Natural course of cannabis use disorders.

BACKGROUND: Despite its importance as a public health concern, relatively little is known about the natural course of cannabis use disorders (CUDs). The primary objective of this research was to provide descriptive data on the onset, recovery and recurrence functions of CUDs during the high-risk periods of adolescence, emerging adulthood and young adulthood based on data from a large prospective community sample. METHOD: Probands (n = 816) from the Oregon Adolescent Depression Project (OADP) participated in four diagnostic assessments (T1-T4) between the ages of 16 and 30 years, during which current and past CUDs were assessed. RESULTS: The weighted lifetime prevalence of CUDs was 19.1% with an average onset age of 18.6 years. Although gender was not significantly related to the age of initial CUD onset, men were more likely to be diagnosed with a lifetime CUD. Of those diagnosed with a CUD episode, 81.8% eventually achieved recovery during the study period. Women achieved recovery significantly more quickly than men. The recurrence rate (27.7%) was relatively modest, and most likely to occur within the first 36 months following the offset of the first CUD episode. CUD recurrence was uncommon after 72 months of remission and recovery. CONCLUSIONS: CUDs are relatively common, affecting about one out of five persons in the OADP sample prior to the age of 30 years. Eventual recovery from index CUD episodes is the norm, although about 30% of those with a CUD exhibit a generally persistent pattern of problematic use extending 7 years or longer.

An evaluation of the effects of Tai Chi exercise on physical function among older persons: a randomized contolled trial.

This study was designed to determine whether a 6-month Tai Chi exercise program can improve self-reported physical functioning limitations among healthy, physically inactive older individuals. Ninety-four community residents ages 65 to 96 (Mage = 72.8 years, SD = 5.1) volunteered to participate in the study. Participants were randomly assigned to either a 6-month experimental (Tai Chi) group (n = 49), which exercised twice per week for 60 min, or a wait-list control group (n = 45). A 6-item self-report physical functioning scale, assessing the extent of behavioral dysfunction caused by health problems, was used to evaluate change in physical functioning limitations as a result of Tai Chi intervention. Results indicated that compared to the control group, participants in the Tai Chi group experienced significant improvements in all aspects of physical functioning over the course of the 6-month intervention. Overall, the experimental group had 65% improvement across all 6 functional status measures ranging from daily activities such as walking and lifting to moderate-vigorous activities such as running. It was concluded that the 6-month Tai Chi exercise program was effective for improving functional status in healthy, physically inactive older adults. A self-paced and self-controlled activity such as Tai Chi has thepotential to be an effective, low-cost means of improving functional status in older persons.

Tai Chi, self-efficacy, and physical function in the elderly.

Using Tai Chi as an exercise mode, this study examined the association between self-efficacy and physical function. Ninety-four healthy, physically inactive older adults (M age = 72.8 years, SD = 5.1) were randomly assigned to either a 6-month, twice a week, Tai Chi condition or a wait-list control condition. Outcome variables included self-reports of movement efficacy and physical function assessed at baseline, middle, and termination of the study. Multisample latent curve analyses revealed a significant rate of change attributable to the Tai Chi intervention in both self-efficacy and physical function, with participants experiencing significant improvements over the course of the intervention. Analyses also showed a positive association between self-efficacy and physical function, indicating that improvements in older adults' self-efficacy of movement as a function of Tai Chi were related to increased levels of perceived physical capability. This study uncovered the need for further exploration of the relationship between exercise self-efficacy and physical function for enhancing health-related quality of life in older adults.

Risk and protective factors influencing adolescent problem behavior: a multivariate latent growth curve analysis.

This study examined the dynamic relations between adolescent problem behaviors (alcohol, marijuana, deviance, academic failure) over time and predictors of these behaviors. Data from the National Youth Survey (1) included 1,044 adolescents (53.5% male; mean age at year 1 = 13.20). Dependent measures were adolescent alcohol use, marijuana use, deviance, and academic failure, assessed annually over 4 years. Independent measures included age, gender, marital status, income, family time, family support, time with friends, friend deviance, knowledge of friends, activities, and neighborhood problems. An associative latent growth modeling (LGM) analysis showed significant increases and relations between the four behaviors in both initial status and development. Second-order multivariate LGM analyses indicated that the four behaviors could be modeled by a higher-order problem behavior construct. Significant effects on the common problem behavior intercept or slope included time with friends, deviant friends, age, marital status, family time, and support. Additional effects were found to be specific to the initial status and slopes of individual problem behaviors. Overall, results indicate the importance of assessing the relations between adolescent problem behaviors as they change over time and identifying the risk and protective factors that have both common and individual influences on these behaviors.

