High-risk Alcohol Use Research Articles

Screening and Brief Intervention to Reduce Marijuana Use Among Youth and Young Adults in a Pediatric Emergency Department

Marijuana was involved in 209,563 emergency department (ED) visits in 2006, according to the Drug Abuse Warning Network. Although screening and brief intervention (SBI) has been effective in changing drinking among ED patients in a number of studies, tests of marijuana SBI in a pediatric emergency department (PED) have not yet been reported. The aim of this pilot study was to test whether SBI is effective in reducing marijuana consumption among youth and young adults presenting to a PED with a diverse range of clinical entities. A three-group randomized controlled preliminary trial was structured to test 1) differences between Intervention (Int) and standard Assessed Control (AC) groups in marijuana consumption, from baseline to 12 months, and 2) the feasibility of adding a Nonassessed Control (NAC) group to evaluate regression to the mean and assessment reactivity. Patients aged 14-21 years in an urban, academic PED were screened during 2006-2007, using standardized risk factor questions. Subjects were eligible if they used marijuana three or more times in the past 30 days, but were excluded for co-occurring high-risk alcohol use. Consented enrollees were randomized to NAC, AC, and Int groups in a two-stage process that permitted blinding to status during assessment and follow-up. NACs received a resource handout, written advice about marijuana use risks, and a 12-month follow-up appointment. ACs were assessed using standardized instruments and received resources, written advice, and 3- and 12-month follow-up appointments. The Int group received assessment, resources, written advice, 3- and 12-month appointments, a 20-minute structured conversation conducted by older peers, and a 10-day booster telephone call. A peer educator utilized a motivational style interview protocol adapted for adolescents to elicit daily life context and future goals, provide feedback, review pros and cons of marijuana use, assess readiness to change, evaluate strengths and assets, negotiate a contract for change, and make referrals to treatment and/or other resources. Measurements included demographic information; 30-day self-report of marijuana use; attempts to quit, cut back, or change conditions of use; and risk factor questions repeated at follow-up. Among 7,804 PED patients screened, 325 were eligible; 210 consented and enrolled (Int, n = 68; AC, n = 71; NAC, n = 71), with a 12-month follow-up rate of 71%. For the primary objective, we compared Int to AC. At 12 months, Int participants were more likely to be abstinent for the past 30 days than ACs (odds ratio [OR] for reported abstinence = 2.89, 95% confidence interval [CI] = 1.22 to 6.84, p < 0.014). The Int group had greater reduction in days used, baseline to 12 months, controlling for baseline (Int = -7.1 vs. AC = -1.8), were less likely to have been high among those who smoked (OR = 0.39, 95% CI = 0.17 to 0.89, p < 0.05), and were more likely to receive referrals. In a linear regression model controlling for baseline use, NACs smoked 4 fewer days per month than ACs, but consumption was not significantly different, suggesting no assessment reactivity effect. A preliminary trial of SBI promoted marijuana abstinence and reduced consumption among PED patients aged 14-21 years. A no-contact condition for the NAC group over the year after enrollment was insufficient to capture enrollees for follow-up across a range of baseline acuity.

A Preliminary Report of Knowledge Translation: Lessons From Taking Screening and Brief Intervention Techniques From the Research Setting Into Regional Systems of Care

