National Institute on Drug Abuse
Director's Report to the National Advisory Council on Drug Abuse
September, 1996
Research Findings
Epidemiology, Etiology and Prevention Research
Executive Cognitive Functioning and Aggressive Behavior in Boys at High
Risk for Substance Abuse
Deficiencies in executive cognitive functioning (ECF), defined as self regulation
of goal-directed behavior, have been linked to antisocial personality disorder,
substance use disorders, conduct disorder, attention deficit hyperactivity
disorder, and other problems. To assess the relationship between ECF deficiencies
and aggressive behavior and the interactive effects of ECF and family history
of substance abuse, researchers at the Center for Education and Drug Abuse
Research (CEDAR) collected multiple measures of executive cognitive functioning
(ECF) and aggressive behavior from 291 10-12-year-old boys with and without
a family history of substance abuse/dependence. Factor analysis of the
ECF measures indicated loading on one factor. ECF was related to aggressive
behavior even controlling for IQ and socio-economic status. Aggressive
behavior also was related to the interaction of ECF and family history of
substance abuse/dependence. These results suggest that programs to prevent
and treat violent behavior in high risk groups should incorporate training
in ECF's, including planning, attention, abstract reasoning, judgment, learning
from experience, and cognitive self-monitoring. Giancola, P.R., Martin,
C.S., Tarter, R.E., Pelham, W.E., and Moss, H.B. Executive Cognitive Functioning
and Aggressive Behavior in Preadolescent Boys at High Risk for Substance
Abuse/Dependence. Journal of Studies on Alcohol, 57: pp. 352-359, 1996.
Cognitive Deficits Associated with Drug Use in Adolescents
Scheier and Botvin used longitudinal data to model the relationships between
several cognitive skills and drug use over time. A small but significant
association was found between drug use and weak cognitive and affective
self-management strategies in early adolescence; this relationship became
stronger over time. The exacerbation of these cognitive weaknesses with
increased drug use may contribute to impaired social, emotional, and psychological
growth in late adolescence. As the authors note in their comment on a study
of cognitive effects of heavy marijuana use, deficits in cognitive efficacy
may actually precede and perhaps predispose to problematic drug use. Weaknesses
in cognitive skills, and learning disabilities, may be undetected factors
which underlie recognized risk factors such as low self-esteem, academic
failure and school dropout; as such, further longitudinal studies and modeling,
and perhaps early identification and intervention, are needed. Scheier,
L.M. and Botvin, G.J. Effects of Early Adolescent Drug Use on Cognitive
Efficacy in Early-Late Adolescence: A Developmental Structural Model. Journal
of Substance Abuse, 7(4), pp. 379-40, 1995. Scheier, L.M. and Botvin, G.J.
Cognitive Effects of Marijuana (letter). JAMA, 275(20), p. 1547, 1996.
Familial Factors in Female Drug Abuse/Dependency
Extending their research with males, Cadoret et al. studied genetic and
environmental factors leading to drug abuse and dependency in female adoptees.
Antisocial personality in a biologic parent was strongly related to the
development of conduct disorder in female offspring; conduct disorder was
associated with aggressive behavior, and both conduct disorder and aggression
were strongly predictive of later drug abuse/dependence in the adoptees.
Drug abuse/dependence was in turn correlated significantly with alcohol
abuse/dependence. Environmental factors in the adoptive home were also
found to be significant. Disturbed adoptive parenting contributed significantly
to the development of aggression in the adoptees, which in turn resulted
in increased risk of drug abuse/dependence. This relationship was complicated,
however, by a finding suggesting selective (non-random) placement; adoptees
from a biologic background of antisocial personality were less likely to
be placed in a disturbed adoptive home. The environmental factors were
thought to act independently of the genetic, thus offering an important
avenue for preventive intervention through reducing aggressiveness early
in life. Cadoret, R.J., Yates, W.R., Troughton, E., Woodworth, G., and
Stewart, M.A. An Adoption Study of Drug Abuse/Dependency in Females. Comprehensive
Psychiatry, 37 (2), pp. 88-94, 1996.
Identifying Adolescents at Risk of Escalating Their Substance Use
To assess risk factors for escalation of substance use, researchers at Yeshiva
University grouped adolescents according to substance use patterns over
three assessments and then examined variables differentiating the groups.
