Sexual victimization and substance abuse in psychiatrically hospitalized adolescents

This article investigates the relationship between substance abuse and sexual abuse in a population of 260 psychiatrically hospitalized adolescents. Seven hypotheses are set forth to test a model that uses parental alcohol abuse, sexual abuse status, and gender as exogenous variables, perceived benefit of alcohol or drugs as an endogenous mediating variable, and substance abuse as the dependent variable. Using these variables, a path model was constructed and revised based on empirical testing. The revised model achieved an adjusted R2 of .38, thus explaining 38 percent of the variance in this sample's abuse of alcohol or drugs. The model suggests that within clinical populations, sexually abused adolescents should be screened for substance abuse, and attention should be given to parental alcohol abuse as well as the degree to which adolescents perceive benefits from their alcohol or drug use.     

Substance abuse

Liddle and Dakof's (1995) comprehensive review of the status of family-based treatment for drug abuse concluded that this modality offered a "promising, but not definitive" approach to treating drug abuse among adolescents and adults. Less than a decade later, significant progress can be seen in the treatment of drug abuse problems using family-based approaches, particularly with adolescents. Family-based treatments are currently recognized as among the most effective approaches for adolescent drug abuse. Family-based treatment of adult drug abuse problems has also advanced in important ways with the recent systematic application and testing of engagement techniques and behavioral couples therapy approaches. The current review characterizes and discusses the developmental status of this subspecialty and outlines areas in which continued research attention is needed.     

History of sexual abuse and parental alcohol misuse: Risk,outcomes and protective factors in adolescents

This study examined the school performance, suicidal involvement, disordered eating behaviors, pregnancy risk and chemical use of teenagers with a history of sexual abuse or parental alcohol misuse and found that they had higher rates of these adverse outcomes than among a comparison group of teenagers without such background risk factors. Adolescents with dual-risk background reported higher levels of suicide risk, disordered eating, sexual behaviors and chemical abuse than teenagers with only one background risk factor. Among index group members, protective factors against these adverse outcomes included a high degree of religiosity and the ability to discuss problems with family or friends. Risk factors that increased the likelihood of adverse outcomes included depression, perceived substance use in school and worries about family financial security.The first author was supported in the preparation of this article by a grant from the Lois and Samuel Silberman Fund of New York.     

Preventing alcohol abuse: an examination of the "Downward Spiral" game and educational videos

Downward Spiral is a board game developed by the authors to illustrate the dangers of continued substance abuse. Previous work has found that college students and probationers find the game interesting, enjoyable, useful, and realistic [1]. In the current study, college students either played Downward Spiral, watched educational videos on substance abuse, or completed a set of questionnaires unrelated to alcohol and drug abuse. Those students who either played the game or watched the videos rated both as beneficial. However, students who watched videos had somewhat higher levels of consumer satisfaction. Students who played the game rated it as smoother, and they felt more positive following the session than students who watched videos. Both videos and the game increased students' intentions to limit alcohol consumption compared to students who served as controls. Individuals in the game group also indicated significantly greater intentions to change their alcohol behavior than those in the other groups.     

Antecedents and correlates of alcohol, cocaine, and alcohol-cocaine abuse in early adulthood

We used a fourfold substance abuse typology consisting of non-abusers, alcohol abusers, cocaine abusers, and joint alcohol and cocaine abusers with a nationally representative sample of young adults (aged 19-26 years) to investigate issues related to prevalence, antecedents, and correlates of substance abuse. The prevalence data indicate higher alcohol abuse among white males, but approximately equal proportions of cocaine abuse and joint alcohol and cocaine abuse across gender and ethnic/racial groups. A simplex-like ordering was found for the four abuse groups with regard to the degree of problem severity associated with most of the antecedents and correlates. Joint alcohol and cocaine abusers demonstrated the highest levels of previous thirty-day and lifetime drug use, high levels of delinquent activity, and the highest rates of unemployment and marital instability. Cocaine abusers demonstrated the second highest levels of problem severity, alcohol abusers the third highest levels, and non-abusers the lowest levels. An exception to the simplex-like pattern was found with respect to educational attainment and verbal intelligence. Joint alcohol and cocaine abusers reported the lowest high school dropout rate and scored the highest on a measure of verbal intelligence. We suggest that joint alcohol and cocaine abusers may be characterized as "non-strivers" or "underachievers," quite possibly as a consequence of substance abuse.     

