Drug and Alcohol Dependence 163 (2016) S37–S45

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Drug and Alcohol Dependence

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Full length article

Emotional self-control and dysregulation: A dual-process analysis of

pathways to externalizing/internalizing symptomatology and positive
well-being in younger adolescents
Thomas A. Wills a,∗ , Jeffrey S. Simons b , Steve Sussman c , Rebecca Knight a
a
Prevention and Control Program, University of Hawaii Cancer Center, Honolulu, HI, United States
b
Department of Psychology, University of South Dakota, Vermilion, SD, United States
c
Preventive Medicine, Psychology, and Social Work, University of Southern California, Los Angeles, CA, United States

a r t i c l e i n f o a b s t r a c t

Article history: Objectives: There is little knowledge about how emotional regulation contributes to vulnerability versus
Received 12 June 2015 resilience to substance use disorder. With younger adolescents, we studied the pathways through which
Received in revised form 22 August 2015 emotion regulation attributes are related to predisposing factors for disorder.
Accepted 22 August 2015
Methods: A sample of 3561 adolescents (M age 12.5 years) was surveyed. Measures for emotional self-
control (regulation of sadness and anger), emotional dysregulation (angerability, affective lability, and
Keywords:
rumination about sadness or anger), and behavioral self-control (planfulness and problem solving) were
Emotion regulation
obtained. A structural model was analyzed with regulation attributes related to six intermediate variables
Behavioral self-control
Symptomatology
that are established risk or protective factors for adolescent substance use (e.g., academic involvement,
Mediation stressful life events). Criterion variables were externalizing and internalizing symptomatology and pos-
Adolescents itive well-being.
Results: Indirect pathways were found from emotional regulation to symptomatology through academic
competence, stressful events, and deviance-prone attitudes and cognitions. Direct effects were also
found: from emotional dysregulation to externalizing and internalizing symptomatology; emotional self-
control to well-being; and behavioral self-control (inverse) to externalizing symptomatology. Emotional
self-control and emotional dysregulation had independent effects and different types of pathways.
Conclusions: Adolescents scoring high on emotional dysregulation are at risk for substance dependence
because of more externalizing and internalizing symptomatology. Independently, youth with better
behavioral and emotional self-control are at lower risk. This occurs partly through relations of regu-
lation constructs to environmental variables that affect levels of symptomatology (e.g., stressful events,
poor academic performance). Effects of emotion regulation were found at an early age, before the typical
onset of substance disorder.
© 2016 University of Kentucky Center for Drug Abuse Research Translation. Published by Elsevier
Ireland Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

1. Introduction et al., 2003; Wills et al., 2011). Furthermore, life-span studies have
shown that early observations of self-regulation predict mental and
Self-regulation has been an increasingly prominent theme in physical health outcomes over considerable time periods (Martin
research on substance use and abuse (Wills et al., 2015b). Self- et al., 2007; Moffitt et al., 2011). Recent neuroimaging studies are
regulation measures have been linked to early-onset substance use showing structural and functional brain anomalies suggestive of
and to substance use problems in late adolescence and early adult- emotion-regulation deficits among individuals with drug use dis-
hood (Patock-Peckham et al., 2001; Simons et al., 2009, 2010; Tarter orders (Ersche et al., 2013; Kober, 2014). However, reviewers point
out that it is not known whether emotion-regulation differences
predate the onset of the disorder (Cheetham et al., 2010; Goldstein
∗ Corresponding author at: Prevention and Control Program, University of Hawaii and Volkow, 2011). In this paper, we discuss evidence on behav-
Cancer Center, 701 Ilalo Street, Room 528, Honolulu, HI 96813, United States. ioral and emotional regulation and report data on how emotion
Fax: +1 808 586 2982. regulation is related to established risk and protective factors for
E-mail addresses: twills@cc.hawaii.edu (T.A. Wills), jeffrey.simons@usd.edu substance use disorders. The data were obtained in early adoles-
(J.S. Simons), ssussma@usc.edu (S. Sussman), rknight@cc.hawaii.edu (R. Knight).

http://dx.doi.org/10.1016/j.drugalcdep.2015.08.039
0376-8716/© 2016 University of Kentucky Center for Drug Abuse Research Translation. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
S38 T.A. Wills et al. / Drug and Alcohol Dependence 163 (2016) S37–S45

cence (11–14 years of age), before the typical age of emergence for 2001c, 2002b, 2004b) and diagnostic studies have consistently
substance disorder. shown that affective disorders (anxiety disorder and depressive
disorder) tend to co-occur with substance use disorders (Kober,
1.1. Behavioral regulation and substance use 2014). However, the temporal ordering of affective and substance
use disorders remains unclear (Cheetham et al., 2010); the fact that
A considerable body of evidence has accumulated on behav- negative mood is elevated among substance abusers does not nec-
ioral self-control and dysregulation. Behavioral self-control (also essarily show how they are causally linked (Kassel and Veilleux,
termed planfulness or reflectiveness) is typically indexed by mea- 2010); and experience sampling studies have not consistently
sures such as planning, persistence, and problem solving (Wills found a real-time relation between negative affect and drinking
and Dishion, 2004), linking behaviors and consequences over time (see Mohr et al., 2010). Thus support for the self-medication model
(Zimbardo and Boyd, 1999), and monitoring progress toward goals remains in flux. New studies have suggested alternate conceptions
(Hoffman et al., 2009). Behavioral self-control has consistently of affectivity and drug use, including reduced sensitivity to natural
shown inverse relations to substance use (e.g., Audrain-McGovern rewards (Audrain-McGovern et al., 2011, 2012); mood variabil-
et al., 2006; Brody and Ge, 2001; Wills et al., 2000, 2001a,b, 2004a, ity (Simons and Carey, 2002; Simons et al., 2009; Weinstein and
2007a,b; Wills and Stoolmiller, 2002; Zimbardo and Boyd, 1999) Mermelstein, 2013b); and distinguishing situational and disposi-
and some moderation effects have been demonstrated (e.g., Wills tional aspects for positive and negative affect (Colder et al., 2010;
et al., 2002a, 2008). Behavioral dysregulation, indexed by measures Simons et al., 2014).
tapping the tendency to act without thinking, be unable to inhibit Studies relating measures of emotional regulation to psychi-
prepotent responses, or have a tendency to rapidly discount the atric or substance use disorders have mainly been conducted with
value of future rewards compared with present rewards, is posi- adult substance abusers and focused on emotional dysregulation
tively related to likelihood/intensity of substance use (for reviews (e.g., Berking et al., 2011; Berking and Wupperman, 2012; Bonn-
see Dawe and Loxton, 2004; Lejuez et al., 2010; Madden and Bickel, Miller et al., 2011; Fox et al., 2008; Fucito et al., 2010; Volkow
2010; Perry and Carroll, 2008). In general, this research has stud- et al., 2010). However, in our view the major issue is that most
ied self-regulation without reference to current or dispositional studies have not determined how emotion regulation is related
emotion. While the participants in these studies may have experi- to substance abuse. We think it is essential to determine the
enced positive or negative emotions at some time, studies relating processes through which emotion regulation is linked to out-
behavioral self-control or impulsiveness to substance use have comes. Though regulation processes may be directly related to
generally been conducted without reference to emotional states, outcomes, some research with adolescents has shown that the link-
though it has been recognized that decision making may be influ- age of behavioral self-regulation to substance use/abuse occurs
enced by emotion (Cyders et al., 2007; Lieberman, 2007a; Metcalfe through relations to intermediate variables (Wills and Ainette,
and Mischel, 1999; Steinberg, 2007). 2010). Here, we adopt this approach for emotion regulation, assess-
The present research was based on a dual-process model of regu- ing likely social/environmental and cognitive/attitudinal mediators
lation. The dual-process approach posits that two distinct systems and using structural equation modeling to determine how emotion
are involved in responding to environmental cues and regulating regulation is related to substance-relevant outcomes.
behavior. The two systems are alternatively termed automatic vs. Previous studies with adolescents have demonstrated a con-
controlled (Lieberman, 2007b; Wiers et al., 2007), reflective vs. sistent measurement structure for behavioral and emotional
impulsive (Hoffman et al., 2009), reasoned vs. reactive (Gerrard regulation (Wills et al., 2006) and have related behavioral and emo-
et al., 2008), or self-control and dysregulation (Wills et al., 2015b). tional regulation to substance use problems (Wills et al., 2011).
The basic findings supporting the dual-process approach are (a) However these studies have assessed a limited range of media-
confirmatory studies of regulation measures show that a two- tors and have not determined the relation of emotional-regulation
factor solution fits better than a one-factor solution, (b) measures measures to externalizing or internalizing symptomatology, which
of self-control and dysregulation show independent contributions are among the most-studied predictors of substance use disorder
(in opposite directions) to prediction of substance use, and (c) the (Wills et al., 2005). Longitudinal studies have shown externalizing
two systems have different types of pathways to substance abuse symptomatology in early adolescence (conduct-disorder related)
(Wills and Ainette, 2010; Wills et al., 2011, 2013). This approach to be a robust predictor of substance use disorder in late adoles-
has heuristic value for clarifying SUD etiology because greater pre- cence and early adulthood (e.g., Brook et al., 1995; Chassin et al.,
dictive power is obtained when considering both systems rather 1999; Englund et al., 2008; Fergusson et al., 2007; Guo et al., 2001;
than only one (Gibbons et al., 2009; Hoffman et al., 2009) and Pulkkinen and Pitkänen, 1994; White et al., 2001; Windle, 1990).
the dual-process model helps to delineate multiple pathways to Findings on internalizing symptomatology (depressive or anxiety-
substance use problems (Simons et al., 2009; Wills et al., 2011). disorder related) are less consistent (for reviews see Cheetham
Previous studies with dual-process models have focused on behav- et al., 2010; Colder et al., 2010). Though some studies have shown
ioral regulation; in the present research we extend this approach positive relations of internalizing symptomatology to substance
to the study of emotional regulation. use, results may vary by substance (King et al., 2004; Maskowsky
et al., 2014; Tarter et al., 2007) and extent of comorbidity (Colder
1.2. Emotional regulation and substance use et al., 2013; Goodman, 2010; King and Chassin, 2008; Pardini et al.,
2007; Roberts et al., 2007; Scalco et al., 2014; Schuckit and Smith,
Theory on emotion regulation has been available (e.g., Calkins, 2006; Wittchen et al., 2007).
1994; Eisenberg and Fabes, 1992; Southam-Gerow and Kendall,
2002), but generally has not been a prominent theme in sub- 1.3. Rationale for present research
stance abuse research. The exception is the self-medication model
of Khantzian (1990), which proposes that poor regulation of neg- To gain more understanding of how emotional regulation con-
ative emotional states (particularly anger) is an underlying factor tributes to risk for substance use disorder, we conducted a study
in vulnerability to substance use disorder. This theory has influ- in early adolescence, a time when few if any persons have devel-
enced research on stress and coping motives for substance use oped a disorder. We used a dual-process approach, positing that
(Audrain-McGovern et al., 2009; Cheetham et al., 2010; Sinha, emotional self-control and dysregulation are distinct constructs
2008; Weinstein and Mermelstein, 2013a; Wills et al., 1999a, that make independent contributions to outcomes. We assessed
 T.A. Wills et al. / Drug and Alcohol Dependence 163 (2016) S37–S45 S39

