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Substance Use Risk Profile Scale: Psychometric Evaluation in First Nation Adolescents Sherry H. Stewart, Ph.D. Dalhousi - PowerPoint PPT Presentation


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S ubstance U se R isk P rofile S cale: Psychometric Evaluation in First Nation Adolescents Sherry H. Stewart, Ph.D. Dalhousie University CIHR Investigator. Collaborators. Patricia J. Conrod, Ph.D. Institute of Psychiatry, London, UK

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SubstanceUseRiskProfileScale:Psychometric Evaluation in First Nation AdolescentsSherry H. Stewart, Ph.D.Dalhousie UniversityCIHR Investigator


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Collaborators

  • Patricia J. Conrod, Ph.D.Institute of Psychiatry, London, UK

  • M. Nancy Comeau, Ph.D. Department of Psychology, Dalhousie University

  • Kaitlin English Department of Psychology, Dalhousie University


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Funding

  • Canadian Institutes of Health Research (CIHR) NET

  • Royal Canadian Mounted Police Foundation


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Substance-Related Disorders: Some Important Facts

  • Prevalent and costly

  • Moderately responsive to treatment

  • Heterogeneous in nature

  • Highly co-morbid with other mental disorders


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Conrod et al.’s (2000) Motivational Model of Substance Abuse Risk

Differences in functioning of four theorized brain motivational systems:

  • specific “vulnerability profiles”

  • susceptibility to patterns of personality and co-morbid psychopathology

  • differential sensitivity to certain types of drug reinforcement

  • Subtypes of substance abusers can be differentiated based on their degree of susceptibility to seek out specific drug reinforcement effects


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    Reinforcing effects of Drugs of Abuse Abuse Risk

    Negative Reinforcement

    anxiety reducing (anxiolytic)

    pain reducing (analgesic)

    Positive Reinforcement

    psycho-stimulant


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    Personality Risk Factors for Drug Abuse Abuse Risk

    • Anxiety Sensitivity

    • Hopelessness

    • Sensation Seeking

    • Impulsivity


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    Anxiety Sensitivity Abuse Risk(Reiss, Peterson, Gursky, & McNally, 1986)

    • increased risk for anxiety disorders, including panic(Maller & Reiss, 1992; Schmidt, Lerew, & Jackson, 1997)

    • greater benzodiazepine use/abuse(Bruce, Speigel, Gregg, & Nuzzarello, 1992)

    • increased rates of alcohol consumption(Stewart, Peterson, & Pihl, 1995; Stewart, Zvolensky, & Eifert, 2001)

    • drinking to cope with negative emotions(Conrod, Pihl, & Vassileva, 1998; Stewart, Karp, Pihl, & Peterson, 1997)

    • sensitivity to the anxiolytic effects of alcohol(Conrod, Pihl, & Vassileva, 1998; MacDonald, Baker, Stewart, & Skinner, 2000; MacDonald, Stewart, Hutson, Loughlin, & Rhyno, 2001; Stewart & Pihl, 1994)

    • AS individuals particularly appreciate anxiolytic effects of alcohol & benzodiazepines(Stewart & Kushner, 2001)


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    Hopelessness Abuse Risk

    • Depression predictive of the eventual development of alcohol problems, particularly for women(Hartka et al., 1991; Helzer & Pryzbeck, 1988).

    • Hopelessness associated with depression and with depression-specific coping motives for alcohol use (Blackwell et al., RSA presentation)

    • Alcohol and narcotics alleviate pain and hurt and suppress the inhibitory effects of punishment on previously-rewarded behavior(Gray, 1987).

    • Hopeless individuals may particularly appreciate the analgesic properties of alcohol and the opiates


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    Sensation Seeking Abuse Risk

    • Psychomotor stimulant theory of addiction: drugs’ addictive properties due to ability to increase dopamine in incentive reward system(Fibiger & Phillips, 1988; Wise & Bozarth, 1987)

    • Sensation seeking linked to dopamine-related biochemical mechanisms related to functioning of incentive reward system(Depue & Collins, 1999)

    • Sensation seekers show elevated drinking levels and drink to experience euphoric/intoxicating effects(Comeau, Stewart, & Loba, 2001; Conrod, Peterson, & Pihl, 1997; Ohannessian & Hesselbrock, 1994; Stewart & Devine, 2000)

    • Sensitivity to incentive motivation and psycho-stimulant properties of alcohol may be associated with propensity toward uncomplicated alcohol abuse


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    Impulsivity Abuse Risk

    • Linked to elevated risk for early onset alcohol and drug problems(Pulkkinen & Pitkänen, 1994)

    • Represents a separate mediator of familial risk for alcoholism(Sher, 1993; Hill, 1994)

    • Deficits in executive cognitive functions(Harden & Pihl, 1995)

