Affect Substance Use Research Articles

Do peer perceptions mediate the effects of ADHD symptoms and conduct problems on substance use for college students?

Although extensive research suggests that attention-deficit/hyperactivity disorder (ADHD) and conduct problems (CP; symptoms of oppositional defiant disorder, conduct disorder, and antisocial personality disorder) contribute to risk for substance use, why these symptoms increase risk for substance use remains unclear. Given that research indicates that perceived peer tolerance and perceived peer substance use affect substance use, we evaluated the degree to which these peer-perception constructs mediated the association that ADHD symptoms, CP symptoms, and their interaction share with substance use (i.e., alcohol use, marijuana use, and illicit drug use). Participants were college students (N = 627; 60% female; 47% European American) with a mean age of 20.23 years. Results indicated that perceived peer use significantly mediated the association of ADHD symptoms with alcohol, marijuana, and illicit drug use, whereas perceived peer use only mediated the association between CP symptoms and alcohol use. Perceived peer tolerance significantly mediated the association that both CP and ADHD symptoms had with marijuana use, but not alcohol or illicit drug use. Finally, CP symptoms moderated the indirect effect that ADHD symptoms had on alcohol use through perceived peer tolerance. At low levels of CP symptoms, increases in ADHD symptoms corresponded to increases in perceived peer tolerance, which was related to increased alcohol use. However, at high levels of CP symptoms, increases in ADHD symptoms corresponded to decreases in perceived peer tolerance, which was associated with decreased alcohol use. Implications of findings are discussed.

Acculturation and perceived discrimination: Predictors of substance use trajectories from adolescence to emerging adulthood among Hispanics

PurposePrevious studies have documented associations between cultural factors and substance use among Hispanic adolescents. Negative cultural experiences such as discrimination have been associated with an increased risk of substance use among Hispanic adolescents, whereas positive cultural resources, such as maintenance of Hispanic cultural orientations, have shown protective effects. However, few studies have examined the continuing influence of cultural factors on substance use from adolescence to emerging adulthood. MethodsWe surveyed a cohort of Hispanic adolescents in Southern California in 9th, 10th, and 11th grades, and 3–4years after high school. Growth curve analyses were conducted to examine the effects of U.S. acculturation, Hispanic acculturation, ethnic identity, and perceived discrimination on change in tobacco, alcohol, and marijuana use over time. ResultsHigher perceived discrimination at baseline was significantly associated with a higher intercept (initial level) of tobacco, alcohol, and marijuana use. Higher initial level of Hispanic acculturation was significantly associated with a lower slope of tobacco, alcohol, and marijuana use. ConclusionsCultural phenomena such as acculturation and perceived discrimination can continue to affect substance use through the transition to emerging adulthood. Health education interventions are needed to help Hispanics navigate this developmental transition without engaging in substance use.

Addiction Prone Personality tests and the prediction of substance use patterns in Canadian undergraduate students

In this investigation the relationship between two measures of vulnerability to substance use (the SURPS and the APP) and substance use patterns in a large Canadian undergraduate student sample ( n = 867) was examined. Structural equation models conducted using the M plus program provided good support for the importance of the positive reinforcement vs. negative reinforcement model in predicting different types of substance use in both the individual personality test models and especially in the combined model. The models also showed how a family loading for substance use affects substance use patterns directly and indirectly through personality traits that are theoretically linked to an orientation toward either positive or negative reinforcement. Results also showed that combining the APP and the SURPS tests in an aggregate model enhanced the ability to predict substance use.

Do Family Dinners Reduce the Risk for Early Adolescent Substance Use? A Propensity Score Analysis

The risks of early adolescent substance use on health and well-being are well documented. In recent years, several experts have claimed that a simple preventive measure for these behaviors is for families to share evening meals. In this study, we use data from the 1997 National Longitudinal Study of Youth (n = 5,419) to estimate propensity score models designed to match on a set of covariates and predict early adolescent substance use frequency and initiation. The results indicate that family dinners are not generally associated with alcohol or cigarette use or with drug use initiation. However, a continuous measure of family dinners is modestly associated with marijuana frequency, thus suggesting a potential causal impact. These results show that family dinners may help prevent one form of substance use in the short term but do not generally affect substance use initiation or alcohol and cigarette use.

