Prevalence, course, and predictors of multiple problem behaviors among gay and bisexual male adolescents.

Multiple problem behaviors, stress, and personal resources were assessed over 2 yrs among 136 mainly Black and Hispanic gay and bisexual male adolescents (aged 14–19 yrs). Whereas sexual risk acts, substance abuse, conduct problems, and emotional distress were common, the risk acts did not form a multiple problem behavior cluster, compared with previous findings with heterosexual youths. Problem behaviors were stable over time: Only 20–30% of the youths changed their pattern of problem behaviors over 2 yrs. For each individual, the pattern of change in one behavior problem was not related to patterns of change in other problem behaviors over 2 yrs. At baseline, personal resources were associated with less alcohol use and emotional distress, and stress was associated with delinquent behaviors. The pattern of results was similar whether youths labeled themselves as gay or bisexual, suggesting that problem behaviors among mainly Black and Hispanic gay and bisexual youths may follow different developmental pathways than among heterosexual youths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special series.

Problems of alcohol and drug abuse among children and adolescents are drawing unprecedented attention from researchers, policymakers, and the lay public. Clearly warranted, that attention focuses on vexing questions about the nature and prevention of substance abuse among youth. The most common questions include these: Are substance rates among youth on the rise? Why do young people use alcohol and drugs? How can we prevent substance abuse among youth? What works in the fight against alcohol and drug abuse? Do we need special programs to prevent substance abuse among youths from different backgrounds? Where should we put our resources to exert a maximum impact on the demand for drugs and alcohol among youth? By answering these and other questions, the 10 articles in this special series lay a foundation for future practice, policy, and research on alcohol and drug abuse among youth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Homeless youths and young adults in Los Angeles: prevalence of mental health problems and the relationship between mental health and substance abuse disorders

Although understanding of the subsistence patterns, service utilization, and HIV-risk behaviors of homeless youths and young adults in increasing, relatively little is known about the epidemiology of mental health problems in this group or the relationships between mental health problems and substance use. This study measured symptoms of depression, low self-esteem, ADHD, suicidality, self-injurious behavior (SIB), and drug and alcohol use disorder in a sample of homeless youth and young adults living in Hollywood, CA. Results indicated extremely high prevalences of mental health problems as compared with corresponding rates of mental health problems found among housed youths in previous studies. Prevalence of mental health problems differed by age and ethnicity. African Americans were at lower risk of suicidal thoughts and SIB than were those of other ethnicities. Older respondents and females were at increased risk of depressive symptoms, and younger respondents were at increased risk of SIB. Previous history of sexual abuse and/or assault was associated with increased risk of suicidality and SIB. Risk factors for drug abuse disorders included ethnicity other than African American, homelessness for 1 year or more, suicidality, SIB, depressive symptoms, and low self-esteem. Risk factors for alcohol abuse disorder included male gender, white ethnicity, homelessness for 1 year or more, suicidality, and SIB. Extremely high rates of mental health problems and substance abuse disorders in this sample suggest the need for street-based and nontraditional mental health services targeted toward these youths and young adults.     

Gamma interferon prevents diabetes in the BB rat

OBJECTIVE: Although increased evidence of disproportionate psychosocial risk and other health problems encountered by lesbian, gay male, and bisexual (LGB) youths has emerged, no study has described how the topic of homosexuality is addressed within child and adolescent residency psychiatry training. METHOD: Residency training directors in U.S. child and adolescent psychiatry programs were asked questions about instruction on the topic of homosexuality and the care of LGB patients, the department's view of whether homosexuality represents a pathological condition, the director's awareness of LGB colleagues and residents, and the director's opinion of LGB residents' disclosure of their homosexuality to their patients and patients' families. Asking similar questions facilitated a comparison of survey results with those of an earlier study of general psychiatry training directors. RESULTS: The reported departmental attitudes about whether homosexuality represents a pathological condition were essentially equivalent in general and child programs. Child and adolescent training directors were, however, less likely to have a favorable view of disclosure of sexual orientation to patients, less likely to know LGB residents or faculty, and less likely to report LGB residents an asset to their departments. CONCLUSIONS: The prediction that the majority of child and adolescent training programs would reflect a heightened awareness of the vulnerability of LGB youths was not confirmed.     