The four groups--nonusers, minimal experimenters, late starters, and escalators--were
identified through cluster analysis of changes in cigarette, alcohol, and
marijuana use among a cohort of 1,184 eighth and ninth graders enrolled
in public schools in Westchester County, NY. By modeling group differences
based on variables from stress-coping theory, problem behavior theory, and
peer-association theory, the researchers identified first-assessment measures
predictive of subsequent escalation in substance use. Compared to nonusers
and minimal experimenters, late starters and escalators had higher life
stress, lower parental support, lower academic competence, more deviant
attitudes, and more nonadaptive modes of coping; they also were higher in
parental and peer substance use. Escalators scored lower on behavioral
competence, positive control, and positive esteem. In contrast to the often
cited study by Shedler and Block (1990), this study found that substance
use experimenters, compared to nonusers, had higher stress, more maladaptive
coping, more deviance-prone attitudes, lower levels of parental support,
and lower levels of self control. Findings support the idea that some people
enter adolescence with less parental support and more life stress, have
less adaptive patterns of coping and competence, and tend to gravitate to
groups of peer substance users. To the extent that these factors prevail
and are not offset, these adolescents become involved in a network of active
users. The experience-regulating function of substance use becomes more
salient and they are primed to continue substance use at increasing rates.
Wills, T.A., McNamara, G., Vaccaro, D. and Hirky, A.E. Escalated Substance
Use: A Longitudinal Grouping Analysis from Early to Middle Adolescence.
Journal of Abnormal Psychology, 105(2), pp. 166-180, 1996.
Effectiveness of School-Based Drug Prevention Programs
Effectiveness of different types of drug prevention was examined in a meta-analysis
of 120 school-based programs in grades 5 through 12 that evaluated success
on self-reported drug use measures. Hypothesis tests using Weighted Least
Squares regressions were conducted on an a priori classification scheme
that was based on program content and its delivery. Two major types of
programs were identified: Interactive and Non-Interactive. Six other factors
related to program effectiveness (sample size, targeted drug, type of control
group, special populations, type of leader, and attrition) were included
as covariates. The Interactive programs achieved significant changes on
knowledge, attitudes and drug use, whereas the Non-Interactive programs
affected only knowledge. The larger Interactive programs were less effective
although still significantly superior to the Non-Interactive programs which
suggests implementation failures. The clinically significant superiority
of Interactive programs was observed for all adolescents, including various
minority populations, and was equal for tobacco, alcohol, marijuana and
illicit drugs. Tobler, N.S. and Stratton, H. Effectiveness of School-Based
Drug Prevention Programs: A Meta-Analysis of the Research. The Journal
of Primary Prevention, In Press.
Fatal Consequences of Cocaine and Opiate Use: Accidental Fatal Drug
Overdoses in New York City: 1990-1992
Cocaine, often with opiates (predominantly heroin) and ethanol, caused almost
75% of accidental fatal drug overdoses in New York City from 1990 through
1992. This study assessed 1,986 cases in that period using data collected
by the Office of the Chief Medical Examiner. This study excluded intentional
(suicidal) fatal drug overdoses. Cocaine with opiates caused 752 (37.9%)
deaths. Cocaine without opiates caused 629 (31.7%) deaths while opiates
without cocaine caused 503 (25.3%) deaths. Drugs other than cocaine or
opiates, predominantly benzodiazepines and antidepressants, caused 102 (5.1%)
deaths. The highest cocaine overdose rates were found among African-American
and Latino males. Rates of opiate overdose without cocaine did not differ
in regard to race/ethnicity except for low rates among Asians. Males had
higher overdose rates than women for all classes of drugs. The highest
rates for cocaine and/or opiates were found among victims 35-44 years of
age. The rates of overdose from cocaine and opiates increased from 1990-1992.
A marked increase of cocaine overdoses in 1991 was followed by a slight
decrease in 1992. The rates of overdoses from drugs other than cocaine
or opiates showed no increase over time. Cocaine is the leading cause of
accidental drug overdoses, unlike in the early 1980's when opiates prevailed
as a cause of death. African-American and Latino males may be particularly
susceptible to cocaine overdoses because of their exposure to crack in poor
neighborhoods. Tardiff, K., Marzuk, P.M., Leon, A.C., Hirsch, C.S., Stajic,
M., Portera, L., Hartwell, N., Accidental Fatal Drug Overdoses in New York
City: 1990-1992. The American Journal of Drug and Alcohol Abuse, 22 (3),
1996.
