S

ubstance

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isk 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 

M. Nancy Comeau, Ph.D.

Department of Psychology, Dalhousie University 

Kaitlin English

Department of Psychology, Dalhousie University

Funding



Canadian Institutes of Health Research (CIHR) NET



Royal Canadian Mounted Police Foundation

Substance-Related Disorders: Some Important Facts

 Prevalent and costly  Moderately responsive to treatment  Heterogeneous in nature  Highly co-morbid with other mental disorders

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

D

ifferences 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

Reinforcing effects of Drugs of Abuse

Negative Reinforcement

anxiety reducing (anxiolytic) pain reducing (analgesic)

Positive Reinforcement

psycho-stimulant

Personality Risk Factors for Drug Abuse

    Anxiety Sensitivity Hopelessness Sensation Seeking Impulsivity



Anxiety Sensitivity

(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)

Hopelessness

    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



Sensation Seeking

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

Impulsivity

 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 1995) (Harden & Pihl,  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)

Personality Theory of Risk for Substance Abuse

Conrod et al.’s (2003) Motivation

systems Personality Type Types of Mental Health Problems other than Substance Abuse Drug of choice

GABA/ Anxiety-Fear

Anxiety Sensitivity Anxiety Disorders Anxiolytics

Opiate / Punishment

Hopelessness Mood Disorders Analgesics

Dopamine/ Reward

Sensation Seeking Alcohol

5-HT/ Self regulation

Impulsivity Antisocial Personality Disorder Stimulants

Utility of model

  Useful in treatment matching with substance abusers (Conrod et al., 2000b)  Useful in predicting drug of choice and co-morbid psychopathology in substance abusers (Conrod et al., 2000a) Useful in school-based early interventions for alcohol abuse in adolescents (Stewart et al., in press)

Measurement Issues

 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

S ubstance

1. I am content.*

U se R isk P rofile

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.

S cale

SURPS Anxiety 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.

SURPS Hopelessness

1. I am content.*

Scale

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.

SURPS Sensation Seeking 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.

SURPS Impulsivity

1. I am content.*

Scale

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.

Substance Abuse in First Nation Communities

 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)

“Nemi’simk, Seeing Oneself”

First Step in Project

 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

Sample Characteristics

      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)

Measures

    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)

Factorial Validity

   Performed principal components analysis Varimax rotation # factors determined by examination of scree plot  Four-factor solution explained 44% variance in SURPS item scores

SURPS ITEM # SURPS 13 SURPS 7 SURPS 23 SURPS 4 SURPS 20 SURPS 1 SURPS 17 SURPS 11 SURPS 15 SURPS 2 SURPS 22 SURPS 5 SURPS 10 SURPS 8 SURPS 14 SURPS 18 SURPS 21

SURPS 9 SURPS 6 SURPS 12 SURPS 19 SURPS 3 SURPS 16

% Var.

F1 - HOP .738* .711* .706* .658* .628* .569* 19.2% F2 IMP .692* .622* .602* .576* .556* 10.1% F3 – AS .721* .629* .600* .571* .532* 9.5% F4 -

SS

.681* .669* .504* 6.0% Comm.

.568

.543

.518

.451

.509

.396

.407

.515

.489

.378

.539

.280

.532

.447

.415

.362

.514

.579

.607

.326

.121

.348

.461

SURPS – Problem Items

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)

Reliability

     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

Construct Validity

 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

Criterion-Related Validity

 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

Criterion-Related Validity: Risky Drinking Motives

  Criterion variable = DMQ-R Conformity Block of SURPS variables significantly increased prediction of conformity motives above demographics  Δ F (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)

DMQ-R Conformity

Age β -.177

Gender .245

Grade AS .237

.231

HOP SS IMP Constant .256

.125

.143

t-value -1.052

2.412

1.341

2.186

2.065

1.005

1.266

-1.345

p-level .296

.018* .184

.031* .042* .318

.209

.182

Criterion-Related Validity: Risky Drinking Motives

  Criterion variable = DMQ-R Coping Block of SURPS variables significantly increased prediction of coping motives above demographics  Δ F (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)

DMQ-R Coping

Age Gender Grade AS HOP SS IMP Constant β .124

.034

-.211

.161

.271

.151

.212

t-value .743

.333

-1.203

1.536

2.214

1.226

1.904

-.588

p-level .460

.740

.232

.128

.029* .223

.060

t

.558

Criterion-Related Validity: Risky Drinking Motives

 Criterion variable = DMQ-R Enhancement  Block of SURPS variables significantly increased prediction of enhancement motives above demographics  Δ F (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

DMQ-R Enhancement

AS β -.006

HOP SS -.095

.215

IMP Constant .159

t-value -.059

-.845

1.839

1.452

.887

p-level .953

.400

.069

t

.150

.377

Criterion-Related Validity: Risky Drinking Motives

  Criterion variable = DMQ-R Social Block of SURPS variables did not significantly increase prediction of social motives above demographics  Δ F (4, 88) = 1.68, p > .05

Criterion-Related Validity: Alcohol Problems

  Criterion variable = RAPI Total Block of SURPS variables significantly increased prediction of alcohol problems above demographics  Δ F (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)

RAPI

Age Gender Grade AS HOP SS IMP Constant β .022

.008

.031

.092

.412

.305

.310

t-value .146

.088

.189

.973

3.754

2.777

3.104

-3.587

p-level .884

.930

.851

.333

.000* .007* .003* .001*

Concurrent Validity: Other Reckless Behavior

  Criterion variable = RBQ Total Block of SURPS variables significantly increased prediction of reckless behavior above demographics  Δ F (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)

RBQ

Age Gender Grade AS HOP SS IMP Constant β .061

-.008

.232

-.022

.285

.378

.197

t-value .561

-.113

2.046

-.299

3.495

4.601

2.521

-3.726

p-level .576

.910

.042* .765

.001* .000* .013* .000*

RBQ Item 1. Driving under influence 2. Sex without contraceptives 3. Damaged property 4. Used marijuana 5. Shoplifted 6. Driving over 80 mph 7. Sex with stranger 8. Used cocaine 9. Driving >20 mph over limit 10. Used other illegal drugs AS HOP -.033 .075

SS .004

IMP .063

.072

-.130* .245** .190** -.088 .006

.055

-.006

.361** .289** .206** .200** .039

.062

.015

.024

-.117 .019

.167* .134* .010

.014

.180* .055

.218** .186** .087

.213** .184** .161* -.026

.341** .032

.207** .117

.149*

Summary of Findings

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

Summary of Findings

  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

Summary of Findings

  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

Summary of Findings

 

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

Summary of Findings

  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

Conclusions

 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