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Biomedical subjects

Andrew R Morral

Publications and source records attributed to Andrew R Morral.

17 recordsLinked to original sources
PubMed2006

Is the drug court model exportable? The cost-effectiveness of a driving-under-the-influence court.

We assessed the cost-effectiveness of the Rio Hondo driving-under-the-influence (DUI) court, a therapeutic court intervention in Los Angeles County targeted to repeat DUI offenders. The effectiveness of this court intervention was determined through a randomized controlled field experiment. Although prior research does not identify differences in alcohol-related or criminal behavior between treated and control individuals at follow-up, we found improvements in behavior for all program participants regardless of treatment status. A cost-minimization analysis found that, on average, costs of the DUI court exceeded traditional court expenditures for second-time offenders but produced cost savings for third-time offenders. This suggests that implementing a DUI-specific court intervention for serious DUI recidivists is a worthwhile investment of public resources. The unique legal treatment of DUI offenders in California may hide additional cost savings that could be accrued in other jurisdictions through the adoption of DUI court programs.

Alcohol Drinking↗
PubMed2006

Reducing substance use improves adolescents' school attendance.

AIMS: Substance use initiation and frequency are associated with reduced educational attainments among adolescents. We examined if decreases in substance use substantially improve youths' school attendance. DESIGN: A total of 1084 US adolescents followed quarterly for 1 year after entering substance abuse treatment. METHODS: Random and fixed effects regression models were used to differentiate the lagged effects of drug use from other time-varying and time-invariant covariates. Self-reports of alcohol, marijuana, stimulants, sedatives, hallucinogens and other drug use were used to predict subsequent school attendance, after controlling for demographic and drug use history characteristics, problem indices and other covariates. FINDINGS: Reductions in the frequency of alcohol, stimulants and other drug use and the elimination of marijuana use were each associated independently with increased likelihoods of school attendance. CONCLUSIONS: Because years of completed schooling is highly correlated with long-term social and economic outcomes, the possibility that reductions in substance use may improve school attendance has significant implications for the cost-effectiveness of substance abuse treatment and other interventions designed to reduce adolescents' substance use.

Absenteeism↗
PubMed2006

Marijuana use and depression among adults: Testing for causal associations.

AIM: To determine whether marijuana use predicts later development of depression after accounting for differences between users and non-users of marijuana. DESIGN: An ongoing longitudinal survey of 12 686 men and women beginning in 1979. SETTING: The National Longitudinal Survey of Youth of 1979, a nationally representative sample from the United States. PARTICIPANTS: A total of 8759 adults (age range 29-37 years) interviewed in 1994 had complete data on past-year marijuana use and current depression. MEASUREMENTS: Self-reported past-year marijuana use was tested as an independent predictor of later adult depression using the Center for Epidemiologic Studies-Depression questionnaire. Individual's propensity to use marijuana was calculated using over 50 baseline covariates. FINDINGS: Before adjusting for group differences, the odds of current depression among past-year marijuana users is 1.4 times higher (95% CI: 1.1, 1.9) than the odds of depression among the non-using comparison group. After adjustment, the odds of current depression among past-year marijuana users is only 1.1 times higher than the comparison group (95% CI: 0.8, 1.7). Similarly, adjustment eliminates significant associations between marijuana use and depression in four additional analyses: heavy marijuana use as the risk factor, stratifying by either gender or age, and using a 4-year lag-time between marijuana use and depression. CONCLUSIONS: After adjusting for differences in baseline risk factors of marijuana use and depression, past-year marijuana use does not significantly predict later development of depression. These findings are discussed in terms of their relevance for understanding possible causal effects of marijuana use on depression.

Adult↗
PubMed2006

Acculturation and driving under the influence: a study of repeat offenders.