how participants dealt with feelings of sadness or anger (i.e., emo- student should not write his/her name on the survey. Method-
tional self-control) and obtained measures on affective variability, ological studies have shown that when participants are assured
rumination, and inability to control anger in problem situations of confidentiality, self-reports of substance use have good validity
(i.e., emotional dysregulation). Our analytic approach addressed (e.g., Brener et al., 2003; Patrick et al., 1994).
the empirical finding in our previous studies that measures of
behavioral and emotional self-control are substantially correlated 2.2. Measures
(Wills et al., 2006, 2011) by including behavioral self-control in
the model. We also wanted to emphasize the concept that self- Measures were scored such that a higher score indicates more
control is partly a social phenomenon which originates in parental of the attribute named in the variable label. Distal variables and
socialization and is actualized in social relationships with peers, intermediate variables are summarized in Table 1. Regulation and
teachers, and other adults (Sussman and Ames, 2008; Sussman symptomatology measures are described below in more detail.
et al., 2003; Wills et al., 2014). Hence, we included paths from
parental variables to self-control in the model in order to recognize
2.2.1. Regulation measures. Items for the regulation measures were
the social background of self-regulation. We tested for pathways
introduced with the stem: “Here are some things that people may
from regulation variables to outcomes through established risk
say about themselves. Circle a number to show what is true for you.”
and protective factors for adolescent substance use (Scheier, 2015).
The items had 5-point Likert response scales (Not at all True–Very
These include developed competencies, life stress, deviance-prone
True). For behavioral self-control, measures were derived from pre-
attitudes, perceptions of substance users, and perceived risk from
vious inventories (Kendall and Wilcox, 1979; Wills et al., 2001c;
substance use (Bryant et al., 2003; Gerrard et al., 2003; Gibbons
Zimbardo and Boyd, 1999). A composite score was based on a 7-
et al., 2015; Jessor and Jessor, 1977; Wills et al., 2002b, 2004b). The
item subscale on planning and persistence (e.g., “I like to plan things
criterion variables were externalizing symptomatology and inter-
ahead of time,” “I stick with what I’m doing until it’s finished”), a 5-
nalizing symptomatology because of their place in affective models
item scale on future time perspective (“Thinking about the future is
of risk for substance use disorder (Kassel et al., 2010). We also
pleasant for me”), and a 6-item subscale on problem solving (“When
included a measure of positive well-being because recent reviews
I have a problem, I think about the choices before I do anything”).
have emphasized its likely importance as a protective factor but
For emotional self-control, measures were derived from the noted
noted that there is a lack of research on the role of positive affect
sources plus an inventory for emotional regulation Zeman et al.
in vulnerability for substance abuse (Cheetham and Allen, 2010;
(2001). A composite score was based on a 5-item scale on soothabil-
Colder et al., 2010; Gilbert, 2012).
ity (e.g., “I can calm down when I am excited or wound up”), 4-item
subscale for sadness control (“When I’m feeling down, I can con-
trol my sadness and carry on with things”), and a 4-item subscale
2. Methods
for anger control (“When I’m feeling mad, I can control my tem-
per”). For emotional dysregulation, measures were from the noted
2.1. Participants and procedure
sources plus a scale on affective lability (Simons and Carey, 2002).
A composite score was based on a 6-item subscale on angerabil-
This research was conducted with middle school students in
ity (e.g., “When I have a problem at school or at home, I get mad
Hawaii. Prior research has demonstrated that predictive effects
at people”), a 5-item scale on affective lability (“My moods change
found with adolescents in Hawaii are similar to findings obtained
a lot from day to day”), and 3-item scales on sadness rumination
elsewhere (Isasi et al., 2013; Wills et al., 2013, 2015a). The partici-
(“I often get sad thinking about things that have happened in the
pants were 3,561 students (74% response rate) in ten public middle
past”) and anger rumination (“When people do something to make
schools (80% of invited schools participated) on Oahu, Hawaii. The
me angry, I don’t forget about it”).
sample was 52% female and mean age was 12.49 years (SD 0.86);
11% of the participants were 6th graders, 47% were 7th graders, and
42% were 8th graders. Regarding race/ethnicity, 34% of the partic- 2.2.2. Symptomatology and well-being. Items all had a 30-day time
ipants were of Asian-American background (Chinese, Japanese, or frame and 5-point Likert response scales (Not at all True–Very
Korean), 8% were Caucasian, 29% were Filipino-American, 23% were True). Externalizing symptomatology (from Achenbach, 1991)
Native Hawaiian or other Pacific Islander, and 6% were of other was a 7-item scale with items indexing arguing, destructive-
race/ethnicity (mainly African-American or Hispanic). Regarding ness, disobedience, and fighting. Internalizing symptomatology
family structure, 20% of participants were living with a single par- (Achenbach, 1991) was a 5-item scale with items indexing lone-
ent, 8% were in a stepparent family, 56% were with two biological liness, anxiety, and sadness. Positive well-being (Veit and Ware,
parents, and 16% were in an extended family structure (two par- 1983) was a 5-item scale indexing happiness, energy, and friendli-
ents + one or more relatives). The mean parental education on a 1–6 ness.
scale was 4.2 years (SD 1.2), indicating some education beyond high
school. 2.3. Statistical analysis
Data were obtained through a self-report questionnaire admin-
istered to students in classrooms by trained research staff. The Structural equation modeling analysis was conducted in Mplus
procedure was reviewed by the Institutional Review Board for the (Muthén and Muthén, 2010), using the maximum likelihood
University of Hawaii and by the Hawaii Department of Education. A method with robust estimates of standard errors to adjust for
consent form sent through the school to parents informed the par- any nonnormality in the variables, and with school included as
ent about the purpose and nature of the research. The parent was a clustering factor. The model was specified with parental sup-
asked to indicate whether his/her child would be allowed to par- port, parent-child conflict, and two demographic variables (gender
ticipate in the research and return the form to the school. Prior to and parental education) as exogenous, with all their covariances
survey administration, students with parental consent were simi- included in the model. Behavioral self-control and the two emo-
larly informed about the purpose and nature of the research, were tional regulation measures were specified as endogenous, with
instructed that participation was voluntary, and signed an assent covariances of their error terms. The six variables hypothesized
form if they decided to participate. Initial instructions to partic- to mediate the effects of regulation were specified subsequent to
ipating students emphasized confidentiality and stated that the the regulation measures, again with all their residual covariances.
S40 T.A. Wills et al. / Drug and Alcohol Dependence 163 (2016) S37–S45

