Director's Report to the National Advisory Council on Drug Abuse
September, 2001
Research Findings
Epidemiology, Etiology and Prevention Research
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.
Session Specific Outcomes
Like their urban counterparts, adolescents from rural areas are at risk for health and behavior problems, including alcohol and other drug use. This study tested the effects of specific sessions of a parent-training intervention on parenting practices. Preparing for the Drug Free Years, an intervention designed to prevent adolescent substance abuse and other problem behaviors was tested with 209 rural families who were randomly assigned to an intervention or a wait-list control condition. Analyses of covariance comparing adjusted post-test scores revealed that parents in the intervention condition reported significant improvements in parenting behaviors targeted in specific sessions when compared with controls. Effects were most pronounced among mothers. No significant effects were found for non-targeted parenting behaviors, and targeted behaviors were most improved among parents attending relevant program sessions. These results strengthen the internal validity of the study and increase the plausibility that reported improvements were due to the intervention. Kosterman, R., Hawkins, J.D., Haggerty, K.P., Spoth, R., and Redmond, C. Preparing for the Drug Free Years: Session-specific Effects of a Universal Parent-training Intervention with Rural Families. Journal of Drug Education, 31(1), pp. 47-68, 2001.
Aggressive Interactions
Results of a seven-session general population intervention for parents and their sixth-grade children were examined to determine the long-term effects of this intervention on aggressive and hostile behaviors during adolescence. Twenty-two public schools were randomly assigned to the Iowa Strengthening Families Program or a control condition. Measures included independent observer ratings of 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-intervention and post-intervention), 7th, 8th, and 10th grades. All measures showed a generally positive trend in intervention-control group differences over time. During 10th grade, significant intervention-control differences were found for adolescent self-report of aggressive and destructive conduct (P=.01),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 (P =.01); differences in family member reports of those behaviors were not significant. Supplemental analyses of both interactional behavior measures, specific to parent sex, indicated significant experimental group differences in interactions with mothers (P=.04 for both measures) but not with fathers. Thus, brief family competency-training interventions designed for general populations can reduce aggressive and hostile behaviors in adolescents' interactions with parents and adolescent aggressive behaviors outside of the home setting. Spoth, R.L., Redmond, C., and Shin, C. Reducing Adolescents' Aggressive And Hostile Behaviors - Randomized Trial Effects of a Brief Family Intervention 4 Years Past Baseline. Archives of Pediatrics & Adolescent Medicine, 154(12), pp. 1248-1257, 2000.
Project EX - Outcomes of a Teen Smoking Cessation Program
Project EX is an eight-session teen school-based clinic tobacco use cessation program that involves the inclusion of enjoyable motivating activities (games, talk show, and alternative medicine-type) to try to enhance quit rates among youth. This clinic program was tested in a three-group experimental design: clinic-only, clinic plus a school-as-community (SAC) component, and standard care control. Eighteen schools were assigned to the three conditions using a randomized block design. A total of 335 smokers participated in the study, making this the largest controlled teen smoking cessation field trial conducted to date. Seventeen percent of the smokers enrolled in the clinics had reports of having quit smoking for at least the last 30 days at 3-month follow-up (5 months after the program quit day), compared to only 8% of the control condition smokers over the same time period. The Project EX clinic component appears to be an effective means of tobacco use cessation among teens. Sussman, S., Dent. C.W., and Lichtman, K.L. Project EX - Outcomes of a Teen Smoking Cessation Program. Addictive Behaviors, 26 (3), pp. 425-438, 2001.
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.
School-based Tobacco Use Prevention and Cessation: Where are We Going?
The objective of this article is to discuss the past, present, and future directions of school-based tobacco use prevention and cessation research. It discusses the origins of tobacco use prevention research; how prevention research advanced with empirical etiologic work; the genesis of comprehensive social influences programming and its contents; multiple modalities of programming beyond the school setting; and the rebirth of teen cessation programming and the issue of dissemination. Results indicate there are many avenues of teen tobacco use prevention and cessation research and practice that need continued exploration, particularly regarding effects on mediation and teen cessation. This discussion provides background to assist health behavior researchers and practitioners to move forward in this area. Sussman, S. School-based Tobacco Use Prevention and Cessation: Where are We Going? American Journal of Health Behavior 20, 25(3), pp. 191-199, 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.
