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...on Adolescents
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www.ProjectCork.org
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Fall 2007
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Adolescent substance use assessment in a primary care setting.
Brodey BB; McMullin D; Winters KC; Rosen CS; Downing DR; Koble JM. American Journal of Drug and Alcohol Abuse 33(3): 447-454, 2007. (17 refs.)
Health initiatives suggest that adolescent substance use assessment may be beneficial as part of primary care to screen for early problematic behaviors. To examine the accuracy of such reporting, we compared the anonymous and confidential self-reports of 180 adolescents in a primary care setting. Matching samples to control for demographic variables, we found that adolescents were more likely to report marijuana use and substance use behaviors, such as selling drugs, when reporting anonymously vs. reporting confidentially. These results challenge the accuracy of confidential self-reports within this setting, and suggest further research is needed. Copyright 2007, Taylor & Francis.
Disparities in young adolescent inhalant use by rurality, gender, and ethnicity.
Edwards RW; Stanley L; Plested BA; Marquart BS; Chen J; Thurman PJ. Substance Use & Misuse 42(4): 643-670, 2007. (39 refs.)
Inhalant use is of increasing concern as rates appear to be rising among young adolescents and gender differences narrowing. Data from 20,684 Mexican American and White non-Hispanic seventh- and eighth-grade males and females from the Western United States and 15,659 African American and White non-Hispanic seventh- and eighth-grade males and females from states in the southeastern United States collected via in-school surveys from 1996 to 2000 were analyzed using a variety of statistical techniques including multilevel modeling. Questions addressed in the study included: Does inhalant use vary by level of rurality? What effect does the ethnic composition of the community have on inhalant use and does this effect differ by an individual's ethnicity? Do males use more inhalants than females and does the level of use by males and females differ by individual ethnicity, ethnicity of the community, or level of rurality? Do males and females of different ethnicities initiate inhalant use at different ages? Limitations of the study and implications of findings for prevention are discussed and areas of future research are suggested. This study was funded by the National Institute on Drug Abuse. Copyright 2007, Taylor & Francis.
Juvenile drug courts: Emerging outcomes and key research issues.
Henggeler SW. Current Opinion in Psychiatry 20(3): 242-246, 2007. (25 refs.)
Purpose of review: In consideration of the widespread adoption of juvenile drug court programs during the past decade, the purpose of this review is to examine the effectiveness of juvenile drug courts and suggest priorities for juvenile drug court research. Recent findings: Consistent with the much more extensive adult drug court literature and the few uncontrolled evaluations of juvenile drug court, findings from a recent randomized clinical trial suggest that juvenile drug court is more effective than family court in decreasing participant criminal behavior and substance use. Perhaps due to the intensive surveillance that juvenile drug court participants receive, however, these favorable outcomes did not translate to reduced rates of rearrest or incarceration during the 12-month study period. In addition, the integration of evidence-based substance-abuse treatments into juvenile drug court enhanced participant substance-related outcomes and rates of juvenile drug court completion. Summary: Although the widespread dissemination of juvenile drug courts has exceeded clear and unambiguous evidence of their effectiveness, few other criminal justice programs have shown such promise with drug-abusing offenders. Moreover, the integration of evidence-based treatments of adolescent substance abuse holds the potential to further enhance the effectiveness of juvenile drug courts. Copyright 2007, Lippincott, Williams & Wilkins.
Deterioration of academic achievement and marijuana use onset among rural adolescents.
Henry KL; Smith EA; Caldwell LL. Health Education Research 22(3): 372-384, 2007. (54 refs.)
This study utilizes discrete-time survival analysis to assess the effect of level of academic achievement (both contemporaneously and prospectively) and changes in academic achievement on initiation of marijuana use among rural adolescents in junior high school. In the sample under consideration, 36% of boys and 23% of girls initiated use of marijuana by the end of ninth grade. Consistent with our hypothesis, poor academic achievement is a salient predictor of initiation of marijuana use among both boys and girls. Both contemporaneous and lagged levels of achievement significantly predict initiation. In addition, change in academic achievement is an important predictor of initiation. That is, students who demonstrate a deterioration of their academic achievement over time are more likely to start using marijuana. Poor academic achievement and deterioration of academic achievement should be considered as risk factors for initiation of marijuana use among rural adolescents. Initiatives targeted at improving academic achievement and/or drug use prevention initiatives designed for poor achieving students may help to prevent initiation of marijuana use. Copyright 2007, Oxford University Press.