Table 1
Description of distal and intermediate variables.

Variable Items Alpha Sample item

Gender 1 n.a. Are you: (female) (male)

Age 1 n.a. Write in your age in years
Ethnicity 14 n.a. What would you say you are? (14 options)
Family structure 9 n.a. What adults do you live with now? (9 options)
Parental education 2 n.a. What is the highest level of education your father has completed? (Grade School−Post College)

Parental support 10a .90 When I feel bad about things, my parent will listen
Parent–child conflict 3a .82 I have a lot of arguments with my parent
Academic involvement 8a .82 Getting good grades is important to me
Academic alienation 7a .69 Usually, school bores me
Negative life events 20b n.a. Subscales for adolescent events, family events
Tolerance for deviance 10c .96 How wrong do you think it is: To take things that don’t belong to you
Prototypes of sub. users 15d .92 Think about the type of kid your age who smokes. Circle a number to show your image of kids who smoke (popular, smart, cool)
Perceived harm 6e .89 How much do you think people would be harming themselves if they smoke 1 pack of cigarettes a day?
Perceived risk 3f .92 If you smoked cigarettes, do you think in the future you could get a sickness that comes from smoking?

Source: Bryant et al. (2003), Gerrard et al. (2003), Gibbons et al. (2015), Jessor and Jessor (1977) and Wills et al. (2004b, 2011, 2013, 2014).
Note: n.a. = not applicable. For analysis, perceived harm and perceived risk were combined in a single score on Cognitive Risk.
a
1–5 Likert scale, Not at all true for me–Very true for me.
b
1–5 scale, Not at all wrong–Very wrong.
c
0–1 scale, No–Yes.
d
1–5 scale, Not at all –Very.
e
Categorical responses, Not harming themselves at all–Will be harming themselves a lot.
f
Categorical responses, Definitely wouldn’t get it–Definitely would get it.

Table 2 Table 3
Descriptive statistics for regulation and symptomatology variables. Significant paths included in model but not graphed in Fig. 1.

Variable Range M SD Skewness Path Beta p

Behavioral self-control 18–90 62.61 12.21 −0.18 Parental support—Positive well-being 0.13 <.0001
Emotional self-control 13–65 42.27 10.42 −0.04 Male gender—Academic Involvement −0.07 <.001
Emotional dysregulation 14–70 31.91 10.21 0.74 Male gender—Internalizing symptomatology −0.10 <.0001
Externalizing symptomatology 7–35 13.55 5.74 1.14 Parent conflict—Academic alienation 0.10 <.0001
Internalizing symptomatology 5–25 11.70 5.53 0.69 Parent conflict—Negative life events 0.13 <.0001
Positive well-being 5–25 19.35 4.30 −0.61 Parent conflict—Externalizing symptomatology 0.13 <.0001

Note: These paths were significant in the model but were excluded from the figure
for graphical simplicity.
Externalizing and internalizing symptomatology and positive well-
being were specified as the criterion variables. The model was 3.2. Structural modeling analysis
initially estimated with all paths from distal variables to the reg-
ulation measures, all paths from the regulation measures to the The final model is presented in Fig. 1 with standardized coef-
intermediates, and all paths from intermediates to the criterion ficients; all coefficients in the figure are significant at p < .01. The
variables. Nonsignificant paths were dropped from the initial model model had chi-square (48 df, N = 3561) = 207.37, Comparative Fit
using a conservative criterion (p > .01) because of the large sample Index = .99, Root Mean Square Error of Approximation of .031
size. Direct effects to mediators or criteria were then added on the (90% Confidence Interval .026–.035), and Standardized Root Mean
basis of modification indices >20. Square Residual = .026, all parameters indicating excellent fit. Sev-
eral paths that were excluded from Fig. 1 for graphical simplicity
are presented in Table 3. For residual correlations among inter-
3. Results mediate variables the mean |r| was .14 (range −.35 to .20). Prior
variables accounted for different amounts of explained variance in
3.1. Descriptive statistics the hypothesized mediators, with R-squares ranging from .49 (aca-
demic involvement) to .05 (for prototypes of users and perceived
Descriptive statistics for the regulation measures (Table 2) risk of use). Together the variables in the model accounted for 49%
showed behavioral self-control and emotional self-control had dis- of the variance in externalizing symptomatology, 35% of the vari-
tributions close to normal; there was a slight shift of emotional ance in internalizing symptomatology, and 34% of the variance in
dysregulation toward lower values but the skewness value (pos- positive well-being.
itive by convention) was moderate. The zero-order correlation of Overall the results were consistent with our predictions. The
emotional self-control and emotional dysregulation was r = −.33, three regulation measures had indirect effects to criterion vari-
consistent with the dual-process model. The zero-order correla- ables through the hypothesized mediators. A summary of the direct
tion of emotional and behavioral self-control was r = .50, consistent and indirect effects is presented in Table 4. All of the indirect
with prior research. effects were significant, with the Critical Ratio (analogous to a t
Distributions for externalizing symptomatology and internal- test) ranging from 3.28 (p < .001) to 17.11 (p < .0001). Four direct
izing symptomatology (Table 2) were somewhat shifted toward effects were also found: behavioral self-control to (less) external-
lower values but there was considerable variance in the symptoma- izing symptomatology, emotional self-control to (more) positive
tology scores and skewness values were moderate. Participants well-being, and emotional dysregulation to more externalizing
tended to endorse relatively good levels of well-being, but again and internalizing symptomatology. The following sections summa-
there was considerable variance of scores and the skewness value rize the findings in a theoretical order. Note that all the findings
(negative by convention) was moderate. reported here are independent effects because the residual corre-
 T.A. Wills et al. / Drug and Alcohol Dependence 163 (2016) S37–S45 S41

Academic
-.16 .54 involvement .35
-.21 (R2 = .49)
.16 Behavioral -.10
.48 self-control -.17 Academic .11
Parental (R2 = .23) -.10 alienation Externalizing
support .28 .21 (R2 = .31) symptomatology
(R2 = .49)

Negative .22
.14 .09 life events
.11 (R2 = .18) .19
Emotional -.07
Gender .08 self-control -.09
(male) 2 Internalizing
.16 (R = .14)
.22 Tolerance symptomatology
-.10 deviance .07 (R2 = .35)
(R2 = .10)
.07
Parental -.06
education -.10 .43 Sub. user
.28 prototypes .14 Positive
Emotional (R2 = .04) well-being
-.11 dysregulation .11 (R2 = .34)
(R2 = .19) .11
.42 Cognitive .06
Parent-adol. .09 .29 perc. risk
.43
conflict (R2 = .05)
.10

Fig. 1. Structural model of distal, intermediate, and criterion variables. Straight single-headed arrows represent path effects, curved double-headed arrows represent
covariances. Values are standardized coefficients; all are significant at p < .01. All covariances among the distal variables, the regulation variables, and the intermediate
variables were included in the model but these three sets of covariances are represented only schematically in the figure. R2 figures indicate the variance accounted for in a
given construct by all constructs to the left of it in the model. Six paths that were included in the model but were excluded from the figure, for graphical simplicity, are in
Table 3.

