pilot investigation to either a skill training or delayed treatment condition. Skill training resulted in significant improvement in parental coping skills relative to delayed treatment. Moderate to large improvement in the parent's report of their own functioning, family communication, and the teen's marijuana use also favored the skill training group. McGillicuddy, N.B., Rychtarik, R.G., Duquette, E.T., and Morsheimer, E.T. J Substance Abuse Treatment (20), pp. 59-68, 2001.

Methods to Decrease Attrition in Longitudinal Studies with Adolescents

This article presents a summary of methods to decrease attrition in longitudinal school-based studies conducted with adolescents beginning junior high schools or middle schools. These include collection of contact information about students, additional days to collect data from absentee students, data collection in new high schools once students graduate from junior high schools or middle schools, sending questionnaires by mail, and conducting telephone or home interviews. Epstein, J.A. and Botvin, G.J. Methods to Decrease Attrition in Longitudinal Studies with Adolescents. Psychological Reports, 87 (1), pp. 139-140, 2000.

Methods to Decrease Attrition in Longitudinal Studies with Adolescents

This article presents a summary of methods to decrease attrition in longitudinal school-based studies conducted with adolescents beginning junior high schools or middle schools. These include collection of contact information about students, additional days to collect data from absentee students, data collection in new high schools once students graduate from junior high schools or middle schools, sending questionnaires by mail, and conducting telephone or home interviews. Epstein, J.A. and Botvin, G.J. Methods to Decrease Attrition in Longitudinal Studies with Adolescents. Psychological Reports, 87 (1), pp. 139-140, 2000.

Predicting Regular Cigarette Use Among Continuation High School Students

The objective of this study was to provide a 1-year prospective examination of social, behavioral, intrapersonal and demographic factors that predict transition from experimental to regular cigarette use among continuation high school students. A cohort of 252 students completed baseline and 1-year followup questionnaires on health behaviors. Results showed relatively low smoking prevalence estimates, intention to smoke in the next year, violence perpetration, perceived stress, sensation seeking, and male gender predicted the transition to regular use 1 year later. It was concluded that intrapersonal variables may be relatively important in predicting the progression from experimental to regular smoking. Skara, S., Sussman, S., and Dent, C.W. Predicting Regular Cigarette Use among Continuation High School Students. American Journal of Health Behavior, 25(2), pp. 147-156, 2001.

Concurrent Prediction of Drug Use Among High-Risk Youth

Correlates of drug use were examined in a continuation high school sample (n = 1.315), using canonical correlation analysis. Fourteen demographic, attitude/belief. and psychosocial pressure/anxiety-type variables were included as concurrent predictors. Eight drug-use-related measures were also placed into the analysis as outcome variables. Two factors were revealed. White ethnicity, not being Latino, all attitude/belief measures, and family conflict and depression showed relatively high loadings on the first predictor factor, and were associated with all drug-use measures. Latino ethnicity and being relatively unacculturated (i.e., tending to speak Spanish), most of the attitude/belief measures (but not sensation seeking or spirituality), and perceived peer approval to use drugs, trait anxiety, and depression showed relatively high loadings on the second predictor factor, and were associated with the hard-drug-use measures. These results suggest that there is a subgroup of unacculturated Latino youth who are anxious, who perceive they will achieve peer approval by using drugs, and who tend to use hard drugs. Indicated drug abuse prevention strategies may need to be tailored to this subgroup when developing and implementing programming. McCuller, W.J., Sussman, S., Dent, C.W., and Teran, L. Concurrent Prediction of Drug Use Among High-Risk Youth. Addictive Behaviors, 26(1), pp. 137-142, 2001.

