PAULA J. F ITE

CLINICAL CHILD PSYCHOLOGY PROGRAMUNIVERSITY OF KANSAS

Substance Use Among Youth

Youth Substance Use

Illegal behavior for which charges can be filed

Most common substances are alcohol, tobacco, and marijuana However prescription drug use and other substances (i.e.,

sniffing household products, heroin) are also of concern

Trends in drug use depend on the substance Marijuana use and tobacco use seem to be increasing and

alcohol binge drinking seems to be declining

Data from Monitoring the Future study, University of Michigan

Past 30 Day Use Across Hispanic, African American, and White Youth

10th grade 12th grade0

5

10

15

20

25

30

35

40

45

MarijuanaAlcoholCigarettes

Perc

ent (

%)

22.6

27.2

18.717.

6

40.0

11.8

Data from Monitoring the Future study, University of Michigan

Lifetime Use Across Hispanic, African American, and White Youth

10th grade 12th grade0

10

20

30

40

50

60

70

80

MarijuanaAlcoholCigarettes

Perc

ent (

%) 45.

5

56

4034.5

70

30.4

Data from Monitoring the Future study, University of Michigan

Alcohol Hazard Model

0

0.1

0.2

0.3

4th 5th 6th 7th 8th 9th

Grade

Haz

ard

Pro

babi

lity Y observed

Y m odelim plied

Tobacco Hazard Model

0

0.1

0.2

0.3

4th 5th 6th 7th 8th 9th

Grade

Haz

ard

Pro

babi

lity

Y observed

Y modelim plied

Marijuana Hazard Model

0

0.1

0.2

0.3

4th 5th 6th 7th 8th 9th

Grade

Haz

ard

Pro

babi

lity

Y observed

Y m odelim plied

Fite et al., 2008, Journal of Abnormal Child Psychology

Why is this a problem?

Costs associated with underage drinking (including treatment, crime, lost wages, etc.) exceed $50 billion annually (Miller, 2004; National Research Council, 2004).

2011 data suggest costs greater than $60 billion (PIRE, 2011)

Adolescent alcohol users are at increased risk for substance abuse and use-related problems throughout the lifespan (e.g., Ellickson et al., 2004; Jacobsen et al., 2005; Tucker et al., 2005)

Which costs society more than $375 billion annually (National Drug Control Policy, 1999).

Each adolescent onset persistent substance user is costing society approximately $970,000 over the course of their lifetime (Cohen, 2005).

Rates of Offenses Among Juveniles

Offense Type # of Arrests in 1 year

Violence (person offenses)

65,767

Property 344,606

Substance 1,033,000

Weapons 80,194

Adolescent Substance

Abuse

Well-Established

CBTGroup CBT

Family TherapyMultidimensional Family Therapy

Functional Family Therapy

Probably Efficacious

Family TherapyBrief Strategic Family Therapy

Behavioral Family Therapy

Multisystemic Therapy

Possibly Efficacious

CBTIndividual CBT

Family TherapyTransitional Family Therapy

Strength Oriented Family Therapy (SOFT)

Minnesota Model 12 Step 

Waldron & Turner, 2008; JCCAP

Current Intervention Programs

- TREATMENT EFFECT SIZES ARE MODEST (SMALL TO MEDIUM).

- OUTCOMES VARY WIDELY AMONG ADOLESCENTS

- NEED A BETTER UNDERSTANDING OF:- What treatment programs are beneficial for

whom

- What factors contribute to treatment outcomes

More Research Needed to Refine Existing Programs

Waldron & Turner, 2008; JCCAP

IDENTIFY FACTORS THAT CONTRIBUTE TO EARLY

SUBSTANCE USE IN ORDER TO AID IN THE REFINEMENT OF

PREVENTION AND INTERVENTION STRATEGIES

Program of Research

WHAT FACTORS CONTRIBUTE

TO SUBSTANCE USE?

Factors

Expectancies Regarding Use (O’Connor et al., 2007)

Neighborhood Disadvantage and Violence (Fite et al., 2009; in press)

Perceived Peer and Caregiver Approval (Fite et al., 2009)

Peer Influence (Fite et al., 2007; 2008) Peer Rejection Peer Delinquency

AGGRESSIVE BEHAVIOR (Fite et al., 2007, 2008, 2010, in press) Proactive vs. Reactive

Pathways from Proactive and Reactive Aggression to

Substance Use

Background

Risk for substance abuse starts earlier than initiation of SU.

