Serious psychological distress among parenting and nonparenting adults.

OBJECTIVES: We compared the prevalence of serious psychological distress among parenting adults with the prevalence among nonparenting adults and the sociodemographic correlates of serious psychological distress between these 2 populations. METHODS: We drew data from 14240 parenting adults and 19224 nonparenting adults who responded to the 2002 National Survey on Drug Use and Health. We used logistic regression procedures in our analysis. RESULTS: An estimated 8.9% of parenting adults had serious psychological distress in the prior year compared with 12.0% of nonparenting adults of similar age. In both groups, the adjusted odds of having serious psychological distress were higher among adults who were women, younger (between the ages of 18 and 44 years), low income, or receiving Medicaid. We found some differences in the correlates of serious psychological distress between parenting adults and nonparenting adults. The odds of having serious psychological distress were lower among parenting adults after we controlled for demographic characteristics. CONCLUSIONS: Serious psychological distress is fairly prevalent among parenting adults, and high-risk sociodemographic groups of parenting adults should be targeted to ensure access to coordination of services.

Risk and protective factors for methamphetamine use and nonmedical use of prescription stimulants among young adults aged 18 to 25.

This article reports on correlates of past-year nonmedical use of prescription stimulants and methamphetamine among young adults aged 18 to 25. Data from the 2002 National Survey on Drug Use and Health (NSDUH) were used to conduct logistic regression analyses of the demographic, psychosocial, and behavioral correlates of nonmedical stimulant use. The sample size was 23,645. Multivariate analyses revealed that selling drugs and using marijuana and other illegal drugs were associated with increased odds of both methamphetamine and nonmedical prescription stimulant use. Females, individuals not enrolled in college, and those who had been arrested were more likely than their counterparts to have used methamphetamine, whereas black individuals and less religious individuals were less likely than their counterparts to have used methamphetamine. Psychological distress, sensation seeking, binge drinking, and college enrollment were associated with increased risks of nonmedical prescription stimulant use, whereas Hispanic and other ethnic identification were associated with decreased risks of nonmedical prescription stimulant use. Different intervention strategies are needed to prevent methamphetamine use versus nonmedical prescription stimulant use.

Nonmedical use of prescription stimulants in the United States.

OBJECTIVE: This study estimated prevalences and correlates of stimulant diversion in the United States and examined relationships between diversion and measures of abuse or dependence. METHODS: We conducted descriptive and multivariate analysis of data from the National Survey on Drug Use and Health. Key measures were nonmedical use (misuse) of any prescription stimulant, any stimulant other than methamphetamine, and stimulants indicated for attention-deficit/hyperactivity disorder (ADHD). RESULTS: Lifetime stimulant misuse included some misuse of longer-acting ADHD drugs. The majority of past-year misuse involved drugs other than methamphetamine, particularly for youth aged 12-17. Past year misuse was more prevalent among persons aged 12-25, compared with older adults, and among Whites, compared with other groups. Prevalences in large metropolitan areas were lower than or similar to those in less populated areas. About 13% of past-year stimulant misusers met the survey criteria for dependence or abuse, as did about 10% of persons aged 12-25 who misused only nonmethamphetamine stimulants. CONCLUSIONS: Most stimulant misuse in the United States (particularly among youth) involved prescription drugs other than methamphetamine. The problem is not limited to metropolitan areas.

Neighborhood safety and social involvement: associations with parenting behaviors and depressive symptoms among African American and Euro-American mothers.

The relation between neighborhood characteristics and parenting and the mediating role of maternal depressive symptoms was examined among African American and Euro-American mothers of kindergarten children. Mothers' ratings of neighborhood safety were related to disciplinary strategies for both African American and Euro-American mothers but not to expressions of affection. Interviewers' ratings of safety were related to mothers' use of hostile socialization strategies. Both mothers' and interviewers' reports of safety were linked with maternal depressive symptoms. Depressive symptoms mediated the relation between neighborhood safety and inconsistent discipline, suggesting that the influence of safety on inconsistent discipline was due to its impact on maternal depression. Although there were similarities across ethnic groups, the relation between social involvement and mothers' withdrawal of interactions with their children differed across groups.

Substance abuse treatment outcomes among American Indians in the Telephone Aftercare Project.

Thirty American Indians who had successfully completed their residential substance abuse treatment program with Phoenix-based Native American Connections, Inc. agreed to participate in the Telephone Aftercare Program when they returned to their homes on the reservation. They were provided with graduated monthly aftercare contacts through the telephone for a nominal period of six months, during which time they were interviewed monthly regarding their substance use, and on other life domains at three and six months following discharge from their residential program. Using their baseline data as the comparison, results suggest that six months following residential treatment, clients showed decreased drinking and other drug use, had fewer encounters with the criminal justice system, and had improved familial and social interactions and relationships.

Evaluation of two web-based alcohol interventions in the U.S. military.