OBJECTIVE: In California, driving under the influence (DUI) arrest and conviction rates are disproportionately higher among the Hispanic population. Acculturation and other factors associated with drinking and driving may help explain this disparity. METHOD: Interviews with Hispanic repeat DUI offenders were conducted immediately prior to sentencing and 2 years later. Arrest records from these offenders were also examined. Analyses were performed to examine the association between acculturation and other sociodemographic characteristics at baseline with DUI arrests and convictions at a 2-year follow-up. RESULTS: Logistic regression modeling showed that acculturation was significantly related to self-reported DUI recidivism even after controlling for other factors associated with DUI convictions during a 2-year follow-up. Acculturation was not found to have a statistically significant relation to DUI arrest rates during that same period. CONCLUSIONS: Among a Hispanic sample of repeat DUI offenders, the less-acculturated members were more likely to report a repeat DUI conviction at 2-year follow-up than the more-acculturated ones, even after controlling for other characteristics associated with DUI behaviors, such as drinking severity and marital status. The same pattern was not found between acculturation and arrest rates. Acculturation may serve as a risk factor for repeat convictions. Efforts to reduce multiple DUI convictions may need to consist of ways to target persons who are less acculturated.

Acculturation↗
PubMed2005

Predicting DUI recidivism: Personality, attitudinal, and behavioral risk factors.

AIMS: To predict DUI recidivism using personality, attitudinal, and behavioral factors. DESIGN: We conducted cross-sectional analyses of survey data. Covariance structure modeling was used to identify unique predictors of driving after drinking (DAD), alcohol consumption, and high-risk driving. PARTICIPANTS: Two hundred and eighty individuals with multiple DUI convictions, predominately male and Hispanic. Participants were surveyed in the Rio Hondo Courthouse, Los Angeles County, California. MEASUREMENTS: The survey included measures of past year frequency of DAD, socially desirable response bias, sensation seeking, trait hostility, high-risk driving style, alcohol expectancies, and alcohol consumption. FINDINGS: DAD was positively related with frequency of drinking and with positive alcohol expectancies. It was negatively associated with socially desirable response bias. Measures of high-risk driving and the personality variables were highly negatively associated with socially desirable response bias. CONCLUSIONS: Individuals who believe that they are affected positively by alcohol intoxication are not responding to the standard penalties for DUI and persist in driving after drinking. These beliefs may serve as an important point of intervention for programs designed to reduce drunk driving. The current research also suggests that self-report measures of DAD, as well as many hypothesized risk factors, are highly correlated with socially desirable response biases. Failure to control for such biases may be a significant threat to the validity of research in this field.

Adult↗
PubMed2005

Dynamic effects among patients' treatment needs, beliefs, and utilization: a prospective study of adolescents in drug treatment.

OBJECTIVE: To document the prospective, reciprocal relationships among substance use problems, utilization of drug treatment, and predisposing beliefs thought to increase treatment utilization. DATA SOURCE: Persistent Effects of Treatment Study-Adolescent (PETS-A), conducted by the Center on Substance Abuse Treatment. This was a longitudinal study of youths originally participating in one of two CSAT studies; one sample included 476 youths receiving residential drug treatment, and the other included 519 youths receiving outpatient treatment. STUDY DESIGN: This study uses five waves of data collected over a 12-month period to examine the temporal relationships among four variables: treatment dose, substance use problems, drug resistance self-efficacy, and perceived need for treatment (PNT). Data from this longitudinal study were analyzed using cross-lagged panel models, and structural equation modeling techniques were used to estimate the prospective, reciprocal relationships among these four variables in each of the two samples, while controlling for several covariates. PRINCIPAL FINDINGS: Both PNT and low drug resistance self-efficacy led to higher levels of subsequent treatment. However, low self-efficacy presaged increases in drug problems while PNT predicted decreases. CONCLUSIONS: Understanding the role of psychological variables in the utilization of health services is complicated for psychological disorders because beliefs that affect treatment can also influence the disorder itself. Efforts to keep adolescents in drug treatment should focus on convincing youth that treatment can help them with their problems, rather than convincing them that they cannot resist drugs on their own. While both messages increase treatment utilization, the latter belief undermines the effects of treatment.