Implications of Aggressive Children's Positively Biased Relatedness Views for Future Relationships

The present study examined the tendency of aggressive children to generalize the positive bias in their perceptions of relatedness across different interpersonal relationships. Secondly, it examined the implications of distorted perceptions of relatedness for quality of aggressive children's future relationships. Subjects included 62 second and third grade children nominated and rated by teachers as aggressive. Self- and others' appraisals of relationship quality were gathered across four interpersonal domains (i.e., mother, teacher, mentor, and peer). Children's positively biased perceptions of social relatedness were concordant across adult relationship domains but not across the peer domain, suggesting that children's relationships with adults and peers represent somewhat distinct socialization contexts. As expected, children who inflate levels of social relatedness establish less close relationships with novel partners (mentors). The findings emphasize the need for clinicians to focus on mental representations while planning interventions with aggressive children. Prasad-Gaur, A., Hughes, J.N., and Cavell, T. Implications of Aggressive Children's Positively Biased Relatedness Views for Future Relationships. Child Psychiatry and Human Development, 31(3), pp. 215-231, 2001.

Social Cognitive Differences Between Aggressive-Rejected and Aggressive-Nonrejected Children

This study investigated differences in social cognitive processing between 2 subtypes of aggressive children: those rejected by their peers and those not rejected. Children in Grades 2-4 classified as aggressive-rejected (AR; n = 34) or aggressive-nonrejected (AN; n = 55), on the basis of teacher ratings of aggression, were administered the Social Cognitive Assessment Profile--Revised (SCAP--R) as a measure of attribution, solution type, outcome expectancy, and self-efficacy for aggressive solutions. The results indicate that aggressive children, in general, have a broad range of social cognitive deficits and distortions. Further, AN children are more likely to believe that aggression leads to positive outcomes and are more confident in their ability to use aggression toward a peer. The pattern of social cognitive differences between AR and AN children is similar to that typically found between proactively and reactively aggressive children. Also AN children appear to have a distinct pattern of social cognitive biases that reflect antisocial beliefs likely to support the use of aggression to obtain desired goals. Yoon, J.S., Hughes, J.N., Cavell, T.A., and Thompson, B. Social Cognitive Differences Between Aggressive-Rejected and Aggressive-Nonrejected Children. Journal of School Psychology, 38(6), pp. 551-570, 2000.

Patterns and Temporal Changes in Peer Affiliation Among Aggressive and Nonaggressive Children

The behavior and affiliation patterns of 118 highly, moderately, and nonaggressive 7-8 yr old children were examined over the course of a 6-week summer school program. During free play, participants did not selectively associate on the basis of behavioral similarity, but initial mutual friendship choices did show a preference for similarly behaved peers. Nonreciprocated friendships at the beginning and end of the program and mutual friendships at the end revealed a preference of all children to befriend non aggressive peers. Moderately aggressive children increased their number of mutual friendships and their association with nonaggressive peers during free play, whereas highly aggressive children lost mutual friends. The aggressiveness of a child's playmates predicted the likelihood of that child behaving inappropriately during free play. Results suggest that selective affiliation may be the result of peer rejection rather than an active process of seeking similarly aggressive peers. Hektner, J.M., August, G.J., and Realmuto, G.M. Patterns and Temporal Changes in Peer Affiliation Among Aggressive and Nonaggressive Children Participating in a Summer School Program. Journal of Clinical Child Psychology, 29(4), pp. 603-614, 2000.

Clinical Correlates of Heavy Tobacco Use Among Adolescents

Investigators affiliated with the CEDAR Center at the University of Pittsburgh conducted a study to determine the clinical factors differentiating adolescents with heavy smoking (10 cigarettes/day) from adolescents with light smoking. A study group of 812 adolescents were recruited from adolescent alcoholism treatment centers and from the community. Logistic regression analyses demonstrated that adolescents with heavy smoking, compared with adolescents with light smoking, were significantly more likely to be Caucasian American and to exhibit drug-use disorders, alcohol-use disorders, and conduct disorder. The findings suggest that the clinical correlates of heavy smoking among adolescents are generally similar to those for smoking at any level (vs. nonsmokers), except that heavy smoking is more strongly associated with Caucasian American ethnicity. Also, depressive disorders were associated with smoking at any level in the sample, but depressive disorders were not associated with heavy smoking. Cornelius, J.R., Lynch, K., Martin, C.S., Cornelius, M.D., and Clark, D.B. Clinical Correlates of Heavy Tobacco Use Among Adolescents. Addictive Behaviors, 26, pp. 273-277, 2001.

