Substance Use & Misuse

ISSN: 1082-6084 (Print) 1532-2491 (Online) Journal homepage: http://www.tandfonline.com/loi/isum20

Anxiety Symptoms and Coping Motives: Examining

a Potential Path to Substance Use-Related
Problems in Adolescents With Psychopathic Traits

Christopher T. A. Gillen, Christopher T. Barry & Lovina R. Bater

To cite this article: Christopher T. A. Gillen, Christopher T. Barry & Lovina R. Bater (2016)
Anxiety Symptoms and Coping Motives: Examining a Potential Path to Substance Use-Related
Problems in Adolescents With Psychopathic Traits, Substance Use & Misuse, 51:14, 1920-1929,
DOI: 10.1080/10826084.2016.1201510

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Published online: 09 Sep 2016.

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SUBSTANCE USE & MISUSE
, VOL. , NO. ,
http://dx.doi.org/./..

ORIGINAL ARTICLE

Anxiety Symptoms and Coping Motives: Examining a Potential Path to Substance

Use-Related Problems in Adolescents With Psychopathic Traits
Christopher T. A. Gillena , Christopher T. Barryb , and Lovina R. Batera
a
Department of Psychology, The University of Southern Mississippi, Hattiesburg, Mississippi, USA; b Department of Psychology, Washington State
University, Pullman, Washington, USA

ABSTRACT KEYWORDS
Background: Although the relation between impulsive-irresponsible psychopathic traits and sub- Anxiety; drinking motives;
stance use is well-documented, the path to developing substance use problems is less understood marijuana use motives;
in adolescents with these characteristics. Objectives: To examine the associations between psychopa- psychopathy; substance use
thy, anxiety, and substance use motives and a mechanism by which anxiety and alcohol and mari-
juana coping motives mediate the relation between psychopathic traits and substance use-related
problems. Methods: A sample of 185 at-risk adolescent males from a residential military-style program
reporting past alcohol or marijuana use (M age = 16.74) participated in the study. Results: Impulsive-
Irresponsible psychopathic traits were uniquely and incrementally predictive of alcohol and mari-
juana use-related problems and anxiety. Anxiety and coping motives appeared to partially explain
the association between impulsivity-irresponsibility and substance use-related problems. Conclu-
sions/Importance: Findings suggest that youth expressing impulsive-irresponsible psychopathic traits
may engage in problematic substance use at least partly as a function of heightened anxiety and a
subsequent desire to alleviate distress by using alcohol or marijuana to cope.

Psychopathy is characterized by deceit and manipula-
tion (interpersonal traits), callousness and remorseless-
ness (affective traits), and impulsivity and irresponsi-
bility (lifestyle traits; van Baardewijk et al., 2011). In
adolescence, psychopathic traits are predictive of a range
of antisocial outcomes, including delinquency and aggres-
sion (Nijhof et al., 2011). Psychopathy is also associated
with different substance use (SU) indices, including sever-
ity and frequency of alcohol and other drug use (Hillege,
Das, & de Ruiter, 2010; Poythress, Dembo, Wareham, &
Greenbaum, 2006).
Despite some research noting moderate relations
between interpersonal and affective psychopathic traits
and SU frequency (ONeil, Lidz, & Heilbrun, 2003) and
proneness (Murrie & Cornell, 2002), most studies have
found that impulsive-irresponsible (II) traits in adoles-
cence are more strongly or exclusively related to SU.
That is, II is more consistently related to SU severity
(Poythress et al., 2006), alcohol use (Hillege et al., 2010),
hard drug use in boys (i.e., cocaine, ecstasy; Nijhof et al.,
2011), and SU disorders (Colins, Bijttebier, Broekaert,
& Andershed, 2014) than are affective or interpersonal
features. Although the relation between II and SU is
well-documented, the path to developing problematic SU
is less understood in youth with these characteristics.
Notably, the effect sizes in the literature linking psycho-
pathic traits to SU indices tend to vary from small to
medium. Consequently, the current study examined a
potential mechanism by which psychopathic traits predict
variance in alcohol and marijuana use-related problems
via anxiety and coping SU motives.
The relation between II and SU may be due in part
to increased emotional reactivity concurrent with anx-
iety. For example, self-reported II traits in adolescent
offenders are uniquely related to multiple types of anxiety
(Kubak & Salekin, 2009). Moreover, when psychopathy is
examined as two heterogeneous variants, adolescent sec-
ondary psychopathy, most often typified by high impul-
sivity, involves more physical anxiety, worry, and social
concern than primary variants defined by higher inter-
personal and affective traits (Kimonis, Tatar, & Cauffman,
2012; Lee & Salekin, 2010).
Given its association with anxiety, it is not surpris-
ing that secondary psychopathy is predictive of SU above
primary psychopathy. In addition to higher SU frequen-
cies (Vaughn, Edens, Howard, & Smith, 2009), Kimonis
and colleagues (2012) found that adolescents classified
within the secondary subtype were four times more likely
to have a SU disorder and were at more risk for depen-
dency than primary subtype youth. Others have identified

