Epidemiology and Adolescent Drug Use

1
Epidemiology andAdolescent Drug Use
Martin Frisher Department of Medicines
Management Keele University http//www.keele.ac.
uk/schools/pharm/drug-misuse/DrugMisuseDownloads.h
tm September 2007
2
LEARNING OBJECTIVES

• Understand basic epidemiological concepts (Slides
  1 - 25)
• Examine relationship between adolescence and
  substance abuse (Slides 26 - 39)
• Consider theories of normalisation (Slides 40 -
  48)
• Compare quantitative and qualitative research
  (49-70)

3
Part 1 EPIDEMIOLOGY

• Epidemiology is concerned with documenting the
  magnitude of a disease or injury problem, and
  describing it in terms of the personal
  characteristics and behavior of those at risk,
  and the place and timing of occurrence. It is
  also a source of research hypotheses.
• Epidemiology is the study of factors affecting
  the health and illness of populations, and serves
  as the foundation and logic of interventions made
  in the interest of public health and preventive
  medicine.

4
PERSON

• Demographic characteristics e.g. age, sex, race,
  marital status, number of children
• Socioeconomic characteristics, e.g. social class,
  employment status, occupation
• Life style/behavior e.g. drinking alcohol/smoking
  marijuana and driving

5
PLACE

• Are the disease cases
• Geographically confined or pervasive?
• Clustered around known potential pathogens,
  toxins, or other hazards?

6
HIERARCHY OF EVIDENCE

• Systematic reviews meta-analyses
• Randomized controlled trials
• Cohort studies
• Case-control studies
• Cross-sectional surveys
• Case Reports

7
TYPES OF EVIDENCE

• Surveys
• Qualitative Studies
• Experimental Studies
• Animal Models
• Neuroimaging, Neurotransmitters

8
Epidemiology (1) Prevalence

• Number of existing cases of disease
• Proportion of individuals in a population with
  disease or condition at a specific point of time
• Diabetes prevalence, smoking prevalence
• Provides estimate of the probability or risk that
  one will be affected at a point in time
• Provides an idea of how severe a problem may be
  measures overall extent
• Useful for planning health services (facilities,
  staff)

9
Calculation of proportion
Males undergoing bypass surgery at Hospital
A Total patients undergoing bypass surgery at
Hospital A

352 males undergoing bypass surgery 539 total
patients undergoing bypass surgery
65.3

10
Epidemiology (2) Incidence

• Measure of new cases of disease (or other events
  of interest) that develop in a population during
  a specified period of time
• E.g. Annual incidence, five-year incidence
• Measure of the probability that unaffected
  persons will develop the disease
• Used when examining an outbreak of a health
  problem

11
Formula for cumulative incidence
Number of new cases of disease during a
given time period CI
Total population at risk
70 new cases of breast cancer in a
5 year period CI 3,000
women at risk 0.023 23 cases per 1,000
women during 5 years
12
Incidence Density
13
Formula for incidence density
Number of new cases of disease during a
given time period ID
Total person-time at risk
70 new cases of breast
cancer ID 13,000
women-years of observation 0.0054 5.4
cases / 1,000 women years
14
Cumulative incidence vs Incidence density
Cumulative incidence 2 cases/5 individuals
over a 5-year period 0.4 over a 5 year period
0.08 over a 1 year period 8 per 100 over
a 1 year period Incidence density 2
cases/16.5 person years 12.1/100 person
years of observation
15
Relationship Between Incidence and Prevalence

• Prevalence varies directly with both incidence
  and duration.
• If incidence is low, but duration is long
  (chronic), prevalence will be large in relation
  to incidence.
• If prevalence is low because of short duration
  (due to recovery, migration or death), prevalence
  will be small in relation to incidence.

