Multivariate Comparison of Male and Female Adolescent Substance Abusers with Accompanying Legal Problems.

PURPOSE: The factors that distinguish adolescent male and female substance abusers with and without legal problems were investigated. METHOD: Youths (N = 4,071) admitted for substance abuse treatment were administered the revised Drug Use Screening Inventory (DUSI-R) to measure severity of health, behavior, and social adjustment problems. RESULTS: Legal problems were more frequent among boys; however, severity of disturbance was greater in girls on 9 of 10 scales. Substance abusing girls and boys with legal problems reported more severe behavior, substance abuse, family adjustment, and peer relationship problems than substance abusing peers without legal problems. Quality of peer relationship mediated the association of family dysfunction, substance abuse and behavior problems with legal problems in boys only. CONCLUSIONS: Gender and legal status both need to be taken into account to potentiate treatment prognosis of substance abusing youths.

Prediction of cannabis use disorder between boyhood and young adulthood: clarifying the phenotype and environtype.

Employing a prospective paradigm, this investigation derived the childhood phenotype and the environtype associated with risk for cannabis use disorder. Two hundred and sixteen boys were evaluated between age 10-12 on a comprehensive protocol using self, mother, and teacher reports and followed-up at ages 19 and 22 to determine the presence of cannabis use disorder. The Transmissible Liability Index (TLI) and Non-Transmissible Liability Index (NTLI) were derived using item response theory. Logistic regression was conducted to evaluate the accuracy of the indexes, singly and in combination, to predict cannabis use disorder. The TLI and NTLI together predicted with 70% and 75% accuracy cannabis use disorder manifest by age 19 and age 22. Sensitivity was 75% at both ages 19 and 22, whereas specificity was respectively 51% and 64%. The findings pertaining to sensitivity indicate that SUD risk for cannabis use disorder can be screened in childhood; however, the specificity scores demonstrate that a low score on the TLI does not inevitably portend a good prognosis up to 10 years later.

Prospective study of the association between neurobehavior disinhibition and peer environment on illegal drug use in boys and girls.

BACKGROUND: Individual and contextual factors jointly participate in the onset and progression of substance abuse; however, the pattern of their relationship in males and females has not been systematically studied. OBJECTIVES: Male and female children and adolescents were compared to determine the relative influence of individual susceptibility (neurobehavior disinhibition or ND) and social environment (deviancy in peers) on use of illegal drugs. METHODS: Boys (N = 380) and girls (N = 127) were prospectively tracked from age 10-12 to age 16 to delineate the role of ND and peer deviancy on use of illegal drugs. RESULTS: Girls exhibited lower ND scores than boys in childhood and were less inclined to affiliate with deviant peers. These differences were reduced or disappeared by mid-adolescence. In boys only, peer deviancy in childhood mediated the association between ND and illegal drug use at age 16. In both genders, peer deviancy in mid-adolescence mediated ND and substance abuse at age 16. CONCLUSIONS: Individual and contextual risk factors promoting substance abuse are more salient at a younger age in boys compared to girls. SCIENTIFIC SIGNIFICANCE: These results point to the need for earlier screening and intervention for boys.

Screening current and future diagnosis of psychiatric disorders using the Revised Drug Use Screening Inventory.

The revised Drug Use Screening Inventory (DUSI-R) is a valid and reliable self-report questionnaire used for quantifying problems that frequently precede and co-occur with substance abuse. The present investigation determined whether the DUSI-R's items can be aggregated into scales that implicate current and future psychiatric disorders. Scales were derived to screen for attention deficit, conduct, antisocial, anxiety, depression, and substance use disorders in a longitudinally tracked cohort of 328 boys. Evaluations were conducted when the boys were 12-14, 16, 19, and 22 years of age. All of the scales identified youths qualifying for current DSM-IV diagnosis with excellent accuracy. Predictive validity of the scales ranged from good to excellent. Accordingly cut-off scores were determined for each scale for use in practical settings to identify youths who require comprehensive diagnostic evaluation. Thus in addition to its utility for detecting problems that precede and correlate with substance abuse, the DUSI-R is cost-efficient for screening youths for mental disorders.

Developmental trajectory classes in substance use disorder etiology.

