Risk factors for adolescent substance abuse

Reviews research on risk factors for adolescent substance use disorders (SUD) and discusses possible relationships between SUDs and learning disabilities (LD). Individual level factors (genetic, biologic, other familial, and psychiatric) emerge as very important in the risk equation, as well as the interaction between individual risk and environmental conditions. Commonalities between SUD risk and LD include prenatal substance exposure, family history of SUD, conduct disorder, social skills deficits, and academic failure; however, further research is needed to establish whether individuals with LD face a specific risk for SUDs, and if so, what the nature of that risk might be.     

Ethnicity and Psychosocial Factors in Alcohol and Tobacco Use in Adolescence

Research on ethnic group differences has suggested that (a) adolescents from various groups differ on a number of dimensions that have been related to risk for substance use initiation, and (b) adolescents of different groups choose different substances. However, there is little consensus regarding the reasons for such differences. There is an especially high rate of alcohol use among Hispanic adolescents, and Hispanics are at high risk for alcohol abuse. In light of ethnic group differences in both substance use and the precursors of substance use in adolescence, this study examined differences among black, Anglo, Puerto Rican, and Dominican adolescents in the relation between cigarette and alcohol use and psychosocial functioning. Comparisons between the Puerto Rican and Dominican subjects were of special interest due to preexisting differences between these groups that may be attributed to acculturation. Results provided evidence of the importance of acculturation in modifying psychosocial vulnerability, especially for alcohol use, with the Dominican group at highest risk.     

Vulnerability or resilience to early substance use among adolescents at risk: The roles of maltreatment and father involvement

Although research has indicated that maltreated children are at higher risk of adolescent substance use, it remains unclear whether the type and timing of maltreatment affect the likelihood of adolescent substance use. Research has also found father involvement to be a potential protective factor against adolescent substance use, but the role of quality vs. quantity of father involvement as well as gender differences in the effects of father involvement on substance use among at-risk adolescents have not been studied. The current study adds value to the existing literature by filling these gaps in knowledge. We conducted a secondary data analysis with a sample of 685 at-risk adolescents drawn from the Longitudinal Studies of Child Abuse and Neglect. The study found a connection between early childhood (birth to 5) physical abuse and adolescent substance use, but not for later childhood physical abuse or other forms of child maltreatment. The quality of father involvement was found to be a protective factor, regardless of child gender; quantity of father involvement was not significant. Based on these findings, development of intervention strategies focusing on prevention of early childhood physical abuse and promoting positive father-child relationships are important prevention strategies for adolescent substance use. Additionally, professionals working with at-risk adolescents need to be cognizant of the implications of early childhood physical abuse and act accordingly to mitigate the increased potential for adolescent substance use.     

Child abuse and AIDS-related knowledge, attitudes and behavior among adolescents in Zambia

OBJECTIVE: To research the correlation between physical and sexual abuse by family members and AIDS-related knowledge, attitudes, self-efficacy and behavior among urban and rural adolescents in Zambia. SAMPLE: The sample comprises 3,360 adolescents, aged 10-19, from urban and rural Zambia; 2,160 of them attended school, while 1,200 of them did not. MEASURES: Standardized scales were utilized to assess AIDS-related knowledge, attitudes, and self-efficacy. In addition, the adolescents reported the extent of their engagement in various high-risk behaviors and their lifetime experience of being sexually or physically abused. RESULTS: As the level of abuse experienced by the adolescents increased, their level of knowledge about HIV/AIDS, tendency to hold positive attitudes toward prevention, and level of self-efficacy regarding HIV/AIDS prevention decreased. Most importantly, when controlling for socio-demographic variables, findings indicate that past abuse was a key factor predicting participation in high-risk behaviors associated with HIV infection. CONCLUSION: Physical and sexual abuse of adolescents in Zambia is significantly related to HIV risk behaviors. Future studies should investigate which factors mediate between the experience of abuse and the tendency to engage in risky behaviors.     

