Adolescent Self-Reported
Behaviors
and Their Association with Marijuana Use
By Janet C.
Greenblatt
<Read
It On The SAMHSA Website>
Check Out These Books
On Adolescent Recovery & Relapse Prevention
Preventing
Adolescent Relapse
Adolescent
Relapse Prevention Workbook
Recovery
Wars: The Attack of The Relapse Man
(A Comic Book for Recovery)
Review
Related
GORSKI-CENAPS Courses & Conference Presentations
Introduction
The National Household Survey on Drug Abuse (NHSDA), sponsored by the
Substance Abuse and Mental Health Services Administration (SAMHSA),
Department of Health and Human Services, has shown that since 1992, the
rate of past month marijuana use among youth has more than doubled,
going from 3.4 percent in 1992 to 7.1 percent in 1996. Similar trends
are evident among both boys and girls; among whites, blacks and
Hispanics; and in metropolitan and nonmetropolitan areas (SAMHSA 1997a).
Other studies have also shown a doubling of marijuana use between 1992
and 1995 among 8th graders, and significant increases among 10th and
12th graders (NIDA 1997). At the same time, the rate of 12 to 17 year
olds perceiving great risk in using marijuana has decreased. In the 1992
NHSDA, 39 percent of youths reported that smoking marijuana once a month
is of great risk to people compared with 33 percent in 1996. Similarly,
in 1992, 64 percent of youths reported smoking marijuana once or twice a
week was of great risk to people compared with 57 percent in 1996
(SAMHSA 1997b).
The National Institute on Drug Abuse (NIDA) has reported that
marijuana can be harmful both from immediate effects and damage to
health over time. Specifically, studies have shown that marijuana can
hinder the users’ short term memory and ability to handle difficult
tasks (Schwartz et al. 1989). Students may find it difficult to study
and learn. While many of the long-term effects of marijuana use are not
yet known, studies have shown that daily marijuana smokers who did not
use tobacco had more sick days and doctor visits for respiratory
problems than a similar group who did not smoke either substance. A
person who smokes marijuana regularly may have many of the same
respiratory problems that tobacco smokers have (Tashkin et al. 1987).
Other studies have shown that the regular use of marijuana may play a
role in cancer and problems of the respiratory, immune and reproductive
systems. Heavy marijuana use can affect hormones in both males and
females. Both animal and human studies have shown that marijuana impairs
the ability of T-cells in the lungs’ immune defense system to fight
off some infections. Because of the drug’s effects on perceptions and
reaction time, users could be involved in automobile accidents (NIDA
1995). According to the 1996 NHSDA, nearly one million 16-18 year olds
(11 percent) reported driving at least once within two hours of using an
illicit drug in the past year (most often marijuana) (SAMHSA 1998).
Although it is not yet known how the use of marijuana relates to
mental illness, some scientists maintain that regular marijuana use can
lead to chronic anxiety, personality disturbances, and depression (NIDA
1995). Some frequent long-term marijuana users show signs of lack of
motivation and tend to perform poorly in school (Pope 1996). A recent
study demonstrated similarities between marijuana’s effect on the
brain and those produced by such addictive drugs as cocaine, heroin,
alcohol, and nicotine (Volkow 1996).
There is substantial interest in the co-occurrence in the general
population of illicit drug use with other kinds of behavioral patterns,
mental syndromes, and psychiatric disorders (Bourden et al. 1992, Kandel
et al. 1997, Kessler et al. 1996, SAMHSA 1996). A number of descriptive
studies have demonstrated that people who use drugs are more likely to
have mental disorders, physical health problems, and family problems
(NIDA 1991). In addition, a recent study (Crowley 1998) was conducted
with 165 boys and 64 girls between the ages of 13 and 19 who had been
referred by social service or criminal justice agencies to a
university-based treatment program for delinquent substance-involved
adolescents. Based on interviews, medical examinations, social history,
and psychological evaluations, the study showed that marijuana use by
teenagers who have prior serious antisocial problems can quickly lead to
dependence on the drug. Most of the youths reported that their
behavioral problems predated, and were not initially caused by, their
drug use.
The 1994, 1995, and 1996 NHSDA incorporated the widely used Youth
Self-Report (YSR) Checklist which ranks adolescents on a variety of
clinically validated scales of behavioral and emotional problem
behaviors (Achenbach 1991). In this paper, the relationship between
marijuana use among those age 12-17 and various problem measures, as
reported on the YSR, is shown. This paper concentrates primarily on the
reported frequency of marijuana use and its relationship with
self-reported behaviors.