CONTACT Christopher T. A. Gillen christopher.gillen@eagles.usm.edu Department of Psychology, The University of Southern Mississippi, College Drive,
Box , Hattiesburg, MS , USA.
Taylor & Francis Group, LLC

highly impulsive-anxious adolescent offenders as having
the highest SU frequency rates compared to youth charac-
terized by primary psychopathy or by impulsivity and low
anxiety (Wareham, Dembo, Poythress, Childs, & Schmei-
dler, 2009). This finding provides additional evidence that
the anxiety and reactivity associated with II traits may be
particularly salient in understanding the psychopathy-SU
relation.
Nevertheless, anxiety independent of other factors may
not completely explain why teens expressing II traits
engage in SU behavior. According to the self-medication
SU model (Khantzian, 2003), individuals experiencing
mental health symptoms, such as anxiety, may engage in
SU as a coping mechanism. Although support has been
mixed (e.g., Breese, Overstreet, & Knapp, 2005), longitu-
dinal research has provided evidence in support of the
model in teens. Specifically, negative affect, social anx-
iety, and posttraumatic stress during mid adolescence
predicted increased alcohol use and alcohol use disor-
ders into late adolescence and young adulthood (Mason,
Hitch, & Spoth, 2009; Wolitzky-Taylor, Bobova, Zinbarg,
Mineka, & Craske, 2012). These authors argued that these
results furthered the self-medication model because anx-
iety preceded subsequent SU, whereas the inverse pattern
was not supported. Moreover, high levels of trait anxiety
and generalized and social anxiety in teens are uniquely
predictive of coping as a motive for alcohol use (Comeau,
Stewart, & Loba, 2001; Windle & Windle, 2012).
Furthermore, when different drinking motives are
examined (i.e., using to socialize or conform, coping
with problems, or enhancing positive affect), drink-
ing to cope with negative affect is consistently predic-
tive of more problematic alcohol-related consequences
(Kuntsche, Stewart, & Cooper, 2008). Research with
adults has noted that using marijuana to cope with social
anxiety is predictive of more marijuana-related prob-
lems above other motives (Buckner & Zvolensky, 2014).
Although conformity and enhancement motives are asso-
ciated with heavy drinking and alcohol-related problems
in teens, coping may be especially problematic for youth
with anxiety because they are most likely to engage in
riskier and heavier use when motivated to alleviate their
negative affect (Goldstein, Vilhena-Churchill, Stewart, &
Wekerle, 2012). Further, using to cope prevents youth
from learning to use alternative problem-focused coping
strategies.
Contrary to unidirectional substance-induced models
of negative affectivity, these studies suggest that SU may
be used as an avoidant coping strategy for anxiety symp-
toms (i.e., SU to cope with heightened arousal because
they do not have well-developed active coping strategies).
Seemingly, adolescents with II psychopathic traits expe-
rience elevated anxiety compared to youths expressing
SUBSTANCE USE & MISUSE 1921
other psychopathic traits, which may be connected to
problematic SU because more adaptive coping alterna-
tives are not readily available.
The current study
The purpose of the present study was to examine anx-
iety and coping motives as factors related to alcohol
and marijuana use-related problems in at-risk adoles-
cents expressing II psychopathic traits. This study is the
first known investigation of whether anxiety and SU cop-
ing motives mediate the relation between II traits and
SU-related problems. Although research with adult sam-
ples has noted that coping motives mediate the rela-
tion between impulsivity and SU problems (Mackinnon,
Kehayes, Clark, Sherry, & Stewart, 2014), II traits encom-
pass additional constructs (i.e., irresponsibility, stimula-
tion seeking, parasitic lifestyle, and a lack of long-term
planning), that have yet to be investigated.
Although SU motives and adolescent psychopathy
have not been examined, past research seemingly sup-
ports individual paths in such a model. Not only are II
traits directly associated with SU severity (Poythress et al.,
2006), anxiety symptoms related to adolescent psychopa-
thy (Kubak & Salekin, 2009) are also predictive of coping
motives within the self-medication framework (Windle
& Windle, 2012). By examining potential variables (i.e.,
anxiety; coping strategies) involved in the relation of
psychopathy with alcohol and marijuana use, this study
aimed to identify factors that could be targeted with
treatment to reduce problematic SU in youth.
Similar to past adolescent research (e.g., Kubak &
Salekin, 2009; Poythress et al., 2006), it was hypothe-
sized that the II psychopathy facet would be uniquely
related to, and incrementally predictive of, self-reported
alcohol and marijuana use-related problems and anxiety
above the interpersonal and affective facets (Hypothesis
1). Second, it was expected that coping motives would
predict SU-related problems above II traits, anxiety, and
other motives (i.e., using to socialize, conform to a peer
group, enhance positive affect, or expand awareness)
(Hypothesis 2; Goldstein et al., 2012).
Lastly, it was hypothesized that self-reported anxiety
symptoms and SU coping motives would serially medi-
ate the relations between II and alcohol and marijuana
use-related problems (Hypothesis 3). Specifically, it was
