Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

25. Adolescent Substance Abuse 565Peer InfluencesPeer influences play a crucial role in the process of involvement in the use andabuse of all substances—tobacco, alcohol, and illicit substances (especially marijuana).Because only a small fraction of adolescent substance users may progressto substance abuse, it is of a significant clinical importance to differentiatebetween the causes for substance use and substance abuse. Most substance useoccurs due to social influences and can be attributed to the adolescent’s immediatesubculture and lifestyle. Substance abuse is more strongly tied to a developmentalprocess involving biobehavioral factors (Glantz & Pickens, 1992),and it occurs as a part of a cluster of behaviors that form a syndrome of problembehavior (Jessor & Jessor, 1977) or general deviance (Newcomb, 1995).Peer relationships have a significant effect on the initiation, development,and maintenance of substance abuse. The most consistent and reproduciblefinding in substance abuse research is the strong relationship between an individual’ssubstance use behavior and the concurrent substance use of his or herfriends (Jessor & Jessor, 1977). Such an association may result from socialization,as well as from a process of interpersonal selection (assortative pairing), inwhich adolescents with similar values and behaviors seek each other out asfriends (Kandel, 1982). Susceptibility to peer influence is related to earlierinvolvement in peer-related activities and to a greater degree of attachmentand reliance on peers rather than parents (Kandel, 1978).Regarding values and attitudes in adolescent substance abusers, substanceabuse is correlated negatively with conventional behaviors and beliefs, such aschurch attendance, good scholastic performance, value of academic achievement,and beliefs in the generalized expectations, norms, and values of society(Jessor, 1987). Substance abuse is correlated positively with risk-taking behavior,sensation-seeking behavior, early sexual activity, higher value of independence,and greater involvement in delinquent behavior (Jessor, 1987).Delinquent peer groups may engage in many shared deviant behaviors,such as using the same drugs of choice, Satanism and related rituals, drug trafficking,and violence. Such activities are deeply rooted in the identity-creatingprocess of these groups and are inseparable components of their code of values.PSYCHIATRIC COMORBIDITYThe presence of one or more comorbid psychiatric disorders, both internalizingand/or externalizing types, is often noted in populations of adolescents withSUDs (Bukstein, Glancy, & Kaminer, 1992; Riggs, Baker, Mikulich, Young, &Crowley, 1995). Psychiatric disorders in childhood, featured by disruptivebehavior disorders, as well as mood or anxiety disorders, confer an increased riskfor the development of SUDs in a majority of the cases in adolescence(Bukstein, Brent, & Kaminer, 1989; Christie et al., 1988; Loeber, 1988). The