Loosening the Grip: a handbook of Alcohol Information 9th


Chapter 11 Special Populations



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Chapter 11 Special Populations

Adolescents

Addiction 99(Supplement 2): entire issue, 2004.
This entire issue is devoted to adolescent substance abuse treatment with a review of research on epidemiology, treatment approaches, and treatment outcome.

Allen M, Donohue WA, Griffin A, Ryan D, Turner MMM. Comparing the influence of parents and peers on the choice to use drugs: A meta-analytic summary of the literature (review). Criminal Justice and Behavior 30(2): 163–186, 2003. (122 refs.)


This literature summary, using meta-analysis, compares the influence of parents versus peers on substance use. The data indicated that the average relationship for peer effects on substance use was larger than the effect for parental influence. Several moderating influences (such as youth age and type of substance) are considered. The findings indicate that the relative size of parental and peer influence varies with the age of the adolescent and the type of substance. The results indicate that both parents and peers influence decisions about substance use. Future educational interventions concerning substance use should consider how best to combine these two sources of influence. (Copyright 2003, American Association of Correctional Psychologists)

American Academy of Pediatrics, Substance Abuse Committee. Indication for management and referral of patients involved in substance abuse. Pediatrics 106(1): 143–146, 2000. (18 refs.)


This statement addresses the challenge of evaluating and managing the various stages of substance use by children and adolescents in the context of pediatric practice. Approaches are suggested that would assist the pediatrician in differentiating highly prevalent experimental and occasional use from more severe use with adverse consequences that affect emotional, behavioral, educational, or physical health. Comorbid psychiatric conditions are common and should be evaluated and treated simultaneously by child and adolescent mental health specialists. Guidelines for referral based on severity of involvement using established patient treatment-matching criteria are outlined. Pediatricians need to become familiar with treatment professionals and facilities in their communities and to ensure that treatment for adolescent patients is appropriate based on their developmental, psychosocial, medical, and mental health needs. The family should be encouraged to participate actively in the treatment process. Copyright 2000, American Academy of Pediatrics
NB. full-text available via Hirewire.

American Journal on Addictions, 15(Supplement 1): entire issue, 2006.
This special issue deals with advances in the assessment and treatment of adolescent substance use disorders.

Andrews JA, Tildesley E, Hops H, Duncan SC, Severson HH. Elementary school age children’s future intentions and use of substances. Journal of Clinical Child and Adolescent Psychology 32(4): 556–567, 2004. (44 refs)


This study describes the lifetime prevalence and future intentions related to trying cigarettes, chewing tobacco, alcohol, marijuana, and inhalants of students in the 1st through 7th grade. This article also describes the identification of these substances by children in the 1st through 3rd grade. Participants were 1,075 1st through 5th graders within a school district in western Oregon who were followed for 3 years. Across most substances, prevalence and intentions increased with grade, with a moderate increase between 3rd and 4th grade and a larger increase between 5th and 6th grade. Boys were more likely than girls to identify alcohol and cigarettes and were more likely than girls to report trying chewing tobacco. In addition, 3rd-grade boys were more likely to identify marijuana and, in the early grades, alcohol. Boys were also more likely than girls to intend to use tobacco and drink alcohol when older. For alcohol and cigarettes, intention was related to subsequent trying of the substance, suggesting that intention may be an early warning sign of subsequent substance use. (Copyright 2004, Lawrence Erlbaum Associates)

Aung AT, Hichman NJ, Moolchan ET. Health and performance related reasons for wanting to quit: Gender differences among teen smokers. Substance Use & Misuse 38(8): 1095–1107, 2003. (28 refs.)


Adolescents frequently state health as a broad-ranging reason for wanting to quit smoking. Much less is known regarding performance-related reasons. We hypothesized that more male than female smokers want to quit for performance-related reasons (e.g., to improve athletic performance). As part of a telephone screen to determine eligibility for participation in a cessation trial in Baltimore, Maryland, 1999-2001, 509 teenage smokers [mean age 15.78 +/- 1.65 years (range 11-21), 60.9% female, 32.6% African-American] were asked the open-ended question: "Why do you want to quit?" Responses were subsequently grouped into categories that included health, performance, cost, social influences, setting an example for others, self-efficacy, cosmetics, no perceived positive reinforcement, or unknown reasons. Health was the most commonly stated primary and overall reason for wanting to quit among both boys and girls. Sixty-five percent of teen smokers endorsing health reasons were girls, and 51% of those endorsing performance-related reasons were boys (chi(2)(2) = 7.78, p = 0.02). Recognizing the greater concern for performance-related issues among boys is important for designing and engaging young smokers into cessation interventions. Copyright 2003, Marcel Dekker

Bachman JG, Safron DJ, Sy SR, Schulenberg JE. Wishing to work: New perspectives on how adolescents’ part-time work intensity is linked to educational disengagement, substance use, and other problem behaviours. International Journal of Behavioral Development 27(4): 301–315, 2003. (77 refs.)


This study examines interrelations among students' educational engagement, desired and actual school-year employment, substance use, and other problem behaviours. Cross-sectional findings from representative samples of 8th-, 10th-, and 12th-grade students in the United States, totalling over 300,000 respondents surveyed during the years 1992-1998, include the following: Large majorities of adolescents wish to work part-time during the school year, although most in earlier grades are not actually employed. Those who desire to work long hours tend to have low grades and low college aspirations; they are also more likely than average to use cigarettes, alcohol, and marijuana. Students' preferences for part-time work emerge at younger ages (i.e., earlier grades) than actual work, and the preferences show equal or stronger correlations with educational disengagement and problem behaviours. (Copyright 2003, Psychology Press)

Balch GI, Tworek C, Barker DC, Sasso B, Mermelstein RJ, Giovino GA. Opportunities for youth smoking cessation: Findings from a national focus group study. Nicotine & Tobacco Research 6(1): 9018, 2004. (33 refs.)


To, identify opportunities for smoking cessation among adolescents, we conducted six computer-assisted telephone focus groups with 48 male and female high school student smokers and former smokers from six states across the United States, all aged 15-17 years, in two groups each of "established smokers," "late experimenters," and "quitters." These adolescents considered addiction to cigarettes real, powerful, stealthy, insidious, harmful, and avoidable. They considered quitting smoking achievable and desirable. Many of the established smokers and some experimenters would not consider quitting until an indefinite future, when they expected adult responsibilities to help them quit. Quitters had been encouraged by friends who did not smoke around them or offer them cigarettes; they also associated more with nonsmoking friends. Some adolescents, especially quitters, reported that parents had tried to help them quit; some smokers reported,that parents had provided them with cigarettes. Some adolescents reported school rules and enforcement that made it hard to smoke; others reported school rules and enforcement that made it easy and tempting to smoke. These adolescents were not aware of the availability of professional help or interested in it. Many did not consider smoking urgent or "intense" enough for professional help. Perceptions of cessation programs were nonexistent or negative. Participants were aware of nicotine replacement therapies but less so of prescription medications. These findings suggest that it is critical to educate adolescents about what good cessation programming is and is not, why it is needed, how it might help, and where it is offered. (Copyright 2004, Carfax Publishing Ltd.)

