ویژگی های ترک کننده استفاده از مواد و رفتار ضد اجتماعی در ایالات متحده

Abstract Purpose Whether lifetime abstainer's antisocial behavior is maladjusted or well-adjusted is unresolved. The aim of this study was to compare abstainers (defined as persons with no lifetime use of alcohol and other drugs and non-engagement in antisocial or delinquent behavior) with non-abstainers across a range of sociodemographic and mental health characteristics in the United States. Methods Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample of U.S. adults. Structured psychiatric interviews (N = 43,093) using the Alcohol Use Disorder and Associated Disabilities Interview Schedule — DSM-IV version (AUDADIS-IV) were completed by trained lay interviewers between 2001 and 2002.

Introduction Engaging in a delinquent act or using a substance such as alcohol over the life-course is thought to be normative. Studies indicate that during adolescence most youths will engage in some form of delinquency and substance experimentation (DeLisi, 2001, Elliott et al., 1989 and Moffitt, 1993. Abstainers are individuals who have not used any psychoactive substances or have not committed any delinquent or antisocial act. It has been theorized that because abstaining behavior is abnormal in a statistical sense that abstainers are therefore suffering from some form of psychopathology. Abstainers are thought to lack interpersonal skills and are therefore loners, avoid close personal relationships, are emotionally and behaviorally bland and are perhaps sad and depressed due to their isolation. Furthermore, abstainers are purported to be overly conscientious, highly conservative, and moralistic. Many of these notions, while theoretically plausible, have been developed from a limited empirical foundation. In an important study, Shedler and Block (1990) did find that abstainers may have impaired psychological well-being and are generally anxious. In contrast, persons who engage in moderate substance use are thought to be expressive, sociable, and fit in well with others. In a seminal work, Moffitt (1993) hypothesized that abstainers are inhibited from opportunities to learn and engage in antisocial behavior because they possess certain characteristics such as social anxiousness. Thus, Moffitt speculated that abstaining may be due to something intrinsic about the individual that results in social isolation and lack of encountering the standard opportunities, such as peer contagion, that lead to engagement in delinquency or drug use. This possibility was tested by Piquero, Brezina, and Turner (2005) using data from the National Longitudinal Survey of Youth. Findings from their study showed that 13 percent of adolescents were abstainers. Abstainers were more likely to be female, have fewer delinquent peers, more prosocial peers, date less, have greater teacher attachment, have higher parental monitoring, be less physically mature, have lower levels of depression, and be less autonomous. However, they did not find that abstainers were socially alienated. Abstention was predicted by high levels of teacher attachment, parental monitoring, and involvement with prosocial peers. Abstention was not predicted by sadness/depression or other mental health variables. Although there are relatively few studies devoted to examining delinquency abstention, a number of studies assessing alcohol and marijuana abstention have recently been published. There have been several studies that have compared abstainers to experimental and heavy users of alcohol. Findings from these studies are mixed. Walton and Roberts (2004) examined relations between substance use and personality traits in two studies using the five factor model of personality as well as other personality inventories. The first study tested the relationship between personality and substance abuse with a comprehensive measure of the Big Five personality traits and perfectionism and impulsivity scales. Study 1 found that heavy users of alcohol and drugs were less conscientious than moderate users or abstainers. Abstainers scored higher on conscientiousness and lower on extraversion compared to the other groups but did not score higher on neurotic over-control or emotional stability. Study 1 relied solely on self-report data. For Study 2, observer ratings of participants' personalities were used. Findings indicated that heavy alcohol and