This article describes a limited statewide dissemination of an evidence-based technology, screening, brief intervention, and referral to treatment (SBIRT), and evaluation of the effects on emergency department (ED) systems of care, utilizing the knowledge translation framework of reach, effectiveness, adoption, implementation, and maintenance (RE-AIM), using both quantitative and qualitative data sources. Screening and brief intervention (SBI) can detect high-risk and dependent alcohol and drug use in the medical setting, provide early intervention, facilitate access to specialty treatment when appropriate, and improve quality of care. Several meta-analyses demonstrate its effectiveness in primary care, and the federal government has developed a well-funded campaign to promote physician training and adoption of SBI. In the busy environment of the ED, with its competing priorities, researchers have tested a collaborative approach that relies on peer educators, with substance abuse treatment experience and broad community contact, as physician extenders. The ED-SBIRT model of care reflects clinician staff time constraints and resource limitations and is designed for the high rates of prevalence and increased acuity typical of ED patients. This report tracks services provided during dissemination of the ED-SBIRT extender model to seven EDs across a northeastern state, in urban, suburban, and rural community settings. Twelve health promotion advocates (HPAs) were hired, trained, and integrated into seven ED teams. Over an 18-month start-up period, HPAs screened 15,383 patients; of those, 4,899 were positive for high risk or dependent drinking and/or drug use. Among the positive screens, 4,035 (82%) received a brief intervention, and 57% of all positives were referred to the substance abuse treatment system and other community resources. Standardized, confidential interviews were conducted by two interviewers external to the program with 24 informants, including HPAs and their supervisors, clinicians, nurse managers, and ED directors across five sites. A detailed semistructured format was followed, and results were coded for thematic material. Barriers, challenges, and successes are described in the respondents' own words to convey their experience of this demonstration of SBIRT knowledge translation. Five of seven sites were sustained through the second year of the program, despite cutbacks in state funding. The dissemination process provided a number of important lessons for a large rollout. Successful implementation of the ED-SBIRT HPA model depends on 1) external funding for start-up; 2) local ED staff acting as champions to support the HPA role, resolve territorial issues, and promote a cultural shift in the ED treatment of drug and alcohol misuse from "treat and street" to prevention, based on a knowledge of the science of addiction; 3) sustainability planning from the beginning involving administrators, the billing and information technology departments, medical records coders, community service providers, and government agencies; and 4) creation and maintenance of a robust referral network to facilitate patient acceptance and access to substance abuse services.

Occupational Risk Factors in the Emergency Medical Services

During a medical emergency, the American public often relies on the expertise of emergency medical technicians (EMTs). These professionals face a number of occupational hazards, and the literature suggests that EMTs are at a greater risk of developing physical and mental stress-related disorders. The purpose of this paper is to systematically examine gaps in the extant literature and to present a theoretically driven conceptual model to serve as a basis for future intervention and research efforts. A systematic review of the literature was conducted utilizing relevant databases (e.g., PsychInfo, Medline). All empirical articles regarding emergency medical responders were reviewed, but given the limited research available, relevant theoretical and conceptual literature on the constructs of interest in other, related populations also were included. Based on this extensive review, a modification of the stress process model is suggested to explain the relationships among occupational stress exposure, post-traumatic stress disorder (PTSD), and high-risk alcohol and other drug use. Exposure to traumatic events was reported to be between 80% and 100% among EMTs, and rates of PTSD are >20%. High-risk alcohol and drug use rates among other emergency response professionals were reported to be as high as 40%. The proposed model suggests direct linkages between occupationally related stress exposure, including chronic and critical incident stress, PTSD, and high-risk alcohol and other drug use. Social support and personal resources (e.g., coping, locus of control) are proposed to have mediating and moderating influences on the three main constructs, and cohesion is introduced as an important, idiosyncratic influence in this population. The moderating influences of gender, age, ethnicity, marital status, and socioeconomic status, level of training, and years of service are included in the proposed model. High-risk alcohol and other drug use and post-traumatic symptomatology pose substantial risks for EMTs, and consequently, for the patients they serve. It is imperative that researchers develop and test a theoretically grounded model of risk and protective factors that will guide intervention development and future study. The model suggested in this paper, based on a comprehensive literature review and development of theory, represents a critical first step in the intervention research process.

Campus Involvement, Perceived Campus Connection, and Alcohol Use in College Athletes

This research study examined the relationship of college athletes' levels of campus involvement and campus connection to their alcohol use. A survey measuring alcohol use, campus involvement and campus connection was administered to 720 athletes at nine institutions. Participants who reported having 5 or more drinks on one occasion in the past two weeks had higher levels of campus connection than those who did not report that level of alcohol consumption; but, conversely these college athletes also reported lower levels of campus involvement. It is suggested that increasing campus involvement of college athletes could be an effective strategy to reduce high-risk alcohol use by college athletes and possibly even college students as a whole.