Barkley RA, Fischer M, Smallish L, Fletcher K. Does the treatment of attention-deficit/hyperactivity disorder with stimulants contribute to drug use/abuse? A 13-year prospective study. Pediatrics 111(1): 97–109, 2003. (74 refs.)


Objective. To examine the impact of stimulant treatment during childhood and high school on risk for substance use, dependence, and abuse by young adulthood. Methods. A total of 147 clinic-referred hyperactive children were followed approximately 13 years into adulthood (mean: 21 years old; range: 19-25). At adolescent (age 15) and adult follow-up, probands were interviewed about their use of various substances and duration of stimulant treatment. Results. Duration of stimulant treatment was not significantly associated with frequency of any form of drug use by young adulthood. Stimulant-treated children had no greater risk of ever trying drugs by adolescence or any significantly greater frequency of drug use by young adulthood. Stimulant treatment in high school also did not influence drug use in adulthood except for greater use of cocaine. This difference was no longer significant after controlling for severity of attention-deficit/hyperactivity disorder and conduct disorder in childhood, adolescence, and adulthood. Stimulant treatment in either childhood or high school was not associated with any greater risk for any formal Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised drug dependence or abuse disorders by adulthood. Treatment with stimulants did not increase the risk of ever having tried most illegal substances by adulthood except for cocaine. Subsequent analyses showed that this elevated risk was primarily mediated by severity of conduct disorder by young adulthood and not by stimulant treatment in childhood. Conclusion. This study concurs with 11 previous studies in finding no compelling evidence that stimulant treatment of children with attention-deficit/hyperactivity disorder leads to an increased risk for substance experimentation, use, dependence, or abuse by adulthood. (Copyright 2003, American Academy of Pediatrics)

Chinet L, Broers B, Humair JP, Narring F. Youth smoking cessation: An update for primary care physicians. Substance Use & Misuse 41(9): 1251–1261, 2006. (60 refs.)


Tobacco use is a major public health problem, and onset usually begins in youth. This article reviews current knowledge and evidence of specific aspects of smoking in youth, tobacco control strategies, and smoking cessation interventions that target young people. Finally, it provides recommendations for primary care physicians. (Copyright 2006, Taylor & Francis)

Calfee R, Fadale P. Popular ergogenic drugs and supplements in young athletes (review). Pediatrics 117(3): E577–E589, 2006. (102 refs.)


Ergogenic drugs are substances that are used to enhance athletic performance. These drugs include illicit substances as well as compounds that are marketed as nutritional supplements. Many such drugs have been used widely by professional and elite athletes for several decades. However, in recent years, research indicates that younger athletes are increasingly experimenting with these drugs to improve both appearance and athletic abilities. Ergogenic drugs that are commonly used by youths today include anabolic-androgenic steroids, steroid precursors (androstenedione and dehydroepiandrosterone), growth hormone, creatine, and ephedra alkaloids. Reviewing the literature to date, it is clear that children are exposed to these substances at younger ages than in years past, with use starting as early as middle school. Anabolic steroids and creatine do offer potential gains in body mass and strength but risk adverse effects to multiple organ systems. Steroid precursors, growth hormone, and ephedra alkaloids have not been proven to enhance any athletic measures, whereas they do impart many risks to their users. To combat this drug abuse, there have been recent changes in the legal status of several substances, changes in the rules of youth athletics including drug testing of high school students, and educational initiatives designed for the young athlete. This article summarizes the current literature regarding these ergogenic substances and details their use, effects, risks, and legal standing. (Copyright 2006, American Academy of Pediatrics)

Clark DB. The natural history of adolescent alcohol use disorders. Addiction 99(Supplement 2): 5–22, 2004. (190 refs.)


Aim: To examine clinically relevant research on the development, course and outcomes of adolescence alcohol use disorders (AUDs). Methods: Observational studies with adolescent samples were selected for inclusion based on systematic assessment of AUDs and clinical relevance. The literature was searched using Medline and Psychinfo. Articles on childhood predictors, characteristics, course, complications and adult outcomes of adolescent AUDs were reviewed. Results: The developmental trajectory toward adolescent AUDs begins with the emergence of childhood mental disorders. These problems are transmitted from parent to child in a developmentally specific fashion, reflect psychological dysregulation dimensions and predict adolescent AUDs. While most DSM-IV AUD diagnostic criterion items are valid for adolescents, tolerance and impaired control items are problematic, and some adolescents with significant alcohol problems are not identified by this diagnostic system. Understanding the psychosocial and biomedical complications that accompany AUDs requires attention to factors other than alcohol involvement itself, including childhood maltreatment and comorbid psychopathology. While some adolescents with AUDs manifest chronic alcohol dependence in adulthood, a substantial proportion overcome alcohol problems and transition to abstinence or normative drinking. Conclusions: Developmentally specific phenotypic characteristics define the natural history of adolescent AUDs, inform clinical assessment and provide the developmental context for treatment research. While alcohol consumption may be the primary treatment focus, other important consequences, comorbidities and complications need to be addressed for successful developmental outcomes to result. (Copyright 2004, Society for the Study of Addiction to Alcohol and Other Drugs)

D’Amico EJ, McCarthy DA. Escalation and initiation of younger adolescents’ substance use: The impact of perceived peer use. Journal of Adolescent Health 39(4): 481–487, 2006. (39 refs.)


Purpose: The middle school years are peak years for substance use initiation. The current study assessed the impact of peer influence on both initiation and escalation of cigarette, alcohol, and marijuana use among sixth, seventh, and eighth graders. Methods: Youth (n = 974; 45% male) were surveyed twice over an academic year and reported on their personal substance use and their perception of peer substance use. The sample ranged in age from 10 to 15 years at Time 1 (M age = 11.95) and was 44% White, 26% Latino, 7% Asian American/Pacific Islander, 4% African American, and 14% mixed ethnic origin. Results: Hierarchical regressions examined whether personal and perceived peer substance use predicted later substance involvement, and logistic regressions assessed whether Time 1 perceived peer and personal use of other substances discriminated between initiates and noninitiates. After controlling for personal substance use, perceived peer alcohol use predicted both increased alcohol and marijuana use, and perceived peer marijuana use predicted increased alcohol use. Only perceived peer alcohol use was associated with initiation of alcohol, and both perceived peer alcohol and marijuana use predicted onset of marijuana use. Conclusions: Results highlight the importance of perceived peer use in predicting both onset and escalation of use and suggest utilizing a multifaceted prevention approach that targets multiple substances. (Copyright 2006, Society for Adolescent Medicine)

Deas D. Adolescent substance abuse and psychiatric comorbidities. Journal of Clinical Psychiatry 67(Supplement 7): 18–23, 2006. (32 refs.)


Substance use disorders have a serious impact on adolescents because these disorders have high prevalence rates and frequent associations with psychiatric disorders. Surveys of adolescent behaviors and substance use show that alcohol is the most common substance abused by adolescents. Despite the high rates of current alcohol use and binge drinking among adolescents, current diagnostic criteria are problematic. Adolescents may have a developing problem with substance dependence but not meet criteria for either substance abuse or dependence. At-risk adolescents, called "diagnostic orphans," may meet only 1 or 2 criteria for alcohol dependence and no abuse criteria and therefore do not receive an alcohol use disorder diagnosis from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Adolescents with substance use disorders tend to have higher rates of comorbid psychiatric disorders and are more likely to report a history of trauma and physical and/or sexual abuse than adolescents without a substance use disorder. In addition, psychiatric disorders in adolescents often predate the substance use disorder. Once the substance use disorder develops, the psychiatric disorder may be further exacerbated. (Copyright 2006, Physicians Postgraduate Press)

Deas D, Thomas SE. An overview of controlled studies of adolescent substance abuse treatment. American Journal on Addictions 10(2): 178–189, 2001. (50 refs.)