Personality-Environment Constellations and Alcohol Use: A Process-Oriented
Study of Intraindividual Change During Adolescence
Within an interactionist and process-oriented perspective, the salience
of documented risk and protective factors in contributing to intraindividual
changes in alcohol use behaviors and negative consequences of use during
adolescence was tested. Participants (N=870) were from a longitudinal study
of normal adolescent development, they were 12 or 15 years old at the first
test and were retested twice at 3-year intervals (92% longitudinal retest
rate). Person-environment constellations comprising high impulsivity, disinhibition,
and deviant peer group associations, and to a lesser extent, low parental
control, most strongly influenced high-risk developmental trajectories of
use intensity and problems. Personality and environmental risk factors
acted as mutual catalysts of alcohol use behaviors and consequences; that
is, their co-occurrence increased the likelihood of sustained movement along
problematic developmental trajectories. Pandina, R. Personality-Environment
Constellations and Alcohol Use: A Process-Oriented Study of Intraindividual
Change During Adolescence. Psychology of Addictive Behaviors, 9 (1),
pp. 23-35, 1995.
High School Students Who Use Crack and Other Drugs
The distinguishing characteristics of adolescents who have reached different
stages of drug use, in particular the highest stage represented by crack,
were studied in a representative sample of students in grades 7 to 12 from
53 New York State schools (N = 7,611). Students were classified in six
mutually exclusive, cumulative categories of drug use: nonusers; alcohol
and/or cigarette users only; marijuana users only; users of illicit drugs
other than marijuana but neither cocaine nor crack; cocaine but not crack
users; and crack users. Students who use illicit drugs show deficits in
school performance, quality of family relationships and health, and increased
psychological symptoms. Compared with nonusers, illicit drug users are
more delinquent and more actively involved with their peers and live in
social environments in which the perceived use of drugs by parents and other
adolescents is more extensive. Crack users exhibit the lowest level of
psychosocial functioning of any drug-using group. Delinquency and extent
of perceived peer drug use consistently increase with each higher stage
of use. There are stage-specific characteristics and common characteristics
(delinquent participation, peer drug use) throughout the developmental sequence
of drug use. Despite declines over the last two decades in the prevalence
of the use of different drugs, young people who use drugs display characteristics
over historical time similar to those of young drug users 20 years ago.
Kandel, D.B., Davies, M. High School Students Who Use Crack and Other
Drugs. Archives of General Psychiatry, 53, pp. 71-80, 1996.
Pathological Gambling Among Methadone Patients
Participation in various forms of gambling activities was assessed to establish
the prevalence of pathological gambling in a sample of patients (N=117)
enrolled in a large methadone maintenance treatment program in New York
City. Respondents were interviewed with a protocol, that incorporates the
South Oaks Gambling Screen, a validated, reliable instrument that offers
a convenient means for screening populations of drug misusers, as well as
general populations, for pathological gambling. Gambling was a common part
of the regular activities of many methadone patients, Fifteen percent of
a sample of methadone patients had some problem with gambling, and an additional
16% were probable pathological gamblers. Heroin and alcohol were the substances
most likely to be used by the pathological gamblers-just prior to or while
gambling; marijuana and cocaine were the substances next most likely to
be used when gambling. About one-quarter had engaged in some type of crime
or hustling activity to pay gambling debts or get money to be able to gamble;
all of these individuals participated in multiple gambling-related criminal/hustling
activities. These data suggest that a significant proportion of heroin
addicts enrolled in methadone treatment programs may be pathological gamblers.
For these individuals, pathological gambling may accompany and reinforce
continued drug dependence, interfere with treatment engagement, and be a
factor in relapse, yet it is likely that the vast majority of methadone
patients who are pathological gamblers have not received and are not receiving
treatment for their gambling pathology. Few pathological gamblers had ever
asked someone for help with a gambling problem or had ever been to Gamblers
Anonymous or a therapist for help with a gambling problem. Spunt, B.J.,
Lesieur, H., Hunt, D., Cahill, I. Pathological Gambling Among Methadone
Patients. International Journal of the Addictions, 30 (8), pp. 929-962,
1995.
Contributions of Mothers and Fathers to Cigarette Smoking in Adolescence
There is a significant dose-related association between maternal smoking
and children's smoking, especially among daughters. This finding has been
obtained in a study of similarity on cigarette smoking among mothers, fathers,
and young adolescents (mean age = 12.6 years) in a sample of 201 triads
in which each respondent was interviewed independently. Both maternal smoking
and quality of parent-child interaction affect lifetime smoking by the child,
but only maternal smoking affects current smoking. Their maternal role
modeling effect is stronger for daughters than for sons and persists with
the inclusion in the model of perceived smoking by the adolescent's close
friends. The observed familial concordance on smoking between parent and
child cannot disentangle environmental from genetic effects. Intervention
and prevention practices targeted toward preventing or reducing cigarette
smoking among children tend to target the child's life skills, knowledge,
attitudes about smoking, and resistance skills toward peer pressure. The
investigation points to another important and neglected focus of intervention,
namely, the smoking behavior of the youth's parents in early adolescence.
