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Onset, Comorbidity, and Predictors of Nicotine, Alcohol, and Marijuana Use Disorders Among North American Indigenous Adolescents

Journal of Abnormal Child Psychology volume 47, pages 1025–1038 (2019)Cite this article

Abstract

North American Indigenous (i.e., American Indian and Canadian First Nations) youth experience inequities in rates of substance abuse and dependence. Despite this, few longitudinal studies examine the developmental course of substance use disorders (SUD) among community-based samples of Indigenous youth. The purpose of the study was to examine onset and predictors of nicotine dependence, alcohol use disorders, marijuana use disorders, any SUD, and multiple SUDs across the entire span of adolescence among a longitudinal sample (N = 744) of reservation/reserve Indigenous youth in the upper-Midwest of the United States and Ontario, Canada. Using discrete time survival analysis, the results show that rates of meeting criteria for SUDs by late adolescence were 22% for nicotine, 43% for alcohol, and 35% for marijuana. Peak periods of risk for new nicotine dependence and marijuana use disorder cases occurred around 14 years of age, whereas peak periods of risk for new alcohol use disorder cases emerged slightly later around 16 years of age. We found high rates of SUD comorbidity, and the cumulative probability of developing two or more SUDs during adolescence was 31%. Internalizing disorders increased the odds of nicotine dependence and multiple SUDs, while externalizing disorders increased the odds of all outcomes except nicotine dependence. Gender, age, and per capita family income were inconsistently associated with SUD onset. The findings are embedded within broader substance use patterns identified among Indigenous youth, and prevention, intervention, and treatment implications are discussed.

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References

  • Allison, P. (2014). Event history and survival analysis. Thousand Oaks: Sage Publications.

    Book  Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: APA.

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C.: APA.

    Book  Google Scholar 

  • Armenta, B., Sittner, K., & Whitbeck, L. (2016). Predicting the onset of alcohol use and the development of alcohol use disorder among Indigenous adolescents. Child Development, 87, 870–882.

    Article  PubMed  PubMed Central  Google Scholar 

  • Asparouhov, T., & Muthen, B. (2010). Multiple imputation with Mplus. Los Angeles: Muthen & Muthen.

    Google Scholar 

  • Beauvais, F. (1998). American Indians and alcohol. Alcohol Health and Research World, 22, 253–259.

    PubMed  PubMed Central  Google Scholar 

  • Behrendt, S., Wittchen, H. U., Hofler, M., Lieb, R., & Beesdo, K. (2009). Transitions from first substance use to substance use disorder in adolescence: is early onset associated with a rapid escalation? Drug and Alcohol Dependence, 99, 68–78.

    Article  PubMed  Google Scholar 

  • Blum, R., Harmon, B., Harris, L., Bergeisen, L., & Resnick, M. (1992). American Indian-Alaska Native youth health. JAMA, 267, 1637–1644. https://doi.org/10.1001/jama.1992.03480120075036.

    Article  PubMed  Google Scholar 

  • Cheadle, J., & Sittner Hartshorn, K. (2012). Marijuana use development over the course of adolescence among North American Indigenous youth. Social Science Research, 41, 1227–1240.

  • Cheadle, J., & Whitbeck, L. (2011). Alcohol use trajectories and problem drinking over the course of adolescence: A study of North American Indigenous adolescents and their caretakers. Journal of Health and Social Behavior, 52, 228–245.

    Article  PubMed  PubMed Central  Google Scholar 

  • Copeland, W., Hill, S., Costello, E. J., & Shanahan, L. (2017). Cannabis use and disorder from childhood to adulthood in a longitudinal community sample with American Indians. Journal of the American Academy of Child & Adolescent Psychiatry, 56, 124–132.

    Article  Google Scholar 

  • Cunningham, J., Solomon, T., & Muramoto, M. (2016). Alcohol use among Native Americans compared to whites: examining the veracity of the ‘Native American’ elevated alcohol consumption belief. Drug and Alcohol Dependence, 160, 65–75.

    Article  PubMed  Google Scholar 

  • Duncan, S., Gau, J., Farmer, R., Seeley, J., Kosty, D., & Lewinsohn, P. (2015). Comorbidity and temporal relations of alcohol and cannabis use disorders from youth through adulthood. Drug and Alcohol Dependence, 149, 80–86.