16
Epidemiologic Analyses

• Causal agents related to disease
• Nutritional agents diet (fats, carbohydrates,
  food nutrients)
• Biological agents bacteria, viruses, insects
• Chemical agents gases, toxic agents
• Physical agents climate, vegetation, chemical
  pollutants (air, water, food)
• Social agents occupation, stress, social class,
  lifestyle, location of residence

17

• WHAT IS THE PURPOSE OF ADDICTION EPIDEMIOLOGY?
• Determine the etiology of a disease by combining
  epidemiological data with information from other
  disciplines such as genetics, biochemistry.
• Basis for developing and evaluating preventive
  procedures, public health services and effective
  treatment.

18
Drug use, smoking and drinking among young people
in England in 2005

• The prevalence of drug use among pupils aged 11
  to 15 has remained steady since 2001, when the
  present method of measuring drug use was
  introduced.
• In 2005, 11 of pupils had taken drugs in the
  last month, 19 in the last year, and 28
  reported having ever taken drugs.
• http//www.ic.nhs.uk/pubs/youngpeopledruguse-smoki
  ng-drinking2005

19
Sample Design And Response Rates

• Survey was conducted in schools by asking
  pre-selected groups of pupils to complete a
  confidential questionnaire. Both the schools and
  pupils were selected randomly so that every
  eligible child had an equal chance of inclusion
  in the study.
• The response from selected pupils in
  participating schools was 89, yielding a total
  of 9,202 completed usable questionnaires. The
  product of the school and pupil rates gave an
  overall response of 60.

20
Reasons For Taking And Refusing Drugs

• Pupils were most likely to have taken drugs for
  the first time to see what it was like (57).
  Other common reasons for trying drugs the first
  time included to get high or feel good (22)
  and because my friends were doing it (18).
• Among pupils who had taken drugs more than once,
  the reasons for taking them on the most recent
  occasion were different. Pupils were most likely
  to have taken drugs the most recent time to get
  high or feel good (44),

21
Stopping Drug Use

• Pupils who had taken drugs in the last year were
  likely to want to stop taking drugs, either
• now (43) or in the future (16). Pupils who had
  taken drugs in the last year were more
• likely to say they were not sure whether they
  wanted to stop (28) than to say they didnt
• want to stop taking drugs (13).

22
Availability Of Drugs

• About half of all pupils (47) did not know how
  easy or difficult it would be to obtain illegal
  drugs.
• Thirty three percent of pupils thought it would
  be easy.

23
Awareness And Information About Drugs

• Over 90 of pupils had heard of cocaine, heroin,
  and cannabis, and almost as many had heard of
  crack (89).
• At least 70 of pupils were aware of magic
  mushrooms, ecstasy, amphetamines and
  tranquilisers. Half or more were aware of LSD,
  methadone, and poppers.
• Awareness of all types of drugs increased with
  age.

24
Attitudes And Beliefs About Drug Taking

• Almost all pupils felt that, if they took drugs,
  their families would either try to stop them
  (84) or try to persuade them not to (14).
• Just 1 said that their family would do nothing
  about their drug taking, and less than 1 said
  that their families would encourage them to take
  drugs.

25
Relationships And Risks

• The prevalence of smoking, drinking and drug use
  all increased with age. At the age of 11, 34 of
  pupils had tried at least one of these, compared
  with 90 of 15 year olds.
• Pupils who do one of these things are more likely
  to do another, with particularly strong links
  between smoking and cannabis use, smoking and
  drinking alcohol, cannabis and Class A drug use,
  and drinking alcohol and using cannabis. However,
  sniffing volatile substances was not strongly
  associated with smoking, drinking or taking other
  drugs.

