Early deviance and related risk factors in the children of narcotic addicts

After NAS

Mothers have used opioids for thousands of years but neonatal abstinence syndrome (NAS) or rather, survivors of NAS, is a modern phenomenon. Unrecognized and/or untreated opioid withdrawal was almost always fatal but with greater awareness and standardization of treatment, NAS is now an uncommon direct cause of infant death. However, opioids are now increasingly accessible and potent and the outcomes of children after the neonatal period are of great concern, especially when coupled with multiple other social and health risks. Complex individual, environmental and genetic factors need to be considered when assessing outcomes or future research for babies with NAS. Any intervention or research efforts must address these multifactorial complexities. This review will discuss pertinent post neonatal outcomes, including mortality, physical and mental health and social functioning of children with a history of NAS.

Affective dysregulation predicts incident nonmedical prescription analgesic use among college students

INTRODUCTION

This study investigated the relationship between four suspected risk factors-affective dysregulation, conduct problems, depressive symptoms, and psychological distress-and incident nonmedical prescription analgesic (NPA) use among college students.

METHODS

The sample was derived from 929 college students from a large, mid-Atlantic university who completed the third annual College Life Study assessment (Y₃) and were NPA use naïve at baseline (Y₁). A series of logistic regression analyses were conducted to evaluate the predictors of incident NPA use by Y₃. Separate models were developed to evaluate the association between the suspected risk factors and (a) NPA use relative to non-use of other drugs, including nonmedical use of other drug classes, (b) NPA use relative to other drug use, and (c) other drug use relative to non-use. All models included gender, parental education level, and race/ethnicity.

RESULTS

Affective dysregulation was significantly associated with becoming an incident NPA user relative to both drug users without NPA use as well as non-users, after statistically controlling for demographic characteristics and other factors. Conduct problems in early childhood were positively related to both incident NPA use and other drug use without NPA use relative to non-users, after statistically controlling for demographic characteristics and other factors. Depressive symptoms were associated with NPA incidence at the bivariate level only.

CONCLUSIONS

These findings extend previous research suggesting that NPA use might be related to deficits in regulating negative emotional states, and highlight possible markers for screening and intervention to prevent NPA use.

Trajectories of energy drink consumption and subsequent drug use during young adulthood

BACKGROUND

Highly caffeinated energy drinks (EDs) are popular with adolescents and young adults, but longitudinal consumption patterns are poorly understood especially in relation to other substance use.

METHODS

ED and other substance use were assessed annually (modal ages 21-25) among a sample (n=1099) who were originally recruited as first-year college students (modal age 18). Trajectory groups were derived based on probability of past-year use during ages 21-24, and compared for possible differences in substance use outcomes at age 25, holding constant demographics, sensation-seeking, other caffeine consumption, and age 21 substance use.

RESULTS

From age 21-25, ED consumption declined in both annual prevalence [62.5%wt to 49.1%wt (wt=weighted)] and frequency of use among consumers (35.2-26.3 days/year). Yet individuals exhibiting a Persistent trajectory (51.4%) of consumption outnumbered those with Non-Use (20.6%), Intermediate (17.4%), or Desisting (10.6%) trajectories. Age 25 cocaine use, nonmedical use of prescription stimulants (NPS), and alcohol use disorder (AUD) risk were significantly associated with trajectory group membership, with Persistent and Intermediate groups exhibiting the highest risk for such outcomes, even accounting for prior substance use and other risk factors. Neither marijuana nor tobacco use were associated with group membership.

CONCLUSIONS

The typical pattern of ED consumption among this sample was sustained use throughout young adulthood. Such individuals appear to be at high risk for adverse substance use outcomes, and results suggest possible specificity regarding cocaine use and NPS, and AUD risk. More research is needed to understand the mechanisms underlying the connection between ED and substance use.

Mechanisms of Association Between Paternal Alcoholism and Abuse of Alcohol and Other Illicit Drugs Among Adolescents

The current study examines the effect of paternal alcohol problems on adolescent use of alcohol and other illicit drugs as a function of maternal communication, as well as adolescent social and coping skills (N = 145). Structural equation modeling (SEM) analyses indicated that adolescents with a paternal history of alcohol problems reported higher levels of problematic communication with their mothers than did adolescents with fathers who were light drinkers or who were non-drinkers. Moreover, problematic maternal communication functioned as a partial mediator for both adolescent negative social skills and self-blame coping skills. Adolescents who reported using self-blame coping skills more frequently also tended to use alcohol more frequently. Findings suggest that these high-risk adolescents might need more intensive and targeted social and psychological services in their schools and communities.

