National Institute on Drug Abuse Women and Sex/Gender Differences Research Director's Report to Council Research Findings Excerpts February, 2001

Behavioral Research

Postpartum Separation from Offspring Produces Long-Lasting Effects in Mother Rats

Prior research has shown that neonatal rat pups exposed to periodic separation from their mothers show an elevated stress-reactivity in adulthood that is manifest on both behavioral and physiologic indices. Researchers at the Emory University School of Medicine now show that this separation also produces long-lasting changes in the dams. Dams separated from their neonatal pups for 3 hours daily on postpartum days 2-14 and tested four to six weeks post-weaning, exhibited anxiety-like behaviors measured via (a) both entries and time spent in the open arms of an elevated plus-maze, (b) time spent in the center of a novel locomotor arena, and (c) ultrasonic vocalizations. The separation also resulted in reduced sensitivity to morphine as measured by tail-flick and hot-plate tests of analgesia. Kalinichev, M., Easterling, K.W., and Holtzman, S.G. Periodic Postpartum Separation from the Offspring Results in Long-Lasting Changes in Anxiety-Related Behaviors and Sensitivity to Morphine in Long-Evans Mother Rats. Pharmacology, 152, pp. 431-439, 2000.

Sex Differences, Estrus Cycle, and Regulation of Self-Administered Cocaine in Rats

Drs. Wendy Lynch and Marilyn Carroll of the University of Minnesota previously demonstrated that female rats acquire cocaine self-administration faster than male rats and that a larger percentage of female than male rats acquire cocaine self-administration. Using a choice procedure, these researchers now find that the mean infusion dose is lowest during metestrus/diestrus and highest during estrus and proestrus. The regulation of cocaine intake was measured by the correlation between the mean interdose interval and the preceding dose. Self-administration regulation was significantly more precise in males and in metestrus/diestrus females as compared to estrus and in proestrus females. Furthermore, there was no difference in regulation between males and metestrus/diestrus females. Lynch, W.J., Arizzi, M.N., and Carroll, M.E. Effects of Sex and the Estrous Cycle on Regulation of Intravenously Self-Administered Cocaine in Rats. Psychopharmacology, 152, pp. 132-139, 2000.

Sex Differences in Nicotine Self-Administration in Rats

Evidence has accumulated that there are sex differences in nicotine use and dependency in humans. However, until now there has been no corroborating evidence in animals. Drs. Eric Donny and Anthony Caggiula at the University of Pittsburgh found that at the lowest dose female rats acquired nicotine self-administration faster than males. Female rats reached higher break points on a progressive ratio schedule of self-administration, and therefore took more nicotine infusions. Female rats displayed a shorter latency before self-administering the first nicotine infusion in a session. No reasons for these differences were found. Self-administration in female rats did not vary with the estrus cycle. Nor were there sex differences in either up-regulation of nicotinic receptor binding sites or in brain or plasma nicotine levels. Donny, E.C., Caggiula, A.R., Rowell, P.P., Gharib, M.A., Maldovan, V., Booth, S., Mielke, M.M., Hoffman, A., McCallum, S. Nicotine Self-Administration in Rats: Estrous Cycle Effects, Sex Differences and Nicotine Receptor Binding. Psychopharmacology, 151, pp. 392-405, 2000.

Opiate Pharmacology and Gender Difference

Dr. Theodore Cicero and his associates demonstrated that morphine served as a positive reinforcer in a place-conditioning paradigm in both male and female rats. However, the dose response curves displayed marked differences by sex. In male rats, morphine at doses above 10 mg/kg ceased to act as a positive reinforcer. Since no gender differences were observed in the blood and brain levels of morphine during the conditioning phase, the investigators suggest that these results may demonstrate intrinsic sex-linked differences in the sensitivity of the CNS to morphine's reinforcing properties. Cicero, T.J., Ennis, T., Ogden, J., and Meyer, E.R. Pharmacology Biochemistry and Behavior, 65, pp. 91-96, 2000.

Treatment Research and Development

Tobacco Withdrawal in Women and Menstrual Cycle Phase

This study examined tobacco withdrawal, mood measures, and menstrual discomfort in 78 premenopausal women who quit smoking during either the follicular (days 1-14 postmenstrual onset) or luteal (day 15+ postmenstrual onset) phase of the menstrual cycle. Women quitting during the luteal phase reported significantly greater increases in tobacco withdrawal and self-reported depressive symptoms than women quitting during the follicular phase. Results indicate that in order to attenuate withdrawal and negative affect in female smokers, they should consider selecting a quit-smoking day early in the follicular phase. Perkins, K.A., Levine, M.D., Marcus, M.D., Shiffman, S., D'Amico, D., Miller, A., Keins, A., Ashwom, J., and Broge, M. Journal of Consulting and Clinical Psychology, 68, pp. 176-180, 2000.