Exploring the nature of the relationship between child sexual abuse and substance use among women

AIMS: This study investigated whether child abuse (CSA) was associated with earlier substance use and greater severity of substance dependence and what aspects of CSA might predict substance abuse. DESIGN: The study compared (a) drug and alcohol treatment clients with and without a history of CSA and (b) CSA survivors outside drug and alcohol treatment who did or did not have current substance abuse. SETTINGS: Semi-structured interviews took place at participants' homes, treatment agencies or the research centre. PARTICIPANTS: Volunteer participants included 100 women recruited from drug and alcohol treatment programmes and 80 CSA survivors recruited through CSA counseling services and medial advertising. MEASUREMENTS: The results focus on data from the Opiate Treatment Index, Severity of Alcohol Dependence Questionnaire, Substance Dependence Scale, Self-Esteem Inventory and self-reported histories of CSA. FINDINGS: There were no differences between CSA survivors and other drug and alcohol treatment clients in their severity of dependence. Women with a history of CSA more frequently identified stimulants as their main problem drug and reported an earlier age of first intoxication and earlier use of inhalants. Among abused CSA survivors outside drug and alcohol treatment, women with current substance abuse had typically been abused during adolescence by someone outside the family, whereas those without current substance abuse were typically abused by family members before adolescence. CONCLUSIONS: The results suggest that adolescence is a crucial time for the influence of CSA experiences on substance abuse.     

Maternal assessment of infant development: associations with alcohol and drug use in pregnancy

Surveillance by parental concern has been advocated to assess whether formal child developmental testing is needed. To determine whether alcohol intake or illicit drug use in pregnancy is associated with differences in maternal perception of infant development, mothers with acknowledge alcohol and drug habits during pregnancy (N = 120) were interviewed at 11 months' postpartum, within 1 month before infant testing by use of the Bayley Scales of Infant Development. Women with heavy alcohol intake during pregnancy (> 3.5 oz absolute alcohol per week) were 15-fold more likely to overestimate their infant's mental development (P < 0.05), whereas mothers using illicit drugs were 4-fold more likely to overestimate their infant's physical development (P = 0.02). Given the frequent denial of substance abuse, we suggest that health care providers be cautious in accepting a lack of parental concern about a child's development and rely more heavily on formal testing, particularly in high-risk populations.     

Development of substance use and psychiatric comorbidity in an epidemiologic study of white and American Indian young adolescents the Great Smoky Mountains Study

The progression of substance use and the patterns of comorbidity of substance use and psychiatric disorders are explored prospectively in young adolescents enrolled in the Great Smoky Mountains Study. This study is an epidemiologic study of white and American Indian youths living in rural Southern Appalachia. Results from this study indicate that alcohol use without permission predicts subsequent use of illicit drugs and regular tobacco use. Use of tobacco was not associated with either later alcohol or drug use. Patterns of comorbidity showed strong cross-sectional relationships between substance use and behavioral disorders, but not emotional disorders. Use of alcohol was also associated with psychiatric diagnosis at a later interview. There were some differences between white and American Indian youths in the pattern of comorbidity of tobacco use and psychiatric disorder and the relationship between prior psychiatric disorder and later alcohol use. These findings suggest that alcohol use without permission may be an important marker for youths who are at risk for illicit drug use and/or psychiatric diagnoses.     

Stress, expectancies, and vulnerability to substance abuse: A test of a model among homosexual men.

We hypothesize that specific attitudes or expectancies make people vulnerable to responding to stress via alcohol or drugs. This "stress-vulnerability" model was tested among homosexual men, who show elevated rates of substance abuse and have culturally specific stressors and vulnerability. Tension reduction expectancies of alcohol effects had a substantial effect on alcohol and marijuana/drug abuse, as did the use of bars as a social resource. Two stress variables—negative affectivity and discrimination attributable to sexual orientation—also had significant, though more moderate effects. Interactions of the vulnerability measures with the stress variables had significant effects on substance abuse beyond the main effects, supporting the central hypothesis. In a second analysis both simple consumption levels and "high-risk" styles of alcohol or drug use predicted alcohol or drug problems better among vulnerable than among nonvulnerable respondents. These findings strongly supported a general stress-vulnerability model of substance abuse and illustrated several important risk factors in homosexual culture. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community studies on adolescent substance use, abuse, or dependence and psychiatric comorbidity.

