Biomedical subjects
Publications and source records attributed to E R Oetting.
Attempts at preventing drug and alcohol use by youth may fail more often than they succeed, but failures are rarely reported in the literature. There are three types of failure: (1) failure to initiate, (2) failure to be effective, and (3) failure to thrive. Brief descriptions of prevention failures of all three types are presented and the reasons for failure are discussed.
Current practice in drug user treatment tends to provide, within any one agency, essentially the same treatment for all clients entering that agency. Instead, an agency should use a team approach, with a specific and unique treatment plan for every client, provided by the members of the team. The psychologist should play a central role on this team, being responsible for the treatment plan, for an individual evaluation plan, for assessing progress, for program evaluation, and, in many instances, for supervision of treatment staff. The functions and the different roles played by the psychologist are described, and the characteristics and skills needed for success are listed.
Adolescent drug use increased until about 1981, but since then it has steadily declined. Current data show some drug use in the 4th and 5th grades and considerable increases from the 6th to the 9th grades. For drugs such as marijuana, cocaine, and stimulants, lifetime prevalence continues to increase through high school; for drugs such as inhalants and heroin, lifetime prevalence may decline for Grades 10, 11, and 12, suggesting that students who use these drugs early may drop out. Drug use of rural youth is similar to that of other youth. Barrio, ghetto, and Native-American reservation youth may have high rates of use, but use of Black and Hispanic seniors may be equivalent to or less than that of White seniors. National data and broadly defined ethnic data, however, may cover up important subgroup differences. For example, Western Mexican-American girls have lower use than Western Spanish-American girls, possibly because of the greater influence of "marianisma." Different locations may also have very different patterns of adolescent drug use, calling for different types of local intervention.
Administered anonymous surveys asking about drug use, emotional distress, and peer drug associations to 11th and 12th grade high school students (N = 563). Emotional distress variables accounted for only 4.8% of the variance in drug use. The addition of peer drug associations as a predictor variable increased the variance accounted for to 43.4%. A path model of adolescent drug use based on peer cluster theory was tested using LISREL, and this provided a good fit with the data. As predicted, peer drug associations dominated the prediction of drug use and mediated the effect of emotional distress on drug use, with the exception of a small residual path directly from anger to drug use. The hypothesis that young people take drugs to alleviate emotional distress does not hold up well; emotional distress variables, with the exception of anger, produced only very small and indirect links to drug use.
Continuing surveillance of drug use among American Indian adolescents living on reservations shows them to have rates of use higher than those of their non-Indian counterparts. Marijuana use is particularly high among Indian students. By the 7th grade a significant number of Indian youth have tried drugs, particularly marijuana and alcohol, and there are few significant differences by gender. Based on observed patterns of use, intervention strategies need to begin in the elementary school years and target both males and females equally.
Anonymous surveys of alcohol use and emotional distress of 11th and 12th grade students were administered to 327 reservation Indian adolescents and 524 Anglo adolescents. Path models based on peer cluster theory were developed and tested. Results argue against a self-medication theory of adolescent alcohol use. Emotional distress variables had little effect on alcohol involvement, with the exception of anger which operated in opposite directions for the two groups. The highest relationship with alcohol involvement in both groups was with peer alcohol associations, confirming the a priori hypothesis that much of adolescent alcohol use is linked to peer associations. Those relationships, however, were much stronger in Anglo youth, suggesting that alcohol may be used more frequently in nonpeer situations by Indian youth, or at least in situations where the peers are not those close friends who have very similar patterns of alcohol use. The most important difference between Indian and Anglo youth, however, may be the role that anger plays in alcohol involvement. In Anglo youth, anger may be associated with problem behaviors including alcohol use. In Indian youth, higher anger is linked to higher self-esteem, and tends to reduce alcohol use.
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This study examined rationales for alcohol, marijuana, and other drug use among Indian and non-Indian youth. Differences were found between reservation Indian and rural non-Indian rationales for alcohol, marijuana, and other drug use. A majority of both Indian and non-Indian eighth graders indicate that they use drugs to enhance positive affective states, for excitement, for parties, to be with friends, to relax, and to handle negative affective states including worries and nervousness. Indian youth appear to also use drugs to cope with boredom. Unlike non-Indian youth, Indian youth have no strong rationales for their use of other drugs. Interventions will have to be impactful and pervasive in order to counter the many positive and negative rationales associated with drug use.
