Predicting Violent Behavior in Adolescent Cannabis Users

1. Predicting Violent Behavior in Adolescent Cannabis Users:Correlates of and Changes in Social Environment Over Time Michelle White, M. S.*, Rod Funk, B. S.,* Michael Dennis, Ph.D.*, Frank Tims, Ph.D.** *Chestnut Health Systems, Bloomington, IL and **Operation PAR, St. Petersburg, FL Poster Session Presentation at the College on Problems of Drug Dependence (CPDD) Sixty-Fifth Annual Meeting, Bal Harbour, FL June 14-19, 2003.

2. Abstract Violence, aggression, and criminal offenses are common among adolescent substance abusers. Using Moffitt’s (1993) taxonomy of offending behavior theory, we examine which social environment factors (e.g. peer group criminality and drug use) are correlated with criminal activity and violence among adolescents entering substance abuse treatment. We then predict how changes in social environment factors affect criminality and violence over time. We use data from the Cannabis Youth Treatment (CYT) multisite randomized field experiment of 600 adolescents meeting outpatient patient treatment placement criteria. Follow-up was extended to 30-months post-intake through a CSAT contract, the Persistent Effects of Treatment Study of Adolescents (PETS-A). Our findings were consistent with the two groups hypothesized by Moffitt in terms of types of crime, correlates, and long-term course of behaviors. There was mixed evidence for the sensitivity of the high (life-course persistent) group to changes in social environment.

3. Aims • To summarize Moffitt’s (1993) taxonomy of behaviors related to criminality and violence. • To examine how this taxonomy is correlated with social environment factors (e.g. peer group criminality and drug use). • To examine how well this taxonomy predicts changes in criminal activity and social environment factors.

4. Moffitt’s Taxonomy • Life-Course Persistent Offenders:begin offending early in life, commit many crimes & engage in violence, have psychopathology factors (CD, other), and generally continue to commit criminal/violent acts in spite of improved social environment. • Adolescence Limited Offenders: begin offending in adolescence, generally engage in crimes of a petty or non-violent nature (e.g., vandalism, property offenses), do not have underlying psychopathology problems, and will generally decrease or stop their illegal behaviors when there are improvements in their social environment.

5. Data are from the Cannabis Youth Treatment (CYT) Randomized Field Experiment Coordinating Center: Chestnut Health Systems, Bloomington, IL, and Chicago, IL University of Miami, Miami, FL University of Conn. Health Center, Farmington, CT Sites: Univ. of Conn. Health Center, Farmington, CT Operation PAR, St. Petersburg, FL Chestnut Health Systems, Madison County, IL Children’s Hosp. of Philadelphia, Phil. ,PA Sponsored by: Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services

6. Design • Target Population: Adolescents with marijuana disorders who are appropriate for 1 to 3 months of outpatient treatment. • Inclusion Criteria: 12 to 18 year olds with symptoms of cannabis abuse or dependence, past 90 day use, and meeting criteria for outpatient treatment. • Data Sources: self report and collateral reports using the Global Appraisal of Individual Needs (GAIN), on-site and laboratory urine testing, therapist alliance and discharge reports, staff service logs, and cost analysis. See www.chestnut.org/li/cyt/ for more information on CYT and list of articles.

7. Implementation of Evaluation • Over 85% of eligible families agreed to participate. • Quarterly follow-up of 94 to 98% of the adolescents from 3- to 12-months (88% all five interviews). • Collateral interviews and urine test data were obtained at intake, 3- and 6-months on over 85% of participants (90% of the adolescents who were not incarcerated or interviewed by phone). • 90% completion in 30-month follow-up (N=599). • Baseline taxonomy based on the GAIN’s Crime and Violence Index (alpha=.9), categorized into three groups 0-2 (low), 3-6 (moderate) and 7-31 (high). • Environmental risk based on the GAIN’s Social Risk Index (alpha=.7).

8. Crime and Violence Index During the past 12 months, have you had a disagreement in which you did the following things? (1=Yes, 0=No) General Conflict Tactic Index (GCTI) - oral violence subscale a. Discussed it calmly and settled the disagreement? b. Left the room or area rather than argue? c. Insulted, swore or cursed at someone? d. Threatened to hit or throw something at another person General Conflict Tactic Index (GCTI) - physical violence subscale e. Actually threw something at someone? g. Slapped another person? h. Kicked, bit, or hit someone? j. Hit or tried to hit anyone with something (an object)? k. Beat up someone? m. Threatened anyone with a knife or gun? n. Actually used a knife or gun on another person?

