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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.

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.

Parental supervision practices with adolescents are thought to be highly relevant to the development of alcohol use in adolescence.1 In early adolescence, adolescents have increasing and highly variable alcohol use. Using data from multiple surveys,2 meta-analyses indicated that the proportion of adolescents with any use in the past 30 days doubles from approximately 20% for eighth graders (i.e., age 13 ± 1 years) to approximately 40% 2 years later. Binge drinking in the past 2 weeks, defined as the consumption of five or more drinks on one occasion, was reported by approximately 12% of eighth graders and approximately 24% of 10th graders. Despite widespread preventive efforts, these estimates have remained stable in recent years.2 While heritable factors likely play some role, environmental influences are the predominant factor determining early adolescent alcohol use trajectories.3 For example, in a large adolescent sample (N = 3744) including monozygotic twins, dizygotic twins, biological siblings, and adoptive siblings, environmental effects accounted for significant variance in adolescent alcohol use while genetic factors did not.4 Parenting behaviors are typically cited as among the most important environmental influences on alcohol use during this age period.5 In community adolescent samples, more parental supervision has been associated with less alcohol involvement.6–8 Inadequate supervision has been shown to predict alcohol use disorders in community-recruited adolescents.9 The parental task of supervising an adolescent differs from the analogous task of supervising a younger child. For younger children, supervision necessarily involves direct observation. By contrast, direct parental observation plays a diminishing role in supervision over the course of adolescence.10 This less direct supervision that occurs during adolescence involves ongoing communication between parents and adolescents about the adolescents’ whereabouts, peers present, their schedule to return home, and contact information enabling parents to directly communicate with adolescents. Supervision of adolescents, by this definition, has been found to be comprised of a unidimensional construct that correlates with communication and emotional support and prospectively predicts alcohol use disorders.11 We note that some scholars refer to this form of supervision as parental monitoring, reserving the term supervision to direct observation.10 These terminologies essentially acknowledge that, in order for parental attempts to supervise an adolescent to be effective, active participation of the adolescent is necessary. Honest communication between the adolescent and parents is necessary for effective supervision to occur.12,13 Parents may have limited awareness or inaccurate assessments of their adolescent’s alcohol use. In a study including approximately 20,000 parent-adolescent dyads,14 mothers of adolescents in grades 7 through 12 showed a strong tendency to underestimate their adolescent’s alcohol use. The tendency of parents to underestimate their adolescent’s alcohol use has also been specifically documented in the early adolescent period.15 Among high school students who reported engaging in specific drinking behaviors over the previous 12 months, only approximately one third of parents were aware that these behaviors had occurred.16 Among adolescents with alcohol use disorders,17 parent interviews indicated that only 27% confirmed the diagnosis. These data clearly document that adolescents do not openly share information about their alcohol use with their parents. Adolescents engaged in alcohol use may actively subvert parents’ attempts to provide supervision. Psychological dysregulation may be a trait evident in childhood influencing parenting practices and predicting later alcohol use. Children with difficulties regulating behavior and emotions have been described as having a difficult temperament18 or psychological dysregulation.5 From infancy through adolescence, a child’s psychological dysregulation may interact with a parent’s personality characteristics to provoke or exacerbate problematic parenting behaviors.19,20 Children perceived as having a difficult temperament by their parents are more likely to be emotionally neglected,21 suggesting that some parents adapt to difficult children by disengagement. Childhood psychological dysregulation, operationalized as Neurobehavioral Disinhibition, has been shown to predict adolescent alcohol and drug involvement.22,23 In the context of the present research, these observations suggest that childhood psychological dysregulation may influence both parental supervision practices and the adolescent’s alcohol use. Parental supervision may be considered to have global as well as developmentally specific features. While parents may have general tendencies to be more or less involved in supervising their adolescents, the specific skills required for carrying out parental responsibilities change from late childhood through adolescence. Similarly, adolescents exhibit both a general propensity toward alcohol use and developmentally specific alcohol use behaviors. Recent developments in statistical modeling and related software facilitate the discrimination of these global and specific factors. Analogous to the state-trait model,24,25 a statistical model may be developed that considers global and developmentally specific characteristics as well as their interactions over time. Specifically, this approach allows the partitioning of a construct’s variance into a global factor that spans developmental states and developmental stage specific variability. We will call this the global-specific developmental model. In this model, alcohol use reported during a specific developmental stage is conceptualized as due to the influence of the global alcohol use factor, the previous alcohol use measurement (i.e., autoregressive carryover), stage-specific parental supervision, and unique sources of variation including measurement error.25 This method was expected to provide information about the relationship between parental supervision and adolescents’ alcohol use not typically evident in results using more conventional statistical approaches. In summary, the purpose of this study was to examine the interaction of parental supervision and offspring alcohol use from late childhood through middle adolescence. We hypothesized that higher supervision levels would correlate with lower alcohol use levels and that adolescents with higher levels of childhood psychological dysregulation and alcohol use would predict less effective parental supervision. In addition to taking childhood psychological dysregulation into consideration, the study uses a novel statistical modeling approach to distinguish effects of parental supervision and alcohol involvement that are global in nature from stage-specific effects within and across late childhood, early adolescence, and middle adolescence.