Three trajectory classes culminating in substance use disorder (SUD) were discerned in a longitudinal study of boys from ages 10-12 to 22 years. Neurobehavior disinhibition, parental SUD, socioeconomic status, and affiliation with deviant peers were measured at baseline. Approval of socially nonnormative behavior was measured at ages 10-12, 12-14, 16, and 19 years. Two high-risk trajectories, indicated by increasing approval of antisociality and progressive social maladjustment during adolescence (SUD rate = 72.7%) and stable high level of disturbance (SUD rate = 85%), were identified. Individual characteristics (neurobehavior disinhibition) in conjunction with contextual factors (low socioeconomic status, parental SUD, affiliation with deviant friends) promote approval of antisociality during adolescence and a high rate of SUD by young adulthood.

Assessment of risk for substance use disorder consequent to consumption of illegal drugs: psychometric validation of the neurobehavior disinhibition trait.

Previous research has shown that the trait neurobehavior disinhibition (ND), which consists of affect, behavior, and cognitive indicators of self-regulation, is a significant predictor of substance use disorder (SUD) between childhood and young adulthood. The authors evaluated the psychometric properties of the ND trait in 278 boys evaluated at ages 10-12 and 16 years. ND score significantly predicted SUD and outcomes that commonly manifest in tandem with SUD by age 19, such as violence, arrests, committing crime while intoxicated, and concussion injury. In addition to predictive validity, the ND trait was found to have good construct, discriminative, and concurrent validity, as well as good test-retest and internal reliability. The ND trait may be useful for detecting youths at high risk for developing SUD and related outcomes.

Application of item response theory to quantify substance use disorder severity.

OBJECTIVE: The present investigation had two main goals: (1) Determine whether binary substance use disorder (SUD) diagnoses are indicators of a unidimensional trait indexing severity of disorder; and, (2) demonstrate the predictive, concurrent and construct validity of the SUD severity scale. METHODS: Boys and their biological parents were administered structured diagnostic interviews to diagnose SUD. Item response theory (IRT) was applied to determine whether the diagnoses are indicators of a unidimensional trait. The score on this scale was correlated with substance use behavior, violence, treatment history, risky sex, and social adjustment. RESULTS: SUD diagnoses are indicators of a unidimensional latent trait. Maternal and paternal SUD severity predicted son's SUD severity at age 19. The score on the SUD severity scale correlated with drug use frequency, number of different drugs used in lifetime, treatment seeking, illegal behavior, social maladjustment, and risky sex. CONCLUSION: SUD can be quantified on an interval scale indexing severity of disorder. The advantages of measuring SUD severity as a continuous trait are discussed.

Neurobehavioral disinhibition in childhood predicts early age at onset of substance use disorder.

OBJECTIVE: This longitudinal study had three aims: 1) determine the extent to which boys at high average risk and low average risk for substance use disorder differ on a construct of neurobehavioral disinhibition, 2) evaluate the capacity of neurobehavioral disinhibition to predict substance use frequency at age 16, and 3) demonstrate the utility of neurobehavioral disinhibition in predicting substance use disorder. METHOD: The authors derived an index of neurobehavioral disinhibition from measures of affect, behavior, and cognition. The neurobehavioral disinhibition score was used to discriminate youth at high and low average risk for substance use disorder and to predict substance use frequency after 4-6 years and substance use disorder after 7-9 years. RESULTS: The neurobehavioral disorder score significantly discriminated boys at high average risk from those at low average risk at ages 10-12. Neurobehavioral disinhibition at age 16, in conjunction with substance use frequency and risk status group, predicted substance use disorder at age 19 with 85% accuracy and accounted for 50% of the variance in Drug Use Screening Inventory overall problem density score. Neurobehavioral disinhibition was a stronger predictor of substance use disorder (odds ratio=6.83) than substance consumption frequency (odds ratio=3.19). CONCLUSIONS: Cross-sectional and longitudinal analyses indicated that neurobehavioral disinhibition is a component of the liability to early age at onset of substance use disorder.

Origins and consequences of child neglect in substance abuse families.

The empirical literature pertaining to the prevalence, origins, and consequences of neglectful parenting as it relates to substance abuse is critically reviewed. Available evidence indicates that children who experience parental neglect, with or without parental alcohol or drug abuse, are at high risk for substance use disorder (SUD). The effects of parental substance abuse on substance abuse outcome of their children appear to be partly mediated by their neglectful parenting. The discussion concludes with presentation of a developmental multifactorial model in which neglect, in conjunction with other individual and environmental factors, can be integratively investigated to quantify the child's overall liability across successive stages of development as well as to map the trajectory toward good and poor outcomes.

Neurobehavior disinhibition in childhood predicts suicide potential and substance use disorder by young adulthood.