Development and evaluation of an interactive CD-ROM refusal skills program to prevent youth substance use: "refuse to use".

An interactive CD-ROM program designed to reduce adolescent substance use was developed and evaluated. The program uses video vignettes to teach refusal skills and socially acceptable responses to substance use situations, specifically offers of marijuana. In a randomized pretest-to-posttest experiment with 74 public school students from six classes in three high schools, significant changes were observed at posttest on (1) the adolescent's personal efficacy to refuse the offer of marijuana, (2) the adolescent's intention to refuse marijuana if offered, and (3) the adolescent's perceptions of the social norms associated with substance use and the importance of respecting another's decision to refuse a drug offer. In addition, adolescents in the treatment condition were able to recall approximately 50% of the portrayed refusal strategies. Findings are discussed with regard to the potential benefits of an interactive multimedia approach for conducting substance use interventions.

Effects of the "Preparing for the Drug Free Years" curriculum on growth in alcohol use and risk for alcohol use in early adolescence.

Preparing for the Drug-Free Years (PDFY) is a curriculum designed to help parents learn skills to consistently communicate clear norms against adolescent substance use, effectively and proactively manage their families, reduce family conflict, and help their children learn skills to resist antisocial peer influences. This study examined the effects of PDFY on the trajectories of these factors, as well as on the trajectory of alcohol use from early to mid adolescence. The sample consisted of 424 rural families of sixth graders from schools randomly assigned to an intervention or a control condition. Data were collected from both parents and students at pretest, posttest, and 1-, 2- and 3 1/2-year follow-ups. Latent growth models were examined. PDFY significantly reduced the growth of alcohol use and improved parent norms regarding adolescent alcohol use over time. Implications for prevention and evaluation are discussed.

Object relations theory and short-term dynamic psychotherapy: findings from the Quality of Object Relations Scale.

This review focuses on the relevance of object relations theory to short-term dynamic psychotherapy (STDP). From diverse theoretical and research literatures, a small number of core theoretical concepts and assessment dimensions are identified. Specific assessment methods are also highlighted. Research evidence concerning a particular object relations concept (quality of object relations) and a corresponding interview scale (Quality of Object Relations Scale) that has emerged from a series of psychotherapy clinical trials is presented in support of the relevance of object relations theory to STDP. Clinical implications and future research directions are considered.

Exploring associations in developmental trends of adolescent substance use and risky sexual behavior in a high-risk population.

This study examined associations between the development of adolescent alcohol, cigarette, and marijuana use and risky sexual behavior, over time, using latent growth modeling methodology. Gender differences in the development and relationships between use of substances and risky sexual behavior were also examined. Participants were 257 adolescents (mean age = 15.96 years) assessed at three time points over an 18-month period. The intercepts of marijuana with cigarettes and alcohol, and all three substances with risky sexual behavior were significantly related. Development of the three substances showed similar patterns and development of cigarette use covaried with development of risky sexual behavior. There were no significant differences for boys and girls in these relationships. Results are discussed in relation to the need for greater understanding of nonsexual and sex-related problem behaviors and for analyses examining development and change in these behaviors during adolescence.

Adolescent problem behavior: the influence of parents and peers.

This paper presents evidence that the Patterson et al. (1992) model of development of antisocial behavior in children generalizes to the development of a wide array of problem behaviors during later adolescence and that youth antisocial behavior, high-risk sexual behavior, academic failure and substance use form a single problem behavior construct. Structural equation modeling methods were applied to 24-month longitudinal data from 204 adolescents and parents. The model fit the data well, accounting for 52% of the variance in adolescent problem behavior. Specifically, families experiencing high levels of conflict were more likely to have low levels of parent-child involvement. These family conditions were related to poor parental monitoring and association with deviant peers one year later. Poor parental monitoring and associations with deviant peers were strong proximal predictors of engagement in an array of problem behaviors at two-year follow-up.

Confirmatory factor analysis of the Task and Ego Orientation in Sport Questionnaire with cross-validation.