Adolescent↗
PubMed2005

Drink-driving and DUI recidivists' attitudes and beliefs: a longitudinal analysis.

OBJECTIVE: Cross-sectional survey research has shown correlations between drink-driving behavior and people's beliefs concerning the riskiness, social acceptability and morality of driving under the influence of alcohol. The current study examines the association between such beliefs and subsequent alcohol-impaired driving in a sample of offenders who were driving under the influence (DUI). METHOD: Repeated interviews were conducted with 182 multiple DUI offenders. Baseline data included measures of moral and prescriptive beliefs concerning alcohol-impaired driving (internal behavioral controls), perceived risks of criminal punishment and crashes associated with alcohol-impaired driving (external behavioral controls) and perceived peer-group attitudes toward alcohol-impaired driving (social control). The dependent variable in the study was a measure of self-reported alcohol-impaired driving over the preceding 2 years, collected at 2-year follow-up from baseline. RESULTS: Results from multiple regression modeling showed significant protective effects associated with the beliefs that driving after drinking is immoral and that random police sobriety checks are a good idea (internal control items). Results also showed that a social desirability control measure was predictive of increased risk, at follow-up, for driving after drinking. CONCLUSIONS: These results suggest that internal controls may protect against alcohol-impaired driving behavior, even in a high-risk sample of repeat DUI offenders. The results also suggest that future policy interventions to curtail drink-driving might profitably be designed to promote these sorts of behavioral controls.

Adult↗
PubMed2004

Shaping smoking cessation using percentile schedules.

Behavioral interventions that provide incentives contingent upon abstinence are effective addiction treatments. Nevertheless, these treatments often fail for individuals whose recent behaviors are very different from those reinforced. These hard-to-treat individuals may require shaping to achieve abstinence. We used percentile schedules to shape smokers' delivery of breath samples indicative of recent smoking abstinence (breath carbon monoxide (BCO) <4 ppm). Percentile schedules deliver incentives to current behaviors proximal to the target. Participants (N = 102) were assigned to treatments delivering incentives for breath COs at or below the 10th, 30th, 50th, or 70th percentile of recent breath COs. Each condition effectively ensured contact with available contingencies, and resulted in BCO <4 ppm in >90% of the 30th, 50th and 70th percentile groups versus 63% in the 10th percentile. The 30th, 50th and 70th percentiles were especially effective in a sub-sample of hard-to-treat participants who did not deliver a breath CO <4 ppm during an initial abstinence test or during a nine-visit baseline period, suggesting the value of shaping for this important sub-sample.

Adult↗
PubMed2004

Effectiveness of community-based treatment for substance-abusing adolescents: 12-month outcomes of youths entering phoenix academy or alternative probation dispositions.

Whereas strong efficacy research has been conducted on novel treatment approaches for adolescent substance abusers, little is known about the effectiveness of the substance abuse treatment approaches most commonly available to youths, their families, and referring agencies. This report compares the 12-month outcomes of adolescent probationers (N = 449) who received either Phoenix Academy, a therapeutic community for adolescents that uses a treatment model that is widely implemented across the U.S., or an alternative probation disposition. Across many pretreatment risk factors for relapse and recidivism, groups were well matched after case-mix adjustment. Repeated measures analyses of substance use, psychological functioning, and crime outcomes collected 3, 6, and 12 months after the baseline interview demonstrated that Phoenix Academy treatment is associated with superior substance use and psychological functioning outcomes over the period of observation. As one of the most rigorous evaluations of the effectiveness of a traditional community-based adolescent drug treatment program, this study provides evidence that one such program is effective. Implications of this finding for the dissemination of efficacious novel treatment approaches are discussed.

Adolescent↗
PubMed2004

Propensity score estimation with boosted regression for evaluating causal effects in observational studies.