Although several treatments for adolescents with substance use disorders are available, there are few well-controlled studies in the extant literature that compare these treatments for efficacy. This paper provides an overview of controlled treatment studies for adolescents with substance use disorders. It focuses specifically on five main treatment modalities: family-based and multi-systemic interventions, behavioral therapy, cognitive behavioral therapy, pharmacotherapy, and twelve step approaches. Examples of adolescent-specific standardized assessment instruments are also provided, the inclusion of which may improve future treatment comparison studies. While the results look especially promising for cognitive behavioral therapy and family-based/multi-systemic therapies for adolescents with SUDs, most of the relevant studies fail to utilize validated outcome measures, making it difficult to conclude that one treatment approach is more effective than another. Copyright 2001, American Academy of Psychiatrists in Alcoholism and Addictions

Fisher SL, Bucholz KK, Reich W, Fox L, Kuperman S, Kramer J, et al. Teenagers are right: Parents do not know much. An analysis of adolescent-parent agreement on reports of adolescent substance use, abuse, and dependence. Alcoholism: Clinical and Experimental Research 30(10): 1699–1710, 2006. (38 refs.)


Background: Previous studies have shown that when assessing child psychopathology, parents tend to report more symptoms than children for externalizing disorders such as attention deficit hyperactivity disorder (ADHD), whereas children tend to report more symptoms for internalizing disorders such as major depression. Whether for clinical or research purposes, parents are also frequently asked to report on their children's experiences with alcohol and drugs. The purpose of this study was to analyze correspondence between adolescent and parent reports of adolescent substance use and abuse or dependence. Methods: In the current study, 591 subjects 12 to 17 years old were interviewed using the child version of the Semi-Structured Assessment for the Genetics of Alcoholism (C-SSAGA) as part of the Collaborative Study on the Genetics of Alcoholism (COGA). One parent was also interviewed about each adolescent using the parent version of the C-SSAGA. Sensitivities, specificities, and kappa coefficients were calculated to assess parental agreement with adolescent reports of lifetime substance use and Diagnostic and Statistical Manual of Mental Disorders-Third Revision substance abuse or dependence. Results: The results indicate that parents are somewhat knowledgeable about their children's use of substances, particularly those that are used most commonly. For example, 55% of adolescents who had smoked cigarettes, 50% who had used alcohol, and 47% who had used marijuana had a parent who knew that they used. However, parents were less aware of substance-related problems experienced by their offspring, agreeing with adolescent reports only 27% of the time for diagnoses of alcohol abuse or dependence and 26% of the time for diagnoses of marijuana abuse or dependence. Parent reports added few cases of substance use for 12- to 13 year-olds and essentially no cases for 16- to 17-year-olds. Parent reports added a nominal number of diagnoses of substance abuse or dependence for older adolescents. Conclusions: Whether for clinical or research purposes, the results emphasize the importance of directly assessing adolescents regarding alcohol and other substance use disorders. Furthermore, investigators should consider the specific disorder(s) being investigated and the ages of the children being studied when determining whether to include parent reports as part of study design. (Copyright 2006, Research Society on Alcoholism

Gervais A, O’Loughlin J, Meshefedjian G, Bancej C, Tremblay M. Milestones in the natural course of onset of cigarette use among adolescents. Canadian Medical Association Journal 175(3): 255–261, 2006. (25 refs.)


Background: The natural course of onset of cigarette use has been conceptualized as progressing sequentially through 5 stages (preparation, trying, irregular use, regular use, nicotine-dependent smoking). However, recent studies suggest that symptoms of nicotine dependence can occur early in the onset process, raising questions about the validity of this model. The objective of our study was to describe the sequence and timing of 12 milestones (6 related to cigarette use and 6 to symptoms of nicotine dependence) during onset of cigarette use. Methods: Grade 7 students in 10 secondary schools in Montreal (n = 1293) were followed prospectively every 3-4 months for 5 years. Using Kaplan-Meier analysis, we computed the number of months after first puff at which the cumulative probability of attaining each milestone was 25%, among 311 participants who initiated cigarette use during follow-up. Results: Inhalation rapidly followed first puff. The cumulative probability of inhalation was 25% at 1.5 months (95% confidence interval [CI] 1.5-2.5). The cumulative probability (and 95% CI) was 2.5 months (1.5-2.5) for mental addiction, 2.5 (1.0-3.0) for smoking a whole cigarette, 4.5 (2.5-8.8) for cravings, 5.4 (3.8-9.7) for physical addiction, 8.8 (7.0-11.9) for monthly smoking, 11.0 (6.4-16.8) for withdrawal symptoms, 13.0 (10.3-20.5) for tolerance, 19.4 (14.5-31.7) for weekly smoking, 19.5 (14.0-23.9) for lifetime total of 100 cigarettes, 23.1 (19.7-37.6) for daily smoking and 40.6 (35.1-56.0) for conversion to tobacco dependence. Interpretation: Symptoms of nicotine dependence develop soon after first puff and can precede monthly, weekly and daily smoking. Cessation interventions that manage dependence symptoms may be needed soon after first puff. (Copyright 2006, Canadian Medical Association)

Grimshaw GM, Stanton A. Tobacco cessation interventions for young people (review). Cochrane Database of Systemic Reviews 4(article no. CD003289), 2006. (110 refs.)