    Article  PubMed  PubMed Central  Google Scholar 

  • Dutra, L., Stathopoulou, G., Basden, S., Leyro, T., Powers, M., & Otto, M. (2008). A meta-analytic review of psychosocial interventions for substance use disorders. The American Journal of Psychiatry, 165, 179–187.

    Article  PubMed  Google Scholar 

  • Evans-Campbell, T. (2008). Historical trauma in American Indian/Native Alaska communities: A multilevel framework for exploring impacts on individuals, families, and communities. Journal of Interpersonal Violence, 23, 316–338.

    Article  PubMed  Google Scholar 

  • Falk, D., Yi, H., & Hiller-Sturmhofel, S. (2006). An epidemiologic analysis of co-occurring alcohol and tobacco use disorders. Alcohol Research & Health, 29, 162–171.

    Google Scholar 

  • Falk, D., Yi, H. Y., & Hiller-Sturmhofel, S. (2008). An epidemiologic analysis of co-occurring alcohol and drug use disorders. Alcohol Research & Health, 31, 100–110.

    Google Scholar 

  • Gilder, D., & Ehlers, C. (2012). Depression symptoms associated with cannabis dependence in an adolescent American Indian community sample. The American Journal on Addictions, 21, 536–543.

    Article  PubMed  PubMed Central  Google Scholar 

  • Greenfield, B., Sittner, K., Forbes, M., Walls, M., & Whitbeck, L. (2017). Conduct disorder and alcohol use disorder trajectories, predictors, and outcomes for Indigenous youth. Journal of the American Academy of Child & Adolescent Psychiatry, 56, 113–139.

    Article  Google Scholar 

  • Harder, H., Rash, J., Holyk, T., Jovel, E., & Harder, K. (2012). Indigenous youth suicide: A systematic review of the literature. Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health, 10, 125–142.

    Google Scholar 

  • Herring, R. (1994). Substance use among Native American Indian youth: A selected review of causality. Journal of Counseling & Development, 72, 578–584.

    Article  Google Scholar 

  • Johnson, L., O’Malley, P., Miech, R., Bachman, J., & Shulenberg, J. (2017). Monitoring the future national survey results on drug use, 1975–2016: Overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan.

    Google Scholar 

  • Kandel, D., & Kandel, E. (2015). The gateway hypothesis of substance abuse: Developmental, biological and societal perspectives. Acta Paediatrica, 104, 130–137.

    Article  PubMed  Google Scholar 

  • Kessler, R., Berglund, P., Demler, O., Jin, R., Merikangas, K., & Walters, E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archive of General Psychiatry, 62, 593–602.

    Article  Google Scholar 

  • Kessler, R., Angermeyer, M., Anthony, J., Graaf, R., Demyttenaere, K., Gasquet, I., … Ustun, T.B. (2007). Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s world mental health initiative. World Psychiatry, 6, 168–176.

  • Link, B., & Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, Extra Issue, 80–94. https://doi.org/10.2307/2626958.

  • Masyn, K. (2014). Discrete-time survival analysis in prevention science. In Z. Sloboda & H. Petras (Eds.), Defining prevention science: Advances in prevention science (pp. 513–535). New York: Springer.

    Chapter  Google Scholar 

  • Merikangas, K., He, J. P., Burstein, M., Swanson, S., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., & Swendsen, J. (2010). Lifetime prevalence of mental disorders in US adolescents: Results from the National Comorbidity Study-Adolescent Supplement (NCS-A). Journal of the Academy of Child and Adolescent Psychiatry, 49, 980–989.

    Article  Google Scholar 

  • Miller, K., Beauvais, F., Burnside, M., & Jumper-Thurman, P. (2008). A comparison of American Indian and non-Indian fourth to sixth graders rates of drug use. Journal of Ethnicity in Substance Abuse, 7, 258–267.

    Article  PubMed  Google Scholar 

  • Mitchell, C., Beals, J., Novins, D., Spicer, P., & AI-SUPERPFP Team. (2003). Drug use among two American Indian populations: Prevalence of lifetime use and DSM-IV substance use disorders. Drug and Alcohol Dependence, 69, 29–41.

    Article  PubMed  Google Scholar 

  • Muthen, B., & Muthen, L. (1998–2017). Mplus user’s guide (8th ed.). Los Angeles: Muthen & Muthen.