Table 4
Unstandardized Indirect and direct effects for regulation variables to symptomatology (b’ and SE), with Critical Ratio (CR).

Total

From To Indirect CR Direct CR

Behavioral Externalizing Sx −0.033 (.004) 9.23**** −0.073 (.007) 10.12****

SC Internalizing Sx −0.016 (.003) 4.71**** n.a.
Pos. well-being 0.143 (.008) 17.11**** n.a.
Emotional Externalizing Sx −0.012 (.003) 4.35**** n.a.
SC Internalizing Sx −0.013 (.004) 3.28*** n.a.
Pos. well-being 0.027 (.005) 5.58**** 0.182 (.014) 13.04****
Emotional Externalizing Sx 0.090 (.007) 13.45**** 0.197 (.012) 16.14****
Dys- Internalizing Sx 0.067 (.008) 8.81**** 0.553 (.024) 23.51****
reg Pos. well-being −0.023 (.005) 4.17**** n.a.

Note: n.a. = not applicable. SC = self-control; Sx = symptomatology; pos. = positive; dysreg = dysregulation.
***
Indicates p < .001.
****
Indicates p < .0001.

lations among regulation variables and mediators were partialled negative life events, as well as more tolerance for deviance and
in any effects noted to subsequent variables in the model. favorable perceptions of substance users. Dysregulation also had
direct effects to both externalizing symptomatology and internal-
izing symptomatology. Behavioral self-control was an important
3.2.1. Regulation variables. Emotional self-control had the fewest
variable in this model, with substantial paths to more academic
unique effects as its substantial correlation with behavioral
involvement and less alienation, and inverse paths noted to the risk
self-control was partialled. It did have statistically significant paths
factor mediators (life events, tolerance for deviance, and prototypes
to more academic involvement, fewer life events, and less toler-
of users) plus a positive path to more perceived risk. Behavioral
ance for deviance; it also had a substantial direct effect to positive
self-control also had an inverse direct effect to externalizing symp-
well-being. In contrast, emotional dysregulation had effects to most
tomatology thus adding to its status as a protective factor.
subsequent variables, with an inverse path to academic involve-
ment and substantial paths to more academic alienation and more
S42 T.A. Wills et al. / Drug and Alcohol Dependence 163 (2016) S37–S45

3.2.2. Mediator variables. Academic domains were important parts Several direct effects to symptomatology dimensions were
of the risk and protection process. Academic involvement had noted for the regulation variables. A straightforward interpreta-
a substantial path to more positive well-being and academic tion is that these symptomatology syndromes represent, in part,
alienation had an inverse path to externalizing symptomatol- disorders of regulation: persons in the high range on externalizing
ogy. Stress-coping aspects of the data are evident in the paths are more reactive to provocations and cannot inhibit inappropri-
from negative life events to both externalizing symptomatology ate behaviors, while persons scoring high on internalizing have
and internalizing symptomatology. Attitudinal and cognitive fac- difficulty managing negative emotions and cannot get depressive
tors were less important in the model, but there were paths thoughts out of their heads. Though this conceptualization seems
from deviant attitudes and perceptions of users to externalizing straightforward, the present results indicate that it is only part of
symptomatology, and perceived risk showed a positive relation to the picture. For example persons with high scores on externaliz-
well-being. ing feel alienated from school, have relatively favorable attitudes
toward smokers/drinkers, and view typical antisocial behaviors as
3.2.3. Background variables. Parental support had substantial paths not being very wrong. The causal orderings in these relations may
to behavioral and emotional self-control and a direct effect to have some complexity; for example, students who fight with oth-
academic involvement (independent of its pathways through self- ers are likely to be disciplined, which would sour their (already
control). In contrast, parent-child conflict had a large positive path negative) attitude toward school. It is undoubtedly more com-
to emotional dysregulation and an inverse path to emotional self- plex to predict symptomatology syndromes rather than individual
control, as well as a direct effect to internalizing symptomatology. variables, but the present research helps us understand the range
Paths from male gender to more academic alienation and toler- of cognitive, attitudinal, and stress-related factors through which
ance for deviance and less perceived risk, as well as a direct effect these syndromes come about.
to externalizing symptomatology, reflect multiple aspects of the
higher risk accruing for boys during adolescence. Higher parental 4.2. Other questions
education was related to more emotional self-control and less emo-
tional dysregulation. We found that the predictors of positive well-being were dif-
ferent from those for negative outcomes, consistent with research
4. Discussion on positive and negative affect (cf. Cheetham et al., 2010; Gilbert,
2012). Indeed, the strongest effect noted for emotional self-control
The purpose of this research was to clarify how emotional regu- was a direct effect to well-being. Because of the protective effects
lation is involved in contributing to externalizing and internalizing noted for long-term positive mood in relation to substance use
symptomatology, which are major risk factors for later substance (Colder and Chassin, 1997; Simons et al., 2014; Wills et al., 1999b)
use problems. We also assessed positive well-being, an under- this indicates an important pathway for the positive aspects of
studied protective factor in adolescent psychopathology (Colder emotional regulation. Also noteworthy was the large path from aca-
et al., 2010; Gilbert, 2012). We found that the emotional regulation demic involvement to well-being. Being accepted and valued for
variables had both direct and indirect effects to symptomatol- academic performance, and affiliating with peers who value aca-
ogy dimensions, controlling for demographic characteristics and demics (Sussman et al., 2007) is a significant benefit for teenagers.
parenting. Moreover, emotional self-control and emotional dys- Thus there is a rationale for attention to emotion regulation as
regulation made independent contributions to intermediate risk a means for enhancing positive affect and academic involvement
and protective factors, supporting a dual-process approach that has (Wills et al., 2015b).
been proposed at the behavioral level (Gerrard et al., 2008; Wills Two additional questions about self-regulation are: How does
et al., 2011) and the neurological level (Smith and Graybiel, 2013; complex self-control ability develop? and Why are behavioral and
Volkow and Baler, 2012). emotional self-control strongly correlated? We suspect that these
issues are related. Complex self-control abilities are based on a sub-
4.1. Direct and indirect pathways strate of simple temperament dimensions that, in transactions with
parental supportiveness, shape the development of self-control
The substantial number of indirect pathways to symptoma- (Farley and Kim-Spoon, 2014; Tarter et al., 1999; Wills and Dishion,
tology were mainly through positive relations of emotional (and 2004). Note, however, that correlations between parental attributes
behavioral) self-control to academic variables and cognitive vari- and adolescent attributes may be attributable in part to shared
ables such as perceived risk. It should be noted, though, that inverse genetic characteristics, and this should be considered for interpret-
paths were also found from these variables to lower levels of neg- ing parent–child correlations (Farley and Kim-Spoon, 2014; Rutter
ative life events and tolerance for deviance. Thus the pathways of et al., 1997).
operation for emotional self-control include both developed com- Regarding the correlation between behavioral and emotional
petencies, cognitive variables, and stress-related factors to some control, attentional control is a component of behavioral self-
extent. Emotional dysregulation showed strong paths to alienation control (Wills et al., 2015b) and is relevant for both behavioral
from academics and occurrence of negative life events. However, and emotional regulation (Rothbart et al., 2000; Rothbart et al.,
it was also related to tolerance for deviance and favorable percep- 2015). In addition, problem situations in adolescence involve both
tions of substance users, so again the effects of emotion regulation provocation and problem solving, and thus require both behavioral
include cognitive as well as stress-related factors. The indirect paths and emotional control. Therefore we think the correlation of these
suggest that regulation of behavior and emotion have effects that dimensions is partly based in the situational context of self-control
extend beyond an influence on individual substance use decisions. and is learned in situations involving parents or peers (Sussman
Substance use itself is sometimes viewed as a failure of self-control et al., 2003; Wills et al., 2011). The results pose several intriguing
or a maladaptive attempt to regulate emotion. Though this may be questions about self-control that are not definitively answered here
true to some extent, the current findings indicate that self-control but may be pursued in further research.
and dysregulation have more distal and subtle effects through shap- Preventive interventions derived from self-control research
ing a developmental trajectory and a socio-environmental context may use explicit training in cognitive-behavioral approaches for
that either encourages or discourages substance use and its associ- managing emotions and identifying situations that are triggers
ated problems. for loss of control of emotion (Conrod et al., 2013; Siegel, 2010;
 T.A. Wills et al. / Drug and Alcohol Dependence 163 (2016) S37–S45 S43