Background: Teenage smoking prevalence is around 15% in developing countries (with wide variation from country to country), and around 26% in the UK and USA. Although most tobacco control programmes for adolescents are based around prevention of uptake, there are also a number of initiatives to help those who want to quit. Since those who do not smoke before the age of 20 are significantly less likely to start as adults, there is a strong case for programmes for young people that address both prevention and treatment. Objectives: To evaluate the effectiveness of strategies that help young people to stop smoking tobacco. Search strategy We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Tobacco Addiction Group's Specialized Register, MEDLINE, EMBASE, PsyclNFO, ERIC, CINAHL, and the bibliographies of identified trials. We also searched the 'grey' literature (unpublished materials), and contacted authors and experts in the field where necessary. Selection criteria Types of studies: Randomized controlled trials, cluster-randomized controlled trials and controlled trials. Types of participants: Young people, aged less than 20, who are regular tobacco smokers. Types of interventions: The interventions ranged from simple ones such as pharmacotherapy, targeting individual young people, through complex programmes targeting people or organizations associated with young people (for example, their families or schools), or the community in which young people live. We included cessation programmes but excluded programmes primarily aimed at prevention of uptake. Types of outcome measures: The primary outcome was smoking status at six months follow up, among those who smoked at baseline. We report the definition of cessation used in each trial (e. g seven-or thirty-day point prevalence abstinence, or sustained or prolonged abstinence), and we preferred biochemically verified cessation when that measure was available. Data collection and analysis Both authors independently assessed the eligibility of candidate trials identified by the searches, and extracted data from them. We categorized included trials as being at low, medium or high risk of bias, based on concealment of allocation, blinding (where applicable) and the handling of attrition and losses to follow up. We conducted limited meta-analyses of some of the trials, provided that it was appropriate to group them and provided that there was minimal heterogeneity between them. We estimated pooled odds ratios using the Mantel-Haenszel method, based on the quit rates at longest follow up for trials with at least six months follow up from the start of the intervention. Main results We found 15 trials, covering 3605 young people, which met our inclusion criteria (seven cluster-randomized controlled trials, six randomized controlled trials and two controlled trials). Three trials used or tested the transtheoretical model (stages of change) approach, two tested pharmacological aids to quitting (nicotine replacement and bupropion), and the remaining trials used various psychosocial interventions, such as motivational enhancement or behavioural management. The trials evaluating TTM interventions achieved moderate long-term success, with a pooled odds ratio (OR) at one year of 1.70 (95% confidence interval (CI) 1.25 to 2.33) persisting at two-year follow up with an OR of 1.38 (95% CI 0.99 to 1.92). Neither of the pharmacological intervention trials achieved statistically significant results (data not pooled), but both were small-scale, with low power to detect an effect. The three interventions (5 trials) which used cognitive behavioural therapy interventions did not individually achieve statistically significant results, although when the three Not on Tobacco trials were pooled the OR 1.87; (95% CI 1.00 to 3.50) suggested some measure of effectiveness. Although the three trials that incorporated motivational interviewing as a component of the intervention achieved a pooled OR of 2.05 (95% CI 1.10 to 3.80), the impossibility of isolating the effect of the motivational interviewing in these trials meant that we could not draw meaningful inferences from that analysis. Authors' conclusions: Complex approaches show promise, with some persistence of abstinence (30 days point prevalence abstinence at six months), especially those incorporating elements sensitive to stage of change. There were few trials with evidence about pharmacological interventions (nicotine replacement and bupropion), and none demonstrated effectiveness for adolescent smokers. Psycho-social interventions have not so far demonstrated effectiveness, although pooled results for the Not on Tobacco trials suggest that that this approach may yet prove to be effective; however, their definition of cessation (one or more smoke-free days) may not adequately account for the episodic nature of much adolescent smoking. There is a need for well-designed adequately powered randomized controlled trials for this population of smokers, with a minimum of six months follow up and rigorous definitions of cessation (sustained and biochemically verified). Attrition and losses to follow up are particularly problematic in trials for young smokers, and need to be kept to a minimum, so that management and interpretation of missing data need not compromise the findings. (Copyright 2005, John Wiley & Sons)

Greydanus DE, Patel DR. The adolescent and substance abuse: Current concepts (review). Current Problems in Pediatric and Adolescent Health Care 35(3): 78–98, 2005. (94 refs.)


This review addresses alcohol and other drug use among adolescents. The article addresses its etiology, adolescent development and how this is affected by and influences substance use. It also addresses factors which may be risk factors including the presence of psychiatric illness, environmental stresses and the widespread availability and access to drugs. The symptoms and stages of drug use and abuse are described. Specific attention is directed to alcohol, marijuana, nicotine, cocaine, opiates, amphetamines, methamphetamines, ecstasy, ketamine, the inhalants, gamma-hydroxybutyrate, barbiturates, PCP, as well as agents used to enhance athletic performance, including the anabolic steroids. There is also discussion of management and approaches to treatment. There are twenty-nine accompanying tables. (Copyright 2005, Mosby)

Hanson K, Allen S, Jensen S, Hatsukami D. Treatment of adolescent smokers with the nicotine patch. Nicotine & Tobacco Research 5(4): 515–526, 2003. (36 refs.)


This study examined the effects of the nicotine patch on craving and withdrawal symptoms, safety, and compliance among adolescents. The secondary goal was to conduct a preliminary investigation of the effectiveness of the nicotine patch in helping adolescents quit smoking. The study design was a double-blind, placebo-controlled, randomized trial of the nicotine patch. The intervention also provided intensive cognitive-behavioral therapy and a contingency-management procedure. Participants (n=100) attended 10 treatment visits over 13 weeks. Compared with the placebo patch group, the active nicotine patch group experienced a significantly lower craving score and overall withdrawal symptom score (p = .011 and p = .025, respectively), as well as a time trend toward lower scores (p <.001) in craving only. Moreover, the nicotine patch appeared safe for adolescents to use. No differences by treatment group were found in experiencing adverse events, except that the participants in the placebo patch group reported more headaches than those in the active nicotine patch group. As another measure of safety, the overall mean salivary cotinine levels were significantly lower at 1, 6, 8, and 10 weeks postquit (all p <.05) compared with baseline levels, although these results were confounded by dropouts. Additionally, a significant number of participants were compliant with using the nicotine patch daily. Finally, point prevalence (7-day and 30-day abstinence rates) and survival analysis of participant abstinence indicated no significant differences between treatment groups. The results of this study suggest that the nicotine patch is a promising medication and a larger clinical trial of the nicotine patch among adolescents is warranted. (Copyright 2003, Carfax Publishing)

Hopfer CJ, Crowley TJ, Hewitt JK. Review of twin and adoption studies of adolescent substance use (review). Journal of the American Academy of Child and Adolescent Psychiatry 42(6): 710–719, 2003. (35 refs.)


To review studies of adolescent substance use and abuse with genetically informative designs. Method: Twin and adoption studies of adolescent substance use were searched in Medline using keywords. Results: Of 19 studies that used adolescent samples, 18 examined initiation or use of substances and 1 examined abuse. Of the 7 retrospective studies using adult samples, 6 examined problematic behaviors such as substance dependence. Genetic and shared environmental influences on adolescent substance use are moderated by the specific substance, age, gender, specific contexts, religiousness, and region. There is some evidence for a common genetic influence on substance use across substances. Genetic influences on adolescent substance use may act through an influence on disinhibited behavior. Shared environment contributed to adolescent substance use consistently across all adolescent samples and common shared environmental influences influenced initiation into tobacco and alcohol use. While parental alcohol use had a small influence on adolescent shared environment, sibling influences were substantial. Conclusions: Twin and adoption studies have increased our understanding of genetic and environmental influences on adolescent substance use and its initiation; however, more studies focusing on clinical syndromes of abuse and dependence are needed. (Copyright 2003, the American Academy of Child and Adolescent Psychiatry.)

Howard J. Substance Abuse Treatment for Persons with Child Abuse and Neglect Issues. Treatment Improvement Protocol (TIP) Series 36. Rockville MD: National Institute on Drug Abuse, 2000.