The objectives of this study were to (a) determine whether two factors that are established components of the risk for substance use disorder (SUD) also impact on the risk for suicide; and (2) evaluate whether SUD manifest by early adulthood predicts suicide propensity. Neurobehavior disinhibition assessed in 227 boys at ages 10-12 and 16 and parental history of SUD were prospectively evaluated to determine their association with the risk for SUD and suicide propensity between ages 16 and 19. The results indicated that neurobehavior disinhibition at age 16 predicts suicide propensity between ages 16 and 19 (p = .04). A trend was observed (p = .08) for SUD manifest between ages 16 and 19 to predict suicide propensity during the same period. Maternal SUD is directly associated with son's SUD risk but not suicide propensity. Paternal SUD predicts son's neurobehavior disinhibition that, in turn, predisposes to SUD. A direct relation between paternal SUD and son's suicide propensity was not observed. These findings suggest that neurobehavior disinhibition, a component of the liability of SUD, is also associated with suicide risk. These results are discussed within a neurobehavioral framework in which prefrontal cortex dysfunction is hypothesized to underlie the risk for these two outcomes.

Dental abnormalities in children of fathers with substance use disorders.

Very little is known about whether parental substance-use disorders (SUDs) affect the prevalence of dental abnormalities among their offspring. This study examined the prevalence of various dental abnormalities in sons of fathers with SUDs (the high average risk, or HAR, group) versus the prevalence of these abnormalities among sons of fathers without SUDs (the low average risk, or LAR, group). A total of 385 sons and their families were comprehensively assessed at five different ages, 10-12, 12-14, 16, 19, and 22. All of these participants were participating in an ongoing longitudinal NIDA-funded center study (CEDAR) evaluating the etiology of SUDs, in collaboration with the University of Pittsburgh Dental School. The data from this study provide evidence that paternal SUDs (HAR vs. LAR status) is associated with poor dental condition, poor oral hygiene, a greater need for dental treatment, and inadequate levels of dental treatment utilization.

Does the "gateway" sequence increase prediction of cannabis use disorder development beyond deviant socialization? Implications for prevention practice and policy.

BACKGROUND: This study was conducted to test whether non-normative socialization mediates the association between transmissible risk measured in childhood and cannabis use disorder manifested by young adulthood, and whether the sequence of drug use initiation ("gateway", i.e., consuming legal drugs before cannabis, or the reverse) increases accuracy of prediction of cannabis use disorder. METHODS: Sons of fathers with or without substance use disorders (SUDs) related to illicit drugs were tracked from 10-12 to 22 years of age to model the association between transmissible risk for SUD, socialization (peer deviance), order of drug use initiation ("gateway" or reverse sequence), and development of cannabis use disorder. Path analysis was used to evaluate relationships among the variables. RESULTS: Non-normative socialization mediates the association between transmissible risk measured during childhood and cannabis use disorder manifest by young adulthood. The sequence of drug use initiation did not contribute additional explanatory information to the model. CONCLUSIONS: The order of drug use initiation does not play a substantial role in the etiology of cannabis use disorder.

Deviant socialization mediates transmissible and contextual risk on cannabis use disorder development: a prospective study.

AIMS: This study examined the contribution of transmissible risk, in conjunction with family and peer contextual factors during childhood and adolescence, on the development of cannabis use disorder in adulthood. DESIGN: The family high-risk design was used to recruit proband fathers with and without substance use disorder and track their sons longitudinally from late childhood to adulthood. SETTING: The families were recruited under the aegis of the Center for Education and Drug Abuse Research in Pittsburgh, Pennsylvania. PARTICIPANTS: The oldest son in the family was studied at ages 10-12, 16, 19 and 22 years. MEASUREMENTS: The transmissible liability index (TLI), along with measures of quality of the parent-child relationship, cooperative behavior at home, social attitudes and peer milieu were administered to model the developmental pathway to cannabis use disorder. FINDINGS: Affiliation with socially deviant peers and harboring non-normative attitudes (age 16) mediate the association between transmissible risk for substance use disorder (SUD) (age 10-12) and use of illegal drugs (age 19), leading to cannabis use disorder (age 22). CONCLUSIONS: Deviant socialization resulting from transmissible risk and poor parent-child relationship is integral to development of cannabis use disorder in young adulthood.

Neurobehavior disinhibition, parental substance use disorder, neighborhood quality and development of cannabis use disorder in boys.