Marijuana motives: Young adults' reasons for using marijuana.
Lee CM; Neighbors C; Woods BA. Addictive Behaviors 32(7): 1384-1394, 2007. (23 refs.)
Previous research has evaluated marijuana motives among adolescents and emerging adults using a predetermined set of motives, largely adapted from the alcohol literature. This research was designed to identify marijuana motives from the perspective of the user. Recent high school graduates who reported using marijuana (N=634) provided self-generated reasons for using. The most frequently reported reasons included enjoyment/fun, conformity, experimentation, social enhancement, boredom, and relaxation. Regression analyses revealed that experimentation was consistently associated with less use and fewer problems whereas enjoyment, habit, activity enhancement, and altered perception or perspectives were associated with heavier use and more problems. Copyright 2007, Elsevier Science.
Genetic and environmental influences on the development of alcoholism: Resilience vs. risk.
Enoch MA. Annals of the New York Academy of Sciences: Resilience in Children 1094: 193-201, 2006. (41 refs.)
The physiological changes of adolescence may promote risk-taking behaviors, including binge drinking. Approximately 40% of alcoholics were already drinking heavily in late adolescence. Most cases of alcoholism are established by the age of 30 years with the peak prevalence at 18-23 years of age. Therefore the key time frame for the development, and prevention, of alcoholism lies in adolescence and young adulthood. Severe childhood stressors have been associated with increased vulnerability to addiction, however, not all stress-exposed children go on to develop alcoholism. Origins of resilience can be both genetic (variation in alcohol-metabolizing genes, increased susceptibility to alcohol's sedative effects) and environmental (lack of alcohol availability, positive peer and parental support). Genetic vulnerability is likely to be conferred by multiple genes of small to modest effects, possibly only apparent in gene-environment interactions. For example, it has been shown that childhood maltreatment interacts with a monoamine oxidase A (MAOA) gene variant to predict antisocial behavior that is often associated with alcoholism, and an interaction between early life stress and a serotonin transporter promoter variant predicts alcohol abuse in nonhuman primates and depression in humans. In addition, a common Met158 variant in the catechol-O-methyltransferase (COMT) gene can confer both risk and resilience to alcoholism in different drinking environments. It is likely that a complex mix of gene(s)-environment(s) interactions underlie addiction vulnerability and development. Risk-resilience factors can best be determined in longitudinal studies, preferably starting during pregnancy. This kind of research is important for planning future measures to prevent harmful drinking in adolescence. Copyright 2006, New York Academy of Sciences.
Is attention-deficit/hyperactivity disorder associated with illicit substance use disorders in male adolescents? A community-based case-control study.
Szobot CM; Rohde LA; Bukstein O; Molina BSG; Martins C; Ruaro P et al. Addiction 102(7): 1122-1130, 2007. (58 refs.)
Aims: This study aims at evaluating the association between attention-deficit/hyperactivity disorder (ADHD) and illicit substance use disorders (SUD) (marijuana, cocaine and inhalants), controlling for the association with conduct disorder (CD), in a community-based sample of adolescents. Design Case-control, community-based study. Setting A delimited geographical area in the South of Brazil, served by four public health clinics. Participants: A total of 968 male adolescents (15-20 years of age) were screened for SUD in their households. Of the subjects who were screened positive, we selected 61 cases with illicit SUD. For each case we selected, from the group which was screened negative, three controls without illicit or alcohol SUD, matched by age and proximity with the case's household. Measurements: The screening instrument was the Alcohol Smoking and Substance Screening Test (ASSIST). SUD diagnoses were assessed by the drug section of the Mini International Neuropsychiatry Interview (MINI). Other psychiatric diagnoses were based on semistructured (Schedule for Affective Disorders and Schizophrenia for School-Age Children-epidemiological version; MINI) and clinical interviews. Findings Adolescents with ADHD presented a significantly higher odds ratio (OR) for illicit SUD than youths without ADHD, even after adjusting for potential confounders (CD, ethnicity, religion and estimated IQ) (OR = 9.12; 95% CI = 2.84 -29.31, P < 0.01). Conclusions: Our results suggest an association between ADHD and illicit SUD in Brazilian adolescents that is not mediated by CD. These findings are potentially important from a prevention perspective because treatments are available for ADHD. Copyright 2007, Society for the Study of Addiction to Alcohol and Other Drugs.
