Adolescents at risk for substance misuse fit three subgroups



Adolescents appear to fall into three distinct subgroups at high risk of misusing drugs and other substances, based on a variety of their previous behaviors, a report published in Addictive Behaviors shows.

If future research confirms this finding, it points the way to tailoring prevention and intervention programs to these three target groups, said James A. Cranford, Ph.D., of the Addiction Research Center, University of Michigan, Ann Arbor, and his associates.

The investigators performed a cross-sectional Web-based survey of adolescents attending five middle schools and high schools in southeastern Michigan to assess whether certain substance-use behaviors could be used to classify them into risk groups. The 2,744 study subjects had a mean age of 14.8 years, and were equally divided between boys and girls. About 64% were white, 31% were black, 4% were Asian, and 2% were Hispanic or other ethnicities (Addict. Behav. 2013;38:2768-71).

These participants first answered questions to classify them into four categories of substance use based on their self-reported behavior during the preceding year: nonuse/low use of prescription agents; nonmedical use of prescription medications such as sleep, antianxiety, stimulant, or pain medications; excessive use of prescription medications such as the aforementioned medicines and antidepressants; or the use of illicit substances such as alcohol, marijuana, tobacco, and others.

In addition, the respondents’ substance use and their parents’ monitoring of it were assessed using several items from the Monitoring the Future instrument, internalizing and externalizing tendencies were assessed using the Youth Self-Report, and parental substance use was measured using the Children of Alcoholics Screening Test.

Nonusers/low users were the largest subgroup of adolescents (76%) and were judged to be at very low risk of substance misuse in the near future

The other three groups were considered to be at high risk of substance misuse in the near future. They included the 12% of study subjects who used tobacco, alcohol, and marijuana at least once during the preceding year; the 8% who reported alcohol, nonmedical prescription drug, and excessive prescription drug use during the preceding year; and the 4% who reported using all substances at least once during the preceding year, Dr. Cranford and his associates said.

Two parental factors – a lack of parental monitoring of the adolescents’ substance use and the parents’ own substance use – predicted membership in all three high-risk groups. This suggests that parent-focused prevention and intervention programs might be beneficial, the researchers said.

Parental factors exerted a more heightened effect on girls than on boys, which further suggests that parent-focused interventions might be particularly helpful to adolescent girls.

Adolescents who had externalizing problems were more likely than were those without such problems to misuse substances, while those who had internalizing problems were the least likely to misuse substances. Similar findings have been reported in previous studies, the investigators said.

Girls were more likely than boys were to report the nonmedical use of prescription drugs and the excessive use of prescription drugs, a trend that also has been reported in previous studies. This finding indicates that parents and teachers should be especially vigilant about possible misuse of prescription drugs among adolescent girls.

Moreover, these risks were particularly high in nonwhite girls, suggesting "a possible unique intervention target for at-risk nonwhite females," they added.

The investigators cited the completion of the survey in school and the possibility that this fact might have led to underestimates of problem behavior as a possible limitation of the study. Furthermore, the results might not be generalizable in the absence of a nationally representative study.

However, the study still "provides important evidence for the existence of distinct subtypes of adolescent substance use based on 12-months use of alcohol, tobacco, marijuana, and illicit drugs, along with excessive medical use and nonmedical use of prescription drugs," they wrote.

This study was supported by the National Institute on Drug Abuse. No financial conflicts of interest were reported.

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