OBJECTIVE: The U.S. military has traditionally had high rates of alcohol misuse and alcohol-related problems, necessitating effective treatment programs that minimize participant burden. Web-based interventions have shown promise as efficient treatment options for college students and adults but have not been widely evaluated in the military. This study evaluated the efficacy of two web-based alcohol interventions originally created for civilians and then adapted for U.S. military personnel. METHOD: Two web-based alcohol interventions, Alcohol Savvy and Drinker's Check-Up, were adapted for use among military populations. The interventions were evaluated using a convenience sample of 3,070 active-duty military personnel at eight installations. Following a baseline survey, participants were assigned to one of three treatment conditions: (a) Alcohol Savvy, (b) Drinker's Check-Up, or (c) control (no program participation). Follow-up surveys were completed by 1,072 participants 1 month following baseline and by 532 participants 6 months following baseline. RESULTS: At 1-month follow-up, participants who completed the Drinker's Check-Up intervention had significant reductions in multiple measures of alcohol use relative to controls. Positive outcomes were found for average number of drinks consumed per occasion, frequent heavy episodic drinker status, and estimated peak blood alcohol concentration. These reductions in alcohol use at the 1-month follow-up were maintained at the 6-month follow-up. There were no statistically significant changes in alcohol use for participants who completed Alcohol Savvy. CONCLUSIONS: This study expands the literature on the effectiveness of web-based treatment for alcohol misuse. Findings indicate that web-based programs (Drinker's Check-Up in particular) can significantly decrease several indicators of alcohol use in U.S. military personnel.

Physical pain, common psychiatric and substance use disorders, and the non-medical use of prescription analgesics in the United States.

This study investigated the link between physical pain and non-medical prescription analgesic use (NMPAU), as well as the degree to which this association may vary by the presence of psychiatric and substance use disorders. Data were from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative, in-person probability sample of adults (n=43,093) aged 18 or older in the United States (2001-2002). Face-to-face interviews were used to gather information on past-year levels of physical pain (i.e., low, medium, high), in addition to DSM-IV classifications for mood, anxiety, substance use problems (i.e., abuse and/or dependence), and personality disorders. Within the analytic sample of those with valid data (n=42,734), the past-year rate of NMPAU was 1.8%, of which 20% met the DSM-IV criteria for abuse/dependence. Among past-year NMPAUs, 53% was incidental (e.g., less than monthly), but daily use was substantial (13% of NMPAUs). Accounting for our target confounding factors, pain was positively associated (p<0.05) with an increased probability of non-disordered (i.e., no abuse and/or dependence) and disordered (i.e., abuse and/or dependence) NMPAU in the past year. Within each level of pain, the odds of past-year non-disordered and disordered NMPAU were significantly higher (p<0.05) for those with disordered alcohol use compared with non-disordered users. This pattern was similar for illicit drugs, although marginally significant (p=0.060) and specific to disordered NMPAU. In contrast, psychiatric disorders increased the probability of both types of NMPAU, but these associations did not differ by levels of pain. These findings suggest that pain is an independent risk factor for non-disordered and disordered NMPAU, yet its effects are substantially modified by patterns of substance use.

Mediating mechanisms of a military Web-based alcohol intervention.

This study explored the mediating mechanisms of two Web-based alcohol interventions in a sample of active duty United States military personnel. Personnel were recruited from eight bases and received the Drinker's Check-Up (N=1483), Alcohol Savvy (N=688), or served as controls (N=919). The interventions drew on motivational interviewing and social learning theory and targeted multiple mediators including social norms, perceived risks and benefits, readiness to change, and coping strategies. Baseline data were collected prior to the intervention and follow-up data on alcohol consumption were gathered 1 month and 6 months after program completion. Two mediation models were examined: (1) a longitudinal two-wave model with outcomes and mediators assessed concurrently at the 1-month follow-up; and (2) a three-wave model in which the causal chain was fully lagged. Results indicated strong support for the role of perceived descriptive norms in transmitting the effects of the Drinker's Check-Up, with consistent mediation across the majority of alcohol outcome measures for both the concurrent and fully lagged mediation models. These results suggest that web-based interventions that are effective in lowering perceived norms about the frequency and quantity of drinking may be a viable strategy for reducing alcohol consumption in military populations. The results did not support program mediation by the other targeted variables, indicating the need for future research on the effective components of alcohol interventions. The mediation models also suggest reasons why program effects were not found for some outcomes or were different across programs.

Moderation and mediation in the relationship between mothers' or fathers' serious psychological distress and adolescent substance use: findings from a national sample.

