Adolescent drug use study; curious conclusions; curious editorial practices at 'Addiction'. Author replies.
Posted: August 01, 2004 21:37
Addiction (2004) 99:897-906
The adolescent behavioural repertoire as a context for drug exposure: behavioural autarcesis at play. Chen C-Y, Dormitzer CM, Butierrez U, Vittetoe K, Gonzales GB, Anthony JC. Addiction (2004) 99:897-906
[NOTE: comments from senior author below]
Dear Colleagues,
This extensive 6-country, 12,000-subject survey of adolescent behaviours derived from the authors' hypothesis of the existence of some innate individual behavioural protection, termed 'autarcesis' by them. It is self-evident that some children are more inclined than others to use drugs or alcohol and, for that matter, to become involved in other risk taking behaviours. It is of crucial interest to parents to know if this is amenable to change. From previous research, we know that about half of the influence leading to drug dependence is environmental and the other half genetic. However, to my knowledge, there is no documented means either to predict which specific individuals are at a greater risk of initiating drug use, nor any definite means to alter the risk. That notwithstanding, there could be nothing more attractive to parents than to know of such factors, if they exist, to improve their children's chances of avoiding drugs.
The study was a massive exercise involving a cross sectional survey including details of drug 'exposure' ('were you offered?') and drug use as well as numerous other activities such as praying, church attendance, sports and dating, etc. The average age of 12,000 subjects was 16 (r 12-19). Being school based questionnaires, the study excluded those underprivileged children not attending school.
Unsurprisingly, those who spent time praying and going to church were less like to be exposed to and to use drugs. This interesting finding is not of much scientific merit with no indication of causation. Drug exposure/use may protect young people from attending church - or vice versa. For a more scientifically rigorous evaluation initial drug exposure and its capital consequence see the study by Vlahov and associates in New York in the same journal [Mortality risk among new onset injection drug users. Vlahov D, Wang C, Galai N, Bareta J, Mehta SH, Strathdee SA, Nelson KE. Addiction (2004) 99:946-954 - summary on request.].
The evidence provided by the authors does not prove their interesting theory on my reading, yet they seem confident that it does. I would proffer that a motor car may display 'autarcesis', just as these authors propose in these children. It has protection against rain, heat, wind and collision. Yet such protection is not a single, definable quality, but rather a combination of all the elements required to make a solid conveyance: steel, tyres, duco, glass, electrical and braking systems for example. Nevertheless, safety of the young from external mischief is such a major issue that this debate must be useful. There can be few issues as pressing as drug uptake and use among the young in our societies.
Addiction editor Griffith Edwards has evidently permitted this study to be viewed by at least two chosen experts prior to publication since two "letters to the editor" give individual comments on the study in the very same edition of Addiction. I am concerned that Edwards did not wait for the normal process of scientific discourse, neither did he caption these letters as invited commentary which they appear to be. Further, in this case Edwards chooses to print two highly critical comments ahead of the usual time for genuine correspondence from the scientific community (or 'people of goodwill' as Edwards puts it). To be productive, such commentary should be even-handed, giving differing points of view. Even the titles given to these letters are critical ... and some might even say derogatory ["Is 'autarcesis' the emperor's new clothes? A comment on Chen et al. (2004)"; "Protection from etymologic infection"]. A detailed reply from the authors appeared a month later as a normal letter-in-reply. When I raise these issues, I am reminded of editorial finality, bordering on truculence (copy on request). 'Letters' authors I have contacted state that they were asked to comment on a pre-publication items, which they duly did. Edwards might be lucent enough to let us know exactly how many such requests were made and what criteria were used for publication.
Having over 12,000 adolescent subjects in 6 countries with NIDA backing, this study is rather 'weighty' in several respects. Yet there seems to be a 'disconnect' between its data and its conclusions regarding a nebulous yet attractive concept of autarcesis or 'drug-proofing'. These wide-ranging data still deserve closer scrutiny in my view, and the authors should be commended on such a novel study of adolescent drug experiences.
comments by Andrew Byrne ..
The senior author Professor Jim Anthony was asked by me to comment on the above. He wrote the following and suggested it be appended herewith:
"Autarcesis is not an object or a property. It is the name of a process or force that has manifestations we can observe. One distant analogy is gravity. Gravity, like autarcesis, is not an object nor is it a property. It is a process or force.
"An autarceologic process is one that helps shield the organism from exposure to a toxic agent or that helps the organism resist the toxic exposure once effective contact has occurred, but autarcesis is a non-specific process. That is, any shielding or resistance strengthening is generic and is not specific to any particular toxic agent as an induced antibody response might be specific to an antigen.
"There are other forces or processes that help shield or protect against a toxic agent, but they have the character of 'specific' shielding or 'specific' resistance strengthening (see 'antibody').
"Our thesis is that aspects of thhe adolescent behavioral repertoire serve an autarceologic function, helping in a non-specific way to shield the youth from drug-taking or to induce in a non-specific way a strengthening of resistance against offers or opportunities to try drugs.
"This feature of the adolescent behavioral repertoire is not 'innate' by any means, and we think of it as a very malleable repertoire (particularly once drug use 'comes on board').
"In many ways, the autarcesis concept is superior to 'risk factor' and 'protective factor' concepts because it conveys a mechanism, albeit of a non-specific character."
Jim Anthony, Epidemiology, Michigan State University
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