Kandel, D.B., Wu, P. The Contributions of Mothers and Fathers to the Intergenerational
Transmission of Cigarette Smoking in Adolescence. Journal of Research on
Adolescence, 52, pp. 225-252, 1995.
Cigarette Use Among Migrant and Nonmigrant Mexican American Youth: A
Socialization Latent-Variable Model
A self-report survey of cigarette use among 1,373 Mexican American 10th
and 12th graders from migrant and non-migrant families in Southern California
shows that children of migrant families use tobacco at about the same level
as children of non-migrants. The strongest risk factor for tobacco use
for Mexican American youth is having peers who use tobacco. Family tobacco
use increases risk except among female children of migrant workers. Protective
factors include having a family that shows a high level of caring and that
closely monitors behavior, having good school adjustment and having a strong
religious identification. Mexican American children who experiment with
tobacco are likely to have already tried tobacco prior to the 11th grade.
Rates for daily use continue to increase so tobacco addiction continues
to grow through the 11th and 12th grades. Swaim, R.C., Oetting, E.R., Casas,
M.J. Cigarette Use Among Migrant and Nonmigrant Mexican American Youth:
A Socialization Latent Variable Model. Health Psychology, 15(4), pp. 269-281,
1996.
Children with Learning Disabilities in Need of Targeted School-Based
Smoking Prevention Programs
NIDA prevention research grantees from the University of North Carolina
conducted a study to assess whether children with learning disabilities
should be included in school-based smoking prevention programs and whether
the existing programs are appropriate for this special population. A sample
was taken of 1,740 3rd and 5th grade children. Measures obtained included:
initiation of smoking, peer pressure, level of self-esteem, and negative
orientation towards school and each was significantly associated with smoking
by all children; those with and without learning disabilities. Current
smoking prevention curricula should address issues relevant to children
with learning disabilities; however, additional research is needed to identify
the special needs of these children and determine the type of smoking prevention
program most likely to be effective with them. Robertson, S.B. and Jackson,
C. Initiation of Cigarette Smoking Among Children With and Without Learning
Disabilities. Journal of Developmental and Behavioral Pediatrics, In Press.
Substance Involvement Among Juvenile Murders
Substance involvement among incarcerated juvenile offenders was evaluated.
Patterns of substance involvement among juvenile offenders were compared
with patterns found in older offenders. Irrespective of age group, close
to one-third of all homicide perpetrators reported that they were affected
by alcohol prior to the offense. In every age group, alcohol was the substance
showing the highest rate of "regular" lifetime use and the highest
rate of ingestion in the week preceding the homicide. In many respects,
the reported substance use patterns in the 16-17-year-old age group were
closer to the patterns demonstrated by the oldest (36+) age group than they
were to the adjacent 18-20-year-old group. Juvenile offenders were generally
less substance involved than all but the oldest group of offenders. Almost
all of the juveniles who were substance involved prior to the homicide attributed
the homicide to the effects of those substances. Narrative accounts suggest
that substances (almost always alcohol) escalated impulsive, spontaneous,
violent, outbursts. Implications for the interpretation of self-reports
about substance use provided by murderers were also discussed. Fendrich,
M., et al. Substance Involvement Among Juvenile Murderers: Comparisons
with Older Offenders Based on Interviews with Prison Inmates. The International
Journal of the Addictions 30 (11), pp. 1363-1382, 1995.
Mechanisms of Noncompletion in Ethnographic Research on Drugs
Case files from two longitudinal ethnographic field studies of drug users
were reviewed in order to examine mechanisms of noncompletion. Two general
mechanisms, including investigator initiated termination and subject initiated
withdrawal were explored. Subjects were terminated when patterns of incoherent
or inconsistent responses were detected in interviews; subjects were also
terminated when they stole from the field site or when they were jailed
or hospitalized. The findings suggest that the initial phases of interviewing
served as an important subject screening period for the researchers conducting
the interviews. Most noncompletion in both studies fell under the category
of subject initiated withdrawal. Analyses suggested that respondents who
dropped out reported significantly less drug involvement and somewhat less
extensive criminal involvement than those who completed the study. Women
who dropped out were more likely to be married than women who completed
the study. Men who dropped out were less likely to reside in shelters for
the homeless than men who remained in the study. The studies' behavioral
findings sharply contrast with findings from studies of attrition in conventional
panel research on drug use. Implications for research on hidden populations
were discussed. These findings suggest some important limitations in ethnographic
research and underscore the importance of systematic descriptive accounts
of noncompletion across a range of ethnographic studies. Fendrich, M.,
et al. Mechanisms of Noncompletion in Ethnographic Research on Drugs: Results
from a Secondary Analysis. Journal of Drug Issues, 26 (1), pp. 23-44, 1996.