This Treatment Improvement Protocol considers treatment issues for two populations -- adults in treatment who may be abusing or neglecting their children and also adult survivors of child abuse or neglect. The first three chapters primarily consider adult survivors. Chapter 1 defines abuse and neglect, the epidemiology and rates in the general population as well as among those in substance abuse treatment, and provides a review of the literature on links between childhood abuse and subsequent substance abuse. Chapter 2 describes screening and assessment tools to assist in evaluating a childhood history of abuse or neglect. Chapter 3 provides guidelines on treating clients with histories of abuse or neglect and considering the need for referral to mental health care clinics. Chapter 4 considers the issues that may be generated within clinicians when working with this client population, and discusses means of addressing these counter-transference issues. Chapters 5 and 6 shifts attention to adults who may be abusing or neglecting their own children. The first of these considers techniques for identifying adults at risk or who have abused/neglected their children. It also considers issues of working with child protective service agencies. Chapter 6 provides an overview of the legal issues of which counselors need to be aware as mandated reporters. The final, concluding chapter (7) addresses emerging issues in this field which will have a bearing on future practice, such as fast-track adoptions and welfare reform. There are seven appendices that include an extensive bibliography, rules pertaining to client confidentiality, description of screening and assessment instruments; and resources related to childhood trauma among adults. Copyright 2000, Project Cork

Hunt MK, Fagan P, Lederman R, Stoddard A, Frazier L, Girod K, et al. Feasibility of implementing intervention methods in an adolescent worksite tobacco control study. Tobacco Control 12(Supplement 4): 40–45, 2003. (39 refs.)


Objective: To present feasibility data on SMART, the first teen worksite behavioural tobacco control intervention. Design: This phase II study was designed to estimate the efficacy and feasibility of a small scale, randomised, controlled intervention. Setting and subjects: This study, addressing youths aged 15-18 years, was implemented in four intervention and five control grocery stores that had an average of 44 eligible teens. Interventions: The tobacco use cessation and prevention interventions were based on social influences and peer leader models. Employee break rooms served as centres both for interactive activities including open houses, teen advisory boards, peer leader interviews, games and contests; and non-interactive interventions including bulletin boards and table tents with health messages and home mailings. Main process measures: Project staff collected process data on the extent of implementation of intervention activities, participation rates in activities, and contacts with peer leaders. On the final survey, teens reported on awareness of, participation in, and motivation for participating in project activities. Results: Indicators of feasibility were identified and discussed, including the number of activities implemented, teen participation, management support, cost, and barriers to and facilitators of implementation. During the 12 month intervention, a mean of 24.1 interactive activities and 55.3 non-interactive activities were implemented, and a mean 14.2% participation rate per activity per site was achieved. Eighty four per cent of teens reported being aware of SMART, and 39% reported participating in interactive and 67% in non-interactive activities. Conclusions: Teen smoking cessation rates in worksite programmes might be improved if they are conducted in companies where there is job stability and if teen programmes are part of worksite-wide tobacco control programmes that include both teens and adults. (Copyright 2003, British Medical Journal Publishing Group)

Knight JR. The role of the primary care provider in preventing and treating alcohol problems in adolescents. Ambulatory Pediatrics 1(3): 150–161, 2001. (116 refs.)


Adolescents use alcohol more frequently and heavily than all other illicit drugs combined.(1) Given the myriad health, developmental, and social problems associated with alcohol use, it is not surprising that the American Medical Association's Guidelines for Adolescent Preventive Services recommends that adolescents be asked annually about their use of alcohol, and those who report any use during the past year should be assessed further. However, routine alcohol screening of adolescents in primary care and emergency medical settings is not universally applied. In March 2000, the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health and the Agency for Health care Research and Quality jointly sponsored a meeting entitled The Expanding Role of Primary Care in the Prevention and Treatment of Alcohol-Use Disorders. The purpose of the meeting was to bring together researchers, policymakers, clinicians, insurance providers, and medical education specialists to determine the best approaches to increase the involvement of primary care physicians and other health care professionals in screening and intervening for alcohol problems in their patients. The National Institute on Alcohol Abuse and Alcoholism and Agency for Health care Research and Quality believe that the evidence of efficacy for primary care involvement is compelling and are working together to promote the translation of these findings into clinical practice. The following article summarizes what is currently known about adolescent alcohol use and how it can be addressed in primary care settings. It provided the background for the meeting's focus on adolescent issues.

Liddle HA. Family-based therapies for adolescent alcohol and drug use: Research contributions and future research needs. Addiction 99(Supplement 2): 76-92, 2004. (117 refs)


Objective: To characterize the developmental status of the family-based adolescent alcohol and drug treatment specialty by identifying and discussing research and clinical advances. Method: Selective and interpretative literature review and analysis. Study selection: Controlled trials and mechanisms of change studies of family-based treatments for adolescent alcohol and drug misuse. Results: Clinical innovations of family-based treatments include development of detailed therapy, training/supervision, and adherence manuals. Different family-based treatments have been tested with success in controlled trials and process studies. Different versions of the same approach might vary on parameters such as treatment dose, setting, and client characteristics. Research advances include findings that engagement and retention rates for family-based treatments are superior to standard treatment engagement/retention methods. Also, in clinical trials in which they are compared with alternative interventions, in the majority of studies, family-based treatments produce superior and stable outcomes with significant decreases on target symptoms of alcohol and drug use, and related problems such as delinquency, school and family problems, and affiliation with substance abusing peers. Mechanisms of change studies support the theory basis of family-based treatments. For instance, improvements in family interaction patterns coincide with decreases in core target alcohol and drug misuse symptoms. Conclusions: Once in the shadows of the adult substance abuse field, the adolescent substance abuse specialty has become a unique, clinically creative, and empirically-based area. Research and clinical advances of family-based treatments have implications for non-family-based interventions in the adolescent substance misuse treatment specialty. (Copyright 2004, Society for the Study of Addiction to Alcohol and Other Drugs)

Liddle HA, Rowe CL, eds. Adolescent Substance Abuse: Research and Clinical Advances. Cambridge: Cambridge University Press, 2006.


This volume covers a range of issues related to adolescent substance abuse, including empirically-based treatment development protocols; how to incorporate innovative treatment models into diverse clinical settings; research advances; interventions with special populations; culturally based intervention guidelines, and recommendations for practice and policy. This edited book has 21 chapter and 33 contributors. It is organized into five sections. Following an introduction and overview of the volume, Part I considers the theoretical, empirical and methodological foundation for research in adolescent substance abuse treatment. It deals with development issues, recent methodological and statistics advances that can underpin research, and highlights a major research initiative the Cannabis Youth Treatment Intervention, and the preliminary findings. Part II examines the practice and treatment policy trends. There is attention to European research, the Drug Abuse Treatment Outcomes Studies ducted at the UCLA Drug Abuse Research Center, contextual issues that are important in adolescent care, and examines the nature of service organization in England. Part III considers the importance and approaches to comprehensive assessment and integrated treatment planning. Individual chapters consider drug therapies, developmental issues in the diagnosis of co-occurring disorders, and HIV/AIDS prevention in adolescent substance abusers. Part IV addresses evidence-based interventions. Directed initiatives examined are adolescent therapeutic communities, school-based group treatment, family and behavioral interventions, as well as cognitive-behavioral therapy with adolescents substance abuse problems. Part V considers culturally based treatments that have been developed, with a focus on family centered programs created for Native Americans and family-based treatment of Hispanic adolescents. Part VI includes a concluding chapter that examines the strides that have been made while also noting important research questions. Copyright 2006, Project Cork

Madan A, Beech D, Flint L. Drugs, guns, and kids: The association between substance use and injury caused by interpersonal violence. Journal of Pediatric Surgery 36(3): 440–442, 2001. (13 refs.)