Treatment outcome for street-living, homeless youth.
Slesnick N; Prestopnik JL; Meyers RJ; Glassman M. Addictive Behaviors 32(6): 1237-1251, 2007. (34 refs.)
Comprehensive intervention for homeless, street living youth that addresses substance use, social stability, physical and mental health issues has received very little attention. In this study, street living youth aged 14-22 were recruited from a drop-in center and randomly assigned to the Community Reinforcement Approach (CRA) or treatment as usual (TAU) through a drop-in center. Findings showed that youth assigned to CRA, compared to TAU, reported significantly reduced substance use (37% vs. 17% reduction), depression (40% vs. 23%) and increased social stability (58% vs. 13%). Youth in both conditions improved in many other behavioral domains including substance use, internalizing and externalizing problems, and emotion and task oriented coping. This study indicates that homeless youth can be engaged into treatment and respond favorably to intervention efforts. However, more treatment development research is needed to address the barriers associated with serving these youth. Copyright 2007, Elsevier Science.
'Pharming': The abuse of prescription and over-the-counter drugs in teens. (review).
Levine DA. Current Opinion in Pediatrics 19(3): 270-274, 2007. (27 refs.)
Purpose of review Prescription and over-the-counter cough and cold medication abuse is rapidly becoming a national health concern for adolescents. Increased awareness of this growing epidemic is essential toward diagnosing, treating and preventing this type of substance abuse. Recent findings Data from surveys and poison control center records demonstrate an increased nonmedical use of prescription and over-the-counter cough and cold preparations, particularly those containing dextromethorphan. The nonmedical use of prescription medications may result in serious clinical effects with potential life-threatening complications, dependence and withdrawal syndromes. Dextrometh-orphan causes alterations in mental status that may contribute to judgment impairment leading to injury or fatality. Coingestion of other substances found in over-the-counter medications may also cause significant morbidity. Alcohol and illicit drug use is highly associated with the abuse of these medications. The incentive for abuse, such as easy accessibility, low cost and decreased perception of potential for harm, and potential interventions are described, Summary: The recent trend of prescription and dextrometh-orphan-containing over-the-counter medication abuse in adolescents is alarming. Improved awareness for these readily available, seemingly benign yet highly dangerous medications is essential. Prevention and early education on substance abuse in young teens are critical in combating this recent epidemic. Copyright 2007, Lippincott, Williams & Wilkins.
Crystal methamphetamine use among young adults in the USA.
Iritani BJ; Hallfors DD; Bauer DJ. Addiction 102(7): 1102-1113, 2007. (42 refs.)
Aims: To examine the prevalence and correlates of crystal methamphetamine use among young adults in the USA. Design: Cross-sectional analyses of nationally representative data of young adults from the National Longitudinal Study of Adolescent Health (Add Health). Setting In-home interviews conducted in 2001-02. Participants A total of 14 322 respondents aged 18-26 years. Measurements Past year and 30-day crystal methamphetamine use; crime/violence (ever arrested, past year drug selling, past year violent behavior) and sexual risk behaviors (multiple partners, poor condom use, regretted sex, sex for money). Findings: Prevalence of past year crystal methamphetamine use was 2.8%; past month was 1.3%. White or Native American race, residence in the west or south, having an ever-incarcerated father, marijuana, cocaine, intravenous drug use and high novelty seeking were associated with greater likelihood of past year use in multivariate analyses. Compared to marijuana and cocaine users, crystal methamphetamine users were more likely to be male, unemployed, reside in the west or south, have an ever-incarcerated father and less likely to be black or Hispanic. Frequent users were no different from occasional users, except being more likely to have dropped out of school. Although crystal methamphetamine use was associated with crime and risky sex, controlling for covariates greatly diminished this relationship. Conclusions: Most users are occasional users, but any past year use is associated with risky and antisocial behaviors, including other illicit drug use. Further research is needed to examine how other drug addiction is associated with methamphetamine use, and to identify longitudinal antecedents for prevention. Copyright 2007, Society for the Study of Addiction to Alcohol and Other Drugs.
