Transcript Style D 36 by 54 - Johns Hopkins University

Patterns of Alcohol Abuse and Dependence Symptoms among Male Youths in the US: Implications for the DSM-V
Brent E. Mancha, Sarra L. Hedden, Silvia S. Martins, William W. Latimer
Johns Hopkins Bloomberg School of Public Health
This research was supported by The Drug Dependence Epidemiology Training Program, NIDA T32 Grant #: DA007292.
Background
Conclusion
Results
• 4 classes of alcohol symptoms were found:
• Adolescent alcohol use is a public health problem associated
with fatal automobile crashes (National Highway Traffic Safety
Administration, 2008), risky sexual behavior (Kaiser Family
Foundation, 2002), and low GPA (Presley et al., 1998)
• Low risk group (few symptoms endorsed)
• Medium risk group: low behavioral problems
• Medium risk group: high behavioral problems
• 9.1% of 15-17 year olds in the US in 2007 met criteria for
DSM-IV Alcohol Abuse or Dependence (SAMSHA, 2007)
• High risk group (many symptoms endorsed)
• DSM-IV Alcohol Dependence: 3 out of 7 Dependence criteria
• More severe classes were associated with:
• DSM-IV Alcohol Abuse: 1 out of 4 Abuse criteria
• More past year DSM-IV Alcohol Abuse and Dependence
• There is heterogeneity in the categories of alcohol use
disorders among youths, but there have been relatively few
studies empirically examining subtypes of alcohol use
disorders among youths (Chung & Martin, 2001)
• More past month alcohol use
• Higher prevalence of past year Illicit substance use
Public Health Implications
• Latent Class Analysis (LCA) is a statistical method used to
determine distinct subtypes of related cases based on several
categorical items (Yes/No, Hagenaars & McCutcheon, 2002)
• Implications for revisions to the DSM-V
• Hierarchical distinction between Abuse and Dependence
symptoms not supported
• The aims of this study were to:
•
Examine the pattern of alcohol symptom endorsement
•
Empirically classify youths according to their alcohol
symptom endorsement
•
• Some dependence symptoms were highly prevalent, even
in less severe classes
• Ex: tolerance, doing something dangerous while drinking,
and a lot of time spent drinking or getting over alcohol
Examine class membership by several criterion variables
• We hypothesize that higher risk groups will be
associated with more alcohol use, alcohol problems, and
drug use (Jessor & Jessor, 1977)
Table 2. Descriptive statistics of criterion variables by class membership.
Methods
Sample
• The National Survey on Drug Use and Health (NSDUH),
2005-2007 (SAMHSA, 2007)
N (%)*
Total
Low Risk
2985 (65.7)
Medium Risk:
Low Beh Prob
1367 (29.1)
DSM-IV Alcohol Use Disorder
No Diagnosis
Abuse
Dependence
2822 (94.9)
163 (5.1)
0 (0.0)
439 (32.2)
629 (44.8)
299 (23.0)
1 (2.7)
90 (67.4)
40 (30.0)
0 (0.0)
1 (0.5)
110 (99.5)
2.8 (4.2)
6.3 (6.6)
4.5 (6.0)
8.6 (7.9)
Nylund, K.L., Asparouhov, T., Muthén, B.O. (2006). Deciding on the number of classes in latent
class analysis and growth mixture modeling. A monte carlo simulation study. Structural
equation modeling. 2006, 535-569.
2068 (71.4)
917 (28.6)
750 (56.4)
617 (43.6)
67 (49.7)
64 (50.3)
38 (34.9)
73 (65.1)
Acock, A..C. (2005). Growth curves and extensions using Mplus. Available at:
http://oregonstate.edu/~acock/growth-curves/
Frequency of Past Mo. Alcohol Use, Mean (SD)
• Cross-sectional survey of the civilian, non-institutionalized
persons 12+ years old in the US
Past Year Illicit Substance Use
No
Yes
*Weighted percents.
• Stratified, cluster, probability sampling design
• Computer Assisted Interviewing (CAI) administered in
household
Probs
hm/wk/
schl
• Restricted sample to males, aged 15-17, who drank more
than 5 drinks in the past year.
Dangerous
Law
trouble
Probs
fam
friends
• Latent Class Analysis (LCA, Hagenaars and McCutcheon
2002) of 11 items of Alcohol Abuse and Dependence criteria
• Hierarchical LCA to account for the complex sampling design
Alcohol Abuse
&
Alcohol Dependence
• Model selection used multiple statistics (AIC and ABIC;
Nylund et al., 2006), along with theoretical and practical
considerations (Acock 2005).
• Class membership by outcome criterion measures:
• DSM-IV Alcohol Abuse or Dependence in the past year
• Illicit substance use (including marijuana) in the past year
Medium Risk:
High Beh Prob
131 (2.9)
High Risk
111 (2.4)
• Screen youths with different risk profiles for different
treatment/prevention programs
• Ex: Medium risk: high behavior problem group may need
different intervention than medium risk: low behavior
problem group
References
Hagenaars, J.A. & McCutcheon, A.L. (2002). Applied Latent Class Analysis. New York:
Cambridge University Press.
US DHHS. SAMHSA. Office of Applied Studies. National Survey on Drug Use and Health, 2007.
Statistical Analysis
• Frequency of alcohol use in the past month
• These subtypes may help with targeting youths to treatments
and prevention programs (Winters, 1999)
A lot
time
spent
Unable
keep
limits
Tolerance
Unable
cut down
or stop
Mental
physical
probs
Reduced
activities
Withdrawal
Table 1: Characteristics of male drinkers aged 15-17 in the
2005-2007NSDUH.
N
(%)*
Gender
Male
4720
(100)
Age
15
1118
(23.5)
16
1626
(34.5)
17
1976
(42.0)
Race/Ethnicity
White
3160
(66.9)
African-American
412
(10.3)
Hispanic
818
(18.2)
Other
330
(4.6)
*Weighted percents.
Jessor, R. & Jessor, S. L. (1977). Problem behavior and psychosocial development: A
longitudinal study of youth. New York, New York: Academic Press.
National Highway Traffic Safety Administration. Traffic Safety. December, 2008.
Kaiser Family Foundation. (2002). Survey Snapshot: Substance Use and Risky Sexual Behavior:
Attitudes and Practices Among Adolescents and Young Adults. Menlo Park, CA: The Henry J.
Kaiser Foundation.
Presley, C.A., Leichliter, J.S., Meilman, P.W. (1998). Alcohol and drugs on college campuses: A
report to college presidents. Third in series 1995, 1996, 1997. Carbondale, Illinois: The Core
Institute.
Chung, T. & Martin, C.S. (2001). Classification and course of alcohol problems among
adolescents in addictions treatment programs. Alcoholism: Clinical and Experimental
Research, 25(12), 1734-1742.
Winters, K. (1999). Treating adolescents with substance use disorders: An overview of practice
issues and treatment outcome. Substance abuse, 20(4), 203-225.