Southam-Gerow, 2013) as well as increasing access to alterna- in study design; collection, analysis, and interpretation of the data;
tive reinforcers (Audrain-McGovern et al., 2011). Another approach writing of the report; and decision to submit the manuscript for
is to use self-control training on simple tasks, such as squeez- publication.
ing a hand grip, on the rationale that enhanced confidence in
self-control will generalize to more complex situations (Muraven, Contributors
2010). Approaches for clinic settings based on implicit cognitions
may use evaluative conditioning to instill negative affective reac- Thomas Wills conceptualized and supervised the study, ana-
tions to alcohol cues (Houben et al., 2010; Wiers et al., 2011) or lyzed the data, drafted the manuscript, and coordinated the
use cognitive bias modification to make positive emotions more submission of the final manuscript. Jeffrey Simons and Steve
cognitively accessible (Hertel and Mathews, 2011). School-based Sussman assisted in the design of the study and reviewed the
training may use games and exercises to build working memory and manuscript critically for important intellectual content. Rebecca
complex executive functions as scaffolding for the development Knight supervised the data collection and data processing and
of enhanced self-control (Berkman et al., 2012; Diamond and Lee, reviewed the manuscript critically for important intellectual con-
2011; Ursache et al., 2012). Training in specific emotion-regulation tent. All authors contributed to and have approved the final
strategies shown effective in laboratory studies (Aldao et al., 2010) manuscript.
and in complex packages such as mindfulness meditation (Brewer
et al., 2013; Elwafi et al., 2013) are unexplored but promising areas.
Conflict of interest
Such prevention-oriented research can expand the scope and effec-
tiveness of treatment for substance dependence as well as testing
No conflicts declared.
the theoretical basis for emotion-regulation constructs in school
and clinical settings.
Acknowledgments
4.3. Limitations
We thank the Superintendent of the Hawaii Department of
Some aspects of this study could be noted as possible limitations. Education and the Principals of the schools for their support,
The measures of emotional regulation were relatively brief ones the participating parents and students for their cooperation, and
and were obtained through self-reports. Further research could Zaldymar Cortez, Russel Fisher, Melissa Jasper, and Mercedes
index emotional regulation through multiple methods including Harwood-Tappé for their able assistance with data collection.
performance measures (though see Meda et al., 2009; Reynolds
et al., 2006). Also, the measures of emotion regulation focused on References
ability to control emotion but did go into extensive detail on specific
strategies of regulation. Further research using epidemiological Achenbach, T.M., 1991. Manual for the Child Behavior Checklist and Youth
Self-report and 1991 Profile. University of Vermont, Burlington, VT.
methods or experience sampling designs could test hypotheses Aldao, A., Nolen-Hoeksema, S., Schweizer, S., 2010. Emotion-regulation strategies
about the effectiveness of particular emotion regulation strategies across psychopathology: a meta-analytic review. Clin. Psychol. Rev. 30,
in general populations (Webb et al., 2012). Finally, this study was 217–237.
Audrain-McGovern, J., Rodriguez, D., Tercyak, K.P., Nenner, G., Moss, H.B., 2006.
cross-sectional so the directionality of some effects is not defini- The impact of self-control indices on peer smoking and adolescent smoking
tively demonstrated and there may be dynamic relations between progression. J. Pediatr. Psychol. 21, 139–151.
stress and self-regulation over time (cf. Gibbons et al., 2012; Simons Audrain-McGovern, J., Rodriguez, D., Kassel, J., 2009. Adolescent smoking and
depression: evidence for self-medication and peer smoking mediation.
et al., 2015). Longitudinal research would be desirable to test for Addiction 104, 1743–1756.
reciprocal relationships among constructs and address the full Audrain-McGovern, J., Rodriguez, D., Rodgers, K., Cuevas, J., 2011. Declining
complexity of relations between self-control and symptomatology. alternative reinforcers link depression to young adult smoking. Addiction 106,
178–187.
Audrain-McGovern, J., Rodriguez, D., Leventhal, A.M., Cuevas, J., Rodgers, K., Sass, J.,
4.4. Conclusions 2012. Low hedonic capacity predicts smoking onset and escalation. Nicotine
Tob. Res. 14, 1187–1196.
Emotional regulation was found to be quite relevant for the Berking, M., Wupperman, P., 2012. Emotion regulation and mental health: recent
findings, current challenges, and future directions. Curr. Opin. Psychiatry 25,
processes that produce early vulnerability versus resilience to sub- 128–134.
stance use. This was observed at an age when few if any participants Berking, M., Margraf, M., Ebert, D., Wupperman, P., Hofmann, S.G., Junghannis, K.,
had developed a disorder; therefore, emotion regulation differ- 2011. Deficits in emotion regulation skills predict alcohol use during and after
cognitive behavioral therapy for alcohol dependence. J. Consult. Clin. Psychol.
ences precede the onset of disorder. Emotional self-control and 79, 307–318.
emotional dysregulation had independent effects hence are dis- Berkman, E.T., Graham, A.M., Fisher, P.A., 2012. Training self-control: a
tinct constructs and not simply opposite ends of one dimension. domain-general neuroscience approach. Child Dev. Perspect. 6, 374–384.
Bonn-Miller, M.O., Vujanovic, A.A., Boden, M.T., Gross, J.J., 2011. Posttraumatic
Emotion regulation operates in part through influencing exposure stress, difficulties in emotion regulation, and coping marijuana use. Cogn.
to intermediate risk and protective factors, which points out several Behav. Ther. 40, 34–44.
pathways for preventive intervention. Brener, N.D., Billy, J.O.G., Grady, W.R., 2003. Assessment of factors affecting the
validity of self-reported health risk behavior among adolescents: evidence
from the scientific literature. J. Adolesc. Health 33, 436–457.
Role of funding sources Brewer, J.A., Elwafi, H.M., Davis, J.H., 2013. Craving to quit: psychological models
and neurobiological mechanisms of mindfulness training as treatment for
addictions. Psychol. Addict. Behav. 27, 366–379.
This research was supported by grant R01 DA021856 from Brody, G.H., Ge, X., 2001. Linking parenting processes and self-regulation to
the National Institute on Drug Abuse (TW). Preparation of the psychological functioning and alcohol use during early adolescence. J. Fam.
manuscript was supported in part by grant P30CA071789 from Psychol. 2001, 82–94.
Brook, J.S., Whiteman, M., Cohen, P., Shapiro, J., Balka, E., 1995. Longitudinally
the National Cancer Institute (TW), grant R01 AA020519 from the
predicting late adolescent and young adult drug use: childhood and adolescent
National Institute on Alcohol abuse and Alcoholism (JS), and grants precursors. J. Am. Acad. Child Adolesc. Psychiatry 34, 1230–1238.
R01 DA020138 and R01 DA 033296 from the National Institute on Bryant, A.L., Schulenberg, J., O’Malley, P.M., Bachman, J.G., Johnston, L.D., 2003.
Drug Abuse (SS). The content of this paper is solely the responsi- How academic achievement and attitudes relate to the course of substance use
during adolescence. J. Res. Adolesc. 13, 361–397.
bility of the authors and does not necessarily reflect the views of Calkins, S.A., 1994. Origins and outcomes of individual differences in emotion
the National Institutes of Health. The study sponsors had no role regulation. Monog. Soc. Res. Child Devel. 59, 53–72.
S44 T.A. Wills et al. / Drug and Alcohol Dependence 163 (2016) S37–S45