Prevention and early intervention is key.

Aggression typically proceeds SU.

One way to further understand the relation between aggression and SU is to examine the relation between subtypes of aggression and SU.

Aggression

Behavior that is intended to harm or injure another individual (Coie & Dodge, 1998).

Aggression construct is comprised of subtypes or sub-dimensions of aggression

Proactive Aggression (PA)

Goal-oriented, calculated aggression motivated by external reward (Dodge, 1991)

Some difficulties, but often positively evaluated by peers and tend to affiliate with other PA children (e.g., Dodge & Coie, 1987; Day et al., 1992; Poulin and Boivin, 2000)

Associated with poor long-term behavioral outcomes (e.g., Fite, et al., 2008; Fite, Stoppelbein, & Greening, 2008; 2009; Vitaro et al., 1998; Cornell et al., 1996)

Reactive Aggression (RA)

Aggression in response to others’ behavior perceived as threatening or intentional (Dodge, 1991)

Not liked by peers at any age (e.g., Day et al., 1992; Prinstein & Cilessen, 2003)

Long-term antisocial prognosis not clear, but internalizing symptomotology clearly indicated (e.g., Card & Little, 2006; Conner et al., 2003; Fite et al.,

2009; Fite et al., 2010; Raine et al., 2006)

PA, RA, and SU (Cont’d)PA

Consistent with current developmental models of risk (Moffit, 1993)

RA Characterized by impulsivity, a predictor of substance use

(e.g., Mc Murran et al., 2002)

Associated with ADHD/CD diagnosis, a diagnosis associated with poor long-term outcomes (e.g., Waschbusch et al.., 2002)

Proactive Aggression

Reactive Aggression

Substance Use Initiation

Substance Use/Abuse

Proactive Aggression

Reactive Aggression

Peer Delinquency

Peer Rejection

Substance Use Initiation

Substance Use/Abuse

Negative Emotions

Delinquency

Contextual Factors

Relation Between Proactive and Reactive Aggression and Frequency of Substance Use

FITE, COLDER, LOCHMAN, & WELLS (2007) PSYCHOLOGY OF ADDICTIVE BEHAVIORS

Examined pathways from 5th grade proactive and reactive aggression to 9th grade SU

Aims of the study: Examine whether proactive aggression and reactive

aggression are related to the development of SU. Examine peer relations as mediators of these relations

Proactive Aggression

Reactive Aggression

Substance Use/Escalation

Peer Rejection

Peer Delinquency

ChildhoodLate Childhood/ Early Adolescence Adolescence

Hypothesis #1

Proactive Aggression

Reactive Aggression

Substance Use/Escalation

Peer Rejection

Peer Delinquency

ChildhoodLate Childhood/ Early Adolescence Adolescence

+

+

Hypothesis #2

Proactive Aggression

Reactive Aggression

Substance Use/Escalation

Peer Rejection

Peer Delinquency

ChildhoodLate Childhood/ Early Adolescence Adolescence

++

Hypothesis #3

Proactive Aggression

Reactive Aggression

Substance Use/Escalation

Peer Rejection

Peer Delinquency

ChildhoodLate Childhood/ Early Adolescence Adolescence

++

Hypothesis #4

Proactive Aggression

Reactive Aggression

Substance Use/Escalation

Peer Rejection

Peer Delinquency

ChildhoodLate Childhood/ Early Adolescence Adolescence

+

+

+

Methods

Control groups of a larger longitudinal study

125 Aggressive individuals in 4th grade at initial assessment

Mean age = 10.4 years 79% African American 66% Male

Data collected annually over 6 years

Data Analytic Strategy

Included PA & RA in the same model to examine unique relations.

Included 8th grade SU in order examine change in SU, above and beyond prior levels of Substance Use

.28*

-.26*

.25†

.24*

.53* .62*

.34*

.00

.38*

.02

-.09

-.05

-.17*

.04 .21

.88

.90

.95

.54

Proactive Agg. 5th Grade

Reactive Agg. 5th Grade

Peer Rejection 5th Grade

Peer Delinquency 8th Grade

Substance Use 9th grade

Substance Use 8th grade

Note: *= p < .05, †= p < .10; Standardized estimates are reported. Standardized estimates for the disturbances are proportions of unexplained variance.

