Drug Abuse Prevention

Research Findings from September, 2000 Director's Report

This section lists selected summaries from NIDA funded research projects that investigate youth drug abuse prevention. The summaries provided were selected from recent issues of the Director's Report to the National Advisory Council on Drug Abuse. For a more comprehensive listing of NIDA funded projects see the Director's Report.

Adolescent Personality and Social-Environmental Antecedents to Drug Use in the Late Twenties

This research focused on the interrelation of the parent-child attachment, drug use in the late twenties, unconventionality, friends' drug use, and the young adult's use of drugs. Data were collected from participants at 4 points in time: early adolescence, late adolescence, early 20s, and late 20s. Data were collected from mothers at the 3 points in time that corresponded with the first 3 collections of data from their children. Both the youths and their mothers were individually interviewed. The findings indicated that the effect of parent-child mutual attachment was mediated through early adolescent personality attributes of greater responsibility, less rebelliousness, and intolerance of deviance. These non-drug-prone personality and behavioral attitudes, in turn, insulated the young adult from affiliating with drug-using peers, and these attitudes were related to less drug use in the early 20s and ultimately in the late 20s. The results suggest that interventions focused on enhancing parent-child mutual attachment should result in a reduction of the risk factors conducive to drug use during the late 20s. The fact that these findings cover a decade and a half, from early adolescence to the late 20s, underscores the significance of placing drug use in a perspective that includes familial and behavioral aspects. Brook, J.S., Whiteman, M., Finch, S., and Cohen, P. Longitudinally Foretelling Drug Use in the Late Twenties: Adolescent Personality and Social-Environmental Antecedents. J Genet Psychol, 161(1), pp. 37-51, 2000.

Cross-national Comparisons of the Prevalences and Correlates of Mental and Substance Use Disorders

Researchers at Harvard University, other U.S. and foreign research institutions and the World Health Organization (WHO) have formed an International Consortium in Psychiatric Epidemiology (ICPE) in order to carry out cross-national comparative studies of the prevalences and correlates of mental disorders. This article describes the findings of surveys in seven countries in North America (Canada and USA), Latin America Brazil and Mexico), and Europe (Germany, Netherlands, and Turkey), using a version of the WHO Composite International Diagnostic Interview (CIDI) to generate diagnoses. The results are reported using DSM-III-R and DSM-IV criteria without diagnostic hierarchy rules for mental disorders and with hierarchy rules for substance-use disorders. Prevalence estimates varied widely--from >40% lifetime prevalence of any mental disorder in Netherlands and the USA to levels of 12% in Turkey and 20% in Mexico. Comparisons of lifetime versus recent prevalence estimates show that mental disorders were often chronic, although chronicity was consistently higher for anxiety disorders than for mood or substance-use disorders. Retrospective reports suggest that mental disorders typically had early ages of onset, with estimated medians of 15 years for anxiety disorders, 26 years for mood disorders, and 21 years for substance-use disorders. All three classes of disorders were positively related to a number of socioeconomic measures of disadvantage (such as low income and education, unemployed, unmarried). Analysis of retrospective age-of-onset reports suggest that lifetime prevalences had increased in recent cohorts, but the increase was less for anxiety disorders than for mood or substance-use disorders. Delays in seeking professional treatment were widespread, especially among early- onset cases, and only a minority of people with prevailing disorders received any treatment. The authors conclude that there is a need for demonstration projects of early outreach and intervention programs for people with early-onset mental disorders, as well as quality assurance programs to look into the widespread problem of inadequate treatment. Andrade, L., Caraveo-Anduaga, J.J., Berglund, P., Bijl, R., Kessler, R.C., Demler, O., Walters, E., Kylyc, C., Offord, D., Ustun, T.B., and Wittchen, H.U. Cross-national Comparisons of the Prevalences and Correlates of Mental Disorders. Bulletin of the World Health Organization, 78(4), pp. 413-426, 2000.

Initiation of Alcohol and Marijuana Use

Guided by the social development model, this study examined dynamic patterns and predictors of alcohol and marijuana use initiation. The sample was derived from a longitudinal study of 808 youth interviewed annually from 10 to 16 years of age and at 18 years of age. Rate of alcohol initiation rose steeply up to the age of 13 years and then increased more gradually; most participants had initiated by 13 years of age. Marijuana initiation showed a different pattern, with more participants initiating after the age of 13 years. The study showed that: (1) the risk of initiation spans the entire course of adolescent development; (2) young people exposed to others who use substances are at higher risk for early initiation; (3) proactive parents can help delay initiation; and (4) clear family standards and proactive family management are important in delaying alcohol and marijuana use, regardless of how closely bonded a child is to his or her mother. Kosterman R., Hawkins J.D., Guo J., Catalano R.F., and Abbott, R.D. The Dynamics of Alcohol and Marijuana Initiation: Patterns and Predictors of First Use in Adolescence. American Journal of Public Health, 90(3), pp. 360-366, 2000.