Decreasing Use of Alcohol, Tobacco, and Other Drugs on a College Campus: Exploring Potential Factors Related to Change

High-risk alcohol, tobacco, and other drug (ATOD) use has been a persistent problem on college campuses despite decades of prevention programming. However, some universities may begin to experience a lower prevalence of high-risk behaviors, not because of education efforts, but because of generational changes in the incoming student population. This study examined the ATOD use of incoming students (n = 5,964) at a large, southeastern, public university over a 5-year period. The data demonstrated an overall decrease in incoming students’ ATOD use, which may be connected to the defining characteristics of the Millennial generation—a need for structure, respect for authority, a tendency to follow rules and institutional policies, and an appreciation for the institution’s increasing focus on academic rigor—as well as increased ethnic diversity of the generation. As increasing numbers of Millennials enter college, these results become critically important for prevention work and policy development.

Predictors of high-risk alcohol consumption in young offenders on community orders: Policy and treatment implications.

The present study examined the relationship between a set of individual and contextual variables and high-risk alcohol use among young offenders placed on community orders in New South Wales, Australia. Participants (n = 777) were compared on a set of factors known to be strong predictors of high-risk alcohol use among adolescents. The authors assessed the strength of the relationship between gender, age, ethnicity, geographical region of residence, school attendance, father absence, history of childhood trauma, and the presence of severe conduct disorder on weekly levels of alcohol use. Living in rural locations, not currently attending school, being female, and not having been raised with a biological father present were associated with significantly increased odds of alcohol abuse. Father absence was a more important risk factor for rural young offenders, but school dropout was associated with more hazardous drinking among young offenders in urban areas. Accordingly, the authors suggest family-focused intervention programs for young offenders living in rural areas and school-based programs for vulnerable young people living in urban areas, although programs should consider including both factors for both groups if feasible and warranted.

Mailed treatment to augment primary care for alcohol disorders: A randomised controlled trial

Remote delivery of interventions is needed to address large numbers of people with alcohol use disorders who are spread over large areas. Previous correspondence trials typically examined its effects as stand-alone treatment. This study aimed to test whether adding postal treatment to general practitioner (GP) support would lower alcohol use more than GP intervention alone. A single-blind, randomised controlled trial with a crossover design was conducted over 12 months on 204 people with alcohol use disorders. Participants in an immediate correspondence condition received treatment over the first 3 months; those receiving delayed treatment received it in months 3-6. Few participants were referred from GPs, and little intervention was offered by them. At 3 months, 78% of participants remained in the study. Those in immediate treatment showed greater reductions in alcohol per week, drinking days, anxiety, depression and distress than those in the delayed condition. However, post-treatment and follow-up outcomes still showed elevated alcohol use, depression, anxiety and distress. Greater baseline anxiety predicted better alcohol outcomes, although more mental distress at baseline predicted dropout. The study gave consistent results with those from previous research on correspondence treatments, and showed that high levels of participant engagement over 3 months can be obtained. Substantial reductions in alcohol use are seen, with indications that they are well maintained. However, many participants continue to show high-risk alcohol use and psychological distress.

Binge drinking in college‐aged women: Framing a gender‐specific prevention strategy

To provide an overview of binge drinking in college-aged women and to suggest strategies for nurse practitioners (NPs) to assist women in preventing the negative consequences associated with this behavior. Original research articles and comprehensive review articles identified through Medline, CINAHL, and OVID databases. Researchers have shown that the rates of binge drinking in college-aged women are increasing, which places these women at increased risk for the long-term complications associated with alcohol use. NPs must be aware of this phenomenon and carefully screen women for high-risk alcohol use. Prevention strategies are reviewed and include the use of brief motivational interviews delivered during individual client encounters as well as through Web-based programs.