    • Lack of ability to delay behavioral response when faced with immediate reinforcement (Spoont, 1992)

    • Risk factor for abuse of immediately reinforcing drugs due to self-regulation deficit (Pihl & Peterson, 1995)


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    Personality Theory of Abuse RiskRisk for Substance Abuse


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    Utility of model Abuse Risk

    • Useful in predicting drug of choice and co-morbid psychopathology in substance abusers (Conrod et al., 2000a)

    • Useful in treatment matching with substance abusers (Conrod et al., 2000b)

    • Useful in school-based early interventions for alcohol abuse in adolescents (Stewart et al., in press)


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    Measurement Issues Abuse Risk

    • Original measurement tool cumbersome; not realistic for use in practice

    • Woicik et al. developed brief version of original battery designed to more efficiently tap four personality constructs

    • Original measure called Drug Abuse Subtyping Scale (DASS)

    • Revised shortened 23-item version called the Substance Use Risk Profile Scale (SURPS)

    • Validated in substance abusers and adolescents/young adults from majority culture


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    S Abuse Riskubstance Use Risk Profile Scale

    1. I am content.*

    2. I often don't think things through before I speak.

    3. I would like to skydive.

    4. I am happy.*

    5. I often involve myself in situations that I later regret being involved in.

    6. I enjoy new and exciting experiences even if they are unconventional.

    7. I have faith that my future holds great promise.*

    8. It's frightening to feel dizzy or faint.

    9. I like doing things that frighten me a little.

    10. It frightens me when I feel my heart beat change.

    11. I usually act without stopping to think.

    12. I would like to learn how to drive a motorcycle.

    13. I feel proud of my accomplishments.*

    14. I get scared when I'm too nervous.

    15. Generally, I am an impulsive person.

    16. I am interested in experience for its own sake even if it is illegal.

    17. I feel that I'm a failure.

    18. I get scared when I experience unusual body sensations.

    19. I would enjoy hiking long distances in wild and uninhabited territory.

    20. I feel pleasant.*

    21. It scares me when I'm unable to focus on a task.

    22. I feel I have to be manipulative to get what I want.

    23. I am very enthusiastic about my future.*

    Asterisk (*) indicates reverse keyed item.


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    SURPS Abuse RiskAnxiety Sensitivity Scale

    1. I am content.*

    2. I often don't think things through before I speak.

    3. I would like to skydive.

    4. I am happy.*

    5. I often involve myself in situations that I later regret being involved in.

    6. I enjoy new and exciting experiences even if they are unconventional.

    7. I have faith that my future holds great promise.*

    8. It's frightening to feel dizzy or faint.

    9. I like doing things that frighten me a little.

    10. It frightens me when I feel my heart beat change.

    11. I usually act without stopping to think.

    12. I would like to learn how to drive a motorcycle.

    13. I feel proud of my accomplishments.*

    14. I get scared when I'm too nervous.

    15. Generally, I am an impulsive person.

    16. I am interested in experience for its own sake even if it is illegal.

    17. I feel that I'm a failure.

    18. I get scared when I experience unusual body sensations.

    19. I would enjoy hiking long distances in wild and uninhabited territory.

    20. I feel pleasant.*

    21. It scares me when I'm unable to focus on a task.

    22. I feel I have to be manipulative to get what I want.

    23. I am very enthusiastic about my future.*

    Asterisk (*) indicates reverse keyed item.


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    SURPS Abuse RiskHopelessness Scale

    1. I am content.*

    2. I often don't think things through before I speak.

    3. I would like to skydive.

    4. I am happy.*

    5. I often involve myself in situations that I later regret being involved in.

    6. I enjoy new and exciting experiences even if they are unconventional.

    7. I have faith that my future holds great promise.*

    8. It's frightening to feel dizzy or faint.

    9. I like doing things that frighten me a little.

    10. It frightens me when I feel my heart beat change.

    11. I usually act without stopping to think.

    12. I would like to learn how to drive a motorcycle.

    13. I feel proud of my accomplishments.*

    14. I get scared when I'm too nervous.

    15. Generally, I am an impulsive person.

    16. I am interested in experience for its own sake even if it is illegal.

    17. I feel that I'm a failure.

    18. I get scared when I experience unusual body sensations.

    19. I would enjoy hiking long distances in wild and uninhabited territory.

    20. I feel pleasant.*

    21. It scares me when I'm unable to focus on a task.

    22. I feel I have to be manipulative to get what I want.

    23. I am very enthusiastic about my future.*

    Asterisk (*) indicates reverse keyed item.


