Substance Use Among Youth

1. Substance Use Among Youth Paula J. Fite Clinical Child Psychology Program University of Kansas

2. Youth Substance Use • Illegal behavior for which charges can be filed • Most common substances are alcohol, tobacco, and marijuana • However prescription drug use and other substances (i.e., sniffing household products, heroin) are also of concern • Trends in drug use depend on the substance • Marijuana use and tobacco use seem to be increasing and alcohol binge drinking seems to be declining Data from Monitoring the Future study, University of Michigan

3. Past 30 Day Use Across Hispanic, African American, and White Youth 40.0 17.6 11.8 Data from Monitoring the Future study, University of Michigan

4. Lifetime Use Across Hispanic, African American, and White Youth 70 34.5 30.4 Data from Monitoring the Future study, University of Michigan

5. Fite et al., 2008, Journal of Abnormal Child Psychology

6. Why is this a problem? • Costs associated with underage drinking (including treatment, crime, lost wages, etc.) exceed $50 billion annually (Miller, 2004; National Research Council, 2004). • 2011 data suggest costs greater than $60 billion (PIRE, 2011) • Adolescent alcohol users are at increased risk for substance abuse and use-related problems throughout the lifespan (e.g., Ellickson et al., 2004; Jacobsen et al., 2005; Tucker et al., 2005) • Which costs society more than $375 billion annually (National Drug Control Policy, 1999). • Each adolescent onset persistent substance user is costing society approximately $970,000 over the course of their lifetime (Cohen, 2005).

7. Rates of Offenses Among Juveniles

8. Current Intervention Programs Waldron & Turner, 2008; JCCAP

9. More Research Needed to Refine Existing Programs Treatment effect sizes are Modest (small to Medium). Outcomes vary widely among adolescents Need a better understanding of: What treatment programs are beneficial for whom What factors contribute to treatment outcomes Waldron & Turner, 2008; JCCAP

10. Program of Research Identify factors that contribute to early substance use in order to aid in the refinement of prevention and intervention strategies

11. What Factors Contribute to Substance use?

12. Factors • Expectancies Regarding Use (O’Connor et al., 2007) • Neighborhood Disadvantage and Violence (Fite et al., 2009; in press) • Perceived Peer and Caregiver Approval (Fite et al., 2009) • Peer Influence (Fite et al., 2007; 2008) • Peer Rejection • Peer Delinquency • AGGRESSIVE BEHAVIOR (Fite et al., 2007, 2008, 2010, in press) • Proactive vs. Reactive

13. Pathways from Proactive and Reactive Aggression to Substance Use

14. Background • Risk for substance abuse starts earlier than initiation of SU. • Prevention and early intervention is key. • Aggression typically proceeds SU. • One way to further understand the relation between aggression and SU is to examine the relation between subtypes of aggression and SU.

15. Aggression • Behavior that is intended to harm or injure another individual (Coie & Dodge, 1998). • Aggression construct is comprised of subtypes or sub-dimensions of aggression

16. Proactive Aggression (PA) • Goal-oriented, calculated aggression motivated by external reward(Dodge, 1991) • Some difficulties, but often positively evaluated by peers and tend to affiliate with other PA children (e.g., Dodge & Coie, 1987; Day et al., 1992; Poulin and Boivin, 2000) • Associated with poor long-term behavioral outcomes(e.g., Fite, et al., 2008; Fite, Stoppelbein, & Greening, 2008; 2009; Vitaro et al., 1998; Cornell et al., 1996)

17. Reactive Aggression (RA) • Aggression in response to others’ behavior perceived as threatening or intentional (Dodge, 1991) • Not liked by peers at any age (e.g., Day et al., 1992; Prinstein & Cilessen, 2003) • Long-term antisocial prognosis not clear, but internalizing symptomotology clearly indicated (e.g., Card & Little, 2006; Conner et al., 2003; Fite et al., 2009; Fite et al., 2010; Raine et al., 2006)

18. PA, RA, and SU (Cont’d) PA Consistent with current developmental models of risk (Moffit, 1993) RA Characterized by impulsivity, a predictor of substance use (e.g., Mc Murran et al., 2002) Associated with ADHD/CD diagnosis, a diagnosis associated with poor long-term outcomes (e.g., Waschbusch et al.., 2002)

19. Proactive Aggression Substance Use Initiation Substance Use/Abuse Reactive Aggression

20. Peer Delinquency Proactive Aggression Delinquency Contextual Factors Substance Use Initiation Substance Use/Abuse Reactive Aggression Negative Emotions Peer Rejection

21. Relation Between Proactive and Reactive Aggression and Frequency of Substance Use Fite, Colder, Lochman, & Wells (2007) Psychology of Addictive Behaviors

22. Examined pathways from 5th grade proactive and reactive aggression to 9th grade SU • Aims of the study: • Examine whether proactive aggression and reactive aggression are related to the development of SU. • Examine peer relations as mediators of these relations

