Background

1. 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. Probs hm/wk/ schl Danger- ous Law trouble Probs fam friends Alcohol Abuse & Alcohol Dependence A lot time spent Unable keep limits Tolerance Unable cut down or stop Mental physical probs Reduced activities With- drawal Background Conclusion Results • 4 classes of alcohol symptoms were found: • Low risk group (few symptoms endorsed) • Medium risk group: low behavioral problems • Medium risk group: high behavioral problems • High risk group (many symptoms endorsed) • More severe classes were associated with: • More past year DSM-IV Alcohol Abuse and Dependence • More past month alcohol use • Higher prevalence of past year Illicit substance use • 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) • 9.1% of 15-17 year olds in the US in 2007 met criteria for DSM-IV Alcohol Abuse or Dependence (SAMSHA, 2007) • DSM-IV Alcohol Dependence: 3 out of 7 Dependence criteria • DSM-IV Alcohol Abuse: 1 out of 4 Abuse criteria • 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) • 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) • The aims of this study were to: • Examine the pattern of alcohol symptom endorsement • Empirically classify youths according to their alcohol symptom endorsement • 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) Public Health Implications • Implications for revisions to the DSM-V • Hierarchical distinction between Abuse and Dependence symptoms not supported • 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 • These subtypes may help with targeting youths to treatments and prevention programs (Winters, 1999) • 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 Methods • Sample • The National Survey on Drug Use and Health (NSDUH), 2005-2007 (SAMHSA, 2007) • Cross-sectional survey of the civilian, non-institutionalized persons 12+ years old in the US • Stratified, cluster, probability sampling design • Computer Assisted Interviewing (CAI) administered in household • Statistical Analysis • Restricted sample to males, aged 15-17, who drank more than 5 drinks in the past year. • 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 • 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 • Frequency of alcohol use in the past month • Illicit substance use (including marijuana) in the past year References 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. Acock, A..C. (2005). Growth curves and extensions using Mplus. Available at: http://oregonstate.edu/~acock/growth-curves/ 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. 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.