Pattern Reliability of Narcotics Addicts' Self-Reported Data
Pattern reliability, or the invariance of relationships among variables
was investigated in this study. The consistency of theoretical constructs
reflected by measures taken at two separate occasions can be tested using
confirmatory factor analysis. Self-report data were obtained from 323 narcotics
addicts in two face-to-face interviews conducted in 1974/75 and 1985/86.
Through the testing of the invariance of measurement and structural models,
pattern reliability was confirmed in one of the models developed. Explication
of pattern reliability offers an alternative means of assessing validity
of self-report data. Chih-Ping C., Yih-Ing H., & Anglin, M. D. Pattern
Reliability of Narcotics Addicts' Self-Reported Data: A Confirmatory Assessment
of Construct Validity and Consistency. The International Journal of the
Addictions 31 (9), pp. 1189-1216, 1996.
A Three-Year Follow-Up of Drug Abuse Resistance Education (D.A.R.E.)
The longterm effectiveness of D.A.R.E. was assessed by contrasting 561 9th
grade students who received the program in the 6th grade with 366 others
who had not received the program. A follow-up survey assessed differences
in latent variables representing central D.A.R.E. concepts such as self-esteem,
resistance to peer pressure, delay of experimentation with drugs, and drug
use. No significant differences were found between D.A.R.E. participants
and controls. However, in general, students in both the D.A.R.E. group
and the control group were doing well in terms of avoiding drugs--an encouraging
outcome. The researchers concluded that D.A.R.E. could be exerting an influence
in a more general way. At the time of the survey, over five-sixths of the
students in the junior high schools had received the program: half of the
ninth graders and all of the seventh and eighth graders. The only students
in the junior high schools who had not received the program were the ninth
graders in the control group. Due to diffusion, the contextual effect of
this massive effort to treat every student with D.A.R.E. (plus the effects
of other programs of drug education) may have created an anti-drug climate
in the junior high schools. Over time, students in the control group may
have caught up to those in the D.A.R.E. group. While mitigation of disadvantages
does make sense, so does an interpretation that the effects wear off. It
is consistent with earlier findings on maturation into the early teens in
which maturation effects operate in a direction opposite to the tenets of
D.A.R.E. (Dukes et al., 1995). Dukes, R., Ullman, J.B., Stein, J.A. A
Three-Year Follow-Up of Drug Abuse Resistance Education (D.A.R.E.), Evaluation
Review, 20, pp. 49-66, 1996.
Statistical Model for Detecting Loci for Drug Abuse and Dependence Using
Affected Relative Pairs in a Genome Search
Family, twin, and adoption studies of substance abuse and dependency have
demonstrated a significant role of genetic determinants. The current paper
develops a general statistical model and test that can be used with traditional
molecular techniques such as markers as well as the emerging GMS procedures.
The model and test are designed to handle realistically complex genetic
etiology and any mixture of relative types such as siblings, cousins, and
grandparent-grandchildren, and also in the presence of phenocopies (i.e.,
misdiagnosis). Using affected pairs, the exact test controls for the elevated
probability of false rejection of the null hypothesis when the entire genome
is searched. This integrative model is the basis of a new research proposal
written by the authors to search the human genome for the susceptibility
genes underlying opioid dependency. Smalley, S.L., Woodward, J.A., Palmer,
C.G.S. A General Statistical Model for Detecting Complex Trait Loci Using
Affected Relative Pairs in a Genome Search. American Journal of Human Genetics,
58, pp. 844-860, 1996.
Inconsistencies in Lifetime Cocaine and Marijuana Use Reports Inconsistencies
in responses to questions about lifetime cocaine and marijuana use asked
of nearly 10,000 respondents from the United States in the National Longitudinal
Survey of Youth in 1984 and 1988 were evaluated. Analyses showed that 14%
of all responses on cocaine use and 17% of all responses on marijuana use
were inconsistent in some way. The types of inconsistencies varied according
to the substance; cocaine reports yielded more inconsistencies with regard
to timing of first use, while for marijuana most of the inconsistencies
were with respect to use disclosure. For both substances, lower level users
were more likely to be inconsistent in their reports of drug use. Alternative
methods for handling inconsistencies affected estimates of incidence and
prevalence. Inconsistencies also varied according to respondent race/ethnicity.
