Sarah L. Pedersen

Less drinking, yet more problems: understanding African American drinking and related problems.

Researchers have found that, compared to European Americans, African Americans report later initiation of drinking, lower rates of use, and lower levels of use across almost all age groups. Nevertheless, African Americans also have higher levels of alcohol problems than European Americans. After reviewing current data regarding these trends, we provide a theory to understand this apparent paradox as well as to understand variability in risk among African Americans. Certain factors appear to operate as both protective factors against heavy use and risk factors for negative consequences from use. For example, African American culture is characterized by norms against heavy alcohol use or intoxication, which protects against heavy use but also provides within-group social disapproval when use does occur. African Americans are more likely to encounter legal problems from drinking than European Americans, even at the same levels of consumption, perhaps thus resulting in reduced consumption but more problems from consumption. There appears to be one particular group of African Americans, low-income African American men, who are at the highest risk for alcoholism and related problems. We theorize that this effect is due to the complex interaction of residential discrimination, racism, age of drinking, and lack of available standard life reinforcers (e.g., stable employment and financial stability). Further empirical research will be needed to test our theories and otherwise move this important field forward. A focus on within-group variation in drinking patterns and problems is necessary. We suggest several new avenues of inquiry.

ADH1B*3 and response to alcohol in African-Americans.

BACKGROUND Variations in the alleles for the alcohol-metabolizing enzymes have been shown to influence risk for alcohol dependence. One variant, ADH1B*3, is observed almost exclusively in populations of African ancestry and has been shown to be associated with reduced rates of alcohol dependence. We conducted an alcohol challenge study to test whether ADH1B*3 is associated with differences in subjective and physiological response to alcohol. METHOD We administered a moderate dose of alcohol (0.72 g/kg for males, 0.65 g/kg for females) to a sample of African-American young adults (n = 91; ages 21 to 26). Participants were genotyped for ADH1B, as well as additional polymorphisms that might contribute to alcohol response. Breath alcohol concentration, self-reported sedation and stimulation, and pulse rate were assessed prior to alcohol administration and for 2.5 hours following administration. RESULTS ADH1B*3 was associated with higher levels of sedation and a sharper increase in pulse rate immediately following alcohol consumption. CONCLUSIONS These findings suggest that the lower rates of alcohol dependence in those with ADH1B*3 alleles may be because of differences in alcohol response, particularly increased sedation.

Impulsivity Moderates the Relationship Between Implicit Associations about Alcohol and Alcohol Use

Implicit associations about alcohol are strong predictors of alcohol use, as is the personality trait of impulsivity. This study examines the role of impulsivity as a moderator of the association between implicit associations about alcohol and alcohol use. Two hundred and 19 participants completed measures of positive and negative implicit associations, as measured by the Implicit Association Test (IAT) and self-report questionnaires of impulsivity and alcohol use in the past month. Trait impulsivity was broken down into five facets identified in previous research. All facets of impulsivity and positive implicit associations about alcohol were positively correlated with past month alcohol use. The urgency facets (positive and negative) of impulsivity (acting rashly in response to strong positive or negative mood) moderated the relationship between positive implicit associations about alcohol and alcohol use. Compared to individuals low on positive or negative urgency, individuals high on positive or negative urgency tended to report acting more in line with their positive implicit associations by reporting more drinking in the past month.

ADHD and Marijuana-Use Expectancies in Young Adulthood

Objective: This study examined mean level differences in marijuana expectancies and the differential associations between expectancies and marijuana use for individuals with and without a history of Attention-Deficit/Hyperactivity Disorder (ADHD). Background: Substance-use expectancies are a widely studied risk factor for alcohol and other drug use. The relations between marijuana-use expectancies and self-reported marijuana use have not been examined in young adults with ADHD, a population shown to be at risk for marijuana use. Method: Participants were 306 (190 ADHD and 116 non-ADHD) young adults (M age = 20.06, SD = 2.03) from the Pittsburgh ADHD Longitudinal Study (PALS) who provided data about marijuana use and marijuana-use expectancies. Results: Individuals in the ADHD group reported lower levels of social enhancement, tension reduction, and cognitive and behavioral-impairment expectancies compared to individuals in the non-ADHD group. Positive and negative marijuana-use expectancies were associated with marijuana use frequency in the whole sample and statistically significant ADHD group by expectancy interactions were found. Sexual-enhancement expectancies were more strongly associated with marijuana use frequency among individuals with ADHD histories while cognitive behavioral-impairment expectancies were more strongly associated with marijuana use frequency among individuals without ADHD. Conclusions: Marijuana-use expectancies may be acquired, and operate differently, for individuals with and without ADHD histories. Although future research is needed to test this speculation, these differences may be associated with ADHD-related difficulties in higher order cognitive processes that affect the encoding and utilization of expectations regarding marijuanas effects.