This prospective investigation examined the contribution of neighborhood context and neurobehavior disinhibition to the association between substance use disorder (SUD) in parents and cannabis use disorder in their sons. It was hypothesized that both neighborhood context and son's neurobehavior disinhibition mediate this association. Two hundred and sixteen boys were tracked from ages 10-12 to age 22. The extent to which neighborhood context and neurobehavior disinhibition mediate the association between parental SUD and son's cannabis use disorder was evaluated using structural equation modeling. The best fitting model positioned neighborhood context and neurobehavior disinhibition as mediators of the association between parental SUD and cannabis use disorder in sons. Neurobehavior disinhibition also was a mediator of the association between neighborhood context and son's cannabis use. The implications of this pattern of association between parental SUD, neighborhood context and individual risk for SUD for improving prevention are discussed.

Parental supervision and alcohol use in adolescence: developmentally specific interactions.

OBJECTIVE: While parental supervision has been demonstrated to predict adolescent alcohol involvement, there has been little focus on the influence of adolescent characteristics, such as personality and alcohol use, on the effectiveness of parental supervisory practices. This study examined the interaction of parental supervision and adolescent alcohol use from late childhood through middle adolescence. METHOD: Families were recruited through fathers with substance use disorders or fathers representing reference groups identified as having a biological child age 10 to 12 years. These children (N = 773) were assessed and follow-up visits conducted in early adolescence (ages 12-14) and middle adolescence (age 16). Parental supervision and alcohol use were determined at each visit. In the context of demographic variables and childhood psychological dysregulation, the statistical model examined global and developmental stage-specific relationships between supervision and alcohol use. RESULTS: Consistent with interactional hypotheses, childhood psychological dysregulation and early adolescent alcohol use predicted less effective parental supervision. CONCLUSIONS: While the study design limited the extent to which predictive associations could be interpreted as indicating causal relationships, adolescents with psychological dysregulation and higher levels of alcohol use may resist parental supervision. The challenges to parents presented by difficult adolescents need to be taken into consideration in developing preventive and treatment interventions.

Reciprocal influence of parent discipline and child's behavior on risk for substance use disorder: a nine-year prospective study.

AIM: This study aimed at determining the association of father's and mother's (parental) substance use disorder (SUD) and discipline styles and son's neurobehavior disinhibition (ND) with son's SUD from childhood (age 10-12) to young adulthood (age 19). It was hypothesized that (1) parental discipline styles and son's ND mediate the association between parental SUD and son's SUD, (2) son's ND mediates the association between parental discipline styles and son's SUD, and (3) parental discipline styles mediate the association between ND and SUD in the son. METHODS: Two-hundred-sixty-three families including a 10-12 year-old son and both parents participated in the study. RESULTS: (1) mother's discipline styles predicted father's discipline styles, (2) son's ND predicted mother's instilling guilt positively and father's punishment negatively, (3) son's ND mediated the association between father's SUD and punishment and son's SUD, and (4) mother's SUD predicted son's ND and SUD. CONCLUSIONS: The reciprocal prediction between son's ND and father's punishment and prediction of father's punishment by mother's punishment point to the need for family-based interventions that take into account the quality of specific dyadic interactions pertaining to discipline behaviors that amplify the risk for SUD in male children.

Child neglect and oral health problems in offspring of substance-abusing fathers.

This study examined (1) orodental (OD) problems in 10-19-year-old children of substance use disorder (SUD) (n = 127) and non-SUD fathers (n = 111) and (2) the moderating effect of child's substance use (SU) involvement in the associations of paternal SUD and neglectful parenting with OD problems in the offspring. The results showed that periodontal problems differentiated between groups and the interactions between child's SU involvement and paternal SUD and neglectful parenting were respectively associated with hard/soft tissue lesions and carious lesions in the offspring, indicating that SU involvement increases risk for OD due to paternal SUD and neglectful parenting.

Executive functioning, temperament, and drug use involvement in adolescent females with a substance use disorder.

BACKGROUND: This study determined whether temperament mediates the relation between executive functioning (EF) and drug use involvement and whether EF and temperament interact to account for unique variance in drug use involvement. METHOD: Participants were 340, 14-18-year-old, adolescent females with a substance use disorder and controls. EF was measured using a battery of neuropsychological tests, temperament was assessed using the Dimensions of Temperament Survey--Revised, and drug use involvement was measured with the Drug Use Screening Inventory. RESULTS: Temperament mediated the relation between EF and drug use involvement. Girls with a 'difficult' temperament exhibited significantly greater drug use involvement than girls with a 'good' temperament. Finally, low EF was significantly related to increased drug use involvement for girls with a good temperament, but not for girls with a difficult temperament. CONCLUSIONS: The results suggest that a difficult temperament is a more important risk factor for drug use than low EF. Given previous studies that have shown significant relations between EF and drug use, further research on this topic is warranted.