expected that II would predict increased alcohol and
marijuana use-related problems via increased anxiety
symptoms and SU coping motives. That is, II would be
associated with higher anxiety, anxiety in turn would
be predictive of increased coping, and coping would be
predictive of increased SU-related problems.
1922 C. T. A. GILLEN ET AL.
Method
Participants
Participants were 185 adolescent males (ages 1619; M =
16.74, SD = .76) reporting past alcohol or marijuana use
on at least one occasion within the past 12 months on
the CRAFFT. Participants were sampled from 205 ado-
lescents enrolled in a residential military-style program
in the southeastern United States for youth who have
dropped out of high school. One hundred forty (140)
teens reported using both substances, whereas 31 and 14
adolescents indicated using only alcohol or marijuana,
respectively. Because of the continual supervision adoles-
cents receive at the program, it is unlikely that participants
were using substances at the time of the study. As such,
our data likely reflect retrospective SU reports. The major-
ity of participants identified as White (54.1%), whereas
24.3% were Black, 1.1% were Hispanic, .5% were Asian,
and 1.6% reported belonging to another ethnic group;
18.4% did not report their ethnicity. Participants repre-
sented 90% of those who were invited to participate.
Unlike past studies examining psychopathic traits, SU,
and anxiety in high-risk male incarcerated samples (i.e.,
Kimonis et al., 2012), this study examined these con-
structs in an at-risk non-forensic sample. As such, this
study represents an attempt to extend past findings to
a lower-risk population of boys who generally exhibit
comparable levels of psychopathic tendencies to detained
youth (see Hawes, Mulvey, Schubert, & Pardini, 2014)
and higher levels than in community samples (see Col-
ins, Noom, & Vanderplasschen, 2012). A male sample was
chosen because males with SU problems express higher
levels of psychopathic traits (Hemphl & Tengstrm,
2010), making them a useful sample for initially studying
the association between SU motives and psychopathy.
Materials
Youth Psychopathic Traits Inventory-Short Version
(YPI-S; van Baardewijk et al., )
The YPI-S is an 18-item abbreviated self-report mea-
sure of adolescent psychopathic traits (total scores
range from 1872, factor scores range from 624).
Research has supported a three-factor model assessing
interpersonal (Grandiose-Manipulative; GM), affective
(Callous-Unemotional; CU), and behavioral (Impulsive-
Irresponsible; II) psychopathic traits (Colins et al., 2012,
2014). YPI-S factor scores are moderately associated with
concurrent scales of other self and clinician-rated psy-
chopathy scales (Colins et al., 2012, 2014; Hawes et al.,
2014) and II is moderately related to frequency of self-
reported drug offenses, alcohol and marijuana use, and
SU-related problems (Colins et al., 2012, 2014; Vahl et al.,
2014) in detained and community samples. In the current
study, total YPI-S scores showed strong internal reliabil-
ity ( = .87), as well as adequate consistency for the GM
( = .83), CU ( = .78), and II ( = .69) scores.
Personality Inventory for Youth (PIY; Lachar & Gruber,
)
The PIY is a 270-item true-false self-report measure
assessing a range of emotional and behavioral function-
ing. The current study used the Fear and Worry (15 items)
subscale to measure anxiety symptoms (scores range from
015). In terms of validity, the Fear and Worry subscale
can differentiate between clinical and non-clinical sam-
ples of children on anxiety (Lachar & Gruber, 1995). The
internal consistency of Fear and Worry scores was good
in the current study ( = .72).
Drinking Motives Questionnaire-Revised (DMQ-R;
Cooper, )
The DMQ-R is a 20-item questionnaire measuring the
reasons why people drink alcohol. Factor analytic stud-
ies with adolescents have identified four motives, includ-
ing enhancement (i.e., increase positive affect; because
its exciting), coping (i.e., decrease negative affect; to
forget your worries), social (i.e., obtain social reward;
because it helps you enjoy a party), and conformity (i.e.,
avoid social rejection; to be liked;Hudson, Wekerle, &
Stewart, 2015). Participants rate their relative frequency
of use for each motive (scores range from 530 for each
motive). In the current study, alphas for the enhance-
ment, coping, social, and conformity motive scores were
.84, .82, .85, and .85, respectively, suggesting good internal
consistency. Intercorrelations between drinking motives
were moderate to strong in magnitude, rs between .24 and
.72, p < .002, with the exception of the relation between
enhancement and conformity motives, r = .07, p > .05.
Marijuana Motives Measure (MMM; Simons, Correia,
Carey, & Borsari, )
The MMM is a 25-item self-report questionnaire assess-
ing the reasons why people smoke marijuana. Research
has identified enhancement, coping, social, conformity
and expansion motive factors (i.e., improve creativity and
awareness; to expand my awareness; Benschop et al.,
2015; scores range from 530 for each motive). In the
current study, alphas for the enhancement, coping, social,
conformity, and expansion motive scores were .86, .86,
.88, .88, and .90, respectively, suggesting good internal
consistency. Intercorrelations between marijuana motives
were significant, rs between .19 and .70, p < .022.