青少年物质滥用防治的内隐认知研究

物质滥用已日益成为严重的国际性社会问题。青少年时期是滥用物质的危险期,也是滥用物质有可能引发一系列负性结果的初始阶段。如何有效地对青少年物质滥用进行防治是当务之急。近年来,有关物质滥用的外显认知研究受到了挑战,内隐认知开始逐渐引起学者的关注。内隐认知的测量方法源于内隐联想学习的原则,强调对物质使用行为偏好自发激活的认知过程,从而有效地避免了自我矫饰的影响。因而,内隐认知研究为物质滥用防治开启了新的思路,其应用领域包括对物质滥用的预测,改变个体内部的认知结构以促使个体向正性行为转变,以及对干预效果的评估等。     

Gender-specific outcomes for sexually abused adolescents

This study examined the gender differences in outcomes related to school performance, suicidal involvement, disordered eating behaviors, sexual risk taking, substance use, and delinquent behaviors of male (n = 370) and female teenagers (n = 2,681) who self-reported a history of sexual abuse. It was found that female adolescents, by and large, engaged in internalizing behaviors and males in externalizing behaviors. Male adolescents were found to be at higher risk than females in poor school performance, delinquent activities, and sexual risk taking. Female adolescents, on the other hand, showed higher risk for suicidal ideation and behavior as well as disordered eating. Females showed more frequent use of alcohol. However, male adolescents exhibited more extreme use of alcohol and more frequent and extreme use of marijuana. Among index female adolescents, protective factors against adverse correlates included a higher emotional attachment to family, being religious or spiritual, presence of both parents at home, and a perception of overall health. Factors that augmented adverse correlates for them included a stressful school environment due to perceived high levels of substance use in and around school, worry of sexual abuse, maternal alcohol consumption, and physical abuse. For male adolescents, maternal education and parental concern appeared to be protective factors.     

Sexual and physical abuse history and adult sexual risk behaviors: relationships among women and potential mediators

OBJECTIVE: While research has supported associations between experiencing abuse and engaging in risky sexual behaviors during adolescence, research regarding these associations among adult women is much more equivocal. In addition, few studies have attempted to identify potential pathways from abuse experiences to sexual risk behaviors. The current study examined the associations between a history of physical or sexual abuse and recent sexual risk behaviors among adult women. Additionally, this study evaluated binge drinking and depressive symptomatology as potential mediators of any relationships between abuse history and sexual risk behaviors. METHODS: A total of 1,428 women between 18 and 40 years of age attending family planning clinic appointments completed a self-report survey regarding their recent sexual behaviors and sexual and physical abuse history. Logistic regressions using backward elimination were conducted to identify factors associated with sexual risk behavior. RESULTS: A history of physical abuse by a romantic partner was associated with several sexual risk behaviors. Few significant associations between intrafamilial physical or sexual abuse and recent sexual risk behaviors were found. Additionally, there was no evidence that these relationships were mediated by binge drinking or depressive symptomatology. CONCLUSIONS: Familial abuse experiences are not necessarily associated with recent sexual risk behaviors among adults. In contrast, physical abuse experiences, particularly those perpetrated by a romantic partner, are associated with engaging in adult sexual risk behaviors among women. However, these associations are not mediated by alcohol use or depressive symptomatology.     

Using Personal Narratives for Curriculum Development about Substance Abuse and Older Adults

This article reports on a project to sensitize graduate social work students taking courses in substance abuse to the needs of older adults. Graduate social work students at a major urban school of social work in the Northeast were recruited and trained to interview older adults with a history of substance abuse problems regarding their life experiences. The authors developed educational vignettes based on the interviews and curriculum units based on these vignettes to be incorporated into the substance abuse curriculum. The challenges and rewards of engaging students in the process of developing educational vignettes based on older adults lived experiences are also discussed.     

