The differential impact of risk factors on illicit drug involvement in females
ABSTRACT Initiation of drug use and progression to abuse/dependence involve complex pathways. Potential risk factors may correlate with initiation or progression or both. Are there risk factors that associate with illicit drug use or illicit drug abuse/dependence? Is the magnitude of the association the same for use and abuse/dependence? Does this pattern of association differ across categories of drugs?
We used data from female-female adult twins to assess the association of 26 putative risk factors with use and abuse/dependence of six illicit psychoactive drugs. Drug involvement was represented by independent dichotomous outcomes and by a single ordinal variable. Odds ratios were obtained by logistic regression and a continuation ratio was used to test the magnitude of association.
Factors associate in similar patterns with different drug categories. Some associated factors interact only with initiation while others relate with both stages. There is a stronger association of significant socio-demographic factors with drug use while the psychiatric diagnoses are more strongly associated with progression to abuse/dependence.
Risk factors may be use-specific, abuse/dependence-specific or common to use and abuse/dependence. The trend of associations is similar across different illicit drugs. This suggests complex, interacting pathways that determine drug habits in individuals. These results are hypothesis-generating and future studies of causal relationships may draw from the outcomes presented in these analyses.
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ABSTRACT: Few longitudinal studies have examined the effects of education on drug use disorders among community populations of African Americans. This study explores the impact of multiple early education indicators on later problem drug use in an African American population followed for more than 35 years. The initial cohort comprised all 1st graders (N=1242, 51% female) living in the Woodlawn community of Chicago in 1966. Follow-up assessments were conducted in adolescence (1975-76), early adulthood (1992-93), and mid adulthood (2002-03). One or both adult interviews were completed by 1053 individuals providing information for identifying lifetime drug use disorders. Logistic regression with multiple imputation revealed several important relationships between early education indicators and DSM-III-R/DSM-IV drug use disorders. Specifically, the risk for adult problem drug use was related to: underachievement in 1st grade; low 7th and 8th grade standardized math scores; both suspension from and skipping school in adolescence; not having a high school diploma (compared to having a college degree), and having a diploma or GED (compared to having a college degree). Also, 1st graders characterized as shy by their teachers were less likely to develop problem drug use in adulthood. Results indicate potential opportunities for targeted intervention at multiple life stages.Drug and Alcohol Dependence 02/2008; 92(1-3):191-9. DOI:10.1016/j.drugalcdep.2007.08.001 · 3.28 Impact Factor
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ABSTRACT: More than 20 million people in the United States have survived a completed or attempted rape in their lifetimes, and approximately 22.5 million people have problematic substance use. The interplay between these two issues is complex: a history of sexual assault predicts substance abuse and, conversely, substance abuse increases sexual assault risk. This secondary analysis of the Virginia Twin Study of Psychiatric and Substance Use Disorders data for White female-female twins (n=1,497) examines the role of multiple traumas in the sexual assault/substance abuse association. Structural models were used to examine pathways between child sexual abuse (CSA), other traumas, familial factors, social support, psychiatric disorders, and substance abuse. The models also integrate the ACE twin design to estimate genetic, shared environment, and individual-specific environment contributions to liability for psychiatric disorders and substance abuse. Study findings support an interplay between childhood trauma, development of substance abuse and psychiatric disorders, and risks for adult victimization. The findings also support assertions that multiple traumas may increase likelihood for substance abuse and psychiatric disorders, and that these disorders predict risk of adult sexual assault. Across all ACE models, both genetics and common environment produced consistently large estimates of influence on liability for substance abuse. Individual-specific environment played a smaller role but was also often significant, and the pathways from trauma variables to both psychiatric disorders and substance abuse tended to be strong. This supports an interaction between genes and environment/experience in which genetic predisposition, though present, may or may not be activated depending on life experiences. Study findings underscore the need for integrated services for clients with history of multiple traumas and for clients with trauma history and substance abuse or psychiatric disorders.
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ABSTRACT: Whether there is an independent association between problem behaviours and substance use disorders (SUD) needs further investigation. This study examined prospective associations of adolescent psychopathology and problem behaviours with SUD in early adulthood, and whether these associations are confounded by other factors. Data were from a prospective study of 2,429 young Australian adults from birth to the age of 21 when data on SUD were collected. Adolescent psychopathology and behaviour were assessed at 14 years via the Youth Self Report instrument on eight sub-scales of emotional and behavioural problems. In multivariate analyses, attention problems, delinquency, and aggression were associated with both single and multiple SUD in early adulthood, with delinquent behaviour being the strongest predictor (OR = 2.0, 95% CI 1.4-2.9 for one SUD and OR = 3.6, 95% CI 2.4-5.0 for multiple SUDs). Problem behaviours, in particular delinquency and aggression in early adolescence predict long-term SUD. The results suggest that substance use prevention programs should target adolescents with early symptoms of psychopathology and problem behaviour.Social Psychiatry and Psychiatric Epidemiology 06/2008; 43(5):356-63. DOI:10.1007/s00127-008-0325-1 · 2.58 Impact Factor