Hilde Pape

Under double influence: Assessment of simultaneous alcohol and cannabis use in general youth populations

BACKGROUND/AIMS We assessed to what extent adolescents use alcohol and cannabis simultaneously and expanded previous research by estimating the proportion of all events of cannabis use that had occurred in relation to drinking. How the prevalence of this form of polysubstance use co-varied with the overall level of alcohol and cannabis use in different countries was also examined. METHOD We analysed individual level data from a survey of 14-20 year-olds in Norway (n=16 813) and population level data from the 2003 ESPAD study on substance use among 15-16 year-olds in 35 European countries. RESULTS The prevalence of simultaneous intake of alcohol and cannabis in the past year among Norwegian youth was 7%. The overall prevalence of cannabis use was only slightly higher (8%), implying that a majority (82%) of the cannabis users had taken the drug in combination with alcohol. Moreover, in about 80% of all incidents of cannabis use, alcohol had been consumed as well. Correspondingly, a majority of the cannabis users in most of the countries in the ESPAD study had used the drug in combination with alcohol. Such simultaneous polysubstance use was more prevalent in countries where cannabis use was relatively widespread and alcohol rather frequently consumed. CONCLUSION Because adolescents most often combine cannabis with alcohol, their use of the drug may be more harmful than assumed. The results also indicate that cannabis is a complement rather than a substitute for alcohol, suggesting that policies that reduce adolescent drinking may reduce the use of cannabis as well.

Alcohol, suppressed anger and violence

AIMS Is alcohol related causally to violence, and if so, is the effect of drinking contingent on suppressed anger such that it is strongest among individuals who are highly inclined to withhold angry feelings? We addressed these questions by analysing panel data using a method that diminishes the effects of confounding factors. DESIGN We analysed data on heavy episodic drinking and violent behaviour from the second (1994) and third (1999) waves of the Young in Norway Longitudinal Study (n = 2697; response rate: 67%). The first difference method was applied to estimate the association between these behaviours, implying that changes in the frequency of violence were regressed on changes in the frequency of drinking. Hence, the effects of time-invariant confounders were eliminated. Analyses were conducted for the whole sample, and for groups scoring low, medium and high on a short version of the STAXI anger suppression scale. FINDINGS Changes in drinking were related positively and significantly to changes in violent behaviour, but the alcohol effect varied with the level of suppressed anger: it was strongest in the high-anger group (elasticity estimate = 0.053, P = 0.011) and weakest (and insignificant) in the low-anger group (elasticity estimate = 0.004, P = 0.806). CONCLUSIONS Alcohol use may be related causally to violence, but the effect of drinking is confined to individuals who are inclined to suppress their angry feelings.

Young people's overestimation of peer substance use: an exaggerated phenomenon?

Aims This paper queries the notion that young people overestimate peer substance use, asking whether there is robust evidence that such misperceptions are widespread and whether the phenomenon may have been exaggerated in the research literature. Method An examination of the research literature was conducted, focusing mainly on studies published since 2000. Some analyses of relevant data on cannabis use from a Norwegian youth survey were also undertaken. Results The research in question is characterized by many weaknesses, including low response rates and widespread use of convenience samples, as well as the presence of contextual factors and the use of assessment tools that may have created a bias in favour of ‘demonstrating’ that youth overestimate peer drinking or drug use. Moreover, in some cases, the apparent tendency to hold such misbeliefs may reflect the reality. Further, although most studies conclude that the modal tendency is to overestimate, high levels of underestimation of peer substance use have been reported. There is also suggestive evidence that many youth may have no pre-existing beliefs when responding to items on the issue. Results from the Norwegian youth survey added to this picture. Conclusion Young peoples tendency to overestimate peer drinking and drug use has been exaggerated, while the uncertainty surrounding the evidence in question has been understated.

“Ordinary” People with “Normal” Lives? a Longitudinal Study of Ecstasy and other Drug use among Norwegian Youth

Ecstasy users have been described as “ordinary people” with “normal lives” in recent literature, but little empirical evidence exists to support this portrayal. One may assume, however, that such a rosy portrayal is more likely to fit individuals who consume drugs that are more commonly used (e.g., cannabis). With this in mind, we have explored characteristics of different categories of drug users by analyzing data from a general population study of young people in Norway (n = 2,761). Respondents were assessed three times over a period of seven years (mean age at time 3 = 21.6 years). Results showed that ecstasy users, cannabis users, and users of “traditional” hard drugs were all relatively unremarkable with respect to socio-economic characteristics. On the other hand, they all tended to have a less favorable family background than nonusers of drugs, and their rates of past and present legal substance use, mental health problems, and antisocial behavior were also much higher. Individuals who included ecstasy in their drug-taking repertoire had a somewhat more deviant profile than other drug users, indicating that their public image of being ordinary and well adjusted is highly overstated. This image did not fit “pure” cannabis users very well either.

Alcohol-Related Problems in Young People: How are Such Problems Linked to Gender, Drinking Levels, and Cannabis Use?

This paper focuses on problems related to drinking, including interpersonal aggression, accidents and injuries, trouble with the police, and problems at school or work. The data stem from a representative, longitudinal survey of Norwegian youth aged 19 to 22 years at the first assessment and 25 to 28 at the last. Men reported more problems due to drinking, in both alcohol consumption and general problem proneness, than women. Furthermore, early age at first intoxication seemed to be a male-specific predictor of negative consequences of drinking. Cannabis users reported more alcohol-related problems than others. There was a substantial reduction in problems attributed to drinking between late adolescence and early adulthood, implying that little individual stability in such problems was found. Even so, multivariate analyses showed that alcohol-related problems before ages 19 to 22 were the most powerful predictor of similar problems 6 years later. Registered criminality, cannabis use, and low self-esteem also had a predictive power, but only for men.