Substance use disorders in young adults with and without LD: predictive and concurrent relationships

This article reports on young people with and without learning disabilities (LD) and substance use disorders (SUD). Participants were assessed for LD at ages 12 and 19 and for SUD and psychiatric disorders at age 19. Participants with LD at ages 12 and 19 were more likely to develop an SUD or a psychiatric disorder compared to participants without consistent LD. Participants with LD at age 19 were more likely to have a concurrent SUD or psychiatric disorder compared to those without LD at age 19, while participants with LD at age 12 showed only a trend toward increased rates of SUD at age 19 when compared to participants without LD at age 12. Participants with and without LD did not differ in substance use, consumption levels, or onset history. In a multivariate model, adolescent LD was associated with a three-fold increased risk for SUD after behavioral problems and family structure had entered the model. Although these results provide some support for the notion that adolescents with LD are at increased risk for SUD, LD also appears to confer a general risk for adverse outcomes.     

Associations between types of maltreatment and substance use during adolescence

OBJECTIVE: The aim of this study was to investigate associations between four categories of maltreatment and substance use among adolescents. METHOD: All 10th through 12th graders n = 2,187) at six public high schools in a rural Oregon county filled out an anonymous survey that included questions about their experience of emotional, sexual, and physical abuse and their use of a variety of substances. Substance use was subsequently categorized as: (1) tobacco use, (2) alcohol use, and (3) illicit drug use. Experience of maltreatment was subsequently categorized as: (1) no type of maltreatment, (2) emotional abuse, (3) physical abuse, (4) sexual abuse, and (5) sexual and physical abuse. RESULTS: Results showed that all four categories of maltreatment were associated with increased levels of all three categories of substance use. Statistical comparisons of the magnitude effects of different types of maltreatment on substance use indicated a linear trend with the effects of emotional abuse being significantly lower than those of physical or sexual abuse, and the effects of the combination of physical and sexual abuse being significantly higher than the other types. CONCLUSION: Results suggested that all types of maltreatment, including emotional abuse, are related to significantly higher levels of substance use and should be considered serious risk factors for substance use during adolescence. Results also indicated that the strength of association between maltreatment and substance use varies by type of maltreatment. Youth who have experienced both physical and sexual abuse are at especially high risk of substance use.     

Childhood adversity and behavioral health outcomes for youth: An investigation using state administrative data

This study aimed to measure the relative contribution of adverse experiences to adolescent behavioral health problems using administrative data. Specifically, we sought to understand the predictive value of adverse experiences on the presence of mental health and substance abuse problems for youth receiving publicly funded social and health services. Medicaid claims and other service records were analyzed for 125,123 youth age 12–17 and their biological parents. Measures from administrative records reflected presence of parental domestic violence, mental illness, substance abuse, criminal justice involvement, child abuse and/or neglect, homelessness, and death of a biological parent. Mental health and substance abuse status of adolescents were analyzed as functions of adverse experiences and other youth characteristics using logistic regression. In multivariate analyses, all predictors except parental domestic violence were statistically significant for substance abuse; parental death, parental mental illness, child abuse or neglect and homelessness were statistically significant for mental illness. Odds ratios for child abuse/neglect were particularly high in both models. The ability to identify risks during childhood using administrative data suggests the potential to target prevention and early intervention efforts for children with specific family risk factors who are at increased risk for developing behavioral health problems during adolescence. This study illustrates the utility of administrative data in understanding adverse experiences on children and the advantages and disadvantages of this approach.     

Sexual abuse and exploitation of children and adults with mental retardation and other handicaps

There is growing recognition that children, adolescents, and adults who are mentally retarded are particularly vulnerable to sexual abuse and exploitation and are in need of intervention services. These people are especially vulnerable due to ther often life-long dependence on caregivers, relatively powerless position in society, emotional and social insecurities, and lack of education regarding sexuality and sexual abuse. In addition the mental health functioning and emotional development of individuals who are mentally retarded are not well understood, and many professionals remain uneducated about their mental health needs. To work effectively with this population, mental health professionals and educators must be alert to what is known about the sexual abuse and exploitation of persons with mental retardation. Furthermore, they need to become educated about the rights of these persons to special legal protection from abuse and neglect and to appropriate and effective mental health interventions. The challenge for mental health professionals and educators is to protect persons who are mentally retarded from sexual abuse and exploitation, to provide appropriate psychotherapeutic interventions when abuse occurs, to respect their right to developmentally appropriate knowledge about sexuality and sexual abuse, and to allow for the fulfillment of their sexuality.     