    Google Scholar 

  • Neale, M., & Kendler, K. (1995). Models of comorbidity for multifactorial disorders. American Journal of Human Genetics, 57, 935–953.

    PubMed  PubMed Central  Google Scholar 

  • Novins, D., & Baron, A. (2004). American Indian substance use: the hazards for substance use initiation and progression for adolescents aged 14 to 20 years. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 316–324.

    PubMed  Google Scholar 

  • Novins, D., Beals, J., & Mitchell, C. (2001). Sequences of substance use among American Indian adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1168–1174.

    Article  PubMed  Google Scholar 

  • O’Neil, K., Conner, B., & Kendall, P. (2011). Internalizing disorders and substance use disorders in youth: comorbidity, risk, temporal order, and implications for intervention. Clinical Psychology Review, 31, 104–112.

    Article  PubMed  Google Scholar 

  • O’Nell, T. D. (1996). Disciplined hearts: History, identity, and depression in an American Indian community. Berkeley: University of California Press.

    Google Scholar 

  • Palmer, R. H. C., Young, S. E., Hopfer, C. J., Corley, R. P., Stallings, M. C., Crowley, T. J., & Hewitt, J. K. (2009). Developmental epidemiology of drug use and abuse in adolescence and young adulthood: evidence of generalized risk. Drug and Alcohol Dependence, 102, 78–87.

    Article  PubMed  PubMed Central  Google Scholar 

  • Perry, S. (2004). American Indians and crime: A BJS statistical profile, 1992–2002. Washington, D.C.: Bureau of Justice Statistics.

    Google Scholar 

  • Rhee, S. H., Hewitt, J. K., Young, S., Corley, R., Crowley, T., Neale, M., & Stallings, M. (2006). Comorbidity between alcohol dependence and illicit drug dependence in adolescents with antisocial behavior and matched controls. Drug and Alcohol Dependence, 84, 85–92.

    Article  PubMed  Google Scholar 

  • Salom, C., Betts, K., Williams, G., Najman, J., & Alati, R. (2015). Predictors of comorbid polysubstance use and mental health disorders in young adults—A latent class analysis. Addiction, 111, 156–164.

    Article  PubMed  Google Scholar 

  • Shaffer, D., Fisher, P., Lucas, C., Dulcan, M., & Schwab-Stone, M. (2000). NIMH diagnostic interview schedule for children version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 28–38.

    Article  PubMed  Google Scholar 

  • Shaw, D., & Shelleby, E. (2014). Early-starting conduct problems: intersection of conduct problems and poverty. Annual Review of Clinical Psychology, 10, 503–528.

    Article  PubMed  PubMed Central  Google Scholar 

  • Singer, J., & Willett, J. (2003). Applied longitudinal data analysis. New York: Oxford University Press.

  • Sittner, K. (2016). Trajectories of substance use: Onset and adverse outcomes among North American Indigenous adolescents. Journal of Research on Adolescence, 26, 830–844.

    Article  PubMed  Google Scholar 

  • Swendsen, J., Conway, K., Degenhardt, L., Glantz, M., Jin, R., Merikangas, K., Sampson, N., & Kessler, R. (2010). Mental disorders as risk factors for substance use, abuse and dependence: results from the 10-year follow-up of the National Comorbidity Survey. Addiction, 105, 1117–1128.

    Article  PubMed  PubMed Central  Google Scholar 

  • Vanyukov, M., Tarter, R., Kirsci, L., Kirillova, G., Maher, B., & Clark, D. (2003). Liability to substance use disorders: 1. Common mechanisms and manifestations. Neuroscience & Biobehavioral Reviews, 27, 507–515.

  • Walls, M. (2008). Marijuana and alcohol use during early adolescence: Gender differences among American Indian/First Nations youth. Journal of Drug Issues, 38, 1139–1160.

    Article  Google Scholar 

  • Walls, M., Sittner Hartshorn, K., & Whitbeck, L. (2013). North American Indigenous adolescent substance use. Addictive Behaviors, 38, 2103–2109.

    Article  PubMed  PubMed Central  Google Scholar 

  • West, B., & Naumann, R. (2011). Motor vehicle-related deaths—United States, 2003-2007. Morbidity and Mortality Weekly Report, 60, 52–55.