Research on AIDS and Other Medical Consequences of Drug Abuse

Quality of Life Measures in the Miami HIV-1 Infected Drug Abusers (MIDAS) Cohort: Relationship to Gender and Disease Status

Shor-Posner and colleagues at the University of Miami report that HIV-infected drug abusers, particularly women, have less social support than men. The investigators assessed activity, daily living, health, support and outlook by using the Physician-administered Spitzer Index in 75 HIV-infected drug abusers (51 men; 24 women) enrolled in the Miami HIV Infected Drug Abusers Study (MIDAS). Total composite scores were significantly lower in HIV-infected women than men (p=0.03). Most women (45%) were homeless or marginally housed as compared to 11% of the men. Women with low activity scores had less social support than women with high activity scores. Cocaine use was significantly related to reports of normal activity, and varied across genders; more men used cocaine than women (p=0.03). Compared to non-AIDS participants, AIDS patients were more likely to have lower scores in health (p=0.009) and poor outlook (p=0.03). These findings reveal specific deficits in areas of psychosocial capacity, particularly in HIV-1 infected women who abuse drugs, that may need to be strengthened in order to enhance function and adherence to treatment, as well as well-being. Shor-Posner, G., Lecusay, R., Miguez-Burbano, M.J., Quesada, J., Rodriguez, A., Ruiz, P., O'Mellan, S., Campa, A., Rincon, H., Wilkie, F., Page, B., and Baum, M. Quality of Life Measures in the Miami HIV-1 Infected Drug Abusers (MIDAS) Cohort: Relationship to Gender and Disease Status. Journal of Substance Abuse, 12, pp. 1-10, 2000.

Study Examines Stage of Change for Condom Use Among Women Crack Users

Attitudes-norms research (the theories of planned behavior and reasoned action) has been successful in accounting for many types of behavior change. One of the strengths of this approach has been to combine individual beliefs and normative influences in the explanation of behavior change. However, the conceptualization of normative influence in these theories makes very strong assumptions about self-awareness in the selection of normative referents. These assumptions are particularly problematic when applied to female cocaine smokers, who report frequent sex while under duress or while cognitively impaired. In this study the original conceptualization of normative influence and two alternatives (assuming emotion-based and interaction-based selection of normative referents) are operationalized to evaluate stage of change for condom use among women who are heavy crack cocaine users with multiple sex partners. Results show that stage of change for use of condoms with nonmain partners is best accounted for by interaction-based selection of normative referents. Richard, A.J., Bell, D.C., Montoya, I.D. Normative Influence on Condom Use in the Personal Networks of Female Cocaine Smokers. AIDS Educ Prev, 12(4), pp. 357-374, 2000.

Prostitution and the Sex Discrepancy in Reported Number of Sexual Partners

Brewer and colleagues report that prostitute women are underrepresented in national household sexual surveys. In their examination of sampling bias to explain previous survey findings that men report more sex partners than women do, the investigators note that the proportion of heterosexual men and women in the United States is roughly balanced and that in the aggregate, men and women in a closed population have relatively the same number of sex partners. The investigators find that prostitutes have been under-represented primarily because their residences or lodgings place them outside sampling frames for household surveys and that when this undersampling is taken into consideration, the discrepancy in sexual behavior survey findings disappears. After adjusting for prostitution-related factors, such as estimated prevalence of prostitutes and their high number of sex partners (Potterat et al., Sexual, drug-using and social networks of persons presumed to be at high risk for HIV infection), the investigators conclude that essentially all the discrepancy is accounted for by undersampling of prostitutes rather than by sex-linked reporting bias such as men's reluctance to report that their partners include prostitutes. Brewer, D.B., Potterat, J.J., Garrett, S.B., Muth, S.Q., Roberts, J.M., Kasprzyk, D., Montano, D.E., and Darrow, W.W. The Proceedings of the National Academy of Sciences, 97(22), pp. 12385-12388, 2000.