Discontinuous college enrollment: associations with substance use and mental health

OBJECTIVE

This study examined the prospective relationship of substance use and mental health problems with risk of discontinuous enrollment in college.

METHODS

Participants were 1,145 students at a large public university who were interviewed annually for four years beginning at college entry in 2004 (year 1). Discontinuous enrollment was defined as a gap in enrollment of one or more semesters during the first two years (early discontinuity) or the second two years (late discontinuity) versus continuous enrollment throughout all four years. Explanatory variables measured in year 1 were scores on the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory, childhood conduct problems, cannabis use, number of illicit drugs used, and alcohol consumption. In years 3 and 4, participants reported lifetime history of clinically diagnosed attention-deficit hyperactivity disorder, depression, and anxiety, including age at diagnosis. Multinomial logistic regression models were developed to evaluate the association between the independent variables and discontinuous enrollment while holding constant background characteristics.

RESULTS

Higher BDI scores predicted early discontinuity but not late discontinuity, whereas cannabis and alcohol use predicted only late discontinuity. Receiving a depression diagnosis during college was associated with both early and late discontinuity. Self-reported precollege diagnoses were not related to discontinuous enrollment once background characteristics were taken into account.

CONCLUSIONS

Students who experience depressive symptoms or seek treatment for depression during college might be at risk of interruptions in their college enrollment. Cannabis use and heavy drinking appear to add to this risk. Students entering college with preexisting psychiatric diagnoses are not necessarily at risk of enrollment interruptions.

Drug use patterns in young adulthood and post-college employment

BACKGROUND

The relationship between serious drug involvement and risk for unemployment is well recognized, but few studies have prospectively examined this relationship among college students. This study used longitudinal data to examine the association between drug use patterns during college and the likelihood of employment post-college, holding constant sociodemographic variables and personality characteristics. Second, we estimate the prevalence of alcohol and other drug use disorders among employed individuals.

METHODS

Data were derived from the College Life Study. Participants entered college as traditional students and were assessed annually for six years, regardless of continued college attendance. Analyses were restricted to 620 individuals no longer enrolled in school by Year 6.

RESULTS

Using multinomial regression modeling, persistent drug users (i.e., used illicit drugs (other than marijuana) and/or nonmedical prescription drugs every year they were assessed during the first four years of study) were significantly more likely than non-users to be unemployed vs. employed full-time post-college. Persistent drug users and infrequent marijuana users were also more likely than non-users to be unemployed vs. employed part-time. In Year 6, 13.2% of individuals employed full-time and 23.7% of individuals employed part-time met DSM-IV criteria for drug abuse or dependence during the past year.

CONCLUSIONS

If confirmed, the results of this study suggest that persistent drug use among academically achieving young adults might increase risk for post-college unemployment. More research is needed to understand the processes underlying this association. Further attention should be directed at managing substance use problems among recent college graduates who have secured employment.

Longitudinal predictors of past-year non-suicidal self-injury and motives among college students

BACKGROUND

Non-suicidal self-injury (NSSI) is the deliberate and direct injuring of body tissue without suicidal intent for purposes not socially sanctioned. Few studies have examined the correlates of NSSI among young adults. This study aimed to identify predictors of lifetime and past-year NSSI, and describe motives for NSSI and disclosure of NSSI to others.

METHOD

Interviews were conducted annually with 1081 students enrolled in the College Life Study, a prospective longitudinal study conducted at a large public mid-Atlantic university. NSSI characteristics were assessed at Year 4. Demographic and predictor variables were assessed during Years 1 to 4. Multivariate logistic regression models were used to identify correlates of lifetime NSSI and predictors of past-year NSSI.

RESULTS

The prevalence of past-year and lifetime NSSI was 2% and 7% respectively (>70% were female for both lifetime and past-year NSSI). Seven percent of NSSI cases self-injured once, whereas almost half self-injured six or more times. Independent predictors of past-year NSSI were maternal depression, non-heterosexual orientation, affective dysregulation and depression. Independent predictors of lifetime NSSI were depression, non-heterosexual orientation, paternal depression and female sex. One in six participants with NSSI had attempted suicide by young adulthood. The three most commonly reported motives for NSSI were mental distress, coping and situational stressors. Most (89%) told someone about their NSSI, most commonly a friend (68%).