CRAFFT (Knight et al., ) the current sample. Anxiety scores were comparable to
The CRAFFT is a six-item screening questionnaire assess-
ing adolescent SU problem severity (i.e., more rea-
sons/contexts in which use occurs). In this sense, the
CRAFFT conceptualizes SU severity as having more var-
ied SU-related problems. CRAFFT is an acronym for Car,
Relax, Alone, Forget, Friends, and Trouble, with each
letter corresponding to one of the questionnaire items
(see Knight et al., 1999 for measure items). Each item
is scored as yes or no, with a higher proportion of
yes responses indicating more severe SU (scores range
from 06). The current study used the CRAFFT to assess
alcohol and marijuana use-related problems. It has been
found to display high sensitivity and specificity in identi-
fying SU problems (Subramaniam, Cheok, Verma, Wong,
& Chong, 2010) and is related to self-reported alcohol
and drug consumption (Skogen, Be, Knudsen, & Hys-
ing, 2013). The internal consistency of CRAFFT alcohol
severity scores ( = .61) and marijuana severity scores
( = .69) in the current study were comparable to past
research examining community, military-recruited, and
hospitalized teens (s between .61 and .73; Kelly, Dono-
van, Chung, Bukstein, & Cornelius, 2009; Skogen et al.,
2013; Subramaniam et al., 2010).
Procedure
Preceding data collection, approval was received from the
Institutional Review Board at the first authors affiliated
university. As the legal guardian of all adolescents, the
director of the program provided consent for all teens to
be invited to participate in the study. Participation did
not affect the teens status within the program. After writ-
ten consent/assent was obtained, participants completed a
battery of self-reports as part of a larger research project.
Questionnaires for the current study were administered
across two sessions within the same week approximately
one month after participants entered the program.
Results
Descriptive statistics
Descriptive statistics for psychopathy, anxiety symp-
toms, SU-related problems, and SU motives are found in
Table 1. Although most scores were normally distributed,
alcohol and marijuana conformity motives were leptokur-
tic and positively skewed, indicating that most partici-
pants reported low levels of conformity motives. Mari-
juana social and coping motive scores were also kurtotic
but were not skewed. Compared to previous studies exam-
ining SU motives in youths in child protective services
(Hudson et al., 2015) and community samples (Comeau
et al., 2001), all mean subscale scores appeared higher in
SUBSTANCE USE & MISUSE 1923
other residential military program samples (Barry, Loflin,
& Doucette, 2015). Mean CRAFFT scores in the current
sample were slightly higher when compared to adoles-
cents receiving emergency hospital care (Kelly et al., 2009)
and community samples (Skogen et al., 2013; Subrama-
niam et al., 2010).
Associations between behavioral impulsivity,
anxiety, and substance-related problems
Table 2 shows the correlations between psychopathy, SU,
and anxiety. Consistent with Hypothesis 1, moderate cor-
relations were observed between II traits and SU-related
problems, and anxiety symptoms; however, correlations
with GM and CU traits were small. Fisher r to z trans-
formations revealed that II traits were not more strongly
related to SU-related problems than were GM or CU
traits, zs between .08 and 1.88, p > .06.
Correlations were calculated to examine the rela-
tions between psychopathy dimensions and SU motives
(Table 2). Total, GM, and CU domains were moder-
ately related to social and enhancement drinking motives,
whereas II was similarly associated with coping and social
motives. Total psychopathy, GM, and II were moderately
related to all marijuana motives.
A series of step-wise regressions with GM and CU
traits entered into step one and II traits entered into step
two were conducted to examine the second portion of
Hypothesis 1 that II would incrementally predict SU-
related problems and anxiety above other psychopathy
domains. In partial support of the hypothesis, II signifi-
cantly predicted marijuana use-related problems and anx-
iety symptoms above the variance predicted by GM and
CU in step 1 (Table 3). These effects were significant even
after controlling family-wise error using a Bonferroni cor-
rection ( pc = .013). The ability of II to incrementally pre-
dict alcohol use-related severity above the GM and CU
domains approached significance, p = .051.
Associations between substance use motives
and related problems
Two multiple regressions were analyzed to examine
Hypothesis 2 that coping motives incrementally predict
alcohol and marijuana use-related problems above other
SU motives, anxiety, and II traits (Table 4). In addition
to SU motives, each model accounted for the effect of II
and anxiety on SU-related problems. In each regression,
II and anxiety were entered into step one. For predict-
ing alcohol-related problems, social, conformity, and
enhancement drinking motives were added into step two,
whereas coping motives were entered into step three. For
predicting marijuana-related problems, marijuana social,
1924 C. T. A. GILLEN ET AL.

