Kevin M. King

Sexual orientation and adolescent substance use : a meta-analysis and methodological review

AIMS Several decades of research have shown that lesbian, gay and bisexual (LGB) adults are at high risk for substance use and substance use disorders (SUDs). These problems may often start prior to young adulthood; however, relatively little is known about risk for substance use in LGB adolescents. The primary aims of this paper were to conduct a meta-analysis of the relationship between sexual orientation and adolescent substance use and a systematic review and critique of the methodological characteristics of this literature. METHODS Medical and social science journals were searched using Medline and PsychInfo. Studies were included if they tested the relationship between sexual orientation and adolescent substance use. Eighteen published studies were identified. Data analysis procedures followed expert guidelines, and used National Institutes of Health (NIH)-sponsored meta-analysis software. RESULTS LGB adolescents reported higher rates of substance use compared to heterosexual youth (overall odds ratio = 2.89, Cohens d = 0.59). Effect sizes varied by gender, bisexuality status, sexual orientation definition and recruitment source. None of the studies tested mediation and only one tested moderation. One employed a matched comparison group design, one used a longitudinal design, and very few controlled for possible confounding variables. CONCLUSIONS The odds of substance use for LGB youth were, on average, 190% higher than for heterosexual youth and substantially higher within some subpopulations of LGB youth (340% higher for bisexual youth, 400% higher for females). Causal mechanisms, protective factors and alternative explanations for this effect, as well as long-term substance use outcomes in LGB youth, remain largely unknown.

Trajectories of alcohol and drug use and dependence from adolescence to adulthood: the effects of familial alcoholism and personality.

This study describes trajectories of substance use and dependence from adolescence to adulthood. Identified consumption groups include heavy drinking/heavy drug use, moderate drinking/experimental drug use, and light drinking/rare drug use. Dependence groups include alcohol only, drug only, and comorbid groups. The heavy drinking/heavy drug use group was at risk for alcohol and drug dependence and persistent dependence and showed more familial alcoholism, negative emotionality, and low constraint. The moderate drinking/experimental drug use group was at risk for alcohol dependence but not comorbid or persistent dependence and showed less negative emotionality and higher constraint. Familial alcoholism raised risk for alcohol and drug use and dependence in part because children from alcoholic families were more impulsive and lower in agreeableness.

The relation between adolescent substance use and young adult internalizing symptoms: findings from a high-risk longitudinal sample.

The present study examined the role of adolescent substance use and its antecedent behavioral and familial risk factors in the prediction of young adult internalizing symptoms 10 years later, using a community sample of children of alcoholics (n = 194) and demographically matched controls (n = 209). Using growth curve modeling, the authors found that initial levels of adolescent alcohol and drug use (mu-sub(age) = 13) and growth in drug use during adolescence predicted higher levels of internalizing symptoms in young adulthood, even after including in the models shared risk factors for both internalizing symptoms and adolescent substance use. These effects remained significant after including concurrent substance use in adulthood, suggesting that adolescent substance use exerts a long-term impact on young adult internalizing symptoms over and above the effects of persistent substance use over time. The present investigation further revealed that initial levels of alcohol and drug use in adolescence mediate the relation between parental alcoholism and young adult internalizing symptoms. Findings provide evidence for the long-term effects of adolescent substance use on young adult functioning and can help inform both etiological and prevention research.

Developmental trajectories of anxiety and depression in early adolescence.