Causal effect modeling with naturalistic rather than experimental data is challenging. In observational studies participants in different treatment conditions may also differ on pretreatment characteristics that influence outcomes. Propensity score methods can theoretically eliminate these confounds for all observed covariates, but accurate estimation of propensity scores is impeded by large numbers of covariates, uncertain functional forms for their associations with treatment selection, and other problems. This article demonstrates that boosting, a modern statistical technique, can overcome many of these obstacles. The authors illustrate this approach with a study of adolescent probationers in substance abuse treatment programs. Propensity score weights estimated using boosting eliminate most pretreatment group differences and substantially alter the apparent relative effects of adolescent substance abuse treatment.

Evaluation Studies as Topic↗
PubMed2004

How can repeat drunk drivers be influenced to change? Analysis of the association between drunk driving and DUI recidivists' attitudes and beliefs.

OBJECTIVE: Public policy interventions designed to deter or prevent drunk driving depend, in part, on modifying beliefs concerning the riskiness, social acceptability and immorality of driving under the influence of alcohol. The current study examines the association of these beliefs with the incidence of alcohol-impaired driving. METHOD: Interviews were conducted with 273 people with multiple driving under the influence (DUI) offenses. Data included self-reported frequency of driving after drinking in the past year, as well as measures of moral and prescriptive beliefs concerning alcohol-impaired driving (internal behavioral controls), perceived risks of criminal punishment and accidents associated with alcohol-impaired driving (external behavioral controls) and perceived peer group attitudes toward alcohol-impaired driving (social controls). RESULTS: Logit regression modeling showed significant, unique protective associations with behavioral control items in each category. CONCLUSIONS: Behavioral controls may protect against alcohol-impaired driving behavior even in a high-risk sample of repeat DUI offenders. Policy interventions designed to curtail drunk driving might seek to enhance these sorts of behavioral controls among DUI offenders.

Alcoholic Intoxication↗
PubMed2003

The influence of partner drug use and relationship power on treatment engagement.

Substance-using intimate partners negatively influence individuals' substance abuse treatment engagement and drug use, but little else is known about effects of intimate relationships on treatment. We examine how relationship dynamics (power, control, dependence, insecurity and decision-making power) influence treatment engagement, and whether this differs by gender and partner drug use. Sixty-four heroin users (42 men, 22 women) receiving methadone detoxification treatment in Los Angeles were interviewed at treatment entry and submitted daily diaries of drug use throughout the 21-day treatment. Total number of reported heroin-free days in the first eight treatment days was the dependent variable. Bivariate analyses revealed, that compared to men, women were more likely to have substance-using partners, reported greater power over a partner and greater household decision-making power in their relationships. Multivariate analysis indicated that individuals whose partners had more control over them reported fewer days abstinent. Among individuals with heroin-using partners, greater household decision-making power was associated with more days abstinent, but there was no association for individuals with non-using partners. Relationship power dynamics may be important influences on the treatment process, and some dimensions of power may interact with partner drug use status.

Adult↗
PubMed2003

Retention of court-referred youths in residential treatment programs: client characteristics and treatment process effects.

The juvenile justice system relies heavily on residential treatment services for adolescents. Because treatment dropout limits the likely effectiveness of these services, in this study we examine the client and program characteristics associated with program retention among a sample of adolescent probationers referred to residential rehabilitation by the Juvenile Court in Los Angeles. Participants in the present study (n = 291) are a subset of those in the Adolescent Outcomes Project, conducted within RAND's Drug Policy Research Center, to examine the outcomes of youths entering treatment at seven residential treatment programs. Three months after a preadmission interview, youths were asked about their perceptions of counselors at the program, other residents, and their feelings of safety in the program. In addition, they were asked whether they needed and had received various services (e.g., job training, legal advice, family counseling). Results of a multivariate survival analysis revealed that pretreatment characteristics including motivation and substance use severity, as well as treatment program factors including safety, and perceived over- and underprovision of services, contribute significantly to the prediction of retention. Pretreatment environmental risk factors and ratings of program counselor and resident support were marginally significant. These results imply that changes in adolescent residential program delivery may serve to increase retention rates, thus improving long-term outcomes.