Drug Use, Partner Violence, and HIV Risk

This study analyzed in-depth interviews with women in methadone maintenance treatment programs (MMTPs) who reported having experienced physical or sexual violence by an intimate partner during the past year. 87% of the women reported experiencing a minor physical assault from an intimate partner within the past year, 58% reported experiencing a severe assault, 64.5% reported experiencing minor sexual coercion, and 12.9% reported severe sexual coercion. 40% of the women indicated that both she and her partner were involved in drug-related activities during the most recent occurrence of partner abuse, 35% reported that only the partner was drug-involved, and only 6.4% of the women indicated that they alone were drug-involved. 20% reported using drugs immediately after the violent event because they were upset or in pain. Crack/cocaine was the drug most frequently mentioned by women reporting drug use before, during, or after the most recent violent event. For male partners, alcohol and crack/cocaine use were the most prevalent substances reported in conjunction with the most recent violent event. In terms of HIV risk behavior, 20% of the women reported having unwanted sex after the most recent incident. Few women reported using condoms with their main partners; yet, two-thirds reported that they had outside relationships or suspected their partners of having outside relationships. 20% reported having exchanged sex for money/drugs within the past 90 days. 20% reported injection drug use within the past year. The multiple ways in which drugs of abuse are related to partner violence and HIV risk behaviors suggest the need for specific interventions for preventing drug relapse, and HIV and HCV infection among abused women in MMTPs. Gilbert, L.,El-Bassel, N., Rajah, V. Foleno, A., Fontdevila, J., Frye, V., and Richman, B.L. The Converging Epidemics of Mood-Altering-Drug Use, HIV, HCV, and Partner Violence: A Conundrum for Methadone Maintenance Treatment. Mt. Sinai J. Med., 67(5-6), pp. 452-464, 2000.

HIV Risk Behavior Among Bisexual and Heterosexual Drug Users

This study examined the sexual and drug use behaviors for bisexual and heterosexual drug users (n=11,435 males and n=5,636 females) who participated in the NIDA AIDS Cooperative Agreement study. Results of the study suggest that, for males, bisexuality was highly associated with being homeless, having ever been paid for sex, having five or more sex partners in the month preceding the interview, having an IV drug-using sexual partner in the month preceding the interview, using crack, and sharing injection equipment in the month preceding the interview. For females, bisexuality was associated with ever having been arrested, past substance abuse treatment, ever having been paid for sex, ever having paid for sex, having five or more sexual partners in the month preceding the interview, ever using cocaine, and sharing injection equipment in the month preceding the interview. Overall, results from this study indicate that both male and female bisexuals, when compared to heterosexuals, were at higher risk for HIV and were more likely to be HIV positive. One implication of these results is that a universal prevention message may not be as effective as targeting prevention messages specifically for bisexual males and females. Logan, T. K., Leukefeld, C. J Psychoactive Drugs, 32, pp. 239-48, 2000.

Delivery of HIV Risk-Reduction Services in Drug Treatment Programs

Receipt of services targeted at HIV risk reduction was examined using data from 4,412 participants in the national Drug Abuse Treatment Outcome Study (DATOS). A higher percentage of individuals in long-term residential programs received HIV-related services, compared with clients in short-term inpatient, methadone maintenance, and outpatient drug-free programs. More men than women received HIV services. Although individuals who engaged in sex work had a higher likelihood than others of receiving HIV-related services, individuals with high-risk or multiple sexual partners were no more likely than others to receive HIV services. More comprehensive service delivery is needed in order to reduce the risk for HIV among clients in drug treatment. Grella, C.E., Etheridge, R.M., Joshi, V., and Anglin, M.D. Journal of Substance Abuse Treatment, 19(3), pp. 229-237, 2000.

Delays in Seeking HIV Care Due To Competing Caregiver Responsibilities

This study described characteristics of HIV-infected persons who delay medical care for themselves because they are caring for others. HIV-infected adults (N = 2864) enrolled in the HIV Cost and Services Utilization Study (1996-1997) were interviewed. Results indicate that the odds were 1.6 times greater for women than for men to put off care. Persons without insurance and with CD4 cell counts above 500 were also significantly more likely to put off care. Those with a child in the household were 1.8 times more likely to put off care. Women or those with a child in the household should be offered services to allow them to avoid delays in seeking their own medical care. Stein, M.D., Crystal, S., Cunningham, W.E., Ananthanarayanan, A., Andersen, R.M., Turner, B.J., Zierler, S., Morton, S., Katz, M.H., Bozzette, S.A., Shapiro, M.F. and Schuster, M.A. Am J Public Health, 90(7), pp. 1138-1140, 2000.