Substance Use Disorder in the Context of LGBT Health: A Social Work Perspective

The impacts of public and private funding of lesbian, gay, bisexual, and transgender (LGBT) health research, the state of integration of LGBT health issues into the academic and professional training programs of health care practitioners, and the larger social reality experienced by LGBT people profoundly affect substance use and substance use disorders in those populations. This analysis uses a social work perspective and considers the current state of research, professional training, and social oppression as they affect the health of LGBT people. Suggestions for action are offered that may improve the health of LGBT peoples and the practice of social work.

Maternal self concept as a provider and cessation of substance use during pregnancy

ObjectiveMaternal substance use during pregnancy is a common modifiable risk factor for poor birth outcomes, and is associated with long term psychological risks to offspring. As self concept is known to affect substance use behaviors in non-pregnant women, we hypothesized that self concept as a provider may be particularly salient to cessation of use during pregnancy. To isolate psychological processes specific to pregnancy from those associated with the transition to parenthood, we examined birth mothers who made adoption placements participating in the Early Growth and Development Study. MethodsWe obtained lifetime and pregnancy substance use history and psychological measures at 3 to 4months postpartum from 693 women recruited from the Northwest, Southwest, and Mid-Atlantic regions of the United States. Life history calendar and computer-assisted personal interviewing methods were used to minimize reporting bias. Using logistic regression, we assessed the association of self concept as an adequate provider with cessation of substance use during pregnancy, controlling for sociodemographic variables, depressive symptoms experienced during pregnancy, past year antisocial behaviors, family history of substance abuse, timing of pregnancy recognition, timing of initiation of prenatal care, and emotional adjustment to the adoption decision. ResultsMore positive self-concept as an adequate provider was independently associated with cessation of substance use and earlier initiation of prenatal care during pregnancy [OR=1.223; 95% C.I. (1.005–1.489); B(SE)=.201(.100)]. Familial substance abuse, depressive symptoms, and antisocial behaviors during pregnancy, were also independent predictors, and more strongly associated with cessation [OR=.531; 95% C.I. (.375–.751); B(SE)=−.634 (.178)], [OR. 940; 95% C.I. (.906–.975); B(SE)=−.062 (.019)], [OR=.961; 95% C.I. (.927–.996); B(SE)=−.040 (.018)]. ConclusionsEnhancing maternal identity as a provider for the fetus during pregnancy, along with treatment of depression, may improve motivation to stop substance use.

Gender Roles and Substance Use Among Mexican American Adolescents: A Relationship Moderated by Acculturation?

This research assesses the effects of adaptive/ maladaptive gender roles and acculturation in predicting substance use in a 2007 sample of 1466 Mexican American seventh-grade adolescents from Phoenix, Arizona, USA. Multiple regression analyses found significant effects for both adaptive and maladaptive gender roles, as well as several gender-specific interactions between gender roles and linguistic acculturation that predicted substance use. Limitations of the research are noted, as well as implications for understanding the impact of acculturation on how gender roles differentially affect substance use in Mexican American boys versus girls.

Psychosocial Adjustment and Substance Use of Cambodian and Vietnamese Immigrant Youth

Southeast Asians living in the United States are a unique Asian immigrant population. They are considered one of the "newer" Asian immigrant groups, tend to be less affluent compared with their East and South Asian counterparts, and are steadily growing in number (U.S. Bureau of the Census, 2000). Unfortunately, few studies exist specifically about Southeast Asian immigrants. The lack of studies, coupled with the community's growing mental health issues, suggests the need for increased research on this population. This study contributes to the literature by examining the extent to which identification with Vietnamese or Cambodian culture, peer relationships, and coping behaviors affect substance use among Cambodian and Vietnamese immigrant youth. A sample of 102 participants, age 12-18 years, completed self-report measures regarding these variables. Overall, results indicate that identification with one's culture of origin and coping behaviors moderate the relationship between deviant peer association and substance use. Results are discussed within a contextual model of problem behavior among Southeast Asian youth.

