The NCCDP is able to provide information on some, but not all, of these topics, specifically
1. Decision to take drugs
There is evidence to suggest that the decision to take a particular drug can be influenced by numerous factors including physical psychological states, commitments, boundaries, environment, availability, finance, friends, peers and the media (Boys et al. 1999). However, one of the most important factors appears to be individuals’ specific expectancies about the functions of the drug (Boys et al., 2001; 2003). According to recent work by Boys and colleagues, it is largely the perceived function of using a drug that drives drug use behaviour (Boys et al., 1999a; Boys and Marsden, 2003). Prosocial and mood-enhancing effects are most prominent among the perceived functions of drug use in general. Ecstasy in particular was reported to be used to prolong socialising during a night out with friends, for physical activation and 'energising', and to feel elated or euphoric (Boys et al., 2001). The data of Hansen et al. (2001) also support the view that social and mood-related effects constitute the main determinants of drug use, including both the initial decision to try a drug as well as the maintenance of its use. Underscoring its social function, users in their study described many drugs as ‘social facilitators’.
It should be noted that the initial experiences of a drug does not necessary lead to regular use but the magnitude of a positive experience with the initial use of cocaine has a marked effect on the escalation, or problematic use (Davidson et al. 1993). The likelihood of developing regular use of a particular drug as a result of having ever used was variable between different types of drugs (Manning et al. 2001). It was reported to be higher for cannabis (33.9%) than for amphetamines (12.8%) and cocaine (13.4%) in a sample of school students in London (Manning et al. 2001).
As can be seen from the evidence, the decision to initiate the use of a particular drug can be one of behavioural choice, which is largely determined by a complex interaction of psychological, environmental and biological factors. Because the use of drugs is often associated with immediate rather than delayed benefits (an immediate short-term ‘buzz’) and later costs (psychological, physical, social and financial damage), the decision may also reflect impulsive decision-making (Kirby & Petry 2004). Some authors have conceptualised problematic drug use as a failure in the control of impulsive behaviour.
2. Patterns of drug use
We are not aware of specific (and robust) information detailing drug use in young people in the Wirral.
Whilst still remaining a minority activity, illegal drug use is not uncommon among school-aged children in England. A recent national survey estimated that one in ten young people (10%) aged between 11 and 15 years old reported having taken illicit drugs in the previous month in 2004, with more pupils (18%) reporting drug use in the previous 12 months (National Centre for Social Research/National Foundation for Educational Research 2005). Although these figures were lower than the same survey result from the previous year, the decline was only small (between 2 and 3 %). The most commonly used illicit drug was reported to be cannabis (11%), followed by glue/solvents (6%). The prevalence of Class A drug use in this population has remained at 4% since 2001. Use of any drug tends to be similar in boys and girls up to the age of 14. After this age, there is a gender divide as more boys than girls report recent drug use (last year and last month), and they tend to take them more frequently. Finally, more boys (aged 11-15yrs) tend to report having ever been offered drugs; mainly cannabis (28 vs 22%); amyl nitrate ‘poppers’ (12 vs 10%), and psilocybin mushrooms (11 vs 10%). However, slightly more girls (aged 11-15yrs) report having been offered volatile substances (15 vs 14%). Offers of any illegal drug are reported to be as high as 50% in other surveys using more localised convenience samples (School Health Education Unit, 2005). The European School Survey Project on Alcohol and Other Drugs (ESPAD), a pan-European school survey conducted every four years in 15-16 year olds, reported that male and female school pupils in the UK consistently report higher levels of lifetime use of any illegal drug than other European citizens (36% vs 16%) (Hibell et al., 2004).
Data from the 2003/04 British Crime Survey (Chivite-Mathews et al., 2005), the most recent available for the general population, have indicated that drug use among young people (aged 16-24) increases somewhat as they get older. In this analysis, nearly a third (28%) of young people aged between 16 and 24 used an illicit drug in the previous year. The most widely used drug was cannabis (24.8% in the previous year), which corresponds with the national survey of the students aged between 11 and 15 (National Centre for Social Research/National Foundation for Educational Research 2005). However, young people seem to use solvents/glue less as they get older (11-15 vs 16-24), as only 0.5 % of 16-24 year olds reported use in the previous year. The second most reported drug of choice in this age group was ecstasy (5.3% in the previous year), followed by cocaine (4.9% in the previous year), amyl nitrate (4.4% in the previous year), and amphetamine (4.0% in the previous year). The use of Class A drugs, excluding cocaine and ecstasy, in the previous year has been stable at around 8 % since 1996. Moreover, young people’s preference for certain drugs has appeared to have changed with time; the BCS revealed that reported use of cocaine and ecstasy had significantly increased since 1998, while the use of LSD decreased.
Detailed analysis of the 2003 Crime and Justice Survey, has indicated that young people (aged 10 – 24) identified as belonging to vulnerable groups account for more than half of the total of young Class A drug users, despite accounting for less than a third of the sampled population (Becker and Roe, 2005). School truants and offenders reported the highest levels of use of cannabis, cocaine, ecstasy, although use of crack cocaine and heroin was less than 1.0%. These groupings are not exclusive, and many young people will be part of multiple groups or transfer between groups and there may be particularly vulnerable sub-sets of young people within these classifications. Accordingly, this analysis found that members of more than one vulnerable group (e.g. a school truant living in care) reported higher levels of Class A drug use than members of just one group.
The World Health Organisation provides the following broad categories of drug use:
• Experimental use that might or might not continue
• Functional use that serves some purpose, such as for recreation, but does not cause problems for the use
• Dysfunctional use that leads to impaired psychological or social functioning
• Harmful use that causes damage to the user’s physical or mental health
• Dependent use that could involve tolerance, and/or withdrawal symptoms if use is ceased, and continued use
3. Progression of drug use
It has been identified that the sequence of drug use tends to follow a series of stages. The use of licit drug use often precedes cannabis use. While cannabis use usually occurs before the initiation of ‘harder’ drugs use such as heroin and cocaine (see Golub & Johnson 2002). According to this evidence, it can be expected that the recognition of future ‘hard’ drug users should correlate with identification of current cannabis users. However, there is accumulating evidence to suggest that the initiation of ‘hard’ drugs use does not always follow the ‘gateway’ sequence, particularly among sub-populations of young people. A quarter of a British clinical sample reported that they started to use cocaine and heroin before they began to use licit drugs (Sanju & Hamdy 2005). The gateway theory could not best characterise drug initiation sequences reported by an US population of arrestees (Golub & Johnson 2002).