A literature review on community studies of adolescent substance use, abuse, or dependence (SU/A/D) and psychiatric comorbidity yielded 22 articles from 15 studies with information on rates, specificity, timing, and differential patterns of comorbidity by gender, race/ethnicity, and other factors. Results revealed that 60% of youths with SU/A/D had a comorbid diagnosis, and conduct disorder (CD) and oppositional defiant disorder (not attention-deficit/hyperactivity disorder) were most commonly associated with SU/A/D, followed by depression. Child psychopathology (particularly CD) was associated with early onset of substance use and abuse in later adolescence. The authors suggest that available data relevant to SU/A/D and psychiatric comorbidity can be used to better address such questions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for adolescent substance abuse and dependence: Data from a national sample.

A national household probability sample of 4,023 adolescents aged 12 to 17 years was interviewed by telephone about substance use, victimization experiences, familial substance use, and posttraumatic reactions to identify risk factors for Diagnostic and Statistical Manual of Mental Disorders- (4th ed.; American Psychiatric Association, 1994) defined substance abuse/dependence. Age and ethnicity data were available for 3,907 participants. Major findings were (a) adolescents who had been physically assaulted, who had been sexually assaulted, who had witnessed violence, or who had family members with alcohol or drug use problems had increased risk for current substance abuse/dependence; (b) posttraumatic stress disorder independently increased risk of marijuana and hard drug abuse/dependence; and (c) when effects of other variables were controlled, African Americans, but not Hispanics or Native Americans, were at approximately 1/3 the risk of substance abuse/dependence as Caucasians. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD.

Children diagnosed with attention-deficit hyperactivity disorder (ADHD; n=142) were prospectively monitored into adolescence (13-18 years old) to evaluate their risk for elevated substance use relative to same-aged adolescents without ADHD (n=100). Probands reported higher levels of alcohol, tobacco, and illicit drug use than did controls. Group differences were apparent for alcohol symptom scores but not for alcohol or marijuana disorder diagnoses. Within probands, severity of childhood inattention symptoms predicted multiple substance use outcomes; childhood oppositional defiant disorder/conduct disorder (ODD/CD) symptoms predicted illicit drug use and CD symptoms. Persistence of ADHD and adolescent CD were each associated with elevated substance use behaviors relative to controls. Further study of the mediating mechanisms that explain risk for early substance use and abuse in children with ADHD is warranted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictive validity of cocaine, sedative, and alcohol dependence diagnoses.

This study examined the predictive validity of Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) (R. L. Spitzer et al, 1990) based substance dependence diagnoses (i.e., cocaine, sedative, and alcohol) for 518 opioid-dependent outpatients entering methadone maintenance. Patients were followed over 1 year of treatment, which involved daily methadone substitution supplemented by individual and group counseling. Urine specimens were tested randomly 1–4 times per month. Patients diagnosed with current cocaine, sedative, or alcohol dependence were more likely to use these drugs than were patients with past only or no dependence syndrome. Current cocaine dependence predicted early treatment dropout. The results demonstrate the predictive and discriminant validity of several substance dependence diagnoses common among patients in substance abuse or other psychiatric treatment settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Incidence and mental health impact of sexual orientation victimization of lesbian, gay, and bisexual youths in high school.

This study examined victimization during high school based on sexual orientation of 350 lesbian, gay, or bisexual (lgb) youths aged 21 and younger. Experiences of direct victimization as well as knowledge of other lgb youths' victimization were assessed. Over half reported verbal abuse in high school because of their sexual orientation, and 11% said they had been physically assaulted. Youths who were more open in high school about their sexual orientation and who had a history of more gender atypical behavior were victimized more often. Male youths were targeted significantly more often than females, Youths' current mental health symptoms, especially traumatic stress reactions, were associated with having experienced more verbal abuse in high school. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Patterns of current and lifetime substance use in schizophrenia

A structured interview and standardized rating scales were used to assess a sample of 194 outpatients with schizophrenia in a regional Australian mental health service for substance use, abuse, and dependence. Case manager assessments and urine drug screens were also used to determine substance use. Additional measurements included demographic information, history of criminal charges, symptom self-reports, personal hopefulness, and social support. The sample was predominantly male and showed relative instability in accommodations, and almost half had a history of criminal offenses, most frequently drug or alcohol related. The 6-month and lifetime prevalence of substance abuse or dependence was 26.8 and 59.8 percent, respectively, with alcohol, cannabis, and amphetamines being the most commonly abused substances. Current users of alcohol comprised 77.3 percent and current users of other nonprescribed substances (excluding tobacco and caffeine) comprised 29.9 percent of the sample. Rates of tobacco and caffeine consumption were high. There was a moderate degree of concordance between case manager determinations of a substance-use problem and research diagnoses. Subjects with current or lifetime diagnoses of substance abuse/dependence were predominantly young, single males with higher rates of criminal charges; however, there was no evidence of increased rates of suicide attempts, hospital admissions, or daily doses of antipsychotic drugs in these groups compared with subjects with no past or current diagnosis of substance abuse or dependence. Subjects with a current diagnosis of substance use were younger at first treatment and currently more symptomatic than those with no past or current substance use diagnosis. The picture emerging from this study replicates the high rate of substance abuse in persons with schizophrenia reported in North American studies but differs from the latter in finding a slightly different pattern of substances abused (i.e., absence of cocaine), reflecting relative differences in the availability of certain drugs.     

