Michael Pemberton

Substance abuse treatment need among older adults in 2020: the impact of the aging baby-boom cohort

BACKGROUND There is concern that as the baby boom population ages in the US, there will be a substantial increase in the number of older adults needing treatment for substance abuse problems. To address this concern, projections of future treatment need for older adults (defined as age 50 and older) were made. METHODS Using data from the National Household Survey on Drug Abuse, regression models including predictors of treatment need in 2000 and 2001 were developed. Treatment need was defined as having a DSM-IV alcohol or illicit drug use disorder in the past year. Regression parameters from these models were applied to the projected 2020 population to obtain estimates of the number of older adults needing treatment in 2020. RESULTS The number of older adults in need of substance abuse treatment is estimated to increase from 1.7 million in 2000 and 2001 to 4.4 million in 2020. This is due to a 50 percent increase in the number of older adults and a 70 percent increase in the rate of treatment need among older adults. CONCLUSIONS The aging baby boom cohort will place increasing demands on the substance abuse treatment system in the next two decades, requiring a shift in focus to address the special needs of an older population of substance abusers. There is also a need to develop improved tools for measuring substance use and abuse among older adults.

Memory for and experience of differential competitive behavior of individuals and groups

Four experiments investigated whether differential experiences with groups and individuals led to previously obtained results of greater competitive expectations in intergroup than interindividual relations. In Experiment 1, participants rated their recalled instances of intergroup relations as more competitive than their interindividual relations. In Experiment 2, a relatively greater proportion of competitive to cooperative intergroup relations were recalled compared with interindividual relations. In Experiment 3, participants recorded relevant interactions for 7 days, and rated their intergroup relations as more competitive than their interindividual relations. In Experiment 4, participants recorded a relatively greater number of cooperative than competitive relations with individuals than with groups. These results can be interpreted as a demonstration in a nonlaboratory context that intergroup relations are more competitive than interindividual relations.

The influence of a family program on adolescent tobacco and alcohol use.

OBJECTIVES This study examined a family-directed programs effectiveness in preventing adolescent tobacco and alcohol use in a general population. METHODS Adolescents aged 12 to 14 years and their families were identified by random-digit dialing throughout the contiguous United States. After providing baseline data by telephone interviews, they were randomly allocated to receive or not receive a family-directed program featuring mailed booklets and telephone contacts by health educators. Follow-up telephone interviews were conducted 3 and 12 months after program completion. RESULTS The findings suggested that smoking onset was reduced by 16.4% at 1 year, with a 25.0% reduction for non-Hispanic Whites but no statistically significant program effect for other races/ethnicities. There were no statistically significant program effects for smokeless tobacco or alcohol use onset. CONCLUSIONS The family-directed program was associated with reduced smoking onset for non-Hispanic Whites, suggesting that it is worthy of further application, development, and evaluation.

Influence of a family program on adolescent smoking and drinking prevalence

Reducing the prevalence of adolescent cigarette smoking and alcohol drinking are public health goals of the United States. Although families have strong influence on their children, few randomized studies have examined whether family-directed programs influence those behaviors in general universal populations. This paper reports findings from an evaluation of a family program that features the mailing of four booklets to adult family members with follow-up telephone calls by health educators. A national sample of adolescent–parent pairs and a randomized experimental design were used to evaluate the program. Baseline users and nonusers of those substances were considered simultaneously in analyses so that program influences on smoking and drinking prevalence could be examined. The findings suggest that the program significantly reduced the prevalence of smoking cigarettes and drinking alcohol among adolescents. These findings are discussed in the context of earlier reports of research on the family program and implications for public health.

When groups are more competitive than individuals: the domain of the discontinuity effect.

The related goals of the research were to delineate the domain of discontinuity, 1st by demonstrating its occurrence in a nonmatrix situation and, 2nd, by establishing the antecedent outcome conditions necessary for producing a discontinuity effect. The 1st goal was met by designing a mixed motive situation involving the production of origami products. Under these conditions, the magnitude of the discontinuity effect did not significantly differ from that in a matrix-only condition. The 2nd goal was met by a separate experiment that used H. H. Kelley and J. W. Thibauts (1978) analysis of degree of noncorrespondence of outcomes. This experiment demonstrated that as noncorrespondence increased, so did the rate of competitive responding by groups but not by individuals. This pattern was qualified by an interaction with gender such that competitiveness was more markedly affected by noncorrespondence for groups of women than for groups of men.