PURPOSE: This study estimated percentages of adolescents living with a mother or father with serious psychological distress (SPD), and examined moderation and mediation of the relationships between mother or father SPD and adolescent substance use. METHODS: We analyzed data from nationally representative samples of adolescents interviewed with their mothers (n = 4734) and fathers (n = 3176) in the combined 2002 and 2003 National Surveys on Drug Use and Health (NSDUHs). RESULTS: An estimated 4.1% of adolescents living with their father had a father with SPD during the past year, and 11.5% of adolescents living with their mother had a mother with SPD during this time period. A positive association was found between mothers' SPD and adolescent binge drinking (OR = 1.49, 95% CI = 1.01-2.21), but no association was found between fathers' SPD and adolescent binge drinking. Mothers' SPD was associated with increased risk of binge drinking among adolescents aged 14-15 years (OR = 2.52, 95% CI = 1.38-4.60), and fathers' SPD was associated with lowered risk of binge drinking among black adolescents (OR = .08, 95% CI = .01-.79). A positive association was found between mothers' SPD and adolescent illicit drug use (OR = 1.55, 95% CI = 1.08-2.23), but no association was found between fathers' SPD and adolescent illicit drug use. Mothers' SPD was associated with increased risk of illicit drug use among female adolescents (OR = 2.14, 95% CI = 1.24-3.70) and among adolescents of white ethnicity (OR = 1.78, 95% CI = 1.19, 2.68). Parental involvement partially mediated the relationship between mothers' SPD and daughters' illicit drug use; mothers' SPD was associated with lower levels of parental involvement, which in turn were associated with an increased probability of daughters' illicit drug use. CONCLUSIONS: Overall, parents' SPD is associated differentially with adolescent substance use depending on the gender of parent and adolescent, adolescent age, race/ethnicity, and substance used. Parental involvement appears to be one mechanism through which mothers' SPD influences daughters' illicit drug use. Future research should further consider the interindividual effects of parents' SPD and associated parenting behaviors on adolescent risk behaviors.

Risk and protective factors for nonmedical use of prescription stimulants and methamphetamine among adolescents.

PURPOSE: This article reports on correlates of past-year nonmedical use of prescription stimulants and methamphetamine among adolescents aged 12 to 17 years. METHODS: Data from the 2002 National Survey of Drug Use and Health (NSDUH) were used to conduct logistic regression analyses of the demographic, psychosocial, and behavioral correlates of illicit stimulant use. The sample size was 17,709. RESULTS: Analyses revealed that mental health treatment utilization and use of marijuana and other illegal drugs were correlated with nonmedical use of prescription stimulants and methamphetamine among adolescents. Females and adolescents who reported low religiosity, binge drinking, and selling drugs were more likely to use methamphetamine than were males or individuals who did not report these attitudes or behaviors. Additionally, black adolescents were less likely than white adolescents to use methamphetamine. Alternatively, adolescents who reported high family conflict and sensation-seeking were more likely than their counterparts to use prescription stimulants nonmedically, and Hispanic adolescents were less likely to use prescription stimulants nonmedically than white adolescents. CONCLUSIONS: Risk for illicit use of stimulants varies by demographic, psychosocial, and behavioral factors. Different intervention mechanisms, populations, and settings should be targeted to prevent nonmedical use of prescription stimulants versus methamphetamine among adolescents.

Mediators of the stress-substance-use relationship in urban male adolescents.

Exposure to chronic or severe acute stressors throughout the lifespan has been linked with numerous negative behavioral, emotional, cognitive, and physical consequences. Adolescence is considered to be a particularly vulnerable period given that the brain is experiencing dramatic developmental change during this time. The present study examined a sample of adolescents (N=125) considered to be at high risk for stress exposures and drug use by virtue of their environment and low income levels to identify possible neurocognitive (i.e., impulsivity, delay of gratification, emotional perception, and risky decision-making) and social competency mechanisms that may mediate this relationship. Using Mplus, a mediational model was tested using full information maximum likelihood estimates. Risky decision-making and poor social competency skills were related to previous stressful experiences; however, only social competencies mediated the effect of stressors on reports of past year marijuana, alcohol, and polydrug use. As such, stress appears to exert its negative impact through alterations in abilities to generate and execute prosocial decisions and behaviors. Interventions that directly address the effects of stress on social competencies may be especially important for children who have experienced adversity including those exposed to parental divorce, parental psychopathology, neglect or abuse, parental death, and poverty.

Substance abuse prevalence and treatment utilization among American Indians residing on-reservation.

American Indians residing on-reservation were interviewed regarding their substance use and treatment utilization. One-third had a current substance abuse problem. Predictors included gender, tribe, age, employment status, household income, and educational attainment. Almost two-thirds of those with substance abuse problems had received no treatment within the past year. A combination of formal and informal treatment was the most common approach. Treatment utilization was predicted by gender, age, and insurance coverage.

The implications of cultural orientation for substance use among American Indians.

American Indians were interviewed about their participation in traditional culture and their substance use behaviors. Analyses indicated that cultural orientation differed by age and employment status. Bicultural or less Indian oriented individuals were more likely to misuse alcohol than their more Indian oriented counterparts. The implications of cultural orientation for substance use behaviors are discussed. The need for more precise conceptualization and measurement of acculturation is recommended.