Dazed and Confused by Self-Medication

To the Editor: Dual diagnosis may be the most pervasive and challenging problem we face in psychiatry that receives the least sufficient or coherent attention. In their article published in the January 2010 issue of the Journal, Denise A. Hien, Ph.D., et al. (1) examined how improvement in posttraumatic stress disorder (PTSD) symptoms as a result of treatment affects substance use outcomes, exemplifying the sort of longitudinal, diagnostically inclusive experimental designs we need. However, I am left dazed and confused by the selfmedication framework the article, and much of the best dualdiagnosis research, so dogmatically espouses. The article begins with defining the importance of this research: “The co-occurrence of (PTSD) and substance use disorders is a major public health concern…because of negative physical and mental health consequences and poor treatment outcomes” (1, p. 95). Yet, the main conclusion of the study was that PTSD patients use substances to self-medicate symptoms. Initial PTSD symptom reduction often precedes substance use disorder reduction, while early substance use disorder improvement does not as robustly lead to PTSD symptom improvement. This is interpreted exclusively as evidence for self-medication. However, these data could reflect a change in a neurobiological state that drives both PTSD symptom severity and compulsive drug-taking that has nothing to do with whether substance use impacts PTSD symptoms in the same manner that treatment with medication affects these symptoms. Exclusive support for self-medication would require not a relative lack of PTSD symptom reduction after substance use disorder improvement (as shown in the article) but an increase in symptoms after substance use reduction (which was not shown). Following the self-medication framework, it was never mentioned that the results also showed that if substance use disorders initially decline either alone or along with declining PTSD symptoms, patients are less likely to relapse to a total (both PTSD and substance use disorder symptoms) nonresponse condition relative to what initial PTSD symptom-alone improvement predicts. In the comparative treatments, trauma-focused/seeking safety versus health education, the former achieved superior efficacy for severe dual diagnosis. The authors explained that trauma-focused/seeking safety “is an integrated cognitive behavior approach that actively links PTSD symptoms with ‘unsafe’ substance use behavior” (1, p. 97). This implies, as shown in bipolar patients (2), that when cognitive-behavioral therapy (CBT) acts to dispel the notion that the link between psychiatric symptoms and substance use is somehow positive (e.g., that it represents self-medicating) and replaces it with a concept that it is detrimental (e.g., that it is a disorder), you actually get superior efficacy. At baseline, more severe PTSD was associated with more severe substance abuse, a finding replicated often in the dual-diagnosis literature but once again interpreted only as evidence of self-medication. However, if we think about drugs proven to help psychiatric symptoms (i.e., psychiatric medications), we find that medication compliance (i.e., self-medication) is often actually worse with greater illness severity. Moreover, for these medications with which patients clearly use to self-medicate, it would be illogical to conclude that since the individuals taking the medications are sicker than the individuals who are not, the medications are actually being used to medicate the illness.

Factors associated with illegal substance use initiation among young students in Mexico City

To assess risk factors for illegal substances use initiation in a cohort of Mexican high-school teenage students. Longitudinal study of a cohort of 10th grade students, with follow up at the time of their enrolment in college (3-4 year follow up). The associations of parental educational level, alcohol abuse in the family, employment status, experiences of physical and sexual aggression, sexual initiation, emotional distress and previous legal substance use at the baseline measurement, with the initiation of illegal substance use were explored. The follow-up analysis was carried out in 21,616 at-risk students. The incidence of substance use initiation was 7%. Male gender (odds ratio 3.86, 95% confidence interval 3.45, 4.32), a higher father's education level, sexual initiation for women (odds ratio 2.67, 95% confidence interval 1.49, 4.79] and use of legal substances at baseline were associated with risk of substance use initiation. The social circumstances surrounding adolescents influence their risk of illegal substance consumption. Although the complex network of factors affecting substance use requires further exploring, young people at risk can be identified and should receive preventive attention.