The role of spirituality and religiosity in neglect etiology is unknown. Further, the effects of these factors may be influenced by existing familial substance use disorder (SUD). This study examined the role of spirituality as conceptualized multidimensionally, in parental child neglect. A sample of 100 (40 SUD; 60 Control) intact families were given measures of spirituality, religiosity, and multiperspective measures of child neglect. Results demonstrated significant direct protective effects for both paternal and maternal neglect of several religious and spiritual dimensions. Interestingly, several other spirituality dimensions were significant risk factors for child neglect. Discussion of implications is included.

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.

We aimed at determining the association of both severity of paternal and maternal substance use disorder (SUD) and psychiatric disorders with paternal child neglect severity during late childhood. The sample comprised 146 intact SUD (n=71) and non SUD (n=75) families with a 10–12 year old female or male biological offspring. The average age of fathers, mothers, and children was 44 (SD=5.9), 42 (SD=4.78), and 11 (SD=.79) years, respectively. The ethnic composition was 85% Caucasian and 15% African American. The results showed that paternal and maternal SUD and psychiatric disorders severity was correlated with paternal child neglect severity. However, paternal psychopathology failed to achieve significance in the regression analyses. Severity of maternal, especially severity of antisocial personality disorder symptoms was associated with paternal child neglect. These results are discussed within the framework of evolutionary psychology research examining paternal investment in the offspring. Implications for the necessity of identifying parental psychopathology and an integrated treatment approach are discussed.

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.

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.

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.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.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).Cross-sectional and longitudinal analyses indicated that neurobehavioral disinhibition is a component of the liability to early age at onset of substance use disorder.

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.

SUMMARY Substance use is a complex phenomenon that changes during the natural history of consumption. Relevant parameters encompass age of initiation, type and amount of drug consumed per episode, and problems resulting from substance consumption. Comprehensive developmental assessment of substance involvement is thus a prerequisite for conducting rigorous research designed to advance understanding of the progression of substance use behavior to a substance use disorder (SUD). At the Center for Education and Drug Abuse Research, a protocol has been developed for detailed temporal assessment of substance involvement. This article describes the evaluation procedures. The diachronic assessment protocol described herein has yielded several important findings pertaining to substance use behavior and SUD.

SUMMARY Emerging evidence indicates that psychological dysregulation is an integral component of the liability for substance use disorder (SUD). To date, the measurement of dysregulation entails using a variety of disparate unstandardized instruments. This report discusses the rationale underlying the Dysregulation Inventory (DI), the methods employed in item selection and scale construction, and describes preliminary results regarding psychometric properties. Satisfactory to superior reliability and validity were observed for the self-report, teacher-report, and parent-report versions of the DI. The scores on the DI discriminate youth who are at high and low average risk for SUD ascertained on the basis of paternal SUD. Moreover, the score on the DI at age 10–12 was found to account for a significant proportion of the variance on substance use at age 12–14, thereby pointing to its predictive validity. In addition, the DI score covaried with SUD severity in a sample of female adolescents. These results in...

SUMMARY Paternal and maternal models of transmission of child neglect were tested separately in 10–12 year old offspring of men with a substance use disorder (SUD) and psychiatrically normal men (n = 156). The model hypothesizes that childhood neglect experienced by parents is related to their neglectful parenting moderated by psychological dysregulation in the child and by parental SUD. The paternal model was not confirmed. However, it was found that a history of childhood neglect in the mother was related to seventy of neglect of her offspring. Child dysregulation was independently related to neglect severity and also enhanced the magnitude of association between history of neglect experienced by the mother and the severity of her neglectful parenting. In addition, SUD in the mother directly correlated with severity of neglectful parenting. Maternal SUD also moderated the association between her history of childhood neglect and severity of neglectful parenting. The ramifications of these results for und...

