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Substance use and violent behavior in adolescence
Pergamon
Aggression and Violent Behavior, Vol. 1, No. 4, pp. 375-387, 1996 Copyright © 1996 Elsevier Science Ltd Printed in the USA. All fights reserved 1359-1789/96 $15.00 + .00
PH S1359-1789(96)00008-0
SUBSTANCE USE AND VIOLENT BEHAVIOR IN ADOLESCENCE Eric F. Wagner Center for Alcohol and Addiction Studies, Brown University
ABSTRACT. The relation between substance use and violent behavior in adolescence is reviewed, and each of five competing models of this relation is examined. I begin by presenting background material on adolescent substance use and adolescent violence. I then describe five different models that have been proposed to explain the association between substance use and violent behavior. Next, I review the adolescent literature concerning substance use and violence, noting methodological weaknesses that have plagued this research. I conclude with an evaluation of the five models and suggestions for future research. Copyright © 1996 Elsevier Science Ltd
NEWCOMB AND BENTLER (1988) have suggested that substance use "may be considered a normative behavior among United States teenagers in terms of prevalence, and from a developmental task perspective" (p. 214). This quote expresses two important issues regarding substance use among adolescents. First, most teenagers will try alcohol and/or other drugs during their adolescent years. For example, in 1994, 80.4% of high school seniors reported using alcohol at some point in their life, 50.1% admitted alcohol use within the last 30 days, 38.2% reported using marijuana at some point in their life, and 19.0% admitted marijuana use within the last 30 days (Johnston, O'Malley, & Bachman, 1994). Second, alcohol and other drug use during adolescence has developmental importance. Many teenagers experiment with substance use in much the same way they experiment with personal appearance and political views. Furthermore, adolescent substance use simultaneously represents the emulation of adults' substance use behavior and the rejection of adult rules prohibiting alcohol and other drug use among minors. In short, substance use among many adolescents can be and has been argued to reflect normal teenage development (Shedler & Block, 1990). Despite the prevalence and developmental importance of adolescent alcohol and other drug use, any substance use by teenagers is an important public health concern. In the case of alcohol, the drug more adolescents have tried than any other, there are several reasons why its use by teenagers may be troublesome. First, alcohol consumption by minors is illegal. Adolescents who consume alcoholic beverages are violating the law. Second, although the Correspondence should be addressed to Eric E Wagner, 3630 N. Bayhomes Drive, Miami, FL 33133. 375
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majority of teenagers who try alcohol do not become problem drinkers, early initiation of drinking is one of the strongest predictors of subsequent alcohol use problems. Third, alcohol use during adolescence directly increases the risk of morbidity and mortality. For example, the risk of traffic crash involvement is nine times higher for teenagers with a blood alcohol level of only .03g/dl (about two drinks) than for youth who have not been drinking. Finally, the majority of alcohol-related death and disability experienced by individuals of all ages is attributable to moderate drinkers. Thus, an adolescent does not have to be a heavy and frequent drinker to experience negative consequences from alcohol use. Similar public health concerns are associated with the use of other drugs during adolescence. An additional concern in regard to adolescent drinking and other drug use is that a sizable minority of teenagers will demonstrate substance-related problems. For example, a recent epidemiological study found that 4% of randomly selected high school students met DSMIII-R diagnostic criteria for substance abuse during the course of a single year (Lewinsohn, Hops, Roberts, Seeley, & Andrews, 1993). Among more highly selected adolescent samples (e.g., juvenile offenders, emotionally disturbed adolescents), much higher rates of substance abuse have been documented (Greenbaum, Prange, Friedman, & Silver, 1991; Kaminer, Wagner, Plummer, & Seifer, 1993; Milin, Halikas, Meller, & Morse, 1991; Winters, 1991). ADOLESCENT VIOLENT BEHAVIOR Violence includes "both intentional and unintentional sudden occurrences that may result in physical or psychological injury to one or more persons" (Sussman, Dent, Stacy, Burton, & Flay, 1994, p. 29). Examples of intentional violent events include suicide and homicide attempts; examples of unintentional violent events include accidents. Aggression is "any form of behavior directed toward the goal of harming or injuring another living being who is motivated to avoid such treatment" (Baron, 1977, p. 7). Physical fighting, murder, and rape are examples of aggressive acts. Finally, delinquency is "that behavior of a juvenile which involves the attempt to obtain desired goods by illegitimate means" (Hirshi & Selvin, 1967, p. 184). Delinquency includes a wide range of behaviors, some of which directly involve violent behavior (e.g., fighting, intentionally hurting someone) and some of which do not (e.g., theft, trespassing, running away). Recent survey research indicates that a small but significant minority of adolescents commits violent acts. In 1993, a national sample of high school seniors was asked "During the last 12 months how often have you...T' engaged in a variety of delinquent behaviors (U.S. Department of Justice, 1993). In regard to violent delinquent behaviors, 22.2% of high school seniors reported participating in a group fight, 17.7% reported involvement in a serious fight at school or work, 13.4% reported that they had hurt someone badly enough to need bandages or a doctor, 4.6% reported using a weapon against someone, and 3.6% reported hitting an instructor or supervisor. In a separate study of the past month prevalence of fighting in a sample of South Carolina eleventh and twelfth graders, 41% reported involvement in a physical fight and 5.5% reported involvement in a fight resulting in an injury requiring medical care (Valois, Vincent, McKeown, Garrison, & Kirby, 1993). THEORETICAL MODELS OF THE RELATION BETWEEN SUBSTANCE ABUSE A N D VIOLENT BEHAVIOR IN ADOLESCENCE It is well established that there is a significant correlation between substance use and violent behavior across a number of studies of both adolescents and adults. This had led to extensive hypothesizing about the nature of this relation. However, it is important to recognize that we currently know very little about the causal connection between alcohol and other drug use and violent behavior. As noted by the U.S. Secretary of Health and Human Services (1993),
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substance use is not the only cause of violence. Violent episodes frequently occur between sober people with no history of heavy alcohol or other drug use. Furthermore, the majority of drinkers and other drug users, and this includes the heaviest of such users, never engage in violent behavior.
Model 1: Substance Use Causes Violent Behavior One model of the relation between substance use and violent behavior is that heavy substance use leads to violence. One example of such a model is the "economic necessity hypothesis," the crux of which is that heavy substance users commit violent, criminal acts in order to generate income to support their substance use habit (Goldstein, 1985). Another example of such a model is the criminal subculture model (Goldstein, 1985), in which it is hypothesized that users of illicit substances are necessarily drawn into a criminal subculture because of their need to obtain substances that are illegal. Repeated contact with this criminal subculture increases the likelihood of exposure to and participation in violent, criminal behavior. A third example involves psychopharmacological models, each of which hypothesizes that psychopharmacological effects of intoxication (e.g., disinhibition, cognitive-perceptual distortions, attention deficits), as well as situational factors associated with intoxication, increase the likelihood that an individual will engage in violent behavior (Boyatzis, 1977, 1983; Marlatt & Rohsenow, 1980; Room & Collins, 1983; Taylor & Leonard, 1983; Taylor & Chermack, 1993). In sum, Model 1 models share in common the idea that heavy substance use engenders violence.
Model 2: Violent Behavior Causes Substance Use A second model of the relation between substance use and violent behavior is that violent behavior leads to heavy substance use. One example of this type of model is "the crime outgrowth hypothesis" (Burr, 1987), which states that heavy use of alcohol and other drugs is a natural consequence of leading a criminal, violent lifestyle. From this perspective, violent, delinquent adolescents are especially attracted and vulnerable to using substances because such behavior embodies an unconventional and criminal image and fits with their own deviant view of the world. A second variant of this type of model is best described as "the social selection hypothesis" and assumes that aggressive individuals are more likely than nonaggressive individuals to select or be pushed into social situations in which heavy substance used is condoned or encouraged (Johnston, O'Malley, & Eveland, 1978). Model 2 models share the notion that violent individuals are somehow prone to becoming heavy substance users.
Model 3: The Reciprocal Model A third model of the relation between substance use and violent behavior is that this relation is bidirectional in nature. A consequence of heavy drinking or other drug use may be increased aggression, and increased aggression may lead to more drinking or substance use. Gandossy, Williams, Cohen, and Harwood (1980) described such an interactive pattern as typical of the crime-drug relation for addictive, expensive drugs: violent crime finances use, use encourages more use, and more use encourages more violent crime.
Model 4: The Common Cause Model A fourth model of the relation between substance use and violent behavior suggests that this relation, to the degree that it has been found in previous studies, is illusory (Fagan, Weis, & Cheng, 1990). Specifically in regard to adolescents, White (1991) has argued that substance use and delinquency are both elements in a concurrent cluster of other adolescent problem
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behaviors or a general deviance orientation. Stated another way, substance use and delinquent behavior are not causally linked but rather share common causes (Milgram, 1993). Hirschi's (1969) control theory represents one common cause model. From this perspective, adolescents who are not well bonded to their parents, teachers, and schools (i.e., social control is weak) are more likely to engage in both substance use and delinquency. Another example of a common cause model is Suthedand and Cressey's (1978) differential association theory, in which association with deviant peers is assumed to induce both substance use and delinquent behavior. In sum, proponents of common cause models would argue that substance use and violent behavior only appear causally related; in actuality, both behaviors are the result of some third underlying psychological or social cause.
