Demographic, individual, and interpersonal predictors of adolescent alcohol and marijuana use following treatment.

A vulnerability model of adolescent substance abuse treatment outcome provided the basis for selection of demographic, individual, interpersonal, and treatment factors to predict the follow-up use of alcohol and marijuana in a sample of 225 adolescents (aged 12–18 yrs) with psychoactive substance use disorders. Pretreatment levels of sibling substance use and aftercare participation predicted alcohol and marijuana use during the first 6 mo posttreatment. Pretreatment levels of deviant behavior also predicted the use of marijuana at 6-mo follow-up. Peer substance use at intake and 6-mo posttreatment both predicted substance use frequency outcomes at 12-mo follow-up. Alcohol and marijuana use frequencies at 6-mo follow-up also predicted continued use for these substances throughout the remainder of the 1st posttreatment year. Shorter treatment length and being male were risk factors for alcohol use during the 2nd half of the 1st posttreatment year. Elevated psychological substance dependence at 6-mo follow-up was a unique risk factor for subsequent marijuana use. Findings support conceptual models that attempt to explain adolescent substance abuse treatment outcome in terms of relationships among demographic, individual, interpersonal, and treatment factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of family and peers in the development of prototypes associated with substance use.

Prior research and theory suggest that adolescents often experiment with substances to acquire desired social images. However, little research has addressed the developmental precursors leading to favorable evaluation of substance users. This study tested a model of parental and peer influence on adolescent prototypes using a longitudinal data set of 463 rural adolescents. For both drinking and smoking, positive prototypes of substance users were best predicted by peer affiliations. Adolescents who affiliated with peers who practiced and encouraged substance use developed more positive prototypes of people who drink and smoke. These social images, in turn, predicted subsequent use of alcohol and cigarettes. In contrast to peers, parents had little direct influence on prototypes but did indirectly affect images through the adolescents' choice of peers. Unexpectedly, there was evidence of a negative modeling effect of parental substance use, such that parental smoking predicted more negative prototypes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of Community-Based Treatment for Substance-Abusing Adolescents: 12-Month Outcomes of Youths Entering Phoenix Academy or Alternative Probation Dispositions.

Whereas strong efficacy research has been conducted on novel treatment approaches for adolescent substance abusers, little is known about the effectiveness of the substance abuse treatment approaches most commonly available to youths, their families, and referring agencies. This report compares the 12-month outcomes of adolescent probationers (N = 449) who received either Phoenix Academy, a therapeutic community for adolescents that uses a treatment model that is widely implemented across the U.S., or an alternative probation disposition. Across many pretreatment risk factors for relapse and recidivism, groups were well matched after case-mix adjustment. Repeated measures analyses of substance use, psychological functioning, and crime outcomes collected 3, 6, and 12 months after the baseline interview demonstrated that Phoenix Academy treatment is associated with superior substance use and psychological functioning outcomes over the period of observation. As one of the most rigorous evaluations of the effectiveness of a traditional community-based adolescent drug treatment program, this study provides evidence that one such program is effective. Implications of this finding for the dissemination of efficacious novel treatment approaches are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood Peer Rejection and Aggression as Predictors of Adolescent Girls' Externalizing and Health Risk Behaviors: A 6-Year Longitudinal Study.

This 6-year longitudinal study examined girls' peer-nominated social preference and aggression in childhood as predictors of self- and parent-reported externalizing symptoms, substance use (i.e.. cigarette, alcohol, and marijuana use), and sexual risk behavior in adolescence. Participants were 148 girls from diverse ethnic backgrounds, who were initially assessed in Grades 4-6 and again in Grades 10-12. Results supported a moderator model, indicating that social preference changed the nature of the association between childhood aggression and adolescent outcomes. When accompanied by peer rejection, aggressive behavior was moderately stable over time and significantly associated with adolescent girls' substance use and sexual risk behavior. However, under conditions of peer acceptance, no significant association between childhood aggression and adolescent outcomes emerged. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of continuing care adherence on environmental risks, substance use, and substance-related problems following adolescent residential treatment.

