Higher Substance Use Research Articles

Identifying factors that predict persistent driving after drinking, unsafe driving after drinking, and driving after using cannabis among young adults

The main aim of this study was to identify adolescent/young adulthood factors that predicted persistent driving after drinking, persistent unsafe driving after drinking, and persistent cannabis use and driving among young adults. It was a longitudinal study of a birth cohort ( n=933, 474 males and 459 females) and was based on data collected at ages 15, 18, 21 and 26 years. At each of these ages members of the cohort attended the research unit for a personal interview by a trained interviewer, using a standardised questionnaire. For this study, the data for the outcome measures (persistent driving after drinking, persistent unsafe driving after drinking, and persistent driving after using cannabis) were obtained at ages 21 and 26 years. The main explanatory measures were collected at ages 15, 18, 21 years and included demographic factors (academic qualifications, employment, parenting); personality measures; mental health measures (substance use, cannabis dependence, alcohol dependence, depression); anti-social behaviour (juvenile arrest, aggressive behaviour, court convictions); early driving behaviour and experiences (car and motorcycle licences, traffic crashes). The analyses were conducted by gender. The results showed that females who persisted in driving after drinking (13%, n=61) were more likely than the others to have a motorcycle licence at 18. The males who persisted in driving after drinking (28%, n=135) were more likely than the other males to have some school academic qualifications and to be employed at age 26. Compared to the other males, those who persisted in unsafe driving after drinking (4%, n=17) were more likely to be aggressive at 18 and alcohol dependent at 21. Only six (1%) females persisted in unsafe driving after drinking so regression analyses were not conducted for this group. For persistent driving after using cannabis, the univariate analyses showed that females who persisted with this behaviour tended to have high substance use at 18, cannabis dependence at 21, police contact as a juvenile, and to be a parent at 21. For this group, because of the small numbers (3%, n=13) multivariate analyses were not appropriate. For the males who persisted in driving after using cannabis (14%, n=68) a wide range of variables were significant at the univariate stage. The multivariate analysis showed that the most important factors were dependence on cannabis at 21, at least one traffic conviction before 21, a non traffic conviction before 18, and low constraint at 18. Conclusion: These results show different characteristics were associated with persistence in each of these outcome behaviours. This indicates that different approaches would be required if intervention programmes were to be developed to target these behaviours.

HIV/AIDS preparedness in mental health care agencies with high and low substance use disorder caseloads.

The Columbia University HIV Mental Health Training Project, created to improve the mental health workforce's AIDS preparedness in New York and neighboring states, sought to compare the perceived HIV-related needs and capacities of mental health care providers in settings where clients with substance use disorders predominated versus those where clients with substance use disorders were the minority of the agencies' caseload. The first consecutive 67 mental health care agencies that requested HIV/AIDS training between March 2000 and January 2001 completed a written needs assessment describing their HIV-related services and training needs. Agencies with higher substance abuse caseloads were significantly more likely than others to have large HIV/AIDS caseloads, to be currently providing condoms to clients, and to rate staff comfort with sexual identity issues as well as drug-related issues as good. Overall, agencies that had received previous training in specific topic areas (e.g., HIV risk assessment) were significantly more likely than others to provide those services. Even so, in all settings, significant gaps in service provision were found. Two decades into the AIDS epidemic, mental health care agencies, especially those treating smaller caseloads of patients with substance use disorders, may not be providing sufficient services to meet their clients' HIV-related needs.

Experience and Covariates of Depressive Symptoms Among a Cohort of HIV Infected Women

