Substance+Abuse

Substance Abuse toc                **Third Edition Authors: Rachel Peterson & Adam Ramsey** <span style="color: #000080; display: block; font-family: georgia,serif; font-size: 110%; text-align: center;">**Second Edition Authors: Ellen Anderson & Avital Deskalo** <span style="color: #000080; display: block; font-family: georgia,serif; font-size: 110%; text-align: center;">**First Edition Authors: Mindy Whalen & Michelle Jochim** <span style="color: #000080; font-family: Georgia,serif; font-size: 130%;">"It's in adolescence that the onset of substance abuse disorders occurs for most individuals. That's where the roots take place" (Swendsen, 2011) =**<span style="font-family: Georgia,serif; font-size: 120%;">Overview **=

<span style="font-family: Georgia,serif;">Substance use and abuse is an epidemic that continues to plague our youth. According to a 2013 press release by the Substance Abuse and Mental Health Services Administration (SAMHSA), on an average day 881,684 youth age 12 to 17 smoke cigarettes, 646,707 adolescents smoke marijuana, and 457,672 drink alcohol. In other words, the number of adolescents using marijuana on an average day could fill the Indianapolis Speedway two and a half times. In terms of daily hospital emergency visits involving adolescents, marijuana is involved in 165 visits, alcohol is involved in 187 visits, and misuse of prescription or nonprescription pain relievers is implicated in 74 visits. Studies have indicated that individuals are already abusing drugs and alcohol by age 12, which likely means that some begin even earlier. Furthermore, research indicates that adolescents who begin drinking before age 14 are significantly more likely to experience alcohol dependence at some point in their lives compared to individuals who begin drinking after 21 years of age.

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**<span style="font-family: Georgia,serif; font-size: 120%;">Indiana **
<span style="font-family: Georgia,serif;">Drug abuse has quickly become a top public health concern not only nationally but for Indiana as well. Approximately 52,000 (9.6 percent) of the 546,000 adolescents in Indiana used an illicit drug in the past month; 35,000 (6.4 percent) used marijuana, and 27,000 (5.0 percent) used an illicit drug other than marijuana. Moreover, 23,000 males and 18,000 females used pain relievers non-medically in the 12 months. In terms of alcohol use, 13.6 percent of adolescents (74,000) used alcohol in the past month and 8.7 percent (48,000) engaged in binge drinking. Despite, the overwhelming number of youth and adolescents using and abusing drugs and alcohol, very few are receiving treatment. For example, 12,000 males (4.2 percent) and 11,000 females (4.1 percent) needed but did not receive treatment for past-year drug problems. Below is a table that compares Indiana drug and alcohol use to the national averages.





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<span style="font-family: Georgia,serif;">A description of commonly abused substances can be found here <span style="font-family: Georgia,serif;"> A glossary of addiction related terms can be found here <span style="font-family: Georgia,serif;"> National and state-wide statistics regarding adolescent drug use can be found at the following sites:

<span style="color: #000080; font-family: georgia,serif; font-size: 90%; line-height: 0px; overflow: hidden; vertical-align: sub;"> Monitoring the Future 2013

<span style="font-family: georgia,serif; font-size: 90%;"> Indiana Statewide Prevalance Rates by Grade: Lifetime and Monthly Use

=**<span style="font-family: Georgia,serif; font-size: 120%;">Risk and Protective Factors for Adolescent Substance Abuse **= <span style="font-family: Georgia,serif; font-size: 120%;"> <span style="font-family: georgia,serif; font-size: 90%;">[|Risk Factors]

=**<span style="font-family: Georgia,serif; font-size: 120%;">Consequences of Substance Abuse in Adolescence **=

<span style="font-family: Georgia,serif;">Youth who persistently abuse substance often experience an array of problems including academic difficulties, physical and mental health-related problems, poor peer relationships, and involvement with the juvenile justice system. Additionally, there're consequences for family members, the community, and the greater society.

//<span style="font-family: Georgia,serif; font-size: 110%;">Academics //
<span style="font-family: Georgia,serif;"> Declining grades, absenteeism from school and other activities, and increased potential for dropping out of school are all problems associated with adolescent substance abuse. Hawkins, Catalano, and Miller (1992) cite research indicating that a low level of commitment to education and higher truancy rates appear to be related to substance use among adolescents. Cognitive and behavioral problems experienced by alcohol- and drug-using youth may interfere with their academic performance and also present absences to learning (Bureau of Justice Statistics, 1992).