Although a number of factor analytic studies have been conducted on the factorial validity of the Task and Ego Orientation in Sport Questionnaire (TEOSQ), the results have been equivocal. To further substantiate its evidence of validity, this study cross-validated the measurement model using a rigorous structural equation modeling (SEM) approach. Data collected from a college student sample were first analyzed on a calibration sample (n = 439). Results confirmed the two-factor orthogonal structure representing the underlying task and ego orientations. The results were cross-validated on a validation sample (n = 439) using various SEM-based cross-validation procedures. Collectively, these findings support the construct validity of the TEOSQ as a measure of achievement goal orientation.

Progressions of alcohol, cigarette, and marijuana use in adolescence.

This study examined the progressive relations among adolescent use of alcohol, cigarettes and marijuana using latent growth curve analyses. Specifically, the present study examined three models to determine (1) the effect of prior cigarette use on alcohol use and development and the relationship between change in cigarette use and the development of alcohol use (N = 115), (2) the effect of prior alcohol use on cigarette use and development and the relationship between change in alcohol use and the development of cigarette use (N = 199); and (3) the effect of prior alcohol and cigarette use on marijuana use and development, and the relationship between change in alcohol use and cigarette use and the development, of marijuana use (N = 287). Support was found for the relation between prior levels of substance use and involvement in other substances. Cigarette use, in particular, was particularly important in the subsequent involvement of alcohol and marijuana.

The effect of attitude on the development of adolescent cigarette use.

The purpose of this study is to examine the relation of attitude toward smoking among never smokers to the growth or development of cigarette use during the adolescent years. Using Latent Growth Modeling, attitude toward smoking of 250 adolescents (48% male, 94% Caucasian), 11 to 15 years of age, who had not previously tried a cigarette, was related to the frequency of use at the next assessment, one year later, and growth in cigarette use across four subsequent years. The results indicated that attitude toward cigarettes significantly predicted both frequency of subsequent cigarette use and growth in use. These results suggest a need to focus prevention efforts on attitude change at an early age, prior to experimentation with cigarette use.

Latent variable modeling of longitudinal and multilevel alcohol use data.

OBJECTIVE: This article demonstrates use of a latent variable model for longitudinal data which encompasses nested structures. Using Multilevel Latent Growth Modeling (LGM), levels of alcohol use and development of alcohol use over 4 years were examined among individuals (adolescents and parents) nested within families. METHOD: An LGM model was tested for alcohol use with a sample of 435 families (435 target adolescents, 203 sibling and 566 parents [168 fathers and 398 mothers]). Adolescents (targets and siblings) comprised 312 boys and 326 girls, with a mean (+/-SD) age at Time 1 (T1) of 13.69 +/- 1.95 years. It was hypothesized that there would be homogeneity in level and development of alcohol use among family members and heterogeneity in alcohol use and development across families. The effects of family status (single-parent, two-parent intact and stepparent families) and socioeconomic status (SES) on family levels of alcohol use were also examined. RESULTS: Results suggested that stepparent families, and less educated and more economically disadvantaged families, had higher family levels of alcohol use and developed in their use of alcohol at a faster rate. CONCLUSIONS: Findings suggest that the alcohol use of individuals in the same family is more alike than that of individuals from different families and that family alcohol use may be influenced by family-level variables such as family status or SES. Methods such as those presented, which incorporate family-level clustering, are likely to provide additional information regarding the etiology of alcohol use and risk factors for alcohol use within and across families.

Contributions of the social context to the development of adolescent substance use: a multivariate latent growth modeling approach.

This article demonstrates a latent growth curve methodology for analyzing longitudinal data of adolescent substance use. Hypotheses concerning the form of growth in alcohol, cigarette, and marijuana use, and covariates influencing the form of growth, were tested. Participants were male and female adolescents (n = 664) assessed at three time points. A common trajectory existed across the developmental period with significant increases in all three substances. Second-order multivariate extensions of the basic latent growth modeling framework suggested that associations among the individual differences parameters, representing growth or change in the various substance use behaviors, could be adequately modeled by a higher-order substance use construct. Inept parental monitoring, parent-child conflict, peer deviance, academic failure, gender, and age, were significant predictors of initial levels and the trajectory of substance use.