Wetter and Better

Background/Aims: The consumption of alcohol and the frequency of intoxication among Norwegian youth increased significantly from 1992 to 2002, and we thus asked what, if anything, can be expected to happen to rates of other problem behaviors when heavy drinking becomes more widespread? Do such aggregate level changes in alcohol use imply that individual level associations between drunkenness and behavioral deviance change as well? Method: School-based surveys of 16- to 19-year-old Norwegians that were carried out in 1992 (n = 4,744, response rate 97%) and 2002 (n = 5,458, response rate 92%). Results: Contrary to rates of drunkenness, the level of theft/pilfering declined from 1992 to 2002, while rates of aggressive behavior and school misconduct remained unchanged. We assumed that heavy-drinking adolescents were relatively less deviant with regard to non-violent problem behaviors when the youth culture was relatively ‘wet’ (2002) as compared to the period when it was much ‘drier’ (1992) and revealed that this was the case. However, the link between drunkenness and aggressive behavior was equally strong at both assessments. Conclusion: Differential temporal trends in the associations between drunkenness and various problem behaviors may reflect variations with respect to the etiological significance of alcohol use on such behaviors.

Effect and Process Evaluation of a Norwegian Community Prevention Project Targeting Alcohol Use and Related Harm

Based on a combination of effect and process evaluation, we aimed to (a) assess whether a community prevention project succeeded in curbing alcohol use and related harm among adolescents and (b) explain the results of the effect evaluation. School surveys among adolescents (n = 20,000) and purchase trials (n = 162) were carried out in intervention and control communities before and after the intervention. Qualitative data from key actors and documents were collected throughout the 3-year project period. The effect evaluation revealed no impact of the intervention on the availability of alcohol, drinking, and alcohol-related harm. The process evaluation showed how and why the prevention project was delayed, that the preventive programs implemented were not likely to be effective, and why these programs were chosen. The latter was essential to explain the finding of the effect evaluation and illustrates the utility and necessity of mixed-method approaches when evaluating a complex intervention.

Changes in alcohol consumption after a natural disaster: a study of Norwegian survivors after the 2004 Southeast Asia tsunami

BackgroundMany studies suggest that disaster exposure is related to a subsequent increase in alcohol consumption. Most of these studies have relied on retrospective self-reports to measure changes in alcohol use. The aim of the present study was to examine the association between disaster exposure and drinking behaviors more closely, analyzing data on both self-perceived changes in alcohol consumption and current drinking habits in groups with different extents of disaster exposure.MethodsA sample of Norwegian adults (≥ 18 years) who resided in areas affected by the 2004 Southeast Asia tsunami (N = 899) were assessed by a postal questionnaire 6 months after the disaster. Based on detailed questions about experiences with the tsunami, participants were grouped according to their extent of disaster exposure. The Impact of Event Scale-Revised was applied to measure the level of post-traumatic stress. Participants were asked whether they had increased or decreased their alcohol consumption after the disaster. Moreover, weekly alcohol consumption and frequency of intoxication during the past month were used as indicators of current drinking behaviors.ResultsSeverely exposed individuals more often reported changing their alcohol consumption compared with those who were less exposed. Severe exposure to the tsunami was associated with both a self-perceived increase (OR 21.38, 95% CI 2.91–157.28) and decrease in alcohol consumption (OR 7.41, 95% CI 1.74–31.51). The odds ratios decreased and were not significant when adjusting for post-traumatic stress symptoms. Weekly consumption and frequency of intoxication during the past month did not vary with extent of disaster exposure.ConclusionsOur findings indicate a polarization effect of severe disaster exposure on self-perceived changes in alcohol consumption; that is, disaster exposure was associated with self-perceived increases and decreases in drinking. However, the absence of associations between disaster exposure and indicators of current drinking behaviors suggests that the observed polarization effect may be overestimated because of attribution and recall bias.

Gender differences in the association between conduct problems and other problems among adolescents

The present paper examines whether there are gender differences in the associations between various dimensions of conduct problems and other problems in adolescence. Other problems studied are both of an externalizing nature (substance use) and an internalizing nature (suicidal behavior and emotional problems). Data stemmed from a large general population sample of Norwegian adolescents (N=9 342). On the basis of earlier studies, conduct problems were decomposed into three dimensions, labeled ‘Theft and vandalism’, ‘School opposition’ and ‘Covert behavior’. The first dimension includes different kinds of stealing and violence against objects, whereas the second includes school-related conduct problems of an overt aggressive kind. The last dimension reflects avoidance of arenas under adult control. Whether or not gender differences were detected, depended on the kind of conduct problems considered. We observed stronger associations between two dimensions of conduct problems, theft and vandalism and school opposition, and other problems among girls than among boys. There were no male/female differences in the associations between covert behavior and other problems.

Structure of conduct problems in adolescence

Scholars disagree about whether adolescent conduct problems (CPs) form a single behavioral syndrome or whether such problems are better conceptualized as different dimensions. The arguments raised by both sides are addressed and tested empirically by analysing data from a large general population sample of Norwegian adolescents (n = 9,342). Confirmatory factor analyses show that a single syndrome of CPs may be subdivided into three highly correlated factors. The first dimension, destructive covert, includes theft and vandalism, whereas the second, nondestructive covert, reflects avoidance of arenas under adult control. The last dimension, overt, includes school opposition and fighting. This three-factor model fits well for both girls and boys, and individuals in their early and late teens. Results from scale analyses are modestly to moderately indicative of a developmental continuum of severity of CPs ranging from nondestructive covert to overt to destructive covert. Taken together the findings imply that both a unidimensional and a multidimensional perspective on CPs are applicable in the general youth population.