Model 5: The Independent Cause Model A final model of the relation between substance use and violent behavior suggests that they are distinct phenomena with separate influences. As suggested by White (1991) in her coincident hypothesis, the substance use and delinquency relationship seen during adolescence may simply be the result of the synchronous occurrence of both behaviors during the same period in development. White argues that onset of adolescent experimentation in both behaviors generally occurs in early to mid adolescence. However, most adolescents mature out of delinquency by late adolescence while the majority of substance users increase their alcohol and other drug use through adolescence and into young adulthood. Like common cause models, proponents of an independent cause model would argue that substance use and violent behavior only appear causally related. However, the independent cause model differs from the common cause models because substance use and violent behavior are assumed to possess independent and separate causes. RECENT EMPIRICAL RESEARCH O N THE RELATION BETWEEN SUBSTANCE USE A N D VIOLENT BEHAVIOR IN ADOLESCENCE
Methodological Issues Several methodological problems plague the existing research. The first problem is that the overwhelming majority of studies in this area are correlational in design. From the perspective of a single measurement point, the coocurrence of substance use and violent behavior is examined. The major limitation of this type of design is that it does not permit causal inferences to be drawn as to the relations between the two phenomena under study. The second problem is that many studies in this area do not adequately consider or control for potentially confounding influences (Dembo, Williams, Fagan, & Schmeidler, 1993; Fagan et al., 1990). For example, violent adolescents may misrepresent their substance use in an attempt to excuse their violent behavior or to avoid punishment for violent acts. Research concerning alcohol or other drug use in a sample of adolescent offenders is clearly vulnerable this type of confound. A second potential confound is that substance use may accompany participation in group events in which there is high risk of violence. As an example, teenagers who use alcohol or other drugs may consume substances while attending rock or rap concerts. Certain aspects of such concerts, including the security staff or the performers themselves, may instigate violent behavior from the audience. Thus, it is the nature of the event, rather than the ingestion of substances per se, that leads to violence. A third potential confound is more systemic in nature. It may be society's prohibitions against use of illicit substances and the resulting high-priced black market, rather than any direct properties of substance use itself, that lead users to commit violent acts to support their habits. A final potential confound is that drug-related bungling of violent crimes may increase likelihood of
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capture. As a result, the finding that substance use and violent crime are strongly related may reflect the fact that delinquents who are heavy users of alcohol and other drugs may be more likely to get caught than delinquents who are less substance involved. A third problem is that many studies have used biased samples (Fagan et al., 1990). For example, several investigations have used captive samples of adolescents in juvenile detention facilities. Such samples do not represent the general population and, as noted in the preceding paragraph, may be inclined to intentionally misrepresent their behavior. General population studies are subject to a different type of bias. Typically, these investigations draw their sampies from schools. Dropouts, absentees, and noncompliant adolescents are not included in these samples, which leads to an undersampling of heavy substance users and delinquents. A third type of bias affects studies which use samples drawn from high density, urban populations. Explanations of the relations between substance abuse and violence become confounded with influences associated with urbanism, such as lower class socialization processes and the ecological effects of urban social areas. A final problem concerns issues in regard to the measurement of both substance use and violence (Fagan etal., 1990). Typically, studies rely on either self-report or official records but not both. While both data sources have their strengths and weaknesses, estimates of substance use and violence obtained through self-report are likely to be quite different from parallel estimates obtained through official records. Self-report data are influenced by adolescents' willingness to admit socially proscribed behaviors, whereas official records reflect only those behaviors that have been documented by some external agency. Furthermore, there are conflicting definitions of alcohol and other drug use and violence/delinquency across studies, and there is currently little consensus as to what are the best indices of these behaviors (e.g., in some studies, violence has been measured terms of its severity; in other studies, violence has been measured in terms of the overall frequency of violent acts). The above described methodological issues notwithstanding, I will review recent empirical studies on the relation between adolescent substance use and violence. I have confined my review to studies published since 1986 because Fagan et al. (1990) have published a comprehensive review of earlier investigations. I will review correlational and longitudinal studies separately, with specific attention to the samples and operational definitions of substance use and violence used in each investigation.
Correlational Studies Johnson, Wish, Schmeidler, and Huizinga (1991) examined the relation between substance use and delinquency in a 1979 probability sample of 1,539 adolescents (gender distribution reported as "representative of 11-17 year olds in 1976") aged 14-20 who took part in the multistage National Youth Survey. Substance use was measured by a self-report questionnaire concerning the use of seven drugs. Participants reported how often they had used each drug in the past year and were subsequently classified hierarchically as cocaine users, pills/psychedelics users, marijuana users, alcohol users, and nondrug users. Delinquency was measured by a self-report questionnaire that included 47 items representing a range of acts for which juveniles can be arrested. Participants reported how many times they had engaged in each behavior during a I-year period and were subsequently classified hierarchically as multiple index offenders, infrequent index offenders, minor offenders, or nondelinquents. Analyses revealed that multiple index offenders were three times more likely to use pills or cocaine than adolescents reporting less delinquency. Within a given delinquency type, higher delinquency rates were associated with the use of more serious drugs. Furthermore, high involvement in both index offending and serious drugs was associated with high delinquency rates and the commission of serious crimes.
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Valois et al. (1993) examined the predictors of violent behavior in a sample of 2,299 South Carolina eleventh and twelvth graders (52% female, 48% male). Data were collected using the Center for Disease Control's Youth Risk Behavior Survey (YRBS), a 70-item self-report questionnaire focused on violent and high risk behaviors. The YRBS includes a series of items concerning the 30-day prevalence of a variety of violent behaviors. Substance use is also included on the YRBS and is measured by five items concerning the 30-day prevalence of alcohol use, binge drinking, marijuana use, and cocaine use, and the lifetime prevalence of IV drug use. After adjusting for race and gender, univariate logistic regression analyses revealed that alcohol users were 3.86 times more likely to report fighting than nondrinkers, binge drinkers were 4.57 more likely to report fighting than those who did binge drink, and illicit substance users were 3.49 times more likely to report fighting than nonusers. Similar results were obtained in analyses predicting carrying a weapon to school; alcohol users were 2.95 times more likely to report carrying a weapon to school than nondrinkers, binge drinkers were 2.86 more likely to report carrying a weapon to school than those who did binge drink, and illicit substance users were 2.55 times more likely to report carrying a weapon to school than nonusers. In multivariate analyses, alcohol use was no longer associated with fighting, and all substance use variables were no longer associated with weapon carrying; however, binge drinkers remained more likely to report fighting than nonbinge drinkers (OR = 3.02), and illicit substance users continued to be more likely to report fighting than nonusers (OR = 2.02). Fagan et al. (1990) examined patterns of drug use and delinquency in a general population sample of 666 tenth-twelvth graders (49% female, 51% male) from inner-city, high crime neighborhoods. Drug use was measured by several self-report items concerning the number of occasions of using various drugs and the experience of substance use problems (i.e., negative social and personal consequences from substance use) during the past 12 months. Composite drug use scores included frequency of total drug use and the severity of drugs used, which was a hierarchical classification including the categories of none, alcohol, marijuana, and opiates/PCP/cocalne. Delinquency was measured by self-report items concerning the prevalence and incidence of a variety of delinquent behaviors during the past 12 months. Participants were subsequently classified hierarchically as multiple index offenders, serious delinquents, minor delinquents, petty delinquents, or nondelinquents. Results indicated the frequency and severity of drug use increased significantly as a function of the seriousness of delinquency. However, the proportion of subjects who were both serious drug users (i.e., used drugs frequently and used hard drugs) and serious delinquents (i.e., multiple index offenders) was approximately equal to the proportion of subjects who were serious drug users but nondelinquents. In regression analyses attempting to explain delinquency, substance use problems added little explanatory power to the models. However, inclusion of substance use problems resulted in significant increases in the explanatory power of regression models predicting the frequency and severity of substance use. Van Kammen, Loeber, and Stouthamer-Loeber (1991) examined the relations between substance use and delinquency in a general population sample of 856 seventh grade boys. Drug use was measured by several self-report items concerning lifetime and past 6-months use of cigarettes, beer, wine, liquor, marijuana, and glue. On the basis of their responses to the lifetime use items, boys were classified hierarchically as never having used any substances, having smoked cigarettes and/or drank beer or wine, having drank liquor, or having used marijuana. Delinquency was measured by 40 self-report items from the National Youth Survey. Each boy was asked to report whether he had ever engaged in each delinquent behavior and how often he had engaged in each behavior during the past 6 months. Results revealed that self-reported delinquency increased significantly as substance use involvement increased.