Sex differences in psychosocial consequences of alcohol and drug abuse

This paper reports analyses of the 1985 National Household Survey on Drug Abuse to evaluate three perspectives on sex differences in the relationship of psychosocial problems to levels of substance use. The results are more consistent with a styles of deviance perspective than with either the generalized feminine vulnerability or the convergence theses. Compared to women, men report higher levels of alcohol and drug abuse during the past year and are more likely than women to have experienced each of 17 psychosocial problems resulting from alcohol or drug use. Significant sex by substance use interaction tests for problem indices and for individual problems suggest that substance abuse is related more strongly to intrapsychic problems among women and to problems in social functioning among men. Decompositions of the sex differences in mean levels of psychological and social/behavioral problems suggest that most of the differences can be explained by males' greater frequency of intoxication and drug use.     

Childhood sexual abuse patterns, psychosocial correlates, and treatment outcomes among adults in drug abuse treatment

This study reports on the effects of having a history of childhood sexual abuse (CSA) on treatment outcomes among substance abusing men and women (N = 2,434) in a national, multisite study of drug treatment outcomes. A history of CSA was reported by 27.2% of the women and 9.2% of the men. Controlling for gender, compared to patients without CSA, patients reporting CSA were younger at entry into the current drug treatment, were more likely to be White, were more likely to have a comorbid mental disorder, be alcohol or cocaine dependent, had higher levels of criminal activities, had a higher level of problem recognition, and had a more negative peer influence. Controlling for these correlates, a history of abuse was related to a lower likelihood of posttreatment abstinence.     

Adolescent attitudes toward random drug testing in schools

The current research examined students' perceptions of random drug testing for students participating in after-school activities. Results found students were more likely to endorse drug testing at their school if they are already engaged in after-school activities and not currently using drugs and/or alcohol. While middle and high school students' scores fell within the median, most reported if drug testing were implemented in their school they believed it would not deter continued participation in after-school activities. However, if drug testing were a prerequisite for participating in after-school activities, high school students were more apprehensive about getting tested than middle school students. Student respondents were more likely to endorse drug testing, if all members of the school system (i.e., teachers, coaches and staff) participated in drug testing. High school students' believed they had enough knowledge about drug abuse and were less likely to endorse drug testing because they believed it would violate their personal privacy compared to grade school students. Results also differed as a function of gender and self-reported drug and alcohol use.     

Eating Disorders and Additional Psychopathology in Women

Eating disordered individuals are often found to exhibit additional psychopathology such as depression, anxiety, substance abuse, and "borderline symptoms" such as self-injury and suicidality. This pilot study examined 535 female subjects with eating disorders to determine the relationship between such additional psychopathology and a prior history of sexual abuse. While few differences were found on general psychiatric/psychological symptoms as measured by the SCL-90-R, subjects that reported a history of sexual abuse were found to have more prior suicide attempts and hospitalizations, and more frequent self-injury and alcohol problems. These findings suggest that symptoms seen in some eating disorder patients that are frequently described as "borderline" may be indicators for a history of sexual abuse.     

Fathers' alcohol use and spousal abuse and mothers' child abuse in multicultural families in South Korea: The mediating role of acculturation and parenting stress

There is a potential high risk for child abuse by foreign-born mothers in multicultural families in Korea, particularly given that they experience acculturation and parenting stress at the same time. Further, the risk for child abuse by foreign-born mothers may be aggravated through the high rate of alcohol abuse among Korean husbands that may increase their spousal abuse and in turn the mothers' acculturation and parenting stress. Therefore, this study examined the associations between Korean fathers' alcohol use and spousal abuse and foreign-born mothers' child abuse in multicultural families, with particular attention to investigating whether foreign-born mothers' acculturation and parenting stress mediated the associations. This study overall found that fathers' alcohol use was directly associated with their spousal abuse, and that fathers' spousal abuse was directly associated with mothers' acculturation stress and child abuse. Further, this study found a full mediation path in which fathers' alcohol use was associated with mothers' child abuse through fathers' spousal abuse. Fathers' spousal abuse was also associated with mothers' parenting stress through mothers' acculturation stress, and mothers' acculturation stress was associated with their child abuse through their parenting stress. The findings of this study provide social work implications for child abuse in multicultural families in Korea.     