Background: Drug and alcohol uses have been linked to the frequency of injury events, recurrent hospital admission for injury, and interpersonal violence. Data regarding the association of recent substance use and injury type and frequency in children and young adults are not available. Such data probably would be valuable in planning interventions to prevent substance use and reduce the risks of injuries. Methods: Evidence of substance use was assessed in trauma patients presenting to the authors' level 1 trauma center over a 6-month interval. Demographic data, mechanisms of injury, revised trauma scores (RTS), injury severity scores (ISS), hospital days, and mortality rate were evaluated. Chi square analysis and 2-tailed, paired t tests were used for statistical analysis. Multivariate logistic regression was utilized to determine the influence of individual variables. Results: From a total group of 743 patients with life-threatening injuries, trauma registry records of 186 patients less than 21 years old were eligible for evaluation, and 126 of these had complete blood and urine drug assessments completed on admission to the trauma center. Forty-two percent (53 of 126) patients tested positive for alcohol or drugs. No patients less than 14 years of age (n = 61) had positive drug screen results. However, in the cohort of patients aged 14 and 15 (n = 17), 71% tested positive. Also, 72% of adolescents (age < 18) who were victims of injuries from gunshot wounds had evidence of substance use. Multivariate analysis showed gunshot wounds (P <.003) to be associated independently with positive drug screens. No statistical differences were observed in ethnic distribution, ISS, RTS, hospital days, or mortality rate when patients with positive screen results were compared with those without evidence of substance use. Conclusions: Trauma victims had evidence of substance use in early teen age years especially in the 14 and 15-year-old age groups. Toxicology screening disclosed that substance use is associated strongly with gunshot wounds. Substance use, along with poverty, inadequate family support, and peer pressure are factors that influence injury risk. Interventions to prevent substance use in young children may reduce the risk of injury. Copyright 2001, W.B. Saunders Co.

Martens MP, Dams-O’Connor K, Beck NC. A systematic review of college student-athlete drinking: Prevalence rates, sport-related factors, and intervention (review). Journal of Substance Abuse Treatment 31(3): 305–316, 2006. (84 refs.)


Alcohol use among college students has become a considerable public health problem. Among this group, intercollegiate athletes are at a particularly high risk for excessive alcohol consumption and resulting negative alcohol-related consequences. The purpose of our review was to systematically examine three main issues related to alcohol consumption among intercollegiate athletes: (a) the prevalence rates and alcohol consumption patterns of this group, especially in comparison with those of collegiate nonathletes; (b) the various factors that might motivate or encourage alcohol use among intercollegiate athletes, primarily sport-related individual and environmental variables; and (c) considerations for conducting alcohol-related interventions with intercollegiate athletes. (Copyright 2006, Elsevier Science)

Miller JW, Naimi TS, Brewer RD, Jones SE. Binge drinking and associated health risk behaviors among high school students. Pediatrics 119(1): 76–85, 2007. (61 refs.)


OBJECTIVES. Underage drinking contributes to the 3 leading causes of death (unintentional injury, homicide, and suicide) among persons aged 12 to 20 years. Most adverse health effects from underage drinking stem from acute intoxication resulting from binge drinking. Although binge drinking, typically defined as consuming >= 5 drinks on an occasion, is a common pattern of alcohol consumption among youth, few population-based studies have focused specifically on the characteristics of underage binge drinkers and their associated health risk behaviors. METHODS. We analyzed data on current drinking, binge drinking, and other health risk behaviors from the 2003 National Youth Risk Behavior Survey. Prevalence estimates and 95% confidence intervals were calculated by using SAS and SUDAAN statistical software. Logistic regression was used to examine the associations between different patterns of alcohol consumption and health risk behaviors. RESULTS. Overall, 44.9% of high school students reported drinking alcohol during the past 30 days (28.8% binge drank and 16.1% drank alcohol but did not binge drink). Although girls reported more current drinking with no binge drinking, binge-drinking rates were similar among boys and girls. Binge-drinking rates increased with age and school grade. Students who binge drank were more likely than both nondrinkers and current drinkers who did not binge to report poor school performance and involvement in other health risk behaviors such as riding with a driver who had been drinking, being currently sexually active, smoking cigarettes or cigars, being a victim of dating violence, attempting suicide, and using illicit drugs. A strong dose-response relationship was found between the frequency of binge drinking and the prevalence of other health risk behaviors. CONCLUSIONS. Binge drinking is the most common pattern of alcohol consumption among high school youth who drink alcohol and is strongly associated with a wide range of other health risk behaviors. Effective intervention strategies (eg, enforcement of the minimum legal drinking age, screening and brief intervention, and increasing alcohol taxes) should be implemented to prevent underage alcohol consumption and adverse health and social consequences resulting from this behavior. Copyright 2007, American Academy of Pediatrics

Miller TR, Levy DT, Spicer RS, Taylor DM. Societal costs of underage drinking. Journal of Studies on Alcohol 67(4): 519–528, 2006. (91 refs.)


Objective: Despite minimum-purchase-age laws, young people regularly drink alcohol. This study estimated the magnitude and costs of problems resulting from underage drinking by category -- traffic crashes, violence, property crime, suicide, bums, drownings, fetal alcohol syndrome, high-risk sex, poisonings, psychoses, and dependency treatment -- and compared those costs with associated alcohol sales. Previous studies did not break out costs of alcohol problems by age. Method: For each category of alcohol-related problems, we estimated fatal and nonfatal cases attributable to underage alcohol use. We multiplied alcohol-attributable cases by estimated costs per case to obtain total costs for each problem. Results: Underage drinking accounted for at least 16% of alcohol sales in 2001. It led to 3,170 deaths and 2.6 million other harmful events. The estimated $61.9 billion bill (relative SE = 18.5%) included $5.4 billion in medical costs, $14.9 billion in work loss and other resource costs, and $41.6 billion in lost quality of life. Quality-of-life costs, which accounted for 67% of total costs, required challenging indirect measurement. Alcohol-attributable violence and traffic crashes dominated the costs. Leaving aside quality of life, the societal harm of $1 per drink consumed by an underage drinker exceeded the average purchase price of $0.90 or the associated $0.10 in tax revenues. Conclusions: Recent attention has focused on problems resulting from youth use of illicit drugs and tobacco. In light of the associated substantial injuries, deaths, and high costs to society, youth drinking behaviors merit the same kind of serious attention. (Copyright 2006, Alcohol Research Documentation)

Nanda S, Konnur N. Adolescent drug & alcohol use in the 21(st) century. Pediatric Annals 35(3): 193–199, 2006. (33 refs.)


This article provides a review of the current trends and patterns of adolescent substance use in the US. It reviews risk factors and the physiological consequences associated with the drugs most commonly used by adolescents. These include alcohol, nicotine, inhalants, stimulants, heroin and opiates including prescription drugs, the club drugs (ecstasy, GHB, and ketamine), the hallucinogens, and anabolic steroids. Several tables are included including the common drugs of abuse and their street names, the drugs used by athletes, and the behavioral changes associated with specific drug classes. Recommendations are made for pediatricians, for screening as part of health maintenance visits. Drug counseling and treatment are seen as best addressed by specialized treatment services. Tables provide the street names of common drugs. (Copyright 2006, Slack Inc.)