Epidemiology, Etiology and Prevention Research

Executive Cognitive Functioning Mediates the Relation Between Language

Competence and Antisocial Behavior in Conduct-Disordered Adolescent Females Researchers affiliated with the Center for Education and Drug Abuse Research (CEDAR) at the University of Pittsburgh conducted a study to determine (1) whether adolescent females with a conduct disorder (CD) demonstrate inferior language skills and lower executive cognitive functioning (ECF) compared with controls and (2) whether the relations between language abilities and different forms of antisocial behavior (ASB) are mediated by ECF. Language skills were measured using the Test of Language Competence-Expanded, ECF was measured using multiple neuropsychological tests, and ASB was assessed using various self-report and psychiatric interview indices reflecting mild delinquency to severe violence. Subjects were 223 adolescent females with a CD and 97 normal controls ranging between 14 and 18 years of age (N = 320). The CD group demonstrated significantly poorer language skills and lower ECF compared with the controls. Moreover, even when controlling for chronological age and socioeconomic status, ECF still fully mediated the relations between language competence and each measure of ASB. The results are discussed in relation to a neurobehavioral model of ASB. Giancola, P.R. and Mezzich, A.C. Executive Cognitive Functioning Mediates The Relation Between Language Competence and Antisocial Behavior in Conduct- Disordered Adolescent Females. Aggressive Behavior, 26(5), pp. 359-375, 2000.

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

Researchers at CEDAR 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 CEDAR 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.

Inhalant Use Among High School Students in Illinois

Researchers at the University of Illinois at Chicago analyzed data from two years (1993 and 1995) of a statewide survey of high school students on drug use. Changes in the rates of inhalant use, and associations between inhalant use and sociodemographic variables, were examined across the two survey years. Measures of inhalant use included lifetime use, past year use, and past month use. Analyses showed no significant difference in the rates of inhalant use across years. Associations with sex, ethnicity, and age were partly consistent with previous research findings. Both lifetime and recent inhalant use were more prevalent among males than females. Blacks were less likely to use inhalants (lifetime and recent) than other racial/ethnic groups in both survey years. Native Americans showed elevated rates of recent inhalant use in 1993 but not in 1995. While patterns in age-specific rates in the 1993 survey were consistent with expectations, those in the 1995 survey were not: recent inhalant use was constant across age groups in the 1995 sample. Also contrary to expectations, inhalant use was not more prevalent in low-income or high- poverty areas. The associations of inhalant use with family intactness and academic performance varied by race/ethnicity. Family intactness was a significant protective factor only for whites and Hispanics. Poor grades were not a significant predictor of lifetime inhalant use for blacks, and the protective effect of high grades was found only for whites. Poor grades were highly predictive of lifetime inhalant use for Asians. Mackesy-Amiti, M.E. and Fendrich, M. Trends in Inhalant Use Among High School Students in Illinois: 1993-1995. American Journal of Drug and Alcohol Abuse, 26(4), pp. 569-590, 2000.

Gender Differences in Validity of Drug Use Reporting by Juvenile Arrestees

In an exploratory study, investigators at the University of Illinois at Chicago looked at the validity of drug use reporting among arrestees. Past studies on this topic have not included enough females to study gender differences. This study examined gender differences in the validity of drug use reporting among juvenile arrestees, using a gender-matched sample (n = 6,377) drawn from the Drug Use Forecasting Program for 1992-1996. Self-reported marijuana and crack and/or cocaine use was compared to urinalysis results to test gender differences in the accuracy of disclosure. Among urine positives, girls were more willing than boys to disclose past month and lifetime marijuana use. Gender was not a significant main effect for cocaine use reporting but interacted with race/ethnicity and family structure in predicting valid disclosure. Hispanic girls were significantly more likely than Hispanic boys to under report recent cocaine use. Among arrestees from homes with one or no parents, girls were significantly more likely than boys to disclose recent cocaine use. Kim, J.Y., Fendrich, M., and Wislar, J.S. The Validity of Juvenile Arrestees' Drug Use Reporting: A Gender Comparison. Journal of Research in Crime and Delinquency, 37(4), pp. 419-432, 2000.

Methamphetamine Use by High School Students

Researchers at the Tri-ethnic Center for Prevention Research at Colorado State University analyzed data on 9th through 12th graders' methamphetamine use reported in the American Drug and Alcohol Survey (n=629,722). From 1989 through 1992, methamphetamine use rates remained relatively stable. Since then, rates have increased, almost doubling, especially in Western states. There were no significant differences in methamphetamine use across year in school, but males were more likely to use than females though use among females has also increased. American Indians and Hispanics were more likely to use methamphetamine, followed (in order) by Asian Americans, White non-Hispanics, and African Americans. Compared to other heavily drug involved youth, methamphetamine users were more likely to use other drugs. The most commonly reported other drugs used by students who used methamphetamine were alcohol, marijuana, hallucinogens, uppers, and cocaine. Methamphetamine users were also more likely than other drug users to suffer drug use consequences such as traffic tickets, car accidents, being arrested, trouble at school, fighting, and other adverse consequences. Oetting, E.R., Deffenbacher, J.L., Taylor, M.J., Luther, N., Beauvais, F., and Edwards, R.W. Methamphetamine Use by High Schools Students: Recent Trends, Gender and Ethnicity Differences, and Use of Other Drugs. Journal of Child and Adolescent Substance Abuse, 10(1), pp. 33-50, 2000.