Implications of these findings for program evaluation were discussed.
Fendrich, M. and Mackesy-Amiti M.E. Inconsistencies in Lifetime Cocaine
and Marijuana Use Reports: Impact on Prevalence and Incidence. Addiction,
90, pp. 111-118, 1995.
Initiation and Maintenance of Tobacco Smoking: Changing Personality
Correlates in Adolescence and Young Adulthood
Youthful smokers have been described as extroverted and peer-involved, whereas
older smokers are often characterized as depressed and withdrawn. Recognizing
this contradiction in personality correlates of smokers, the researchers
examined cross-sectional and prospective associations between smoking and
personality and social constructs assessed every four years in a sample
(N = 461) originally recruited in junior high school. At Time 1, smoking
was positively related to good Social Relations, Extroversion, Friends'
Cigarette Use, and Cheerfulness. At Times 2-4, smoking was positively related
to Depression and Friends' Cigarette Use, negatively correlated with good
Social Relations, and unrelated to Extroversion. Cigarette Use was stable
over time, but least stable between Times 1 and 2. Findings suggested the
instability of early social smoking with peers; those who persist may smoke
for tension-reduction and self-medication. Extrapolating from a use/abuse
distinction, the researchers suggested that more attention should be paid
to the precursors and correlates of addiction (abuse) or maintenance of
the tobacco habit rather than onset since youthful experimentation may not
continue. In view of the changing dynamics over time and early instability
of cigarette smoking revealed in our analyses, an effective prevention program
in junior high may be quite different from one that would be appropriate
in senior high school. The results suggest that learning techniques for
peer-resistance might be more applicable in the junior high setting, while
teaching effective and positive stress-reduction and coping skills might
be more useful for high school students. Stein, J.A., Newcomb, M.D., Bentler,
P.M. Initiation and Maintenance of Tobacco Smoking: Changing Personality
Correlates in Adolescence and Young Adulthood. Journal of Applied Social
Psychology, 26, pp. 160-187, 1996.
Self-Generated Drug Outcomes in Continuation High School Students
The perceived outcomes of drug use were studied in a sample of high risk
adolescents. Participants' self generated responses provided the actual
words they used to describe drug outcomes as well as associative frequency
norms valuable for future research. Outcomes were compared in terms of
class of outcome (positive versus negative) and class of drug (alcohol,
marijuana, cigarettes, cocaine, speed, and LSD). Although the studied drugs
have divergent pharmacological effects, subjects self-generated some of
the same outcomes (e.g., relaxation) across some of the drugs. In addition,
outcomes self-generated as positive outcomes were very rarely also self-generated
as negative outcomes. Regressions revealed that self-generated responses
were not predicted by ethnicity, gender, or previous drug use. Many drug
use outcomes appeared to be available in memory regardless of previous drug
use or other characteristics. Memory availability (memory storage) does
not necessarily imply memory accessibility (i.e., ease of retrieval). Other
research has recently indicated that as drug use increases in frequency,
positive outcomes of drug use become more strongly associated with drug
use in memory, and thoughts about potential positive outcomes (e.g., relaxation)
more readily trigger drug consistent thoughts and actions. Findings from
the present study and other recent studies converge on the notion that memory
associations regarding drug cues and outcomes may mediate drug use decisions,
although memory availability (storage) of outcomes may not have any mediational
or predictive effect. Taken together, these findings have implications
for interventions because programs that merely increase the availability
of knowledge or skills in memory (e.g., as indicated by typical tests of
knowledge) are not likely to be optimally effective, whereas interventions
that make program information highly accessible from memory in high-risk
settings should show stronger effects. The findings across studies also
suggest that interpretations and evaluations of the mediators of program
effects should take into account manipulations of cognitive processes (e.g.,
memory access) that are likely to vary across program conditions rather
than simply the program content that labels the condition (e.g., refusal
assertion versus negative consequence information). Stacy, A.W., Galaif,
E., Sussman, S., Dent, C.W. Self-Generated Drug Outcomes in Continuation
High School Students. Psychology of Addictive Behaviors, 10, pp. 18-27,
1996.
Prevalence of Substance Abuse and Psychiatric Disorders are High Among
Incarcerated Women
In-person interviews were conducted with a near census (N=805) of women
felons entering prison in North Carolina between July 1991 and November
1992. Assessments were made for eight psychiatric disorders using the Composite
International Diagnostic Interview as the primary assessment measure, and
25 percent of the women were reassessed for two of these disorders for purposes
of validation. Results were then compared with data from the Epidemiologic
Catchment Area (ECA) Study for the North Carolina site. The researchers
found the most prevalent disorders to be alcohol and drug abuse and dependence.