CONCLUSIONS

This study identified unique predictors of NSSI, which should help to elucidate its etiology and has implications for early identification and interventions.

The association between early conduct problems and early marijuana use in college students

Early conduct problems have been linked to early marijuana use in adolescence. The present study examines this association in a sample of 1,076 college students that was divided into three groups: 1) early marijuana users (began marijuana use prior to age 15; n=126), 2) late marijuana users (began marijuana use at or after age 15; n=607), and 3) non-users (never used marijuana; n=343). A conduct problem inventory used in previous studies was adapted for use in the present study. Early conduct problems were associated with early marijuana use but not with late marijuana use, holding constant other risk factors. Results suggest that early conduct problems are a risk factor for early marijuana use even among academically-achieving college-bound students.

A longitudinal study of sexual risk behavior among the adolescent children of HIV-positive and HIV-negative drug-abusing fathers

PURPOSE

This is a longitudinal study of the precursors of sexual risk behavior among a cohort of adolescent children of HIV-positive and HIV-negative drug-abusing or drug-dependent fathers.

METHODS

Individual structured interviews were administered to 296 drug-abusing or drug-dependent fathers, 43% of whom were HIV positive, and an adolescent child of each father (mean age = 16.3 years; SD = 2.8). Adolescents were reinterviewed approximately 1 year later, at Time 2.

RESULTS

Structural equation modeling showed multiple direct and indirect pathways from psychosocial factors to adolescent sexual risk behavior (sexually active, number of sexual partners, and frequency of condom use). Greater paternal drug addiction and infection with HIV/AIDS, and the youth's perception of environmental hostility (discrimination and victimization), were both related to increased adolescent maladjustment and substance use. Greater paternal drug addiction and infection with HIV/AIDS also were associated with a weaker father-child mutual attachment, which was linked with increased adolescent maladjustment and substance use. Greater perceived environmental hostility (discrimination and victimization), a weak father-child relationship, and greater adolescent maladjustment and substance use had direct pathways to adolescent sexual risk behavior.

CONCLUSIONS

Findings suggest complex interrelationships among paternal, environmental, social, personal, and substance use factors as longitudinal predictors of sexual risk behavior in children whose fathers abuse or are dependent upon drugs. The importance of perceived environmental hostility, the father-child relationship, and adolescent maladjustment and substance use may have implications for public policy as well as prevention and treatment programs.

Neurobiological processes in adolescent addictive disorders

The purpose of this review is to summarize the neurobiological factors involved in the etiology of adolescent addiction and present evidence implicating various mechanisms in its development. Adolescents are at heightened risk for experimentation with substances, and early experimentation is associated with higher rates of SUD in adulthood. Both normative (e.g., immature frontal-limbic connections, immature frontal lobe development) and non-normative (e.g., lowered serotonergic function, abnormal hypothalamic-pituitary-adrenal axis function) neurobiological developmental factors can predispose adolescents to a heightened risk for SUD. In addition, a normative imbalance in the adolescent neurobiological motivational system may be caused by the relative underdevelopment of suppressive mechanisms when compared to stimulatory systems. These neurobiological liabilities may correspond to neurobehavioral impairments in decision-making, affiliation with deviant peers and externalizing behavior; these and other cognitive and behavioral traits converge with neurobiological factors to increase SUD risk. The progression to SUD acts as an amplifying feedback loop, where the development of SUD results in reciprocal impairments in neurobehavioral and neurobiological processes. A clearer understanding of adolescent neurobiology is a necessary step in the development of prevention and treatment interventions for adolescent SUD.

Paternal, perceived maternal, and youth risk factors as predictors of youth stage of substance use a longitudinal study

This longitudinal study examined paternal, perceived maternal, and youth risk factors at Time 1 (T1) (e.g., substance use, violent victimization, parental rules) as predictors of the stage of substance use in the adolescent child at Time 2 (T2). Participants (N = 296) consisted of drug-abusing fathers and one of their adolescent children, aged 12 to 20 years. Fathers and youths were each administered structured interviews separately and in private. Adolescents were re-interviewed approximately one year later. Pearson correlation analyses showed that the paternal, perceived maternal, and youth risk factors were significantly related to adolescent stage of substance use at T2. With an increase in risk factors, there was an increase in T2 stage of substance use in the child. Findings imply that father-oriented treatment programs should focus on how paternal behaviors, such as illegal drug use, inadequate parenting skills, and a poor father-child relationship contribute to youth problem behaviors, including alcohol, tobacco, and illicit drug use.