Substance abuse, suicidality, and self-esteem in South African adolescents

Associations among six different domains of self-esteem (peers, school, family, sports/athletics, body image, and global self-worth) and risk behaviors related to substance use and suicidality were investigated in a sample of South African adolescents. Students enrolled in Grades 8 and 11 at independent secondary schools in Cape Town (N = 116) completed the Self-Esteem Questionnaire (SEQ) and a questionnaire that asked about their participation in a range of risk behaviors. Logistic regression analyses indicated that particular domains of self-esteem were differentially associated with indicators of alcohol, cigarette and drug use and suicidal ideation or behaviors in adolescents. Family self-esteem showed the strongest overall pattern of associations with the risk behaviors. Overall, the findings of this study suggest that interventions which aim to protect adolescents from engaging in risk behaviors by increasing their self-esteem are likely to be most effective and cost-efficient if they are aimed at the family and school domains.     

Predictors of substance abuse treatment outcomes in Tennessee

In planning and implementing programs to treat substance abuse, it is important to understand which factors influence post-treatment abstinence.This article identifies and analyzes several variables important in predicting the likelihood of abstinence among substance abuse clients. The data used in this study was collected from 1,350 clients treated for alcohol or drug abuse in residential, halfway house, or outpatient facilities in Tennessee. We analyzed 22 variables as possible treatment outcome predictors by using two statistical procedures: stepwise logistic regression analysis and Quick, Unbiased, Efficient, Statistical Tree (QUEST) analysis, a tree-structured classification algorithm analysis. We found one pretreatment, five in-treatment, and three post-treatment variables to be significant predictors of treatment outcome: previous treatment history, perceived helpfulness of the treatment, simultaneous treatment for mental health, number of days in treatment,completion of treatment, special skills training during treatment, obtaining healthcare services for major physical health problem after treatment, living with someone using alcohol or drugs post treatment, and arrest record since treatment.     

Childhood sexual abuse, dissociation, and adult self-destructive behavior

Female college students reporting a history of childhood sexual abuse (N=175) and not reporting a history of childhood sexual abuse (N=260) were compared on indices of six self-destructive behaviors, including drug use, alcohol abuse, binge eating, self-mutilation, risky sex, and suicidality. The samples were also compared on two measures of dissociation, the Trauma Symptom Checklist dissociation subscale and the Dissociative Experiences Scale. The CSA group had significantly higher mean scores on all the indices of self-destructive behavior except self-mutilation (where the mean difference approached significance), and on both measures of dissociation. One or both dissociation measures were related significantly to each index of self-destructive behavior except binge eating. Multiple regression mediation analyses provided support for the hypothesis that dissociation mediates the relationships between CSA and both drug use and alcohol abuse. Dissociation also explained significant variability when added to the regressions of risky sex and suicidality on CSA.     

The influence of adolescent physical abuse on school adjustment in South Korea: The mediating effects of perceived parenting types

The present study examined whether adolescents' perceptions of parenting behavior mediated the link between physical abuse and school adjustment in South Korea. Additionally, we investigated adolescents' perceptions of their parents' acceptance as a potential protective factor of the relation between physical abuse and school adjustment. Participants included 1354 South Korean adolescents from 26 schools in a metropolitan area of Seoul. Structural equation modeling and hierarchical regression analyses were conducted. Our results suggested that the perceived acceptance fully mediated the association between physical abuse and school adjustment. Moreover, the negative association between physical abuse and school adjustment is likely to be less strong for adolescents with high perceived acceptance than those with low perceived acceptance. These findings highlight the importance of adolescents' perceptions of parenting in understanding how and when physical abuse affects their school adjustment in South Korea.     

The Marihuana Perception Inventory: the effects of substance abuse instruction

This article reports the latest results of a continuing effort to develop a perceptual inventory of factors associated with the onset of marihuana use among youths and young people. In addition to better understanding why adolescents begin using marihuana, the inventory is intended to assist drug educators target their programs. This phase studied 617 students in three Midwest school districts prior to and after substance abuse instruction to determine the relationship between perceptions and demographic characteristics, and to learn if substance abuse instruction was related to changes in the student's perception of the relationships. Factor analysis again revealed a five-factor solution. All thirty-four inventory items were included in the final solution. Items appeared to group themselves among the scales in a fashion similar to that found in prior studies. However, the larger sample size permitted refinement of the scales: Maturational Difficulties; Excessive Pressure; Parental Failings; Rebelliousness; and Societal/Institutional Weaknesses. The inventory appears to be remarkably stable across demographic characteristics. Significant differences between pretest and posttest scores indicated that students perceived less of a relationship between Maturational Difficulties, Excessive Pressure, and Societal/Institutional Weaknesses and the onset of marihuana use after instruction, and more of a relationship between Parental Failings and the young person's decision to begin using marihuana. It appears that instructional programs can be expected to at least contribute to changes in perceptions concerning the relationship between societal and familial factors and the onset of marihuana use.     