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Choquet, Menke, and Manfredi (1991) examined the relation between alcohol and drug consumption and interpersonal aggressive behavior in a sample of 1,602 suburban French adolescents (44% female, 56% male) aged 13-16. Alcohol and drug consumption were measured by nine self-report items concerning lifetime and current use of tobacco, alcohol, and illicit drugs. Interpersonal aggressive behavior was measured by four items concerning the frequency of aggressive behavior during the past year (i.e., broken things or hit people, shouted, taken part in fights, and used or threatened violence to obtain money/objects from people), and participants were subsequently classified as aggressive or nonaggressive. Compared to nonaggressive adolescents, aggressive adolescents were 2.7 times more likely to be regular smokers, 6.1 times more likely to be regular drinkers, and 4.7 times more likely to have tried illicit drugs. In multivariate logistic regression analysis attempting to explain aggression, drug users were more likely to report aggressive behavior than nonusers (OR = 4.1), and adolescents who reported regular drinking for at least 3 years were more likely to report aggressive behavior than nondrinkers (OR = 4.5). Inciardi and Pottieger (1991) conducted a street survey concerning drug use and crime with a sample of 254 seriously delinquent adolescents (15% female, 85% male) from Miami. All of the participants met criteria for serious delinquency, which was defined as having committed at least 10 FBI index offenses or 100 lesser crimes during the past year. Drug use was measured with a series of interview questions about drug use histories and the frequency of current use of various licit and illicit substances. Crime involvement was measured with a series of interview questions about the number and type of crimes committed during the past year. Results indicated that all of the participants had histories of multiple drug use, all reported having used marijuana regularly, and all but 50 (19.7%) had some type of current involvement in the crack cocaine business (i.e., the sale and distribution of crack cocaine). As the degree of involvement in the crack cocaine business increased, daily or at least regular use of such drugs as marijuana, depressants, and crack also increased. Furthermore, greater involvement in the crack cocaine business was associated with greater involvement in other types of criminal activity. Farrow and French (1986) studied the relationship between drug use and delinquent behavior in a sample of 91 juvenile correction facility detainees (26% female, 74% male). Drug use was measured with a series of interview questions concerning the frequency of use of various licit and illicit substances during the previous 6 months. Delinquent behavior was measured with a series of interview questions concerning lifetime criminal offenses. Additionally, participants were asked whether and how their drug use and delinquent behavior may be related. During the prior 6 months, 81% of the sample admitted alcohol or other drug use, 31% reported daily alcohol use, and 50% reported daily marijuana use. Thirty-five percent of this sample reported that all or most of their crimes were committed under the influence of drugs, while 29% reported that none of their crimes were committed under the influence. Thirty-nine percent of the sample reported that they believed that drug use was directly related to their criminal behavior, whereas 26% reported that they believed that their delinquent lifestyle led them to use drugs more often and in a greater variety. To summarize, recent correlational investigations are consistent in providing support for a relation between substance use and violent behavior in adolescence. General population studies have demonstrated that alcohol and other drug use is positively related to violence, with a two- to four-fold increase in the likelihood of committing violent acts among adolescents who are drug involved. Similarly, studies of delinquent samples have found that substance use and violent behavior are positively and significantly related. Furthermore, one investigation (i.e., Farrow & French, 1986) suggests that the relation between substance use and violent behavior may be different for different adolescents; some delinquents reported using drugs while committing crimes whereas others did not, and some delinquents believed
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that drugs led them to crime while others believed the reverse. However, due to their correlational design, none of the studies reviewed in this section can address causality in the association between teenage substance use and violence.
LongitudinalStudies Newcomb and McGee (1989) examined the relation between alcohol use and delinquent behavior in a community sample of 847 tenth-twelfth grade students (67% female, 33% male). Participants were assessed twice with a 1-year interval between assessments. Alcohol use was assessed at both time points by three self-report questions concerning the frequency of beer, wine, and liquor consumption during the past 6 months. At the second assessment, an additional item concerning the amount of alcohol consumed on a typical drinking day was also administered. Delinquent behavior was assessed at both time points by three dichotomous items (legal trouble, stealing, and school trouble), which were summed to provide a deviance events scale. At the second assessment, additional items concerning the frequency of 16 different delinquent acts during the past 6 months were also administered. Analyses were conducted separately for males and females due to gender differences in the rates of substance use and delinquency. For both females and males, causal modeling revealed that Time 1 alcohol use predicted Time 2 alcohol use, Time 1 deviance events predicted Time 2 deviance events, and Time 1 alcohol use predicted Time 2 deviance events and delinquent acts. However, Time 1 deviance events were not associated with Time 2 alcohol use among males, whereas Time 1 deviance events were modestly, yet significantly, related to Time 2 alcohol use among females. White, Brick, and Hansell (1993) examined the relation between alcohol use and aggressive behavior in a community sample of 431 New Jersey adolescents (49% female, 51% male). Participants were 12 years old when fwst contacted and were assessed three times with 3-year intervals between assessments. Alcohol use was assessed at all three time points by three measures derived from self-report items concerning alcohol use during the last year: typical quantity-frequency, most quantity-frequency, and number of times intoxicated. Aggressive behavior was assessed at all three time points by five self-report items: the number of times during the last three years participants hurt someone badly, used a weapon in a fight, engaged in vandalism, and hit parents, and the number of times during the last year participants fought at school. Alcohol-related aggression was also measured at all three time points with five items concerning the number of times during the last 3 years participants had engaged in aggressive acts while drinking or because of drinking. Because of low rates of aggressive behavior in females, analyses of the relation between alcohol and aggression were performed for males only. Causal modeling revealed that Time 1 alcohol use predicted Time 2 alcohol use, which in turn predicted Time 3 alcohol use. Similarly, Time 1 aggression predicted Time 2 aggression, which in turn predicted Time 3 aggression. No significant relations were found between alcohol use and subsequent aggressive behavior. In contrast, Tune 1 aggressive behavior predicted Time 2 alcohol use. Furthermore, both Time 1 aggressive behavior and Time 1 alcohol use predicted and Time 2 alcohol-related aggression, but early aggressive behavior was a better predictor than early alcohol use of later alcohol-related aggression. In a related study, White (1991) examined the relation between marijuana use and delinquency in a community sample of 892 New Jersey adolescents (49% female, 51% male). Participants were 12 or 15 years old when first contacted and were assessed a second time 3 years later. Marijuana use was assessed at both time points by three self-report items: frequency of use in the past year, quantity on a typical occasion, and frequency of getting high when smoking marijuana. Delinquency was assessed at both time points by nine self-report items concerning the frequency of property crime, violent crime, and minor delinquent activ-
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ity. Correlational analyses indicated that the relation between marijuana use and delinquency is moderate at best (75% of the variance is not shared). Cluster analysis was used to identify groups of adolescents with differing involvement in marijuana use and delinquency across both measurement points. Four clusters were identified: (a) low marijuana/low delinquency at both time points, (b) high marijuana/low delinquency at both time points, (c) low marijuana/high delinquency at Time 1 but low delinquency at Time 2, and (d) low marijuana/low delinquency at Time 1 but high delinquency at Time 2. Cluster analysis results were regarded by White as evidence that marijuana use and delinquency do not necessarily cluster together in one group of adolescents, thus refuting the notion of a general deviance syndrome. Finally, analyses concerning the longitudinal prediction of marijuana use and delinquency indicated that independent influences (i.e., peer use of marijuana for marijuana use vs. peer delinquency for delinquency) determine each behavior. Kandel, Simcha-Fagan, and Davies (1986) examined the relation between illicit drug use and delinquency in a representative sample of 1,325 New York State adolescents (53% female, 47% male). Participants were contacted first at ages 15-16 and were assessed twice with a 9-year interval between assessments. Illicit drug use was measured at Time 1 by two scales derived from interview questions; one scale indicated whether participants had ever used marijuana, and the other indicated whether they had ever used other illicit drugs. Illicit drug use measures at Time 2 included the Time 1 measures as well as additional items concerning the past year frequency of marijuana and other illicit drug use. Delinquency was measured at Time 1 by a series of interview questions concerning lifetime participation in five delinquent acts. Delinquency was measured at Time 2 by presenting participants with a list of 16 antisocial acts and asking them about lifetime prevalence and past year frequency of these acts. Analyses were conducted separately for males and females due to gender differences in the rates of substance use and delinquency. Among males, illicit drug use and delinquency demonstrated considerable stability over time, with Time 1 measures of these variables predicting Time 2 measures of these same variables. Illicit drug use did not predict subsequent antisocial behavior, but Time 1 delinquency was highly predictive of subsequent illicit drug involvement. Among females, illicit drug use was similarly stable over time; however, Time 1 delinquency did not predict Time 2 antisocial behavior. Furthermore, illicit drug use predicted subsequent antisocial behavior, but delinquency did not predict subsequent illicit drug involvement. Windle (1990) examined the relation between substance use and antisocial behaviors in a secondary analysis of data from the National Longitudinal Survey of Youth. This analysis included 2,411 adolescents (48% female, 52% male) who were first assessed at ages 14-15 and again at ages 18-19. Substance use was assessed only at Time 2, and measures included self-reports of the average number of alcoholic beverages consumed per day over the past 30 days, eight dichotomous items concerning alcohol dependency symptoms, the number of lifetime occasions of marijuana or hashish use, the number of lifetime occasions of other illicit substance use, and three dichotomous items concerning alcohol-related aggression. Antisocial behavior was assessed only at Time 1 and by self-report items concerning the number of times each respondent had committed each of 20 antisocial behaviors in his or her lifetime. An overall general delinquency score and four subscales scores (status offenses, property offense, person offenses, and substance involvement) were derived from these items. Analyses were conducted separately for males and females due to gender differences in the rates of substance use and delinquency. Among males, early adolescent antisocial behaviors were highly predictive of later substance use and abuse. Among females, this relation was less strong, although still statistically significant, particularly in the case of property offenses. For both sexes, early substance use (i.e., the substance involvement subscale derived from the delinquency items) was the most consistent predictor of subsequent substance use, alcohol-related
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aggression, and alcohol dependency. However, early adolescent general delinquency remained a significant predictor of later substance use, even after controlling for early substance involvement. Dembo et al. (1993) examined the relation between substance use and delinquency in a sample of 297 juvenile correction facility detainees (23% female, 77% male) in Florida. Participants were assessed twice with a 10-15-month interval between assessments and were on average 15 years of age at Time 1. Alcohol use was assessed at both time points with interview items from the National Institute on Drug Abuse (NIDA) household survey concerning alcohol intake and number of drinking days during the past 30 days. Use of other substances was assessed at Time 1 with NIDA household survey items concerning lifetime use of various drugs and at Time 2 with versions of these same items modified to apply only to the past year. Delinquency was assessed at both time points with National Youth Survey items concerning the past year incidence of 23 delinquent behaviors. This juvenile detainee sample demonstrated significantly higher rates of 30-day alcohol use and lifetime and annual other drug use than national averages. Multiple regression analyses revealed that Time 1 other delinquency (i.e., delinquent behavior other than the offenses that has resulted in detainment) significantly contributed to the prediction of Time 2 substance use involvement. However, Time 1 substance involvement did not predict Time 2 delinquency. To summarize, recent longitudinal investigations offer support for the proposition that early adolescent violent behavior predicts later substance use. Five out of six longitudinal studies found that aggressive or delinquent behavior predicted subsequent alcohol and other drug use, at least for one gender. In contrast, two of the six studies found that early substance use predicted later antisocial behaviors, at least for one gender. Furthermore, one study (i.e., White, 1991) suggested that substance use and antisocial behavior during adolescence may be unrelated to one another. Additionally, nearly every study found evidence of stability effects (i.e., a variable at Time 1 predicts the same variable measured at a later time point) for both substance use and violent behavior. Interestingly, relations between substance use and violence appear generally stronger for males than for females, and both studies that found that early substance use predicts later antisocial behavior suggest that the direction of causality may differ based on gender. Newcomb and McGee (1989) found that early delinquency predicted later alcohol use among females but not males; however, early alcohol use predicted later delinquency for both sexes. Kandel, Simcha-Fagan, and Davies (1986) found that early delinquency predicted later illicit substance use among males, and, conversely, early illicit substance use predicted later antisocial behavior among females. In contrast, Windle (1990) found that early antisocial behavior predicted later substance use for both females and males. The remaining studies summarized above did not examine the issue of gender differences in the relation between substance use and violent behavior.