26
Part 2 Epidemiology and AddictionBritish Crime
Survey 1996-2006 age 16-24
27
British Crime Survey 1996-2006 Age 16-24
28
European School Survey Project on Alcohol and
Other Drugs (ESPAD)proportion of students
lifetime experience of illicit drugs 1995-1999
1999
1995
29
DRUGS OFFERED, TRIED AND REGULAR USE ()SCHOOL
SURVEY 2003
more than once in last year
used in last year (all drugs exc solvents)
used in last year (all drugs)
been offered
age
2
2
8
19
11
8
12
18
39
13
23
36
38
65
15
Drug use, smoking and drinking among young people
in England in 2003 National Centre for Social
Research/National Foundation for Educational
Research
30
BRITISH CRIME SURVEY 2002AGE 16-24
31
PATTERNS OF CANNABIS/COCAINE USE USE AMONG
EXPERIENCED USERS IN HOLLAND, 1995
32
Most difficult to give up (among those who
consume in previous year)
Night life and recreative drug use in Europe. A
study in 10 European Cities 1998. (Calafat et al
1999).
33
Distribution Of Cholera Deaths, London 1850
Source www.ph.ucla.edu/epi/snow.html
34
TEN PUBLIC HEALTH ACHIEVEMENTS 1900-1999

• Vaccination
• Motor Vehicle Safety
• Safer Workplaces
• Control of Infectious Diseases
• Decline in deaths from coronary heart disease and
  stroke
• CDCs Morbidity and Mortality Weekly Report
  (MMWR), April, 1999.

35
Ten Great Achievements (Continued)

• Safer and healthier foods
• Healthier mothers and babies
• Family Planning
• Fluoridation of Drinking Water
• Recognition of Tobacco Use as a Health Hazard
• CDCs Morbidity and Mortality Weekly Report
  (MMWR), April, 1999.

36
LIFE COURSE OF A DRUG ADDICT?
Offered Drugs at School
Not Offered Drugs
No Parental Substance Use
Parental Substance Use
Poor Neighbourhood
Affluent Neighbourhood
Friends Using Drugs
Friends not using drugs
Low Parental Discipline
High Parental Discipline
DRUG ADDICTION
37
WHAT IS ADDICTION? AGE-RELATED DIFFERENCES IN THE
MEANING OF ADDICTION

• In Northern Ireland, Rugkasa et al. (2001) found
  that children (10-11) distinguished between
  adolescent and adult smoking, and did not view
  adolescent smokers as addicted. Rugkasa, J.,
  Knox, B., Sittlington, J., Kennedy, O., Treacy,
  M.P. and Abaunza, P.S. (2001) Anxious adults vs.
  cool children children's views on smoking and
  addiction. Social Science and Medicine, 53,
  593602.
• Participants were adolescents ages 1018 and
  their parents, at least one of whom was also a
  participant in our ongoing, longitudinal, smoking
  survey.
• Adolescents rated both the appetitive and
  compulsive dimensions as equally important in
  defining addiction whereas for adults, the
  compulsive dimension was more important
• Adolescent smokers viewed smoking as less
  addictive than did non-smokers. In fact,
  adolescent smokers expressed the least belief in
  the addictiveness of smoking.
• Chassin et al Drug and Alcohol Dependence 87
  (2007) 3038

38
RELATIVE RISK FACTORS DETECTING ADOLESCENT DRUG
ABUSE

• Peer drug use, suspension at school, law
  infringements, truancy, conflict with parents,
  alcohol use and cigarette smoking were the
  relative risk factors investigated among 953
  adolescents.
• The most predictive of those was peer drug use.
  The more of those factors were present in an
  adolescent, the higher the risk of possible drug
  use.
• Swadi H. Drug Alcohol Depend. 1992
  Feb29(3)253-4.

39
RISK FACTORS FOR DIFFERENT DIMENSIONS OF
ADOLESCENT DRUG USE

• A total of 467 students aged 14-15 (234 boys and
  233 girls) were included in the study and a
  series of multivariate logistic regressions were
  estimated.
• The results show that the effects of family
  disruption, conflict in the family, parental
  monitoring, academic performance, time spent with
  friends and peer deviance differ significantly
  across the various dimensions of drug use
  studied.
• Parental monitoring, time spent with friends and
  peer deviance showed themselves to be the most
  important risk factors across these various
  dimensions.
• The number of risk factors present was also found
  to have an effect on drug use.
• Svensson R, Journal Of Child Adolescent
  Substance Abuse Volume 9 Number 3 2000