Truancy and Escalation of Substance Use During Adolescence

The aim of this study was to examine the relationship between truancy and escalation of substance use during adolescence and to explore potential mechanisms of this relationship. Using data from the Rochester Youth Development Study, a longitudinal sample of predominantly minority youth, growth models with time-varying covariates were utilized to assess the relationship between truancy and substance use. Mediated growth models were used to examine potential mechanisms of the relationship. The analyses used five waves of panel data collected from 971 youth and their primary caregivers. Data were collected every 6 months from 1988 to 1990, spanning ages 14-16. Twenty-seven percent of the sample was female. Findings indicate that truant youth engaged in more substance use, both when comparing one adolescent with another (i.e., a truant adolescent used more substances than an adolescent who was not truant) and when comparing periods of change within an adolescent (i.e., during periods when an adolescent's truancy escalated, his or her involvement in substance use escalated). Moreover, the effect of escalation of truancy on escalation of substance use was, in part, mediated by escalation of risky, unsupervised time spent with peers. Truancy appears to be a robust predictor of substance use. The effect is likely to be, in part, a result of the deleterious effects of reduced school bonding and, in part, a result of the unsupervised, risky time afforded by truancy. Gaining a better understanding of how truancy may affect substance use is important for the development of prevention and intervention initiatives.

Do Treatment Improvements in PTSD Severity Affect Substance Use Outcomes? A Secondary Analysis From a Randomized Clinical Trial in NIDA's Clinical Trials Network

The purpose of the analysis was to examine the temporal course of improvement in symptoms of posttraumatic stress disorder (PTSD) and substance use disorder among women in outpatient substance abuse treatment. Participants were 353 women randomly assigned to 12 sessions of either trauma-focused or health education group treatment. PTSD and substance use assessments were conducted during treatment and posttreatment at 1 week and after 3, 6, and 12 months. A continuous Markov model was fit on four defined response categories (nonresponse, substance use response, PTSD response, or global response [improvement in both PTSD and substance use]) to investigate the temporal association between improvement in PTSD and substance use symptom severity during the study's treatment phase. A generalized linear model was applied to test this relationship over the follow-up period. Subjects exhibiting nonresponse, substance use response, or global response tended to maintain original classification; subjects exhibiting PTSD response were significantly more likely to transition to global response over time, indicating maintained PTSD improvement was associated with subsequent substance use improvement. Trauma-focused treatment was significantly more effective than health education in achieving substance use improvement, but only among those who were heavy substance users at baseline and had achieved significant PTSD reductions. PTSD severity reductions were more likely to be associated with substance use improvement, with minimal evidence of substance use symptom reduction improving PTSD symptoms. Results support the self-medication model of coping with PTSD symptoms and an empirical basis for integrated interventions for improved substance use outcomes in patients with severe symptoms.

Construction of the Structural Equation Model on Substance Use in Adolescents

The aim of this study was to construct a structural equation model that would further explain the continuously increasing substance use disorder in Korean adolescents. Survey visits using a structured questionnaire were conducted with 3,885 students in 2 middle schools and 2 high schools in Busan. A total of 13 instruments were used in this model. The analysis of data was done with both SPSS 14.0 for descriptive statistics and AMOS 5.0 for covariance structure analysis. Based on the constructed model, belief on substance use was found to have a significantly direct effect in influencing adolescent substance use. In addition, other factors such as family environment, satisfaction with school life, self-concept, social support, and personality vulnerability indirectly affected substance use. The final modified model yielded Chi-square=2,987 (p<.001), df=121, chi(2)/df=22.1, GFI=.96, AGFI=.93, NFI=.91, PNFI=.72, PGFI=.72, RMSEA=.07 and exhibited fit indices. This study constructed a model that addresses the factors related to adolescent substance use and explains the relationship of these factors in influencing substance use among Korean adolescents. Findings from this study can contribute to designing appropriate prevention strategies to reduce substance related disorders in adolescents.