Predictors of Smoking Cessation from Adolescence into Young Adulthood
Although smoking cigarettes is hazardous to health and cessation has positive health benefits, few smokers are able to successfully quit. The purpose of this study was to examine the predictors of smoking cessation in a non-clinical sample of 134 male and 190 female, young adult, regular (daily) smokers within a social learning and maturing-out framework. Four waves of prospective, longitudinal data from a community sample followed from adolescence into young adulthood were analyzed. Logistic regression analyses were used to test the effects of differential associations, definitions, differential reinforcement, and changes in adult role status on smoking cessation in young adulthood. Becoming married to a nonsmoker and decreases in the proportion of friends who smoked were significant predictors of cessation. Current smokers and stoppers did not differ significantly in terms of prior intensity of cigarette use or alcohol abuse/dependence. They also did not differ in terms of psychological characteristics, including depression and prior coping use of cigarettes. Social networks were more important than social roles for predicting cessation in young adulthood. Thus, smoking cessation programs should focus on social learning processes. Chen, P.H, White, H.R., and Pandina, R.J. Predictors of Smoking Cessation from Adolescence into Young Adulthood. Addict Behav, 26(4), pp. 517-529 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.
The Association between Inattention and Tobacco Use in Early Adolescence
This longitudinal study examined the relation between distinct dimensions of attention-deficit hyperactivity disorder (ADHD) and substance use among 177 clinic-referred boys (initially between ages 7 and 12) followed thru age 15. The use of tobacco, alcohol, marijuana, or other illicit drugs was reported by 78% of the participants, with 51% reporting any tobacco use. Although the inclusion of conduct disorder (CD) rendered all bivariate relationships with the full diagnosis of ADHD nonsignificant, adolescent inattention, considered independently, was associated with a 2.3 times greater risk for concurrent tobacco use - even after controlling for CD, duration of tobacco use by age 12, poor parental communication in childhood, and ethnicity. These findings highlight the importance of considering the risks for substance use separately by individual dimensions of ADHD. Burke, J.D., Loeber, R., and Lahey, B.B. Which Aspects of ADHD are Associated with Tobacco Use in Early Adolescence? Journal of Child Psychology and Psychiatry, 42(4), pp. 493-502, 2001.
Psychosocial Versus Nicotine-Only Self-Report Measures for Predicting Follow-Up Smoking Status
The most popular measure of tobacco dependence, the Fagerstrom Tolerance Questionnaire (FTQ), measures only tobacco-specific behaviors. In contrast, the most popular assessment of addiction among drug users is the Addiction Severity Index (ASI). Most of the subscales comprising the ASI are psychosocial measures, not drug-specific measures. A study was undertaken to compare the predictive utility of these two contrasting measures. The NAS (adapted from the FTQ) and the Addiction Severity Index (ASI) were used to predict future smoking status in a cohort of polydrug users followed annually for 3 years. The baseline NAS score explained more of the variance in Time 2 and Time 3 smoking status than did the ASI subscales. When previous smoking status was included as a covariate, however, the NAS no longer predicted future smoking status, whereas the ASI Subscales continued to explain significant variance in future smoking status. Results suggest that when past smoking behavior is known, a respondent's legal status and alcohol use may be more useful than a measure of tobacco dependence for predicting future smoking status. McCarthy, W.J., Zhou, Y., and Hser, Y. Psychosocial Versus Nicotine-Only Self-Report Measures for Predicting Follow-up Smoking Status. Journal of Behavioral Medicine, 24(1), pp. 75-91, 2001.
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.
Influence of Parental Child-rearing Practices and Environment on Adolescent Drug Use
This study examined the relationship between the domains of environmental factors, family illegal drug use, parental child-rearing practices, maternal and adolescent personality attributes, and adolescent illegal drug use. A nonclinical sample of 2,837 Colombian youths and their mothers were interviewed about intrapersonal, interpersonal, and environmental factors in their lives. Results indicated that certain environmental factors (e.g., violence, drug availability, and machismo), family drug use, a distant parent-child relationship, and unconventional behaviors are risk factors for adolescent illegal drug use. As hypothesized, results showed that the adverse effects of family illegal drug use on adolescent drug use can be buffered by protective parental child-rearing practices and environmental factors, leading to less adolescent illegal drug use. Prevention and treatment efforts should incorporate protective environmental, familial, and intrapersonal components in order to reduce adolescent illegal drug use. Brook, J.S., Brook, D.W., De La Rosa, M., Whiteman, M., Johnson, E., and Montoya, I. J. Behav Med, April 24(2), pp. 183-203, 2001.