40
CLINICAL PHENOMENOLOGY OF ADOLESCENT SUBSTANCE USE

• Clinical phenomenology is very heterogeneous in
  the population with respect to substance use
  topography, psychiatric comorbidity, risk
  factors, and natural history. This heterogeneity
  is further magnified by the fact that there is a
  high degree of variation in the population with
  respect to environmental risk factors (family,
  school, culture, etc.), genetic predisposition,
  and socialization experience.
• www.isamweb.com/pages/pdfs/e-book20Issue201/Kami
  ners.pdf

41
Part 3 NormalisationNORMATIVE SOCIALIZATION

• It appears that modest exposure may be a
  component of normative socialization and not
  necessarily reflect a current problem or portend
  a poor prognosis.
• www.isamweb.com/pages/pdfs/e-book20Issue201/Kami
  ners.pdf

42
Developmentally Accepted Normal Use

• Although adolescence is a time of heightened
  risk, heavy use is often adolescence limited,
  that is, the progression does not invariably
  continue to increasing severity culminating in
  dependence. Indeed, moderation or even cessation
  may occur during or following adolescence.
• Several studies have found little or only a weak
  association between substance use in adolescence
  and a variety of outcome measures in young
  adulthood including substance abuse
• Marsha E. Bates and Erich W. Labouvie Alcoholism
  Clinical And Experimental Research Vol. 21, No. 5
  August 1997

43
ADOLESCENT DRUG USE AND PSYCHOLOGICAL HEALTHA
LONGITUDINAL INQUIRY. SHEDLER BLOCK

• Psychological differences between frequent drug
  users, experimenters, and abstainers could be
  traced to the earliest years of childhood and
  related to the quality of parenting received.
• Findings indicate that (a) problem drug use is a
  symptom, not a cause, of personal and social
  maladjustment, and (b) the meaning of drug use
  can be understood only in the context of an
  individual's personality structure and
  developmental history.
• Suggest that current efforts at drug prevention
  are misguided to the extent that they focus on
  symptoms, rather than on the psychological
  syndrome underlying drug abuse.

44
ADOLESCENT DRUG USE AND PSYCHOLOGICAL HEALTHA
LONGITUDINAL INQUIRY. SHEDLER BLOCK

• Drug use and drug abstinence have theoretically
  coherent antecedents and must be understood
  within the context of an individual's total
  psychology.
• In the case of experimenters, drug use appears to
  reflect age appropriate and developmentally
  understandable experimentation.
• In the case of frequent users, drug use appears
  to be a manifestation of a more general pattern
  of maladjustment, a pattern that appears to
  predate adolescence and predate initiation of
  drug use.

45
ADOLESCENT USE OF DRUGS NORMALITY OR DEVIANCE?

• Most adolescents who use substances of abuse do
  so with normal psychosocial development and will
  not develop problematic dependence on these
  drugs.
• Adolescent users who have difficulty with drugs
  often lack coping skills, have dysfunctional
  families, poor self images, and/or feel socially
  and emotionally insecure.

J Drug Issues 1998 Fiona Measham et al
46
CRITIQUE OF NORMALISATION BY PHILIP HAYNES

• The problem is that decades later social science
  has not done much more to critically expose a
  policy system (so called harm reduction') that
  seeks to take health promotion seriously by
  enlightening the harmful' choices that young
  people make, and which rather denies the wider
  social and psychological traumas that young
  people face in a modern (or is it post modern?)
  world.
• http//her.oxfordjournals.org/cgi/content/full/14/
  4/57575