23. Late Childhood/ Early Adolescence Adolescence Childhood Peer Delinquency Proactive Aggression Substance Use/Escalation Reactive Aggression Peer Rejection

24. Hypothesis #1 Late Childhood/ Early Adolescence Adolescence Childhood Peer Delinquency Proactive Aggression + Substance Use/Escalation + Reactive Aggression Peer Rejection

25. Hypothesis #2 Late Childhood/ Early Adolescence Adolescence Childhood Peer Delinquency + Proactive Aggression + Substance Use/Escalation Reactive Aggression Peer Rejection

26. Hypothesis #3 Late Childhood/ Early Adolescence Adolescence Childhood Peer Delinquency Proactive Aggression Substance Use/Escalation Reactive Aggression + Peer Rejection +

27. Hypothesis #4 Late Childhood/ Early Adolescence Adolescence Childhood Peer Delinquency Proactive Aggression + Substance Use/Escalation + Reactive Aggression Peer Rejection +

28. Methods • Control groups of a larger longitudinal study • 125 Aggressive individuals in 4th grade at initial assessment • Mean age = 10.4 years • 79% African American • 66% Male • Data collected annually over 6 years

29. Data Analytic Strategy • Included PA & RA in the same model to examine unique relations. • Included 8th grade SU in order examine change in SU, above and beyond prior levels of Substance Use

32. Conclusions • PA → SU through peer delinquency = continuity of problem behavior • RA → SU complex • RA associated with SU through complex mediational chain, which is consistent with previous research • RA associated with hypervigilance to threat cues = protective of substance use

33. Timing of Initiation of Substance UseFite, Colder, Lochman & Wells (2008) Journal of Abnormal Child Psychology Note of Replication/Extension

34. Reactive and Proactive Aggression in Adolescent Males:Examining Differential Outcomes 10-Years Later in Early Adulthood Fite, Raine, Stouthamer-Loeber, Loeber, & Pardini (2010) Criminal Justice and Behavior

35. Very little research has examined the long-term outcomes of proactive and reactive aggression into adulthood • Understanding long-term associations can aid in refining current early prevention efforts and has implications for targeted intervention strategies

36. Current Study • Examined proactive and reactive aggression at age 16 as predictors of adult outcomes 10 years later (mean age =26) while also controlling for prior levels of negative behavior.

37. Methods • 335 boys followed-up longitudinally from age 7 to 26 years • 57% African American • 40% Caucasian • 3% other ethnicity • Predictor variables collected at age 16 and outcome data at age 26

39. Substance Use in a Predominantly Hispanic Sample of Youth Fite, Hendrickson, Evans, Rubens, Johnson-Motoyama, & Savage in press Journal of Child and Adolescent Substance Abuse

40. Hispanic youth are at increased risk for substance use, particularly marijuana use No research has examined associations between aggression subtypes and substance use in a Hispanic Sample Current study examined associations in a sample of 152 adolescents (95% Hispanic)

41. .62(1.10)* Alcohol R2 = .40 Proactive Aggression Reactive Aggression .30(.46)* Neighborhood Violence Tobacco R2 = .20 .24(.34)* Gender .25(.38)* Grade .24(.35)* Marijuana R2 = .21 Note. *p < .05. Standardized betas reported outside parentheses and unstandardized betas reported inside parentheses.

42. Take Home Message Proactive Aggression most robustly associated with substance use, particularly alcohol use, across racial groups and genders Reactive Aggression associated with substance use, tobacco and marijuana in particular, but only under particular situations and circumstances Unique interventions for different subtypes of aggression

43. Questions

44. Collaborators: Dr. Craig Colder Dr. Sara Elkins Dr. Leilani Greening Dr. John Lochman Dr. Rolf Loeber Dr. Dustin Pardini Dr. Adrian Raine Dr. Laura Stoppelbein Dr. Magda Stouthamer-Loeber Dr. Karen Wells Dr. Helene White Dr. Michelle Johnson-Motoyama UT Child Behavior Lab (Gaertner, Grassetti, Preddy, Wimsatt, Rathert, Vitulano, & Wynn) KU Child Behavior Lab (Rubens, Cooley, Hendrickson, Evans, Gabrielli, Tunno) Lochman Research Group UB Child Development Project Members Families who participated in the studies Funding Sources: National Institute on Drug Abuse DA031719 (PI:Fite) DA018016 (PI: Fite) DA14386 (PI: Colder) DA411018 (PI: Loeber) National Institute on Mental Health MH48890 (PI: Loeber) MH 50778 (PI: Loeber) MH078039 (PI: Pardini) SAMHSA Center for Substance Abuse Prevention UR6 5907956 (PI: Lochman) KD1 SP08633 (PI: Lochman) Office of Juvenile Justice and Delinquency Prevention 96-MU-FX-0012 (PI: Loeber) SUNY Graduate Student Employee Union Professional Development Funds (PI: Fite) University of Tennessee (PI: Fite) University of Kansas (PI:Fite) Acknowledgements