Origins and Pathways to Drug Abuse

Research Findings from September, 2001 Director's Report

This section lists selected summaries from NIDA funded research projects that investigate the origins and pathways to drug abuse. 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.

Study Links Recalled Adolescent Peer Norms About Drug Use With Current Drug Use

Drug use among adolescents is a significant social and public health problem in the U.S. and in many other countries. This study explored the relationship between the drug use norms of young adult peers (recalled from age 15) and subjects' current drug use in the past 12 months. Subjects included two samples of 18-24 year olds from a low income, minority neighborhood in New York City, a probabilistically selected household sample, and a targeted sample of users of cocaine, heroin, crack or injected drugs. Norms varied by drug, and were least for marijuana, and increasingly negative for cocaine, heroin, crack, and injected drugs. There was a strong relationship between recalled norms and current use for both individual drugs and a hierarchically defined level of drug use; this relationship remained significant after controlling for socio-demographics and parental and sibling drug use. Intervention programs for young teens that influence peer selection and norms of groups of adolescents should be developed and tested. Research is also needed on the social, economic, political, and other determinants of norms in the neighborhood and community context. Flom, P.L., Friedman, S.R., Kottiri, B.J., Neaigus, A., and Curtis, R. Recalled Adolescent Peer Norms Towards Drug Use in Young Adulthood in a Low-Income, Minority Urban Neighborhood. Journal of Drug Issues, pp. 425-444, Spring 2001.

Predicting Violent Behavior

The social development model seeks to explain human behavior through specification of predictive and mediating development relationships. It incorporates the effects of empirical predictors ("risk factors' and "protective factors) for antisocial behavior and seeks to synthesize the most strongly supported propositions of control theory, social learning theory, and differential association theory. This article examines the fit of the social development model using constructs measured at ages 10, 13, 14, and 16 to predict violent behavior at age 18. The sample of 808 is from the longitudinal panel of the Seattle Social Development Project, which in 1985 surveyed fifth-grade students from schools serving high crime neighborhoods in Seattle, Washington. Structural equation modeling techniques were used to examine the fit of the model to the data. Findings indicate that the social development model adequately predicts violence at age 18 and mediates much of the effect of prior violence. Huang, B., Kosterman R., Catalano, R.F., Hawkins, J.D., and Abbott, R.D. Modeling Mediation in the Etiology of Violent Behavior and Adolescence: A Test of the Social Development Model. Criminology, 39(1), pp. 75-107, 2001.

Timing of Violence Initiation

This study used data from the Seattle Social Development Project (SSDP) to compare social developmental mechanisms predictive of violence at age 18 for youth who initiated violence in childhood compared with those who initiated violence during adolescence. The SSDP is a theory-guided longitudinal study of youth development and behavior that began in 1985 when children were in the fifth grade. A multiple-group structural equation modeling approach was used to test relationships among social development model constructs hypothesized to predict violence and other forms of antisocial behavior. Analyses revealed that socialization pathways leading to violence at age 18 were similar for those who initiated violence in childhood and in adolescence, suggesting that the same preventive interventions may be effective for individuals in both groups. Herrenkohl, T.I., Huang, B., Kosterman, R., Hawkins, J.D., Catalano, R.F., and Smith, B.H. A Comparison of Social Development Processes Leading to Violent Behavior in Late Adolescence for Childhood Initiators and Adolescent Initiators of Violence. Journal Of Research In Crime And Delinquency, 38(1), pp. 45-63, 2001.

Adolescent Problem Behavior by Observed Psychopathology

This study examines adult reports of externalizing and internalizing psychopathology at home and school in a sample of 224 high-risk adolescent boys and girls (average age 12 years). Four groups of young adolescents were defined, based on the consistency of the teacher and parent CBCL reports: normal, internalizing, externalizing, and co-morbid. Group comparisons revealed the co-morbid and externalizing only groups were more engaged in a deviant peer group and were observed in higher levels of deviancy training with their friends, compared to the other groups. In general, elevated levels of arrest, drug use, and sexual promiscuity were associated with cross-setting consistency in externalizing disorders. Co-morbid youth, however, showed the highest levels of sexual promiscuity in middle adolescence, compared to all other groups. These findings are consistent with a developmental account of adolescent maladjustment and suggest that emotional disturbance in early adolescence might exacerbate youth vulnerability, especially to deviancy training within friendships. Dishion, T.J. Cross-setting Consistency in Early Adolescent Psychopathology: Deviant Friendships and Problem Behavior Sequelae. Journal of Personality, 68(6), pp. 1109-1126, 2000.