Malpractice?

Although the Affordable Care Act (ACA) is anticipated to affect substance use disorder (SUD) treatment, its impact on the supply of physicians waivered to treat opioid dependence with buprenorphine has not been considered. This study examined whether states more supportive of ACA, meaning those that had opted to expand Medicaid and establish a state-based health insurance exchange, experienced greater growth in physician supply than less supportive states.Buprenorphine physician supply, including total physician supply, supply of 30-patient physicians, and supply of 100-patient physicians per 100,000 state residents, was measured from June 2013 to May 2015. State characteristics were drawn from multiple secondary sources, with states categorized as ACA-supportive, ACA-hybrid (where states either expanded Medicaid or established a state-based exchange), or ACA-resistant (where states took neither action). Mixed effects regression was used to estimate state-level growth curves to test whether rates of growth varied by states’ approaches to implementing ACA.The supply of waivered physicians grew significantly over the two-year period. Rates of growth were significantly lower in ACA-hybrid and ACA-resistant states relative to growth in ACA-supportive states. Average buprenorphine physician supply at baseline varied by region, the percentage of residents covered by Medicaid, and the supply of specialty SUD treatment programs.This study found a positive impact of the ACA on growth in the supply of buprenorphine-waivered physicians in US states. Future research should address whether the ACA affects the number of patients receiving buprenorphine, Medicaid spending, and the quality of treatment services delivered.

Extending the Theory of Planned Behavior to Predict Alcohol, Tobacco, and Marijuana Use Among Youth of Mexican Heritage

This study examined the applicability of extending the theory of planned behavior to explain the normative processes in substance use among Mexican-heritage youth. The theory identifies norms, attitudes, and perceived behavioral control as predictors of intentions, which in turn, predict behaviors. To date, the theory had a limited conceptualization of norms and had not been extended to youth of Mexican descent, one of the fastest growing segments of the U.S. population and one at particular risk for alcohol, tobacco, and marijuana use. Based on norm focus theory, it was hypothesized that norms are multidimensional, consisting of parental injunctive, peer injunctive, descriptive, and personal substance use norms. Second, it was hypothesized that parental injunctive, peer injunctive, and descriptive norms indirectly affect substance use intentions through attitudes, personal norms, and perceived behavioral control. The third hypothesis postulated that the model would operate differently based on Mexican-heritage youths' country of origin. Mexican-heritage youth (N = 1,499) from 30 elementary schools in Phoenix, AZ completed questionnaires in three waves over 18 months as part of a larger study. The findings supported the first hypothesis, showing the multidimensionality of norms. The second hypothesis was partially supported by findings from a multi-group multilevel path analysis using Mplus. Descriptive norms' association with intentions was partially mediated by attitudes, personal norms, and perceived behavioral control, while parental and peer injunctive norms were fully mediated, partially supporting the second hypothesis. Contrary to the third hypothesis, the mediation model did not differ based on Mexican-heritage youths' country of origin.

Effects of Parental Monitoring, Permissiveness, and Injunctive Norms on Substance Use among Mexican and Mexican American Adolescents

The prevention literature has given little attention to how parental influences affect substance use among Mexican origin adolescents, even though they form part of the largest ethnic minority group in the United States. This study explored the effects of three types of parental influences-parental monitoring of the child's whereabouts, degree of parental permissiveness, and the strength of parental injunctive norms discouraging substance use-on alcohol, cigarette, and marijuana use and anti-drug norms. Results showed that parental permissiveness and parental injunctive norms, particularly anti-drug injunctive norms, had the strongest effects on the substance use outcomes, but parental monitoring generally was not a significant predictor. These results and implications for prevention are discussed in light of Mexican cultural norms toward substance use, gender roles, and family roles.