    Google Scholar 

  • Whitbeck, L., & Armenta, B. (2015). Patterns of substance use initiation among Indigenous adolescents. Addictive Behaviors, 45, 172–179.

    Article  PubMed  PubMed Central  Google Scholar 

  • Whitbeck, L., Yu, M., Johnson, K., Hoyt, D., & Walls, M. (2008). Diagnostic prevalence rates from early to mid-adolescence among Indigenous adolescents: first results from a longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 890–900.

    Article  PubMed  PubMed Central  Google Scholar 

  • Whitbeck, L., Yu, M., McChargue, D., & Crawford, D. (2009). Depressive symptoms, gender, and growth in cigarette smoking among Indigenous adolescents. Addictive Behaviors, 34, 421–426.

    Article  PubMed  Google Scholar 

  • Whitbeck, L., Sittner Hartshorn, K., McQuillan, J., & Crawford, D. (2012). Factors associated with growth in daily smoking among Indigneous adolescents. Journal of Research on Adolscence, 22, 768–781.

    Article  Google Scholar 

  • Whitbeck, L., Sittner Hartshorn, K., Crawford, D., Walls, M., Gentzler, K., & Hoyt, D. (2014a). Mental and substance use disorders from early adolescence to young adulthood among Indigenous young people: final diagnostic results form an 8-year panel study. Social Psychiatry and Psychiatric Epidemiology, 49, 961–973.

    Article  PubMed  PubMed Central  Google Scholar 

  • Whitbeck, L., Sittner Hartshorn, K., & Walls, M. (2014b). Indigenous adolescent development: Psychological, social and historical contexts. New York: Routledge.

    Book  Google Scholar 

  • White, I., Royston, P., & Wood, A. (2011). Multiple imputation using chained equations: issues and guidance for practice. Statistics in Medicine, 30, 377–399.

    Article  PubMed  Google Scholar 

  • Whitesell, N., Beals, J., Mitchell, C., Novins, D., Spicer, P., Manson, S., & Team, A. I.-S. U. P. E. R. P. F. P. (2006). Latent class analysis of substance use: Comparison of two American Indian reservation populations and a national sample. Journal of Studies on Alcohol, 67, 32–43.

    Article  PubMed  Google Scholar 

  • Whitesell, N., Asdigian, N., Kaufman, C., Big Crow, C., Shangreau, C., Keane, E., Mousseau, A., & Mitchell, C. (2014). Trajectories of substance use among young American Indian adolescents: patterns and predictors. Journal of Youth and Adolescence, 43, 437–453.

    Article  PubMed  Google Scholar 

  • Yu, M., & Whitbeck, L. (2016). A prospective, longitudinal study of cigarette smoking status among North American Indigenous adolescents. Addictive Behaviors, 58, 35–41.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to thank Les Whitbeck and Community Research Councils for their feedback on prior drafts of the manuscript. A previous version of this paper was presented at the 2016 American Sociological Association Annual Meeting in Seattle, WA and at the 2017 Native Children’s Research Exchange in Denver, CO.

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Authors and Affiliations

  1. Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth Campus, 231 SMed, 1035 University Drive, Duluth, MN, 55812, USA

    Dane Hautala & Melissa Walls

  2. Department of Sociology, Oklahoma State University, 471 Murray Hall, Stillwater, OK, 74078, USA

    Kelley Sittner

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  1. Dane Hautala
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Correspondence to Dane Hautala.

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Funding

This research was supported in part by the National Institute on Drug Abuse under grants R01DA13580 and T32DA037183, the National Institute of Mental Health under grant R01MH67281, and the National Institute on Alcohol Abuse and Alcoholism under grant R01AA020299. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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The authors declare that they have no conflicts of interest.

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All procedures were approved by the University of Nebraska-Lincoln’s Institutional Review Board and tribal council appointed advisory boards.

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Informed consent was obtained from all individual participants involved in the study.

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Hautala, D., Sittner, K. & Walls, M. Onset, Comorbidity, and Predictors of Nicotine, Alcohol, and Marijuana Use Disorders Among North American Indigenous Adolescents. J Abnorm Child Psychol 47, 1025–1038 (2019). https://doi.org/10.1007/s10802-018-0500-0

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Keywords

  • American Indian
  • First Nations
  • Psychiatric comorbidity
  • Substance abuse
  • Longitudinal