Multimethod Assessment of Psychopathology Among DSM-IV Subtypes of Children with Attention-Deficit/Hyperactivity Disorder

Using data based on self-, parent, and teacher reports, various aspects of psychopathology were assessed in a large sample of control children and those with ADHD. Confirmatory factor analysis was employed to extract response bias from latent constructs of aggression, anxiety, attention problems, depression, conduct disorder, and hyperactivity. These latent constructs were then entered into logistic regression equations to predict membership in control versus ADHD groups, and to discriminate between ADHD subtypes. Results of the regression equations showed that higher levels of attention problems and aggression were the best predictors of membership in the ADHD group relative to controls. Logistic regression also indicated that a higher degree of aggression was the only significant predictor of membership in the ADHD-Combined group compared to the ADHD-Inattentive group. However, when comorbid diagnoses of Oppositional Defiant Disorder and Conduct Disorder were controlled for in the logistic regression, greater hyperactivity rather than aggression was the sole variable with which to distinguish the ADHD Combined from the ADHD-Inattentive subtype. Crystal, D.S., Ostrander, R., Chen, R.S., and August, G.J. Multimethod Assessment of Psychopathology Among DSM-IV Subtypes of Children with Attention-Deficit/Hyperactivity Disorder: Self-, Parent, and Teacher Reports. Journal of Abnormal Child Psychology, 29(3), pp. 189-205, 2001.

Replication of a Problem Behavior Model with American Indian, Hispanic, and Caucasian Youth

The replicability of a model of family and peer influences on adolescent problem behavior was evaluated with samples of adolescent boys and girls from three ethnic groups: American Indians, Hispanics, and Caucasians. Participants were 1,450 seventh-grade students from 16 communities. The model included links between three aspects of family functioning and adolescents' association with deviant peers. Those variables were hypothesized predictors of adolescents' problem behavior (antisocial behavior; poor school performance, and frequency of substance use). The resulting cross-sectional model showed good consistency across the three ethnic groups for both genders, but some subgroup differences emerged in the magnitude of relations between monitoring and adolescents' associations with deviant peers and between substance use and the problem behavior construct. With those qualifications, the model was applicable to Hispanic and Native American adolescents in the sample. Barrera, M., Jr., Biglan, A., Ary, D.V., and Li, F. Replication of a Problem Behavior Model with American Indian, Hispanic, and Caucasian Youth. Journal of Early Adolescence, 21 (2), pp. 133-157, 2001.

Further Support for the Developmental Significance of the Quality of the Teacher-Student Relationship

Sociometric nominations and ratings assessed peer's perceptions of supportive and conflicted teacher-student relationships, evaluations of children's positive and negative attributes, and peer-rated liking. Participants were 993 3rd and 4th grade children. Girls obtained higher Teacher Support and lower Teacher Conflict scores, compared to boys. The pattern of correlations between teacher-student relationship scores and other peer evaluations was comparable across genders. Both Teacher Support and Teacher Conflict made independent contributions to peer evaluations of children's competencies and acceptance of children. Teacher Support contributes to the prediction of social preference scores beyond that predicted by peer nominations of aggression. Teacher ratings of aggression were available for a sub-sample of 71 behaviorally at-risk children. For this sub-sample, Teacher Support predicted social preference scores after controlling for both peer nominations of aggression and teacher ratings of aggression. Peer's perceptions of Teacher Support may function as an "affective bias", influencing both perceptions of child competencies and liking for the child. Implications for these findings for classroom-based interventions with peer-rejected children are discussed. Further Support for the Developmental Significance of the Quality of the Teacher-Student Relationship. Hughes, J.N., Cavell, T.A., and Willson, V. Journal of School Psychology, 39(4), pp. 289-301, 2001.