Rates for mood disorders, antisocial personality disorders, and lifetime
exposures to traumatic events were also high. Rates of disorders were found
to be greater among white women than among African Americans. The researchers
conclude that women prisoners have major needs for both substance abuse
and mental health treatment. Jordan, B. K., Schlenger, W.E., Fairbank, J.A.,
and Caddell, J.M. Prevalence of Psychiatric Disorders Among Incarcerated
Women. Archives of General Psychiatry, 53, pp. 513-519, 1996.
Parental Modeling Major Factor in Childrens' Risk for Early Onset of
Smoking
Research to examine the relationship between smoking and anti-smoking practices
in terms of socialization variables was conducted. Among 3rd and 5th grade
children, it was found that early onset of smoking increases with increase
of exposure to parent smoking models, and it does not matter if parents
are current or former smokers; quitting by parents does not eradicate the
effects of modeling. Only when parents (whether current or former smokers)
engaged in
anti-smoking socialization was the rate of smoking onset significantly reduced.
Jackson, C. and Henriksen, L. Do As I Say: Parent Smoking, Anti-Smoking
Socialization, and Smoking Onset Among Children. Addictive Behaviors, In
Press.
Children's Early Use of Tobacco and Alcohol is related to Weak Competence
Development and Socialization
Researchers at the University of North Carolina conducted cross sectional
surveys to measure tobacco and alcohol use, multiple indicators of child
competence, parent behaviors and parent modeling of tobacco and alcohol
use. Children's tobacco and alcohol use was strongly related to low scores
on child competence, both self-report and teacher rated as well as with
less effective parenting behaviors and parental use of these substances.
Jackson. C., Henriksen, L., Dickinson, D. and Levine, D. Early Use of
Alcohol and Tobacco: Relation to Child Competence and Parental Behavior,
American Journal of Public Health, In Press.
Women Who Kill in Drug Market Situations
Open ended and semi-structured interviews were used in a study with 215
women sentenced to prison in New York State for homicide, of which 19 women
killed in drug market situations. The study was to explore the ways in
which changing drug markets may have influenced women's involvement in lethal
violence. Through qualitative analysis of the narratives offered by these
women to explain their involvement in the killing, evidence was found that
supports the conclusion that women will use violence, as will men, to protect
or augment an economic interest in a drug market, From further analysis,
however, it was concluded that even in a clearly economic context in which
women are able to acquire their own economic interest, some women will kill
or participate in a killing in connection with their relationship to a male
business or intimate partner. That is, women who kill in the economic context
of a drug market may kill for economic reasons, but the specific circumstance
of involvement in a drug market does not necessarily negate the significance
of gender. Brownstein, H.H., Spunt, B.J., Crimmins, S.M., Langley, S.
Women Who Kill In Drug Market Situations. Justice Quarterly, 12, pp. 473-498,
1995.
Expectancy in Mediational Models of Cocaine Use
Several theoretical explanations of how expectancies may influence cocaine
use were studied. Hypotheses from these approaches use trait (sensation
seeking and social conformity), cognitive (expectancy), and state-like (depression
and loneliness) constructs to explain cocaine use and its problem consequences.
Constructs from these different approaches were compared as predictors
of cocaine use among a community sample of adults. Results revealed that
general and specific components of an expectancy construct predicted cocaine
use independently from all other constructs. The general component of this
construct represented expectancies for a variety of drugs in addition to
cocaine. The specific component represented expectancies about cocaine use
only. The results regarding the effects of the general component can be
interpreted in terms of recent memory models of generalization processes
in addictive behavior, although assessment of memory processes is needed
to fully validate this contention. Another important finding involved mediational
effects of expectancy. These findings suggested that expectancies may mediate
the effects of certain personality constructs on cocaine use and abuse.
The results contrast and integrate cognitive approaches to the explanation
of drug use and other behaviors with trait and state approaches to personality.
They also suggest that some form of cognitive processing of expected outcomes
of drug use mediate and predict drug use behaviors. However, the measurement
of cognitive processing effects through expectancy assessment does not reveal
the precise form that this processing takes. Additional research is needed
to specify exactly how cognitive processes predict and mediate drug use
decisions. Stacy, A.W., Newcomb, M.D., and Bentler, P.M. Expectancy in
Mediational Models of Cocaine Use. Personality and Individual Differences,
19, pp. 655-668, 1995.