SUMMARY A N D RECOMMENDATIONS This article has described five different theoretical models of the relation between substance abuse and violent behavior in adolescence. These models include Substance Use Causes Violent Behavior, Violent Behavior Causes Substance Use, the Reciprocal Model, the Common Cause Model, and the Independent Cause Model. Recent correlational studies support the premise that adolescent substance use and violent behavior are related, but such studies cannot offer insights as to the causal relations between substance use and violence. Thus, the six recent longitudinal studies will be relied on for evaluating the plausibility of each of the five models. The existing literature offers only limited support for the proposition that early substance use leads to later violent and antisocial behavior. Although Newcomb and McGhee (1989)
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found that this model applies to both females and males, Kandel et al.'s (1986) work suggests that this model may only apply to females. The remaining longitudinal studies do not support this model of the relation between adolescent substance use and violent behavior. However, given somewhat equivocal findings across studies, the hypothesis that substance use causes violent behavior cannot be rejected at the current time. Additional research should attempt to explore the degree to which this model may apply to female versus male adolescents. Furthermore, it may be useful to examine whether this model may be appropriate for certain other subgroups of adolescents for which it could be argued substance use could precipitate violent behavior (e.g., children of alcoholics). Strong support can be found in the literature for the proposition that early violent behavior predicts later substance use. Five of six recent longitudinal studies of the relation between adolescent substance use and violence found at least some support for the hypothesis that violent behavior leads to substance use. Most investigations found that this relation is strongest for males, although one study (i.e., Newcomb & McGhee, 1989) found that this model applies to female but not male adolescents. Given the relative consistency across studies, it seems reasonable to assume that one pathway to later substance use begins with early adolescent violent, aggressive, and delinquent behavior. However, additional research is needed to examine the mechanisms and intervening processes by which violent behavior may produce subsequent substance use involvement. The three remaining models, the Reciprocal Model, the Common Cause Model, and the Independent Cause Model, have not received sufficient research attention to allow conclusive statements as to their validity. As for the proposition that there may be bidirectional influence over time between substance use and violence, Newcomb and McGee (1989) found statistically significant paths between early substance use and later antisocial behavior and between early antisocial behavior and later substance use for the females in their sample. This suggests, at least for females, that the relation between substance use and violent behavior may indeed involve reciprocal influences. However, this result is best regarded as preliminary, and additional research is needed to support or refute the hypothesis that the relation between adolescent substance use and violence is bidirectional. In addition, future research should include multiple assessments across time in order to begin to examine possible age-related shifts in directions of influence. Unfortunately, we currently know very little about possible third variable influences (e.g., social control, peer influence) that may affect the relation between adolescent substance use and violent behavior. While White (1991) found support for the hypothesis that substance use and violent behavior may indeed have different causes, her findings are unique in the literature and may be specific to marijuana use. An important future undertaking will be the exploration of intrapersonal and interpersonal variables that could plausibly account for the association between the use of various substances and violent behavior in adolescence. Furthermore, extended follow-up assessments of early adolescent samples into adulthood are needed to examine in greater detail the possibility, suggested by White (1991) in her coincident hypothesis, that the substance use and delinquency relationship seen during adolescence is primarily result of the synchronous occurrence of both behaviors during the same period in development.
Acknowledgements - - Preparation of this article was supported in part by training grant AA07459 from
the National Institute on Alcohol Abuse and Alcoholism. This article is based in part on a keynote presentation at the Fallon Health Care System Adolescent Addictions Conference, Worcester, MA, in November, 1994.
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REFERENCES Baron, R. A. (1977). Human aggression. New York: Plenum Press. Boyatzis, R. E. (1977). Alcohol and interpersonal aggression. In M. M. Gross (Ed.), Advances in experimental medicine and biology (Vol. 85B, pp. i 196-1207). New York: Plenum Press. Boyatzis, R. E. (1983). Who should drink what, when, and where if looking for a fight. In E. Gottheil, K. A. Druley, T. E. Skoloda, & H. M. Waxman (Eds.), Alcohol, drug abuse, and aggression (pp. 314-329). Springfield, IL: Charles C. Thomas. Burr, A. (1987). Chasing the dragon: Heroin misuse, delinquency and crime in the context of South London culture. The British Journal of Criminology, 27, 333-357. Choquet, M., Menke, H., & Manfredi, R. (1991). Interpersonal aggressive behaviour and alcohol consumption among young urban adolescents in France. Alcohol and Alcoholism, 26, 381-390. Dembo, R., Williams, L., Fagan, J., & Schmeidler, J. (1993). The relationships of substance abuse and other delinquency over time in a sample of juvenile detainees. Criminal Behoviour and Mental Health, 3, 158-179. Fagan, J., Weis, J. G., & Cheng, Y.-T., (1990). Delinquency and substance use among inner-city students. The Journal of Drug Issues, 20, 351-402. Farrow, J. A., & French, J. (1986). The drug-abuse-delinquency connection revisited. Adolescence, 21,951-960. Gandossy, R. P., Williams, J., Cohen, J., & Harwood, H. (1980). Drugs and crime: A survey and analysis of the literature. Washington, I)(2: National Institute of Justice. Goldstein, P. J. (1985). The drugs-violence nexus: A tri-partite conceptual framework. Journal of Drug Issues, 15, 493-506. Greenbaum, P. E., Prange, M. E., Friedman, R. M., & Silver, S. E. (1991). Substance abuse prevalence and comorbidity with other psychiatric disorders among adolescents with severe emotional disorders. Journal of the Academy of Child and Adolescent Psychiatry, 30, 575-583. Hirsehi, T. (1969). Cause of delinquency. Berkeley, CA: University of California Press. Hirshi, T., & Selvin, H. C. (1967). Delinquency research: An appraisal of analytic methods. New York: The Free Press. Inciardi, J. A., & Pottieger, A. E. (1991). Kids, crack, and crime. The Journal of Drug Issues, 21,257-270. Johnson, B. D., Wish, E. D., Schmeidler, J., & Huizinga, D. (1991). Concentration of delinquent offending: Serious drug involvement and high delinquency rates. The Journal of Drug Issues, 21, 205-229. Johnston, L. D., O'Malley, P. M., & Bachman, G. (December 8, 1994). Drug use continues to climb among American teen-agers, as attitudes and beliefs about the dangers of drugs soften, U-M survey says. Ann Arbor, MI: Institute for Social Research, The Univerisity of Michigan. Johnston, L. D., O'Malley, P. M., & Eveland, L. K. (1978). Drug and delinquency: A search for causal connections. In D. B. Kandel (Ed.), Longitudinal research on drug use: Empirical findings and methodological issues (pp. 137-156). New York: John Wiley & Sons. Kaminer, Y., Wagner, E. E, Plummer, B. A., & Seifer, R. (1993). Validation of the Teen Addiction Severity Index (T-ASI): Preliminary findings. The American Journal on Addictions, 2, 250-254. Kandel, D., Simcha-Fagan, O., & Davies, M. (1986). Risk factors for delinquency and illicit drug use from adolescence to young adulthood. The Journal of Drug Issues, 16, 67-90. Lewinsohn, P. M., Hops, H., Roberts, R., Seeley, J. R., & Andrews, J. A. (1993). Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students. Journal of Abnormal Psychology, 102, 133-144. Marlatt, G. A., & Rohsenow, D. J. (1980). Cognitive processes in alcohol use: Expectancy and the balanced placebo design. In N. K. Mello (Ed.), Advances in substance abuse: Vol. 1. Behavioral and biological research (pp. 159-199). Greenwich, CT: JAI Press. Milgram, G. G. (1993). Adolescents, alcohol, and aggression. Journal of Stndies on Alcohol, Supplement No. 11, 53-61. Milin, R., Halikas, J. A., Meller, J. E., & Morse, C. (1991). Psychopathology among substance abusing juvenile offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 569-574. Newcomb, M. D., & Bentler, P. M. (1988). Consequences of adolescent drug use. Berverly Hills, CA: Sage. Newcomb, M. D., & McGee, L. (1989). Adolescent alcohol use and other delinquent behaviors. Criminal Justice and Behavior, 16, 345-369. Room, R., & Collins, G. (Eds.). (1983). Alcohol and disinhibition: Nature and meaning of the link (DHHS Publication No. ADM 83-1246). Washington, DC: U.S. Government Printing Office. Shedler, J., & Block, J. (1990). Adolescent drug use and psychological health: A longitudinal inquiry. American Psychologist, 45, 612-630. Sussman, S., Dent, C. W., Stacy, A. W., Burton, D., & Flay, B. R. (1994). Psychosocial variables as prospective predictors of violent events among adolescents. Health Values, 18, 29-40. Sutherland, E. H., & Cressey, D. R. (1978). Criminology (10th ed.). Philadelphia: Lippincott.
