Cognition, negative affectivity and substance use in adolescent boys with and without a family history of a substance use disorder.

OBJECTIVE: The purpose of this study was to test a model of substance use in adolescent males. The model is based on the premise that cognitive distortions and poor constructive thinking represent weaknesses in the ability to adaptively cope with everyday problems. It is postulated that failures in adaptive coping result in increased negative affectivity (e.g., frustration, anger, and anxiety), which fosters substance use as a means of alleviating unpleasant feelings. METHOD: Subjects (N = 276) were 15- to 17-year-old males with a positive (FHP; n = 118) or a negative (FHN; n = 158) family history of a substance use disorder (SUD). Subjects completed self-report measures of constructive thinking, cognitive distortions, negative affectivity, substance use frequency and substance use problems. RESULTS: Negative affectivity mediated the relations between constructive thinking and both substance use variables, in separate analyses, for the FNP and FHN groups. Negative affectivity also moderated the relation between constructive thinking and substance use frequency, such that constructive thinking was negatively related to substance use frequency but only for individuals high in negative affectivity. CONCLUSIONS: Poor constructive thinking skills are related to increased substance use in adolescent males, in part through an association with greater negative affectivity. SUD treatment and prevention efforts may benefit from strategies aimed at improving constructive thinking abilities and reducing negative affectivity.

Constructive thinking, executive functioning, antisocial behavior, and drug use involvement in adolescent females with a substance use disorder.

The main aim of this study was to determine how constructive thinking (CT), executive functioning (EF), and antisocial behavior (ASB) are related to drug use involvement in 282 adolescent females, 14-18 years of age, with a substance use disorder (SUD) and in controls. CT was measured using the Constructive Thinking Inventory (S. Epstein & P. Meier, 1989), EF was measured using a battery of neuropsychological tests, and ASB was measured using the Youth Self-Report Inventory (T. Achenbach, 1991) and a psychiatric interview. Females with an SUD demonstrated lower CT and EF scores and higher ASB scores compared with the controls. Low CT and low EF were significantly related to increased drug use involvement even when controlling for age, socioeconomic status, and vocabulary level. ASB partially mediated the relation between CT and drug use involvement, and it fully mediated the relation between EF and drug use involvement. Moreover, ASB moderated the relation between EF and drug use involvement.

A six-year prospective study of pathways toward drug use in adolescent boys with and without a family history of a substance use disorder.

OBJECTIVE: The purpose of this study was to test a developmental model of drug use in male adolescents. The model postulates that low executive functioning and a difficult temperament are related to aggression and affiliations with delinquent peers which, in turn, are related to elevated drug use. METHOD: Boys (N = 187) with and without a family history of a substance use disorder (SUD) were followed over a 6-year period. Executive functioning and temperament were measured at age 10-12, aggression and affiliations with delinquent peers were assessed at age 12-14 and drug use was measured at age 16. RESULTS: Low executive functioning and a difficult temperament were related to increased aggression and affiliations with delinquent peers. These latter variables were related to increased drug use. Furthermore, the relation between difficult temperament and drug use was fully mediated by aggression and affiliations with delinquent peers. CONCLUSIONS: Drug abuse prevention efforts may benefit from clinical interventions aimed at strengthening executive functioning, regulating temperament and improving socialization strategies in antisocial children.

Executive functioning: a conceptual framework for alcohol-related aggression.

The causal mechanisms underlying alcohol-related aggression are not well understood. This article presents a conceptual framework designed to guide thinking and generate new research in this area of study. According to the framework, executive functioning is both a mediator and a moderator of intoxicated aggression. Literatures describing associations between alcohol and aggression, executive functioning and aggression, and the acute effects of alcohol on executive functioning are reviewed. On the basis of these findings, it is proposed that (a) executive functioning mediates the alcohol-aggression relation in that acute alcohol intoxication disrupts executive functioning, which then heightens the probability of aggression, and (b) executive functioning moderates the alcohol-aggression relation in that acute alcohol consumption is more likely to facilitate aggressive behavior in persons with low, rather than high, executive functioning.

Developmental sources of variation in liability to adolescent substance use disorders.

This review provides a synthesis of the literature on the complex sequence of maturational, psychosocial, and neuroadaptive processes that lead to substance use disorders (SUD) in adolescence. A brief overview introduces the concepts of liability to SUD and epigenesis. A theory is presented explaining how affective, cognitive, and behavioral dysregulation in late childhood is exacerbated during early and middle adolescence by family and peer factors, as well as puberty, leading to substance use. Continued exacerbation of the three components of dysregulation by drug and non-drug stressors during late adolescence is posited to result in neuroadaptations that increase the likelihood of developing SUD, particularly in high-risk individuals. Implications for etiologic research as well as clinical and preventive interventions are discussed.