There are three distinct types of inhalant users: young inhalant users, adolescent polydrug users, and inhalant-dependent adults. Young inhalant users have a modal age of 12 to 13. They use inhalants and may also use alcohol and marijuana. They are likely to have more emotional problems than nondrug users or young marijuana users. These problems, particularly when they involve feelings of anger and alienation, increase the chances that they will identify with other youth who have similar feelings. When this happens, young people form peer clusters; they find a best friend or form a small gang that has a high potential for getting involved with drugs. Most of these peer clusters use inhalants only a few times a month, although some may become obsessed with inhalant use to the exclusion of nearly all other activities. The data showing that young inhalant users have more emotional problems than either nondrug users or young marijuana users suggest that treatment should involve therapy as well as drug avoidance approaches. Every youth caught using inhalants, however, should not automatically be sent for therapy. Sometimes a youth caught using a drug is not really drug involved and overreaction can be damaging. In addition, the emotional problems of all young inhalant users are not identical. A higher average level of emotional problems only means that some of the young inhalant users have those problems, not all of them. Older adolescents, including those who used inhalants earlier, are not likely to use inhalants. Since young inhalant users seem to be troubled youth, have shown an early penchant for drug use, and have drug-using associates, it seem unlikely that they quit using drugs. They probably move on to other drugs, leaving inhalants behind. The older adolescents who do use inhalants are adolescent polydrug users, with a modal age of around 15 to 16. They take many different drugs, and some of them use inhalants as well. The adolescents who use inhalants are probably using a wider range of drugs than other adolescents and are probably getting high more often. Furthermore, they are likely to be more deviant and may be involved in more aggression and more crime. Inhalant-dependent adults usually have a long history of alcohol and other drug involvement. At some point, inhalants have become their preferred drug. By that time, they are usually in their midtwenties to early thirties. They have serious problems.(ABSTRACT TRUNCATED AT 400 WORDS)
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There is some basis for the perception that Indian youth are more susceptible to inhalant use than their non-Indian peers. Many Indian youth live in disadvantaged and often stressful environments that set the stage for turning to drugs for relief or to seek excitement. Inhalants are cheap and available even to very young children. While levels of inhalant use are comparatively high, the tendency to overrate this use and to label all Indian youth as inhalant abusers must be avoided. By the time Indian youth reach their senior year, only around 4 percent are using inhalants seriously enough to warrant concern. On the other hand, those 4 percent cannot be ignored and, for them, prevention efforts at earlier ages could avert a great deal of needless suffering. Furthermore, there are a significant number of school dropouts who are likely to be chronically inhalant involved. The age pattern of inhalant use indicates that such use by Indian youth begins when they are very young--the predisposing factors are well in place by the 4th and 5th grades. Prevention efforts may need to start very early if they are to succeed.
The study of the nature and extent of the use of volatile, psychoactive substances has been hampered by a confusing terminology. Widely disparate substances such as glue, gasoline, anesthetic gases, and nitrites have all been discussed under the single rubric of "inhalant abuse." A classification scheme is proposed which differentiates users of substances such as volatile hydrocarbons (gasoline, glue, etc.) from users of the anesthetic gases and of the amyl and butyl nitrites. Since users of these three types of volatile chemicals differ on predisposing factors, level of dysfunction, and consequences of use, the former group should be classed generically as "inhalant" users, while the latter should be diagnosed as users of a specific drug.
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Anonymous surveys on drug use were administered to 7th-12th grade students in Indian reservation schools. A large number of tribes were surveyed from 1975 through 1983. There is reason to believe the results are reasonably representative of Indian youth living on reservations. Lifetime prevalence for most drugs is higher than that for non-Indian youth throughout this period, and rates for alcohol, marijuana, and inhalants, the most frequently tried drugs, were particularly high. Since 1981 there has been a slight drop in lifetime prevalence for most drugs. Current use figures show the same trends, with increasing current use through 1981 and a drop since that time. Analysis of patterns of drug use, classifying youth according to number, type, and depth of involvement with drugs, shows a similar trend, with radical increases until 1981 and then a drop in all but one of the more serious drug use types. Despite this drop, 53% of Indian youth would still be classified as "at risk" in their drug involvement, compared with 35% of non-Indian youth. Reasons probably relate to severely detrimental conditions on reservations; unemployment, prejudice, poverty, and lack of optimism about the future.
A method is presented to chart how a group acquires exposure to a drug. The resulting drug acquisition curve has a number of different parameters that describe the group's drug involvement. Key parameters include: (1) the age of exposure when the group begins to use the drug in greater numbers, probably because of exposure to drug-using peers; (2) the acquisition rate, the percent of the group who are newly exposed each year, a rate that is surprisingly constant over as much as 5 years; and (3) the asymptote, establishing the total percent of the group who will eventually try the drug. Acquisition curves for sequential age cohorts show changing trends in these parameters and can also be used to predict future drug epidemiology. A 4-year prediction based on this method proved to be very accurate for two of three drugs. For the third drug, a large increase in use was predicted, but the increase was even greater than expected.
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