Adolescence is a period of heightened vulnerability for the onset of internalizing psychopathology. Characterizing developmental patterns of symptom stability, progression, and co-occurrence is important in order to identify adolescents most at risk for persistent problems. We use latent growth curve modeling to characterize developmental trajectories of depressive symptoms and four classes of anxiety symptoms (GAD, physical symptoms, separation anxiety, and social anxiety) across early adolescence, prospective associations of depression and anxiety trajectories with one another, and variation in trajectories by gender. A diverse sample of early adolescents (N = 1 065) was assessed at three time points across a one-year period. All classes of anxiety symptoms declined across the study period and depressive symptoms remained stable. In between-individual analysis, adolescents with high levels of depressive symptoms experienced less decline over time in symptoms of physical, social, and separation anxiety. Consistent associations were observed between depression and anxiety symptom trajectories within-individuals over time, such that adolescents who experienced a higher level of a specific symptom type than would be expected given their overall symptom trajectory were more likely to experience a later deflection from their average trajectory in other symptoms. Within-individual deflections in GAD, physical, and social symptoms predicted later deflections in depressive symptoms, and deflections in depressive symptoms predicted later deflections in GAD and separation anxiety symptoms. Females had higher levels of symptoms than males, but no evidence was found for variation in symptom trajectories or their associations with one another by gender or by age.

Callous-Unemotional Traits as Unique Prospective Risk Factors for Substance Use in Early Adolescent Boys and Girls

Youth with elevated conduct disorder (CD) symptoms who also have callous-unemotional (CU) traits exhibit more antisocial behavior than youth without CU traits. However, evidence regarding whether CU traits increase risk of substance use over and above CD symptoms, and whether these associations differ for boys and girls, is scarce. Using the Developmental Pathways Project sample of 521 middle school students, we examined whether adolescent- and parent-reported CU traits measured in 6th grade prospectively predicted the onset and recurrence of substance use and use-related impairment by 9th grade. We also examined the degree to which CU traits uniquely predicted substance use and impairment over and above CD symptoms, as well as whether gender moderated these associations. Results indicated that adolescent-reported CU traits increased the likelihood of substance use and impairment onset and recurrence by 9th grade. Analyses revealed that CD symptoms accounted for prospective associations between adolescent-reported CU and substance use, but gender moderated these associations. Boys with elevated CU traits and CD symptoms were not more likely to report alcohol use onset or recurrence, but they were at highest risk of recurrent marijuana use, use of both alcohol and marijuana, and use-related impairment by 9th grade. Girls with low CU traits and high CD symptoms were most likely to report onset and recurrent use of alcohol, as well as recurrent marijuana use, use of both substances and impairment. Study findings highlight the importance of accounting for CD symptoms and gender when examining links between CU traits and substance use in early adolescence.

Changes in self-control problems and attention problems during middle school predict alcohol, tobacco, and marijuana use during high school.

Although deficits in impulse control have been linked to adolescent use of alcohol and illicit drugs, less attention has been given to variability in change in impulse control across adolescence and whether this variability may be a signal of risk for early substance use. The goals of the current study were to examine growth in two aspects of impulse control, self-control problems and attention problems, across middle adolescence, and to test the prospective effects of level and change in these variables on levels and change over time in substance use. Data are from a community sample of 955 adolescents interviewed (along with their parents and teachers) annually from 6th to 11th grade. Results indicated that greater self-control problems and attentional problems in the 6th grade and increases in these problems over time were associated with higher levels of substance use at 11th grade. Our results suggest that modeling change over time enhances the understanding of how impulse control influences the development of substance use.

Buffering Effects of General and Medication-Specific Social Support on the Association Between Substance Use and HIV Medication Adherence

The success of highly active antiretroviral therapy (HAART) among persons living with HIV is largely dependent on strict medication adherence. Recent research suggests that alcohol and other drug use (AOD) may be an important barrier to HAART adherence. In this study, we examined the impact of AOD on HAART adherence as well as the moderating effects of general and medication-specific social support. The data were collected as part of a longitudinal randomized control trial with 224 HIV-positive patients at an HIV primary care clinic in the northwestern United States. Findings indicated that AOD use was negatively associated with HAART adherence and that medication-specific (but not general) social support moderated the AOD-adherence association at 3 (but not at 6 or 9) months. Results indicate the importance of medication-specific social support to treat comorbid AOD use and HIV; implications for future research and intervention programs for HIV-positive AOD users are discussed.