Ethnic and Gender Differences and Similarities in Adolescent Drug Behaviors

This study examined relationships among ethnicity, gender, drug use, and resistance to drug offers in a sample of 2,622 African American, Mexican American, and White American seventh graders. Findings included: first, the adolescents did not possess large or sophisticated repertoires of drug resistance strategies. Second, most offers came from acquaintances in contrast to data on older adolescents where offers generally come from intimate friends. Third, ethnicity had significant effects on use and the offer process. Mexican Americans received more offers, used more drugs, and were more likely to be offered drugs by peers, family members and at parties. European Americans were more likely to receive drug offers from acquaintances and at friends' homes and on the street. African Americans were more likely to receive offers from dating partners and parents, and in the park, and were more likely to resist offers of drugs-using explanations. Fourth, gender significantly affected drug offers and types of offers. Males were more at risk for offers and use at a younger age. Offers of drugs to males were more likely to come from parents or other males, while offers to females were more likely to come from other females or dating partners. Males were also more likely to receive drug offers that appealed to their social standing or self-image whereas females received either simple offers or those that minimize effects. Finally, offers of drugs to males were more likely to be made in public, while those to females were more likely to occur in private. Moon, D.G., Hecht M.L., Jackson, K.M., and Spellers R.E. Ethnic and Gender Differences and Similarities in Adolescent Drug Use and Refusals of Drug Offers. Substance Use and Misuse. 34 (8), pp. 1059-1083, 1999.

Results of a Community Intervention to Prevent Adolescent Tobacco Use

This study consisted of an experimental evaluation of a comprehensive community wide program to prevent adolescent tobacco use. Eight pairs of small Oregon communities were randomly assigned to receive a school-based prevention program or the school-based program plus a community program. The community program included: (a) media advocacy, (b) youth anti-tobacco activities, (c) family communications about tobacco use, and (d) reduction of youth access to tobacco. Effects were assessed through five annual surveys (time 1-5) of seventh through ninth grade students, ages 12-15 years. The main outcome measure used was the prevalence of self-reported smoking and smokeless tobacco use in the week before assessment. The results showed that the community program had significant effects on the prevalence of weekly cigarette use at times 2 and 5 and the effect approached significance at time 4. An effect on the slope of prevalence across time points was evident only when time 2 data points were eliminated from the analysis. The intervention affected the prevalence of smokeless tobacco among grade 9 boys at time 2. There were also significant effects on the slope of alcohol use among ninth graders and the quadratic slope of marijuana for all students. Biglan, A., Ary, D.V., Smolkowski, K., Duncan, T., and Black, C. A Randomized Controlled Trial of a Community Intervention to Prevent Adolescent Tobacco Use. Tobacco Control, 9 (1), pp. 24-32, 2000.

Institutionalizing Drug Abuse Prevention Through Policy Change

This article summarizes community policies that have been effective in decreasing youth drug use, the contribution of community organization to policy change, and the role of policy change on institutionalizing community-based prevention efforts. Two types of policy change are considered: implementation and regulations. Implementation policies are aimed at institutionalizing prevention programs, usually through raising funds, requiring standard implementation, and creating a formal non-profit organization to implement programs. Regulatory policies include all formal laws, regulations, and ordinances aimed directly at decreasing drug use, for example, regulations which enforce the monitoring of drug-free zones. Results of studies suggest that regulatory policies show the most immediate effect on youth tobacco and alcohol use. However, implementation policies have more potential for long-term effects on use. Community organization appears to stimulate change in both types of policy. As yet unresolved is whether policy change contributes to long-term community prevention efforts. Recent research identified barriers to the translation of evidence-based prevention into practice including: (a) a lack of perceived empowerment by community leaders to continue prevention work; (b) insufficient preparation of community leaders for adoption of evidence-based programs; (c) the tendency to continue using ineffective approaches because of the past investment; and (d) a general perception that no proscribed evidence-based approach can work because each community has its own unique needs. Despite these barriers, several factors that may expedite movement in this direction emerged from case studies: (a) identification of a local "champion" for prevention; (2) development of local resources to sustain prevention; (3) feedback about prevention program effects; and (4) strategic use of supportive mass media. Pentz, M.A. Institutionalizing Community- Based Prevention Through Policy Change. J Community Psychology. 28 (3), pp. 257-270, 2000.

The Participatory Intervention Model

This article examines the participatory approach for conceptualizing and implementing research-based interventions, the primary aim of which is the development of acceptable and sustainable prevention change efforts. The Participatory Intervention Model (PIM), rooted in participatory action research, provides a mechanism for integrating theory, research, and practice and for promoting involvement of stakeholders. PIM has demonstrated the capacity for promoting intervention acceptability, bridging the gap between research and practice, addressing cultural diversity, fostering partnerships, promoting disciplined reflective practice, and integrating the multiple roles of the school psychologist in international sexual-risk prevention work. Nastasi B.K.,Varjas, K., Schensul, S.L., Silva, K.T., Schensul, J.J., and Ratnayake, P. The Participatory Intervention Model: A Framework for Conceptualizing and Promoting Intervention Acceptability. School Psychology Quarterly. 15 (2), pp. 207-232, 2000.