Table . Descriptive statistics for psychopathy, anxiety, and alcohol and marijuana use-related problems and motives.
Scale/Subscale M SD Range Skew Kurtosis

Total Psychopathy . . . .
GM . . . .
CU . . . .
II . . . .
Anxiety Symptoms . . . .
Alcohol Problems . . . .
Marijuana Problems . . . .
DM (MM)
Social . (.) . (.) () . (.) . (.)
Coping . (.) . (.) () . (.) . (.)
Enhancement . (.) . (.) () . (.) . (.)
Conformity . (.) . (.) () . (.) . (.)
Expansion (.) (.) () (.) (.)

GM = Grandiose-Manipulative; CU = Callous-Unemotional; II = Impulsive-Irresponsible; DM = Drinking Motives; MM = Marijuana Motives.

Table . Zero-order correlations between psychopathy and anxi- enhancement motives predicted alcohol use-related prob-
ety and alcohol and Marijuana use-related problems and motives. lems above step one, whereas no motives significantly pre-
Correlated dicted marijuana use-related problems. II did not remain
measures Psychopathy GM CU II a significant predictor in step two. Consistent with our
Anxiety . . . . hypothesis, coping motives incrementally predicted alco-
symptoms hol, Fchange (1, 164) = 31.50, p < .001, and marijuana use-
Alcohol . . . .
Problems related problems above step two, Fchange (1, 145) = 8.30,
Marijuana . . . . p = .005. The effect for enhancement drinking motives
Problems
DM (MM) approached significance in step three, B = .05, SE = .02,
Social . (. ) . (. ) . (. ) . (. ) p = .032.
Coping . (. ) . (. ) . (.) . (. )
Enhancement . (. ) . (. ) . (. ) . (. )
Conformity . (. ) . (. ) . (.) . (. )
Expansion (. ) (. ) (. ) (. ) The mediating role of anxiety and coping in the
GM = Grandiose-Manipulative; CU = Callous-Unemotional; II = Impulsive- relation between psychopathy and substance use
Irresponsible; DM = Drinking Motives; Alcohol (n = ); MM = Marijuana
Motives, Marijuana (n = ). p < .; p < .; p < .. SPSS PROCESS macro model 6 (Hayes, 2013) was used2
to examine whether anxiety and coping SU motives act as
serial mediators of the relation between II psychopathic
conformity, enhancement, and expansion motives were traits and SU-related problems (Hypothesis 3). Five thou-
added into step two, and coping motives were added sand bootstrap samples were used to create 95% bias-
into step three.1 Family-wise error was controlled using a corrected confidence intervals to test the significance of
Bonferroni correction ( pc = .025). the direct and indirect effects of II on SU-related prob-
Results revealed that step one significantly predicted lems in the two specified models. Models with standard-
marijuana use-related problems, F(2, 150) = 5.97, p = ized effects for each path are in Figure 1.
.003, but not alcohol related problems, F(2, 168) = 3.70, Although the effect of II on alcohol, B = .078,
p = .027. Only II was a significant predictor of marijuana SE = .033, p = .012, and marijuana use-related prob-
use. Step two significantly predicted alcohol, Fchange (3, lems, B = .115, SE = .033, p = .001, were initially sig-
165) = 11.57, p < .001, and marijuana use-related prob- nificant, only the direct effect of II on marijuana prob-
lems above step one, Fchange (4, 146) = 3.62, p = .008. Only lem use remained significant when anxiety and coping
motives were included, B = .069, p = .047. In addition,
three indirect effects in each model were tested (i.e., the
Because two CRAFFT items contained similar content as MMM and DMQ-R relation between II and SU-related problems mediated by
coping motive items (i.e., using drugs to relax, using drugs to forget), these
items were excluded from CRAFFT total scores. The same pattern of results both anxiety and coping, by anxiety alone, and by cop-
as shown in Table was found. The serial-mediation analyses outlined in ing alone). For alcohol, the indirect effect of II on alcohol
Figure also remain unchanged. Exploratory zero-order correlations between
SU-related problems and motives were calculated to further examine the
overlap between the two constructs. For alcohol use, the relation with cop- AMOS was used to examine a serial-mediation model where alcohol and mar-
ing motives was strong, r= ., p < ., whereas the relations with the other ijuana coping and problem use were indicators of latent SU coping and prob-
motives were low to moderate, rs between . and ., p < .. Relations lem use variables, respectively. Due to poor model t, RMSEA = ., TLI =
between marijuana use and all motives were moderate, rs between . and ., CFI = ., alcohol and marijuana models were analyzed individually with
., p ., except conformity motives, r = ., p = .. PROCESS.
 SUBSTANCE USE & MISUSE 1925