A Theoretical Framework for Designing Effective Tuberculosis Control
Strategies.
Dr. Blower and colleagues describe a theoretical framework to determine
treatment levels for tuberculosis eradication, to assess the effects of
noneradicating control, and to examine the global goals for controlling
tuberculosis by the World Health Organization. The authors assess the effects
of suboptimal control programs on the evolution of multi-drug resistant
tuberculosis and define a new evaluation criterion to show how control strategies
can be improved. They demonstrate that their new theoretical framework
-- based on the maximum acceptable probability of treatment failure -- can
be used to build tuberculosis transmission models for developing control
strategies tailored to specific environments. In particular, treatment
failure rates must be lower in developing countries than in developed countries.
Blower, S.M., Small, P.M., and Hopewell, P.C. Control Strategies for Tuberculosis
Epidemics: New Models for Old Problems. Science, July 1996.
Assessing and Tracking Family Histories of Alcoholism
This study sought to (1) determine the rates of family history of alcoholism
among a community sample, using both specific questions and structured interviews,
(2) document conversions from negative (FH-) to positive (FH+) alcoholism
diagnoses among parents and grandparents of subjects, and (3) investigate
the concordance between interview and questionnaire methods in assessing
alcoholism in family members. Method: Information concerning alcoholism
among relatives of a sample of 1,201 (620 female) probands was gathered
longitudinally over a 13-year period, spanning adolescence into adulthood.
At Times 1 through 3 of the study, information was gleaned from personal
interviews with subjects, medical health forms and information from subjects'
parents, which was used to determine a "best estimate diagnosis."
At Time 4, the Family History Research Diagnostic Criteria (FH-RDC) interview
was used. Results: The number of subjects having an alcoholic relative
increased at each test time with the largest rise occurring at Time 4.
Over 80% of subjects whose parent converted to FH+ at Time 4 had previously
described that parent as a heavy or problem drinker. Conclusions: The
higher than previously seen escalation in FH+ status occurring at Time 4
is speculated to be the result of one or more of the following: an actual
increase in the number of relatives becoming alcoholic, a newfound awareness
on the part of probands about alcohol-related problems, the fact that a
global judgement or single behavior observation provides an inadequate indication
of familial alcoholism, or that the FH-RDC may include a more global measure
of "alcohol-related problems" or "problem drinking."
Johnson , V. and Bennett, M.E. Assessing and Tracking Family Histories
of Alcoholism. Journal of Studies of Alcohol, 56, pp. 654-660, 1995.
The Relationship Between Work-Specific and Generalized Stress and Alcohol
and Marijuana Use Among Recent Entrants to the Labor Force
This study examined changes in alcohol and marijuana use and problems in
relation to the transition into full-time work, and the effects of work-related
and generalized stress among a group of recent entrants to the labor force.
Data were obtained from a sample of males and females who were originally
interviewed when they were eighteen years old and followed up twice more
at three year intervals. The authors hypothesized that those who transit
into and maintain a full-time job will not increase their level of consumption
if they find the job to be the "right fit." The data indicated
that when age, gender, and marital status were controlled, there were few
significant effects of the transition to full-time work on use measure.
Data from this study provide evidence of a stronger role for generalized
stress over that of work-specific stress in predicting changes in drug use
in young adulthood. Pandina, R. The Relationship Between Work-Specific
and Generalized Stress and Alcohol and Marihuana Use Among Recent Entrants
to the Labor Force. The Journal of Drug Issues, 25 (2), pp. 237 251, 1995.
Social Support Among Impoverished Women
Types of social support, their use and efficacy were assessed in a convenience
sample of 3,021 homeless and drug addicted African American and Latino women.
Type of support most commonly cited was someone who listens (78%) followed
by someone who provides confidence (74%), advice (74%) and understanding
(73%). Almost 30% of the women reported having at least one friend or neighbor
with whom they could talk. However, only 12% could count on friends or
neighbors to help in changing things. Only 20% had a husband or partner
to confide in and receive emotional support from but their partners were
less helpful when it came to explaining things or assisting with change.
Professionals, such as counselors and social workers, were most helpful
in facilitating change. Implications reveal that enabling factors and barriers
to the use of support from professional agencies need to be explored with
a view toward designing interventions that include strengthening effective
social support in different populations of homeless women. Nyamathi, A.,
Bennett, C., Leake, B., Chen, S. Social Support Among Impoverished Women.
Nursing Research, 44, pp. 376-378, 1995.
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