drug users scored lower in agreeableness and conscientiousness. Abstainers scored the highest of the groups on conscientiousness and lowest on extraversion. Leifman and colleagues (1995) compared Swedish, military eighteen to nineteen year old alcohol-abstainer males to alcohol consumers in terms of “sociability,” which was defined in terms of social insecurity, number of close friends, quality of conversations with friends and school popularity. Swedish military men born 1969–1970 were broken into five groups, with 5.9 percent of the study being abstainers (2,691 persons) who drank 0 g alcohol/week, 25.3 percent being light consumers (11,563 persons) who drank 1–25 g alcohol/week, 53.2 percent being moderate consumers (24,329) who drank 26–100 g/week, 13.2 percent being frequent consumers (6,051) who drank 101–250 g/week, and 2.4 percent being high consumers (1,112) who drank > 250 g/week. For sociability, abstainers were highest in the categories “often insecure in the company of others,” “unpopular in school,” and “no friends or one friend.” Skogen, Harvey, Henderson, Stordal, and Mykletun's (2009) study of anxiety and depression among abstainers and low-level alcohol consumers used data from the Nord-Trøndelag Health Study (N = 38,930) in two waves. Alcohol consumption was measured by self-report while anxiety and depression were measured using the Hospital Anxiety and Depression Rating Scale. Findings indicated that abstention was related to increased odds for case-level anxiety and depression. In a study that assessed relations between alcohol abstention and cognitive performance, Anstey and colleagues (2005) identified several key findings. Cognitively, abstainers performed worse on all measures in all age groups. More women than men were abstainers and abstainers had lower education levels. In comparison to same-age drinkers, abstainers were less likely to smoke marijuana in last twelve months and had lower levels of extroversion and behavior activation system-fun-seeking. In a study designed to directly test Shedler and Block's (1990) classic assertion that abstainers are less psychologically healthy than experimenters, Milich et al. and colleagues (2000) classified study participants into three groups: those with marijuana use by age twenty; alcohol use during 10th grade; and alcohol use at age twenty. These groups were compared at age twenty in terms of personality characteristics, deviant behavior, and psychopathology. Findings indicated that abstainers were less psychologically impaired, and were generally healthier. In a study examining psychological maladjustment among adolescents who were abstainers from marijuana use suggested that abstainers were healthier than experimenters and frequent users. Tucker, Ellickson, Collins, and Klein (2006) analyzed a longitudinal study composed of seventh graders recruited from middle schools in California and Oregon in 1985 and assessed again in 1990 (12th grade) and 1995 (age twenty three) with self-report surveys. Abstainers from marijuana fared better than experimenters and frequent users in school, family and peer relations, mental health, and behavior.

Results Sociodemographic characteristics of abstainers and non-abstainers by gender Table 1 shows sociodemographic characteristics of adults with and without a lifetime history abstaining stratified by gender with odds ratios adjusted for other socidemographic variables. Abstainers (N = 4,780, 11 percent) were composed largely of females (74.3 percent). There were no significant differences in gender composition among non-abstainers (N = 38,313). With respect to race/ethnicity, Hispanic abstainers were more likely to be female (OR = 1.39, 95 percent CI = 1.15–1.67), Asians, both male (OR = 1.90, 95 percent CI = 1.37–2.62) and female (OR = 2.57, 95 percent CI = 2.08–3.17), were more likely to be abstainers compared to Whites as were African–American males (OR = 1.71, 95 percent CI = 1.34–2.18) and females (1.74, 95 percent CI = 1.50–2.02). Persons born in the U.S. were significantly less likely to be abstainers compared to persons born in a foreign country. Younger age categories were significantly less likely to be abstainers than older age categories. Lower levels of education and income were significantly lower among female abstainers only. However, abstainers, both male and female, were less likely to be unemployed. Both male and