Predicting Regular Cigarette Use Among Continuation High School Students

This article provides a 1-year prospective examination of social, behavioral, intrapersonal and demographic factors that predict transition from experimental to regular cigarette use among continuation (i.e. alternative) high school students. A cohort of 252 students completed baseline and 1-year follow-up questionnaires on health behaviors. 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. This implies 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 (i.e. alternative) high school sample of 1,315, using canonical correlation analysis. Fourteen demographic, attitudes/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, 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. Current Prediction of Drug Use Among High-risk Youth. Addictive Behaviors 26 (1), pp. 137-142, 2001.

From Early to Late Adolescence: Alcohol Use and Anger Relationships

The purpose of this article is to evaluate the longitudinal relationship of alcohol use in early adolescent to anger in late adolescence. Data from 1201 students were collected in Indianapolis, Indiana, from 1987 to 1993 as part of a large drug abuse prevention trial. Subjects were asked four anger-related questions: "When I have a problem, I get mad at people," "When I have a problem, I do bad things or cause trouble," and "I am a hotheaded person." Two additional items asked subjects to report the number of alcoholic drinks consumed and frequency of drunkenness in the past 30 days. Odds ratios were used to assess the predictive relationship of alcohol use in early adolescence to anger in late adolescence. Early use of alcohol increased the odds of later anger. Specifically, alcohol use in the past month in grades 6/7 increased the odds in grades 11/12 of saying or doing nasty things, self-reported hotheadedness, and high anger on a composite anger scale. Drunkenness in the past month in grade 6/7 increased the odds of self-reported hotheadedness and high anger on the anger scale in grade 9/10 and doing something bad to cause trouble in grade 11/12. For subjects in grade 9/10, alcohol use in the past month increased the odds in grade 11/12 of doing something bad to cause trouble, saying or doing nasty things, and self-reported hotheadedness. This study showed that alcohol use in early adolescence was associated with increased anger, both in middle and late adolescence, controlling for gender, age, and socioeconomic status. These findings suggest that alcohol and drug prevention programs delivered in early adolescence may have the capacity to prevent risk for later anger and related violent behavior. Weiner, M.D., Pentz, M.A., Turner, G.E., and Dwyer, J.H. From Early to Late Adolescence: Alcohol Use and Anger Relationships. Journal of Adolescent Health, 28(6), pp. 450-457, 2001.

Identifying Trajectories of Adolescent Smoking: An Application of Latent Growth Mixture Modeling

The goal of this study was to identify discrete longitudinal patterns of change in adolescent smoking using latent growth mixture modeling. Five distinct longitudinal patterns were identified. A group of early rapid escalators was characterized by early escalation (at age 13) that rapidly increased to heavy smoking. A pattern characterized by occasional puffing up until age 15, at which time smoking escalated to moderate levels was also identified (late moderate escalators). Another group included adolescents who, after age 15, began to escalate slowly in their smoking to light (0.5 cigarettes per month) levels (late slow escalators). Finally, a group of stable light smokers (those who smoked 1-2 cigarettes per month) and a group of stable puffers (those who smoked only a few puffs per month) were also identified. The stable puffer group was the largest group and represented 25% of smokers. Colder, C.R., Mehta, P., Balanda, K., Campbell, R.T., Mayhew, K., Stanton, W.R., Pentz, M., and Flay, B.R. Identifying Trajectories of Adolescent Smoking: An Application of Latent Growth Mixture Modeling. Health Psychology, 20(2), 2001.

Psychosocial Correlates of Adolescent Smoking Patterns

The purpose of this cross-sectional study of high school students was to examine and to compare the psychosocial characteristics associated with four dimensions of smoking: abstinence (never vs. ever), experimentation, frequency (daily vs. non-daily), and persistence (former vs. current). Six smoking groups were defined: never smokers (n = 862), experimenters (n = 235), former non-daily (n = 80), current non-daily (n = 73), former daily (n = 71), and current daily (n = 110). As found in previous studies, smokers compared to never-smokers had substantially higher scores on most indices of dysfunction. Both frequent and persistent smoking was associated with higher lifetime prevalence of drug abuse/dependence and number of friends who smoke. Smoking persistence was uniquely related to greater conflict with parents and more problematic academic behavior, and smoking frequency was uniquely associated with higher impulsiveness. The associations between smoking status and the psychosocial functioning did not differ by gender. Lewinsohn, P.M., Brown, R.A., Seeley, J.R., and Ramsey, S.E. Psychosocial Correlates of Cigarette Smoking Abstinence, Experimentation, Persistence and Frequency during Adolescence. Nicotine and Tobacco Research, 2(2), pp. 121-131, 2000.

