Risk and protective factors associated with alcohol, cigarette, and marijuana use during adolescence.

Adolescents and families who enroll in mental health services often present with a variety of needs above and beyond mental health needs that require treatment. Unfortunately, mental health professionals often focus exclusively on the identified mental health problem behaviors without considering other aspects of adolescents' lives that might be related to such behaviors. One such aspect that commonly goes unapprised in mental health assessment and treatment planning is substance use. Research indicates a strong positive relationship between mental illness and substance use among adolescents (Greenblatt, 2000; White et al., 1993, 1999). However, little is known about the risk and protective factors that might be linked differentially to specific types of substances such as alcohol, cigarettes, and marijuana. Therefore, the present study investigates whether various risk and protective factors are differentially related to the frequency of use of 3 specific substances (alcohol, cigarettes, and marijuana) within a clinical sample of adolescents with serious emotional disturbance.

Because substance use "undermines motivation, interferes with cognitive processes, contributes to debilitating mood disorders ... increases risk of accidental injury or death," and contributes to several major health problems such as lung cancer and AIDS (Hawkins et al., 1992, p. 64), the importance of identifying risk and protective factors of substance use cannot be overemphasized. In 1996, the Institute of Medicine issued a report that high-lighted the gaps in the current substance use literature and recommended areas for future research. One of the top recommendations of that report was to expand the research base regarding the etiology of drug use disorders, including risk and protective factors related to substance use both for specific populations (e.g., White adolescents vs. Black adolescents) and for specific developmental periods (e.g., adolescence). However, the relative influences of risk and protective factors for specific substances such as alcohol, cigarettes, or marijuana remain unclear. The lack of such knowledge poses a major threat to the possible effectiveness of mental health treatment and individualized service planning. Therefore, consistent with previous research focusing mostly on alcohol, cigarettes, and marijuana (e.g., Hawkins et al., 1992; Madu and Matla, 2003), those 3 substances were identified as the targets for the current study.

The consequences of substance use can influence multiple domains in the lives of adolescents. At the individual level, adolescent substance use can interfere with motivation and thinking processes, increase the risk of accidental death and violent crimes, and increase the risk of serious medical complications (Hawkins et al., 1992). For families, adolescent substance use can be destructive to family functioning via increased parental stress, loss of work productivity and income, and a weakening of parent-child bonds. For societies, adolescent substance use quickly depletes community resources and is extremely costly in terms of health care, mental health and drug treatment services, and juvenile crime rates. In fact, it is estimated that the total economic cost of alcohol and drug abuse (including treatment, prevention, health care, and crime) is more than $240 billion annually (Martin, 2001). With such widespread consequences, the urgent need to identify risk and protective factors related to the use of alcohol, cigarettes, and marijuana is clear. What remains unclear, however, is whether the risk and protective factors differ in terms of the magnitude of their association depending on the target substance, a question that the present study will attempt to answer.

Thus, the purpose of the present study is to extend research on the links between risk and protective factors for specific substances, namely alcohol, cigarettes, and marijuana. Based on previous research (e.g., Brook et al., 1999; Wagner et al., 2002), it was hypothesized that, (a) older adolescents would report higher frequency of alcohol, cigarette, and marijuana use compared to younger adolescents, (b) male adolescents would report higher frequency of alcohol, cigarette, and marijuana use compared to female adolescents, (c) a history of parental criminal involvement would be linked with higher levels of alcohol, cigarette, and marijuana use, (d) a history of parental substance use would be linked with higher levels of alcohol, cigarette, and marijuana use, (e) higher levels of protective factors (i.e., parent-child communication, behavioral control, general family functioning, family involvement, and school functioning) would be linked with lower levels of alcohol, cigarette, and marijuana use, and would be linked most strongly with cigarette and alcohol use due to their overall higher prevalence and frequency rate among adolescents.

METHOD

Participants

Participants were a subset of adolescents drawn from the NC FACES (North Carolina Families and Communities Equals Success) grant communities funded by the Center for Mental Health Services in 1997 as part of the Comprehensive Mental Services for Children and Their Families Program. The goal of that nation-wide program was to provide services that are child-centered and family-focused, strengths-based, community-based, and culturally competent. The program also included an evaluation component that assessed system development and individual outcomes for children and families. A full description of the national evaluation protocol and data-collection procedures is provided elsewhere (see Holden et al., 2001).

This cross-sectional study focuses on substance use among adolescents aged 11- to 17-years-old who participated in the outcome study. Over 500 children and their families were enrolled, 376 of whom were at least 11-years-old. Adolescents who had missing data in relation to either substance use (n = 80) or protective factors (n = 25) were eliminated. The resulting sample for the present study includes 271 adolescents and their primary caregivers. The present sample (N = 271) had about the same mean age (M = 14.50, SD = 1.62) as those who were excluded from the study (M = 14.00, SD = 1.68). Distributions of adolescent gender and ethnicity for the current sample also were similar to the total number of adolescents served. …