Association of Maladaptive Parental Behavior with Psychiatric Disorder among Parents and their Offspring
This longitudinal study was conducted to investigate the role of maladaptive parental behavior in the association between parent and offspring psychiatric disorder. Psychosocial and psychiatric interviews were administered to a representative community sample of 593 biological parents and their offspring from 2 counties in the state of New York in 1975, 1983, 1985 to 1986, and 1991 to 1993. In 1975, the offspring were a mean age of 6 years. Maladaptive parental behavior was assessed in 1975, 1983, and 1985 to 1986. Parent and offspring psychiatric symptoms were assessed in 1983, 1985 to 1986, and 1991 to 1993. Maladaptive parental behavior substantially mediated a significant association between parental and offspring psychiatric symptoms. Parents with psychiatric disorders had higher levels of maladaptive behavior in the household than did parents without psychiatric disorders. Maladaptive parental behavior, in turn, was associated with increased offspring risk for psychiatric disorders during adolescence and early adulthood. Most of the youths that experienced high levels of maladaptive parental behavior during childhood had psychiatric disorders during adolescence or early adulthood, whether or not their parents had psychiatric disorders. In contrast, the offspring of parents with psychiatric disorders were not at increased risk for psychiatric disorders unless there was a history of maladaptive parental behavior. Maladaptive parental behavior is associated with increased risk for the development of psychiatric disorders among the offspring of parents with and without psychiatric disorders. Maladaptive parental behavior appears to be an important mediator of the association between parental and offspring psychiatric symptoms. Johnson, J.G., Cohen, P., Kasen, S., Smailes, E., and Brook, J.S. Association of Maladaptive Parental Behavior with Psychiatric Disorder among Parents and their Offspring. Arch Gen Psychiatry, 58(5), pp. 453-460, May 2001.
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.
Drug Treatment Careers: Conceptual Overview and Clinical, Research, and Policy Applications
This study illustrates the treatment career perspective as a conceptual framework for consolidating research findings and suggesting research directions that have important policy implications. It presents findings of research by the UCLA Drug Abuse Research Center (DARC) as examples of the products of empirical applications of the concept and discusses related clinical, research, and policy questions. This career concept is valuable in understanding the effects of policy and program practice on treatment outcomes and in suggesting modifications to improve policy and treatment. Although the treatment career approach is in an early stage and needs to be more fully developed with theoretical rigor and research applications, its benefit is significant in matters relevant to drug policy, as indicated by available empirical findings. This conceptual framework will further our understanding of the addiction and treatment career patterns of individuals at treatment entry and the relation of career characteristics and treatment outcomes, particularly within the context of ongoing changes in client service needs and treatment program characteristics. Anglin, M.D., Hser, Y., Grella, C.E., Longshore, D., and Prendergast, P. In J. Platt, C. Leukefeld, and F.M. Tims (Eds.), Drug Treatment Careers: Conceptual Overview and Clinical, Research, and Policy Applications. Relapse and Recovery Processes in the Addictions. Yale University Press, 2001.
Analytic Approaches for Assessing Long-Term Treatment Effects: Examples of Empirical Applications and Findings
Analytic approaches including the structural equation model (autoregressive panel model), hierarchical linear model, latent growth curve model, survival/event history analysis, latent transition model, and time series analysis (interrupted time series, multivariate time series analysis) are discussed for their applicability to data of different structures (panel data, clustered data, duration data for critical events, and time series data) and their utility in evaluating temporal effects of drug and alcohol treatment. Methods are illustrated by presenting applications of the various approaches in previous studies examining temporal patterns of treatment effects. Recent advancements in these longitudinal modeling approaches and the accompanying computer software development offer tremendous flexibility in examining long-term treatment effects through longitudinal data with varying numbers and intervals of assessment, and types of measures. A multi-method assessment will contribute to a more complete understanding of the complex phenomena of the long-term courses of substance use and its treatment. Hser, Y., Shen, H., Chou, C.-P., Messer, S. and Anglin, M.D. Analytic Approaches for Assessing Long-Term Treatment Effects: Examples of Empirical Applications and Findings. Evaluation Review, 25(2), 233-262, 2001.