Methods
The NHSDA, currently conducted by SAMHSA, has provided estimates of
the prevalence, consequences, and patterns of drug use and abuse in the
United States periodically since 1971. It is the primary source of
statistical information on the use of illegal drugs by the United States
population age 12 and older. The survey collects data by administering
questionnaires to a representative sample of persons living in the U.S.
(SAMHSA, 1998).
The respondent universe includes residents of noninstitutional group
quarters such as shelters, rooming houses, dormitories and residents of
civilian housing on military bases. Persons excluded from the universe
include the homeless not found in shelters, residents of institutional
quarters, such as jails and hospitals, and active military personnel.
The survey employs a multistage area probability sample design that
includes over-sampling of young people, African-Americans, and
Hispanics. In 1993, 1994, and 1995, cigarette smokers age 18-34 were
also over-sampled.
The household interview takes about an hour to complete, and includes
a combination of interviewer-administered and self-administered
questions. With this procedure, the answers to sensitive questions (such
as those on illicit drug use) are recorded on separate answer sheets by
the respondent and are not seen by the interviewer. After the answer
sheets are completed, they are placed by the respondent in an envelope,
which is sealed and mailed with no name or address information included.
A concern of NHSDA data users is that the data are based on
self-reports of drug use, and their value depends on respondents'
truthfulness and memory. Although many studies have generally
established the validity of self-report data and the NHSDA procedures
were designed to encourage honesty and recall, some underreporting may
have taken place (Harrell 1986). The methodology used in the NHSDA has
been shown to produce more valid results than other self-report
methodssuch as interviews by telephone (Turner et al. 1992). However,
comparisons of NHSDA data with data from surveys conducted in classrooms
suggest that underreporting of drug use by youths in their homes may be
substantial (Gfroerer 1997).
For this study, data from the 1994, 1995, and 1996 NHSDA datasets
were combined, dividing the analytic weights by 3 to produce average
annual yearly estimates for the combined dataset. Questionnaires and
data collection and estimation methodologies were essentially the same
in those three years. The household screening completion rate for the
1994-6 surveys was 94 percent. This study is restricted to those age
12-17. In 1994, 83 percent of sample persons age 12-17 completed the
interview resulting in a sample size of 4,698. The 1995 NHSDA achieved a
response rate of 85 percent for the 4,595 respondents age 12-17; the
1996 response rate was 82 percent for a sample size of 4,538.
Three-fourths of the interviews (in the combined dataset) among those
age 12-17 were completed in complete privacy or with minor distractions.
In 1994, SAMHSA began collecting mental health data on the NHSDA. A
youth mental health module for the age group 12-17 was adopted from work
by Thomas M. Achenbach and colleagues (1991a) to obtain youths’
reports of their competencies and problems in a standardized format. The
module was designed to measure depression, anxiety, social withdrawal,
somatic complains, social problems, thought problems, attention
problems, delinquent behavior, and aggressive behavior during the past 6
months. Psycho-social problem behaviors in the past 6 months were
measured using a module composed of 118 items from the Youth Self-Report
(YSR) which has been used extensively in studies of adolescents. Scores
that sum up responses to the YSR have been shown to distinguish
adolescents typically seen in clinical settings for counseling or
psychotherapy from those seldom referred for treatment, in other words,
to identify individuals who are likely to have clinically significant
levels of functional, cognitive, or emotional problems. For this study,
the responses to each of the 118 items were analyzed separately.
Results
Characteristics of Past Year Marijuana Users Age 12-17
Youths were asked how often in the past 12 months they used marijuana
(Table 1). The majority of 12, 13, and 14 year olds (64%, 59%, and 52%,
respectively) who used marijuana used less often than monthly (1-11 days
in the past year) compared with 47% of 15 year olds and 39% of 16-17
year olds. More than 27 percent of users age 16 to 17 used marijuana 1
to 7 days a week in the past year compared with 12 percent of 12 year
old users and 21-24 percent of 13-15 year old users.
Table 2 shows the demographic characteristics of marijuana users by
frequency of use. The teenagers using monthly or more often were more
likely to be older (age 16 to 17). The monthly or more often users were
also more likely to be male than those who used less frequently. Those
who used monthly or more often were more likely than less frequent users
to live in the West and to have moved 2 or more times in the past year.
