Coping and emotion regulation profiles as predictors of nonmedical prescription drug and illicit drug use among high-risk young adults
Introduction
Nonmedical use or “misuse” of prescription drugs has been linked to a range of negative health outcomes among adolescents and young adults, including drug dependence in adulthood (McCabe et al., 2007), drug overdose (Paulozzi et al., 2012), and psychiatric dysfunctions (Schepis and Hakes, 2011). Since most research on prescription drug misuse patterns tend to focus on typically-developing adolescents and young adults, there may be a reduced understanding of current patterns of prescription drug misuse among high-risk young adults, including homeless persons, injection drug users, or polydrug users (Daniulaityte et al., 2009, Kurtz et al., 2005, Lankenau et al., 2007). These young active drug users are considered “high-risk” because they may be at greater risk for drug overdose and other negative health consequences such as hepatitis, HIV, and long-term drug dependence compared to lower-risk populations (Benotsh et al., 2011, SAMSHA, 2010). Studies that do not include high-risk groups may underestimate more serious or complex patterns of prescription drug misuse and illicit drug use, as research has revealed higher rates of prescription drug and illicit drug misuse among high-risk youth compared to general young adult populations (Lord et al., 2009, McCauley et al., 2010).
Furthermore, research to date among prescription drug misusers has sparsely addressed the impact of psychological factors related to the management of emotions and stress on misuse (Ford, 2008, Ford and Arrastia, 2008, Sung et al., 2005), despite the fact that the management of stress and the management of both positive and negative emotions are fundamental features of motivations to misuse drugs (Arnett, 1995, Conrad et al., 1992). It has been postulated that substance misuse is a symptom, not a cause, of psychological and social maladjustment among adolescents and young adults, suggesting that individuals’ ability to handle stress and distress would be important determinants/drivers of substance misuse (Shedler and Block, 1990). Hence, greater empirical attention is needed to understand how individuals’ coping responses and emotion regulation tendencies in the face of stress and distress might be associated with their initiation and persistence in misusing prescription and illicit drugs. This is also a particular concern among high-risk youth who may contend with more difficult life circumstances than youth from general youth populations (McCauley et al., 2010, Sinha, 2008). A better understanding of individual differences in both coping and emotion regulation could inform programs and facilitate the development of interventions that build on specific strengths and characteristics of high-risk young adults.
Even though both coping and emotion regulation (ER) can be conceptualized as traits (i.e., predispositions/tendencies) or states (Lazarus, 1993), the current study focused on individuals’ predisposition to cope and manage their emotions. Coping is defined as behavioral and cognitive responses to manage external and internal demands that exceed a person's resources and encompasses strategies that may or may not be directed at emotions (Lazarus and Folkman, 1984). ER strategies, though related to coping, refer to strategies used to influence, experience, and modulate emotions (e.g., suppression and cognitive reappraisal). ER includes processes that may not be typically considered as coping, such as managing expressions of emotions or enhancing positive emotions (Gross, 1999). Adaptive ER can be characterized by individuals’ ability to use effective coping strategies during stressful situations. Effective coping, in turn, can buffer substance use behaviors and emotional distress (Stein and Nyamathi, 1999).
Deficits in individuals’ ability to organize, integrate, and modulate emotions, thoughts, and behaviors when dealing with stress (i.e., impairment in coping) have been found to be related to the onset and escalation of substance use among adolescents and young adults (Compas et al., 1992, Wills et al., 2001). For example, strategies that have been found to perpetuate substance use include disengagement coping, such as venting. On the other hand, proactive behavior or task-oriented coping (e.g., use of problem-solving strategies) have been found to deter substance use and initiation among general adolescents and young adults. Wills et al. (2001) found behavioral coping (i.e., doing something to solve a problem) to have a protective effect on drug use initiation and diminished growth in drug use over time among adolescents, while avoidant or anger coping (e.g., using distraction or social diversion) was associated with initiation and escalation of substance use. Similarly, low emotional restraint has been found to be associated with increases in gateway-drug use among a sample of middle-school aged boys (Farrell and Danish, 1993). In contrast, a study of homeless youth revealed avoidant coping to be significantly associated with lower HIV-risk taking behaviors, fewer depressive or anxiety-related symptoms, and less frequent alcohol use (Dashora et al., 2011). In the same study, task-oriented coping and emotion-oriented coping (e.g., self-blame, rumination) were not significantly associated with HIV risk-taking and substance use. Another study of homeless youth indicated that the use of nondisclosure coping (i.e., not telling others how you feel), self-destructive escape coping (i.e., engaging in dangerous activities to reduce tension), and withdrawal coping were related to increased illicit drug use. However, problem-solving coping did not reduce drug use (Nyamathi et al., 2010).