In contrast, there is some general population evidence to suggest that the gateway sequence most commonly characterises the ordering of drugs use in the USA (Golub & Johnson 2002; Morral et al. 2002). Also, the cannabis gateway effect has been adequately explained by a common factor, a propensity for drug use (Morral et al. 2002). The gateway sequence observed in this population could be a reflection of ordering of opportunities to come across particular types of drugs. Individuals in the population may have more opportunities to obtain or be offered cannabis than any other types of illicit drugs. There is some evidence to support this assumption. Data from a survey of secondary school students in London revealed that 46.3% of the respondents said they have been offered cannabis while 10% of them reported that they had been offered cocaine (Manning et al. 2001). Furthermore, the data have shown that the access to drugs does not necessary lead to the use of drugs. About a third (34%) of those who were offered cannabis reported that they did not take the drug. While the majority of those who were offered cocaine said they did not use the drug (70%).
Manning et al. (2001) have suggested that the higher prevalence of cannabis use (compared to cocaine and heroin use) may also result from young people’s assumptions or perceptions about cannabis. These consist of low levels of perceived health risk, high perceived controllability and the short-term nature the effect with a limited impact on other activities. However, work with ecstasy users (Gamma et al., 2005) suggests that many are fully aware of the associated risks but discount them because of comparisons with other drugs/activities (relative risk), or because they hold no personal significance (affective risk assessment). Drug price (and perceived quality) may be another important factor (Manning et al. 2001; Sumnall et al., 2004). One of the simplest applications of this type of economic analysis is the study of constraints on access, in particular the purchase price of controlled drugs. Cannabis is cheaper than heroin or cocaine and young person’s budget is limited. The drop in price in ecstasy to £2 or £3 in some regions therefore needs to be monitored (Sumnall et al., 2004). UK school survey data on drug use has shown that a minority of 14 – 15 year olds (up to 14%) said they receive more than £30 per week from pocket money and jobs (Schools Health Education Unit 2005). The results of a survey of licit and illicit drug use among Scottish school children have also revealed their limited budget for drug use (The Child and Adolescent Health Research Unit 2004). The average amount spent on drugs was £11 per week among the majority of those who reported monthly use of drugs (65%). In this context, decision making may be constrained by the economics of controlled drugs. According to the matching law (Herrnstein, 1970), increasing/decreasing the benefit or decreasing/increasing the cost of a particular activity will alter its value relative to all available alternatives, which will then alter the allocation of behaviour to that activity. That is, the proportion of behaviour allocated to any particular activity will match the relative reinforcement gained from it (Heather and Vuchinich, 2003). Therefore, the individual will allocate their limited resources, such as time and money, to maximise their utility (i.e. a favourable cost/benefit ratio) from the options available to them. In relation to drug use, it is hypothesised that the value of drug use is a function of the cost/benefit ratio of consumption relative to the cost/benefit ratio of all other available alternative activities.
MacDonald and Marsh (2002) highlighted the complexities of the relationship between vulnerability and drug use based on a qualitative study of young people living in a severely socially excluded and deprived area. More simplistic notions of normalisation were questioned as drug abstinence was found to co-exist with recreational and problematic drug use, although it was suggested that the distinction between the latter two categories was becoming increasingly blurred. It was suggested that drug careers are shaped by the interaction of individual factors [e.g. family background] with structural opportunities [e.g. access to decent employment] at different points in time. The importance of considering young people's biographies within the broader context [e.g. socio-economic climate, drugs markets] was stressed. In support of this, Egginton and Parker (2000; 2001) identified young heroin users in the NW of England who could not be identified as vulnerable, but who initiated heroin us through social networks known to them via the recreational drug scene.
4. Risks and harms of drug use
To better understand this discussion, some background regarding the concepts of risk and risk perception may be helpful. While in the pre-modern era, 'risk' meant simply the probability of occurrence of an event, in the past century, the term developed a negative connotation, as it came to be associated with the undesirable, adverse consequences of a situation or activity. Today, risk is used with various, often overlapping, meanings (Slovic, 1998): risk as hazard or danger, i.e. a situation or activity that may have harmful consequences (e.g. smoking cigarettes); risk as a term for the harmful consequences of a hazard ('the risk of smoking is lung cancer'); and, closer to its original meaning, risk as the probability of a (usually adverse) outcome occurring (the probability of getting lung cancer). According to Slovic (1998), a reasonable definition views risk as a composite of the probability and severity of an adverse outcome. This definition acknowledges two important dimensions of risk which play a role in how people assess risks in their daily lives. Thus, the risk of smoking is not only the probability of contracting lung cancer, but involves some idea of the severity of lung cancer.
Reflecting on the conceptual heterogeneity of the term ‘risk‘, 'risk perception' is also used today with diverse, partly overlapping meanings. It can be taken to mean the content of individuals' beliefs about risk and their vulnerability to it, the recognition of risks inherent in some situation, or the accuracy of judgments about risks. Risk perception can be focused on situations or on possible outcomes, and it can be assessed in absolute or relative terms. In general, the concept tends to have a cognitive flavour, a legacy it inherited from its early days when it was appropriated by cognitive science and modelled according to theories of rational choice and decision-making. These models conceptualised risk perception as a relatively straightforward rational process of translating objective risk information into appropriately guided behaviour. Today, this narrow view is beginning to open up to incorporate a wide range of influences, not only cognitive, but also affective, social and cultural. For our purposes, it is useful to supplement the cognitive aspect of risk perception with a second, more affective process of risk evaluation, whose outcome is the personal significance of risk information, defined as the impact this information has in determining subsequent risk behaviour, relative to other factors that also influence behaviour.
The process of personal risk evaluation is subject to many influences, among them: affective processing (what Slovic and colleagues call the 'affect heuristic' (Slovic, 2001)), social and moral values, preferences, normative beliefs, perceived benefits, and emotional coping strategies (e.g. Millstein, 2003). There is also a group of specific psychological "modifiers" of risk perception. These include, but are not limited to, immediacy of consequences (immediate consequences have more impact on risk behaviour than long-term consequences), optimistic bias (risks to oneself are judged to be smaller than the risk facing others in the same situation; Weinstein, 1982, 1989; Romer, 2001), voluntariness of action (risks taken voluntarily are seen as less severe), perceived control (risks believed to be under one's control are seen as less severe) and familiarity of an event (familiar risks are seen as less severe; Douglas, 1986).