Tobacco Use Among Argentinean High School Students

This study assessed the prevalence and correlates of tobacco use among high school students in Buenos Aires, Argentina. Anonymous, self-administered questionnaires were given to 3,909 8th and 11th graders in a stratified random sample of 49 public and private schools. The instrument included items from American surveys, translated and validated among Argentinean teens. Multiple logistic regression analysis was used to estimate possible effects on smoking behavior of environment, students' personal characteristics, and their knowledge, beliefs, and attitudes regarding smoking. Of 8th and 11th graders, 20% and 43%, respectively, were classified as current smokers. Overall, 29% of males and 32% of females were current smokers. Students attending public schools were more likely to smoke than those in private schools (p < .05). Current smoking was associated with having a best friend who smokes, reporting that more than 50% of friends of the same sex smoke, having positive attitudes and beliefs toward smoking, and having a positive intention to smoke within the next year (all p < .001). Over 20% of the 8th graders in our sample were current smokers; prevention efforts must therefore start early. Morello, P., Duggan, A., Adger, H. Jr, Anthony, J.C., and Joffe, A. Tobacco Use Among High School Students in Buenos Aires, Argentina. American Journal of Public Health, 91(2), pp. 219-224, 2001.

Drug Use By Adolescent Mexican Americans and Adolescents in Mexico

Investigators at UCLA compared high school students in Baja California Norte (BCN), Mexico (n = 775), with Mexican American students in Los Angeles (LA), California (n = 516). The students' use of cigarettes, alcohol, marijuana, cocaine, inhalants, and other illicit drugs were compared, because these vary by gender, country, and their age of first drug use and are influenced by demographic variables, individual characteristics, and environmental influences. More BCN students than LA students had used alcohol, but more LA than BCN students had used illicit drugs and initiated drug use earlier. When demographic variables were influential, they were most powerful and increased the risk for drug use more than environmental factors or individual characteristics. Environmental factors were most influential for boys' drug use, whereas environmental and demographic variables were most influential for girls' drug use. Felix-Ortiz, M., Villatoro-Velazquez, J.A., Medina-Mora, M.E., and Newcomb, M.D. Adolescent Drug Use in Mexico and Among Mexican American Adolescents in the United States: Environmental Influences and Individual Characteristics. Cultural Diversity and Ethnic Minority Psychology, 7(1), pp. 27-46, 2001.

Modeling Suspected Influences on Youthful Drug Involvement

In longitudinal behavioral studies it is common to have multiple categorical indicators for measuring a theoretical construct of interest. In this study, researchers at Johns Hopkins illustrate the application of a latent class model that accounts for the structure in a set of correlated, categorical variables measured at discrete time periods, drawing information from these variables to form a smaller number of latent classes. The dependence of the resulting latent class model parameters on suspected factors over time is simultaneously modeled using a baseline-category logistic regression model. Estimation of the model parameters is achieved using an estimating equations procedure. A motivating example is provided from a longitudinal study of suspected linkages between monitoring or supervision by parents and the occurrence of drug use behaviors in an epidemiologic sample of school-attending youths. The latent class analyses extracted three subgroups representing youths in different stages of drug involvement. At the beginning of the study, the cohort of 8 to 10 year olds with little or no drug involvement were the most prevalent subgroup. By the end of the study, when these youths were 11 to 13 years old, the majority of youths had not only tried alcohol but had opportunities to use tobacco cigarettes, marijuana and inhalants. The model showed that drug involvement developed over time, starting with alcohol and then progressing to opportunity to use tobacco cigarettes, use of cigarettes, and finally opportunities to use internationally controlled drugs such as marijuana. These results are consistent with the model proposed by Kandel of stages of drug use, but in addition, the results provide evidence that opportunity to use drugs deserves consideration in the pathway leading toward serious drug involvement. Reboussin, B.A. and Anthony, J.C. Latent Class Marginal Regression Models for Modeling Youthful Drug Involvement and its Suspected Influences. Statistics in Medicine, 20(4), pp. 623-639, 2001.