A 33-Year Follow-Up of Narcotics Addicts
This study examined longitudinal patterns of heroin use, other substance use, health, mental health, employment, criminal involvement, and mortality among heroin addicts. The sample comprised 581 male heroin addicts admitted to the California Civil Addict Program (CAP) during the years 1962 through 1964; CAP was a compulsory drug treatment program for heroin dependent criminal offenders. This 33-year follow-up study updates information previously obtained from admission records and two face-to-face interviews conducted in 1974-75 and 1985-86; in 1996-97, at the latest follow-up, 284 were dead and 242 were interviewed. In 1996-97, the mean age of the 242 interviewed subjects was 57.4 years. Age, disability, years since first heroin use, and heavy alcohol use were significant correlates of mortality. Of the 242 subjects interviewed, 20.7% tested positive for heroin (with additional 9.5% urine refusal and 14.0% incarceration, for whom urinalyses were unavailable), 66.9% reported tobacco use, 22.1% were daily alcohol drinkers, and many reported illicit drug use (e.g., past year heroin use was 40.5%, marijuana 35.5%, cocaine 19.4%, crack 10.3%, amphetamine 11.6%). The group also reported high rates of health problems, mental health problems, and criminal justice system involvement. Long-term heroin abstinence was associated with less criminality, morbidity, psychological distress, and higher employment. While the number of deaths increased steadily over time, heroin use patterns were remarkably stable for the group as a whole. For some, heroin addiction has been a life-long condition associated with severe health and social consequences. Hser, Y., Hoffman, V., Grella, C.E., and Anglin, M.D. A 33-Year Follow-Up of Narcotics Addicts. Archives of General Psychiatry, 58, pp. 503-508, 2001.
Services Needs of Substance Abusing Women in Jail
While women account for only 11% of the U.S. jail population, the population of women in the nation's jails has increased 7% annually since 1990 (compared to a 4.5% rate of growth among males). Since about two-thirds of female arrestees use illicit drugs, there is a need for substance abuse services and other services for females in jail. But historically programs for substance abusers in jail have focused on males and have not considered the special needs of women. This study compared the self-reported service needs of women requesting drug abuse services with those not in need of substance abuse treatment. Interviews were conducted with 165 women incarcerated in an urban county jail in Ohio. The study population was predominantly African-American (72%), aged 30 to 40, and most women were mothers. Women who reported a need for substance abuse treatment were more likely than those not needing drug abuse treatment to report the need for housing, medical care, education, mental health services, family support, and parenting assistance. Housing was the need most frequently mentioned; more than one quarter of drug abuse treatment-seeking women reported that they did not know where they would live when released from jail as compared to 11% of non-treatment seeking women This study suggests that successful drug treatment of women in jail must consider the multidimensional needs of these women in order to break the cycle of drug use and incarceration. Alemagno, S.A. Women in Jail: Is Substance Abuse Treatment Enough? Amer. J. Pub. Health, 91(5), pp. 798-800, 2001.
Psychiatric Enviromics
Using a selective literature review and synthesis, Dr. James Anthony introduces 'psychiatric enviromics' as a complement to human genomics and proteomics as applied to mental health. He proposes that psychiatric enviromics is the way in which epidemiologists and psychiatrists who study causes of mental and behavioral disturbances and the concomitant prevention strategies, can focus on aspects of environment that affect mental health and behavior. Since "the human genome dwells within environment, determines environment, and its expression is shaped by environment" (p. s9), epidemiological research in general and psychiatric epidemiology in particular can develop a 'human environment project' "that seeks to the total ensemble of environments, both current and in earlier life, that affect the occurrence of mental and behavioral disturbances" (p. s9). The argument here is that "subsets of the psychiatric environment will be discovered to have functional importance precisely because specific environmental conditions or processes will reduce, amplify or otherwise modulate the expression of earlier genes or multiple gene interactions at identifiable periods of life-span development." Needless to say, "other salubrious environmental conditions and processes will have functional importance but lack specificity of action with respect to gene expression" (p. s8). Dr. Anthony advocates an international forum and/or collaboration to assess the evidence. Anthony, J.C. The Promise of Psychiatric Enviromics. British Journal of Psychiatry, 178 (suppl. 40), pp. s8-s11, 2001.