female abstainers were significantly less likely to be widowed, separated, or divorced compared to non-abstainers. Regionally, female abstainers were significantly more likely to be from the South (OR = 1.56, 95 percent CI = 1.22–1.98) than the West and male abstainers were less likely to reside in the Midwest than the West. Multivariate logistic regression analyses examining associations between abstainers and non-abstainers by gender Table 2 compares prevalence rates of lifetime psychiatric disorders of abstainers versus non-abstainers stratified by gender. Recall odd ratios are adjusted for sociodemographic factors (i.e., race, education, marital status, age, income, region, and urbanicity) and previously described lifetime DSM-IV psychiatric disorders. With respect to lifetime mood disorders, both male and female abstainers were significantly less likely to be diagnosed with major depressive disorder, and females only were less likely to be diagnosed with bipolar disorder. Female and male abstainers were also significantly less likely to be diagnosed with any specific phobias. Abstainers were also significantly less likely to have a family history of antisocial behavior. Finally, personality disorder analyses indicated that male abstainers were significantly less likely to be diagnosed with obsessive–compulsive, paranoid, and schizoid personality disorders compared to male abstainers. Female abstainers were significantly less likely to be diagnosed with paranoid and histrionic personality disorders compared to female non-abstainers. There was no psychiatric disorder where abstainers were more likely to meet diagnostic criteria for compared to non-abstainers. Table 2. Psychiatric correlates of male and female adults with and without a lifetime history of abstaining behavior Psychiatric disorder Male abstainers (N = 1,038) % (95% CIa) Female abstainers (N = 3,742) % (95% CIa) Male non-abstainers (N = 17,480) % (95% CI) Female non-abstainers (N = 20,833) % (95% CI) Male abstainers AOR (95% CI) Female abstainers AOR (95% CI) Mood disorders Major depressive disorder 2.86 (1.83–4.43) 7.30 (6.00–8.85) 12.31 (11.68–12.97) 23.11 (22.09–24.16) 0.40 (0.27–0.60) 0.47 (0.39–0.57) Bipolar disorder 1.41 (0.74–2.70) 1.43 (0.99–2.07) 5.87 (5.45–6.34) 6.32 (5.83–6.83) 0.54 (0.28–1.06) 0.56 (0.38–0.83) Dysthymia 0.90 (0.38–2.15) 1.75 (1.29–2.36) 3.13 (2.81–3.48) 6.09 (5.66–6.56) 1.10 (0.50–2.41) 0.76 (0.54–1.06) Anxiety disorders Panic disorder 0.55 (0.22–1.34) 2.19 (1.60–2.99) 2.72 (2.43–3.05) 5.78 (5.34–6.26) 0.46 (0.18–1.17) 0.77 (0.55–1.08) Social phobia 1.21(0.54–2.70) 2.67 (1.98–3.59) 4.37 (3.94–4.84) 6.17 (5.66–6.72) 0.78 (0.34–1.81) 1.09 (0.79–1.49) Specific phobia 1.52 (0.84–2.72) 5.61 (4.59–6.84) 6.42 (5.89–7.01) 13.45 (12.64–14.31) 0.41 (0.23–0.72) 0.60 (0.49–0.75) Generalized anxiety disorder 0.73 (0.26–2.04) 1.67 (1.20–2.33) 2.94 (2.58–3.33) 5.95 (5.46–6.48) 0.93 (0.33–2.62) 0.80 (0.57–1.13) Psychotic disorder Substance use disorders 0.24 (0.04–1.26) 0.22 (0.09–0.53) 0.85 (0.68–1.06) 0.89 (0.75–1.05) 0.53 (0.09–3.07) 0.53 (0.22–1.32) Alcohol use disorder 0.00 0.00 44.32 (42.37–46.29) 22.71 (21.44–24.03) * * Illicit drug use disorder 0.00 0.00 7.32 (6.74–7.95) 4.35 (3.94–4.80) * * Marijuana Use disorder 0.00 0.00 12.44 (11.65–13.27) 6.28 (5.76–6.84) * * Pathological Gambling 0.00 0.00 0.67 (0.54–0.84) 0.26 (0.20–0.35) * * Family history of antisocial 7.52 (5.76–9.76) 10.18 (8.80–11.76) 22.03 (20.87–23.24) 26.43 (25.26–27.64) 0.44 (0.33–0.58) 0.50 (0.43–0.58) Behavior Personality disorders Antisocial PD * 1.89 (1.69–2.12) 5.84 (5.33–6.38) 2.20 (1.96–2.47) * * Avoidant PD 0.39 (0.08–1.82) 1.08 (0.76–1.53) 2.00 (1.73–2.30) 3.04 (2.70–3.41) 0.74 (0.14–3.80) 1.35 (0.86–2.14) Obsessive–Compulsive PD 2.07 (1.27–3.35) 3.22 (2.47–4.20) 8.19 (7.63–8.79) 8.65 (8.08–9.26) 0.53 (0.31–0.89) 0.79 (0.57–1.09) Paranoid PD 0.35 (0.17–0.75) 1.46 (1.04–2.04) 4.02 (3.62–4.46) 5.53 (5.09–6.00) 0.27 (0.12–0.59) 0.54 (0.36–0.81) Schizoid PD 0.27 (0.10–0.77) 0.97 (0.64–1.46) 3.35 (3.00–3.73) 3.42 (3.11–3.76) 0.19 (0.07–0.56) 0.75 (0.48–1.17) Histrionic PD 0.33 (0.09–1.14) 0.28 (0.14–0.56) 1.97 (1.72–2.27) 2.05 (1.82–2.30) 0.58 (0.16–2.10) 0.42 (0.20g–0.87) CI: confidence interval, OR: odds ratio adjusted for sociodemographic variables, lifetime psychiatric disorders, and a family history of antisocial behavior. OR values that are in bold are statistically significant.