Adolescent↗
PubMed2003

Mental health and medical problems and service use among adolescent substance users.

OBJECTIVE: Adolescents entering the substance abuse treatment system frequently exhibit mental health and medical problems. Because little is known about whether these youths receive services to address these problems, this study examined the services received by youths admitted to substance abuse treatment. METHOD: Admission and 3-month follow-up reports of mental health, medical problems, and service use were examined within a large cohort (N = 1,088) of 12-19-year-olds admitted to seven inpatient and outpatient substance abuse treatment programs across the United States between 1998 and 2001. RESULTS: High levels of mental health problems were found at both time points, but few received mental health treatment. In contrast, there were lower rates of medical problems, and more than half received services. Logistic regression predicting mental health treatment receipt found females in residential settings with more current and baseline distress to be more likely to receive services. Ethnicity, baseline behavioral problems, and whether or not currently in substance abuse treatment did not predict service use. A logistic regression predicting medical services showed that females in residential treatment were also more likely to receive medical treatment. CONCLUSION: Although these results require replication and validation, they suggest that more could be done to take advantage of the opportunity to link youths entering substance use treatment with mental health services.

Adolescent↗
PubMed2002

Reassessing the marijuana gateway effect.

AIMS: Strong associations between marijuana use and initiation of hard drugs are cited in support of the claim that marijuana use per se increases youths' risk of initiating hard drugs (the 'marijuana gateway' effect). This report examines whether these associations could instead be explained as the result of a common factor-drug use propensity-influencing the probability of both marijuana and other drug use. DESIGN: A model of adolescent drug use initiation in the United States is constructed using parameter estimates derived from US household surveys of drug use conducted between 1982 and 1994. Model assumptions include: (1) individuals have a non-specific random propensity to use drugs that is normally distributed in the population; (2) this propensity is correlated with the risk of having an opportunity to use drugs and with the probability of using them given an opportunity, and (3) neither use nor opportunity to use marijuana is associated with hard drug initiation after conditioning on drug use propensity. FINDINGS: Each of the phenomena used to support claims of a 'marijuana gateway effect' are reproduced by the model, even though marijuana use has no causal influence over hard drug initiation in the model. CONCLUSIONS: Marijuana gateway effects may exist. However, our results demonstrate that the phenomena used to motivate belief in such an effect are consistent with an alternative simple, plausible common-factor model. No gateway effect is required to explain them. The common-factor model has implications for evaluating marijuana control policies that differ significantly from those supported by the gateway model.

Adolescent↗
PubMedDate not supplied

Measurement of adolescent drug use.

There is widespread agreement that estimates of adolescent drug use prevalence from the National Household Survey of Drug Abuse (NHSDA) and Monitoring the Future (MTF) are subject to considerable measurement error. Nevertheless, some have suggested that trends over time in these prevalence estimates probably reflect true trends in drug use, since underreporting may be assumed to be constant over time. A recent National Research Council report criticizes this assumption on logical grounds. The present study examines adolescent drug use responses on the NHSDA and MTF for evidence of "drug omission," "jargon confusion" and "conceptual confusion," three types of misreporting expected to vary in magnitude with changes in drug use practices and changes in survey items. Results demonstrate that adolescent drug users are significantly more likely than adults to report use of drugs not listed in the NHSDA. Among adolescents who wrote in the "other" drugs they used, 66% and 86% of hallucinogen and inhalant responses showed confusion over the meaning of the pharmacological terms used in the NHSDA. Almost 20% of MTF respondents who report lifetime use of Rohypnol or ecstasy, when specifically queried about these drugs, deny lifetime use of any substances in the drug classes intended to assess use of Rohypnol and ecstasy. MTF respondents reporting lifetime use of PCP underreport use of hallucinogens at rates that vary substantially over time, from a high of 45% (in 1986), to a low of just 8% (in 1998). The implications of these findings for adolescent drug use prevalence estimation and survey design are discussed.

Administration, Inhalation↗