47
DIFFERENCES IN YOUNG ADULT PSYCHOPATHOLOGY AMONG
DRUG ABSTAINERS, EXPERIMENTERS, AND FREQUENT USERS

• In an effort to specify under what conditions
  Shedler and Block's conclusions might hold, the
  present study examined three groups of drug users
  (abstainers, experimenters, frequent users)
  classified according to three different criteria
  (a) marijuana use at age 20 (b) alcohol use
  during 10th grade and (c) alcohol use at age 20.
  The three groups were compared at age 20 in terms
  of personality, deviant behavior, and
  psychopathology.
• Milich R et al. Journal of Substance Abuse,
  Volume 11, Number 1, January 2000, pp. 69-88(20)

48
DIFFERENCES IN YOUNG ADULT PSYCHOPATHOLOGY AMONG
DRUG ABSTAINERS, EXPERIMENTERS, AND FREQUENT USERS

• No matter the outcome measure, the abstainers
  were never more symptomatic than the
  experimenters.
• No matter the outcome measure, the frequent users
  of marijuana were consistently more symptomatic
  than the other two groups.

49
DIFFERENCES IN YOUNG ADULT PSYCHOPATHOLOGY AMONG
DRUG ABSTAINERS, EXPERIMENTERS, AND FREQUENT USERS

• Wills et al. (1996) examined five groups of
  substance using adolescents stable non-users,
  minimal experimenters, late starters, and
  escalated substance users. Substance use was
  defined as a composite of cigarette, alcohol, and
  other drug use.
• Non-users tended to be better adjusted than the
  experimenters, who had higher levels of stress,
  maladaptive coping, and deviance-prone attitudes.
  
• However, this study employed a much younger
  sample (mean age 14.4) than the Shedler and
  Block (1990) study, so that experimentation at
  this age may mean something different from
  experimentation by age 18 (see Moffitt, 1993)

50
Part 4 Different Approaches To
Research RESEARCH PARADIGMS
Normative Interpretative Society
Individual Medium/Large Scale Small
Scale Impersonal Human Actions Natural
Sciences Non-statistical Objectivity Subject
ivity Approach From The Outside Personal
Involvement Of Researcher Explaining
Understanding Generalizing From
Specific Interpreting The Specific
Cohen, L, Manion, L. Morrison, K.(2000).
Research Methods in Education, 5th Ed, Routledge
Falmer.
51
TRANSITION FROM USE TO ABUSE

• Familial contextual factors include
• stressful life events, deficient parental
  support or supervision, poor discipline
  practices, ambiguous parental attitude towards
  substance use, parental and sibling substance use
• www.isamweb.com/pages/pdfs/e-book20Issue201/Kami
  ners.pdf

52
TRANSITION FROM USE TO ABUSE

• Behavioral characteristics include
• impulsivity, aggression, sensation seeking, low
  harm avoidance, inability to delay gratification,
  low achievement striving, lack of religiosity,
  and psychopathology, in particular conduct
  disorder and mood disorders.
• www.isamweb.com/pages/pdfs/e-book20Issue201/Kami
  ners.pdf

53
TRANSITION FROM USE TO ABUSE

• social and environmental factors include
• peer pressure to use, absence of normative
  peers, affiliation with deviant or delinquent
  peers, perception of high drug availability,
  social norms facilitating drug use, and relaxed
  laws and regulatory policies.
• www.isamweb.com/pages/pdfs/e-book20Issue201/Kami
  ners.pdf

54
HOME OFFICE STUDY PRECURSORS AND CONSEQUENCES OF
PROBLEMATIC DRUG USE A STUDY OF YOUNG PEOPLE
ACCESSING DESIGNATED DRUG SERVICES

• Previous research indicates that young people who
  access drug services have problems in multiple
  domains (psychological, physical, familial and
  environmental) in addition to their identified
  substance misuse.
• www.homeoffice.gov.uk/rds/pdfs04/rdsolr1504.pdf