ABSTRACT Objectives: The objectives of this study are to assess (a) the level of depressive symptoms among a cohort of HIV infected women and comparable controls and (b) the relationship with covariates including socioeconomic status, substance use, social relations, disease status. Methods: Participants were enrolled in the Women's Interagency HIV Study (WIHS). Depressive symptoms were measured using the Center for Epidemiological Studies Depression Scale (CESD). Data from 1993 HIV seropositive and 551 seronegative women are presented. Results: Of HIV positive women 57.7% of HIV positive women scored 16 or higher on the CESD (ns) as compared to 55.0% of HIV negative women; at a cutoff of 23, the percents were 40.4% and 35.9% respectively (p = .06). The mean score was high 19.8 but not significantly different between groups. Scores were higher among women who had less education, lower income, were of Hispanic ethnicity, used alcohol or drugs, experienced domestic abuse, had more than one partner, or had less supportive relationships. Among infected women, higher CESD scores were not significantly associated with CD4 cell count but were elevated for self-reported Class C AIDS defining clinical conditions. Conclusions: The scores on the CESD were elevated for both HIV positive and HIV negative women and the differences between the groups were small. Lower socioeconomic status and social support and higher substance use and domestic abuse were associated with depressive symptoms similarly for both groups.

Adolescent Risk for HIV Infection

ABSTRACT Adolescents (N= 482) at elevated risk for sexually-transmitted diseases, including HIV/AIDS, were assessed on theoretically-derived measures of knowledge and attitudes toward precautionary behavior, frequencies of high risk sexual and substance use behaviors, and other psychosocial factors implicated in adolescents' risky behavior such as impulsivity, risk-taking propensity, and social support. The adolescent samples included drug-dependent adolescents (n = 77), incarcerated youth (n = 194), homeless and runaway youth (n= 55), and urban African-American adolescents (n= 156). Drug-dependent and incarcerated youth evidenced exceedingly high HIV-risk and less favorable psychosocial profiles, with drug-dependent females reporting the highest levels of overall risk. Youth in homeless shelters were lower in HIV-risk and had more favorable psychosocial profiles than drug-dependent and incarcerated youth and were slightly higher on these measures than African-American youth sampled from the community. Ge...

The influence of self-efficacy on alcohol use among American Indians.

The influence of self-efficacy (general and substance use) on alcohol use among 114 American Indian and Native Alaskan adults was examined. Analysis of variance was performed to assess differences between alcohol use groups (nonuse, low use, and medium-high use). Low general self-efficacy (GSE) was associated with higher alcohol use. High substance use self-efficacy (SSE) was associated with higher alcohol use. Moreover, low GSE was associated with higher SSE. Results indicate that alcohol use may be in response to feelings of powerlessness within one's life and may be sustained by perceived feelings of control over use. The study suggests that the concept of self-efficacy appears to relate to empowerment issues and, as such, would have important applications for use with minority individuals.

Resilience and risk: childhood and uncertainty in the AIDS epidemic.

In a study of depression and risk among HIV-affected young people (children whose parents are infected with or have died from HIV/AIDS), subjects did not report high risk sexual or substance use behavior. Findings are attributed to parental participation in a community-based HIV service program that provides parents with HIV prevention education and long term social and emotional support. Multi-generational community based models of prevention that include parents as critical elements of instruction may also be effective in substance abuse treatment programs and in programs for children who experience difficulty in school.

The African‐American Health Project (AAHP): Study overview and select findings on high risk behaviors and psychiatric disorders in African American men

The AAHP investigated the neurobehavioral and psychosocial sequelae of HIV‐1 and substance use in urban African American men. A community resident sample of 502 African American men stratified by HIV‐1 serostatus, drug use and sexual orientation were recruited. A comprehensive battery of measures of neurobehavioral and health status, lifestyle and psychosocial characteristics were administered to all participants, and a stratified sub‐sample of 120 participants were tested using state of the art brain imaging techniques to investigate differences in the functional and neurophysiologic effects of HIV‐1 and substance use. An overview of the methodology of the AAHP and results on high risk sexual and substance use behaviors, and psychiatric disorders are presented and discussed. The sample was primarily HIV‐negative (63%), heterosexual (49% gay or bisexual) and a high percentage used substances during the past year (56% used drugs and 30% moderate/heavy drinkers). High‐risk sexual practices were relatively prevalent, and a high percentage reported a history of STDs and other infections. Finally, 25% had a current psychiatric disorder, with gays/bisexuals and HIV‐seropositives evidencing greater psychiatric vulnerability. More research is needed to further explore the apparent greater risk for psychiatric disorders among gay and bisexual men, and to determine whether being African American and lower social class exacerbate this risk.