D1

D2

D3

D4

.28*

-.26*

.25†

.24*

.53* .34*

-.17*

Proactive Agg. 5th Grade

Reactive Agg. 5th Grade

Peer Rejection 5th Grade

Peer Delinquency 8th Grade

Substance Use 9th grade

Substance Use 8th grade

Note: *= p < .05, †= p < .10; Standardized estimates are reported. Standardized estimates for the disturbances are proportions of unexplained variance.

Conclusions

PA → SU through peer delinquency = continuity of problem behavior

RA → SU complex RA associated with SU through complex mediational

chain, which is consistent with previous research RA associated with hypervigilance to threat cues =

protective of substance use

Timing of Initiation of Substance Use

Fite, Colder, Lochman & Wells (2008) Journal of Abnormal Child Psychology

Note of Replication/Extension

Reactive and Proactive Aggression in Adolescent Males:Examining Differential Outcomes 10-Years Later in Early

Adulthood

FITE, RAINE, STOUTHAMER-LOEBER, LOEBER, & PARDINI

(2010)CRIMINAL JUSTICE AND BEHAVIOR

Very little research has examined the long-term outcomes of proactive and reactive aggression into adulthood

Understanding long-term associations can aid in refining current early prevention efforts and has implications for targeted intervention strategies

Current Study

Examined proactive and reactive aggression at age 16 as predictors of adult outcomes 10 years later (mean age =26) while also controlling for prior levels of negative behavior.

Methods

335 boys followed-up longitudinally from age 7 to 26 years 57% African American 40% Caucasian 3% other ethnicity

Predictor variables collected at age 16 and outcome data at age 26

Cigarette AlcoholBinge

Drinking MarijuanaAny Hard

Drug

R2 = .17 R2 = .03 R2 = .04 R2 = .08 R2 = .09

Path Estimate Path Estimate Path Estimate Path Estimate Path Estimate

Proactive Aggression .10 .05 .20* -.02 -.05

Reactive Aggression -.09 -.02 -.06 .13† .19*

Substance Use in a Predominantly Hispanic Sample

of Youth

FITE, HENDRICKSON, EVANS, RUBENS, JOHNSON-MOTOYAMA, & SAVAGE

IN PRESS

JOURNAL OF CHILD AND ADOLESCENT SUBSTANCE ABUSE

Hispanic youth are at increased risk for substance use, particularly marijuana use

No research has examined associations between aggression subtypes and substance use in a Hispanic Sample

Current study examined associations in a sample of 152 adolescents (95% Hispanic)

Proactive Aggression

Reactive Aggression

Neighborhood Violence

Gender

Grade

Marijuana

R2 = .21

Tobacco

R2 = .20

Alcohol

R2 = .40

.62(1.10)*

.30(.46)*

.24(.34)*

.25(.38)*

.24(.35)*

Take Home Message

Proactive Aggression most robustly associated with substance use, particularly alcohol use, across racial groups and genders

Reactive Aggression associated with substance use, tobacco and marijuana in particular, but only under particular situations and circumstances

Unique interventions for different subtypes of aggression

QUESTIONS

Acknowledgements Collaborators:

Dr. Craig Colder Dr. Sara Elkins Dr. Leilani Greening Dr. John Lochman Dr. Rolf Loeber Dr. Dustin Pardini Dr. Adrian Raine Dr. Laura Stoppelbein Dr. Magda Stouthamer-Loeber Dr. Karen Wells Dr. Helene White Dr. Michelle Johnson-Motoyama UT Child Behavior Lab (Gaertner,

Grassetti, Preddy, Wimsatt, Rathert, Vitulano, & Wynn)

KU Child Behavior Lab (Rubens, Cooley, Hendrickson, Evans, Gabrielli, Tunno)

Lochman Research Group UB Child Development Project

Members

Families who participated in the studies

Funding Sources: National Institute on Drug Abuse

DA031719 (PI:Fite) DA018016 (PI: Fite) DA14386 (PI: Colder) DA411018 (PI: Loeber)

National Institute on Mental Health MH48890 (PI: Loeber) MH 50778 (PI: Loeber) MH078039 (PI: Pardini)

SAMHSA Center for Substance Abuse Prevention UR6 5907956 (PI: Lochman) KD1 SP08633 (PI: Lochman)

Office of Juvenile Justice and Delinquency Prevention 96-MU-FX-0012 (PI: Loeber)

SUNY Graduate Student Employee Union Professional Development Funds (PI: Fite)

University of Tennessee (PI: Fite)

University of Kansas (PI:Fite)