Table . Prediction of anxiety symptoms and alcohol and marijuana use-related problems from psychopathy.
Anxiety symptoms Alcohol related problems Marijuana related problems
Predictor B (SE) B B (SE) B (SE)

Step R = . R = . R = .
GM . (.) . . (.) . . (.) .
CU . (.) . . (.) . . (.) .
Step R change= . R change= . R change= .
GM . (.) . . (.) . . (.) .
CU . (.) . . (.) . . (.) .
II . (.) . . (.) . . (.) .

GM = Grandiose-Manipulative; CU = Callous-Unemotional; II = Impulsive-Irresponsible; Alcohol (n = ); Marijuana (n = ).

p < .; p < .; p < ..

Table . Prediction of alcohol and marijuana use-related problems To examine whether these indirect effects were unique
from impulsivity-irresponsible psychopathic traits, anxiety symp- to II traits and coping motives, both hypothesized serial
toms, and drinking and marijuana use motives. mediation models in Figure 1 were tested using GM and
Alcohol related Marijuana related CU traits instead of II (4 models) and other alcohol (3
problems problems
models, one for each motive) and marijuana motives (4
Predictor B (SE) B B (SE) models, one for each motive). Only one factor was sub-
Step R = . R = . stituted from the originally proposed models in Figure 1
Impulsive- . (.) . . (.) . for each of the 11 models. When GM or CU were sub-
Irresponsible stituted into the original models for II, all serial indirect
Anxiety Symptoms . (.) . . (.) .
paths predicting alcohol and marijuana use-related prob-
Step R change = . R change = . lems were not significant. When each of the different SU
Social . (.) . . (.) . motives were substituted, all of the biased-corrected con-
Enhancement . (.) . . (.) .
Conformity . (.) . . (.) . fidence intervals for the serial indirect paths contained or
Expansion . (.) . approached zero, such as the indirect effect through anx-
Step R change = . R change = . iety and marijuana expansion motives, B = .003, SE =
Coping . (.) . . (.) . .003, 95% CI = .001.012, and through anxiety and drink-
p < .; p < .. ing conformity motives, B = .003, SE = .002, 95% CI =
.000.011.
To investigate a substance-induced model of negative
use-related problems through anxiety and coping motives affectivity, the effect of II on anxiety through alcohol and
was significant as hypothesized, B = .015, SE = .006, marijuana use-related problems was examined using one
95% CI = .006.031. The individual indirect paths from model for each substance. Indirect effects were not sig-
II to alcohol use-related problems through anxiety alone, nificant. Two alternative models were tested to examine
B = .004, SE = .007, 95% CI =.021.009, and coping whether alcohol and marijuana use predicted II through
alone, B = .029, SE = .016, 95% CI = .000.063, were not anxiety. The indirect effect of alcohol use-related prob-
significant. lems on II via anxiety was significant, B = .073, SE = .046,
For marijuana use, the confidence interval contain- 95% CI = .007.191; however, the indirect effect of the
ing the indirect effect of II on marijuana use-related concurrent model using marijuana as a predictor was not
problems through both anxiety and coping motives significant.
approximately contained zero, B = .005, SE = .004,
95% CI = .001.011.3 Although the individual indi-
rect path through anxiety alone was not significant
as in the alcohol model, B = .003, SE = .008, Discussion
95% CI = .021.013, the indirect effect of II on This study was the first known investigation of poten-
marijuana use-related problems through coping alone tial motives for at-risk teens expressing II psychopathic
was significant, B = .044, SE = .017, 95% CI = traits to engage in problematic SU. Results of the present
.017.081. study help generalize past findings regarding adolescent