Two Alternative Approaches to Conventional Person-Mean Imputation Scoring of the Self-Rating of the Effects of Alcohol Scale (SRE)

A low level of response to alcohol is considered a significant risk factor for alcohol use disorder. Survey measures of this construct assess the number of drinks required to experience various alcohol effects, so data will be missing for effects participants have not experienced. Furthermore, missingness will likely be more common for items with higher means, as more severe effects are likely experienced both less commonly and at higher consumption levels. We explored whether these atypical characteristics of response-to-alcohol survey data cause problems when using conventional person-mean imputation scoring. This scoring approach involves averaging across nonmissing items for each participant, implicitly assuming that missing items have similar distributional properties (e.g., means) as nonmissing items. Analyses used data from the most commonly utilized response-to-alcohol survey measure: The Self-Rating of the Effects of Alcohol Scale (SRE). Results (a) revealed a strong relationship between higher item means and greater item missingness, (b) established that this relation causes person-mean imputation to produce more downwardly biased response-to-alcohol summary scores for participants with more missing data, (c) established that this induced a spurious relationship between higher response-to-alcohol summary scores and higher alcohol-effect endorsement (i.e., the number of SRE alcohol effects experienced), and (d) found that these biases can be reduced with 2 alternative scoring approaches. We discuss these and other potential problems with person-mean imputation, and common and unique advantages of the 2 alternative approaches. We consider generalizability, including how the problems shown here may vary in practical significance across different populations and measures. (PsycINFO Database Record

Heavy alcohol use in early adulthood as a function of childhood ADHD: developmentally specific mediation by social impairment and delinquency

Frequent heavy drinking in early adulthood, particularly prior to age 21, is associated with multiple health and legal consequences including continued problems with drinking later into adulthood. Children with attention-deficit/hyperactivity disorder (ADHD) are at risk of alcohol use disorder in adulthood, but little is known about their frequency of underage drinking as young adults or about mediational pathways that might contribute to this risky outcome. The current study used data from the Pittsburgh ADHD Longitudinal Study to test social impairment and delinquency pathways from childhood ADHD to heavy drinking in early adulthood for individuals with (n = 148) and without (n = 117) childhood ADHD. Although ADHD did not predict heavy drinking, indirect mediating effects in opposing directions were found. A delinquency pathway from childhood ADHD to increased heavy drinking included adolescent and subsequently adult delinquent behavior. A social impairment pathway from childhood ADHD to decreased heavy drinking included adolescent, but not adult, social impairment. These findings help explain the heterogeneity of results for alcohol use among individuals with ADHD and suggest that common ADHD-related impairments may operate differently from each other and distinctly across developmental periods.

Motorsports involvement among adolescents and young adults with childhood ADHD.

Although children with attention-deficit/hyperactivity disorder (ADHD) are at risk for impulsive, health-endangering behavior, few studies have examined nonsubstance, use-related risk-taking behaviors. This study examined whether adolescents and young adults with ADHD histories were more likely than those without ADHD histories to report frequent engagement in motorsports, a collection of risky driving-related activities associated with elevated rates of physical injury. Path analyses tested whether persistent impulsivity, comorbid conduct disorder or antisocial personality disorder (CD/ASP), and heavy alcohol use mediated this association. Analyses also explored whether frequent motorsporting was associated with unsafe and alcohol-influenced driving. Two hundred twenty-one adolescent and young adult males (16–25 years old) diagnosed with ADHD in childhood and 139 demographically similar males without ADHD histories reported their motorsports involvement. Persistent impulsivity, CD/ASP, heavy drinking, and hazardous driving were also measured in adolescence/young adulthood. Adolescents and young adults with ADHD histories were more likely to report frequent motorsports involvement than those without childhood ADHD. Impulsivity, CD/ASP, and heavy drinking partially mediated this association, such that individuals with ADHD histories, who had persistent impulsivity or CD/ASP diagnoses, were more likely to engage in heavy drinking, which was positively associated with frequent motorsporting. Motorsports involvement was associated with more unsafe and alcohol-influenced driving, and this association was more often found among those with, than without, ADHD histories. Adolescents and young adults with ADHD histories, especially those with persisting impulsivity, comorbid CD/ASP and heavy drinking tendencies, are more likely to engage in motorsports, which may heighten risk of injury.