//<span style="font-family: Georgia,serif; font-size: 110%;">Physical Health //
<span style="font-family: Georgia,serif;">Injuries due to accidents (i.e. vehicular accidents), physical disabilities and disease (i.e. sexually-transmitted diseases, HIV/AIDS), and the effects of possible overdoses are among the health-related consequences of teenage substance abuse. Disproportionate numbers of youth with alcohol and other drugs face in increased risk of death by suicide, homicide, accident, and illness.



//<span style="font-family: Georgia,serif; font-size: 110%;">Mental Health //
<span style="font-family: Georgia,serif;">Mental health problems such as depression, developmental delays, apathy, withdrawal, and other psychosocial dysfunctions frequently are linked to substance abuse among adolescents. Substance-abusing youth are at higher risk than non-users for mental health problems including depression, conduct problems, personality disorders, suicidal ideations, attempted suicide, and suicide. Adolescents with alcohol use disorders, compared to healthy matches, have been found to have smaller prefrontal cortices and white matter volumes in the brain. Research has also shown that individuals who began using cannabis before the age of 17 are more vulnerable to cognitive impairments. Marijuana use, in particular, has been shown to interfere with short-term memory, learning, and psychomotor skills.



//<span style="font-family: Georgia,serif; font-size: 110%;">Peer Relationships //
<span style="font-family: Georgia,serif;">Substance-abusing youth often are alienated and stigmatized by their peers. Adolescents using alcohol and other drugs also often disengage from school and community activities, depriving their peers and communities of the positive contributions they might otherwise have made.



//<span style="font-family: Georgia,serif; font-size: 110%;">Family Relationships //
<span style="font-family: Georgia,serif;">In addition to personal adversities, the abuse of alcohol and other drugs by youth may result in family crises and jeopardize many aspects of family life, sometimes resulting in family dysfunction. Both siblings and parents are profoundly affected by alcohol- and drug-involved youth (Nowinski, 1990). Substance abuse can also drain a family's financial and emotional resources Bureau of Justice Statistics, 1992).



//<span style="font-family: Georgia,serif; font-size: 110%;">Delinquency //
<span style="font-family: Georgia,serif;">There is an undeniable link between substance abuse and delinquency. Arrest, adjudication, and intervention by the juvenile justice system are eventual consequences for many youth engaged in alcohol and other drug use. It cannot be claimed that substance abuse causes delinquent behavior or delinquency causes alcohol and other drug use; however, the two behaviors are strongly correlated and often bring about school and family problems, involvement with negative peer groups, a lack of neighborhood social controls, and physical or sexual abuse ( Hawkins et al., 1987; Wilson & Howell, 1993). Gangs, drug trafficking, prostitution, and growing numbers of youth homicides are among the social and criminal justice problems linked to adolescent substance abuse.



//<span style="font-family: Georgia,serif; font-size: 110%;">Social and Economic Consequences //
<span style="font-family: Georgia,serif;">The social and economic costs related to youth substance abuse are high. They result from the financial losses and distress suffered by alcohol- and drug-related crime victims, increased burdens for the support of adolescents and young adults who are not able to become self-supporting, and greater demands for medical and other treatment services for these youth.

<span style="font-family: Georgia,serif;"> [|Science Behind Drugs]

=**<span style="font-family: Georgia,serif; font-size: 120%;">Assessment of Substance Abuse/Dependence **=