Developing Attachment through Prosocial Family Activities

Child attachment to parents has been shown to reduce the likelihood of problem behaviors, such as substance abuse, through enhancing resiliency. Research examining attachment and its relationship to antisocial behavioral outcomes in adolescents has been shaped largely by social control theorists who have theorized that attachment to prosocial others inhibits the expression of antisocial behavioral outcomes. This paper expands the literature by investigating the development of child attachment to parent(s) during the early elementary school years. The social development model posits that consistently applied opportunities for prosocial interactions and involvement with family, praise and recognition by parents, and child social and decision-making skills, predict future level of attachment. Results indicate that level of attachment in grade one or two is the strongest predictor of attachment in grade three or four. In addition, the socializing activities of parents (opportunities and involvement) had a strong positive relationship with rewards, which was a significant predictor of attachment in grade three or four over and above the effects of prior attachment. Only child skill was unrelated to reward. This may be due to the developmental status of the children and parents expectations. Oxford, M.L., Harachi, T.W., Catalano, R.F., Haggerty, K.P., and Abbott, R.D. Early Elementary School-aged Child Attachment to Parents: A Test of Theory and Implications for Prevention. Prevention Science, 1(2), pp. 61-69, 2000.

Parenting Skills Program Successful in Changing Behavior

This study explored the effectiveness of using trained, supervised group leaders who were not mental health clinicians to lead an intervention developed for parents of at-risk middle school students. The program was evaluated in a randomized controlled trial in eight small communities. Three hundred three parents were randomly assigned to immediate treatment or a wait-list condition. Latent growth modeling showed that participation in the program led to significant improvements in problem-solving interactions. Parents' over-reactivity and laxness toward their children's behavior were reduced and their feelings toward their children improved significantly as a function of treatment. Parent-reported antisocial behavior was also reduced. Thus, evidence was found for the effectiveness of using non mental health clinicians to aid in behavior change. Irvine, A.B., Biglan, A., Smolkowski, K., Metzler, C.W., and Ary, D.V. The Effectiveness of a Parenting Skills Program for Parents of Middle School Students in Small Communities. Journal of Consulting and Clinical Psychology 67(6), pp. 811-825, 1999.

Outcomes of a Secondary Preventive Intervention with Aggressive Children

Teacher-identified aggressive children were randomly assigned to one of two treatment conditions, both of which involved college student mentors. The experimental condition (PrimeTime) combined therapeutic mentoring, training in problem-solving skills, and consultation with parents and teachers. The comparison treatment (Standard Mentoring) relied solely on the skills of minimally trained, unsupervised mentors. Both interventions lasted 16 months. The goal was to examine the efficacy of the PrimeTime intervention and the soundness of the model of change. Outcome assessments (at posttreatment and at one-year follow-up) were based on parent-, teacher-, and peer-reports of children's aggression and others' acceptance, as well as on children's self-rated competence and acceptance by others. Outcome analyses revealed small gains for both treatments and provided only partial support for the efficacy of the PrimeTime intervention. Analyses of change processes supported the conceptual model but also identified iatrogenic effects that may have attenuated the therapeutic impact of PrimeTime. The discussion highlights the importance of testing both intervention efficacy and putative mechanisms of change when evaluating newly developed treatment models. Cavell, T.A., and Hughes, J.N. Secondary Prevention as Context for Assessing Change Processes in Aggressive Children. Journal of School Psychology, 38 (3), pp. 199-235, 2000.

A Manualized Preventive Intervention for Juvenile Offenders

Multi-problem families are often unprepared to provide support for recovering juvenile offenders that can prevent recidivism and associated negative outcomes, including substance abuse. Despite this, juvenile courts often return juvenile offenders to their families during parole, probation, and as an alternative to prosecution. This article provides information on a manual that describes Prosocial Family Therapy (PFT), a method of multisystemic care for juvenile offenders based on theories of risk and protective factors and therapy process. PFT integrates specific parent training techniques and nonspecific family therapy strategies. It includes techniques for reinforcing positive behaviors, skills training in communication, and strategies for motivating behavior change. Additionally, the manual describes how courts, schools, community agencies, and residential treatment centers can provide comprehensive care to juvenile offenders, ensure protocol adherence, and assess clinical significance of results. Blechman, E.A. and Vryan, K.D. Prosocial Family Therapy: A Manualized Preventive Intervention for Juvenile Offenders. Aggression and Violent Behavior 5(4), pp. 343-378, 2000.