The effectiveness of adolescent treatment to reduce substance use has been demonstrated by a number of different literature reviews, yet longer term outcome studies have suggested that continued alcohol and other drug use is common. Participation in continuing care services and reductions in environmental risk factors (e.g., peer substance use or alcohol or drug use in the home) have both been found to be associated with improved posttreatment substance use. The authors conducted Path analysis to examine the experimental direct effect of the Assertive Continuing Care Protocol (S. H. Godley, M. D. Godley, & M. L. Dennis, 2001) on general continuing care adherence following residential treatment and the protocol's indirect effect (via general continuing care adherence) on social and environmental risk factors, as well as subsequent substance use and substance-related problems. Supporting previous findings, the final model indicates that greater adherence to continuing care is associated with reductions in environmental risk, which in turn is associated with reduced adolescent substance use and substance-related problems 9 months after discharge from residential treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal examination of the reciprocal relations between perceived parenting and adolescents' substance use and externalizing behaviors.

Although studies have found an association between adolescent problem behavior and deficits in parental support and control, questions remain concerning the causal nature of these relations. Using longitudinal data, this study explored prospective reciprocal relations between perceived parenting and adolescents' substance use and externalizing symptoms. A community sample of adolescents and their parents (N?=?441) was studied, within which half of the adolescents were at risk for problem behavior because of parental alcoholism. Covariance structural modeling revealed full reciprocal relations between adolescent substance use and levels of parental support and control. Furthermore, although adolescent externalizing behaviors prospectively predicted parental control and support, parenting was not prospectively related to externalizing symptoms. The findings support the reciprocal effects model of socialization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Monthly measures of salivary testosterone predict sexual activity in adolescent males

Strong relationships between one-time serum testosterone (T) measures and sexual activity have been demonstrated in cross-sectional analyses of adolescent males. However, a subsequent longitudinal study of a separate adolescent sample, using semiannual plasma measures, failed to replicate cross-sectional findings. The present study reexamined the relationship between T and sexual activity using more frequently collected measures of salivary T and behavior. Saliva samples and weekly behavior checklists were collected over a 2-year period from the same panel sample of males on which semiannual analyses were based. Saliva samples representing measures approximately every fourth week of study participation were selected for T assay. The association between these monthly salivary T measures and weekly reports of incidents of sexual activity was assessed with repeated measures analyses. Higher levels of salivary T were significantly associated with an increasing hazard of coital initiation, and with more frequent coital and noncoital activity. Within-individual change analyses demonstrated that increases in salivary T were associated with increased sexual activity. Comparisons of models that varied specimen type, schedule of T measurement, and type of behavioral report indicated that all three factors contribute to the varying magnitude of hormone/behavior relationships that are demonstrated. These findings are consistent with a biosocial model of adolescent sexual development that pubertal changes in T are a causal factor in the timing of sexual initiation and the frequency of activity during adolescence.     

The relation between social problems and substance use in adolescent boys: An investigation of potential moderators.

This study investigated the relation between social problems and adolescent male substance use in the context of other potential moderating variables. Two hundred eighty adolescent boys completed measures of social problems, cognitive distortions, constructive thinking, affiliation with delinquent peers, and multiple aspects of substance use. Results revealed that social problems were not directly related to most substance use variables. Cognitive distortions moderated the relation between social problems and substance use in social situations, such that the relation was significant only at high levels of cognitive distortions. Constructive thinking and affiliation with delinquent peers were both related to substance use, but neither served a moderating function. It is concluded that the widely accepted relation between social difficulties and adolescent male substance use may be better understood in the context of cognitive variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Good self-control as a buffering agent for adolescent substance use: An investigation in early adolescence with time-varying covariates.

This study tested the prediction that self-control would have buffering effects for adolescent substance use (tobacco, alcohol, and marijuana) with regard to 3 risk factors: family life events, adolescent life events, and peer substance use. Participants were a sample of public school students (N = 1,767) who were surveyed at 4 yearly intervals between 6th grade and 9th grade. Good self-control was assessed with multiple indicators (e.g., planning and problem solving). Results showed that the impact of all 3 risk factors on substance use was reduced among persons with higher scores on good self-control. Buffering was found in cross-sectional analyses with multiple regression and in longitudinal analyses in a latent growth model with time-varying covariates. Implications for addressing self-control in prevention programs are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The unique effect of paternal depressive symptoms on adolescent functioning: Associations with gender and father–adolescent relationship closeness.

Prospective, longitudinal data from a community sample of 451 families were used to assess the unique contribution of paternal depressive symptoms to adolescent functioning. Results indicated that paternal depressive symptoms were significantly related to subsequent depressive symptoms in adolescent offspring; this association remained significant after controlling for previous adolescent depressive symptoms, maternal depressive symptoms, gender, and family demographic variables. Adolescent gender and perception of father–adolescent relationship closeness moderated this association such that paternal depressive symptoms were positively associated with adolescent depressive symptoms for girls whose relations with fathers lacked closeness. These findings add to a growing literature on the interpersonal mechanisms through which depression runs in families, highlighting the need for future investigation of paternal mental health, adolescent gender, and intrafamily relationship quality in relation to adolescent development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ecological predictors of substance use in middle school students.