382: DIAL: Decreasing Injuries from ALcohol

Brief interventions (BI) for alcohol for injured patients have been demonstrated to be effective.1 DIAL is RCT of a telephone BI for high-risk alcohol use with injured emergency department (ED) patients who we have previously reported a significant change in a risky alcohol-related behavior (impaired driving) at 3-months for those receiving BI compared to standard care (SC).2 We now examine the efficacy of DIAL for the distal outcome of change in alcohol-related injuries at 12 months.

The Healthy Moms Study: The Efficacy of Brief Alcohol Intervention in Postpartum Women

The prevention and treatment of alcohol use disorders among women of reproductive age have been well described. However, there is limited information on women specifically during the postpartum period. This period in a woman's life is a time of transition and it provides an ideal opportunity for primary care providers to intervene. The goal of this report was to present the results of a brief alcohol intervention conducted in 34 obstetrical practices with women seeking routine postpartum care. A randomized clinical trial was conducted from 2002 to 2005 in a diverse sample of women located in 15 Wisconsin counties. This report presents 6-month follow-up data. A total of 8,706 women were screened for high-risk alcohol use during routine postpartum care with 997 (12%) of these women testing positive for at-risk drinking. A total of 235 women met inclusion criteria and were randomized to either "usual care" or "brief intervention." The 4-session intervention was delivered by outpatient obstetrical nurses and research staff. The mean age of the women in the sample was 28, 19.3% were from minority groups, 60.8% were married, 53.2% reported current tobacco use, and 17.9% had used marijuana in the previous 30 days. At the 6 month follow-up appointment, there were significant reductions in mean number of total drinks in the previous 28 days (p < 0.013), number of drinking days (p < 0.024) and heavy drinking days (p < 0.019). In addition to a statistical difference between groups, there was a 19% difference in the mean number of drinks and number of drinking days, and a 36% difference in the number of heavy drinking days in favor of the intervention group. The findings of the Healthy Moms Trial support the implementation of brief alcohol intervention during the postpartum period.

DIAL: A Telephone Brief Intervention for High-Risk Alcohol Use With Injured Emergency Department Patients

Brief interventions for high-risk alcohol use for injured emergency department (ED) patients have demonstrated effectiveness and may have a more pronounced effect with motor vehicle crash patients. We report on 3-month outcome data of a randomized controlled trial of injured patients, using a novel model of telephone-delivered brief interventions after ED discharge. ED research assistants recruited adult injured patients who screened positive for high-risk alcohol use and were to be discharged home. After discharge, participants received by telephone an assessment of alcohol use and impaired driving and then were randomized to treatment (n=140) or standard care (n=145). Treatment consisted of 2 sessions of brief interventions done by telephone, focusing on risky alcohol use. At 3 months, both groups had an assessment of alcohol use and impaired driving. Two hundred eighty-five patients were randomized and had a baseline mean Alcohol Use Disorders Inventory Test (AUDIT) score of 11.0 (SD=7.4). Three-month follow-up assessments were completed on 273 (95%). Mean AUDIT score decreased in both the treatment (mean change=-3.4; 95% confidence interval [CI] -4.5 to -2.3) and standard care group (mean change=-3.2; 95% CI -4.2 to -2.2). Measures of impaired driving decreased for the treatment group (mean change=-1.4 95%; CI -3.0 to 0.2) compared with standard care group (mean change=1.0; 95% CI -0.9 to 2.9; P=.04; d=0.31). Participants were stratified post hoc into 3 groups by baseline alcohol problem, with the treatment effect only being in the highest-scoring group (d=.30). Telephone brief interventions decreased impaired driving in our treatment group. Telephone brief intervention appears to offer an alternative mechanism to deliver brief intervention for alcohol in this at-risk ED population.

