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Adolescent Marijuana Abusers and Their Families Adolescent, Marijuana Abusers and Their Families U. S. DEPARTMENT OF HEALTH AND HUMAN SERVICES • Public Health Service • Alcohol, Drug Abuse, and Mental Health Administration Adolescent Marijuana Abusers and Their Families Herbert Hendin, M.D. Ann Pollinger, Ph.D. Richard Ulman,Ph.D. Arthur C. Carr, Ph.D. NIDA Research Monograph 40 September 1981 DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Alcohol, Drug Abuse, and Mental Health Administration National Institute on Drug Abuse Division of Research 5600 Fishers Lane Rockville, Maryland 20857 For sale by the Superintendent of Documents. U.S. Government Printing Office Washington, D.C. 20402 The NIDA Research Monograph series is prepared by the Division of Research of the National lnstitute on Drug Abuse. Its primary objective is to provide critical reviews of research problem areas and techniques. the content of state-of-the-art conferences, integrative research reviews and significant original research its dual publication emphasis is rapid and targeted dissemination to the scientific and professional community. Editorial Advisory Board Avram Goldstein, M.D. Addiction Research Foundation Palo Alto, California Jerome Jaffe, M.D. College of Physicians and Surgeons Columbia University, New York Reese T. Jones, M.D. Langley Porter Neurpsychiatric Institute Unversity of California San Francisco, California Jack Mendelson, M.D. Alcohol and Drug Abuse Research Center Harvard Medical School McLean Hospital Belmont, Massachusetts Helen Nowlis, Ph.D. Office of Drug Education. DHHS Washington, D.C. Lee Robins, Ph.D. Washington Unversity School of Medicine St. Louis, Missouri NIDA Research Monograph series William Pollin, M.D. DIRECTOR, NIDA Marvin Snyder, Ph.D. DIRECTOR, DIVISION OF RESEARCH, NIDA Robert C. Petersen, Ph.D. EDITOR-IN-CHIEF Eleanor W. Waldrop MANAGING EDITOR Parklawn Building, 5600 Fishers Lane, Rockville, Maryland 20857 The contents of this monograph are in the public domain and may be used and reprinted without special permission. Citation as to source is appreciated. Library of Congress catalog card number 81-600122 DHHS publication number (ADM)81-1168 Printed 1981 NIDA Research Monographs are indexed in the Index Medicus. They are selectively included in the coverage of BioSciences Information Service, Chemical Abstracts, Current Contents, Psychological Abstracts, and Psychopharmacology Abstracts. ACKNOWLEDGMENTS This study of the lives of adolescent marijuana abusers and their families was supported by Grant No. DA-01489 from the National Institute on Drug Abuse. We wish to acknowledge, but cannot individually list, the many physicians, social workers, family court judges, pro- bation officers, and guidance counsellors in New York City and suburban counties who referred cases to us. We also owe a great debt of gratitude to all the youngsters and their families for their willingness to share their lives with us. Herbert Hendin, M.D. Ann Pollinger, Ph.D. Richard Ulman, Ph.D. Center for Psychosocial Studies Veterans Administration Medical Center Montrose, New York, and Department of Psychiatry New York Medical College Arthur C. Carr, Ph.D. Department of Psychiatry Cornell University Medical Center Foreword Substantial evidence is accumulating which emphasizes the signifi- cant role the family plays in the initiation, maintenance, cessa- tion, and prevention of drug abuse by its members. This monograph depicts and investigates that role by studying the families of a small number of adolescents involved in heavy marijuana use. The study provides a robust “real life” description of the inter- play between family dynamics and heavy adolescent marijuana use. As the authors state, their specific aims are, “first, to explore through psychodynamic techniques what in the adolescent’s adapta- tion and interaction with his or her family contributed to the marijuana abuse; and second, to identify the functions which mari- juana plays in the adolescent’s overall psychosocial adaptation.” Dr. Hendin and his colleagues offer a number of insightful per- spectives and approaches to their subject. First, they utilize the psychodynamic approach, both in the design of the study and interpretation of its results, that has not often been taken in the drug field. Second, they present extensive information about nondrug-abusing siblings of the target adolescents, comprising an informal control or comparison group about whom little has been known. Third, they delineate the adolescent’s family interactions and relationships in terms of such themes as self-destructiveness, anger, and grandiosity, an approach superbly utilized in such family studies as Jules Henry’s Pathways to Madness, but seldom seen in the drug abuse literature. Fourth, few previous studies of marijuana-using adolescents have focused exclusively on the heavy user, and none so intensively. Finally, the authors make use of the representative case design methodology, a research approach which has often been praised but infrequently applied. The National Institute on Drug Abuse believes that these unique elements, in addition to the information provided through more traditional means, make this study a valuable addition in the continuing effort to understand, prevent, and treat adolescent drug abuse. Marvin Snyder, Ph.D. Director Division of Research National Institute on Drug Abuse Contents Foreword Marvin Snyder . v I. INTRODUCTION Chapter 1. Background ................. 