Psychological impact of writing about abuse or positive experiences

Writing often helps people deal with trauma. To see if writing about childhood physical or sexual abuse, or positive experiences, helps, psychology undergraduates wrote for 20 minutes on 4 days about their abuse, a positive experience, or a trivial topic. Among 102 who began and 85 who completed pre-, post-, and 4-week follow-up measures of depression, anxiety, and suicidal ideas, abuse writers were more likely to discontinue, and positive writers were more depressed and anxious. Compared to pretest, all completers were less depressed, anxious, and suicidal at follow-up, but nonsignificantly different in health visits. Completers who wrote about abuse rated the study as more valuable than did those who wrote about positive experiences. College students who wrote about childhood physical or sexual abuse benefited from any type of structured writing assignment (where they interacted with a researcher and got extra credit) in terms of reduced anxiety, depression, and suicidal ideas, but they found value in writing about their trauma more than writing about innocuous topics.     

How child protective services investigators decide to substantiate mothers for failure-to-protect in sexual abuse cases

The purpose of this study was to determine how Child Protective Services (CPS) investigators decide to substantiate mothers for failure-to-protect from sexual abuse. A case-comparison study was used to compare 31 mothers who were and 62 mothers who were not substantiated for failure-to-protect by CPS. The multivariate analysis showed that mothers who did not consistently believe the sexual abuse occurred and who did not consistently act protectively were more likely to be substantiated. In addition, if they knew about the abuse from more than one source were less supportive of the children; and had a substance abuse problem, a mental health problem or were being battered, then they were more likely to be substantiated. Investigators appear to apply criteria consistently to substantiate mothers. doi:10.1300/J070v15n04_04.     

Perspectives on elder abuse in Greece

The sample for this exploratory qualitative study of Greek perceptions of elder abuse consisted of 43 Greek participants from urban centers and 28 Greeks from a small island village. Participants were asked to provide examples of extreme, moderate, and mild abuse from an adult child toward his/her aging parent. Half of the examples of extreme abuse were various forms of physical aggression. Predominant examples of moderate abuse were psychological abuse and neglect, and at the mild level neglect was the most highly cited category. The most frequently mentioned specific types of elder mistreatment were verbal abuse, psychological neglect, physical neglect, and hitting. There were no gender differences in the kinds of examples that participants gave or the severity they attributed to their examples. Females were more often presented as victims of abuse than males. A negative correlation was found between age and the number of physical abuse examples given overall, and as types of severe abuse.     

Drug Use/Abuse and Supermarket Workers' Job Performance

In 34 stores of a supermarket chain 1,414 employees were interviewed on their histories of substance use, and were diagnosed for alcohol and drug abuse. The ratings of their job performance were obtained from their supervisors. Many statistically significant correlations were found between measures and indicators of substance use/abuse and the supervisors' ratings of job performance. Greater use of prescribed stimulant medication and greater coffee consumption were both associated with better rated job performance. In summary, while some of correlations found between the substance use measures/abuse and job performance were highly significant, due to the large sample size, this does not necessarily demonstrate that the relationship is strong enough to have practical implications for the hiring practices of management. Whether the degree of the relationship found was sufficient to warrant preemployment drug testing of supermarket employees, given the cost of testing and the privacy questions, is probably moot. There was evidence that, when they are interviewed at or near their workplace, employees tend to deny recent and current substance use more than they deny past substance use, in spite of the promise of confidentiality and anonymity.     

"Natural recovery" from alcohol abuse among college students

As they progress through college, a significant number of students reduce their abusive alcohol consumption without formal interventions on the part of the university, other agencies, or counseling/mental health services. Such "natural recovery" may offer important clues as to both the etiology and reduction of alcohol abuse on campus. The author reviews factors hypothesized to play a significant role in facilitating natural recovery and offers suggestions about how such findings might be used to shape campus structures and activities so as to reduce excessive alcohol consumption by college students.