<span style="font-family: Georgia,serif;"> Universal assessment of substance abuse/dependence is used to determine an individual's risk and protective factors, mental health status, and substance use. By conducting universal screening in the schools, school psychologists and counselors have a unique opportunity to identify youths at-risk for developing substance abuse problems. Additionally, administering universal screeners in schools can assist in the identification of students who may not be eligible for a [|Substance Abuse] or Substance Dependence Disorder but still require interventions. According to Hallfors and colleagues, an ideal universal screening tool should be readily available, cost-effective, easily implemented, robust, and reliable in identifying problem behaviors. One example of an effective universal screener is the High School Questionnaire (HSQ), which is a self-report survey that encompasses questions regarding demographics, protective factors, and problem outcomes. A Suicide Risk Screen is embedded into the HSQ, and it contains three sub-scales regarding suicide behavior, depression symptoms, and substance use control problems. Students who "screen" positive for at-risk substance abuse or current substance abuse require more intensive and comprehensive assessment procedures. A comprehensive drug abuse instrument needs to address the specific factors that will aid in the individual's continued prevention or rehabilitation. Additionally, substance abuse assessment procedures should be multi-faceted, including a self-report, parent report, and structured/unstructured interviews, to enhance accurate identification of the individual's substance abuse status and appropriate intervention selection. Finally, the school support staff (e.g., school psychologists, counselors) responsible for administering the <span style="font-family: Georgia,serif;">assessments must be well-trained and knowledgeable about the assessment process. <span style="font-family: Georgia,serif;"> Winters highlights several content areas that formulate an effective and appropriate drug screener: <span style="font-family: Georgia,serif;"> 1) Severity of drug abuse <span style="font-family: Georgia,serif;">2) Protective and risk factors <span style="font-family: Georgia,serif;">3) Cognitive factors > <span style="font-family: Georgia,serif;">**<span style="font-family: Georgia,serif; font-size: 120%;"> Examples of comprehensive drug abuse measures: ** <span style="font-family: georgia,serif; font-size: 110%;"> Drug Use Screening Inventory <span style="font-family: georgia,serif; font-size: 110%;"> Drug and Alcohol Problem Quick Screen <span style="font-family: georgia,serif; font-size: 110%;"> <span style="font-family: georgia,serif; font-size: 110%;"> Diagnostic Interview Schedule for Children
 * <span style="font-family: Georgia,serif;">Onset of initial drug use; onset of regular (weekly or more frequently) drug use
 * <span style="font-family: Georgia,serif;">Frequency, duration, and quantity of specific drugs in the past 6 months and over the course of lifetime
 * <span style="font-family: Georgia,serif;">Preferred drug
 * <span style="font-family: Georgia,serif;">Reasons for drug use (e.g., social, psychological, stress-relieving)
 * <span style="font-family: Georgia,serif;">Personal ramifications of drug use (e.g. what social, family, emotional, legal, physical [HIV/AIDS], behavioral factors are affected?)
 * <span style="font-family: Georgia,serif;">Personality characteristics (e.g., self-image, perspective on conventional values, tendency to engage in delinquent behaviors, status of psychological well-being, learning capabilities, school affiliation)
 * <span style="font-family: Georgia,serif;">Peer environment (e.g., peer drug use, peer norms and values, abstinent peer role models)
 * <span style="font-family: Georgia,serif;">Home environment (e.g., family cohesiveness, parenting discipline practices, parental/sibling drug use and attitudes toward drug use, family norms, values, and expectations)
 * <span style="font-family: Georgia,serif;">Community and neighborhood characteristics (e.g., population density, crime rates, socioeconomic status)
 * <span style="font-family: Georgia,serif;">Motivations for using (e.g., recreational benefits, helps cope with stress, peer pressure and social conformity, and mood enhancement)
 * <span style="font-family: Georgia,serif;">Perceived risks and costs of drug use (e.g., perceived vulnerability to and knowledge regarding health risks, denial, and optimistic bias- that consequence won't happen to me even though it happened to someone else who used the same drug)
 * <span style="font-family: Georgia,serif;">Readiness for behavior change (e.g., problem recognition, availability and accessbility to treatment, and what contributed to the coercive pressure to seek treatment)
 * <span style="font-family: Georgia,serif;">Self-efficacy (e.g., goal achievement)

=<span style="font-family: Georgia,serif; font-size: 120%;">Diagnosis of Substance Abuse = <span style="font-family: Georgia,serif;"> In May 2013, the American Psychiatric Association issued the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Although there is considerable overlap between DSM-5 and DSM-IV, the prior edition, there are several important differences. <span style="font-family: Georgia,serif;">

=<span style="font-family: Georgia,serif;">** Treatment of Adolescent Substance Abuse ** = <span style="font-family: Georgia,serif;"> Adolescents are less likely to receive treatment for their drug abuse/dependence disorders. Only 10% of adolescents with drug problems are receiving treatment, compared to 20% of adults who receive drug treatment. This is in part due to adolescents' lack of motivation to enter or remain in treatment. In one study, it was found that only 20% of adolescents entering outpatient treatment, primarily for marijuana use, reported that they needed help for their problem. There are numerous reasons why adolescents are reluctant to enter treatment for substance abuse; therefore, it's imperative that a drug abuse treatment center provides a variety of diverse services to meet individual needs. <span style="display: block; font-family: georgia,serif; font-size: 90%; text-align: left;"> <span style="font-family: Georgia,serif; font-size: 90%;"> Adapted from The Principles of Drug Addiction Treatment by The National Institute on Drug Abuse.