Temperament and antisocial behavior in preadolescent boys with or without a family history of a substance use disorder.

The goals of this study were to determine the relations between different dimensions of temperament, and their interactions, with antisocial behavior (ASB) in 351 preadolescent boys with (n = 175) or without (n = 176) a family history of a substance use disorder (SUD) and to determine whether these relations are moderated by a family history of SUD. Participants were administered the Revised Dimensions of Temperament Survey (DOTS-R) and multiple measures of ASB. Factor analysis reduced the DOTS-R subscales into three factors: Rhythmicity, Behavioral Regulation, and Positive Affectivity. Results indicated that above and beyond the effects of age and socioeconomic status, low rhythmicity, low behavioral regulation, and low positive affectivity, as well as some of their higher order interactive effects, are important indicators of different types of ASB and, in some cases, only in boys with a family history of SUD.

Neuropsychological deficits in female adolescents with a substance use disorder: better accounted for by conduct disorder?

OBJECTIVE: To determine whether neuropsychological deficits in female adolescents are more closely related to a diagnosis of a substance use disorder (SUD) or a conduct disorder (CD). METHOD: Subjects were 470 female adolescents between the ages of 14 and 18 years. They were categorized into one of four groups: (1) SUD-only (n = 63), (2) CD-only (n = 58), (3) SUD+CD (n = 239) and (4) normal controls (n = 110). The groups were compared on multiple neuropsychological measures covering four cognitive domains: general intelligence, executive functioning, language competence and academic achievement. RESULTS: The findings were consistent across all measures. Multivariate analyses of variance revealed significant group differences for all four neuropsychological domains. Univariate tests indicated that the two CD groups equally exhibited the poorest performance of all four groups on nearly all measures of intelligence, executive functioning, language competence and academic achievement. The SUD-only group performed better than the two CD groups but not as well as the control group. Socioeconomic status and chronological age were statistically controlled for in all analyses. CONCLUSIONS: These data suggest that the neuropsychological deficits found in our sample of female adolescents with SUD are more closely related to CD, or antisociality in general, than to SUD. Future studies assessing the neuropsychological functioning of persons with SUD should make efforts to measure comorbid antisociality.

Adolescent females with a substance use disorder: affiliations with adult male sexual partners.

OBJECTIVE: To test the hypothesis that low socioeconomic status (SES), a disturbed parent-daughter relationship, early sexual development, and antisocial behavior are risk factors in adolescent females affiliating with adult male sexual partners. To determine whether the relation between these risk factors and affiliating with adult male sexual partners is stronger in females with greater, rather than fewer, substance use disorders (SUD). METHOD: Subjects were 180 adolescent females with SUD and 87 normal controls (14-18 years of age). RESULTS: The SUD group had a lower SES and more negative parent-daughter interactions, and exhibited greater antisocial tendencies. Also, the SUD group showed a more frequent affiliation with adult male sexual partners. Chronological age, age of menarche (sexual development), antisocial behavior, and quality of the parent-daughter relationship were significantly associated with affiliation with adult male sexual partners. Moreover, the number of SUD diagnoses enhanced the relation between the quality of the parent-daughter relationship and antisocial behavior with affiliation with adult male sexual partners. CONCLUSIONS: From a prevention perspective, interventions directed at enhancing child rearing practices, communication skills, and involvement in children's needs and activities might result in improved parent-child attachments that may attentuate young women's propensities to become involved in antisocial behavior and affiliate with adult sexual partners. Also, the risk imposed by an early sexual maturation may be offset by enhancing the female adolescent's social skills to select non-deviant and supportive male partners.

Etiology of early age onset substance use disorder: a maturational perspective.

The etiology of early age onset substance use disorder (SUD), an Axis I psychiatric illness, is examined from the perspective of the multifactorial model of complex disorders. Beginning at conception, genetic and environment interactions produce a sequence of biobehavioral phenotypes during development which bias the ontogenetic pathway toward SUD. One pathway to SUD is theorized to emanate from a deviation in somatic and neurological maturation, which, in the context of adverse environments, predisposes to affective and behavioral dysregulation as the cardinal SUD liability-contributing phenotype. Dysregulation progresses via epigenesis from difficult temperament in infancy to conduct problems in childhood to substance use by early adolescence and to severe SUD by young adulthood.