Childhood Sexual Abuse Predicts Adult Psychiatric and Substance Use Disorders in Women

Dr. Kenneth Kendler and colleagues at the Medical College of Virginia used a genetically-informed design and population-based sample of 1411 female adult twins to explore the association between childhood sexual abuse and adult psychiatric disorders, including alcohol and substance abuse, assessed retrospectively. They found that women who reported childhood sexual abuse are at substantially increased risk to develop a range of psychopathologic outcomes, particularly alcohol and substance use disorders, primarily due to more severe sexual abuse. Of note, this relationship held when parental psychopathology was controlled in the analyses, suggesting that the relationship between childhood sexual abuse and adult outcomes is indeed causal. Although the association between sexual abuse and psychopathology has been reported previously, this study is remarkable for applying methodology that can help distinguish between association and causation by including family factors and using a co-twin report method in a population-based sample. Kendler, K.S., Bulik, C.M., Silberg, J., Hettema, J.M., Myers, J., and Prescott, C.A. Childhood Sexual Abuse And Adult Psychiatric And Substance Use Disorders In Women: An Epidemiological And Cotwin Control Analysis. Archives of General Psychiatry, 57, pp. 953-959, 2000.

Nicotine Dependence Rates Vary by Gender, Ethnicity, and Age

This study used data from the National Household Survey on Drug Abuse to look at the relationship between numbers of cigarettes used and symptoms of nicotine dependence, for various groups. The authors found that rates of nicotine dependence were highest among females, whites, and adolescents and younger adults (below age 50); each of these groups experienced more dependence symptoms while using the same or fewer number of cigarettes. Dependence rates increase sharply up to half a pack of cigarettes smoked per day. This study is unusual in using epidemiologic data from a large study to begin examining population prevalence and differential rates of nicotine dependence symptoms. It suggests that different thresholds of quantity and duration of smoking should be used in assessing different groups for risk for nicotine dependence, and that the risk for developing dependence increases sharply at lower levels of smoking (up to half a pack per day). Of particular note is the finding that adolescents, women, and whites were particularly vulnerable to the development of dependence symptoms at lower levels of consumption than their counterparts. Kandel, D.B. and Chen, K. Extent of Smoking and Nicotine Dependence in the United States: 1991-1993. Nicotine and Tobacco Research, 2, pp. 263-274, 2000.

Heritability of Tobacco Consumption Varies by Gender and Time Cohort

This article reports the largest and most comprehensive analysis to date of twin data yielding heritability estimates for tobacco use. The probands were obtained from a Swedish registry of twins born since 1886. By comparing monozygotic (MZ) and dizygotic (DZ) twin pairs, heritabilities for males was 56% with considerably lower contributions to the variance for use of tobacco; 24% and 20% for familial-environment and individual-specific environment risk factors, respectively. The pattern for females was not the same and subsequent analyses were needed to understand the differences. What seemed to matter for females was the era of their birth: those born in the first and second third of the cohort had much less heritability than those born in the last third (since 1940). In fact, those females born most recently had essentially the same heritability as males. The authors' conclude that "a reduction in the social restrictions on smoking in women in Sweden as the twentieth century progressed permitted genetic factors influencing the risk for regular tobacco use to increasingly express themselves."

A second result from this study is noteworthy. Twin correlations for amount of tobacco consumed were significant in MZ twins but not DZ twins, supporting the hypothesis that substance use is a two stage process: initiation and continued use (or misuse). Finally, the large number of twins studied allowed comparison of both MZ and DZ twin pairs who were either reared together or reared apart. This is important to address what is known as the "equal environment assumption" that assumes MZ and DZ twins are correlated in their exposure to their environment. In analyses addressing this issue, it was found that that the equal environment assumption was sufficiently valid so as not to introduce particular environmental biases due to zygosity. Kendler, K.S., Thornton, L.M., and Pedersen, N.L. Tobacco Consumption in Swedish Twins Reared Apart and Reared Together. Archives of General Psychiatry, 57, pp. 886-892, 2000.