Community Epidemiology Work Group
The 50th meeting of the Community Epidemiology Work Group (CEWG), chaired by Nicolas Kozel, DESPR, was held in Rockville, Maryland on June 12-15, 2001. The CEWG is composed of researchers from 21 metropolitan areas of the United States who meet semiannually to report on patterns and trends of drug abuse in their respective areas, emerging drugs of abuse, vulnerable populations and factors that may place people at risk of drug abuse, and negative health and social consequences. Reports are based on a variety of drug abuse indicator data, such as morbidity and mortality information, treatment data and local and State law enforcement data. Additional sources of information include criminal justice, correctional, medical and community health data, local and State survey information, and findings from focus groups and qualitative research studies.
The following are highlights from the meeting.
Cocaine/Crack - Cocaine/crack indicators decreased in 10 CEWG areas, increased in 5, and were stable in 6. Since stabilizing in the mid-1990s, cocaine/crack indicators have been decreasing in most CEWG areas. Yet, cocaine/crack remains the major drug problem in most CEWG areas. DAWN Emergency Department (ED) cocaine rates per 100,000 population in the first half of 2000 were especially high in Chicago (121), Miami (110), Philadelphia (105), Baltimore (99), Detroit (94), and Newark (74).
Heroin - Heroin indicators continue an upward trend, increasing in 15 CEWG areas, remaining level or mixed in 5, and decreasing in 1. CEWG members continued to report, as they have since 1994, that heroin abuse is spreading to younger populations and to areas outside the inner cities. Inhaling the drug is increasing in popularity. Several factors appear related to these patterns and trends, including the availability of different types of heroin from different regions of the world, increases in the purity of heroin, and decreases in the price of the drug. In early 2000, purity levels were very high in Northeast and mid-Atlantic areas such as Newark (77 percent), Philadelphia (73 percent), Boston (66 percent), and New York (60 percent).
Semi-Synthetic Narcotic Prescription Drugs - Indicators continued to increase in urban, suburban, and rural areas. However, the indicator numbers are relatively small compared with other drug categories. Purchased on the street, pharmaceutical narcotics such as hydrocodone and oxycodone (including OxyContin) are being used as a substitute for heroin, and also are being abused by other populations, including long-term prescription drug users and younger populations. Ocycodone/OxyContin are known as "poor man's heroin" in areas such as Philadelphia, St. Louis, and Washington, D.C.
Marijuana - Indicators began leveling off in 1999-2000 in 14 CEWG areas but continued to trend upward in 7. In some areas, substantial and increasing numbers of marijuana abusers are being referred to treatment by the criminal justice system.
Methamphetamine - Indicators varied in the CEWG areas that typically report relatively high levels of methamphetamine abuse. However, in the second half of 1999 and in the first half of 2000, DAWN methamphetamine ED mentions were trending upward in most of these areas. As use of the drug has spread, indicators have increased in areas such as Minneapolis/St. Paul and St. Louis.
"Other" Drugs - Other drugs, including MDMA (ecstasy), gamma hydroxybutyrate (GHB), ketamine, and phencyclidine (PCP), often referred to as "club drugs," are being abused primarily by youth and young adults in many CEWG areas. Ecstasy indicators point to increases in abuse in 13 CEWG areas. CEWG members continue to report use of ecstasy in social settings other than nightclubs and raves, such as house parties and small group gatherings. Reports on GHB indicators show that they increased in nine CEWG areas and decreased in one.
Polydrug Use - Indicators clearly show that multiple drug use is the norm, rather than the exception among drug abusers. Most treatment admissions report current use of at least three drugs, with cocaine frequently being the most commonly reported secondary drug. Medical examiners report the presence of multiple substances in a majority of decedents. Both semi-synthetic narcotics and the so-called "club drugs" are generally used concomitantly or sequentially with other drugs, including alcohol.
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