4.1 Risk factors
Successful targeted drug prevention programmes require the accurate and reliable identification of subgroups of young people who have higher risk at developing drug use than the general population. A number of biological, psychological and situational factors that can predict drug use have been identified. Inherited vulnerability (for males), maternal smoking and alcohol use, extreme social disadvantage, family breakdown, and child abuse and neglect are the earliest risk factors that can increase the probability that infants develop behavioural and adjustment. When children enter school, risk factors include experience at school (school failure) as well as intra-individual factors (childhood conduct disorder, aggression) and familial experiences (favourable parental attitudes to drug use). From adolescence, types of risk factors widen and include low involvement in activities with adults, the perceived and actual level of community drug use, availability of drugs, parent-adolescent conflict, parental alcohol and drug problems, poor family management, school failure, deviant peer associations, delinquency and favourable attitudes to drugs (National Drug Research Institute and the Centre for Adolescent Health in Australia 2004). Some researchers have identified risk factors for the onset of cocaine use. Relatively young age, less family caring, less coping ability, infrequent church attendance and low educational aspirations were significantly associated with cocaine use among students attending dropout prevention/recovery high schools in Texas (Grunbaum et al. 2000).
It should be emphasised that it is not appropriate to identify participants for targeted interventions solely based on the existence of these factors, as the relationship between these factors and drug use is probabilistic (Frisher et al. 2005). It should be noted that risk factors can differ in importance across individuals or groups and risk factors and can change over the course of development (Pandina 1996). Another important characteristic of risk factors is that their effect is cumulative or synergetic and the presence of a single risk factor cannot adequately predict later drug use (National Drug Research Institute and the Centre for Adolescent Health in Australia 2004). However, it cannot be assumed that drug use is caused by a simple added result of these factors. Their negative effects can be moderated by ‘protective’ factors (Haines & Case 2005; National Drug Research Institute and the Centre for Adolescent Health in Australia 2004).
To conclude, certain risk factors, current cannabis use and being part of vulnerable groups have been associated with Class A drug use. However, it should be noted that none of the factors can accurately identify those who are contemplating to the use of Class A drugs. The decision requires an individual to want to use a particular drug because s/he expects the drug to fulfil certain positive but not negative functions. Also, s/he has to have an access and resources to obtain and use the drug. The decision to initiate the use of a particular drug appears to be one of complex behavioural choice, which are largely determined by an interaction of psychological, environmental and biological factors.
5. Approaches to working with drug using children
This is too broad an area to cover in this discussion as most drug prevention interventions have been targeted at children and young people. We refer the reader to the following documents which provide and overview of approaches, and identify gaps and inconsistencies. All of these are attached to this answer:
i) Universal prevention – please refer to Canning et al., 2004 (attached); McIntosh et al., 2005
ii) Vulnerable groups – please refer to Edmonds et al., 2005
Several groups of young people have been identified as having higher risk of developing problematic drug use (Canning et al. 2004). These groups are often termed ‘vulnerable’ groups and include homeless young people, school excludes/truants, young offenders, cared for children, young people who work in sex industries and children of drug using parents.
These subpopulations of young people are reported to have high levels of drug use compared to the general population. The data from the 2003 Crime and Justice Survey (Becker & Roe 2005) have revealed that 16% of the vulnerable young people reported to have used Class A drugs in the previous year. The reported use of Class A drugs in the past 12 months was markedly low among young people in the general population (4%). Among the identified groups, truants had the highest levels of drug use (16%) while those in care had the lowest levels of use (5%). There may be particularly vulnerable sub-sets of young people within these classifications. Members of more than one group reported higher levels of Class A drug use than members of just one group (more than one 39.0%; one group 18.0%). These findings indicate that it may be possible to provide targeted Class A drug prevention to young people who belong to these groups. However, it must be noted that a large proportion of young people who are part of these groups do not take or develop regular use of Class A drugs.
iii) Family based prevention and support – bibliography of relevant work
Academic and nonacademic papers
Drug education/prevention with/for parents
Banwell, C., Denton, B., & Bammer, G. 2002 “Programmes for the children of illicit drug-using parents: issues and dilemmas”, Drug and Alcohol Review, vol. 21, pp. 381-386.
ABSTRACT: Concern about the health and general well-being of children whose parents use illicit drugs has contributed to an increased interest in intervention programmes, but the number of such services is still limited. We review published papers about residential, home-visiting and non-residential programmes and use these and our experience in studying playgroup-based clinics to outline issues and dilemmas they face. These include balancing trust and acceptance with intervention when problems are identified, harmonizing accessibility and flexibility with the provision of child-focused activities and adult education, finding a location that is both suitable and affordable, appropriately supporting staff, collaborating with other services and securing adequate funding, including for ongoing evaluation and monitoring.
Davis, M. Drugs education for Turkish speaking parents and their children in Haringey.
1998. (A Project initiated by the Haringey Drugs Education Team)
Dishion, T. J. & Kavanagh, K. 2003, Intervening in adolescent problem behavior: A family-centred approach The Guilford Press, London.
Dishion, T. J. & Kavanagh, K. 2001, "An ecological approach to family intervention for adolescent substance use," in Innovations in adolescent substance abuse interventions, H. B. Waldron & E. F. Wagner, eds., Pergamon/Elsevier Science, London, pp. 127-142.
Evans, R., Mallick, J., & Stein, G. 1998, "The role of parents in drugs education," in Drugs: Partnerships for policy, prevention and education: A practical approach for working together, L. O'Connor, D. O'Connor, & R. Best, eds., Cassell, London, pp. 17-29.
Guyll, M., Spoth, R., Chao, W., Wickarama, K., & Russell, D. 2004, "Family-focused preventive interventions: evaluating parental risk moderation of substance use trajectories", Journal of Family Psychology, vol. 18, no. 2, pp. 293-301.