These results showed that individuals’ coping and ER responses are important factors that impact drug-use and other risk-taking behaviors among general and high-risk young adults. Results also revealed interesting differences on which types of strategies are considered “adaptive” or “mal-adaptive” for different youth populations. While these studies are informative, no studies to date have considered how coping and ER tendencies constitute meaningful profiles or typologies that account for intra-individual differences in the different types of strategies one might use. This approach can provide a more complex and complete characterization of individuals’ underlying coping and ER response to stress and distress because individuals are categorized based on the multitude of coping and ER strategies they prefer/tend to use or not use.
In the present study, we employed latent profile analysis (LPA) to develop distinct coping and ER profiles that are then used to predict patterns of prescription and illicit drug misuse among a sample of high-risk young adults. Specifically, we examined how coping and ER typologies are able to differentiate age of initiation of specific prescription and illicit drugs, and magnitude of recent drug use and other high-risk behaviors, such as injection drug use (IDU). LPA enables us to link these typologies/profiles to different patterns of prescription and illicit drug use behaviors while accounting for socio-demographic and significant early life experiences (e.g., having experienced abuse) that could influence the formation of coping and ER tendencies.
Section snippets
Participants and procedures
Data for this study come from a previously reported study of youth who misuse prescription drugs (Lankenau et al., 2012a), recruited in Los Angeles (LA) and New York (NY) between October 2009 and March 2011. Eligible participants were between 16 and 25 years old and had engaged in misuse of a prescription drug (i.e., opioid, tranquilizer, stimulant, or any combination, at least three times in the last 90 days). “Misuse” was defined as taking prescription drugs “when they were not prescribed for
Coping and emotion regulation profiles
We identified latent classes or profiles based on the following coping and ER strategies: self-distraction, active coping, emotional support seeking, instrumental support seeking, venting, positive reframing, planning, emotional suppression, and cognitive reappraisal. The best-fitting solution (Nylund et al., 2007) resulted in four latent classes (adjusted BIC = 13597.6; entropy = 0.79), and the smallest class represented 15% of the participants. The standardized conditional response means for each
Discussion
This is among the first studies to examine how typologies formed by coping and ER tendencies predict prescription and illicit drug use among a sample of high-risk young adults. Given that individuals’ ability to handle stress and distress are important drivers of substance misuse (Carrico et al., 2012, Dashora et al., 2011, Wills et al., 2001), it was expected that profiles based on their coping and ER would be useful for distinguishing different patterns of substance misuse. Consistent with
Role of funding source
This research was supported by funding from the National Institute of Drug Use (DA021299). NIDA had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.
Contributors
CFW developed this manuscript and conducted the analyses with assistance from KS, AK, SMS, and SL. Detailed comments on draft manuscripts prepared by CFW were provided by KS, AK, SMS, JJB, EI, and SL. In addition, SL developed the study design and implementation protocols. EI oversaw participant recruitment. All authors have approved the final version of this manuscript.
Conflict of interest
No conflict of interest is declared.
Acknowledgments
The authors gratefully acknowledge Cesar Arauz-Cuadra, Meghan Treese, and Alex Harocopos for participant recruitment and interviews. We also would like to acknowledge the young adults who participated in this study.
References (44)
- et al.
Psychological processes and stimulant use among men who have sex with men
Drug Alcohol Depend.
(2012) - et al.
Illicit use of pharmaceutical opioids among young polydrug users in Ohio
Addict. Behav.
(2009) - et al.
Pill-poppers and dopers: a comparison of non-medical prescription drug use and illicit/street drug use among college students
Addict. Behav.
(2008) - et al.
Initiation into prescription opioid misuse amongst young injection drug users
Int. J. Drug Policy
(2012) - et al.
Nonmedical use of prescription opioids and stimulants among student pharmacists
J. Am. Pharm. Assoc.
(2009) The drug abuse screening test
Addict. Behav.
(1982)- et al.
Nonmedical use of prescription opioids among teenagers in the United States: trends and correlates
J. Adolesc. Health
(2005) - et al.
Understanding the trends in HIV and hepatitis C prevalence amongst injecting drug users in different settings: implications for intervention impact
Drug Alcohol Depend.
(2012) - et al.
A comprehensive review of the psychometric properties of the Drug Abuse Screening Test
J. Sub. Abuse Treat.
(2007) The young and the reckless: adolescent reckless behavior
Curr. Direct. Psychol. Sci.
(1995)