Data Collection Strategies and Measurement Tools for Assessing Academic and Therapeutic Outcomes in Recovery Schools

Accurate evaluation and documentation of the efficacy of recovery schools can be vital to the continuation and expansion of these beneficial resources. A very limited data set currently exists that examines the value of specific schools established to support adolescents and young adults in recovery; additional research is necessary. The following article outlines the methodology utilized in a current quasi-experimental study evaluating both academic and therapeutic outcomes of adolescents attending recovery high schools as compared to traditional (non-recovery-based) high schools. The developmental considerations in assessing adolescents in recovery and their parents is delineated in this article, which underscores the need for extensive knowledge of adolescent substance abuse and other mental health issues. In addition, sensitivity around privacy among adolescents, parents, schools, and health providers is highlighted, as well as the validity of assessment. Key assessment strategies, including protocol of recruitment and interviewing techniques, are also presented along with a list of parent and adolescent assessment instruments and their corresponding interpretive variables. Protocol recommendations for future research are also outlined.     

Underserved and Unprepared: Postsecondary Learning Disabilities

The adolescent and adult population with learning disabilities (LD) continues to be underserved and underprepared to meet the demands of postsecondary education. Evidence pertaining to postsecondary education outcomes for the population with LD is extremely bleak. One purpose of this article is to situate thinking about adolescents and adults with LD across the spectrum of ability and socioeconomic status within the current world context. The second objective is to heighten awareness of the changing needs of this population based on social, educational, economic, and political directives. Several academic options are presented as alternative pathways available to individuals in the transition from secondary to postsecondary environments.     

Substance use, substance abuse, and LD among adolescents with a childhood history of ADHD

A clinic-referred sample of 109 children with attention-deficit/hyperactivity disorder (ADHD) was followed into adolescence for the ascertainment of alcohol and other drug use and abuse. Learning disability (reading or math) in childhood was examined as a predictor of adolescent substance use and substance use disorder for alcohol and marijuana. No statistically significant group differences for children with LD versus those without LD emerged even after using different methods to compute LD. IQ/achievement discrepancy scores were similarly not predictive of later use or abuse. However, children with ADHD who had higher IQs and higher levels of academic achievement in childhood were more likely to try cigarettes, to smoke daily, and to have their first drink of alcohol or first cigarette at an early age. Children with ADHD who had higher reading achievement scores were less likely to have later alcohol use disorder. Although these findings are necessarily preliminary, due to the small number of children interviewed, the pattern of results suggests that level of cognitive functioning--rather than discrepancy between IQ and achievement--is important for the prediction of later substance use and abuse, at least in this clinic-referred sample of children with ADHD. Further, different mechanisms of risk related to cognitive functioning may be operating for experimentation with legal drugs such as alcohol and tobacco, regular cigarette smoking, and problematic alcohol use.     

Psychosocial Status of Adolescents with Learning Disabilities With and Without Comorbid Attention Deficit Hyperactivity Disorder

Some researchers suggest that having a learning disability (LD) may act as a risk factor, increasing the likelihood that adolescents experience more negative outcomes in many areas of their lives. However, researchers have yet to examine in one study how having LD with and without attention deficit hyperactivity disorder (ADHD) is related to a comprehensive set of psychosocial variables across a diverse set of domains (e.g., peer, family, school, intrapersonal). The purpose of the present study was to address that limitation by comparing the perceptions of adolescents with LD (N= 230), with comorbid LD/ADHD (N= 92), and without LD or ADHD (N= 322) regarding their academic orientation, temperament, well‐being, loneliness, parental relationships, victimization, activities, and friendships. Results are consistent with the hypothesis that LD may indeed act as a risk factor increasing the likelihood of more negative outcomes. The results also indicate that for some psychosocial variables this likelihood may be increased in adolescents with comorbid LD/ADHD. The findings have important implications for stakeholders concerned about supporting adolescents with LD with and without comorbid ADHD.     