<span style="font-family: Georgia,serif; font-size: 110%;"> Prevention Programs
<span style="font-family: Georgia,serif;"> The following general principles for effective substance abuse prevention programs are intended to help parents, educators, and community leaders think about, plan for, and deliver research-based drug abuse prevention programs at the community level. The references following each principle are representative of current research.

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<span style="font-family: Georgia,serif;"> **<span style="font-family: Georgia,serif; font-size: 120%; line-height: 1.5;"> Prevention Programs for High-Risk Youth **

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> Additionally, Springer et al. describe 5 characteristics of effective prevention programs for high-risk youth. These programs <span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> 1. Emphasize strong behavioral life skills programming (e.g., refusal skill-building, anger management, conflict resolution, social skills, and academics) as opposed to information-only approaches. <span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> 2. Use interactive learning (rather than passive, classroom style) learning methods, wherein youth are engaged in thought-provoking, meaningful activities that encourage group work and teambuilding. Activities aim to help youth build positive relationships with peers and supportive adults. <span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> 3. Are designed so that there are clear links between outcome objectives and the program activities. Programs are organized, with a consistent, well-planned schedule. <span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> 4. Are intense enough to meet student need. Students receive at least four hours of programming per week. <span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> 5. Have multiple positive components and activities.

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> **<span style="font-family: Georgia,serif; font-size: 120%;"> School-Based Prevention Programs **

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> Because drug and alcohol use is highly influenced by the attitudes and perceived norms of peers, school-based approaches that are open to every student in the school are needed, in addition to approaches that target drug-using teens (Winters, 2007). School-based programs may include school-day, extended-day, or afterschool programs, may be delivered by school personnel or by community-based facilitators, and may be mandatory (like a health education class) or voluntary (like an elective or a drop in afterschool program).

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> Effective approaches to school-based drug and alcohol prevention include teaching students how to resist peer influences, improving life skills, involving families, and providing opportunities to become involved in positive experiences with others in the school and community (NIDA, 2003). Furthermore, these programs for elementary school students address issues such as self-control, emotional awareness, communication skills, and social problem-solving skills; and effective programs for older students seek to build communication skills; self-efficacy and assertiveness, and drug resistance skills (NIDA, 2003). In contrast, ineffective approaches include those that group substance users together (NIDA, 2003) and approaches that focus only on information dissemination or teaching about the dangers of substance use (Dishion & Andrews, 1995; NIDA, 2003; Soole et al., 2005; Tobler et al., 2003).

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> Substance use prevention programs should be long-term and include booster sessions to prevent program impacts from decaying over time (NIDA, 2003, Botvin & Griffin, 2003). Programs should also be implemented for an adequate number of hours (at least 11 hours, according to Tobler et al., 2000). When substance use is rampant within the community, school-based drug prevention programs can be implemented in conjunction with community-based strategies that reduce risk factors such as the availability of drugs and alcohol and promote norms that discourage underage drinking and drug use (Winters, 2007).

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> **<span style="font-family: Georgia,serif; font-size: 120%;"> Model Programs Incorporating Evidence-Based Strategies **

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> __<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;">Across Ages __<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> was originally designed as a school-based program for substance abuse prevention but the model was expanded to address multiple risk/protective factors and can be utilized as a wide-ranging prevention strategy incorporating life skills training, promoting pro-social norms and connecting to community prevention efforts in a variety of settings. Across Ages is a school and community based drug prevention program that seeks to strengthen the bonds between adults and youth and provide opportunities for positive community involvement. The centerpiece of Across Ages is the involvement of older adults as mentors for youth ages 9 to 15. In addition to spending time with their mentors, children in Across Ages are involved in community service activities that benefit the neighborhoods around their schools, and they receive classroom instruction to cope with stress and promote positive decision-making. To learn more about Across Ages click on [|www.temple.edu/cil/acrossages.htm].

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> __Life Skills Training__ is a highly rated, recommended and researched substance abuse prevention program today. Rather than just teaching information about a drug this program teaches students to develop skills so they are less likely to engage in high-risk behaviors. Life Skills is designed for elementary and junior high school students and has been effective with white middle-class and ethnic-minority students in rural, suburban, and inner-city populations. Life Skills Training consists of three major components: Drug Resistance Skills, Personal Self-Management Skills, and General Social Skills. Drug Resistance Skills enable young people to recognize and challenge misconceptions about tobacco, alcohol, and other drug use. By increasing perception of person risk and life skills training students learn alcohol, tobacco, and drug abuse information and resistance skills to deal with peer and media pressure through coaching and practice. Personal Self-Management Skills teach students how to examine their self-image and its effects on behavior. Students learn to set goals, make decisions, analyze problems and consider the consequences of each solution before making a decision. They also learn to look at challenges in a positive light. General Social Skills teach students to communicate effectively and avoid misunderstandings. Students also learn to initiate conversations and handle social requests. Life Skills Training teaches students that they have a choice other then being aggressive or passive. To learn more about Life Skills Training click on [|www.lifeskillstraining.com].