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    SURPS Abuse RiskSensationSeeking Scale

    1. I am content.*

    2. I often don't think things through before I speak.

    3. I would like to skydive.

    4. I am happy.*

    5. I often involve myself in situations that I later regret being involved in.

    6. I enjoy new and exciting experiences even if they are unconventional.

    7. I have faith that my future holds great promise.*

    8. It's frightening to feel dizzy or faint.

    9. I like doing things that frighten me a little.

    10. It frightens me when I feel my heart beat change.

    11. I usually act without stopping to think.

    12. I would like to learn how to drive a motorcycle.

    13. I feel proud of my accomplishments.*

    14. I get scared when I'm too nervous.

    15. Generally, I am an impulsive person.

    16. I am interested in experience for its own sake even if it is illegal.

    17. I feel that I'm a failure.

    18. I get scared when I experience unusual body sensations.

    19. I would enjoy hiking long distances in wild and uninhabited territory.

    20. I feel pleasant.*

    21. It scares me when I'm unable to focus on a task.

    22. I feel I have to be manipulative to get what I want.

    23. I am very enthusiastic about my future.*

    Asterisk (*) indicates reverse keyed item.


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    SURPS Abuse RiskImpulsivity Scale

    1. I am content.*

    2. I often don't think things through before I speak.

    3. I would like to skydive.

    4. I am happy.*

    5. I often involve myself in situations that I later regret being involved in.

    6. I enjoy new and exciting experiences even if they are unconventional.

    7. I have faith that my future holds great promise.*

    8. It's frightening to feel dizzy or faint.

    9. I like doing things that frighten me a little.

    10. It frightens me when I feel my heart beat change.

    11. I usually act without stopping to think.

    12. I would like to learn how to drive a motorcycle.

    13. I feel proud of my accomplishments.*

    14. I get scared when I'm too nervous.

    15. Generally, I am an impulsive person.

    16. I am interested in experience for its own sake even if it is illegal.

    17. I feel that I'm a failure.

    18. I get scared when I experience unusual body sensations.

    19. I would enjoy hiking long distances in wild and uninhabited territory.

    20. I feel pleasant.*

    21. It scares me when I'm unable to focus on a task.

    22. I feel I have to be manipulative to get what I want.

    23. I am very enthusiastic about my future.*

    Asterisk (*) indicates reverse keyed item.


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    Substance Abuse in First Nation Communities Abuse Risk

    • Alcohol abuse and other substance abuse an enormous problem for First Nation communities and peoples

    • Substance abuse the most common problem contributing to mental health service use in study of Cree males in James Bay Quebec (Lavallee et al., 1991)

    • High rates of alcohol abuse contribute to the extremely high rates of suicide in many First Nations communities (Malchy et al., 1997; Wilkie et al., 1998)



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    First Step in Project Abuse Risk

    • Examine psychometric properties of SURPS in First Nation youth

    • Specifically, examine the following properties:

      • Factorial validity

      • Reliability

      • Construct Validity

      • Criterion-Related Validity

        • Risky drinking motives, alcohol problems, reckless behavior


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    Sample Characteristics Abuse Risk

    • N = 164 First Nation adolescents

    • 2 Mi’kmaq communities in N.S.

    • 3 schools

    • Age Range = 14-18 yrs (mean = 16.3)

    • 85 girls; 79 boys

    • Grade Range = Gr. 8-12 (mean = 10.1)


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    Measures Abuse Risk

    • SURPS (Woicik et al., in preparation)

    • Demographics (age, gender, grade)

    • CASI, STAIT-C, AISS-I, BSI-DEP

    • DMQ-R: Coping, Conformity, Enhancement, and Social Motives

    • RAPI (alcohol problems)

    • RBQ (reckless behavior)


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    Factorial Validity Abuse Risk

    • Performed principal components analysis

    • Varimax rotation

    • # factors determined by examination of scree plot

    • Four-factor solution explained 44% variance in SURPS item scores


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    SURPS – Problem Items Abuse Risk

    3. I would like to skydive. (SS-hyperplane)

    5. I often involve myself in situations that I later regret being involved in. (IMP-hyperplane)

    16. I am interested in experience for its own sake even if it is illegal. (SS but loads as IMP)

    17. I feel that I'm a failure. (HOP-hyperplane)

    19. I would enjoy hiking long distances in wild and uninhabited territory.(SS-hyperplane)


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    Reliability Abuse Risk

    • Anxiety Sensitivity Scale

      • 5 items

      • α = .65

    • Hopelessness Scale

      • 7 items

      • α = .76

    • Sensation Seeking Scale

      • 6 items

      • α = .62

    • Impulsivity Scale

      • 5 items

      • α = .61

    • Acceptable internal consistency for short scales


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    Construct Validity Abuse Risk

    • SURPS AS

      • With CASI (N = 164): r = .57, p < .001

      • With STAIC-T (N = 164): r = .28, p < .001

    • SURPS HOP

      • With BSI-DEP (N = 162): r = .30, p < .001

    • SURPS SS

      • With AISS-I (N = 164): r = .36, p < .001


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    Criterion-Related Validity Abuse Risk