Abuse, Support, and Depression among Homeless and Runaway Adolescents

This study examines the effectiveness of social support networks on psychological well being among 602 homeless and runaway adolescents. The respondents were interviewed in shelters, drop-in centers, and on the streets in cities of four midwestern states (Missouri, Iowa, Nebraska, and Kansas). The path model was used to test the direct effect of family abuse and precocious independence on adolescent depressive symptoms and indirect effects through social support networks. Results indicate that although abusive family origins contribute directly to depressive symptoms there are indirect effects of family abuse and early independence through social support networks. Family abuse and early independence drive homeless adolescents to rely on peers for social support. While support from friends on the street reduces depression, association with deviant peers increases depression. Bao, W.N., Whitbeck, L.B., Hoyt, D.R. Abuse, Support, and Depression among Homeless and Runaway Adolescents. J Health Soc Behav, 41(4), pp. 408-420 2000.

Childhood Depression and Adult Personality Disorder

This study extends previous findings of the risks posed by childhood major depressive disorder and other psychopathological features for later personality disorder (PD) in a random sample of 551 youths. Self-reports and mother reports were used to evaluate DSM-III-R (Axes I and II) psychiatric disorders at mean ages of 12.7, 15.2, and 21.1 years. Logistic regression was used to examine the independent effects of major depressive disorder in childhood or adolescence on 10 PDs in young adulthood. Odds of dependent, antisocial, passive-aggressive, and histrionic PDs increased by more than 13, 10, 7, and 3 times, respectively, given prior major depressive disorder. Those effects were independent of age, sex, disadvantaged socioeconomic status, a history of child maltreatment, non-intact family status, parental conflict, preexisting PD in adolescence, and other childhood or adolescent Axis I psychopathological features, including disruptive and anxiety disorders. In addition, odds of schizoid and narcissistic PD increased by almost 6 times and odds of antisocial PD increased by almost 5 times given a prior disruptive disorder, and odds of paranoid PD increased by 4 times given a prior anxiety disorder. Personality disorders may represent alternative pathways of continuity for major depressive disorder and other Axis I disorders across the child-adult transition. Kasen, S., Cohen, P., Skodol, A.E., Johnson, J.G., Smailes, E., and Brook, J.S. Childhood Depression and Adult Personality Disorder: Alternative Pathways of Continuity. Arch Gen Psychiatry, 58(3), pp. 231-236, March 2001.

Tic, Obsessive-Compulsive, and Attention-Deficit/Hyperactivity Disorders

Understanding the interrelatedness of tics, obsessive-compulsive disorder (OCD), and attention-deficit/ hyperactivity disorder (ADHD) has been complicated by studying only cross-sectional samples of clinically referred subjects. The authors report the cross-sectional and longitudinal associations of these disorders in an epidemiological sample of children followed prospectively into early adulthood. Structured diagnostic interview information was acquired on 976 children, aged 1 to 10 years, who were randomly selected from families living in upstate New York in 1975. Reassessments were acquired in 776 of these subjects 8, 10, and 15 years later. Diagnostic prevalences were estimated at each time point. The associations among tics, OCD, and ADHD were assessed within and across time points, as were their associations with comorbid illnesses and demographic risk factors. In temporal cross-section, tics and ADHD symptoms were associated with OCD symptoms in late adolescence and early adulthood after demographic features and comorbid psychiatric symptoms were controlled. In prospective analyses, tics in childhood and early adolescence predicted an increase in OCD symptoms in late adolescence and early adulthood. ADHD symptoms in adolescence predicted more OCD symptoms in early adulthood, and OCD in adolescence predicted more ADHD symptoms in adulthood. The associations of tics with ADHD were unimpressive in temporal cross-section and were not significant in prospective analyses. Tics, OCD, and ADHD shared numerous complex associations with demographic and psychopathological risk factors. ADHD was associated with lower IQ and lower social status, whereas OCD was associated with higher IQ. Tics and OCD were significantly associated in this sample, as were OCD and ADHD. These findings are in general consistent with those from family studies, and they help to define the natural history, comorbid illnesses, and interrelatedness of these conditions. Peterson, B.S., Pine, D.S., Cohen, P., and Brook, J.S. Prospective, Longitudinal Study of Tic, Obsessive-Compulsive, and Attention-Deficit/Hyperactivity Disorders in an Epidemiological Sample. J Am Acad Child Adolesc Psychiatry, 40(6), pp. 685-695, June 2001.