Ethnicity and Gender in Polydrug Use

The purpose of this study was to determine if ethnic and gender differences in polydrug use exist among a cohort of inner-city adolescents during the three-year middle school period. Students in 22 urban schools completed self-report questionnaires with measures of drug use (smoking, drinking, and marijuana use) at three annual assessments. For participating students, (N=2354), analyses of variance were conducted to test for ethnic group (Asian, Black, Hispanic, and White) and gender differences in polydrug use. Ethnic differences were found for polydrug use measures at each assessment point. Asian and Black adolescents generally reported less polydrug use than White and Hispanic youth. When gender differences were evident, boys engaged in more use than girls. The relatively high rates of polydrug use indicate that prevention intervention programs that target multiple substances may be more efficient in reducing overall risk than prevention programs that focus on a single substance (e.g., smoking prevention only). Epstein, J.A., Botvin, G.J., Griffin, K.W., and Diaz, T. Role of Ethnicity and Gender in Polydrug Use Among a Longitudinal Sample of Inner-City Adolescents. Journal of Alcohol and Drug Education, 45, pp. 1- 12, Fall 2000.

Monthly Bursts in Adolescent Drug Use

The goal of this study was to determine the extent to which monthly bursts in substance use (i.e., tobacco, marijuana, alcohol) were related to family and peer relations. Using a structured protocol, monthly interviews were conducted with 181 young adolescents, ages 11-14 yrs old, and their parents. Scores derived from monthly telephone reports described variation in parent involvement, exposure to deviant peers, peer conflicts, and level of family stress. Consistent with an ecological framework of development, environmental factors varied by gender and family membership. Across gender in both 1- and 2-parent families, exposure to peer problem behavior co-varied with increased substance use in the same month. Other monthly predictors varied by gender. Findings suggest that intervention programs for high-risk youth targeting adolescent problem behavior need to focus on managing the peer environment. Dishion, T.J. and Medici Skaggs, N. An Ecological Analysis of Monthly "Bursts" in Early Adolescent Substance Use. Applied Developmental Science, 4(2), pp. 89-97, 2000.

Aggression and Drug Use Related in Inner-City Youth

In a study of 517 inner-city eighth graders, investigators found that self-reported aggressive and unsafe behaviors were associated with initiation of drug use (use of tobacco, alcohol, and marijuana). Sex differences were found for aggressive behavior, victimization, and unsafe behavior. Epstein, J.A., Botvin, G.J., Diaz, T., Williams, C., and Griffin, K. Aggression, Victimization and Problem Behavior Among Inner-City Minority Adolescents. J. of Child and Adolescent Substance Abuse, 9(3), pp. 51-66, 2000.

Reducing Adolescent Aggressive Behavior

Data from a randomized trial including 22 public schools assigned either to the Iowa Strengthening Families Program or a control condition were examined for long-term effects of this seven-session intervention for parents and their sixth-grade children on aggressive and hostile behaviors of adolescents. Analyses supported sample representativeness of this general population study and failed to show differential attrition effects 4 years after baseline. The multi-informant, multi-method measures included independent observer ratings of adolescent aggressive and hostile behaviors in adolescent-parent interactions, family-member report of aggressive and hostile behaviors in those interactions, and adolescent self-report of aggressive and destructive conduct across settings. Data were collected during the 6th (pre- and post-intervention), 7th, 8th, and 10th grades. All measures showed a generally positive trend in intervention compared to the control group over time. During 10th grade, significant intervention-control differences were found for adolescent self-report of aggressive and destructive conduct with relative reduction rates ranging from 31.7% to 77.0%. Significant differences were shown for observer-rated aggressive and hostile behaviors in adolescent-parent interactions; differences in family member reports of those behaviors were not significant. Supplemental analyses interaction behavior measures, specific to parent gender, indicated significant experimental group differences in interactions with mothers for both measures, but not with fathers. Spoth, R.L., Redmond, C., and Shin, C. Reducing Adolescents' Aggressive and Hostile Behaviors - Randomized Trial Effects of a Brief Family Intervention Four Years Past Baseline. Archives of Pediatrics and Adolescent Medicine, 154 (12), pp. 1248-1257, 2000.

Psychosocial and Behavioral Factors Predict Heavy Drinking

A longitudinal study found that heavy drinking in 12th grade was predicted by multiple factors measured in the 7th grade, including experimentation with alcohol or cigarettes, having had a majority of friends who drink and having had poor behavioral self-control. Several effects were limited to either boys or girls. For example, positive alcohol expectancies in 7th grade predicted greater heavy drinking later in boys, while friends' smoking predicted later heavy drinking in girls. Griffin, K.W., Botvin, G.J., Epstein, J.A., Doyle, M.M. and Diaz, T. Psychosocial and Behavioral Factors in Early Adolescence as Predictors of Heavy Drinking Among High School Seniors. J. of Studies on Alcohol 61(4), pp. 603-606, 2000.