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Taylor, S. P., & Leonard, K. E. (1983). Alcohol and human physical aggression. In R. G. Green & E. I. Donnerstein (Eds.), Aggression: Vol. 2. Theoretical and empirical reviews (pp. 77-101). San Diego, CA: Academic Press. Taylor, S. P., & Chermack, S. T. (1993). Alcohol, drugs, and human physical aggression. Journal of Studies on Alcohol, Supplement No. 11, 78-88. U.S. Department of Justice. (1993). Sourcebook of criminal justice statistics - - 1993. Rockville, MD: Author. U.S. Secretary of Health and Human Services. (1993). Eighth special report to the U.S. Congress on alcohol and health. Rockville, MD: U.S. Department of Health and Human Services. Valois, R. E, Vincent, M. L., McKeown, R. E., Garrison, C., & Kirby, S. D. (1993). Adolescent risk behaviors and the potential for violence: A look at what's coming to campus. Journal of the Association for College Health, 41, 141-143. Van Kammen, W. B., Loeber, R., & Stouthamer-Loeber, M. (1991). Substance use and its relationship to conduct disorder problems and delinquency in young boys. Journal of Youth and Adolescence, 20, 399-413. White, H. R. (1991). Marijuana use and delinquency: A test of the "independent cause" hypothesis. The Journal of Drug Issues, 21,231-256. White, H. R., Brick, J., & Hansell, S. (1993). A longitudinal investigation of alcohol use and aggression in adolescence. Journal of Studies on Alcohol, Supplement No. 11, 62-77. Windle, M. (1990). A longitudinal study of antisocial behaviors in early adolescence as predictors of late adolescent substance use: Gender and ethnic group differences. Journal of Abnormal Psychology, 99, 86-91. Winters, K. C. (1991). The personal experience screeening questionnaire. Los Angeles: Western Psychological Services.
Aggression and Violent Behavior, Vol. 1, No. 4, pp. 375-387, 1996 Copyright © 1996 Elsevier Science Ltd Printed in the USA. All fights reserved 1359-1789/96 $15.00 + .00
PH S1359-1789(96)00008-0
SUBSTANCE USE AND VIOLENT BEHAVIOR IN ADOLESCENCE Eric F. Wagner Center for Alcohol and Addiction Studies, Brown University
ABSTRACT. The relation between substance use and violent behavior in adolescence is reviewed, and each of five competing models of this relation is examined. I begin by presenting background material on adolescent substance use and adolescent violence. I then describe five different models that have been proposed to explain the association between substance use and violent behavior. Next, I review the adolescent literature concerning substance use and violence, noting methodological weaknesses that have plagued this research. I conclude with an evaluation of the five models and suggestions for future research. Copyright © 1996 Elsevier Science Ltd
NEWCOMB AND BENTLER (1988) have suggested that substance use "may be considered a normative behavior among United States teenagers in terms of prevalence, and from a developmental task perspective" (p. 214). This quote expresses two important issues regarding substance use among adolescents. First, most teenagers will try alcohol and/or other drugs during their adolescent years. For example, in 1994, 80.4% of high school seniors reported using alcohol at some point in their life, 50.1% admitted alcohol use within the last 30 days, 38.2% reported using marijuana at some point in their life, and 19.0% admitted marijuana use within the last 30 days (Johnston, O'Malley, & Bachman, 1994). Second, alcohol and other drug use during adolescence has developmental importance. Many teenagers experiment with substance use in much the same way they experiment with personal appearance and political views. Furthermore, adolescent substance use simultaneously represents the emulation of adults' substance use behavior and the rejection of adult rules prohibiting alcohol and other drug use among minors. In short, substance use among many adolescents can be and has been argued to reflect normal teenage development (Shedler & Block, 1990). Despite the prevalence and developmental importance of adolescent alcohol and other drug use, any substance use by teenagers is an important public health concern. In the case of alcohol, the drug more adolescents have tried than any other, there are several reasons why its use by teenagers may be troublesome. First, alcohol consumption by minors is illegal. Adolescents who consume alcoholic beverages are violating the law. Second, although the Correspondence should be addressed to Eric E Wagner, 3630 N. Bayhomes Drive, Miami, FL 33133. 375
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majority of teenagers who try alcohol do not become problem drinkers, early initiation of drinking is one of the strongest predictors of subsequent alcohol use problems. Third, alcohol use during adolescence directly increases the risk of morbidity and mortality. For example, the risk of traffic crash involvement is nine times higher for teenagers with a blood alcohol level of only .03g/dl (about two drinks) than for youth who have not been drinking. Finally, the majority of alcohol-related death and disability experienced by individuals of all ages is attributable to moderate drinkers. Thus, an adolescent does not have to be a heavy and frequent drinker to experience negative consequences from alcohol use. Similar public health concerns are associated with the use of other drugs during adolescence. An additional concern in regard to adolescent drinking and other drug use is that a sizable minority of teenagers will demonstrate substance-related problems. For example, a recent epidemiological study found that 4% of randomly selected high school students met DSMIII-R diagnostic criteria for substance abuse during the course of a single year (Lewinsohn, Hops, Roberts, Seeley, & Andrews, 1993). Among more highly selected adolescent samples (e.g., juvenile offenders, emotionally disturbed adolescents), much higher rates of substance abuse have been documented (Greenbaum, Prange, Friedman, & Silver, 1991; Kaminer, Wagner, Plummer, & Seifer, 1993; Milin, Halikas, Meller, & Morse, 1991; Winters, 1991). ADOLESCENT VIOLENT BEHAVIOR Violence includes "both intentional and unintentional sudden occurrences that may result in physical or psychological injury to one or more persons" (Sussman, Dent, Stacy, Burton, & Flay, 1994, p. 29). Examples of intentional violent events include suicide and homicide attempts; examples of unintentional violent events include accidents. Aggression is "any form of behavior directed toward the goal of harming or injuring another living being who is motivated to avoid such treatment" (Baron, 1977, p. 7). Physical fighting, murder, and rape are examples of aggressive acts. Finally, delinquency is "that behavior of a juvenile which involves the attempt to obtain desired goods by illegitimate means" (Hirshi & Selvin, 1967, p. 184). Delinquency includes a wide range of behaviors, some of which directly involve violent behavior (e.g., fighting, intentionally hurting someone) and some of which do not (e.g., theft, trespassing, running away). Recent survey research indicates that a small but significant minority of adolescents commits violent acts. In 1993, a national sample of high school seniors was asked "During the last 12 months how often have you...T' engaged in a variety of delinquent behaviors (U.S. Department of Justice, 1993). In regard to violent delinquent behaviors, 22.2% of high school seniors reported participating in a group fight, 17.7% reported involvement in a serious fight at school or work, 13.4% reported that they had hurt someone badly enough to need bandages or a doctor, 4.6% reported using a weapon against someone, and 3.6% reported hitting an instructor or supervisor. In a separate study of the past month prevalence of fighting in a sample of South Carolina eleventh and twelfth graders, 41% reported involvement in a physical fight and 5.5% reported involvement in a fight resulting in an injury requiring medical care (Valois, Vincent, McKeown, Garrison, & Kirby, 1993). THEORETICAL MODELS OF THE RELATION BETWEEN SUBSTANCE ABUSE A N D VIOLENT BEHAVIOR IN ADOLESCENCE It is well established that there is a significant correlation between substance use and violent behavior across a number of studies of both adolescents and adults. This had led to extensive hypothesizing about the nature of this relation. However, it is important to recognize that we currently know very little about the causal connection between alcohol and other drug use and violent behavior. As noted by the U.S. Secretary of Health and Human Services (1993),
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substance use is not the only cause of violence. Violent episodes frequently occur between sober people with no history of heavy alcohol or other drug use. Furthermore, the majority of drinkers and other drug users, and this includes the heaviest of such users, never engage in violent behavior.