Executive cognitive functioning, temperament, and antisocial behavior in conduct-disordered adolescent females.

The authors assessed whether low executive cognitive functioning (ECF) and a difficult temperament are related to aggressive and nonaggressive forms of antisocial behavior (ASB) in 249, 14-18-year-old, conduct-disordered females and controls. ECF was measured using neuropsychological tests; temperament was measured using the Dimensions of Temperament Survey-revised; and ASB was assessed using psychiatric symptom counts for conduct disorder. The conduct-disordered females exhibited lower ECF capacity and a greater difficult temperament compared with the controls. The combined influence of low ECF and difficult temperament was significantly related to both forms of ASB. In comparison with low ECF, difficult temperament was more strongly related to nonaggressive ASB, whereas in comparison with difficult temperament, low ECF was more strongly related to aggressive ASB. Last, ECF mediated the relation between difficult temperament and aggressive ASB.

Executive cognitive functioning in alcohol use disorders.

Executive cognitive functioning (ECF) has been identified as an important determinant in the etiology of alcoholism. ECF represents a "higher-order" cognitive construct involved in the self-regulation of goal-directed behavior. The prefrontal cortex and its subcortical connections represent the primary neurological substrate that subserves ECF. Both alcoholics and individuals at high risk for alcoholism exhibit a mild dysfunction in ECF. However, this deficit appears to be significantly stronger in alcoholics with a comorbid diagnosis of an antisocial personality disorder. Individuals with other disorders that are also highly comorbid with alcoholism, such as attention deficit hyperactivity disorder and conduct disorder, also demonstrate deficits in ECF. As such, compromised ECF may not be specific to alcoholism, but instead, might be a potential underlying etiologic substrate for a number of disorders of behavioral excess-disinhibition. Subsequent to reviewing the literature implicating ECF deficits in alcoholism and comorbid disorders, the authors present a heuristic cognitive-neurobehavioral model of alcoholism implicating the frontostriatal system. Finally, recommendations for the prevention and treatment of alcoholism, based on this model, are discussed.

Disruptive, delinquent and aggressive behavior in female adolescents with a psychoactive substance use disorder: relation to executive cognitive functioning.

OBJECTIVE: This study had four objectives: (1) to determine whether female adolescents with a psychoactive substance use disorder are more impaired than controls on a battery of neuropsychological tests of Executive Cognitive Functioning (ECF); (2) to determine whether these individuals exhibit higher levels of disruptive, delinquent and aggressive behavior compared with controls; (3) to determine whether ECF is related to disruptive, delinquent and aggressive behavior in this population; and (4) to determine whether these relations are moderated by drug use. METHOD: Multiple indicators of ECF, and disruptive, delinquent and aggressive behavior, as well as drug use, were used to test these relations in a sample of 188 female adolescents who qualified for a DSM-III-R diagnosis of a psychoactive substance use disorder (PSUD) and 95 normal controls between the ages of 14-18 years (N = 283). RESULTS: Hierarchical multiple regression equations determined that ECF was related to disruptive, delinquent and aggressive behavior even when chronological age, SES and drug use were accounted for. The final regression models suggested that drug use was more strongly related to disruptive and delinquent behavior, whereas ECF was more strongly related to aggression. Drug use did not moderate any relation between ECF and the dependent measures. CONCLUSIONS: One implication of these results is that violence prevention and treatment outcomes may be ameliorated by incorporating cognitive habilitation of ECF as an integral component of multimodel interventions.

Executive cognitive functions as mediators of alcohol-related aggression.

A large body of literature has documented a relation between executive cognitive functioning (ECF) and aggression. ECF encompasses 'higher-order' mental abilities such as attention, planning, organization, abstract reasoning, and self-monitoring. ECF has been defined as the ability to utilize these functions to self-regulate goal-directed behaviour. The prefrontal cortex represents the primary neurological substrate that subserves ECF. Acute alcohol consumption has been shown to disrupt ECF/prefrontal cortical functioning. Literature is reviewed linking ECF/prefrontal cortical functioning, alcohol consumption, and aggressive behaviour. A hypothetical model, based on empirical data, is presented, suggesting that ECF/prefrontal cortical functioning is an underlying aetiological mechanism for the relation between acute alcohol consumption and aggressive behaviour.

Alcohol-induced stimulation and sedation: relation to physical aggression.