Opportunistic screening and clinician‐delivered brief intervention for high‐risk alcohol use among emergency department attendees: A randomized controlled trial

To evaluate the feasibility and efficacy of routine opportunistic screening and brief intervention (BI) by ED staff to reduce high-risk alcohol consumption. This was an open, randomized controlled trial with allocation blinding performed over 12 months. Using the Paddington Alcohol Test, adult patients were screened for high-risk alcohol use. Consenting patients who were screened positive were eligible for randomization to no counselling (standard care, SC), same-day BI by an emergency nurse or doctor or motivational intervention (MI) within 1 week by off-site drug and alcohol counsellors. Telephone follow up was performed at 1 and 3 months. The primary outcome was maximum self-reported daily standard drinks consumed. Analysis was by intention to treat. Of 32,965 eligible patients, 10,274 were screened, 1043 were positive, 468 consented to the study, and 161, 159 and 148 were allocated to SC, BI and MI, respectively. In the MI group, 133 declined intervention or failed to attend. At 3 months, 96, 81 and 74 participants in the SC, BI and MI groups, respectively, were contactable and consented to telephone interview. Overall, maximum daily alcohol consumption decreased from a median of 13.5 standard drinks at enrolment to 9.25 drinks at 3 months. At 3 months, SC participants reported fewer drinks than those randomized to MI. In the present study, neither BI nor MI was better than SC in reducing high-risk alcohol consumption. Uptake of opportunistic screening by ED staff was poor, as was patient compliance with off-site counselling.

Getting Beyond “Don’t Ask; Don’t Tell”: an Evaluation of US Veterans Administration Postdeployment Mental Health Screening of Veterans Returning From Iraq and Afghanistan

We sought to evaluate outcomes of the Veterans Administration (VA) Afghan and Iraq Post-Deployment Screen for mental health symptoms. Veterans Administration clinicians were encouraged to refer Iraq or Afghanistan veterans who screened positive for posttraumatic stress disorder, depression, or high-risk alcohol use to a VA mental health clinic. Multivariate methods were used to determine predictors of screening, the proportions who screened positive for particular mental health problems, and predictors of VA mental health clinic attendance. Among 750 Iraq and Afghanistan veterans who were referred to a VA medical center and 5 associated community clinics, 338 underwent postdeployment screening; 233 (69%) screened positive for mental health problems. Having been seen in primary care (adjusted odd ratio [AOR]=13.3; 95% confidence interval [CI]=8.31, 21.3) and at a VA community clinic (AOR=3.28; 95% CI=2.03, 5.28) predicted screening. African American veterans were less likely to have been screened than were White veterans (AOR=0.45; 95% CI=0.22, 0.91). Of 233 veterans who screened positive, 170 (73%) completed a mental health follow-up visit. A substantial proportion of veterans met screening criteria for co-occurring mental health problems, suggesting that the VA screens may help overcome a "don't ask, don't tell" climate that surrounds stigmatized mental illness. Based on data from 1 VA facility, VA postdeployment screening increases mental health clinic attendance among Iraq and Afghanistan veterans.

The influence of alcohol and tobacco use in orthopaedic inpatients on complications of surgery

Tobacco use and heavy alcohol consumption are associated with increased morbidity and mortality. There is limited research on the correlation between tobacco and risky levels of alcohol use and the possible complications associated with a hospital admission. The underestimation of problem drinking, in particular, has obvious repercussions for the management of patients in hospital. If alcohol-related problems go undetected or unrecorded, treatment may be inadequate or inappropriate. The aims of the project were to assess the prevalence of high-risk alcohol and tobacco use in orthopaedic in-patients and to examine any relationship between alcohol and tobacco use and the number and type of complications, management and length of stay. One hundred and fifty-three consecutive orthopaedic admissions to the Orthopaedic Ward at Lismore Base Hospital were screened using the Drinkcheck questionnaire, which is based on the Alcohol Use Disorders Identification Test (AUDIT), but which also screens for tobacco use. Nursing staff on the ward completed a Complications Evaluation Questionnaire (CEQ). The risk status of the subjects was compared to the number and type of complications, to assess any effects of alcohol and tobacco on post-surgical complications. Significant correlations were found between tobacco use, hazardous and harmful alcohol use and numerous medical complications and behavioural problems. Behavioural problems associated with risky alcohol use included verbal abuse, agitation and sleep disturbances, particularly in men; problems associated with tobacco use included agitation and non-compliance. Orthopaedic patients who smoke and/or drink heavily prior to surgery may have more non-medical complications than non-smokers and light or non-drinkers. All surgery patients should thus be screened for alcohol and tobacco use and alcohol withdrawal, which may cause other symptoms such as behavioural problems, non-compliance and verbal abuse post-surgery.