Chassin, L., Pitts, S.C., DeLucia, C., Todd, M., 1999. A longitudinal study of children Isasi, C.R., Ostrovsky, N.W., Wills, T.A., 2013. The association of emotion regulation
of alcoholics: predicting young adult substance use disorders. J. Abnorm. with lifestyle behaviors among inner-city adolescents. Eating Behav. 14,
Psychol. 108, 106–119. 518–521.
Cheetham, A., Allen, N.B., Yücel, M., Lubman, D.I., 2010. The role of affective Jessor, R., Jessor, S., 1977. Problem Behavior and Psychosocial Development.
dysregulation in drug addiction. Clin. Psychol. Rev. 30, 621–634. Academic Press, New York.
Colder, C.R., Chassin, L.M., 1997. Affectivity and impulsivity: temperamental risk Kassel, J.D., Veilleux, J.C., 2010. Introduction: the complex interplay between
for alcohol involvement. Psychol. Addict. Behav. 11, 83–97. substance abuse and emotion. In: Kassel, J.D. (Ed.), Substance Abuse and
Colder, C.R., Chassin, L., Lee, M.R., Villalta, I.K., 2010. Developmental perspectives: Emotion. American Psychological Association, Washington, DC, pp. 3–12.
affect and adolescent substance use. In: Kassel, J.D. (Ed.), Substance Abuse and Kassel, J.D., Hussong, A.M., Wardle, M.C., Veilleux, J.C., Heinz, A., Greenstein, J.E.,
Emotion. American Psychological Association, Washington, DC, pp. 109–135. Evatt, D.P., 2010. Affective influences in drug use etiology. In: Scheier, L. (Ed.),
Colder, C.R., Scalco, M., Trucco, E.M., Read, J.P., Lengua, L.J., Wieczorek, W.F., Hawk, Handbook of Drug Use Etiology. American Psychological Association,
L.W., 2013. Prospective associations of externalizing and internalizing Washington, DC, pp. 183–205.
problems and their co-occurrence with early adolescent substance use. J. Kendall, P.C., Wilcox, L.E., 1979. Self-control in children: development of a rating
Abnorm. Child Psychol. 41, 667–677. scale. J. Consult. Clin. Psychol. 47, 1020–1029.
Conrod, P.J., O’Leary-Barrett, M., Newton, N., Toper, L., Castelanos-Ryan, N., Mackie, Khantzian, E.J., 1990. Self-regulation and self-medication factors in alcoholism and
C., Girard, A., 2013. Selective personality-targeted prevention program for the addictions. In: Galanter, M. (Ed.), Recent Developments in Alcoholism, vol.
adolescent alcohol use and misuse: a cluster randomized controlled trial. JAMA 8. Plenum Press, New York, pp. 255–271.
Psychiatry 70, 334–342. King, K.M., Chassin, L., 2008. Adolescent stressors, psychopathology, and young
Cyders, M.S., Smith, G.T., Spillane, N.S., Fischer, S., Annus, A.M., Peterson, C., 2007. adult substance dependence: a prospective study. J. Stud. Alcohol Drugs 69,
Development of a measure of positive urgency. Psychol. Assess. 19, 107–118. 629–638.
Dawe, S., Loxton, N.J., 2004. The role of impulsivity in the development of King, S.M., Iacono, W.G., McGue, M., 2004. Childhood externalizing and
substance use and eating disorders. Neurosci. Biobehav. Rev. 28, 43–351. internalizing psychopathology in the prediction of early substance use.
Diamond, A., Lee, K., 2011. Interventions shown to aid executive function Addiction 99, 1548–1559.
development in children 4 to 12 years old. Science 333, 959–964. Kober, H., 2014. Emotion regulation in substance use disorders. In: Gross, J.J. (Ed.),
Eisenberg, N., Fabes, R.A., 1992. Emotion regulation and the development of social Handbook of Emotion Regulation. , 2nd ed. Guilford, New York, pp. 428–446.
competence. In: Clark, M.S. (Ed.), Review of Personality and Social Psychology Lejuez, C.W., Magidson, J.F., Mitchell, S.H., Sinha, R., Stevens, M.C., de Wit, H., 2010.
Emotion and Social Behavior, vol. 14. Sage Publications, Newbury Park, CA, pp. Behavioral and biological indicators of impulsivity in the development of
119–150. alcohol use, problems, and disorders. Alcohol. Clin. Exp. Res. 34, 1334–1345.
Elwafi, H.M., Witkiewitz, K., Mallik, S., Thornhill, T.A., Brewer, J.A., 2013. Lieberman, M.D., 2007a. Social cognitive neuroscience: a review of core processes.
Mindfulness training for smoking cessation: moderation of the relationship Ann. Rev. Psychol. 58, 259–289.
between craving and cigarette use. Drug Alcohol. Depend. 130, 222–229. Lieberman, M.D., 2007b. The X- and C-systems: the neural basis of automatic and
Englund, M.M., Egeland, B., Oliva, E.M., Collins, W.A., 2008. Childhood and controlled social cognition. In: Harmon-Jones, E., Winkelman, P. (Eds.),
adolescent predictors of heavy drinking and alcohol use disorders in early Integrating Biological and Psychological Explanations of Social Behavior.
adulthood: a longitudinal developmental analysis. Addiction 103 (Suppl. 1), Guilford, New York, pp. 290–315.
23–35. Madden, G.J., Bickel, W.K., 2010. Impulsivity: The Behavioral and Neurological
Ersche, K.D., Williams, G.B., Robbins, T.W., Bullmore, E.T., 2013. Meta-analysis of Science of Discounting. American Psychological Association, Washington DC.
structural brain abnormalities associated with stimulant drug dependence and Martin, L.R., Friedman, H.S., Schwartz, J.E., 2007. Personality and mortality across
neuroimaging of addiction vulnerability and resilience. Curr. Opinion the life span: the importance of conscientiousness. Health Psychol. 26,
Neurobiol. 23, 615–624. 428–436.
Farley, J.P., Kim-Spoon, J., 2014. The development of adolescent self-regulation: Maskowsky, J., Schulenberg, J.E., Zucker, R.A., 2014. Influence of conduct problems
reviewing the role of parent and peer relationships. J. Adolesc. 37, 433–440. and depressive symptomatology on adolescent substance use:
Fergusson, D.M., Horwood, L.J., Ridder, E.M., 2007. Conduct and attentional developmentally proximal versus distal effects. Dev. Psychol. 50, 1179–1189.