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)     

Victimization Over the Life Span: A Comparison of Lesbian, Gay, Bisexual, and Heterosexual Siblings.

Lifetime victimization was examined in a primarily European American sample that comprised 557 lesbian/gay, 163 bisexual, and 525 heterosexual adults. Lesbian, gay, and bisexual (LGB) participants were recruited via LGB e-mail lists, periodicals, and organizations; these participants recruited 1 or more siblings for participation in the study (81% heterosexual, 19% LGB). In hierarchical linear modeling analyses, sexual orientation was a significant predictor of most of the victimization variables. Compared with heterosexual participants, LGB participants reported more childhood psychological and physical abuse by parents or caretakers, more childhood sexual abuse, more partner psychological and physical victimization in adulthood, and more sexual assault experiences in adulthood. Sexual orientation differences in sexual victimization were greater among men than among women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of public support payments to substance abuse among homeless veterans with mental illness

OBJECTIVE: A suspicion that disability payments may exacerbate substance use among persons with chemical addictions recently led Congress to limit federal disability entitlements of applicants whose disability status is related to substance abuse, even if they have another serious mental disorder. This study empirically explored the relationship between receipt of disability payments and substance use among homeless mentally ill veterans. METHODS: The study sample included 2,474 homeless veterans with a current diagnosis of schizophrenia and a substance abuse or dependence disorder who were assessed in a community outreach program sponsored by the Department of Veterans Affairs. RESULTS: After adjustment for other relevant factors, receipt of disability payments showed no significant relationship to the number of days of substance use a month, even among frequent users of alcohol and drugs. CONCLUSIONS: Findings about substance use among the homeless veterans with serious mental disorders in this study provide no support for the assertion that disability payments exacerbate substance use.     

Relation of early menarche to depression, eating disorders, substance abuse, and comorbid psychopathology among adolescent girls.

This prospective study tested whether early menarche partially accounts for the increases in depression, eating pathology, substance abuse, and comorbid psychopathology that occur among adolescent girls, with structured interview data from a community sample (N?=?496). Early menarche (prior to 11.6 years) was associated with elevated depression, substance abuse, and "any" disorder but did not confer increased risk for anorexia nervosa, bulimia nervosa, or binge eating disorder. Although there was significant comorbidity across all three classes of pathology, early menarche was associated only with comorbid depression and substance abuse. Results provide partial support for the assertion that early menarche is a general risk factor for psychopathology among adolescent girls but suggest that this risk may not apply to certain disorders and that the effects are modest in size. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cocaine abusers with and without alcohol dependence respond equally well to contingency management treatments.

Contingency management (CM) treatments are efficacious in treating cocaine abuse. Despite high prevalence rates of alcohol dependence (AD) among individuals with cocaine use disorders, relatively little data are available regarding whether comorbid AD is associated with poorer treatment outcomes in general, or in response to CM in particular. Using data from 3 randomized trials of CM for cocaine abuse, we compared cocaine abusers (N = 393) with and without AD in terms of abstinence and psychosocial problems during treatment and follow-up. Alcohol dependent participants had more lifetime years of cocaine and alcohol use and greater severity of alcohol and psychiatric problems. CM was positively and significantly associated with longer durations of abstinence, regardless of AD status. Although not significantly associated with abstinence, the presence of AD was related to improvement in medical and alcohol-related problems during treatment, and these gains were maintained posttreatment. The results suggest that cocaine abusers benefit equally well from CM treatments, regardless of AD status. Further, alcohol dependent participants are able to offset greater baseline severity in psychosocial functioning and maintain these improvements with CM. (PsycINFO Database Record (c) 2010 APA, all rights reserved)