316: DIAL: A Telephone Intervention for High-Risk Alcohol Use With Injured ED Patients

Alcohol-related motor vehicle crashes (MVC) continue to be a substantial public health problem. Brief interventions (BI) for alcohol for injured ED patients have been demonstrated to be effective, and perhaps more so for MVC patients. Telephone communications have been utilized in varying ways in health care. We report on 3-month outcome data of a RCT of injured ED patients using a novel model of telephone-delivered BI after ED discharge.

Emergency clinician‐delivered screening and intervention for high‐risk alcohol use: A qualitative analysis

To evaluate qualitative feedback from patients who received opportunistic screening and brief intervention for harmful alcohol use during an ED attendance; to evaluate emergency staff attitudes to performing alcohol screening and delivering opportunistic brief intervention; and to document process issues associated with the introduction of routine clinician-initiated opportunistic screening and training and administration of brief intervention. Structured and semi-structured interviews with emergency staff and recipients of brief intervention. Sixty-nine patients were interviewed 3 months after an ED attendance where they received emergency clinician-delivered brief intervention for high-risk alcohol use. Twenty-two (32%; 95% CI 21-43%) reported a positive effect of brief intervention on thoughts or behaviour, but 29% (95% CI 18-40%) felt the intervention was not relevant for them or could not recall it. Four people (6%; 95% CI 1-12%) felt confronted or embarrassed, and 17 (25%; 95% CI 15-36%) felt timing or delivery could be improved. Staff had a positive attitude to delivering brief intervention, but nominated lack of time as the main barrier. Fourteen of 15 staff felt brief intervention should become routine in emergency care. Emergency clinicians can be trained to provide brief intervention for high-risk alcohol in an ED. The use of emergency clinician brief intervention is acceptable to most staff and patients.

Social norms and alcohol consumption among intercollegiate athletes: The role of athlete and nonathlete reference groups

The relationship between perceived alcohol use among peers and personal alcohol use was assessed in a sample of collegiate athletes. Data were collected on 109 intercollegiate athletes during the competitive season and 119 athletes during the off-season at a large, state university in the Northeastern United States. Participants were asked to estimate the normative alcohol use of four reference groups (closest athlete friend, closest nonathlete friend, typical athlete, and typical nonathlete). Results of both in-season and off-season analyses indicated that athletes estimated that others consumed more drinks per week than they did, and perceptions of these social norms predicted personal use. Although the typical athlete norm emerged as the strongest predictor of personal alcohol use, the relative strength of the relationships between individual behavior and the athlete and nonathlete norms varied according to seasonal status. Results have implications for the content and timing of prevention and intervention programs aimed at reducing high-risk alcohol use among intercollegiate athletes.