problems in childhood and adolescence and later substance use, abuse, and Meda, S.A., Stevens, M.C., Potenza, M.N., Pittman, B., Gueorguieva, R., Andrews,
dependence. Drug Alcohol Depend. 88, S14–S26. M.M., Thomas, A.D., Muska, C., Hylton, J.L., Pearlson, G.D., 2009. Investigating
Fox, H.C., Hong, K.A., Sinha, R., 2008. Difficulties in emotion regulation and impulse behavioral and self-report constructs of impulsivity using principal component
control in recently abstinent alcoholics compared with social drinkers. Addict. analysis. Behav. Pharmacol. 20, 390–399.
Behav. 33, 388–394. Metcalfe, J., Mischel, W., 1999. A hot/cool-system analysis of delay of gratification:
Fucito, L.M., Juliano, L.M., Toll, B.A., 2010. Cognitive reappraisal and expressive the dynamics of willpower. Psychol. Rev. 106, 3–19.
suppression emotion regulation strategies in cigarette smokers. Nicotine Tob. Moffitt, T.E., Arsenault, L., Belsky, D., Dickson, N., Hancox, R.J., Harrington, H.,
Res. 12, 1156–1161. Houts, R., Poulton, R., Roberts, B.W., Ross, S., Sears, M.R., Thomson, W.M., Caspi,
Gerrard, M., Gibbons, F.X., Gano, M., 2003. Adolescents’ risk perceptions and A., 2011. A gradient of childhood self-control predicts health wealth, and
behavioral willingness: implications for intervention. In: Romer, D. (Ed.), public safety. Proc. Natl. Acad. Sci. U. S. A. 108, 2693–2698.
Reducing Adolescent Risk: Toward an Integrated Approach. Sage Publications, Mohr, C., Armeli, S., Tennen, H., Todd, M., 2010. The complexities of modeling
Newbury Park, CA, pp. 75–81. mood-drinking relationships: lessons learned from daily process research. In:
Gerrard, M., Gibbons, F.X., Houlihan, A.E., Stock, M.L., Pomery, E.A., 2008. A Kassel, J.D. (Ed.), Substance Abuse and Emotion. American Psychological
dual-process approach to health risk decision making. Dev. Rev. 28, 29–61. Association, Washington, DC, pp. 189–216.
Gibbons, F.X., Houlihan, A.E., Gerrard, M., 2009. Reason and reaction: the utility of a Muraven, M., 2010. Practicing self-control lowers the risk of smoking lapse.
dual-focus perspective on prevention of adolescent health risk behavior. Br. J. Psychol. Addict. Behav 24, 446–452.
Health Psychol. 14, 231–248. Muthén, L., Muthén, B., 2010. Mplus User’s Guide. Author, Los Angeles, CA.
Gibbons, F.X., O’Hara, R.E., Stock, M.L., Gerrard, M., Weng, C.-Y., Wills, T.A., 2012. Pardini, D., White, H.R., Stouthamer-Loeber, M., 2007. Early adolescent
The erosive effects of racism: reduced self-control mediates the relation psychopathology as a predictor of alcohol use disorders in young adulthood.
between racial discrimination and substance use in African American Drug Alcohol Depend. 88, S38–S49.
adolescents. J. Pers. Soc. Psychol. 102, 1089–1104. Patock-Peckham, J.A., Cheong, J.-W., Balhorn, M.E., Nagoshi, C.T., 2001. A model of
Gibbons, F.X., Stock, M.L., Gerrard, M., Finneran, S., 2015. The parenting styles, self-regulation, perceived drinking control, and alcohol use
prototype-willingness model. In: Conner, M., Norman, P. (Eds.), Predicting and and problems. Alcohol. Exp. Clin. Res. 25, 1284–1292.
Changing Health Behaviour: Research and Practice with Social Cognition Patrick, D.L., Cheadle, A., Thompson, D., Diehr, P., Koepsell, T., Kinne, S., 1994. The
Models. , 3rd ed. Open University Press, Berkshire, UK, pp. 189–224. validity of self-reported smoking. Am. J. Public Health 84, 1086–1093.
Gilbert, K.E., 2012. The neglected role of positive emotion in adolescent Perry, J.L., Carroll, M.E., 2008. The role of impulsive behavior in drug abuse.
psychopathology. Clin. Psychol. Rev. 32, 467–481. Psychopharmacology 200, 1–26.
Goldstein, R.Z., Volkow, N.D., 2011. Dysfunction of the prefrontal cortex in Pulkkinen, L., Pitkänen, T., 1994. A prospective study of the precursors to problem
addiction: neuroimaging findings and clinical implications. Nat. Rev. Neurosc. drinking in young adulthood. J. Stud. Alcohol 55, 578–587.
12, 652–669. Reynolds, B., Ortengren, A., Richards, J.B., de Wit, H., 2006. Dimensions of impulsive
Goodman, A., 2010. Substance use and common mental health problems: behavior: personality and behavioral measures. Pers. Individ. Differ. 40,
examining longitudinal associations in a British sample. Addiction 105, 305–315.
1484–1496. Roberts, R.E., Roberts, C.R., Xing, Y., 2007. Comorbidity of substance use disorders
Guo, J., Hawkins, J.D., Hill, K.G., Abbott, R.D., 2001. Childhood and adolescent and other psychiatric disorders among adolescents. Drug Alcohol Depend. 88,
predictors of alcohol abuse and dependence in young adulthood. J. Stud. S4–S13.
Alcohol 62, 754–762. Rothbart, M.K., Ahadi, S.A., Evans, D.E., 2000. Temperament and personality:
Hertel, P.T., Mathews, A., 2011. Cognitive bias modification: past perspectives, origins and outcomes. J. Pers. Soc. Psychol. 78, 122–135.
current findings, and future applications. Perspect. Psychol. Sci. 6, 521–536. Rothbart, M.K., Sheese, E., Posner, M.I., 2015. Temperament and emotion
Hoffman, W., Friese, M., Strack, F., 2009. Impulse and self-control from a regulation. In: Gross, J.J. (Ed.), Handbook of Emotion Regulation. Guilford, New
dual-systems perspective. Perspect. Psychol. Sci. 4, 162–175. York, pp. 305–320.
Houben, K., Schoenmakers, T.M., Wiers, R.W., 2010. I didn’t feel like drinking but I Rutter, M., Dunn, J., Plomin, R., Simonoff, E., Pickles, A., Eaves, L., 1997. Integrating
don’t know why: the effects of evaluative conditioning on alcohol-related nature and nurture. Dev. Psychopathol. 9, 335–364.
attitudes, craving, and behavior. Addict. Behav. 35, 1161–1163. Scalco, M., Colder, C.R., Hawk, L.W., Read, J.P., Wieczorek, W.F., Lengua, L.J., 2014.
Internalizing and externalizing problem behavior and early adolescent
 T.A. Wills et al. / Drug and Alcohol Dependence 163 (2016) S37–S45 S45

