Susan L. Ames

Automatic and Controlled Processes and the Development of Addictive Behaviors in Adolescents: A Review and a Model

This paper presents a review and a model of the development of addictive behaviors in (human) adolescents, with a focus on alcohol. The model proposes that addictive behaviors develop as the result of an imbalance between two systems: an appetitive, approach-oriented system that becomes sensitized with repeated alcohol use and a regulatory executive system that is not fully developed and that is compromised by exposure to alcohol. Self-regulation critically depends on two factors: ability and motivation to regulate the appetitive response tendency. The motivational aspect is often still weak in heavy drinking adolescents, who typically do not recognize their drinking as problematic. Motivation to regulate use often develops only years later, after the individual has encountered serious alcohol-related problems. Unfortunately, at that point behavioral change becomes harder due to several neurocognitive adaptations that result from heavy drinking. As we document, there is preliminary support for the central elements of the model (appetitive motivation vs. self-regulation), but there is a paucity of research directly addressing these mechanisms in human adolescents. Further, we emphasize that adolescent alcohol use primarily takes place in a social context, and that therefore studies should not solely focus on intra-individual factors predicting substance use and misuse but also on interpersonal social factors. Finally, we discuss implications of the model for interventions.

Substance Abuse Among Adolescents

Substance use and dependence are among the most prevalent causes of adolescent morbidity and mortality in the United States. This paper provides a review of differences between adolescent and adult substance abuse, prevention and treatment approaches, and future potential directions and needs for more effective programming in the treatment of adolescent substance abuse 1 and dependence on psychoactive substances. 1 The journals style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editors note.

Motivational interviewing with adolescents and young adults for drug-related problems

This article reviews studies of brief motivational interviewing (MI) interventions applied to adolescents (ages 13 to 18 years) and young adults (ages 19 to 25 years) using alcohol or other psychoactive substances. An overview of the principles of MI is provided followed by a review of 17 clinical studies reported in the literature. This review revealed mixed findings for the efficacy of brief MI among these populations. However, in 29% of the studies (5 of 17), there was a clear advantage of the brief MI demonstrated compared to standard care or other programming. Components common to successful brief MI interventions included one-on-one sessions and feedback on substance use compared to norms. Interviewer empathy has been shown to be a key component in studies with adults, but this was not measured in a standardized manner across the current studies. The studies reviewed here indicate that brief MI might be effective among these populations, but the key components necessary for successful MI interventions have not been fully identified.

Comparison of indirect assessments of association as predictors of marijuana use among at-risk adolescents

In this study, the authors compared indirect measures that attempt to quantify the level of marijuana associations among adolescents. They also evaluated whether these various methods overlap or tap different aspects of associative processes that may act in concert to influence marijuana use. Automatic drug-relevant associations were assessed in 121 at-risk youth in continuation high schools in California with the use of a word association index and computer-based, reaction time measures (i.e., Implicit Association Test [IAT] and Extrinsic Affective Simon Task [EAST]). Measures of working memory capacity, sensation seeking, and explicit cognitions also were included in analyses as potential confounders. The word association index and the marijuana IAT excited D measure were significant predictors of marijuana use. The word association index accounted for more variance in marijuana use than did the IAT or EAST measures. Further, confirmatory factor analytic models of the indirect measures of marijuana use revealed a significant moderate correlation between the EAST Excitement and Word Association factors but no significant correlations between the Word Association and IAT factors. These findings suggest that there is some convergence among the different indirect measures, but these assessments also appear to tap different aspects of associative processes. The types of indirect measures evaluated in this work provide information about spontaneous cognitions related to substance use, capturing influences on behavior that are not evaluated with traditional explicit assessments of behavior. Findings from this work add to a growing body of research that implicates the importance of implicit associative processes in risk and health behaviors.

Neurologically Plausible Distinctions in Cognition Relevant to Drug Use Etiology and Prevention

This article outlines several distinctions in cognition and related topics in emotion that receive support from work in cognitive neuroscience and have important implications for prevention: implicit cognition, working memory, nonverbal memory, and neurobiological systems of habit. These distinctions have not been widely acknowledged or applied in drug use prevention research, despite their neural plausibility and the availability of methods to make this link. The authors briefly review the basis for the distinctions and indicate general implications and assessment possibilities for prevention researchers conducting large-scale field trials. Subse-quently, the article outlines a connectionist framework for specific applications in prevention interventions. These possibilities begin the attempt to derive useful fusions of normally distinct areas of prevention and cognitive neuroscience, in the spirit of a transdisciplinary approach.

Apples and oranges? Comparing indirect measures of alcohol-related cognition predicting alcohol use in at-risk adolescents.