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> __Positive Action__ incorporates evidence based strategies such as increasing perception of personal risk, life skills training, promoting pro-social norms and connecting to community prevention efforts. Positive Action is a comprehensive program for students 3-18 years old. It is targeted for all groups of individuals, regardless of age, gender, race, urban, rural, suburban, etc. Its methodology integrates daily classroom curriculum with a school based prevention program. The Positive Action approach teaches physical, intellectual, social, and emotional positive actions. Students focus on the importance of their thoughts, actions, and feelings. Some of the goals of this program are to improve students’ academic performance, instill students motivation to learn, assist the school, improve students’ behavior, develop students character, develop well rounded students, develop thinking skills, and promote good mental health in students. This program has been effective in increasing protective factors such as social skills, positive personal characteristics, knowledge regarding risks associated with substance use, information on positive health behaviors, promoting negative attitude toward drug-related topics, positive relationships with adults, positive bonding to social institutions, and commitment to pro-social values. To learn more about Positive Action click on the link [|www.positiveaction.net].

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> __Project Alert__ is designed for sixth through eighth grade students. The goals of Project ALERT are to prevent adolescents from beginning to use drugs, and to prevent those who have already experimented from becoming regular users. Also, to prevent or curb risk factors demonstrated to predict drug use. The curriculum achieves these goals by motivating adolescents not to use drugs and by teaching them skills to translate that motivation into effective resistance. The lessons that focus on correcting misperceptions of norms, beliefs about drugs, and intentions help motivate adolescents not to use. Other evidence based strategies incorporated in Project Alert are life skills training and increasing perception of personal risk. These strategies are used to teach students to recognize that most students don’t use drugs, understand the consequences of using drugs, and resist internal and social pressures. To learn more about Project Alert click on [|www.projectalert.com].

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> __Project Northland__ is rated an exemplary program by the U.S. Department of Education. The focus is on prevention of alcohol, tobacco, and other drug use for students in grades six through eight. The project’s goals are to delay the age when young people begin drinking, reduce alcohol among young people who have already tried it and limit the number of drug related problems. Project Northland was effective in changing peer influence to use alcohol, normative expectations about how many young people drink, and parent-child communication about the consequences of alcohol use and the reasons for not using alcohol. By incorporating evidence based strategies such as correcting misperceptions of norms, increasing perception of personal risk, life skills training and promoting pro-social norms Project Northland teaches youth decision making skills, assists in strengthening parenting skills, teaches youth interpersonal skills and provides information on substance abuse. To learn more about Project Northland click on the link [|www.hazelden.org].

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> __Promoting Alternative Thinking Strategies (PATHS)__ is a comprehensive program for promoting emotional and social competencies and reducing aggression and behavior problems in elementary school-aged children while simultaneously enhancing the educational process. PATHS designed an innovative curriculum to be used by both educators and counselors. This curriculum incorporates life skills trainings by teaching students to build emotional literacy, self control, social skills, positive peer relationships and interpersonal problem solving skills. It has improved self control, understanding and recognition of emotions, increased ability to tolerate frustration and use of more effect conflict-resolution. To learn more about PATHS click on [|www.prevention.psu.edu]

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> __The Seattle Social Development Project__ promotes pro-social norms and corrects misperception of norms by training teachers in active classroom management, promoting children’s pro-social involvement and commitment to the norm of not using drugs. This is a school based intervention program for grades 1-6 that seeks to reduce shared childhood risks for delinquency and drug abuse by enhancing protective factors and decreasing risk factors. Targeted risk factors to decrease are family management problems, early anti-social behaviors, academic failure, low commitment to schools, and friends involved in problem behaviors. Targeted protective factors to increase are opportunities, life skills, and bonding with family and schools. By increasing these protective factors students have healthy beliefs and clear standards which lead to healthy behaviors. Therefore students avoid drugs, delinquency, risky sexual behavior, violence and dropping out of school. To learn more about Seattle Social Development click on [|www.preventionnet.com].