Newes-Adeyi G, Chen CM, Williams GE, Faden VB. Trends in Underage Drinking in the United States, 1991–2003. Surveillance Report #74. Bethesda, MD: NIAAA, 2005. (37 refs)


This surveillance report from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), presents data on underage drinking for 1991-2003. This is the first of a series of reports to be published every two years on underage drinking and related attitudes and risk behaviors. Data for this series are compiled from three separate national surveys, the National Survey on Drug Use and Health (NSDUH), the Monitoring the Future (MTF) survey, and the Youth Risk Behavior Survey (YRBS). The following are highlights of trends from 1991 through 2003. Prevalence of use: There are differences across all three surveys data sources but all show an overall decline in the prevalence of alcohol consumption in the past 30 days between 1991 and 2003. In 2003, 29.3 percent of youth ages 12-20 reported consuming alcohol in the past 30 days. Throughout the decade, rates of underage drinking remained highest among non-Hispanic whites, followed by Hispanics and non-Hispanic blacks. Rates were also higher among youth not enrolled in school as compared with those enrolled in school. Drinking patterns: The mean age of onset for drinking alcohol has increased slightly from 13.8 years in 1991 to 14 years in 2003. In addition, over the decade there has been a decline in those who reported beginning to drink before age 12 or younger. Differences between males and females continue. Males report drinking more frequently and greater quantities. In 2003, youth ages 12 to 20 reported drinking on a mean of 5.8 days in the past 30 days. They consumed an average of 4.9 drinks on these days, corresponding to an average total of 35.4 drinks in the past 30 days (NSDUH). Overall rates of binge drinking have increased among 12 to 20 year olds between 1991 and 2003, from 15.2 to 18.9 percent. (Data from the secondary school based surveys (MTF and YRBS), however, show an overall decline in binge drinking rates during this time period.] These data also show an increase in binge drinking rates among girls, whereas the rates declined among boys. Although rates increased for both males and females in the NSDUH data, the increase is steeper for females than for males. Alcohol-related attitudes: There has been a gradual shift in attitudes towards underage drinking. Between 1991 and 2003 there has been a decline in the number of youth who strongly disapproving of others regularly consuming alcohol or binge drinking, as well as a decrease in those who consider regular or binge drinking a great risk. Alcohol-related risk behaviors: In respect to driving while under the influence, between 1991 and 2003, there was a decline in secondary school students. However, for those age 18-20, there was a substantial increase --from 14.9% to 19.1%. Data is presented in 96 figures and 8 tables. (Public Domain)

Office of Applied Science, Crane E, Herman-Stahl M. The DAWN Report: Disposition of emergency department visits for drug-related suicide attempts by adolescents: 2004. Issue 6. Rockville MD: SAMHSA, 2006.


The Drug Abuse Warning Network (DAWN) is a public health surveillance system that monitors drug-related morbidity and mortality. This brief report presents findings related to adolescents seen in emergency departments for suicide attempts. In 2004 there were over 15,000 such among those age 12-17. These attempts involved an average of 1.7 drugs. Almost three-quarters of these were serious enough to warrant an admission to a hospital of transfer to another. Of those admitted, most involved alcohol in combination with another drug. Pain medications were involved in about half of the attempts; antidepressants or other psychotherapeutic medications were involved in over 40%. (Public Domain)

Paschall MJ, Bersamin M, Flewelling RL. Racial/ethnic differences in the association between college attendance and heavy alcohol use: A national study. Journal of Studies on Alcohol 66(2): 266–274, 2005. (21 refs.)


Objective: This study examined racial/ethnic differences in the association between college attendance and heavy alcohol use and factors that may underlie this relationship. Method: Interview data collected from 12,993 young adults who participated in the National Longitudinal Study of Adolescent Health were analyzed to determine if 4-or 2-year college status is differentially associated with heavy alcohol use for five racial/ethnic groups (white, black, Hispanic, Asian, Other) and to assess the explanatory value of selected social and psychological factors. Results: Four-year college status was positively associated with heavy alcohol use among white young adults but inversely related to heavy drinking among blacks and Asians. Two-year college status also was inversely associated with heavy drinking among blacks, Hispanics and Others. Among whites, the association between 4-year college attendance and heavy drinking was partially explained by living away from parents, friends' heavy drinking and time socializing with friends. Among blacks, the inverse relationship between college attendance and heavy alcohol use was partially explained by lower levels of friends' heavy drinking, depression and delinquency. Friends' heavy drinking also partially explained observed relationships between college attendance and heavy drinking among Asians and Others. Conclusions: Four-year college attendance increases the likelihood of heavy alcohol use among white young adults but may decrease the likelihood of heavy drinking among blacks and Asians. Two-year college attendance also may reduce the risk for heavy drinking among blacks, Hispanics and young adults who are Native American or multi-ethnic. Social and psychological factors partly explain these relationships and also differ for racial/ethnic groups. (Copyright 2005, Copyright 2005, Alcohol Research Documentation)

Patten CA, Lopez K, Thomas JL, Offord KP, Decker PA, Pingree S, et al. Reported willingness among adolescent nonsmokers to help parents, peers, and others to stop smoking. Preventive Medicine 39(6): 1099–1106, 2004. (46 refs.)


Background. This study of 1025 adolescent nonsmokers aged 11–19 years examined level of interest and factors associated with reported willingness to help someone stop smoking. Methods. Data were collected from a survey distributed primarily in the schools at four geographic and ethnically diverse study sites. Results. A total of 692 adolescents identified someone close to them who smokes whom they thought should quit. Of these, 90% reported that they would be willing to help this person stop smoking. Multivariate predictors of willingness to help were female gender, less difficulty reading English, and greater level of comfort with talking to the smoker about their smoking. The smoker that the adolescents were willing to help was most often a parent or same age friend. Conclusions. If this strong interest among adolescents could be tapped, engaging teens as support persons could be a novel public health approach to reaching parents, adolescents, and other smokers in the population. (Copyright 2004, The Institute for Cancer Prevention)

Rome ES. It’s a rave new world: Rave culture and illicit drug use in the young (review). Cleveland Clinic Journal of Medicine 68(6): 541–550, 2001. (14 refs.)


Illicit drug use by young people has changed in the last decade, with the increasing use of "designer" or "club" drugs such as ecstasy. Keeping abreast of current trends in illicit drug use prepares the primary care clinician to recognize the clinical effects of drug use, to manage drug emergencies, and to detect addictive behavior. Today's widely used drugs, their street names, their effects, and how to manage overdoses are reviewed. Copyright 2001, Cleveland Clinic Foundation

Rotunda RJ, Scherer DG, Imm PS. Family systems and alcohol misuse: Research on the effects of alcoholism on family functioning and effective family interventions (review). Professional Psychology: Research and Practice 26(1): 95–104, 1995. (106 refs.)


This article reviews the most prominent research at the interface between studies of alcohol addiction and family systems psychology. The review addresses the general effects of alcohol misuse on family functioning as determined in empirical studies comparing healthy families, alcohol afflicted families, and otherwise troubled families. Three factors ("dry" versus "wet" families, family development and the progression of alcoholism, and family structure) are identified as particularly relevant to understanding the treatment needs of families affected by alcohol misuse. Research examining the general efficacy of family interventions in the treatment of alcoholism and specific treatment considerations unique to treating families coping with alcohol misuse are reviewed. Copyright 1995, American Psychological Association, Inc.