Correlates of Mental Health Service Utilization and Unmet Need Among Male Adolescents

Researchers at the University of Pittsburgh sought to identify the correlates of mental health services utilization and unmet need for these services among a sample of adolescent males. They hypothesized that their findings would replicate and extend those of the recent Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) study, which found that parental factors play a major role in their children's unmet mental health care needs. The study involved an evaluation of mental health service utilization and unmet need during the prior 2 years, as reported by the subjects at a follow-up assessment at age 16. Four factors were found to predict increased mental health services utilization, including attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) among the adolescent males, the father's alcohol use disorder, and the mother's amphetamine use disorder. One factor was found to predict decreased utilization, the father's cannabis use disorder. Four factors significantly predicted unmet treatment need, including conduct disorder, the mother's amphetamine use disorder, a higher number of siblings, and a parental history of having had a childhood anxiety disorder. The results of this study suggest that parental psychopathology, parental substance abuse, the presence of conduct disorder, and an increased number of siblings act as barriers to adequate mental health treatment among adolescents. These findings confirm the crucial role that parental factors play in the treatment utilization and the unmet treatment need of their children, and also suggest that an increased number of siblings can also be associated with unmet treatment need. Cornelius, J.R., Pringle, J., Jernigan, J., Kirisci, L., and Clark, D.B. Correlates of Mental Health Service Utilization and Unmet Need Among a Sample of Male Adolescents. Addictive Behaviors, 26(1), pp. 11-19, 2001.

Developmental Factors in Liability to Adolescent Substance Use Disorders

Investigators at CEDAR reviewed the literature on the complex sequence of maturational, psychosocial, and neuroadaptive processes that lead to substance use disorders (SUD) in adolescence and constructed a synthesis of findings. After introducing the concepts of liability to SUD and epigenesis, they present a theory of how affective, cognitive, and behavioral dysregulation in late childhood is exacerbated during early and middle adolescence by family and peer factors, as well as puberty, leading to substance use. Continued exacerbation of the three components of dysregulation by drug and non-drug stressors during late adolescence is posited to result in neuroadaptations that increase the likelihood of developing SUD, particularly in high-risk individuals. Implications for etiologic research as well as clinical and preventive interventions are discussed. Dawes, M.A., Antelman, S.M., Vanyukov, M.M., Giancola, P., Tarter, R.E., Susman, E.J., Mezzich, A., and Clark, D.B. Developmental Sources of Variation in Liability to Adolescent Substance Use Disorders. Drug and Alcohol Dependence, 61(1), pp. 3-14, 2000.

Trauma, Drugs and Violence Among Juvenile Offenders

Trauma typically occurs when one experiences a situation where life has been threatened or lost. If the trauma is not resolved, negative residual effects may result in alcohol and drug use, involvement in violent activities as well as the development of mental health problems such as posttraumatic stress disorder (PTSD). This study examined the link between trauma, drug use, and violence among youth. Results from interviews with 414 juveniles remanded to the Office of Children and Family Services (formerly New York State Division For Youth) for assault, sexual assault, robbery or homicide, document the trauma experienced by these youth, as well as how it correlated with their drug usage and participation in violent, illegal activities. Discussion of these findings, their implications for understanding and intervening, and recommendations for future research are highlighted. Crimmins, S.M., Cleary, S.D., Brownstein, H.H., Spunt, B.J., Warley, R.M. Trauma, Drugs and Violence Among Juvenile Offenders. J Psychoactive Drugs, 32(1) pp. 43-54, 2000.