Genetic and Environmental Influences on Antisocial Personality Disorder in Adoptees

This investigation used data from the Iowa Adoption studies to examine the biological and environmental influences and clinical correlates of adult antisocial behavior, a well-established risk factor for drug abuse. We defined three subgroups: antisocials with conduct disorder (n = 30), antisocials without conduct disorder (n = 25), and controls (n = 142). Results demonstrate that having an antisocial biological parent was a specific risk factor for ASPD. In contrast, fetal alcohol exposure, male gender, and adverse environmental factors were associated with the adult antisocial syndrome, regardless of a history of conduct disorder in childhood. The two antisocial groups were similar with respect to clinical characteristics including sociopathy scores, comoribid disorders, and most individual symptoms. Because the phenotypic expression of the potential genetic-risk for ASPD appears to be manifest before adulthood, findings suggest that a history of conduct disorder may be more relevant to the etiological than clinical understanding of adult antisocial behavior. Langbehn, D.R. and Cadoret, R.J. The Adult Antisocial Syndrome with and without Antecedent Conduct Disorder: Comparisons from an Adoption Study. Comprehensive Psychiatry, 42(4), pp. 272-282, 2001.

The Insidious Course of Alcohol Use Disorders from Adolescence to Adulthood

This study investigated whether alcohol use disorder (AUD) in adolescence is a risk factor for AUD and other forms of psychopathology in young adulthood. Nine hundred forty participants from a large community sample in western Oregon were interviewed twice during adolescence (14-18 years of age the first assessment; between 1987 and 1991) and once at age 24 (1993-1999). Participants were classified into non-problematic drinkers, problem drinkers (symptoms of AUD but no diagnosis), and AUD groups. Both problem drinking and AUD significantly predicted adult AUD, substance use disorder, depression, and antisocial personality disorder symptoms. Compared to the problem drinkers, the AUD group had higher rates of adult AUD, more antisocial personality disorder symptoms, and was at risk of borderline personality disorder. Other findings showed that daily smoking and conduct/oppositional defiant disorders predicted future AUD, after controlling for adolescent AUD and other disorders. Paternal, but not maternal, AUD was associated with greater risk of future AUD. In conclusion, findings indicate that AUD and problem drinking in adolescents are not benign conditions that resolve over time. Assessment, treatment, and prevention recommendations are discussed. Rohde, P., Lewinsohn, P.M., Kahler, C.W., Seeley, J.R., and Brown, R.A. Natural Course of Alcohol Use Disorders from Adolescence to Young Adulthood. Journal of the American Academy of Child and Adolescent Psychiatry, 40(1), pp. 83-90, 2001.

Evaluation of a 6-item Self-Report Screener for Conduct Disorder

This study evaluated the ability of a very brief (6-item) self-report screener, the Oregon Adolescent Depression Project Conduct Disorder Screener (OADP-CDS), to identify adolescents with a lifetime diagnosis of conduct disorder and to examine its ability to predict antisocial personality disorder by age 24. Relevant scales from the Youth Self-Report and the Child Behavior Checklist were examined for comparison purposes. A total of 1,709 high school students completed an initial questionnaire and diagnostic interview assessment (T1); 1,507 participants returned approximately 1 year later for a second assessment (T2). A third (T3) assessment was conducted with selected T2 participants (n = 940) after they had turned 24 years of age. The OADP-CDS demonstrated good internal consistency, test-retest stability, and screening properties. The screening ability of the OADP-CDS did not differ by gender or social desirability, and was as effective as the longer adolescent- and parent-report measures. Perhaps most importantly, the OADP-CDS was able to identify future cases of antisocial personality disorder in young adulthood, thereby underscoring the utility of self-report screening for conduct disorder, a well established risk factor of drug use disorders. Lewinsohn, P.M., Rohde, P., and Farrington, D.P. The OADP-CDS: A Brief Screener for Adolescent Conduct Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 39(7), pp. 888-895, 2000.