The weekly users were 1.7 times more likely than nonusers to be living
in other than a 2-parent family (55% and 33% respectively). As the
frequency of use increased, the percent of 12-17 year olds living in a
2-parent family decreased.
Self-reported Problem Behaviors Associated With Marijuana Use
In completing the YSR, youths were asked to read the list of 118
statements and indicate if the statement was not true, somewhat or
sometimes true, or very or often true for them. Although causal
conclusions about the relationship between substance use and problems
cannot be drawn from the NHSDA data alone, these data provide a useful
complement to other studies. While the reported behaviors are not
necessarily caused by the use of marijuana or, conversely, the cause of
marijuana use, there appears to be a strong positive correlation between
the reporting of certain behaviors and reported frequency of marijuana
use. The more frequent the use, the more likely the 12-17 year olds were
to report problem behaviors.
Withdrawal:
There were 7 measures that comprised the withdrawal category (Table
3). There was a strong correlation between the reporting of withdrawal
items and the frequency of reported marijuana use. Those who used
marijuana on 1-7 days a week in the past year were nearly twice as
likely as non-users to report they refuse to talk (25% vs. 16%), they
don’t have much energy (47% vs. 25%), and they are unhappy, sad or
depressed (40% vs. 23%). Those who used marijuana at least monthly in
the past year reported being more likely than nonusers to say they were
secretive or kept things to themselves.
Somatic Complaints:
Those age 12 to 17 who used marijuana in the past year were more
likely than nonusers to report feeling dizzy, overtired, and nauseous or
sick (Table 4). There appeared to be little correlation between
frequency of marijuana use and certain reported somatic complaints with
the more frequent users being as likely as less frequent users to report
symptoms such as having headaches, rashes or other skin problems.
Anxiety/Depression:
As seen in Table 5, those who used marijuana at least once a month in
the past year were nearly 3 times as likely as nonusers to say they
think about killing themselves (24% vs. 8%). Those who used marijuana in
the past year were more likely than nonusers to report that they
deliberately try to hurt or kill themselves, feel lonely and that no one
loves them, that other people are out to get them, and
they are worthless and inferior. For some items, as the frequency of
use increased, the percent of adolescents reporting these feelings also
increased. For example, weekly users were more likely than less frequent
users to feel "others are out to get me", "I am worthless
or inferior" or "I am unhappy or sad".
Social Problems:
Those who used marijuana in the past year were more likely than
nonusers to report that they do not get along with other kids and weekly
users were nearly twice as likely as nonusers to report this (33% vs
19%) (see Table 6). The weekly users were less likely than
nonusers to report they act too young for their age (27% vs. 36%), they
prefer younger kids as friends (15% vs. 22%), and they get teased a lot
(17% vs. 25%). However, weekly users were more likely than
nonusers to say they are not liked by other kids (25% vs. 18%).
Thought Problems:
Past year marijuana users age 12 to 17 were more likely than nonusers
to report four thought problems: "I can not get my mind off certain
thoughts", "I repeat certain actions over and over",
"I do things other people think are strange", and "I have
thoughts people would think are strange" (Table 7). In addition,
monthly or more often users were more likely than nonusers to say they
see and hear things that other people think are not there.
Attention Problems:
Those who used marijuana in the past year were more likely than
nonusers to report they have trouble concentrating (72% vs. 51%), they
feel confused or in a fog (41% vs. 24%), they daydream a lot (68% vs.
52%), they act without stopping to think (63% vs. 44%), and their school
work is poor (59% vs. 30%) (see Table 8). As before, the percent of
those reporting attention problems generally increased with frequency of
use.
Delinquent Behavior:
Differences of the greatest magnitude between users and nonusers were
found in measures of delinquent behavior (Table 9). Those who used
marijuana weekly were 9 times as likely as nonusers to say they use
alcohol or drugs for nonmedical purposes (76% vs. 8%), 6 times as likely
to say they had run away from home (24% vs. 4%), nearly 6 times as
likely to say they had cut classes or skipped school (60% vs. 11%), 5
times as likely to say they stole from places other than home (34% vs.
6%), and 3 times as likely to say they steal at home (17% vs. 5%).
Moreover, a higher proportion of past year marijuana users reported
these behaviors than did nonusers. Past year users were also more likely
than nonusers to report they do not feel guilty after doing something
they shouldn’t, they hang around with kids who get into trouble, and
they lie and cheat. As noted elsewhere, the proportion saying these
statements were somewhat, very or often true about them generally
increased with frequency of marijuana use. For example, weekly marijuana
users were about twice as likely as those who used fewer than 12 times
in the past year to say they had run away from home or they had cut
classes or skipped school in the past 6 months.