The current study examined important predictors of substance use during early adolescence. The authors hypothesized that adolescents' relationships with key adults (i.e., teachers and parents) influence their choices to use substances indirectly through links with their decisions regarding peer groups. A total of 461 middle school students from an affluent suburban community completed self-report measures of authoritative parenting, perceived social support from teachers, affiliation with rule-breaking and substance-using peers, and frequency of alcohol, cigarette, and drug use. Results of structural equation modeling supported the hypothesized model. Authoritative parenting and teacher support accounted for 31% of the variance in affiliation with deviant peers which, in turn, accounted for 27% of the variance in adolescent substance use; direct paths from parenting and teacher support to substance use were not indicated. Implications for school psychologists' involvement in substance use prevention and intervention are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of parents and older siblings in predicting adolescent substance use: Modeling development via structural equation latent growth methodology.

Using latent growth curve methodology, this study investigated developmental trends in adolescent, parent, and older sibling substance use across a 3-year period and the predictive effect of these trends on adolescent substance use 2 years later. Participants were 101 adolescents (50 boys and 51 girls) who were an average of 12.34 years old at the first assessment, their parents, and an older sibling. Results indicate that although both parents and siblings contribute to the level of adolescent use, only siblings appear to contribute to the adolescents' subsequent substance use development. The adolescents' developmental trajectory was the best predictor of later use, but siblings contributed to later use indirectly through their influence on adolescents' substance use development. Findings discuss the role of sibling and parent substance use on adolescent substance use and emphasize the utility of latent growth modeling in the study of developmental change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal study of children of alcoholics: Predicting young adult substance use disorders, anxiety, and depression.

This study tested the specificity of parent alcoholism effects on young adult alcohol and drug abuse/dependence, anxiety, and depression, and tested whether adolescent symptomatology and substance use mediated parent alcoholism effects. Participants were from a longitudinal study in which a target child was assessed in adolescence and young adulthood with structured interview measures (N?=?454 families at Time 1). Results showed unique effects of parent alcoholism on young adult substance abuse/dependence diagnoses over and above the effects of other parental psychopathology. There was some evidence of parent alcoholism effects on young adult depression and of maternal alcoholism effects on young adult anxiety, although these were not found consistently across subsamples. Mediational models suggested that parent alcoholism effects could be partially (but not totally) explained by adolescent externalizing symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pubertal timing and substance use: Associations between and within families across late adolescence.

In the present study, between-family analyses of data from adolescent twin girls offer new evidence that early menarche is associated with earlier initiation and greater frequency of smoking and drinking. The role of personality factors and peer relationships in that association was investigated, and little support was found for their involvement. Novel within-family analyses replicating associations of substance use with pubertal timing in contrasts of twin sisters selected for extreme discordance for age at menarche are reported. Within-family replications demonstrated that the association of pubertal timing with substance use cannot be explained solely by between-family confounds. Within-family analyses demonstrated contextual modulation of the influence of pubertal timing: Its impact on drinking frequency is apparent only among girls in urban settings. Sibling comparisons illustrate a promising analytic tool for studying diverse developmental outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A 2-year longitudinal analysis of the relationships between violent assault and substance use in women.

Women experience alarming levels of physical and sexual assault, which may lead to escalation of substance use. Reciprocally, evidence from cross-sectional studies indicates that substance use may increase risk of assault. To date, directionality of this relationship remains unclear. This issue is addressed by the present 3-wave longitudinal study in which a national probability sample of 3,006 women were followed for 2 years. Dependent measures were obtained at each wave of the study and included questions about lifetime and new assault status, alcohol abuse, and drug use. Wave 1 use of drugs, but not abuse of alcohol, increased odds of new assault in the subsequent 2 years. Reciprocally, after a new assault, odds of both alcohol abuse and drug use were significantly increased, even among women with no previous use or assault history. For illicit drug use, findings support a vicious cycle relationship in which substance use increases risk of future assault and assault increases risk of subsequent substance use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

5-HTTLPR status moderates the effect of early adolescent substance use on risky sexual behavior.