Two child self-report scales were developed to measure parental neglect (emotional distance and parental involvement) in a sample of 344 boys between 10 and 12 years of age. Psychometric analyses of the parental emotional distance and involvement scales demonstrated their unidimensionality; construct, concurrent, and predictive validity; and reliability. Cross-sectional analyses indicated that neglect was more severe among boys who had a parent with a DSM-III-R lifetime substance use disorder (SUD) compared to youth whose parents had no Axis I psychiatric disorder. In addition, children reported more severe neglect by the mother than the father. Longitudinal analyses of a subsample (n = 99) revealed that child neglect at ages 10-12 predicted significant variance on a composite measure of substance use involvement and severity of substance use as well as increased the risk for SUD at age 19.

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.

The purpose of this study was to determine (1) whether adolescent females with a conduct disorder (CD) demonstrate inferior language skills and lower executive cognitive functioning (ECF) compared with controls and (2) whether the relations between language abilities and different forms of antisocial behavior (ASB) are mediated by ECF. Language skills were measured using the Test of Language Competence–Expanded, ECF was measured using multiple neuropsychological tests, and ASB was assessed using various self-report and psychiatric interview indices reflecting mild delinquency to severe violence. Subjects were 223 adolescent females with a CD and 97 normal controls ranging between 14 and 18 years of age (N = 320). The CD group demonstrated significantly poorer language skills and lower ECF compared with the controls. Moreover, even when controlling for chronological age and socioeconomic status, ECF still fully mediated the relations between language competence and each measure of ASB. The results are discussed in relation to a neurobehavioral model of ASB. Aggr. Behav. 26:359–375, 2000. © 2000 Wiley-Liss, Inc.

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).Subjects were 180 adolescent females with SUD and 87 normal controls (14-18 years of age).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.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.

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.

Objective Although several mental disorders have been shown to be common in adolescents with substance use disorders, prior studies have not specifically focused on alcohol dependence and have not had sufficient sample sizes to examine gender effects. This study contrasts mental disorder diagnoses and symptoms between a sample of adolescents with alcohol dependence and a community control sample of adolescents and incorporates gender analyses. Method Adolescents (aged 14 years 0 months to 18 years 0 months) with alcohol dependence (females: n = 55; males: n = 78) and community-dwelling control adolescents without substance use disorders (females: n = 44; males: n = 42) were assessed by means of a semistructured interview for DSM-III-R. Results While cannabis and hallucinogen use disorders were common in the alcohol dependence group, females and males had similar rates. Conduct disorder (CD), oppositional defiant disorder, attention-deficit hyperactivity disorder, major depression (MD), and posttraumatic stress disorder (PTSD) had significantly higher rates in the alcohol dependence group than in the community control group. Depression and PTSD symptoms were more strongly associated with alcohol dependence in females than in males. A configural frequency analysis showed that CD and MD tended to occur together in both female and male adolescents with alcohol dependence. Conclusions While alcohol-dependent females and males similarly exhibited more comorbid disorders than control adolescents, gender affects the relationships of alcohol dependence to MD and PTSD. Rather than reflecting distinct types, the comorbid disorders of CD and MD jointly characterize many adolescents with alcohol dependence.

Adolescent patients qualifying for a DSM-II-R diagnosis of alcohol use disorder were studied to determine whether a multidimensional schema could classify subjects into subgroups. The Drug Use Screening Inventory was administered to 151 subjects. To test the concurrent validity of the subtypes, subjects also received a structured diagnostic psychiatric evaluation along with measures of personality, academic achievement, and drinking behavior. Two clusters were identified for each gender. Differences between clusters were reflected primarily on indicators of severity of disorder. Young women were more inclined toward affective disturbances, whereas conduct disorder was the most frequent disorder in young men. This study underscores the heterogeneity of the adolescent population qualifying for a diagnosis of alcohol use disorder. The differential pattern of alcohol involvement and comorbid psychopathology within clusters and between genders demonstrates the need for interventions tailored to specific clinical presentation.

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.