Aggressive Behavior:
Past year marijuana users were more likely than nonusers to report
all aggressive behaviors shown in Table 10. For many items, the
percentage reporting the behavior increased as frequency of use
increased. Weekly users were nearly 4 times as likely as nonusers to
report they physically attack people (26% vs. 7%), and 3 times as likely
to report they destroy things that belong to others (22% vs. 7%), they
threaten to hurt people (38% vs. 13%), and they get in many fights (37%
vs. 14%). The weekly users were also twice as likely as nonusers to
report they disobey at school (59% vs. 24%) and they destroy their own
things (22% vs. 10%). On average, past year marijuana users, regardless
of frequency of use, were twice as likely as nonusers to report they
destroy things that belong to others, they disobey at school, they get
in many fights, and they threaten to hurt people.
Criminal Behavior:
In addition to the YSR module, the NHSDA included questions about
some past-year activities that may have been illegal. In each comparison
shown in table 11, adolescents age 12 to 17 who used marijuana in the
past year were 3 or more times more likely than nonusers to report
past-year involvement in these activities. Past year marijuana users
were more likely than nonusers to report that in the past year, they
were on probation, and they had 1) taken something from a store without
paying, 2) purposely damaged property that wasn’t theirs, 3) driven
under the influence of alcohol or drugs, 4) hurt someone enough to need
a bandage, and 5) sold illegal drugs. As before, in most cases, the
percentage reporting these behavioral problems increased with the
frequency of marijuana use. In particular, weekly users of marijuana
were more than 5 times as likely as those who used only 1 to 11 times in
the past year to have driven under the influence of drugs (29% vs. 4%)
or to have sold illegal drugs in the past year (29% vs. 6%). Weekly
users were also 2-3 times more likely than those who used less often
than monthly to be on probation (20% vs. 7%), to have driven under the
influence of alcohol (20% vs. 9%), or to have purposely damaged property
that was not theirs (35% vs. 18%).
Conclusion
This report shows that among those age 12-17, past year marijuana
users were more likely than nonusers to report problem behaviors in the
past 6 months. Further, for the majority of items measured, the more
frequent the use, the more likely the youths were to report problem
behaviors.
The more frequent users were more likely to be the older youths (6
out of 10 were age 16-17), white, male, to live in a metropolitan area
and the West. They were more likely than less frequent users to have
moved in the past year and are less likely to live in a 2-parent family.
Frequent marijuana users were more likely than less frequent users to
report delinquent behaviors such as running away from home, stealing,
and cutting classes or skipping school. They were also more likely than
less frequent users to report aggressive behaviors such as destroying
things that belong to others and physically attacking people. Monthly or
more often users were more likely than less frequent users to have
driven under the influence of alcohol or drugs or sold illegal drugs in
the past year. From a psychological view, youths who used marijuana in
the past year reported many behaviors symptomatic of anxiety and
depression. Users were 2 to 4 times more likely than nonusers to report
they think about killing themselves or that they deliberately try to
hurt or kill themselves. They weremore likely than nonusers to say they
were unhappy, sad or depressed and that they feel "no one loves
me". The users were more likely than nonusers to report that
"others are out to get me" and "I am suspicious".
Regardless of whether the problem behaviors preceded marijuana use or
marijuana use preceded the behaviors (which we are not able to ascertain
from the NHSDA), it is apparent from these data that the marijuana users
are exhibiting many signs of anxiety and depression and exhibiting
delinquent and aggressive behaviors far in excess of the nonusers.
Further, there appears to be a high correlation between the presence of
many of these reported behaviors and the frequency of marijuana use.
These findings strengthen the argument that
marijuana is not a benign substance. Not only can it be associated with
many destructive and aggressive behaviors, it can also be associated
with severe symptoms of anxiety and depression. Longitudinal studies are
needed to determine if the symptoms and behaviors preceded the marijuana
use or vice versa. Whether this can be determined or not, this report
shows the importance of preventing the use of marijuana in youths and
the need for treatment for marijuana use in conjunction with treatment
for comorbid mental disorders.