    • Set of analyses examining incremental validity of block of SURPS personality variables in predicting risky drinking motives, alcohol problems, and other reckless behavior, over-and-above demographic variables

    • Block of demographic variables = age, gender, grade


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    Criterion-Related Validity: Risky Drinking Motives Abuse Risk

    • Criterion variable = DMQ-R Conformity

    • Block of SURPS variables significantly increased prediction of conformity motives above demographics

      • ΔF (4, 88) = 2.68, p < .05 (10.3% additional variance explained by SURPS variables)

    • Final Model significant

      • F (7, 88) = 2.33, p < .05 (demographics and personality variables together predict 15.7% variance in conformity motives scores)


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    Criterion-Related Validity: Risky Drinking Motives Abuse Risk

    • Criterion variable = DMQ-R Coping

    • Block of SURPS variables significantly increased prediction of coping motives above demographics

      • ΔF (4, 88) = 3.13, p < .05 (11.8% additional variance explained by SURPS variables)

    • Final Model significant

      • F (7, 88) = 2.62, p < .05 (demographics and personality variables together predict 17.3% variance in conformity motives scores)


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    Criterion-Related Validity: Risky Drinking Motives Abuse Risk

    • Criterion variable = DMQ-R Enhancement

    • Block of SURPS variables significantly increased prediction of enhancement motives above demographics

      • ΔF (4, 88) = 3.13, p < .05 (12.3% additional variance explained by SURPS variables)

    • Final Model not significant

      • F (7, 88) = 2.02, p > .05

    • Therefore considered SURPS only model


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    Criterion-Related Validity: Risky Drinking Motives Abuse Risk

    • Criterion variable = DMQ-R Social

    • Block of SURPS variables did not significantly increase prediction of social motives above demographics

      • ΔF (4, 88) = 1.68, p > .05


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    Criterion-Related Validity: Alcohol Problems Abuse Risk

    • Criterion variable = RAPI Total

    • Block of SURPS variables significantly increased prediction of alcohol problems above demographics

      • ΔF (4, 94) = 8.76, p < .001 (26.6% additional variance explained by SURPS variables)

    • Final Model significant

      • F (7, 94) = 5.41, p < .001 (demographics and personality variables together predict 28.7% variance in RAPI scores)


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    Concurrent Validity: Other Reckless Behavior Abuse Risk

    • Criterion variable = RBQ Total

    • Block of SURPS variables significantly increased prediction of reckless behavior above demographics

      • ΔF (4, 156) = 10.89, p < .001 (21.0% additional variance explained by SURPS variables)

    • Final Model significant

      • F (7, 156) = 7.42, p < .001 (demographics and personality variables together predict 25.0% variance in RBQ scores)


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    Summary of Findings Abuse Risk

    Factorial validity

    • Findings encouraging

    • Four factors emerged clearly relating to the hypothesized personality factors

    • Some items may need revision to improve psychometric properties in this cultural and age group


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    Summary of Findings Abuse Risk

    Anxiety Sensitivity

    • Good construct validity (CASI, STAIC-T)

    • Acceptable internal consistency

    • Predicted conformity-motivated drinking but not coping-motivated drinking (cf. Comeau et al., 2001)

    • Unexpectedly, predicted cocaine use

    • Did not predict alcohol problems on RAPI


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    Summary of Findings Abuse Risk

    Hopelessness

    • Adequate construct validity (BSI-DEP)

    • Good internal consistency

    • Predicted conformity- and coping-motivated drinking

    • Predicted alcohol problems on RAPI

    • Predicted reckless behavior, particularly use of cocaine and other illegal drugs


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    Summary of Findings Abuse Risk

    Sensation Seeking

    • Adequate construct validity (AISS-I)

    • Acceptable internal consistency

    • Predicted enhancement-motivated drinking, but only marginally

    • Predicted alcohol problems on RAPI

    • Predicted reckless behavior, particularly sexual risk taking, property damage, shoplifting, speeding, and marijuana use

    • Not associated with use of cocaine or other illegal drugs


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    Summary of Findings Abuse Risk

    Impulsivity

    • Construct validity remains unknown

    • Acceptable internal consistency

    • Predicted coping-motivated drinking, but only marginally

    • Predicted alcohol problems on RAPI

    • Predicted reckless behavior, particularly sexual risk taking, property damage, shoplifting, marijuana use, cocaine use, and use of other illegal drugs

    • Not associated with speeding


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    Conclusions Abuse Risk

    • SURPS appears a promising measure for tapping personality variables related to substance abuse risk and other problem behaviors in First Nations youth

    • Should prove useful instrument for selecting high-risk youth to participate in personality-matched early interventions for substance abuse modified for use in First Nations culture


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