9. During the past 12 months, how many times have you . . Property Crime Index (PCI) subscale 1. purposely damaged or destroyed property that did not belong to you? 2. bought, received, possessed or sold any stolen goods? 3. passed bad checks, forged (or altered) a prescription or took money from an employer? 4. taken something from a store without paying for it? 5. other than from a store, taken money or property that didn’t belong to you? 6. broken into a house or building to steal something or just to look around? 7. taken a car that didn’t belong to you?

10. Interpersonal Crime Index (ICI) subscale 8. used a weapon, force, or strong-arm methods to get money or things from a person? 9. hit someone or got into a physical fight? 10. hurt someone badly enough they needed bandages or a doctor? 11. used a knife or gun or some other thing (like a club) to get something from a person? 12. made someone have sex with you by force when they did not want to have sex? 13. been involved in the death or murder of another person (including accidents)? 14. intentionally set a building, car or other property on fire? Drug Crime Index (DCI) subscale 15. driven a vehicle while under the influence of alcohol or illegal drugs? 16. sold, distributed or helped to make illegal drugs? 17. traded sex for food, drugs, or money? 18. been a member of a gang? 19. gambled illegally? Scored 0 for none and 1 for one or more times. Each subscale is sum of “types” of crime. Total is sum across all types.

11. Social Risk Index (SRI) Of the people you have regularly socialized with or hung out with in the past year, would you say that none, a few, some, most or all of them... a. were employed or in school or training full-time? b. were involved in illegal activity? c. weekly got drunk or had 5 or more drinks in a day? d. used any drugs during the past 90 days? e. shout, argue, and fight most weeks? f. have ever been in drug or alcohol treatment? g. would describe themselves as being in recovery? With risk items (b,c,d,e) scored 0=none, 1=a few, 2=some, 3=most, 4=all and protective items (a, f, g) scored 4=none, 3=a few, 2=some, 1=most, 0=all

12. Validation of the CVI scale and subgroups • The CVI and each of its subscales were internally consistent (alpha = .7+ for subscales, .9 for total). • Endorsement of all items and subscales increased with the shift from low to moderate to high (with all those with prevalence of 3% or more significant). • Shifting from low to moderate was associated with increased oral violence, property crime, and drug related crime. • Shifting from moderate to high was associated with even more of these things, as well as more physical violence and interpersonal (aka violent) crimes.

13. Behaviors by Crime/Violence Sub-Groups CVIGP Crime/Violence groups Low 0-2 Medium 3- High 7-29 Total Chi- (N=172) 6 (N=173) (N=240) (N=585) Square Crime/Violence Index In past year, have you had a disagreement in Gen. Conflict Tactic Index (GCTI) df =2 which you : Discussed it calmly and settled it 8% 61% 68% 49% 161.26 *** GCTI –oral violence Left room or area rather than argue 8% 68% 84% 57% 247.67 *** Insulted or swore at someone 5% 73% 94% 61% 349.12 *** Threatened to hit or throw something 0% 29% 75% 39% 243.57 *** GCTI –Physical violence Actually threw something at someone 0% 12% 49% 24% 149.97 *** Pushed grabbed or shoved someone 1% 34% 82% 44% 273.25 *** Slapped another person 1% 10% 48% 23% 149.04 *** Kicked, bit or hit someone 1% 24% 70% 36% 225.71 *** Hit or tried to hit anyone with something 0% 6% 37% 17% 117.20 *** Beat up someone 0% 20% 65% 33% 209.74 *** Threatened anyone with gun or knife 0% 1% 10% 4% 29.85 *** Actually used gun or knife on someone 1% 1% 5% 3% 9.78 ** GCI – General Crime Index During the past year, have you: GCI – Property Crime Index Purposely damaged/destroyed property 3% 12% 42% 21% 103.65 *** Passed bad checks/forged prescription 1% 2% 4% 3% 5.22 Taken something from store w/o paying 2% 19% 39% 22% 79.81 *** Taken money/property didn't belong to you 1% 8% 31% 15% 77.79 *** Broken into house/building to steal 2% 4% 21% 11% 49.00 *** Taken a car that didn't belong to you 2% 6% 18% 10% 34.35 *** GCI – Interper. Crime Index Used a weapon/force to get money 0% 1% 9% 4% 26.82 *** Hit someone or got into physical fight 5% 18% 66% 34% 197.62 *** Hurt someone badly they needed MD 1% 7% 29% 14% 76.18 *** Used knife/gun to get something 0% 1% 4% 2% 11.96 ** Made someone have sex with you/force 0% 1% 0% 0% 2.39 Been involved in death/murder of person 0% 1% 1% 1% 1.38 Intentionally set building/car/etc on fire 1% 2% 3% 2% 2.20 GCI – Drug Crime Index Driven vehicle while under influence of AOD 5% 14% 37% 21% 68.84 *** Sold/distributed/made illegal drugs 4% 13% 48% 25% 122.66 *** Traded sex for food/drugs/money 0% 0% 1% 1% 4.34 Been a member of a gang 0% 1% 8% 3% 25.02 *** * p < .05, ** p < .01, *** p < .001.