Results Linking Parenting Practices and Problem Behavior Replicated With Urban Minority Youth

A study of 228 6th grade urban minority youth found that boys from single-parent families engaged in the highest rates of problem behavior. The relationship between parenting practices and outcomes was moderated by family structure and gender. More parental monitoring was associated with less delinquency overall, as well as less drinking in boys only. Eating family dinners together was associated with less aggression overall, as well as less delinquency in youth from single-parent families and in girls. Unsupervised time at home alone was associated with more smoking for girls only. Griffin, K.W., Botvin, G.J., Scheier, L.M., Diaz, T. and Miller, N.L. Parenting Practices as Predictors of Substance Use, Delinquency, and Aggression Among Urban Minority Youth: Moderating Effects of Family Structure and Gender. Psychology of Addictive Behaviors, 14(2), pp. 174-184, 2000.

Childhood Sexual Abuse Among Female Addicts and Subsequent Parenting

The relationship between childhood sexual abuse (CSA), family of origin and the status of 248 female narcotic addicts currently raising adolescent children was examined. Seventy-eight of these women reported a history of CSA. The CSA group and the non- CSA group were compared on variables related to parental substance abuse, parenting behavior, and other family dynamics (retrospectively for families of origin and contemporaneously for current families). Findings suggest that the abuse of alcohol by the mothers of some of the CSA subjects was a contributing factor in creating an environment or set of circumstances in which the abuse took place. The two groups also differed on variables such as involvement, attachment, responsibility, discipline, and punitive actions. CSA was also related to addiction careers, parental substance use, adult psychological symptoms, and home atmosphere. Blatchley, R.J., Hanlon, T.E., Nurco, D.N., and O'Grady, K. Childhood Sexual Abuse Among Female Addicts and Changes in Parenting Across Two Generations. Fishbein, D.H. (Ed), et al. The Science, Treatment and Prevention of Antisocial Behaviors: Application to the Criminal Justice System, Kingston, NJ, US: Civic Research Institute, pp. 27-25, 2000.

Development of Marijuana Use From Childhood to Young Adulthood

The present study was designed to examine the relationship between unconventionality and marijuana use over time. The sample for this paper consisted of 532 male and female participants interviewed during early adolescence, late adolescence, their early twenties, and their late twenties. Latent growth modeling was used. The findings indicated that (1) the influence of initial unconventionality (T2) on initial marijuana use (T2) was stronger for males, (2) unconventionality at T2 was not significantly related to overall rate of growth in marijuana use, and (3) change in unconventionality was related to overall growth rate of marijuana use. The implications of the findings for prevention and treatment are discussed. Brook, J.S., Whiteman, M., Finch, S.J., Morojele, N.K. and Cohen, P. Individual Latent Growth Curves in the Development of Marijuana Use from Childhood to Young Adulthood. J Behav Med 23(5), pp. 451-464, 2000.

Personality Disorders Associated With Violence and Criminal Behavior

This community-based, longitudinal prospective study investigated whether personality disorders during adolescence are associated with elevated risk for violent behavior during adolescence and early adulthood. A community-based sample of 717 youths from upstate New York and their mothers were interviewed in 1983, 1985-1986, and 1991-1993. Axis I and II disorders were assessed in 1983 and 1985-1986. Antisocial personality disorder was not assessed because most participants were less than 18 years of age in 1983 and 1985-1986. Violent behavior was assessed in 1985-1986 and 1991-1993. Results show that adolescents with a greater number of DSM-IV cluster A or cluster B personality disorder symptoms were more likely than other adolescents in the community to commit violent acts during adolescence and early adulthood, including arson, assault, breaking and entering, initiating physical fights, robbery, and threats to injure others. These associations remained significant after controlling for the youths' age and sex, for parental psychopathology and socioeconomic status, and for co-occurring psychiatric disorders during adolescence. Paranoid, narcissistic, and passive-aggressive personality disorder symptoms during adolescence were independently associated with risk for violent acts and criminal behavior during adolescence and early adulthood after the covariates were controlled. Cluster A and cluster B personality disorders and paranoid, narcissistic, and passive-aggressive personality disorder symptoms during adolescence may increase risk for violent behavior that persists into early adulthood. Johnson, J.G., Cohen, P., Smailes, E., Kasen, S., Oldham, J.M., Skodol, A.E. and Brook, J.S. Adolescent Personality Disorders Associated with Violence and Criminal Behavior during Adolescence and Early Adulthood. Am J Psychiatry, 157(9), pp. 1406-1412, 2000.