ABSTRACT: Four years of longitudinal data from 373 families participating in a randomized intervention-control clinical trial were used to examine whether intervention effects on adolescent alcohol and tobacco use trajectories were moderated by family risk, as defined by parental social emotional maladjustment. Consistent with earlier outcome evaluations based on analyses of covariance, analyses confirmed that both the Preparing for the Drug Free Years program and the Iowa Strengthening Families Program favorably influenced alcohol use index trajectories across the time frame of the study; only the latter program, however, evidenced positive effects on a tobacco use index. Concerning the primary research question, analyses provided no support for family risk moderation of any intervention effect. Findings indicate the feasibility of developing universal preventive interventions that offer comparable benefits to all families.
Harbach, R. L. & Jones, W. P. 1995, "Family beliefs among adolescents at risk for substance abuse", Journal of Drug Education, vol. 25, no. 1, pp. 1-9.
Kaplow, J. B., Curran, P. J., Dodge, K. A., Bierman, K. L., Coie, J. D., Greenberg, M. T., Lochman, J. E., McMahon, R. J., & Pinderhughes, E. E. 2002, "Child, parent, and peer predictors of early-onset substance use: A multisite longitudinal study", Journal of Abnormal Child Psychology, vol. 30, no. 3, pp. 199-216.
Kumpfer, K. & Bluth, B. 2004, "Parent/child transactional processes predictive of resilience or vulnerability to "substance abuse disorders"", Substance Use and Misuse, vol. 39, no. 5, pp. 671-698.
ABSTRACT: This article discusses implications of a theoretical model of resilience--the Resilience Framework, including the impact of parent/child transactional processes in moderating or mediating a child's biological or environmental risks and later substance misuse. Research is presented on behavioral and emotional precursors of substance abuse disorders in children of substance users. Detrimental processes within dysfunctional family environments are presented followed by a listing of strategies for increasing resilience in youth by improving family dynamics. The value in elucidating these interactive processes is to increase our understanding of ways to reduce the impact of risk factors. Prevention providers should use these strategies as benchmarks for selecting or developing effective family-focused prevention programs. Resources are presented for finding effective family interventions as well as an example of a family intervention based on resilience principles, namely the Strengthening Families Program. Recommendations are made for future research and better dissemination of evidence-based family interventions.
Lommel, K. M. & Martin, A. 2004, "Intervention in adolescent problem behavior: A family-centered approach", Journal of the American Academy of Child and Adolescent Psychiatry, vol. 43, no. 11, pp. 1451-1452.
ABSTRACT: Reviews the book, "Intervening in Adolescent Problem Behavior: A Family-Centered Approach," by Thomas J. Dishion and Kate Kavanagh (see record 2003-07131-000). Adolescent problem behavior is an issue that child psychiatrists and pediatricians deal with on a daily basis. This book provides a detailed look at a family-centered intervention model for addressing such behaviors. The authors are psychologists who have written this book in a science-based discussion format. Despite the scientific slant to the book, they provide adequate realistic examples of behavior and intervention techniques that a therapist could use in practice. The suggestions in this book could be applied to most any therapeutic situation and by anyone, from pediatrician to psychiatrist to very experienced therapist. Although it may not always be feasible to invest in the entire Family Management Curriculum, the information provided in this book may be useful in engaging families in a comprehensive form of treatment for their adolescents with problem behaviors.
National Institute on Drug Abuse. 2004. Preventing drug use among children and adolescents: A research based guide for parents, educators, and community leaders, Second edition. NIDA, Bethesda
National Institute on Drug Abuse. 2004 Preventing drug use among children and adolescents: A research based guide for parents, educators, and community leaders, Second edition, In brief. NIDA, Bethesda
Pilgrim, C., Abbey, A., & Kershow, T. 2004, "The direct and indirect effects of mothers' and adolescents' family cohesion on young adolescents' attitudes toward substance use", Journal of Primary Prevention, vol. 24, no. 3, pp. 263-283.
ABSTRACT: This study examined the influence of parental, school, and peer bonding for rural youth making the transition into middle school. Survey data were collected from 225 adolescents and their mothers answering parallel items on family cohesion, school attachment, and attitudes toward substance use by minors. Adolescents also reported on social support from friends, and mothers reported on the family's involvement in religious activities. Using structural equation modeling, greater family cohesion at the start of middle school/junior high was directly and indirectly related to negative attitudes toward substance use by the adolescent one year later. Factors that mediated family cohesion were school and peer attachment, the family's involvement in religious activities, and the mothers' attitudes toward substance use by minors. Implications for prevention and recommendations for parents are discussed.
Redmond, C., Spoth, R., Shin, C., & Hill, G. 2004, "Engaging rural parents in family-focused programs to prevent youth substance abuse", Journal of Primary Prevention, vol. 24, no. 3, pp. 223-242.
ABSTRACT: We employed multilevel structural equation modeling with data collected during telephone interviews with 1,156 parents of sixth graders from 36 rural schools to examine the relationships of family sociodemographic factors, parents' perceptions of their child's susceptibility to future substance use involvement, parents' perceptions of their ability to prevent such problems, and the perceived benefits of family-skills programs designed to prevent adolescent problems. Family-level findings suggested that parent gender and marital status were particularly salient; each exhibited direct effects on each of the three parent perceptions examined. Findings supported the hypotheses that parental efficacy perceptions inversely affect perceptions of child susceptibility and that perceptions of child susceptibility positively affect perceived program benefits. At the community level, lower household incomes were associated with higher levels of perceived child susceptibility to substance use.
Riddle, H. A. 2004, “Family-based therapies for adolescent alcohol and drug use: Research contributions and future research needs”, Addiction, vol. 99[supplement 2], pp. 76-92.
ABSTRACT: Objective
To characterize the developmental status of the family-based adolescent alcohol and drug treatment specialty by identifying and discussing research and clinical advances.
Method
Selective and interpretative literature review and analysis.
Study selection
Controlled trials and mechanisms of change studies of family-based treatments for adolescent alcohol and drug misuse.
Results
Clinical innovations of family-based treatments include development of detailed therapy, training/supervision, and adherence manuals. Different family-based treatments have been tested with success in controlled trials and process studies. Different versions of the same approach might vary on parameters such as treatment dose, setting, and client characteristics.