The relation between the stimulating and the sedating effects of acute alcohol consumption on human physical aggression was examined. Sixty male social drinkers were assigned to either an alcohol or a sober group. Aggression was measured using a modified version of S. Taylor's (1967) aggression paradigm, in which electric shocks are received from and administered to a fictitious opponent during a competitive task. Aggression was operationalized as the intensity and the duration of the shocks selected. Stimulation and sedation were measured using a self-report inventory. Results demonstrated that stimulation was positively related to aggression, but only in the intoxicated state. Sedation was not related to aggression in either the intoxicated or the sober state.

The biphasic effects of alcohol on human physical aggression.

The authors assessed the biphasic effects of alcohol on human physical aggression. Sixty male social drinkers were assigned to 1 of 4 groups: alcohol ascending limb (AAL), alcohol descending limb (ADL), or 1 of 2 sober control groups. Aggression was assessed in the AAL and ADL groups at respective ascending or descending blood alcohol concentrations (BAC) of 0.08%. Each participant in the control groups was respectively yoked with a participant in either the AAL or the ADL group to control for the longer period of time needed to reach a BAC of 0.08% on the descending limb compared with the ascending limb (i.e., passage of time effect). The authors measured aggression using a modified version of the Taylor aggression paradigm (S. Taylor, 1967), in which electric shocks are received from and administered to a fictitious opponent during a competitive task. The AAL group was more aggressive than the ADL groups. There were no differences between the ADL group and the control groups, which suggests that alcohol does not appear to increase aggression on the descending limb. The control groups did not differ in aggression, thus ruling out a passage of time effect.

Violence, suicidality, and alcohol/drug use involvement in adolescent females with a psychoactive substance use disorder and controls.

This study had three aims: (1) to determine the relations between behavioral dysregulation, negative affectivity, and familial impairment with violence and suicidality (i.e., severity of ideation and attempts) in a sample of adolescent females with a psychoactive substance use disorder and controls; (2) to determine whether these relations are mediated by internalizing (depression/anxiety) and externalizing (nonviolent antisocial behavior) symptomatology; and (3) to determine whether severity of alcohol/drug use involvement moderates the relations between the mediating variables with violence and suicidality. Multiple behavioral, psychiatric interview, and self-report measures were used to index behavioral dysregulation, negative affectivity, familial impairment, internalizing and externalizing symptomatology, and violence and suicidality in one hundred sixty-one 14- to 18-year-old adolescent females with a psychoactive substance use disorder and in 80 controls. Structural equation modeling was used to determine the proposed relations. Results indicated that behavioral dysregulation, negative affectivity, and familial impairment were related to violence, whereas only familial impairment was related to suicidality. Internalizing symptomatology mediated the relation between familial impairment and suicidality, and was related to violence, whereas externalizing symptomatology mediated the relations between behavioral dysregulation, negative affectivity, and familial impairment with violence. Severity of alcohol/drug use involvement did not moderate the relations between internalizing or externalizing symptomatology with suicidality or violence. Nevertheless, the relation between internalizing symptomatology and suicidality was stronger in females with a greater degree of alcohol/drug use involvement, compared with those with a milder degree of involvement. Therefore, from a prevention standpoint, behavioral dysregulation, negative affectivity, familial impairment, as well as internalizing and externalizing symptoms, may serve as clinical "points of intervention" for altering the development of violence and suicidality in high risk and substance abusing youth.

Substance use and risky sexual behavior in female adolescents.

The purpose of this study was to elucidate the etiological pathways towards substance use and risky sexual behavior in female adolescent substance abusers. The study had three aims: (1) to determine the relations between behavioral dysregulation, negative affectivity, and childhood victimization with substance use and risky sexual behavior, (2) to determine whether these relations are mediated by internalizing symptomatology, antisocial behavior, and affiliating with an adult boyfriend; and (3) to determine whether age of menarche moderates the relation between the mediating variables and substance use and risky sexual behavior. Multiple behavioral, psychiatric interview, and self-report measures were used to index behavioral dysregulation, negative affectivity, childhood victimization, internalizing symptomatology, antisocial behavior, affiliation with adult boyfriends, substance use, and risky sexual behavior in 125 substance abusing female adolescents and 78 controls between the ages of 14-18 years. Structural equation modeling was used to determine the etiological pathways. Results indicated that behavioral dysregulation, negative affectivity, and childhood victimization were related to substance use and risky sexual behavior. Age of menarche was significantly correlated with affiliation with an older boyfriend and risky sexual behavior. Antisocial behavior mediated the associations between behavioral dysregulation, negative affectivity and childhood victimization with substance use and risky sexual behavior. Affiliation with an adult boyfriend was directly associated with substance use involvement and accounted for the relationship between chronological age and risky sexual behavior. Finally, late menarche enhanced the association between internalizing symptomatology and substance use involvement. The results highlight the importance of behavioral dysregulation, negative affectivity, and childhood victimization in predicting substance use and risky sexual behavior, as well as the finding that antisocial behavior and affiliation with an adult boyfriend may be etiologically important in predicting these outcomes. Therefore, from a prevention and treatment standpoint, behavioral and affective dysregulation, childhood victimization as well as antisocial behavior may serve as clinical 'gateways' for altering the developmental trajectory toward substance use and risky sexual behavior in high risk and substance abusing youth. For example, reducing dysregulation through behavior modification procedures that have been developed for conduct disordered children would appear to be a heuristic avenue of investigation emanating from the results obtained in this study.