Turner LR, Mermelstein R, Berbaum ML, Veldhuis CB. School-based smoking cessation programs for adolescents: What predicts attendance? Nicotine & Tobacco Research 6(3): 559–588, 2004. (34 refs.)


The present study examined contextual and individual predictors of attendance in a 10-session school-based teen smoking cessation program. Participants were 349 students at 29 Illinois high schools. Predictor variables included demographics, smoking history, psychosocial variables, and social environment variables. School-level characteristics of interest included proportion of low-income students, group size, and program timing. Overall attendance was predicted by higher motivation and less stress at baseline. Students also were more likely to attend if they had already tried to quit, were more dependent on nicotine, and had more positive smoking expectancies. Percentage of low-income students and program timing also predicted program attendance; students were more likely to attend the program at schools with lower percentages of low-income students and where the program was offered during the school day. We also examined predictors of attendance before and after quit week (week 5). Early in the program, only the school-level variables (program timing and percentage of low-income students) predicted attendance. After quit week, the school variables also were important, and baseline motivation and perceived stress also predicted attendance at these sessions. Results highlight the importance of individual characteristics in determining program participation, as well as the importance of considering school context and programmatic issues when planning school-based smoking cessation programs. (Copyright 2004, Taylor & Francis)

Vakalahi HF. Adolescent substance use and family-based risk and protective factors: A literature review (review). Journal of Drug Education 31(1): 29–46, 2001. (117 refs.)


Adolescent substance use has become a serious concern nationwide. Although there are many ways of viewing adolescent substance use, family influence has been established as one of the strongest sources of risk and protection. A review of the literature indicated relevant theories for understanding adolescent substance use and specific family-based variables influencing adolescent substance use. In general, there seems to be a relationship between adolescent substance use and family-based risk and protective factors. Relevant theories identified in the literature review include family systems theory social cognitive theory, social control theory, and strain theory. Specific family-based risk and protective factors include family relationships such as with siblings and parents and family characteristics such as ethnicity and religious backgrounds. Future implications for research and prevention/intervention in relation to family-based risk and protective factors are discussed. Copyright 2001, Baywood Publishing Co., Inc.

Wakefield M, Flay B, Nichter M, Giovino G. Role of the media in influencing trajectories of youth smoking (review). Addiction 98:79–103, 2003. (204 refs.)


This paper reviews empirical studies, encompassing community trials and field experiments, and evaluates government-funded anti-smoking campaigns, ecologic studies of population impact of anti-smoking advertising, and qualitative studies that have examined the effects of anti-smoking advertising on teenagers. We conclude that anti-smoking advertising appears to have more reliable positive effects on those in pre-adolescence or early adolescence by preventing commencement of smoking. It is unclear whether this is due to developmental differences, or is a reflection of smoking experience, or a combination of the two. In addition, it is evident that social group interactions, through family, peer and cultural contexts, can play an important role in reinforcing, denying, or neutralizing potential effects of anti-smoking advertising. Although there is some research to suggest that advertising genres that graphically depict the health effects of smoking, emphasize social norms against smoking, and portray the tobacco industry as manipulative can positively influence teenagers, these findings are far from consistent. Finally, the effects of anti-smoking advertising on youth smoking can be enhanced by the use of other tobacco control strategies, and may be dampened by tobacco advertising and marketing. Overall, the findings of this review indicate that there is no single "recipe "for anti-smoking advertising that leads to reductions in youth smoking. Anti-smoking advertising can influence youth smoking, but whether it does in the context of individual anti-smoking campaigns needs to be the subject of careful evaluation. (Copyright 2003, Taylor and Francis, Inc.)

Wilens TE, Adler LA, Adams J, Sgambati S, Rotrosen J, Sawtelle R et al. Misuse and diversion of stimulants prescribed for ADHD: A systematic review of the literature. (review). Journal of the American Academy of Child and Adolescent Psychiatry 47(1): 21-31, 2008. (56 refs.)


Recent studies have provided variable information on the frequency and context of diversion and the use of nonprescribed and prescribed stimulant medications in adolescent and young adult populations. The purpose of this systematic review of the literature is to evaluate the extent and characteristics of stimulant misuse and diversion in attention-cleficit/hyperactivity disorder (ADHD) and non-ADHD individuals. Method: We conducted a systematic review of the literature of available studies looking at misuse and diversion of prescription ADHD medications using misuse, diversion, stimulants, illicit use, and ADHD medications as key words for the search. Results: We identified 21 studies representing 113,104 subjects. The studies reported rates of past year nonprescribed stimulant use to range from 5% to 9% in grade school and high school-age children and 5% to 35% in college-age individuals. Lifetime rates of diversion ranged from 16% to 29% of students with stimulant prescriptions asked to give, sell, or trade their medications. Recent work suggests that whites, members of fraternities and sororities, individuals with lower grade point averages, use of immediate-release compared to extended-release preparations, and individuals who report ADHD symptoms are at highest risk for misusing and diverting stimulants. Reported reasons for use, misuse, and diversion of stimulants include to concentrate, improve alertness, "get high," or to experiment. Conclusions: The literature suggests that individuals both with and without ADHD misuse stimulant medications. Recent work has begun to document the context, motivation, and demographic profile of those most at risk for using, misusing, and diverting stimulants. The literature highlights the need to carefully monitor high-risk individuals for the use of nonprescribed stimulants and educate individuals with ADHD as to the pitfalls of the misuse and diversion of the stimulants. (Copyright 2008, American Academy of Child and Adolescent Psychiatry)

Wilens TE, Faraone SV, Biederman J, Gunawardene S. Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature (review). Pediatrics 111(1): 179–185, 2003. (56 refs.)


Objective. Concerns exist that stimulant therapy of youths with attention-deficit/hyperactivity disorder (ADHD) may result in an increased risk for subsequent substance use disorders (SUD). We investigated all long-term studies in which pharmacologically treated and untreated youths with ADHD were examined for later SUD outcomes. Methods. A search of all available prospective and retrospective studies of children, adolescents, and adults with ADHD that had information relating childhood exposure to stimulant therapy and later SUD outcome in adolescence or adulthood was conducted through PubMed supplemented with data from scientific presentations. Meta-analysis was used to evaluate the relationship between stimulant therapy and subsequent SUD in youths with ADHD in general while addressing specifically differential effects on alcohol use disorders or drug use disorders and the potential effects of covariates. Results. Six studies-2 with follow-up in adolescence and 4 in young adulthood-were included and comprised 674 medicated subjects and 360 unmedicated subjects who were followed at least 4 years. The pooled estimate of the odds ratio indicated a 1.9-fold reduction in risk for SUD in youths who were treated with stimulants compared with youths who did not receive pharmacotherapy for ADHD (z = 2.1; 95% confidence interval for odds ratio [OR]: 1.1-3.6). We found similar reductions in risk for later drug and alcohol use disorders (z = 1.1). Studies that reported follow-up into adolescence showed a greater protective effect on the development of SUD (OR: 5.8) than studies that followed subjects into adulthood (OR: 1.4). Additional analyses showed that the results could not be accounted for by any single study or by publication bias. Conclusion. Our results suggest that stimulant therapy in childhood is associated with a reduction in the risk for subsequent drug and alcohol use disorders. (Copyright 2003, American Academy of Pediatrics)

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