Research advances include findings that engagement and retention rates for family-based treatments are superior to standard treatment engagement/retention methods. Also, in clinical trials in which they are compared with alternative interventions, in the majority of studies, family-based treatments produce superior and stable outcomes with significant decreases on target symptoms of alcohol and drug use, and related problems such as delinquency, school and family problems, and affiliation with substance abusing peers. Mechanisms of change studies support the theory basis of family-based treatments. For instance, improvements in family interaction patterns coincide with decreases in core target alcohol and drug misuse symptoms.
Conclusions
Once in the shadows of the adult substance abuse field, the adolescent substance abuse specialty has become a unique, clinically creative, and empirically-based area. Research and clinical advances of family-based treatments have implications for non-family-based interventions in the adolescent substance misuse treatment specialty.
Stanton, B., Cole, M., Galbraith, J., Li, X. M., Pendleton, S., Cottrel, L., Marshall, S., Wu, Y., & Kaljee, L. 2004, “Randomized trail of a parent intervention: Parents can make a difference in long-term adolescent risk behaviors, perceptions, and knowledge”, Archives of Pediatrics and Adolescent Medicine, vol. 158, no. 10, pp. 947-955.
ABSTRACT: Although numerous interventions have been demonstrated to reduce targeted adolescent risk behaviors for brief periods, sustained behavior changes covering multiple risk behaviors have been elusive. Objective: To determine whether a parental monitoring intervention (informed Parents and Children Together [ImPACT]) with and without boosters can further reduce adolescent truancy, substance abuse, and sexual risk behaviors and can alter related perceptions 24 months after intervention among youth who have all received an adolescent risk-reduction intervention, Focus on Kids (FOK). Design: Randomized, controlled, 3-celled longitudinal trial.
Setting: Thirty-five low-income, urban community sites. Participants: Eight hundred seventeen African American youth aged 13 to 1.6 at baseline. Intervention: All youth participated in FOK, an 8-session, theory-based, small group, face-to-face risk-reduction intervention, 496 youth and parents received the I-session ImPACT intervention (a videotape and discussion), 238 of the ImPACT youth also received four 90-minute FOK boosters delivered in small groups. Main Outcome Measures: Responses at baseline and 24 months after intervention to a questionnaire assessing risk and protective behaviors and perceptions. Analyses used General Linear Modeling, intraclass correlation coefficient, analysis of covariance, and multiple comparisons with least significant difference test adjustment. Results: After adjusting for the intraclass correlation coefficient, 6 of 16 risk behaviors were significantly reduced (Pless than or equal to.05) among youth receiving ImPACT compared with youth who only received FOK (respectively, mean number of days suspended, 0.65 vs 1.17; carry a bat as a weapon, 4.1% vs 9.6%; smoked cigarettes, 12.5% vs 22.7%; used marijuana, 18.3% vs 26.8%; used other illicit drugs, 1.4% vs 5.6%; and, asked sexual partner if condom always used, 77.9% vs 64.9%). Four of the 7 theory-based subscales reflected significant protective changes among youth who received ImPACT. ImPACT did not produce any significant adverse effects on behaviors or perceptions. Conclusion: A parent monitoring intervention can significantly broaden and sustain protection beyond that conferred through an adolescent risk-reduction intervention.
Stead, M., MacKintosh, A. M., Eadie, D., & Hastings, G. 2000, NE Choices: the development of a multi-component drug prevention programme for adolescents Centre for Social Marketing, The University of Strathclyde.
Stead, M., MacKintosh, A. M., Eadie, D., & Hastings, G. 2001, NE Choices: the results of a multi-component drug prevention programme for adolescents.
Strand, P. S. 2002, "Treating antisocial behaviour: a context for substance abuse prevention", Clinical Psychology Review, vol. 22, no. 5, pp. 707-728.
ABSTRACT: A large body of literature illustrates an association between antisocial behaviour and substance abuse. In the present paper, this association is reviewed from a behavioral-economic standpoint. It is suggested that childhood antisocial
behavior is a behavioral complement of substance abuse, and that prosocial behaviour is a substitute for substance abuse. Based on this formulation, efforts to reduce or prevent antisocial behavior may be conceptualised as prevention programmes for substance abuse. Four empirically supported approaches for the treatment of antisocial behaviour are reviewed with respect to their promise for preventing and treating substance abuse. Taken together, they suggest that successful interventions for substance abuse may occur at various points over the course of development, beginning in infancy and extending into adolescence.
Tolan, P., Gorman-Smith, D., & Henry, D. 2004, “Supporting families in a high-risk setting: Proximal effects of the SAFEChildren preventive intervention”, Journal of Consulting and Clinical Psychology, vol. 72, no. 5, pp. 855-869.
ABSTRACT: Four hundred twenty-four families who resided in inner-city neighborhoods and had a child entering 1st grade were randomly assigned to a control condition or to a family-focused preventive intervention combined with academic tutoring. SAFEChildren, which was developed from a developmental-ecological perspective, emphasizes developmental tasks and community factors in understanding risk and prevention. Tracking of linear-growth trends through 6 months after intervention indicated an overall effect of increased academic performance and better parental involvement in school. High-risk families had additional benefits for parental monitoring, child-problem behaviors, and children's social competence. High-risk youth showed improvement in problem behaviors and social competence. Results support a family-focused intervention that addresses risk in low-income communities as managing abnormal challenges.
Vakalahi, H. F. 2001, “Adolescent substance use and family-based risk and protective factors: A literature review”, Journal of Drug Education, vol. 31, no. 1, pp. 29-46.
ABSTRACT: Adolescent substance use has become a serious concern nationwide. Although there are many ways of viewing adolescent substance use, family influence has been established as one of the strongest sources of risk and protection. A review of the literature indicated relevant theories for understanding adolescent substance use and specific family-based variables influencing adolescent substance use. In general, there seems to be a relationship between adolescent substance use and family-based risk and protective factors. Relevant theories identified in the literature review include family systems theory, social cognitive theory, social control theory, and strain theory. Specific family-based risk and protective factors include family relationships such as with siblings and parents and family characteristics such as ethnicity and religious backgrounds. Future implications for research and prevention/intervention in relation to family-based risk and protective factors are discussed.
Williams, R. J., McDermitt, D. R., Bertrand, L. D., & Davis, R. M. 2003, "Parental awareness of adolescent substance use", Addictive Behaviors, vol. 28, no. 4, pp. 803-809.