psychopathy, SU, and anxiety to non-forensic samples and

A competing moderation model was tested (i.e., the eect of II on SU-related
problems moderated by anxiety and coping). II did not interact with either extend the literature by identifying specific factors which
factor to predict alcohol or marijuana use-related problems. may help account for the observed relations.
1926 C. T. A. GILLEN ET AL.
Figure . Serial mediation model outlining the direct and indirect paths of the relation between impulsive-irresponsible behavioral psy-
chopathic traits and substance use severity. Standardized coecients () are presented. Terms in brackets represent eects without fear
and worry and coping motives in the model. p< ., p < ., p < .
Consistent with our hypothesis and past studies exam-
ining adolescent psychopathy and SU (e.g., Colins et al.,
2014; Poythress et al., 2006), II traits were related to,
and incrementally predictive of, alcohol and marijuana
use-related problems above interpersonal and affective
psychopathic traits with small to moderate effect sizes.
Comparable to studies examining higher-risk offender
samples (Kubak & Salekin, 2009), the II dimension was
also uniquely related to, and incrementally predictive of,
anxiety symptoms. These findings are consistent with
conceptualizations that secondary psychopathy variants
most often typified by heightened II profiles include
more physical anxiety, worry, and social concern (Lee &
Salekin, 2010), as well as greater SU problems (Kimo-
nis et al., 2012), than primary variants more often asso-
ciated with interpersonal and affective features. Never-
theless, primary features should not be discounted when
studying SU, as some research has found that elevated
secondary and primary features are associated with more
problematic SU (e.g., Wymbs et al., 2012). Consistent with
other research (Buckner & Zvolensky, 2014; Goldstein
et al., 2012), coping was incrementally predictive of more
severe SU above other motives. Although other motives
were associated with SU-related problems at the zero-
order level, coping may be especially problematic because
it could prevent utilization of more adaptive coping
strategies.
Serial mediation models examined in this study sug-
gest that using substances to cope may be important in
understanding why adolescents expressing II traits engage
in problematic SU. As hypothesized, anxiety symptoms
and coping SU motives mediated the relation between
II psychopathic traits and alcohol use-related problems.
Moreover, when other psychopathic traits were consid-
ered, the serial indirect paths were no longer significant,
indicating that the relation between psychopathy and SU
may be partly a function of higher anxiety (Kubak &
Salekin, 2009) and a subsequent desire to reduce nega-
tive affectivity with SU (Comeau et al., 2001; Windle &
Windle, 2012). It appears that secondary-like variants are
uniquely associated with SU as a coping strategy in the
face of anxiety. Because the confidence interval of the
marijuana serial mediation approached zero, these con-
clusions need to be viewed cautiously as they apply to
marijuana use.
Consequently, multi-faceted preventative interven-
tions targeting anxiety symptoms while improving coping
strategies may be helpful in reducing SU-related problems
in this population, especially problems related to alco-
hol use. For example, cognitive-behavioral interventions