Model 1: Substance Use Causes Violent Behavior One model of the relation between substance use and violent behavior is that heavy substance use leads to violence. One example of such a model is the "economic necessity hypothesis," the crux of which is that heavy substance users commit violent, criminal acts in order to generate income to support their substance use habit (Goldstein, 1985). Another example of such a model is the criminal subculture model (Goldstein, 1985), in which it is hypothesized that users of illicit substances are necessarily drawn into a criminal subculture because of their need to obtain substances that are illegal. Repeated contact with this criminal subculture increases the likelihood of exposure to and participation in violent, criminal behavior. A third example involves psychopharmacological models, each of which hypothesizes that psychopharmacological effects of intoxication (e.g., disinhibition, cognitive-perceptual distortions, attention deficits), as well as situational factors associated with intoxication, increase the likelihood that an individual will engage in violent behavior (Boyatzis, 1977, 1983; Marlatt & Rohsenow, 1980; Room & Collins, 1983; Taylor & Leonard, 1983; Taylor & Chermack, 1993). In sum, Model 1 models share in common the idea that heavy substance use engenders violence.
Model 2: Violent Behavior Causes Substance Use A second model of the relation between substance use and violent behavior is that violent behavior leads to heavy substance use. One example of this type of model is "the crime outgrowth hypothesis" (Burr, 1987), which states that heavy use of alcohol and other drugs is a natural consequence of leading a criminal, violent lifestyle. From this perspective, violent, delinquent adolescents are especially attracted and vulnerable to using substances because such behavior embodies an unconventional and criminal image and fits with their own deviant view of the world. A second variant of this type of model is best described as "the social selection hypothesis" and assumes that aggressive individuals are more likely than nonaggressive individuals to select or be pushed into social situations in which heavy substance used is condoned or encouraged (Johnston, O'Malley, & Eveland, 1978). Model 2 models share the notion that violent individuals are somehow prone to becoming heavy substance users.
Model 3: The Reciprocal Model A third model of the relation between substance use and violent behavior is that this relation is bidirectional in nature. A consequence of heavy drinking or other drug use may be increased aggression, and increased aggression may lead to more drinking or substance use. Gandossy, Williams, Cohen, and Harwood (1980) described such an interactive pattern as typical of the crime-drug relation for addictive, expensive drugs: violent crime finances use, use encourages more use, and more use encourages more violent crime.
Model 4: The Common Cause Model A fourth model of the relation between substance use and violent behavior suggests that this relation, to the degree that it has been found in previous studies, is illusory (Fagan, Weis, & Cheng, 1990). Specifically in regard to adolescents, White (1991) has argued that substance use and delinquency are both elements in a concurrent cluster of other adolescent problem
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behaviors or a general deviance orientation. Stated another way, substance use and delinquent behavior are not causally linked but rather share common causes (Milgram, 1993). Hirschi's (1969) control theory represents one common cause model. From this perspective, adolescents who are not well bonded to their parents, teachers, and schools (i.e., social control is weak) are more likely to engage in both substance use and delinquency. Another example of a common cause model is Suthedand and Cressey's (1978) differential association theory, in which association with deviant peers is assumed to induce both substance use and delinquent behavior. In sum, proponents of common cause models would argue that substance use and violent behavior only appear causally related; in actuality, both behaviors are the result of some third underlying psychological or social cause.
Model 5: The Independent Cause Model A final model of the relation between substance use and violent behavior suggests that they are distinct phenomena with separate influences. As suggested by White (1991) in her coincident hypothesis, the substance use and delinquency relationship seen during adolescence may simply be the result of the synchronous occurrence of both behaviors during the same period in development. White argues that onset of adolescent experimentation in both behaviors generally occurs in early to mid adolescence. However, most adolescents mature out of delinquency by late adolescence while the majority of substance users increase their alcohol and other drug use through adolescence and into young adulthood. Like common cause models, proponents of an independent cause model would argue that substance use and violent behavior only appear causally related. However, the independent cause model differs from the common cause models because substance use and violent behavior are assumed to possess independent and separate causes. RECENT EMPIRICAL RESEARCH O N THE RELATION BETWEEN SUBSTANCE USE A N D VIOLENT BEHAVIOR IN ADOLESCENCE
Methodological Issues Several methodological problems plague the existing research. The first problem is that the overwhelming majority of studies in this area are correlational in design. From the perspective of a single measurement point, the coocurrence of substance use and violent behavior is examined. The major limitation of this type of design is that it does not permit causal inferences to be drawn as to the relations between the two phenomena under study. The second problem is that many studies in this area do not adequately consider or control for potentially confounding influences (Dembo, Williams, Fagan, & Schmeidler, 1993; Fagan et al., 1990). For example, violent adolescents may misrepresent their substance use in an attempt to excuse their violent behavior or to avoid punishment for violent acts. Research concerning alcohol or other drug use in a sample of adolescent offenders is clearly vulnerable this type of confound. A second potential confound is that substance use may accompany participation in group events in which there is high risk of violence. As an example, teenagers who use alcohol or other drugs may consume substances while attending rock or rap concerts. Certain aspects of such concerts, including the security staff or the performers themselves, may instigate violent behavior from the audience. Thus, it is the nature of the event, rather than the ingestion of substances per se, that leads to violence. A third potential confound is more systemic in nature. It may be society's prohibitions against use of illicit substances and the resulting high-priced black market, rather than any direct properties of substance use itself, that lead users to commit violent acts to support their habits. A final potential confound is that drug-related bungling of violent crimes may increase likelihood of
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capture. As a result, the finding that substance use and violent crime are strongly related may reflect the fact that delinquents who are heavy users of alcohol and other drugs may be more likely to get caught than delinquents who are less substance involved. A third problem is that many studies have used biased samples (Fagan et al., 1990). For example, several investigations have used captive samples of adolescents in juvenile detention facilities. Such samples do not represent the general population and, as noted in the preceding paragraph, may be inclined to intentionally misrepresent their behavior. General population studies are subject to a different type of bias. Typically, these investigations draw their sampies from schools. Dropouts, absentees, and noncompliant adolescents are not included in these samples, which leads to an undersampling of heavy substance users and delinquents. A third type of bias affects studies which use samples drawn from high density, urban populations. Explanations of the relations between substance abuse and violence become confounded with influences associated with urbanism, such as lower class socialization processes and the ecological effects of urban social areas. A final problem concerns issues in regard to the measurement of both substance use and violence (Fagan etal., 1990). Typically, studies rely on either self-report or official records but not both. While both data sources have their strengths and weaknesses, estimates of substance use and violence obtained through self-report are likely to be quite different from parallel estimates obtained through official records. Self-report data are influenced by adolescents' willingness to admit socially proscribed behaviors, whereas official records reflect only those behaviors that have been documented by some external agency. Furthermore, there are conflicting definitions of alcohol and other drug use and violence/delinquency across studies, and there is currently little consensus as to what are the best indices of these behaviors (e.g., in some studies, violence has been measured terms of its severity; in other studies, violence has been measured in terms of the overall frequency of violent acts). The above described methodological issues notwithstanding, I will review recent empirical studies on the relation between adolescent substance use and violence. I have confined my review to studies published since 1986 because Fagan et al. (1990) have published a comprehensive review of earlier investigations. I will review correlational and longitudinal studies separately, with specific attention to the samples and operational definitions of substance use and violence used in each investigation.
Correlational Studies Johnson, Wish, Schmeidler, and Huizinga (1991) examined the relation between substance use and delinquency in a 1979 probability sample of 1,539 adolescents (gender distribution reported as "representative of 11-17 year olds in 1976") aged 14-20 who took part in the multistage National Youth Survey. Substance use was measured by a self-report questionnaire concerning the use of seven drugs. Participants reported how often they had used each drug in the past year and were subsequently classified hierarchically as cocaine users, pills/psychedelics users, marijuana users, alcohol users, and nondrug users. Delinquency was measured by a self-report questionnaire that included 47 items representing a range of acts for which juveniles can be arrested. Participants reported how many times they had engaged in each behavior during a I-year period and were subsequently classified hierarchically as multiple index offenders, infrequent index offenders, minor offenders, or nondelinquents. Analyses revealed that multiple index offenders were three times more likely to use pills or cocaine than adolescents reporting less delinquency. Within a given delinquency type, higher delinquency rates were associated with the use of more serious drugs. Furthermore, high involvement in both index offending and serious drugs was associated with high delinquency rates and the commission of serious crimes.
