Leveraging the Full Continuum of Care to Prevent Opioid Use Disorder.

Substance use disorder prevention programs are most effective when matched appropriately to the baseline risk of the population. Individuals who misuse opioids often have unique risk profiles different from those who use other substances such as alcohol or cannabis. However, most substance use prevention programs are geared toward universal audiences, neglecting key inflection points along the continuum of care. The HEAL Prevention Cooperative (HPC) is a unique cohort of research projects that represents a continuum of care, from community-level universal prevention to indicated prevention among older adolescents and young adults who are currently misusing opioids or other substances. This paper describes the theoretical basis for addressing opioid misuse and opioid use disorder across the prevention continuum, using examples from research projects in the HPC.

Outcomes of alcohol treatment for adolescents.

The use by adolescents and young adults of alcohol and other drugs continues to be a tremendous problem for this nation. Over 30% of all high school students nationwide report episodes of hazardous drinking (five or more drinks on one occasion), when both moderate and heavy alcohol consumption are associated with a higher risk of alcohol-related medical consequences and accidental injuries for youth. Increased awareness and concern related to adolescent substance use has led to the outgrowth of additional treatment facilities and programs for this age group. The current chapter discusses how developmental factors may impact the assessment process and subsequent treatment for adolescent alcohol use disorders. In addition, outcome research, intervention studies, relapse, and factors that may influence the recovery process are discussed.

Four-year outcomes from adolescent alcohol and drug treatment.

OBJECTIVE: Knowledge of treatment response for alcohol and drug problems among adults is mounting; less is known about long-term outcome for adolescents who receive treatment for alcohol and drug problems. The current study examined youth substance involvement over 4 years (using five waves of data collection) following treatment for alcohol and drug abuse. METHOD: A cohort of youth (N = 162, 60% male) treated during adolescence (mean age = 16 years) was followed into young adulthood, a period associated with stabilization of alcohol use patterns and elevated risk for life problems secondary to both alcohol and drug use. Participants (14-18 years old) were consecutive admissions to inpatient adolescent alcohol and drug treatment centers in San Diego that were abstinence focused and based on the 12-step approach. RESULTS: Alcohol and other drug use were reduced during the 4 years posttreatment, with the exception of nicotine. The greatest prevalence reduction occurred for stimulants; modest changes were evident in alcohol and marijuana use. Nicotine was the most commonly used substance throughout the 4 years after treatment. Several distinct substance involvement trajectories were evident during the 4 years following treatment. CONCLUSIONS: Alcohol and drug use patterns during the 4 years following treatment highlight both changes and diversity in substance involvement as youth make the transitions from middle to late adolescence and into young adulthood. Findings demonstrate the importance of identifying transitional periods and the need for alternative intervention strategies that may help the progression of this population into young adulthood.

Power analysis for multivariate and repeated measures designs: a flexible approach using the SPSS MANOVA procedure.

Although power analysis is an important component in the planning and implementation of research designs, it is often ignored. Computer programs for performing power analysis are available, but most have limitations, particularly for complex multivariate designs. An SPSS procedure is presented that can be used for calculating power for univariate, multivariate, and repeated measures models with and without time-varying and time-constant covariates. Three examples provide a framework for calculating power via this method: an ANCOVA, a MANOVA, and a repeated measures ANOVA with two or more groups. The benefits and limitations of this procedure are discussed.

Progression into and out of binge drinking among high school students.

The current study examined binge drinking among high school students over an academic year. Adolescent drinkers (N = 621; 58% female) were grouped into 4 trajectories: drinkers (35%), increasers (14%), decreasers (16%), and persistent binge drinkers (35%). Prospective analyses indicated several factors that predicted escalation and de-escalation of binge drinking. Increasers were more likely to regularly use alcohol and cigarettes at a younger age than drinkers. Compared with decreasers, persistent binge drinkers reported regular alcohol and marijuana use at younger ages. Lower levels of perceived student drinking appeared to be a protective factor for onset of binge drinking. The results highlight the need to study precursors to the naturally occurring fluctuations in binge drinking and suggest factors that may accentuate the risk of binge drinking.

Measuring adolescent alcohol outcome expectancies.

The psychometric properties and construct validity of the Comprehensive Effects of Alcohol (CEOA) questionnaire were compared with those of the Alcohol Expectancy Questionnaire--Adolescent version (AEQ-A) in relation to adolescent alcohol consumption. Both measures of adolescent alcohol expectancies were found to be internally reliable and temporally stable. Alcohol use was significantly associated with subjective evaluations for Cognitive and Behavioral Impairment and Self-Perception on the CEOA and with expected effects for Cognitive and Motor Impairment and Changes in Social Behavior on the AEQ-A. Compared with the AEQ-A, the CEOA explained more variance in quantity (28%) and a similar variance in frequency (15%) for adolescent alcohol use (AEQ-A quantity = 20%, frequency = 15%). Whereas the general content and psychometric properties of the 2 measures are markedly similar, the Likert response format, shorter length, and assessment of both expected effects and subjective evaluations with the CEOA may offer measurement advantages over the AEQ-A.

Intoxicated sexual risk taking: an expectancy or cognitive impairment explanation?

OBJECTIVE: Two experimental studies tested expectancy and impairment explanations for the association between alcohol consumption and unsafe sexual behaviors. METHOD: Young adults, who were administered alcohol (blood alcohol concentration mean = .08 mg%), placebo or water, rated the likelihood that potential consequences would result from risky sexual practices (Study 1, N = 161) and listed potential consequences that could result from having sex without a condom (Study 2, N = 135). RESULTS: Intoxicated participants reported lower perceptions of risk (mean [+/-SD] = 4.5+/-2.1) than those who received placebo (mean = 5.8+/-1.3) or water (mean = 5.5+/-1.7). Intoxicated participants also listed fewer negative consequences (mean = 1.3+/-1.2) than those who received placebo (mean = 1.5+/-1.2) or water (mean = 2.1+/-1.5). In addition, participants who expected alcohol to disinhibit their sexual behavior reported stronger postdrinking perceptions of benefit (mean = 2.6+/-1.8) and indicated that they were more likely to engage in risky sexual practices (mean = 2.4+/-1.7) than those who did not expect sexual disinhibition (mean = 2.0+/-1.7, benefit; mean = 1.8+/-1.1, involvement). CONCLUSIONS: Results support the hypotheses that (1) alcohol-related impairment reduces the drinker's perception of personal risk, and (2) positive outcome expectancies motivate drinkers to engage in risky sexual practices.

Health risk behaviors of adolescent and young adult siblings.

The present study tested the effects of older siblings' outcome expectancies, health risk behaviors, and consequences on the behavior and health-related expectancies of their younger adolescent siblings. Data were analyzed for 140 matched pairs of younger (n = 147) and older (n = 195) siblings. Younger siblings' alcohol use and expectancies were significantly associated with perceptions of their older siblings' drinking. Younger siblings' positive expectancies for other health risk behaviors (e.g., sex without a condom) were associated with their perceptions about the positive consequences their older sibling had experienced and with their older siblings' positive expectancies. These results suggest that vicarious learning from an older sibling is one mechanism through which adolescents form expectancies about health risk behaviors. Prevention strategies are discussed that focus on expectancies and older sibling influence on adolescent risk involvement.