Perception of competence: risk and protective predictors following an e‐self‐advocacy intervention for adolescents with learning disabilities

The purpose of this study was to identify predictors of competence among adolescents with learning disabilities (LD) who participated in a virtual supported self‐advocacy programme within the risk and protective paradigm. The sample consisted of 374 adolescents with and without learning disabilities, students of the 7th to 9th grades, at 15 schools across Israel. The adolescents were divided into three groups, matched by age and gender: 111 adolescents with LD who participated in a five‐month virtual‐supported intervention, and two comparison groups: adolescents with LD (N = 115) who did not participate in the program and adolescents without LD (N = 148). The self‐perceptions of adolescents were assessed using the following questionnaires: basic psychological skills (competence and relatedness); hope and loneliness. Following the intervention, higher competence scores were reported by students with LD who participated in the programme. At that time (the end of the academic year), the predictors of the groups of students with LD for the competence measure were their level of competence at the beginning of the period, their belonging to the group who participated in the intervention, their loneliness and hope. Comparisons with predictors of the group of students without LD, and with predictors of competence at the beginning of the year, emphasized the importance of risk factors (loneliness) and the protective factors (hope) for students with LD. In addition, the results focused attention at the contribution of the participation in an e‐supported self advocacy programme for enhancing competence among students with LD.     

Occupational and educational aspirations and attainment of young adults with and without LD 2 years after high school completion

A national longitudinal database was used to compare the aspirations and attainment of individuals with and without learning disabilities (LD) 2 years after high school completion. Analyses revealed that individuals with LD reported lower graduation rates, were more likely to aspire to moderate- (men) or low-prestige (women) occupations, and were more likely to be employed and less likely to be enrolled in some type of postsecondary education program than their nondisabled peers. High educational aspirations in Grade 12 and successful completion of an academic or college-prep high school program were equally important in predicting 2-year postsecondary status for adolescents enrolled in postsecondary education regardless of disability status. However, depending on disability status, different predictors were identified for individuals who were either employed or out of the workforce. These results point to a continued need for transition planning and support for young adults with LD and suggest ways in which professionals can anticipate and adjust for identified differences in aspirations and postsecondary attainment.     

Interactional effects of marital status and physical abuse on adolescent psychopathology

OBJECTIVE: The purpose of this study was to explore the interactional effects of parental marital disruption and physical abuse on risk for adolescent psychopathology in a nonclinical sample with a randomly selected control group. METHOD: The sample was drawn from 99 community-based adolescents indicated as physically abused by Child Protective Services and 99 randomly selected controls. Nonabused adolescents whose parents were married, abused adolescents whose parents were married, nonabused adolescents with a parental marital disruption, and abused adolescents with a parental marital disruption were compared. Outcome was psychopathology as measured by psychiatric diagnosis based on a best-estimate procedure subsequent to semistructured diagnostic interviewing. RESULTS: Interactional effects of marital disruption and abuse were found for risk for lifetime Attention Deficit Hyperactivity Disorder (ADHD), with parental marital disruption and having been physically abused combining to increase the risk 15 times for diagnosis of lifetime ADHD. Parental marital status alone was not a significant risk factor for adolescent psychopathology, but physical abuse was a significant risk factor for several diagnostic categories. CONCLUSIONS: Future divorce research should include abuse history as a possible confounding variable. Possible reasons for the findings are reviewed and clinical implications are discussed.     

Assessing Student Problem-Solving Skills

This article examines the structure of several HIV risk behaviors in an ethnically and geographically diverse sample of 8,251 clients from 10 innovative demonstration projects intended for adolescents living with, or at risk for, HIV. Exploratory and confirmatory factor analyses identified 2 risk factors for men (sexual intercourse with men and a general risk factor) and 3 factors for women (sexual intercourse with men, substance abuse, and a high risky sex behavior factor). All factors except women engaging in risky sex with men strongly predicted known HIV status of clients for men and women. The findings from this investigation highlight the use of structural equation modeling for applied problems involving overlapping and complex sets of risk behaviors in youth who present at community health programs.