substance use: a test of a latent variable interaction model and conditional Wills, T.A., Dishion, T., 2004. Temperament and adolescent substance use: an
indirect effects. Psychol. Addict. Behav. 23, 828–840. analysis of emerging self-control. J. Clin. Child Adolesc. Psychol. 33, 69–81.
Scheier, L.A. (Ed.), 2015. Handbook of Adolescent Drug Use Prevention: Research, Wills, T.A., Ainette, M.G., 2010. Temperament, self-control, and adolescent
Intervention, and Practice. American Psychological Association, Washington, substance use: a two-factor model of etiological processes. In: Scheier, L.M.
DC. (Ed.), Handbook of Drug Use Etiology. American Psychological Association,
Schuckit, M.A., Smith, T.L., 2006. An evaluation of externalizing symptoms and Washington, DC, pp. 127–146.
depressive symptoms as predictors of alcoholism. J. Stud. Alcohol 67, 215–277. Wills, T.A., Sandy, J.M., Shinar, O., 1999a. Cloninger’s constructs related to
Siegel, J., 2010. Stop Overreacting: Effective Strategies For Calming Your Emotions. substance use level and problems in late adolescence: a mediational model
New Harbinger Publications, Oakland, CA. based on self-control and coping motives. Exp. Clin. Psychopharmacol. 7,
Simons, J.S., Carey, K.B., 2002. Risk and vulnerability for marijuana use problems: 122–134.
the role of affect dysregulation. Psychol. Addict. Behav 16, 72–75. Wills, T.A., Sandy, J.M., Shinar, O., Yaeger, A., 1999b. Contributions of positive and
Simons, J.S., Carey, K.B., Wills, T.A., 2009. Alcohol abuse and dependence: negative affect to adolescent substance use. Psychol. Addict. Behav. 13,
multidimensional model of common and specific etiology. Psychol. Addict. 327–338.
Behav. 23, 415–427. Wills, T.A., Gibbons, F.X., Gerrard, M., Brody, G., 2000. Protection and vulnerability
Simons, J.S., Dvorak, R.D., Batien, B.D., Wray, T.B., 2010. Event-level associations processes for early substance use: a test among African–American children.
between affect, alcohol intoxication, and acute dependence symptoms: effects Health Psychol. 19, 253–263.
of urgency, self-control, and drinking experience. Addict. Behav. 35, Wills, T.A., Cleary, S.D., Filer, M., Shinar, O., Mariani, J., Spera, K., 2001a.
1045–1053. Temperament related to early-onset substance use: test of a developmental
Simons, J.S., Wills, T.A., Neal, D.J., 2014. The many faces of affect: a multilevel model. Prev. Sci. 2, 145–163.
model of drinking frequency/quantity and alcohol dependence symptoms Wills, T.A., Sandy, J.M., Yaeger, A., 2001b. Time perspective and early-onset
among young adults. J. Abnorm. Psychol. 123, 676–694. substance use: a model based on stress-coping theory. Psychol. Addict. Behav.
Simons, J.S., Wills, T.A., Emery, N.N., Spellman, P., 2015. Keep calm and carry on: 15, 118–125.
maintaining self-control when intoxicated, upset, or depleted. Cogn. Emot., Wills, T.A., Sandy, J.M., Yaeger, A.M., Cleary, S.D., Shinar, O., 2001c. Coping, life
http://dx.doi.org/10.1080/02699931.2015.1069733. stress, and adolescent substance use: a latent growth analysis. J. Abnorm.
Sinha, R., 2008. Chronic stress, drug use, and vulnerability to addiction. Ann. N.Y. Psychol. 110, 309–323.
Acad. Sci. 1141, 105–130. Wills, T.A., Sandy, J.M., Yaeger, A., 2002a. Moderators of the relation between
Smith, K.S., Graybiel, A.M., 2013. A dual-operator view of habitual behavior substance use level and problems: test of a self-regulation model. J. Abnorm.
reflecting cortical and striatal dynamics. Neuron 79, 361–374. Psychol. 111, 3–21.
Southam-Gerow, M.A., 2013. Emotion Regulation in Children and Adolescents: A Wills, T.A., Sandy, J.M., Yaeger, A.M., 2002b. Stress and smoking in adolescence: a
Practitioner’s Guide. Guilford, New York. test of directional hypotheses with latent growth analysis. Health Psychol. 21,
Southam-Gerow, M.A., Kendall, P.C., 2002. Emotional regulation and 122–130.
understanding: implications for child psychopathology. Clin. Psychol. Rev. 22, Wills, T.A., Resko, J., Ainette, M., Mendoza, D., 2004a. The role of parent and peer
189–222. support in adolescent substance use: a test of mediated effects. Psychol.
Steinberg, L., 2007. Risk taking in adolescence: new perspectives from brain and Addict. Behav. 18, 122–134.
behavioral science. Curr. Dir. Psychol. Sci. 16, 55–59. Wills, T.A., Resko, J., Ainette, M., Mendoza, D., 2004b. Smoking onset in
Sussman, S., Ames, S.L., 2008. Drug Abuse: Concepts, Prevention, and Cessation. adolescence: a person-centered analysis with time-varying predictors. Health
Cambridge University Press, New York. Psychol. 23, 158–167.
Sussman, S., McCuller, W.J., Dent, C., 2003. The association of social self-control Wills, T.A., Walker, C., Resko, J.A., 2005. Longitudinal studies of drug use and abuse.
and personality disorders with drug use in a sample of high risk youth. Addict. In: Sloboda, Z. (Ed.), Epidemiology of Drug Abuse. Springer, New York, pp.
Behav. 28, 1159–1166. 177–192.
Sussman, S., Pokhrel, P., Ashmore, R.D., Brown, B.B., 2007. Adolescent peer group Wills, T.A., Walker, C., Mendoza, D., Ainette, M.G., 2006. Behavioral and emotional
identification and characteristics: a review of the literature. Addict. Behav. 32, self- control: relations to substance use in samples of middle- and high-school
1602–1627. students. Psychol. Addict. Behav. 20, 265–278.
Tarter, R., Vanyukov, M., Giancola, P., Dawes, M., Blackson, T., Mezzich, A., Clark, D., Wills, T.A., Murry, V., Brody, G., Gibbons, F.X., Gerrard, M., Walker, C., Ainette, M.,
1999. Etiology of early age onset substance use disorder: a maturational 2007a. Ethnic pride, self-control, and protective/risk factors. Health Psychol.
perspective. Dev. Psychopathol. 11, 657–683. 26, 50–59.
Tarter, R., Kirisci, L., Mezzich, A., Cornelius, J., Pajer, K., Vanyukov, M., Gardner, W., Wills, T.A., Ainette, M.G., Mendoza, D., Gibbons, F.X., Brody, G.H., 2007b.
Blackson, T., Clark, D., 2003. Neurobehavioral disinhibition in childhood Self-control, symptomatology, and substance use precursors: test of a
predicts early onset of substance use disorder. Am. J. Psychiatry 160, theoretical model in a community sample of 9-year-old children. Psychol.
1078–1085. Addict. Behav. 21, 205–215.
Tarter, R.E., Kirisci, L., Feske, U., Vanyukov, M., 2007. Modeling the pathways Wills, T.A., Ainette, M.G., Stoolmiller, M., Gibbons, F.X., Shinar, O., 2008. Good
linking childhood hyperactivity and substance use disorder in young self-control as a buffering agent for adolescent substance use: an investigation
adulthood. Psychol. Addict. Behav. 21, 266–271. in early adolescence with time-varying covariates. Psychol. Addict. Behav. 22,
Ursache, A., Blair, C., Raver, C.C., 2012. The promotion of self-regulation as a means 459–471.
for enhancing school readiness and early achievement in children at risk for Wills, T.A., Pokhrel, P., Morehouse, E., Fenster, B., 2011. Behavioral and emotional
school failure. Child Dev. Perspect. 6, 122–128. regulation and adolescent substance use problems: a test of moderation effects
Veit, C.T., Ware, J.E., 1983. Structure of psychological distress and well-being in in a dual-process model. Psychol. Addict. Behav. 25, 279–292.
general populations. J. Consult. Clin. Psychol. 51, 730–742. Wills, T.A., Bantum, E.O., Pokhrel, P., Maddock, J.E., Ainette, M.G., Morehouse, E.,
Volkow, N.D., Baler, R.D., 2012. To stop or not to stop? Science 335, 546–548. Fenster, B., 2013. A dual-process model of early substance use: tests in two
Volkow, N.D., Fowler, J., Wang, G., Telang, F., Logan, J., Jayne, M., Ma, Y., Pradhan, K., diverse populations of adolescents. Health Psychol. 32, 533–542.
Wong, C., Swanson, J.M., 2010. Cognitive control of drug craving inhibits brain Wills, T.A., Forbes, M., Gibbons, F.X., 2014. Parental and peer support: an analysis of
reward regions in cocaine abusers. Neuroimage 49, 2536–2543. their relations to adolescent substance use. In: Scheier, L.W., Hansen, W.B.
Webb, T.L., Miles, E., Sheeran, P., 2012. A meta-analysis of the effectiveness of (Eds.), Parenting and Teen Drug Use. Oxford, New York, pp. 148–165.
strategies derived from the process model of emotion regulation. Psychol. Bull. Wills, T.A., Knight, R., Williams, R., Pagano, I., Sargent, J.D., 2015a. Risk factors for
138, 775–808. E-cigarette use and dual E-cigarette and tobacco use in adolescents. Pediatrics
Weinstein, S.M., Mermelstein, M., 2013a. Dynamic associations of negative mood 135, e43–e51.
and smoking in the development of smoking in adolescence. J. Clin. Child Wills, T.A., Simons, J.S., Gibbons, F.X., 2015b. Self-control and substance use
Adolesc. Psychol. 42, 629–642. prevention. In: Scheier, L.A. (Ed.), Handbook of Adolescent Drug Use
Weinstein, S.M., Mermelstein, R.J., 2013b. Influences of mood variability, negative Prevention: Research, Intervention, and Practice. American Psychological
moods, and depression on adolescent smoking. Psychol. Addict. Behav. 27, Association, Washington, DC, pp. 121–139.
1068–1078. Windle, M., 1990. A longitudinal study of antisocial behaviors in early adolescence
White, H.R., Xie, M., Thompson, W., Loeber, R., Stouthamer-Loeber, M., 2001. as predictors of late adolescent substance use. J. Abnorm. Psychol. 99, 86–91.
Psychopathology as a predictor of adolescent drug use trajectories. Psychol. Wittchen, H.-U., Fröhlich, C., Behrendt, S., Günther, A., Rehm, J., Zimmerman, P.,
Addict. Behav. 15, 210–218. Lieb, R., Perkonigg, R., 2007. Cannabis use and disorders and their relation to
Wiers, R., Bartholow, B., van den Wildenberg, E., Thush, C., Engels, R., Sher, K., mental disorders: a 10-year prospective-longitudinal study in adolescents.
Grenard, J., Ames, S., Stacy, A., 2007. Automatic and controlled processes and Drug Alcohol Depend. 88, S60–S70.
the development of addictive behaviors in adolescents. Pharmacol. Biochem. Zeman, J., Shipman, K., Penza-Clyve, S., 2001. Development and validation of the
Behav. 86, 263–283. children’s sadness management scale. J. Nonverbal Behav. 25, 187–205.
Wiers, R.W., Eberl, C., Rinck, M., Becker, E.S., Lindenmeyer, J., 2011. Retraining Zimbardo, P.G., Boyd, J.N., 1999. Time perspective: a valid, reliable
automatic action tendencies changes alcohol patients’ approach bias for individual-differences metric. J. Pers. Soc. Psychol. 77, 1271–1288.
alcohol and improves treatment outcome. Psychol. Sci. 22, 490–497.
Wills, T.A., Stoolmiller, M., 2002. Role of self-control in early escalation of
substance use: a time-varying analysis. J. Consult. Clin. Psychol. 70, 986–997.