14. Crime/Violence Subscales by Sub-Groups 12 10 8 6 4 2 0 DCI Drug Crime Index GCI General Crime Index VCI Verbal Conflict Index PCI Property Crime Index CVI Crime/Violence Index PHCI Physical Conflict Index ICI Interpersonal Crime Index GCTI General Conflict Tactic Index Low 0-2 (N=172) Medium 3-6 (N=173) High 7-29 (N=240)

15. Expected Correlates of CVI subgroups • There were no significant differences in the demographic characteristics of the three groups. • The low CVI group experienced less environmental risk and fewer problems (including substance use and HIV risk behaviors), but there were few differences between the moderate and high group. • The rates of more pathological problems (including dependence, mental distress, traumatic distress, ADHD, and conduct disorder) increased from low to moderate to high.

16. Correlates of Crime/Violence Sub-Groups Low 0-2 Medium 3-6 High 7-29 Total Chi-square (N=172) (N=173) (N=240) (N=585) Demographics Female 14% 20% 18% 18% 2.49 African American 37% 24% 27% 29% 9.34 Caucasian 56% 66% 64% 62% Hispanic 2% 4% 5% 4% Other/Mixed 5% 6% 5% 5% Non-white 44% 34% 36% 38% 4.22 12-14 Years Old 17% 15% 14% 15% 1.07 15-18 Years Old 83% 85% 86% 85% Family Single Parent Family 55% 44% 50% 50% 4.04 Weekly Alcohol Use in Home 21% 22% 27% 24% 2.72 Weekly Drug Use in Home 6% 8% 16% 11% 11.59 ** Social Peers Regular Peer Alcohol Use at Work/School 45% 60% 62% 57% 10.00 ** Regular Peer Alcohol Use Socially 50% 65% 75% 64% 25.95 *** Regular Peer Drug Use at Work/School 69% 81% 83% 78% 8.78 * Regular Peer Drug Use Socially 80% 91% 94% 89% 19.47 *** Environment In school 89% 87% 86% 87% 0.83 Employed 38% 53% 49% 47% 8.40 * Current CJ Involvement 62% 59% 64% 62% 0.84 Controlled Environment 17% 25% 30% 25% 8.47 * Ever Been Victimized 39% 51% 74% 57% 53.92 *** Acute Victimization 20% 29% 56% 37% 58.69 *** Ever Homeless/Runaway 4% 8% 12% 8% 6.66 *

