Impact of Ethnic Composition on Mechanisms of Change in School-Based Substance Use Intervention Groups.

Delivering alcohol use intervention services in the school setting represents a key approach to engaging youth of all backgrounds, particularly underserved populations, in such programming. Relative progress has been made toward implementing culturally responsive services for youth; however, little is known about the role of ethnic composition on group processes purported to underlie mechanisms of change. We examined associations between ethnic group composition and therapeutic processes within a voluntary, school-based alcohol use intervention at seven schools across three cities (N groups = 353). Ethnic composition was characterized as: group ethnic diversity on a continuum, group ethnic homogeneity (i.e., where at least 66% of participants shared the same ethnicity), and comparing groups where one of the three largest ethnicities in the sample reached the majority (i.e., African-American vs. Hispanic vs. non-Hispanic white). Ratings on group processes were obtained from participants (satisfaction; belonging), facilitators (empathy; rapport), and coders (engagement; responsiveness). Mixed-effects models revealed that students in groups with African-American and Hispanic majorities reported a higher sense of satisfaction compared to groups with non-Hispanic white majorities. Facilitators endorsed expressing empathy more frequently with majority African-American and Hispanic groups than with non-Hispanic white groups. Study findings highlight the importance of considering different dimensions of ethnic composition when examining mechanisms of change in group intervention research.

Peer Victimization and Adolescent Adjustment: Does School Belonging Matter?

Recent research highlights the role of peer victimization in students' adjustment across a variety of domains (e.g., academic, social), but less often identifies potential mediating variables. In the current study, we tested for direct effects from peer victimization to adolescents' academic behavior and alcohol use, as well as indirect effects through school belonging. Adolescents from two large samples (middle school: N = 2,808; high school: N = 6,821) self-reported on peer victimization, school belonging, academic outcomes (GPA, school truancy), and alcohol use (lifetime, past 30 days). Two-group structural equation models revealed (a) direct and indirect paths from peer victimization to academic functioning; (b) indirect, but not direct, effects through school belonging for lifetime drinking; and (c) direct and indirect effects from peer victimization to current drinking. Findings implicate school belonging as a mediator between peer victimization and important outcomes in adolescence.

Feasibility and Reliability of a Coding System to Capture In-Session Group Behavior in Adolescents.

Limited research has explored the role of in-session behavior during motivational enhancement (ME) in group formats. The current study presents initial feasibility of assessing behavior of high school students (N = 425) attending Project Options, a voluntary secondary drug and alcohol prevention program utilizing ME techniques. Building on previous research exploring client language supporting/opposing health behavior, student group behavior was coded live at the specific utterance and global level; group leader behavior was also coded globally. Interrater reliability of the coding system was assessed, and preliminary validity of the coding system was examined by exploring associations between characteristics of group members and in-session group behavior. Initial reliability estimates were excellent for the specific behavior codes. Reliability of the global codes was mixed, with raters demonstrating good reliability on support for unhealthy behavior, opposition to unhealthy behavior, and support for healthy behavior. Reliability of the group leader codes was fair to poor. Greater percent healthy talk was associated with a lower percentage of group members reporting lifetime alcohol use. The results of the current study suggest that some in-session behavior at the group level can be coded reliably via live observation and that in-session behavior at the group level is associated with alcohol use prior to attending the program. Future research is needed to explore the utility of in-session behavior in terms of predicting future behavior at the group and individual level.

The National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA): A Multisite Study of Adolescent Development and Substance Use.

OBJECTIVE: During adolescence, neurobiological maturation occurs concurrently with social and interpersonal changes, including the initiation of alcohol and other substance use. The National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA) is designed to disentangle the complex relationships between onset, escalation, and desistance of alcohol use and changes in neurocognitive functioning and neuromaturation. METHOD: A sample of 831 youth, ages 12-21 years, was recruited at five sites across the United States, oversampling those at risk for alcohol use problems. Most (83%) had limited or no history of alcohol or other drug use, and a smaller portion (17%) exceeded drinking thresholds. A comprehensive assessment of biological development, family background, psychiatric symptomatology, and neuropsychological functioning-in addition to anatomical, diffusion, and functional brain magnetic resonance imaging-was completed at baseline. RESULTS: The NCANDA sample of youth is nationally representative of sex and racial/ethnic groups. More than 50% have at least one risk characteristic for subsequent heavy drinking (e.g., family history, internalizing or externalizing symptoms). As expected, those who exceeded drinking thresholds (n = 139) differ from those who did not (n = 692) on identified factors associated with early alcohol use and problems. CONCLUSIONS: NCANDA successfully recruited a large sample of adolescents and comprehensively assessed psychosocial functioning across multiple domains. Based on the sample's risk profile, NCANDA is well positioned to capture the transition into drinking and alcohol problems in a large portion of the cohort, as well as to help disentangle the associations between alcohol use, neurobiological maturation, and neurocognitive development and functioning.