Childhood ADHD potentiates the association between problematic drinking and intimate partner violence

Objective: Excessive alcohol consumption increases risk of perpetrating intimate partner violence (IPV). ADHD is associated with problematic drinking and IPV, but it is unclear whether problem drinkers with ADHD are more likely than those without ADHD to perpetrate IPV. Method: We compared the strength of association between problem drinking trajectories and IPV perpetration among 19- to 24-year-old men with (n = 241) and without (n = 180) childhood ADHD. Results: Men with ADHD who reported higher heavy episodic drinking or alcohol use problems at age 19, and slower decreases in alcohol use problems from age 19 to 24, were more likely to perpetrate IPV than problem drinkers without ADHD, among whom the same associations were non-significant. Associations between problem drinking and IPV were not attenuated in adults with ADHD upon controlling for antisocial personality disorder. Conclusion: Study findings highlight the heightened risk of problem drinkers with ADHD perpetrating IPV.

Racial Differences in Type of Alcoholic Beverage Consumed During Adolescence in the Pittsburgh Girls Study

BACKGROUND White, compared with Black, adolescents have higher rates of alcohol use and show more rapid increases in alcohol use. Racial differences in type of alcohol beverage (i.e., beer, wine, and liquor) consumed by youth have received scant attention, and little is known regarding changes in type of alcohol beverage consumed during adolescence, when experimentation may transition to more regular use. METHODS This study used repeated measures latent class analysis to identify distinct profiles that represent change in type of alcohol beverage consumed across ages 11 to 18 and to examine predictors (e.g., caretaker alcohol use, perceived peer alcohol use, ease in accessing alcohol, perceived neighborhood risk indicated by witnessing drug dealing), most of which were measured at ages 11 to 12, of alcohol use profiles in the Pittsburgh Girls Study (n = 2,171; 57% Black, 43% White), a community sample with annual follow-ups. RESULTS Among Black girls, 2 profiles were identified: Low Use (76%), and Alcohol Use involving primarily liquor starting around age 15 (24%). Among White girls, 4 profiles were identified: Wine sippers (11%); a Low Use profile with low probability of drinking until age 18, when use of beer and liquor increased (52%); an Increasing Use profile with increased probability of drinking beer and liquor starting at age 15 (23%); and a High Alcohol Use profile, starting with use of wine, then shifting to use primarily of beer and liquor after age 13 (14%). Separate risk factor analyses conducted by race indicated similar predictors for Black and White girls: perceived ease in accessing alcohol, witnessing neighborhood drug dealing, and perceived peer alcohol use were each associated with heavier drinking profiles. CONCLUSIONS Longitudinal profiles of type of alcoholic beverages, within and across racial groups, can guide the tailoring of interventions to address developmentally salient turning points in alcohol use for specific subgroups of girls.

Change over time in adolescent and friend alcohol use: Differential associations for youth with and without childhood attention-deficit/hyperactivity disorder (ADHD).

Individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for experiencing alcohol-related problems by adulthood. However, few studies have examined contextual factors that may contribute to this risk. The current study examined 1 widely investigated social-contextual risk factor, friend alcohol use, in a sample of adolescents with and without a history of ADHD. One hundred and 59 adolescents (14-17 years old) with childhood ADHD and 117 demographically similar youth without ADHD were interviewed annually in the Pittsburgh ADHD Longitudinal Study. Adolescents reported the frequency of their own alcohol use in the prior 12 months and the number of friends who used alcohol regularly or occasionally (perceived friend alcohol use). Multiple-group parallel process models indicated that increases in friend alcohol use were more strongly associated with increases in adolescent alcohol use over time for individuals with ADHD (r = .15, SE = 0.04; 95% confidence interval [CI] = [0.08, 0.22]) than for those without ADHD (r = .06, SE = 0.03; 95% CI [0.00, 0.11]). These results suggest that social factors are an important part of escalating alcohol use among adolescents with ADHD histories, and they highlight the possibility that interventions focused on the peer context could be important for these at-risk youth. Additional social network research on adolescent alcohol use within the larger context of other relationships (e.g., family and romantic relationships) is indicated.