Trajectories of adolescent alcohol and cannabis use into young adulthood

Both alcohol and cannabis use carry health risks. Both are commonly initiated in adolescence. To date little research has described trajectories of adolescent cannabis or alcohol use or compared their respective consequences in young adulthood. The design was a 10-year eight-wave cohort study of a state-wide community sample of 1943 Victorians initially aged 14-15 years. Moderate- and high-risk alcohol use was defined according to total weekly alcohol consumption. Moderate- and high-risk cannabis use were defined as weekly and daily use, respectively. Around 90% of young adults used either alcohol or cannabis. Although an association existed between alcohol and cannabis use, there was a tendency for heavy users to use one substance predominantly at any one time. Weekly or more frequent cannabis use in the absence of moderate-risk alcohol use in teenagers predicted a sevenfold higher rate of daily cannabis use in young adults but only a twofold increase in high-risk alcohol use. Conversely, moderate-risk adolescent alcohol use in the absence of weekly cannabis predicted an approximately threefold increased rate of both high-risk drinking and daily cannabis use in young adulthood. Selective heavy cannabis use in both adolescence and young adulthood was associated with greater illicit substance use and poorer social outcomes in young adulthood than selective alcohol use. Heavier teenage cannabis users tend to continue selectively with cannabis use. Considering their poor young adult outcomes, regular adolescent cannabis users appear to be on a problematic trajectory.

Social Marketing Campaigns for Youth Gambling Prevention: Lessons Learned from Youth

Youth gambling is an important, although often overlooked adolescent health issue. Media-based prevention programs have long been employed as tools to address high risk behaviours, namely drug, alcohol and tobacco use, as well as sexual health. However, social marketing has yet to be drawn upon as a strategy to address problem gambling among adolescents. This strategy would appear to be especially relevant given the recent rise in the portrayal of gambling in the mass media, often glamorizing and normalizing games and practices. The authors aimed to examine the use of social marketing as a strategy for gambling prevention among adolescent. A qualitative study using focus groups was conducted to explore adolescents’ exposure to existing prevention campaigns and their message content and communication preferences for a youth gambling social marketing campaign. Social marketing advertisements, depicting real-life stories with an emotional appeal, that portrayed the negative consequences associated with a gambling problem were highly endorsed by participants. Participants further recommended illustrating the basic facts of gambling using simple messages that raise awareness in a non-judgmental manner. Adolescents are critical of the “don’t do it” message as this approach does not reflect the current youth gambling culture. It is expected that this study serve as a source for the development of future social marketing campaigns on youth gambling. Targeting variable and campaign strategies recommended herein should be considered in the early stages and tested along the way.

Effect of Differentiation of Self on Adolescent Risk Behavior

Innovative theoretical models are needed to explain the occurrence of high-risk sexual behaviors, alcohol and other-drug (AOD) use, and academic engagement among ethnically diverse, inner-city adolescents. The aim of this study was to test the credibility of a theoretical model based on the Bowen family systems theory to explain adolescent risk behavior. Specifically tested was the relationship between the predictor variables of differentiation of self, chronic anxiety, and social problem solving and the dependent variables of high-risk sexual behaviors, AOD use, and academic engagement. An ex post facto cross-sectional design was used to test the usefulness of the theoretical model. Data were collected from 161 racially/ethnically diverse, inner-city high school students, 14 to 19 years of age. Participants completed self-report written questionnaires, including the Differentiation of Self Inventory, State-Trait Anxiety Inventory, Social Problem Solving for Adolescents, Drug Involvement Scale for Adolescents, and the Sexual Behavior Questionnaire. Consistent with the model, higher levels of differentiation of self related to lower levels of chronic anxiety (p < .001) and higher levels of social problem solving (p < .01). Higher chronic anxiety was related to lower social problem solving (p < .001). A test of mediation showed that chronic anxiety mediates the relationship between differentiation of self and social problem solving (p < .001), indicating that differentiation influences social problem solving through chronic anxiety. Higher levels of social problem solving were related to less drug use (p < .05), less high-risk sexual behaviors (p < .01), and an increase in academic engagement (p < .01). Findings support the theoretical model's credibility and provide evidence that differentiation of self is an important cognitive factor that enables adolescents to manage chronic anxiety and motivates them to use effective problem solving, resulting in less involvement in health-comprising behaviors and increased academic engagement.