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Adolescents and Substance Use Disorders

Li, Chaoyang, Pentz, M. A., & Chou, Chih-Ping (2002). Parental substance use as a modifier of adolescent substance use risk. Addiction, 97, 1537–1550. National prevention efforts focus largely on efforts to reduce peer pressure to use drugs and alcohol. The effect that parental drug use has on teenagers’ use of substances (alcohol, marijuana, tobacco) has not been a major focus of these programs despite research that demonstrates that parents’ substance use does predict substance use in adolescents. Data were analyzed from a survey of 1807 sixth and seventh graders from Indianapolis, Indiana, at baseline, 6 months and 18 months to see what effect parental drug use (defined as the two most important adults in the teen’s life) has on teen drug use and the inter-relationship between parents and friends’ drug use on adolescent substance use. Substance offers referred to the number of times the teen had had one of the substances offered to them in the last month, and ranged from never to more than 5 times. Refusal self-efficacy, based on social learning theory, was defined as the how sure the teen was that he or she could say “no” to drug use when it was offered in the next month. A six response scale was used for the quantity used of the three drugs. For example, with marijuana, the range was from no marijuana to more than 20 times it was used in the past month. With alcohol, the range was from no drinks to 11 or more drinks in the past month, and for cigarette smoking the range was from none to more than one pack smoked in the past month. Even a “1” on any of the 3 questions related to the drugs categorized the teen as “using” the substance. Parents were categorized as users if they had ever used any of the three substances. For those teens whose parents both smoked cigarettes, there were more adolescents who used alcohol, tobacco and nicotine at the 18-month survey. When only one parent smoked there was a higher risk of smoking cigarettes at the 18-month follow up. Marijuana use by one or both parents also influenced all three drugs–tobacco, alcohol and marijuana use, with more of an influence on all three drugs when both parents used marijuana. Marijuana use by one parent, however, accounted for twice the risk for cigarette use, alcohol, or marijuana. For those teens whose parents drank alcohol but didn’t used nicotine and marijuana, more teens were likely to drink alcohol but not use nicotine or marijuana at the 18-month marker. Both parents drinking increased the use by the teens more than with just one parent drinking alcohol. More teens used alcohol, tobacco or marijuana when both parents used any of the three drugs. Overall, any substance use by both parents was associated with higher levels of use of all the 3 drugs. The influence of peer use was even greater than the parents. The risk of smoking cigarettes was 6 times greater in those who had 5 friends who smoked, and increased the risk for marijuana use threefold and the risk for alcohol twofold. When their friends drank alcohol there was higher use of all 3 of the drugs. The risk for those who had 5 or more friends using alcohol was 5 times higher than those who had no alcohol using friends. Marijuana use was associated with an increased risk for cigarettes (2.8 times), alcohol (2.8 times) and marijuana (2.7 times). Logistic regression models were used to test the interaction between parents’ and friends’ substance use, and the odds ratios of each substance increased when the number of parents and friends who used the same type of substance increased. When the number of the friends (5 or more) who used all three substances was combined with both parents using these drugs, the greatest risk of using alcohol, tobacco or marijuana resulted. The teens who had both parents and more than 5 friends who smoked or used alcohol, were at the greatest risk of smoking cigarettes or using alcohol, respectively, and the interactions were not statistically significant. In contrast, when both parents of the teens used marijuana, and only 1 to 4 friends used marijuana, the risk for marijuana use was at its highest and the interaction was statistically significant. A structural equation model demonstrated that parent substance use and no use groups, baseline substance use, substance offers and refusal self-efficacy affected adolescent substance use. When alcohol, cigarettes and marijuana were offered to the teens, they had more influence on refusal self-efficacy in the teens who had a parent who had used substances When both friends and parents used these 3 drugs, then there was a significant effect on later substance use. However. when friends used substances and the parents did not use substances, there was no significant risk for later substance use. Thus, when friends used substances, the risk was intensified if the parents also used substances.