Abstract: Parental awareness of adolescent substance use was investigated in a high school sample of 985 adolescents and their parents. Only 39% of parents were aware their adolescent used tobacco, only 34% were aware of alcohol use, and only 11% were aware of illicit drug use. There were no variables that differentiated aware from unaware parents for all substances. Greater parental awareness of alcohol and tobacco use occurred with older adolescents. High adolescent ratings of family communication combined with low parental ratings of family communication were also associated with greater parental awareness of alcohol and tobacco use. Better school grades predicted greater awareness of alcohol and illicit drug use. Single parents and blended families were more aware of tobacco and illicit drug use.
Drug education. Needs of vulnerable young people
Allen, D. 2002, "Research involving vulnerable young people: A discussion of ethical and methodological concerns", Drugs: Education, Prevention and Policy, vol. 9, no. 3, pp. 275-283.
ABSTRACT: The stimulus for this paper arose from some research that the author isinvolved with which required the participation of a range of young people, gaining their experiences and views on illicit drug use. Some of the young people involved in the research were living in areas of social and material deprivation and others were attending a pupil referral unit, they could collectively be described as `vulnerable'. Working withthese young people presented some particular ethical and methodological problems. It is the intention of this paper to explore some of those problems with a view to opening debate on some of the challenges that were presented during the research process. While it is not intended to discuss the findings of the study in this paper, some of the unique ways in which participants responded during the process will be discussed. Bellamy, N. D., Springer, U., Sale, E. W., & Espiritu, R. C. 2004, “Structuring a multi-site evaluation for youth mentoring programs to prevent teen alcohol and drug use” Journal of Drug Education, vol. 34, no. 2, pp. 197-212.
ABSTRACT: Despite mentoring's rapidly increasing popularity as an intervention for the prevention of teen alcohol and drug abuse and associated problems, there is little research consensus on its overall effectiveness or on the core principles and components that define effective mentoring. To advance knowledge concerning this important prevention intervention, the Center for Substance Abuse Prevention has designed and funded a multi-site cooperative agreement involving seven mentoring programs. The programs are designed to provide a rigorous outcome evaluation that allows comparisons of differing approaches to organizing and delivering mentoring services to adolescents at high risk for substance abuse. The cooperative agreement guidelines set service parameters and options that focus on issues that are grounded in past research on mentoring prevention interventions. The cooperative agreement includes a quasi-experimental, longitudinal multi-site evaluation that provides evidence-based recommendations to advance the effective use of mentoring as a prevention strategy.
Butters, J. E. 2004, “The impact of peers and social disapproval on high-risk cannabis use: Gender differences and implications for drug education”, Drugs, Education, Prevention and Policy, vol. 11, no.5, pp. 381-390.
ABSTRACT: Drug education programs that rely on an abstinence based philosophy neglect, and may even contribute to, the potentially adverse consequences experienced by young people who already engage in this potentially health-compromising behaviour. A predominant focus of drug research during the initial wave of rising cannabis use by young people in the 1960's and 1970's, was centred on identifying the factors that contributed to this trend. Less attention has been devoted to uncovering those factors that may inhibit the progression to high-risk levels of use and particularly whether their impact differs for adolescent males and females. In spite of the questionable effectiveness, formal control mechanisms (i.e., criminal laws) and a reliance on prevention-based drug education remain primary approaches for combating drug use. This paper identifies a sub-group of adolescents already using cannabis and estimates the effects of peers, social disapproval and perceived health effects on inhibiting the escalation of use to problem levels. The results suggest that the risk for problem cannabis use among adolescents may be attenuated by some of these informal control items. The findings also suggest however, that the effects of these factors may be different for males and females. The implications for drug education initiatives are discussed.
Tolan, P., Gorman-Smith, D., & Henry, D. 2004, “Supporting families in a high-risk setting: Proximal effects of the SAFEChildren preventive intervention”, Journal of Consulting and Clinical Psychology, vol. 72, no. 5, pp. 855-869.
ABSTRACT: Four hundred twenty-four families who resided in inner-city neighborhoods and had a child entering 1st grade were randomly assigned to a control condition or to a family-focused preventive intervention combined with academic tutoring. SAFEChildren, which was developed from a developmental-ecological perspective, emphasizes developmental tasks and community factors in understanding risk and prevention. Tracking of linear-growth trends through 6 months after intervention indicated an overall effect of increased academic performance and better parental involvement in school. High-risk families had additional benefits for parental monitoring, child-problem behaviors, and children's social competence. High-risk youth showed improvement in problem behaviors and social competence. Results support a family-focused intervention that addresses risk in low-income communities as managing abnormal challenges.
Springer, J. F., Sale, E., Hermann, J., Sambrano, S., Kasim, R., & Nistler, M. 2004, "Characteristics of effective substance abuse prevention programs for high-risk youth", Journal of Primary Prevention, vol. 25, no. 2, pp. 171-194.
Drug prevention & BME
Unger, J. B., Baezconde-Garbanati, L., Shakib, S., Palmer, P. H., Nezami, E., & Mora, J. A. 2004, “Cultural psychology approach to "drug abuse" prevention”, Substance Use and Misuse, vol. 39, no. 10-12, pp. 1779-1820.
ABSTRACT: Much research on the etiology of adolescent drug use has focused on posited risk and protective factors at the level of the individual or small group. However, those proximal influences exist within a cultural context that also influences drug use. To prevent drug use in the diverse population of the United States, research is needed on the influence of the cultural context on adolescent drug use, including the effects of immigrating from one cultural or sociodemographic context to another, as well as the effects of living within two different cultural systems simultaneously. Theoretical models and research methods from cultural psychology and cultural sociology are well-suited to examine the cultural context of drug use. We examine causal mechanisms by which acculturation might affect drug use by using two paradigms to conceptualize culture: a stress/coping paradigm and a cultural values paradigm. Implications of cultural risk and protective factors for transdisciplinary research on drug abuse prevention are also discussed.
Bledsoe, K. & Lynn, J. 2003, "Effectiveness of drug prevention programmes designed for adolescents of color: A meta-analysis", Dissertation Abstracts International: Section B The Sciences and Engineering, vol. 63, no. 9B, p. 4414.
