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Substance Use Risk Profile Scale: Psychometric Evaluation in First Nation Adolescents Sherry H. Stewart, Ph.D. Dalhousie University CIHR Investigator.

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Presentation on theme: "Substance Use Risk Profile Scale: Psychometric Evaluation in First Nation Adolescents Sherry H. Stewart, Ph.D. Dalhousie University CIHR Investigator."— Presentation transcript:

1 Substance Use Risk Profile Scale: Psychometric Evaluation in First Nation Adolescents Sherry H. Stewart, Ph.D. Dalhousie University CIHR Investigator

2 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

3 Funding  Canadian Institutes of Health Research (CIHR) NET  Royal Canadian Mounted Police Foundation

4 Substance-Related Disorders: Some Important Facts  Prevalent and costly  Moderately responsive to treatment  Heterogeneous in nature  Highly co-morbid with other mental disorders

5 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

6 Reinforcing effects of Drugs of Abuse Negative Reinforcement anxiety reducing (anxiolytic) pain reducing (analgesic) Positive Reinforcement psycho-stimulant

7 Personality Risk Factors for Drug Abuse  Anxiety Sensitivity  Hopelessness  Sensation Seeking  Impulsivity

8 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)

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10 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

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

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14 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 (Harden & Pihl, 1995)  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)

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16 Personality Theory of Risk for Substance Abuse

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

18 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

19 Substance Use Risk Profile 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.

20 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.

21 SURPS Hopelessness 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.

22 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.

23 SURPS Impulsivity 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.

24 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)

25 “Nemi’simk, Seeing Oneself”

26 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

27 Sample Characteristics  N = 164 First Nation adolescents  2 Mi’kmaq communities in N.S.  3 schools  Age Range = yrs (mean = 16.3)  85 girls; 79 boys  Grade Range = Gr (mean = 10.1)

28 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)

29 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

30 SURPS ITEM # F1 - HOP F2 - IMP F3 – AS F4 - SS Comm. SURPS *.568 SURPS 7.711*.543 SURPS *.518 SURPS 4.658*.451 SURPS *.509 SURPS 1.569*.396 SURPS SURPS *.515 SURPS *.489 SURPS 2.602*.378 SURPS *.539 SURPS SURPS *.532 SURPS 8.629*.447 SURPS *.415 SURPS *.362 SURPS *.514 SURPS 9.681*.579 SURPS 6.669*.607 SURPS *.326 SURPS SURPS SURPS *.461 % Var. 19.2%10.1%9.5%6.0%

31 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)

32 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

33 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

34 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

35 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)

36 DMQ-R Conformity βt-valuep-level Age Gender * Grade AS * HOP * SS IMP Constant

37 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)

38 DMQ-R Coping βt-valuep-level Age Gender Grade AS HOP * SS IMP t Constant

39 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

40 DMQ-R Enhancement βt-valuep-level AS HOP SS t IMP Constant

41 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

42 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)

43 RAPIβt-valuep-level Age Gender Grade AS HOP * SS * IMP * Constant *

44 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)

45 RBQβt-valuep-level Age Gender Grade * AS HOP * SS * IMP * Constant *

46 RBQ Item ASHOPSSIMP 1. Driving under influence Sex without contraceptives *.245**.190** 3. Damaged property **.289** 4. Used marijuana **.200** 5. Shoplifted *.218** 6. Driving over 80 mph ** Sex with stranger **.184** 8. Used cocaine.167*.134* * 9. Driving >20 mph over limit ** Used other illegal drugs ** *

47 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

48 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

49 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

50 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

51 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

52 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


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