Deficits in Neurocognitive Functions May Affect Outcomes of Preventive Interventions Among Adolescent Boys
Deficits in executive control functions—such as abstract thinking, planning, and self-control— may play a direct role in regulating behavioral problems such as drug abuse and violence. Results of a NIDA-funded study suggest these neurocognitive functions may also influence an adolescent’s ability to respond to drug abuse and violence prevention interventions.
Dr. Diana Fishbein, of RTI International, and her colleagues examined neurocognitive function and emotional perception in 120 ninth-grade boys. Approximately half of the study participants had conduct disorder (CD)—a host of disruptive behaviors that increase the risk for substance abuse. Following a series of tasks measuring neurocognitive and emotional perception, the students were assigned to an experimental or control group. The experimental group completed a prevention intervention designed to teach specific social skills and help reduce their risk of becoming victims or perpetrators of violence. The teens completed virtual reality vignettes and three questionnaires designed to measure social competency skills such as negotiation, delayed gratification, and impulse control in each student.
The researchers found that students with CD and poor cognitive and emotional performance were less responsive to the prevention curriculum and experienced difficulties adopting social competency skills such as problem solving and negotiation. Adolescents reporting past drug abuse also had lower social competency skills when compared with those who had never abused drugs.
- WHAT IT MEANS: These study findings suggest that variations in certain neurocognitive functions and emotional deficits may play a role in an individual’s ability to respond to and adopt positive behaviors fostered by preventive interventions. Thus, tailoring intervention strategies to target specific neurocognitive and emotional deficits may improve prevention success and decrease drug abuse and violence among adolescents.
The paper is available for online viewing in the March 15, 2006 issue of Drug and Alcohol Dependency.
Teens Who Engage in Risky Behaviors Are More Likely To Become Depressed
New research suggests that adolescents—particularly girls—who engage in sex and drugtaking are at significantly greater risk for depression than their abstaining peers.
Researchers analyzed various sex and drug behavior patterns via data from The National Longitudinal Study of Adolescent Health (Add Health), surveys of 13,491 teens in grades 7–12 who were interviewed in 1995 and again in 1996. The researchers clustered the teens into 16 groups according to their behaviors. Groups included abstainers (who refrained from using drugs and sex), teens who tried drugs a few times, teens who experimented a few times with sex, binge drinkers, regular marijuana users, those who regularly abused marijuana and other drugs, and intravenous drug abusers.
The researchers found that girls who tried drugs of abuse, sex, or alcohol were 2 to 3 times more likely to be depressed when interviewed a year later, compared with abstainers. Boys who tried drugs or sex showed little added risk, but their risk of depression increased 3 to 4 times, compared with abstainers, if they participated in binge drinking and frequent marijuana use.
- WHAT IT MEANS: This is the first study to suggest that substance abuse precedes depression, particularly among adolescent girls. Future research will help clarify the mechanisms that underlie the connections between adolescent behaviors and depression, and determine whether preventing these behaviors—or intervening when they are present—also will reduce the risk of developing depression.
The study, led by Dr. Denise Hallfors of the Pacific Institute for Research and Evaluation in Chapel Hill, North Carolina, was published in the October 2005 issue of the American Journal of Preventive Medicine.
Lack of Empowerment on the Job Is Associated With Higher Risk of Drug Abuse
Job environments characterized by job strain (a combination of high demand and low control) may increase the risk of ill health, particularly cardiovascular disease. Now, results of a recently published study suggest that young adult workers who are in “low control” jobs—little decision-making authority, and little flexibility in how they accomplish their tasks—have a higher risk of developing drug addiction.
In 2000–2001, job strain assessment data were collected for 1,418 young adults who were working for pay and not self-employed. About 1 year later, data were collected for 985 members of the group.
Slightly more than 5 percent of the 985 workers qualified for the study’s case definition of drug addiction at the one year follow-up. When the scientists analyzed data for 861 young adults who initially showed no clinical features of drug addiction, they observed that those who had the least job control had an almost threefold excess risk of having developed drug addiction at the one-year follow-up.
- WHAT IT MEANS: Young adult workers whose job-related stress stems from low control may be at increased risk of drug addiction. Future research may help define how particular aspects of the work environment might guide specific physiological and psychological mechanisms that cause drug addiction, setting up new opportunities for drug abuse prevention in the young adult years.
Dr. Philip Reed and Dr. James Anthony of Michigan State University and Dr. Carla Storr of The Johns Hopkins University Bloomberg School of Public Health published their NIDA-supported study in the March 1, 2006 issue of the American Journal of Epidemiology.
New Behavioral Intervention Shows Promise in Patients with Co-Occurring Disorders
A recent NIDA-funded study finds Behavioral Treatment for Substance Abuse in Severe and Persistent Mental Illness (BTAS)—a behavioral approach that combines social skills training, motivational interviewing, and urine checks—may be effective in treating co-occurring, severe mental illness and drug abuse disorders.
A team of scientists led by Dr. Alan Bellack from the University of Maryland randomized 129 patients with drug dependence (heroin, cocaine, and marijuana) and severe mental illness to receive BTAS or supportive group therapy—the standard form of treatment at the University of Maryland’s community mental health center. Both treatment groups met twice weekly for 6 months in small group settings.
The researchers found that BTAS was significantly more effective than supportive group discussion, producing a significantly higher proportion of clean urine tests, and greater periods of continuous abstinence at 4 and 8 weeks. BTAS was also associated with better meeting attendance, long-term adherence to the program, and improved quality of life.
- WHAT IT MEANS: Dual disorders are complex conditions that profoundly affect the everyday functioning and clinical treatment of an individual. These findings suggest that by targeting barriers to drug abuse reduction, BTAS may be an effective treatment approach for individuals with a dual diagnosis of severe mental illness and drug abuse (heroin, cocaine, and marijuana). Additional research is needed to develop parallel interventions for patients with serious mental illness who abuse other substances.
These study findings were published in the April 2006 issue of Archives of General Psychiatry.
PRISM Diagnostic Tool Reliably Diagnoses Substance Abuse, Psychiatric Disorders
Psychiatric and substance abuse disorders co-occur frequently but the complex, overlapping symptoms present challenges to diagnostic accuracy. A new study, supported in part by NIDA, indicates that many psychiatric disorders recognized by DSM-IV (Diagnostic and Statistical Manual, 4th edition)—including substance dependence, primary and substance-induced major depressive disorder, and primary and substance-induced psychotic disorder—can be reliably diagnosed with the Psychiatric Research Interview for Substance and Mental Disorders (PRISM), a semi-structured interview that aids in diagnosing psychiatric disorders in substance abusers.
A total of 285 substance-abusing patients with co-occurring mental disorders participated in the assessment, in which the researchers conducted interviews using PRISM.
Statistical measures showed that for most categories of DSM-IV substance dependence—including alcohol, cocaine, heroin, cannabis, and sedative dependence—reliability of diagnosis with PRISM was good to excellent. The results also indicate that PRISM can reliably diagnose primary and substance-induced psychotic disorder, some primary anxiety disorders, antisocial personality disorder, and borderline personality disorder.
- WHAT IT MEANS: Understanding the relationship between substance abuse disorders and psychiatric disorders is important for identifying causes of the conditions and improve treatment. The study showed that most psychiatric disorders can be reliably evaluated in substance-abusing patients via PRISM.
Dr. Deborah Hasin, of Columbia University, and her colleagues published their findings in the April 2006 issue of the American Journal of Psychiatry.