17. Prior SA Treatment Episodes None 78% 75% 73% 75% 4.91 One 13% 13% 19% 15% 2+ episodes 9% 12% 9% 10% Drug Use: Weekly Any Alcohol or Drug Use\3 69% 73% 82% 76% 10.01 ** Weekly Alcohol Use\3 11% 14% 23% 17% 11.58 ** Weekly Marijuana Use\3 64% 65% 81% 72% 19.23 *** Weekly Crack/Cocaine Use\3 0% 0% 0% 0% N/A Weekly Heroin/Opiod Use\3 0% 0% 0% 0% N/A Weekly Other Drug Use\3 0% 2% 0% 1% 4.24 Age of First Use Under 15 81% 84% 87% 85% 2.92 13+ days in Cont. Env.\3 6% 7% 12% 9% 4.44 Substance Severity:\5 No use 0% 0% 0% 0% 27.81 *** Use 5% 4% 1% 3% Abuse 59% 49% 38% 48% Dependence 4% 5% 5% 5% Physiological Dependence 31% 43% 55% 44% Biomedical: Acute Health Problems\7 20% 26% 30% 26% 5.49 Pregnant within Past Year\8 10% 7% 14% 11% 0.39 HIV Risk: Sexually Active\3 60% 72% 80% 72% 19.72 *** Multiple Sexual Partners \3 32% 34% 44% 38% 8.07 * Unprotected Sex\3 16% 19% 33% 24% 17.69 *** Any Needle Use\3 1% 1% 1% 1% 0.34 Mental Health: Acute Mental Distress\9 15% 24% 37% 27% 27.14 *** Acute Traumatic Distress\10 5% 10% 22% 14% 28.35 *** ADHD\11 25% 36% 49% 38% 25.35 *** Conduct Disorder\12 26% 47% 76% 53% 102.09 *** * p < .05, ** p < .01, *** p < .001.

18. Predictive Validity of the CVI subgroups • The baseline CVI groups can also be used to predict illegal activity 30 months after intake. • Both the Moderate and High groups were more likely than the low group to commit nonviolent crimes (Odds ratio=1.3 and 1.6 respectively) but these groups are not significantly different from each other. • Those in the High group were significantly more likely to have committed violent crimes than those in the moderate (Odds ratio=2.8) or low (Odds ratio=4.5) • Those in the High group were significantly more likely to have committed 3 or more crimes than those in the moderate (Odds ratio=3.4) or low (Odds ratio=4.0) groups.

19. 30 Month Criminal Activity by Baseline Crime/Violence Sub-Groups 100% 90% 80% 70% No crime Incarcerated 60% Substance Use only 50% Non-violent crime Violent crime 40% X2(8)=18.36, p<.05 30% 20% 10% 0% Low (n=150) Moderate (n=158) High (n=216)

20. Frequency of Criminal Activity at 30 Months by Baseline Crime/Violence Sub-Groups 100% 90% 80% 70% 60% No Crime 50% 1-2 Crimes 3+ Crimes 40% X2(4)=24.56, p<.001 30% 20% 10% 0% Low (n=150) Moderate (n=158) High (n=216)

21. Changes in Social Environment Over Time • Both the moderate and high group significantly reduced their illegal activities between intake and 30-months post-intake. • In both groups, increased social risk was associated with continued illegal activity. Same risk and reduced risk over time was associated with increasingly larger reductions in illegal activity. • The model supports Moffitt’s theory for the moderate (adolescence-limited) group (criminal activity decreased with changes in social environment). • For the high risk group, the findings were mixed: • The high CVI group was at much higher risk of continued involvement in spite of changes in social risk (as expected) • When there were reductions in social environmental risks, however, the high risk group did reduce their illegal activity (not expected)

22. Change in Illegal Activity by CVI group and Change in Social Environment Over Time

23. Discussion • The GAIN’s CVI scale appears to be face valid and internally consistent. • The CVI’s subgroup typology provides a simple taxonomy that is consistent with the two groups hypothesized by Moffitt in terms of types of crime, correlates, and long-term course of behaviors. • It provides mixed evidence for the sensitivity of the high group to changes in social environment.

24. Limitations and Next Steps • This analysis was limited to self report data and should ideally be replicated. • During the coming months we will be doing more work to examine • cluster analysis of trajectories across all of the longitudinal observations at intake, 3, 6, 9, 12 and 30 months. • PATH analysis of the role of changing environmental factors on this process. • the comparability of these measures with collateral reports and records.

25. Further Information and Acknowledgement • For further information contact: Michelle White, M. S., Chestnut Health Systems, 720 W. Chestnut St., Bloomington, IL 61701, mwhite@chestnut.org. (309) 827-6026 • Preparation of this manuscript was supported by funding from the Center for Substance Abuse Treatment (CSAT) through the Persistent Effects of Treatment Study (PETS, Contract No. 270-97-7011, as well as Grant #s TI11317, TI11320, TI11321, TI11323, and TI11324, TI11422, TI11433, and TI11432) • The content of this publication does not necessarily reflect the views or policies of the government