Effects of sex composition on group processes in alcohol prevention groups for teens.

Although most alcohol and other drug prevention programs for adolescents are offered in group settings, little is known about the possible effects of sex composition on group processes and mechanisms of change. Using the Group Actor-Partner Interdependence Model framework, we examined how the sex constellation of adolescent prevention group members influenced youth satisfaction, engagement, and endorsement of healthy behavior during group. Participants in Project Options (N = 379; 61.8% girls; Mage = 16.1; SD = 1.4), a voluntary school-based alcohol prevention program, completed measures of satisfaction at each prevention session and observers rated engagement and change talk for each group. When analyses were oriented toward girls, their personal satisfaction, group-rated satisfaction, and group-level engagement were positively related to having more girls in the group. Similarly, in boys, personal satisfaction, satisfaction of the group as a whole, and engagement in groups improved when groups were composed of more girls. Statements supportive of healthy alcohol/drug-related decision making were unrelated to group composition. The findings suggest that the composition of girls and boys in groups has differential effects on some group processes. This avenue of research has merit for understanding the mechanisms associated with satisfaction and engagement in adolescent substance use prevention programs.

Social Anxiety and Onset of Drinking in Early Adolescence.

The present study examines several types of social anxiety that may be associated with the onset of alcohol use in middle school students, and whether the relationship differs by sex and grade. Students in the seventh and eighth grades (N = 2621) completed the Social Anxiety Scale for Adolescents and a measure of lifetime drinking via school-wide surveys. Distinct aspects of social anxiety were associated with higher and lower rates of onset of alcohol use. A high level of fear of negative evaluation was associated with drinking initiation in boys and girls, while girls who reported no social anxiety or distress in new situations were more likely than other groups to have started drinking by early adolescence. Youth with either very low or very high levels of generalized anxiety had higher rates of drinking than youth with scores in between. These findings suggest that the relationship between social anxiety and initiation of alcohol use is complex and varies by type of anxiety symptomatology.

Alcohol and Other Drug Use in Middle School: The Interplay of Gender, Peer Victimization, and Supportive Social Relationships.

The current study examined the impact of supportive social relationships (i.e., teacher support, adult support, school relatedness) and peer victimization on middle school students' substance use. Over 3,000 middle school students reported on alcohol, cigarette, and marijuana use, supportive social relationships, and instances in which they were the victim of aggressive behavior. Mixed-effects logit regression analyses revealed complementary patterns of results across types of substances. Students who perceived high levels of social support were less likely to report alcohol and drug use initiation, particularly at low levels of peer victimization. Gender moderated the negative effect of peer victimization, with highly victimized boys most likely to report alcohol, cigarette, and marijuana use. Results indicated a complex interplay of social influences and moderating variables in predicting early onset alcohol and other drug use, one that researchers should consider when studying adolescents' decisions to use alcohol and other drugs.

Self-medication or social learning? A comparison of models to predict early adolescent drinking.

The current study examined the effects of social anxiety, depressive symptoms, and alcohol expectancies of social behavior change on alcohol involvement to determine whether the self-medication and/or social learning models predicted drinking behavior in a sample of over 400 eighth grade students. Middle school students completed confidential surveys that assessed current alcohol use and expectancies as well as negative affectivity including social anxiety and depressive symptoms. Consistent with the self-medication hypothesis, depressive symptoms predicted more frequent and heavier alcohol use as well as solitary drinking. The social learning model was supported by a negative association between social anxiety and quantity/frequency of drinking and less drinking at parties, and a positive association between alcohol expectancies and all drinking outcomes. Additionally, social anxiety moderated the association between expectancies and alcohol use. These findings suggest that self-medication and social learning processes may both play a role in predicting early adolescent alcohol use and the contexts in which youths drink.

Friends or foes: social anxiety, peer affiliation, and drinking in middle school.

OBJECTIVE: The relation between social anxiety and alcohol consumption suggests aspects of both risk and protection, but most research has focused on late adolescents and emerging adults. METHOD: We investigated the synergistic impact of social anxiety, a need for affiliation with others, and perceived peer alcohol use on drinking in a sample of more than 1,500 early adolescents from southern California (48% girls). Via school-wide surveys, middle school students completed the Social Anxiety Scale for Children-Revised, a modified version of the Interpersonal Orientation Scale, as well as measures of perceived peer drinking and self-reported lifetime and current drinking. RESULTS: For socially anxious youths, high levels of perceived peer use in conjunction with high levels of affiliation need was associated with greater alcohol use on average and more frequent episodic drinking. Specific to heavy episodic drinking, the interaction of social anxiety and perceived peer drinking seemed to affect girls and boys differentially. Sex differences emerged for the moderation of social anxiety's influence on drinking initiation by perceived peer influence. CONCLUSIONS: These findings suggest that alcohol-related risks associated with social anxiety might be gender specific and more important in earlier stages of alcohol use than previously believed.

An examination of self-medication and rebound effects: Psychiatric symptomatology before and after alcohol or drug relapse.