Substance use attitudes among urban black adolescents: The role of parent, peer, and cultural factors.
Wallace SA; Fisher CB. Journal of Youth and Adolescence 36(4): 441-451, 2007. (60 refs.)
This study examined the influence of perceived parental, peer, and cultural factors on Black American adolescent attitudes toward substance use. One-hundred-eight Black American youth (grades 9-12) from economically disadvantaged urban neighbor-hoods of New York, completed self-report measures on: (a) parent-child involvement, parental supervision, and parent attitudes toward high risk behaviors; (b) peer bonds and peer attitudes toward high risk behaviors; and (c) ethnic identity, parental racial socialization, and extended family support. Youth disapproval of substance use was positively associated with higher perceived levels of peer and parental disapproval of high risk behaviors, parental supervision, and ethnic identity. Youth who reported parental messages about racial discrimination without balanced parental messages about racial pride and racial equality were more likely to approve substance use. Copyright 2007, Springer.
Perceived awareness and caring influences alcohol use by high school and college students.
Wetherill RR; Fromme K. Psychology of Addictive Behaviors 21(2): 147-154, 2007. (47 refs.)
Perceived awareness and caring, or beliefs about how much parents and peers know and care about students' behavior, was assessed in relation to students' drinking patterns. Prior to and at the end of the first semester at college, participants completed Web-based surveys assessing alcohol use, family and social motives, and perceived awareness and caring from parents and peers. Family motives moderated the effect of perceived parental awareness and caring on the quantity of high school alcohol use, whereas social motives moderated the effect of perceived peer awareness and caring on frequency and quantity of college drinking. Longitudinally, college alcohol use was predicted by perceived awareness and caring from parents. Perceived awareness and caring may affect alcohol use whereby parents exert influence during high school but peers are more influential in college. Copyright 2007, American Psychological Association.
Misuse of methamphetamine and prescription stimulants among youths and young adults in the community.
Wu LT; Pilowsky DJ; Schlenger WE; Galvin DM. Drug and Alcohol Dependence 89(2-3): 195-205, 2007. (59 refs.)
Background: Gender differences in the prevalence and characteristics of misuse of methamphetamine (meth) and prescription stimulants were examined in a representative US sample of youths and young adults aged 16-25 (N= 24,409). Methods: Stimulant misusers were categorized into three mutually exclusive subgroups: meth users only, meth and prescription stimulant users, and prescription stimulant users only (e.g., Benzedrine (R), Ritalin (R), or Dexedrine (R)). Multinominal logistic regression analyses identified the characteristics associated with misuse of meth and prescription stimulants. Results: About I in 10 youths reported any misuse of stimulants in their lifetime. Prescription stimulant misuse occurred earlier and was more frequent than meth misuse. About 47% of meth misusers also reported prescription stimulant misuse. Among misusers of meth and prescription stimulants, males were more likely than females to misuse methylphenidate (82% versus 65%) but were less likely to misuse diet pills or amphetamines (37% versus 49%). Multinominal logistic regression analyses indicated that all subgroups of lifetime stimulant misuse were associated with past year substance abuse. The characteristics of meth misusers differed slightly from prescription stimulants misusers. Conclusions: Multidrug use is common among stimulant misusers. Parents should be informed about the risk of prescription stimulant misuse by their youths. Copyright 2007, Elsevier Science
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