High‐activity catechol‐O‐methyltransferase allele is more prevalent in polysubstance abusers

Allelic variants at the catechol-O-methyl-transferase (COMT) locus are candidates to contribute to genetic components of interindividual differences in vulnerability to substance abuse. COMT plays a prominent role in dopaminergic circuits important for drug reward, and COMT alleles encode enzymes whose activities vary from three- to four-fold. We compared COMT allele frequencies in control research volunteers reporting insignificant lifetime use of addictive substances with those in volunteers reporting substantial polysubstance use. Homozygosity for the high-activity COMT allele was found in 18% of controls, 31% of volunteers with high lifetime substance use, and 39% meeting DSMIII-R substance abuse criteria [odds ratio (relative risks) 2.0 (control vs. use; 95% confidence interval 1.2-3.5; P < 0.013) and 2.8 (control vs. DSM; 1.3-6.1; P < 0.008)]. Individuals with the high-activity COMT variant may have greater genetic vulnerability to drug abuse. Am. J. Med. Genet. 74:439–442, 1997. © 1997 Wiley-Liss, Inc.

High-activity catechol-O-methyltransferase allele is more prevalent in polysubstance abusers

Allelic variants at the catechol-O-methyltransferase (COMT) locus are candidates to contribute to genetic components of interindividual differences in vulnerability to substance abuse. COMT plays a prominent role in dopaminergic circuits important for drug reward, and COMT alleles encode enzymes whose activities vary from three- to four-fold. We compared COMT allele frequencies in control research volunteers reporting insignificant lifetime use of addictive substances with those in volunteers reporting substantial polysubstance use. Homozygosity for the high-activity COMT allele was found in 18% of controls, 31% of volunteers with high lifetime substance use, and 39% meeting DSMIII-R substance abuse criteria [odds ratio (relative risks) 2.0 (control vs. use; 95% confidence interval 1.2-3.5; P < 0.013) and 2.8 (control vs. DSM; 1.3-6.1; P < 0.008)]. Individuals with the high-activity COMT variant may have greater genetic vulnerability to drug abuse.

A Comparative Analysis of Cigarette, Alcohol, and Illicit Drug Use among an Ethnically Diverse Sample of Hispanic, African American, and Non-Hispanic White Adolescents

Longitudinal findings are presented on lifetime, past year, and magnitude of use of cigarettes, alcohol, and illicit drugs among non-Hispanic White (NHW), African-American, Cuban, Nicaraguan, Colombian, and Puerto Rican adolescent boys. The T-3 sample included 5,370 adolescents of whom 3,403 were Hispanic. About one-half the Hispanic sample was foreign born. Significant increases in lifetime use and magnitude of use of all three substances were found over the three data collection periods for all six groups. NHW and Hispanic adolescents had higher substance use rates than African-Americans. Most differences were not significant for NHW and Hispanic subgroups. Foreign-born Hispanics reported positive relationships between length of time in country and substance use. Significant relationships were found in two instances. Length of time in country was related to lifetime use of all substances for Cubans and for past year use of alcohol and illicit drugs. It was also significantly related to lifetime and past year use of alcohol and for lifetime illicit drug use among Nicaraguans. Although substance use did not vary greatly for different Hispanic groups, the authors suggest caution be used in offering generalizations, especially among young groups with diverse nativity and immigration histories.

Dropping Out of High School and Drug Involvement

The relationship between dropping out of high school and substance use was explored using the National Longitudinal Survey of Young Adults, a national longitudinal sample of young Americans aged 19-27 in 1984. Cross-sectional data indicated that high school dropouts were more involved with cigarettes and illicit drugs than were graduates and that those who obtained a graduate equivalency diploma were the most intensely involved. Event-history analysis indicates that, controlling for other important risk factors, prior use of cigarettes, marijuana, and other illicit drugs increases the propensity to drop out and that the earlier the initiation into drugs, the greater the probability of premature school leaving. Thus, preventing or at least delaying the initiation of drug use will reduce the incidence of dropping out from our nation's high schools.