55
STRUCTURAL EQUATION MODELLING
56
PARTICIPANTS PROFILE
57
(No Transcript)
58
PARENTS PROFILE
59
POTENTIAL RISK FACTORS
60
UNIVARIATE ANALYSIS
Factor
Sig. Level
F value
Variable
Protective
0.00
11.28
parents set time to be home
Protective
0.01
7.36
currently living in household with mother
Protective
0.01
6.57
currently living in household with adults
Protective
0.05
3.20
parents try to control what I do
Protective
0.14
2.27
live with same people as last year
Protective
0.14
2.03
places for young people to meet in your area
Risk
0.00
19.62
aged 16 at interview
Risk
0.00
9.62
majority of friends use drugs
Risk
0.00
9.09
parents dont like you drinking
Risk
0.02
5.82
run away from home
Risk
0.04
4.49
favourite subject is academic
Risk
0.05
3.16
majority of friends smoke
Risk
0.05
3.07
burglary is a problem in your area
Risk
0.10
2.41
assaults are a problem in your area
Risk
0.18
1.76
poor transport in your area
Risk
0.30
1.08
did not always go to school regularly
61
HIERARCHY OF RISK?
Relative Importance
Variable
11.2
Perceived lack of parental discipline
10.9
Respondents friends using drugs
8.8
Age at interview
6.1
History of running away from home
4.3
Parental lack of concerns about smoking and
alcohol problems
3.9
Perception of problems in area (e.g. assault,
burglary)
2.8
Perception of poor local amenities (places to
meet, transport)
1.7
Age began substance use
1.4
Poor school attendance ( left school before age
16)
1
Not living in a household with adults (especially
natural mother)
62
Preventing Drug Use
What we know now from our own longitudinal
studies is that if we create more opportunities
for young people to be engaged in positive
pro-social waysin family, in school, in
classroom, in neighborhoodif we ensure they have
the skills they need developmentally to master
those opportunities they have, and if we are
consistent in reinforcing and recognizing
them...for doing a good job, they become more
committed and attached to school, more bonded to
family, more committed and attached to the
neighborhood. And once theyve bonded, theyre
more likely to live according to healthy beliefs
and clear standards. David Hawkins
Adolescent Substance Abuse A Public Health
Priority An evidence-based, comprehensive, and
integrative approach Center for Alcohol and
Addiction Studies Brown University August 2002
63
FURTHER RESEARCH

• Using the model as a framework for qualitative
  study.
• For example, the model highlights the importance
  of the variable running away from home yet this
  was only measured by a simple yes/no response.
• Similarly with friends use of drugs. Did these
  friends predate initiation into drug use, or did
  the respondent gravitate towards friends who were
  already drug users.
• Exploring personality and social factors in
  quasi-experimental settings. The field of
  cognitive social psychology offers numerous
  paradigms which could be used to explore drug
  users behaviour.

64
PREVENTION

• These data could be used to argue that prevention
  activities should be directed and initiated in
  early adolescence. Among this sample, early
  experimentation with drugs at age 13 invariably
  led to problematic drug use involving heroin and
  cocaine at age 16.
• One possible argument against early intervention
  is that the age of onset only has a small impact
  on LPDU. Another argument against early
  intervention is that there are difficulties in
  trying to prevent a behaviour (i.e. problematic
  drug use) which has not yet occurred. As higher
  levels of problematic drug use seem to develop
  around the age of 15-16, attempts to modify
  behaviour at 15/16 may be more productive.

65
IS EARLY AGE ONSET A RISK FACTOR

• Early age onset illicit drug use has been found
  to increase the risk of drug problems during late
  adolescence.
• However, contrasting results have been reported
  in a prospective study of adolescents. Age of
  first illicit use did not emerge as an
  independent risk factor for either persistence or
  severity of drug use in adulthood.
• Adolescent Risk Factors and the Prediction of
  Persistent Alcohol and Drug Use into Adulthood
  Marsha E. Bates and Erich W. Labouvie ALCOHOLISM
  CLINICAL AND EXPERIMENTAL RESEARCH Vol. 21, No. 5
  August 1997

66
REASONS FOR AND/OR CAUSES OF DRUG USE?

• Environmental factors
• Drug availability
• Susceptible
• Effects of drugs on individuals
  (appetitive/compulsive)
• Alter mood