Approaches to Testing Interaction Effects Using Structural Equation Modeling Methodology.

Use of structural equation modeling (SEM) methodology to study interactive relationships among latent variables began with the work of Kenny and Judd (1984) who developed a method of testing interactions involving continuous latent variables by forming products of multiple indicator variables. Until recently, there has been considerable difficulty implementing the method in SEM programs. This article reviews a single indicator approach (Joreskog & Yang, 1996) and multiple indicator approaches (Jaccard & Wan, 1995; Ping, 1996) that simplify Kenny and Judd's method. An illustrative application using an empirical example examining the interactive effect of perceptions of competence and perceptions of autonomy on exercise intrinsic motivation is presented. Practical issues surrounding the use of these different approaches are discussed.

Multi-level covariance structure analysis of intra-familial substance use.

Conventional covariance structure analysis, such as factor analysis, is often applied to data that are obtained in a hierarchical fashion, such as parents and siblings observed within families. However, multivariate modeling of such data are most frequently done as if the data were obtained as a simple random sample from a single population. An alternative specification is presented which explicitly models the within-level and between-level covariance matrices in familial substance use. Results demonstrate homogeneity in substance use within families but heterogeneity across families which could be accounted for by family-level variables of marital status, economic status, and biological relationships. It is shown that conventional covariance structure software can be easily adapted to handle hierarchical models, providing a large set of new analysis possibilities for multi-level data.

Adolescent alcohol use development and young adult outcomes.

This study used latent growth modeling to examine the effects of level of alcohol use and development of alcohol use during adolescence, on young adult outcomes for males and females. Adolescents (N = 480; mean = 13.03 years, S.D. = 1.44; 264 female) were assessed annually over a 4-year period and then 5-6 years later in young adulthood (mean = 22.49 years, S.D. = 1.50). Chronicity of alcohol use in adolescence was related to higher alcohol use, alcohol-related problems, aggressive behavior, theft, and suicide ideation in young adulthood among both males and females. Development of alcohol use during adolescence was related to alcohol-related problems in young adulthood for males and females, and to higher levels of alcohol use and aggressive behavior for males only. The results indicate that development of alcohol use as well as level of alcohol use in adolescence is important for future adjustment outcomes, and that these relationships vary as a function of gender.

Examining the reciprocal relation between academic motivation and substance use: effects of family relationships, self-esteem, and general deviance.

The present study examined the reciprocal relation between academic motivation and cigarette, alcohol, and marijuana use across four annual assessments during adolescence. Data were obtained from 435 adolescents, 13 to 17 years of age at the first assessment, and their mothers. The results of generalized estimating equations (GEE) analysis suggested inverse reciprocal relations across time between academic motivation and both cigarette and marijuana use. Reciprocal relations between academic motivation and alcohol use were not found, possibly due to the normative use of this substance. The examination of mediational mechanisms, including general deviance, self-esteem and family relationships, suggested that the relation between marijuana use and, for younger adolescents, cigarette use and academic motivation is not direct but is indirect, mediated through the general deviance of the adolescent. Deviance, self-esteem, and, for the youngest adolescents, family relationships mediated the relation between academic motivation and subsequent marijuana use.

Latent Variable Modeling of Longitudinal and Multilevel Substance Use Data.

This article demonstrates the use of a general model for latent variable growth analysis which takes into account cluster sampling. Multilevel Latent Growth Modeling (MLGR4) was used to analyze longitudinal and multilevel data for adolescent and parent substance use measured at four annual time points. An associative LGM model was tested for alcohol, marijuana, and cigarette use with a sample of 435 families. Hypotheses concerning the shape of the growth curve and the extent of individual differences in the common trajectory over time were tested. The effects of marital and family status and socio-economic status on family levels of substance use were also examined. Findings are discussed in terms of family-level substance use and similarities in developmental trajectories across substances, and the impact of contextual factors on family levels of substance use and development.

Limiting time-unlimited group psychotherapy.

For a number of reasons, we decided to bring three long-term, open-ended psychodynamic therapy groups to termination. We examine the process that began with the announcement of the change to a time-limited format, and concluded with the termination of the group. The transition had a powerful impact on the members and the group-as-a-whole. The therapists used supervision to deal with the intensity of the group process and the countertransference demands posed by the transition. Groups facing a similar change due to economic pressures may benefit from these observations.