Adolescent Substance Abuse Treatment Outcome: The Role of Substance Abuse Problem Severity, Psychosocial, and Treatment Factors

A structural equation model incorporating substance abuse problem severity, psychosocial risk and protection, and treatment variables was used to examine adolescent drug abuse treatment outcome pathways across 6- and 12-month follow-up points. Findings on resiliency factors and an empirical method adapted from previous research were used to select and assign 10 psychosocial factors to either a multiple protective factor index or a risk factor index. Gender, substance abuse problem severity, treatment modality, treatment length, and aftercare participation were also examined as outcome predictors. The findings suggest that treatment intensity decisions may be better informed by pretreatment psychosocial risk level rather than by substance abuse problem severity. The present study also suggests that drug-abusing adolescents who receive sufficiently long treatment, participate in aftercare, and possess at least 1 individual or interpersonal protective factor during their recovery process have the best chance to maintain gains made during treatment. Latimer, W.W., Newcomb, M., Winters, K.C., and Stinchfield, R.D. Journal of Consulting and Clinical Psychology, 68(4), pp. 684-696, August 2000.

Demographic, Individual, and Interpersonal Predictors of Adolescent Alcohol and Marijuana Use Following Treatment

A vulnerability model of adolescent substance abuse treatment outcome provided the basis for selection of demographic, individual, interpersonal, and treatment factors to predict the follow-up use of alcohol and marijuana in a sample of adolescents (N = 225) with psychoactive substance use disorders. Pretreatment levels of sibling substance use and aftercare participation predicted alcohol and marijuana use during the first 6 months post treatment. Pretreatment levels of deviant behavior also predicted the use of marijuana at 6-month follow-up. Peer substance use at intake and 6-month post treatment both predicted substance use frequency outcomes at 12-month follow-up. Alcohol and marijuana use frequencies at 6-month follow-up also predicted continued use for these substances throughout the remainder of the 1st post treatment year. Shorter treatment length and being male were risk factors for alcohol use during the 2nd half of the 1st post treatment year. Elevated psychological substance dependence at 6-month follow-up was a unique risk factor for subsequent marijuana use. Findings support conceptual models that attempt to explain adolescent substance abuse treatment outcome in terms of relationships among demographic, individual, interpersonal, and treatment factors. Latimer, W.W., Winters, K.C., Stinchfield, R., and Traver, R.E. Psychology of Addictive Behaviors, 14(2), pp. 162-173, June 2000.

African-American Teen Smokers: Issues to Consider for Cessation Treatment

Previous reports have indicated ethnic differences in both tobacco-related morbidity and treatment outcome for smoking cessation among adults. IRP investigators assessed smoking-related characteristics in African-American and non-African American teenagers applying to a cessation trial. 115 teens (15.9 +/- 1.8 years, 68% females, 27% African-American) responded via telephone to media ads. Self-reported sociodemographic, medical and smoking-related data were obtained to determine pre-eligibility for a full intake screen prior to trial participation. Compared to non-African American, African American teen applicants were older (16.4 +/- 1.7 years versus 15.6 +/- 1.6; p = 0.015), had lower Fagerstrom Test for Nicotine Dependence (FTND) scores (5.3 +/- 2.3 versus 6.1 +/- 1.8; p = 0.018, ANOVA controlling for age) and smoked fewer cigarettes on the weekend (27 +/- 16 versus 38 +/- 17; p = 0.001). African American teens reported similar duration of smoking (3.3 +/- 1.4 versus 3.1 +/- 1.5 years) and time elapsed between first cigarette ever smoked and daily smoking (0.7 +/- 0.9 versus 0.6 +/- 0.7 years). African American and non-African American teens had similar motivation to quit scores and frequency of reported health problems (e.g., asthma, psychiatric conditions). These data suggest that cessation treatment programs designed for African American youth should include lower Fagerstrom-defined levels, and possibly other criteria for tobacco dependence. These observations also highlight the importance of ethnocultural issues in treatment research programs. Moolchan, E.T., Berlin, I., Robinson, M.L., and Cadet, J.L. J Natl Med Assoc., 92(12), pp. 558-562, 2000.