We conducted this study with a sample of sons of fathers having a Psychoactive Substance Use Disorder (PSUD+, n = 55) and sons of fathers who did not qualify for a PSUD (PSUD-, n = 97). Parental discipline practice from the child's perspective was investigated in relation to the child's difficult temperament to determine their association with sons' externalizing and internalizing behavior problems reported by mothers. PSUD+ status, difficult temperament in the boys, and their ratings of parental discipline practices accounted for a significant proportion of variance with respect to their externalizing behavior (11%), but only PSUD+ status had a main effect on internalizing behavior. However, the main finding of this study was that the interaction of parental discipline and difficult temperament in the child moderated both externalizing and internalizing behavior problems, accounting for an additional 5% of an explained variance. Thus, this study illustrates the importance of the conjoint influence of children's temperament characteristics and parental discipline practices on the children's adjustment. These results support the findings from previous studies showing that a difficult temperament disposition places the child at risk for maltreatment by parents and for development of a disruptive behavior disorder. Both outcomes have been found in many investigations to presage alcohol and drug abuse in adolescence. The findings also underscore the importance of both individual and contextual variables for understanding the development of psychopathology. In this regard, the results show the need for prevention and treatment to encompass strategies directed at disaggregating the basis of maladaptive family interaction patterns.

Female adolescents (n = 40) and male adolescents (n = 42) with conjoint conduct disorder and substance abuse were compared to elucidate differential substance use and abuse patterns and to determine the probability and rate of transition from alcohol and drug use to a DSM-III-R diagnosis of abuse/dependence. It was found that young women were more likely to have experimented with nonprescription diet pills and caffeine. Young men, on the other hand, were more likely to have experimented with snuff or chewing tobacco. Women more frequently had a diagnosis of nicotine dependence and were at greater risk than men to qualify for that diagnosis. Women started drinking alcohol at a later age than men, although the age at which they qualified for a diagnosis of alcohol abuse/dependence did not differ. The interval between alcohol use and a diagnosis of alcohol abuse/dependence was shorter for women than men. Furthermore, compared to the men, the women exhibited a shorter interval between cannabis use and a diagn...

Psychometric reliability of the Drug Use Screening Inventory (DUSI) was examined in 191 adolescents who qualified for a DSM-III-R diagnosis of Psychoactive Substance Use Disorder. Internal, split-half and test-retest reliability was found to be superior. Caucasian subjects exhibited more severe substance use problems than African-American subjects but did not differ in any other domain. Females reported more severe disturbances than males on health status, psychiatric disorder, social competence, family system and leisure/recreation compared to males but were less severely disrupted in work adjustment. These results suggest that the DUSI may be useful for identifyign and quantifying substance use and related problems.

The authors examined both the nonspecific effects of psycho-pathology and the interactions of alcohol use disorders with other specific comorbid psychiatric conditions in an adolescent population on perceived self-efficacy to resist heavy drinking. The results suggest that nonspecific psychopathology, manifested in the form of any common psychiatric disorder, is associated with decreased situational confidence to resist heavy drinking across various situations. Main effects of alcohol use disorders, and several other specific psychiatric disorders, and specific comorbid interactions were also associated with decreased situational confidence. These results have implications for the etiology, prevention, and treatment of adolescents who abuse alcohol.

Platelet monoamine oxidase (MAO) activities were compared between female adolescent substance abusers and normal control females. No differences were observed on this biochemical trait. The two groups were discriminable on psychosocial, and behavioral adjustment, personality traits measuring aggression, self control, and stress reactivity, and on the temperament constellations of difficult temperament index, dysrythmicity, and difficult affective temperament. Platelet MAO activity was associated with difficult affective temperament only in the substance abuse group but not in the controls, suggesting that this temperament variant and lower MAO activities may comprise one form of predisposition to substance abuse.

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.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.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.The order of drug use initiation does not play a substantial role in the etiology of cannabis use disorder.

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.

Conduct disorder (CD) symptom counts in preadolescent boys, and antisocial personality disorder (ASP) and childhood conduct disorder symptom counts in their parents, were used as dimensional measures of behavioral deviation. A significant correlation was found for CD and ASP symptom counts between the two parents and between CD symptom counts of the children and parental CD and ASP symptom counts. Although socioeconomic level correlated negatively with parental symptom counts, no association was observed between parental socioeconomic status and children's CD symptom counts. Saliva cortisol level in the children was negatively associated with their CD symptom count and with their fathers' ASP count. Cortisol level was also lower among sons whose fathers had CD as children and subsequently developed ASP compared with the cortisol level in sons whose fathers either did not have any Axis I psychiatric disorder or did not develop ASP.