Co-occurrence of sexual risk behaviors and substance use across emerging adulthood: evidence for state- and trait-level associations*

AIMS   Prior research has suggested that problematic alcohol and drug use are related to risky sexual behaviors, either due to trait-level associations driven by shared risk factors such as sensation seeking or by state-specific effects, such as the direct effects of substance use on sexual behaviors. Although the prevalence of both high-risk sexual activity and alcohol problems decline with age, little is known about how the associations between substance use disorder symptoms and high-risk sexual behaviors change across young adulthood. DESIGN, SETTING AND PARTICIPANTS   Using a community sample (n = 790) interviewed every 3 years from age 21 to age 30 years, we tested trait- and state-level associations among symptoms of alcohol and drug abuse and dependence and high-risk sexual behaviors across young adulthood using latent growth curve models. MEASUREMENTS   We utilized diagnostic interviews to obtain self-report of past-year drug and alcohol abuse and dependence symptoms. High-risk sexual behaviors were assessed with a composite of four self-reported behaviors. FINDINGS   Results showed time-specific associations between alcohol disorder symptoms and risky sexual behaviors (r = 0.195, P < 0.001), but not associations between their trajectories of change. Conversely, risky sexual behaviors and drug disorder symptoms were associated only at the trait level, not the state level, such that the levels and rate of change over time of both were correlated (r = 0.35, P < 0.001). CONCLUSIONS   High-risk sexual behaviors during young adulthood seem to be driven both by trait and state factors, and intervention efforts may be successful if they are either aimed at high-risk individuals or if they work to disaggregate alcohol use from risky sexual activities.

Evidence for a multi-dimensional latent structural model of externalizing disorders

Strong associations between conduct disorder (CD), antisocial personality disorder (ASPD) and substance use disorders (SUD) seem to reflect a general vulnerability to externalizing behaviors. Recent studies have characterized this vulnerability on a continuous scale, rather than as distinct categories, suggesting that the revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) take into account the underlying continuum of externalizing behaviors. However, most of this research has not included measures of disorders that appear in childhood [e.g., attention-deficit/hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD)], nor has it considered the full range of possibilities for the latent structure of externalizing behaviors, particularly factor mixture models, which allow for a latent factor to have both continuous and categorical dimensions. Finally, the majority of prior studies have not tested multidimensional models. Using lifetime diagnoses of externalizing disorders from participants in the Fast Track Project (n = 715), we analyzed a series of latent variable models ranging from fully continuous factor models to fully categorical mixture models. Continuous models provided the best fit to the observed data and also suggested that a two-factor model of externalizing behavior, defined as (1) ODD+ADHD+CD and (2) SUD with adult antisocial behavior sharing common variance with both factors, was necessary to explain the covariation in externalizing disorders. The two-factor model of externalizing behavior was then replicated using a nationally representative sample drawn from the National Comorbidity Survey-Replication data (n = 5,692). These results have important implications for the conceptualization of externalizing disorders in DSM-5.

Trajectories of Alcohol and Cigarette Use Among Sexual Minority and Heterosexual Girls

PURPOSE To examine disparities between sexual minority girls (SMGs) and heterosexual girls in trajectories of substance use over time. METHOD Girls were included in the analyses if they were 12-18 years of age at wave 1 and did not miss sexual orientation data at wave 4 (n = 7,765). Latent curve models were estimated across all four waves (extending from middle adolescence into young adulthood) to examine trajectories of cigarette and alcohol use. RESULTS Initial levels of substance use were higher for SMGs than they were for heterosexual girls. SMGs also exhibited sharper escalations in use across all substances over time as they were transitioning into young adulthood. CONCLUSIONS Persistent rates of cigarette and heavy alcohol use among SMGs may increase their risk for a host of mental and physical health problems in adulthood. Clinicians should be prepared to discuss SMG health topics effectively and in private, and discuss prevention and intervention programs with girls at risk.