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> __Second Step__ is designed for Pre k-8th grade students to reduce impulsive, high risk, and aggressive behaviors. Students learn to recognize and understand feelings, make positive and effective choices, and keep anger from escalating into violence. Research indicates that aggressive behavior in children predicts risk of later delinquency, substance abuse, school dropout, early parenthood, and depression. Classroom use of the Second Step program incorporates strategies such as life skills training for students to develop the skills they need to create safe environments and become successful adults. Integration activities tie the lessons into academic learning requirements—health, science, math, social studies, and language arts—helping teachers build on what they are already doing in the classroom. To learn more about Second Step click on [|www.cfchildren.org/violence.htm].

<span style="display: block; font-family: georgia,serif; font-size: 90%; text-align: left;"><span style="display: block; font-family: georgia,serif; font-size: 12.22px;">  <span style="display: block; font-family: georgia,serif; font-size: 90%; text-align: left;">

<span style="font-family: Georgia,serif; font-size: 110%; line-height: 1.5;">Effective Treatment Options
<span style="display: block; font-family: georgia,serif; font-size: 90%; text-align: left;"> <span style="display: block; font-family: georgia,serif; font-size: 90%; text-align: left;"><span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;">Characteristics of Effective Prevention Programs for At-Risk Youth 1. Programs emphasize strong behavioral life skills programming (e.g., refusal skill-building, anger management, conflict resolution, social skills, and academics) as opposed to information-only approaches.2. Programs use interactive learning (rather than passive, classroom style) learning methods, wherein youth are engaged in thought-provoking, meaningful activities that encourage group work and teambuilding. Activities aim to help youth build positive relationships with peers and supportive adults.3. Programs are designed so that there are clear links between outcome objectives and the program activities. Programs are organized, with a consistent, well-planned schedule.4. Programs are intense enough to meet student need. Students receive at least four hours of programming per week. 5. Programs have multiple positive components and activities. <span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> Medication and behavioral therapy, especially when combined, are important elements of an overall therapeutic process that often begins with detoxification, followed by treatment and relapse prevention. Easing withdrawal symptoms can be important in the initiation of treatment; preventing relapse is necessary for maintaining its effects. And sometimes, as with other chronic conditions, episodes of relapse may require a return to prior treatment components. A continuum of care that includes a customized treatment regimen—addressing all aspects of an individual's life, including medical and mental health services—and follow–up options (e.g., community – or family-based recovery support systems) can be crucial to a person's success in achieving and maintaining a drug–free lifestyle.

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> **<span style="font-family: Georgia,serif;"> //<span style="font-family: Georgia,serif; font-size: 110%;">Medication // **

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> Medications can be used to help with different aspects of the treatment process.

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> __Withdrawal__: Medications offer help in suppressing withdrawal symptoms during detoxification. However, medically assisted detoxification is not in itself "treatment"—it is only the first step in the treatment process. Patients who go through medically assisted withdrawal but do not receive any further treatment show drug abuse patterns similar to those who were never treated.

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> <span style="font-family: Georgia,serif;"> __Treatment__: Medications can be used to help reestablish normal brain function and to prevent relapse and diminish cravings. Currently, we have medications for opioids (heroin, morphine), tobacco (nicotine), and alcohol addiction and are developing others for treating stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction. Most people with severe addiction problems, however, are polydrug users (users of more than one drug) and will requ <span style="font-family: Georgia,serif; font-size: 90%;">ire treatment for all of the substances that they abuse. > <span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;">**<span style="font-family: Georgia,serif;">//<span style="font-family: Georgia,serif; font-size: 110%;"> Behavioral // **
 * <span style="font-family: Georgia,serif;">Opioids: Methadone, buprenorphine and, for some individuals, naltrexone are effective medications for the treatment of opiate addiction. Acting on the same targets in the brain as heroin and morphine, methadone and buprenorphine suppress withdrawal symptoms and relieve cravings. Naltrexone works by blocking the effects of heroin or other opioids at their receptor sites and should only be used in patients who have already been detoxified. Because of compliance issues, naltrexone is not as widely used as the other medications. All medications help patients disengage from drug seeking and related criminal behavior and become more receptive to behavioral treatments.
 * <span style="font-family: Georgia,serif;">Tobacco: A variety of formulations of nicotine replacement therapies now exist—including the patch, spray, gum, and lozenges—that are available over the counter. In addition, two prescription medications have been FDA–approved for tobacco addiction: bupropion and varenicline. They have different mechanisms of action in the brain, but both help prevent relapse in people trying to quit. Each of the above medications is recommended for use in combination with behavioral treatments, including group and individual therapies, as well as telephone quitlines.
 * <span style="font-family: Georgia,serif;">Alcohol: Three medications have been FDA–approved for treating alcohol dependence: naltrexone, acamprosate, and disulfiram. A fourth, topiramate, is showing encouraging results in clinical trials. Naltrexone blocks opioid receptors that are involved in the rewarding effects of drinking and in the craving for alcohol. It reduces relapse to heavy drinking and is highly effective in some but not all patients—this is likely related to genetic differences. Acamprosate is thought to reduce symptoms of protracted withdrawal, such as insomnia, anxiety, restlessness, and dysphoria (an unpleasant or uncomfortable emotional state, such as depression, anxiety, or irritability). It may be more effective in patients with severe dependence. Disulfiram interferes with the degradation of alcohol, resulting in the accumulation of acetaldehyde, which, in turn, produces a very unpleasant reaction that includes flushing, nausea, and palpitations if the patient drinks alcohol. Compliance can be a problem, but among patients who are highly motivated, disulfiram can be very effective.