It is clear that alcohol abuse by adolescents rarely exists today without the concurrent use of other drugs. Little is known, however, about the extent and patterns of polydrug use in clinical samples of adolescent alcohol abusers. The present study examined patterns and correlates of polydrug use in 72 adolescents admitted to an inpatient treatment unit with a diagnosis of alcohol abuse. The degree of lifetime involvement with 10 different drug classes was assessed in a clinical interview. Ninety-six percent of subjects reported use of drugs other than alcohol, and there were substantial rates of use for most drug classes. Males and females did not differ in the percentage of subjects who used different drug classes or in severity of involvement ratings for these drug classes. The data suggest a consistent ordering of drug classes, such that the use of drug classes later in this order was rare in the absence of the use of drug classes earlier in the order. The data suggest that polydrug use characterizes the large majority of adolescent alcohol abusers, and that such use is often quite extensive. Implications for assessment and treatment are discussed.

The authors investigated the association between age at menarche and age at onset of substance use with frequency of alcohol consumption in mid-adolescence; age at first DSM-III-R diagnosis of psychoactive substance use disorder (PSUD); severity of physical health, substance use, and psychosocial problems; and psychiatric disorders in female adolescents. Twenty-eight PSUD female adolescents (age 14–18 years) were studied. Chronological age at first substance use, and not age at menarche, was associated with the four variables mentioned above. These findings indicate that substance use in this population is encompassed within significant psychiatric disturbance that most commonly precedes the onset of PSUD.

The authors investigated the association between age at menarche and age at onset of substance use with frequency of alcohol consumption in mid-adolescence; age at first DSM-III-R diagnosis of psychoactive substance use disorder (PSUD); severity of physical health, substance use, and psychosocial problems; and psychiatric disorders in female adolescents. Twenty-eight PSUD female adolescents (age 14-28 years) were studied. Chronological age at first substance use, and not age at menarche, was associated with the four variables mentioned above. These findings indicate that substance use in this population is encompassed within significant psychiatric disturbance that most commonly precedes the onset of PSUD.

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.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.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.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.Individual and contextual risk factors promoting substance abuse are more salient at a younger age in boys compared to girls.These results point to the need for earlier screening and intervention for boys.

Although psychiatric comorbidity is often observed among individuals in treatment facilities for alcoholism, the prevalence and pattern of psychiatric comorbidity among alcoholic cirrhotics has not been well characterized. The present study aimed first to compare the prevalence of psychiatric comorbidity in cirrhotic individuals with alcoholism ascertained from a gastroenterology service with alcoholics ascertained from a treatment facility for alcoholism. Consistent with the findings of other investigators, the data suggest that there is a great degree of variability regarding the severity of alcoholism in alcoholic cirrhotic individuals. Furthermore, cirrhotics with alcoholism exhibited a less severe clinical picture of alcoholism as measured by less alcohol dependence and lower prevalence of psychiatric comorbidity than individuals in treatment for alcoholism. The main conclusion of this study is that ascertainment source is an important determinant of psychiatric comorbidity observed in alcoholic samples.

The present study identified four types (Stable Behavioral Handicapped, Brighter and Reactive Late Starter, Early Frequent, and Serious Offender) and two higher order types (Fair Adaptive Functioning Late Starter and Under socialized Aggressive Early Starter). This typology may be useful to (1) identify those adolescents who are already violent delinquents and those who are at risk for becoming violent delinquents, (2) create effective matched treatment and prevention procedures, and (3) investigate etiologic mechanisms of criminal behavior.

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.

This study was aimed at implementing a multiaxial diagnostic system developed for violent delinquent adolescents (VDAs) on a sample of 100 subjects. The results revealed that the most prevalent psychiatric diagnoses were conduct disorder, substance use disorder, specific developmental disorders, and personality disorders. There was a high prevalence of severity of psychosocial stressors, levels of poor and very poor adaptive functioning, low IQ, mental illness and criminality in the family, and a high level of chronicity and severity of delinquency. Additionally, the axes with more informational richness were chronicity of delinquency (age at first offense, recidivism, and number of offenses) and diagnosis of conduct disorder, substance use disorders and specific developmental disorders.

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.

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.Two-hundred-sixty-three families including a 10-12 year-old son and both parents participated in the study.(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.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.

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.

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.

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.

In structured clinical interviews of 43 adolescents hospitalized for alcohol abuse or dependence, 17 subjects met criteria for an anxiety disorder, with social phobia (N = 9) and posttraumatic stress disorder (N = 7) most common. Of these 17 subjects, only four were identified in hospital records as having an anxiety disorder. In a comparison of 30 hospitalized adolescents with a matched control group of 30 adolescents from the community, the hospitalized adolescents had a higher rate of anxiety disorders, psychoactive substance use disorders, disruptive behavior disorders, and mood disorders.

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.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.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.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.

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).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.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.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.

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.