67
INTERGROUP PROCESSES

• The role of identification within a group has
  been examined by Tajfel (1978). In his analysis,
  issues of intergroup relations turn on the
  individual sense of belonging to, or
  identification within his/her group
• An interesting application of Tajfels theory
  relates to groups that find themselves
  disadvantaged in terms of one dimension. Such
  groups will look for new comparisons to achieve a
  positive identity

68
INTELLIGENCE/ACADEMIC ACHIEVEMENT

• Adolescents with SUD score on average lower on
  tests of intelligence and academic achievement
  compared to youth who do not qualify for
  diagnosis. Neuropsychological tests suggest that
  the deficits are primarily circumscribed to
  language-based processes.
• Tarter R, Mezzich A, Hsieh Y, et al. Cognitive
  capacities in female adolescent substance
  abusers Association with severity of drug abuse.
  Drug and Alcohol Dependence 1995 915-21.

69
PARENTING

• When experiencing problems of whatever nature,
  it is easy to feel alone, not knowing who to turn
  to for help. This was my experience before I was
  introduced to the Parenting programme by the YOT.
  There was no light at the end of the tunnel for
  me and life seemed to be in a downward spiral.
  But once I joined the group I soon realised that
  I was not alone and that there were other parents
  who were experiencing the same and often worse
  problems than myself.
• After a short time I began to look at my life
  from a different perspective. My relationship
  with my son changed, as did my attitude. As no
  one taught us to be parents, sometimes it is
  difficult to know how to react when faced with
  problems.
• Bancroft, A., Carty, A., Cunningham-Burley, S.,
  et al. (2000) Support for the Families of Drug
  Users A review of the literature. Edinburgh
  Scottish Office.

70
QUALITATIVE RESEARCH

• Moving from experimentation with illicit drugs
  in the early teens to dance drugs and the Class
  As was seen as a sign of maturity both inherent
  in the image of the individual drugs themselves
  and also practically in the drugs effects.
• The continuation of drug use after an initial
  experience depended not only on the perceived
  positive and negative effects of the drug itself
  but also on how the drug trier learned to
  identify and interpret those effects.
• Measham F. Parker , H. Aldridge, J.
  Starting, switching, slowing and stopping. pp.
  69. Report for the Drugs Prevention Initiative
  Integrated Programme, London, 1998.

71
QUANTITATIVE RESEARCH

• One of the potential advantages of the
  quantitative approach is the opportunity to
  assess variables which respondents might not
  think was causally associated with their drug use
  (e.g. perception of parental controls).
• Furthermore people are adept at finding reasons
  for their behaviour which may not accord with the
  actual causes (i.e. poor exam performance
  explained by not feeling well).
• Interestingly, Measham et al. note that The
  experience of the Manchester University research
  team, and that of other qualitative researchers,
  suggests that respondents are not always aware of
  the reasons why they do or do not engage in
  certain behaviours
• Measham, F., Parker, H. and Aldridge, J. (1998)
  Starting, Switching, Slowing and Stopping (Report
  for the Drugs Prevention Initiative Integrated
  Programme). London Home Office.

72
Vulnerable young people andtheir vulnerability
to drug misuse

• Many participants felt that nothing would have
  prevented them from taking drugs when they did as
  they wouldnt have listened to anyone at the
  time.
• Many felt that they would not need the help of
  outside agencies to stop taking drugs if they
  should decide to do so they felt that their
  drug taking wasnt a problem and that they could
  stop when and if they wanted to.

Vulnerable young people and drugs Opportunities
to tackle inequalities. DrugScope 2001 (See
Chapter 2 by Margaret Melrose and Isabelle Brodie
(University of Luton)
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SUMMARY

• How does epidemiology relate to addiction?
• How should adolescent addiction be studied?
• How is addiction defined and diagnosed?
• What role is there for prevention?
• What should studies of adolescent addiction
  address (eg interventions, outcomes?)