The Protective and Risk Effects of Parents and Peers on Substance Use, Attitudes, and Behaviors of Mexican and Mexican American Female and Male Adolescents

This study explores the extent to which parental and peer behaviors and norms may affect substance use, personal anti-drug norms and intentions to use drugs in a group of Mexican heritage preadolescents in the Southwest, and whether these parental and peer influences differ according to gender. Secondary data from a randomized trial of a drug prevention program was used. The sample consisted of 2,733 adolescents. The outcomes were recent alcohol, cigarette, and marijuana use, personal anti-drug norms and intentions to use drugs. In this study, peer variables were more consistently related to the outcomes than parent variables, with the exception of parental injunctive norms which were the most predictive parent factor. Recommendations are provided to further study the protective processes that are maintained through the transition into adolescence and acculturation as a foundation for the design of resiliency-focused prevention interventions.

Long-Term Employment Trajectories Among Participants With Severe Mental Illness in Supported Employment

Long-Term Employment Trajectories Among Participants With Severe Mental Illness in Supported Employment

Long-Term Employment Trajectories Among Participants With Severe Mental Illness in Supported Employment

The long-term trajectories of participants in supported employment have not been clear. This exploratory study presents eight- to 12-year employment trajectories among adults with psychiatric disabilities who participated in supported employment. We reinterviewed 38 of 78 participants (49%) with severe mental illness eight to 12 years after they enrolled in supported employment studies in a small urban mental health center in New England. Data were analyzed by using quantitative and qualitative methods. All 38 participants worked during the follow-up period, a great majority (82%) in competitive jobs, and 71% worked for more than half of the follow-up years. Participants reported numerous benefits related to employment, including enhancements to self-esteem, relationships, and illness management. Psychiatric illness was the major barrier to work; part-time employment and long-term supports were the major facilitators. Three overlapping themes emerged from the qualitative analysis as significant perceived influences on participants' work-related behavior. First, the successful management of symptoms and the deployment of appropriate coping skills appeared to play an important role in finding and maintaining work. Second, participants generally preferred to work part-time because of the lesser demands of this type of job and because it was perceived to allow for the maintenance of Social Security and health care entitlements. Third, participants saw the importance of ongoing individual placement and support services. Participants stated that this was imperative in making successful transitions between jobs or from unemployment to employment and in helping negotiate pay raises or changes in conditions. The long-term trajectories of participants in supported employment programs, both vocational and nonvocational, appear to be positive.

Gene–lifecourse interaction for alcohol consumption in adolescence and young adulthood: Five monoamine genes

Association analysis has suggested that common sequence variants of genes that affect monoamine function can affect substance use and abuse. Demonstration of these associations has been inconsistent because of limited sample sizes and phenotype definition. Drawing on the life course perspective, we predicted a stronger association between the polymorphisms in 5HTT, DAT1, DRD4, DRD2, and MAOA and alcohol consumption in young adulthood than adolescence. This analysis tested for the gene-lifecourse interaction for the frequency of alcohol consumption in a nationally representative non-alcohol-dependent sample of 2,466 individuals that were visited during adolescence and young adulthood for four times between 1994 and 2002. All five genes are significantly associated with the frequency of alcohol consumption, with the genotype effects ranging 7%-20% of the mean score of alcohol consumption and their P values being 0.014, 0.0003, 0.003, 0.007, 0.005, and 0.003, respectively. The association is only observed in the life stage of young adulthood and not in adolescence. This analysis has demonstrated the potential usefulness of the life course perspective in genetic studies of human behaviors such as alcohol consumption.