Long-term outcome maximization and the reduction of interindividual-intergroup discontinuity

Two experiments demonstrated that different procedures can be used to reduce the tendency for intergroup relations to be more competitive than interindividual relations. Experiment 1 revealed that this tendency was reduced when individual or group participants interacted with individual or group confederates who followed a tit-for-tat strategy as opposed to a Pavlov strategy or a standard control condition that did not involve confederates. Experiment 2 revealed that the tendency for groups to be more competitive than individuals was less pronounced with successive responding than with simultaneous responding. Further results indicated that the higher the total session score on the Consideration of Future Consequences Scale, the less the competition between groups. The results from both experiments were interpreted as indicating that intergroup competitiveness can be reduced by inducing a concern with long-term outcomes.

Correlates of Participation in a Family-Directed Tobacco and Alcohol Prevention Program for Adolescents:

This study examined correlates of program initiation and completion in a family-directed program that involved families of adolescents throughout the United States. Correlates varied by whether program initiation, program completion, or the number of activities completed was the indicator of participation. In final regression models, participation was relatively likely by non-Hispanic whites when compared with persons of race/ethnicity other than white, black, and Hispanic; by families with a female adolescent as the program recipient; by families with mothers who had many years of education; and by families with both parents living in the household. There was more participation if parents thought their child would smoke in the future and if the parent thought the adolescent did not smoke currently. Participation was higher if the adolescent felt strongly attached to the parent and if parents did not smoke. The findings are considered in the context of similar programs and future research on family-directed programs to prevent adolescent tobacco and alcohol use.

Mediating mechanisms of a military web-based alcohol intervention:

This study explored the mediating mechanisms of two Web-based alcohol interventions in a sample of active duty United States military personnel. Personnel were recruited from eight bases and received the Drinkers Check-Up (N=1483), Alcohol Savvy (N=688), or served as controls (N=919). The interventions drew on motivational interviewing and social learning theory and targeted multiple mediators including social norms, perceived risks and benefits, readiness to change, and coping strategies. Baseline data were collected prior to the intervention and follow-up data on alcohol consumption were gathered 1 month and 6 months after program completion. Two mediation models were examined: (1) a longitudinal two-wave model with outcomes and mediators assessed concurrently at the 1-month follow-up; and (2) a three-wave model in which the causal chain was fully lagged. Results indicated strong support for the role of perceived descriptive norms in transmitting the effects of the Drinkers Check-Up, with consistent mediation across the majority of alcohol outcome measures for both the concurrent and fully lagged mediation models. These results suggest that web-based interventions that are effective in lowering perceived norms about the frequency and quantity of drinking may be a viable strategy for reducing alcohol consumption in military populations. The results did not support program mediation by the other targeted variables, indicating the need for future research on the effective components of alcohol interventions. The mediation models also suggest reasons why program effects were not found for some outcomes or were different across programs.

Influence of a Family-Directed Program on Adolescent Cigarette and Alcohol Cessation

Programs to reduce adolescent cigarette or alcohol use by users in general populations have only recently been evaluated. Moreover, in spite of the substantial influence families have on their children, few family-directed programs designed to reduce the prevalence of adolescent smoking and drinking have been rigorously evaluated. This paper reports the findings of research designed to determine whether a family program reduced use of cigarettes or alcohol by users. The program consisted of a series of booklets mailed to families and follow-up telephone calls by health educators. A randomized experimental design involved families with children ages 12–14 throughout the United States. Data were collected by telephone at baseline and 3 and 12 months after the program was completed. No statistically significant program effects were observed for cessation or decrease in smoking and drinking by users.

Family Matters: A Family-Directed Program Designed to Prevent Adolescent Tobacco and Alcohol Use

This article describes a program for families that is intended to reduce adolescent tobacco and alcohol use. The program, featuring mailed booklets and follow-up telephone contacts by health educators, is directed toward general populations and is being evaluated with a randomized experiment involving families throughout the contiguous states of the United States. Considerations include description of the principles that influenced program features, the conceptual model for the program, the formative research conducted to design the program, the attributes of the final program as implemented nationally for 658 families, parent assessments of the program, program costs, and the evaluation design.