Recently, there has been increased interest in the role of implicit cognitive processes in the development of addictive behaviors. In this study, the authors compared 3 indirect measures of alcohol-related cognitions in the prospective prediction of alcohol use in at-risk adolescents. Implicit alcohol-related cognitions were assessed in 88 Dutch at-risk adolescents ranging in age from 14 to 20 years (51 males, 37 females) by means of varieties of word association tasks, Implicit Association Tests, and Extrinsic Affective Simon Tasks adapted for alcohol use. Alcohol use and alcohol-related problems were measured with self-report questionnaires at baseline and after 1 month. Results showed that the indirect measures predicted unique variance in prospective alcohol use after controlling for the direct measure of alcohol-related cognitions and background variables. The results indicate that the word association tasks were the best indirect measure of alcohol-related cognitions. These indirect measures appear to assess cognitive motivational processes that affect behavior in ways not reflected by direct measures of alcohol-related cognitions.

Impulsivity, impulsive and reflective processes and the development of alcohol use and misuse in adolescents and young adults

This paper contrasts dual-process and personality approaches in the prediction of addictive behaviors and related risk behaviors. In dual-process models, behavior is described as the joint outcome of qualitatively different “impulsive” (or associative) and “reflective” processes. There are important individual differences regarding both types of processes, and the relative strength of both in a specific situation is influenced by prior behavior and state variables (e.g., fatigue, alcohol use). From this perspective, a specific behavior (e.g., alcohol misuse) can be predicted by the combined indices of the behavior-related impulsive processes (e.g., associations with alcohol), and reflective processes, including the ability to refrain from a motivationally salient action. Personality approaches have reported that general traits such as impulsivity predict addictive behaviors. Here we contrast these two approaches, with supplementary analyses on four datasets. We hypothesized that trait impulsivity can predict specific risky behaviors, but that its predictive power disappears once specific behavior-related associations, indicators of executive functioning, and their interaction are entered into the equation. In all four studies the observed interaction between specific associations and executive control (EC) was robust: trait impulsivity did not diminish the prediction of alcohol use by the interaction. Trait impulsivity was not always related to alcohol use, and when it was, the predictive power disappeared after entering the interaction between behavior-specific associations and EC in one study, but not in the other. These findings are interpreted in relation to the validity of the measurements used, which leads to a more refined hypothesis.

Implicit Cognition and HIV Risk Behavior

Implicit cognition theory differs from most other approaches to health behavior in that it emphasizes neurobiologically plausible and experimentally documented memory association processes rather than rational decisions, considerations of pros and cons, or beliefs. The present study of adults from a community population investigated the predictive effects of implicit cognition, as well as behavioral and personality variables (sensation seeking, hostility, conscientiousness, and polydrug use), on risky sexual behaviors (lack of condom use, sex after drug use, and multiple sexual partners). In addition, this study simultaneously investigated the predictors in both a high-risk and a low-risk sample. Results showed that the implicit cognition indicator was a significant, independent predictor of lack of condom use in the high-risk sample. Polydrug use and sensation seeking also had important predictive effects. The results encourage more research on implicit cognition in health behavior and further document links among drug use, personality, and HIV risk behavior.

Implicit cognition, sensation seeking, marijuana use and driving behavior among drug offenders

This research addresses the relative contributions of cognitive and personality constructs in drug use motivation and problem behaviors associated with use. The purpose of this study was to investigate the relationships among four factors: Sensation seeking, memory association, marijuana use, and driving under the influence (DUI) in a high-risk population. Gender was also analyzed for its potentially confounding effects. Participants were 166 first- and second-time drug offenders ranging in age from 18 to 50 who were enrolled in a drug diversion education/counseling program in southern California. Results showed that memory association independently predicted marijuana use and mediated the predictive effects of sensation seeking on marijuana use. Memory association, but not sensation seeking, also had a significant indirect effect on DUI, mediated through marijuana use. These findings have important implications for the development of prediction models of drug use and DUI for high-risk populations.

Sweetened Drink and Snacking Cues in Adolescents: A Study Using Ecological Momentary Assessment

The objective of this study was to identify physical, social, and intrapersonal cues that were associated with the consumption of sweetened beverages and sweet and salty snacks among adolescents from lower SES neighborhoods. Students were recruited from high schools with a minimum level of 25% free or reduced cost lunches. Using ecological momentary assessment, participants (N=158) were trained to answer brief questionnaires on handheld PDA devices: (a) each time they ate or drank, (b) when prompted randomly, and (c) once each evening. Data were collected over 7days for each participant. Participants reported their location (e.g., school grounds, home), mood, social environment, activities (e.g., watching TV, texting), cravings, food cues (e.g., saw a snack), and food choices. Results showed that having unhealthy snacks or sweet drinks among adolescents was associated with being at school, being with friends, feeling lonely or bored, craving a drink or snack, and being exposed to food cues. Surprisingly, sweet drink consumption was associated with exercising. Watching TV was associated with consuming sweet snacks but not with salty snacks or sweet drinks. These findings identify important environmental and intrapersonal cues to poor snacking choices that may be applied to interventions designed to disrupt these food-related, cue-behavior linked habits.