Services Research

Comparison of Outcomes By Gender and for Fee-For-Service Versus Managed Care: A Study of Nine Community Programs

During-treatment services and 7-month post-treatment entry outcome of cocaine- or alcohol-dependent men (N = 145) and women (N = 149) Target City patients receiving either standard fee-for-services (N = 183) or managed care treatment funding (N = 111) in nine community outpatient programs were compared. No differences were found in treatment services received by the various subgroups. Regression analyses compared the four described subgroups (Gender x Type of Funding) on their seven Addiction Severity Index composite scores at 7 months post-admission controlling for the respective baseline composite score and several background variables on which the groups differed. Surprisingly few outcome differences were revealed between men and women patients and patients receiving the two forms of treatment funding. The only difference noted was that patients treated via managed care showed more improvement in the drug area. The need for further evaluation of the effects of managed care is emphasized. Alterman, A.I., Randall, M., McLellan, A.T. J Subst Abuse Treatment, 19(2), pp. 127-134, 2000.

Program Variation in Treatment Outcomes Among Women in Residential Drug Treatment

Multilevel modeling was used to assess the program characteristics associated with treatment retention among 637 women in 16 residential drug treatment programs in the Drug Abuse Treatment Outcome Study. Women who were pregnant or had dependent children had higher rates of retention in programs in which there were higher percentages of other such women. Programs with higher proportions of pregnant and parenting women provided more services related to women's needs. Longer retention was associated with higher rates of post-treatment abstinence. The findings support provision of specialized services and programs for pregnant and parenting women. Grella, C.E., Joshi, V., Hser, Y.I. Eval Review, 24(4), pp. 364-383, 2000.

A Search for Strategies To Engage Women in Substance Abuse Treatment

In order to remain in treatment, patients must initially engage in the treatment process, and clinicians seek motivational strategies to draw each patient into the treatment process. This study found that outpatient clients who received engagement services during the intake period showed increased use of these services, relative to a comparison group, throughout the treatment process. Tangible engagement services provided to women during the intake period for outpatient substance abuse treatment had no significant effect on the rates of admission, discharge, and service utilization. Comfort, M., Loverro, J., Kaltenbach, K. Social Work in Health Care, 31(4), pp. 59-70, 2000.

Detoxification Centers: Who's in the Revolving Door?

Data from 443,812 admissions to publicly funded detoxification centers in Massachusetts from 1984 to 1996 were analyzed to assess changes in the population served. Substantial increases in admissions of women, African Americans, and Hispanics were apparent. Mean age at admission declined and unemployment increased. A 25% decline in admissions reporting alcohol use was coupled with a twofold increase in reported cocaine use and a fourfold increase in heroin use. Detoxification services have evolved. The older, white, male alcoholic is no longer the primary consumer. Policy initiatives (e.g., increased services for women) and the changing epidemiology of drugs abuse (e.g., increased access to heroin) contributed to the changing population served in detoxification centers. McCarty, D., Caspi, Y., Panas, L., Krakow, M., Mulligan, D.H. J Behav Health Serv Res, 27(3), pp. 245-256, 2000.

Predictors of Substance Abuse Treatment Retention Among Women and Men in an HMO

Although research has examined treatment retention in public drug treatment programs, little is known about factors that influence treatment retention in an insured outpatient population. All eligible intakes to a health maintenance organization's outpatient alcohol and drug treatment programs (abstinence based day hospital and traditional outpatient modalities) were recruited during a 2-year period, for a sample of 317 women and 599 men. One general pattern of predictors of increased retention was shared by women and men -- fewer and less severe drug problems. Most other predictors were gender-specific. Among women, higher retention was predicted by having higher incomes, belonging to ethnic categories other than African American, being unemployed, being married, and having lower levels of psychiatric severity. Among men, predictors of higher retention included being older, receiving employer suggestions to enter treatment, and having abstinence goals. These findings suggest treatment factors that may enhance retention among insured populations, including employer referrals, psychiatric services, and drug-related services. Mertens, J.R., Weisner, C.M. Alcohol Clin Exp Res, 24(10), pp. 1525-1533, 2000.

NIDA Home | Site Map | Search | FAQs | Accessibility | Privacy | FOIA (NIH) | Employment | Print Version _ The National Institute on Drug Abuse (NIDA) is part of the National Institutes of Health (NIH) , a component of the U.S. Department of Health and Human Services. Questions? See our Contact Information. Last updated on Monday, February 11, 2008.