Health and Developmental Consequences of Youth Drug Abuse

Research Findings from September, 2000 Director's Report

This section lists selected summaries from NIDA funded research projects that investigate the developmental implications of drug use. The summaries provided were selected from recent issues of the Director's Report to the National Advisory Council on Drug Abuse. For a more comprehensive listing of NIDA funded projects see the Director's Report.

Gender Differences in Adolescent Drug Abuse: Issues of Comorbidity and Family Functioning

Dr. Gayle Dakof, University of Miami, investigated gender differences in patterns of co-morbidity and family functioning among a sample of 95 youths (42 girls) referred by juvenile justice (80%), education (10%) and social welfare (10%) for substance abuse treatment. Findings indicate that male and female adolescent substance users (13-17 years) entering treatment do differ. The girls not only used drugs and engaged in externalizing behaviors as extensively as did their male counterparts but they also were distinguished by their higher levels of internalizing symptoms and family dysfunction. Dakof, G. Journal of Psychoactive Drugs, 32(1), pp. 25-32, 2000.

Chronic Effects of Marijuana as a Function of Age of First Use

Since a significant degree of brain development occurs during adolescence, males and females with a history of teenage marijuana use received both positive emission tomography (PET) to assess cerebral blood flow (CBF) and magnetic resonance imaging (MRI) scans to evaluate brain volume. Median age of first marijuana use was the variable used to stratify the volunteers into Early (< age 17) or Late (> age 17) use. Primary findings related to age of first use include: 1) those who were identified as Early users had smaller whole brain and percent cortical gray matter and percent white matter volumes compared to those who started use later, suggesting that the mechanism of this effect has more to do with brain development than with atrophy; 2) functionally, males who began use Early, had significantly higher resting CBF compared to the Late males but was not significantly different from females, supporting additional changes in gonadal and pituitary hormones that alter development; these changes, in turn, are related to global CBF and to reduction in gray matter; 3) both males and females who started using marijuana younger were physically smaller in height and weight, with the effects being greater in males. Since THC suppresses the release of prolactin, growth hormone and gonadotropin and because the adolescent growth period for males starts earlier and lasts longer than for females, starting marijuana use early would expose males longer to the adverse effects of reduced growth hormone release. Overall, these findings suggest that exposure to marijuana (and possibly other drugs) at certain critical periods such as during early adolescence, may alter normal patterns of development. Wilson, W., Mathew, R., Turkington, T., Hawk, T., Coleman, R.E., and Provenzale, J. Brain Morphology Changes and Early Marijuana Use: A Magnetic Resonance and Positron Emission Tomography Study. Journal of Addictive Diseases, 19, pp. 1-22, 2000.

Effects of Parent Personality, Upbringing, and Marijuana Use on the Parent-Child Relationship

This study examined predictors of the quality of the parent-child attachment relationship among a sample of 248 young adults with children. In this longitudinal study, data were collected during early adulthood in 1992 and in 1996/1997 via a structured questionnaire. Using logistic regression and multiple regression analyses, the authors assessed the extent to which participants' personality attributes, substance use, and relationships with their mothers predicted the quality of the parent-child bond. Results showed that participants with certain personality attributes (e.g., high sensitivity), less frequent marijuana use, or a close relationship with their mothers had a greater likelihood of having a close parent-child attachment relationship with their own children at a later time. Analyses also showed that the risk of earlier substance use on the parent-child relationship was offset by protective factors in the parents' personality domain. In addition, protective factors in the various parental domains synergistically interacted with a low frequency of marijuana use, relating to a closer parent-child attachment relationship. The findings suggest that certain parenting styles are transmitted across generations and interventions in the personality and drug use domains can help increase the likelihood that parents will form close attachment relationships with their own children. Brook, J.S., Richter, L., and Whiteman, M. Effects of Parent Personality, Upbringing, and Marijuana Use on the Parent-Child Attachment Relationship. J Am Acad Child Adolesc Psychiatry, 39(2), pp. 240-248, 2000.

Pathways into Prostitution Among Female Jail Detainees and Mental Health Services

To explore the service needs of women in jail, the authors examined three pathways into prostitution: childhood sexual victimization, running away, and drug use. Studies typically have explored only one or two of these pathways, and the relationships among the three points of entry remain unclear. Data on 1,142 female jail detainees were used to examine the effects of childhood sexual victimization, running away, and drug use on entry into prostitution and their differential effects over the life course. Two distinct pathways into prostitution were identified. Running away had a dramatic effect on entry into prostitution in early adolescence, but little effect later in the life course. Childhood sexual victimization, by contrast, nearly doubled the odds of entry into prostitution throughout the lives of women. Although the prevalence of drug use was significantly higher among prostitutes than among non-prostitutes, drug abuse did not explain entry into prostitution. Running away and childhood sexual victimization provide distinct pathways into prostitution. The findings suggest that women wishing to leave prostitution may benefit from different mental health service strategies depending on which pathway to prostitution they experienced. McClanahan, S.F., McClelland, G.M., Abram, K.M., and Teplin, L.A. Pathways into Prostitution Among Female Jail Detainees and their Implications for Mental Health Services. Psychiatr Serv, 50(12), pp. 1606-1613, 1999.