Do male and female adolescents differ in the effect of individual and family characteristics on their use of psychotropic drugs?

This study assesses the effects of individual and family characteristics on psychotropic drug use among male and female adolescents. The sample included 2,396 subjects attending two middle schools and two high schools. Respondents completed self-administered questionnaires covering gender, age, body mass index, smoking, alcohol use, illicit drug use, tiredness during the daytime, self-reported personality traits, family conditions, and psychotropic drug use. The data were analyzed using logistic models. The prevalence of frequent psychotropic drug use (for headache, tiredness, nervousness, anxiety, insomnia) was 43.0% overall; twice as high among girls than boys. Among the girls, frequent psychotropic drug use was associated with frequent tiredness during the daytime (adjusted odds ratio OR 2.03, 95% CI 1.61-2.57), smoking (2.02, 1.50-2.71), alcohol use (1.34, 1.04-1.74), higher body mass index (>18 kg/m(2), 1.54, 1.16-2.04), poor family atmosphere (1.33, 1.03-1.72), and being worried (1.93, 1.53-2.43) or easily becoming irritable (1.28, 1.01-1.62). In boys the factors with significant ORs were frequent tiredness during the daytime (2.21, 1.67-2.93), alcohol use (1.52, 1.15-2.01), and being worried (1.70, 1.28-2.26) or easily becoming irritable (1.42, 1.06-1.89); univariate analysis revealed a significant relationship with smoking and family atmosphere. An association was also observed for illicit drugs in both sexes and for age > or = 17 years in girls. Individual and family characteristics have marked influence on psychotropic drug use among both male and female adolescents. Preventive measures should be taken to make adolescents and their parents more aware of the risks and to improve their living conditions.

Aggressive behaviors in the adolescent children of HIV-positive and HIV-negative drug-abusing fathers

This study examined aggressive behaviors in the adolescent children of HIV-positive and HIV-negative drug-abusing fathers. Data were collected via individual structured interviews of low-income, predominantly African American and Hispanic, father-child dyads (N = 415). Structural Equation Modeling was used to assess the interrelationship of several latent constructs with respect to adolescent aggression. Results showed a mediational model linking paternal attributes (including HIV status) and ecological factors with the father-child relationship, which impacted peer influences and the adolescent's vulnerable personality, which was the most proximal construct to aggressive behaviors. Ecological factors were also mediated by peer influences and directly linked with adolescent aggression.

Cigarette smoking in the adolescent children of drug-abusing fathers

OBJECTIVE

This study examined the longitudinal predictors of cigarette smoking in a sample of at-risk adolescents whose fathers were drug abusers (N = 296).

METHODS

At time 1, structured interviews were administered, separately and in private, to male and female youth (X age = 16.3) and their fathers; adolescents were reinterviewed approximately 1 year later (at time 2). Structural equation modeling was used to examine the interrelationship of time 1 paternal tobacco and illicit drug use, father-child relations, adolescent psychological adjustment, and peer group factors and adolescent smoking at time 2. A supplementary analysis assessed the same model with control on the adolescent's age, gender, frequency of contact with the father, and the father's treatment status.

RESULTS

The structural equation model showed a mediational pathway linking paternal tobacco and drug use to a weak and conflictual father-child relationship, which was associated with greater adolescent maladjustment, which in turn was related to deviant peer affiliations, which predicted adolescent smoking at time 2. There was also a direct path from paternal tobacco and drug use to adolescent time 2 smoking. The supplementary analysis found no significant differences between the models with and without control.

CONCLUSIONS

Findings provide evidence of the mechanisms that underlie the association between paternal drug use characteristics and smoking in the adolescent child. Clinical implications suggest the importance of the father-child relationship to smoking prevention programs for at-risk youth.