designed to develop positive problem-solving strategies
to cope with anxiety (Goldsmith, Tran, Smith, & Howe,
2009) or motivational interviewing may be helpful in fos-
tering adaptive anxiety coping strategies (DeMartini &
Carey, 2011). Additional behavioral approaches target-
ing peer SU behavior and parental monitoring may also
be beneficial (e.g., Ewing et al., 2015). These approaches
deserve further research in teens with psychopathic traits.
Coping was not the only motive serially mediating the
relation between II traits and SU-related problems. Anx-
iety predicted drinking conformity motives and expan-
sion marijuana use motives, which in turn predicted
SU-related problems. Whereas increasing creativity could
be an alternative coping strategy for teens with anxiety,
drinking to conform may also act via negative reinforce-
ment for individuals with social anxiety (Villarosa, Mad-
son, Zeigler-Hill, Noble, & Mohn, 2014). Nevertheless,
these alternative paths may be less salient in understand-
ing the most severe SU (i.e., coping was incrementally
predictive of problematic use) and informing treatment
approaches (i.e., in adults, reducing expansion motives
may be associated with worse outcomes; Banes, Stephens,
Blevins, Walker, & Roffman, 2014). Moreover, the confi-
dence intervals of each of these mediations approached
zero, further indicating that these alternate paths should
be viewed cautiously.
Limitations and future directions
These findings need to be viewed within the context
of this studys limitations, mainly its single informant
and cross-sectional design. Although self-report mea-
sures of psychopathy, anxiety, and SU are well-validated
for adolescent research (e.g., Skogen et al., 2013; Vahl
et al., 2014; Wrobel, Lachar & Wrobel, 2005), relying
on a single source could inflate the associations between
factors. The use of a multi-informant design can pro-
tect against this limitation. For example, clinician-ratings
of psychopathology and behavioral SU indicators (i.e.,
urine/blood samples) could be used in addition to self-
reports to examine the relations between these constructs,
especially given the low internal consistency of CRAFFT
alcohol scores. Nonetheless, many of our findings are con-
sistent with those of past research using multiple sources
(i.e., Kubak & Salekin, 2009; Wolitzky-Taylor et al., 2012),
suggesting that the results are not simply due to rater
effects. Further, our results do not appear to be due to item
overlap between variables in the chosen model.
Second, this sample consisted of males from an at-
risk, non-forensic sample. Therefore, the results of this
study have limited generalizability. To extend the utility of
SUBSTANCE USE & MISUSE 1927
this research to other populations, future work examining
the relationship of these variables should consider female
participants, as well as community and incarcerated
samples.
Third, a longitudinal design would help determine the
temporal order of the factors in the mediation model. For
instance, it is possible that SU precedes the expression of
psychopathy or that anxiety is a product of SU. According
to the substance-induced enhancement theory, SU or
withdrawal can precipitate feelings of agitation and panic
(e.g., Anthony, Tien, & Petronis, 1989), whereas frequent
drinking seems to affect neural circuits regulating the fear
response, increasing anxiety (Breese et al., 2005). Such
competing theories highlight that we cannot be certain of
the specified paths in our model given our cross-sectional
design.
However, many studies supporting the substance-
induced enhancement theory have relied on retrospec-
tive designs. The available longitudinal research with
adolescents suggests that the self-medication hypothe-
sis is supported, particularly regarding anxiety disorders
(Wolitzky-Taylor et al., 2012). Evidence of substance-
induced anxiety was also not supported in the current
study. Although we found support for an alternative
model with alcohol severity predicting II through anxi-
ety, longitudinal research has found that II traits in ado-
lescence predict the development of future alcohol and
SU disorder symptoms (Hemphl & Hodgins, 2014).
These findings do not discount the limitations of cross-
sectional research, but they support the temporal order
of our model. Further, this study provides initial evidence
with respect to psychopathy and SU motives that can
assist future research.
In addition to addressing these limitations, future
research should examine whether interventions (i.e.,
cognitive-behavioral or motivational approaches), can
effectively target anxiety and adaptive coping mecha-
nisms in youth with psychopathic traits to help reduce
problematic SU. Future research should also examine
the models while controlling for additional SU risk
factors, including conduct disorder, oppositional defi-
ant disorder, and attention-deficit/hyperactivity disor-
der, especially given that these disorders are associated
with II psychopathic traits and other longitudinal pre-
dictors of adolescent SU, such as parental monitoring
(Belendiuk, Pedersen, King, Pelham, & Molina, 2015;
Vahl et al., 2014). Lastly, research should investigate
whether the associations between anxiety, psychopathy,
and SU motives differ in community and incarcerated
samples across different cultures and genders and whether
the proposed mediation model pertains to other sub-
stances and different SU outcomes.
1928 C. T. A. GILLEN ET AL.

Acknowledgment DeMartini, K. S., & Carey, K. B. (2011). The role of anxi-

ety sensitivity and drinking motives in predicting alcohol
We would like to thank Corey Brawner for his assistance with use: A critical review. Clinical Psychology Review, 31, 169
this article. 177.
Ewing, B. A., Osilla, K. C., Pedersen, E. R., Hunter, S. B., Miles,
J. V., & DAmico, E. J. (2015). Longitudinal family effects on
Declaration of interest substance use among an at-risk adolescent sample. Addictive
Behaviors, 4, 185191.
The authors report no conflicts of interest. The authors alone Goldsmith, A. A., Tran, G. Q., Smith, J. P., & Howe, S. R.
are responsible for the content and writing of the article. (2009). Alcohol expectancies and drinking motives in col-
lege drinkers: Mediating effects on the relationship between
generalized anxiety and heavy drinking in negative-affect
situations. Addictive Behaviors, 34, 505513.
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