The relation between alcohol and aggression: an integrated biopsychosocial conceptualization.

The relation between acute alcohol consumption and aggressive behavior is a complex phenomenon that has been studied from a variety of different disciplines. This article reviews findings from both survey and experimental research. The influence of both situational and individual difference variables on the alcohol-aggression relation is discussed and the strengths and weaknesses of various methodological approaches are highlighted. Current theoretical perspectives of the alcohol-aggression relation are reviewed. An integrated heuristic framework of the alcohol-aggression relation also is outlined. This conceptualization involves both distal and proximal risk factors for problems with alcohol and violence, which include biological, psychological, interpersonal, and contextual influences. Research and treatment implications of this framework are also discussed. It is recommended that researchers attempt to measure variables from a variety of domains in order to obtain a better understanding of this complex phenomenon. Furthermore, it is emphasized that there is a clear need to further implement and assess primary and secondary prevention efforts and to design integrated and flexible approaches for individuals with alcohol and violence problems.

Relation between executive cognitive functioning and the adverse consequences of alcohol use in social drinkers.

The purpose of this study was to assess the relation between Executive Cognitive Functioning (ECF) and the adverse consequences of alcohol consumption. ECF encompasses "higher order" cognitive abilities involved in goal-directed behavior, such as attentional control, mental flexibility, planning, and self-monitoring. Impaired ECF has been shown to result in a variety of negative consequences, including excessive drug and alcohol use. Subjects were 79 nonalcoholic male social drinkers between 17 to 30 years of age. ECF was measured using three neuropsychological tests: the Wisconsin Card Sorting Test (WCST), the Conditional Associative Learning Test (CAT), and the Sequential Matching Memory Test (SMMT). Adverse drinking consequences were measured using the Drinker Inventory of Consequences (DrInC). The DrInC assesses drinking consequences in five domains: Physical, Intrapersonal, Interpersonal, Social Responsibility, and Impulse Control. Scores from the neuropsychological tests were reduced into two latent variables: one representing the WCST and the other representing the CAT and SMMT. The results indicated that errors on the CAT/SMMT variable were positively related to adverse consequences in each domain, except for physical consequences. A similar association was found between the WCST variable and impulse control consequences. These findings indicate that performance on tests measuring ECF is related to the severity of drinking consequences. Therefore, prevention and treatment outcomes may be improved by incorporating cognitive habilitation into current interventions.

Executive cognitive functioning and aggressive behavior in preadolescent boys at high risk for substance abuse/dependence.

OBJECTIVE: This study had three purposes; (1) to assess the underlying factor structure of a battery of neuropsychological tests putatively measuring executive cognitive functioning (ECF) in a sample of boys at high and low risk for substance abuse/dependence; (2) to assess the relationship between ECF and aggressive behavior; and (3) to determine the interactive effects of ECF and a family history (FH) of substance dependence on aggressive behavior. METHOD: Multiple measures of ECF and aggressive behavior were used to test these relationships in a sample of 291 10-12 year old boys with and without a FH of substance dependence. RESULTS: Analyses indicated that the measures of ECF loaded on one factor. ECF was related to aggressive behavior even when accounting for IQ and SES. The interaction between ECF and a FH of substance dependence was also associated with aggressive behavior. CONCLUSIONS: The central finding of this investigation indicates that ECF and its interaction with a FH of substance dependence are associated with aggressive behavior. These results suggest that violence prevention and treatment efforts in high risk groups should incorporate cognitive habilitation focusing on training in ECFs.