Importance Laws and attitudes toward marijuana in the United States are becoming more permissive but little is known about whether the prevalence rates of marijuana use and marijuana use disorders have changed in the 21st century. Objective To present nationally representative information on the past-year prevalence rates of marijuana use, marijuana use disorder, and marijuana use disorder among marijuana users in the US adult general population and whether this has changed between 2001-2002 and 2012-2013. Design, Setting, and Participants Face-to-face interviews conducted in surveys of 2 nationally representative samples of US adults: the National Epidemiologic Survey on Alcohol and Related Conditions (data collected April 2001-April 2002; N = 43 093) and the National Epidemiologic Survey on Alcohol and Related Conditions–III (data collected April 2012-June 2013; N = 36 309). Data were analyzed March through May 2015. Main Outcomes and Measures Past-year marijuana use and DSM-IV marijuana use disorder (abuse or dependence). Results The past-year prevalence of marijuana use was 4.1% (SE, 0.15) in 2001-2002 and 9.5% (SE, 0.27) in 2012-2013, a significant increase ( P DSM-IV marijuana use disorder was 1.5% (0.08) in 2001-2002 and 2.9% (SE, 0.13) in 2012-2013 ( P P Conclusions and Relevance The prevalence of marijuana use more than doubled between 2001-2002 and 2012-2013, and there was a large increase in marijuana use disorders during that time. While not all marijuana users experience problems, nearly 3 of 10 marijuana users manifested a marijuana use disorder in 2012-2013. Because the risk for marijuana use disorder did not increase among users, the increase in prevalence of marijuana use disorder is owing to an increase in prevalence of users in the US adult population. Given changing laws and attitudes toward marijuana, a balanced presentation of the likelihood of adverse consequences of marijuana use to policy makers, professionals, and the public is needed.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/2464591/yoi150057.pdf

Prevalence of Marijuana Use Disorders in the United States Between 2001-2002 and 2012-2013.

This paper explores the relationships among neighborhood disadvantage, stress, and the likelihood of drug use in a sample of adults (N = 1,101). Using the 1995 Detroit Area Study in conjunction with tract-level data from the 1990 census, we find a positive relationship between neighborhood disadvantage and drug use, and this relationship remains statistically significant net of controls for individual-level socioeconomic status. Neighborhood disadvantage is moderately associated with drug related behaviors, indirectly through increased social stressors and higher levels of psychological distress among residents of disadvantaged neighborhoods. A residual effect of neighborhood disadvantage remains, net of a large number of socially relevant controls. Finally, results from interactive models suggest that the relationship between neighborhood disadvantage and drug use is most pronounced among individuals with lower incomes.

Neighborhood disadvantage, stress, and drug use among adults.

The longitudinal relations among contact with one's social network (social contact), perceived social support, depression, and alcohol use were examined. An integrative model was developed from affect regulation theory and theories of social support and dysfunctional drinking. Data were obtained from a random sample of 1,192 adults. The 3-wave panel model was tested using structural equation modeling analysis. Results revealed that (a) social contact was positively related to perceived social support; (b) perceived social support was, in turn, negatively related to depression; and (c) depression was, in turn, positively related to alcohol use for 1 of 2 longitudinal lags. There was partial support for the feedback hypothesis that increased alcohol use leads to decreased contact with family and friends. Although the results generally supported the authors' hypotheses, the significant coefficients in the model were generally small in size.

A longitudinal model of social contact, social support, depression, and alcohol use.

Although the neighborhood microsystem is recognized as an important domain for adolescent development, relative to the family and peer contexts, neighborhood factors have been understudied in relation to adolescent substance abuse. In addition, recent research suggests that risk factors for adolescent substance use may differ for African Americans when compared to Caucasian youth. This study investigated the association between perceived neighborhood disorganization and later substance use, as well as possible mediators of that association, among a community sample of urban African American adolescents. Perceptions of neighborhood disorganization (i.e., violence/safety and drug activity) in grade 7 were associated with increased tobacco, alcohol, and marijuana use in grade 9. For females, this association was mediated by attitudes about drug use and perceptions of drug harmfulness. Findings highlight the importance of neighborhood contextual variables for African American substance use. Implications and directions for future research are presented.

The relationship between perceptions of neighborhood characteristics and substance use among urban African American adolescents.

Limited research has examined the relationship between financial strain and alcohol use and abuse. Building on affect regulation theory and recent research in the stress and alcohol literatures, this study developed and tested a model relating financial strain, social resources, personal resources, depression, and drinking to cope to alcohol use and abuse. Data were obtained from a random sample of 1,424 adults who indicated that they had drunk alcohol in the previous year. We tested and then revised our model using structural equation modeling analysis. Results supported the affect regulation model of financial strain and alcohol use and abuse. Generally, depression mediated the relationship between financial strain and drinking to cope, and drinking to cope mediated the relationship between depression and alcohol use and abuse. In addition, both gender and race moderated six of the relationships in our revised model.