ABSTRACT: Abuse of alcohol, tobacco and illicit drugs is a widespread problem in the United States, challenging government, health care, and law enforcement systems. Thus, drug prevention programs have been at the forefront of discussions in political, health, economic, and social arenas. Programs that target youth populations are of particular concern. Youth who use drugs are likely to develop lifetime dependency problems such as chronic drug abuse. When characteristics such as ethnicity are taken into account, the connection between adolescent and adult use becomes more complex.
The purpose of this meta-analysis was to examine whether prevention programs for adolescents of color lead to changes in behavior, attitude, and knowledge. This was accomplished by examining the results of prevention programs with cultural components versus those without cultural components. Also, differences in theoretical foundations upon which the programs were based, the program content, and the delivery of program content were examined. Thirty-six studies yielding 418 effect sizes for 22,000 program participants were included in the analyses.
Hypotheses for the use of cultural components in prevention programs received no support on a overarching level. When viewed individually, it was found that those programs that dealt with spirituality or made of use of cultural activities were more effective than those programs that did not. African American participants benefited from the inclusion of the components of spirituality, violence and stress.
Drug prevention program delivery provided affirming results in terms of effectiveness for refusal skills training. This was strongest for Latino populations. Affective strategies were found to be least effective, especially for the ethnic group labeled as "Other."
Finally, results indicated that using theoretical foundations to develop prevention strategies did not increase effectiveness. Programs without such theoretical models were found to be more effective than those with such models.
The answer to the question, "Do programs with cultural components serve adolescents of color more effectively than those programs without such components," depends on the type of study conducted, strategies used, and the type of outcome desired. Results of this study may provide useful contributions to the research on ethnicity and culture, and their relationship to adolescent health.
Davis, M. Drugs education for Turkish speaking parents and their children in Haringey. 1998. (A Project initiated by the Haringey Drugs Education Team)
Finch, E. 2001, "Social and transcultural aspects of substance misuse", Current Opinion in Psychiatry, vol. 14, no. 3, pp. 173-177.
Drug prevention: Rural areas
Redmond, C., Spoth, R., Shin, C., & Hill, G. 2004, "Engaging rural parents in family-focused programs to prevent youth substance abuse", Journal of Primary Prevention, vol. 24, no. 3, pp. 223-242.
ABSTRACT: We employed multilevel structural equation modeling with data collected during telephone interviews with 1,156 parents of sixth graders from 36 rural schools to examine the relationships of family sociodemographic factors, parents' perceptions of their child's susceptibility to future substance use involvement, parents' perceptions of their ability to prevent such problems, and the perceived benefits of family-skills programs designed to prevent adolescent problems. Family-level findings suggested that parent gender and marital status were particularly salient; each exhibited direct effects on each of the three parent perceptions examined. Findings supported the hypotheses that parental efficacy perceptions inversely affect perceptions of child susceptibility and that perceptions of child susceptibility positively affect perceived program benefits. At the community level, lower household incomes were associated with higher levels of perceived child susceptibility to substance use.
Drug prevention: Extended families See Section 1.
Drug Prevention: Community
Cuijpers, P. 2002, "Effective ingredients of school-based drug prevention programs. A systematic review.", Addictive Behaviors, vol. 27, no. 6, pp. 1009-1023.
ABSTRACT: Drug prevention in schools is a top priority in most Western countries and several well-designed studies have shown that prevention programs have the potential of reducing drug use in adolescents. However, most prevention programs
are not effective and there are no general criteria available for deciding which program is effective and which is not. In this systematic review of the literature, the current scientific knowledge about which characteristics determine the effectiveness of drug prevention programs is examined. Three types of studies are reviewed: meta-analyses (3 studies were included), studies examining mediating variables of interventions (6 studies), and studies directly comparing prevention programs with or without specific characteristics (4 studies on boosters, 12 on peer-versus adult-led programs, and 5 on adding community interventions to school programs). Seven evidence-based quality criteria were formulated: the effects of a program should have been proven; interactive delivery methods are superior; the "social influence model" is the best we have; focus on norms, commitment not to use, and intentions not to use;
adding community interventions increases effects; the use of peer leaders is better; and adding life skills to programs may strengthen effects.
Hawkins, J. D., Van Horn, M. L., & Arthur, M. W. 2004, “Community variation in risk and protective factors and substance use outcomes”, Prevention Science, vol. 5, no. 4, pp. 213-220.
ABSTRACT: Communities are the context in which many prevention activities take place. One approach to community prevention is to identify the most elevated risk factors and most depressed protective factors for substance use in a community and then to select and implement preventive interventions to address the most elevated risk factors and most depressed protective factors in the community. This approach presumes that there are reliable differences between communities in risk and protection and that these differences relate to differences in substance use across communities. This paper addresses these issues using data from 28,091 students in 41 communities across the U. S. Intraclass correlation coefficients are used to assess the degree to which there are reliable and meaningful differences between communities in levels of risk and protective factors. The community means of the risk and protective factors are then correlated with levels of substance use. Findings indicate that there are meaningful differences between communities in levels of specific risk and protective factors, and that those differences are related to different levels of substance use in these communities. These results provide an empirical foundation for tailoring community-wide efforts to prevent substance abuse to the specific profiles of risk and protective factors experienced by youths in different communities.
Jones, M., Salmon, D., & Orme, J. 2004, “Young people's involvement in a substance misuse communication campaign”, Drugs, Education, Prevention and Policy, vol. 11, no. 5, pp. 391-405.
ABSTRACT: There is growing emphasis in public policy on involving young people in the development of health promotion campaigns and information resources on substance misuse. To date there has been little literature that explores the level and nature young people's involvement in such initiatives. This paper reports on an evaluation of a substance misuse communications campaign that sought to involve young people in the project process and the production of locally focused media products. The findings from this study indicate potential benefits in terms of the production of credible and locally appropriate messages on substance misuse. It also found that there were wider benefits associated with the promotion of young people's citizenship and participation in local service delivery. Young people's involvement needs to be understood as part of a process across a range of different types of activities. Participation by young people vulnerable to substance misuse may contribute to agendas on inclusion and targeted welfare, however it requires a high level of commitment by local agencies and strategic authorities. The key to realizing young people's potential is the use of experienced facilitators, well-informed advisors and dedicated media experts who can work alongside young people in a range of settings within their communities.
Rantala, K. 2004, “Drug prevention as co-ordination: The vicious circle of developing responsibility in primary prevention”, Drugs, Education, Prevention and Policy, vol. 11, no. 5, pp. 367-379. 2004.