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Valois et al. (1993) examined the predictors of violent behavior in a sample of 2,299 South Carolina eleventh and twelvth graders (52% female, 48% male). Data were collected using the Center for Disease Control's Youth Risk Behavior Survey (YRBS), a 70-item self-report questionnaire focused on violent and high risk behaviors. The YRBS includes a series of items concerning the 30-day prevalence of a variety of violent behaviors. Substance use is also included on the YRBS and is measured by five items concerning the 30-day prevalence of alcohol use, binge drinking, marijuana use, and cocaine use, and the lifetime prevalence of IV drug use. After adjusting for race and gender, univariate logistic regression analyses revealed that alcohol users were 3.86 times more likely to report fighting than nondrinkers, binge drinkers were 4.57 more likely to report fighting than those who did binge drink, and illicit substance users were 3.49 times more likely to report fighting than nonusers. Similar results were obtained in analyses predicting carrying a weapon to school; alcohol users were 2.95 times more likely to report carrying a weapon to school than nondrinkers, binge drinkers were 2.86 more likely to report carrying a weapon to school than those who did binge drink, and illicit substance users were 2.55 times more likely to report carrying a weapon to school than nonusers. In multivariate analyses, alcohol use was no longer associated with fighting, and all substance use variables were no longer associated with weapon carrying; however, binge drinkers remained more likely to report fighting than nonbinge drinkers (OR = 3.02), and illicit substance users continued to be more likely to report fighting than nonusers (OR = 2.02). Fagan et al. (1990) examined patterns of drug use and delinquency in a general population sample of 666 tenth-twelvth graders (49% female, 51% male) from inner-city, high crime neighborhoods. Drug use was measured by several self-report items concerning the number of occasions of using various drugs and the experience of substance use problems (i.e., negative social and personal consequences from substance use) during the past 12 months. Composite drug use scores included frequency of total drug use and the severity of drugs used, which was a hierarchical classification including the categories of none, alcohol, marijuana, and opiates/PCP/cocalne. Delinquency was measured by self-report items concerning the prevalence and incidence of a variety of delinquent behaviors during the past 12 months. Participants were subsequently classified hierarchically as multiple index offenders, serious delinquents, minor delinquents, petty delinquents, or nondelinquents. Results indicated the frequency and severity of drug use increased significantly as a function of the seriousness of delinquency. However, the proportion of subjects who were both serious drug users (i.e., used drugs frequently and used hard drugs) and serious delinquents (i.e., multiple index offenders) was approximately equal to the proportion of subjects who were serious drug users but nondelinquents. In regression analyses attempting to explain delinquency, substance use problems added little explanatory power to the models. However, inclusion of substance use problems resulted in significant increases in the explanatory power of regression models predicting the frequency and severity of substance use. Van Kammen, Loeber, and Stouthamer-Loeber (1991) examined the relations between substance use and delinquency in a general population sample of 856 seventh grade boys. Drug use was measured by several self-report items concerning lifetime and past 6-months use of cigarettes, beer, wine, liquor, marijuana, and glue. On the basis of their responses to the lifetime use items, boys were classified hierarchically as never having used any substances, having smoked cigarettes and/or drank beer or wine, having drank liquor, or having used marijuana. Delinquency was measured by 40 self-report items from the National Youth Survey. Each boy was asked to report whether he had ever engaged in each delinquent behavior and how often he had engaged in each behavior during the past 6 months. Results revealed that self-reported delinquency increased significantly as substance use involvement increased.
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Choquet, Menke, and Manfredi (1991) examined the relation between alcohol and drug consumption and interpersonal aggressive behavior in a sample of 1,602 suburban French adolescents (44% female, 56% male) aged 13-16. Alcohol and drug consumption were measured by nine self-report items concerning lifetime and current use of tobacco, alcohol, and illicit drugs. Interpersonal aggressive behavior was measured by four items concerning the frequency of aggressive behavior during the past year (i.e., broken things or hit people, shouted, taken part in fights, and used or threatened violence to obtain money/objects from people), and participants were subsequently classified as aggressive or nonaggressive. Compared to nonaggressive adolescents, aggressive adolescents were 2.7 times more likely to be regular smokers, 6.1 times more likely to be regular drinkers, and 4.7 times more likely to have tried illicit drugs. In multivariate logistic regression analysis attempting to explain aggression, drug users were more likely to report aggressive behavior than nonusers (OR = 4.1), and adolescents who reported regular drinking for at least 3 years were more likely to report aggressive behavior than nondrinkers (OR = 4.5). Inciardi and Pottieger (1991) conducted a street survey concerning drug use and crime with a sample of 254 seriously delinquent adolescents (15% female, 85% male) from Miami. All of the participants met criteria for serious delinquency, which was defined as having committed at least 10 FBI index offenses or 100 lesser crimes during the past year. Drug use was measured with a series of interview questions about drug use histories and the frequency of current use of various licit and illicit substances. Crime involvement was measured with a series of interview questions about the number and type of crimes committed during the past year. Results indicated that all of the participants had histories of multiple drug use, all reported having used marijuana regularly, and all but 50 (19.7%) had some type of current involvement in the crack cocaine business (i.e., the sale and distribution of crack cocaine). As the degree of involvement in the crack cocaine business increased, daily or at least regular use of such drugs as marijuana, depressants, and crack also increased. Furthermore, greater involvement in the crack cocaine business was associated with greater involvement in other types of criminal activity. Farrow and French (1986) studied the relationship between drug use and delinquent behavior in a sample of 91 juvenile correction facility detainees (26% female, 74% male). Drug use was measured with a series of interview questions concerning the frequency of use of various licit and illicit substances during the previous 6 months. Delinquent behavior was measured with a series of interview questions concerning lifetime criminal offenses. Additionally, participants were asked whether and how their drug use and delinquent behavior may be related. During the prior 6 months, 81% of the sample admitted alcohol or other drug use, 31% reported daily alcohol use, and 50% reported daily marijuana use. Thirty-five percent of this sample reported that all or most of their crimes were committed under the influence of drugs, while 29% reported that none of their crimes were committed under the influence. Thirty-nine percent of the sample reported that they believed that drug use was directly related to their criminal behavior, whereas 26% reported that they believed that their delinquent lifestyle led them to use drugs more often and in a greater variety. To summarize, recent correlational investigations are consistent in providing support for a relation between substance use and violent behavior in adolescence. General population studies have demonstrated that alcohol and other drug use is positively related to violence, with a two- to four-fold increase in the likelihood of committing violent acts among adolescents who are drug involved. Similarly, studies of delinquent samples have found that substance use and violent behavior are positively and significantly related. Furthermore, one investigation (i.e., Farrow & French, 1986) suggests that the relation between substance use and violent behavior may be different for different adolescents; some delinquents reported using drugs while committing crimes whereas others did not, and some delinquents believed
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that drugs led them to crime while others believed the reverse. However, due to their correlational design, none of the studies reviewed in this section can address causality in the association between teenage substance use and violence.
LongitudinalStudies Newcomb and McGee (1989) examined the relation between alcohol use and delinquent behavior in a community sample of 847 tenth-twelfth grade students (67% female, 33% male). Participants were assessed twice with a 1-year interval between assessments. Alcohol use was assessed at both time points by three self-report questions concerning the frequency of beer, wine, and liquor consumption during the past 6 months. At the second assessment, an additional item concerning the amount of alcohol consumed on a typical drinking day was also administered. Delinquent behavior was assessed at both time points by three dichotomous items (legal trouble, stealing, and school trouble), which were summed to provide a deviance events scale. At the second assessment, additional items concerning the frequency of 16 different delinquent acts during the past 6 months were also administered. Analyses were conducted separately for males and females due to gender differences in the rates of substance use and delinquency. For both females and males, causal modeling revealed that Time 1 alcohol use predicted Time 2 alcohol use, Time 1 deviance events predicted Time 2 deviance events, and Time 1 alcohol use predicted Time 2 deviance events and delinquent acts. However, Time 1 deviance events were not associated with Time 2 alcohol use among males, whereas Time 1 deviance events were modestly, yet significantly, related to Time 2 alcohol use among females. White, Brick, and Hansell (1993) examined the relation between alcohol use and aggressive behavior in a community sample of 431 New Jersey adolescents (49% female, 51% male). Participants were 12 years old when fwst contacted and were assessed three times with 3-year intervals between assessments. Alcohol use was assessed at all three time points by three measures derived from self-report items concerning alcohol use during the last year: typical quantity-frequency, most quantity-frequency, and number of times intoxicated. Aggressive behavior was assessed at all three time points by five self-report items: the number of times during the last three years participants hurt someone badly, used a weapon in a fight, engaged in vandalism, and hit parents, and the number of times during the last year participants fought at school. Alcohol-related aggression was also measured at all three time points with five items concerning the number of times during the last 3 years participants had engaged in aggressive acts while drinking or because of drinking. Because of low rates of aggressive behavior in females, analyses of the relation between alcohol and aggression were performed for males only. Causal modeling revealed that Time 1 alcohol use predicted Time 2 alcohol use, which in turn predicted Time 3 alcohol use. Similarly, Time 1 aggression predicted Time 2 aggression, which in turn predicted Time 3 aggression. No significant relations were found between alcohol use and subsequent aggressive behavior. In contrast, Tune 1 aggressive behavior predicted Time 2 alcohol use. Furthermore, both Time 1 aggressive behavior and Time 1 alcohol use predicted and Time 2 alcohol-related aggression, but early aggressive behavior was a better predictor than early alcohol use of later alcohol-related aggression. In a related study, White (1991) examined the relation between marijuana use and delinquency in a community sample of 892 New Jersey adolescents (49% female, 51% male). Participants were 12 or 15 years old when first contacted and were assessed a second time 3 years later. Marijuana use was assessed at both time points by three self-report items: frequency of use in the past year, quantity on a typical occasion, and frequency of getting high when smoking marijuana. Delinquency was assessed at both time points by nine self-report items concerning the frequency of property crime, violent crime, and minor delinquent activ-