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> Behavioral treatments help patients engage in the treatment process, modify their attitudes and behaviors related to drug abuse, and increase healthy life skills. These treatments can also enhance the effectiveness of medications and help people stay in treatment longer. Treatment for drug abuse and addiction can be delivered in many different settings using a variety of behavioral approaches.

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> Outpatient behavioral treatment encompasses a wide variety of programs for patients who visit a clinic at regular intervals. Most of the programs involve individual or group drug counseling. Some programs also offer other forms of behavioral treatment such as <span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> Residential treatment programs can also be very effective, especially for those with more severe problems. For example, therapeutic communities (TCs) are highly structured programs in which patients remain at a residence, typically for 6 to 12 months. TCs differ from other treatment approaches principally in their use of the community—treatment staff and those in recovery—as a key agent of change to influence patient attitudes, perceptions, and behaviors associated with drug use. Patients in TCs may include those with relatively long histories of drug addiction, involvement in serious criminal activities, and seriously impaired social functioning. TCs are now also being designed to accommodate the needs of women who are pregnant or have children. The focus of the TC is on the resocialization of the patient to a drug-free, crime–free lifestyle.
 * <span style="font-family: Georgia,serif;">Cognitive–behavioral therapy, which seeks to help patients recognize, avoid, and cope with the situations in which they are most likely to abuse drugs.
 * <span style="font-family: Georgia,serif;">Multidimensional family therapy, which was developed for adolescents with drug abuse problems—as well as their families—addresses a range of influences on their drug abuse patterns and is designed to improve overall family functioning.
 * <span style="font-family: Georgia,serif;">Motivational interviewing, which capitalizes on the readiness of individuals to change their behavior and enter treatment.
 * <span style="font-family: Georgia,serif;">Motivational incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs.

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> **<span style="font-family: Georgia,serif;"> //<span style="font-family: Georgia,serif; font-size: 110%;"> Criminal Justice // **

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> Treatment in a criminal justice setting can succeed in preventing an offender's return to criminal behavior, particularly when treatment continues as the person transitions back into the community. Studies show that treatment does not need to be voluntary to be effective.

<span style="font-family: Georgia,serif; font-size: 90%; line-height: 1.5;"> To locate the drug and alcohol abuse treatment programs nearest you: <span style="font-family: Georgia,serif; font-size: 90%; line-height: 1.5;"> http://findtreatment.samhsa.gov/TreatmentLocator/faces/quickSearch.jspx

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> //<span style="font-family: Georgia,serif;"> **<span style="font-family: Georgia,serif; font-size: 120%;"> Cultural Considerations ** //

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> “The cultures from which people hail affect all aspects of mental health and illness, including the types of stresses they confront, whether they seek help, what types of help they seek… and what types of coping styles and social supports they possess…. Just as health disparities are a cause for public concern, so is our diversity a national asset” (U.S. Department of Health and Human Services [DHHS], 2001.)