This study evaluated psychiatric symptoms preceding and following initial posttreatment substance use episodes. 125 veterans meeting DSM-IV criteria for alcohol, cannabis, and/or stimulant dependence at treatment entry were followed with quarterly interviews for one year. Approximately half of the sample met criteria for substance use disorders only (n = 65; SUD-only) and half additionally met criteria for an independent non-substance related Axis I disorder (n = 60; SUD-PSY). SUD-PSY adults reported more psychiatric symptoms preceding and following substance use compared to SUD-only adults. Depression and anxiety symptoms were commonly reported by both groups. Symptoms typically did not change or worsened after substance use, with depression worsening more than anxiety or psychotic symptoms. Findings are discussed in relation to the Self-Medication Hypothesis and the Rebound Hypothesis.

Relapse in alcohol- and drug-disordered adolescents with comorbid psychopathology: changes in psychiatric symptoms.

This study examined reciprocal relationships between posttreatment substance use and psychiatric symptoms in adolescents with both a substance use disorder and an Axis I mental health disorder. Participants (13-18 years old) were recruited from inpatient treatment centers and interviewed during treatment and monthly for 6 months. Participants who relapsed (N=103; 48% female) reported the incidence and severity of psychiatric symptoms experienced before and after their 1st posttreatment substance use. The number of symptoms and depression symptoms experienced were related to use of stimulants and other drugs during relapse. There was evidence for both self-medication (symptom reduction) and rebound (symptom exacerbation) effects of substance use on symptom severity. These results demonstrate that, for adolescents with both substance use and mental health disorders, psychiatric symptoms are 1 factor influencing posttreatment substance use.

Treatment of adolescent alcohol-related problems. A translational perspective.

In the present chapter we have sought to articulate a translational perspective linking development during adolescence to alcohol treatment and its evaluation. Clearly adolescents with alcohol use disorders cannot be treated as younger versions of adults. The unique demands of their developmental stage permeate all aspects of their behavior, including alcohol use and abuse. Multi-dimensional developmental models help inform the design, implementation, and evaluation of alcohol and drug treatment programs. While an understanding of individual risk factors is informative, only through models integrating multiple risk pathways embedded in the context of adolescent development can we hope to build more efficacious and effective systems of intervention for youth with AUDs. Effective treatment of adolescent AUDs not only urges translation of the developmental perspective into pre-existing treatment approaches but argues for a paradigm shift towards alternative intervention designs and evaluation procedures and foci.

Psychiatric comorbidity and substance use treatment outcomes of adolescents.

Treatment outcomes of 126 adolescents (13-18 years old) with comorbid substance use disorders (SUDs) and Axis I psychiatric disorders (mood, anxiety, conduct, and attention-deficit/hyperactivity disorders) were compared to 81 SUD adolescents with no additional Axis I disorder. Participants completed structured interviews and symptom measures while participating in an adolescent treatment program and at 6 months following treatment. Results indicated that comorbid youth received more treatment during the outcome period; despite this, more comorbid SUD-Axis I disordered adolescents used substances following treatment than SUD-only youth, even after controlling for socioeconomic status and ethnicity. Among comorbid youth, internalizing disordered adolescents were less likely to use substances during the follow-up period, and externalizing disordered youth returned to substance use most rapidly after discharge from treatment.

Social anxiety, negative affectivity, and substance use among high school students.

The literature regarding the relationship between adolescent social anxiety and substance use is sparse, and available studies have produced discrepant results. Similarly, negative affectivity is a mood-dispositional dimension that is infrequently considered in studies of substance use. The authors used dispositional structural equation modeling to examine the concurrent relationships of social anxiety and negative affectivity with adolescent substance involvement among 724 students in 1 southern California high school. The final model indicated that increased substance use was associated with having lower grade-point average, being male, being White, having higher levels of negative affectivity, and having lower levels of social anxiety. The findings confirm that negative affectivity is positively related to adolescent substance use, whereas social anxiety appears to be protective against substance involvement.

Reliability, stability, and factor structure of the Bulimia Test-Revised and Eating Disorder Inventory-2 scales in adolescence.

The Eating Disorder Inventory-2 (EDI-2) and Bulimia Test-Revised (BULIT-R) have demonstrated strong reliability and validity in college students and adults. Although used in adolescent samples, little is known about the psychometric properties of these measures for adolescents. The reliability, factor structure, and mean levels of five EDI-2 scales and the BULIT-R were evaluated over 3 years. Data were collected yearly from two samples of adolescent females, one recruited from three public middle schools (n = 239, mean baseline age = 12.8) and one from two public high schools (n = 119, mean baseline age = 15.9). Results provide strong evidence for the reliability and stability of these measures. Mean levels of both measures appeared remarkably consistent over the 3 years. These results provide evidence of good psychometric performance for these scales in adolescence. The lack of change in these measures raises questions about the developmental trajectory of these variables through adolescence.