Objective: A longitudinal, prospective design was used to investigate a moderation effect in the association between early adolescent substance use and risky sexual behavior 2 years later. A genetic vulnerability factor, a variable nucleotide repeat polymorphism (VNTR) in the promoter region of the serotonin transporter gene SLC6A4, known as 5-HTTLPR, was hypothesized to moderate the link between substance use at age 14 and risky sexual behavior at age 16. This VNTR has been associated with risk-taking behavior. Design: African American youths in rural Georgia (N = 185) provided 2 waves of data on their substance use and sexual behavior. Genetic data were obtained via saliva samples. Main Outcome Measures: Substance use and sexual risk behavior were assessed using youth self-report items developed for this investigation. Results: Multiple regression analyses indicated that the presence of 1 or 2 copies of the short allele of the VNTR interacted with substance use to predict sexual behavior. Substance use had little effect on sexual behavior for youths without the short allele; this effect was greatly increased for youths with the short allele. Conclusion: Genetic vulnerability affected the implications of early onset substance use for later sexual behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Summary measures and statistics for comparison of quality of life in a clinical trial of cancer therapy

Assessment of health related quality of life (QOL) has become an important endpoint in many clinical trials of cancer therapy. Most of these studies entail multiple QOL scales that are assessed repeatedly over time. As a result, the problem of multiple comparisons is a primary analytic challenge with these trials. The use of summary measures and statistics both reduces the number of hypotheses tested and facilitates the interpretation of trial results where the primary question is 'Does the overall QOL differ between treatment arms?' I present two classes of summary measures that are sensitive to consistent trends in the same direction across multiple assessment times or multiple QOL scales. Missing data strongly influences the choice between the two classes, where one class handles missing data on an individual basis, while the other class uses model-based strategies. I present the results from a clinical trial of adjuvant therapy for breast cancer that use summary measures with a focus on the practical issues that affect these analysis strategies, such as missing data and integration of QOL with efficacy endpoints such as survival.     

Effectiveness of multidimensional family therapy with higher severity substance-abusing adolescents: Report from two randomized controlled trials.

Objective: We used growth mixture modeling to examine heterogeneity in treatment response in a secondary analysis of 2 randomized controlled trials testing multidimensional family therapy (MDFT), an established evidence-based therapy for adolescent drug abuse and delinquency. Method: The first study compared 2 evidence-based adolescent substance abuse treatments: individually focused cognitive–behavioral therapy and MDFT in a sample of 224 urban, low-income, ethnic minority youths (average age = 15 years, 81% male, 72% African American). The second compared a cross-systems version of MDFT (MDFT—detention to community) with enhanced services as usual for 154 youths, also primarily urban and ethnic minority (average age = 15 years, 83% male, 61% African American, 22% Latino), who were incarcerated in detention facilities. Results: In both studies, the analyses supported the distinctiveness of 2 classes of substance use severity, characterized primarily by adolescents with higher and lower initial severity; the higher severity class also had greater psychiatric comorbidity. In each study, the 2 treatments showed similar effects in the classes with lower severity/frequency of substance use and fewer comorbid diagnoses. Further, in both studies, MDFT was more effective for the classes with greater overall substance use severity and frequency and more comorbid diagnoses. Conclusions: Results indicate that for youths with more severe drug use and greater psychiatric comorbidity, MDFT produced superior treatment outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Working Alliance, Treatment Satisfaction, and Patterns of Posttreatment Use Among Adolescent Substance Users.

This longitudinal study examined the relationships among the working alliance, treatment satisfaction, and posttreatment use among adolescents in treatment for substance abuse. Adolescents (N = 600) from the Cannabis Youth Treatment study (M. L. Dennis et al., 2002) completed measures of working alliance and treatment satisfaction as well as substance use and substance-related problems at intake and 3, 6, 9, 12, and 30 months' postintake. When controlling for initial substance use and substance-related problems, working alliance, but not treatment satisfaction, predicted use at 3 and 6 months' postintake. Neither working alliance nor treatment satisfaction were predictive of longitudinal patterns of posttreatment use. Implications for the assessment of working alliance and treatment satisfaction are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social Anxiety, Negative Affectivity, and Substance Use Among High School Students.

The literature regarding the relationship between adolescent social anxiety and substance use is sparse, and available studies have produced discrepant results. Similarly, negative affectivity is a mood-dispositional dimension that is infrequently considered in studies of substance use. The authors used dispositional structural equation modeling to examine the concurrent relationships of social anxiety and negative affectivity with adolescent substance involvement among 724 students in 1 southern California high school. The final model indicated that increased substance use was associated with having lower grade-point average, being male, being White, having higher levels of negative affectivity, and having lower levels of social anxiety. The findings confirm that negative affectivity is positively related to adolescent substance use, whereas social anxiety appears to be protective against substance involvement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)