<span style="font-family: Georgia,serif; font-size: 90%; line-height: 1.5;">

<span style="font-family: Georgia,serif; font-size: 13px; line-height: 1.5;"> It is important to consider the extent to which race, ethnicity, and culture may or may not contribute to substance abuse risk and wow substance abuse prevention activities can be selected and implemented so that they are most relevant to the youth for whom they are intended. Prevention leaders can increase their cultural competence by (CSAP, 1994c):
 * <span style="font-family: Georgia,serif;">Validating the specific country of origin. Recognize historical and cultural backgrounds by acknowledging and validating specific countries of origin.
 * <span style="font-family: Georgia,serif;">Remembering that individuals are members of groups. Be aware that respecting the group is a large part of respecting the individual.
 * <span style="font-family: Georgia,serif;">Acknowledging the importance of family. Understand the importance of family and extended family as primary support networks in many ethnic communities.
 * <span style="font-family: Georgia,serif;">Recognizing the degree of acculturation. A common mistake in working with communities of color is in making broad generalizations based on interactions with a narrow segment of the group. Strategies effective with third generation populations may not be effective with recent immigrant populations because of differences in acculturation and values.
 * <span style="font-family: Georgia,serif;">Understanding that culture’s “world view.” Learn the fundamental values and philosophies that drive the choices.

=<span style="font-family: Georgia,serif;">**<span style="font-family: Georgia,serif; font-size: 120%;">Resources ** =
 * <span style="font-family: Georgia,serif;">[|National Substance Abuse Prevention Month] – a month-long observance in October focused on the role substance abuse prevention plays in promoting safe and healthy communities. Access substance abuse prevention resources and materials for individuals and prevention professionals.
 * <span style="font-family: Georgia,serif;">[|Stop Underage Drinking] - a comprehensive portal of Federal resources for information on underage drinking and ideas for combating this issue.
 * <span style="font-family: Georgia,serif;">[|The Strategic Prevention Framework (SPF)] uses a five-step process known to promote youth development, reduce risk-taking behaviors, build assets and resilience, and prevent problem behaviors across the life span.
 * <span style="font-family: Georgia,serif;">[|Find Youth Info] - promotes the goal of positive, healthy outcomes for youth.
 * <span style="font-family: Georgia,serif;">[|Safe Schools/Healthy Students] - a grant program designed to prevent violence and substance abuse among our Nation's youth, schools, and communities.
 * <span style="font-family: Georgia,serif;">[|Too Smart to Start] - helps youth, families, educators, and communities prevent underage alcohol use and its related problems.
 * <span style="font-family: Georgia,serif;">[|Building Blocks for a Healthy Future] - provides parents, caregivers, and teachers of children aged 3 to 6 the opportunity to find lots of great tips, materials, and ideas for spending time with their children and learning together.
 * <span style="font-family: Georgia,serif;">[|National Registry of Effective Programs and Practices] - a searchable online registry of more than 160 interventions supporting mental health promotion, substance abuse prevention, and mental health and substance abuse treatment.
 * <span style="font-family: Georgia,serif;">[|Communities That Care (CTC)]- a coalition-based community prevention operating system that uses a public health approach to prevent youth problem behaviors including underage drinking, tobacco use, violence, delinquency, school dropout and substance abuse.
 * <span style="font-family: Georgia,serif;">[|Prevention Management Reporting and Training System] - provides substance abuse prevention resources, data collection, and reporting services.
 * <span style="font-family: Georgia,serif;">[|Center for the Application of Prevention Technologies] - provides responsive, tailored, and outcomes-focused training and technical assistance to prevent and reduce substance abuse and associated public health issues across the lifespan.
 * <span style="font-family: Georgia,serif;">[|Fetal Alcohol Spectrum Disorders (FASD)] - information and resources about the prevention and treatment of FASD.
 * <span style="font-family: Georgia,serif;">[|Drug-Free Workplace] - addressing substance abuse prevention in the workplace through comprehensive drug-free and health/wellness workplace programs.
 * <span style="font-family: Georgia,serif;">[|Native American Center for Excellence] - a national resource center for up-to-date information on American Indian and Alaska Native (AI/AN) substance abuse prevention programs, practices, and policies.
 * <span style="font-family: Georgia,serif;">[|Medication Assisted Treatment] - the use of medications, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders.
 * <span style="font-family: Georgia,serif;">[|Screening, Brief Intervention, and Referral to Treatment (SBIRT)] is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those who are at risk of developing these disorders. Primary care centers, hospital emergency rooms, trauma centers, and other community settings provide opportunities for early intervention with at-risk substance users before more severe consequences occur.
 * [|Drug and Alcohol Addiction Help for Teens] - Help for teens who have questions about drug and alcohol abuse or think they are suffering from an addiction.