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ity. Correlational analyses indicated that the relation between marijuana use and delinquency is moderate at best (75% of the variance is not shared). Cluster analysis was used to identify groups of adolescents with differing involvement in marijuana use and delinquency across both measurement points. Four clusters were identified: (a) low marijuana/low delinquency at both time points, (b) high marijuana/low delinquency at both time points, (c) low marijuana/high delinquency at Time 1 but low delinquency at Time 2, and (d) low marijuana/low delinquency at Time 1 but high delinquency at Time 2. Cluster analysis results were regarded by White as evidence that marijuana use and delinquency do not necessarily cluster together in one group of adolescents, thus refuting the notion of a general deviance syndrome. Finally, analyses concerning the longitudinal prediction of marijuana use and delinquency indicated that independent influences (i.e., peer use of marijuana for marijuana use vs. peer delinquency for delinquency) determine each behavior. Kandel, Simcha-Fagan, and Davies (1986) examined the relation between illicit drug use and delinquency in a representative sample of 1,325 New York State adolescents (53% female, 47% male). Participants were contacted first at ages 15-16 and were assessed twice with a 9-year interval between assessments. Illicit drug use was measured at Time 1 by two scales derived from interview questions; one scale indicated whether participants had ever used marijuana, and the other indicated whether they had ever used other illicit drugs. Illicit drug use measures at Time 2 included the Time 1 measures as well as additional items concerning the past year frequency of marijuana and other illicit drug use. Delinquency was measured at Time 1 by a series of interview questions concerning lifetime participation in five delinquent acts. Delinquency was measured at Time 2 by presenting participants with a list of 16 antisocial acts and asking them about lifetime prevalence and past year frequency of these acts. Analyses were conducted separately for males and females due to gender differences in the rates of substance use and delinquency. Among males, illicit drug use and delinquency demonstrated considerable stability over time, with Time 1 measures of these variables predicting Time 2 measures of these same variables. Illicit drug use did not predict subsequent antisocial behavior, but Time 1 delinquency was highly predictive of subsequent illicit drug involvement. Among females, illicit drug use was similarly stable over time; however, Time 1 delinquency did not predict Time 2 antisocial behavior. Furthermore, illicit drug use predicted subsequent antisocial behavior, but delinquency did not predict subsequent illicit drug involvement. Windle (1990) examined the relation between substance use and antisocial behaviors in a secondary analysis of data from the National Longitudinal Survey of Youth. This analysis included 2,411 adolescents (48% female, 52% male) who were first assessed at ages 14-15 and again at ages 18-19. Substance use was assessed only at Time 2, and measures included self-reports of the average number of alcoholic beverages consumed per day over the past 30 days, eight dichotomous items concerning alcohol dependency symptoms, the number of lifetime occasions of marijuana or hashish use, the number of lifetime occasions of other illicit substance use, and three dichotomous items concerning alcohol-related aggression. Antisocial behavior was assessed only at Time 1 and by self-report items concerning the number of times each respondent had committed each of 20 antisocial behaviors in his or her lifetime. An overall general delinquency score and four subscales scores (status offenses, property offense, person offenses, and substance involvement) were derived from these items. Analyses were conducted separately for males and females due to gender differences in the rates of substance use and delinquency. Among males, early adolescent antisocial behaviors were highly predictive of later substance use and abuse. Among females, this relation was less strong, although still statistically significant, particularly in the case of property offenses. For both sexes, early substance use (i.e., the substance involvement subscale derived from the delinquency items) was the most consistent predictor of subsequent substance use, alcohol-related
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aggression, and alcohol dependency. However, early adolescent general delinquency remained a significant predictor of later substance use, even after controlling for early substance involvement. Dembo et al. (1993) examined the relation between substance use and delinquency in a sample of 297 juvenile correction facility detainees (23% female, 77% male) in Florida. Participants were assessed twice with a 10-15-month interval between assessments and were on average 15 years of age at Time 1. Alcohol use was assessed at both time points with interview items from the National Institute on Drug Abuse (NIDA) household survey concerning alcohol intake and number of drinking days during the past 30 days. Use of other substances was assessed at Time 1 with NIDA household survey items concerning lifetime use of various drugs and at Time 2 with versions of these same items modified to apply only to the past year. Delinquency was assessed at both time points with National Youth Survey items concerning the past year incidence of 23 delinquent behaviors. This juvenile detainee sample demonstrated significantly higher rates of 30-day alcohol use and lifetime and annual other drug use than national averages. Multiple regression analyses revealed that Time 1 other delinquency (i.e., delinquent behavior other than the offenses that has resulted in detainment) significantly contributed to the prediction of Time 2 substance use involvement. However, Time 1 substance involvement did not predict Time 2 delinquency. To summarize, recent longitudinal investigations offer support for the proposition that early adolescent violent behavior predicts later substance use. Five out of six longitudinal studies found that aggressive or delinquent behavior predicted subsequent alcohol and other drug use, at least for one gender. In contrast, two of the six studies found that early substance use predicted later antisocial behaviors, at least for one gender. Furthermore, one study (i.e., White, 1991) suggested that substance use and antisocial behavior during adolescence may be unrelated to one another. Additionally, nearly every study found evidence of stability effects (i.e., a variable at Time 1 predicts the same variable measured at a later time point) for both substance use and violent behavior. Interestingly, relations between substance use and violence appear generally stronger for males than for females, and both studies that found that early substance use predicts later antisocial behavior suggest that the direction of causality may differ based on gender. Newcomb and McGee (1989) found that early delinquency predicted later alcohol use among females but not males; however, early alcohol use predicted later delinquency for both sexes. Kandel, Simcha-Fagan, and Davies (1986) found that early delinquency predicted later illicit substance use among males, and, conversely, early illicit substance use predicted later antisocial behavior among females. In contrast, Windle (1990) found that early antisocial behavior predicted later substance use for both females and males. The remaining studies summarized above did not examine the issue of gender differences in the relation between substance use and violent behavior.
SUMMARY A N D RECOMMENDATIONS This article has described five different theoretical models of the relation between substance abuse and violent behavior in adolescence. These models include Substance Use Causes Violent Behavior, Violent Behavior Causes Substance Use, the Reciprocal Model, the Common Cause Model, and the Independent Cause Model. Recent correlational studies support the premise that adolescent substance use and violent behavior are related, but such studies cannot offer insights as to the causal relations between substance use and violence. Thus, the six recent longitudinal studies will be relied on for evaluating the plausibility of each of the five models. The existing literature offers only limited support for the proposition that early substance use leads to later violent and antisocial behavior. Although Newcomb and McGhee (1989)
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found that this model applies to both females and males, Kandel et al.'s (1986) work suggests that this model may only apply to females. The remaining longitudinal studies do not support this model of the relation between adolescent substance use and violent behavior. However, given somewhat equivocal findings across studies, the hypothesis that substance use causes violent behavior cannot be rejected at the current time. Additional research should attempt to explore the degree to which this model may apply to female versus male adolescents. Furthermore, it may be useful to examine whether this model may be appropriate for certain other subgroups of adolescents for which it could be argued substance use could precipitate violent behavior (e.g., children of alcoholics). Strong support can be found in the literature for the proposition that early violent behavior predicts later substance use. Five of six recent longitudinal studies of the relation between adolescent substance use and violence found at least some support for the hypothesis that violent behavior leads to substance use. Most investigations found that this relation is strongest for males, although one study (i.e., Newcomb & McGhee, 1989) found that this model applies to female but not male adolescents. Given the relative consistency across studies, it seems reasonable to assume that one pathway to later substance use begins with early adolescent violent, aggressive, and delinquent behavior. However, additional research is needed to examine the mechanisms and intervening processes by which violent behavior may produce subsequent substance use involvement. The three remaining models, the Reciprocal Model, the Common Cause Model, and the Independent Cause Model, have not received sufficient research attention to allow conclusive statements as to their validity. As for the proposition that there may be bidirectional influence over time between substance use and violence, Newcomb and McGee (1989) found statistically significant paths between early substance use and later antisocial behavior and between early antisocial behavior and later substance use for the females in their sample. This suggests, at least for females, that the relation between substance use and violent behavior may indeed involve reciprocal influences. However, this result is best regarded as preliminary, and additional research is needed to support or refute the hypothesis that the relation between adolescent substance use and violence is bidirectional. In addition, future research should include multiple assessments across time in order to begin to examine possible age-related shifts in directions of influence. Unfortunately, we currently know very little about possible third variable influences (e.g., social control, peer influence) that may affect the relation between adolescent substance use and violent behavior. While White (1991) found support for the hypothesis that substance use and violent behavior may indeed have different causes, her findings are unique in the literature and may be specific to marijuana use. An important future undertaking will be the exploration of intrapersonal and interpersonal variables that could plausibly account for the association between the use of various substances and violent behavior in adolescence. Furthermore, extended follow-up assessments of early adolescent samples into adulthood are needed to examine in greater detail the possibility, suggested by White (1991) in her coincident hypothesis, that the substance use and delinquency relationship seen during adolescence is primarily result of the synchronous occurrence of both behaviors during the same period in development.
Acknowledgements - - Preparation of this article was supported in part by training grant AA07459 from
the National Institute on Alcohol Abuse and Alcoholism. This article is based in part on a keynote presentation at the Fallon Health Care System Adolescent Addictions Conference, Worcester, MA, in November, 1994.
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