1 Chapter 2. Design of the Study ............ 8 II. THE LIVES OF ADOLESCENT MARIJUANA ABUSERS Chapter 3. An overview of Adolescent Marijuana Abusers . 17 Chapter 4. Representative Cases ............ 26 Angela A ............... 26 Clara D .................. 3 3 Tim H ................... 3 9 Dave M ..................4 6 Eddie J ..................5 1 Bobby G .................. 58 Chapter 5. Family Psychodynamics ........... 65 Chapter 6. The Functions of Marijuana .........73 III. PSYCHOLOGICAL TEST RESULTS Chapter 7. An Overview of Psychological Test Results . 81 Chapter 8. Psychological Contrast of Marijuana Abusers and Their Siblings . 91 Clara and Vanessa D . 91 Tim and Dennis H . 92 Dave and Fred M . .. 94 Eddie and Deborah J . 95 Bobby and Diane G . 96 Chapter 9. Discussion of Psychological Findings . 98 IV. CONCLUSION Chapter 10. Summary of Findings . 103 List of NIDA Research Monographs . 110 I. Introduction Chapter 1 Background It has been almost two decades since marijuana made its way from the ghettos and bohemian enclaves of large American cities into the white, middle class, urban, and suburban youth culture. Drug use surveys have documented its rapid spread, with the proportion of adolescents using the drug increasing steadily throughout the 1970’s. The well-established picture of the adolescent drug abuser as the product of a broken home and a deprived environment (Chein et al. 1964, Chambers et al. 1968) began to be broadened as a result of increasing evidence of marijuana abuse among white youngsters who are not socially disadvantaged and who come from intact working and middle class families (McGlothlin and West 1968; Blum et al. 1972; Blum and Richards 1979). Fueled by the alarm expressed by parents, educators, social workers, psycholo- gists, and psychiatrists, researchers representing a wide range of disciplinary perspectives have sought to explain adolescent attraction to this illegal substance. The study described in this monograph builds on past work in this area which has been done by ourselves and others during the past decade. Although it is unique in its focus on white, working and middle class, high-school-aged youngsters who are marijuana abusers rather than simply users, as well as in its particular approach to understanding adolescent marijuana abuse within the psychodynamic context of the family, this research should be viewed in relation to both the strengths and deficits of past work. Much of recent research on adolescent marijuana use grew out of an attempt to distinguish youngsters who used the drug from those who did not. In their early work the Jessors (1973, 1976, 1977) identified role modeling with marijuana smoking friends and peer pressure as the two most significant factors accounting for a youngster’s use of marijuana. Somewhat later, Jessor and his colleagues (1980) reported that such conformity with peers extended beyond marijuana smoking to include a variety of “problem be- haviors” such as early sexual experience, excessive alcohol con- sumption, forms of delinquent behavior, and use of other illegal drugs. Kandel (1973, 1978) likewise reported peer modeling and peer pressure as the critical variables in explaining use of marijuana by adolescents, although suggesting that certain psycho- logical states, notably high levels of personal dissatisfaction, 1 depression, and strong feelings of alienation from parents, may play a role in the use of ‘more serious” drugs (Paton et al. 1977). Another group of researchers stressed psychological rather than peer variables as determinant of adolescent marijuana smoking. These studies have identified such factors as low self-esteem (Kaplan 1975 a,b 1978; Norem-Hebeisen 1975); anxiety, depression, and lack of self-control (Kupfer et al. 1973); difficulties in establishing meaningful relationships with others (Esman 1967; Mirin et al. 1971); and the need to repress feelings of hostility and aggression (Allen and West 1968) as characterizing young marijuana smokers and differentiating them from those who do not use the drug. Studies correlating marijuana use with
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