Developmental antecedents of late adolescence substance use patterns

This longitudinal study examined antecedents of substance use behavior among 176 (53% male) adolescents. Adolescents were classified as (a) abstainers (n = 19), (b) experimenters (n = 65), (c) at-risk youth (n = 63), and (d) abusers (n = 29) based on their reported substance use behavior at age 17.5. Parental behavior, peer competence, and problem behavior, measured from early childhood through age 16, were examined as predictors of substance use patterns. Multinomial logistic regression models revealed that early maternal hostility, externalizing behavior problems in first grade and at age 16, internalizing behavior in first grade and at age 16, and parental monitoring at age 16 significantly differentiated substance use groups. The study provides evidence that experiences occurring early in development, in addition to those that occur later in development, can play a pivotal role in setting the stage for late adolescent substance use behavior.

The impact of parental problem drug use on children: what is the problem and what can be done to help?

AIM

To review the literature on the impact of parental problem drug use on children, and indicate the efficacy of key evaluated interventions to reduce the impact of parental drug use on children.

METHODS

Comprehensive narrative review of English language published research and intervention spanning the last three decades identified through searching library databases and citation.

FINDINGS

Problem drug use can impede parenting and the provision of a nurturing environment. Although small-scale, localized and resource-intensive these key evaluated interventions show cautious optimism that problem drug-using parents can reduce drug use and achieve better family management. Children have rarely been directly the focus of intervention.

CONCLUSIONS

Wider application and more rigorous evaluation of interventions in this area are needed. Given the scale of the problem it is important to establish how statutory services can apply the lessons of these more localized interventions.

Alcohol use in adolescents whose fathers abuse drugs

This study examined the interrelation of several domains, including father attributes, father-child relations, peer influences, environmental factors, and youth personality, as they related to adolescent alcohol use. Several aspects of the father-child relationship were also examined as possible protective factors against adolescent drinking. Subjects consisted of 204 HIV-positive and HIV-negative drug-abusing fathers and their adolescent children between the ages of 12-20. Data were collected via individual structured interviews of both the fathers and the youth. Results indicated that several items from each domain were related to adolescent drinking, and that an affectionate father-child bond had a protective effect. Moreover, hierarchical regression analyses demonstrated that the youth's personality mediated between all other domains and adolescent alcohol use. There was also a direct effect of peer influences on adolescent drinking. Findings extend the literature on the specific mechanisms which link parental substance use with adolescent alcohol use in a high-risk population.

Parent figure transitions and delinquency and drug use among early adolescent children of substance abusers

Children of substance abusing parents have an elevated risk for experiencing disruptions in household composition and for engaging in problem behaviors. This study investigated whether multiple parent figure transitions predicted the likelihood of delinquency and drug use among a sample of early adolescents with parents receiving methadone treatment for opiate addiction. Controlling for baseline delinquency, child characteristics, family conflict, parental depression, and parent criminal history, a greater number of parenting disruptions during the longitudinal study period was associated with a higher probability of delinquent behavior. Gender moderated the effect of parent figure transitions in a parallel analysis for drug use. After accounting for baseline drug use and potentially confounding factors, only adolescent females had a higher likelihood of drug use as the number of family disruptions increased. In contrast, age was strongly associated with drug use for males. A subgroup of youths who experienced tremendous family instability and had no single consistent parent figure during the study period were at extreme risk for delinquent behavior. The findings are interpreted in terms of cumulative stress resulting from multiple parenting disruptions over time and differential influences on the expression of problem behaviors depending on gender.

Attachment and family therapy: clinical utility of adolescent-family attachment research

The divide separating research and clinical work is narrowing. New therapies have been informed by research from specialties such as developmental psychology and developmental psychopathology. In this article, we attempt to illustrate the usefulness of research on attachment relations for family-based therapy with adolescents. We examine the clinical utility of adolescent attachment research within the context of multidimensional family therapy, an empirically supported treatment model that has incorporated developmental research, including basic research on attachment, in its assessment and intervention framework.

Drugs--not here!--model of group intervention as preventative therapeutic tool for children of drug addicts

Children of addicts suffer from emotional, cognitive, social, and behavioral problems. In view of the problems the children face, they are undoubtedly "a population at risk," in need of preventive and therapeutic intervention. The purpose of this article is to describe a model of group intervention as one of the preventive therapeutic tools for children of addicts. The project was conducted over 18 months of weekly meetings. The article will deal with the characteristics of children of addicts, the group intervention model with reference to the group framework, and the work carried out with the group, as well as its evaluation. The evaluation indicated positive effects on several psychosocial variables.