Adolescent Substance Use and Later Health Status

This paper critically reviews the literature on the hypothesized relationship between drug use and physical health status, and uses data from a 20 year follow up of adolescents to examine key mediators in the relationship. There was evidence for a persistent relationship between drug use in adolescence and detrimental adult health status, whether psychological maladjustment was controlled for or treated as an intervening variable. Including adolescent deviance as a mediator reduced the relationship between drug use and later health status to non-significance, and modeling showed adolescent deviance to be a significant intervening construct. Thus, the authors conclude that it is the deviant lifestyle, with effects such as risk-taking, poor diet, and poor medical care, that accounts for the relationship between substance use and adult health status, rather than a unique effect of drug ingestion. Spohn, R.E., and Kaplan, H.B. Adolescent Substance Use and Adult Health Status. Advances in Medical Sociology, 7, pp. 45-65, 2000.

Prediction of Violent Behavior

Using a developmental framework, this study replicates earlier research on risk factors for youth violence and explores the effects of risks for other problem behaviors on violence. Data from the Seattle Social Development Project (SSDP), a prospective study involving a panel of youths followed since 1985 were used. Potential risk factors for violence at age 18 years were measured at ages 10, 14, and 16 years. Risk factors in the individual, family, school, peer and community domains and violence were examined at each age to assess changes in their strength of prediction over time. Attention was also given to the additive strength of increasing numbers of risk factors in the prediction of violence at age 18 years. A final set of analyses explored the extent to which youths were correctly classified as having committed a violent act (or not) at age 18 on the basis of their overall level of risk at ages 10, 14, and 16 years. At each age, risk factors strongly related to later violence were distributed among the five domains. Ten of 15 risk factors measured at age 10 years; 20 of 25 at age 14; and 19 of 21 at age 16 years were significantly predictive of violence at age 18. Many constructs predicted violence from more than one developmental point. Hyperactivity (parent rating), low academic performance, peer delinquency, and availability of drugs in the neighborhood predicted violence from ages 10, 14, and 16 years. Analyses of the additive effects of risk factors revealed that youths exposed to multiple risks were more likely than others to engage in later violence. Youths exposed to more than five risk factors at each age were seven times more likely at age 20, nearly 11 times more likely at age 16 and 10 times more likely at age 14 years to have been violent than youths exposed to fewer than two risk factors at each age. Despite information gained from all significant risk factors, the overall accuracy in predicting which youth would go on to commit violent acts was limited. Herrenkohl, T .I., Maguin, E., Hill, K.G., Hawkins, J.D., Abbott, R.D., and Catalano, R.F. Developmental Risk Factors for Youth Violence. Journal of Adolescent Health, 26(3), pp. 176-186, 2000.

Identifying Suicidal Risk Among Potential High School Dropouts

This study examined the validity of the Suicide Risk Screen (SRS) for identifying suicide-risk youths among potential high school dropouts. Five hundred eighty-one potential dropouts, aged 14 to 20 years, participated in a 3-stage case identification protocol. Randomly selected students completed a questionnaire containing the SRS and participated in an assessment interview. Validity measures included Reynolds' Suicide Ideation Questionnaire (SIQ-JR) and two clinical rating scales, the Direct Suicide Risk (DSR) and Clinical Risk Assessment (CRA). Suicide-risk severity was significantly associated with categorization defined by the SRS criteria. Of seven SRS elements, depression, suicidal ideation, and suicide threats predicted all validity measures. Suicide attempts predicted the DSR and CRA, but not Reynolds' SIQ-JR. Drug involvement, though relatively weaker, consistently predicted all validity measures. No additional psychosocial indicators improved the prediction of SIQ-JR or the DSR. Family support, likelihood of dropout, and risky behaviors, however, were additional predictors of the CRA ratings. Thompson, E.A. and Eggert, L.L. Using the Suicide Risk Screen to Identify Suicidal Adolescents Among Potential High School Dropouts. J American Academic Child Adolescent Psychiatry 38 (12), pp. 1506-1514, 1999.