The link between anxiety disorders and alcohol abuse and dependence has been established in adults, but the relationship between anxiety and adolescent alcohol involvement is less clear. In this dissertation, we compared explanatory models of substance use including the self-medication hypothesis, the social learning model, and the rebound hypothesis to characterize the association between anxiety and alcohol use in groups with various levels of experience with drinking. Additionally, we included depression symptoms in our studies to assess whether the relationships we found between anxiety and alcohol were unique or similar to those found with other forms of negative affect. In chapter 1, we investigated the relationships between several types of social anxiety symptoms and the onset of alcohol use in middle school students. We found that social anxiety significantly predicted initiation of drinking at both extremely high and low levels, and sex differences were observed. Chapter 2 follows with an analysis of the impact of social anxiety, depression, and alcohol expectancies on youths' drinking. We found that the self-medication hypothesis characterized the relationship between depression symptoms and drinking behavior, while the relationship between social anxiety and alcohol use was explained by social learning theory. Chapters 3 and 4 examined alcohol and drug use relapse characteristics in an adolescent substance use disordered treatment sample. In chapter 3 we found that compared to youth with only a substance use disorder, comorbid youth relapsed more often and more rapidly after treatment. In chapter 4, anxiety symptoms were more likely reported to improve than worsen immediately after relapse and in the two weeks following the relapse episode, indicating support for the self-medication hypothesis, while depression symptoms worsened in youth who relapsed with stimulants, which is consistent with a rebound effect. Chapter 5 is a replication of the study in chapter 4 with adults post-treatment for substance use disorders, with and without comorbid psychopathology. Unlike in the adolescent sample, almost no adults reported improvements in any psychiatric symptoms following relapse, however depression symptoms were rated as worsening more than anxiety symptoms

Limited research has explored the role of in-session behavior during motivational enhancement (ME) in group formats. The current study presents initial feasibility of assessing behavior of high school students (N = 425) attending Project Options, a voluntary secondary drug and alcohol prevention program utilizing ME techniques. Building on previous research exploring client language supporting/opposing health behavior, student group behavior was coded live at the specific utterance and global level; group leader behavior was also coded globally. Interrater reliability of the coding system was assessed, and preliminary validity of the coding system was examined by exploring associations between characteristics of group members and in-session group behavior. Initial reliability estimates were excellent for the specific behavior codes. Reliability of the global codes was mixed, with raters demonstrating good reliability on support for unhealthy behavior, opposition to unhealthy behavior, and support for healthy behavior. Reliability of the group leader codes was fair to poor. Greater percent healthy talk was associated with a lower percentage of group members reporting lifetime alcohol use. The results of the current study suggest that some in-session behavior at the group level can be coded reliably via live observation and that in-session behavior at the group level is associated with alcohol use prior to attending the program. Future research is needed to explore the utility of in-session behavior in terms of predicting future behavior at the group and individual level.

Delivering alcohol use intervention services in the school setting represents a key approach to engaging youth of all backgrounds, particularly underserved populations, in such programming. Relative progress has been made toward implementing culturally responsive services for youth; however, little is known about the role of ethnic composition on group processes purported to underlie mechanisms of change. We examined associations between ethnic group composition and therapeutic processes within a voluntary, school-based alcohol use intervention at seven schools across three cities (N groups = 353). Ethnic composition was characterized as: group ethnic diversity on a continuum, group ethnic homogeneity (i.e., where at least 66% of participants shared the same ethnicity), and comparing groups where one of the three largest ethnicities in the sample reached the majority (i.e., African-American vs. Hispanic vs. non-Hispanic white). Ratings on group processes were obtained from participants (satisfaction; belonging), facilitators (empathy; rapport), and coders (engagement; responsiveness). Mixed-effects models revealed that students in groups with African-American and Hispanic majorities reported a higher sense of satisfaction compared to groups with non-Hispanic white majorities. Facilitators endorsed expressing empathy more frequently with majority African-American and Hispanic groups than with non-Hispanic white groups. Study findings highlight the importance of considering different dimensions of ethnic composition when examining mechanisms of change in group intervention research.

Recent research highlights the role of peer victimization in students' adjustment across a variety of domains (e.g., academic, social), but less often identifies potential mediating variables. In the current study, we tested for direct effects from peer victimization to adolescents' academic behavior and alcohol use, as well as indirect effects through school belonging. Adolescents from two large samples (middle school: N = 2,808; high school: N = 6,821) self-reported on peer victimization, school belonging, academic outcomes (GPA, school truancy), and alcohol use (lifetime, past 30 days). Two-group structural equation models revealed (a) direct and indirect paths from peer victimization to academic functioning; (b) indirect, but not direct, effects through school belonging for lifetime drinking; and (c) direct and indirect effects from peer victimization to current drinking. Findings implicate school belonging as a mediator between peer victimization and important outcomes in adolescence.

Objective

During adolescence, neurobiological maturation occurs concurrently with social and interpersonal changes, including the initiation of alcohol and other substance use. The National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA) is designed to disentangle the complex relationships between onset, escalation, and desistance of alcohol use and changes in neurocognitive functioning and neuromaturation.

Method

A sample of 831 youth, ages 12-21 years, was recruited at five sites across the United States, oversampling those at risk for alcohol use problems. Most (83%) had limited or no history of alcohol or other drug use, and a smaller portion (17%) exceeded drinking thresholds. A comprehensive assessment of biological development, family background, psychiatric symptomatology, and neuropsychological functioning-in addition to anatomical, diffusion, and functional brain magnetic resonance imaging-was completed at baseline.

Results

The NCANDA sample of youth is nationally representative of sex and racial/ethnic groups. More than 50% have at least one risk characteristic for subsequent heavy drinking (e.g., family history, internalizing or externalizing symptoms). As expected, those who exceeded drinking thresholds (n = 139) differ from those who did not (n = 692) on identified factors associated with early alcohol use and problems.

Conclusions

NCANDA successfully recruited a large sample of adolescents and comprehensively assessed psychosocial functioning across multiple domains. Based on the sample's risk profile, NCANDA is well positioned to capture the transition into drinking and alcohol problems in a large portion of the cohort, as well as to help disentangle the associations between alcohol use, neurobiological maturation, and neurocognitive development and functioning.