Social Influence on Adolescent Polysubstance Use: The Escalation to Opioid Use

Abstract

Background: Fewer than 9% of 12–17 year olds in need (∼146,000 of 1.7 million) receive inpatient or outpatient substance abuse recovery services or other mental health services (SAMHSA, 2012). The literature on adolescent addiction is sparse, however, as most published addiction recovery efforts involve adult populations—often college students. Objectives: The present study examined social influences on escalating substance use (from tobacco, alcohol, and marijuana use to polysubstance use involving opioids) for students enrolled in recovery high schools. Methods: A sample of 31 adolescents enrolled in substance use recovery high schools were surveyed on their patterns of substance use leading to their abuse of opioids. Results: Youth who begin their substance use as young as age 8 are often pressured by peer culture to do so and come from substance-using families. Their escalation in polysubstance use to a pattern including opioids was also most often attributed to peer influence over several years. Conclusions/Importance: This paper is one of scant few that address patterns of use in high school students. Perhaps most salient from this study are the tertiary prevention implications: similar to their adult counterparts, students enrolled in recovery high school programs are likely from substance-using families and have combined complex constellations of substances including opioids by dint of their relationships with substance-using peers.

Keywords :

• adolescent addiction
• opioid use
• substance use recovery
• social influences

THE AUTHORS

Beth Shoshana Russell, Ph.D., is an Assistant Professor of Human Development at the University of Connecticut where she studies the development of self-regulation. Her research program examines individual differences and contextual influences in self-regulation from birth through adolescence in normative and high-risk populations. As an affiliate of UCONN's Center for Health, Intervention, and Prevention and of the Center for Applied Research in Human Development, her work is translational in nature and emphasizes implications for prevention and intervention practice. Dr. Russell's work with adolescents focuses on the self-regulatory mechanisms believed to underlay several mental and behavioral health issues for this age group - specifically, self-control and impulsivity

Jeremiah J. Trudeau, PhD, is a cognitive psychologist specializing in research methods and statistics. He taught cognitive psychology at Mount Holyoke and Hampshire Colleges before embarking on a research program in pain measurement. This work included the study of opiate use and misuse, with an eye towards substance use prevention. Since then, Dr. Trudeau's research interests have spanned patient-reported outcomes in central nervous system disorders, including schizophrenia and Alzheimer's Disease. He has published in peer-review venues on measure validation, cognitive psychology, opiate abuse, neuropathic pain treatment, and psychophysics. He is currently an Associate Director of Health Economics and Outcomes Research at Boehringer Ingelheim Pharmaceuticals, Inc

Alicia J. Leland obtained her M.A. in Human Development and Family Studies from the University of Connecticut under the guidance of Beth S. Russell, Ph.D., where she studied the development of self-regulation from early childhood onward. Her research interests include the social influences on self-regulation across the lifespan and the relative valence of family structure, parent-child relationship quality, and resilience. Of particular interest to her is the dyadic management of conflict between parents and their children. Alicia is currently completing further clinical graduate studies

GLOSSARY

Analgesic: A drug or treatment that decreases the subjective intensity and/or unpleasantness of pain.

Cognitive debriefing: A semi-structured interview process to obtain qualitative feedback from subjects about their understanding of material, e.g., whether a subject reads a survey question to mean what the author intended.

Polysubstance use: The concurrent use of multiple substances.

Root cause analysis: An iterative problem-solving process which attempts to identify the fundamental or root cause of a problem or event. E.g., failure of a machine was caused by a faulty part, which was caused by manufacturing defect, which was caused by human error, which was caused by poor training practices. Poor training would be the root cause of the machine failure.

Sample homogeneity: When a sample has limited variability or range on a relevant trait, e.g. a sample of subjects are aged 18 to 22. Sample homogeneity may limit the generalizability of results.

Sentinel sampling: The use of a prototypical pool of subjects for assessment, typically when access to or sampling from a broader population may be impractical.

Usability testing: Use of an instrument in a small sample to determine if it will be practical and functional in real use. Usability testing is not intended for collection of valid data for analysis, but as part of instrument development.

Notes

⁴ Category examples were presented to participants including a mixture of street and brand names for each when available, e.g.: Club drugs (GHB, Rohypnol), Psychedelics (mushrooms, LSD/acid, mescalin, peyote), Dissociatives (ketamine/Special K, DXM/robotrip, PCP/angel dust).