ABSTRACT: Due to ongoing managerial and decentralizing trends in public policy, responsibility for drug prevention is continuously being devolved from one level to another, from the European Union all the way down to the civil society. In this paper, a drug prevention program in Helsinki represents a realization of the EU drugs strategy due to similar rhetoric and goals: co-ordinating multi-agency co-operation. An analysis of contradictions inherent in this setting is based on interviews of the program workers as well as representatives of governmental and national drug-prevention agencies. The analysis results show that 'almost anything goes' because no single body has the legitimacy to prioritize any particular approach over any other. The situation easily results in either ineffective indecision or overdoing preventive enthusiasm that simplifies the drugs issue. This vicious circle is difficult to break. In order to provide more realistic prevention, a systematic increase in the knowledge base of the practitioners in the drug field is needed. Simultaneously, the issue becomes political, requiring authority and agreement on concrete guidelines at a national level-issues that prevailing public policy tries to evade.
Eadie, D., Stead, M., & Hastings, G. 2002, Tackling drugs in disadvantaged communities: An investigation into the role and potential of media advocacy Centre for Social Marketing. University of Strathclyde.
Henderson, P. 1995, Drugs Prevention And Community Development: principles of good practice, Home Office, London, 7.
National Institute on Drug Abuse. 2002. A collection of articles on drug abuse prevention research and the community. NIDA, Bethesda
Parkin, S. G. 1998, A process evaluation of Crew 2000, Centre for Drug Misuse Research. The University of Glasgow, Glasgow.
Stead, M., MacKintosh, A. M., Eadie, D., & Hastings, G. 2000, NE Choices: the development of a multi-component drug prevention programme for adolescents Centre for Social Marketing, The University of Strathclyde.
Teeman, D., South, N., & Henderson, S. 1999, "Multi-impact drugs prevention in the community," in Young people, drugs and community safety, A. Marlow & G. Pearson, eds., Russell House Publishing, pp. 99-108.
UK Governmental Reports/Papers
Vulnerable young people
Bauld, L., Butler, R., Hay, G., Judge, K., & McKeganey, N. 2002, Drug prevention for vulnerable young people: Mapping pump-priming projects in Health Action Zones, Department of Health.
Bauld, L., Butler, R., Hay, G., & McKeganey, N. 2003, Drug prevention for vulnerable young people in England: Final report.
Chase, E., Statham, J., & Thomas Coram Research Unit 2004, Commercial sexual exploitation of children and young people.
Cragg Ross Dawson 2003, Drugs scoping study: Asylum seekers and refugee communities, COI Communications, 255419.
Cusik, L., Martin, A., & May, T. 2003, Vulnerability and involvement in drug use and sex work, Home Office Research Development and Statistics Directorate, London, HORS 268.
Drug Education Prevention Information Service 2004, Review of drug education materials for children/young people with special needs - travellers.
Drugscope & Department of Health 2002, Vulnerable Young People and Drugs: Opportunities to tackle inequalities, Drugscope, London.
Front Line 2004, Resources needed to support homeless young people, COI Communications, London, COI 262783.
Hester, M. & Westmarland, N. 2004, Tackling prostitution towards a holistic approach, Home Office Research Development and Statistics, London, HORS 279.
Homelessness and Housing Support Directorate 2004, Acheiving positive shared outcomes in health and homelessness:A homelessness and housing support directorate advice note to local authorities, PCTs and other partners.
Hunter, G., May, T., & Drug Strategy Directorate 2004, Solutions and strategies: Drug problems and street sex markets. Guidance for partnerships and providers., Home Office, London.
Randall, G. & Drugscope 2002, Drug services for homeless people: a good practice handbook, ODPM.
Stead, M., Hastings, G., & Eadie, D. 2002, Desk research to inform the development of communications to reduce drug use and drug related harm in socially excluded communities, COI, London, COI:DHEA4855.
Ward, J., Henderson, Z., & Pearson, G. 2003, One problem among many: Drug use among care leavers in transition to independent living, Home Office Research Development and Statistics, London, HORS 260.
Wincup, E., Buckland, G., & Bayliss, R. 2003, Youth homelessness and substance use: Report to the drugs and alcohol research unit, Home Office, London, HORS 258.
Drug prevention & BME
Bashford, J., Buffin, J., & Patel, K. 2003, The Department of Health's Black and Minority Ethnic Drug Misuse Needs assessment Project: Community Engagement. Report 2: The Findings.
Matrix Research and Consultancy 2004, The Effectiveness of the Communities Against Drugs Funding Programme: A Qualitative Assessment of 6 site studies, Home Office, London.
Winters, M. & Patel, K. 2003, The Department of Health's Black and Minority Ethnic Drug Misuse Needs assessment Project: Community Engagement. Report 1: The Process 1.
Drug prevention & rural areas
Henderson, S. 1998, Drugs prevention in rural areas: An evaluation report, Home Office.
Mentor UK & Department of Health 2004, Mentor UK rural youth project: Involving rural young people in evaluation.
Drugs prevention & community
Bashford, J., Buffin, J., & Patel, K. 2003, The Department of Health's Black and Minority Ethnic Drug Misuse Needs assessment Project: Community Engagement. Report 2: The Findings.
Borrill, J., Madden, A., Martin, A., Weaver, T., Stimson, G., Farrell, M., & Barnes, T. 2003, Differential substance misuse treatment needs of women, ethnic minorities and young offenders in prison: prevalence of substance misuse and treatment needs, Home Office, London, 33/03.
Cragg Ross Dawson 2003, Drugs scoping study: Asylum seekers and refugee communities, COI Communications, 255419.
Drug Education Prevention Information Service 2004, Review of drug education materials for children/young people with special needs - travellers.
Fountain, J., Bashford, J., Winters, M., & Patel, K. 2003, Black and minority ethnic communities in England: a review of the literature on drug use and related service provision, National Treatment Agency, London.
Turnstone 2003, Asian Families and Drug Treatment: Qualitative research report London, 255708.
Winters, M. & Patel, K. 2003, The Department of Health's Black and Minority Ethnic Drug Misuse Needs assessment Project: Community Engagement. Report 1: The Process 1.
Answered by Dr Harry Sumnall
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link
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