Relationship of financial strain and psychosocial resources to alcohol use and abuse: the mediating role of negative affect and drinking motives.

The Social Stress Model of Substance Abuse builds upon and integrates knowledge from numerous psychosocial theories and models. According to this model, the likelihood of an individual engaging in drug abuse is a function of the stress level and the extent to which it is offset by stress modifiers such as social networks, social competence, and resources. This article synthesizes current empirical evidence for this model. Thirty-five primary research studies are described, with special attention to the four psychosocial constructs inherent in the model: stress, social networks, social competence, and resources. Consistencies and inconsistencies in the findings, a critique of key methodological issues, and suggestions for future research are provided. © 1993 John Wiley & Sons, Inc.

Empirical evidence for the social stress model of substance abuse

The Social Stress Model of Substance Abuse has been derived from numerous psychosocial theories and models. This model suggests that the likelihood of an individual engaging in drug abuse is influenced by the stress level and the extent to which it is offset by stress modifiers such as social networks, social competence and resources. This article synthesizes current empirical evidence for this model. Thirteen primary research studies of women are synthesized and described, with special attention to the four key constructs inherent in the model: stress, social networks, social competencies, and resources. Consistencies and inconsistencies in the findings, a critique of key methodological issues, implications for future research, and implications for clinical policy and practice are provided.

The Social Stress Model of Substance Abuse among Childbearing-Age Women: A Review of the Literature:

OBJECTIVE To identify factors that prevent drug abuse among young Hispanic women living in inner cities and to acquire ideas for preventive strategies. DESIGN Qualitative interviews of focus group participants to explore perceptions about drug use. SETTING An urban location adjacent to a neighborhood health clinic. PARTICIPANTS Twenty-four young Hispanic women recruited from an inner-city prenatal clinic. MAIN OUTCOME MEASURES Identification of themes that trigger or deter drug use. Acquisition of preliminary knowledge required for further development of data collection instruments and design of interventions for use with inner-city Hispanic women. RESULTS Identified six themes through qualitative data analysis of interview narratives. CONCLUSIONS Compared themes with existing theoretical models and described implications for nursing practice.

Substance Abuse Among Inner‐City Hispanic Women: Exploring Resiliency

Statistics show that use of harmful substances (alcohol, cigarettes, marijuana, cocaine) among women of childbearing age is widespread and serious. Numerous theoretical models and empirical studies have attempted to explain the complex factors that lead individuals to use drugs. The Social Stress Model of Substance Abuse [1] is one model developed to explain parameters that influence drug use. According to the model, the likelihood of an individual engaging in drug use is seen as a function of the stress level and the extent to which it is offset by stress modifiers such as social networks, social competencies, and resources. The variables of the denominator are viewed as interacting with each other to buffer the impact of stress [1]. This article focuses on one of the constructs in this model: that of competence. It presents a summary of theoretical and conceptual formulations for the construct of competence, a review of empirical evidence for the association of competence with drug use, and describes the preliminary development of a multi-scale instrument designed to assess drug protective competence among low-income Hispanic childbearing women. Based upon theoretical and empirical studies, eight domains of drug protective competence were identified and conceptually defined. Using subscales from existing instruments with psychometric evidence for their validity and reliability, a multi-scale instrument was developed to assess drug protective competence. Hypothesis testing was used to assess construct validity. Four drug protective competence domains (social influence, sociability, self-worth, and control/responsibility) were found to be statistically associated with drug use behaviors. Although not statistically significant, expected trends were observed between drug use and the other four domains of drug protective competence (intimacy, nurturance, goal directedness, and spiritual directedness). Study limitations and suggestions for further psychometric testing of the instrument are described.

Competence and drug use: theoretical frameworks, empirical evidence and measurement.

Risk and resilience: building protective factors. An intervention for preventing substance abuse and sexual risk-taking and for promoting strength and protection among young, low-income Hispanic women.

Cathy Strachan Lindenberg

Papers

Empirical evidence for the social stress model of substance abuse

The Social Stress Model of Substance Abuse among Childbearing-Age Women: A Review of the Literature:

Substance Abuse Among Inner‐City Hispanic Women: Exploring Resiliency

Competence and drug use: theoretical frameworks, empirical evidence and measurement.

Risk and resilience: building protective factors. An intervention for preventing substance abuse and sexual risk-taking and for promoting strength and protection among young, low-income Hispanic women.