Check Out These Books
On Adolescent Recovery & Relapse Prevention
Preventing
Adolescent Relapse
Adolescent
Relapse Prevention Workbook
Recovery
Wars: The Attack of The Relapse Man
(A Comic Book for Recovery)
Review
Related
GORSKI-CENAPS Courses & Conference Presentations
References
1)Substance Abuse and Mental Health Services Administration (1997a).
Drug Abuse Series: H-3. Preliminary Estimates from the 1996 National
Household Survey on Drug Abuse. Office of Applied Studies, July
1997.
2)National Institute on Drug Abuse (1997). Press Release for the
Monitoring the Future Study, The University of Michigan Institute for
Social Research, December 1997.
3)Substance Abuse and Mental Health Services Administration (1997b). 1996
National Household Survey on Drug Abuse: Preliminary Tables
(Unpublished). Office of Applied Studies, June 1997.
4)Schwartz, R.H., Gruenewald, P.J., Klitzner, M., and Fedio, P.
(1989) Short-term memory impairment in cannabis-dependent adolescents. American
J. of Diseases of the Child 1989; 143:1214-1219.
5)Tashkin, D.P., Coulson, A.H., Clark, V.A., et al. Respiratory
system and lung function in habitual, heavy smokers of marijuana alone,
smokers of marijuana and tobacco, smokers of tobacco alone, and
nonsmokers. Am Rev Respir Dis 1987; 135:209-216.
6)National Institute on Drug Abuse (1995) Marijuana: Facts Parents
Should know. Booklet NCADI #PHD712, GPO#017-024-01570-0.
7)Substance Abuse and Mental Health Services Administration (1998).
Drug Abuse Series: H-5. National Household Survey on Drug Abuse Main
Findings 1996, Office of Applied Studies, May 1998.
8)Pope, HG Jr, Yurgelun-Todd,D. The residual cognitive effects of
heavy marijuana use in college students. JAMA 1996 Feb 21;
275(7): 521-7.
9)Volkow, N.D., Ding, Y.-S., Fowler, J.S., & Wang, G.-J. 1996.
Cocaine Addiction: Hypothesis Derived from Imaging Studies with PET. J.
Addictive Diseases, 1996.
10)Bourden, H., Rae, D., Narrow, W., Manderscheid, R., and Regier,
D., National Prevalence and Treatment of Mental and Addictive
Disorders, Mental Health, United States, Center for Mental Health
Services, DHHS Pub. No. (SMA)92-1942 (1992).
11)Kandel, D.B., Johnson, J.G., Bird, H.R., Canino, G., Goodman, S.H.,
Lahey, B.B., Regier, D.A., and Schwab-Stone, M. Psychiatric Disorders
Associated with Substance Use Among Children and Adolescents: Findings
from the Methods for the Epidemiology of Child and Adolescent Mental
Disorders (MECA) Study. Journal of Abnormal Child Psychology
1997, 25(2), pp. 121-132.
12)
Kessler, R.C., Nelson, C.B., McGongle, K.A., Edlund, M.J., Frank, R.G.,
and Leaf, P.J., The Epidemiology of Co-occurring Addictive and Mental
Disorders in the National ComorbiditySurvey: Implications for Prevention
and Service Utilization. American Journal of Orthopsychiatry 66:17-31
(1996).
13)Substance Abuse and Mental Health Services Administration (1996). Advance
Report 15. Mental Health Estimates from the 1994 National Household
Survey on Drug Abuse. Office of Applied Studies, July 1996.
14)Crowley, T (1998). Troubled Teens Risk Rapid Dependence on
Marijuana. Drug and Alcohol Dependence 50:1.
15)Achenbach, T.M., (1991) Manual for the youth Self-Report and 1991
profile. Burlington, VT: University of Vermont Department of Psychiatry.
16)Harrell, A.V., Kapsak, K.A., Cisin, I.H., and Wirtz, P.W. (1986). The
Validity of Self-Reported Drug Use Data: The Accuracy of Responses on
Confidential Self-Administered Answer Sheets. Prepared for the
National Institute on Drug Abuse, Contract Number 271-85-8305.
17)Turner, C.F., Lessler, J.T., and Gfroerer, J.C. (1992). Survey
Measurement of Drug Use: Methodological Studies. National Institute
on Drug Abuse. DHHS Pub. No. (ADM) 92-1929.
18)Gfroerer, J.C. (1997). Prevalence of youth substance use: the
impact of methodological differences between two national surveys. Drug
and Alcohol Dependence 47 (1997) 19-30.
